Manitoba Hansard — 2 May 2008 (Sitting 34C, 39th Legislature, 2nd Session)

39-2-34c

Manitoba — Debates (Hansard)

Second Session - Thirty-Ninth Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS Official Report (Hansard) Published under the authority of The Honourable George Hickes Speaker Vol. LX No. 34C – 10 a.m., Friday, May 2, 2008 ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thirty-Ninth Legislature Member Constituency Political Affiliation ALLAN, Nancy, Hon. St. Vital N.D.P. ALTEMEYER, Rob Wolseley N.D.P. ASHTON, Steve, Hon. Thompson N.D.P. BJORNSON, Peter, Hon. Gimli N.D.P. BLADY, Sharon Kirkfield Park N.D.P. BOROTSIK, Rick Brandon West P.C. BRAUN, Erna Rossmere N.D.P. BRICK, Marilyn St. Norbert N.D.P. BRIESE, Stuart Ste. Rose P.C. CALDWELL, Drew Brandon East N.D.P. CHOMIAK, Dave, Hon. Kildonan N.D.P. CULLEN, Cliff Turtle Mountain P.C. DERKACH, Leonard Russell P.C. DEWAR, Gregory Selkirk N.D.P. DOER, Gary, Hon. Concordia N.D.P.

DRIEDGER, Myrna Charleswood P.C. DYCK, Peter Pembina P.C. EICHLER, Ralph Lakeside P.C. FAURSCHOU, David Portage la Prairie P.C. GERRARD, Jon, Hon. River Heights Lib. GOERTZEN, Kelvin Steinbach P.C. GRAYDON, Cliff Emerson P.C. HAWRANIK, Gerald Lac du Bonnet P.C. HICKES, George, Hon. Point Douglas N.D.P. HOWARD, Jennifer Fort Rouge N.D.P. IRVIN-ROSS, Kerri, Hon. Fort Garry N.D.P. JENNISSEN, Gerard Flin Flon N.D.P. JHA, Bidhu Radisson N.D.P. KORZENIOWSKI, Bonnie St. James N.D.P. LAMOUREUX, Kevin Inkster Lib. LATHLIN, Oscar, Hon. The Pas N.D.P. LEMIEUX, Ron, Hon. La Verendrye N.D.P. MACKINTOSH, Gord, Hon. St.

Johns N.D.P. MAGUIRE, Larry Arthur-Virden P.C. MALOWAY, Jim Elmwood N.D.P. MARCELINO, Flor Wellington N.D.P. MARTINDALE, Doug Burrows N.D.P. McFADYEN, Hugh Fort Whyte P.C. McGIFFORD, Diane, Hon. Lord Roberts N.D.P. MELNICK, Christine, Hon. Riel N.D.P. MITCHELSON, Bonnie River East P.C. NEVAKSHONOFF, Tom Interlake N.D.P. OSWALD, Theresa, Hon. Seine River N.D.P. PEDERSEN, Blaine Carman P.C. REID, Daryl Transcona N.D.P. ROBINSON, Eric, Hon. Rupertsland N.D.P. RONDEAU, Jim, Hon. Assiniboia N.D.P. ROWAT, Leanne Minnedosa P.C. SARAN, Mohinder The Maples N.D.P. SCHULER, Ron Springfield P.C. SELBY, Erin Southdale N.D.P.

SELINGER, Greg, Hon. St. Boniface N.D.P. STEFANSON, Heather Tuxedo P.C. STRUTHERS, Stan, Hon. Dauphin-Roblin N.D.P. SWAN, Andrew, Hon. Minto N.D.P. TAILLIEU, Mavis Morris P.C. WOWCHUK, Rosann, Hon. Swan River N.D.P.

1555 LEGISLATIVE ASSEMBLY OF MANITOBA Friday, May 2, 2008 The House met at 10 a.m. ORDERS OF THE DAY (Continued) GOVERNMENT BUSINESS COMMITTEE OF SUPPLY (Concurrent Sections) HEALTH AND HEALTHY LIVING * (10:00) Madam Chairperson (Marilyn Brick): Will the Committee of Supply please come to order. This

section of the Committee of Supply will now resume consideration of the Estimates for the Department of Health and Healthy Living. As had been previously agreed, questioning for this department will proceed in a global manner. The floor is now open for questions. Mr. Kelvin Goertzen (Steinbach): Good morning, Madam Chair. Yesterday, when we left off with questions, the minister in response to a question I'd posed regarding the previous question, she'd indicated that her department was working with the clinic in Steinbach to address the upcoming, the ongoing doctor shortage there and I asked for more specifics.

I know the minister into her answer was sort of general. She probably just ran out of time. I'm sure there are more specifics coming, and it is important, I think, for the community to hear because it does impact a lot of people personally, not the least of which is myself, or maybe the least of which is myself. My own family, a good portion of it, will be without a family doctor. Are there any more specifics that the minister can give in terms of what her department is doing to work with the clinic to address this issue for the residents of Steinbach and southeastern Manitoba? Hon.

Theresa Oswald (Minister of Health): Certainly, I think the most specific that the member opposite would want to hear, not only as a representative for the area, but as somebody who is important and is going to be perhaps without a doctor for his family, including a young child, would be to be able to say that there has been a securing of more physicians for that clinic. That is not a specific that I can provide him with today. That has not yet occurred.

But I do know, as I stated yesterday, that the region is working in co-operation with the Physician Recruitment Coordination Office that has a variety of tools at their disposal to endeavour to recruit and retain doctors to areas ar ound the province. What I didn't quite finish saying yesterday was that I am informed that the RHA has also hired a full-time recruiter who is working specifically with the clinic. The member opposite, of course, is aware that recruiting and retaining doctors is of a greater challenge generally in rural and northern Manitoba. But South Eastman has had very good success over time.

We saw that with what happened after the agreement with ER doctors in June of 2007, and I would say that I am optimistic. The nature of the community is a very attractive one and with those resources in place we know that the region and with the support of the department, we'll work very hard to try to bring doctors to replace the two doctors that are leaving. Mr. Goertzen: I certainly echo the comments about the attractiveness of not just the community but really the entire region, in terms of places to live and work and to raise a family.

I can say personally, and I hope that that is something that's a natural draw for the region, but obviously there needs to be more than that in this competitive environment for doctors. I'll take the minister at her word that she will continue to work with the clinic and the region and the RHA to attract doctors. I know that there are things that the minister's office can do to help that along. I don't pretend to say that she has a cure-all for all of these issues, but I do think that there are things that she can do to advance the agenda to make it easi er for the doctors to be attracted.

I'll leave it on the specifics there but just as a closing, just to reiterate what the minister already knows, that this is a very important issue for the region, not just the residents that I represent, but residents of other MLAs in the Legislature represent because, of course, there are people coming to the Steinbach hospital facilities and the clinics from as far away as Emerson, and from La Verendrye and different areas as well. So it is important for the

1556 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 region as a whole. I thank the minister for that commitment. Sort of as a dovetail to that question, I know when the community and others have been looking around at what some of the other challenges are in other areas of Manitoba, I notice a lot of communities have put forward incentive programs. Some chambers have put forward incentive programs.

Town councils and regions have compiled together incentive programs to attract doctors and there's sort of a wide range that I have seen, whether it's chamber dollars or facilities being built or offered to be built to have doctors practise in or, in some cases, housing arrangements. What is the minister's general opinion of individual communities going out there and using these incentives for doctors to come to their communities? Ms. Oswald: Again, I appreciate the member opposite acknowledging that there is ongoing work on recruitment and retention. As the member knows, it's an international competition.

We know that, aside from just the sunny and friendly nature of Steinbach being a wonderful place to– [interjection] and the region. Yes, let's not forget that. I noticed that that has crept into the member's answers more often lately, that of course–I won't read anything into that, of course I wouldn't dream of doing such a thing. But we know that our commitment to help build communities as attractive places to be for doctors specifically is really exemplified in the Steinbach area.

Our investment in and in partnerships with new chemotherapy and obstetrical facilities at Bethesda, a $3.8-million expansion to which we contributed I think somewhere in the neighbourhood of $2.24 million, investing $299,000 in ultrasound equipment, monitors, work stations, which is going to come together with building our complement of Health human resources to bring those wait times down. They are a challenge for us right now and we're working to do that.

