Mr. Chairperson (Ben Sveinson): Order, please. I guess we will resume consideration of the Estimates of the Department of Health. I would like to thank the honourable member for Pembina (Mr. Dyck) for taking over for me this morning, but back to our honourable member for Kildonan.
Mr. Dave Chomiak (Kildonan): As indicated earlier, I anticipate that we will spend the balance of the day on capital, and we will probably have to return to capital for a short period of time at some later date that we can negotiate. My colleagues will also be joining us to deal with some questions. I tried to give a quick briefing to my colleagues. I hope we do not cover too much ground that has already been covered, but unfortunately the nature of the way things work it has not been advisable, so there may be ground covered again.
Just at the onset, can the minister indicate who will retain responsibility for capital decision making? Is it going to be ceded to the various authorities, and how is that process going to work?
Hon. Darren Praznik (Minister of Health): The change in structure for decision making, the ultimate authority to approve capital projects, will remain with the Ministry of Health. Obviously we deal with Treasury Board on our allotment for capital programming, but what we have done is we have asked regional health authorities in their planning process to review their capital needs, sort out their capital planning and to make recommendations or requests, I guess is more the correct term, to us on a regular basis for their capital needs. Then what we do is we will assess them against criteria that we develop and setting priorities throughout the system and take forward our list for approval.
So there are really sort of two stages of sorting. There is the sorting within the region, and I think the regional health authorities have been developing. There is some trial and error in this and getting a feel for it in the first few years, so it is not that it is written in stone, but I think they are developing a sense of their own criteria, and we have been working with them a bit on that and what they use on assessing projects and vetting projects and sorting them out on what is really needed and then moving their lists and priorities forward to us for a similar kind of province-wide assessment of need, and then we move to our annual approvals.
Mr. Chomiak: Suffice to say roughly the process is not changing with respect to capital from the previous system as it relates to regional health authorities other than that it is a different administrative body that will be making the capital requests? Is that a fair observation?
Mr. Praznik: Mr. Chair, in process, yes, I guess, other than before facilities used to make requests for their capital needs or communities.
Yes, Mr. Chair, one difference, I guess in practical terms, is that their capital program has to be tied to their regional health plan. So as opposed to just sort of holus-bolus requests from communities that one would get, their capital has to fit into their overall health planning. I think what we are starting to see, particularly on the rural side or the outside of Winnipeg part of the province, is that as regional health authorities are taking over their facilities, they are able to look at where they deliver services within those facilities.
One of our objectives is to make sure we are getting the best use out of the current capital that we have. That is one of the reasons why we created the conversion fund. I know, for example, in the Marquette region of the province, when you look at the region overall you find out that on acute care beds it probably has some 100-plus acute care beds today that it does not need. It does not have a need for that 100 acute care beds. On the other side of the coin, they are probably short 80 to 100 long-term care beds.
So one of the things we would expect in their planning process is, as much as practical, be converting acute care beds to long-term beds and bunching them and making use of their facilities in a manner that will sort of maximize the appropriate use of that space. Other things that come up in this process, too, is regions look at the services that they deliver. I know in my particular region of North Eastman there was a need for a rehabilitation service, physiotherapy, people who have gone through hip/knee replacements. Just in saying, where are you going to put that, well, there was a fair bit of space available at the Pinawa facility, and so that became the obvious place, and the local health authority decisions were made that that would be developed at that particular facility.
So, again, we want to make use of our existing capital as best we can, and that is somewhat new in a practical sense because under the old system, when each facility was dealt with separately, it was much harder to get that kind of planning process. It was almost impossible to make sure space was being well used throughout a region.
Mr. Chomiak: When we next meet, would it be possible to get an update as to the status of the major capital plans that were announced last year when the capital plans were unfrozen, if we could have an idea of the status as to the various stages of those particular projects?
Mr. Praznik: Mr. Chair, I am going to ask Ms. Bakken to do that to the committee at this time.
Ms. Linda Bakken (Director, Facilities Development): The first project would be the Cancer Foundation, and we are anticipating that that project will go to tender within the next six weeks. The Red Cross project, or the Winnipeg blood transfusion centre project, is already under construction.
Then in the 1997-98 capital program, there were what we called six major projects approved. The Health Sciences Centre, the project has now moved into what we call schematic design, and we are hopeful that the first phase of the project, which is what we call CN decanting, which is a building that has to be taken down in order to prepare the site, could go to tender late this fall.
The second would be Brandon, which I gave a verbal briefing on this morning. The third would be Boundary Trails, and we are anticipating the construction tender for the piles will be let this fall. The main project tenders will be let in the spring of '99. The Betel project that the minister has already referred to, the Lions project--well, I am being safe by saying August. It could be July, depending on how things go. It will go to tender. The Sharon Home, which is a replacement of the 60 beds, the community is still looking for a site that is appropriate, because they want to have not just a care home but some supportive housing.
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Mr. Chomiak: Just two quick questions arising out of that. Is the community contribution for the Boundary Trails still $6 million and, secondly, are you saying in the Sharon Home that the site still has not been arrived at?
Mr. Praznik: Mr. Chair, I think the member does hit upon one of the frustrations, I guess, in dealing with the Sharon Home. There are more delays than we would have liked. Part of it, as the member may know, is that their administrator, Mr. Daniel Ruth, departed sort of midway in this process, which caused some delay. We know those beds have to be replaced. I would have loved to have seen them in the ground a lot earlier, so we continue to push them. But as sponsors for the project, they have some decisions that they want to make. By the way, I have not included those 60 replacement beds in the calculation of construction that we discussed this morning, because they are, in fact, replacement. They do not add new beds at the end of the day. The only additional service they would provide is if we get them constructed and keep the old ones open so much longer, but I do not think that is a very desirable option, given the quality of the current capital.
With respect to Boundary Trails, I am going to get Ms. Bakken to describe them in greater detail. She has done some more work on revising the costs of that project, but I also understand that the community has gone a long way to raise dollars in the process of doing it with municipal commitment, and there are some credits and some other issues that are coming along there. So she will give us an update.
Ms. Bakken: The application of the community contribution policy in terms of a 20 percent would require that the Boundary Trails communities pay $6 million, but the details that were announced this morning on the community contribution policy, we do not know at this point how that community will take that, what pieces of cash they will put down. So the bottom line in terms of how much they will have to come up with and the credit for the land that they have already purchased and things like that, we are not able to give that to you, because those discussions have not occurred and because the policy has just been really announced today.
Mr. Praznik: Mr. Chair, I may add that the member for Pembina, Mr. Peter George Dyck, has been working with me very closely on this particular project. I know he has been very closely involved with the RHA and the various municipalities in that area, and he was one of the colleagues that I certainly consulted as we moved through here on changes that are needed to the policy. I know he is very confident that the changes we made today should go a long way on that particular project to ensure that it is manageable by the community.
Mr. Chomiak: We indicated when we last met and talked about food services that there were some details to be forwarded regarding the renovations to the kitchen facilities at Health Sciences and St. Boniface and figures and numbers. I wonder if we have that information.
Mr. Praznik: Mr. Sheil I know will be returning to the committee. If I may have a moment with Ms. Bakken. With respect to that matter, the base numbers of capital, and there are some issues of transition, we will want Mr. Sheil to be back, I think, and Ms. Bakken at that time to go through both, because the estimated $35 million, there are a number of components to it, and I want to make sure both of these people have had a chance to discuss it and ensure that the accurate information is coming to the committee.
Ms. Rosann Wowchuk (Swan River): Mr. Chairman, I would like to ask a couple of questions under the capital area that apply to my constituency or in the Parklands region. There are three projects that I would like to ask some questions on. One of them is the Winnipegosis facility, the conversions there. I would like to ask what the anticipated cost of that is and whether or not, when there are conversions, there are any community contributions that are required in conversion? There are two projects, the Winnipegosis one and then there is one in Ste. Rose that has a conversion. What are the costs, and when you anticipate they will be done?
Mr. Praznik: Mr. Chair, with respect to the policy issue--and I know members are in and out of three committees--we today indicated at this committee we had made changes to our policy. There have been no changes in the conversion area. Conversion dollars is I have a $10-million fund with a ceiling of $500,000 per project. The purpose of the fund is to be able to take space in existing facilities and convert it to better use space; for example, an operating theatre in a hospital that does not do surgery, converted it might become a clinic for a doctor, it may become a room for nurses, it may become additional beds, whatever is required.
We do not require a community contribution for conversions. I think to date we have approved some $4 million of the $10-million fund, and that is available because there are other projects that are coming up through the RHA and community process.
I am going to have Ms. Bakken respond directly on the two projects to give you an update of what she knows from our capital program.
Ms. Bakken: Mr. Chairman, as conversion projects, they will not exceed $500,000 each, but we do not know what the actual cost will be until they are tendered. The staff have talked to the facilities, the facilities are now recruiting an architect, and we anticipate that those projects will go to tender this fall. They will have a very short construction period because they are relatively minor projects.
