Manitoba Hansard — Sitting 40B (35th Legislature, 3rd Session)

35-3-40b

Manitoba — Debates (Hansard)

MG-8048 Third Session - Thirty-Fifth Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS {HANSARD) 39-40 Elizabeth II Published under the authority of The Honourable Denis C. Rocan Speaker VOL. XLI No. 408 • 8 p.m., MONDAY, APRIL 6, 1992 Printed by the Office of the Queens Printer. Province of Manitoba ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thirty-Fifth Legislature Members, Constituencies and Political Affi liation NAME ALCOCK, Reg ASHTON, Steve BARRETI, Becky CARSTAIRS, Sharon CERILLI, Marianne CHEEMA, Guizar CHOM IAK, Dave CONNERY, Edward CUMMINGS, Glen, Hon. DACQUAY , Louise DERKACH, Leonard, Hon. DEWAR, Gregory DOER, Gary DOWNEY , James, Hon. DRIEDGER, Albert, Hon. DUCHARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim, Hon. EVANS, Clif EVANS, Leonard S. FILMON, Gary, Hon. FINDLAY, Glen, Hon. FRIESEN, Jean GAUDRY, Neil GILLESHAM MER, Harold, Hon. HARPER, Elijah HELWER, Edward R.

HICKES, George LAMOUREUX , Kevin LA THLIN, Oscar LAURENDEAU, Marcel MALOWAY , Jim MANNESS, Clayton, Hon. MARTINDALE, Doug McALPINE, Gerry McCRAE, James, Hon. MciNTOSH, Linda, Hon. MITCHELSON, Bonnie, Hon. NEUFELD, Harold ORCHARD, Donald, Hon. PENNER, Jack PLOHMAN, John PRAZN IK, Darr en, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROCAN, De nis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric, Hon. STORIE , Jerry SVEIN SON, Ben VODREY, Rosemary, Hon. WASY L YCIA-LEIS, Judy WOWCHUK, Rosann CONSTITUENC Y Osborne Thompson Wellington River Heights Radisson The Maples Kildonan Portage Ia Prairie Ste.

Rose Seine River Roblin- Russell Selkirk Concordia Arthur- Virden Steinbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Springfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas Inkster The Pas St. Norbert Elmwood Morris Burrows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park Flin Flon La Verendrye Fort Garry St.

Johns Swan River PARTY Liberal NDP NDP Liberal NDP Liberal NDP PC PC PC PC NDP NDP PC PC PC Liberal PC PC NDP NDP PC PC NDP Liberal PC NDP PC NDP Liberal NDP PC NDP PC NDP PC PC PC PC PC PC PC NDP PC NDP PC PC PC PC NDP PC NDP PC PC NDP NDP

18 38 LEGISLATIVE ASSEMBLY OF MANITOBA Monday,Ap�l6,1992 The House met at 8 p.m. COMMITTEE OF SUPPLY (Concurrent Sections) HEALTH Mr. Deputy Chairperson (Marcel Laurendeau): Order, please. When the Committee of Supply was last sitting this afternoon we were considering the Estimates of Hea lth, No. 1. (

b) Executive Support Salaries on Page 82. Shall the item pass? Mr. Leonard Evans (Brandon East): I would like the opportunity, because this is a general item and also because the matter of the Brandon General Hospital was ra ised and discussed in some detail by the minister himself, to ask a few questions of the minister by way of getting some information and understanding where his position is on this.

It comes out of the meeting that was held last Th ur sday in Brandon where there were well over 500 people in attendance, I must tell you , a lot of confused , angry, concerned citize ns, and they generally wanted some information , and they wanted to get some answers. We had the representative of the board, Mr. Singleton, who did his best. He did a fairly good job. We had Mr. McCrae representing the government in his ri ding and myself in the opposition in Brandon East, and neither Mr. McCrae nor I could give that many answe rs, but Mr.

Singleton was right front and centre, as perhaps he should be as the acting representative of the board and former chairperson of the board . I would like to ask by way of obtaining some information from the minister firstly whether -and I am only talking about the Brandon General Hospital, but what happens at Brandon Gene ral has some bear ing on the general policy and it is something that could be repeated throughout Manitoba when you discuss other specific hospitals.

The point is, there is, accor ding to the information that has been given to the public by the administration of Brandon General Hosp ital, a shortfall of $1 .3 million, that is $1 .3 million short in order to maintain the status quo in the organization and the level of service they had last year. Yes, indeed, there was an increase in the budget, a substantial incre ase, and I acknowledged that at the meeting. I am not debating that, but obviously that increase still was not enough-for whatever reason I do not know.

This is why I want to get some answer s-t o allow the administration and the board of Brandon General to maintain the status quo. Therefore they have come up with some cuts that are widely known, the layoff of nurses, the scaling down of the palliative care ward and the elimination of the gynec ology ward and its absorption elsewhere in the hospital and whatever. It was a very emotional meeting, people did not understand, and they wanted some information.

There is no question in my mind thatthe board would have been well advised- and hindsight is easier than foresight-to have had some kind of public dialogue of maybe two months ago or whatever , in fact, before they even made a final announcement to enable the public to be clued into what their problems were and to what they were suggesting, what they were looking at, and to offer some feedback and some legitimate dialogue. In fact, if anything came out of that meeting it was the importance of having more public participation in decision making to the extent that you can have it in this type of setup. Mr.

McCrae furthermore agreed with them , and he is on record as saying that he agrees that there should be more public information consultation by boards prior to any major decisions being made of the nature that we are talking about that has caused such a great stir. As I said earlier today, I have not in my history of represe nting that area have known any rally or public meeting to express concern and dismay over reduction of services at the hospital. That is a new development in the city of Brandon. I do not believe ever in its history has there been a public meeting in this respect.

I wanted to ask some questions that I think the people there would have liked to have asked the minister. I would like to see if I can get some answers by way of being productive and positive about this. I wondered if the minister could tell us whether -and I am just assuming that because of

18 39 LEGISL ATIVE ASS EMBLY OF MAN ITOBA April 6, 19 92 MHSC now being integr ated into the department. We live in the day and age of computerization. I know that there is enormous amount of detail published even in the annual reports of the Manitoba Health Services Commission on all kinds of costs of operation. •

(2005) I know the minister and his senior staff have access to all of this detailed information. They have a planning division, there is analyses that go on all the time and so on. I would assume that the minister was aware of the fact that Brandon General was facing a $1 .3 million shortfall, even though we are talking about an increas e-- [inte�ection] Well, the minister asks, this is the statement made by the administrator of the hospital and the represe ntative of the board .

They have stated publicly-it is their words not min e--a $1 .3 million shortfall to maintain, even though the reve nues have increased , the level of services and the status quo that existed last year. Now that is how I used the term "shortfall," the term that was used by the hospital itself. So maybe one general question is: Was the minister aware of some of the consequences of the level of funding that was approved for this year?-the increased level, I repeat, I appreciate that.

It was an increased level, but was he aware that there was, what the administration of the hospital said, insufficient amount to maintain the status quo and that there was going to have to be a red uction in service levels? Was the minister aware of these consequences? Hon. Donald Orchard (Minister of Health): No, Mr. Deputy Chairperson. Mr. Leonard Evans: One of the very emotional areas is the downgrading or down sizing of the palliative care service level.

I wondered if the mi nister could advise whether from his knowledge and the department's knowledge , is there any way that he can see the Brandon General Hospital maintaining the palliative care service at the level that existed last year? Mr. Orchard : Yes, I can, because it is my under standing in making the decision to reduce the siz e of the pall iative care war d that the administration and board are downsizing it to reflect the occupancy pattern of the last 18 months, and the numb er of beds proposed in the reorganized structure of the hospital will accommodate that patient load. Mr.

Leonard Evans: This was the type of answer, I guess, that the representative of the board, Mr. Singleton, gave, but then member s of the audience, including one person who was suffering and, I guess, still is suffering from cancer who spent time in the unit, maintained that all beds were filled when he was there, all 19 beds. He pleaded, I mean, he said he was alive today, and five of the people who were living there at the time he was there have already had their obituaries in the paper. In other words, they have passed on, but he was pleading for the same level of serv ice.

By that I mean the same number of beds, the same size of operation. He maintained that really, well, he questioned the hospital's figures on it, and there were other mem bers in the audience who did that as well. Now, I am no expert on this. I do not have the data. I do not work there , obviously, so there was this concern expressed that the scale-down proposal would not be sufficient really to accommodate people in these circumstances .

There was also the other angle that was thrown out that organizations such as the lODE Diamond Jubilee Chapter, which over the many years had raised money in teas and bake sales and however that organiz ation raises money to provide furnishings and so on to make it a very comfortable place for the family of people who were term inally ill, they were distraught to see that that work and those contributions were seemingly pushed aside in this type of reorganiza tion.

I am asking the minister then, I am suggesting to the minister that a lot of people dispute these figures and believe that a downsized palliative care ward is not sufficient. Mr. Orchard: Mr. Deputy Chairperson, as I indicated to my honourable friend in my last answe r, the board analyzed the use of the palliative care ward over an 1 8-month period of time and found that downsizing it to the flexible capacity ranging fr om, I believe, six to nine beds would accommodate the needs for palliative care. Possibly I might help my honourable friend by-and I presume this quotation is accurate.

It is out of Friday, April 3, Brandon Sun. It is a quote from Robin Singleton, who, I understand, represented the board at the meeting:

April 6, 19 92 LEGISLA TIVE ASSEMBL Y OF MAN ITOBA 18 40 It is impor tant to emphasize that the beds taken out of service were unused beds.

A continuation of the quote: Some of those beds in palliative care are not used for what they were designed for, he added later, noting the unit is for the terminally ill and chemo patients should be in regular medical beds. • (2010 ) I, without having direct knowledge, would assume that the palliative care ward was used for other than palliative care , in that the new configur ation of beds, which at the press conference that I was at to support the board and the administration's decision some three weeks ago, they indicated that they had some flexibility within the hospital system to increase the numbers if the demand warranted such flexibility but that their analysis of 18 months of utilization would indicate the new configur ation would provide for adequate patient care .

I tend to believe that because, as I have indicated to my honourable friend, in the last four years the budget for home care in the city of Brandon as well as the generous increa se-not my words but the words of the member for Brandon East (Mr. Leonard Evans)-l ast yea r to the Br andon Gene ral Hospital 's budget was accompanied over a four-year period of time by 149 percent increase in home care budget, with almost a doubling of the units of servi ce. Some of that service went to palliation in the community, in one's home.

That is what caused the reduction over the last 18 months, I would speculate, of the utilization of the inpatient palliative care unit. So what we have in this example is exactly what many people, including my honourable friend's party critic for Hea lth-that when you move services from the institution to the community and you have empty beds, you do not staff empty beds, that you close empty beds if you have tranferred some of the service to the community by increased funding of services in the community. You then transfer the budget from the hospital to the commu nity and you close the beds.

The shor tfall in funding is a deficit that the Brandon General Hospital is projecting to incur this past fiscal year and the current fiscal year, if they did not take some action. Deficits are not allowed, as my honourable friend knows . He was at the cabinet that set that policy, and we have continued with that policy. Even with the generous funding increase to Brandon General Hospital-not my words but the member for Brandon East's words-of last year, they still project it to be runnin g at a deficit.