The investment of $1.6 million for a CT scanner and computerized radiography unit in March of '03, we have seen success in being able to build environment and, of course, the investment in ER, let's not forget about that. I do enjoy talking about that whenever I get the chance.

So those things combined create an enviro nment where, even if a family practice member, a member of a clinic, may not be in direct contact with a brand new ER or be right next door to a CT scanner, we know that these are the kinds of things that will encourage a partnership perhaps or an individual physician to lay down roots in a community because there are those innovations and investments in such close proximity.

So, not only on the remuneration side, not only on the provision of grants or increasing educational opportunities or increasing opportunities for nurse practitioners, those kinds of investments that I would call on the purely human resource side–not only are those things important but working to create environments of a physical nature and of a technological nature where doctors want to come and lay down roots, I think, is a very important commitment that we can make to recruiting and retaining doctors. * (10:10) On the issue of incentives that the member opposite is referring to from municipalities in terms of bringing health resources to their regions, of course the member would be aware that I've had a number of discussions, formal meetings, informal discussions with a variety of municipalities on this issue of competing for Health human resources.

Again, they acknowledge that it's a national and international challenge. Our goal certainly is to provide, within a reasonable budget of course, the kind of things that I outlined in the initial part of my answer to help bring doctors to rural Manitoba. We would hope that no municipality would need to aggressively invest on their own in incentive making for health human resources. In the current climate we know that that is the kind of thing that municipalities are banding together to do. Our goal is to work as effectively and as responsibly as we can so that municipalities aren't required to do that. Mr.

Goertzen: Certainly, I think the minister in some ways was saying that she doesn't think that's an ideal situation. I would agree with her. I don't think it is an ideal situation. It's probably indicative of, obviously, what different areas are facing the challenges. But it's also, I think, somewhat symbolic or at least of the growing nature of private, and it's always difficult to use that word when we talk about health care. But I think it is indicative of the sort of private nature the health care goes when you don't have a properly functioning system.

We've seen obviously legal challenges, whether it's in Québec, in Alberta, and I'm sure we'll see more legal challenges in Canada.

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1557 When there is a break down in the single-payer universal health-care system, which all of us in the Legislature, I know, support, when that breaks down, it does lead to creeping in, in a lot of different ways, of private investment into health care. That's certainly one way that it happens, where municipalities, even though they are using public funds in some ways, but are often raising money privately to try to attract doctors. It's an indication of a breakdown of the system.

The minister needs to view it as not an early warn ing system at this point, but certainly a warning system that the system is breaking down, the system that she said that she cherishes. I think all members in the Legislature do also support. But just to recognize that it's an indication that there are problems within the overall single-payer system that need to be addressed or, unfortunately, other bodies like the courts are going to step in and address it for us. As legislators, I don't think any of us want to see that happen.

The minister references the importance of having good capital facilities to attract doctors, and I agree with her. I think that is, certainly in my discussions with doctors, part of the reason that doctors choose to practise in one area or the other. Obviously, Madam Chairperson, they are professionals, and they want to be treated as professionals and work in a professional environment.

With that in mind, when the minister was out for the opening in Steinbach of Bethesda Hospital for the CancerCare unit, which I hasten to add was paid significantly with private dollars from the Bethesda health care foundation, does a tremendous job in raising funds, there was also mention made of the need for new operating rooms in Steinbach. I know the minister heard their comments. She didn't sort of make a commitment at that point. I wouldn't have expected her to, but she acknowledged the concerns at the announcement.

Certainly I know it's one of the priorities for the region an d for Bethesda Foundation and certainly for the doctors because the ORs at Bethesda–I mean, I've certa inly heard stories that they might not always even be up to, not only practice standards, but perhaps code standards because of how old they are. Can she give any indication whether or not within the capital allowance for this year there'll be funding for upgrading new operating rooms at Bethesda Hospital in Steinbach for the benefit of the entire region? Ms.

Oswald: Madam Chair, I appreciate the member's comments concerning the pressures that exist with Health human resources in rural and in northern Manitoba. Again, we know that Manitoba is not unique in this situation. We know other provinces face this particular challenge and need to face it head on, and I know that sometimes, between our political lines, we do endeavour to get into some battles whenever the words "universal health care" or "private and public" come into the discourse. You know no intention on my part to inflame that discussion.

We have some clearly set points of view on these issues, and we also have feelings and attitudes that we share on it. You don't often hear that in the political discourse, but I acknowledge that to be true. I would certainly say that when it comes to municipalities becoming very creative in their ability to make their towns and communities attractive, sometimes it's with money, sometimes it's with programs.

I do recognize that they are expending calories, if you will, in their public meetings, trying to deal with their very re al concerns about retaining health-care professionals, because the member, of course, knows, one would even argue better than I do, as a city dweller that I am, the member knows that hospitals in rural communities aren't singularly about mending what is broken in our bodies or our health, that communities will speak very passionately about health-care facilities being a life blood for communities, being a centre, being that which will attract development and economic development in the area.

So they hold very dear the notion that they want to maintain their health facilities as best they can and their services as best they can. So, while they care very deeply, I know, about the health of their citizens, they know that there are even more considerations of the economic, of the population development variety. This, of course, goes to the reason as to why they work to try to preserve the services that they have.

We know that we find ourselves in situations of shortages of human resources of the health variety for any number of reason s, for decline in our educational institutions, for a variety of reasons where we've seen cuts in the past and these cuts don't heal that quickly. We bear the scars today, and we know that our rural communities, in particular, face these wounds from decisions that have occurred in the past. So it's a cumulative effect of events.

1558 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 On the subject of foundations, by the way, and I do acknowledge the Bethesda Hospital Foundation. That's a blockbuster group, no question about it. Foundations have been raising money for health equipment and enhancements, if you will, to health facilities since long before the member and I trod on the earth. That's not going to change any time soon. It's the pride of a community and, you know, Manitoba Health would not wish to criticize or to be defensive about the work that foundations do and always wish to acknowledge them appropriately.

So, certainly, we know that foundations have an incredible role to play and they are our partners. On the issue of capital expenditures for Bethesda Hospital concerning operating rooms, certainly, I did have some dialogue when I was at the announcement that day and ongoing with members from the region, and I can commit to the member that we will continue to have those conversations and really that have evolved beyond that into strategic discussions about how we can best use our capital dollars to continue to make investments across Manitoba.

I'm sure I don't have to inform the member that the list of capital requests coming from every member of the House, every one of his compatriots on his side of the House and indeed on my side of the House, people want to build health capital. We want to make sure that we work with our regions, make sure that there is a healthy, in the truest sense of the word, distribution of the resources that we have available, and we'll take very seriously the requests of Bethesda Hospital and of South Eastman.

We'll, of course, pay very close attention to issues concerning safety and ensuring that those rooms are as appropriate as can be fo r the people that require surgery there. So I can commit to the member that we'll continue those dialogues and prioritize as very best we can within the context of our capital budget. * (10:20) Mr. Goertzen: I wasn't, I suppose, expecting, I'm always a hopeful person, I think I'm a hopeful person, but I wasn't expecting an announcement here about the ORs. I'd be happy just to get an invitation to the announcement about the ORs in Bethesda. [interjection] No, not the last one.

Regardless, I did raise it and I will continue to raise it because it is important for the region and it's important that the minister know that it needs to be a priority and will continue to have the dialogue here in the Legislature. I hope that dialogue that she has with others in the community results in quick action on those needed ERs at Bethesda for the benefit of all the community residents and region residents. I wonder, because we were talking about foundation contributions to capital projects. This may already exist, and if it does, I apologize, I don't mean to duplicate work for the department.

Could she provide, not necessarily on the spot obviously, but in the near future, a list of foundation contributions for capital pr ojects over the last two or three years for the different capital projects that have happened in Manitoba and what portion of that was paid by foundations? Ms. Oswald: The member's quite right, I've not committed that number to memory, but we can endeavour to, as it would be a matter of public record, of course, in releases that have gone out or announcements, so we will endeavour to compile a list, if it doesn't exist neatly on a piece of paper already, and get it to the member. Mr.

