Hon. Darren Praznik (Minister of Health): Mr. Chair, when we adjourned last week, I believe it was the member for Thompson put a very in-depth question, and I do not have my note in front of me. Perhaps he could just refresh me as to the topic on which he addressed a question, and then I can provide the answer to him.
Mr. Steve Ashton (Thompson): I am wondering, given the lack of time, if I could just ask that the minister respond perhaps in writing. It was in regard to the funding for the Burntwood Regional Health Authority. Since we started a little bit late--we have about 25 minutes left in this committee--I do have a couple of other questions, but if the minister has some comments he would like to put on the record, no problem.
Mr. Praznik: Mr. Chair, I will be very brief. I know we have had exchanges in the House about this particular issue, and I think it is worthy of a bit of explanation.
When we embarked on the regionalization process, I think our planners in health and those who have looked at this, talked about--as I discovered when I came into being minister--a funding mechanism that would divide up the health care pie on the basis of population, health factors, risk factors, age, demographics, et cetera, and give to each regional health authority a block budget for which they would be 100 percent responsible for the purchase of health care services for the citizens in that region, and if those services were purchased in another place, such as the Winnipeg hospital system, et cetera, they would have to pay for those services.
When I became minister and after working with the boards, I recognized that may be a very good idea in theory, but one has to have a great deal of development, community development and board development before you could tackle that particular type of issue, that it was far too soon in the process to be able to use that as a means of basis for funding delivery of health services.
The other problem, and I say quite frankly to the member for Thompson, is within our ministry because so much of our funding was block funds to institutions. I could not tell him, nor my department tell me more aptly, what we were purchasing often, how we were paying for it, were we providing adequate funding for the service. There were many cases where dollars were siphoned or used for other things that I am sure the member and I would not agree are a health priority, but the nature of a very diffuse governance system and a diffuse budgeting system had led to that.
So what I have done as minister is we are building over the next two, three years a budgeting system that will indicate what services we will be funding in each region. It will be based upon need in that region. It will be an envelope-funding base as we try to tie dollars directly to services where purchased, and it is not in any way intended to diminish the health needs of specific regions.
In fact, I am working with our Treasury Board now, because we have recognized a whole host of inequities in funding across the province, by and large based on the historic development of health care. One that comes to mind is the placement of public health nurses. When that program was developed, they often developed in communities based on a community, and we know we have had major shifts in population in the province that has not necessarily been accounted for in where service was delivered.
So we have found a host of these issues, and I think we have to be able to find out what we are doing now, provide some level of that based on need within communities, build up I think the expertise of our board, their structures, their community involvement, and at some point in the future I can see moving to that system. But as minister--and the member knows this very well--when you get working with organizations, you get working with scenarios, you appreciate sometimes you cannot push more onto people than they are ready with their skills and information to handle. We did not have the information to do that, we did not have the skills, and I think we would have had an even greater problem than we have seen in trying to sort out financing.
So I can assure the member that, as we fine tune our budgeting and we develop those skills, the kind of unique health issues around a Burntwood health district that we are learning more about as we get into this issue, we are addressing bit by bit as we get a better handle on expenditures, how money is being spent, what are we purchasing and needs of communities. I expect that I will be having some more announcements during the course of this year as we further fine tune our budgeting system.
So I hope I have given him a bit of a snapshot and put in a little bit different context than the exchange we had in Question Period.
Mr. Ashton: I will be pursuing this, because I do believe that the funding formula requested by the regional health authority is the only way in which the North is going to be able to deal with the health care needs, particularly areas where we do not have any services currently. There is no personal care home, for example, in the entire Burntwood region and what has essentially happened is we were caught in the previous freeze. People told us at the time, and I had discussions with people in the Department of Health, wait for regional health. So if there is any evolution, I hope the minister understands that people are a bit frustrated. They are hoping it will be a very quick evolution, because issues such as this are crying out for action, and they have been ongoing for years.
I also, by the way, would like to indicate my own support for the efforts of the regional health authority, both the executive director and the board. I think they have already established a fair amount of credibility in the community. I am referring here both to staff with the health authority of the board and also some of the new initiatives of the staff, for example, at the clinic which is located in the City Centre Mall. I can tell the minister that the view that we need this funding model is clearly held by everyone at the regional health authority from the board through to workers. So when the minister received the correspondence he did from the acting chair of the board, it was a seriously held opinion and certainly something that deserves action.