Based on their analysis of utilization, a downsizing of the palliative care ward would not compromise inpatient palliative care. The capacity would be there as needed . Their analysis of the occupancy rate of three other wards indicated a 51 percent occupancy rate over the past 18 months, a 67 percent occupancy rate, and a 68 percent occupancy rate. Those three wards were collapsed into two wards, which I believe, if my memory serves me cor rectly, will average about an 85 percent occupancy rate on two wards-in other wor ds, a staffing or a utilization of those beds which will fully employ the staffing patterns.

Now when you close one ward, the staff accompanying that ward will be laid off, or else you continue to pay costs for staff not to look after patients because the beds are empty. Now that is a difficult decision any time you have the prospects of layoff. The alternative is you pay staff to occupy and serve empty war ds. Every dollar you put in there you take away from the commu nity or other areas of health care spending and further confound and deny the ability to reform the system and continue the shift to the community.

That is why I had the opportunity and created the opportunity of a press conference in Brandon three weeks ago-to meet with the media, to defend a reasonable management decision of the hospital and the board. I did not duck the issue. I went out and met with the media in Brandon. I would have been there Thursday of last week at the meeting, but you know my children are only out of school for this past week. I have made a habit of taking them on holidays, and that is where I was, with my family.

I regret not being able to interrupt my holidays and go to Bran don, but I had been there three weeks before. • (201 5) Mr. Leonard Evans: I thank the minister for that information. Even though the organizers of the event had an empty chair and put up a sign for Don Orchard, because I know people do make such plans and they do like to be with their family, I want the minister to know that I made no issue whatsoever. I made no mention of anything with

18 41 LEGISL ATIVE ASSEM BLY OF MAN ITOBA April 6, 19 92 regard to the minister's plans. That was not my business. You were not there and that is your business. I want you to know that !-because frankl y I think that would be very unfair if someone did that. Although I have seen it happen in the past in different situations, and I am not going to mention any names or any places. What I would like to ask the minister, you said the home care units were increased, and I think you said 14 9.

I was just wondering if you could tell me, what were the number of home care units in-1 think you said 19 87 and then you compared it with 19 91 , did you?-or April or March 1992? Mr. Orchard: I will give my honourable friend two figures which I think will demonstrate the issue that I am trying to point out to my honourable fri end. I will give my honourable friend the Continuing Care budget for the Westman region and the units of service for two years. The first year is 19 87-88. I do that very deliberate ly because that is the last year that my honourable friend had some responsibility for the budget.

The budget for Continuing Care for the Westman region for home care was $2,1 90,500, and in that year of 19 87-88, 269,81 1 units of service were purchased. The budget is projected to be-and this is a preliminary projection for year-end fiscal year 19 91 -92-$ 5,71 7,000. More than double the budget when we inher ited government. The units of service purchased with that increased budget is projected to be 442,000. Not a doubling of units of service obviously, because we have had some salary increases so that a unit of service costs more but individual units of service almost doubled for Westman region.

I will give my honourable friend the same figures for Brandon city which are incorp orated in the last figur es for Westman regi on-the home care services expenditures were $424,276 in 19 87-88. That represented the purchase of 53,271 units of service. The prelimi nary projections for fiscal year ending 19 91 -92, March 31 , is that the budget will be in excess of $1 ,056,400. That will have purchased over 1 00,450 units for almost a doubling of the units of service with more than double the budget in Brandon. An Honourable Member: Excuse me, 1 00,415 ? Mr. Orchard : One hu ndred thousand, four hundred and fifty.

Mr. Leonard Eva ns: Excus e me, jus t for clar ifi ca ti on-'87-88 un its for Brandon again-w ould you mi nd repeating them? Mr. Orchard: Fifty-th ree thousand, two hundred and seventy-one units of service were purchased in 19 87-88 with a budget of $424,276. It is estimated that the budget for the past fiscal year just ended will exceed $1 ,056,400 and that will have purchased in excess of 10 0,450 units of serv ice. Mr. Leonard Evans: I appreciate the information, and obviously we are glad to see the numbers increase .

The only point I can make is I have been told by some people who work in the system, even though the level is higher, that there are still insufficient funds for home care. Now this is what I have been told by people in the system. They are not politicians, and I am not going to repeat their names. They do not necessarily work directly in home care, but they are in the health care system in that area. They say that if you want to take more pressure off the hospital, that budget has to be substantially increased .

I offer that opinion from people who are health care providers or whatever the expression is-health care admin istrators , actually. *

(2020) I just wanted to say about the palliative car e-1 know the minister has given the reasons and he did so at a news conference in Brand on- It cert ainly did not register with the 500-plus people here, because one of the highlights of the evening was a fellow by the name of Henry Buhler, who probably should not have been in the palliative unit because he seems since to have been cured. He was at the meeting, and by his own statement maybe he should not have been there.

He was told he did not have very long to live, and apparently the doctors are amazed that he made such an im portant, significant, vital recove ry. He went on and on about how it was all filled and there was a standing ovation for minutes. I mean, for minutes people were just taken by his description of the service in the palliative care unit and really expr essing a concern that, even though these average figures recorded by Mr. Singleton and so on, there still would not be the level of service that had been available up until that point. You know , it was a very emotional thing.

I had never met the gentleman before in my life, but he was there making that presentation. I am just

April 6, 19 92 LEGISL ATIVE ASS EMBLY OF MAN ITOBA 18 42 saying there is a feeling out there or under standing out there that there is this insufficient level, that it is not going to be provided in the future. This is why I get back to my original point that the hospital should, all hospitals should have public information sessions, allow for dialogue, provide in fo rma tion, allo w que sti ons to be asked, suggestions to be made and so on.

The people there were certainly-the 500-plus people who were there as I said- well, there is a pictur e of them standing and giving a standing ovation after a 15 -minute eloquent description of his particular situation and his feelings on the matter. At any rate, I gather the minister is satisfied nevertheless with the decision made by the hospital and believes they should live by it. I wanted to ask another question and that is wheth er the minister and his staff, senior advisers, believe that the administrative costs at the Brandon General Hospital are excessive or out of line with the other urban hospitals.

Mr. Orchard: Mr. Deputy Chairperson, I really cannot answer that question tonight, but I would be fully prepared to get into that discussion when I have appropria te staff here in the hospital lines. Appreciate that the detail of that kind of question is not av aila ble ton ig ht to acc ommo date my honourable friend. My honourable friend must understand that I do not know the exact details, but there was a collapse of two positions or three positions into two at the senior management level at the hospital, and the elimin ation of one senior management position.

You know, my honourable friend makes the point that at the public meeting a man who was on the palliative care ward, and is now alive and well, maybe should not have been there. I think that is what Mr. Singleton is saying when he was saying that the occupancy, when it was full, it was not always with people dying, terminally ill from cancer, so that was not an appropriate use of the palliative care ward . That is for, unfortunately, where you have people terminally ill who are going to die and you provide them with as much comfort as you can and as homelike an atmosphere as possible.

It is not for people with chemotherapy. It is not for people with other treatment modalities suffering from cancer or other serious diseases. *

(2025) You know, I under stand the emotion behind the issue and there will always be emotion behind any health-care issue, but the budget increased and inc reased significantly to the Brandon General Hospital. My honourable friend called it generous, the increase for 19 91- 92. Well, despite that and despite a significant increase in home care, you have people telling you that neither budget is sufficient. I guess maybe what we should do is cancel all other departments in government and spend all of our budget on health care. You know what I will tell my honourable friend?

That would not be enough, because there would be someone who would not receive the instant treatment as they wished, when they wished, et cetera. Now, my honourable frien d , when he communicated with constituents in January, 19 87, ind icated to Dear Cons tituent : You shou ld understand that the decision to close beds at Brandon General Hospital was made by the board of directors of the hospital because of the large deficit. My honourable friend is saying that is the reason for bed closures then.

I am saying that, in part, sure, more money to the hospital would have averted that, but we gave them a generous increa se-n ot my languag e, the member for Brandon East's language-and still they ran a deficit. But in trying to come to grips with that deficit they did not compromise the program service delivery in the hospital, because they analyzed their use of palliative care , downsized to accommodate use. They analyzed occupancy on th ree oth er war ds-5 1 per cent, 67 percent, 68 percent-collapsed three into two.

The same bed capacity for acute patient care and admission is there today as was there last year, the difference being they are going to save dollars by not staffing empty beds. Now my honourable friend can say, as he has said at that meeting, well, you should just give them the money. That is the point I have been trying to get around all this afternoon. If that is the solution that you proffer to the Brandon citizens in 1992 when they are faced with a deficit, why is it that you did not do it when you had the ability in government to do it?

You could have gone to the Premier, Howard Pawley, and to Larry Desjar dins, the Minister of Health, as the member for Brandon East, senior cabinet minister in west ern Manitoba, and said, cover the deficit so they do not have to close the

18 43 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 6, 19 92 beds. Did you do that, sir? The answer is obvious, no. Why then, sir, are you saying from opposition that this government should simply provide the money to staff empty beds when you would not even provide the money to prevent the closure of those beds to solve a deficit problem when you had the complete authority and control to do so?

That, sir, is why this debate on health care is going to go on for an awfu lly long time, until we get some consistent answers to pressi ng problems in health care, because I wantto assure my honourable friend that in this province, no different from any other province in Canada, we cannot afford to fund the unlimited demands of the health care system, just as my honourable friend when he was in cabinet could not afford to fund the unlimited demands of even the hospital side of the health care system, because my honourable friend's government put in a no-deficit policy for hospitals.

We cannot afford to fund-I will be very direct-a 12 .1 percent incr ease in taxpaye rs' doll ars demanded by the MMA on behalf of physicians in Manitoba. We cannot afford that. We do not have that kind of money. If you think we are unique, ask Ms. Lankin from Ontario, Minister of Health. She is saying to the health care system, we need to manage better, that there is up to 30 percent waste in the expenditure of dollars in the health care system in Ontario. That 30 percent translates into over $5 billion.

That is why, sir, they are giving the hospitals a 1 percent increase, not roughly a 4 percent to 5 percent increase that is coming in our budget this year. That is why the Minis ter of Hea lth in Saskatchewan says in a press release, and I will dig it out for my honourable friend and give it to him, that we do not need more money in health care, we need more management. That is a Minister of Health who happens to be a New Democrat who happens to be in the government of Saskatchewan. The Pr emier of British Columbia, another New Dem ocrat, is saying, we cannot afford to fund ever-gro wing budgets in health care .

We have to contain the costs. Now, tha t is not some nee>-Conservative, right-wing Attila the Hun. That is Mike Harcourt, man of the people, New Dem ocrat. That is why I say to my honourable friend, you can go to Brandon, and you can whip up another meeting of 500, and you can pass out more petitions, and you can get more names on petitions. You can do that, and you can get the public whipped up. You passed out petitions at the meeting, right?

So you can do those sorts of things, but you would be hypocritical to the people you serve if you tell them you would do anything different than what we are doing, because when you were in government you did not give them more money to cover their deficit. You forced them to close 31 beds. *

(2030) That is where I started this afternoon's discussion, saying what we need is some honesty, and I have to give my honour able friend in the second opposition party some credit for laying issues on the line. You have not even answered today, neither of you have answered today, whether you have changed your mind on the policy you have put in place of no deficit. You will not even give that candid admission. Yet you want every answer of me. How can you debate health care reform ? How can you debate the principles of health care reform if we are not talking about starting from even policy keels.

If you say hospitals can run deficits and I say they cannot, we are not talking the same kind of health care ref orm. My health care reform is based on no deficits in the hospitals. My health care reform is in moving hospital budgets to the commu nity as quickly as possible by following the patient with the budget. That is what I explained in my opening remarks and I will continue to explain that, and I want to tell you that the public, when informed of that, agree with that process. Mr. Deputy Chairperson: Order, please.