In Ste. Rose, they are using the existing operating theatre space to provide expanded space for ambulatory care and clinic offices. In Winnipegosis, they are using the space now dedicated to the operating theatre and the delivery room to provide for physician clinic space.
Ms. Wowchuk: Mr. Chairman, so those two are conversion projects. The other project that is listed in the capital project is a community health centre at Sapotaweyak Cree Nation, and it is listed as a major project. I would assume that if those projects cannot exceed $500,000, that a major project would be a larger amount of money.
Can the minister indicate what amount of money is targeted for Sapotaweyak Cree Nation community health centre and at what stage that project is at?
Mr. Praznik: Mr. Chair, I am going to ask Ms. Bakken to describe the project, the information she has and the costs, et cetera. I know the member for The Pas (Mr. Lathlin) joins us, and I expect he has some questions.
We have revised our policy and I have shared that with members of the committee this morning, so I know I can expect everyone to be up to date on that, but there are some issues that we have dealt with with respect to First Nations and unorganized territories, Northern Affairs communities, and how that is treated because there are different funding mechanisms. I think it now makes it much easier to deal with these projects when we determine the community contributions, so I am going to have Ms. Bakken describe to you the project, and then perhaps we can discuss some of the other issues.
Ms. Bakken: Mr. Chairman, the Sapotaweyak Cree Nation project is primarily a federal project, and the province was asked to make a contribution to support the space that would normally be occupied by staff that are funded by the province. So the actual stage of this project is really in the hands of the federal government. The province has approved a contribution to support the space for the operating dollars that the province would be transferring to this Nation, and so the actual scope of the project and the timing of the project is really in the hands of the federal government.
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Ms. Wowchuk: What you are saying, then, is that the province will be allocating money to provide space for people from the province who come to provide service such as the provincial public health nurse that comes out, then the province will want to ensure that there is space available for the people to work there. Is that the space you are providing? I am not clear on what is being proposed.
Ms. Bakken: My understanding is that there is no dedicated health centre space in that community at this point, and that community, along with a neighbouring Metis community, is negotiating with the federal government for the transfer of health services to their control and that when that transfer occurs, part of that transfer will include a building.
They are also talking with the province--and I really want to defer more to Sue here--around the transferring of the authority for the services that the province has been delivering and therefore the operating costs associated with them. When those transfers occur to the authority of the community, the province will contribute to building space to support those functions.
Mr. Praznik: If I may add to this, I guess part of the relationships--and one has to appreciate the different jurisdictions and delivery systems that are in place and what we are trying to manage throughout this. I know that I have to put some people in place in my department in the next number of months to manage relationships with MKO, for example, who are moving into the health care area and negotiating a transfer agreement with the federal government. We have a number of these other issues, and we have to staff up to deal with them, but we want to have some common sense in the delivery of systems.
If a First Nation who has a different jurisdiction than the province--although there is a lot of overlap in health care delivery and funding--if they are taking over the delivery system from the federal government Health and Welfare Canada and that facility or system that they are building in a particular area is also going to service or can service neighbouring communities that are obviously smaller, it makes absolutely no sense for anybody to reinvent the wheel twice.
You know, we do not want to see the regional health authority setting up a health centre. I guess Norway House, which I believe is in the constituency of the member for The Pas (Mr. Lathlin), and I know the member is familiar with Mrs. Isbister and the Northern Affairs community there. There are a lot of issues and they are complicated, but it makes no sense for the provincial regional health authority to set up a parallel system of delivering health care when you are next door to a First Nation who is building their health care service, which is the larger community. It just makes eminently good sense for us to be contracting for those services, and vice versa, in cases where you may have a small First Nation next to a much larger provincial community.
I think we want common sense to apply, so in this particular case I gather what is happening is the First Nation here is negotiating transfer of health care services. They are going to be building a clinic. There are a certain amount of services that the province provides there now. I gather the plan is to transfer those health dollars with the regional health authority. Why replicate the wheel?
With that is also a capital requirement for that, so this would be the budget for our share of the capital to that project when the First Nation and federal government get it going, but it is committed in this year's budget. Whenever it is spent is out of our control, but it is committed and should not be a reason for the project not proceeding.
Ms. Wowchuk: Can the minister indicate what amount is committed to the project in this year's capital project?
Mr. Praznik: I gather it is a percentage of the tendered cost. The only reason we are a little reluctant to put out a number with that is, my staff continually make the point with me, if you put out numbers before projects are tendered, they tend to affect the tender price. So we probably worked out a contribution agreement on a percentage based on space or use. I am not sure if that is the case or not, but Ms. Bakken may want to comment further.
Ms. Bakken: We have a number in the capital program that we think would adequately provide space for the number of operating dollars that the province would be transferring, but like the minister says, the exact number is generally not made public at this time. I can just assure that the province has provided for an appropriate amount to support the transfer of provincial responsibility to that community.
Ms. Wowchuk: I am not trying to pin the minister down for an exact number, but I guess I am trying to see--you talk about percentages. How do you work out what your percentage share is? Do you take into consideration the nonaboriginal, the Metis people that will be served, or is the government responsible for certain services on the reserve? How do you work out what percentage is the province's responsibility?
Mr. Praznik: I am going to ask Ms. Hicks, in whose area of responsibility this lies. She is much more familiar with the specific negotiations than I am. I will have her answer this question.
Ms. Sue Hicks (Associate Deputy Minister, External Programs & Operations Division): The formula that we use, or what we are actually doing here is that in the transfer of dollars, where the 64 agreement is still in place, we are looking at transferring to the Swampy Cree First Nations and the adjoining communities the amount of service that we currently provide, and so the actual amount that we provide right now.
Ms. Wowchuk: Given that the Swan River Hospital now provides the services to this area, and the Swan River Hospital is part of the Parkland Regional Health Authority--and I know there are lots of layers in here--will there be an impact on the dollars available to the Parkland Regional Health Authority or to the Swan River Hospital for services that they provide when this new facility is established, or is the department going to have to find new dollars to provide these services?
Ms. Hicks: The Swan River Hospital will still be providing the hospital care and the community health centre is essentially picking up the community-based care. We currently provide service on the community, out of the Parklands area, and it is that community-based service that we will be transferring to them. Now, presumably, there could be some reduction in the utilization of the Swan River Hospital if people are getting their community-type care closer in the community, but the service would still then be available to them, and I do not see that it would be all that significant. It is a different kind of care, the comparison.
Ms. Wowchuk: Would the department play any role in the designing of what the community wants or doing an assessment of the services that are required within Sapotaweyak Cree Nation, or are they responsible to do all their own assessment and planning of what they need, and then going to the federal government?
What is the role of the department in ensuring that the services that are being requested are the ones that are actually needed there and assurances there are not oversights in some places, that there may be other services that can be provided, or maybe there are some that are being suggested that do not necessarily have to be there. What is the role of the department?
Mr. Praznik: Just by way of a general principle, and I am being somewhat cautious in this area because we are developing some relationships now, I know we have had discussions with MKO, and I know the member for The Pas (Mr. Lathlin) is probably far more familiar with the details of this than I am, so I look for his correction should I be off track.
My understanding is that MKO and First Nations generally are in the process of negotiating or planning how they want to deliver or to take over the delivery of health care services. I have recognized very fully in this that there is a different jurisdiction for delivery of health care, and I respect that. There are overlaps in delivery of service. Obviously, hospital care is paid for by the province, and most of it is delivered other than the--I guess the hospital at Norway House would be one hospital in a First Nation.
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In the discussions I have had with MKO--and we want to get into some formal agreement with them shortly. We want to make sure that as they set up--and it is their decision how they do it--their health authority or authorities, we want to make sure that we are dovetailing with them with our provincial regional health authorities so that we want to build the co-operation and co-ordination in this process, and we are not tripping over each other or at odds.
How we are going to do that, we still have some work to do, and I know in principle there was an agreement that we would even look at doing some joint appointments to each other's boards so that regional health authorities in the North, Burntwood and Norman would, say, have two individuals who would sit as ex officio members of whatever health authority the First Nations structure, and two of their members on each board would sit on those regional health authorities.
So people are talking, and we have always said we are prepared to work, provide assistance and planning, and that is what we are sort of dealing on this agreement that we want to put in place now, but we respect there are two jurisdictions.
I know initially some of the people at our regional health authorities took the view that we were delivering all health care everywhere. Well, you cannot deliver where you do not have the jurisdiction. You have to respect other people's jurisdiction and work co-operatively. So that is what we are attempting to do.
Ms. Hicks may want to talk specifically about this planning, but I would imagine that the initiative for this is coming from either the tribal council or that community. We certainly want to work with them. We have some obligation for the provincial communities around the First Nation that are serviced out of that, as does the regional health authority, but it is a matter of sorting this out. If there is expertise we can bring to the process that they would like, we are more than prepared to do it, but I do respect that by and large this is an initiative of the First Nations within their jurisdiction, and we are the tag-along to this by and large because the majority of service is in their jurisdiction.
