Manitoba Hansard — Sitting 103 (30th Legislature, 2nd Session)

30-2-103

Manitoba — Debates (Hansard)

TH E LEGISLATIVE ASSEMBLY OF MANITOBA 8:00 o'clock, Thursday , May 29, 1975 BILL NO . 50 3183 MR . SPEAKER: The Honourable Minister of He alth wish to speak on procedure ? We are on Bill 50, that's right . MR . DESJARDINS: Mr . Speaker, the gentl eman that was speaking , the Member from As siniboia , is not here , so I wonder if we should leave that and maybe go to second reading of Bill 52 and 53. MR . SPEAKER : Order pleas e. We can leave it providing we dispose of it one way or the other . We just can't leave it in limbo . Now, either ... The Honourable Member for Morri s. MR .

JORGENSON: When the House adjourned , we were on Bill 50 , but there's no way that we can just simply let it stand by . We have to either vote on it now or approve it , or the Member for As siniboia has to be here to complete his remarks . There 's no way we can do otherwise than continue on with that particular bill . MR . SPEAKER: Correct . The Honourable Minister of Health . MR . DE SJARDINS: I wonder if we could - somebod y 's interested in taking the adjourn ment . Mind you, that would mean that the Member for As siniboia would not be permitted to speak, his time would be finished . MR .

SPEAKER: The Honourable Member for Morris. MR . JORGENSON: If somebody else takes the adj ournment , then the Member for As siniboia is precluded from speaking . MR . SPEAKER: That's correct . MR . DESJARDINS: Well what else can we do . MR . JORG ENSON: He's not here . My suggestion, sir , is we just simply proceed with the conclusion of that bill . If he 's not here to speak on it , we vote on it . MR . SPEAKER: Are you ready for the question ? The Honourable Mem ber for Birtle Russell . MR . HARRY GRAHAM (Birtle-Ru ssell) : Mr .

Speaker , I beg to move , seconded by the Honourable Me mber for ... well , I can take the adj ournment on deba te , can I not ? MR . SPEAKER : The Honourable Minister of He alth . MR . DESJARDINS: Mr . Speaker , it 's true that the Honourable Member from As siniboia was in the middle of a speech, and I think by not being here, he forfeits his right to continue . So therefore the bill , I believe it 's properly in order for the member to adjourn it now and I think that the adjournment would be right . MR . JORGENSON: The Member for A ssinib oia has forfeited his right . MR . DESJARDINS: That's right .

He's finished . MR . SPEAKER: The Honourable Mem ber for Birtle-Russell . MR . GRAHAM: Mr . Speaker, on a point of order , I believe that I do have the right to adjourn debate on a bill . MR . SPEAKER : Correct . MR . GRAHAM : So I would move , seconded by the Me mb er for Sturgeon Cr eek , that debate be adjourned . MOTION presented and carried . BILL NO . 52 MR . SPEAKER : Bill No . 52. The Honourable Mini ster of Health . MR . DESJARDINS pre sented Bill No . 52, The Dental He alth Services Act , for sec ond readi ng . MOTION prese nted . MR . SPEAKER : The Honourable Minister of He alth . MR .

DE SJARDINS: Mr . Speaker , the intent of the Dental He alth Services Act is to enable the governm ent to . . . MR . SPEAKER: Order please . On a matter of proced ure , the Honourable Member of Morris . MR . JOR GENSON: I must rise on a point of order . Since this is a government bill , I believe it should be seconded by a member of the Cabinet and I see there is another member

3184 May 29, 1975 BILL 52 (MR. JORGENSON cont'd) . . . . . of the Cabinet. I would much prefer MR . SPEAKER: Order please. Order please. On that matter of procedure, there are no directions as to who seconds a bill. MR . JORGENSON: Well, if a government order which involves the expenditure of money is presented to this House, only the Cabinet is allowed to do that and I ... MR. SPEAKER: Order please. The bill is being pres ented by a Minister and seconded by . MR o JORGENSON: . . . and seconded by a Minister. MR. SPEAKER: Not necessary, according to our rules.

Unless the honourable member has a particular citation to quote, I am not aware that it's necessary that it has to be a Cabinet member. The Honourable Member for Morris. MR. JORGENSON: I don't have a particular citation, sir, but on a previous occasion in this Chamber while you were in the Chair, sir, this matter was raised once before and the Premier, I believe it was who bowed to the suggestion that I made and had the measure seconded by a member of the Cabinet. MR o SPEAKER: The Honourable Minister of Health. MR. DESJARDINS: Mr.

Speaker, with your permission and leave of the House, and with my former seconder's permission, I wonder if I could change my seconder to the Minister of Industry and Commerce. MR . SPEAKER: Is it agreed? The Honourable Minister of Industry and Commerce is the seconder. The Honourable Minister of Health. MR . DESJARDINS: I see this is one of those nights. The intent of the Dental Health Services Act is to enable the government to deliver dental health services. The Act permits the government to develop both preventive and treatment services.

Under the Act, the govern ment may enter into contracts with private dentists for the provision of services or may deliver services through government employed dentists and dental health workers. Under the new Act, the dental nurse, dental hygienist or dental nurse who is certified can render dental services prescribed in the regulations made under the Dental Health Act. The procedures which a certified dental health worker can carry out will not be subject to the Dental Associa tion Act. Under

Section 8 of the Act, a dentist who has agreed to provide dental services through an agreement with the government will not be permitted to charge, demand or accept a fee greater than the fee stated in the contract. It is the government' s intention not to allow dentists to charge patients beyond the fee agreed upon in contracts with the government. MR. SPEAKER: The Honourable Member for Fort Garry. MR. SHERMAN: Mr. Speaker, I beg to move, sir, seconded by the Honourable Member for Morris, that debate be adjourned. MOTION presented and carried. BILL NO. 53 MR. SPEAKER: Bill No. 53.

The Honourable Minister of Health. MR . DESJARDINS presented Bill No. 5 3, The Dental Health Workers Act, for second reading. MOTION presented. MR. SPEAKER: The Honourable Minister of Health. MR . DESJARDINS: The intent of the Dental Health Workers Act is to provide separate legislation for the training and governance of dental health auxiliaries. At the present time, dental health workers are covered under the Dental Association Act.

The new act permits the government to provide for the education and training of auxiliaries, either alone or through a department of government or in conjunction with the University of Manitoba or other educational institution. Under the new Act, the Dental Association can continue to train and hire dental health auxiliaries in a dental office. These auxiliaries, however, will not be permitted to use the title "Certified Dental Health Worker" unless they have been registered by a board estab lished by the Minister.

The board will be in power to register and cer tify dental auxiliaries, determine those dental services which can be carried out by a dental health worker without the supervision of a dentist, and which procedures cannot be carried out. The board may revoke certificates and can employ inspectors to determine the quality of dental services rendered by Dental Health Workers. This Act, in conjunction with the Dental Health Services Act, will

May 29, 1975 3185 BILL 53 (MR. DESJARDINS cont'd) .. .. . enable the government to plan, develop and deliver dental health services in a rational and comprehensive manner. MR. SPEAKER: The Honourable Member for Fort Garry. MR. SHERMAN: Mr. Speaker, I beg to move, sir, seconded by t!oe Honourable Mem- ber for Morris, that debate be adjourned. MOTION presented and carried. MR. SPEAKER: The Honourable Minister of Health. MR. DESJARDINS: Mr. Speaker, I'd like to move, seconded by the Honourable Minister of Industry and Commerce, that Mr.

Speaker leave the Chair and the House resolve itself into a Committee to consider the supply to be granted to Her Majesty . MOTION presented and carried, and the House resolved itself into a Committee of Supply, with the Honourable Member for Logan in the Chair. COMMITTEE OF SUPPLY - HEALTH AND SOCIAL DEVELO PMENT MR. CHAIRMAN (Mr. Jenkins): I direct the honourable members to Page 27 of their Estimate Book. We're on Resolution No. 60, Administration. The Honourable Minister of Health. MR. DESJARDINS: Mr.

Speaker, I wonder if I could give an answer to a question that I took as notice the last time they had the estimate. It's under (3)(h)(l)(

b) Community Opera tions Division, Operation, Administrative and Other Expenditures. There was a difference - my honourable friend can remember - the reason of an increase from $51, 500 to $100, 500. Of the $100, 500, $51, 500 is to be spent on the operation, administration function which is the same amount requested last year, and the remaining $49, OOO has been budgeted for the pur pose of funding the provincial job office which administered the now phased-out Pensioners Home Repair Program.

Last year, by error, the required funds were omitted from the bud get, and the current funds requested are required for a short period to clean up the final phase of the operation. The program has served its purpose in providing repairs and temporary employment. Mr. Speaker, for the first time I think, that we have instead of just one line under the Manitoba Health Services Commission - as I had promised before, we would try to give more information to the Members of the House and allow for a proper scrutiny of what is going on. After all it's a pretty important amount. Mr.

Chairman, with the consent of the Members of the House - you will see that the different lines have not been numbered - I wonder if we could go on the same procedure, maybe start with Administration, stay with that and pass that, so we won't jump from one place to the other. So I see that this is fine, then we can start with Administration. MR. CHAIRMAN: Administration, that is what I called. Agreed? (Agreed) The Honourable Member for Fort Garry. MR. SHERMAN: Thank you, Mr. Chairman. Well, this is as good a place to start as any in examining this particular

section of the Health and Social Development Department• s operations and appropriations for the ensuing year. The figure of $7.1 million requested in these Estimates to finance administration of the program for the current year represents a substantial increase over that requested last year; the figure for last year having been $5. 8 million. Now we got into a technical argument the other evening - technical debate in the House the other evening - between my colleague the Member for Lakeside and the Minister as to just what the figures for last year in the esti mates really mean.

Do they mean that that was the amount of money asked for or do they mean that was the amount of money spent? I gather from the Minister's remarks of two evenings ago that that figure represents what was asked for. At this point - and I will have some other things to say on this area, but at this point I would like to keep my remarks and my questions brief and I would like to ask the Minister what was spent on administration last year? Are we comparing apples and apples or are we comparing apples and oranges? MR. SPEAKER: The Honourable Minister of Health. MR.

DESJARDINS: I'm informed that - of course this is the figure that was voted last year, like all these figures on the left, as we know - and I am told that this is very close, approximately the amount; I don't know, certainly not to the cent. And it might help if I give the information at this time that there was a surplus last year - I'm not talking about adminis tration now - at the Commission, and I'll try to get that for you. I don't know if we have a

3186 May 29, 1975 SUPPLY - HEALTH (l\ffi, DESJARDINS cont'd) ••..• breakdown, if I do this at this time, we won't have to ask the same question at . . . The surplus last year was $5 million at the Commission. I beg your pardon? l\ffi, SHERMAN: The surplus last year was 5 million? l\ffi, DESJARDINS: Right. l\ffi, SHERMAN: The department last year asked for 5. 8 million for administration. l\ffi. DESJARDINS: Excuse me, I'm talking about the overall surplus of the Commission. l\ffi, SHERMAN: Oh. l\ffi.

DESJARDINS: As far as the administration, I think that most of the money was spent, I'm informed that it's very close. Now we haven't got the detail of everything in the surplus, I'm trying to get the larger ••. Most of it has been that some construction didn't go through that was supposed to go through, they didn't start last year - so therefore the money for the construction, besides the operating costs, which was quite a bit. I remember when I was being briefed, there was half a million, and I don't remember what it . . . I wonder if we could leave that - there might be somebody upstairs that's listening in.

What I'm trying to get for the members is a detailed breakdown as much as possible of the surplus of a little over $5 million. · l\ffi, CHAIRMAN: The Honourable Member for Fort Garry. l\ffi, SHERMAN: Well, Mr. Chairman, I would be perfectly happy if the Minister would wish it this way, to go - or maybe I misunderstand the Minister - if the Minister is sugges ting that he would like to go on to the next item and then come back to administration, that's perfectly all right. --(lnterjection)--Well, Mr.