At this time I would like to remind the honourable minister the word "hypocritic al" is unparliamen tary and does not fall un der the other category of being parliamentary, so I would ask him to retract that statement at this time. Mr. Orchard: Mr. Deputy Chairperson , I gladly retract that statement. Mr. Deputy Chairperson: Thank you. Mr. Leonard Evans: Mr. Deputy Chairperson, first of alii want to make it clear, the minister seemed to infer, or at least I thought he was inferri ng, that somehow or other I organized this meeting.

I was invited to the meeting, and I had nothing to do whatsoever with the organization of it. I was not even sure who else was going to speak. I knew someone was going to speak from the board and I knew Mr. McCrae . I thought maybe there

April S, 19 92 LEGISL ATIVE ASSEM BLY OF MAN ITOBA 18 44 would be city councillors and so on. I had absolutely nothing to do with the organization of the meeting. It was really a truly grassroots meeting organized by a citizen in the comm unity who put ads around the comm unity, posters and in no time got this response. The hall was paid for by silver collection or at the door. Furthermore, I want to make it clear that, yes, I have a petition. The petition I was talking about today signed by 5,300 people, this was done by people I have never met.

I do not really know these people, although one of them advised me that he was a student of mine some years ago, but I have not seen him for about 25 years. The fact is, I had nothing to do with this petition. This is from people who are concerned and distressed. Now, it is directed to the board of the Brandon Ge neral Hospital , and it is asking the boarcl-[ interjection] It is not the petition that I have got going, that is another petition again. This petition is asking the board not to close the palliative care unit and the gynecological unit.

They want the board to work to find a more equitable and cost-effective way of meeting the budget ary restra ints. This is where I was getting my question: What else could the board have done? I do not know what else the board could have done. It seems to me they are between a rock and a hard place in terms of how you cope with not having enough money to maintain the status quo from last year, even though there has been an increase , and at the same time provide these services that the public obviously seemed to think are pretty vital and have req uested.

I might add that the people who signed this were not the city of Brandon alone. Yes, many from the city of Brandon, but there are 84 communities in southwestern Manitoba who are represented in this. I also want to make a point to the minister. You know , he says, well, when we were in office, and he keeps on harping back at '87, if you want to talk about '87, fine. In this area we had some cutbacks and that was it. Therefo re, we are being hypocritical because now we are being concerned about cutbacks.

The fact is that there was a lot of reform going on at that time and a great deal of money was being spent to make the system more efficient. Home care was being expanded then too, but besides that, around that time we brought in the day surgery program which was very significant in the hospital- well, in around that tim e-to take pressure off. Also there were other developments in the hospital that helped to impr ove the level of service , the CAT scan, that came in around that era and also very importantly there were 320 nursing home beds built at a cost of over $18 million in that period, '87-'88.

An Honourable Member: Was Rideau Park one of them? Mr. Leonard Evans: Rideau Park was one. Well, look, let me say this, there were 10 0 beds there. They were psychogeriatrics from BMHC. What the minister does not know, and he may no�omeone should tell him if he does not know and I will tell him-that psychogeriatric people who are elderly at BMHC over the years had been put into this system. They have gone to Fairview Home; they have gone to the Hil lcrest home; they have gone to the Dinsdale home.

To that extent a place was provided for them but there was still-so it did take pressure off of the system in that respect. Furthermore, in the years ahead it will be there , unless this governmen t ceases to fund it for whatever reason, as part and parce l of the nursing home supply, if you will, in that community. There were a lot of major reforms that took place and mor e very top- class be ds, top- quali ty accommodation put into place so there was a development.

Obviously, the people in the communi ty were not concerned that there were a few beds closed in the acute care side because of the other developments. There was certainly no public meeting to criticize the government at that time. There was no outcry as we have today. It was not perceived to be as anything-maybe there was the odd doctor who might have been upset or what have you. There were no layoffs of nurses. Ask the nurses' union, they will tell you. The point is, we were in the process of reform and the process of upgrading the hospital in terms of the kind of equipment and the kind of program s that it had.

Mr. Deputy Chairper son, I was asking the minister whether he could advise this comm ittee whether the administrative costs of that hospital were in line, because a great deal of that meeting was spent on people questioning various specific positions in the hospital, and there seemed to be an inference that

18 45 LEGISLATIVE ASS EMBLY OF MAN ITOBA April 6, 19 92 too much money was going into administration, and if that money was not going into administration it would have resolved the problem of the palliative care ward and the gynecological ward closures, or scaling down. To some extent I thought some of the people were unfair, I really did. I thought they were unfair in their statements, but nevertheless there was that strong feeling that somehow or other Brandon General Hospital is top-heavy with management, excessive amount of money is into administration.

In fact, I think a Jot of the people who signed this petition think that, because there is reference to that. That is why, even though there was some increase in the overall budget this year, nevertheless there were these closures, because too mu ch money is being funnelled into administration. The minister said earlier, well, he does not have that kind of detail with him, but this brings me to another point and that is we should be given more information. Ther e should be a report on the administration of hospitals. I know there are annual repor ts but they do not give you very mu ch information.

I have seen the Brandon General report and it is not detailed enough as far as I am concerned. The citizenry would be well served if we had that type of report. So I ask the minister, does he have the impression that there are excessive funds going into administration of the Brandon General Hospital? Mr. Orchard: Mr.

Deputy Chairperson , I will deal with the administration issue later, but lest my honourable friend get too far out on a limb about the wondrous days when he was responsible for bed closures and whatnot in Bran don, I want to point out to him these 320 beds that he is talking about on the personal care home side, just off the top of my head wit hout analyzing my hono ur able frien d 's statement, I know 1 00 of them were a dir ect replacement for beds at the Brandon Mental Health Centre. They were not new beds, additional capacity.

They were simply new beds built, beds closed on the hill at the Brandon Mental Health Centre and the patients transferred to the new beds. *

(2040) I know that my honourable friend while he was in the Pawley government saw the end of International Nur sing Home and two others because I toured both of them as an opposition criti c. Those were in part replaced by Dinsdale home, so that before my honourable friend starts getting into this dynamic that they put 320 additional new beds in Brandon, I advise him not to get too far out on that limb because there are rather sharp saws that will leave him on the end of that branch falling fast.

Just off the top of my head I can tell my honourable fri end where he is wrong in at least 200 of the beds that he claims were there. Let us not get into that, because we will get into the frozen capital budget that I inherited in 1988 as well where there was no construction for nine or 10 months. Let me deal with the issue of administration. I have a concern over administration costs in our acute-care health system. I have concerns, for instance--and I will give you some of the concerns and some of the areas of reform that we are going to be working towards.

Communities, and some exist where there are separ ate admin istrative structures for the personal care home side and the acute hospital side. I say other commu nities are operating very effectively with joint administration and with cost savings.

So in those areas we are going to be very solidly encouraging the boards and the administrations of those facilities, before they cry insufficient budget to gover nment, that they look at ways of economizing on administration within their commu nities, because I do not see a whole lot of sense for a personal care home which is 15 0 steps away from an acute-care hospital to each have its own separate administrative CEO and structures par alleling, when I know commu nities that have the acute-care hospital and the personal care home, both of them fairly substantive units, administered by one administration and they are a half mile apart in the town .

I know it can work and it can contain costs. I want to deal with another couple of areas on adm i nistrati on. Brandon-! cannot give my honourable friend a sense for whether they are above or belo w the admini strative costs of comparable-sized facilities, but let me tell you where I am starting to point questions at my bureaucracy. Very quickly they are going to be asked directly of our senior hospital administrators in Winnipeg, because Brandon cannot really fit into this sort of an administrative structu re.

Each hospital has a personnel department staffed by a personnel director and personnel officers, et cetera. The majority of the staff hirings in hospitals are nursing staff or support staff. I ask myself the sim ple question: Do we have to have eight

April 6, 19 92 LEGISL ATIVE ASSEM BLY OF MAN ITOBA 18 46 separate personnel divisions for eight hospitals in the city of Winnipeg, or is there an opportu nity for some centrali zation of that fu nction and a considerable dollar savings without compromising patient care one iota? Second area: purchasing. In the purchasing of supplies for hospitals, there are eight separate purchasi ng areas, all of them essentially purchasing the same kinds of supplies in an acute care hospital. Can there be savings by amalgamating purchasing function? That will mean layoffs.

Those are difficult decisions, but let me assure you I see an opportunity to undertake them without compromising patient care one iota, but where would my honourable friend stand if that came out of this government as an investigated direct ion? Would my honourable friend cry the usual cutback and compromise of patient care , the usual rhetoric, or would he say, reasonable to investigate, it should have been done a long time ago? That is where we are heading.

Before hospitals come to us saying that under this year's budget proposals our only response is massive closure of beds, massive staff laying off at the nur sing level, which is the most sensitive political level, we are going to be asking those fund am en tal qu estions about their management structures and whether there can be a Winni peg hospital personnel dir ective and purchasi ng departm ent. Those do not compromise one iota of patient care . I have to admit, I am not a mental giant, maybe it is impossible to do.

Everything is impossible to do if you do not want to do it, but I think there is a heck of a lot of room for creativity in today's acute care hospital system under the $950 million that we are projecting to spend there to save a tremendous amount of dollars without compromising one iota the service to the patient, to the client, to the individual Manitoban needing care . That is what Ms. Lankin in Ontario means, I suspect, when she says 30 percent of the funding on health care is wasted in Ontario.

I do not think she may be too far off in Ontario, and maybe that figure could even be transposable to Manitoba, but in getting at it, you are going to have every professional group whip up the people of Manitoba crying cutbacks, claiming people are going to die on the streets, that they are not going to get their surgery. Do you realize that the decisions made by Brandon General Hospital will not compromise one iota the level of surgical activity in that hospital? How many times did you hear the issue brought up of line-up s for surgery?

Entirety not related, because they were not using the beds for surgery patients anyway . The last point I want to correct my honourable friend on before he gets out on that proverbial limb again, the outpatient surgery did not exist in 1987 when my honourable friend was communic ating to the citizens of Brandon. It was funded for the first time by this government. It was a proposal that was made by the hospital board and developed, and we ended up providing the funding for it.

I believe it commenced operation in late 19 88, not anywhere near the time my honourable friend is trying to justify the statement he made. You should under stand that the decision to close beds at Brandon General Hospital was made by the board of directors of the hospital because of the large deficit. It had nothing to do with outpatient surgery. It had nothing to do with 320 or whatever number of beds my honourable friend talks about in personal care homes.

It had everything to do with the deficit at the hospit al, a deficit that my honourable friend, as I indicated earlier, when he had the ability to do it did not cover, but yet is asking me to cover today. I do not find that being very consistent. Mr. Leonard Evans: I know others want to get on, but I am not responsible for the length of the answers, Mr. Deputy Chairpers on. Jjustwant toask a couple of more questions, make a couple of more points. We can debate this business about how many beds were added and so on.

Alii can say, though, is that this government did close the In ternational Nur sing Home when you were minister. I believe there were 44 beds at that time. They were gone and that was your decision. Mr. Orchard: No, no, that was your decision that we carried out. Mr. Leonard Evans: Well, that was our decision but day surgery was your decision and you carried it out. We did not make that decision-[interjection] Mr. Deputy Chairperson: Order, please. Mr. Leonard Evans: I was very concerned that this mi nister was going to elimina te International Home-[interjection] Mr. Deputy Chairperson: Order, please.

