Mr. Chairperson (Ben Sveinson): Order, please. Will the Committee of Supply please come to order. The committee will resume consideration of the Estimates of the Department of Health.
When the committee last sat it had been considering item 21.1.(b)(1) on page 71. Shall the item pass? The honourable member for Kildonan was posing some questions.
Mr. Dave Chomiak (Kildonan): I wonder if the minister might outline for me--we talked about planning to have some individuals here today. Maybe perhaps he could outline what the arrangement is thus far.
Hon. Darren Praznik (Minister of Health): Yes, Mr. Chair, we have Mr. Potter and Mr. McCormack, who have been dealing with the Betaseron issue. They are here and available today. We also have Heather McLaren from the legislative unit if we wanted to discuss legislative proposals. Mr. O'Neill is here with respect to health information. So those were the areas you had requested for today and our staff are here as requested.
Mr. Chomiak: We are going to have a morning session and an afternoon session, so perhaps since staff are here we should deal with the individuals who are here and then this afternoon we could deal with a sort of pot pourri of issues that were remaining from the last session and talk about a couple of other issues that have arisen.
Perhaps we should start with the Betaseron issue?
Mr. Praznik: Yes, I have Mr. Potter, who is my Associate Deputy Minister for Internal Operations, which includes the Pharmacare program, and Mr. Tom McCormack, who has actually been the staffperson who has been working directly on this since Ms. Deborah Vivian departed from the provincial government to take on other responsibilities elsewhere. She had been initially the individual who had taken on this particular project.
Mr. Chomiak: As has been reported and is fairly obvious with respect to the Betaseron and, I might add, Copaxone issue, which I would also like to query on today, the question of delay and the question of the up-and-running nature of the program is, of course, paramount to everyone in the system, particularly those who are suffering.
So maybe we could commence by the minister outlining specifically from the provincial perspective exactly where the program is at and also as much indication as possible when we might see the actual flowing through of benefits to the individuals.
Mr. Praznik: Mr. Chair, I will deal with the first part of the question which is the general perspective. Then I will let Mr. Potter or Mr. McCormack update you on the specific details as they can of the program, because they have been involved with the committee and the MS centre clinic which will be hosting the pilot project.
When this matter was first brought to my attention, by way of background, it was brought to my attention because our pharmacal economic committee which advises on whether or not drugs are included in the formulary and I believe, as well, interchangeability of drugs within the formulary. When Betaseron had first come to their attention, they had recommended it not be included. That had been the general recommendation of similar committees across the country.
Several provinces then did overturn that, either their committee did--or I am not familiar with the specific details--but several provinces did develop programs, some on a limited basis, to start using the particular drug. At that time because of the public interest in this and, certainly, I know the member for Kildonan had spoken to me about it, both formally and informally. I think we both shared some concern about was this a fair treatment for the drug. In fairness to all involved, this is one of those drugs that is in the early stages of its formation. Yes, it is approved for public use, but its effectiveness or the amount of effectiveness, I guess, or what it does contribute to improvement of the relevant patient's life has been, particularly during that period, a matter of great debate over its effectiveness.
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If numbers serve me correctly, the initial information I had was that it prevented one relapse period in a three-year period, with a cost during that period of about $17,000 a year, so putting it close to $50,000 per patient for the prevention of one relapse without making an impact on the longevity. It was felt it did not prevent the further development of MS, et cetera. I think on that basis and on the basis of that information, the committee had recommended that its cost versus its very limited medical value did not make it a worthy candidate for inclusion on the formulary.
Needless to say, as drugs develop, often the first generation of a drug product has more limited value. As drugs are used and utilized and refined further, the value of that drug in terms of the outcome, the medical outcome, improves, and I think that is the history of many, many products in the pharmaceutical industry. So the concern was where is this? It is a developing product. I did make some effort as a minister because, as a new minister wanting to understand how my Pharmacare approval process worked, were there shortcomings in the process.
I want to say very firmly--and I have never had the member for Kildonan occasion to challenge this particular point. In fact, I believe, sincerely, if he were in my shoes, he would be supportive of it. Governments and ministers should not be making decisions on individual drugs and be the ones who decide whether there is a value or no medical value in that drug. We are not equipped for it technically, and there should be some committee of experts who provide that advice and we rely on that advice. The question always, of course, is what is the process for that committee to operate; what is the process and options for that committee to decide? That is what I was interested in very much, as a minister, is the process involved in those approvals. I know I had meetings with representatives of the MS Society in Winnipeg, the MS Society of Manitoba, MS Clinic.
I met with our pharmacal economic committee that makes these recommendations, and we recognized a number of improvements I think we could have made to our process. One is our process traditionally has only involved paper reviews. Often a drug, because the evolution of a product is one that is going on, it is not static, sometimes a drug may be used on an experimental basis in the province or in some program where there are much different results or improved results or better information that may not have made it into the literature yet at the time of the decision making, and there is a lag period there.
So we felt it was important that the committee who had the power, on occasion where it deemed appropriate, take technical representation or information from people involved in using the drug as opposed to just a paper review. Of course, one did not want to open that up that any particular lobby group or interest group would be able to come in and make a case based on anecdote. It has to be scientific information, but certainly allowing those who are qualified to provide that information to be part of that process and make an oral presentation seemed reasonable as long as it was done in a scientific-based manner.
So we talked to the committee about doing that. The other thing is the committee had traditionally done what I called the red light, green light approach. It was a yes or a no for inclusion in the formulary. I felt, and particularly as we see more drugs developed and go through this process of their value and improvements in their value, that it was important not to give such a stark or have such a stark set of choices that there would be occasions when a drug was in that gray area, that it was not really clear, that it had limited value or it had great value but it was in a developing sense, a gray sense, and have just a standard that it had to be proven of certain amount of value, or it did not get approved to have what I call a yellow light process, a yellow light option where the committee could recommend on a limited basis, a time set basis, a trial program or a test program with that product to determine exactly if the medical benefits were sufficient to warrant the value of the product.
So this is the first time with Betaseron that that new yellow light process is taking place. We asked the committee to reconsider the drug in light of the process changes that we thought would be good. I should tell members that in the meetings I had with the MS Society, they were fully supportive of this approach when they met with me, because they recognized that there would be other products coming down the tube, including copaxine which we will discuss. That would be in that same category, and rather than having stark choices and a more limited process, having this option would mean at the end of the day that it would allow, I think, for better decision making and improving products.
One of the ironies of this I share with the member and we might want to pursue is when I met with the physicians from the MS Clinic. They said in the two or three years that will be needed to do a fair assessment on Betaseron, other potential products that are now in the development stage or coming onto the market may overtake Betaseron and its value. That is something too we have to be cognizant of that some of the drugs that go into this product may not ever end up on the formulary, because other products may overtake them in medical value.