Chairman, then we infer from the Minister's remarks that the $5. 8 million requested voted last year for administration under the MHSC was pretty close to target. l\ffi, DESJARDINS: Excuse me. I have the answer. The actual money spent on that was 5. 9, so there was a little more for administration. And the surplus that I was talking about is for the whole Commission. l\ffi, SHERMAN: Okay. I thank the Honourable Minister, Mr. Chairman. So the figure voted last year was pretty close to target, 5. 87; the amount spent was $5. 9 million.

This year the government is asking $7. 12 million, and I would ask the Minister what is represented in the increased appropriation being sought beyond the obvious and natural in creases that would result from inflation. l\ffi, CHAIRMAN: The Honourable Minister of Health. l\ffi. DESJARDINS: I think my honourable friend is suggesting that I give him the main reason for the items there have been quite an increase •.• Well, the first one is in the rental of office equipment; last year voted 361, OOO, this year 480, OOO for an increase of 119, OOO.

Now the rental of an optical scanner was $50, OOO, and then the rest was for the increased costs. Then we have - for travel, from $65, OOO to 100, OOO for an increase of 35, OOO. This was for the provision of transfer of the planning group to MHSC, an addition was staff man years and price increase on that - this was the staff of ESP that went back to the Commission and extra staff-man-years on that also. Now on stationery and office supplies, from $245, OOO to 340, OOO, - 95, OOO. That provides for new Pharmacare, ambulance and doctor reporting forms.

Professional Consultant, $80, OOO to 185, OOO; 105, OOO, that includes provision for $100, OOO for the balance of the $200, OOO for the study by Clarkson-Vayda at the Health Sciences Centre. The other one, furniture and equipment, an increase of $20, OOO, from 40, OOO to 60, OOO. This increase, provision for additional staff-man-years. Building renovation, 80, OOO to 195, OOO; 115, OOO increase, includes provision for balance of renovation and replacement of light fixtures on second level, something that was never done since that building was completed. 7.

Employers contribution, 85, OOO to 150, OOO - for $65, OOO increase. That includes provision for rate increase and additional staff man years. Now, besides that of course there is the salaries. There is an increase of 42 staff man-years. I'll give you the increase now. There are seven positions of the data proces sing for increased volume, and new Pharmacare and Ambulance Programs for MHSC and MMA contractual agreement, and for an additional shift; one position, Systems and

May 29, 1975 3187 SUPPLY - HEALTH (MR • . DESJARDINS cont'd) ••••• Procedures for new program and increased workload; three positions, Controllers Office; two positions to provide overall internal control of MHSC administrative budget and payment system to providers of service, and one position for salary and wage studies pertinent to providers of service.

Facilities Division, seven positions, to handle increased workload and make adequate provision for consulting services, financial review and programs, evaluation of 200 health care facilities in addition to the annual audit of hospitals and personal care homes; Insurance Division, two positions for a new Pharmacare program; Services Division, three positions, Cadman Laboratory, to proceed on a service basis would be congenital and rubella, a control program which was funded in the research phase by the Federal Government; 13 positions, diagnostic X-ray to handle increased volume; expanded a new program to fulfill responsibility for 24-hour, seven days per week lab and X-ray service; and six new positions in Planning Division to adequately carry out expanded MHSC role for health planning and evaluation which should result in improved services, fund ing, relocation and selected types of costs savings .

MR. CHAIRMAN: The Honourable Member for Fort Garry. MR. SHERMAN: Mr. Speaker, I thank the Minister for his information. However, on the last phase of the subject that he just went through for us, I was not able to keep up with the figures that he provided and I would appreciate it if he could give me an approximate total of the new positions that he's referred to. What would be the total, or approximately? MR . DESJARDINS: Forty-two new positions, and an increase of $674, OOO. MR. SHERMAN: Forty-two new positions, Mr. Chairman.

Are those positions that are contemplated, anticipated, or have they already been created and filled? MR. DESJARDINS: No, I think there's been some advertising for some. There might have been a few that were filled. There are about half of them filled and the others are still pending. MR. SHERMAN: Why would 42 ••. I'm sorry, Mr. Chairman. I'm sorry, I should have waited for your recognition. Why would 42 new positions be required this year? MR. DESJARDINS: ••• giving you all this information. MR. SHERMAN: I know, I know.

I realize he just gave me that, but I'm asking him why is it necessary to increase the bureaucracy by 42 new positions. MR . DESJARDINS: Because of the reason that I just mentioned. I read that, I enumer ated the different positions and I gave the reason why either new programs or work load, and if my • • . I'm ready to give a copy of this to my honourable friend.

Of course it will be an answer, but I don't know if I'm supposed to ••• No, there's 6 in planning, there are 13 positions diagnostic X-rays, Cadman Laboratory, Insurance Division, 2 for new Pharmacare program, and all the . • • This is what I was reading a minute ago. MR. SHERMAN: Well, I appreciate that, Mr. Chairman, but the point of my question is, why is it necessary? For example, the Minist er has referred to six in planning. Are we getting - let's say the six in planning are paid an average of $15, OOO a year; I don't know what they're paid, but let's say $15, OOO a year, that's approximately $100, OOO.

Are we getting $100, OOO worth more of planning in the department? Why is the establishment increased by forty-two? Is the back room, is the ivory tower thinking establishment increased, or are the programs increased, and are the services obviously and evidently and demonstrably increased? MR. JORGENSON: Or they've just not forty-two more relatives. MR. SHERMAN: Or is it, as my colleague, the Member from Morris, suggests, have they just found 42 more relatives? MR. DESJARDINS: Well, you know, I could maybe ask relatives of who? I don't know.

But that would mean we would have about 738 relatives that have jobs with the Commission. There is a varied number of reasons why these • . • and I think that I've covered that. There are new programs, there's an added work load, there's been more services rendered - and as far as the planning, the planning incorporates many things. There was very little long term planning that was done in the Commission and, as I say, these people are now planning, are implementing programs, are doing research or evaluation and so on, and I could speak all day on that. I certainly will stand behind that.

I think that if anything, we weren't doing enough of that and now we're going to evaluate the programs and plan properly, and not plan from day to day but have long range planning, and I certainly don't apologize for these added six in planning.

31 88 May 29, 1975 SUPPLY - HEALTH MR . CHAIBMAN: The Honourable Member for Birtle-Russell. MR . GRAHAM: Thank you, Mr. Speaker. I'd like to ask the Minister a specific ques tion. I believe he said he had seven staff man years to handle the Manitoba Medical payments, I believe, if I'm correct. Are these seven people that the department plans to engage when the time comes, that there is going to be a confrontation with the Manitoba Medical and the doctors will be opting out? Is that why you need seven extra men? MR . DESJARDINS: I don't intend to answer a ridiculous question, Mr.

Chairman, so he might as well know right now. MR. CHAIBMAN: The Honourable Member for Roblin. MR. McKENZIE: Well, Mr. Chairman, my comments are going to be rather wide ranging. We're looking at administration here, and I don't know where else in the Estimates of the Health Services Commission we can deal with where we're going, how we're going to get there, and what's it going to cost. And this government, you know, I just can't believe the thrust or the intent of this government. I heard the Minister of Mines and Natural Resources say yesterday that Autopac is going to be like Medicare.

Now that's unbelievable for the people of this province. We're going to be faced with personal care, hospitals, Medicare, Pharmacare, ambulance, and now we're going into auto insurance; and that's going to be another government expense, and the government's going to run everybody in this province. And I just - let• s deal with it in a serious vein. This Minister - and I feel sorry for this Minister, and I hope that he's • MR . CHAIBMAN: Order. MR . DESJARDINS: Mr.

Speaker, on a point of order, especially if we are going to treat this seriously - and if my friend can wipe the grin off his face - there's no way that I'm going to discuss Autopac under this item, I can tell you that --(lnterjection)--Since when are you the Speaker? MR . CHAIBMAN: Order, please. The Chairman will decide what is a point of order. I think the point is well taken. Under this item, we are ••• Order please! We're dealing with Health and Social Development, the Manitoba Health Services Commission.

Nowhere under this item do I see anything referring to Autopac or Mines or Natural Resources or any thing else. It's dealing with Health and Social Development. MR . McKENZIE: Well, Mr. Chairman, I thank you for your comments and your reprimand, and I'll try and keep my comments. But, in administration, surely this Minister and this government can give us some idea of where we're going with the health care. Where are we going with hospitals? Where are we going with doctors? Where are we going with druggists? Now you're going to nationalize the dentists, we have the legislation before us.

So I go back, and I ask the Minister, of these six planning people ••. MR. DESJARDINS: Mr. Chairman, on a point of order. MR . CHAIBMAN: The Honourable Minister of Health on a point of order. The Honour- able Minister state his point of order please. to . MR . DESJARDINS: First of all, nobody ever said anything about nationalizing dentists •• MR. McKENZIE: Read the bill. MR. DESJARDINS: I only introduced the damn bill. And, Mr. Chairman, I would like MR. CHAIBMAN: Order please. MR . DESJARDINS: I'd like to have direction from you.

I think that it was agreed by all the members of this House that we would go on the Minister's salary after the estimates were finished. Now we're dealing with only one thing, the administration of services. We'll be covering all tbese services and I would hope, I'd ask the co-operation of our friends, to dis cuss the administration of the Health Services Commission. After all, I'm taking this very seriously. This is the first time you've been given this kind of information. In the past - I've been here fifteen years - this has gone through in fifteen minutes.

I know it's not going to - but let's get a little serious and let's not waste time. MR . CHAIBMAN: I think that we should look at our books again - and I just wish there was some way I could prescribe this as recommended reading for the members. I know I prescribed it the other evening for the Honourable Member for Lakeside, I don't know whether he did or not. But I would refer honourable members to 64(2), Page 31 of our House Rules, speeches in the Committee of the Whole House, and this is strictly relevant to the item or

May 29, 1975 3189 SUPPLY - HEALTH (MR. CHAIRMAN cont'd) ••••• clause under discussion. You want to have a discussion on the philosophy of the Health Department and Social Development, the Minister's salary is still open under that item. It can be as wide-ranging as possible. The Honourable Member for Roblin. MR. McKENZIE: Mr. Chairman, and members of the committee, I'm referring to the six people that he has hired in planning.

He has already ad mitted, the Minister has ad mitted, he's hired six new people - now I'm asking him on behalf of the Opposition, the members of the committee and the people of this province, to tell me what I asked him when I stood up, where are we going? Where are we going with this program that you have before us, and how are we going to get there, and who's going to pay for it? And if the administrative

section of the Health Services Commission can't come up with those answers, then I may as well sit down, because I'm concerned and a heck of a lot of people in this province are concerned. When you look back and trace the history of this program - it was a good pro gram, I support the concept - Medicare and hospitals, and the government operating the hos pitals. I'm asking you under the Manitoba Health Services Commission and the administrators of that, where are we going, what's going to happen next year, and what's going to happen the year after? What's it going to cost?

What's going to be the responsibility of the taxpayers of this province? Are we going to have to go without doctors? Are we going to have to go without nurses? And where is it all going to go? Because there's no way, Mr. Chairman, that the administrative

section of the Manitoba Health Services Commission can get in a conflict with the doctors of this province on a daily basis, because the doctors won't take it. They never have in the past and they won't in the future, and I don't think that we as legislators should ask them to stand up. I asked them what's going to happen with the nurses. Are we going to have to have continual problems like we had at Thompson the other day where due to a certain matter, the patients had to be transferred by air ••• MR. CHAIRMAN: Order please. The Honourable Minister of Health. MR. DESJARDINS: Mr. Chairman, on a point of order.

Again, I'm asking co-operation from my honourable friend. The administration is strictly the administration at the Manitoba Health Services Commission. The next item is Personal Care Homes and my friend then could take that apart and ask us where we're going on personal care homes and I'll try to tell him. The next one will be Hospital Programs, he can ask where we're going on that, I'll try to tell him. The next one is Medical Programs, he can talk about all the confrontation with doctors and we can look into that as long as he wants.

The next one is Pharmacare, the next one is Ambulance, and that will cover our programs. Now if at any time he would suggest that we should cancel one of the programs, that's fine, but now we are expressly talking about admin istration. The administrators of the plan are not the ones that set the policies at all, this is just doing their work to go ahead with these programs, and I request again, my honourable friends, to try to do this in an ordinary way, I'll try to give you all the information that you want.