18 47 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 6, 19 92 Mr. Leonard Evans: -t hat when this government closed International house, it did not come up with a pr ogram for additi onal nur sing home beds-[inte�ection) Well, Mr. Deputy Chairperson , the minister is interru pting me, but as I said, he cannot compare the Rideau Park and BMHC. You know what conditions those people lived in at BMHC? They lived in huge war ds.

They had absolutely no privacy whatsoever, and in the Rideau Park they have a bona fide personal care home at top-level standards, good quality, private rooms, private bathrooms and lounge facilities and so on, and they are much better off and that facility is there . It took pressure off the other nursing homes that did take patients out of BMHC. It did take elderly people out of BMHC. They went to Hil lcrest, they went to Fairvi ew, et cetera, so it did take pressure oft, and secondly, the other facilities too. There is no question, it raised the quality of nursing home care in the commu nity enormously. •

(2050) My under standing was-1 do not have all the files with me- that we made a decision, and I thought it had been carried out, to implement the day surgery at the hospital because that was one way of reform ing, taking the pressure and containing the costs that the minister is talking about. This was my under standing. I remember Mr. Desjar dins talking about it, and I thought that was an agreement and that it was proceeding.

But the point I am making is that there were not just cutbacks, there was not just a small reduction in beds, or however you want to des cri be it, but ther e wer e these other developm ents. The CAT scan was a major investment decision for that commu nity. Mr. Deputy Chairperson, I want to go on to another area, and very specific, because there is an industrial adjustment comm ittee that has been established. The minister is probably aware of it, and I am advised that it is a federal-provincial initiative.

It is meant to help cope with the people who are to be laid oft, no matter whether it is a hospital, a meat-packing plant or whatever it is. In this case, these people are, if they are going to be out of work, they are looking for alternative employment, and my under standing is that there may not be sufficient funds to enable these LPNs who are being laid off to train into some other type of health care occupation or whate ver. So I am asking the minister, can his government or will his government or will he look into this, to see whether funds can be provided?

I understand there is some talk of maybe three or four being able to go on to registered nursing training if they feel so inclined, but I do not think the individuals necessarily have the money to do that, but all the others have no financial support either, so maybe the minister could enlighten us on this. It is a question and it is a request that the minister look at funding for the retr aining of the affected nur ses so that they can seek alternate employment, and I think it is a positive request. I mean it is a req uest made in all earnestness and seriousness, and I wonder if the minister could respond. Mr.

Orchard: Mr.

Deputy Chairper son, when I was in Brandon at the press conference with the administration and board members, some of the board members, I recall one of the answers that was given in response to a media question, that in fact the School of Nursing in Brandon had budgeted or planned for an increased student intake in case any of the LPNs who may be laid off, and my understanding is that number is not determined because the "bumping processw is going on right now, so we do not even know how many numbers definitively we are dealing with, but that they were making extra spaces available in the School of Nursing to accomm odate those who may wish to upgr ade their nursing career trai ning.

I am not aware of any insufficiency in that regard . In terms of the other co mm ittee stru cture, I under stand that this has some attachment to, what is it, the federal jobs strategy or, I do not know the exact name, but a federal government program. I will attempt to find out whether there are any constraints to funding that the federal government might have on that aspect of retrai ning. Mr. Leonard Evans: I thank the minister for that.

My un de rstan ding is that it is a joint federal-provincial effort, and there may be some precedent where the province has put some money in to help retraining of people, but if the minister could look into it and let us know, that is what we are asking. There are a lot of LPNs who are very concerned. I might say some of them with 20, 25 years of service at that hospital have told me they will not have a job after the beginning of May or whatever.

April 6, 19 92 LEGISLATIVE ASS EMBLY OF MAN ITOBA 18 48 I have a lot of other detailed questions that we could debate for some time. I under stand some of my colleagues on this side are getting anxious, and they want to ask some questions, so maybe subsequently in the Estimates some other day, we can have an opportunity at some appropriate time to ask further questions. Thank you, Mr. Deputy Chairpers on. Mr. Guizar Cheema {The Maples): Mr.

Deputy Chairperson , can we go back again to the whole hospital so-called reorganiza tion, and can we at least have a rough time fram e of when the Urban Hospital Council is going to bring out their reports on the possible restruc turing of some of the hospital beds? That is my No. 1 question. Mr. Orchard: Mr. Deputy Chairperson , I think we have, toward the end of next week, a couple of reports coming down that will be formally passed from the Urban Hospital Council to myself, and then I have made a commitment to undertake fairly quick decision making on it.

That is when the first ones will come out and others will be presented---a nd I hesitate to give my honourable friend definitive times, because I recall the Health Advisory Network, where I would say a given date and I would be embarrassed to have to report that an extension had been requ ested. We are certainly hoping to have a number of the issues dealt with by mid-summer. Mr. Cheema: Will the minister be releasing the reports to the members of the Legislative Assembly before the final decisions are made? Mr.

Orchard: I had not given that a great deal of thought about releasing the reports before the final decision was made. Let me just do a little quick consult ation here. I am treading on terribly dangerous political ground, but I believe we will be doing that. Mr. Cheema: Mr. Deputy Chairpers on, I do not think the minister is really going in any wrong direction . I think he is on the right move, and I think it will help all of us to make a rational judgment on some of the very important issues. My next question is: Can the minister share with us the bed occupancy rate in each and every hospital?

If they do not have it today, can we have it tomorrow? My second part of the question is the occupancy rate over the weekends. Mr. Or chard: I can provide that information, but I will tell you what my problem is. If we get into that kind of detail with the hospitals before we get down to that line, we will revisit it all again. That is all right by me, I love Estimates. I mean, I could be here until June, it would not matter. It would be kind of enjoyable, especially if I had such pleasant exchanges as I just had with the member for Brandon East (Mr. Leonard Evans).

He is a lot more pleasant and he is a lot more calm here than he is in Question Period. I do not know what happens to him in Question Period. [interjection] Oh, it Is the television camera, I forgot. At any rate, we have that informa tion, and I think it is broken down even as far as weekend occupancy goes. We can provide that information. The only thing that I would ask my honourable friend is, should we get into that kind of discussion tomorrow when we have not really gotten to that line. Mr. Deputy Chairp erson has called me to order tonight for unparliamentary language. He might not let us do that.

He is a fairly stringent individual. * (21 00) Mr. Cheema: Mr. Deputy Chairperson, rather than going into every detail, we are simply asking for information. I think it comes under the Executive Support staff, and that is the major policy direction the government is moving in. Health care reform is the only policy direction government is moving in, I believe, so I think it would be helpful if we get the information. It will definitely make the minister's job a lot easier in the long run. Can we get the information, what are the beds per 1 ,000 in Manitoba as compared to the national average? Mr.

Orchard: Definitely, we will get that. Mr. Cheema: Mr. Deputy Chairperson, those things are again very important for all of us to make a rational decision. Can we get data in terms of the teaching hospitals across this nation? Where do we fall, the medium range of admissions and discharge dates, and what is the average occupancy as was given to us last week by the minister, before the holidays? I think that will make more sense for us to compare as well. Mr.

Orchard: You know, my honourable friend is really into an interesting area, and if I understand his question correc tly, you want to have an ability to compare admission rates and lengths of stays and that sort of thing-not necessarily length of stays? Mr. Cheema: No. Mr. Orchard: Like, he wants to do a comparison of our teaching hospitals with other teaching hospitals across Canada. I will give my honourable friend a

18 49 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 6, 19 92 little bit of an indication of some of the challenge that is to us. You might recall Manitoba and Medicare , the report that was done about six or seven years ago for the form er Minister of Health. That indicated an alarming trend where we were, over a 15-year period of time or 13 year, I forget which, but anyway we went from below to above the national average in cost- per-patient day, of paid labour hours per patient day, et cetera.

Subsequent to that, we struck a task force of the Health Advisory Network to try and provide further details to that Manitoba and Medicare report. In some ofthe discussions that I have had around that report, because it is now currently out for discussion to the two tea ching hospitals before coming back to the Health Advisory Network, there is an extre me difficu lty in finding com parable teaching hospitals in terms of size and program offering, et cetera.

Even such things as their physical location in the citie&-like, Health Sciences Centre is a core area hospital and has a lot of emer gency traffic that other teaching hospitals like, for instance, the teaching hospital in London, Ontario, so that there was difficulty in coming up with com parables that would give some reasoned compa rison of how we compare in terms of our activity in all of the management ratios and analyses in our teaching hospitals versus other national ones.

They have come close, and what may be-n o, I guess I cannot share that report with my honourable friend because it is in the interim discussion stage. Yes, it is over at both teaching hospitals to be reported, for them to return their comments to the Health Advisory Network shortly. My honourable friend is on the right track. I just point out that we had a consultant retained, for several tens of thousands of dollars, to try and do that comparison , and it is difficult. It is very difficult, but they have done it in a reasonable fashion, and that will, I hope, soon be a report that we release. Mr.

Cheema: Can the mi nister also get the information in terms of the use of the ORs in some ofthe communi ties outside the city of Winnipeg, how many times the ORs have been used per month on a per procedure basis? Mr. Orchard : Yes, I think we can provide that information because we did it about two or three years ago when we did the anesthesia upgr ade and we set the national standards. They were, 200 hours per year of anesthesia to require the upgr ade. We lowered that to 10 0 because we had a number of our smaller rural hospitals that were not utilizing their equipment for 200 hours.

I think we can get a pretty good idea on that. It may be a year or two old, but I doubt if it would have been significantly changed. Mr. Cheema: The reason for that kind of informati on, I think the minister is well aware of that. During the Health Advisory Network's information session in the smaller communities, the point was made that if we want to combine, say, one or two hospitals doing one kind of critical surgery, it will make more sense for them to do it, and I think that kind of data is going to be a required part of the health care reform . It can be used because the work has already been done.

I do not have the information, but I think that is one very, very effective way of putting three or four hospitals together to do procedures rather than-if they are doing one or two appendectomies per year and if the next-door hospital is doing more than that, if the population is compatible and if there is no danger to immediate life, then I think some of the procedures may have to be very well centralized. That could be a part of taking som e of the unnecessary, transferred from the communities to Winnipeg.

That has been happening and was very well outlined the first day in some of the minister's remarks, that some of the admissions which are being done, according to information that we have from the minister, could be taken care of in the communi ties. That is the reason we want to have all that inform ation, because then we can tell the people who are calling us that our decisions are based on the information that we have and on the scientific data, which is very crucial for people to know, that the system is going to be changed based on the facts and not simply on unknown figures from nowhere .

Can the minister tell us, have they hired any consulting company to deal with the health care reform? I am not talking about the mental health reform ; I am talking about dealing with the health care reform as such in Manitoba. Have we approached anybody outside of Manitoba to tell us how we would do it?

April 6, 19 92 LEGISL ATIVE ASSEMBLY OF MAN ITOBA 18 50 Mr. Orchard: Let me deal with my honourable friend's first suggestion. The information on the level of activity, et cetera, is going to be a fairly important piece of information as we parallel the Urban Hospital Council in rural Manitoba. Our first meeting on that is coming up, I guess, within about a month's tim e.

What I have been trying to encourage for the last almost four years is commu nity co-operation because I think there is a growing realization amongst board members and citizens in rural Manitoba that every community cannot have every single service, and that they are more apt to be able to provide a full range of services if they share commu nity needs for those services.