So we will work with people. We want to make sure everyone's interests are there, but the lead on this is and has to be the First Nation because the majority of the services there is within their jurisdiction.
Ms. Wowchuk: I also recognize that, and I know that the people at Sapotaweyak Cree Nation have been working for a long time wanting a nursing station there, and I recognize their concern. If the minister has ever been out there, it is a pretty isolated area and a long ways from a hospital if you get in trouble, and lots of people have gotten in trouble. So I recognize their need, and I support them fully on their endeavour to bring a nursing station to their community.
What I am hearing then, it is in the hands of the First Nations to move it along. The money, the provincial share, when the agreement is come to, then the provincial money is there, but we do not know exactly how much money that is. Roughly, you know how much it is.
I guess the question is, of the project, what percentage--you must have worked that out--of this project do you feel is an obligation on the part of the province for the capital project? Is it 10 percent; is it 20 percent; is it 50 percent? What percentage of the project?
Mr. Praznik: My staff advise me--they do not have the exact percentage--the bulk of the service here and provision is outside of our jurisdiction. I am advised that less than 10 percent is our contribution respective of our share of what we are contributing. So I do not want to leave any impression we are the major player. That is for the capital. It would be somewhere under that, which would be representative of our share of what we are buying and what is an essentially federal First Nations initiative.
So that is why we have been asked to contribute, I gather, to make this work on the basis of our usage. We are prepared to be there. I imagine one could always argue whether it is 8 percent or 9 percent or 10 percent, but I leave that to others to work on the basis of fact, how they work it out, but we are there with those dollars. If some circumstances change that it is a little more here than others, we have the ability to adjust that, but we are really the minor players in that project.
Ms. Wowchuk: I heard your staff saying this is on capital. I want to ask, and I know we are talking about capital, but once the project is done, what responsibility will there be on the part of the Department of Health to ensure that services are provided there? Will there be a commitment of dollars to ensure that the facility can also operate?
Mr. Praznik: Ms. Hicks may want to comment, but our current delivery of service, I believe, is based on the 1964 agreement, which I do not for a moment pretend to fully understand. She may want to respond, but again we are relatively minor players in this.
Ms. Hicks: We are in the process of working with the Cree Nation and with Swampy Cree to look at transferring of the dollars that are assigned through the 64 agreement. Essentially, we want to dissolve the 64 agreement, and our negotiations that have been going on are that once the 64 agreement is dissolved, then we will transfer the service that we currently fund or provide. We will transfer that service most likely through dollars to the First Nations and adjoining communities. They will then use those dollars to provide the community-based service, and this relates only to community-based service, to both communities, the First Nations and the adjoining community, and the Metis community.
So those dollars have been determined based on actual dollars, and I do not have the numbers for the individual First Nations and adjoining communities, but we have gone community by community, and once we have come to some agreement, we will transfer those dollars over. Then if there is additional dollars that are needed for community-based services, then that takes on a different negotiation.
Mr. Praznik: If I may just add, I know this will be of interest to the member for The Pas (Mr. Lathlin) as well. As the members may know, Mr. Rock and the federal Liberal government made several hundreds of million dollars available for pilot development in home care and Pharmacare, and I think they are now walking away from Pharmacare and are looking at home care. I have had occasion to meet with Mr. Rock, and I said to him very bluntly, you want to develop a national home care program. I hope you recognize what Manitoba has already done in terms of development of home care.
I give credit to previous governments, because our two parties in particular have developed the home care program over 20, 30 years in Manitoba. I know we have more than tripled or quadrupled the funding on it, and the initiative to begin it goes back to the Schreyer years, so both parties can claim credit to developing what has become one of the best home care programs in Manitoba. That home care program is not provided in any way by the federal government in its health care support on First Nations.
When I met with Mr. Rock, I said to him, I asked him: if you want to develop a national home care program, are you prepared to give us dollars today for what we are doing if we are already meeting or exceeding the standards you want to raise the country to? And he said, no, his dollars, which are very limited--in fact, I think his total budget would buy only three or four days of health care in the province of Ontario, just to put it in perspective. He said no, this is for innovative programming or new things.
He then said to me, what would be your priority in Manitoba? I said, well, you are not giving me any new money for my Home Care program. That is right, he said, no, I am not going to do that. What would be your priority? Well, I said, we need an information system, that is one thing. But, I said, even greater, Mr. Rock, the area where we really have a gap in home care is in your department, in your jurisdiction, that there is not home care or anything near adequate home care provided in First Nations communities. The delivery of those community services is through his department, Health and Welfare Canada, Medical Services branch.
He has indicated to me, he said, will that be your priority. I said, you know, Mr. Rock, I obviously have to go to cabinet on this, but my view is that if you were to, through your department, you do not have to funnel any money to the province, if you, through your department with the First Nations, were to use your resources to set up through your funding of First Nations health care, home care programs on First Nations in Manitoba, the Manitoba government, I believe, would consider that our share of that program nationally. The benefit to Manitobans, of course, all Manitobans, is we would have--aboriginal citizens in those First Nations have home care. That has an effect on hospitalization use in the North and others because one of the problems, I guess, in early release is you cannot take people out of The Pas hospital to take them to a distant community. There is not the home care supports.
So he said that is where you would get your savings as a province, which you would free up dollars for other things, and we said, great. So the latest word I have on this is that this is on his agenda over this year to be talking about it, and I think he would like to get to the point a year from now to be able to make a commitment in this area.
I wanted to put on the record today that that would be our priority. If the federal government is asking, how do you want us to spend your share of those dollars in Manitoba, we have identified that as a priority.
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So the reason I raise it in this context is if that develops, that obviously has the potential to see some additional services provided out of this centre and would make the thing work very well. But I wanted to put that on the record. I have said that privately to Mr. Rock. We have had some discussions internally about it, and I say that publicly today. I have also shared that information with MKO and others in the leadership of First Nations.
Mr. Oscar Lathlin (The Pas): Mr. Chairperson, I just wanted to ask this. I have several questions, but I wanted to--for the benefit of my colleague for Swan River. See, the federal government contracted with the provincial government in 1964 for the provision of health services to adjacent Indian reserves, I guess, such as what exists in Moose Lake, Easterville, Shoal River and Grand Rapids.
Now, since around about 1980-81, I guess, and even before that, when the tribal council movement really got going in Manitoba, I was an employee of SCTC in the fall of '79 as their executive director, and we had already started talks with the federal and provincial governments about terminating the 1964 agreement and having an agreement with the federal government for the provision of all services to Indian reserves. As a matter of fact, we had negotiated a dental agreement with the province where we looked after everybody, Indian and non-Indian, but the province paid for the non-Indian clients. There was a contract between Swampy Cree and the province.
So this agreement has been in existence since 1964, and the past 10, 15 years, there has been a movement to get away from that so that there is one jurisdiction operating in those communities. I think the problem has been in the past is that while negotiations have gone on, governments have been slowly chipping away at what was there originally, for example, on the federal side. Now that we have had health reform happening for five years now, I think the First Nations are a bit leery and--how shall we put it?--are being transferred an empty basket or almost empty basket. I think that is what has been the problem in those negotiations.
So when the member for Swan River (Ms. Wowchuk) is asking, well, how much and what is the percentage, Ms. Hicks, I think said, insofar as capital is concerned, that they would transfer the existing dollars that are included in the agreement. So I do not think it would be that difficult to determine the dollar amount, because all you have to do is go to your current agreement and say the current agreement calls for a million dollars, so that is what the transfer will be, if indeed, as Ms. Hicks says, we will transfer what is there now.
Mr. Praznik: Mr. Chair, I just want to clarify. The operating dollars, we know what we are spending on operating, and Ms. Hicks will provide that number or endeavour to provide it for the member or the member for Swan River. The question was on the capital, and that is working out a percentage share of the services and space, and we have that number--she does not recall it, does not have it at her fingertips. We do not give out the total cost of the capital of the project until it has been tendered, and that is why in doing that--I am going to let Ms. Hicks just clarify and provide that additional information.
Ms. Hicks: Mr. Chairperson, you are correct in that there are two issues here. There is the transfer of the community based services which, in essence, are the public health nursing services and those kinds of services through the 64 agreement, and that is what we have been negotiating for some time, as you are well aware, and have not completed those negotiations. Then there is the capital project that does not really link into that process. We have not been negotiating the capital through the 64 agreement. That has been a separate process through our capital program in conjunction with the federal government.
Mr. Lathlin: Mr. Chairperson, I think maybe I will ask the minister. There were in those 64 agreement communities--for example, in Grand Rapids there is a provincial nursing station there. Moose Lake, there is one there, and I am not sure about Indian Birch and Shoal rivers. There was never any station at Shoal River, right? [interjection] Okay.
What about in Easterville? Can the minister maybe tell us, because there was a new nursing station built in Easterville. I understand that nursing station was built on reserve land by the province, and I am not sure if it was literally transferred, the ownership which was transferred to the band. I am really not sure. Could I ask the minister to clarify that?