I'm just talking about now the administration of these programs, and these administra tors at the Commission are not charged with the setting up of programs, they can't tell you where we're going. We can do that on every program. MR. CHAIRMAN: The Honourable Member for Morris. MR. JORGENSON: And on that point of order that the Minister has just raised, I listened to my honourable friend the Member for Roblin very carefully during the course of his remarks and I came to the conclusion that he was very relevant to the point of discussion.

The adminis tration of the Manitoba Health Services Commission does involve philosophy, does involve direction, and what my honourable friend was talking about was the direction of the Manitoba Health Services Commission and the direction that they' re heading, the problems that might occur as a result of the direction that they're pursuing. I submit sir, that the Member for Roblin is in order in discussing these things under this particular item. If he deviates from that particular subject, then I think you're in order in calling him out of order.

But in the remarks that he was just making, I submit, sir, that he was in order - as long as he is dis cussing the direction of the Health Services Commission, which does involve administration, and which does involve the philosophy and the direction that the Health Services Commission is going. MR. CHAIRMAN; The Honourable Minister of Urban Affairs. MR. MILLER: Mr. Chairman, to add to the confusion that reigns, the fact is that the administration carries forward policies established by government. The Health Services

31 90 May 29, 1975 SUPPLY - HEALTH (l\ffi. MILLER cont'd) .••.. Commission is charged with the responsibility of administering programs once the policy is established, and that is I think the point that the Minister is trying to raise here. There are items in the appropriations which specifically deals with programs, and it's under those programs that the question of the program itself can be raised.

As far as the administration, they simply carry forward and implement the programs which are con ceived by government, put forward either in the Throne Speech, in bills and in election plat form, whichever vehicle is used. But the Commission is simply an administering body, administering programs which are launched by government. l\IB . CHAIRMAN: The Honourable Member for Morris. l\IB . JORGENSON: I fear that the Minister of Urban Affairs is drawing too fine a dis tinction between administration and philosophy.

I think the two are very much inter-related, and that when you're discussing administration of a particular philosophy of government insofar as it applies to the Manitoba Health Services Commission, as long as you're discussing the direction in which that particular body is moving, then I think that the discussion is in order.

And I am convinced, in listening very carefully to my honourable friend the Member for Roblin, that the remarks that he was making were very pertinent and very relevant to the discussion that is now taking place; and I suggest, sir, that if you attempt to curtail that kind of discussion, you are really - what you'll be doing, is preventing members of this side of the House from discussing the very thing that this

section is suppoed to discuss. Now, it's true enough when you get to the Minister's item, there's a full-rang ing discussion - but we're dis cussing the question of the Manitoba Health Services Commission; that involves all of its ramifications, not only the administration item, which is very much the same as the first item on the Minister's Estima tes, insofar as it applies to the Health Services Commission. l\IB . CHAIRMAN: The Honourable Minister of Health. l\IB . DESJARDINS: Mr. Chairman, if I may, I'm not interested in losing hours in argu ing this thing. I don't care where we are.

I don't intend to hide anything at all, I'll give all the information possible. And it's not just a question or order, I appeal to the members to have this in an orderly way. And I can't see - I'm not suggesting that you wait till we get to my salary, I'm suggesting that all those programs that you want to know will come one by one. Now, you know, I was looking at the intent, and what I was told - with discussion, my honour able friend - we're trying to do this in an orderly way, it's easier for the fellow that has to give the answer because it's pretty complicated, we jump from one to the other.

And I thought that we would achieve more of what my honourable friend is looking for if we gave a damn good scrutiny to the medical care when we come with this item on medical program. You know, we've got to talk about that then.

And I think that one of the reasons why if this was the case, if I did not accept and the government did not accept the responsibility of the planning - and I do accept all the responsibility, there is no way that I'm going to dump it on these people - but if we were, we'd go back to last year and we would have, if they were doing the planning, we would have one line, Manitoba Health Services Commission and they would be a Commission by their own, and you would have the report and that's it. And we'd do it in 15 minutes, like we did it for 15 years in this House. I don't want that.

I want to be scrutinized because I think this is the only way. I have some of the same concern as the honourable members in this House have, where are we going on all this, and I would like to have this year a good discus sion on this. Now I'm not going to insist, we're not going to have a vote, I'm not going to challenge your ruling, I just want a final indication. If my honourable friend wants an adminis tration to cover the waterfront, we'll do it, because we're going to lose an hour in arguing if that's not the case.

But I'll tell you one thing, there is no way that I'm going to repeat the same thing on every item when we get back there. l\ffi. CHAIRMAN: The Honourable Member for Fort Garry. Same point of order? l\ffi. SHERMAN: Yes. Thank you, Mr. Chairman, on the same point of order, I would just ask you, Mr. Chairman, whether you would consider asking the Member for Roblin perhaps to rephrase his question or rephrase his approach.

I acknowledge and appreciate what the Minister is saying, nobody is questioning the fact that he has opened up this area of his depart ment to line-by-line scrutiny; I appreciate that and I thank him for that. But I think that when you come to a question like administration, you can't have administration unless you've got something to administer, and when you're administering something, you're naturally start ing from a philosophical point of view. I think perhaps the Member for Roblin has asked too

May 29, 1975 3191 SUPPLY - HEALTH (MR. SHERMAN cont'd) ..•.. broad a question, and I am rather inclined to agree with the Minister on this point. And my only request on this point of order, Mr. Chairman, would be that you would, in your usual impartial and fair way, consider the situation and perhaps ask the Member for Roblin to rephrase his question. MR. CHAIBMAN: Well, I thank all the honourable members for their observations and their usual buttering-up. You put the Chairman in a very difficult position.

I would ask the Honourable Member for Roblin - order please - I would ask the Honourable Member for Roblin, if he would just reconsider, and under the items here as they fall in line, if he would ask those questions there. If he can't get the answers under this section, I would say to him that the Minister's Salary is still open, and that is wide-ranging and you can cover anything from soup to nuts as long as it's in Health and Social Development. But not Autopac or Mines and Natural Resources or anything else. MR. McKENZIE: Mr.

Chairman, I thank you for your remarks, and I thank the other members on the committee for their comments and their remarks. Unfortunately I don't have the oratory ability of the Mines Minister or other members of the House ; nor, Mr. Chairman, have I the knowledge or ability to phrase my questions as some other members in the House. I do have many limitations, and I apologize for them, and I apologize to the Minister of Health, he becomes impatient with me.

Because I don't know how else I can talk about the adminis tration of the Manitoba Health Services Commission, which involves 15 7 million bucks - and that's a lot of money - unless I do it in my own rural sort of low I.Q. way than what I'm doing. And I'll be more specific - the Minister and others that have borne with me, I'll ask you some specific questions. I'll ask you if you can give me a copy of what you say in the 1974 High lights of the Annual Report - and that's what I'm dealing with the Annual Report of the Health Services Commission, I'm not reading off any comments.

Can I have a copy of the signed agreement which the Manitoba Health Services Commission had with the Manitoba Medical Association respecting payment for physicians' services? And then can we have some of the Minutes whereby a committee was formed to consult with the association on an ongoing basis last year? Can we have that? Can I go on? Can we have - the members of the committee and the opposition, can we have some information about this task force that was set up to develop recommendations for an integrated health information service? Can we have that, or do we have to do it by debate the way I was raising it?

Let me go on, Mr. Chairman. Can we have some information about these pilot projects with hospitals, clinics and group practitioners that was done by the Admin istration

Section of the Manitoba Health Services to develop more efficient document and data exchange processing procedures? Can I go on, Mr. Chairman? Can we have some informa tion about this modified data processing system that's been established? I have nothing on my desk to deal with it. Can we talk about the integrated standards of nursing and doctors, which is in the Highlights of 1974 - the budget, the program review, and the thrust where we're going on this program? Can I go on and on?

Can you give me some information about the 19 build ings and renovation projects in the facilities that were constructed last night? Where are they, what did they cost? And we can go on and on. And that• s the kind of information that I would like from the Minister if he wants it that way, and I'll sit down and he can give it to us. MR. CHAIBMAN: Resolution 60 . The Honourable Member for Sturgeon Creek. MR. J. F. JOHNSTON: Mr.

Chairman, the statement that we have before us, Adminis tration, obviously the Minister has said and the Honourable Minister of Urban Affairs has said that administration are just a group of people who are carrying out programs. In other words, the administration in this particular line has really nothing to say at any time, other than they will carry out programs that were presented.

And I would ask the Minister then, when we go down the lines in this book tonight, that he would have to say that there is administration costs in all of those lines, because if that's the case, we then can question under these items the administrators of the - well, Pharmacare, etc. So really, administration on the top line means the typists, and it means the people involved within the programs, etc. who have no policy, so we can then question the administration and the people talking with organizations within this province about health services under the other lines. So the other lines, Mr.

Chairman, do include administration. MR. CHAIBMAN: The Honourable Minister of Health. MR. DESJARDINS: First of all, I would like to say that the - to give you an idea what the

31 92 May 29, 1975 SUPPLY - HEALTH (MR. DESJARDINS cont'd) ...•. percentage is, in Manitoba in 19 73, the percentage of the total budget for administration was in 1973, 2. 4 in Manitoba; in Alberta 2. 1 ; in Quebec - and I'm giving all those the information that we have -Quebec, we only have the Medical, it was 5 . 3; Newfoundland, the Medical was 5. 3; P. E. I. Medical was 7.1; and Saskatchewan the Medical 4. 3, and the Hospital Medicare was 2. 5. In 1974- 75, 2 . 2 was voted in Manitoba, the actual estimates came to 2 .1 , and this year what we're asking comes to 2 . 2.

As far as the administration, much of the work done by the Health Services Commission is pretty well work done the same as some kind of an insurance. A lot of the work in the administration are the people that are making the payments to the public, that are compiling that, paying the doctors, and this is the type of things they do. The administration of all the people are all in the first line, to answer the last question of my honourable friend.

Now the policy though, the policy I suggested - but I'm ready to debate at any time - I suggest that the policy for each program would be on the line that is given, but if it's better to discuss it here, we will do that. And I think that one of my honourable friends wanted to know where we're going, I think that this concerns all the people in Canada, in the Legislatures in Canada, and practically every country. This is something that there's an awful lot of pioneering in this thing, and we are working with people that are emotional many times.

And I think that this is one of the areas where the different parties - and if we are interested in the welfare of our people and if we are interested in the rising cost in this, we will have to work together on this. I think that this is something that in many ways is over and above partisan politics, and I think that we have to be reasonable. I can give you an example. You know, today some of the members are saying, where are we going, why are we spending this much money?

But too often the same people, the same type of people are saying, why haven't you got beds for everybody, why the long waiting lists, why can't doctors get in their patients any time they want for an operation, why haven't you got more nurses, why aren't you paying the nurses more money, why aren't you getting along with the doctors when they want more money, why and why and why? So I think if we want to cover the waterfront like this, fine.

But I think if we're sincere, and if the people that have the different ideas want to criticize, I think it's a much better way - when we talk about, for instance, the hospital program, to criticize the hospital program. Tell us that we're having too much construction and that it's costing too much money. And then in the Medicare, tell us on one hand that we're spending too much money, but tell us that we're fighting with the doctors because we don't want to give them what they want. You know, we will have to be responsible. And tell us if you're against the Pharmacare program or the Ambulance program.

I would hope and I sincerely hope there should be an awful lot of con structive criticism here tonight. Because this is the thing, as I say, that is very difficult - and some politicians will have to stand up and have the guts of their conviction and say to the people, I don't care if you're going to play politics. And I'm not suggesting that my honour able friends are doing that, I'm saying anywhere in Canada, And to say we have more beds in this country than anywhere else, and the people will have to - they're spoiled, and the bills have to be paid by one million people, and that's it.

And I think that this is the important thing because I don't think we could cut down on this, but we've got to slow down the total cost of the services. And I think, I guess I'm naive - but I thought that evaluation of existing programs, planning, working with communities from Day One, we've had for example a situation that my honourable friend here was the Mayor of West Kildonan before he came in this House. The people said, "We need a hospital in Seven Oaks.