I have to tell my honourable friend, though, that that is political dynamite in rural Manitoba because every communi ty so cherishes their individual facility, their physicians, and they jealously guard them from their neighbouring communities, et cetera. I understand that.

I have grown up and I have lived in rural Manitoba, but there is a coming realization that we cannot retain physicians, for instance, in rural Manitoba unless communities co-operate to provide them relief so that they have a weekend with their family, that they have a lifestyle that is comparable or at least coming close to comparable to some of the lifestyle they might have in the city of Winnipeg or another major centre.

I think the rural communities are very actively coming around that issue, and I really have to tell you I am looking forward to the Urban Hospital Council equiv alent creation in rural Manitoba because I think they will come around those issues in a very, very reasonable and quick fashion. The second question around the health care reform, in terms of whether we have approached any outside individuals on the reform process-yes, we have. Dr. Jack Weinberg is head of evaluative clinical studies at Dartmouth-Hitchcock Medical Centre. He is one of our board members on the Centre for Health Policy and Evaluation.

We have had a number of meetings with the Dartmouth people, the Weinberg group. When I say we, I mean myself and senior staff of the department, as well as senior medical people in the health care community.

We even had an exchange with them in January where a number of physicians and administrators went down to Dartmouth to see what they have done down there and how we can approach reform of the health care system. * (21 10 ) Subs equent to those discussions, we have approached the Weinberg group on their ability to help us analyze and track the care to the patient and the individual's health status in a reformed system as we change from institution to commun ity-based care, so that we can take away any of the fears and the natural accusations that bed closures mean compromised patient care, etcetera, so that we can, with clarity and with analysis, prove or disprove that theory.

We quite frankly happen to think we can disprove the theory that you com promise the quality of care in a reformed health care system. The Weinberg group is very interested in working with us in developing an evaluation process and a monitoring process to demo nstrate at timely intervals how the system is dealing with patients' needs-the system, not the hospital in isolation or the community in isolation, but the system.

They actually are quite excited about it. [interjection] My deputy reminds me that it is a joint effort that we are proposing between our medical school, the Centre for Health Policy and Evaluation and the Weinberg group in Dartmouth-Hitchcock. So, yes, we are contemplating retaining their services because they are probably as good as anybody in North America for that kind of analysis. Mr. Cheema: Mr.

Deputy Chairperson, on the question I raised, that was the use of some of the resources in some of the com munity hospitals outside Winnipeg, and I want to reinforce and make it very clear that we are in favour of such a role for each and every hospital in the communities where they could be specified for a certain specialized role.

That will not only save on cost for the taxpayers, but I think it will help the economy of the communities, because when anybody comes out of some of the commu nities, when they come to Winnipeg for some of the procedures, that is simply draining some of the money, and it could be used in their own communities and in a way, in some areas, the medical establishment or the health services are a major part of the local economy.

I think that could be one of the issues that most people in North America are talking about, as the minister said in his opening remarks also, that the whole issue of health has to be dealt with, the local economy plus how in dividuals feel about themselves, how they feel part of the system and how they feel confident. If we can keep them in their

18 51 LEGISL ATIVE ASSEMBLY OF MAN ITOBA April 6, 19 92 own com munities and still provide health care, provided they will feel comfortable, because they do not have to work seven days a week if they can share the calls. Such a system has to come. It does not matter if it is done now. Eventually this will happen. The minister said it is political dynamite. I do not think that for all of us it is dynamite, but when we are all burning in the same fire, we do not have to worry if somebody is going to be saved or the other person is going to come out without any burns.

I think the issue here is that the reform has to be the total package. Accord ing to the minister's reply, this group now, is this going to be an extra cost, other than the health policy centre , where we are spending a large amount of money already to evaluate some of the things and some of the work? They have already produced a couple of reports, and we are hoping that they will come and tell mem ber s of the Legislative Assembly and the media what are their inferences and in which direction they are leading.

I am just inter ested whether this will be an extra cost, and if so, then can the minister justify, why do we need an extra cost to the centre which has already a large amount of money attached to the operation of this particular centre . Mr. Orchard: Yes, there will be additional costs in utilizing the service of the Dartmouth-Hit chcock Medical Centre group under Dr. Weinberg. Now, the reason that we are having them participate is twofold.

First of all, they have subs tantive experience on the medical side because their primary analytical evaluation abilities have concentrated on the medical side, physician services side, so from that standpoint, they have impeccable credenti als. Married with the University of Manitoba and the centre, we think it is a good combination, but it will cost us some additional dollars which will come from the Health Services development fund, we anticipate.

The centre , for all of its expertise, does not have the kind of depth and medical expertise that the Weinberg centre in Dartmouth does have, so that we are in fact complementing two very significant bodies of knowledge and research by having them participate with the centre . I want to also indicate so the discussion does not get narrowed down to physicians only, we are going to be utilizing, on a not as extensive a basis, an individual by the name of Connie Curran.

She is currently the editor of Nursing Economics and was one of the major presenters at the National Nursing Symposium that I hosted about two years ago-a very, very knowledgeable individual on nursing issues, an exceptional person. She has been in Winnipeg rece ntly, and we anticipate having her partici pate in a consultative role with the reform process as well and the impact that reform has, as in Bran don, where we have a layoff of nurses and a requirement of change in the focus of employment from acute care institution to comm unity per chance.

She has had some considerable experience in that, and we would hope to engage her assistance on the nursing side of the reform issue. Mr. Cheema: Mr. Deputy Chairpers on, can the minister tell us in dollar amounts how much this particular group is going to cost per year during this reform ? Mr. Orchard: They are in the process right now of giving us a proposal, so I cannot outline what the costs would be at this time, but we are going to be paying them for a design of protocol so that we can evaluate the impact on the patient in a reformed system. Mr. Cheema: Mr.

Deputy Chairperson, we will wait for the information when it can be made public. We do not want to destroy the whole process at this time. Now, not on the same issue, but it is also part of the whole health care reform, can the minister tell us whether this government has been approached, or they have approached a company out of Flo rida-it is called Florida Couns ellin g Incorpor ated-a commu nity clinic concept to do work in Manitoba? Mr. Orchard: No, the ministry has not. Maybe one of our commu nity clinics or one of our hospitals might have-1 could not answer, but the ministry has not. Mr. Cheema: Mr.

Deputy Chairperson, I just wanted to confirm that. I think it will be worthwhile for the minister to check with the Premier 's Office or through cabinet if there has been a contact through somebody called Aorida Counselling Incorpora ted. They deal with mental health services . According to the information I have, and I just wanted to confirm whether that is the case, they are trying to develop a system for us in Manitoba.

April 6, 19 92 LEGI SLATIVE ASSEMBLY OF MAN ITOBA 18 52 I just wanted to know why we have to go to somebody in the south when the mental health reform has been so well placed in Manitoba. I just wanted the minister to check, and that is simply information that I have no way of confirm ing. I thought I would just check with the mi nister rather than going through other sources. I just wanted the minister to know that.

I think they should be very carefu l and not be seen by others who are supposed to be expert in mental health reform when we have a system right now, and you are almost there to take over and not derai l the whole image of the system. I just wanted to be very cautious because whatever you have achieved, if these individuals, these companies, would come and try to take money, it will not do any good to us. * (21 20) (Mr . Bob Rose, Acting Deputy Chairpers on, in the Chair) Mr. Orchard: Mr. Acting Deputy Chairperson, I appreciate my honourable friend's advice, because it is good advice.

We have not made any contact, butthat is not to say that- this organization may well have contacted the Premier 's Office to offer their services, and I will check on that. We have not- the only group that we have talked with outside of the province of Manitoba is the Weinberg group at Dartmouth and Connie Curran as an individual. Both of those are out of country , I will admit, but I simply say to you that anyone within our health care system who has crossed paths with either Weinberg and his associates or Connie Curran in the nursing profession holds a great deal of respect for those individuals.

Although they are not home-gr own Manitobans, their advice is welcomed, in my estimation, by those who have had the benefit of meeting with them and discussing and listening to them. Mr. Cheema: Mr. Acting Deputy Chairperson, can the minister tell us what is the estimated amount of bridge money they are going to require when we are changing the system from the-1 am not talking about mental health reform , I am simply talking about the general medical services of the hospital restruc turing which has to happen and will happen, and there will be some time for transferring some of the services.

That will take some time and also will require bridge money to make sure that the patients are not displaced so that they get the proper care . Even though the care in the commu nity is going to be less costly, still the money is going to be req uired. Can the minister tell us where that money is going to come from , and how much is that amount? Mr. Orchard: Mr. Acting Deputy Chairperson, the budget, for instance, in Continuing Care , we have budgeted a fairly significant incr ease in there. Now one can always face the argu me nt as was presented by the memb er for Brandon East (Mr.

Leonard Evans) that the increased funding that we have put in place over the last several years is not enough. We will always have those arguments, but we have increased, fairly significantly-it is probably one of the larger single increases in the ministry-on the Continuing Care side, so we hope that this will help us.

Secondly, we have established a $3-million fund within the $950 million-plus on the hospital side to help with two areas of endeavour: the reform of the system in terms of funding innovation within the hospitals for innovative programs within this year's budget, and also to assist hospitals in commencing the process of continuous quality improvement or total qua li ty mana gemen t as an aspect of management that we think holds a great deal of prom ise in terms of improvi ng service levels in the hospital. Mr. Cheema: Mr.

Acting Deputy Chairperson , does that mean the minister feels comfortable that $3 million is going to be a sufficient amount over a period of one year, when some of the services have to be eventually transferred to that community? Is that a realistic goal or realistic approach ? I personally do not feel it is realistic, because if the reform has to take place, $3 million means how many, per day, per patient, per bed, how much is going to be totally transferred out of the hospitals?

If at one end we are talking more the major shift than at the other end and we do not have the real dollars attached to it, I think we will have a lot of difficulties and I just want the minister to be aware of that, and want to register our objection to that. I think it may not be re alistic and there may be some other ways of doing it or explaining how it could be done. It is going to be tough, but $3 million is not going to be sufficient, and the minister knows it, but definitely if they are going to transfer money in at the same time from the hospital to the community which is going to be very tough. You

18 53 LEGISL ATIVE ASSEM BLY OF MAN ITOBA April 6, 19 92 cannot just shut one day and next day open a shop somewhere else. It is not possible; it is not practical. So I think maybe a time is going to come for explanation to the people, the health-care providers and the patients that there may be a period of difficulty, and I want the minister to know that $3 million is not going to do much in that regard . Mr. Orchard: Mr.

Acting Deputy Chairperson, I appreciate my honourable friend's concern, but also built into the budget is funding for additional bed capacity in the personal care home side and the He alth Ser vices Developm ent Fund has an additional $4 million, some of which could be accessed as well. I have to tell my honourable friend, I do not know what we are going to have to come up with, because the task before us is rather an immen se one. Some of the information that I shared Monday la st in terms of the types of admissions to, for instance, our teaching hospitals are pretty dramati c pieces of informa tion.

Let me do a little speculation. This is always dangerous when one does this, but let us deal with those first percentile of complexity admissions to the teaching hospitals. I believe it was 36 percent at St. Boniface and 28 per cent at Health Sciences Centre and those were from rural Manitoba.

If you were just able to have half of those carried out in existing rural and northern facilities because a lot of them do not operate at the occupancy rate that we have in our major Winnipeg hospitals, that you can probably achieve that transfer of care with an imme diate im pact on the budget because you would not significantly increase the cost in existing rural and northern hospitals because probably you have wards that are staffed and 60 percent occupancy, and could achieve almost an instant removal of budget from the teaching hospitals if you could come around that issue, but that, of course, is the difficult issue.

