Mr. Dave Chomiak (Kildonan): Mr. Chairperson, just to commence, from my knowledge it appears that we will be going until six o'clock today, which will then leave us, all things being equal, an hour and a half tomorrow, which will then conclude the time devoted to Estimates.

What I am hoping to cover today, the bulk of the material today, as I had indicated to the minister, some questioning on the personal continuing care line, then probably move down through the other lines fairly quickly, probably try to get to capital today, the bulk of that issue, probably cover most of the issues today and then tomorrow be basically devoted to some follow-up on probably some other issues. That is what I am contemplating, although it is sometimes difficult to gauge these things accordingly, but for the purposes of planning, that is what I intend to do from my perspective.

Just one other sidelight, the minister just received a communication from the Westway family, who also provided a letter to me as well, and it would be inappropriate for me to ask a question about it today, but I thought perhaps tomorrow when we get back into this forum we could deal with the Westway issue. It is an issue--the minister has just received correspondence from a family concerning care of an individual by the name of Kim Westway. We could--I am advising the minister that perhaps tomorrow we can just do some quick follow-up to see what the status is of that communication.

Returning to the issue of the structure that has now been put into place at personal care homes, the minister provided me on Thursday with a description of a program that has been put in place and correspondence that has gone to personal care homes dealing with complaints at the personal care homes, and I want to go through obviously for reasons signified earlier in the Estimates procedure.

As I understand it from this process, individuals are first encouraged to formally approach the management of the respective personal care home. If at that time their complaints are not dealt with adequately, then they are encouraged to fill out a complaint form that is available at the personal care homes. In addition to that, if it is still not satisfied or if at any point they request anonymity, there is an 800-line number that has been put in place, and that directs it to the Seniors Directorate. I understand from the information provided to me that there is a specific follow-up on urgent complaints that is in place that requires some kind of immediate follow-up, 24 hours, as I understand it. Can the minister indicate what happens in the department when a complaint is forwarded? What is the process that takes place now within the department if a concern is raised about care of an individual at a particular nursing home that is not satisfied by their management? What assurances can be given that that will be completely followed up on?

Hon. Darren Praznik (Minister of Health): Just to put it in perspective, there will be two parts to the answer. Prior to the changes that I have instituted here with Mr. McFarlane's good work, if we had a complaint to the department, it obviously was forwarded to the staff at the Long Term Care unit or division of the department. They would investigate it. If it required follow-up with the facility, either they or one of our consultants who work with the facilities was sent to work with them.

Now there is some change in that today. With the committee's consent, I would like to have Mr. McFarlane get into the detail of this new system, because we are just starting to get it going, and he will be able to provide the details.

Mr. Chairperson: In this area only, the committee is allowing a staff member to make presentation of sorts? [agreed]

Mr. Jim McFarlane (Executive Director, Employment Standards Division): Again, the change in the process is how the ministry is captured with the information. In the past, the person would usually or most often informally approach the home and indicate they have a concern. It might be with their mother or their grandmother, somebody in the home. If they were not satisfied with that response, or if the nature of the response was such that the home felt that it might not be an issue that they could deal with but rather an issue of funding from the ministry or something and beyond their control, then it was often left to the individual to then promote it. That would be dependent sometimes on whether they knew where to go in the next step, whether they were familiar with the existence of the Long Term Care unit or whether they would contact their MLA or somebody else in the process.

The system that has been implemented now clearly identifies who would be the next level in the process that would assist the resident or the family of the resident in trying to deal with those types of issues if the home was not able to, or the facility was not able to, satisfy their complaint. When it is put in writing, it automatically--now, again, a copy is provided to the person filing the complaint, but it automatically also promotes the complaint issue to either the regional health authority's liaison individual or to the Long Term Care unit of the Ministry of Health.

In either case, those individuals would look at what the nature of the issue was, whether it was an urgent issue, whether it was a systemic issue, and have to make some judgment in terms of how they would work with the home to try to resolve the issue.

Oftentimes people do not want their--they are concerned about retribution in the process or they have a fear of retribution in the process. They would be very concerned about putting things in writing. There was also the mechanism to allow them to phone the 1-800 number and have anonymity in the process, where the issues would be looked at, if they are systemic or if they are serious in nature. Again, the ministry or the liaison officer and, through the liaison officer, the regional health authority would be captured with working with the home in trying to resolve the issue.

Mr. Chomiak: Aside from the process that is now in place, has there been put in place any change of resources or change in systematic approach to ensure that the actual follow-up that takes place, follow-up that is recommended or follow-up that is suggested, is actually followed through with?

Mr. Praznik: Mr. Chair, with this new system, we have obviously added some additional time and effort on behalf of staff at the Seniors Directorate where calls are being received. We also have given this responsibility to working at significant problems with the 10 liaison officers we have with regional health authorities. That is now part of their responsibility. So, if a matter comes up, it is one of their roles to be taking that complaint and working with that regional health authority to have it resolved and reporting back.

With respect to the directorate, specifically, we have not added any resources in our own Long Term Care unit. That is under consideration. That is part of the work that Mr. McFarlane is doing for me now to give me an assessment of whether or not we need to increase our staff loads there and what functions.

I just share this with the member, one of my concerns is how we, in fact, write standards. Standards in my mind should be very much operating manuals describing how things should be done correctly. They should be very user friendly to the people who are using them, and we have identified some work that perhaps needs to be done in this area. Mr. McFarlane, right now, part of his mandate here is to give me some advice. He is still working on that particular piece of it.

Mr. Chomiak: In the case of Holiday Haven complaints, the solution appears to have been to have had Holiday Haven engage an outside consultant. I am wondering if, in fact, that process would still be in place with respect to similar problems that occurred today.

* (1510)

Mr. Praznik: Mr. Chair, Holiday Haven, the issue there was an independent study of their system that was conducted. I think it was the Manitoba Association of Personal Care Homes or, as such, a nursing home association who did a review for Holiday Haven of their operation some time ago and the member--he and I are both well aware of how that ended. What we asked on the Friday, or the day on which I made the decision that we had to do something here, was I asked my senior staff to call and ask if the home would voluntarily give up its management of the facility, which they agreed to do. As a consequence, we put in another manager who was unrelated to the people who were managing it, and now we have hired a company who runs personal care homes to put in a management team to run the facility.

They, today, do not have a consultant in place. There is another management running that facility; so they are under new management. I do not know exactly where they are in their agreement. That has been worked out. I think the goal was to stay for two years to get them to the position where they could be certified or accredited, pardon me, by the national body and--I gather the detail of which has been worked out between the personal care home and that management company--and I think Manitoba Health had monitored that.

If we had a similar situation today, and, I guess, this is the concern he and I both share. We all know from time to time we are going to have problems or complaints or service issues on an individual basis. It is the nature of the system. There are a lot of very, very high-need people in those facilities. They are high-stress positions for many who work in them, and from time to time things will happen. That is human nature. We have to make sure when they do that they are corrected and they do not become a systemic or ongoing problem. The larger issue and it is one that Mr. McFarlane is identifying, if we continue to have either a continual number of complaints from a facility which flags then a problem in the facility, an ongoing problem in the facility or we have a lot of complaints from every facility of the same nature, which flags a systemic problem, we have to be able to assess that and move that quickly.

If it is a facility problem and we are unable to resolve it with changes that are needed quickly, the powers I am asking the Legislature for, as minister for the office of minister under The Regional Health Authorities Amendment Act, would then allow this ministry to be able to move in because patient care would be at risk and, on an interim temporary basis, replace the management to stabilize the situation and then proceed from there to work out arrangements for a long-term solution. Today that power does not exist. The only power that does exist is the removal of the licence.

Without the consent of the owners, that power to remove a licence in many ways is a very impractical result, because if you have 150 people as there were in Holiday Haven, if there had not been agreement to turn over management, my only option would have been to remove the licence, and then in January we would have been moving 150 bedridden elderly people out of that facility into other locations in the dead of winter, and that is to assume we could even find enough bed space for them. So the conditions into which they may have been going are likely to have been crowded for many, as we had to accommodate them in an emergency situation as we probably would do if we had a fire or flood.

But the fact of the matter is that weighs very heavy for any Minister of Health if those are your only options--pull a licence and move people out or try to negotiate a suitable arrangement. In January, your practical ability to pull people out of a facility has to be pretty bad because you may be putting them at greater risk with your decision than their current situation. That is why we are seeking that amendment in the Legislature, which would then give the minister of the day the power to step in, take over management, stabilize the situation.

I would expect, within the system that we are building here with Mr. McFarlane, that a minister will be notified in good time in order to take that step should everyone else fail to resolve a problem. I am hoping that today, once this bill is passed, a Holiday Haven-type situation that might go on as long as it did may not, in fact, happen.

Mr. Chomiak: Is the ministry convinced that all of the present facilities have in place sufficient complaint mechanisms, information and co-operation to ensure that the process will work at the individual facilities on an individual level?

Mr. Praznik: One thing a minister learns is never to indicate clearly they are convinced everything will work well. Rarely does it always work well. I hope that we have improved the system significantly and that we will have far better results and a much better warning system of when we have problems in a system that will result in their resolution in a timely and effective fashion.

We have notified all of those facilities, provided them with the poster and complaint forms with the requirement they be posted. We have written to them to put into place the complaint process. We have set up the 1-800 line with the Seniors Directorate. You see, that is a bit of insurance in all of this, because if a particular facility is not dealing with a complaint, the 1-800 line ultimately is there to pick that fact up quickly as long as people choose to use it. We have the support of the regional health authorities. They are very well aware of this, and when they are running facilities, of course, are part of that complaint process. So what more we can do, I am not quite sure. We have already had phone calls on the 1-800 line, so people are using it. They are aware of it. I guess, over the next number of months, we will continue to assess this. If there is a way to improve it or if it is not meeting the need, then we will have to look at it again.

I would ask the honourable member because if the system is not working, he is likely one of the first to find out about it as people call critics of opposition parties, I would ask that he--and as I know he will do--let us know, because we need that kind of feedback. I am not for one moment saying we have a perfect system, but we have moved quickly here to put something in place that is better than what we had, and we hope it will do the job. If there are ways to improve it, I am certainly the first one who will want to know that. If there are things that do not work, we want to know that as well.

Mr. Chomiak: I would suggest addendums to the annual report or something along those lines that might indicate the extent and the gravity of complaints and information, not just for statistical purposes but to get some assessment as well as to let individuals know that this exists. So I think some kind of ongoing dialogue in this regard would probably assist.

Mr. Praznik: That is an excellent suggestion. Something we thought about yet have not got to that point of how we report this, but obviously we are going to want to keep track of the data and be able to provide it and how things are resolved but in a fair manner, obviously. Some of the complaints one gets sometimes are not founded, most tend to have an issue. His suggestion that we perhaps make an addendum to an annual report is very worthy of consideration, and I will certainly note it. It is something we are looking at already, but I appreciate his suggestion.