" He came in and he saw the then-Minister, and he said, "We need a hospital in that part of the area." He didn't know a damn thing about hospitals - he's been a Minister since then maybe he knows a little more. So they said, "Well yes, okay, go ahead," and he says, "Well go ahead? What do I do?" You know, he panicked: "What do I do?" "Well, you must have friends in the area. Come back with a friend. Tell us what you want." So he left, they formed a group, then they came in years after, and then the Commission said, "Are you nuts?" "Well, you know, we were told this. " They had no idea where they were going.

The cost was prohibitive and so on, so we had to start the people at the Com mission. The staff wasn't there and so on. There were a lot of battles that were political and people were criticizing and so on. Now I want to see a system, and the Minister before me co-operated with me when I was

May 29, 1975 3193 SUPPLY - HEALTH (MR. DESJARDINS cont'd) ..... at the Commission. If there's a req uest like that we '11 say, "Yes, we will send somebody that '11 go and see you in your community, see what you need, give you the policy of government, tell you what our guidelines are for how many acute beds per thousand, and how many personal care homes per thousand. We'll give you this kind of infor mation. We '11 let you know, try to work with you so you can get doctors; maybe we should get you in contact with the University and so on, to see what kind of a service you can give. You shouldn't do this here.

This is open-heart surgery - this is done at another hospital. There's no way; it's too costly and you need real experts. There's no way that we're going to duplicate things. " This is planning. And this is exactly why we have people in the Planning Division, to be able to give this kind of information, to be able to evaluate programs, and if programs are not good programs, to cancel them, change them, modify them, improve them, or cancel them. This is exactly what we're trying to do. As I said, I don't apologize at all for those six posi tions.

Other positions - and I try to make that quite clear - other positions were given for added service that the people want. And I would hope that you will be responsible. If you 're saying that we're spending too much money, I would like to know in what area. Everybody can say, well, you can make better use of your people. We 're going to try that. But I don't know exactly how many people . . . I say that we 're spending an average of - we 're asking for 2. 2 percent of our total budget, and I don't think that's bad. I don't think that's bad for adminis tration.

Now I might say at this time that there was a bill that was introduced last week where I suggested that we put all our cards on the table; that the Commission will keep on working with the people, will keep on, because I think one of the reasons you had a Commission was be cause you wanted to take partisan politics out of construction of beds, of location of beds, and this kind of thing, and I would hope that the Commission will keep on doing that.

But the polic ies -and I make no bones about it and I accept full responsibility and I will in the future - the policies, and that is why there's been a bill amending the Manitoba Health Services Commission Act, is to make it quite clear that the Commission, the Commissioner and so on, will plan under the direction of the Minister or after having checked with the Minister. You've had , for instance, times where the Commissioner would want to do certain things that it was quite ob vious that the government didn't want to move in.

For instance - and it could be difficult, yes, politically and otherwise, and I'll give you an example: There was the Commission gentleman, Mr. Cunnings, to prepare the Cunnings Report, to see how the doctors would be paid. It was a good work. It caused a lot of concern. The Minister knew nothing about it; the First Minister knew nothing about it. It was the Commission, and they were acting exactly in the way, the right that they had. But this is a way that if there is going to be change and so on, it becomes a major policy, and it is going to be at the discretion of the government. We make no bones about that.

Now, there will be recommendations from the board, but the government makes it quite clear that they don't feel obligated to take all the recommendations that come in - and I say any government. Now I want to disillusion some of the members that, you know, this is a socialist government and where we're going on this. There has been problems in this and we have the same problems, and we have many big problems in this area, and we look like a caucus when we discuss this with the Ministers of different provinces because we have the same problems.

We have the same problems with wages, with strikes, of senior people - we have exactly the same problem. I think that we're probably in a better rapport, and I stand and I hope that I will be scrutinized on my attitude with the doctors. There is nothing that I would like better but to explain to the public of Manitoba my feeling on this, and my feeling is not one of confrontation at all. I want to be ableto sit across the tablefrom somebody where I'm respected, where I respect the people, and it would not be a requisite of the President of the MMA to knock the government, any government.

Because you can't work like this, and there is no way that you can plan when people across from you are insulting to you and have no respect whatsoever. This cannot be done like that. So I say that this is an area that most of the problems are fed eral problems. We have some problems that there's no participa tion of the Federal Govern ment and we can be criticized on that. Pharmacare is not and will not be cost-shared. If certain people feel that we've done too much in Pharmacare, fine. You know, this is what we're here for.

But onhospital beds, when we're talking about guidelines we're very close to the other provinces. We are only one of the three provinces that is covering the Personal Care

31 94 May 29, 1975 SUPPLY - HEALTH (MR. DESJARDINS cont'd) •.••. Homes. There's not too many. We are working with the Federal Government. We have indication that they will be more flexible, that they'll have more leeway, and it might be that. IJE!rsonal care beds will be covered. They are coming in more on home care. In more of these areas they're giving us more flexibility that we asked for. They have been very clear in certain areas, for instance that they will not cover the mentally ill patients, and, as I say, Pharmacare and acupuncture and some of these things, not at this time. Fine.

Some of the members who are saying that we're spending too much money, will say, "Why aren't you covering acupuncture? Why aren't you giving more to the chiropractors? Why aren't you giving more to the optometrists?" And some people say, "Well, why don't you start with the dentists?" It'll be a question of priority. It'll be a question at times to see what will be cost-shared. It'll be a question of money available and it'll be a question also of how much should a government do for the people of Manitoba in this field.

I certainly think that, if any thing, there'll probably be better care in Manitoba and in Canada than practically anywhere else in the world, in general, for our people, including the United States of America. Including the United States of America. So I would love to, very seriously, discuss these problems because it's going to help you, it's going to help the people of Manitoba. God knows that it's going to help me. So I'll accept all the constructive criticism or any kind of criticism. If it does become political I'll try to fight that. And I can assure you that I won't try to stall anything.

Having said that, I put on my shoulder the responsibility of planning. These people now are mostly - and don't forget that there's a Commission; there are commissioners that tell the staff what to do also. And the Chairman of the Commission reports to the Minister also, and they're not responsible for all the services. The Manitoba Health Services Commission doesn't itself, the Commission itself, deliver too much services. It is like an insurance company. So these are the main lines that we put in - and all the lines, the hospital, the personal care beds, Pharmacare and Medicare, so I would suggest • . .

I think I answered the question that was posed. I didn't •.. the invitation of my honourable friend to start talking about my attitude towards doctors and so on. I'm not rejecting his questions but I'll answer that, I'll make my speech on this when we come to this item. MR. CHAIRMAN: The Honourable Member for Sturgeon Creek. MR. J. FRANK JOHNSTON (Sturgeon Creek): Thank you, Mr. Chairman. We've just had an exercise in the fact that if the Minister is not too happy about what we've been asking him, we may possibly get a ... he's telling us we're going to get a 20 or 25 minute speech. Mr.

Chairman, I really want to get back to administration. My question earlier was, do we talk about the administrators of the different policies under the program or do we talk about the administrators now? So I would ask - and I really don't want to go through what's being spent in many other places. I don't want to hear that we are people who are sarcastic on this side or anything of that nature. The Minister has explained that he wants to give all the answers and if he thinks we're sarcastic when we ask these questions, that's up to him. Mr.

Chairman, the word 'administration• then, I would ask the Minister this, that he has people who advise him as to what policies will be brought forward, and I would think that those people must be administrative people when I look at the Public Accounts; I see Deputies, Assist ant Deputies, and I see people in charge of all these different departments. So the administra tion must include the people who advise him on policies.

Then I would ask him; is it the policy in an administration of his department regarding hospital services, is it the policy of the administrative people, while making policies of Manitoba, to have complete discussions with, say, the dentists, the doctors, the nurses, and everybody involved? Does his administrators talk to these people? MR. CHAIRMAN: The Honourable Minister of Health. MR. DESJARDINS: My honourable friend seems disturbed that I didn't answer his ques tion. Had he been listening, he'd have realized that I did answer his question.

He asked if the administration was only in the first line or in any other area, and I told him that all the admin istration was on this line. Now, as far as advisers - we're talking about the bulk of administration, is the adminis tration the people running the programs - the advisers could be considered certainly the com missioners themselves. The Minister deals mostly with the Chairman and the Executive Director of the Commission, and the Commission reports through the Chairman, depending on

May 29, 19 75 31 95 SUPPLY - HEALTH (MR. DESJARDINS cont'd) ..... the Minister, I guess, and I can't answer, I don't know how the other Ministe rs operate this. I li ke to discuss with the people that are actually doing the service. When I was Chairman of the Commission I had an open line to the Ministe r, and the Acting Chairman now and the Executive-Director have an open line to me any time they want to talk to me.

We have a policy comm ittee once a week in the department, where the Deputy Minister, the Chie f Medical Consultant, the Associate d Deputy Minister in charge of resources, responsible for resource s, and the Executive Director of the Commission meet, once a week at least with me, where policies that we've been dire cted to follow, that we need some work done ei ther by the Cabine t or sub-comm ittee of Cabine t - which is HESP, which we ex plained ea rlier in the Session - are conside red, if we're dire cted, as I say, by the Cabinet or HESP. If there is any suggestion by the Commission this is also studie d.

Now, I named the people that are members of this policy comm ittee. Those are the regular members. Besides that, the people that are administrating or that are responsible for the program in the area that we're discussing also attend the policy commi ttee, not as a resource person but as a full-fledged member of the policy committee, without having to worry to see what his Deputy Minister or ADM is saying, or what he thinks, because this is free ex change of ideas. I now spea k about myself because, as I say, I don't know what the previous ...

Well, I know, but I don't think we're concerned now what was done in the past. This mo rning, for instance, I me t with the adm inistrators of all the Metro hospitals and the MHO. It was agreed that we would meet quite often. I've me t with the Colle ge of Physicians a number of times and also I want to increase those mee tings. I've me t independently with administrators and mem bers of boards of different hospitals, ei ther in my office or at the hospital.

I intend to, if at all possible, visit all the institutions, hospitals, and personal care homes some time after the Session, to talk with these people dire ctly to see what their concerns are. Well, now I'm mix ing up what I did when I was Chairman of the Comm ission. I met with members of the MMA. I intend to mee t with the member s of the MMA again. I have met with individual doctors. I'm having lunch with Drs. Clarkson and Vayda tomorrow to have a progressive report on the re port that they have been working on. I've had briefings by people that are responsible in different areas and - well, what else?

I've met with groups such as optometri sts, chiropractors, and I intend to do mo re of that. I'm li stening to an awful lot of people from above, the orde rs that I get from the Cabinet or HESP, the people that are serving in this field .

I mi ght say that at the policy comm ittee one thing that I don't like that we've seen in governme nt too long, where you've had administrators or you've had staff that has had an ide a, that without checking with anybody have developed that idea on their own - I think we see that in too many departme nts - and then they bring it up only to find out that this is definitely not policy of government or that it is being done by another departmen t, or that it is not some thing that has a high priority.

So the instruction that we have at the Commission and at the department is that anybody - because we certainly don't want to stifle these ide as; we want to encourage them - but if anybody has an idea, before they start developing a program that mi ght involve many high-priced people for many hours and so on, they come to the Policy Comm ittee, they present it themselves, and there it is ei ther, "N o, leave it alone; it's already being done, " or "It's definitely against the policy of governme nt.

" So the work is not done for nothing, or there is a team that is formed - not a team of planners only, who mi ght be very good and could put ideas on paper, but the team is composed of planners, of policy planners, of people in the resource s who will try to look at the best way to set up a program to get the best possible cost sharing, who will also be able to tell the government before and not after the program is there, what it's going to cost this year, next year and the following year, who will be able to look to see what is going on in these programs in other areas" Then you will have people on that team that will - if and when the program is accepted - who will be launching and will be implementing this program.