Goertzen: I appreciate that commitment by the minister. To continue on with some local issues, I always like to put the needs of my constituents first, and so if the minister will indulge me until we get into more broader issues. There's been a lot of discussion in the region about the need for a crisis stabilization unit in, whether it's located in Steinbach or elsewhere, but certainly for the region.

There's certainly a growing awareness about the needs of mental health, not, of course, just in South Eastman but also throughout Manitoba and the fact that we might not always deal appropriately, or maybe misidentify the people who are dealing with mental health issues. I believe that the regional health authority has either made this it's top or at least one of its top priorities to have a crisis stabilization unit in Steinbach or the region to ensure that those people who have an immediate need can have that filled without going to Selkirk or somewhere else.

I've gone through an education process on this myself in talking with people like Chris Summerville and certainly people who are much more knowledgeable about the needs of mental health than I am at this stage in my life. They've shared with me the importance of having a local facility because moving somebody, not only out of their community, but really considerably out of their region sometimes makes the challenges more challenging. There was and has been, I think, a push. I also think there's also

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1559 been representation made from the regional health authority to the department about the need for a CSU, a crisis stabilization unit, in the region. Can the minister provide an update for my constituents on the status of that? Ms. Oswald: At the risk of treading on my colleague the Minister of Healthy Living's (Ms. Irvin-Ross) territory here, I can answer briefly and would encourage the member, as, of course, she has as a major part of her portfolio, supports for people living with mental health issues. She does a bang-up job at it as well.

What I can say is that we are in the process of reviewing RHA requests for '08-09. We're reviewing those closely. Certainly, I will endeavour to make sure that we look at where that particular request is on the slate of requests from South Eastman. I will, however, concur with the member that the more we learn about mental health and the variety of approaches that are absolutely required to be able to respond to the complexity of those needs, that we need to be taking advice from our community advocates and from our community workers about the supports that might be best for a given community.

A crisis stabilization unit is a very effective way of supporting those presenting with some of the most challenging of needs and so we will take the member's comments and inquiries on the subject. I think you may have had a letter to the Minister of Healthy Living about this recently, if I'm not mistaken, and we'll work with the region to prioritize and provide the supports that we can for those people living with mental health issues in your region and elsewhere. Mr. Goertzen: I thank the minister. I will raise it as well with the Minister of Healthy Living.

I know there's some crossover, I think, on some of these issues, but I wanted to raise it with the Minister of Health and look forward to any response she can provide for me, because it is an important issue in the region, but also elsewhere in the province as well. Certainly, as an advocate for southeastern Manitoba, I thought it was important that I raised the issue. Also, and perhaps I'll get an announcement here, but I'm losing hope, the Menno Home in Grunthal, which is a long-term-care facility, personal care home, is undertaking work for an expansion.

I know there's some crossover here as well with the Department of Family Services in that I think they're looking to have some assisted living, supportive living portions to the Grunthal Menno Home expansion, but they've done some private fundraising and they're under design work right now and were given support, I think, from Family Services for the design work. There may have been some money from Health as well. I'm not entirely sure. My predecessor–one of my predecessors–Mr. Albert Driedger is involved with the Menno Home and certainly has been a very passionate advocate for it.

My grandfather, before he passed away, was at the Menno Home, so I would declare a conflict of interest in my support for the project, but it's an important regional project. There are needs throughout southeastern Manitoba for personal care home beds, not just in Grunthal, obviously, but, I think, looking at it as a regional perspective, it certainly can provide some relief to even communities like Steinbach where there is going to be an immediate or a need for more personal care home space in Steinbach, as well.

Specifically to the project of the Menno Home, then, can the minister give us any update in terms of her department's involvement or support for the Menno Home project at this point? Ms. Oswald: I thank the member for the question. I think I want to declare at the outset that I think when you go and visit regularly a loved one in a personal care home facility, I don't think is a conflict of interest to say that you feel passionate about the staff there and want to support them in the work that they're doing even after your loved one has passed.

I think it's completely fair baseball for the individual to say, you know, these are fine people and we want to work together to provide a good work environment and a good living environment for our seniors. I would certainly agree and concur with our need to develop a variety of options for our seniors.

I know the member opposite is aware that, within the context of our long-term-care strategy, we're really doing, I think, what the member is asking and that is listening to people like the foundation from Menno Home who recognized that we need to be building up a variety of options, whether it's supports for seniors in group living or supportive housing right on through the continuum to a time when our seniors need to have more complex care in a personal care home.

I can commit to the member to be in contact with Family Services and Housing so I more fully understand the journey that Menno Home has been on in their seeking of capital funds for their

1560 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 development and endeavour to learn more about the particular status at this time. * (10:30) As I say, we are looking at those requests from RHAs at the present time, and I'll endeavour to get back to the member on the status. Again, at the risk of sounding like a broken record, we do have a very sizable volume of requests for capital investments and endeavouring to live within a manageable budget. For such things we need to work with our regions and with our community foundations and citizens, same thing, to make sure that we prioritize as best we can. Mr.

Goertzen: I thank the minister for the commitment to be in contact with Family Services to hopefully support the Menno Home project. I do recognize that there are ca pital pressures obviously on all parts of government. I'm not completely unaware of some of those challenges and how they are sometimes dealt with. But I also recognize that it's not a zero sum game in a budget of $9 billion. It's not as though one project happens, another one doesn't. There are many different projects that can happen under a budget like that.

So I don't feel that I'm competing necessarily with any of the colleagues for the minister or my own colleagues, because, again, it isn't a zero sum game. I do think the Menno Home project, though, is very important for the region, and we will continue to support it for the good residents of southeastern Manitoba. I look forward to the minister's response after she's had an opportunity to speak with Family Services. I do want to put on the record just to commend the fundraising that's taken place in the region for Menno Home. Mr.

Driedger, who is president of the Menno Home board, has passionately advocated on behalf of them at a time when he probably could have done something else at this stage of his life and spent more time with his wife, Mary, down south or in other places. He has decided to give back to the community that he would probably say has given greatly to him. So I want to commend him and all the people who are involved with fundraising at the Menno Home. As much as I would love to continue on with questions that pertain to my own region, I know that there are some broader issues.

One question that goes a little bit outside my region at this point is Falcon Lake. We had some discussion last year about the Falcon Lake ambulance. I understand there's been some alleviation of the challenges there, I think, in working with the regional health authority. There are some discussions going on there in terms of how they can partner with the regional health authority. I had some discussions with residents of Falcon Lake in the last week just to get an update on the situation, and again, I think there's been some advancement and improvement in the situation.

But, for the record, can the minister just indicate the status of Falcon Lake ambulance service, whet her or not they expect there to be service disruptions in the balance of the year, or if that situation has improved to the point where there won't be service disruptions. Ms. Oswald: Madam Chair, I thank the member for the question. We did have this conversation last year, and there certainly had been at that time ongoing challenges on the subject of staffing at Falcon Lake. Those challenges did continue for some time.

Best efforts were made, but I can say that back in January, or the end of January, Manitoba Conservation served notice that they were ending their service purchase agreement for the Falcon Lake service. Of course, the region was endeavouring to take over the work that needed to be done to assist in increasing Health human resources at Falcon Lake. The anticipated completion of that transfer was to be, in fact, May 1. So I will endeavour to make sure that all the i's were dotted and t's were crossed in that regard.

We know that, in the context of the region taking over the issues of staffing that area, we made an announcement back in April, investing $4.4 million to enhance EMS across the province, and one of the central issues of that was the hiring of additional front-line staff. We know that the regions expressed to us a need for having more funds in place to be able to really stabilize their complement of paramedics, of workers on the front line.

They had some disjointed pockets of part-time and partial contracts and having more resources available to them to be able to post positions in such a way that they would have more robust positions to fill and therefore be able to stabilize their workforce was pretty important to them. We also, within that context, plan to upgrade and purchase some 34 more ambulances and also augment our fund for inter-f acility transfer but a good portion of that money was for the RHAs to be able to work towards a solution in those staffing issues.