In other areas of length of stay, the difference from five days to seven and a half days for the one procedure that I e xplained Monday last, even bringing the higher length of stay hospitals down is an almost im mediate saving in budget without compromising patient care, probably impr oving it. So there are opportunities for very quick savings in the hospitals. The difficu lty is that the natural tendency is not to allow government to reallocate those savings from the in sti tutional b ud get li nes as indi vid ual institutions generally to the commu nity, to impr ove those services in the community.

Of course , as my honourable friend has quite accurate ly identified, that is the challenge in health care reform . Mr. Cheema: Exactly that is what I was trying to reach, to the point that putting in $3 million or $4 million, eventually that figure may be nonviable. In either way, it could be positive or negative because we do not know yet, because there is so much that is going to happen. That is why, as long as the hospital funding is based on some base line and there is room to maneuver and save, depending upon the condition of health care reform , then I think government has the room to play.

If you put the exact figures right now, I think you are in a bind, and simply for a year you cannot do anything. So I think it will be wort hwhile to say, this is what the base line is going to be, but on the condition attached to the health care reform that any advantages coming out of health care reform have to be translated back to the taxpayers, and if money saving is going to be made, so be it. That is why we were a little bit hesitant initially to criticize $3 million or $4 million, because we thought that may not be a realistic figure.

If we are g oing to reform the whole thing-what we are doing--it may be a substantial saving, and it is going to come right away . .. (21 30) If the government would develop a policy to give a hospital, say, $10 million and say, that is it, then if the spending is only $4 million or $5 million or $6 million or $8 million, $9 million, why give an extra million? Why not say, this is based on the present circumstanc es; when the system will change, your funding formula is going to change depending upon the circums tances?

As the case has been made many times, the reform , of course, means that we want to settle the patient the best way, but that has a basic value attached to the financial aspect. We are going to have substantial savings, no doubt, about that, but that is why we have a difficulty when people say, well, you are saving $800 per bed in the hospital, why are you not spending, giving me 24-hour coverage in home care ? The argument is that those services are not to replace what you had.

Those services are to simply complement or replace in a way which economically may not be the same, but you may get, not the same kind of environment, but the same kind of services.

April 6, 19 92 LEGISL ATIVE ASS EMBLY OF MAN ITOBA 18 54 I think that is the issue which for a governmen t it will be very risky to put an exact figure. I think then, next year is going to come for some of us, and it does not matter who it is, that cannot get up and we have a $20-million cut. That may not be a real cut because that is a perceived cut, and depending upon how much you want to put your number s up and say, well, we were supposed to give you $10 million, you saved $2 million; we saved for the taxpayers $2 million, so we have to keep that back.

I think that that should be the bridge money, in the bank, in terms of-the reform must be attached to the financial incentive otherwise we are just wasti ng the public's money again. It is going to be the same thing again. We will have the duplication of services which happened in the past. Now, we are seeing some home care problems because the policy put in by the last government, I mean the home care in Manitoba was one of the best, but then it got out of hand because the real definition was never given.

I mean, everything was so fuzzy that under the home care you could get this or that or orderly services or cleaning servic es. They were not meant to be provided under home care . Home care has a special function, but then we missed the point. If we are going to continue to do the same thing, then next year we will be doing the same thing here again and talking about the same issue. So I think it will be worthwhile to be very realistic and say that we are having this major reform, but then we have to have an outcome.

Of course, the patient is then the No. 1 one priority , but the taxpayer is also a priority, and in this case they are both the same. I think the people would really appreciate if they were given the right information. That is why we keep on emphasizing the information is very crucial to the success of health care reform . I think the most important thing right now is to let people know exactly where we are coming fr om.

Given the circumstances, within even half an hour after the Br andon gatheri ng, mo st of the individuals-1 was not there, but we heard from individuals and their minds were changed once they came to know how the funding has been done and what has been happening. I think it is very crucial. I would like the minister to look into that area, not attach a specific number when we are in the reform . You do not do that. With our own personal life, if we are changing other things, we do not put $20,000 for this and that is it. If you save or you over spend, I think we have to be very, very carefu l.

I want to emphasize again it is very important from our point of view and taxpayers' point of view to be very-aga in, I will use the same line-open and frank to the people that this is what we are going to have, and when we are shifting the services, there is going to be some difficulty, bridge money is going to be required. Of course , this is the right way, we get a saving, because $900 compared to $120 is a $780 difference. That $780 has to go to the governmen t's pocket and go back to the people rather than going back to some other services which may or may not be required.

There are going to be tons of people coming from everywhere , I can provide this, or we can provide that. That is why, even if consultation is required from outside source s, we will judge them on their merit. That is the issue here, not shooting down anybody who wants to provide, whether they are from Manitoba or from outside, as long as they are in keeping with our goal in Manitoba that we want to provide the patient with the best care possible, but also keeping the ability of the taxpayers to pay it and try to preserve at least the necessity services in the long run.

I want the minister to have those views from our point of view. I do run out of my vocabulary which is very lim ited, so I try to put 20 words into everything, so I hope that I have conveyed the message in a very realistic view. I think I will end my questions in terms of the health care reform right now, but I would just ask the minister again, have we done the work on the uncollected bills, the out-of-country individuals who have not paid the taxpayers when they come and use our services? Mr. Orchar d: Mr. Acting Deputy Chairperson, I have two years information that I will share with my honou r able fr iend.

There are two types of admissions. The emergency admissions, which we do not have a whole lot of control over, say, an automobile accident, an unexpected accident or illness. Then there is the case of the elective adm issions wher e the faci li ties mak e prior arrangements with the patient for repayment of hospital accounts. I am informed though that the uncollectable accounts are minimal as a result of the elective

18 55 LEGISL ATIVE ASSEMBLY OF MAN ITOBA April 6, 19 92 admissions, but they can range from 14 to 20 percent on the emergency side. I will give my honourable friend some numbers. In 19 89-90, there was $81 ,000 out of 387 nonreside nt-of-Canada revenue in uncollectable accounts. In 19 89-90 the total billed services was just about $400,000, $387,000, and of that, $81 ,000 was uncollectable or uncollected to date at any rate. Now in '90- 91 , the nonreside nt-of-Canada reve nue billed for services performed amounted to $507,000, and in '90-91 $73,000 was not collected, so that was down to around 14 percent.

For the second hospital that we have information for, 19 89-90 the total billings were $258,000, $40,000 of which was uncollected, and 1990-91 for that second hospital, total billings were $358,000, $65,000 of which was uncollected to date. The breakdown is roughly, of the uncollected, United States patients 3.1 percent of the 14 .5 percent, and other nonresidents accounted for the balance.

The interesting thing is, for that first hospital where there was $73,000 out of $507,000 uncollected, one patient who was a nonresident of the United States, who was from another country obviously, accounted for $54,000 out of the $57,700 of uncollected, so one individual. That is why it can vary quite a little bit from 1 0 percent to 20 percent. One individual can skew it a fair little bit. • (21 40) Mr. Cheema: Mr.

Acting Deputy Chairperson , it may seem that it is only-1 should not say only; it is a substantial amount in terms of even $75,000 to $80,000 per year, and that is the record we have at least for four years now. You know, that means the percept ion, in terms of the hospitals and the health care provided and taxpayer, is correct. That is what we have been told, that sometimes those things are happening. That is why I would like the minister to tell us what is being done to at least-it is never goi ng to be 10 0 percent elimin ated ; that is impossible.

I am not saying we should be banning everybody just to come into a hospital without a cheque in their bag, but I think taxpayers still have a right to ask for people who do not have insurance, and they should pay the bills. I think one way is to have some identification or try to secure some down payment in some of these servic es, or some kind of follow-u p has to be there. That means this $320,000 could have gone for our own people in Manitoba to provide some of the very important services, so something has to be done. I think one way is to have identification or insurance.

Secondly, I think we should look at the whole issue of the elective admissions out of the country and see whether they will pay in advance so that taxpayers of Manitoba are not taken for a ride. Certainly we can at least try to discourage-that kind of behaviour is not tolerated in Manitoba. Specifically, I am not saying somebody who comes with cardiac arrest, we are going to tum that person aw ay, but if somebody comes and wants to have a wart removed or have a finger stitched, they must pay their bills, because if they are not paying, we are paying.

Somebody else is paying their bills, so that is unfair to our people. Mr. Orchard: Mr. Acting Deputy Chairperson, the figure that I gave you for '90-91 of the first facility, where it was $73,000 uncollected, $54,000 of that was one patient in an emergency circums tance, but the total $73,000 represented seven patients over that year. These are always emergency and unplanned admissions.

The information I have is that where it is an elective admission, where there has been some planning ahead of time, the uncollectable accounts are very minimal, so that it is on this emergency and there you get into the judgment call. I th ink probably the fir st concern of the professionals, let us say, in an em ergency is to provide care for the individual first and then worry about the ability to pay later. That has been the nature of the system.

But in total, in two years of those hospitals there is $250,000, and I do not know how we could come around it any differently than what they do because I think they put in a pretty good effort to try to collect. Because I do not think that Manitobans would necessarily think that refusal to provide the service would be an appropriate response. I think most Manitobans would want to see the individuals cared for in the hopes that we would not be paying for it as taxpayers. (Mr. Deputy Chairperson in the Chair) Ms. Judy Wasylycla-Lels (St.

Johns): Let me ask some questions, in part related to some of the areas touched on by the Liberal critic, pertaining to studies and reviews underway and tie it directly to the issues we were discussing this afternoon. I would like to know , given the Premier 's (Mr. Filmon) promise in 19 88 to not permanently close hospital beds until a

April 6, 19 92 LEGISLATIVE ASSEM BLY OF MAN ITOBA 18 56 comprehensive review had been completed, could the minis ter indic ate if that review has been completed and if so is he prepared to table it for us today? Mr. Orchard: Mr. Deputy Chairpers on, so that my honourable friend does not get off the trac k, that commitment made in the 1988 election was carried out as com m itted for the first term of this government's mi nority. That commitment was undertaken and delivered on. Now, a number of studies have been undertaken to understand our health care system.

My honourable friend has re ceived a number of those studies, and as I am able to table them she will receive further of those studies. All of them provide underpinning to the dir ection of health care reform that we are undertaking. I want to refer specifically to the first Centre for Health Policy and Evaluation study.

I want to remind my honourable friend that this study and its resultant reco mm endations was a compilation of studies that have been undertaken for about an eight to 1 0-year period of time, thereabouts, studies which, I have to say with all the delicacy that I can put in , were not ac ted upon by previous governments, the one I served in included. You know , one of the things that I want to point out to my honourable friend is a rec ommendation that comes in page 11 of the recommendations.

It says, evidence from studies both in Manitoba and elsewhere point to the im portance of closing beds in conjunction with expanding resources for outpatient surgery. That is a rec ommendation by professionals who study the system, and it is therefore recommen ded that no expansio n of outpatient su rgery or independent surgical centres be funded unless accompanied by enough hospital bed closures to produce real cost reductions.

Now, that is the piece of policy advice that my honourable friend may wish to argue against, and has argued against in terms of the Brandon situation because that is exactly what happened in Bran don. It happened after the fact. We funded the outpatient surgery and had it in place and operating. The occupancy rate on the beds went down, and subsequently the board and the administration made the decision to close the beds, exactly as the Centre for Health Policy and Evaluation recom mended ought to take place.