So it is an interesting and dynamic process, but we did not want a process that saw Manitobans in need of the benefits of new pharmaceuticals disadvantaged by the generally slow pace that takes place in the development and approvals and acceptance and understanding of pharmaceuticals products. So that is what we have done by way of process. Betaseron went back to the committee. I think the committee was not able to meet until the early part of January. They considered and stuck by their position that based on the evidence that they had received, they viewed it was of more limited medical value for the cost involved, but they did recommend that we test this in the yellow light process.
We agreed to do that with a pilot--actually, I would not say a pilot, a yellow light test process. It is a pilot for us in doing the first one, so we want to make sure we learn as much as we can from those who have been before us and do it in a manner that we can repeat on other products. When we did discuss doing this, we agreed that the product would be available to all Manitobans who met the medical criteria for using Betaseron. So, I want to make this clear, no Manitoban who would meet the medical criteria for trying the drug will be refused access to the first pilot or test program.
So this is not a test in saying we are taking 10 percent of the sample community and we are only giving it to 10 or 15 percent and the rest have to wait for the results of the program.
I did have opportunity to visit the group in British Columbia who brought in their pilot. I think it took them three-four months to set up their particular program. Saskatchewan I think was five-seven months, something in that range, to get their program. So we have learned, contact has been made, we have learned what others have done. With the MS Clinic as hosts, and I want to indicate that the Manitoba government's role really is to be the funder of the drug under the pilot and to make sure that the evaluation process is acceptable to us so that we can have that information for our committee.
The financial parts are in place; they have been approved by Treasury Board some time ago, in fact. That was the easiest and fastest component to have in place, the dollar support. The evaluation tool is being developed with the MS Clinic and, if I may, Mr. Chair, allow Mr. Potter and Mr. McCormack to update committee exactly on the technical information, I understand that they met yesterday with the MS Clinic, and they certainly would want to update this committee.
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Mr. Don Potter (Associate Deputy Minister, Internal Programs & Operations): Basically, the project, the pilot project is being managed through a steering committee process, a steering committee that is chaired by the Department of Health, but it includes representation from the MS Society of Manitoba. It includes representation from the MS Clinic; it includes representation from our Drug Standards Committee.
This group is developing the pilot program. There is a great deal of work that is being done to put the pilot program in place. The MS Clinic itself has agreed to be the host for this project, but, of course, we have to put staffing in place, and right now the MS Clinic is in the process of putting that staffing in place to operate it. We have been working on the criteria, and the steering committee has agreed on the criteria for the program. We have also been working in terms of the evaluation process, and the committee has just recently approved a proposal for an evaluation coming from a Dr. Colleen Metge at the University of Manitoba, who is a doctor in pharmacy.
The proposal, we believe, is very solid and will provide the type of information that is required as we proceed through the program. So the project is underway. Obviously, we are not in a position yet to provide the drugs until the MS Clinic is up and functioning, but we are working towards that end.
Mr. Chomiak: So just to sum up so that I understand, the steering committee has been set up, criteria have been established, evaluation process is established, funding is in place, MS Clinic is to be the host. Essentially the two major issues remaining, I presume, are for MS Clinic to staff itself up and secondly to begin the application or screening procedures. Is that correct?
Mr. Potter: Mr. Chairman, that is correct. The protocols have been developed for the program as well, so now we are in a case of getting everything operational, and that is what we are working on at this point.
Mr. Chomiak: This might be difficult to answer, and I will not hold anyone to this, but if I were an MS patient who met the criteria, when would there be a likelihood that I would be in a position to be able to obtain Betaseron?
Mr. Potter: The steering committee has established an implementation date of May 4 as the date that the facility will be open for business, if you like. As you say, it is very difficult to guarantee, but that is a target date that has been set by the steering committee with all of the groups participating in the discussion. That is recognizing the timely need to get the staff on and to put the other supports in place for the program.
Mr. Chomiak: I appreciate that answer and I appreciate also that the May 4 date is, of course, conditional and subject, but I appreciate the fact that there is some time line that can be sort of looked forward to.
Can the minister advise me whether or not he can table the protocols and the criteria for the program?
Mr. Praznik: Mr. Chair, I understand that there the process or the final touches are being put on them, and I have no problem sharing this with the member as we go along. I think he appreciates it and, by the way, I appreciate his comments about the time frame, because there are so many factors beyond anyone's control, but I think he gathers that there is a great deal of work involved in setting this up for the MS Clinic, that they have been moving I think at fair speed to get this done and that it is a new process that we are developing on the evaluation.
So, I think it is in everyone's interest to be able to follow this very closely and to fine tune it as we go along, because what we do here, what we learn from this yellow-light process is one I hope that we can use in the case of many other products.
So when we have that in place, when we are in a position to provide you with a complete copy of what we are applying, I will be prepared to do so.
Mr. Chomiak: Mr. Chairperson, can the minister indicate, in terms of the staffing in MS Clinic, what are we looking, is it new staff years, is it additional physicians or additional clerical? What is the issue with respect to staffing?
Mr. Praznik: It is, as I understand it, clerical support and also nurse support. The nurse support, if I may just comment on this, when we were in British Columbia, one of the points that they made to Ms. Vivian and myself very, very strongly was that it was important to have, I think they used a nurse in British Columbia, if I am not mistaken, who actually works with the people on a regular basis, because many of the side effects of using Betaseron can be very difficult, and having a person involved with the clinic to be able to work with people through this process and be supportive of them ensures, I think, a greater success on the program.
A comment they made to us, that by having good prescreening, and that is not just the medical side of are you eligible for this drug, could this drug be helpful to you, the understanding of the side effects that can take place as well are important because in British Columbia, if I remember correctly, and it has been some time since we spoke to them, but by having a good prescreening where people are aware of the side effects, they make their decision at the beginning so they tend to have a higher retention rate of people who will remain on the product over a period of time. Those who are not prepared to deal with the side effects tend to make that decision at the outset. That was one of the things we learned, and it was important. So the staffing goes along with the clerical part of keeping track of everything, and also providing that kind of hands-on, day-to-day support for the people who are on the program.
Mr. Chomiak: Can the minister indicate what the cost of the program will be?
Mr. Praznik: Yes, Mr. Chair, somewhere between $1.5 million and a little over $1.7 million on an annual basis.
Mr. Chomiak: So has this funding now been appropriated to the pharmacare line in the budget and will be appropriated on an annual basis, based on that figure?
Mr. Praznik: Yes, that is my understanding of it, and I know when I was part of a meeting with the doctors from the MS Clinic, they made the point that this program would probably need two to three years, if I remember correctly, three years to do a proper assessment, something in that range. So we know we will have to budget for this period.
One of the comments they did make to us, which was interesting, was within that same period some of the other drugs that are coming on the scene may, in fact, overtake Betaseron, but you never know on these things. Certainly, we want to proceed with this study on Betaseron.
Mr. Chomiak: And the funding to the MS Clinic for the additional clerical help, where and how will that be funded?