Mr. Chomiak: I think the issue that perhaps is missed in all of this is the fact that there is often no advocate, no individual, no advocate, no ombudsperson to represent many of these people. Often there are no families and no relatives. Certainly, in the case of Holiday Haven, that was one of the issues. I am wondering if the minister might comment on guarantees and assurances in this regard.

* (1520)

Mr. Praznik: In a very practical way, for many, many people in our personal care homes, their own family is often their best advocate, who are not happy when they get letters that the member has brought to my attention coming from family members. MLAs are often an excellent Ombudsman role to bring a matter to attention and to be resolved. The concern that the member has, and I identify with those individuals who have no family, no ability to speak to an MLA, are really very much alone.

They may be very, very aged with no family remaining and their contemporaries are just as aged and unlikely to be in a position to help them. Those people are the ones, I think, that are truly helpless. That is why one of the things that we are trying to work into our system, as Mr. McFarlane may have mentioned, is to be doing more regular, unannounced visits and audits of facilities so that we can catch any difficulty that may not get attention or be reported. To have a specific individual in that kind of ombudsperson role does present some administrative difficulties, because often you do not even know who those are.

How do you even make contact with that? We have thought about some of this. I guess the most practical way is to ensure we are doing a fair amount of unannounced inspections on a fairly regular basis to keep the whole system cognizant that there are people watching to make sure that things are done right and meeting standards. That is one of the staffing issues about whether we add resources or reassign existing resources. We need to have people within that branch, who are very capable of doing those kind of things. We are trying to get a grip right now on some of our options for meeting that need.

Mr. Chomiak: The other issue of concern, with respect to alerting authorities as to difficulties, is the issue of staff and their ability to do so. From the process that has been put in place, it appears the only realistic way a staffperson who disagrees or who has information can bring the information forward is through the 1-800 number, and I am wondering if the minister might comment on the extent to which that may or may not be an adequate resource.

Mr. Praznik: The member flags what is always a difficult matter for staff in any facility, to bring forward the concerns that they have, and we all know from time to time there are staff who bring forward concerns that are really unwarranted, and that is part of maybe their own employment situation. You have to be wary of those things, but there is from time to time very legitimately situations that are severe enough that warrant a staff member wanting to do something about it. The 1-800 line that he has mentioned is absolutely an excellent way of doing that and assures confidentiality and leads to a matter at least being checked out.

We also know from the experience of my deputy minister that we have had over the years correspondence or contact with staff in facilities that come to the ministry. That is always kept, to his knowledge and mine, on a confidential basis. It is always that balance between wanting the information and making sure your system is not being used for someone's personal agenda, fairness to the facility, fairness to the patient, how you keep it confidential. It is always a hard balancing act, but I think between the 1-800 number and the ability to contact the ministry or even the regional health authority to provide that information is certainly there.

I do not know how else one would do it. If the member has some suggestions, we would be pleased to look at them.

Mr. Chomiak: Mr. Chairperson, it is obviously clear from the record of Holiday Haven that staff at all kinds of levels had raised warning flags, as well as the fact that it appeared that issues of follow-up from previous investigations by the Department of Health had not been followed up.

For example, there had been recommendations from previous incidents that a social worker be hired at Holiday Haven, and, in fact, a social worker was hired and subsequently let go and that many of the difficulties that occurred, occurred subsequent to the social worker being let go, and there was no tangible way of connecting the original recommendations that there had to be a social worker to the subsequent dismissal of the social worker, and problems ensued.

I am really actually trying to avoid going down and reopening the Holiday Haven fiasco, but I do want to understand some of the dynamics. I guess my question to the minister is, the minister indicated at the time that there was an internal review of what happened in the department with respect to the concerns at Holiday Haven, and I wonder if the minister can share with us the results of that internal review.

Mr. Praznik: I do not think it was a formal internal review that has produced a report. What it is is I have asked my associate deputy minister who is responsible for that area--and we brought in Mr. McFarlane--to give us an assessment of how the department functions.

I am going to just share a couple of observations because that is ultimately what I have out of the work that has gone on. It is one of these issues where I do not think you can necessarily point to one person's misfeasance or malfeasance that resulted in this. I think the difficulty is more the way the system in fact works, because these facilities, and whether they be for-profit or not for-profit, are private facilities that are licensed, and our ability as a department to be able to do anything when the problem is detected is really one of good will. It is either good will or you pull the licence.

The practical matter of pulling a licence is a couple of things, and this is what we found in talking with our staff, that they are cognizant of it. If you are going to pull someone's licence, you have to have very, very good reasons to do it, or the department will be in court and challenged by those owners. You just cannot do it on a whim, so it has to be a very, very strong case that there is a problem here. Then, when you do pull a licence, if you do pull a licence, you have to have another place to put those people, and the system does not have 150 or 75 or 80 spare beds that are available on very short notice. So now you are talking about a severe disruption to the lives of people who are in a facility.

The problem again in weighing the balance that staff have to face is that often the difficulties that are encountered in these facilities are not necessarily of a life-threatening nature. They are inconvenience. They are not a pleasant place to be. There are issues around response time to being able to clean up body functions where people are unable to control them. They may be an attitude of staff. That is probably in itself the hardest one to deal with, is attitude. How do you prove a bad attitude? How do you prove a nasty attitude on behalf of an individual who just treats people without respect? This is a very hard thing. I know from my labour relations days, and I share that with Mr. McFarlane, it is a very hard area to prove. Yet it is a very real service issue to people who live in those facilities.

So here you have staff trying to balance those issues with ultimately the power to do only a very severe action, which is recommend the minister pull the licence. So I think that setup--I add, Mr. McFarlane finds with me that often the No. 1 issue of complaint that he has discovered is laundry. He tells me that this is ironical, and I do not mean to take away in any way from the complaints that we have had, but the No. 1 issue to date that he has noted in his work is it is issues related to laundry, that clothes are mixed up, they are not getting back to people the way they should, et cetera. That is a very frustrating thing for someone who is aged and in a personal care home.

* (1530)

So, when you have a host of these things, they may be indicative of a management that is not well organized or not very good at what it does, but it does not in itself provide enough weight on that balancing scale to say we are going to take the extraordinary step of pulling the licence. So what that sets off, what I think we have found in the branch and through Mr. McFarlane's work, is you set up a situation where the people who are there dealing with these issues find it very difficult to be able to come down hard to get the results that they want. Yes, they will get an improvement here and yes, they will get homes to make a change, but then, you know, six months later, you are back to maybe where you were. But the offence, mixing up laundry in that case or maybe taking a little too long to clean up a patient or some such thing or being unfriendly, having an unfriendly atmosphere, is a hard thing on which to remove a licence and move 150 people in the dead of winter, but it is very important to the people living in the facility.

Holiday Haven also had that additional element of a social worker and some other issues that fit into that, so I do not want to take away from what the member says or take away from the issue, the seriousness of it. We are hoping, with this complaint procedure, with the addition of onsite inspections, with a push, I guess, ultimately towards more accreditation in the system and also the power of the minister to not have to pull a licence and move people--but if a situation really gets bad, that the staff then know that we can move in on a temporary basis, take over the administration of a facility and correct a lot of these what appear in isolation to be small problems but in a mass form can result in a pretty unhappy place in which to live, can move in for three months, six months, whatever is necessary to fix that systemic problem and make the changes in that system, and not have to endanger the health of the people because they have to move.

So the combination of this new system, the request to the Legislature for the additional power--and ultimately we have some staffing issues to deal with in terms of standards enforcement. That is one of the issues I am addressing right now with my senior executive. I am a great believer that the standards enforcement has to be housed a little ways away from operations, so even within the same organization it is a little more objective, a healthy tension perhaps where people are looking at standards, doing those kinds of spot checks. We also have some work to do on standards, as Mr. McFarlane has recognized, that some of our standards work to date is not quite where he and I would have it. Maybe we have a higher standard of standards, but we think standards should be a manual of ideal operation, and we need somewhere to go where those documents become much more a manual of ideal operation and very easily read and digested by the people who have to deliver the service.

There is one other point here; I have a note handed to me. The last point Mr. McFarlane flags with me is that audit of standards function has to be somewhat independent from the day-to-day administration and perceived to be as such. That is why when he and I spoke about appeal boards and Manitoba health boards, ultimately some of these disputes of service may not get resolved, and there may not in themselves be enough to step in and take over a personal care home. There may be two sides to the story, and that is why ultimately having some appeal function or board which can hear both sides and in an independent, objective and consistent way make a recommendation or a determination is important. Temporarily we are using the Home Care Appeal board for any dispute settlement here, but our plan would be to have a much broader based health appeal board to deal with some of these things. That is one of our options today.

I have spoken a long time, but I hope I give the member a sense of where I am coming from, where I am at on this issue.

Mr. Chomiak: Mr. Chairperson, so the reference to the appeal board that the minister just made is in reference to his earlier comments during the Estimates process when he said he was planning some kind of administrative appeal body to be put in place to deal with all appeals in the long-term area. The minister was talking about a judicial type of function to be set up for appeals. Is that what the minister is making reference to now?

Mr. Praznik: Well, what I am looking for is we have a Home Care Appeal body right now which, if you are not happy with a determination on whether your facts meet the criteria for service and it cannot be resolved by the supervisor at the supervisory level, you have a right to appeal to that board. A panel of that board will hear your facts, hear the department and make a determination and order care.

We also have a health appeal board that hears appeals on whether or not your monetary conditions are such that you meet whatever requirements in your dispute. I am sure from time to time we are going to have disputes about quality of service, whether a standard is being met, where there will be a dispute between an individual and their family and the people who operate the home, and it is not going to get resolved in reasonable discussions. Before the minister has to make a determination on any of these things, I would like to be able to have a body that builds up a body of experience in dealing with these matters, that can sit down, hear that case and make a determination as to, yes, this is a reasonable service complaint, or no, really there is not a problem here and give people their day in court in essence to be able to have an independent group adjudicate on their complaint issue.

If you just sort of look--if we have the Home Care Appeal tribunal now or group now, they are going to take on this role. We have the Manitoba Health Board. It just makes good logical sense on a cursory review that combining those functions into one appeal board that would then have however many members you would require--but could sit in panels. Obviously, some would have expertise in different areas. We would be able to have a Francophone contingent to hear complaints in French, as is required by our language policy; all of those issues could be dealt with. It makes good logical sense. So I am looking at that at this current time. I share that with the member. I hope by next year I will have had a decision made if that is what we are going to do and it implemented if that is in fact what we are going to do, but I am sharing with him, I am thinking out loud a little bit and sharing my thoughts. There may be some reason why that does not work and that may be presented to me in the next number of months, and we can discuss that next year, but currently that is the way I am heading.

Mr. Chomiak: Mr. Chairperson, I do not think the minister two questions ago was trying to avoid my question about the accountability issue with respect to Holiday Haven. I do not want to dwell so much, because there is so much area to cover, with respect to what happened at Holiday Haven, but some time between February 3 when the minister wrote to me about the complaints I had sent to him on November 22 wherein he said he could not comment on the management, in my opinion that the management should be taken over, and February 15 when Mr. Molnar died, somehow there was a change in the department with respect to whether or not the former management was capable of managing that home. Given that there has been no admission on anyone's part that in fact Mr. Molnar's death was directly attributed to the management at this point, or in fact we do not know, somehow it changed, and there was a recognition between February 3 and February 15 when the death occurred that in fact the management could no longer carry on at Holiday Haven, which to my mind only made the point that we had recognized far earlier, that is, that the management was not capable of running that home.