Mr. Praznik: Mr. Chair, I do not have that detail. I am going to ask Ms. Hicks to answer on some of this to the best of her knowledge. Some of these details we may not have with us.
I just want by way of a policy comment to make. I think we are recognizing as the First Nations take over--and I am very encouraging of it--more and more responsibility for health care, and I know what we want to do is we want common sense to apply. Obviously, I do not want to be replicating, having RHAs replicate health services for non-First Nation citizens who live around a First Nation, particularly in an isolated area. It makes no sense to reinvent the wheel.
So we want to ensure that we are working to deliver to community areas, and, obviously, in many of these areas it is the First Nations, who is the larger community, who are going to be building the health care. We want to make sure that we are contracting to provide services outside of that by way of principle.
Mr. Mervin Tweed, Acting Chairperson, in the Chair
So there is obviously a lot of revision to the 64 agreement and change, and I do not know where it is all going to go, but that general principle is where we want to be. I am sure there are First Nations in the province, for example, who are small enough and close enough to other centres who are not going to want to reinvent the wheel either locally. I think, for example, the Brokenhead First Nation in my constituency is relatively close to Selkirk, relatively small community. You are not going to build a hospital. In that particular field, you may have a health clinic.
So we want common sense to apply to make sure we are delivering adequately, and that works both ways. Most communities in the North will probably mean the First Nation will be the deliverer, and through the RHA we will provide a financial contribution to cover the services in their jurisdiction. That is the way I see things heading, bit by bit. I do not think that there is much disagreement on that issue, but I am going to have Ms. Hicks answer some of these specifics, if she has the information available.
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Ms. Hicks: Mr. Chairperson, the community health buildings are the health centres that are on the First Nations land. At the moment, in the 64 agreement, what we have been negotiating as step No. 1 has been the staff and the services. At this point in time, Government Services of the government owns those nursing stations, owns one of them. [interjection]
Mr. Lathlin: Well, I am not going to argue with Ms. Hicks. Maybe, as far as I know, what I know of the Indian Act, any building, whether it is federal or provincial, property that is situated on reserve land, unless there is a specific agreement between the band council and a property owner, but even then when the use and purpose for that particular project is no longer there, automatically, whether there is a reversionary clause in the agreement or in the resolution, the BCR, the building automatically reverts to the band.
For example, if you had a medical services building, federal, once the federal government has no use of that building anymore for that purpose then it automatically becomes an asset of the band.
Ms. Hicks: Mr. Chairperson, we can certainly double-check the actual ownership. It was my understanding that Government Services owns the nursing station and that the intention was that we would do some negotiation as far as the transfer of that, but so far the transfer process has only dealt with the transfer of services and people, and we have not looked at the property aspect. We can double-check for you the ownership, but to date, the 64 agreement discussions have only been relevant to staff and programs.
Mr. Praznik: Mr. Chair, I think just as a matter of common sense, I am sure the member for The Pas would agree, obviously the land underneath the building is trust land. The most one would have is a lease on it or a right to be there, if you are building a building, or you get the right to put the building up and you own the building. You never can own the land. I just want to correct a comment. Unless it is taken out of the First Nation territory, you cannot own it as a provincial government without going through all the legal formality of taking it out of the reserve.
The practical matter is, I am sure, if the province has built buildings on First Nations they are intended for health care purposes. If the structure by which health care is delivered in the First Nation changes, buildings are transferred, they are still meeting the purpose for which they were intended. I guess the only time it becomes a matter of issue is if the province has invested in a building, it is no longer being used and it is being sold or converted to other purpose, if there is any equity we would still have in that building.
I would doubt in practical terms that there is any equity left in most cases, so, you know, I say this just as a matter of public policy. We want to have common sense apply in these cases. If the delivery mechanism has changed, we own a building, it is part of a transfer, of course it is going to be transferred as part of our contribution to making this work, particularly if it is certainly still being used to meet health purposes.
Certainly, if there is no equity or value in the building and new buildings are built there is nothing to argue over at all. I would suspect if a building is not going to continue to be used for health purposes then it has probably reached the point there is not much value in it anyway.
Ms. Wowchuk: I, again, want to just ask about the Sapotaweyak Cree Nation and this capital project. If they anticipate that the project is going to be somewhere in the range of $1 million, then you are saying they could anticipate somewhere in the range of 10 percent of the project would be provincial share. Is that what you are saying, somewhere in the 10 percent range is what we are looking for that we would anticipate would be the provincial contribution?
Ms. Bakken: Mr. Chair, the policy concept behind this is that the province, who has been responsible for the delivery of a certain set of services, I think it is public health, if when you transfer those services to the community, say there are two public health nurses and two public health nurses require each an office and an examining room and share a clinic room, then we would contribute to the capital costs associated with supporting their function in the building.
So since the scope of the building is really in negotiation with the federal government in the Sapotaweyak Cree Nation, it is very difficult for us to determine percentage, because we do not really know how big it is, but what we have done is made a commitment to ensure that the space that is required to support the transfer of program responsibility will be sufficient, and the province will pay 100 percent of that cost.
Mr. Praznik: Mr. Chair, I guess just to put it--in listening to Ms. Bakken's explanation, I guess an example would be if we required 1,000 square feet to support the function that we are providing, that we will pay for 1,000 square feet. If the community negotiates a 2,000 square foot building, we are paying for half. If it is a 3,000 square foot building, we are paying for a third, and so on.
The idea is to pay for the space that would support the staff providing the services we have traditionally provided.
Ms. Wowchuk: I do not want to drag this on, but I have to clarify this for myself and what would be the province's responsibility. As I look at what is being proposed, they are proposing to have X-ray services and they are proposing to have, for example, X-ray services and dental services. The province now provides those services through another facility. Does it mean the province would have a responsibility to provide some of the equipment for those facilities? What do you negotiate on? What kinds of services do you consider to be part of what the province will provide?
Mr. Praznik: Mr. Chair, I believe the principle on which my staff have negotiated this agreement is on the basis of the space that is required to support the services we are now providing in the community, in the community. So if that is 1,000 square feet, then that is what we are paying for.
The additional are being funded as part of the negotiations with the federal government, which is somewhat consistent because northern nursing stations and others that may provide a level of care are paid for by the national government now.
Mr. Lathlin: Mr. Chairperson, I have a hard time understanding that very sudden change of mode of operation. Up until now, you have been under contract with the federal government to provide services for everybody, including non-Indians in that community, right?--treaty. You have been under contract to provide those services, as well as nontreaty people. If the bands had not insisted on taking over control of their health services or if there was no health transfer policy from the federal government, in all probability the agreement would probably go on and on and the provincial government would continue to provide those services under contract.
Now, all of a sudden because the roles are going to be reversed, all of a sudden the province is saying, oh, oh, you know, we have two staff people there so all we are responsible for is space for two staff people. Anyway, that is one observation.
Mr. Chairperson in the Chair
I guess the other, before we leave that area, is I keep hearing people say, well, we do not really know until we tender it out. We do not want to give the number out till we tender it out, because we do not want people to know what to bid for and all that. I appreciate that. I used to do the same thing when I was a chief.
But there is such a thing as, after you have your architectural drawings, you begin to narrow the picture down, you begin to firm up numbers. By the time you get to a class B estimate--this is what we used to call ours--you can have a pretty good cost estimation. When you have a class B estimate based on your drawings, you cost out your drawings, your architectural drawings. As a matter of fact, I think the normal variance allowed would be around 4 to 6 percent in those class B estimates.
So unless you do not have any architectural drawings of any kind today, yes, you would not be able to give out numbers, but as soon as you have class B estimates, drawings, based on the drawings you would be able to give a pretty firm number. As a last resort, when one puts numbers in a budget, you do not just pick numbers off the air. So there are three ways to get the numbers.
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Mr. Praznik: Mr. Chair, just to clarify, the point of not providing the numbers is not because one does not have them or base their estimates on them, and I appreciate what the member is saying. As you get closer and closer in finalizing your plans, you know what they are. The reason you do not want to have them out publicly is because obviously that may affect what people bid. You may end up paying more for the project than you have to because if people anticipate you are going to spend a certain amount of dollars, the tenders tend to come in around that amount even if they do not need to come in around that amount.
I am going to ask my staff to answer the first part of your question, I think, on the delivery of service. Ms. Hicks points out to me today that we have no staff in that area. She will give you the detail of that.
Ms. Hicks: Mr. Chairperson, the 64 agreement which we in partnership with the First Nations are wanting to dissolve, the 64 agreement basically was an agreement where we provided some services to First Nations and to the adjoining communities, and in other areas the federal government provided services to First Nations and the adjoining community. It was in agreement that was developed, which by dissolving it, we would basically transfer what we have been providing to the adjoining community and the First Nations to the two communities jointly. That is the intent of the dissolution of the 64 agreement.
