Hon. Darren Praznik (Minister of Health): Mr. Chair, I think people would be surprised if I did not have an opening statement. First of all, it is certainly my great privilege to be here as a new Minister of Health and my first Estimates with this department. It is for the fiscal year ending March 31, 1998.

Today I am asking this committee to support our department's request for $1,825,551,100 inclusive of operating and capital expenditures. At the outset I want to acknowledge and thank all health care providers and professionals within the system, community groups, professional associations, voluntary agencies and individuals for their support, participation and contributions to operating our health care system here in our province which is of great quality; a very high quality system in the world.

I extend a special thanks to the 10 regional health authority boards who have just completed their first anniversary. I also want to thank the people who have been working and developing the Brandon regional hospital authority, to which the first tranche of appointments have now been made as well as the Winnipeg Hospital Authority. I look forward to making very soon the first round of appointments to the Winnipeg community and Long Term Care Authority.

I would also like to pay tribute to my predecessor, the Honourable Jim McCrae, the new Minister of Environment, who I think through some very difficult years steered this department through a host of issues, did a great deal of work on planning for where we need to take our system and reorganizing it to meet changing realities. I certainly want to pay tribute to his efforts. He has been very gracious in the transition. We worked very closely together over the years and certainly in the last few months as he has brought me up to speed on much of the work that he has done during his tenure here. My mandate from the Premier (Mr. Filmon) is to get on with implementing many of those plans, and so his contribution in bringing me up to speed is very, very much appreciated, and I want to thank him today.

I would also like to thank my critic, Mr. Chomiak, the member for Kildonan. We have had an opportunity to speak, and he has been very gracious to a new minister in the opening weeks. I know our issues have remained debates about facts, debates about policies, debates about directions. They have not been ones of a personal nature, and I certainly admire and respect that in colleagues because that is what I think the public expects of us in this place, and I wanted to make that comment today to him.

My predecessor, the Honourable Jim McCrae, laid the foundation for a renewed health care system and the mandate that I have been given is to implement and build on that foundation.

The department is continuing to move from a treatment and institutional focus to one of prevention, health promotion, and community- and home-based services. This is a similar trend that is being followed across the country, indeed most of the western world, and really is a trend that knows no particular political base, but one that is being followed by governments of all stripes. Recognizing the broad determinants of health, we are implementing a multisectoral approach aimed at a seamless continuum of care.

The reduction of over $7 billion in federal funding to the provinces in the last three years alone has resulted in severe pressures on all provinces including ours. We cannot afford to wait; we must act now. Manitoba is taking the necessary steps to ensure the sustainability of our health system and to provide Manitobans with the health care system they deserve, and one that they can expect to be sustainable into the next century despite those reductions in dollars from the federal government.

* (1650)

Mr. Chair, the funding and delivery of health services historically has been a provincial responsibility. That is even more so today. Today the Canadian health and social transfer through the Canada Health Act provides for funding of necessary hospital and physician and other health services, but federal cash transfers have decreased from 30 percent in 1980 to less than 16 percent today for comparable services.

Even with these reductions, Manitoba has a health care system that I believe is exemplary not only in Canada but throughout the world. Our system is broadly based and includes a wide range of treatment, prevention and support services, such as ambulance and emergency medical services, a prescription medicine program known as Pharmacare, personal care homes, a home care program as well as physician and hospital services. Although these are not perfect in any way, they certainly provide a foundation and a delivery mechanism for a broad base of services which is not replicated in many jurisdictions throughout the industrialized world.

Mr. Chair, this reduction in federal cash contributions which we have seen has constrained Manitoba and other provinces in the provision and introduction of extended programs and services. However, our province is meeting the challenge of reduced federal contributions to health care in a manner similar to that in which we have met the challenge of this flood in this particular spring. We have met that challenge head on. We did not shirk from our responsibility to the residents of our province and have worked to ensure that Manitoba's health care system continues to deliver as high a quality product as we possibly can with the resources available to us.

The major challenge facing Manitoba is to preserve, protect and promote our health system in the face of these reductions in funding and also increasing costs from a variety of factors including technology as well as changes and increases in demands with an aging population. The demand for increases in health services, as I have indicated, is attributable in part to the pace of technological advances not only in health but in other areas of communication, technology, transportation, et cetera. Progress and diagnosis and treatment have changed the way we do business, the way we provide health care and the kind of health care we as consumers expect and use. We must be certain however that the new technologies, such as those in diagnostic imaging, surgical procedures or pharmaceuticals represent a true improvement in health care and are not simply an add-on, because the ultimate goal of our system is of course a healthier population, not just the expenditure of dollars.

Let me explain if I will for a moment: The population health approach focuses on the things that enhance the health and well-being of the overall population. This concern with the impact of our living and working environments as well as our other social factors on health status requires a co-ordinated effort across government departments to address these broad determinants of health. They also, perhaps even more importantly, require the willingness of individuals and communities to improve their health. My department is committed to working co-operatively with other departments, with health care providers and professionals, and with the community and individuals to achieve a co-ordinated and integrated approach to services which enable Manitobans to attain improved health status.

Health care renewal and restructuring in Manitoba is evolving along carefully designed pathways leading to better co-ordinated, integrated health services. The rural and northern health associations or authorities are providing new approaches for better management of the service delivery system. It is our hope that more services will be provided closer to home, such as dialysis, chemical dependency programs, mental health programs and of course an expanded home intravenous program. We are aware that 20 to 30 percent of rural residents today must leave their community to obtain necessary services. At the same time, many rural hospitals and facilities have occupancy rates below 50 percent. Moreover, virtually all medical specialists practise in Winnipeg. The challenge is to ensure that, regardless of place of residence, all Manitobans have reasonable access to specialized diagnostic treatment and therapeutic services.