* (1540)

There is enough information on file, I believe, and there was enough, and the minister talked about triggering, and I fully appreciate his comments, when is action triggered? When is it sufficient? There is no question that the temporary or the permanent takeover of management is a very, very unique move and is taken only after considerable thought and resources have been utilized, but clearly some time, the department certainly agreed to it after February 15, and therein lies the difficulty.

There is still a story to be told about what happened at Holiday Haven. It still, in my view, ought to come out in some kind of a form, if only in the minister has already recognized that there are serious difficulties and has proceeded to try to fill the gaps, but I think there is enough information that ought to come out yet that would surely show more failings in the system that could only help to improve the system in the future.

Mr. Praznik: Mr. Chair, the member asks a very fair question. What happened in that period? Well, I cannot answer for previous ministers. I cannot answer for previous staff. I can only answer for myself. I think much of it comes back to, and please appreciate, the member appreciate that I have spent a fair bit of time with Mr. McFarlane and my staff trying to get a handle on this myself. If I am going to be held accountable and responsible in the Legislative Assembly, I would like to know what is the root cause of some of this, and so I share my sense of it as someone who has been a cabinet minister for going on seven years and seen a fair bit administratively.

Again, my sense is that the nature of the system, the limited power to effect change, the, to some degree, standards that are not necessarily as readable or clear, that manual sense of standards--the standard is there, but maybe a little too broad-based in definition--all of these factors really contribute to a view that we have got to work with people to solve the problem, which we want to happen. I do not want to take that away.

But, ultimately, the only vehicle, if you cannot work with people, is to pull their licence, which, to recommend that to a minister, is such a harsh reality given whatever problems you are having, because you have 150 people at Holiday Haven in the midst of winter that you have to move out and find space for. I would say that you probably would put more people at risk for their lives moving them out in that weather into maybe crowded facilities than you would trying to continue to deal with the ongoing issues at Holiday Haven. So, given that balance, you result in maybe the lack of action to take over or make that recommendation that the member for Kildonan (Mr. Chomiak) and I may want to see.

So what happened, in essence, you have people working, trying to work things out, trying to work things out, trying to work things out, because their options are very, very limited despite the public perception that there are more.

As the minister, I noticed in my first few weeks on the job as I went through the huge amount of correspondence that of all the personal care homes in the province the one that I was signing off letters regarding complaints about the most was Holiday Haven, and we had that particular incident that he has flagged, and, again, we are not sure what caused the gentleman's death. That is why there is a coroner's inquest. We await that result. I hope the chief medical officer takes a fairly wide view in giving us recommendations. I am hoping he is not totally narrow. If there are things he thinks we could learn to improve the system, I would like to--or he learns that we can improve the system, I would like to know about it.

Having said that, once that happens--I mean, here I have all these letters of complaint, and I have this death, not knowing what the cause was, but it happened, and, obviously, this was of concern to us about the facility. I think it was a concern to the public, and I think it was necessary, and my department had been working for some time with the facility to make a very significant change in their management. Again, the powers to do that, to force that, were very limited. They were only to remove licence.

So, at that point, I made a decision as minister with my senior staff that we should approach Holiday Haven's management and ask them to voluntarily give up management of that facility. By the way, I do not know if that has ever been done before. For the people who are working with me, they did not flag that with me as something that happened every day when we made the decision on Holiday Haven.

It is a very rare occurrence and perhaps just my style, but I thought, let us go, we have to do something here, and let us see if it is done voluntarily. Obviously, if they had refused, then I would have had to deal with that very tough issue of pulling their licence, knowing full well that we would have had to move out 150 people. I was hoping I would not have to have made that decision, because that is a tough decision to make, given the weather, the time of year and what you are going to do to those people. Fortunately, I did not have to make it because the owners of the facility voluntarily gave up their right to manage, and we managed to get someone else in. I am advised today, we are getting a much better response from the families and people in the facility and improvements are underway.

But the member has hit upon a very good issue in the sense that it is one that requires some work to get right in. I am hoping the steps we have taken and a few of the other things we are going to have to do in the next few months will give Manitobans a sense that the system is going to be able to work much faster and much more productively in resolving issues and ultimately protecting the safety of people in personal care homes.

The one caveat I put on this, Mr. Chair, is that, given the nature of our health care system, we are able to keep people home for longer periods than ever before with care. Ever before, within the health care system, people stayed at home before we had personal care homes. But we are able to keep people with home care comfortable in their homes longer than we have had since the advent of personal care homes. The consequence is that people who go into them are much older on average, much more in need of care and much more in need of a higher level of care. So the stresses that come with this are always going to be greater, so the one certainty, the one constant is that we will have problems from time to time. The question is are we able to deal with them speedily and in a positive way. I am hoping the steps we have taken are going to do that. With that success, if we achieve it, will come a confidence that Manitobans can have in their system, and that is my plan.

Mr. Chomiak: I just want to indicate that I was very pleased at the time that the minister took the steps that he did. This is not generally the kind of question that lends itself to an answer, but I want to put it on the record nonetheless, and that is, the most frightening thing to me about the entire Holiday Haven matter was the fact--I am sure the minister will have a response to this, I am not totally confident in this area--when the death occurred, I fortunately heard about it from an individual. Then, I phoned all of my sources at Holiday Haven. The first individual who confirmed it said to me, yes, we knew about it, but so what? No one ever has done anything in the past at Holiday Haven anyway, so no one bothered to tell you.

I phoned a couple other sources who confirmed, because obviously I was not going to make this a major issue unless I could confirm it from very many sources. The frightening thing for me was people in the system knew about the death. Do not forget, it did not become a public issue until after the death, well after. I believe it was February 24. If the information had not come to me and I had not made it public, I am just not confident there may have not been a response. I do not feel good having to say that. Certainly, I mean the public does not even know a lot of the issues surrounding that. The medical officer, the doctor at Holiday Haven, quit as a result of this death. No one knows about that generally. I am not sure it would have been flagged, and I think that is one of the real tragedies for me personally as an MLA and for the system as well. I do not feel very good knowing that we had to get action the way we did and that is in the form of having to call a press conference in order to do it.

* (1550)

Mr. Praznik: On a personal note, I can tell the member whether he had a press conference or not, I appreciate why he had one. If I was in his shoes, I would have done exactly the same thing, and I would be asking exactly the same question. So my response is in no way meant to diminish his words. I can tell him this on a personal note that my decision to move was not related to his press conference, but the fact that as a new minister, he has hundreds of things happening around you all the time. If something comes up, you ask for more information. Obviously having a press conference or not sometimes focuses you on an issue today instead of tomorrow morning. But, when the event happened, I asked the week before, I guess, for a full report from my staff, and I wanted what options we had to do something. It was based, by and large, on my going through all of these letters in my signing book realizing there is something wrong here, I do not know what it is, but it has been ongoing for a long time.

The real question is not whether Darren Praznik would have done it or not done it or David Chomiak had a press conference or not. The real issue is the system or process should in itself produce that same result no matter who sits in these chairs, and that is ultimately my goal here as well.

Now, it is a human system and it is a matter of judgment calls, and it is only going to be as good as the people we have in it. My intention here with Mr. McFarlane's good efforts is to move towards a standards manual ultimately that is much clearer and better than we have today. I want to see a system in place where people expect to have their work checked on a regular basis so that people know that is part of the system, that the standards are there, that they are not afraid of that. It is not a fearsome thing that we are here to continue to remind people to make the system better, and we know that the work is hard for the people who work in those facilities, but that because it is hard does not mean that we should not be trying to achieve our best.

Also, from a minister's sense, I want to have a system that is going to be able to pull off facilities from time to time that have significant problems or a systemic problem and flag them with me, if I am the minister, or the minister of the day. That ultimately means that the person we put who will be in charge of our Long Term Care unit, because I understand we have a vacancy in the directorship there and we have an acting director now who is close to retirement or within the next few years, as we look at restaffing that, as you do when you have significant change, whoever we have in that position in the long run is going to have to be someone who is very cognizant and can feel comfortable enough that if they flag a problem that they can take that problem to the deputy minister and the minister and be supported in their recommendation because they have confidence in them and they are doing their job.

As a human system, I think that is the most we can ever ask for, because ultimately if there is a very serious problem to exercise the power to replace management, it has to get to the ministerial level. Whether that is through the complaint body recommendation that there is a problem here or the staff in the department, I have to make sure that is working, and that is my goal, and I share that with the member for Kildonan. I would like a system that can naturally feel comfortable enough when they have a problem that if they cannot resolve it at that level to move it up as part of the culture to be dealt with by the person who has the authority; the minister has the authority to take the necessary steps if people are at risk.

I do not know what else more one can do. It is very much a cultural thing in terms of how the system works and thinks about. That is one of the reasons I brought Mr. McFarlane in, because he is very, very good at working these kind of changes, and that is the only long-term way. That does not mean someday in the future you might have different players at the table. I hope the system can survive, whoever is at the table, to be able to generate that kind of information to the minister of the day on a timely matter that steps can be taken so that people are not at risk.

Mr. Chomiak: I am pleased with that response and I am glad to hear that the minister would have moved regardless. That was a major area of concern on my part. Did the minister or the department ever see the Nursing Home Association report that was produced?

Mr. Praznik: That report was done by them, I think, under agreement with us. They paid for that agreement. We were not provided with it, although I think our staff had a pretty good idea of a lot of the things that were in it, of which one recommendation was change of management or a significant change in the way they managed that facility. We were working with them; our staff were talking with them. Again, putting it in the context of the culture here, if you did not work co-operatively, your only remedy was to pull the licence, which is such a severe remedy, given the danger in which you put the people who live there with a move in winter and having beds available that it does force that kind of--okay, let us keep working at it, and that is where we were.

So, although I do not think we have ever received that report, a lot of it was shared with our staff or they were aware of it, as I am sure the member has had information shared with him. Time marched beyond that report, and the circumstances of the early winter and our decision to make that request of their management really implemented the report on a very quick basis if that is in fact what its recommendation was.

Mr. Chomiak: Given that report was--

Mr. Praznik: Mr. Chair, I was just notified by Mr. McFarlane, if I left any impression that the current acting director in that area was being held responsible for this, I certainly do not want to do that. My observation about how a system works--I do not think this was the result of a malfeasance or misfeasance by any staff. As Mr. McFarlane points out to me, part of the difficulty in the Long Term Care branch is that they have to work with personal care homes in a whole host of areas, not just problems with meeting standards. So the working relationship is such that we encourage them to be co-operative and wanting to work with people and resolve issues in that way, because that is the biggest part of their job. That is why, in fact, when we talk about my thinking of reorganizing the department, one of Mr. McFarlane's observations is that the enforcement of standards should very much be removed from the part of the department that deals with people operationally so that there is another piece of the branch that is doing the spot checking, doing the spot auditing, doing the regular inspections and coming back and then saying to the administrative branch: you have a problem in this personal care home. In that way you are not putting people in the position where they are having to have an ongoing daily working relationship with the management of a facility on a host of issues and then also be the enforcers. It does create a natural human conflict there that is not productive.