So I have a lot of confidence that we're going to see a smoothing out of some of the issues that we saw at Falcon Lake. The member quite rightly points

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1561 out that as summer approaches we need to make sure that that's the case and that's what we're committed to do. Mr. Goertzen: I thank the minister for the response and I look forward to just a more formal response about whether or not the agreement for May 1 is now in place, and I'll be happy to report that back to residents of Falcon Lake who have been continuing to raise the issue with me.

Certainly, I'd be happy and would acknowledge if there is a solution to it for the benefit, not only to the people within Falcon Lake itself but the immediate region who have been happy to speak on this issue. There will be other questions from the broader region, whether its Lac du Bonnet and personal care home needs there, or in Emerson regarding the ambulance situation, that my colleagues will bring forward, I'm sure, over the next few days as we go through the Estimates process.

We look forward to some positive responses there as well for the residents in the Lac du Bonnet region, in Emerson and, of course, also in Morris and in Springfield where there would be further questions about ensuring that the health-care needs of those residents are met as well. We look forward to the responses from the minister as we go through that. On to some more questions that we often begin with and, again, I'd like to put the needs of local residents first, always, and now to move on to also important issues but that aren't specific to one region or another.

Can the minister provide for us, or perhaps just present for us in record, a list of the political staff that currently occupy her office. Ms. Oswald: I have political staff located in my office: Jennifer Faulder, senior adviser; Keir Johnson, project manager; Breigh Kusmack, special assistant; Daniel Blaikie, policy assistant; Ben Wickstrom, intake co-ordinator; and, I think, on this list, I'm also required to list my executive assistant, my EA, who is Colleen Siles. Mr. Goertzen: Can the minister indicate whether any of those individuals are new from last year? Ms. Oswald: Yes.

Jennifer Faulder maintains this position from last year. Breigh Kusmack last year was intake co-ordinator and has moved into the special assistant job. Daniel Blaikie was for the latter portion of last year intake co-ordinator and has moved into policy assistant role. New to the list filling in the intake co-ordinator is Ben Wickstrom and new, I believe, from last year at this time is Keir Johnson in the role of project manager. So, yes, I think that that's how it works out. * (10:40) Mr.

Goertzen: So there's been some shuffling of the deck within the office, but clearly a couple of people, at least, have left then in the last year. Can the minister indicate where they've gone to? Ms. Oswald: Okay, I should have read this list better. Yes.

Jennifer Faulder, the same as last year; Breigh Kusmack was with us last year but is taking on a different role as special assistant from intake co-ordinator; Daniel Blaiki e was intake co-ordinator but is now policy assistant; Jeff Langen, who worked with me last year as project manager, has moved on to work for our caucus; Joanne Collins, who worked with me last year and has been replaced by Keir Johnson, has moved on to the WRHA.

She was, in fact, seconded, so she's returned; Richard Mahe, who worked as special assistant has moved on to study, in fact, so has left government; and my EA at this time last year was Sarah Zaharia and she has moved on and Colleen Siles has taken her place. Mr. Goertzen: So just for my clarity because I'm not familiar with these individuals, obviously, as the minister is, one of the last individuals, Sarah, you said, had moved on. She's moved on to–? Ms. Oswald: Sorry.

I beg your pardon, Sarah has moved on to work in CDEM, a Francophone community development entity, which I think is a branch, perhaps, in Interg overnmental Affairs, but I would want absolutely to confirm that. Mr. Goertzen: Maybe the minister, when she's confirming that, if she can just confirm whether Sarah has taken on a term or full-time position within Intergovernmental Affairs, that maybe the Minister of Intergovernmental Affairs (Mr. Ashton) wants to respond, that's fine with me, just the nature of her employment, whether that was a competition.

Now, if I'm correct, Jennifer had gone to the WRHA as a secondment, is that correct? And then returned? Ms. Oswald: I'm actually not trying to confuse you. I apologize. Yes, sorry about that. I'm looking at a chart here that I thought was going to have me so prepared. No, first of all, on the subject of Sarah, Sarah did go through a competition for that job. I can confirm that absolutely right now, and I was sorry she got it. She was a great worker. No, I'm kidding.

1562 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 I'm very happy for her. Jennifer, no. Jennifer's sitting at the back and is still very much alive and well so far as my special assistan t. It was Joanne Collins who had come as a secondment from the WRHA. She had particular expertise. She had a Master's of Social Work with special emphasis in caring for the elderly, and it was an area that I really felt needed to be filled in our office. Sh e has since returned to a position through the WRHA. Mr. Goertzen: And which position did she return to at the WRHA? Ms. Oswald: Very good. Okay.

Joanne has gone back to the WRHA, but in fact works as a policy analyst in the cross-departmental co-ordination initiatives project that's going on right now, which is to help bridge programs between Family Services and Health concerning seniors housing and mental health issues. In fact, she is the WRHA's contribution to that project, so, while she does work within the context of bridging departments and ensuring that we can move projects along in the most co-operative of ways, she is working from the WRHA's perspective to help see this through. Mr. Goertzen: I thank the minister for that.

Can the minister provide for us a list of ministerial expenses and travel expenses for the last year, including the purpose, the destination of the travel and, obviously, the amount spent? I know that in past times there has been some discussion about releasing those all at once as an executive branch, but can the minister indicate when those expenses will be released? Ms. Oswald: Yes. I can confirm–I need to go back on my absolutely thorough and clear analysis of staff and where they've gone. You know, really honing in on how well we've done this.

I did want to confirm for the member that the CDEM and the ANIM organization with which Sarah Zaharia works; it's actually external to government. I was mistaken when I said it was part of IGA–and then Madam Chair knew that and was nodding, and I should have just listened to her, but I didn't. So I can confirm for that that it is external to government. The issue on travel expenses, I can endeavour to find out. I don't know the exact date of when they're releasing that as a block entity, but I know that it is coming forward in a timely way.

I know the member was thrilled and delighted–I'm sure less so than me– to see me fall at the bottom of the list of expenses last year for travel. I can assure him now that there will be no dramatic changes to that this year. Mr. Goertzen: I thank the minister for that. I'm not trying to keep her landlocked or anything in terms of her travel. I mean there's obviously sometimes that there–it's just appropriate for the minister to be at certain places. But obviously, all of us as politicians have to be accountable for the public dollars that we spend.

So it's not my intention to make her the least- travelled minister in government. Just probably not interested in having her th e most-travelled minister in government. I look forward then to the commitment to provide a more detailed and a clear response in terms of who has come into the office and who is left and where they've gone then, sometime soon. On the issue of travel, still. Can the minister indicate whether or not th e Premier (Mr. Doer) has travelled in the last year and had those expenses not deferred, but perhaps picked up by the Department of Health or Healthy Living? Ms.

Oswald: Just as a point of clarification. Did the member just ask me to provide a letter or some written form of staffing movement rather than navigating the Hansard that we just went through? Is that what you asked? Mr. Goertzen: That would be nice for clarity–for my own sake–because there seems to be some confusion on it. Ms. Oswald: Thank you for that clarification. We can provide that. As for the question con cerning travel from the Premier. Again, as I understand, this information is going to be provided imminently as I understand.

I think it might even be within the next week, but I'd ask the member not to hold me to that. But I understand it's very soon and I believe all information that will be necessary in that regard will be contained in that publication. Mr. Goertzen: That's fine. I look forward then to seeing that imminent release in the next week or so. I'm not going to hold the minister to that commitment, but certainly soon. Just on the issue of staffing as well then. On page 10 of this year's Estimates book, the flow chart– or organizational chart, actually, that's provided on the department.

If I'm correct in just some of my comparisons between this Estimates book and last year's, looking at mostly the ADMs in the

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1563 organizational chart there seem to have been a lot of changes from last year other than, obviously, Dr. Kettner's position. Was I correct in assuming that the five of the six ADM or associate ADM positions have changed since last year in terms of the people filling those roles? Ms. Oswald: Yes, the member is correct. There are assistant deputy minister s by the way, and an associate, and on this chart there is acting as well. But that's correct. * (10:50) Mr.