The development of the Brandon Regional Health Authority, the Winnipeg Hospital Authority and the Winnipeg Long Term Care and Community Health Authority is well underway. One important result will be more effective health care services that will be provided in a system that is widely based and makes more effective use of our facility resources and our human resources as well.

The result of that is that each patient will receive the care that is needed in an efficient way. Each patient will be properly matched to the hospital or community environment that best meets their care requirements. In Winnipeg, clinical program managers are being recruited to oversee and co-ordinate the delivery of clinical services throughout all health care facilities.

We believe in doing things right to the best of our ability, and we believe in doing the right thing. The way we know we are doing the right thing is to base our decisions on evidence. Health service utilization data are a key element in determining the appropriate range and distribution of services. Manitoba has one of the best hospital and medical care databases in the country. As just one example, the Manitoba Centre for Health Policy and Evaluation has an international reputation in the analysis of health services utilization data. The centre is playing a key role in providing Manitoba Health with the evidence needed for determining priorities in necessary services which should be available and accessible to all Manitobans.

However, we must balance the need for information with the need for individual privacy and confidentiality. This will be addressed by the privacy legislation that is being introduced shortly in this legislative session. We do know from our information systems that considerable efforts are still required to improve the health status of the most vulnerable segments of our population. That is why the department is committed to working in partnership with communities and other departments, such as Education, Justice, and Family Services, to improve the health of Manitoba children, especially those who are living in poverty and aboriginal children. Accordingly, my department is an active partner with the Children and Youth Secretariat on the co-ordination and integration of services for children at risk.

Manitoba has the highest proportion of aboriginal people in its population in the country. Health among urban aboriginal groups is poor compared to that of the overall urban population, generally speaking. Hospital utilization patterns are significantly higher, particularly for acute respiratory infections and other illnesses associated with low income.

I am concerned about services for aboriginal people within our system, and that is why the department is very supportive of aboriginal health initiatives which focus on health status or disproportionate use of medical services and inaccessible or unavailable health services which have also seen their difficulties because of reduction of federal support over the last number of years.

Consistent with this concern, the department is establishing an aboriginal health unit to interact with communities, regional health authorities and the governance mechanisms that First Nations are in the process of putting into place as part of the devolution of authority within the health budget of Health and Welfare Canada for First Nations people.

An aboriginal health and wellness centre in Winnipeg is also being developed and funded as a pilot project to provide primary health services and community development and community education and outreach. I believe this facility is located in the new Aboriginal Centre of Winnipeg, the old CPR railway station, and I know we are very much firmly committed to funding this pilot project.

I want to touch, Mr. Chair, briefly on some of the other ways in which we are striving to improve the health and well-being of Manitobans. Foremost among these, efforts have been aimed at reducing the fragmentation and inappropriate duplication of services, particularly in our large urban centres, principally Winnipeg. This includes the realignment of the service provided by our teaching and community hospitals, consolidation of laboratory services, as well as other support services, and the expansion of nursing roles, as well as the establishment of midwifery. We, of course, will remain vigilant, ensuring that the appropriate array of services for our seniors through additional personal care home beds, coupled with alternative support of housing and other community-based support services, continues to be built as needed.

The department has established a framework for renewal that is consistent with the renewed vision of Canada's health system and the consensus of provincial and territorial ministers of Health. The world, as we all know, is changing at an ever-increasing pace. We cannot try to keep trying to do new things in the same old way. This is why we are moving to a broader approach with emphasis on the development of strategies, policies, priorities and accountabilities in an overall funding allocation framework. This has also become so much more important as we recognize that, if we are to afford the next advances or improvements in diagnostic and medical technology, for example, which inevitably will be upon us, that we have a structure that is going to be able to best use them to continue to make them affordable.

The goal, of course, is a high-quality accessible health care system for our province, the wise use of our health care resources, and, of course, most importantly, a healthier population. As Minister of Health, I am determined to pursue and achieve these goals, but, of course, one cannot do it alone. The department has already received the help and assistance of literally thousands of Manitobans in helping us move towards change in our system and improvements in our overall health delivery system. I also ask for your assistance as members of this committee in co-operation as we continue to work towards developing an appropriate health care system for our province of which we can all be proud. Thank you, Mr. Chair.

Mr. Chairperson: We thank the Minister of Health for those comments. Does the official opposition critic, the honourable member for Kildonan, have any opening statements?

Mr. Dave Chomiak (Kildonan): Mr. Chairperson, I thank the minister for those comments. Due to the fact that the Estimates process has proceeded in the way that it has, I am severely limiting my remarks to thanking the minister for his comments and anticipating moving on to the questioning lines.

Mr. Chairperson: I thank the critic for the official opposition for those remarks.

Mr. Praznik: Mr. Chair.

Mr. Chairperson: Yes, Mr. Minister.

Mr. Praznik: Mr. Chair, before we go on, I would just like to ask my critic how he would like to proceed.

Mr. Chairperson: If we might just hold on, we will get there.

Under the Manitoba practice, debate of the Minister's Salary is traditionally the last item considered for the Estimates of the department. Accordingly, we shall defer consideration of this item and now proceed with consideration of the next line. Before we do that, we invite the minister to introduce his staff present.

* (1700)

Mr. Praznik: Mr. Chair, before I introduce my staff here today, I would just like to seek the recommendation of the member for Kildonan, my critic, because, as he knows all too well from his years as critic, this is a large department with lots of staff in a host of different program areas; and, over the next number of days, as we go through this, it would be most helpful to us if he could at least provide us with what areas he would like to cover in a given day so that we can arrange to have the appropriate staff here. Obviously, that, I think, makes it move much more smoothly. I understand as well that there is usually a list of particular information that he requests each year to be provided to him, and if he had that list, then we could proceed to gather that information that he requests, and this is something we can have staff work on. So I would ask your advice or his advice as to if that is acceptable.

Mr. Chomiak: Yes, Mr. Chairperson, I have had discussions with the critic for the Liberal Party in the Legislature as well with respect to how we should proceed. Generally, we have tried to proceed on a line-by-line item basis and try to deal with the matters under their appropriate allocation, which has not always been the case in Health previous to my tenure.