The way we have been looking at the contribution there is looking at the actual staff now in the Parkland Region that currently go to the First Nations and the adjoining community, and it is the dollars attached to those staff positions and/or the staff--there is the option of both through negotiation--that will then go under the jurisdiction of the First Nations and the adjoining community to manage their care. We would hand the money over for the management of those particular services.
Mr. Praznik: Mr. Chair, the member for Swan River (Ms. Wowchuk) and I have had a chance just to chat privately, and there are some issues that I think--she is obviously getting her constituents speaking to her, and there is a negotiation process going on. I would say to her on the record that I think perhaps we may want to have a discussion with her privately with respect to numbers. Our concern about numbers being public is it affects the tendering process. I think she is prepared to acknowledge on the record she agrees with that.
She has a constituency matter that she would like to deal with, and I think it is in everyone's interest that she have as much information as possible, and she appreciates and acknowledges that we do not want to put that on a public record today. But I say to her, as a private constituency matter, as a constituency matter, I have no problem with her dealing with my staff and Ms. Hicks on this and sharing that information, her knowing, of course, and acknowledging that it is not for public consumption at this point.
Ms. Wowchuk: That would be helpful, rather than us continuing to go around and trying to get a number. If we could have a discussion at a later date, that would be very helpful.
Ms. Bakken: I would just like to say that this is not a provincial project, okay. What we have here is a commitment by the province to pay its share when the project is negotiated between the First Nations and the federal government. I actually do not have a status report on where that is at on a daily basis, and maybe you could provide me with that information.
Mr. Lathlin: By the way, Mr. Chair, I do not completely buy the position that, oh, we do not want to give our numbers up because we do not want companies to, you know--because I see press releases all the time--well, we are going to spend $6 million there, or we are going to spend a million dollars for Cormorant and Dawson Bay. [interjection] The only thing he never gives out--well, they even give out their phone number in the press releases.
What I wanted to go on to next, Mr. Chairperson, is maybe ask the minister to give us an update on issues concerning my constituency, and it has to do with capital. Now I know The Pas, the town of The Pas and areas have been promised a personal care home for the third time this year--well, yes, the third time been promised.
I know the minister was in The Pas some two or three weeks ago to, I understand, have a look at the facility and talk to people. I would like to ask him to give an update. First of all, what did he think of the facility, and No. 2, again, does he have any plans right now--and when I say plans, I guess I mean even project development plans or architectural plans or whatever. Does he have any plans of that kind? Again, I would like to ask him what is approximately the cost of the building. What is going to be the size? Maybe I will stop there now and give the minister a chance to answer.
Mr. Praznik: Mr. Chair, the member did me the privilege of asking what I thought of the facility. I can tell him that I thought it was on a very nice piece of property. I think its relationship to the hospital is a very convenient one. I think the staff are very dedicated and work very hard. The residents were very nice to meet with. I met with one of his other constituents, I believe, from Cross Lake, who was there visiting her mother who is in that facility, who lobbied very hard for the new one, and it sounds as if there are a lot of people in the community who are supporters of that facility and help out.
But with respect to the capital structure, it was probably a good facility when it was built for its day, given the standards of the day, but it is certainly time warranted and it needs replacement. There is no doubt about that. Many of the issues around it were pointed out to me, and it became very evident when I had a chance to spend time there. One of the great benefits of that facility is its relationship to The Pas hospital and being so close and being able to fit it in, and that is a good thing. There is plenty of room on site for the redevelopment, et cetera. So those are my observations on the facility.
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I know the member--we are running three committees today, and members have other issues in other committees, and so not everyone can be in here at the same time. This morning I had the opportunity to discuss the changes in the capital program or in the community contribution program with his colleague the member for Kildonan (Mr. Chomiak). Some of the changes that we have since made are a direct result of the visit I did make to The Pas and discussions I had with Mr. Percy Pielak who is on the regional health authority, and I believe he is reeve of the LGD of Consol or still on--
An Honourable Member: Who, Percy?
Mr. Praznik: Yes.
An Honourable Member: No, the former mayor of the town.
Mr. Praznik: Former mayor of the town of The Pas, that is right--and with some of the other people that I was there with and some issues that have been raised. So I should tell him today--and I have no problem going over these issues because they are very timely and very important to his community, and I know he will want to convey that to them. We still have an 80-20 split, but what we have now done is we are including within the total project cost the land and servicing of that land, as well as change orders during construction, where, of course, we have all agreed that they are required, which means that there is an 80-20 split on all of those things. Even before the community contribution policy, communities were required to provide serviced land and pay for their change work orders, so they did have a cost.
Now, in the case of The Pas, the land is available there. It would not have had to have been purchased, but under our policy, because that land was never paid for by the province, they will get an 80 percent credit for the value of that land. The land and servicing costs will be added to the costs of that project, and they will only be responsible for 20 percent. So in reality, they will get a credit for 80 percent of the value of that property. Another change that we have made that actually comes out of my visit to The Pas was the point that was made with me that that facility services a number of First Nations and a number of unorganized territories, Northern Affairs communities, and that it would be unfair to the ratepayers in The Pas and the LGD of Consol and the surrounding municipalities to have to pay 20 percent of the cost when it was servicing a larger population than their own.
As the member is probably more aware than I, for First Nations residents of that facility, the fees that are paid on their behalf for their costs of being there include a capital portion. So we said okay, we should then look at the usage of that facility and give a credit or deduct from the community contribution the usage by First Nations communities because they are already paying for the capital in the fee.
How we work that out in terms of if the RHA is the financier of the project, then they, of course, will get that capital portion. If the province is financing it, we will, in fact, get it to recoup, but we will take it out of the community contribution. With respect to unorganized territories, particularly Northern Affairs communities, the percentage of usage of the facility by people in those communities will also be taken out, and now we will have to deal with the Department of Northern Affairs and how that is accounted for, but that becomes an internal accounting within the provincial government.
So that will reduce considerably, I think, the community contribution in The Pas. We have also done a number of other things. We recognize that financing a community contribution has become a bit of an issue and a problem. How do we do this? So the province is now prepared, and I have announced that we have approved that, and I have indicated to the committee this morning that the province is now prepared to finance the community contribution.
Now, this becomes a little bit interesting because we are prepared to finance it over a 10-year period, interest free. Now, if we just did that, even if a community raised dollars, and it is much easier, of course, to raise your community contribution at the start of a project, because there is interest and excitement and we need this, than it is five years out. So what we have said is, if we did not provide some incentive at the beginning, even if a community had a million or half a million dollars in their foundation, there would be no incentive to put that money in if the province were financing it over a 10-year period with no interest.
So we have said, for every dollar that the community contributes to their share of the contribution or contributes in the community contribution up front at the time we need the money, in essence we will double its value. So, in other words, just by way of an example, if the project were a $1-million project, and the community contribution after we calculated for the land and did all those credits was $200,000, if the community had $50,000 raised and put that in at the beginning, they would get double value. So they would get the value of $100,000, and they would only then owe $100,000, and we would finance that over 10 years, interest free. So then they would have to commit to raising $10,000 a year for 10 years.
Now, in the case of The Pas project, I do not know if we have some estimates. We are still working on what the community contribution is likely to be, but I think these factors: credit for the land at the site and servicing of it, the different financing with respect to First Nations contribution for usage, which is paid for through the fee, the Northern Affairs communities on organized territories, those credits, plus the ability to get double value for money put up front, plus the interest-free financing that the province is prepared to contribute, I think will meet the needs of The Pas community in meeting their community contribution.
Now, I am going to suggest that once Ms. Bakken's people are able to work out these numbers on this particular project, I would encourage her to share them with the member for The Pas, and I would invite the member to go over them with Ms. Bakken to make sure we have not missed anything from his perspective, but I think he will find that it is a much more palatable and a much more achievable contribution, and again these changes, several of them come out of my visit to The Pas and discussions I had with the regional health authority. They made some very good cases as to some of the difficulties, and we have since corrected them.
Mr. Lathlin: Mr. Chairperson, I would like to ask the minister if--I know the numbers have to be worked out and everything. That was my concern too when I first heard about this 20 percent contribution. Well, I should say, I go back a little bit even further than that, and that is those days when there would not have been any need for a contribution had this project gone ahead as it was announced before the last election. If it had gone ahead, there would not have been the need for that 20 percent contribution. Okay, but if it is there now, the government said there would have to be a 20 percent contribution by the community.
So my concern at that time was I know and I recognize that there are--first of all, in the hospital, the majority of the patients that you have in a hospital, and again this is what I have been telling the Minister of Health and whoever I can latch on to from the government side to tell my stories to, is the surrounding aboriginal communities. I keep telling the minister that, while I agree with prevention, education, awareness and all of those wonderful things that will prevent or cut down on health care costs down the road, after having said that though, the minister has to realize that in the aboriginal community we are not even at that stage yet. Yes, we are talking about prevention and awareness, but you know what, for the next 15 years, maybe even more, we are going to be in the treatment mode yet because it takes a long, long time for us to get there.