Mr. Praznik: That is part of the Pharmacare side, and it is included in that particular total. As I have indicated, this is somewhat new for us, a new process, so we are learning a lot about how we are going to be doing these kind of allocations and these kind of issues, because we may have again other products that require a pilot project. For a pilot to work well, in many cases, it is important--not all--but in many cases it is important to have a host facility, clinic, et cetera, to be able to manage it on a consistent basis, so that we remain consistency in measurement. I think the members recognize that.
Mr. Chomiak: Mr. Chairperson, which does bring us to the issue of Copaxone and which I think probably we could use as an example. Certainly in the early stages of Copaxone, and in some cases, appears to be overtaking the effectiveness of the Betaseron. I do not think any of us want to go through with Betaseron what we went through with Copaxone. I wonder if the minister might outline for me what the process is in place, and I appreciate there will be other drugs, but let us use Copaxone or other drugs as an example as to what is going to happen from here on in.
Mr. Praznik: Mr. Chair, Copaxone was also raised with us at the time I had a meeting with the MS Clinic with Ms. Vivian and Mr. Potter, and we wanted to ensure that--the committee I think initially had rejected it. One of the benefits that I have learned in this process is allowing the committee to receive evidence from experts in the field gives us a chance to check our own internal administrative process of the committee as to what information is provided to the committee. I am not pointing fingers and saying someone is at fault, but it is a very dynamic, pharmaceutical development is a very dynamic area of science and of industry, and there is lots happening all the time. So we want to make sure as many avenues as possible are there to ensure the most up-to-date information comes forward for consideration.
I was advised that with the case of Copaxone there had either been new information or a piece of information that had not originally come to the committee. That has now been provided administratively, and the drug is going back to the committee, I take it, at their next session, and we will await their recommendation with that new information.
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Mr. Chomiak: Mr. Chairperson, I appreciate this is hypothetical, but let us take it one step further. Assuming that Copaxone, if this red light, green light, yellow light process is in place, let us assume that the same thing happens with Copaxone as happened with the Betaseron, that there is a rejection or there is a tentative approval, a yellow light. Is it the department's intention then, therefore, to go into a similar process whereby Copaxone would be made available through the MS Clinic funded, et cetera, and how would that work?
Mr. Praznik: Mr. Chair, I know it is always difficult when you get into hypotheticals, but I gather the member is asking if we had another yellow light recommendation. Because this drug obviously, it is my understanding, covers the same group of people and there is quite a bit of overlap, a huge amount of overlap, I do not know how such a process would work, but we would obviously, if we had that recommendation, would want to be sitting down and dealing with those in the medical community about how we would handle such a project, because they do obviously overlap. So I do not want to speculate on that today, but obviously if that is the recommendation, we would have to then deal with the appropriate medical people to see how we would handle it.
Mr. Chomiak: Mr. Chairperson, I will come back to that, but I want to go back to the therapeutic drug committee at this point. Do we have a list of who is on that committee?
Mr. Praznik: Mr. Chair, we are going to see if we have that list today. Just a caveat I put to that, and I have no problem sharing the list with the member, but I met with members of the committee and--I believe the members get an honorarium, but this is becoming a very more involved process. One of the things they did flag with us when I met with them--and, again, I am sure the member can appreciate the difficulty in attracting experts in this field to be on the committee.
Mr. Chomiak: Can we have a list?
Mr. Praznik: We do not have one here, but we will get it this afternoon for the member. One of the difficulties they flagged with us is that they do not want to be in a position where every particular group--and I have seen this and I know the member has seen it--that people who are suffering from an illness hear of a drug. If one is in very desperate medical circumstances, the hope that drug brings can--and I would be in the same position if I were in their shoes, so I do not offer this as a criticism.
I think it is a reality of human nature and of life. We all want to live and if we feel we are dying, we want to go after whatever possible cure could be out there. One of the things they flagged with us is they do not want to be in a position where they are individually lobbied at their homes or their offices with respect to their decisions, that what makes the committee work is that their decisions are based on scientific evidence. I think it is in the public interest that that happen. So the only reason I flag that with the member, I have no problem providing that list, but I ask for some discretion in how he shares that list, because I would not want to be in a position some day where individuals with their own circumstances lobby members and I cannot get members for the committee.
Mr. Chomiak: I certainly appreciate that difficulty. Can the minister, because this actually is the fundamental question, outline the guidelines and criteria that are utilized by the committee in reaching its decisions?
Mr. Praznik: Mr. Chair, one of the things I have learned as we have developed this process on the Betaseron issue--and I am very thankful for it--is in a plate that is more of a platter than a dinner plate of issues. As a Minister of Health, you only have so many hours in the day, and this issue allowed me to get into the Pharmacare process. I know in meetings I have had with them, we do have guidelines for their approval, and we will bring those for you this afternoon. Mr. Potter thought we would only be discussing specifically Betaseron and does not have that information. So we will make sure we get it for you for this afternoon's sitting, but we do have guidelines.
One of the things that we are working on developing is to refine those further. I shared this issue informally with some of my provincial colleagues from across the country, and they have the same problem. On a national basis, there is a need to be developing some criteria, more in-depth criteria for the assessment and approval of pharmaceutical products. It is somewhat a hodgepodge. Now we have the general guidelines; they are relatively similar. Some of the principles are similar, but many of the criteria for establishing whether or not those principles are met, pardon me, are not very well defined, and it is the case in Manitoba, too, and so somewhat the committee sometimes feels that they need more sense of direction. I am a great believer that within the nation, there is a need to be doing this on somewhat of a consistent basis across the country.
So there is a lot of work still to do in this area, and when we provide you with those guidelines, I indicate very clearly, they are not as complete or in-depth in terms of criteria as, in fact, the committee would like. One of the charges I have given them, and we will be working with it nationally is to refine those further, because this will become a growing area within health administration. As the pharmaceutical industry continues to grow, more research is being done.
The value of products, often high-cost products, is going to become a big question in health care, and I share with the member this very brief story. I visited a pharmacist who lives in my constituency who works in a rural hospital and regularly is inundated with drug companies dropping by him products. He made the observation with me that often a new product on the market will have minimal medical value but have a considerably higher cost, but it will be the next generation of the product that you can say is a little bit better.
I think the member agrees, if we are going to have public health care and it is going to survive into the next century, we as the administrators and funders of that system have to ensure that we are getting value out of the products that are developed for the dollars we are paying for them. How we do that is still a matter of a great deal of work and refinement, but that general principle certainly is one that we must be looking at.
Mr. Chomiak: Some of the issues that I wish to pursue are contingent on some of the documentation that is going to come back this afternoon, so the minister has indicated they will be here. The other tie-in with this, of course, is, we probably are going to have a more in-depth discussion on Pharmacare in general when we get to that line or when we schedule it. Maybe I will cease this line of questioning at this point. Perhaps we should move on to the legislative portion. We can come back to this when the documents come this afternoon, something along those lines. Does that make sense?
Mr. Praznik: Yes, it certainly does. I know the member appreciates this as a very important area, I think, the future of the Pharmacare program and some of these principles.