My honourable friend congratulated the centre for this report, although without having the opportunity to read it, I would not dare to say that she agreed with the rec ommendations that are in there. But, if my honourable friend does not agree with some of the observations in here, and believes they are not appropriate directions for government to pursue, I would certainly be interested in knowing, because many of the recom mendations in here form, in part, platform policies which will guide the reform of our health care system. Ms. Wasylycla-Lels: Mr.

Deputy Chairperson , is the minister saying that the previous promise by the Prem ier (Mr. Filmon) to put any bed closures in the context of a framework and a comprehensive plan based on a review is no longer the case, and that, in fact, bed closures are in the works, are being executed by this government without the benefit of any kind of a comprehensive review? Mr. Orchard: No, Mr. Deputy Chairpers on. * (21 50) Ms.

Wasylycla-L els : Back in 19 88, upon questioning in this Legislative Assembly, the Premier indicated that the comprehensive review promised in the 19 88 election was, in fact, the Health Advisory Network. Now, more than several years later, the minister is telling us today that the Health Advisory Network has yet to provide that kind of comprehensive review upon which decisions around bed closures and other decisions would be made. He is now also suggesting and pointing to other studies.

We keep going through this cycle, this interesting circuitous route, in terms of promises and studies, groups that do not deliver, new study groups being formed, those studies not being forthcoming and others appointed to, in terms of the magic solution and the basis upon which this government is acting. Perhaps the minister could tell us tonight how many of the Advisory Network task forces have handed in final reports, and how many he is prepared to table. Mr. Orchard: Mr. Deputy Chairperson, when the Pr emi er (Mr .

Filmon) in di cated the pol icy underpinning reform in 1988, that commitment was lived up to in the lifetime of that gover nment-l ived up to. There were no hospital beds that were closed prior to having an understanding of the health care system. I know my honour able friend liv ed in a government where one idea was probably the only

18 57 LEGISL ATIVE ASSEMBLY OF MAN ITOBA April 6, 19 92 one they exercised, but the Premier, in referring to the Health Advisory Network, did not say at any time that that was the only investigative body that this government would create and use to provide advice on health care system policy. Nowhere did the Premier say the Health Advisory Network is the only idea that we will have. That was the fir st major in vesti gati ve body that we established. The Premier never indicated it would be the only one and the last one.

That is why I have indicated to my honourable friend that such things as the Centre for Health Policy and Evaluation are providing input, policy advice, statistical and scientific analysis to guide the reform of the health care system.

The Urban Hospital Council-t he old boys' club that my honourable friend referred to as if there is something diabolically wrong with CEOs who happen to be males in the city of Winnipeg being part of the Urban Hospital Council; I mean that is some kind of an interesting analogy that it is an old boys' club, nevertheless my honourable friend's wor ds, not mi ne- is looking at some 40-plus issues, all of which are issues dealing with program system-wide hospital delivery in Winnipeg and Brandon . They are providing us advice on how we can change the system.

The Provincial Advisory Council on Mental Health Reform is yet another body which is building upon the bluepr int for reform that I have tabled in mental health as yet another issue of reform in the mental health system. In approximately a month's time the rural northern equivalent to the Urban Hospital Council will commence its deliberations to give us the same kind of across-the-system approach to change.

Again, it is going to be CEOs and other individuals dealing with it, so that my honourable friend, if she is wanting to have a single report which deals with every aspect of health care in the province of Manitoba and a blueprint reform , I regret to tell my honourable friend that I do not have such a document, nor did I ever intend to have such a document because I think it is fair to say that it does not exist anywhere in Canada. There are royal comm issions which deal quite comprehensively with a number of issues but not completely across the health care service delivery spectrum.

That is why we have got the Health Advisory Network dealing with a number of issues. That is why we have got the Urban Hospital Council, the Centre for Health Policy Evaluation, the Provincial Advisory Council on Mental Hea lth Reform.

That is why we are creating and supporting the establishment of a rural and northern hospital council, so that all of those individuals, a far wider range of consultative input than has ever existed in health care planning in the history of the province of Manitoba, are now working actively to bring a greater understanding of the health care system and how it can change without compromising the patient.

I want to indicate to my honourable friend that basically that grouping gives us the kind of complete consultation that has never before existed in the history of the province of Manitoba, because the Health Advisory Network is very much people friend ly, user fri endly, as are the regional mental health councils whi ch have consum ers and individuals on them , so that you have the people side of the consu ltation process there. The operational side of the health care system is embodied in the Urban Hospital Council with the CEOs.

The senior managers are highly skilled, highly paid administrators of the major institutions. Then for the analytical and the scientific side, we have the Centre for Health Policy and Evaluation.

Although it may not look like anything of substance to my honourable friend, it is the most complete and comprehensive abil ity to review the system involving people, involving professionals in terms of the care delivery, the operational side and the best scientists in Canada on the analytical and scientific research side, their collective reports are part of the planning, the part of the policy underpinning that will guide our planning in reform ing the health care system. I have received the Extended Treatm ent Bed Review, and of course my honourable friend has that.

I have three other reports on the services to the elderly which are now ready for release, and I will be releasing those within a very short period of time. I have a number of the reports that are going to be-a nd I have got the report on rural health services. I have not read that one yet, the rural health services report. It is now pri nted in English and French and will be released. I will try to release all of those at the same time. An Honourable Member: Sorry, what was the last one? Mr. Orchard: Rural health services. I have a number of other reports that are very close to being

April 6, 19 92 LEGISLATIVE ASSEMBLY OF MAN ITOBA 18 58 released, antici pated release of a number of additional reports before the end of June this year. •

(2200) Mr. Dep uty Chairperson: Order, please. The hour now being ten o'clock, what is the will of the committee? Continue? Okay, carry on till midnight or so. Ms. Wasylycla-L els: Mr. Deputy Chairperson, that was certa inly an interesting statement from a minister who, when he first took up this position back in 19 88, made a gre at to-do and many public statements about the fact that we really had enough studies in this whole ar ea of health care reform . As I have quoted to him on previous occasions, let me do so again.

The minister said on November 23, 1 988: I do not intend to spend a lot of time or money on further studies. We do not need another huge stack of studies. In fact, the only thing that has been going up faster than costs in the health care system has been the number of studies. We have studied it to death. Now it is time to start doing something. (Mr. Ben Sveinson, Acting Deputy Chairpers on, in the Chair) Fine words, Mr. Acting Deputy Chairperson. Yes, fine words, but hard ly the case. Certai nly the minister has done the opposite of that kind of public pronouncement.

In fact, I think he is probably in the process of setting a record in this country for numb ers of studies, revie ws, task forc es, committees, working groups, you name it, in this country. It is interesting as well that the minister should suggest that the Premier (Mr. Filmon) never indicated that the Advisory Network would in fact be the gr ou p, the me chanism by which the comprehensive review would be done.

In fact, I refer to Es timates of August 22, 19 88, when the Premier said in re sponse to questioning, it indicates he refers to the Speech from the Throne: our commitment to the establishment of a Health Advisory Network to do that comprehensive review of the health care system in Manitoba. That is in response to the questions about the election promise, of course, for a review before any bed closures happen.

It is clear from all public records and the minister's own statements that the Health Advisory Network in fact was set up originally as the vehicle by which the government would receive this comprehensiv e review of the health care system, the basis for reform , the basis for major change. Obviously, based on the information the minister has provided today, that whole process has been less than up to the expectations of this minister . To date, more than three years after the announcement of the Health Advisory Network we still only have one final report made available to the Legislative Assembly, to the public.

That leaves, if one breaks this down into different components, about 20-1 am rounding off figures her e-s tudies that have been in the works for a number of years for which we have yet to see any final report. The minister says that he is in the process of reading a number of final reports from the Health Advisory Network and will release the information shortly. I am not holding my breath. I have asked these questions in the past, Mr. Acting Deputy Chairperson, and we keep getting the same answers.

Obviously, and we know the minister has received final reports from a number of groups under this Health Advisory Network the minister is not happy with the reports he has been handed and may be doing some quick editing and quick changes, some reviews, some major damage control in terms of how he will respond with an action plan to reports which are critical and require major, major solutions by the government.

Interesting that this minister should tell us today that reports pertaining to health services for the elderly, that the report pertaining to rural health services are, have been on his desk, that he is not finished reading them all and that we will get those reports when he is finished reading them. Mr. Acting Deputy Chairpers on, we asked these questions last spring and summer in the Assembly when we heard that the minister had received final reports for health promotion services for the elderly, health prevention for the elderly, housing and home care. services for the elderly.

The minister said he had to read the reports, he had to review the reports, he had to have the reports translated. Now, what are we, nine, ten months since those final reports have been submit ted to the mi nister, and the minister is still saying he has to finish rea ding those reports and that he will release them shortly. Would it be too much to ask the minister if he could tell us preci sely when each and every one of these final repor ts will be released to the Legislative Assembly and to the public of Manitoba? Mr. Orchard: Mr.

Acting Deputy Chairperson, the release of those reports will happe n, I would hope,

18 59 LEGISL ATIVE ASSEMBL Y OF MAN ITOBA April 6, 19 92 fairly expeditiously. To answer my honourable friend directly, no, I cannot give her an exact date, time, hour, minu te that they will be released. However , I can assure my honourable friend that when they are released, she will find them most instructive and inform ing. Mr. Acting Deputy Chairperson, I just want my honourable friend not to run amuck with some of her

interpretation which, I mean, it is up to her to interpret what she wants. I was very clear to my honourable fr iend that nowhere did we say we were limiting our analysis of the health care system to the sole vehicle of the Health Advisory Network. My honourable friend, in critic izing the establishment of other investigative groups, is my honourable friend now changing her mind on yet another subject, that she believes the Centre for Health Policy and Evaluation ought not to have been set up in the province of Manitoba?

I do not think that is what my honourable friend said in the House in response to the receipt of the first report. I do not think my honourable friend is saying that we should not have established the Centre for Health Policy and Evaluation. I cannot be so certain that my honourable friend would not want to disband that old boys' club, the Urban Hospital Council-old boys' club, her language, not mine. I do not think that my honourable friend would provide that advice. Maybe she will.

It almost seems as if I have to keep track, because there is a very new moon out there and today's criticism from the New Democrats under a very new moon is that we are studying the issues to death. Approximately two to three weeks from now, when it is a full moon, I am positive that my honourable friend will accuse me of no consultation, that I have acted unilaterally without seeking advice, et cetera. Over the three and a half years I have been here, it has been sort of like the tides.

One day the tide is out and you are consulting too much, you never make any decisions, then when we make a decision, well, you never consulted, so you should have consulted.

I guess what my honourable friend is really saying is that she is quite frustrated with the way we have been able to bring together a lot of very, very dedicated professionals to provide us advice on a changing health care system, something I know that even a New Dem ocratic government would be quite envious of, bringing those kinds of professional groups together, individual profess ionals and concerned citizens to provide solid advice to government.

I accept that frustration that my honourable friend no doubt feels and shares, but I simply tell my honourable friend that it will not curtail the kind of discussion, the kind of investigation, the kind of analysis, the kind of expert opinion that we will constantly seek as the health care system is guiding through a process of reform which is going to be difficult. I am not in any way going to take advice that I hear from my honourable friend tonight that I should stop consulting with people and act unilaterally. I will not take that advice.

I will continue to seek the best possible professional advice in this province, and as I indicated in answers to questions earlier on, outside of this provi nce, where we can have individuals like Ms. Curran, a pre-eminent expert in the nursing field, and Dr. Jack Weinberg, a pre-eminent expert out of Dartm outh, who can help us with physician and other analytical issues of care delivery. * (2210 ) Ms.