And those also will be le ft, when all the glamour is gone, who will be left to adm ister the policy. So this is the kind of a team that we want. Now, when these policies are acce pted at the policy comm ittee of government - and I'm talking about the department because I'm asked that, and the Comm ission is participating also on that. Once it passes, it rece ives the OK from the departme nt, then it goes to HESP for approval, which is a sub-committee , and this is where it goes. So I think that we're cutting

31 96 May 29, 1975 SUP PLY - HEALT H (MR. DESJARDINS co nt'd) . . . . . down a lot of ideas that might come from everybody that on their own are planning, without telling them, we don't want you to think anymore - but we do it in an ord erly way, and then we plug in all the resources that we have at our di sposal. I think we want more and more. We haven't got enough of that to start working early with the people, as I said, in the community. Th ese are the people ... We have another bill that is set up to have these larger boards, these district boards.

We try to get the boards in the area of the hospital, the personal care homes, the public health nurse and so on, to gether, to see how we can work on this and to get the comm unit y to participate. We at times are instrume ntal to bringing different municipali ties together to show them that it is to their advantage to unite and to try to deliver the service together. So this is the kind of planning that we do , this is where we get our information, this is where we get the ideas, and this is where we try it on the people of Manitoba. MR . CHAIRMAN: Th e Honourable Member for Fort Garry. MR. SHERMAN: Mr.

Chairman, I don't want to be petty or picky with the Minis ter, and I sincerely don't want to fight with the Min ister. I think the Minister - at the risk of making a seriou s politi cal error, I'm prepared to say, sir, for the record, that I think the Minis ter is probably the mo st open, the most candid Minister in the adminis tration. He gives us mo re information, answers our questions more fully than any other member of the adminis tration, but I think that the Opposition has a legitimate right to look at public expenditures as they trans late themselves into any area.

And I think that, you know, admin istration is a built-in launch ing pad for bureaucracy. If bureaucracy is going to exist anywhere, if it's going to take place anywhere, it's going to take place at the level of adminis tration. Now the Minister may be able to convince us that the additional 42 positions in adminis tration are justifiable and legitimate, and if he convinces us of that, then that's fair game; that's his job and it's his right, and it's fair game.

But I think we have a right to ask why there are 42 new positions at the admin istrative level of this particular sect ion of what is a pretty heavily staffed department. I don't deny that the expenditures of this department are extremely valuable and crit ical to the welfare of the people of the province, but nonetheless, even the Minister would have to admit it's a big department, it's a heavily staffed department, it 1 s a legitimate suspicion of Oppo sition that it might be an over-s taffed department.

And I suggest to the Min ister that if our posit ions in this House were reversed, that he would raise the same qu estion. We have 42 new posit ions. I don't know how that compared with the overall establish ment in the Manitoba Health Services Commissi on, I don't know what the total establishment is.

But if that represents a 5 perce nt or a 10 perc ent increase, then perhaps that's acceptable for one year, but if that establishment were to increase by 5 perc ent or 10 perc ent every year, well it doesn't take very long until you 've got a bureau cracy that's even more top heavy than on e suspects it might be at the prese nt ti me. So that is really what is behind my questions in this area - and although I can't speak for my colleagues, I suspect that it's at least partially behind what they're asking.

Th e fact is, sir, that bureaucracy can begin, and usually does begin with admin istration; not so much with programs, not so much with services in the field, but with adminis tration. If we need those 42 new position s, then all well and good, but I feel that it's incumbent upon the Minister to demons trate that we do need that kind of thing. If we were to take every

section and every area and every sector of the spectrum of governmen t in this province, and we were to add 42 new posi tions to every one, or to add the equiv alent in percentage terms of what that represen ts to everyone; and we were to do that for three or four years, which is the sort of no rmal lifeti me of an administration, then I suggest to you , Mr. Chairman, we would be faced with a really impressive, if not depressing, increase in the roles of governme nt employees and in the roles of the bureaucracy. Th at's what we have to keep an eye on.

When we look at the kinds of budget that the department we're dealing with here is expanding and is going to the taxpayers for approval on, we have to come down to individ ual people and to establishment. So the question of what and why those 42 new posi tions were created and filled, I think, is a valid and legiti mate one. The Min ister suggested in the area of planning - and he's gone into some detail in answering the question, that they can be explained and just ified.

I wasn't satisfied when he first suggested that six new posit ions, the six new op enings had been filled or were being filled in that area, but I �m prepared to accept his explanation. But I think his explanation was

May 29, 1975 31 97 SUPPLY - HEA LTH (MR . SHERMAN cont'd) ..... import ant and was nec es sary . I'm not overly disturbed about the increase in office rental , that's part and parcel of the economy of the day . I'm not overly di sturbed about the increase in office supplies and in the increase in renovation costs or employer s' contributions, or even in salarie s. That's part and parcel of the day . But I am interes ted in the increase in the travel sector of the budget and I would like a little elaboration on that point .

And I am dee ply interested in the $1 05 , OOO incre ase, I think it is in the area of professional consultants' fees to Clarkson, Gordon and Company . What is Cl arkson, Gordon and Company doing to earn that mon ey ? MR . CHAIRMA N: The Honourable Minister of Health . MR . DE SJARDINS: Mr . Chairman , I think I know why we didn 't start on the right foot. We talk about an increase in administra tion cost . I think we involved the increase in the cost and then we mixed that with the staff also; and we looked at the addition of 42 instead of looking at, first of all , a better study of the staff .

And I think that I should give you at this time - I think it'll place you in a much better position . First of all , the office of the Chairman and the Executive Director and so on, there were 11 in 1974 -75 , and there were 11 this year . Well before that, I want to give you the inc rease from 1972 -73; there were 679 emplo yees; in 1973 -74 , 682, so that's not much of an increase; and in 1974-75 , 696 ; and this year 738, for 42 . So that answers one of the questions of my honourable friend . There is no doubt that we did some rev amping at the Commis sion . There 's no doubt about that .

There is no doubt that we brought back people to do some planning . And we 've had new program s. Now I think that this will help my honourable friend if I tell him that , as I said, office of the Chairman , there were 11 last year and 11 this year . Administration Divis ion , there were 113 and there's 124 . That 's a big jump , a big jump . In those 42 , there's 11 . Well that is the Comptroller 's Office , the data processing, management informa tion, system and procedure .

This is all the people that are doing that work for the bills coming in and the cheques going out, all that kind of thing, and there are more and more clai ms . I think we can come to that - probably you can find the claims that we 've had . There are more programs and so on, so we 've had an increase of 11. As I say, I'm very pleased that my honourable friend asked me is that an annual thing and so on, because I think it gives you a better idea now, that we went from 679 to 738 from 1972 to now, with added programs also and with planning, because there was very little , if any, planning.

That 's why I'm always harping back to planning, because that was one of my pet projects out there . But I'm jumping around from one to the other now . I started to talk about the Adm ini s tration Division . Okay, 11 3 to 124 , that's 11. Facilities Division , was 49 to 56 - that's 7 more . Now the Facilities Divisi on, some of the people in the hospitals did not know who to relate and so on . Now we have a director that is re sponsible for the hospitals in the city , the large hospitals.

There is another one for the personal care homes, and another one that is looking at the construction , rural health facili ti es, ye s, all these things - and they're the people that are working with them , and I don 't think that 56 is that many . These people in effect are doing some of the planning also; they 're helping the people , they 're going into corn - munit ies which we couldn 't do before . We know we could go back without these people , and the service will be slow and there'll be a lot of criticism . It 's a combination of ever ything .

Then in the Insurance Division, this is the people that are doing most of the work of paying out and so on; there were 260 - there's 262 now . Then , as I say, there's new pro gram s. We have new program s, as you know , Pharmacare and so on , which will take some . The Pharmacare , by the way , was not admini stered - the Pharmacare that we had before for senior citizens was not administered by the Commissi on . That came in , and the new Pharma care program also . So that's quite a program ; you know, if we start just with that, that could be out of the 42, maybe take 10 of that .

The Servic e Division, there were 251 - wait a minu te, the Insurance Divisi on - I should give you an idea , those are the claim s, the general servi ces, manpower and education , medical assessment also . Now, the Services Division, from 251 to 26 7, which is an increase of 16 . The Commis sion runs the Cadham Provincial Lab; the lab and X-rays, diag nostic unit , the emerg ency health and ambula nce services , which is another new program , by the way . Now these people have an inc rease of 16 . Well , as I say , they run the new program .

And then the Pl anning Division had a grand total of 12 , now they've got 18. So we had a total of 696 and now we 're asking for 738, which is the 42 as I explained .

3198 May 29, 1975 SUPPLY - HEALTH (MR . DESJARDINS cont'

d) But now I mus t in all fai rness tell you that there's mo re in adm inistration, now that we're talking about personnel , be cause we have some people on contract also, and I'll try to give you this at this time , to give you the full one. Data processing, we have one consultant - he was there last year also. I'm not just giving you the increase in staff now, I'm telling you what these people are doing, be cause that is all in administration costs. Medical , there were four in 1974- 75, there are three now under contract, and one was transferred to professional consultant be cause it's part-tim e work.

There is anoth er consult ant, a legal person that we had - and I don't know, why is this here, this 35 ? I can tell you that this 35 for this legal person will not all be spent. I think he's finishing his contract. He was on a three-year contract. He's finishing his contract here and we don't need the 35 on that unless ... Well, yes; it could be that this money will be hired. It mi ght be that we'll need somebody else during the consultation and so on during the negotiating for a fee. So this is there. Libr arian 2, and it stays 2. Pharmacy.

Well, pharmacy, this was something, a new program that we got that didn't exist last year, I think, so we took the staff in that - there's 21. And then the health planners - I told you there were 18 planners, but we also got the complete transfer of health planners, as I said earlier, that were working for HESP - not complete but mos t of them .

We got 19 of those that were on contract, be cause one of the reasons why especially that you have the plan ners on contract is be cause, depending on where my honourable friend would be saying, "whe re are we going" if the emphasis on a new program is this personal care home, you need some kind of planners. If it's something else you'd have another kind of planner.

So instead of having somebody, a civil servant or somebody in the force that when you 're finished with this program they're there be cause they have to have security and so on, these people are on con tract and then these people could be changed after that. Programme rs. In the planning group there were 12 , and now there's 13 . Oh, excuse me. I've be en leading you astray all this time . The line that I gave is not the number. I'm very sorry . I'll have to come back after. I'm reading the dollars now. So if you'd excuse me I'll start over again on this one.

The consultant there's one, and he' s staying the same, and it's the sam e that wehad. The other, that was for data processing. The Medical I gave you the right information. I said four and one of them was transferred, there's only 3. This is where I went wrong, on the consultant, the legal, the libr arian and the pharmacy; that's where I went wrong and we don't have to back up that far. Pharmacy and health planner - there's two positions, not 21 and 19 .

This 21 is for the Pharmacist on this new program , this $2 1, OOO, and the health planners there's $19, OOO. --(Interjection) --That 's why I hurried and then ba cked up be cause that was 40 right there. So that's only two new mo re, and we had a nursing consultant in 1974 that we haven't got now. So then I'm only one ahead. And the programmer, we had one and we now have - these are new positions - an architect, an economist, health planner, developer, clerical , health planner, half-time, and the developer also, the developers, there are three. Three.

I'll try to give you the extra one - well here, we had in 197 4 el even, now we have 19 . Some of them are part time for a special job and so on; and it was $246 , OOO and now it's $412 , OOO . Now I think that you misunderstood me when I talked about Clarkson, Gordon . Yo u should remember what happened to Clarkson, Gordon and the friendship they have with this govern ment. Yo u could see that there was a mis take. It was not Clarkson , Gordon, it 's Clarkson Vayda. It is two doctors that are here that the form er Minister commissione d last year to do the study at the Health Sciences Centre. It's Dr.

Clarkson , who had be en working in Alberta, and Dr. Vayda who has be en in Ontario. And these people are working in planning. You remember the announcement was made at the time, this was going to be a two year program . They are working with the Health Sciences Ce ntre on the planning there and helping us in other areas. Now that's a fee, it'll be roughly $200 ,0 00 . $100, 000 was paid last year but it wasn't voted on be cause that came in during the mi ddle of the year, and now another $1 00 , OOO.