So the nature of which this thing has been organized for 30 years, I think, has led to some of these difficulties. That is why, if you notice, we are trying to make that move. So Mr. McFarlane suggested I clarify that, and I totally agree. I think I would not want the current acting director to be--they are so conscientious in their work, and I feel so bad over some of these things, and operate in a place where the tools they have to do this job are also so limited. That is part of the reason why we are adding to the box of tools for them. I want to put it in that sense.

Mr. Chomiak: I certainly do not want to be seen to be unfairly attacking staff. I just wanted to make that clear as well. I guess what I am still not clear on is if we were to run into a Holiday Haven-type scenario again, which, I think, is less likely--you see, part of the frustration that both I and advocates on behalf of Holiday Haven had was that we were assured problems were being looked after. There was a consultant's report that was being prepared. Now, little did we--well, we did know that there were recommendations to change the management which is why I wrote to the ministry saying I know about this recommendation; how are you following up?

* (1600)

Wherein will the department now have the controls and wherein will the department now step in to ensure that--what effectively happened here was management skirted around their responsibilities. Management--and I have no problem saying this, management covered up. Management were wholly inadequate and incapable and kept running away from their responsibilities, and somehow there was no way the department could force them into the situation where they could be accountable.

The presence of an outside consultant's report, which we had accepted as perhaps a possible solution, was, in fact, no solution because there was no way that those recommendations were coming forward to the department.

I mean, wherein are the controls and wherein is the ability now to make sure that that scenario does not repeat itself?

Mr. Praznik: The member asks what concerns me as well in setting this up, and I think the difference is, with respect to staff, twofold, is that our standards enforcement audit group that we will be assembling and building over the next while within Mr. Potter's part of the department has a mandate that will be very focused. We will be building that out of, I guess, existing resources and putting it together, but much more focused. And they will have available to them, if this Legislative Assembly puts into law our request in The Regional Health Authorities Amendment Act for the powers of the minister to take over management.

That tool in itself, I think, is a very strong tool because it alleviates or reduces the legal liabilities. If there is cause, the minister has the authority from the Legislature to step in and on an interim basis take over management. That is a huge tool, not only in a practical sense, but I think in the cultural sense of enforcement of standards because now you can make a serious move if you are not getting co-operation from a facility, if they are not acting quickly enough, and patient care is at risk, is the way we have worded it, not that lives are at risk, but patient care is at risk. Then the ministry can move in on the authority of the minister and on an interim basis take over that facility. They did not have that power.

So I would think as part of the culture of dealing with standards, the caution, the reluctance that staff may have in working with facilities which are quite reluctant, actually, to work with them, they now have a tremendous tool because they do not have to go the minister and say kill the licence, and the minister says, what are you going to do with 150 people?

Now they can say, Mr. Minister, here is our case. There is a problem here. Here are our complaints. This is documented. These people have had plenty of time to solve the problem; they are not doing it. The minister can say, okay, should we act here? Yes. What can we do? We can step in and appoint an interim manager, and that interim manager might be two weeks, maybe three weeks.

Even the threat of that interim manager, I think, is a huge tool to get the management of personal care homes, both private and nonprofit, to respond to the department to fix a problem whether it be a small one or a large one. That tool does not exist today, will not exist until we have that in our legislation, but it will, I believe, change the nature of the enforcement of standards in a very positive way.

Mr. Chomiak: When the minister indicated that Mr. McFarlane first indicated that the major concerns he heard from personal care homes was that laundry concerns were a major concern, I was first surprised and then on reflection was not when I consider the kind of problems one hears about. I differ though with respect to what is the major concern in province with respect to personal care homes. [interjection]

I am sorry, the minister is correcting me, that it is in fact the No. 1 complaint.

Mr. Praznik: Mr. Chair, I believe we were saying it is the No. 1--in terms of frequency of complaints, it is the No. 1 complaint; we did not say it was the No. 1 concern. Laundry, and I think there is an important distinction there I wanted to clarify.

Mr. Chomiak: I think that is a correct clarification and it has been more aptly put, but it does lead to my next line of questioning and that is, one of the individuals I respect a lot in the personal care home field advised me this way with respect to personal care homes. He said that 10 or 15 years ago in a personal care home 75 percent of your patients were ambulatory, 25 percent were nonambulatory. Today it is just the opposite, and the minister has alluded to that in several of his answers.

To my mind the key issue, the single most significant issue with respect to personal care homes, is the staff configuration and staff mix. I do not think that we will make any progress in terms of improving situations in personal care homes until the staff mix issue and the staff volumes are dealt with. That was identified in the steering committee report as well. I am wondering if the minister might comment specifically on the staff issue as it relates to personal care homes.

Mr. Praznik: I have said on numerous occasions in the Legislature, and publicly as well, that is one of the issues that concerns me, both in personal care homes and hospitals, is that the degree of severity of people who will be using those institutions are today and will be in the future much greater. The same is true of our hospitals, very much so. Hospital stays or length of stay are way down. The severity of people who have to stay in overnight is way up. There is much more laser surgery, day surgery, various procedures that are less intrusive and consequently recovery times are faster. Those people are out of the system. Those who are left in our institutions are in much greater need of care.

That is going to continue to put greater pressure on our staff in those facilities. Even if workloads are handled, I think it is much harder to be dealing every day with people who are nonambulatory, maybe much older, maybe suffering from dementia. It is a gruelling way in which to earn one's living to often have to work in those circumstances. For many, there are many who thrive on it, and I have met many of them in personal care homes who enjoy that work greatly and feel very personally rewarded by it, but over time it is very difficult work. I think we all acknowledge it would not be an easy way that I would want to earn my living, and I have a great deal of respect for people working in those facilities.

What is my challenge as the Minister of Health? Well, understand the playing field. We understand that need is increasing. We also understand that the training, consequently salary levels of staff working in health care have increased in many ways. A lot of that pressure can be taken off, in my opinion, and this is again a cursory judgment, by adding more hands in the giving of care. In many of those, particularly personal care homes, the requirement is for more hands, for hands-on care. We have put in additional dollars each year for increases in levels of care, or facilities have had an increase in their level of care requirements, but I would suspect over the next few years we are going to have to look at how do we get actually more hands working in a number of these facilities. There is a certain amount one can do in increasing the efficiency of how we do work. A lot of that has gone on its way, but ultimately it is hands in hospitals and personal care homes. That is why some of the issues we have touched upon with staff aides, nurse's aides, whatever we want to call them, developing that program, adjusting staff mixes to be able to give us more hands-on care are going to be an important part of where we proceed in the future.

* (1610)

This is one area that if I had my druthers, I guess, and could find a few more resources for is an area that increasing the staff side we would obviously have to look at. But I recognize what the member is saying, and that is going to be the big issue for us and facilities over the next number of years is getting, particularly personal care homes, more hands-on kind of care levels and appropriate training to do that job.

Just another point here if the member would just give me a second. By the way, that is not just a challenge for government, but it is a challenge for the people who administer these homes whether they be profit or nonprofit homes. There is going to be some real hard work needed in this area in the next few years, but I think we agree that it is a concern and it is an area that has to be addressed, and I am hoping over the next few years we are going to be able to get a few more hands in these facilities to do that basic care work.

Mr. Chomiak: Without going into too long a question, the minister will know that in '93 there were problems in some nursing homes, that the steering committee was set up and made a report. The minister will know that there were 39 recommendations that came out in June of '95, and that many of these recommendations dealt with issues that we actually have talked about in the last few days. Some of them clearly are being implemented. Can we get an update on the implementation of the 39 recommendations made in the steering committee report?

Mr. Praznik: I would love to be able to table a list of those and their status. The information I have, I had some questions about, and I am having staff revisit some of those issues. So I cannot table that with the member today. I can tell him this: When this issue came to light, and I have had Mr. McFarlane look into it, many of those recommendations were ones related to education, and there were a host of other things that I think have been done. How effective they have been, I mean, time will tell. There are others where there was some work done but not as much as we would have liked ultimately, and I have had staff go back to reassess what has to be done. So today I cannot give him that, but if the member gives me some more time with Mr. McFarlane in this area we perhaps will be able to review that in a better context in the future.

Ms. Bakken is here. Do members plan to go into capital after the break?

Mr. Chomiak: Probably. We are going till six, right?

Mr. Praznik: Mr. Chair, if we could do capital today, I would appreciate it, and leave sort of general stuff, touch-ups, on Monday in that hour and a half. The reason why is, Ms. Bakken is here and, as the member knows, we are preparing--we have so much underway in capital right now that her time is really better spent in her office. So if we can do it this afternoon, I would appreciate it.

Mr. Chomiak: Mr. Chairperson, yes, my plan was to get to capital probably later, but why do we not just agree after the break we will slip into capital--I do not think the questioning will be as extensive as it has been in this area--and then we will come back and just continue going.

The committee recessed at 4:15 p.m.

The committee resumed at 4:28 p.m.

Mr. Chomiak: Just to sort of wind up this portion, is the minister indicating that he will be providing us with updates at some point as to the 39 recommendations contained in the report?

Mr. Praznik: Yes, I will. I am asking my staff to make sure we do, and we have got all of our work done in implementing, that we can provide a report to him. If I do not, I know the member will remind me, and we will provide it at that time.

Mr. Chomiak: I presume we are now going to move into the area of capital. I wonder if the minister can table for me, he was going to provide me with some specific information with respect to the capital projects to the best that he had. I wonder if we might have access to that.

* (1630)

Mr. Praznik: Mr. Chair, as I indicated, this was sort of an extraordinary year for us, a little different. There are only--I said five the other day, there are six projects actually, I missed the Sharon Home--that have been approved: Health Sciences Centre, which is an area, a project to address the most critical patient areas in need of redevelopment such as the adult and pediatric operating rooms, intensive care beds, and emergency departments; Brandon General Hospital, again to deal with their most critical infrastructure issues involving operating theatres, emergency department, pharmacy and some building fabric and building systems in their general centre; Boundary Trails, which is a new hospital which will allow for the closure of the current Morden and Winkler facilities; Sharon Home, a new 60-bed personal care home to replace 60 existing beds at the Sharon site on Magnus; a 102-bed facility at the existing Lions Manor on Portage Avenue, which is replacing 62 hostel-style beds. The personal care facility will add another component to a full continuum of care and services provided by their housing corporation; Betel Home, which would be a new 100-bed facility in the west end of Winnipeg linked to the elderly persons' housing unit owned by the Betel Foundation. So those are the six projects that have been approved to date.

We have a $10-million fund available for conversions for rural health authorities. We expect to start receiving proposals later this summer, early this fall, as those facilities work--is that correct?