Wasylycla-Lels: Perhaps then the minister could tell us which of the 15 Health Advisory Network studies or which of the 41 Urban Hospital Council groups, or which of any of the other among the other number of organizations and Individuals you refer to as important parts of his whole review process, which one of those studies is providing the basis to this minister and this government for the 440 bed cuts that urban hospitals are being asked to consider? Mr. Orchard: I do not want to have my honourable friend be able to claim that she has another scored victory in her little game of seeking information.

As I have indicated to my honourable friend in my opening remark s-and she might revisit them-1 clearly indicated that we are going to change the system from institutional preponderance , reliance and care delivery to a more commu nity-based care delivery system. In doing so, that will mean the retire ment from service , the closure of beds in a number of hospital institutions across this province quite possibly, but I cannot get into my honourable friend's numbers game. That was a game that a numb er of individuals wanted me to get into in terms of mental

April 6, 19 92 LEGISLATIVE ASSEMBLY OF MAN ITOBA 18 60 health reform because as my honourable friend well knows, this was the circu mstance that existed when she sat around cabinet. Again, we have a preponderance of institutional capacity in mental health service delivery. We are going to shift that to a more balanced approach of community plus institutional care . But in making that shift, we have not come with a preconceived quota of institutional beds to be closed in the mental health system.

That quota system was vested upon the province in 19 82-83 in terms of quotas for placement in the commu nity under the Community Living Progr am, and that program is not one of the hallmarks of success in terms of communalization. So we have been very deliberate in not setting target numbers which have a finite quantity to them and a finite achievable goal, but there will be reduced bed capacity in the hospital sector, one year from now, two years from now, three years from now.

What it will be reduced to I cannot answer my honourable friend because had my honourable friend, three and a half months ago, asked me how many beds are going to close at Brandon , I could not have told my honourable friend because that was a decision of the board based on program and utilization and a number of other factors. There will be fewer beds in service , and I indicated that to my honourable friend in my opening remarks. I shared with my honourable friend, and I will dig it out again because it seems as if she needs to know this: Rated beds, Health Scie nces Cen tre, 1982-83, 1, 19 0.

When we came into government in '88-89, it had been reduced to 1, 11 3, because program had changed in that period of time and need for those acute care beds was not as it was at the heyday of the early '70s, and beds were retired from service . That process will continue.

Wha t will mak e the pr ocess work is the underpinning of information that is coming to us from a variety of investigational groups, bodies and studies, from the Urban Hospital Council, through the Centre for Health Policy and Evaluation, through the Health Advisory Network and through a number of other individual issue studies that we have on the go, because we do not tend to act in this mi nistry in an arbitrary and unilateral fashion. We attempt to have as good an information base at our disposal as possible, before we make decisions.

We do not set finite quotas, quantities, et cetera , because the system will change and reduce in size with budget transfer, service to the people moved from the institution to lesser cost institutions to lesser cost commun ity-based care , with the closure of beds in our hospitals, as I indicated to my honourable friend happened from '82-83, when she was in gover nm ent, to when we came into gover nm ent, without fanfare, without major announcements, because the system was even changing then. Not as much as it is going to change in the next three years, but it was even changing then. Ms.

Wasylycla-Lels: So we have learned tonight that the promise and policy of this government as it pertains to bed closures has changed. That promise that originally tied bed closures to a review , is no longer in effect. The minister has said that very clearly. He has also told us that there is no longer one comprehensive study and he has pointed to 15 studies under the Health Advisory Network, 41 studies under the Urban Hospital Council and a numb er of other studies and individuals and organizations providing advice to this minister.

So we have got, just based on what the minister has said tonight, about 75 different points to look at, to refe r to, in terms of advice being provided to this government when it comes to health care reform . So now we are left with trying to fit all this together with this government's directives on bed closures, which the minister likes to keep pretending do not exist, one day admits this is part of the government's strategy, the next minute he blames it on the hospitals, the next minute it is a figment of someone else's, my, imagi nation, the next minute it is opposition fear-m ongering. It goes on and on, Mr.

Acting Deputy Chairperson. All we would like to know tonight is on what basis the bed cuts are based, on what basis those decisions and directives are being made; what study, what review, what group has suggested these bed cuts that are clearly, and the minister has acknowledged, being directed by government. Mr.

Orchard: I know I am not going to succeed in helping my honourable friend develop her political issue, her narrow, political issue, but do you want me to read again to you recom mendation 11.6.1 , Centre for Health Policy and Evaluation, Manitoba Health Care Studies and their Policy Implic ations, tabled in the House, applauded by my honourable friend?

18 61 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 6 , 19 92 That recomme ndation says: "Evidence from studies both in Manitoba and elsewhere point to the imp ortance of closing beds in conjunction with expanding resources for outpatient surgery. It is, therefore, recommended that: no expansion of outpatient surgery or independent surgical centres be funded unless accompanied by enough hospital bed closures to produce real cost reductions" -a rec ommen dation from the centre which my honourable fr iend endorsed. Now my honourable fri end is saying, where did you get that advice?

Well, it is in the report she has had in her hands for almost a month. Did she not read It? Did her eyes go blank and close when she got to that rec ommen dation?

Because that is exactly the policy that was followed in Brand on-to close by amalgamating a 51 percent occupied ward, a 67 percent occupied ward , a 68 percent occupied ward in gynecology, medicine and surgery, to two wards at about 85 percent occupancy because a great number of procedures were being performed on an outpatient basis, and the inpatient bed capacity would be accomplished with the utilization of two wards , not thr ee, two wards more fully occupied.

That is the policy underpinning that guided that board decision, tha t gu ided govern men t's acceptance of that decision, that gu ided government's defence of that board's decision, because it is a recomm endation of the Centre for Health Policy and Evaluation. Does my honourable friend under stand where that recommen dation came from ? She may not agree with it now when she realizes how it may be used by boards or government, but does she under stand what it says, where it came from and how it was utilized in the Brandon situation?

If my honourable friend under stands it for the Brandon situation, then my honourable friend will come to understand it in other areas of the system as well, as these kinds of program change decisions impact on the system. •

(2220) Ms. Wasylycla-L els : Mr. Acti ng Deputy Chairperson, I am sure it will come as a surprise to the Centre for Policy and Evaluation that it is their research and their recommenda tions and their advice that is being used as the basis for this governmen t's directive to Health Sciences and St. Boniface to red uce their beds by 240, and that their recomme ndations and their advice and their review are providing the basis for this government 's directive to commu nity hospitals to cut their beds by 200.

It certai nly would be useful to get more information from the minister now that he has clearly said last Monday that the basis for the 240-bed reduction at the Health Sciences Centre and St. Boniface was, and I will paraphrase quickly and generally, for health care reform purposes. It would be now useful to have the minister give us the breakdown for and the rationale behind the 200 community hospital beds and on what impact that kind of bed reduction will have on our com mun ity-based hospital system.

I would hope that the minister will avoid the obfuscation in dancing around the subject and just get to the heart of the matter. It is clear we know these are government directives . Hospitals have told us they are government directives. Community hospitals have told us about the decrees from the minister and his staff in terms of numbers of beds and in terms of budget red uction targets. So we do not need to dance around this anymore. We know that those numbers are out there, that this mi nister and his staff are respons ible for the numbers. They are directing the agenda.

They are responsible for the agenda, and it would be now, I think, appropriate after spending some five and a half hours at this today for the minister to simply indicate the breakdown of the 200 commu nity hospital beds, or the bed reduction at the community hospitals of 200, so that we can under stand the rationale, and so that we can help allay some fears among Winnip egger s and Manitobans about hospital services and about problems that they are now facing with respect to being held in emergency hallways for considerable lengths of time, and with respect to longer and longer waiting lists for various surgeries.

Mr. Orchard: Mr. Acting Deputy Chairperson , I am unable to play my honourable friend's political game tonight, and I do apologize to her for not being able to give her the next mailing to the membership of the New Democratic Party , and to give her the wor ding for the next- An Honourable Member: The whole provi nce, forget the memb ership.

April 6, 19 92 LEGISL ATIVE ASSEM BLY OF MAN ITOBA 18 62 Mr. Orchard: Yes, the whole provi nce, I am sorry. That is why your budget for mailing in the New Dem ocratic caucus room is triple what it ought to be. Mr. Acting Deputy Chairperson , my honourable friend when she receives an answer that makes sense, that gives background to decisions made by boards and administrators as in the case of Brandon General Hospital, finds that unacceptable, does not agree with it. Well, that is not good enough. I mean, what reason is that?

You know, I guess my honourable friend what I should do is I should thumb back to the good old days of Howard Pawley and the NDP. I ought to do things the way Howard Pawley and the NDP did because they dragged in the hospital administrators of those affected by the dictatorial closing that Wilson Parasiuk as Health minister ordered on them, collared them, forced them into a press conference and said, smile and agree with government. I have not done that. We have invited them to be part of a system-wide discus sion .

Now , my honourable friend criticizes the 41 topics that the Urban Hospital Council has under consideration. Which one of those does she consider inappropriate? Which one would she suggest we drop that is not valuable to the system? I would be interested in knowing because that would certainly give us some idea of what the New Dem ocrats may consider to be important in health care reform and what is not important. But all my honourable friend does is sit and carp about what we are doing. I have never heard a suggestion yet as to what we should do.

Except on the full moon, it is, we are making unilateral decisions without consultation, and on the new moon, as it is tonight, well, we are studying too much. All we do is study, study, study. That is not good enough. You cannot flip-flop around. My honourable friend says, well, now it is the Centre for Health Policy and Evaluation that is giving us all of the background to health reform . Well, I explained to my honourable friend, and I will explain again, that they are part of the information equation. They are not the only part.

They are an important part, but they are not the sole and only driv ing force behind it. They do underpin us with a great deal of understanding of what goes on in the system. Let me give you an example. Mental health reform process underway, great concern, and I understand the dynamics of that concern from a number of groups representing individuals suffering from depression and schizophr enia. They are very concerned when they hear about bed closures, very concerned. Okay?

Well, so am I, and I want to make sure that we have the appropriate ability to offer service to Manitobans suffering from mental illness. (Mr. Deputy Chairper son in the Chair) I want to share with my honourable fri end some statistics. Here is length of stay for individuals suf fering from psychos es. Now these are individuals suffering from the same relative degree of impairment. So we are not talking extreme versus moderate versus mild cases. I mean, these are a relatively equiv alent group of patients. Hospital A has an average length of stay of 24 days.

Hospital F has an average length of stay for that same type of patient of 39 days. That is a difference of 15 days, over two weeks occupancy of that psychiatric bed in hospital F versus hospital A. *

(2230) By using patient service techniques in hospital F comparable to hospital A, you can, for all intents and purposes, remove three-eighths of the beds and maintain the same level of patient service and use the budget savings, for instance , to develop community services to intervene earlier in mental illness. That has not compromised patient care one iota. What it has done is asked the managers and the care deliverers in the system to consider why one hospital has an inpatient stay 24 days average length versus 39 days for another hospital, and the range is everything in between.

That is the kind of reform around statistical analysis that we are asking managers and care deliverers to make in the system. Do you know who is at the centre of that change? The individual re

Document details

Collection	Manitoba — Debates (Hansard)
Citation	35-3-40b
Type	hansard
Volume / chapter	35th 3rd hansardpdf 40b.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	0766915c79342f6b8148a160457f7d7edfff7182

Source file is stored in the law ingest library (pdf).