Mr. Chairperson: The honourable minister might want to introduce another staff member.
Mr. Praznik: Yes, Mr. Chair, I would like to introduce Ms. Heather McLaren, who is a barrister and solicitor by trade, and manages our Legislative Unit. She is responsible for the development of legislation, including many of the private acts that this ministry is responsible for, as well as all of our regulation, which is fairly extensive.
Mr. Chomiak: I thought we would commence by perhaps discussing the legislation that is coming forward, that we discussed at a previous occasion that we met, that is coming forward in terms of this session.
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Mr. Praznik: Within this year's legislative agenda, as we move forward, as the member knows, I introduced The Medical Amendment Act, Bill 20, yesterday into the House. We are also committed in this session to bring forward The Mental Health and Consequential Amendments Act, which we discussed, which is an important piece of legislation. I would have liked to have done it last year, but it was not far enough advanced in the detailed drafting and, given the resources available in an extensive legislative session, it was not physically possible to bring it forward but, following the session, we worked very hard over the fall to have it completed. There are still a few little pieces that we are finalizing before we bring it forward to the House.
The Pharmaceutical Amendment Act is one I plan to introduce and have authority for from cabinet. It basically involves a number of housekeeping issues, some related to some changes in federal legislation that the Pharmaceutical Association has brought to my attention and wants us to move forward. There are some issues in The Prescription Drugs Cost Assistance Act, by and large, housekeeping, if I am not mistaken with respect to delegation and fees and those type of things that need to be dealt with.
I believe The Addictions Foundation Amendment Act--I am looking here. The Prescription Drugs Cost Assistance Amendment Act I believe already is Bill 13 listed on the Order Paper. The Addictions Foundation Amendment Act is Bill 12 on the Order Paper. Also we will be bringing forward the Regulated Health Professionals Acts Amendment Act which is to tidy up some of the issues with respect to confidentiality that comes out of general trust privacy legislation. The Health Services Insurance Amendment Act, I intend to bring forward, which will deal with the licensing of personal care homes in terms of empowering the establishment of that scheme which is necessary.
The member and I have talked about that. Some issues around the Manitoba Health Board and the appeals that it hears--I just say to the member, if we are going to have a licensing scheme for personal care homes, we have to have an appeal function from those decisions. I also would like to change the name of the board to the Manitoba Health Appeal Board, because that is primarily what they do and it leads to some confusion. We have some issues around the Canada Health Act and tray fees that we would have to address in this piece of legislation.
I can tell the member we are still working away on how to manage that within our general legal scheme for the administration of health care, so that would generally be the agenda for which I have authority to bring forward. I know the member had flagged two days ago some professional acts with respect to nurses, and I wondered where he was coming from. Yesterday I received on my desk a request for some legislative amendments from the Licensed Practical Nurses Association, but they have certainly missed our deadlines for advancing those issues and this year, given staff, in fact, actually wanted to meet with me in May. So I would expect that we will. If there are any amendments that arise out of that, they would have to be in the next legislative session.
Mr. Chomiak: So the minister is saying definitively--there is never anything definitive in this line of work--but they are not anticipating amendments to The Licensed Practical Nurses Act this session because the deadline has been missed in terms of legislative drafting.
Mr. Praznik: Yes, that is correct. I need some time to sort through. The member well knows because we as elected people always get brought into--wherever you have a profession with a number of professional organizations, there are always the issues of where those organizations butt up against one another and whose turf is being regulated and what effects on other organizations. I hate to say it, but one always feels when you get into professional legislation, in whatever profession, you are getting into a hornets nest, and before one jumps into it, it is a good idea to check if the hornets are home.
So I always make it a practice in dealing with that of ensuring that before I recommend we make an amendment, unless it is an extremely minor one, that there is a good consultation with various professional groups. I would imagine he does the same thing before he offers criticism of it because it really is a hornets nest for us as legislators.
Mr. Chomiak: Can the minister indicate what the thrust will be of the amendments to The Mental Health Act and; secondly, have the amendments been circulated? Have the proposed amendments been circulated to the community at large?
Mr. Praznik: Mr. Chair, this act will be a resubmission--actually pardon me here, I am just checking my notes. A commitment was made I believe in 1992 in a consultation paper entitled Building the Future of Mental Health Services in Manitoba. The proposal called for the repeal of the current act, and it is really rewrite because it was difficult to follow and did not accommodate the shift in emphasis from institutional care to community mental health care. As well, the proclamation of The Vulnerable Persons Living with a Mentally Disability Act and changes to The Powers of Attorney Act, as well as significant consequential amendments would be required to the current act if we carried on. So it was felt it was much better to redraft this piece of legislation in light of all the amendment that would have to be made. There was a fairly extensive review of this Mental Health Act, the recommendations coming forward, and this act comes as a result of that process.
The member knows very well that in many of these communities there are always debates about process, debates about theory of care. I have no doubt that there will probably be people who are on two sides of an issue and will come forward during this, and I expect that will probably be the case. It always is when you are dealing with these particular areas. But these changes really result from a pretty extensive consultation and the practical need of having to make so many amendments to the old legislation that our draftspeople felt it was better just to rewrite the act.
Mr. Chomiak: Mr. Chairperson, am I not correct in assuming or indicating that there was a draft of this proposed act that was circulated in the community within the last two years?
Mr. Praznik: Mr. Chair, that was, I understand, the recommendations of the review committee, as opposed to a draft act.
Mr. Chomiak: Mr. Chairperson, so the review committee was comprised of members of the public and members of the government, or simply public representation.
Mr. Praznik: Mr. Chair, I am going to ask Ms. McLaren to advise the committee of the composition of this committee, because she was very much involved with it.
Ms. Heather McLaren (Director, Legislative Unit, Department of Health): Mr. Chairperson, the committee was very broadly based with representatives from pretty well every aspect of the mental health community, and the representation on the committee I think was as broadly based as you could get.
Mr. Chomiak: Mr. Chairperson, does the minister have a time line as to when this legislation might be introduced?
Mr. Praznik: Mr. Chair, I would hope, with our normal negotiations, et cetera, by House leaders--we have an expectation that the member will need some time to study it, but I would hope by the end of this month we will have it into second reading and circulated. I know there are just a few issues yet that have to be sorted out on some matters that came up in the last few months that I have to have clarified and checked. Otherwise, it would have had it in already.
Mr. Chomiak: Mr. Chairperson, the minister made a reference to the act dealing with licensing of personal care homes. Can the minister indicate: what act is he going to be amending and what are the criteria? Will there be regulations, as well, filed with that, and is it possible to have a look at those?
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Mr. Praznik: Mr. Chair, last year, as the member and I had to deal with, from our respective vantage points, the Holiday Haven situation, it brought to I think both of our light, and I know to my surprise and I believe to his, that the power of government in regulating and dealing with health care facilities was extremely limited. It came to my great surprise, I must admit, but it was extremely limited, and one of the reasons I think is because the historical development of health care in Canada was private providers and government as insurers.