We should start to receive some of those proposals, I would hope, early in the fall. It might take a little longer for some who are doing their needs assessment. We have a $10-million fund for the regular upgrade in safety and security. We also have another tranche of dollars that have been identified for major--I would not say major--other projects that will flow out of the needs assessments of the regional health authorities.

Mr. Chair, if there are specifics that the member has with respect to any one of these announced programs, I would be delighted to have Ms. Bakken address her answers directly to the committee. I think that would save a fair bit of effort and time.

Mr. Chairperson: So it is agreed under this area of capital that Ms. Bakken will answer some of the questions? [agreed]

Mr. Chomiak: Just prior to perhaps--because there are policy and related issues, so I will frame the question and the minister can determine who best will respond. Normally, in terms of the capital program, we see a three-stage program in the announcement of capitalization, the actual capital, then the committed drawings and the various processes. Where are we this year with respect to the overall capital program, and can the minister put a number on it?

Mr. Praznik: I am going to have Ms. Bakken answer that with respect to the estimated value. She and her staff are the ones who are working on the detail of this, so she is far better to answer this than I.

Ms. Linda Bakken (Director, Facilities Development, Department of Health): Two of the projects that have been announced, their drawings are complete, so they would be in the--what you would be familiar with is the approved-for construction category. If we are successful at negotiating a project with those two proponents, we should be able to go to construction in the fall.

An Honourable Member: Which two?

Ms. Bakken: Betel and Lions.

The Health Sciences Centre, we are in the process of actually coming to grips with the size and the siting of those components on the site, and if all things go well, the first construction should begin in the spring of 1999. The Boundary Trails Health facility design will begin, again, in about two months, and, again, if all things go well, we should begin construction in the spring of '99.

The Brandon project will have a number of construction starts. The first project that will go to construction is their new energy plant. There are some clinical components there and some other sort of infrastructure upgrades that will come along in various stages. The Sharon Home is still very much in the idea stage, and the board of the Sharon Home has not determined whether they want to build in the south end of the city or linked to the existing Sharon Home, so we are still very much working with that organization around where the home will be. Therefore, the design has not started.

Mr. Chomiak: Where does the Cancer Treatment Foundation capital fit into this plan?

Ms. Bakken: The Cancer Foundation project was announced by the government in the spring, prior to Mr. Praznik's sitting in the Chair, and that project is anticipated to begin construction around November or December of this year. It is well into what we call design development and will soon be going into working drawings.

Mr. Chomiak: On an individual basis can we place some values--is it possible to place some capital values on each of the projects? For example, we know Betel and Lions have both approved their construction, what the value is, and then is it possible to do that as well with the Health Sciences, Boundary, Brandon, Sharon and the Cancer Treatment?

Ms. Bakken: The actual value, construction value or project value is usually not announced until the construction contract is signed. That is when the public is made aware of what the costs are.

Mr. Praznik: I think the member will appreciate part of the difficulties if we put even an estimate value that will probably be close to where our tenders come in, so we can probably give a total value on the overall package for all of the projects that have been flagged--an estimate. But, again, with the specifics, it has not been policy to reference that in huge detail until tenders have been let and results have been determined, just as the member appreciates. We want to get the best deal on construction we can, but I think we can provide an overall estimate.

Ms. Bakken: The estimated value of the six capital projects that were announced in the spring of this year is $156 million. That is for the Department of Health's share, and the value of the Cancer Foundation project was announced when the Cancer Foundation approval announcement went out, and that is $38 million, $23 million of which is coming from the province, and the remainder is coming from the Cancer Foundation itself.

Mr. Chomiak: So just for clarification, Health Sciences, Brandon, Boundary, Sharon, Lions and Betel comprise a total of $156 million.

Ms. Bakken: Yes, it is $156 million of the province's contribution. The cost is estimated to be a little bit more and has taken into consideration the requirement for community contribution.

Mr. Chomiak: When we look into our capital Estimates under appropriation No. 7, of course, we see total capital of $66.6 million. That, I understand, entails a variety of other projects including the upgrades and the conversions, but, just for my understanding, is it a fair conclusion to state that within the $66 million allocated this year, that will include the provincial portion of the total cost of the six projects for this year that you have made reference to.

I know it is more complicated than that, so maybe you could explain it to me.

* (1640)

Ms. Bakken: The amount of money that is in this year's Estimates is the cost associated with supporting the capital program in this fiscal year. So there will be a cost associated with those six projects in future fiscal years.

Mr. Praznik: Mr. Chair, the bulk of the cost of those projects, obviously, will be in future years, and that is taking into account, I think, going seven or eight years out on our capital program.

Mr. Chomiak: Can we get an individual breakdown or a breakdown as to what extent each of the individual organizations are required to put up capital for their projects?

Mr. Praznik: Under our new policies, the member appreciates, we are looking for a 20 percent capital contribution on those projects. That is capped at $6 million in total. So, obviously, the Health Sciences project by its nature is much more significant than 20 percent equating with $6 million. The exact amount of that contribution is dependent on what the estimates are, and those are part of the confidential negotiations that go on with the sponsors.

I know, Mr. Chair, this must be terribly frustrating for members because the numbers always put things in perspective, but the reason why we do not get into them, and I put on the record again, is we do not want to be tipping our hand prematurely on the tendering price. We do want to try to achieve the best price, but I appreciate the frustration that this does cause.

Mr. Chomiak: I am wondering if it is possible to get some specifics on precisely what each of the major--and I appreciate the minister has just given me a list--capital projects entails, because, specifically, if one is to look to both Brandon and the Health Sciences Centre, they have been on the books for some time, and knowing the experience of the cancer treatment institute, there are changes, and I understand there are changes, but we are trying to get grips as to what the Health Sciences Centre proposal consists of--what improvements, where and to what extent--as well as the Brandon project.

Mr. Praznik: I am going to table, I guess--I do not know if this was a press release or a draft press release. It was a draft at some time, but I think it contains a fair bit of the information. Everything in it is accurate? I look to my staff. Let me just check it to make sure since it was a draft.

Mr. Chair, I have no problem. I would like to just table this. I think this will provide--it will be fairly insightful to the member for Kildonan. I only have one copy, so if staff could--thank you.

Mr. Chomiak: I thank the minister for providing me with that information. I look forward to a review and some questions in that regard.

The minister talked about a $10-million conversion program, as well as a $10-million upgrade for safety. I wonder if we might have some specifics in terms of how the $10-million conversion program works, as well as some specifics with respect to what is happening in terms of the upgrade, safety and security, and where the upgrade, safety and security, is related to.

Mr. Praznik: Mr. Chair, I think I will answer the queries with respect to the conversion plan, and I am going to leave the safety and upgrade issue to Ms. Bakken to give some detail to. She is well aware of the needs there better than I.

With respect to the conversion, what we wanted to achieve with that is with regionalization there are many facilities in rural and northern parts of Manitoba, particularly rural Manitoba, that are terribly underutilized today or inappropriately utilized.

I know in the Marquette region, just some very rough numbers, we are short somewhere close to 75 personal care home beds in that region. We probably have a hundred acute care hospital beds more than that region requires. Common sense would dictate that by converting underutilized or unused hospital beds into personal care home beds, that it makes much better use of a facility. There are some facilities that are very underutilized today in a hospital role and are looking at--in fact, even before regionalization were talking about becoming health centres, centres for community, long-term care, et cetera.

So what we realized if our policy here is not to close facilities, it is to make them relevant, and if facilities are going to become more relevant, that may require some capital need. They may have some capital needs to change their structure.

I share with the member the example in my own constituency of Pine Falls some years ago, a great demand for dialysis. We wanted to put a dialysis unit in the Pine Falls Hospital. Where do you put it? I think we took out eight or nine empty beds, beds that were not used. They did some consolidation of wards there, so that actually they could have a more efficient operation with their nursing stations. We put the dialysis unit into where there had been rooms before. No one missed the rooms because they were not being used, by and large, or were terribly underutilized, and today we have a much better used facility with a relevant need for that community being filled.

But that takes some capital. I do not know how much it took to convert those rooms. We recognize, though, if you are going to encourage people to do this, you have to have some money available on a quick basis to further those conversions of space from one function or underutilized function to a more used function.

So our Treasury Board this year has given us $10 million for this year. I suspect many of these conversions are going to happen, and they could be relatively small conversions. They may not require a long-term planning process in terms of architectural design. Some of them may be rather short order. So we have $10 million in this year's budget to commit. If we require more next year, we will have to look at that again.

We also have to encourage people to get the best use out of their facilities. We have also not put a community capital contribution into the conversion program. So we have asked RHAs now to look at their needs as they do their needs survey. I know some of them have some very obvious examples that they want to proceed on. They will probably be early in the fall. Others need a little bit more time, so we expect come September to start getting the first idea of what kinds of projects we are going to see under this fund.

But I have to have some money there in order to facilitate that kind of thinking, that people knew that if they rethought the function of their facility and could get a better use of it by maybe putting in a doctors' clinic, as an example, or converting personal care home beds or whatever, putting the public health offices or home care offices into unused space, that if they realized and could justify that that was going to make the facility more relevant, they needed some dollars on a quick basis to get in and do the job, and we wanted to do this. I do not want to lose the good momentum that has developed.

So that is why this fund is there. It requires no community contribution. We are drafting up some criteria, I think, to make sure that we are going to see the dollars used appropriately. I know this $10 million we expect on our projects to be used over three years in total. If we have a greater demand on it, we may have to look at increasing it, but at this stage of the game we think it is a good start on encouraging this kind of rational thinking of how we use our facilities to make sure they are relevant and well used.

* (1650)

Mr. Chomiak: I believe Ms. Bakken was going to discuss fire and safety.

Ms. Bakken: The money that has been allocated by the province for what we call the safety and security really speaks to the safety and security of the infrastructure and the care of patients, residents or staff in them, and, therefore, the money can be earmarked for something like an air-handling system in an infection-control situation which would be a patient-safety issue, or it could be earmarked for replacing the brick that is falling off of a building.

I have a number of examples here that both create environments to improve the safety of patients or residents as well as to maintain the buildings in safe and effective operating. We have approved replacement of the chillers at the Brandon General Hospital. We have replaced the skylights at the Brandon General Hospital. We have done a large number of roof repairs, air conditioning equipment--I see so many roof repairs here--elevator repairs, emergency department relocations, a number of fire commissioner upgrades, flooring repairs when the floor gets to the point that it needs to be totally repaired, upgrading of wastewater systems, air handling system for tuberculosis control, fire detection devices, renovations to accommodate wheelchair accessible washrooms, fuel oil tank replacement, replacement of the outer shell at the Victoria Hospital. That is the kind of thing that has been funded out of the safety and security fund.

Mr. Chomiak: Is there a special consideration or fund with respect to personal care homes in ensuring the facilities have the appropriate wards and the appropriate security in place to deal with recommendations in the steering committee report and other reports dealing with dementia and the isolating of patients in common areas, et cetera?

Ms. Bakken: The personal care homes have access to this fund and the kind of a project that you have just described would meet the criteria for resident safety.