In discussions with the member for Inkster (Mr. Lamoureux), I am under the impression that because there are a number of broad policy issues that we will be dealing with, I was going to recommend and suggest that we try to deal with as many of them-and I look around and see the staff that is available, and I think it probably would be appropriate that we tend to try to deal with the larger, broad policy issues under line 1.(b), for several days, I would suggest, and then proceed on a line-by-line basis as expeditiously as we can, coming back to issues that perhaps have not been addressed.

But I think that if the minister feels comfortable with that, and I believe the member for Inkster does, and if he feels that is appropriate with his staff, that is what I am recommending we do this time.

Mr. Praznik: I have no problem with that. I think it allows us to address the larger issues in a broader context. All I would ask is if I could perhaps have the day before some sense of those issues, so that I could arrange to have the appropriate staff here for those discussions. It would make life easier for all, and I would be prepared to agree to that.

Mr. Chairperson: Agreed?

Mr. Chomiak: I will endeavour with my colleague the member for Inkster to provide that, as well as to provide tomorrow a list to the minister of documents that are normally tabled during the Estimates process.

Mr. Praznik: I would now, Mr. Chair, like to introduce my staff; first of all, not a member of my staff but a colleague who serves as my legislative assistant, the member for Turtle Mountain (Mr. Tweed), who has been assigned those responsibilities by the Premier (Mr. Filmon). The member for Turtle Mountain has been working with me since, I guess, the end of January when he came on board as part of our team, and I want to thank him for his efforts and work. He has been very, very helpful and a good part of the team, and I wanted to recognize him here today.

Since this committee last met to consider Estimates of this department, there have been some very, very significant changes in the senior levels of the department, of course a new minister but also a new deputy minister. Mr. Frank DeCock joins us today as the new Deputy Minister of Health. I believe that took effect on the 1st of April.

I want also to recognize the departure of Dr. John Wade who very ably served this department for a number of years. Dr. Wade has retired from his active role as a deputy minister to go on to do other things, but he certainly was a very committed deputy and worked very hard on behalf of the people of this province, and I want to pay tribute to him here today.

In introducing Frank, I think he is no stranger to anyone at this table. He has been a long-time member of the provincial public service. He was a former Associate Deputy Minister of Health, and his appointment to this position I do not think surprised anyone in the province. It was certainly well deserved, and I am glad to be working with him.

We have reorganized our department as a result of those changes, and where we used to have one associate deputy and three assistant deputy ministers of Health at one time, we have flattened our organizational structure for a variety of reasons, and we now have a deputy minister and three associate deputy ministers. Part of the reason was the individuals whom we recruited. One is a former deputy minister who is no stranger to me, who served as my deputy minister in the Labour department for quite a number of years, and that is Roberta Ellis who is here today. She is the associate deputy minister in charge of Human Resources and Planning, and her role is to work on many of the human resource issues that are a big part of health care as well as a number of special projects that come our way from time to time.

Also joining us from another department is Mr. Don Potter who is formerly an associate deputy minister of Finance, and we have recruited Don to be associate deputy minister of Health for internal operations.

The way, in fact, we have reorganized the department, in addition to kind of a special project piece that Roberta Ellis manages of which Human Resources are a part because there are many human resources issues, physician remuneration being one that she manages, with the movement of so much of our department into the regional health authorities, we have divided the remaining part of our operations into internal and external operations. So Mr. Potter joins us as the associate deputy for internal operations of the department. He is responsible for finance, administration, audit function within the department, standards enforcement, province-wide programs such as Pharmacare, the Ambulance program, Public Health, et cetera. So items that we would administer within the ministry, in essence, are housed within Mr. Potter's bailiwick.

Also joining us, the third associate deputy, no stranger, a former assistant deputy minister promoted to this position is Ms. Sue Hicks who was responsible for the operations of the department, and she now takes on the role of associate deputy minister for external operations. She is responsible for the operation side of all health delivered through external agencies, primarily the regional health authorities. So she joins us today. So that is in essence our new team, and I am very pleased to have them with us here today.

Mr. Chairperson: We will now proceed to line 1.(b)(1) Salaries and Employee Benefits on page 68 of the Estimates book. Shall the item pass?

Mr. Chomiak: Mr. Chairperson, I thank the minister for that introduction. It kind of circumvents my first line of questioning insofar as the Organization Chart in the Supplementary Estimates book dated January 31, 1997, is obviously significantly changed, and I would hope-I would wonder if tomorrow or as soon as possible we could have a new Organization Chart in order to-I might ask also at the same time if the individuals who are assuming each of the positions within the Organization Chart can be named, because the January 31 chart does not have the names, although previous organization charts had done that as a matter of course.

Mr. Praznik: Mr. Chair, no problem at all with that. I apologize that we did not have that available today, but we will have that tomorrow. We will undertake to have that for the member.

Mr. Chomiak: Mr. Chairperson, for clarification, under the item Executive Support, are we talking about an increase in staff years within the Department of Health or a decrease, the reallocation? How is that expenditure item under 21.1(b) going to be reconciled with the new organization chart?

Mr. Praznik: Mr. Chair, my understanding on the senior staff side-our staff are checking because we are just putting this together from the reorganization, but we understand we have the same number of staff years although all of them are not filled. At one point we had one associate deputy and three assistant deputies. One of those assistant deputies has been seconded to the Health Sciences Centre, Finance, Mr. Tim Duprey. Another is vacant, that was Mr. Glenn Alexander, and Ms. Sue Hickes has moved into a new position. So we have the same number on the books, but we have not filled all of them.

* (1710)

Mr. Chomiak: So could I ask also tomorrow if the reconfiguration will also include the names so that we can have some ideas to the-the reconstruction of the department is significant in so far as there was some previous reconstruction, some significant reconfiguration of the department, but I will leave that until I have an opportunity to view the flowchart.