Goertzen: Great, and so just making it easier– whether it's associate, acting or assistant, they're still all ADMs. So I'm just going to use the acronym ADMs. Can she indicate where the five new ADMs, respectively for their positi ons, have come from in terms of taking over their new roles? Ms. Oswald: This is really going to be clear this time. Yes, Kim Sharman came from the Treasury Board Secretariat. Karen Herd, of course, comes from the department, as does Terry Goertzen and Bernadette Preun. Marie O'Neill came from the Burntwood Regional Health Authority, and Dr. Kettner comes from the department. Mr.

Goertzen: Were each of them, other than Dr. Kettner, hired through a competition? Ms. Oswald: Yes, thank you. Ms. Preun and Ms. Herd are in acting capacities, so there was not a competition. But all the rest, yes. Mr. Goertzen: Particularly on Terry Goertzen's appointment, can the minister indicate how many people were involved with that competition– obviously not who the other candidates were, but just the number of people who had put their name in for that competition? Ms.

Oswald: We would want to confirm absolutely for the member, but I am informed that the process is always such that there's a short list of five. We would want to go back to check how many there were beyond that. I recall it was a very reasonable competition. Mr. Goertzen: Just for clarification then, I know there are lots of Terry Goertzens out in the world. The minister sometimes likes to refer to the 1990s–at times she likes to refer to the 1990s. Would this be the same individual who would have worked for the then-opposition leader, Member for Concordia and now the Premier (Mr. Doer)? Ms. Oswald: Yes. Mr.

Goertzen: Does the minister know in what capacity in opposition Mr. Goertzen worked for the then-opposition leader? Ms. Oswald: Again, I would want to confirm this absolutely, but it's my understanding it was a communications role. But I'll have to find out specifically. Before my time. Mr. Goertzen: That response almost leads me to think that perhaps it was a surprise for the minister that Mr. Goertzen had worked for the Premier in a different capacity in opposition. Is that correct? Is the first that she's heard that Mr.

Goertzen had a working relationship at what I would consider to be a senior level within opposition? Ms. Oswald: No, I do not suggest in any way that I am not aware that the member has in past had a political role. I am acutely aware of that. I guess that I have been more focussed on my relationship with Mr. Goertzen in his capacity of departmental work, which has proven to be exemplary. While I had an awareness about his affiliation, it sort of was entirely irrelevant, from my standpo int. So, no, no surprise, but just not front and centre on my windshield in my dealings with Mr. Goertzen. Mr.

Goertzen: I wonder if the minister could indicate whether or not it caused her any second thoughts or concern, that political affiliation. The reason I say that is, I know it was before her time, but I can certainly hark back to some days in the '90s, and I suspect that people like the members for Concordia (Mr. Doe

r) or St. Johns (Mr. Mackintosh) would probably have been doing handstands in the Legislature had ADMs come up from previous positions with the then-Premier Filmon or others. In fact, I know they would have been doing handstands in the Legislature in protest. So I just, not as a reflection of any of Mr. Goertzen's skills, but just from the fact that these things always have to pass the smell test, as the Premier likes to say, in politics. Could she not see how there could have been seen to be a perceived conflict in interest? Ms. Oswald: Well, that's why there was a robust competition.

I think that the member, you know, insinuates what kind of celebrating or haymaking may have been done in the past or will happen in the

1564 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 future on such matters, and I really don't want to speculate on that. We collectively have enough trouble with what actually happens in the here and now let alone speculating what might have been or what's going to be. What I can say is that we know that this was not the first time that Mr. Goertzen had applied for such a position, and we know that in going through a competition sometimes you're successful and the best candidate and sometimes you are not. That is no different for Mr. Go ertzen.

So I understand, I think, what the member opposite is implying, but I think counting on our civil servants to ensure that there is a fair process and a fair competition that we can be protected against political interference or appointment making. Again, I would remind the member opposite that all of these positions, save the ones that are currently in acting mode, and very, very good jobs are being done by the way, have been done through a competition. I think this is how it ought to be. Mr.

Goertzen: The minister sort of makes my point in her answer when she says that we count on our civil servants to be acting impartially, and she was referring to it in terms of the competition itself. But there's a more general point to be made from what she said is that we do, in fact, count on our civil servants to be impartial, both to be seen to be impartial but also to be acting impartially. Mr.

Goertzen has now assumed the position as a civil servant and had previously under this government, and so the question is simply, does the minister not recognize that there certainly could be a perception of a conflict when Mr. Goertzen is signing Freedom of Information requests which I've seen in the past, whether they're accepting them or denying them when it's relatively common knowledge that he had a very close working relationship with the now-Premier when he was opposition leader? Ms.

Oswald: Again, I thank the member for the question and I would go back to the very issue that that's why we need to ensure that there is a competition in place and that under leadership that there are checks and balances in place to ensure that work is being done in the best interest of all Manitobans.

I suppose we could trace through history and spend a lot of time picking out, you know, Conservative members in history that have been appointed to an ADM level through competition or otherwise, and we could weave our way through this particular jungle and take more time on this. * (11:00) You know, what I would suggest is that not every person who engages in political activity and who engages in their passion to stand up for what they believe in in a political way are political lifers.

Some people are, but not all, and I think that to engage in a second career or a third career and for us to be able to, in a fair competition, assert that people can believe passionately in certain tenets, political tenets, but also do the work of the people for the benefit of all the people of Manitoba, is something that we need to, through fair competition, allow people to do.

Again, I would suggest to the member if there are any particular concerns at present or in future that he might have about anyone in the department, I would encourage him to do what he always does when he has concerns of any nature and that is to raise them and they will be explored and investigated accordingly. I do want to say on the record that I believe that Mr. Goertzen is very committed to helping make the health system even better in Manitoba.

I believe that he has the dignity and respect for the people of Manitoba and for the department which he so ably serves to take any political leanings and set them aside for the best interests of the people and the goals which we work every day to try to achieve. Again, if the member has concerns today or in future, I would just encourage him to bring those forward and we'll deal with them in due course. Mr. Goertzen: I know the minister talks about the fact we could sort of weave back through history and see if there were Conservative appointments that would rise to the same level of concern.

My suspicion, having spent some time in this building in past years, even prior to being elected, is that had there been those sort of appointments, there would have also been attached to them a strong level of concern and disagreement from the party that she now represents. So I think in some ways this transcends politics in that all political parties, I think, raise these concerns in a similar nature for similar reasons, and that is that civil servants not only have to act impartially but they have to be seen to be impartial, so I think those concerns are fair.

Having said that, I do wa nt to say for the record that I have some personal knowledge, obviously, of

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1565 Mr. Goertzen and I do want to say that I do think he has passion and I have a lot of respect for what he's achieved within his life. That doesn't mean that these questions aren't fair and ar en't reasonable and they don't have to be asked on behalf of all Manitobans who expect their civil servants to always be as passionate. Again, I expect that he acts passionately in his current role and he probably–in fact, I know he acted passionately in his role with the Premier (Mr.

Doer) when he was an assistant to the Member for Concordia when he was an opposition leader, but I don't want to leave any sort of misunderstanding on the record. I do have a respect for Mr. Goertzen personally and for what he's achieved in his life, but these questions are important to be asked on behalf of all Manitobans because I know that New Democratic members, if they were in opposition, would be asking the same questions for the same reasons, even though I won't–it's obviously a little unusual to have a personal connection with the person who I'm asking the questions of.

I want to move forward, though, into other questioning for the minister, particularly as it to relates to health spending and accountability. There's often a lot of questions around costing in the Department of Health and how much spending is going on and where that spending is happening. Those are legitimate questions as the health budget, you know, accounts now for over 40 percent of the overall provincial budget and doesn't seem to be slowing down in terms of the proportion of the budget that it assumes here in Manitoba and, to some degree, in all provinces.

It seems to me that there's been an increase on the proportion of administrative costs in RHAs as compared to, if we go back to 1999, that the amount of money being spent on administration as opposed to what we would probably describe as front-line services, that that proportion has increased since 1999. Can the minister indicate (a), does she concur with that statement, but also, why the proportional increase in administrative costs that's ha ppened since 1999? Ms. Oswald: Just finishing on the last line of question. I want to assure the member that I appreciate his role in wishing to ask such questions.