Personal care homes which are relatively, I guess, new in some ways but come out of the old nursing home concept were originally and continue to be licensed under The Public Health Act as opposed to The Health Services Insurances Act. The consequence of that licensing provision is we granted a licence, we can repeal a licence, and there was very little power to make regulations around the licence, so you either said you are or you do not have a licence.
So all of our personal care homes in the province are licensed under that very narrow limited licensing provision. We also discovered, whether it be a hospital, a personal care home, whatever, that was independent of government, its own governance base, we had no power to step in if patient care was at risk, and we learned that at Holiday Haven. We had no legal authority to walk in and take over.
We had a similar problem in Dauphin at one particular point where they were some months away from not being able to make their payroll because of decisions of their governors, and if that had reached that point, surely to goodness the member for Kildonan would have asked us to step in and take over the facility. Legally we could have only done it if their governors had not agreed when a receiver was appointed because they could not take payroll. Well, that is just not acceptable, so we made changes to The Regional Health Authorities Act that give the minister the power to appoint interim management for a facility to straighten out problems so patient care is there. As part of our review, we also recognized that our licensing scheme for personal care homes in Manitoba I guess goes back in decades--was before '73 actually, goes back a long way--has been in place and is really inadequate.
So what we will be putting into The Health Services Insurance Amendment Act are the powers to create the necessary regulations around a licensor scheme for personal care homes, and once that is created, Ms. McLaren and her staff then will be working on the development of those regulations. So I do not have those to share today. We are far from that point, but at this particular point it was important to develop the legislative framework and the legal scheme to empower that regulation, so that is what this is about.
Mr. Chomiak: Mr. Chairperson, I am dealing with a bit of a gray area here because of circumstances, but I attended, as much as I could, the inquest with respect to the Holiday Haven matter, and during the course of that, there were officials from the Department of Health who testified and, as well, to the surprise of the presiding judge, there were concerns expressed about the licensing provisions with respect to personal care homes.
I was under the impression that the official from the Department of Health had in her custody a draft regulation with respect to licencing which she referred to in terms of potential changes in terms of licencing now, and I guess, unless my memory is faulty on this point, because of the public interest involved, I am wondering if those are accessible.
Mr. Praznik: Yes, I am asking Ms. McLaren to provide me some information on that. She believes that the documents being referred to were draft standards that would--in fact, I might get her to explain this technically to the committee.
Ms. McLaren: Mr. Chairperson, although I was not in attendance at the inquest, what the official may have had is a draft of a standards regulation in which there was some reference to licencing. However, we have a legal opinion that you cannot put something like that just into a regulation. You need to have an empowering provision in an act for something like that. So it was a preliminary draft, and the licensing will go into the act, not into the standards regulation.
Mr. Chomiak: So, if I understand it correctly, the amendments that are coming forward are going to be amendments with respect to licensing and empowering the minister or the governing body to have the licensing authority, and there will be underneath that authority the regulatory control to set standards. Is that correct?
Ms. McLaren: Yes, that is correct.
Mr. Chomiak: Will we be seeing that regime effectively in place this session?
Mr. Praznik: Mr. Chair, yes, if the legislation, I assume, will become law with this session or be passed by the Legislature, it will become effective upon proclamation. Our staff are working away at the regulations. When those are ready, we will want time to share them with the personal care homes and have a transition period before we proclaim the act and the licensing process.
As the member appreciates, for the vast majority of personal care homes in the province, they have been operating for many decades under the old regime and sort of look at us and say: well, what is all this about?--we have not had a problem. They are right, but there have been problems in one facility in particular and, from time to time, in some others of a different nature. So, as a consequence, we believe that it is important to have the scheme in place to modernize our governance and regulatory schemes for personal care homes. But we certainly want to have some time to work with them before it is proclaimed into law. The first step, of course, is to have the legislative authority in place.
Mr. Chomiak: I just want to correct the minister on one point in fact. Certainly, the recommendations for this occurred prior to the Holiday Haven matter and were as a result of the task force that was established by the previous minister in 1993, arising out of some incidents in personal care homes. The task force recommended that the licensing and standard procedures be put in place along these lines. That is what I assumed when I attended the inquest that the standards and regulations being dealt with by that particular department official were as a result of that process.
Mr. Praznik: Yes, I stand corrected. The member is right. My involvement with all of this started shortly after my appointment in January 6 of 1997, and my first encounter with this whole issue was the Holiday Haven issue. So that was because of my reference, but he is quite correct that much work had gone on prior to that.
Mr. Chomiak: Can the minister give us any indication in terms of the thrust of the issue relating to health care act and the tray fee issue and how it is going to be resolved in legislation?
Mr. Praznik: Mr. Chair, I cannot do that today because we are working through a number of options and some difficulties that we had not foreseen. I am still seeking some counsel and advice on our process, but we recognize--and I think the member has; his leader has raised it in Estimates with the Premier--that we are losing some 60,000-plus a month from the federal government as their allocation of the tray fee issue. We would like to be able to deal with that--and I think the member would agree--in a manner too that does not in any way compound waiting-list problem issues. So we are attempting to do it in a manner that allows us to keep a surgical capacity in the province but does not create the tray fee issue. Of course, that raises the spectre of two-tier health care, which is not something that I am supportive of.
So we have a number of options. We have encountered a few difficulties we did not anticipate. I know I have had some meetings on it this week with Ms. McLaren as a couple of these problems arose in the legalities involved, and we are attempting to work through them.
So I do not want to get into that detail today on the public record, because I am not quite sure how they are going to be resolved yet. But I would hope we would have them done in the next couple of weeks and the bill before the Legislature by the end of the month.
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Mr. Chomiak: Mr. Chairperson, so basically, the commitment is, barring some major unforeseen event, this legislation will be brought forward before the end of the month to deal with the relationship of the Canada Health Act and tray fees. Is that correct?
Mr. Praznik: Yes, Mr. Chair, and we are particularly interested in dealing with many of those surgical procedures for which we have waiting lists, and certainly we have seen that with cataracts and a number of other things. It has been a point of issue, and it needs to be dealt with. I think there has been some stabilization now on the federal position and a little more co-operation, and it is a matter of being able to deal with it. So we are trying to figure out the legal mechanism to do that.
Mr. Peter Dyck, Acting Chairperson, in the Chair
Mr. Chomiak: Mr. Chairperson, the legislation is going to be brought in to deal with the licensing and standards of personal care homes.
Will it be confined only to personal care homes or will it be broadened to include other institutions and other organizations?
Mr. Praznik: Mr. Chair, at this point, just personal care homes.
One of the difficulties we find is that because of the nature in which health care is developed in Canada and in Manitoba, the development of institutions, appropriate legislation, health insurance schemes, the Canada Health Act, et cetera, one on top of the other, we really do not have the kind of clear legislative authority. So we are correcting them in the sense of a bit of a hodge-podge of the status quo.