So I have been telling the minister, when you cut back on the hospitals, where are our people going to come. The hospitals are cut back. Our people come there and they are told to go home after one day, to communities. Like he earlier admitted, there is no home care. Home care is nonexistent. There are not even handicapped places. A lot of our communities do not even have care homes. The Pas is lucky; OCN is lucky. They have one care home there, and there too we have people from Moose Lake, Grand Rapids, Easterville, Pukatawagan, Oxford House, all over northern Manitoba coming to our care home on the reserve because you know facilities like that do not exist on Indian reserves, or at least very few of them.
So, yes, we have a problem. You know, as I said to the government, if we just ram through with all these changes, you know what? There are going to be people in very serious difficulty. So I come back to the personal care home in The Pas. I do not think it would be fair for the townspeople, the taxpayers in the town who pay taxes to the town to be saddled with an expense, because there are quite a few aboriginal people in the care home. So I agree that there should be another source of funding.
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I was going to, at one time, suggest to the mayor that he contact the federal government and see if there could be any offsetting of costs from that source, but in consultation with the surrounding aboriginal communities there, because they have their own capital allocation process--the federal government to the Indian bands--and if there is to be any allocation of capital from the federal side to this project, we want to be very sure that it does not impact on their current levels of capital funding from the federal government.
But I would go so far as to suggest that to the minister and say, you know, why do we not look for funding from the federal government to help the town, because inevitably our people are going to end up--you know, those we cannot house on the reserve, on our reserve at OCN, a lot of other aboriginal people from Easterville or Grand Rapids, Moose Lake will eventually end up in St. Paul's anyway. So that is one suggestion that I have to help alleviate the financial burden that the townspeople are going to be faced with.
Mr. Praznik: Mr. Chair, if I may just comment on that. I know when we looked at the funding arrangements currently for St. Paul's, for those First Nations citizens that the federal government provides the per diem rate for within that--it was pointed out to me--was build in a contribution to the capital side of the building. So we felt that that mechanism exists today. It is there in the rates that are paid by the federal government, so they pay for the day-to-day costs and make a contribution towards the capital, which I gather in the case of St. Paul's has sort of been well amortized, so that it was felt that that would be the best way to deal with the First Nation issue, then it did not interfere with capital allocation, it was built into the per diem fee, and we felt it would be unfair to saddle the RHA with having to work that out necessarily. That is something we would have to ensure was in our provincial rates and would finance. So we have a few issues to work out there, but it should not interfere with either.
When the member was speaking, it occurred to me that there will probably be some capital requirements at The Pas hospital at some point in the future which the member has flagged with me, and that is a point in time as we address that. We have put a limit on the 20 percent over it. It is a rolling total over a 10-year period. So we would require 20 percent capped at $6 million for any community over a 10-year period in practical terms, and that would include all of the credits and things we would do in doing that.
So at some point when The Pas hospital project, which I guess is moving up the ladder or will likely be moving up the ladder, I would be delighted to have some of those discussions with him and some strategy around how we do this, because obviously the First Nations health care is developing. It is in a state of development. If a contribution is made towards operating a hospital, I expect we do not want to repeat having two hospitals in, in essence, one community, but there is a lot of room to discuss ways of managing this, of meeting both needs and dealing with those issues.
The member for The Pas has a long history of being involved in these types of issues, and I say this very sincerely to him today. When we get to that point, I would like to invite him to have discussions with us about how we could manage this with the First Nations in his community and with the federal government and with aboriginal health in whatever form it develops in its own governance. It is new ground for everyone, and the more minds we have at the table--and that could be coming up in the relatively near future--I would say, the more minds we have at the table to kind of steer our course the better it is. I certainly do not come here being all knowing or all seeing, and the more we can involve people who have experience in this area, the better.
So I make that invitation to him today, and I appreciate his suggestions, and at some point over the next year we should be talking more specifically about it.
Mr. Lathlin: I would like to ask the minister--I think my initial question I asked him what he thought of the facility, and then I think I asked him to what degree this project has been planned out, you know, whether there is a project development plan in place. I know he stated at one time, I believe during his visit, that he would even assign a project manager to this project to ensure that things are fast-tracked. So what about the plans?
Mr. Praznik: I thank the member for reminding me. We have had quite an exchange on issues, and that is a very, very important one in the detail. I am going to ask Ms. Bakken, who manages our capital projects, to update the member. I can tell him that right now, in order to fast track many of these projects, I have asked Ms. Bakken to gear up her Capital Branch. If we have to bring in some contract project managers to be able to drive these projects at as fast a pace as possible, we will, and I think we have enough projects going on in that region that justify us having someone doing that. So that is part of her plans, and we have given her the approval to figure out how we are going to do this. So I am going to ask her to update the member and the committee.
Ms. Bakken: Mr. Chairman, I have a number of things to report. What we call the site feasibility study, which confirms that we can, in fact, fit 60 beds on the site, has been completed. So we have sort of a schematic sketch of how this is going to be approached. The CEO of the Norman Regional Health Authority called me yesterday. He was just, you know, sort of a day or two away from hiring a project manager. That project manager will take responsibility for managing all of the projects in the Norman region. [interjection] We are paying for it. Well, it will be cost-shared.
They were also very close to hiring somebody to assist the project manager in the actual drafting of what we call the functional program and the architectural space program. We have been directed by Mr. Praznik to have the project go to tender this September, and we are working very hard on trying to achieve that directive. There are many players here, so we may be successful. We may not be successful, but that has been the publicly stated goal, and that is what we are working towards.
Mr. Lathlin: The tender is out by September '98. We are in the middle of April--May, June, July, August.
Could I ask, then, Mr. Chairperson, whether any architects have been asked to start the project or begin drawings anyway?
Ms. Bakken: The CEO of the health authority has told me about the process that he is going to use to select an architect. So he is very close to coming, again, to that final decision. There are three appointments that are just about to be made: one is for the project manager for the region as a whole for all of the projects; second is the appointment of an architect; and the third is the sort of staff support to actually write the functional and architectural space program.
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Mr. Chairperson: The minister asked for a--
Mr. Praznik: Yes, do you want to take five or 10 minutes and come back, Oscar?
Mr. Chairperson: Is that agreed, a 10-minute break? [agreed] Thank you.
The committee recessed at 4:10 p.m.
The committee resumed at 4:26 p.m.
Mr. Chairperson: Order, please. We will resume the questions in the Ministry of Health Estimates.
Mr. Lathlin: The other question that I had, but I think it has been sort of partially answered, and that was the size of the facility. I was going to ask what the size would be, but--and also the site. Would it be on the same site ? I think it will be a 60-bed facility, and it will be built on the same site.
Ms. Bakken: It will be built on the hospital site, and we have figured out how we can build it on the hospital site and still keep the hospital and the existing personal care home running, so nothing needs to be knocked down. We have been able to squeeze it in between the two buildings.
Mr. Praznik: On this particular point, because these are some of the questions I had when I visited. It is a good thing we can squeeze it on the site, because personal care homes, particularly in rural points, where they can be attached to or linked to hospitals are just much more convenient care for all involved and easier to administer.
I did ask what the intention is with the existing facility, and I gather that it is going to be converted. It will not be demolished. It will be converted to other use and Ms. Bakken may just want to update the member on that plan.
Ms. Bakken: Mr. Chairman, the regional health authority has asked that we look at the existing St. Paul's Residence as a facility to house ambulatory care and the Department of Health and Family Services staff that have been assigned to the region. That work will be done. Assessing the capacity to do that, the cost and the timing will be done closer to the opening of the new St. Paul's Residence.
Mr. Lathlin: The reason that I was asking what the size would be if it was going to be built on the same site was because I was sort of thinking that it would be torn down. It does not matter which way, whatever, it is going to go, if the current existing facility is going to be used for other purposes within safety codes, I guess that would be all right for the people in The Pas.
But the main reason why I asked that question was because I think if I hear the minister when he gets up in the House answering questions related to people who have had to spend three or four days in the hallways and, Mr. Chairperson, he says if only we had personal care home beds, that is where we would free up a lot of beds in the hospital so nobody would be lying around in the hallways. So I am just wondering: what would be the net gain in personal care home beds then on opening day, for example, in The Pas?
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Mr. Praznik: An excellent set of questions, because the answer varies considerably in different places across the province. I am prepared to share with him these occupancy figures, but in The Pas hospital, for example, as of I guess, what is the date--this is the usage numbers for the last fiscal year--I believe there are 58 acute care beds in The Pas hospital, and that accounts for a total of 10,900 patient days. I will provide the member with a copy of this, which means the occupancy rate in The Pas facility is 51.5 percent.
The number of patients on the waiting list for the facility, for the Paul residence, I do not know what that number is, but Ms. Bakken will elaborate a little further, but in assessing the need for bed space in The Pas, I gather that based on the hospital occupancy rate capacity there and expected need, that adding additional beds to the system was not required. I have no objection to adding them if they are needed, and if they are, we would, but I am going to let Ms. Bakken get into those numbers a little bit more.