Mr. Chomiak: When I look at the individual projects such as the Brandon General Hospital project, I understand that Brandon is to have a facility to deal with psychiatric and/or mental health patients. Is that included within the allocation for Brandon? If it is not, where is the accounting for that in the time line?

Mr. Praznik: Mr. Chair, I know there is a separate budget fund to deal with the mental health reform, and Ms. Bakken will speak to that.

Ms. Bakken: That particular project is actually under construction at Brandon General right now. It is part of a number of projects that were approved by government as part of the mental health reform.

Mr. Chomiak: As I understand, there were exclusions previous when the Health capital was frozen for mental health projects. Can we have just the general description as to what projects are going forward and the dollar number value with respect to those areas of mental health that have been excluded from the original freeze that was put in place?

Ms. Bakken: Yes, I will start in the North. There is a project approved for Thompson which is now under construction; a project in The Pas which will go to construction very shortly. The project in Dauphin is now under construction; the project in Portage is now under construction; the project in Selkirk is now under construction. Two projects in Brandon are now under construction. They are the adult psychiatry, acute psychiatry and the psychogeriatric. An additional project in Brandon is still in design. It is the child and adolescent centre.

Our deputy minister has just pointed out to me that in the printed Estimates, the mental health capital projects for '97-98 have been voted $8.474 million. It is part of what appears as Other Capital Projects 21.7(d) in Expenditures Related to Capital, with a total of $18.5 million.

Mr. Chomiak: I would like to go through some specifics on the Health Sciences Centre project. It indicates in the press release that the adult and pediatric operating rooms are being dealt with. Are we constructing new operating rooms for adults and for pediatric surgery at the Health Sciences Centre, and how many are we constructing?

Ms. Bakken: The operating theatres will be new. The exact number of operating theatres is now under discussion with the Health Sciences Centre. I anticipate that an agreement will be reached in the next three months.

Mr. Chomiak: Does that include that agreement? Does that include pediatric and adult?

Ms. Bakken: Yes, it includes pediatric and adult ORs, pediatric and adult intensive care units, and pediatric and adult emergency departments.

Mr. Chomiak: Is it safe to assume that in the pediatric operating section of Children's Hospital that the present five operating rooms are going to be retired?

Ms. Bakken: Yes.

Mr. Chomiak: Is it also safe to assume to the ICU units are going to be converted or retired?

Ms. Bakken: You are getting into some of the details of architectural solution to the problems, okay, and all of those have not been worked out. We will attempt to utilize existing space if it lends itself to creating environments that meet today's standards, and there are a number of architectural solutions on the table right now, and the final one has not been determined.

Mr. Chomiak: Regardless of how many operating rooms are going to be functioning at Health Sciences Centre, adult, is it safe to assume that the present operating rooms will be retired?

Ms. Bakken: You can assume that the existing OR theatres for adults and children will be retired.

Mr. Chomiak: I know this is difficult, but is it also safe to assume that there will be an increased number of ICU beds resulting from the ultimate configuration once constructed and approved?

Ms. Bakken: The exact number of ORs and the exact number of ICUs is being planned in the context of the urban hospital restructuring, and it is being directed by the task forces that existed about a year ago. The need for increasing the number or decreasing the number will occur in the context of an urban health plan.

Mr. Praznik: What I would just like to point out is, I guess as a new minister coming into this and inheriting the plans, what I am trying to achieve with the Winnipeg Hospital Authority is the best utilization of existing resources. We have some operating theatres now in the city of Winnipeg that are underutilized or not utilized at all. Some are locked. Before we build new ones, we want to ensure that we are making use of what we have. That obviously has a result in intensive care space and configuration of services, which has to fit in the plan. So in fairness to Ms. Bakken, some of those practical decisions have yet to have been made, and when they do that will affect the kind of numbers over which we are negotiating.

* (1700)

Mr. Chomiak: I thank the minister for that response. I was not trying to trap Ms. Bakken. The fact is that the operating rooms at Children's Hospital are the worst in the country and it is acknowledged by everyone, as well as the operating rooms, for the most part, at the Health Sciences Centre are the worst in the country, as has been acknowledged by everyone. What I was attempting to ascertain is, regardless of the configuration, the number, just trying to assume that, trying to determine that there will be, in fact, proper operating rooms that will occur in the future, and clearly that is going to be the case as a result of this project.

The minister talked about the taking out of service of 100,000 square feet at Health Sciences Centre. I wonder if we could have an explanation as to what is meant and what that entails.

Mr. Praznik: Mr. Chair, I would like to table this today, but I am not in a position to because these are still matters we are negotiating with facilities, and also this comes out of the proposal with MDS. If we are unable to conclude an arrangement with MDS, this cannot be realized. So I am not in a position to table this today, but I can tell him in total, in existing lab space across the facilities in Winnipeg, we have some 153,000-plus square feet of space. It is estimated by our department we would still require 53,000 of that, I guess, on-site work within labs in the part of the lab work that still best stay in the hospital. So it does make available about 100,000 square feet at Health Sciences Centre. My estimate is that there would be somewhere in the neighbourhood--I do not have the estimate, but it is a rather significant amount of square feet, and if we are able to make an arrangement with MDS, a suitable arrangement, it will free up somewhere around 35,000-40,000 square feet of space, in that neighbourhood, which allows for then conversion on a much faster basis than new construction.

Mr. Chomiak: Mr. Chairperson, does the capital for the Emergency department at Health Sciences Centre imply a replacement to the existing Emergency department?

Ms. Bakken: Mr. Chairperson, we anticipate that we will have to replace both of the spaces, but again you are getting into architectural solutions. At the end of the project you will see a brand new Emergency department.

Mr. Chomiak: Mr. Chairperson, does any of the capital entail equipment, or is that a separate line item?

Ms. Bakken: The capital budget includes the equipment that is required for the parts of the facility that are being redeveloped.

Mr. Chomiak: How will the capital function differ once the regional boards are up and running?

Mr. Praznik: Mr. Chair, Ms. Bakken may want to give some detail as to the process, but we are now dealing with regional health authorities. In essence, we are dealing with them directly on their capital construction needs as opposed to individual boards. The boards, if there still is a facility that is governing, they obviously enter into that as a facility as part of that negotiation. I understand in the Boundary Trails case, for example, the RHA is involved, but they have struck a committee or are using the former building committee or hospital board in some way because they had the knowledge of the project. Ms. Bakken may want to give some more detail.

Ms. Bakken: Mr. Chairperson, the next capital program that the government announces will be one based on the recommendations of the regional health authorities. Capital projects must come in recommended by the regional health authority and set within the context of their community health needs assessment and their business plan. When there is a nondevolved health facility, it too will have to have its capital requirements recommended by the regional health authority to ensure that there has been regional planning and prioritization of the infrastructure requirements within the health authority.

Mr. Chomiak: Mr. Chairperson, under the budgetary line item 21.4.(d) under Personal Care Homes it indicates the grant for personal care homes as $238,265,900. Does that entail any capital?

Ms. Bakken: Mr. Chairman, it includes the interest component for projects that have been completed. The capital component or the principal component is on page 105 under (b) the Personal Care Homes Program (1) Principal Repayments.

Mr. Chomiak: Then perhaps this question will go to the minister. When questioned during the release of the budget, the Minister of Finance (Mr. Stefanson) made the argument that the Personal Care Home funding was down some $6.5 million because of the capital or the interest or some kind of capital-related payment.

I wonder if the minister might explain to me how that works.

Mr. Praznik: Mr. Chair, I am going to ask Sue Murphy, who is one of our senior Finance people to explain this because it was she and Linda Bacon and their staff who were challenged with the responsibility of finding the best way of spending $150 million of new cash.

I have to appreciate, we have funded our capital facilities not on a pay-as-you-go but on a financed paydown, sinking-fund basis. Last winter, after the sale of MTS, it was our Treasury Board's proposal to us that if they gave us $150 million from those proceeds, how could we best influence our capital program? Should we be spending it on new construction, or what is the best way to do it?

These two individuals in their respective areas spent a great deal of effort in analyzing everything up, down, sideways and over to come up with the best way to get the most value out of that $150,000, and appreciate that their decision was made in the context of a policy decision of government which I defend here today that we would eventually move from having a Health capital budget which was a financed budget where we borrowed money and we financed the principal and interest over time, where we would convert over a number of years--and it would take some time; we are not going to do it overnight--but over time would get to the goal of having a pay-as-you-go capital program like we do in Highways, that, in essence, whatever amount of money we were spending on capital would be spent in that year, and we would eliminate the financing costs which would be a more efficient way of ensuring dollars going into Health capital. Now, it is going to take many years to get there, but we are on that road.

* (1710)

In essence, what our hope was was that if we could maintain a constant level of funding over time as we pay down on sinking funds existing debt for construction that has already taken place, the savings on the interest would then become a new capital budget. We recognized over time that that would limit our construction to very little for the first few years until eventually we had eliminated our capital debt. This, obviously, creates some problems because capital needs regular infusion. There is work that needs to be done.

So, in that context, I am going to leave it to both of these individuals to I think answer the member's question and also if there are any others flowing from why we made the decision we did to use the $150 million to pay down debt as opposed to new construction. So I turn it over to Ms. Murphy.

Mr. Chairperson: Order, please. Is it the will of the committee to allow Ms. Murphy to answer some questions in this capital area? [agreed]

Ms. Susan Murphy (Director, Finance and Administration, Department of Health): Mr. Chairperson, the question is related specifically to personal care homes, first of all, in the Personal Care Home line in 21.4(d),and the member is referring to what appears to be a reduction in the overall line and the expenditures for 1997-98.

(Mr. Peter Dyck, Acting Chairperson, in the Chair)

First of all, there is a reduction in the interest component for 1997-98 of about $8.9 million which is a direct reflection of the paydown of $150 million in debt in 1996-97 and also a result of a reduction in interest rate between 7.5 percent and 6.5 percent. Interest rates have in fact reduced over the last period of years, and when the department is funded on an annual basis for what its interest costs are, it is funded on the basis of what current interest rates are. So the combination of those two factors means that there is a saving in 1997-98 of about $8.9 million.

You will notice that the decrease overall in that particular line is only $6 million, so there have in fact been increased costs that are reflected in there as well. One of them, for example, is increased staffing levels, which were referred to earlier, of approximately $1.9 million and some other items such as annualization of construction costs and other various increases. But that also applies to the hospital program where in the operating side there are interest costs on an annual basis of the component of outstanding debt, which is in the operating side of hospitals and personal care homes, so the same applies in the hospital. The principal repayment is in, as I pointed out before, page 105, and the principal has been reduced to some degree as well because of that $150-million paydown.

Mr. Chomiak: Can you give me the commensurate figure for the reduction on the numbers for the hospital side as well?

Ms. Murphy: It is approximately $10.5 million as well. Now the major part of that is a reflection of the reduction in interest rate as most of the $150 million in paydown was for personal care home loans in 1996-97. The greater part of the paydown was in the personal care home program, then the hospital, but between the two programs, on the operating side it is approximately $20 million in interest that was saved in '97-98.