I think that it's part of his job and if I gave the impression that I didn't think he should ask them, I humbly apologize. I think they're fine questions and fair to be asked, and I'm sure that the member understands that they're fair to be answered, and doggone-it, if we don't necessarily agree. I think it might even happen again someday. I just wanted to go back and say that I have been able to confirm that in that particular instance, 21 individuals applied. Three individuals, not five, as I mentioned, met all the criteria and were the shortlisted.

It was an open competition and he was the successful candidate. So that's the answer to that question. Going back to the issue of the Health budget generally. I, just in broad strokes, can say to the member that we know that Manitoba Health and Healthy Living's budget will represent 41.9 percent of the overall budget which compares to 41.8 in '07-08. We know the total budget is $4.1 billion compared to close to $3.9 billion last year. It represents a budgetary incr ease of $251.2 million or $6.5 million more than last year. We know that the $251.2-million increase largely falls into two areas.

The first of which is the regional health authorities; it's $67.7 million of the increase for $170.2 million. The next is medical remuneration. That's 22.9 percent of the increase, or $57.5 million. And the remaining 9.4 percent of the increase, which is $23.5 million, is spread across seven other areas of Manitoba Health and Healthy Living. Some 95.7 percent of the Manitoba Health and Healthy Living total budget is spent in five spending areas. As mentioned, the RHAs, Medical Remun, Pharmacare, Provincial Health Services and Health Capital.

We know that three Manitoba Health- and Healthy Living-operated services form 1.2 percent of the budget. That would include Selkirk Mental Health Centre at $33.2 million, Cadham Provincial Lab at $11.1 million and the northern nursing stations at $3.3 million. So, indeed, we are talking about, you know, a very significant amount of money that we are working very hard to ensure falls into the area of front-line care whenever we can. Talking specifically about references to administrative costs.

I can speak about the staffing at Manitoba Health, if that's what the member is specifically referring to–I 'm a distance from the question now; I think that's what he asked. A total of 1,231.3 positions in the department. That's a total cost of $77.8 million which is up from 1,147.1

1566 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 positions last year. Nearly 80 percent of the increase or 84.2 positions this year over last year are for direct-care related functions, including over 56 positions at the Selkirk Mental Health Centre and 11 at Cadham Lab, and in Public Health. * (11:10) Also, a large portion of the positions at Manitoba Health are related to direct care, where we endeavour to make the most intense investments that we can for direct care or service delivery, including Selkirk Mental Health and Cadham Lab.

Again, of the 1,231 positions at Manitoba Health this year, only 42 are indeed classified as management. That's the same as last year, 336 positions, that's $14.1 million, are classified as admin support. Though it's worthwhile to note that the latter includes many positions that are critical to patient care and critical to those items that we receive inquiries about from members opposite, like insured benefit support, people responsible for processing insurance claims, and so forth. Mr.

Goertzen: Just for more certainty, more clarity, the question was specific to RHA administration costs and the proportion of costs being eaten up by admin costs as opposed to front-line care services since 1999. Can the minister indicate why administrative costs seem to be taking up a greater proportion of overall health spending in RHAs as opposed to front-line services? Mr. Mohinder Saran, Acting Chairperson, in the Chair Ms.

Oswald: We know that the provincial administration costs as a percentage of total operating costs in all the RHAs, and this includes CancerCare, actually reve al a downward trend from 5.5 percent in '02-03 to 4.6 percent in '06-07. We know that the rural RHAs' averages have remained relatively stable during this time.

So, again, we know that there is often a question about administrative costs for RHAs, but we know that, as a percentage, we are seeing that trend downward, and we continue to be committed to ensuring that the majority of our investments go to the front line where people need the care the most, bearing in mind that often those things that we refer to as administrative costs are the kinds of things that dire ctly affect patient care, patient care and concern, in fact.

As I stated earlier, when we have someone that would be defined as an administrator in the context of the Department of Health or in the context of an RHA, these would be people that would be working on processing information about insurance claims, processing information about insured benefits, so, again, we want to make sure that we make absolutely sure that when we talk about administration costs, we're realizing that these often have a very direct effect on client care and patient care, and we would not want to paint them with a tone, if you will, or a brush that would suggest that they are unnecessary in nature.

In fact, if we draw our attention to the regional health authority review that just took place, we find within its context a recommendation that perhaps we need more administration to offer support in places, and so I think that painting a very wide brushstroke across people that have dedicated their lives, even of a clerical nature, not perhaps with a scalpel in hand and a mask across their face, to caring about helping people who are in need. I think it's important that we take this into account when we're talking about costs in health care and what people do. Mr.

Goertzen: Certainly the minister will know that in the question that was asked, and I think it's a question that really most Manitobans would be interested in knowing because, when they show up at a hospital or they show up at a clinic, what they're looking for is medical care, not administrative services, and their interest is in getting front-line service and seeing a doctor or a nurse or a nurse practitioner or an LPN and getting that sort of service and not in having an administrative service.

So, if she feels that Manitobans have some sort of a negative view or a negative tone toward this particular portion of the health-care system, I think that's regrettable. I think that most Manitobans would want the question answered for the right reasons, and that's because they care about getting the services for their loved one or for themselves individually. I think it's regrettable that the minister might try to impute those sort of motives on Manitobans who just simply want to have care for themselves.

Obviously, there can be debate and questions about what takes up administrative costs and what forms administrative costs. I've learned, even prior to my time in the Legislature, that debating facts and figures can be sometimes a bit of a futile exercise because everybody derives those facts and figures from their own calculations, and they don't always necessarily agree. Perhap s drilling down a little further because we might be able to determine sort of the root of some of this disagreement if we could get clear answers to very specif ic questions, such as the

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1567 number of administrative staff that currently work at the WRHA. Can the minister provide the number of people employed at the WRHA who would be qualified as administrative staff? Ms. Oswald: I would respond to the member's comments that I have absolutely no negative feeling whatsoever towards Manitobans asking questions about where health dollars go.

I think that that's something that they ought to know, and I think that it's helpful to know where their investments are being made, whether they're being made investing in putting more seats into the medical school or investing in bringing more nurses to the front line or in capital infrastructure or supporting administrative positions that are a conduit to help our front-line people, whether it's in Manitoba Health or in the Winnipeg Regional Health Authority. A point that I neglected to mention before is also relevant, I think, to this very point.

That is starting in '08-09, we will be implementing a new and more detailed public reporting system of RHA administrative costs that really speaks to the question of the member opposite. That is, that we want to be as open and transparent as possible. It's going to, we believe that this new system will improve the transparency and accountabi lity and help us ensure that as many resources as possible are directed to front-line care. It will not only enable us to continue to have even more checks and balances in place, but to allow the public to have a look like they have never had before at where spending goes.

So, I think that that's an important point in the conversation. I also think it's important to note that while I believe that there are many important functions that can be done of an administrative nature, that our commitment is, and continues to be, with the public that we bring those resources to the front line.

We know that since 1999, the WRHA alone has made somewhere in the neighbourhood of $19 million in administrative savings by reducing duplication, by merging the previously separated admins of HSC and Deer Lodge, by merging the VON into the WRHA, by working hard to ensure that bulk purchasing of insurance occurs for Winnipeg hospitals. That was a half a million dollar saving alone and also by cutting 26 admin positions from the bureaucracy at the WRHA.

That in addition to centralizing things such as purchasing ambulances really resulted in what could be called administrative spending. * (11:20) We think that we have made considerable efforts to focus our spending on front-line care, not on administration per se. We know that the RHA reviewers themselves suggested that this was an area where we had had some success in the past, and that all RHAs–this is from page 42 of the report–have taken actions to reduce administrative costs. There is a constant focus on cost savings and evidence of reduced costs. This is a very positive step, we know.

Specifically, within the context of the question of the member opposite about administrative positions, a listing thereof, could the member explain, perhaps more precisely, what he might mean by administration? This would have a good bearing on what that listing of people might look like. Mr. Goertzen: Perhaps I'm incorrect, but I would assume that the WRHA itself would break down within its own functions whom they would consider to be administrative and whom they wouldn't consider to be administrative.