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I want to move on to AIDS Strategy. First of all, I would like to indicate to the minister that, in terms of the provincial AIDS Strategy, I would certainly encourage the minister to consider the addition to the implementation advisory committee of a representative from northern Manitoba. The minister will be receiving correspondence from me supporting the appointment of Catherine Spence who is the co-ordinator of the Thompson AIDS Project, the northern representative.
I want to indicate, by the way, that I had the opportunity to attend a workshop that was held on HIV-AIDS this past Friday. It was a very excellent presentation. Some of the information I thought that was presented there was information that should be made available to the committee. I give Catherine and the others who organized the workshop full credit, and I certainly hope that she will be in the position of being on the implementation committee. She does have direct personal experience in her family with AIDS. She has been involved with HIV-AIDS issues for some time and has established quite a fair amount of credibility in Thompson and the North on this issue.
What I would like to ask the minister, because this came out of discussions I had with people at the workshop, is the status of the provincial strategy. I talked to one individual who is reactive on the HIV-AIDS issue, pointed, for example, to the program that is going on in British Columbia. He indicated there was $60 million being spent in that province. I think that compares to about a million and a half here. The provincial AIDS Strategy, which was announced a couple of years ago, is now in the process I guess of being implemented. What was striking about the presentation was the fact that we are seeing a real shift away from the population that previously was predominant, which was gay men, into other groups, particularly HIV drug users. There are also an increasing number of women, although the vast majority of sufferers of HIV and AIDS are still men.
What was particularly striking was the growth of HIV-AIDS amongst intravenous drug users. What was interesting, too, what was particularly concerning, was they had information both from Manitoba and Saskatchewan, and seeing some of the clustering that is beginning to occur already in Saskatchewan, where you are getting 10, 11 cases of HIV being reported in relatively small communities, and by and large, that is coming from intravenous drug use. I would like to add to that that there is a great deal of concern.
I know in my own community there have been a number of reported cases of heroin use recently. There was a heroin overdose, so that kind of drug, which has previously been perhaps associated with larger centres and certainly with Vancouver, which is considered I know the gateway for heroin access to North America, is starting to hit Manitoba. There is a real concern that, when you are dealing with this particular population, there is so much greater potential for spread than we have ever seen before.
This comes just at a time when there has been some real progress on HIV-AIDS in the sense that I think there has been a lot of work done, not just by governments, by the way. I think within the gay community, for example, there has been a lot of work done there on prevention. There certainly are improved treatments available. Fewer people are moving from HIV into full-blown AIDS because of the improvement in what is available in terms of drugs. What really concerns me is if you are dealing with intravenous drug use the percentage of transmission, whether it is an infection, is dramatically higher than anything that we have seen before in any population involving transmission through sexual intercourse.
It is virtually the equivalent of injecting anything into one's system, and that is essentially what it is, including HIV. I am wondering what action the minister is proposing to deal with this. There have been various programs in place, and I had this discussion, by the way, with his predecessor, Don Orchard. A number of years ago, when I was Health critic, I raised the issue of needle exchanges, and there has been a fair amount of indication of how effective that is. It has been put in place in a number of cases. This was at a time when it was very much a pilot project, but what actions is the minister planning on taking to deal with this dramatic shift in HIV-AIDS infection that we are seeing away from gay men into--and I am not saying it is not a problem in that community, but it is moving much more into drug use and much more into the general population.
Mr. Praznik: A very important area we have had some discussion on before earlier in the Estimates process. Part of the difficulty that I faced is we have somewhat limited resources in our ability within the department to tackle everything that we have to tackle. There is a lot of expertise and ability in the AIDS community, for lack of a better term, and the member knows that probably far greater than I would be able to muster within the department.
What we are attempting to do with our provincial AIDS Strategy is, and it does not answer the member's question directly, but the thrust in a sentence or two is to be able to have one central support program or co-ordination of programs so that someone who is diagnosed with HIV-AIDS can access the whole variety of service that they need through one-window shopping, in essence. That should include, in my view and the advice I am getting, access to housing projects, social allowance, if income is there, assistance with disability pension, health needs, medical needs, et cetera, Pharmacare, addiction needs, if that is part of the whole issue. Although we have a number of organizations out there who have sort of developed in an ad hoc way--and thank goodness for them, they are fulfilling needs. Bringing them together and be able to have this one-stop window for those who are suffering in this area, I think, goes a long way. That is the thrust.