My next question is: The minister made reference to the former deputy minister, John Wade, and I understand that Dr. Wade has been given a role with respect to health and some form of a contract. I wonder if the minister might outline for us specifically what that is.

Mr. Praznik: I believe he is referencing an Order-in-Council that was required for him to be able to do some work with us should we require his services. To date we have not negotiated a contract. Dr. Wade indicated to us he is doing work across the country in a variety of areas, and he indicated to us if there were some areas where his services could be of use to us that he would be available, hence, we passed the Order-in-Council.

My immediate concern was, and at any time you have a transition, that there were a number of projects that Dr. Wade had been pursuing. Some of them had been the regionalization of various surgery programs on a western-Canada basis, et cetera, and we wanted to assure that he was available to us should we need his expertise and experience in completing that work. To date we have not asked him to take on a particular function as of this date, so that is why we have not put a contract in place; but should we require his services at some point, then we will, and I would be pleased to provide that at that time.

Mr. Chomiak: Dr. Wade is not working in any kind of capacity with the Premier as was reported at one time with respect to Health projects?

Mr. Praznik: I believe the reference or the point that the member makes may come from a decision by the Western Premiers to have deputies work on a variety of these consolidation of services. In his capacity as deputy, Dr. Wade was pursuing those, but since his departure as deputy minister, other than the Order-in-Council that puts the mechanism in place for us to have him work with us, we have not yet required those services. So he is not working for us anywhere to my knowledge in government as of this day.

Mr. Chomiak: Can the minister confirm that Dr. Wade acted as the interim chair of the board of the Order-in-Council of the Winnipeg Regional Health Authority that was set up?

Mr. Praznik: Yes. After I was appointed, Dr. Wade informed me that he had put himself in or had been placed in that position-and for a logical reason. There were certain program functions that required some central direction, and under the plan as developed, the CEO was required to appoint some interim program heads. So Dr. Wade as the deputy took on that particular responsibility which, of course, has now ended and, in that capacity as an interim CEO in that position, made, I believe, nine interim appointments of program heads, which we have now as the new board and CEO has certainly in their purview to review and change, but they were there because there was some central direction. Dr. Wade felt needed at that particular time, and that is why he proceeded to make those appointments.

Mr. Chomiak: The minister has referred to the Winnipeg Regional Health Authority as well as the continuing Long Term Care Authority. I wonder if the minister might, tomorrow, table the list of members on the Winnipeg Regional Health Authority. If it is just the press release, then that is fine. We already have access to that, so I thank you for that.

Can the minister indicate what the policy was with respect to nominations to that board, what organizations were contacted, not only with respect to the Winnipeg Regional Health Authority Board, but the Long Term Care board that the minister indicated earlier in his comments was going to be shortly appointed?

Mr. Praznik: Mr. Chair, I will endeavour to get him the complete list. The intention in setting up that board was to have the minister appoint a chair and two vice-chairs to that board, as well as, a number of citizen representatives. But the current facilities, I believe, nine in total plus university, the Manitoba Cancer Treatment and Research Foundation-and we will get him the complete list-we are asked to submit names to us for consideration as appointments out of those facilities. I know some of those appointments have been made in the case of the University of Manitoba. Also, I believe the Keewatin, I believe it is, health council, because part of the arrangement in them using that territorial council, using facilities in the city, was to have an appointment. They submitted nominations, one of whom has been appointed in the first round.

I know we have had to go back to some organizations, because of a variety of issues surrounding nominations that were put forward. We also identified off the facility a list of nominations, individuals who will be appointed upon the decisions by their boards or upon the completion of an agreement in principle for either operating or evolutionary agreements with the Winnipeg Hospital Authority. My concern was that I did not want individuals nominated from existing boards as part of the hospital authority until the relationship with their facility was established at least in principle, an agreement in principle, because we did not want to see the accusation of various facilities being on both sides of the bargaining table in that process as they are developed. So most of those facilities, at least orally, have been informed of which of their nominees will be appointed in due course to that board. I would be prepared to share that with the member tomorrow.

Mr. Chomiak: Is a similar process taking place with respect to the long-term board, and can the minister enlighten us as to what the process is in that regard?

Mr. Praznik: Yes, Mr. Chair, very similar process. I think there is only one vice-chair. The board is a smaller board; I think, it is 15 members as opposed to 21 for the hospital authority. We have gone to the various associations representing many of the players, stakeholders in that area, and asked for nominations. There will also be a number of community citizen representatives on that board. We have not yet appointed it. I am still working through that list, regrettably. The flood delayed that process somewhat, as I know the member appreciates and understands, but I hope to have that completed by the end of June.

Mr. Chomiak: Does the minister anticipate legislation with respect to either of those boards this session?

Mr. Praznik: An excellent question, and I must offer somewhat our apologies. This whole process of the flood has delayed and put some pressure on other areas. But within the next few days, it is my intention to be introducing a bill in the Legislature which will, in essence, be an amendment bill to the previous legislation. It is our intention to amend that legislation to allow for the creation of the two Winnipeg authorities and basically to follow the same rules and provisions of the existing statutes for rural and northern, for the two Winnipeg boards with the obvious provisions that are somewhat different. In the case of Winnipeg as a region, it has two authorities instead of one. This will also be applicable for Brandon as well. So this way there is really no great surprise.

* (1720)

As a minister, my preference, I think there might have been some plan at some point in time to have separate legislation, but in reviewing the matter, coming in as a new minister, I thought it was important to have a consistent legislative base for regional hospital authorities as much as possible, and this was felt probably the best way to do it. So I will be able to share with him that legislation very, very shortly.

Mr. Chomiak: Because a lot has not been said about the long-term care board, it is a relatively unknown quantity. I am wondering if the minister might explain perhaps the difference with respect to having a health authority look after long-term care vis-a-vis Winnipeg and the regional health authorities look after long-term care outside of Winnipeg and how that matter can and will be reconciled.