I would be pretty surprised if they didn't have that sort of listing, between who's providing administrative service purely and not involved with any sort of on-hands medical treatment or provision of any medical services, as opposed to who's giving strictly administrative function. Did they not break that down themselves? Madam Chairperson in the Chair Ms. Oswald: Again, it sounds to be a very simple science but, if we take the CEO of the Winnipeg Regional Health Authority, Dr.

Brian Postl, he himself has clinics a couple of days a week where he provides care, front-line care from his clinic to children and families. Do we peel that out of his allotment of administrative time and non-administrative time? We really do see a number of those individuals doing a combination of clinical and administration time. It's not as an exact science as one would think. I think the spirit of the question if I understand it correctly is, is it a breakdown of what is front-line spending and what is not front-line spending?

I don't want to over-simplify or put words into the member's mouth but, as you can see, there are complexities within that very question itself. Just before the member is allowed to clarify his question, I might ask his indulgence if we could have a short recess.

1568 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 Madam Chairperson: Is there leave for a short recess? Mr. Goertzen: Yes, why don't we take a 10-minute recess then. Madam Chairperson: Thank you. We will take a 10-minute recess. The committee recessed at 11:23 a.m. ____________ The committee resumed at 11:33 a.m. Madam Chairperson: We will now resume debate in the committee, and the floor's open for questions. Mr. Ralph Eichler (Lakeside): I just have a few questions mainly at the constituent level that I would like to just ask the minister in regard to.

I know that during the election we have certain announcements that take place and we in opposition sometimes fully don't get our share when it comes to those announcements but certainly do appreciate anything we can do in health care to keep our province healthy and vibrant and strong. But I was wondering if the minister could outline for me the procedure. I know in some announcements, whenever they come out, there's no 10 percent requirements made from the community, and then when the election's over, in order to establish a personal care home, for an example, then you have to get the 10 percent.

If the minister could clarify that for me. Ms. Oswald: I thank the member for the question. I certainly do want to say that the community contribution formula does apply. What I would say on its–you know, broadly it's applied uniformly.

I have had discussions with a number of groups, perhaps even groups from the member's constituency, although I'm not going to say that specifically right now, but many of them, so the likelihood is very great about the issue of community contribution particularly in a climate where our capital construction costs are rising and therefore the community contribution policy is, of course, in concert rising. In my conversations with groups, I've let them know that we are well-prepared to do a review of the contribution policy and we're committed to do that.

I don't want the member to hear me saying that we're going to be throwing the community contribution policy out the window any time soon. We know that it's a very important part of our capital development program, and we know that the percentage requirement is variable depending on timing of payments. So one of the criticisms, I think, has been that it seems to be applied inconsistently and I would say it's not applied inconsistently.

There is a variability, you know, 10 percent of sharable costs up front or 20 percent over time interest free or a combination of both and those sharable costs would include front-end planning, project administration, prime consultant fees, construction, furnishings, equipment and commissioning, service LAN, post- tender change orders, those kinds of things. What I know the department has worked very diligently to do is to pay very close attention to investments that have been made by communities and in communities that could in honest application of the policy be applied to that 10 percent contribution.

So, as people in the department have made, I think, you know, excellent efforts to try to support communities in making that contribution, there have been other communities that may have thought that it was being unevenly applied, and I don't think that's the case. I think that there's a very terrific effort on the part of the department to apply every possible contribution in one way or another to bring that cost down.

Madam Chair, there are cases where the community contribution does not come into play and those ones include things like safety and security projects, conversion projects that go to a half-a- million-dollar maximum or sort of unique province- wide programs or services like cancer, dialysis and blood. So those kinds of things aren't ever captured within that community contribution. We are talking with municipalities about any sort of amendments that might take place with a policy like that.

We aren't there yet, in terms of making any sort of a change, and we know that we need to continue to work with our municipalities and our communities to, in a shared responsibility, bring these capital resources to communities as best we can and share the load wherever we can. Mr. Eichler: So, if we can get into the specifics, then, just for my own personal knowledge, so the announcement for the Selkirk mental hospital and then, of course, the Gimli hospital that was built, was there a community contribution required on those two specific bills? * (11:40)

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1569 Ms. Oswald: May I just ask the member to clarify. When you said Selkirk, you said Selkirk mental hospital. Do you mean Selkirk hospital? Mr. Eichler: Yes, the Selkirk hospital. Thank you for the clarification. Ms. Oswald: I can certainly begin by explaining the circumstances surrounding the Selkirk hospital. That was a situation where a community contribution was not required.

The community didn't request that capital construction being built but we knew after a number of audits of safety and just generally crumbling construction, that that hospital, after some analysis, any sort of renovations or upgrades or improvements had sort of gone to their limit. The hospital itself needed to be replaced for any number of those reasons. So there was not a community contribution in that case. In the case of Gimli, certainly I do believe there was a community contribution there.

I'm just awaiting those details but instead of wasting time right now, I can commit to the member to provide a more fulsome answer on the Gimli site. Mr. Eichler: That would be fine, Madam Minister. I do want to come back to one more announcement that was made just prior to the election and that was on the ambulance service centre that was placed in, I believe, was either Selkirk or Gimli constituency. I was wondering if there was any contribution that had to be required for that, or is that a total provincial cost and no contribution required for that? Ms. Oswald: Yes.

To clarify, there's not a community contribution for EMS. Mr. Eichler: Now, it comes back to Teulon on our personal care home. We have, as you know, talked about this a number of times and you've had a number of meetings with me about this and discussions. We have a $400,000 promissory note that the minister has asked her staff to check into. We have had meetings with her departmental staff and the chair of that committee for our area, and the doctors, of course. They assured me, along with RHA, that this contribution will not be lost, but I haven't got anything back from you, Madam Minister.

With that, will this $400,000 be allowed to go forward once you announce, I'm sure very shortly, the addition to the Teulon personal care home? Ms. Oswald: Certainly, we have had conversations about this money before and the question of it lapsing because of time. I regret if we have not sent anything directly to you on that subject and will endeavour to do so immediately. The member is correct in that that money is not going to evaporate into thin air. It will be firmly planted in any projects going forward.

As I've said to the member's colleague, we are just now in the process of reviewing the '08-09 requests from the regional health authorities, their priorities and commitments. I know that the member is well aware that the requests for capital investment far exceed the capital budget that we have. I think they far exceed the provincial budget of several provinces. We have to be very diligent and work with our regional health authorities to make those investments that we can. We certainly did make a number of capital commitments as well, that we have to continue to move forward on.

So we're going to work with the community and work with the region to find these requests, if possible, their places, in the capital schedule. We're working on that right now. As I said before, we will endeavour to get something directly to you concerning that money that you've referenced. Mr. Eichler: I do thank the minister for her comments and look forward to getting that letter to confirm the fact that that community money will not be lost. Just to update the minister, we have gone through the Freedom of Information and accessed the records of the RHA for the Interlake region.

It has been the No. 1 recommended build for their area over the past three years. This is information that's been shared with me, and that was prior to the elections, of course. We do know that the announcement in regard to Selkirk was a bit of a surprise, but certainly I ag ree with the minister, it was well needed. But the people in our area, the Municipality of Rosser, the Town of Stonewall, R.M. of Rockwood, the L.D.G. of Armstrong, the R.M. of Woodlands have all sent letters of support in. I know the minister has gotten copies of those.

We have approximately 54 on the waiting list for our personal care home in the community of Teulon. I know that it would go a long ways into helping attract doctors in our area because of the personal care home and the care that they certainly do require. Plus, the community has been behind this. We're ready to move forward and would encourage the

1570 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 minister to have a real good look at it when they're planning their next announcements as far as additions to personal care homes. I'll just, maybe, leave it at that and thank my colleague from Steinbach for allowing me to ask a few questions in regard to constituency issues. Ms. Oswald: I appreciate the advocacy that the member does on behalf of his constituents and also appreciate the capital prioritization that the regional health authority does with respect to its capital projects.

I know the member is aware that we need to take into account those regions, and then, within the regions, all of the regions' priorities, we need to prioritize and set on a time line. I know, also, that regions look very closely at their distribution of personal care home beds and do their best to ensure that those beds are as accessible as possible in areas where they assess that they are needed.