Now that pays, it's not only their salaries, their expenses, and they br ought in architects, I think they have architects that have worked before, an architect firm from London, England, who

May 29 , 1975 31 99 SUPPLY - HEAL TH (MR. DE SJARDINS cont 'd) ..... have been coming in , who have been expert in this - so this is the answer . MR . CHAIR MAN : The Honourable Member for Fort Rouge . MR . DE SJARDINS: Excuse me . Medical claims run about $450 ,0 00 per month , or $5 .5 million-plus in 1974 and this will incease by about 4 perc ent over the previous year . I hope that's all the . . . MR . CHAIRMA N: The Honourable Member for Fort Rouge . MR . AXWORTHY: Well , Mr .

Chairman , I hope that the Minister would allow us to examine in this area of administration the question of manpower planning in the medical field . Before he jumps on a point of order , is that fair game for this

section ? MR . DESJARDINS: Would you mind repeating your . . . ? MR . AXWORTHY : Well , I just say that in terms of looking at the line by line exami na tion of estima tes, I would hope that the Minister would acknowledge or recognize that we can talk about the supply of medical per sonnel under this line of administration , the planning of medical per sonnel for future nee ds. Is this a fair area of ... ? MR . DESJARDINS: No , this would be under the line Medical Program . MR . AXWORTHY: Under Medical Program . He prefers to wait until that point , is that ... ? MR .

DESJARDINS: Unless we want to cover every thing . I've always said that I don't care now the way we start, let 's do it the way you want . MR . AX WORTHY: Well fine , I'm quite prepared to wait . I think we have a long evening ahead of us . Then perhaps , Mr . Chairman, I could ask the Mini ster to give us what informa tion may be available.

I notice that under the comptroller 's office in the Administration area that one of the responsibilit ies is for long-range financial forecasting, which I would take would give us some estimate of future dollar costs, and this is under Report 1974 , Page 19 , Administ ration Division , Comptroller 's Office , bottom of the page , it says, "long range financ ial forecasting ." Now I would expect that under that, the Minister would be able to supply, or through his officials give us what some of the foreca sting is about the future dollar costs of medical care in the provinc e, let 's say what kind of dollars are we looking at in the next five years in gross terms and in aggregate terms, and perhaps he could break down for us some of the costs related to the pre sent cost for acute hospital beds and for the supply of geriatric care , in other words the services that we 're providing, and what kind of forecasts or expectations we mig ht look at .

I think the reason for the que stion is quite obvious, that at the heart of mos t of the discus sion that we have to face up to is at what point do we provide some limit on the expenditures in the medical fie ld , in the health field , and until we have some esti mate as to what we have to expect , then it 's very difficul t for us to debat e questions of dollars and ce nts until we know what we 're looking at . MR . DESJARDINS: This forecast , these people are strictly dealing with the Federal Government on federal and provincial cost sharing .

It 's not exactly the kind of work that my honourable friend was saying . It is practically im possible to forecast , especially at this time , especially this year . I don't know if it will be any better than before . As I just finished say ing, we 're expecting some time in July , or some time this year anyway , the Clarkson-Vayda report, which will be de aling with acute beds , some geriatric beds . We have a pilot project that will give us a better idea what the costs will be to take care of the geriatric people .

We are disc ussing now with the Shriners to try to use the Shriners Hospital for something new, some thing that is needed here, to use the hospital as mostly a day ho spital , kind of a rehab hospital for children, which we didn't have before - a day hospital . Maybe we 'd have 20 be ds . That 's not finished yet . It is quite difficult at this time to tell you exactly what the forecast is . I hope that with these additional people on the staff that we can get some of this inf orma tion .

This is one of the reasons we want these people, but to tell you what forecast that we will have, how much that we feel the Commissi on will need in one year , two years or three year s, I 'm not in a position to give you this at this time . And a lot depends also on the cost -sharing with Ottawa and this is being negotiated now. I think that there will be some major changes in the cost -sharing formula with Ottawa and that will also be a factor in what the future will be . While I'm on my feet - I don't want the questions to accumulate - I endeavoured to give you an idea of where the surplus came in .

The 197 4- 75 original vote was $1 50 , 363, OOO. The 197 4-75 actual draw was $1 45 , 250 , OOO for a surplus of $5 , 113 , OOO. The Administration, there

3200 May 29 , 1975 SUPPLY - HEALTH (MR. DESJARDINS cont 'd) ..... was a deficit of $1 00 ,0 00 . The Personal Ca re Home there was a deficit of $573 ,0 00, more than open, or open faster and so on . The Ho spital, there was a surplus of 105, OOO. Medical, there was a deficit of $1, 185 , OOO - that's the payment to the doctors . Pharmacare, there was a surplus of $1, 35 0,0 00 . The program was delayed. We were delayed in starting the program. You came at the wrong ti me, Ha rry; I'll catch hell on that point . Ambulance, there was a surplus of 1.5 million. That also did not start as early as we thought.

And the other was a surplus in Other He alth Services for 321 . Therefore the surplus on expense was $1, 428, OOO, and there were the Recoveries , primarily federal contri bution, of $3, 68 5, OOO, for a total surplus of $5 , 113 , OOO. But, as I say, out of that we must remember there was a surplus on revenue, on contribution from the Federal Government that we 're negotiating during the years and so on, and that came to $3 , 68 5, OOO out of that 5 million . MR . CHAIRMAN: The Ho nourable Member for Roblin on a point of order. MR . McKENZIE: Mr.

Chairman , on a point of order, I take strong issue with the senti ments of the Minister and the way he's conducting hims elf in this debat e. I raised the quest ion of long-range planning earlier in this debate and the Minister stood up and used every vehicle at his disposal to rule me out of order. And I ... Well, I referred the Minister to Admini s tration, Page No . 19 , and the second last line in that particular paragraph of his Annual Report where it says, "the admini stration division as well, this subs ection is responsible for the long-range financial forecasting of the department ." And, Mr .

Chairman, those were the quest ions I raised earli er . I wanted the long-range forecasting of the Department, and the Minister and the administ ration staff wouldn ' t provide me with the answers and he as much as ruled me out of order . MR . CHAIRMAN: Orde r please. Order please. The honourable member has not been ruled out of order . There's only one person that rules somebody out of order here and that happens to be myself, and I have not, to my recollection, ruled any member out of order this evening . The Ho nourable Minister of He alth . MR.

DESJARDINS: I would like to say on this that I do not object to the question of my honourable friend and you've already covered that I certainly have no power, no right to rule anybody out of order. What I did say, and all I did is appeal for co- operation from my friend, who was telling me, where are we going on hospital, where are we going on Pe rsonal Ca re, why are you fighting with doctors, and I said we can cover these things and I've asked for appeal.

Then before sitting down, or later on during the debat e, I got up and I said it doesn't matter to me if this is the way you want to do it; it would be much easier if we went ... and we had already, when we first started the Co mmitt ee, we had already agreed to go line by line. I certainly have no intention of ruling my friend out of order and, as I say, they can go ahead and ask the question the way they want. MR . CHAIR MAN: The Ho nourable Member for Fo rt Rouge . MR. AXWORTH Y: Mr. Chairman, I just wanted to pursue this a little bit further .

The Ministe r says that as far as his capacity in the Co mmissi on for long-range forecasting, it only relates to feder al-provincial financial relationships. Fi rst, I find it diffic ult to believe that you 're going to be determining your federal- provincial cost- sharing requir ements without knowing what your own costs are going to be, and if we don't know that, it means that we've got a $157 million corporation that's flying blind.

Which I find hard to believe that any corpora tion or operation of that si ze, with the tremendous responsibilities , would not know from one month to the next how much money it's going to be expected to spend, or whether it should be spending for more beds of this kind or that kind. MR. DESJARDINS: One month to the next is hardly long-range planning. MR. AXWORTH Y: Well, let's say from one year to the next.

If we can't even deter mine in effect what we're doing from next year or two years down the track, and yet we're making commitments to build new hospitals , to supply new services , to negotiate fees , to undertake all these things which have a very significant dollar cost attached to them, and yet we have no forecasting ability, or have had none at least up to this point, it really strikes me as exceedingly sort of strange that we have allowed the Co mmission to operate with such kind of totally clos ed-eyes approach, and it 's no wonder that we get into problems if that capacity isn't there.

Now I gather what the Mnister is saying is that he doesn't expect to have that capacit y for some forecasting method in place for another year or two, so it means in effect, are we

May 29 , 1975 3201 SUPPLY - HEA LTH (MR . AXWORTHY cont 'd) ..... making commitment s, then , of various sorts in terms of beds, hospita ls, per sonnel , servi ces , research, all the rest of that kind of thing, without really knowing what the kind of dollar figures are at the end and so we have to determine whether we should be putting "X" millions of dollars into this kind of service or that kind of service . Now, is that a fair statem ent of what the Minister said ? Because if it is, then that should become a proper issue of debate and assess ment in this House . The real point . MR . CHAIR MAN: Order pleas e.

The Honourable Minister of He alth . MR . DESJARDINS: Mr . Chairman, if my honourable friend from the Liberal Party, who last year was saying that we didn't have enough, we should build more acute beds, and we're saying now we 're going to wait to see if we need those acute beds, we're going to build what we need , and if he can tell me what the inflation will be next year , if he can tell me what the nur ses will ask, if he can tell me what the doctors will want , if he can te ll me ahead of time what Clarkson and Vayda say is needed at the Health Sciences Ce ntre , then I'll tell him what it 's going to cost .

In the me antim e, any commitme nt that we make , sure we 'll tell him what that'll cost . MR . ENNS: There 's nothing like a good fight between Grits . MR , AXWORTHY : That's right .--(Inte rjection) -- MR . CHAIRM AN: Order pleas e. The Honourable Member for Fort Rouge . MR , AXWORTHY: We could always appear at our Caucus room and conduct it there . Well , Mr . Chairman , I still find , certainly I think any organizatio n has to do with con- tingenci es, but ce rtainly you can plan for those as well . And I again come back to my point . --(Interjectio n) --Inflation .

You know , you can make estimat es on these things and--(In terjec tion) --Well , you know, the Minister keeps ... Mr . Chairman, the one thing I find sort of totally really out of order , not in a procedural sense but in an organizational program sense with this particular departm ent , is that every time you get down to talking fairly hard terms about what it 's going to cost , we keep saying that some how or other we're waiting for another Federal -Provincial Conferenc e, and I've --(Interject ion) --Well , I'm not ... MR . CHAIR MAN: Order please . MR . AXWORTHY: Yes, Mr .

Chairma n , I think that, you know, you mig ht find , if we were turned around a little bit you might find Mr . Lalonde saying, "I have to wait for those guys at the provincial levels to make up their min ds, " because if you read the Ottawa papers you get the opposite point of view, and what it really seems to me is that the medical system's in a mess . It 's about as simple as that; that we 're like blind men going down a dark street at midnight .

It 's just simply we 're groping our way into this area , and if we beg in asking ques tions as to sort of why we get ourselves into trouble again , as we have in a lot of areas in the medical fie ld , it 's pretty clear, that we have no capaci ty to know where we 're going . I can't, I really can't acce pt , in any way , the Minister 's excuse that (

a) It 's Ottawa; (

b) It 's the Clarkson-Vayda Report ; (

c) It 's we don't know what the nurses are going to bargain for, and all the rest of it . Because ce rtainly I think any corporation , any organization , has to plan to some degree as to what it costs are going to be, even if you don 't do that . It simply means that you've got an open-ended purse and every time something comes along you're putting the dollars on the table again without having any idea at what point you sort of say , "L ook, I want to put money into this kind of service; that's our priority ," and therefore you have to say no to somebody el se . It means that we 're saying yes to everybody .

Well , okay , the question is, isn't it about time we started saying no a little bit more and know why we 're saying yes to things , rather than simply kind of wondering when you get up in the morning what we 're going to spend that day ? Which seems to be the way we 're at . Pe rhaps the Minister - but, you know, he was the Chairman of the Commis sion for a period of time , and again I'm just simply saying that I would want to know then, specif ically , when can this province expect to have a re spectable planning system in the health care field so we start getting proper use of our dollar s?