Mr. Praznik: Mr. Chair, the member for Kildonan, who has been in this business of health care somewhat longer than I in his role as a critic, I think, in the tone of his question, flags one of the ironies of these boards. In many ways, the board where so much of needed care will be provided is through the long-term continuing care board, but the area that will always seem to garner the greatest public interest, of course, is the hospital authority. It is the nature of a building and bricks and mortar and what goes on there that I think does that. In reality, it may be that the long-term care board is, at the end of the day, more significant in terms of the number of people it deals with and so much of the needed care, and it is unlikely to garner the same public interest. So an interesting irony.

My understanding in taking over this plan was, given the size of the city of Winnipeg and the number of services delivered, that the task of having one health authority at this stage of the game to govern all of Winnipeg was very daunting indeed and that it would take a very large effort to integrate the services between our existing Winnipeg hospital long-term care facilities-I am thinking of really Riverview and Deer Lodge plus the seven hospitals being the nine facilities being affected by this board. The efforts to take those independently governed boards today and to be able to amalgamate the service-delivery parts of it, still recognizing some of the unique parts of governments locally in some of those facilities, would be a fairly daunting task. So it was felt that it was best to separate those two functions at this stage of the game.

At some time in the future, and I believe our draft legislation, as the member will see when we table in the House, will address and provide some authority. It would be my intention to provide some authority at some point if it was felt that bringing the two together would best serve the needs of the city and the province that that could happen.

The difference, of course, with rural and northern boards is that their populations are so much smaller, the service is much more local, smaller centres. The task of amalgamating and integrating facilities and community service I think is much easier in those rural districts by and large than they are in Winnipeg. So that was the logic behind it.

You know, we recognize, and I think the member may point out that not having our community care side integrated with the hospitals does create a little bit of a void, maybe a large one, that we are going to have to manage over the next while. At some point in time, when the facilities integration is done and the Long Term Care and community facilities board have done their work, amalgamating the two might be the logical thing to do, and I would certainly want to provide for that should that become the right thing to do.

Mr. Chomiak: Continuing down this line, I wonder if the minister might outline for me structurally how the process will function. I will use the example of Home Care, recognizing that we are not in that line item and I am not really looking for specific details, but rather a structural understanding of how the matter will function.

We will have home care come under the auspices and delivery of the rural health authority outside of Winnipeg, and presumably the Long Term Care Authority. I am assuming the Long Term Care Authority within Winnipeg, and I am wondering how that will structurally function, how the department sees the functioning in terms of the services provided.

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

Of course that raises the larger issue which I am sure we are going to get into in terms of who in fact is employing employees and the like, but just in terms of the structural and the initial stages how that is in fact envisioned by the department to function.

Mr. Praznik: Mr. Chair, with respect to rural, the rural services home care-and I just want to separate that for a moment, because on the 1st of April under an agreement that Roberta Ellis put together with the Manitoba Government Employees' Union for a year of transition, the employing authority and direction of our staff, our provincial staff transferred to those rural health authorities and that integration is now beginning as regional health authorities take over.

In Winnipeg our provincial staff continues to report to the department, to Sue Hicks' side of it of external operations. As the Winnipeg Long Term Care Authority board gets up and operational over this transitional year, we will do the same kind of evolution into that board over the year. That is part of it structurally.

One concern that he flags, and I am glad he flagged the labour employing authority side, because one of the things we are trying to achieve with this, and we are not there yet, and I recognize it is going to take a number of years to do, is to be able to achieve the kind of organizational structure that gives us as much flexibility as possible in being able to accommodate and move staff with need. I am not trying to do that to circumvent any collective agreements or rights that people have, and that is why it is going to take some time to properly sort those things out, but what I would like to do, and I heed his advice that he does offer in Question Period in our exchanges. So many of the times the moves we have to make result in unnecessary pain to people working in the system because it leaves their future, whether they are going to be employed or their job, in doubt.

So we have a lot of work to do there. I have begun some discussions with union leaders in the health care field. Certainly with our planners we have certainly involved the Labour Board because we would like many of these things to be worked out in existing mechanisms and not imposed. So we are going to give it a couple of years to do, but ultimately that is our goal.

The other part of his question that I want to address is the continuum of care for patients, which ultimately is why we are doing all of this. We would expect that the authorities, whether they be rural authorities working with the appropriate Winnipeg authority in movement of patients and clients or between the two authorities, and obviously in Winnipeg being able to have a good working relationship between home care and the facilities so that as people are able to be discharged that they are being dealt with in that facility and moved out to their homes and get the care so there is not a lapse or not a breach in that continuum of care is a great concern to us because, if there is, then it is not working. So that is going to be a fundamental charge to these new managers in the system, to make sure that component is put together. I am hoping there will be a minimum number of glitches.

Today we have the void in essence, and we have before the regionalization 180 different facility boards, government delivering service, often despite ourselves. It was managed reasonably well on an operational basis and other times it was not, but we are hoping to make improvements in there. I do not know if I have answered the member's question specifically. It was a broad-based question. I hope I have.

Mr. Chomiak: Yes, that has been helpful. Just continuing down this line, the individual who requires home care, be it an individual who is being discharged from hospital or an individual who is resident in their home are now assessed by Continuing Care and the services put in place. Presumably that process will continue except it will be under the direction of the Continuing Care board to be put in place.

* (1730)

Mr. Praznik: The Home Care program will function hopefully where there are improvements that we can make in terms of relationships with hospitals, because that is an ongoing complaint about how the two function together and we hope to improve that, but ultimately the direction and responsibility for that service will be with the Winnipeg Long Term Care board. They, in essence, will be running and be responsible for the Home Care program.

Mr. Chomiak: So structurally the one-entry system that we have, multiple points, one-entry system, will still exist but it will be under the auspices of that board within the city of Winnipeg.