But I appreciate the member's questions and, as we advance and see changes in health care delivery, we recognize that a great deal of this legislation will need to be standardized and brought forward so that the ministry does have the power to license facilities that are doing various procedures and that part of the licence is that they meet an acceptable standard. So personal care homes to start, and we are continuing to do an ongoing review of this. So I suspect next year, if required, we would be bringing a licence scheme for other facilities where that may be needed.
Mr. Chomiak: Mr. Chairperson, will the regulations in licensing also include, and I know this is slightly out of jurisdiction, but, in fact, it is in jurisdiction, residential care sectors and other care sectors, or is it going to be confined only to the Department of Health and the personal care home sector?
Mr. Praznik: Mr. Chair, I am advised as we work this through that we in health are dealing only with personal care homes because they are an insured service. The current provision in The Public Health Act, I am advised, will still remain in place with respect to residential care facilities that Family Services license.
Mr. Chomiak: So the minister is not aware of similar regulations, regulatory change taking place on the other side in terms of Family Services.
Mr. Praznik: As the member would appreciate, that is a matter within the Ministry of Family Services which they have to assess and deal with, and we are managing the issues on our side. That is a question or an issue best raised with my colleague.
Mr. Chomiak: Will these regulations and standards also apply to those centres that are housing or maintaining individuals who are panelled but not yet specifically in personal care homes?
Mr. Praznik: Mr. Chair, I am trying to envision which facilities we are talking about. Hospitals would be one, and they obviously have a responsibility with the regional health authorities and again, if they are not meeting up to those, we have the power to administer them.
If within a hospital there is a designated personal care home space, as is currently the case at Concordia, it would govern them as well. If it was simply a holding bed in a hospital, it would not be. They would be part of hospital care in that regime. If they would be a Level 1 or Level 2 licensed facility, this would also include being covered by the licensing, so I am not sure what other facilities the member would be addressing.
Mr. Chomiak: You did cover them, but I did not hear what the minister said about the Level 1 and 2 situation.
Mr. Praznik: Well, Mr. Chair, if a facility is a Level 1 or 2, it still would be a personal care home, and so it would fall within the licensing provisions here.
Mr. Chomiak: Other than the issues we have discussed, the minister is not planning any other significant legislative changes, is that correct?
Mr. Praznik: No, I am certainly not planning that. That is the agenda for this session. The vast majority of it, I would think, is housekeeping. The licensing is obviously a new area in terms of empowerment. What becomes critical there, of course, are the regulations. The Mental Health Act, as I said, is one that brings with it by its nature its own controversies within the mental health community. I am just going over this agenda. Unless there is something that I am fundamentally missing, that some organization or group has trouble with in the housekeeping issues, I do not view this as any major policy issues at this time. I stand to be corrected. One always learns as you go through the process, but that would be our agenda for this session.
Mr. Chomiak: Just returning to the licensing of personal care homes, et cetera, will the Long Term Care Authority in Winnipeg be responsible for the implementation and review of this, or will it be retained with the Department of Health through some other regulatory capacity?
Mr. Praznik: Mr. Chair, in the new world of health care delivery, I think it is very important that those who administer a facility on a day to day, are not the people that ensure the enforcement of standards. That, I think, is just not a good scenario. So, as we divvy up responsibilities, the vast majority of health care delivery is now in the hands of regional health authorities. They are the administrators and delivery of care, and one of the functions that I want to keep within the ministry is the enforcement of standards, so that it is the ministry who is ensuring standards are met, and they are not delivering the service. They can deal I think more effectively with those who are dealing with the service.
Self-regulation works very well in many ways, but ultimately the ministry has that responsibility to ensure that facilities and regional health authorities are meeting the standards and regulatory regimes that require of them. So within Mr. Potter's operation currently, and that may change somewhat as we redefine the department, but within the ministry, the internal operations of the department, the standards, enforcements and checks, and those types of things should remain within the ministry.
Mr. Chomiak: So for clarification, and we will probably get into this more in-depth when we get to personal care homes, but the inspectors and those who carry out the standard evaluation enforcement and follow-up will be maintained as employees of the Department of Health, as opposed to the various regional health authorities.
Mr. Praznik: That is correct. The only--just not to be proven a liar at some point--qualification I would put on that is if we are going to be doing spot inspection programs, we may, in fact, retain a services contract with individuals, say, who, for example, are experienced in the operation of facilities and are retired.
The only reason I say that with the minister, as opposed to having direct employees in the department, is that if we are going to have an effective inspection program, particularly an effective drop-in, if you are going to check out personal care homes, you want to drop in at hours of the day when things sometimes are the most difficult, evening meals, for example. Those do not often co-coincide with office hours for our people and also being able to have a cadre of inspectors to do a number of inspections a year in different parts of the province, et cetera.
It may be a way we do it, but the function and the people doing the function will be with the Ministry of Health and not with the regional health authorities, so their reporting relationship will be to the Minister of Health.
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Mr. Chomiak: So the reference that the minister made to Mr. Potter's operation I assume is under Program Standards, Evaluation and Monitoring.
Mr. Praznik: That is correct.
Mr. Chomiak: So then I can assume that when a complaint or a concern is raised with respect to, say, a personal care home and that complaint comes into the department and/or a spot monitor is done, that comes out of Mr. Potter's operation at this point?
Mr. Praznik: Mr. Chair, perhaps one of my staff may want to explain the process today. Last year, as a result of some of these issues that we discussed, we did put in place in personal care homes a complaint process modelled very much as a collective agreement grievance procedure with different levels for dealing with complaints and paper routing so that there was assurance of follow-up. I think Ms. Hicks may want to describe that process and some of the results in the last year.
That is important. The ministry obviously has to make sure these things are followed up and dealt with, and that is part of the paper routing in any grievance procedure. I think what one has found is often the first level of the grievance at the local level resolves a lot of issues, and, of course, the tracking has to be there to make sure that is done.
What concerns myself more somewhat--that is an important part of the process to deal with complaints--but it is the spot check. I think that is very, very important that we as a ministry have a number of people, who understand and appreciate the issues of administering a personal care home, their operation, that we have available to us from time to time to just drop in at different times of the day and night, that we will be able to walk through a facility to see how things run.
One of the complaints with processes of value standards, evaluations and accreditations is that people know they are coming. They set up for them, et cetera, and you are not catching people during the worst times. We started recently doing these spot checks. We are kind of testing how we are going to be doing them and what kind of criteria and reporting, and we still have some work to do there, but I think it is a very important tool. You learn things about the operation of a personal care home. Sometimes you learn things about the needs that they have at stress times that need to be filled in terms of our funding or our support or how we administer, so it is a good process, and we are starting to build up. But I am going to ask Ms. Hicks, with the indulgence of the committee, to just go through that grievance procedure and indicate what has happened with it over the last year.