At what time can we come back to this House and say, "Now, we know that in the Manitoba Health Servic es Commissi on , we 've got the capacity to know that two years or three years down the road this is what kind of cost the tax payer s are going to be having to bear through their votes of their public represen tative s, " so that we know at this point whether we should start cutting back or putting forward ? Now when are we going to have that capacity ? MR . CHAIRMA N: The Honourable Member for Lakeside .

3202 May 29 , 1975 SUPP LY - HE AL TH MR . ENNS: Mr. Chairman , I believe that it always takes, you know - it possibly is because I have some deference of feeling of the position that any Minister of the Treasury Bench is in - you need some time to digest comm ent s that have just been made, particularly comme nt s that have been made in such rapid-fire delivery as the Honourable Member for Fort Rouge has ma de, and I' m sure that the Ho nourable Minister will appreciate this in terces sion on my part to be able to digest those remarks made by the Honourab le Member for Fort Rouge and to properly respond to him .

I just want to say that very briefly and in very few com men ts, Mr. Chairman , that in agreeing to - and we will agree, and we will pass the appropriation that we are now talking about , which is probably in its single self the biggest appropriation that we will pass in this Cham ber, and we're talking about - we're on 6, we 're talking about $157 mil lion . Well, on the first item , you know, in 6. What worries me , Mr.

Chairman , is that last night without a great deal of research, with in fact nothing else other than the mundane help of an engine er friend of mine who now sits beside me, and his slide rule , he was able to show to me that this Minister has the capacity of padding his budget by a few million dollars on rela tively minor items which he still has not been able to explain in this House , even with the help of the former Minis ter , even with the help of the former Minister be side him . Mr.

Chairman, I know that health care has to proceed in this province, and the Progressive Cons ervative Party will not be put in the position of voting against it . We will approve it . We will carry on with it . But we cannot condone the kind of sloppiness that is apparent in the considera tion of these estima tes . We can't just take a million dollars without , you know, taking a little look at it in thi s Chamber , and when the Honourable Member for Fort Rouge says that we are expending dollars here that you know ... Sure, we 're spending dollars, but how much research planning is going int o the dollars ?

How much follow-through is going into the dollars? And what direction are you leading us into , Mr. Minis ter ? Th ose , Mr . Chairman, are questions that certainly we in the Opposition have to ask, if, Mr. Chairman, just in passing . Mr . Chairman , I'm not the critic of Hea lth and Social Development of my party . As a matter of fact I must report to you , Mr. Chairman, that our critic of Hea lth is right now in the ho spital, and there was a rumour for a little while that the Minister was going to be exercising the knife that was going to resolve his gall bladder problems, but ... MR . CHAIRM AN : Order .

I think those kind of remarks are not in keeping with the rules of order in this House . Personal allusions against one member or anothe r, I think , are not in the good taste that we are expected to have in this Hou se . I mean, what the Member want s to jokingly maybe refer to I don 't think is really in good taste in this Hou se , and I would ask the honourab le member to reconsider what he is saying . MR . ENNS: All right, Mr . Chairma n , but when a little farmer can come in from Woodlands and find a million dollars . . . MR . CHAIRM AN: ORDER ! MR .

ENNS: ... can find a million dollars and you can call me to order MR . CHAIRMAN: Order . ORDER ! MR . ENNS: He can find a million dollars that he hasn't spent MR . CHAIRMAN: Order please . MR . ENNS: ... of taxpayers' dollars ... MR . CHAIRMAN : Order. If the honourable member had listened and had been in the House the other night , the mill ion dollars that he is referring to was explained in this House . The honoura ble member was not in his seat at the time . Now I think the honoura ble member should just reconsider what he is saying .

Just think for a mom ent on what he has been alluding to in the last mo ment . The Honourable Member for Lakeside . MR . ENNS: Well , Mr. Chairman, if the honourab le chairman is telling me that the Honourable Minister found that million dollars under his bed lately and that that money is acc ount ed for, then fine . MR . CHAIRMAN: Order. That is not the point that I was referring to . MR . ENNS: Fine . MR . CH AIRMAN: I was referring to something that the honourab le member had said before. Now I think the honoura ble member should just reconsider and perhaps withdraw that remark. MR . ENNS: Well, Mr.

Ch airman, you're asking me to withdraw the remark . I will ask

May 29 , 1975 3203 SUPPLY - HEAL TH (MR . ENNS cont 'd) . . . . . the Honourable Minister now to tell me how he intends to spend $3 . 5 million on this particular . . . MR . CHAI RMAN: Order please . That is not the point that I was raising . The point that I was raising was that the honourable member was casting allusions in this House that one honourable member in this House is going to be operated on by another honourable member . Now I think the honourable member should just ... MR . ENNS: Mr . Chairman , I'm the first one to retract that .

Should that happen , should that happen that one of our honourable mem bers should have to operate on another honourable mem ber , you know, the poor fellow would never survive , and I'm the first one to retract that suggestion . I thought that was, Mr . Chairman , I thought that ... Well , Mr . Chairman , just between you and I, I thought we had that kind of rapport going that you would acce pt that in the spirit that that remark was made . Let me put it officially on the record .

I do not expect the Minister of He alth to physically cut and take the knife in his hand and take the gall bladder out of my honourable friend , the absent Member of Rhineland, who's suffering right now in the I do not expect the Minister of Health to do that . Now , is that offic ial ? MR . CHAIRM AN: Thank you . MR . ENNS: Fine . MR . CHAIRM AN: The honourable member carry on . MR . ENNS: I have retracted that position . I have retracted that position and the Honourable Minister of Health has just lost a fee for servic e, but , Mr .

Chairman , the point of the matter is that we are placed in this position that just the other night , despite the explana tions that are given , we have , you know, exposed a weakne ss in the estimations of this depart ment of considerable amount . We are now being asked to pass a sum of $157 millio n , and I've already indicat ed, Mr .Chairman, that we will pass that sum because we don't want to deny health services to the people of this province , but Mr . Chairman , we do it with a degree of reluctance because we wonder to what extent the amount is padded . MR . CHAI RMAN: The Honourable Minister of Health .

MR . DE SJARDINS: First of all , I wish the House Leader was here because I'd tell him never to

schedule me to go on my estimates after a party from the Lieutenant -Governor because I think we 'll be here for a long day . Tell my honourable friend that we had a surplus, not of one million dollars, sir, we have a surplus of $5 million . Another thing I would like to ask my friend , that when they change shifts that could they keep the team captain here, because a while ago I was being chastised because I was hiring too many people to do this kind of work to make sure that we're planning the right thing , now I'm told I'm not giving them enough informa tion, that we haven't got the planning capaci ty .

I have right in front of me a projection for the next two or three years and I'm not going to give it to anybody because it's outdated . It 's useles s. It 's outdated and I '11 tell my honour able friend why . Now my honourable friend from Fort Rouge is not too happy because I'm say ing that we are neg otiating with Ottawa , all the provinc es are , that they will change the cost sharing system , they will mak e it more flexible , but damn it , Mr . Chairman , that 's what we 're doing . I'm not going to lie to him and tell him we 're negotiating with Lower Slobovia.

We 're negotiating with Ottawa and we 're waiting . Then we had no idea what the salary of nurses would go up; we have inflation that will change all that . Not only nurses , every day there's somebody on strike in this field . There 's so many people that are working here , half of Manitoba is working in this field , is getting money from the Services Commissio n . They're working in the hospitals, they 're working all over the pla ce. And then exactly with this plan- ning that 's coming up , we'll have to ... Is my honourable friend making a speech or just . ? A MEMBER : We 're listeni ng, Larry .

3204 May 29, 197 5 SUPPLY - HEA LTH MR . DESJARDINS: Yes, but I want the former speaker to hear me also to make sure. So, Mr. Chairman, sure we'll project. I think that every year we'll have trouble because they 'll be changing the economy, there'l l be changes in the sharing that we will get from Ottawa. It might be that we will go in a different direction. I was asked a while ago where we're going, what direction. Let me give you an example. No matter what you say, I'm not going to build any more acute beds for quite awhile.

That's a direction that I'm telling you we're going to take, because this is no longer the priority. This was done for too long. The people would panic ; we'd build an acute bed and the cost, the per diem rate was prohibitive. Now we 're . going to look to see if we can get the people out of those acute beds, place them in facilities that are less costly, try to keep them in the home and so on, so therefore we might end up - I think that we've got a rate now probably higher in Canada than any other country. No, any other country . I said Canada. Canada is ... you know. What ? A can ?

That's Doern's department, not mine. MR . CH AIRMAN : The Honourable Member for Fort Rouge. MR . AXWOR THY: Yes, that 's right, he didn 't hear you. Mr. Chairman, I wante d to ... MR. DESJARDINS: Would my honourable friend let me finish because he might leave, and let me ... MR . AXWOR THY: I wouldn 't want to breakup your act. MR. DES.JARDINS: Let me tell you that I'm not padding, that we will come back to you for approximately 20 more million dollars that you don't see here today. Now you think that over and you've got a speech for another hour. MR . CHAIRMAN : The Honourable Member for Fort Rouge. MR .

AXW OR THY : Mr. Chairman, I hope the act doesn't break up soon. It 's a proper sequel to this evening 's entertainment. You've been rehearsing it for a long time. It 's probably the longest standing floor show in the province. Mr. Cha irman, I want to come back to the point before we leave it because I think there are some issues that still require a little more serious attent ion. The Minister says, "Okay, I have all these thi ngs, unknowns, I ca n't figure out. Well the re's a number of thi ngs that I'm bouncing in the air that I don't know how they 're going to fall down. " Okay.

The question is th is, thou gh, that at some time or other we have to find a way of getting ahold of th ose sort of items because we have in front of us , I thi nk, a good example of what happens when you don't do it. We 're probably reading it in every day's newspaper about how the City of New York has gone bankrupt. And why have they gone bankrupt ? Because all of a sudden, you know, there were certain social serv ices that were good thi ngs. Everyone said, "This is a good thing to have.

Le t's provide a better salary for policemen and for nu rses, and have it city docto rs, " and all the rest of it, and everyone agrees that what was being done was basic ally good thi ngs , but at some point all the good thi ngs got together and became one big horrendous bad thing, and I believe that the Minister in this particular department is looking after the area where the costs can most quickly get out of hand because they 're all geared to uni versal programs , they 're geared to human demand, and it's very difficult to sort of deny someone who's sick or ill, or whatever the personal grievance or problem may be, it 's just very difficult to say no.

Yet the concern I have is that if you should take the two items of health and education, tho se two items alone, and allow the trends as I see them - and I was reading the Ho spital Insurance and Diagno stic Services put out by Hea lth and Welfare on the other side of the picture if you allow the trends to continue for the next three or four years, they 're going to bankrupt the province. It's as simple as that.

If we allow the very trends that we see in today 's esti mates, the $1 57 million, and without anything extraordinary, without doing anything really substantially new or different, if that trend conti nues, by about 1980 this province will be bank rupt and almost on that item alone. Now I don't want to be an alarmist but it 's there. With the rest of the country, sure. We 're all in the same bag of tricks.

But tha t's the kind of danger we're facing, and that 's why I'm asking the question of the Mini ster; at what point do we get the capacity and the ability to forecast, to control tho se thing s, so that you can begin making the judgme nts and the hard judgme nts that are going to be required, to begin knowing exactly where you have to cut back or where you're going to suppor t, or whether we're going to have to, you know, face that hor rible thing called deterrent fees at some point, to restrict services, or whatev er the issue may be as to how you control that kind of expediential growth, we'r e going to have to face it,

May 29, 1975 3205 SUPPLY - HEAL TII (MR .

AXWORTHY cont'd) .. . . and I don't think it's good enough, as we 've witnessed this year - and I don't blame the Minister for this - to do it by crisis planning, meaning that, you know, running down to the Fort Garry Hotel and having a little tete-a-tete with the doctors and running back and saying, "I'm going to draw the line there. 11 I'm not being facitious about the Ministe r's performance, that's a hell of a way to plan, you know, doing it by the seat of your pants. --( Interjection)-- Well, I think we were doing that kind of sort of jo ckeying back wards and forwards where we were worr ying about the kinds of, we 're playing the sort of, kind of, I guess what you , .. almost brinkmanship daily with medical personn el of vari ous kinds , and you're right - I 'm not sure it's quite half the Province of Manitoba working in Health Services but there's a goodly number of people.