Ms. Bakken: Mr. Chairman, The Pas health facility does not have a history of having a large number of panelled patients that impact negatively on the ability of people to be admitted for acute care into the hospital, and the number of beds that we are building in The Pas is consistent with the provincial bed planning guideline and is a number that has been fully accepted by the people of The Pas and by the Norman Regional Health Authority.
An Honourable Member: As what is required.
Ms. Bakken: As what is required, yes.
Mr. Lathlin: Mr. Chairperson, Ms. Bakken is absolutely right. In The Pas, it is not like Winnipeg where people are lying in the hallways and so on, but The Pas is different from Winnipeg too in that I believe we have one, two, three, four nursing stations within the area who will bring patients to The Pas hospital. We have aboriginal communities in the surrounding area who will come to The Pas.
As a matter of fact, the minister will recall the letter that I wrote to him regarding a Mr. Percy Jensen [phonetic] who had to live in the Kikiwak Inn for six weeks, I am told, because there was no room anywhere in the town or even in our own facility on the reserve. So this individual had to get by by staying at the Kikiwak Inn, an individual who is confined to a wheelchair, has to receive dialysis three times a week and here he was living in a hotel room for six weeks. So that is the kind of volume that I am thinking about more or less. It is not the same as Winnipeg.
Mr. Praznik: Mr. Chair, I am very glad the member has raised that with me, because one of the observations that I have made, and he and I have had a chance to discuss this privately, is there is a great difference in the provision of care when you have people from more isolated remote facilities or communities using a facility, because for obvious reasons they may be able to be discharged from a facility by all regular standards, but if you send them back to their community and something goes wrong, it is much more riskier.
I have come to appreciate that I think what we probably need to do collectively is invest some dollars and energy in communities like The Pas, perhaps Thompson and others, where we have some sort of transitional beds or--I would not even call them beds, really, facility of some sort, almost like a mini--the term that I think my staff say is subacute where really you have a home-like bed, I gather, not a hospital bed but a mini-apartment or something of that nature, a hospice-type thing where someone who maybe has to come in for a period of dialysis or a medical review does not need to be in a hospital bed, they do not have a place to stay, there is not home care back home, and I think that would fill a need that is there.
The member has identified that, yes, there is a big need here. What comes to mind in this discussion is I would like my staff when we get into the planning--and the member may want to be part of that locally--but when we get into the planning portion of what we do with the old St. Paul's Residence, there is a lot of square footage of space there. I would certainly be willing to entertain as minister--and I make this commitment today to look at it--what would be the logistics of--and dealing with the First Nations, obviously many of these are their citizens--being able to put in some acute hostel-type units where that person who needs to be close to the hospital in The Pas, but really if they had their own suite or their own home in The Pas, they would be there, with some home care assistance. Realistically, it is impossible, given the distance.
So we certainly would be willing to look at the development of some of the space in the existing St. Paul's Residence. I am talking about a major refurbishment, because obviously if we are putting offices and ambulatory care into that facility, it needs a fair bit of internal reworking because it is an old facility. But that is a possibility, and I undertake with our staff when we get to that point in the planning to consider and raise that with the regional health authority as an option of a service that is much needed in that area.
Mr. Lathlin: Yes, as the minister was talking, an individual comes to mind from Pukatawagan who was in the hospital, sent to The Pas hospital and confined to a wheelchair. I believe he was in a car accident and he has no movement, I think, from the waist down. So he is confined to a wheelchair. But, anyway, he was brought into The Pas hospital, and the people in the hospital were really adamant and bound and determined to send this individual back home to Pukatawagan. The nurses in Pukatawagan are saying, no, no, please do not send him back here because what are we going to do with him. There is no pavement even in Pukatawagan for wheelchairs. There is absolutely no facility whatsoever. So when he approached me, what I did was got together Swampy Cree and Cree Nation Health and I said call for a meeting with the doctor and tell him that there is no way this individual can go back to Pukatawagan. So I do not know what has happened to the individual since then, but every now and then I see him go along the sidewalk in his wheelchair, so he is probably living somewhere. So that is why we have needed the care home for a long time.
I want to ask the minister, as well, you know, if he were to approach the feds for the aboriginal portion of the cost of building the care home, I have no doubt whatsoever that he would have absolutely 100 percent co-operation from our chief, William George, and I know the mayor would be more than willing, along with the minister, to approach the federal government, the federal minister, and the three of them lobby the feds so that the town is not left there holding the bag for everybody, because it just seems totally unfair to me.
Mr. Praznik: Mr. Chair, I fully appreciate the member's point. It did not seem fair to me either. That is one of the reasons we have agreed to sort of take over that issue as a provincial issue as opposed to leaving it up to the town. But I think we are prepared. My staff want to do a little homework on this, but I would like to make the invitation to the member today, including we may even want to involve Ms. Bev Desjarlais who is the member of Parliament for that area, and I think perhaps if the member would undertake to work with us and with Sue Hicks, my associate deputy minister, maybe we should do a plan to do a joint effort with the community and the First Nations because there are some issues where the federal government has walked away with Level 4 care, where they are not so interested in funding, and it is to the great detriment of First Nations people.
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So if the member is prepared to do that today, I know Ms. Hicks is going to be away for three weeks, but when she comes back, she will make a note to speak to the member. Let us work together to bring those parties and let us make a joint effort. I think it carries a much greater amount of weight if the New Democrats and Conservatives in Manitoba are making this point in a united front. It just politically, I think, speaks, where we are all speaking together for Manitobans. I thank him for raising that, and Ms. Hicks will take the note and when she returns--she is here for this week and then she is away for three--she will be speaking upon her return to the member for The Pas, and we can do some strategizing around this issue.
Mr. Lathlin: Yes, I would be willing to co-operate in that way.
Mr. Chairperson, I thought I heard the minister earlier say that the ceiling, as far as the costs are concerned--did he say the ceiling would be $6 million for any project?
Mr. Praznik: Mr. Chair, the $6-million cap or ceiling is the total community contribution for all projects within the community on a 10-year rolling period. So, for example, when doing the St. Paul's Residence, there will be a community contribution. When we do the hospital project, there will be a community contribution. The total contribution of any community--and in the case of The Pas, out of that $6 million would be deducted the First Nations issues which we deal with separately and the Northern Affairs. So obviously the $6 million, I do not know what the population divide would be between First Nations and non-First Nations in that area. I do not know whether it is 50-50 or what the ratio would be, but whatever that is, it will bring that $6-million total over 10 years down to that number. That is all we would expect from the community in a 10-year rolling period towards capital contribution. Once they have hit that cap, it is 100 percent provincial funding thereafter. We recognize there are only so many dollars available in communities over a long period of time.
Mr. Lathlin: So the honourable minister was obviously not referring to the total project cost.
Mr. Praznik: No. If I may, it is 20 percent of total project costs to a maximum of $6 million on a 10-year basis, all projects totalled up within the community.
Mr. Lathlin: I am just about finished here, but I would like to ask the minister--he has been up to The Pas; he has talked to the people there; he has talked to the RHA obviously--does he have any idea of what kind of money we are talking about in terms of what the project would cost?
Mr. Praznik: Mr. Chair, the member, the last time we discussed tendering issues, did make the comment--I guess we are guilty. We throw out numbers when it appears to be to our advantage and we get to specifics. Around tendering, we are more reluctant. The member's point is well noted.
Mr. Chair, I am advised that our experience has shown that the approximate cost range for a personal care home bed is $100,000 to $110,000 per bed, so a 60-bed facility would normally be between $6 million and $6.6 million. In northern construction, depending on a variety of factors, there can be an additional cost of between 10 percent and 25 percent on top of that. So there is a fairly large range. A project could be anywhere from $6 million to $10 million as it gets refined in this particular area.
Mr. Lathlin: Mr. Chairperson, I was wondering if the minister, when he went to The Pas to tour the St. Paul's Residence, did he consult with any other community member other than the tour guide, the people at St. Paul's, the RHA? For example, did he consult with the mayor or the chief or the reeve?
Mr. Praznik: Mr. Chair, my visit to The Pas was with the regional health authority. I think virtually all the members were in attendance at my meeting. They invited me to come to meet with them. We had a host of issues to discuss. The capital contribution was very high on their list. They obviously had been speaking with the mayor and with the reeve of council and with others in the community, and the concerns about raising the dollars was expressed through them. I was in The Pas for a number of hours. When I toured the St. Paul's Residence, the administration was with me as we went through the tour. I had the chance to speak to a number of staff as I went through the tour and then I had to move on for other meetings at Swan River.
So I also had an opportunity to say a few words to the residents when I was there. I can tell the member that I did meet his constituent from Cross Lake and her daughter, and they were very effective lobbyists. I think she happened to be in town that day and made an effort to make the point they needed a new facility, and it was certainly acknowledged, but I spent a fair bit of time with the RHA board. We had a very lengthy agenda of issues to discuss and I believe--I am not sure if some of the RHA board members are sitting on council in that area as well. I am not sure if they were, but the concerns of the council obviously were expressed through them and my purpose was to meet with the RHA board.