Ms. Sue Hicks (Associate Deputy Minister, External Programs & Operations, Department of Health): Mr. Chairperson, we have two processes really, the unannounced visit process and also the monitoring process. The monitoring process or the complaint process, sorry, is one where we have an individual who sits in the Seniors Directorate at this point in time. Calls can come in to this individual anonymously or identified, depending on what the individual wishes, then they do a screening of this, and it is then determined how best to handle it.
In some instances it is just a matter of relaying information to the individual. In other instances it requires a follow-up, either through the department or directly with the regional health authority. It is then referred into the department, and between the department and the regional health authority they will deal with it. But as the minister indicated, in most instances the complaints are dealt with at the regional health authority and usually dealt with very effectively, but if someone wishes not to do it that way they have the option and they have the other process available to them.
At this point, we are getting about three or four calls a month only into the Seniors Directorate, and they are all being dealt with effectively. The unannounced visits is the other process that we have. To date we have done 21. We have instigated this, as indicated, with a team of people who are co-ordinated through our department but a couple of people are put on contract to do this for the purposes of doing it. We involve the RHA in this visit and so if there is any need for follow-up or problem-solving with the personal care home the regional health authority is always involved with this. As I said, we have done 21 so far and, to date, they have been very amicable and they have been able to work with the personal care homes very effectively.
Mr. Chomiak: Does the department have staff, specific staff dedicated to inspections? If they do, how many do they have?
Ms. Hicks: Mr. Chairperson, we have one person who co-ordinates it in our department in the long-term care area, and then we have hired I believe it is two people on contract to work with this person. So we have one person in the department and two people on contract.
Mr. Praznik: If I may just add, one of the issues in terms of staffing levels and gearing up is, as we move forward with delivery moving to regional health authorities, another issue we had in our Long Term Care Branch is we had a number of employees who reached the age of retirement. So we had quite a number leave within a very short period of time. So how we replace them and gear up, it has given us the opportunity to look at what do we want that shop to do and to be able to staff it appropriately. So in some ways we are sort of feeling our way around as to where this shop is going to be, what are their responsibilities going to be.
One of the changes that I just flag for members opposite is that, prior to regionalization, every personal care home in the province dealt directly with the Ministry of Health so that our Long Term Care Branch was continually dealing with issues with personal care homes with everyone across the province. By going into regional health authorities, those facilities, even if they have retained their own board, in the case of Winnipeg, now deal with the regional health authority.
So the nature of the work in that branch has changed dramatically. It really has a policy function, I guess, in terms of determining standards and care. It has an evaluation inspection function to carry on dealing with complaints that come to us, and only, in fact, administratively very, very small, if any, because the dollars flow now through the regional health authorities. So with the retirements and the change in function, we are now sort of in that transition of shifting that branch over and figuring out what do we need there and how many staff. As we sort of get a feel for what we will need then we will make sure it is staffed appropriately with not only the right positions but the right skill sets and tool sets to be able to do that changed job.
Ms. Diane McGifford (Osborne): I just have a brief question. I understand then in the matter of complaints, that complaints are sometimes received at the Seniors Directorate and I think it was indicated that there are two or three complaints received a month. I am wondering how the public knows that there is a person who receives complaints at the Seniors Directorate.
Mr. Praznik: Mr. Chair, I think the bit of information that was missing here is that we have a 1-800 line that is advertised in each personal care home. We developed a poster that we require personal care homes to display in prominent places so that family members coming in to a personal care home who detect a problem or note an issue, the 1-800 number is well displayed. I believe the Seniors Directorate in their information publishes or advertises the 1-800 number, and the recipient of the information on the 1-800 number is housed in the Seniors Directorate. That is why that connection is there.
Also, as part of the poster is a form that can be torn off and taken with the individual, which allows them to actually, with the information they need, write down their complaints. So they can access the system either directly at the personal care home, and it indicates that on the material, or they can call the 1-800 if they require anonymity. That was a concern that was raised, I think, by members of the opposition, the member for Kildonan (Mr. Chomiak), that there was a concern that people felt if they complained at the facility, then their loved one could be at further risk for reprisal. So we set it up both ways.
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Ms. McGifford: So it would appear, then, the public is well informed as to this number, and I wonder, just before the minister responds, if it would be possible to have a copy of the poster.
Mr. Praznik: Yes, Mr. Chair, I am even going to do one further. I am going to ask my staff to provide one, I do not know if we did it last year or not, but one to every member of the Legislature because I am sure you would want to have it in your constituency office.
Mr. Chomiak: I can indicate I will be pursuing this line of questioning when we get started dealing with personal care homes, but I wondered if we might return to some of the issues that we left from the previous occasion, which were some of the issues surrounding the--documents were going to be tabled, am I correct, outlining some of the activities as discussed under the appropriation dealing with the planning policy and special projects, or am I mistaken?
Mr. Praznik: I understand Mr. Berry has been away the last few days, so we have not been able to prepare that for you, but when we do, we will provide it. I am sure we will be here for a while.
Mr. Chomiak: I guess I am just debating out loud here.
An Honourable Member: Do you want to take a five-minute break?
Mr. Chomiak: Yes, perhaps that will make some sense. Perhaps we will take a short break and then determine--I am just debating whether I deal with a few short snappers, as it were, until 12 and then start information services right after lunch--
Mr. Praznik: That would be fine.
Mr. Chomiak: --or whether I can do the short snappers now. Well, perhaps we will take five minutes.
The committee recessed at 11:21 a.m.
The committee resumed at 11:29 a.m.
Mr. Chomiak: Mr. Chairperson, I guess what I am sort of planning to do is ask a few generalized questions at this point and then perhaps this afternoon we can either commence and deal with the Betaseron issue or then start the Information Services and deal with Betaseron later, or something along those lines and move things along.
I guess we are still planning on Tuesday, when we next meet, at least to deal with the USSC issue, if that is acceptable. I am thinking ahead, I am assuming we are not going to meet on Wednesday. I am thinking ahead that perhaps Thursday we could deal with the capital issues, if that would be--I am not sure if the minister has another capital report that he wants to submit, but would that be an acceptable or rough agenda?
Mr. Praznik: The only difficulty I foresaw is our head of capital has been away on a two-week leave, and I believe has been overseas. She, I understand, gets back on Tuesday, but I will advise the member on Tuesday. If all available, Thursday would be fine.
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Mr. Chomiak: Mr. Chairperson, I just want to ask a few general questions to the minister, some general policy-related questions. There has been a concern brought to my attention concerning the capital issue and the 20 percent allocation, and I wonder if the minister might outline specifically what the policy is in that regard. Is it only new capital, old capital, what the criteria are and how it applies?
Mr. Praznik: Mr. Chair, if the member would indulge me just for a moment, by way of logistics, I was just reminded of the fact that Ms. Hicks will be leaving on the 24th of April. She will be away for some time on an educational program. If the areas in which she is responsible, if in the member's planning, the two of them may actually like to talk after our meeting today to ensure that the areas that he would like her available for that we could cover before her departure. It would be very much appreciated.