I think the only way you begin to restr ain their particular demands at some point in this very large area is to lay the facts on the table, to know exactly what kind of costs we 're going to have to face so that doctors and nurses and interns and sort of laundry workers and all the res t of it know what we 'r e going to have to cope with. But I can't believe that we 'r e in any way able to do that until we get through this admin istr ative branch of government, some kind of ability to do it. Now, Mr.

Chairman, the issue I think that dramatizes that particular problem of the lack of planning that goes on, is the thing that we have badgered back and forth in this House for the last two years that I have been here, and that is the whole question of hospital bed shortage. And I listened to the Minister say to me, look, we 've got 6 . 8 beds per whatever it is, per person, per capita, or whatever it is, and that's about the national average, it's better than a lot of provinces, not as good as Ontario but pretty good, and therefore we 're doing all we should be doing.

At the same time, on the other side of it, you have a number of people who phone up and say, look I can't get into a bed this spring, this summ er , this fall, I have to wait out three or four months, I can't .. . in other words, there's somehow some major slippage in the sys tem, that som ehow we 've got enough beds but we don't have enough beds for people who need them.

And again that strikes me as being an example that perhaps through the commission and arrangements with the ho1Jpitals that we 'r e not making the connection be tween it, that we 're not making the planning so that the dips and the valleys or the hills and the cres ts of supply and demand are sort of averaged out so that somehow we can assign that 7. 8 number of beds per population of the people who need them when they need them and not go through this kind of situation where we 're supposed to have enough beds but there's an awful lot of people who don't seem to be able to get to use them.

And it was a problem, we faced it last spr ing in very extraordinary circumstances, and I think as much as the former Minister of Health wanted to deny the fact, that there was very severe hardship on a lot of people who couldn't get in to hospital beds. I don't think the problem was anywhere near as severe this spr ing. MR . MILL ER: All emergencies were met. MR . AXWOR TII Y: Emergencies were met but there was a lot of people who had sort of acute problems and there was a tremendous cramming up.

This spring you still find that there is a number of wards in hospitals being closed for various reason s, there's a shortage of nurses, there's a turnover in personnel. Another re ason may be again that the facts keep coming up in those cases that there's shortages , there's problems in terms of fitting supply and demand or fitting needs to services.

Now again I'm saying that presuma bly one way you handle that is by having the ability to work out some planning system through the Commission that will make sure that there is a proper assign ment of people to services when they need them and to overcome those kinds of personal individual problems. Because when you have someone who needs an operation and it is an acute nature, it's not enough to say, "Lo ok st a tistically we have enough beds per capita. 11 They' re not worried about what the statistics say, they'r e worried about how do they get into the hospitals.

And so that is the kind of question I' m saying , how do we start building that capacity in and if the Minister can provide - I don't mind if he needs to hire some more people to do it as long as the system works. But when he tells me that we 'r e going to hire the 42 people and still not have the capacity to plan, then I -- (Interj ection)-- Well I can't forecast things, so why bother doing it. If we're going to be flying blind, why hire 42 people to help us fly blind, why don't we jus t do it by the old quill and pen method that we 'r e using anyway.

Let's not get so sophist icated and spend more money if it's not going to make a difference. MR. DESJARDINS: That's unbelievable. He's covered the whole thing and he said yes

3206 May 29, 197 5 SUPPLY - HEALT H (MR . DE S.JARDINS cont'd) .... and no at the same time. You know first of all he's going back on thi s thi ng, Mr. Chairman, that I should be able to tell him what it 's going to cost in such a time. Seventy percent of this budget is for salaries, 70 percent. There's over 18, OOO people working in hospitals and personal care homes, and the re's about 1 2, OOO doctors, 1, 200 doctors. And I am supposed to be able to tell him with thi s kind of condition in the world today and in Canada, I'm supposed to be able to tell him what the wages, what the salaries are.

You know if I was that smart I wouldn't be wasting my time here tonight, I wouldn 't be here I can assure you of that. I wouldn 't be here I know that. No, my honou rable friend, my honourable friend ... Then I was very happy because I figured well fine I'l l get up and I'l l tell him why I can't forecast this. There' s certain policies that have to be done, but I'l l tell him that I, certa inly I will acc ept my responsi bility , and I will be able to plan.

We were really on the same wave length for awhile there because he was saying, you know, by such a date the country will be bankrupt and the province would be bank rupt with education and health, and I know this is a difficult thing because there is a motion tha t's political and so on. I figured boy I've got an ally, this will be fun. Lo and behold then he starts saying, "Well you know this guy can't get into the hospital, he's got an operation. No matter what the Minister said you've got to give him a bed. You've got to �ive him a bed.

" There is no way unless we build 1 million beds and issue one to everybody. You know you heard of a chicken in every pot. That 's what we will have to do to make damn sure that every body will have a bed when they want it. That's exactly the first thi ng. You know, let me tell you - and all the blame comes on the poor Minister, and I say poor Minister because I wish to hell he still had this job. You know let me tell you an idea, and you're not discussi ng with the doctor s. --(Interject ion) -- In the States - What are you saying, Frank. --(Interje ction) -- Oh tha t's right.

We agree that we're going all over the waterfront and I'm gonna join in. I'm told that I'm not answering the question s. So, Mr .... I'm a Frenchman and I use my hands this way. Mr. Chairman - God damn it now I don't remember what I was saying. And I didn't even goto the party, Mr. Chairman, tha t's the worst thing. Yes, all right. I'm saying that - I'l l give you an example of what is done in the country south of us.

Instea d of having a un iversal cover age for people to pay doctors and hospital they get - I think it 's called the Kaiser Plan, and the people join this and they 've got doctors that are in this plan and the doctors are paid so much, and it is their advantage to keep people out of hospital, they 'll make more money. And you know . .. MR. BIL TON : You keep them in. MR. DE S.JARDIN S: ... Now I keep them in. So by that system they have by paying the doctors in a different way, the doctor s will do everything to keep them out of the hospital. It is of more benefit to them.

And you know that they 've got - I wish I had the rate - but they 've got way less beds than we have, way less beds then we ha ve. You know a lot depends on the doctors. Of course the doctor is a human being and he wants his patient in right away, and they will be. When I'm saying that we're not going to build any more beds, of course, tomorrow I'l l have a bunch of people phoning me an d say, "Well you say there's enough beds and we've been w aiting for a month or two month s.

" But that's part of my job, I've got to take that, and I'm not going to panic and start building any more acute beds, not now, because my honour able friend is saying, "Well plan and resist, resist the emotion, and resist tho se thing s, and try to plan because after all one million people can spend only so much money. If you don 't do that you're going to have utilization fees, tha t's the only thing you 're going to do. " So what are we saying, you know, that we're afraid, that we're planni ng, we're not doing anythin g.

We resisted, we took a chance, there have been all kinds of promises made - I'l l give you an example: At the muni ci pal hospitals we said, "That's bad plannin g. " We waited, we said, "No we can't have a free-standing hospital, we'r e not going to throw this out and have another 400 beds there. " MR. AXWOR THY: I think the Minister - if I may interrupt the Ministe rb efore he cont inu es in his answer.

The issue I was bringing was not to build more beds but saying that we have sort of a continual example, as we're having this spring, where there appears to be empty beds, or beds of certain kinds that aren't being used and yet the people can't get into the m, that we've got wards of hospitals which are being closed down for lack of services or manpower, or what ever it may be, and tha t's the question I'm asking, is how you start matching up those facilities

May 29, 197 5 3207 SUPPLY - HE ALTH (MR. AXWOR THY cont'd ) .. .. that we've got sitting there and get better utilization and better use of them? That's the co ntradiction I was pointing out. I wasn't recom mending you build more, I' m simply saying, on the one hand you've got a lot of people who say, "I can't get in" and on the other hand you'v e got a bunch of things being closed down or shut up, or being reserved for summer months, and so on. I'm saying, how do we get that kind of use out of, a much more effective use out of the services we've got. And that seems to me is the gist of what we call planning. MR.

DESJARDINS: Well I apologize if I misunderstood my friend and I feel a lot better, because I feel that I regained my ally. But I think he should be careful because it's not enough to say, okay, don't build anymore beds, but then com plain that there's not enough beds. That comes pr etty well the same thing. Now you know I guess that's my jo b, and that's the jo b of my staff, to plan and to see that this is being done, and this is what I' m trying to do. This is why we started a geriatric pilot proj ect in St. Boniface that we hope we'll have later on in this.

This will work, you will try to get the pe ople running the hospital, people admini strating, running the personal care home, public health nurses, people running home care, day care also, day care for the aged, and all these things, to work together to do exactly that. But it' ll be difficult, and so on, because you are dealing with people that are interested in different areas. I' m not cr iticizing I guess that's their job.

I've had an Administrator of a hospital during the year, and during the session last year, that phoned the ambulance, don't bother stopping here anymore, we've got no room We 're sorry, we've got no ro om, you know, and everybody panicked, and the Minister got hell. What was he doing ? Three weeks after another hospital was negotiating a co ntract, there 's talk of a stri ke. I called all the dir ectors in, I said, "W hat are we going to d3 ? We've got to be re ady.

" The same administrator was talking about operation "K ick Back" and all of a sudden he was ready to take about four or five hundred patie nts or something like that - I'm exaggerating a bit to show a point, but all of a sudden you know they were ready to send people home in an emergency. So who is going to determine, who's going to determine that ? You know, there 's a lot of factors. If the medical prof ession say, we're going to take a study today. That's a hell of a lot of operation that could happen in one day in all these hospitals when every thing is closed. That's not my fault, that's not my fault.

Now if some of the doctors leave for the summe r, they're human beings, they want to go, they have worked hard, they're entitled to holidays. That's not my fault. If the nurses because of the supply and demand are going to leave to get marr ied, or go on a trip, or the marrie d one will say I'll take - like my daug hter - say I'm not going to work the next two months in summer, I'm going to stay with my children. That's not my foult. MR. BILT ON: Who cr eated it ? MR. DESJARDINS: God I hope, because I don 't know who else can. You're sure giving me a lot of cr edit tonight. So these are certain factors.

Now I' m not saying that I don't want to have an excuse , I know I've got a re sponsibility, a big responsibility, and I' m saying that this is exactly ... But I think we've demons trated that, I think I've demonstrated my willing ness to do that, and to accept responsi bilities and to accept criticism on this. I would like, for instance, to know why we can't use - and that's one thing I want to discuss with the College of Physicians - why we can't use a hospital, like a hospital that co sts so much money, why we can't use a hospital on a Saturday for instance.

Not nec essarily the same doctor seven days, six days a week, but there's all kinds of young doctors, they say, "I can't get my patients in. " And I' m sure now maybe it'll be the staff of the operating room will be hard to get, be cause there is a shortage. Maybe we should train special people for that, and I think we've got to start to look in the future. Maybe it sounds stupid, maybe it'll sound stupid, but maybe out of 10 stupid id eas we might hit one that's not bad. It seems to me that we could 0.ise our hospi tals on Saturdays.

Right now you go in many hospitals in Winni peg that are talking about shortage of beds, you go on a Friday they're not in any hurry to kick you out because the pe ople - on Sunday, the weekend there' s nothing done, as long as you're out by 2 o' clock Sunday - because the pe ople slated for operations on Monday will com e in on Sunday afternoon. You know, they'll just walk in, but the others can stay because it doesn' t matt er there will be empty beds. So those are one of the factors. But, gentlemen, sure ly one or two people can' t do it alone. This is where we need the co- operation.

This is where th e pe op le li ke yo u have go t to sa y, fine, le t 's give the Mini st er

3208 May 29, 197 5 SUPPLY - HE ALT H (MR . DESJARD

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Collection	Manitoba — Debates (Hansard)
Citation	30-2-103
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Volume / chapter	30th 2nd hansardpdf 103.pdf
Language	en
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