Mr. Lathlin: Mr. Chairperson, I would like to thank the minister and his staff for putting up with me for the last little while. That is all the questions I have, and I believe the member for Dauphin has a couple.
Mr. Praznik: I know that we have multicommittees and members try to be in numerous committees to deal with specific constituency issues. I want to thank the member for The Pas. I have enjoyed the discussion very much, and he certainly brought some interesting information and suggestions to the table. I would just like to reiterate my invitation to him. Ms. Hicks will be in touch.
If for some reason it gets mixed up, Ms. Hicks, give her a call in about a month because she will be away for three weeks and we can work together on that issue. I would like to invite the member formally that, as the project manager is appointed and we start working through the issues, I would invite him to be touching base from time to time with the CEO of the RHA and the project manager to keep himself informed as to the project. There may be the odd local issue that comes up that will require his assistance to speed it up and I know he would be willing to do that in the interest in his constituents. I have enjoyed the afternoon with him immensely.
Mr. Stan Struthers (Dauphin): Mr. Chairperson, I want to talk about something and get some dialogue going on something that I have been pretty keen on for several years now, ever since my teaching experience in the North taught me the value of nursing stations in the overall range of health care services.
In particular, I want to talk about a part of my riding, Waterhen. When I use the term Waterhen, there is a reserve, the Skownan First Nation, Waterhen First Nation, the northern community of Mallard and Waterhen itself. Also, the area would include Meadow Portage, which lies within my constituency.
Mr. Chairperson, some things I think that need to happen through regionalization is that there has to be a move towards local decision making. There has to be I think an improvement in co-ordination within the region. I think that by doing that we can get better services and have our programs be much more cost-effective.
I give the local Parkland Regional Health Authority good credit for the needs assessment that they did. I think they have done a good job in consulting the people in our area about what their needs are, and I think they got a lot of good information back in terms of capital.
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I know that the local folks in Waterhen, some of the community councils there have been talking in terms of a nursing station. They have a trailer there now that houses some public health people. The trailer is not on the First Nation, but it is on the Waterhen side, the Northern Affairs community.
It is my belief that a little bit of capital spent in the Waterhen area on a nursing station would provide not only a better service, but I think would reduce the cost on the Parkland health system as a whole. What we are seeing right now is cases where people have some kind of an illness, some kind of an ailment, maybe they have been involved in an accident that would not require the attention of the emergency room at Dauphin or being moved to Ste. Rose or anywhere, Winnipegosis, another hospital close by. I think that it would be valuable to have a nursing station in that area to act as a bit of a screen for those ailments that do not need to be rushed into the most expensive door at the Dauphin Regional Health Centre.
This is something that I know the local council at Waterhen is very much interested in. They have passed resolutions and have lobbied the Parkland Regional Health Authority. I have put my two bits in with the Parkland Regional Health Authority, as well, and I would like to do that again today.
My questions are in terms of are there federal dollars that can be accessed to help in this case since there is a reserve involved, and how would the 80-20 split on capitalization apply in the case of a nursing station in this part of our province?
Mr. Praznik: Mr. Chair, I thank the member for his results and comments. I do not want to pretend to know the Waterhen community well, but in my other days as Minister of Labour, and my former Labour deputy, Roberta Ellis, now joins us in the Health department as associate deputy, we did spend some time in Waterhen. In fact, I was there for the opening of the new fire hall that was built under the Norther Affairs budget in my capacity as Minister of Norther Affairs.
In fact, I even remember coming in as the Minister of Labour, and we looked at where we had offices. It always amazed me, we had offices in Brandon, we had offices in Portage, we had offices in Winnipeg, in Thompson and we had an office in Waterhen. It was somewhat odd that of all the communities in Manitoba that had Fire Commissioner's offices, Waterhen, given its size, there were no comparable communities that had a Fire Commissioner's office.
Of course, the reason was our then deputy fire commissioner, Doug Popowich, lived in Waterhen. He spent a good deal of his time on the road, and it just made eminently good sense to accommodate his family and his needs, because he was on the road all the time, to have a small office available--I think it was in the Northern Affairs offices--for a fax machine and those kinds of things, to service his work when he worked out of his home base.
So I have a soft spot in my heart, I must admit, for Waterhen, and have had many good hours there on a variety of my visits and certainly have been the guest at the Popowich ranch and always been treated wonderfully by the people in that community. So when the member speaks about some of their health care needs I am in full concurrence with that. The member is, I would say, dead-on in his assessment of that need. I am advised by Ms. Hicks that we have not yet had a proposal on the capital side for that kind of facility. I can tell him now that we would be very interested in entertaining that. I think part of the issue for the regional health authority in fairness to him, and I know the member recognizes the great amount of effort it takes to take over a health system and to build up your own ability to manage it, and I appreciate his compliments on the work that the RHA has done in the needs assessment.
I believe in the last year they have been spending a great deal of time just getting their own structures in place. They had a host of issues around hospitals that they had to deal with, and as that board gets a greater comfort level and gets some of the bigger issues for its region handled, I am very sure that their attention will turn to meeting those needs. I want to assure him today that, should we receive a capital proposal for such a facility, it would be one that in principle would be very much welcomed, because it is the kind of service delivery change that I think leads to better health and better utilization of service, so we are very, very supportive of that particular concept. In fact, I have often used the example that if one has that facility and properly staffs it--I mean, it even gives the ability, particularly as RHAs look at bringing doctors on contract in primary health care, to be able to have itinerant doctor services.
I do not know what the volume need would be in a Waterhen but if it is one day a week or one day every two or et cetera, where it would save a great deal of travel time for the people in that area who are not wealthy people, to be able to have a community doctor come in on a regular basis just for their regular health checkups and needs. These kinds of steps are where we envision the system moving, and I would encourage him--in fact, I would invite him to meet with his RHA and convey my message as we will through our channels that some work should be done in this area, and it should be identified in their planning and continually pushed forward. It is a project I would love to be with the member to see sod turned or opened in the near future.
With respect to federal contribution, wherever there is a First Nation community and the federal government and the First Nations have responsibility for delivery of community health in those areas, we obviously do not want to reinvent the wheel in having a First Nations health centre and a provincial one in two communities next door. I mean, it just defeats the purpose. So, obviously, if a facility is servicing and providing a variety of community services to a First Nation, we would look to the federal government and that First Nation to take the lead in ensuring that there was a fair contribution split.
I know the member was not able to join us for all of the issues we discussed with the member for Swan River (Ms. Wowchuk) and the member for The Pas (Mr. Lathlin), but we discussed earlier this afternoon the opposite situation where we have, in a community in the member for Swan River's riding, a health care centre being built by the First Nation, and we are contributing part of the capital for the services that are being provided to the non-First Nations people. In essence, it would be reversed here, so yes, we are very interested putting this together, and I think certainly the RHA would probably appreciate the active support and involvement of the local MLA in helping to put this project together, and we would certainly want to work with him on it.
Mr. Struthers: Mr. Chair, the one part of the question that I did not hear an answer for, and I appreciate the rest, is an explanation of how the 80-20 split would work, whether there would still be that need for that contribution of the 20 percent locally.
This will be just my last question before time runs out, but the other thing is that there are a lot more areas, other than Waterhen, in the Parkland who I think could really benefit. I am thinking of Ebb and Flow and Crane River and other areas that would need to be taken into consideration.
Mr. Praznik: Very briefly, again, we have discussed this throughout the afternoon, and I appreciate members are moving to different committees. We have made changes to the community contribution policy which I have indicated to the committee earlier in the day. One of them, of course, is where there is a Northern Affairs community or an organized territory, that we give credit to the RHA. We work out those arrangements with the Department of Northern Affairs who has responsibility for that, because in most cases, outside of the city, the community contribution is being raised by municipalities, and we recognize the same taxing authority and things do not exist.
In the case of First Nations, we as a province would give a credit for the usage and then we would have to work out the arrangements with the neighbouring First Nation. I know in The Pas personal care home, we discussed this with the member for The Pas (Mr. Lathlin), the federal government currently pays a per diem fee for its residents or citizens that are in personal care homes, and there is a capital portion attached to that, so we do recoup in that way. We did not think it was fair to require the municipal community to have to raise the whole contribution for areas that it had no ability to share in the taxing area.
We have also made a couple of other changes where we will for dollars raised up front give a two-for-one credit, so if a community had to raise a hundred thousand as their share, if they had 20,000, we would give them $40,000 credit. We have announced today that we will be financing the remainder of the community contribution on a 10-year basis interest free, so there are lots of ways to make this work. I imagine if you looked, that in Waterhen, given all of those factors, it would become a rather minor local contribution that could probably be handled through a variety of means that would not be onerous.
Mr. Chairperson: The time being five o'clock, it is time for private members' hour. Committee rise.