Mr. Praznik: Yes, that is correct. Obviously there is an integration in operations between long-term care facilities, home care and a variety of the programs that we deliver, and we will integrate them in that way. Eventually, if the system can handle it, that may even get integrated with the hospital authorities in one, in essence, health authority for the city of Winnipeg. We did not think at this stage that was possible, given how large a task that would be.

Mr. Chomiak: At one time the plan was for the Home Care group, if I can put it in those terms, Continuing Care portion to be under the auspices of a Winnipeg regional authority and there was a manager that was advertised for in terms of co-ordinating that role. Is that function still in place?

Mr. Praznik: Yes, Mr. Chair, in this transition period that position was advertised. A successful candidate was recruited and hired, and they are doing their work and amalgamating and integrating our programs which are today housed in the ministry and report to Sue Hicks. That will evolve at the end of the transition year into the Winnipeg long-term care facility with that individual.

Mr. Chomiak: Outside of the city of Winnipeg, the reporting structure will be not through the Department of Health Continuing Care in Winnipeg, but rather will be through the appropriate regional authority in that jurisdiction?

Mr. Praznik: As of April 1 of this year, that is in effect, in fact, and in law the case. Our Home Care programs, our Continuing Care programs were transferred on as effective April 1 to the regional health authorities, and I just add this caveat that we negotiated with the Manitoba Government Employees' Union an agreement that allowed for up to one year for the continuation of all of the benefits, payroll, et cetera, by the Ministry of Health, and then we just work out the difference in accounting.

In essence we gave the regional health authorities a year to set up their own payroll systems, work out any issues in transferring these employees, et cetera, so no employee of our provincial programs-I did not want anybody losing a pay cheque or a benefit or anything during this period. So today their pay cheques come with Province of Manitoba, but they work for the regional health authority. We do the accounting. By the end of this period, I guess by April 1 of next year, their cheques will be from their regional health authority.

Mr. Chomiak: What central authority is in place to determine the extent of services and the base line and standard of services that are offered, and I am using home care only as an example of all activities with respect to health.

Mr. Praznik: I am glad the member used this as an example, because one of the accusations against the program generally over the years has been inconsistencies and differences in the delivery of the program in various parts of the province. So a lot of work is going on currently to make sure we have a common standard of expectation and what people are entitled to, and it will be Sue Hicks' responsibility as the associate deputy minister for external operations and part of the mandate for which we will fund the regional health authorities to deliver and meet a common standard of service across the province.

Obviously, there is going to be some variation in delivery mechanism to suit individual needs in different parts that require some uniqueness in how you deliver a program, but the expectation of the public is that they are entitled to the same type of service wherever they be served in Manitoba, reasonably entitled, because there is always an isolated spot that people cannot get to, the odd one here or there, but the same degree of service.

Now, the other part of this that I raise with him, and it comes from discussions we have had earlier in the year on other issues, is that we would like to be able to put in place not only the standard or expectation or model that we fund which Sue Hicks will be responsible for ensuring the RHAs are delivering, but we want to be able to have a service-audit function independent of that process which will be housed in the internal operations of the ministry in Mr. Potter's section, which will be able to do the checks from time to time, not only audit it financially, but very importantly, a service audit. It gives us, I think, a little bit of an independent check, obviously, on ensuring that the standards as developed by the ministry are, in fact, being met and adhered to.

The other component, of course, is appeals as another mechanism that we want to ensure is there, not only in home care and long-term care issues but others, and we are addressing now how we can ensure that there is a very good appeal function. We have a number of appeal bodies in the ministry now. Can they be appropriately consolidated to ensure that there is always a public appeal mechanism and that if there is a consistent number of appeals coming on an issue demonstrating there is a problem, that we are reacting quickly to get on that problem.

So we are trying to put those mechanisms in place to ensure that there are standards that are delivered, program expectations and deliverables, and they are delivered across the province, ensuring that they are meeting the standards we set and that the audit of those is somewhat independent from the program delivery.

Mr. Chomiak: I thank the minister. That has been useful. What form will these standards or directives take? Will it be internal? Will it be an Order-in-Council; will it be regulation? What guarantee, because I am sure the minister is well aware of the oft-repeated phrase that home care, for example, is not a guaranteed service. What form will these standards take?

Mr. Praznik: I want to be careful on definitions of words, because they often have different meanings. I think it is important to recognize that home care or any other area has a program with services that we provide. Whether they are guaranteed or not guaranteed, I guess, is always a concern to the users, whether government guarantees them or not, but there is a bundle of services that a program is expected to deliver through the appropriate delivery agent, if that is the regional health authorities. The ministry funds for those services, and they are there.

The standards I guess are not the bundle of services, but it is the manner in which the services are delivered. My experience in the ministry in some areas, as we are going through some of these questions, is sometimes the standards and service deliverables become somewhat confused. I would like to separate them, because I think standards say how you will deliver a service, what expectation that people have as to how that service will be delivered. That question of how services, agreed-to services are delivered, I want to make sure are somewhat separate from the delivery mechanism.

The issue the member raises about guaranteed service, I know that Paula Keirstead, who chairs our, I think it is the advisory committee, has raised this issue about guaranteed services. I guess, guarantees, what do they really mean? If one is worried about losing something you may have a comfort level, but ultimately what we are talking about, whether we use the word or not, is the bundle of services that our Home Care program will provide to all Manitobans to which they are entitled under that bundle that we have agreed to provide, and that obviously we want to make sure is consistently delivered across the province, and I think, most importantly, adequate for our expectations of the Home Care program. That will probably be an evolving and maybe even expanding bundle over time as there are changes in hospitals.

So I appreciate the concern of some who talk about guarantee. I do not foresee reductions in home care deliverables over the years. In fact, if anything, I see them somewhat expanding in the fact that we are looking at the home IV program and other services that we can now, with technology and other changes, deliver in the area. But there will always be some, and perhaps rightly so in areas of restraint, who would like to see a guarantee, and I appreciate that. Thank you.