Mr. Chomiak: So the $8.9 million is a reduction in interest payments that would have occurred had the province not taken part of that fund and reallocated it?

Ms. Murphy: Mr. Chairperson, it is a combination of the two things; the majority is a result of a $150-million paydown of debt, which would be similar to you or I making a lump-sum payment on a mortgage or paying our mortgage off, and the remainder of it is the interest rate reduction from 7.5 percent to 6.5 percent on short-term loans.

Mr. Chomiak: Can you give an indication as to how much principal was reduced on both the personal care home side and the hospital side?

Ms. Murphy: I would have to come back tomorrow with that. I am not certain of the breakdown.

Mr. Chomiak: Do we have figures as to what the interest payments were on the personal care home side for '96-97?

Ms. Murphy: I can get it for the member, but it is not here.

Mr. Chomiak: I think that takes care of my questioning on that particular item.

The Acting Chairperson (Mr. Dyck): Item 21.7.(a)(1) Principal Repayments--

An Honourable Member: No, no, Mr. Chair. We are not there yet. Let us just carry on with his questions.

Mr. Chomiak: Mr. Chairperson, one of the issues that I wanted to try to determine is how many net new beds are we going to see as a result of the personal care home projects. [interjection] It does not add up. I think I need an explanation as to how it is determined that there are 262 full-service care home beds that are being put in place when, in fact, some beds are going to be taken out of circulation. I just do not understand that number.

Ms. Bakken: Mr. Chairperson, could I see the document that you are referring to? Thank you. I would like to get back to you on the specifics of this, but basically the Sharon Home project is a replacement of substandard beds and the Lions Manor project will replace 62 substandard beds and build 102, so that the actual addition to the system is the difference between those two numbers, whereas the Betel Home will be a pure addition. If our numbers at the bottom here do not add up, I will provide you a written explanation tomorrow.

Mr. Chomiak: Mr. Chairperson, we have had a lot of fun with bed numbers throughout the years, and I am not trying to be tricky on this. It just does not add up in terms of--but maybe it is something that I am not seeing. I appreciate the fact that we are going to have an explanation come back. Regrettably, I do not have a lot of questions at this point in terms of the capital. I say regrettably because I cannot find it within my card system, but that will have to be as it may. I am suggesting we can perhaps go back to where we were, which I believe was the Home Care line, and begin to pass some of the line items and go through some of the systematic questioning and then proceed on that basis.

* (1720)

Mr. Praznik: Mr. Chairman, my staff have just reminded me that I have some things that the member has asked for. I think he asked for the "Nursing Resources in Manitoba" report for 1996. Actually, he looked for a general plan. The only caveat I would put onto this--it is a public document, but the only caveat I would put on is any of the discussions that we have had around this table with respect to roles and professions and some of the voids and changes is a caveat to these documents. They are not written in stone. I will table those. There was another matter I wanted to table. We do not seem to have it right here, but we will have it for the member tomorrow. Thank you, Mr. Chair.

(Mr. Chairperson in the Chair)

Mr. Chairperson: Item 21.3. Community and Mental Health Services (c) Home Care (4) External Agencies - Home Care $2,314,300--pass; (5) External Agencies - Services for Seniors $3,857,100--pass; (6) Less: Recoverable from other appropriations ($90,000)--pass.

21.3.(d) Winnipeg Operations (1) Salaries and Employee Benefits $14,065,700--pass; (2) Other Expenditures $2,116,300--pass; (3) External Agencies $276,700--pass.

21.3.(e) Rural and Northern Operations (1) Salaries and Employee Benefits $25,265,300.

Mr. Chomiak: With respect to this appropriation, I think that the minister has acknowledged and I think most observers will agree that with respect to some of the difficulties being incurred by Manitobans with health--are those in rural and in northern Manitoba, in particular. I am wondering what specific provisions and what specific attention is being paid in the context of the regionalization to the specific needs of northerners in particular and rural Manitobans where that applies.

An Honourable Member: That is 4?

Mr. Chairperson: We are on Rural and Northern Operations.

An Honourable Member: 3.(e).

Mr. Praznik: Mr. Chair, in general terms, with respect to Rural and Northern Operations, obviously there are some specific issues in physician recruitment. Although we have a clinic model in place, that is not seeming to resolve the matter fast enough. We have some work to do there.

Regional health authorities--I cannot stress enough--again, I think are going to prove to be a very effective tool because they allow for a better understanding and a better integrated operational system. So many of the issues that have been around for some time, I think we have better tools to work at them, which is now happening throughout the system. I do not know if the member wants me to be more specific in a particular area, but we have been through so many of these issues already in our discussions.

Mr. Chomiak: It strikes me or it seems to me that, given the allocation, there is almost a need for a special funding and special allocation particularly to northern Manitoba as it relates to some of the needs in northern Manitoba that are not met at the same level that we are used to in other regions of the province, and that is where I am specifically looking, whether or not there is any special--with respect to the consideration, are the northern communities, for example, rated on the same basis in terms of their funding allocations for the regional authorities, on the same basis as some other communities that have perhaps access to resources closer to the city of Winnipeg in general?

Mr. Praznik: Mr. Chair, today they are, by and large, with some exceptions, but as we move to a needs-based system of funding, given some of the real concerns in aboriginal health, those will be taken into account in going to a needs-based funding system, so we are not there yet, but we are moving in that direction.

Mr. Chomiak: This area does require some specific treatment, but for time considerations, I think we are going to have to move on in order to deal with some of the other areas.

Mr. Chairperson: I would like to take you back just a spec here just to make sure of a number that I quoted 3. (d)(1) $14,065,700--pass.

21.3. Community and Mental Health Services (e) Rural and Northern Operations (1) Salaries and Employee Benefits $25,265,300--pass; (2) Other Expenditures $5,303,900--pass.

21.3.(f) Chief Provincial Psychiatrist (1) Salaries and Employee Benefits $197,100.

Mr. Chomiak: A while ago, the previous minister announced an initiative with respect to physicians assisting in psychiatric health. That was physicians I believe who are not specifically trained as psychiatrists, but a program that allowed them to fill the gap in areas and communities in which access to psychiatrists may not be available. I wonder if the minister might give us an update as to the status of that.

Mr. Praznik: Mr. Chair, I do not have a number as to how many GPs we now have in that program. We will endeavour to get that for the member, but the program is continuing, I am advised.

Mr. Chairperson: 21.3. Community and Mental Health Services (f) Chief Provincial Psychiatrist (1) Salaries and Employee Benefits $197,100--pass; (2) Other Expenditures $43,000--pass.

21.3.(g) Adult Mental Health Services (1) Salaries and Employee Benefits $778,200.

Mr. Chomiak: This is an area where we traditionally spend considerable time. Again, it is not going to happen, although it has been canvassed pretty extensively, and I thank the minister for providing me with information last session which dealt with some of the programs in Mental Health and their application, which allowed us to have some of the initial information.

I have a few questions in this area though, however. The first question is, one of the concerns that has been expressed is the interrelationship between mental health and its integration in the regional health authority. There has been much concern expressed concerning whether or not mental health resources and mental health concerns when fighting for resources against acute care and others may get the short end of the shrift. What structurally has been put in place to ensure that there is adequate representation in the regional authorities as well as the Winnipeg Health Authority and other bodies to ensure that the mental health community and their representatives have an adequate say in terms of developments?

Mr. Praznik: I guess this is always a difficult issue whenever you integrate services, to take one particular component and say we are going to single this out and ensure that it has a different mechanism. One is loath to do that, because you could make the argument for everything. We did try, in making appointments to the regional health authority, to ensure there was some background, but that is a first step, temporary step. We are concerned that mental health services be properly integrated when in fact that happens, but currently mental health services are today and will continue to be funded directly by the ministry in Ms. Hicks's area, External Programs and Operations, and the regional health authorities have a lot to do in building up their other areas of service. So in the current time we are not moving them into the regional health authorities. At some point in time, when there is a comfort level that this is not going to be disruptive to the work that they do, then we would look at it, but today it remains as a separately funded part and we hope to build an integration to be able to get working relationships developed so by the time it actually does happen it would be something that would not result in any diminution of service or interest.

* (1730)

Mr. Chomiak: So the minister is saying, for this upcoming budgetary year--I am sorry, maybe the minister wants to clarify.

Mr. Praznik: I thank the member. Just to clarify, it is a separate line in their budget, and it is directly under the supervision of Ms. Hicks, so they cannot take money out of that budget to do something else with it. So there is a delivery and an integration, but budgetwise it is a separate budget item. I just want to clarify that.

Mr. Chomiak: So the provision of mental health services still comes under the operation of the regional authority, but they have a budget line item in each of their budgets that is allocated towards mental health, is that correct?

Mr. Praznik: Yes, that is correct. As well there is a special line in our organizational chart, under Ms. Hicks, as associate deputy minister. So we recognize that although there are things that integrated in delivery, there is in terms of offices, administration and working with other care providers, because Mental Health Services often have a role to play with other health services. We wanted to make sure that all the work that has been done in developing reform in Mental Health was not in any way jeopardized by moving them into the system.

Mr. Chomiak: Will that also occur in the Winnipeg Regional Health Authority?

Mr. Praznik: That is our intention at the current time.

Mr. Chomiak: Is it correct to say that is an exception to the general rule? For example, the Department of Health would not say, or does not say, that you must allocate X amount of dollars to Acute Care and X amount of dollars to Personal Care Home in your line item, as opposed to they now saying that you must allocate X amount of dollars to Mental Health. Is that a correct observation?

Mr. Praznik: Yes, it is, although just to put it into context, when we moved all dollars this year it was, by and large, on a status quo basis. We suspect as regional health authorities get more into their planning and being able to effect changes in operation, there will be natural shifts that occur. Dollars that are now budgeted for underutilized or unused acute care beds are likely to flow into personal care home beds. Where there is a greater need for home care and a reduced need for acute care, there is likely to be that flow.

So, although we have moved everything over, I guess the exception--the member is right, that Mental Health is a bit of an exception because we do not expect to see that kind of a change, and we will probably have to ensure that does not happen in the future, but in the current way everybody came over, all those budgets came over status quo. Many of them we expect just by their nature will result in shifts beginning next year as people get better ways of delivering service, but Mental Health is not one of those that we expect to shift in, nor have we allowed for that.

Mr. Chomiak: The minister's Mental Health Advisory Committee, does it still report directly to the minister, and who comprises it?

Mr. Praznik: I think we have tabled that list, yes, on the Mental Health Advisory Committee.

Mr. Chomiak: Just for clarification, I do not recall seeing it. I did not see it on the flowchart and that is the reason. It used to be a separate item reporting directly to the minister and that is what prompted the question. I agree, I did not get--

Mr. Praznik: Yes, Mr. Chair, it is missing from that draft. There are several other advisory committees that do not show up on that draft either. Obviously if they are ministerial advisory committees, they will report to me.

Mr. Chomiak: In terms of the various categories that are being allocated and worked on now with respect to the city of Winnipeg, is Mental Health and psychiatry a separate category that is making recommendations?