With respect to the capital program, the reason we got into this, I guess, is twofold; one, obviously, it stretches money a little bit more, but secondly--and I have found this in my tenure as Minister of Health--that very often when you are going into a community, particularly in rural Manitoba where there is a greater community focus on a facility and municipalities have been involved with health care, that when a new facility is requested, if all of the funding, other than say the land and the add-ons are coming from the province, there tends to be a tendency to increase the expectation level as to what that facility will do.
For example, in many rural hospitals that have been based in recent years, they have been set up with operating facilities that often are never used or so rarely used that they are not justified being there because to the traditional thinking of a hospital having an operating room, even if there is not a surgeon available or an anaesthetist and, of course, because all of the funding has been coming from the province other than land and the add-ons and changed work orders, communities have an expectation that these things will be there.
So one of the main purposes I think of this policy, which, by the way, is widely used across the country and was in place in Manitoba to the mid-'70s, is to have the community focus on what do they really need in a facility, and by having some of their own dollars on the table, it tends to focus the mind--because we are paying for this too--is this something we really need to go through. I know my own community of Beausejour is having to go through that process now as we look at putting a new facility onto our personal care home in terms of hospital or renovating an existing facility, and we are doing some of that research now. But it tends to focus all the players on what do we really need in our community. I am sure the member would agree that it is important we use our health capital dollars to build what communities really need, as opposed to what may appear to be wants and desires.
So having said that, having this kind of policy in place is a very effective tool and I have seen it happen. Just one example is in Shoal Lake where their hospital is 20-plus beds, time expired, and there was an expectation of building a new hospital. We need a hospital in Shoal Lake. I have visited that community with the RHA and their doctor--they have three doctors who have now settled in the community--and they said to me what they really needed was six to eight acute care beds to maintain their practice.
They do not do surgery in that facility; they will not be doing surgery. There are hospitals that are larger half hour to an hour down the road, but they needed those beds for observation, they needed them for certain medical, acute care purposes, they needed them for palliative care. Six to eight beds for them would provide the bed support, the hospital support they need to carry on their practice in a community--Shoal Lake, I think there are just over a thousand people in the village and the surrounding area might be 1,400, 1,500 people.
So we said you do not build a hospital for eight beds. I mean, it just does not work. So we looked at options and the option, because they would be helping to pay for this, it focused their mind on it as well, and the option that works is to do what we call or are starting to call an integrated facility where we would add eight, I believe it is eight, six to eight acute care beds on to the personal care home where they could share a nursing station that deals with the overstaffing, in essence, for a number of patients, for evening shifts in particular, have an examination room, emergency room as part of that. So the staffing level, in combining it with personal care home facility, means your staffing is well managed, you get an efficient use of space and you are able to have six to eight beds to service the medical community in that area, their needs, the community's needs in an efficient manner. That happened, I believe, because the community was at the table with money. They focused on what do we really need, what can we afford, what works.
So having said that, and the member's question is a very good one: what is our policy with respect to contribution? If our goal is to have people focus, it is not to prevent facilities from being built for want of community support. We came out with an initial proposal of 20 percent plus land and the add-ons and certain things like chapels. We recognize that there were some issues with that, and we have been refining the policy as we have gone along. I think that is fair because you want to see how it is going to work. We have done some changes in it. For example, we now include the land and the total cost. So the community provides its land. The change orders we are now including in the 20:80 split instead of being 100 percent community, and we have a few others that have come out of some specific problems and issues in terms of financing it with municipalities, some of the credits that we provide.
I know when I visited The Pas recently, they raised the fact that if their municipalities were going to do a levy for the community contribution that they did not want to have to levy for the First Nation, they could not levy for the First Nation that use the hospital or the Northern Affairs communities. So obviously there has to be some credit in there so the taxpayers of The Pas and council are not bearing the costs of others. The Department of Northern Affairs has a role to play, so we have prepared a list of further refinements that I am in the process of getting approval on and I hope to be able to make public in the next week or so as municipalities look for that information. I think what the member will find is that it is refined further.
Our goal was to have people at the table, communities at the table with some money to focus on what, in fact, their community needed. Even if we had all the money in the world, that is still worth doing so that we do not overbuild in our system because that is a waste of valuable dollars. We do not want the policy to be so onerous that it prevents a facility from being built. Getting the details right takes a little bit of trial and error, and we have been going through that with the new capital announcements, and I would think within a very short period of time we will have a further refinement that I would be delighted to bring to this committee for discussion.
Mr. Chomiak: So the minister is indicating that he will table definitively the policy with respect to capital within a week, give or take a few days.
Mr. Praznik: We have had done, as I indicated, some further refinements on this policy, and I am in the process of having those approved within the general government system. I know I have to have that done very quickly as people are waiting for that information. So when I do, I will be putting that out. I will be bringing it to this committee--I think he can look to it for next week or the week after at the latest.
One clarification I would make is that safety and security issues--and provincial programs do not require the community to raise the capital. That is paid for 100 percent by Manitoba Health. I should just add, the Chair of this committee has been anxiously looking forward and very much involved in the refinement of this policy.
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Mr. Chomiak: Mr. Chairperson, yes, I intend to pursue this line of questioning in a lot more detail when we get to the capital end, because I do have some very specific questions on some specific facilities and the like which are obviously more appropriate at that time.
The minister recently outlined a blueprint for activities that would be taken in the future in terms of health in Winnipeg, and I have a copy of the article here which I will share with the--[interjection]
Mr. Praznik: Mr. Chair, you know what I would like to do on this area and I know we are using up some time briefly, but much of the content of this issue is within the planning of the Winnipeg Hospital Authority, and I think, to have a very thorough discussion on this--we can discuss it in some generalities--but I want to make available to this committee Dr. Brian Postl, on whose planning and work I rely for my comments, to be able to attend here with Mr. Webster as part of our discussions in that area.
Mr. Chomiak: Yes, I have no problem with that. That makes a lot of sense, and I guess the issue, depending upon how things develop next week, whether or not we achieve some of the issues that we are going to deal with, I guess I was sort of contemplating commencing the following Monday, perhaps in that area and which probably would then meet with the--gosh, I do not know the dates any more but that would deal with that. So I have no problem with that.
Having said that, I guess the legislative issues and the issues relating to some of the policy and planning we are going to wait on. I guess we could start on Information Services or we can adjourn the committee and just start again on Information Services. There seems to be a consensus that we will recommence. I am prepared to do do that.
Mr. Praznik: Mr. Chair, I think the member for Kildonan and I have been around here long enough not to beat dead horses in terms of time, and 15 minutes or additional time before preparing for the House is always welcome. I thank him for that indulgence and certainly am agreeable.
The Acting Chairperson (Mr. Dyck): The time being 12 noon, I am interrupting proceedings. The Committee of Supply will resume sitting this afternoon following the conclusion of Routine Proceedings.