Mr. Chomiak: Mr. Chairman, it becomes extremely important, and I appreciate this distinction, but it becomes very important when one considers that the final authority for the various regional plans is in the hands of the minister, and the minister is going to have to have some base level in order to make the determination.

So I guess my next question is: Where are we at with respect to the delineation of core services?

* (1740)

Mr. Praznik: I am informed by my associate deputy that the core services are the ones that have always been in place. I think they are fairly well defined currently. We want to, of course, make sure that they are delivered on an equal basis across the province, and that has been of some concern from time to time, but they are there.

I would hope that-we are working on it now. I do not know if it is completed. Have we completed our document, our manual on what we provide? We have not quite completed our document. When it is, I want to make sure the member has a copy.

We want to be able to define the services in general terms, I guess, as specifically as we can, the bundle of core services we provide and ensure that it is in a document that outlines the program, what people can be expected to-the processes and procedures including the appeal mechanism, if they disagree, and have it in a plain-language format that we can provide across the province. That is one of the things that I have asked for and that we are working on now.

I think that will go a long way to give Manitobans, particular elderly Manitobans who look to the program as something they will need at some point in their life or need now, a sense of what they can expect, the information they need and the comfort level they need to know that service will be there. So we are working on that document.

Mr. Chomiak: When we have been dealing with home care, as an example, will the core services document and the delineation apply to all services offered by the minister?

Mr. Praznik: Just to clarify, is that everything we offer in home care or everything in the department? Yes, eventually we would love to be able to do that. I just hesitate to say absolutely yes, because this department is so broad in every service it provides, I would be very surprised if we had-I am advised that we have a document. I would like to have a look at it to make sure it is there, to be blunt. I am sure the member appreciates that this is such a broad department, I am sure there are services that we provide that may not necessarily be listed in that document. I am thinking of certain things we do in public health or other areas. But his point, I gather from his question, is a very important one I think. People like to see what services are there that they are entitled to receive, and it has always been my belief that should be there as much as possible.

Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. It also goes further, because each of the regional health boards, of course, have to know what their legal responsibilities are, and they must have-so clearly there must be more than just an information package available. There are clearly some guidelines, probably further than guidelines, some-would, in effect, amount to regulations or some kind of directive and some kind of bottom line that has to go to regional health authorities. If that is available for our perusal, following review, we would certainly appreciate having a chance to look at that.

Mr. Praznik: Mr. Chair, the member is right. The authority has to be there, the direction to regional health authorities. The exception to his comment that I take is that because we are moving to a needs-based model of funding and we are doing needs assessments now, and because there is a great variation into just physically what regional health authorities can provide in different areas based on the availability of specialists or the needs in their area, we recognize that there may be some very significant differences between the services that regional health authorities will be able to provide to their populations. That does not mean that their populations are not entitled to the service. They may have to receive the service in some other place.

Just for example, in the north Eastman Region that I share with the member for Springfield (Mr. Findlay), who is in this committee today, we do not have a chemotherapy program in our region. We are currently not likely to get one in the foreseeable future because of the need. We have a chemotherapy program in the Selkirk General Hospital which is right next door to us. So every citizen of our health region is entitled to use that program and will be directed there, but it will not be delivered by their regional health authority. So there is likely to be those variations.

Obviously, if you take the member's concern to its logical, extreme conclusion, you could have a health authority that delivers nothing. Well, obviously, then you do not need a health authority. So, yes, we want to certainly work towards that. Citizens are entitled to the same services all across the province; it is just they may not be delivered in their specific health authority depending on the nature of the service. I am sure he appreciates that.

Mr. Chomiak: I did not intend to take it down this road, but we are sort of going down this road. So again this is the abstract, and the minister used the chemotherapy program. How in fact will that function? Will the regional health authority in northeast be reimbursed in terms of the cost from the Selkirk program? How will the funding model-I was given to believe earlier that the funding model will be following the patient. How will that be reconciled?

Mr. Praznik: Mr. Chair, ultimately the funding follows the patient. Now, whether that be in a direct payment from one authority to another or it be into taking account what we fund in the region and the services they provide-so, if the Interlake Region, for example, is providing chemotherapy services on a basis of so many people from northeast-we might fund them directly for that and that would be part of their service deliverables with the province would be to provide that particular service to a larger group than their own health region. I am sure we are going to have a number of these happen across the province. I know Brandon, for example, by its very nature is a region that is providing a higher degree of service than the two rural health authorities that surround it just because the Brandon General Hospital is a regional hospital. So they will be funded for that service.

In the initial stages, we will be funding directly for service as opposed to having dollars flow through one health authority to another. Now over time that may change somewhat, but if it works well, I would not see the reason to change it.

Mr. Chomiak: It does lead to the question of the contracting for service and the competitive nature of it, and the minister used the example of Brandon and the two corresponding rural regions. Are we in a situation where regional health authorities will be forced to go to the lowest-cost provider on a sort of contractual competitive basis, rather than what might be the logical or the, and again I am only dealing in the abstract, but would we be forced to go with the lowest-cost provider in competitions between various centres, to provide that lower cost as opposed to something that might be, say, logical or normal for the process?

Mr. Praznik: You know, I think what we want to apply is paramount, and I appreciate the abstract discussion and one has to have it, and so I think it is a good way to sort of flush out where we are moving here, and I appreciate the member's questions. Ultimately, we would like common sense to apply, and whenever you set up any type of governance system, sometimes common sense does not always apply, but ultimately the rule of thumb is common sense should apply.

We are not going to necessarily be able to have, say, a surgical program in every regional health authority based on numbers, the type of facilities. Some may be able to do that. Some may be able to attract a surgeon, an anesthetist and a team on an itinerant basis to bring a surgery program to the area, frequently or infrequently, depending on need. So we want what works best to apply.