For clarification, we know that there are various reviews going on with respect to the allocation of services in the city of Winnipeg be it surgical programs and be it the various programs of excellence. Is psychiatry and Mental Health a separate program, and who heads that up?

Mr. Praznik: I am going to table this. This is the list of interim clinical program managers. Currently, with respect to psychiatry, is Dr. S. Barakat.

Mr. Chomiak: There has been a lot of confusion about where psychiatric programs might be located, and there has been a lot of debate going on. Is there any way the minister can advise as to what the present status might be?

Mr. Praznik: This is an area that my deputy is much better versed in than I. I am going to, with the committee's indulgence, give him the question, because as I said, this is an area there has been a lot of discussion. He is more familiar with it than I am.

Mr. Chairperson: Is it agreed that the deputy minister will answer some questions in this area? [agreed]

Mr. Frank DeCock (Deputy Minister of Health): This was one of the areas where the design teams did not put in a lot of recommendations with regard to major changes either in mental health or in psychiatry in the city of Winnipeg. The rationale for that was because we just completed the mental health reform and a majority of the changes had been made. The ones that had been made were well into the planning stage, so there did not need to be a lot of changes to be made.

Mr. Chomiak: We can pass.

Mr. Chairperson: Item 21.3.(g) Adult Mental Health Services (1) Salaries and Employee Benefits $778,200--pass; (2) Other Expenditures $1,948,300--pass; (3) External Agencies $7,765,200--pass.

Item 21.3.(h) Child and Adolescent Mental Health Services (1) Salaries and Employee Benefits $178,200.

Mr. Chomiak: I again thank the minister for providing me a list of programs and funding dealing with this area. That assisted in getting a fairly good understanding as to what is going on. This area itself, however, if one is to make an exception for mental health, some allocation or some recognition of the separate nature of it, certainly within that exception, the exception of children and adolescent mental health is probably a highest priority. Is there any special provision within the context of the RHAs' establishment and, more to the point, the Winnipeg Hospital Authority board, to deal with the child and adolescent mental health on a priority and a specific basis?

Mr. Praznik: Not specifically today, but once they are up and running that may be something that they identify.

* (1740)

Mr. Chairperson: Item 21.3.(h) Child and Adolescent Mental Health Services (1) Salaries and Employee Benefits $178,200--pass; (2) Other Expenditures $141,500--pass.

Item 21.3.(j) Brandon Mental Health Centre (1) Salaries and Employee Benefits $16,234,000.

Mr. Chomiak: I wonder if the minister might just give an update as to the present status of the time line for the closure of the Brandon Mental Health Centre.

Mr. Praznik: I understand April of 1998 is the time line, so that obviously necessitates some capital construction this year for the replacement beds and the suitable notification of staff, et cetera. Two projects that are referenced are the ones Ms. Bakken referred to in a capital program that will allow for that to happen and will be underway this year

Mr. Chairperson: 21.3. Community and Mental Health Services (j) Brandon Mental Health Centre (1) Salaries and Employee Benefits $16,234,000--pass; (2) Other Expenditures $1,649,000--pass; (3) Less: Recoverable from other appropriations ($3,264,400)--pass.

21.3.(k) Selkirk Mental Health Centre (1) Salaries and Employee Benefits $16,791,200--pass; (2) Other Expenditures $2,558,500--pass.

21.3.(m) Public Health (1) Public Health and Epidemiology (a) Salaries and Employee Benefits $1,402,600.

Mr. Chomiak: Under the Activity Identification on page 68 of the subappropriation, it is indicated that the branch is administering, they are detecting and controlling the Canada/Manitoba Meat Inspection Program. Can the minister indicate whether there has been an expansion or a retrenchment of this program?

Mr. Praznik: I will endeavour my staff. I do not have the detail on that here. If the member does not mind, I will endeavour to have that for him tomorrow.

Mr. Chomiak: I am specifically asking it because I am of the impression that some of the federal government resources that have been allocated in this area are declining and are being devolved to the province. I wanted to see the relationship between the decline of the federal resources and the commensurate activities from the province, so that is just a clarification as to where I am actually looking, who I am going to with respect to that program.

The activities also indicate support, revision of a new Public Health Act. Can the minister clarify what this refers to and where we are heading with respect to a new Public Health Act?

Mr. Praznik: As in all pieces of major legislation, every now and again they require a review. I know Dr. Guilfoyle is part of a group that is looking at the whole act, its structure, what we are attempting to accomplish with it, what we are able to do in a world of new technology, so there is a fair bit of effort that has to go into that. It is not an act I am planning--well, certainly none this session of the Legislature. We would expect sometime in the future to have a major rewrite of our Public Health Act, but it would be just like any other piece of legislation that is probably long--it is now overdue.

Mr. Chomiak: I raised that because we did amend The Public Health Act significantly, relatively significantly last year.

Mr. Praznik: Mr. Chair, I am advised that this has been suggested, I guess, internally, that it is really time, given the change in administration of health care with regional health authorities, new changes in technology, a variety of other things that face us, that a major rewrite is needed now.

I must admit to him I have not had an opportunity yet as minister to assess all of that. I inherited that process underway. I have great confidence in Dr. Guilfoyle and the advice that he offers. I come into this somewhat new but, from the very preliminary discussion I have had with him on the matter, he makes a very strong case for a major rewrite, so I would rely on his advice and we will see what this produces.

Mr. Chomiak: During the course of hearings with respect to Bill 49 last year, one of the strong recommendations that certainly came through from public presentations of individuals who have some familiarity with public heath was that one of the changes that ought to take place in terms of changing health resources is resources applied to the public health area. I am wondering if that is reflected at all in the--and it does not appear to be in terms of the financial allocation, but I am wondering if there is any recognition of the increased role of public health, particularly outside of Winnipeg, as it relates to the new RHAs as they come into existence.

Mr. Praznik: I think we for many years have recognized that if you want to improve the health status of your citizens, being able to effect changes in lifestyle, life circumstance, can make a big difference, and, of course, many of those are public health issues. One practical difficulty is as you struggle with the day-to-day critical issues of treating illness and having a treatment-based system, it is very hard to see a movement of resources, particularly in tough times as we have gone through in the last few years, from health care services and delivery and treatment into the public health side. I know this has been a debate for some time.

Obviously, as we start to get, I think, a little bit better handle on things, regional health authorities have a role to play in augmenting the awareness of issues dealing with public health concerns--it is very important in northern Manitoba in our aboriginal communities--and somewhere in there, hopefully, we will be able to accommodate a shift of resources that will lead to better results in the future, but it is always hard to move resources from current points of crisis into other areas knowing it is some years before you see the result. You do have to do that, but it is somewhat difficult to do.

I would suspect in my very preliminary discussions with Dr. Guilfoyle that this is part of the basis, recognizing the need to have a greater public health role as part of the basis on which a rewrite of the act is flowing from.

Mr. Chomiak: I am assuming that the public health function will remain a centrally operated function under the provision of the RHAs and the Winnipeg Authority, or am I incorrect in that assumption?

Mr. Praznik: Mr. Chair, the member is partly correct. The medical officers of health which deal with a host of, obviously, province-wide issues will remain a central function, but public health nurses, for example, and many of the service providers have already in rural Manitoba and northern Manitoba been transferred to the regional health authorities, and that will happen in Winnipeg. So, in essence, the direction on major issues of public health will be held centrally, but the delivery of public health service to the public office, in many cases, will reside with the regional health authorities.

Some exception to that, because there are policy issues from municipalities or communities, et cetera, which still may receive a service from the central function, but many of the current services provided by public health nurses, for example, will be provided under the auspices of the RHAs because they are much better to integrate with other service providers, but the policy-monitoring functions of public health will be housed in the ministry under Mr. Potter's section.

Mr. Chomiak: So public health officers will be employed by whom?

Mr. Praznik: Mr. Chair, the medical officers of health, by and large, will be employed by the province under the direction of our chief medical officer of health, Dr. Guilfoyle, or his successor, and the public health nurses, those who deliver the service, will be housed by the regional health authorities.

So, in essence, on many of these issues that require a provincial health warning or something to put out for a particular illness or bacteria in the province, they will be issued to the regional health authorities, whoever their designated person is to receive it.

Mr. Chomiak: Mr. Chairperson, how many medical health officers do we have at present?

* (1750)

Mr. Praznik: Mr. Chair, we will have that exact number for the member tomorrow. Part of our difficulty is we are in the process of hiring at least two staff currently, and if I give him the number, I do not know if we have actually hired those individuals or they are in process, so we will have the exact count for him tomorrow.

Mr. Chomiak: There is a long history of amalgamation and nonamalgamation between the public health function and the City of Winnipeg and the Province of Manitoba. Given that Winnipeg is going to be regionalized, do we have a definitive word as to who will assume the public health function within the City of Winnipeg?

Mr. Praznik: We do not today have a definitive answer. We are into negotiations and discussions with the City of Winnipeg. They have negotiated arrangements or are with the Department of Environment over certain element of inspection service, and we are interested with the Winnipeg Long Term and Continuing Care Authority to be able to see if an amalgamation of public health and other nursing functions can be provided out of that one authority.

There are a host of administrative issues, collective agreement issues to be worked out. We are having those discussions now and ambulance is another area where we are not quite sure where best to house the ambulance service, whether the Winnipeg Hospital Authority or the City of Winnipeg. They have had some thoughts of amalgamating it with Fire. I met with the city officials last week and we advised them that in our Regional Health Authority Amendment Act we have provision for a number of areas to correct or to change or amend parts of The City of Winnipeg Act and several other pieces of legislation that require the City of Winnipeg to perform some of those functions. If we conclude satisfactory arrangements with them, the act as we have proposed it to the Legislature will allow for those sections to be repealed on proclamation. And so we have allowed for that to happen. Hopefully we can work a reasonable agreement in which case those authorities would be changed in other statutes.

Mr. Chomiak: Mr. Chairperson, further to my earlier question concerning the meat inspection program, if the minister could tomorrow provide us with information about the national harmonized food inspection system and the various resources that are being allocated towards that as referenced on page 68 of the subappropriation book.

Mr. Praznik: Yes, Mr. Chair, my staff will endeavour to have that information tomorrow.

Do you want to call it six?

Mr. Chomiak: As the clock nears six o'clock, I just ask that--this is always mandatory in the Estimates--an update with respect to the tobacco enforcement legislation and any developments in this regard. The minister periodically receives correspondence from myself and others with respect to enforcement and other related matters and if we could just have an update. [interjection] The Tobacco Act, the control, minors. It would be appropriate if we could perhaps have that information if it is possible for tomorrow.

Mr. Praznik: Mr. Chair, as the member appreciates, it is not an issue I have become familiar with in terms of its administration in the last few months, but I will endeavour to get an update from my deputy on that for the member tomorrow. I gather, since it has not been a huge burning issue in my department, perhaps it is actually going well. I thank the member for the question.

Mr. Chairperson: Order, please. Is it the will of the committee to call it six o'clock? [agreed]

The time being six o'clock, committee rise.