The advisory board for this, we have asked for nominations. The member--I would be glad to entertain his nomination from the north, and I hope to be able to make those appointments by the time we depart from this place, relatively shortly, before we depart for the summer.
In terms of housing this program, I felt it best, in discussion with my staff, that it would probably be best housed within the Winnipeg long-term and community care program as a provincial program, but having them, under contract, take on this responsibility. Simply, they have much greater experience in working with many of those organizations in terms of the people that they are bringing on board, I think much closer contact to the delivery of service. We have other programs that are province-wide programs that we have asked the Winnipeg Hospital Authority, for example, to run on a province-wide basis. So there is nothing unusual about this.
We also recognize that for many sufferers of HIV-AIDS, when it comes to support of housing and other things, there is a tendency to migrate to Winnipeg because just the sheer size of services that are available here makes it easier. That does not mean that services cannot be or should not be available in other parts of the province, but basically there are logistic issues around this. I see some of those services developing over time, but the logistics of the province are such that particularly many of the leading edge medical treatments are more likely to be available in a larger centre. So we recognize and the community has recognized that Winnipeg still tends to be the major centre for delivery.
So we have asked the Winnipeg Hospital Authority to be the host for this program. We will be appointing the advisory process shortly--pardon me, not the Winnipeg Hospital Authority. The Winnipeg Community and Long Term Care Authority is the host for it. We also expect to use them as a conduit for developing whatever type of promotional material or preventative programs because, again, they are working very closely with the community clinics. In fact, those clinics respond to them for funding. This health authority would be their funding source. So that is the best vehicle as opposed to having a stand-alone program within the ministry.
So those are the efforts we are taking, and I appreciate his comments. I also recognize the need to ensure that the advisory committee is representative of other issues outside the province. The North, because of distance again, and particularly in the aboriginal community--Thompson is a community that has become a centre for activity in the North and within the northern aboriginal communities. So this program has to think about that and take that into advice as this issue develops. So I thank the member for his comments.
Mr. Ashton: In fact, I will even drop off the résumé, rather than send it through the mail. [interjection] I will mark it here for that purpose, and I would like to thank the minister.
I would particularly like to encourage the continuance of development of a strategy in terms of aboriginal people. It is certainly a concern. I know Albert McLeod from the Manitoba aboriginal AIDS task force and others have been working very consistently on this, and there is real concern that there is a great deal of potential for a traumatic spread in the aboriginal population because of some of the factors already mentioned. I would certainly strongly urge that that happen.
I want to ask another question about the nursing station at Sapotaweyak First Nation which I understand is listed in the capital projects. I know I was just talking to my colleague, the member for Swan River (Ms. Wowchuk), and there was some concern why it was even listed when the amount that is being approved is only $80,000--certainly in comparison to other similar-sized facilities. I would like to raise that question. I know there is some frustration in the community, and certainly the member for Swan River did ask me to raise that. I do not know if there is information available right now. If not, I would be quite prepared to have it provided in writing at a later date.
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Mr. Praznik: Mr. Chair, we had a very lengthy discussion with the member for Swan River on this particular clinic in the early part of Estimates but, just for the member's information, this is a federal project. It is serving a First Nation. Because of the geography of that area, the Manitoba Health programs use or will use that clinic for some of our delivery of our programs. We agreed to make a financial contribution towards the capital cost when the program moves forward. Our share of the capital cost, we understand through our negotiations with the federal government, will be $80,000, but that is a small percentage of the overall clinic cost.
It is a federal project in the federal capital program with Health and Welfare Canada, Medical Services branch. We are not the driving force of that project. We are not the major funders. We have agreed, in essence, to pay for the use of the space that we will be using in this new facility, to deliver the provincial programs that we do to neighbouring communities.
I wish I could provide him more information, but, as he can appreciate, it is not our program. It is not our project. It is not in our Capital Branch. We can undertake to make an inquiry of the federal department as to the status of that project, but, again, we are only a small contributor to it to pay for the space we will need to utilize, for our provincial staff delivering their programs to, I believe, neighbouring communities.
Mr. Ashton: I have a whole series of questions I would love to ask on another issue. I will just briefly raise the subject now, and I will perhaps continue it. That is the ongoing problem with physician recruitment and retention in rural and northern communities. I have raised this with the minister, I know, with the minister's predecessor. I am aware of some of the things that have happened.