There will be time-I am sure we all know that two services may be available from relatively close areas with significant differences in cost, in which case the ministry, I think, in its role as funder would want to be involved to ensure that we are getting-where the common sense says you could use one or the other equally so and one is considerably more economical to use for whatever reason, that that would probably be the one that would be the provider. Ultimately, the dollars you save there are available for other services, and I would not expect the member to say we should do it otherwise, nor has he ever suggested that, but common sense is going to be the rule.

* (1750)

From time to time we may disagree on what makes common sense, but that is what we are trying to see happen within the system. One interesting comment I would like to add is, our council of CEOs and chairs which I meet with, most weeks we have a conference call. We have been conferencing weekly since January, and now I think we are every couple of weeks simply because the workload has changed somewhat and many of the issues that need my involvement are not as great as earlier, but I meet with them personally every month.

The sense we are trying to build among the chairs and CEOs who meet together as councils of the regional health authorities-and I am pleased to tell you that the Winnipeg chair and CEO of the hospital authority, we have asked to join that group, because I think it is very important that they function as chairs and CEOs and together and not have a rural and northern and a Winnipeg component.

There are obviously issues that the two Winnipeg boards will have to work on together, but they should still be part of that overall group to be sharing and working together and working out deals, as opposed to separating Winnipeg from the rural and having two organizations. So the Winnipeg chair was at the last meeting I attended, and the CEO, I believe, was not available that day but will be at the next one.

In working with them and seeing how they are looking at things, the real spirit there, interestingly enough, is not to be competing against each other for work but to really co-operating to get the best efficiencies in the system and the best delivery of service.

This becomes very important on border areas. I am sure as the member appreciates, in western Manitoba a number of our health districts have areas where communities are in one district, but many who come to them-you know, there are areas where people go 50 percent to, say, Minnedosa and 50 percent to Neepawa. So they have to adjust to make sure it makes common sense, and we will probably end up making a few boundary revisions as well over time. One that your colleague, the member's colleague has suggested, I think, had to do with one of the northern-the Mathias Colomb community that was placed in one region and should be in another. We are just waiting for a confirmation letter there, and then we will make the appropriate change. So, again, common sense is what we want, and we hope we get it most of the time.

Mr. Chomiak: Mr. Chairperson, perhaps I can give a brief listing to the minister of some of the lines of questioning and documentation that we will be requesting. Certainly we will be requesting an update of the list of all of the various advisory committees and composition of those committees and the status of those committees that the department kindly provides us every year.

Also, we will be asking for-now this is not necessarily in the context of the appropriation 1.(b), but we will be asking for the status of most of the major reports' implementations, including the personal care home report from 1993-94, the status of the emergency care report, the Lerner report and subsequent actions in that regard. I was hoping to also get an update from the minister with respect to the blood-the meeting that he had with his fellow ministers yesterday, the status of the Urban Health Advisory group, any information the minister might have with respect to waiting lists as they relate to the hospital, mostly surgical functions, reports of the status of the palliative care committee, the AIDS strategy. Of course, we are also awaiting the capital reports.

I will also be requesting reports from the advisory committee on continuing care, as well as any data the minister or the department might have with respect to population health, population needs analysis statistics and information, because it forms the basis of so much that is going to be done in the short term and in the long term. As well, if the minister-if it is possible to table the names of those hospitals with vacancy rates below 50 percent that the minister has referred to on numerous occasions. Just as a start, those are some of the areas that I will be requesting from the minister.

With respect to a question, the minister made mention of the aboriginal health unit. I wonder if the minister might explain what the function of that body will be and where in the department it will be located, reporting to whom and its function.

Mr. Praznik: Mr. Chair, currently that is housed under our Rural Operations with the rural health authorities group and working under John Gow, who is part of the team setting up rural health authorities. It is temporarily housed there because many of the issues that we have to address first deal with our regional health authorities and their relationships with the soon to be emerging governance of aboriginal health.

If I may just for a moment indicate to the member that in the last number of months, I have been visited by a number of organizations: MKO, a number of tribal councils, Manitoba Assembly of Chiefs, and I am informed that there are negotiations under way to transfer the dollars provided under Health and Welfare Canada's budget for health promotion and community health in First Nations communities to some sort of organization or structure run by First Nations people that they take on those responsibilities.

There are obviously some jurisdictional issues here, and a number of his colleagues have criticized from time to time how these can appear to get in the way of solving problems. We all agreed in those meetings we did not want that to happen. We want to make sure we respect each others' jurisdictions, but we want good working relationships between our regional health authorities and whatever structure those communities put in place, because obviously we are serving the same people in different ways through different budgets, and we should make sure we are working together.

They appreciated very much that approach, and we left it with them to be speaking with Loretta Bayer, who is our person in that office, to ensure that as they develop their structures we are able to meet with ours to work together. There were still a lot of questions as to whether their structures would be a province-wide, a tribal-council basis, a community basis. So they have some decisions to work out. The reason why I say these are so important, the member and his colleagues have rightly flagged issues like diabetes as being one of almost epidemic proportions in First Nations communities. That particular ailment or illness requires a huge amount of community work, and I do not think it is going to work if we send an army of public health nurses from southern Manitoba into those communities to deal with it. We require the community to take on that issue.

There are dollars available. The federal government has earmarked, the federal Liberal Party has earmarked additional dollars that they would like to spend. We have suggested that they look at these areas as something to put those dollars in that would be of greater use to us in Manitoba than some of the areas they are planning currently, but we want to make sure that those aboriginal communities are really in charge of this. It is going to work if it is from their community and they are making decisions and really taking this on.

So all of these things sort of fit in together as we move forward and we can talk about that more as we move through the Estimates. If the member is willing, tomorrow when we reconvene, perhaps I can begin with a report on the meeting on blood.

The Acting Chairperson (Mr. Tweed): The hour now being six o'clock, committee rise.