Certainly, in my own area the allocation of four salaried positions, I think, was a very significant step. In fact, shortly before the minister came in in his current role as Minister of Health, the previous Minister of Health was, I think, very influential on getting that through the system. It was just a question to my mind of recognizing the shift that is happening out there in terms of physicians, that is, more and more physicians not only are willing to work on salary but are very interested in that. That is particularly the case of newer physicians and younger physicians who want a balance of a reasonable practice and a reasonable income and a family life. I think that one of the elements that has been missing in the recruitment, quite frankly--and this is not a criticism I level at the government; it is a criticism at the local communities--is that far too little attention is paid to the quality of practice and personal life for the physician involved. We are, I think, at risk right now in this province of burning out many of our long-standing physicians, many newer physicians, and because of the on-call situation in many communities that is very difficult.
We have people who have heavy workloads, and it is becoming increasingly difficult to maintain adequate levels of physician services when you consider that Thompson is, for example, the third largest city, has significant number of amenities, and we have had difficulty. I think the minister can understand the seriousness of that. We have had problems similar to what other areas have had with surgical services. It was not that long ago as the minister is quite aware that people were being sent to Winnipeg for surgery, and it created a great deal of frustration, worry, anguish, concern. I talked to a number of people, for example, who had to have appendicitis operations in Winnipeg because of a lack of an on-call physician in Thompson.
What I would like to get from the minister is some indication, and I realize part of what is happening is going to be the MMA, obviously the negotiations, but I am wondering if there is going to be any movement on dealing with some of these particular issues, in particular whether the minister has looked at the kind of program that is in place in Saskatchewan, which does provide some limited financial incentives. I think fairly significant because what I have noticed talking to physicians is that when physicians are straight out of medical school and have significant debts and little cash, it is amazing what a difference a small amount, relative to overall salaries in the way of either direct grant or loans, conditional as it may be, can make in terms of recruitment. This was an issue that came up with me with many of the physicians who left Thompson. I actually talked to a number of them, and they said that one of the biggest problems was--even as immigrant doctors coming over--lack of resources.
So, I would like to ask in a general sense--and I realize we are short of time, but if the minister could respond in writing, or perhaps if we could continue this in concurrence over the next period of time. I would like to really focus in on what is a major concern in rural and northern communities.
Mr. Praznik: Mr. Chair, I imagine we only have seconds remaining in this most momentous event, the completion of Estimates. I would be delighted to have that discussion in concurrence with the member.
Mr. Chairperson: Order, please. I am interrupting the proceedings of this section of the committee of Supply, because the total time allowed for Estimates consideration has now expired. Our Rule 71.(1) provides in part that not more than 240 hours shall be allowed for the consideration in Committee of the Whole of Ways and Means and Supply Resolutions respecting all types of Estimates and of relevant Supply Bills.
Our Rule 71.(3) provides that where the time limit has expired, the Chairperson shall forthwith put all remaining questions necessary to dispose of the matter, and such questions shall not be subject to debate, amendment or adjournment.
I am, therefore, going to call in sequence the questions on the following matters:
Resolution 21.1: RESOLVED that there be granted to Her Majesty a sum not exceeding $7,661,600 for Health, Administration and Finance, for the fiscal year ending the 31st day of March, 1999.
Resolution 21.2: RESOLVED that there be granted to Her Majesty a sum not exceeding $24,977,700 for Health, Program Support Services, for the fiscal year ending the 31st day of March, 1999.
Resolution 21.3: RESOLVED that there be granted to Her Majesty a sum not exceeding $73,234,400 for Health, External Programs and Operations, for the fiscal year ending the 31st day of March, 1999.
Resolution 21.4: RESOLVED that there be granted to Her Majesty a sum not exceeding $177,594,400 for Health, Funding to Health Authorities - Community Services, for the fiscal year ending the 31st day of March, 1999.
Resolution 21.5: RESOLVED that there be granted to Her Majesty a sum not exceeding $1,566,122,600 for Health, Health Services Insurance Fund, for the fiscal year ending the 31st day of March, 1999.
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Resolution 21.6: RESOLVED that there be granted to Her Majesty a sum not exceeding $9,662,800 for Health, Addictions Foundation of Manitoba, for the fiscal year ending the 31st day of March, 1999.
Resolution 21.7: RESOLVED that there be granted to Her Majesty a sum not exceeding $66,389,500 for Health, Expenditures Related to Capital, for the fiscal year ending the 31st day of March, 1999.
This now concludes the consideration of the Estimates in this section of the Committee of Supply.
I would like to thank the ministers and the critics for their co-operation. Committee rise.