We also know that within the context of the long-term-care strategy that regions are working, as I've said before, very industriously on ensuring that there's a range of options available, too, of the personal care home variety, of the supportive housing variety, of the supports for seniors in group- living variety. I know that the member is aware that it is a complex plan that we are talking about, and I respect the member's advocacy for his community. As I have said before, we're committed to work with the regions and the communities to prioritize and to invest our dollars as best we possibly can. Mr.

Goertzen: I thank my friend from Lakeside for his comments and for his questions on behalf of his region, as well. Prior to the break, the minister and I were talking about administrative staff. One of the things I think would be helpful perhaps–I know she raised the issue of Dr. Postl and the time that he splits between practice and work in his position. I'd be hard pressed to imagine that there wouldn't be allocations for pay reasons on that within the RHA.

But, that aside, perhaps one of the ways to delve down or just in terms of disclosure, is for the minister to provide a listing of all the people who work at corporate WRHA. She might not want to provide the names for privacy reasons, and that's fine perhaps, just the positions that are staffed out of corporate headquarters. * (11:50) Ms. Oswald: I thank the member for the clarification on the question.

I'm not a hundred percent sure I haven't seen or heard of or talked about with you before that this information has been sought from the WRHA or FIPPA'd from the WRHA, but I may be making that up in my own mind, so I am perfectly prepared to endeavour to get that information for the member as swiftly as we can. Mr. Goertzen: I appreciate that. I don't think that we've had that discussion, but I know I have a lot of colleagues who have an interest in health care in the Legislature. Perhaps it was another colleague whom that commitment had been made to or a discussion happened before and that's fine.

The minister referenced, in response to a previous question, about changes that she's looking at undertaking in terms of reporting on administrative costs. I k now there's been discussion in the Legislature in the past about trying to get an accurate picture of the corp orate and administrative costs out of the WRHA because they seem to be– hidden might be too strong of a word but certainly buried within facility costs in individual hospitals so it's difficult to get a real handle on it.

I know she mentioned that the RHA review had suggested that administrative costs were within line or didn't seem to raise a red flag about it, but then in the same vein she recognizes that the same report indicates that there is some incomplete transparency on the administrative costs. So I think it's difficult to draw a conclusion where a report says there needs to be more transparency on a particular issue, and then she tries to link it and say, well, they thought that the administrative costs were okay. I think the lack of transparency itself speaks to the fact that maybe we just can't make that conclusion.

So I wonder if the minister could just indicate the nature of the changes she's looking to make on the disclosure of administra tive costs within regional health authorities. Ms. Oswald: Just before answering as specifically as I'm able at this time about providing more details, that's the very nature of the kind of reporting system that we've committed to implement.

I did want to say that it was actually the RHA reviewers that made the statements about RHAs have taken considerable actions to reduce the admin costs, and they did take a very close look at this for sure, that there is a constant focus on cost savings and

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1571 evidence of reduced costs. That's what they write in the report while at the same time recommending that the best measures that we can take are to find more ways to provide some details and some openness. So it was the reviewers, themselves, that said that openness continues to be a good thing and did note that there had been a number of steps taken in the past few years that have been very helpful in providing that kind of public accountability and that taking even more would be even better.

So it's not me, specifically as the minister, saying that one equals the other or one results in the other or anything like that. It was th e reviewers that said that, and we took those recommendations to heart.

I can say that one of the things that will happen within the context of providing more detail will be to look at the national definition of admin costs as set out by CIHI, which includes things like salaries and benefits and other expenses in general admin, finance, human resources and communication for all the facilities and the RHA central offices of each region, and also to take into account the factors that affect spending on admin-type services which could include the complexity of care provided by the organization.

It could include management practice, the structure and the size of the organization, indeed, of course, the geography of a region. So it's going to be those kinds of issues that will appear in a more detailed accounting of what those admin costs are spent on. Indeed, another nature of the recommendation was to work on consistency among regions in what was reported and how it was reported. That makes sense. So working to finely hone those kinds of things would be important, too. Mr.

Goertzen: Not to belabour the point, I think that it's difficult to, on the one hand, look at a report–I wasn't ascribing the comments to the minister–but on the one hand to look at a report that said there needs to be more transparency on administrative costs, but then also, on the other hand, to draw a firm and fast conclusion that there are problems with the administrative costs. I think just the fact that the report itself points to the need for more transparency certainly raises the question that maybe we don't have the facts to draw that conclusion.

So we look forward to the changes and for more transparency, because I think it is important, not just for the system as a whole, but certainly for Manitobans themselves to know where their tax dollars are going as it relates to health care. A question related to something that happened in British Columbia earlier this year. The British Columbia Liberal government there enshrined in legislation the five principles of the Canada health care act, and they added a sixth.

I think that they trumpeted the fact they're the first to do this in legislation provincially, but they added a sixth principle of sustainability in health-care spending–I have the news release from British Columbia of April 8, 2008, of this year–with the notion that they believe in British Columbia making management for health-care spending to remain sustainable was an important part of a commitment to the residents of British Columbia. Has the minister–is she aware of her colleagues in British Columbia taking that stance and what effect she thinks it might have in applicability here in Manitoba? Ms.

Oswald: Certainly, on a federal-provincial- territorial stage, we keep in contact with our colleagues across the nation and learn from one another certainly and pay very close attention to the initiatives and to the policies, to the challenges and to the triumphs in other jurisdictions. So, this would really be no different.

Jurisdictions making commitments formally or informally to commit to maintain the sustainability of a health-care system that provides care for all people, not dependent of course on the size of their wallet, but dependent on their medical need, is a tenet that of course many, many people share.

Of course, that's why we have committed every single day to ensure that the resources that we're investing in maintaining patient care, ensuring that we have supports where we need them for acute care, continuing to invest in a very comprehensive and robust prevention strategy, which is arguably all about keeping our health- care costs maintained and sustainable.

If we can become a healthier society, which, of course, I know that we're all aware we need to do, we're going to be having to spend less on the acute-care side, and also focussing our investments on innovation. * (12:00) I know the member opposite might leap up and agree when I say that it's not always about pouring more money into a system; it's about finding innovations within a system to work even smarter and even stronger. There are lots of examples of this that are existing within our health-care system, and I can cite one of my personal favourites–the work that's been done at Concordia Hospital on

1572 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 orthopedics. Having a close look at those quality-of- life surgeries that mean so much to people who are, admittedly, different from people who need lifesaving treatment, which we always have to have as a priority, but still, you know, deal with very real challenges in their lives when they want to have a knee replaced or they need to have a hip replaced so that they can return to a lifestyle that they once enjoyed.

By not only making strong investments in increasing our number of surgeries that we've done, and that's in partnership, of course, with the federal government's money, which, you know, we're grateful for, but not only increasing the number of surgeries, but how they're being done. Being able to use the two operating room model and using clinical assists to be in those operating rooms doing, you know, if I may say in rudimentary terms, the opening up and the closing up of patients so that surgeons can move even more swiftly and move from three operations a day to eight operations a day.

This is about doing better with the resources that we have and, indeed, making a commitment to keeping health care for everybody available and indeed, sustainable as the member mentions. I think that we're committed to that every single day. Mr. Goertzen: Just maybe to focus the minister a little bit, I do know that even back in 2004, Minister Selinger, sorry, the Minister of Finance, had then stated that there was a major sustainability challenge in health care. So we've known for some time the sustainability issue is ther e. It's been acknowledged by her colleagues in Cabinet.

I think and interesting in reading some of the background on the B.C. decision. Even there the Minister of Health, who this minister will no doubt have some connection with, Mr. Abbott in British Columbia, had said: "I don't think that it's on anyone's mind, except possibly the NDP, that sustainability is about private care." I think he's right in saying that, and perhaps it would only be an NDP government who would sort of raise sustainability under the spectre of private care and there was some allusion to it in the minister's answer.

I think the reason, if I could ascribe motive to that British Columbia moved in this direction, is they believe mandating in legislation the notion of sustainability will also then provide accountability in that they have to provide in real and reasonable ways how they're improving the effici ency within the health- care system itself because of the legislative framework to do that, the legislative framework that'll be set out. So really all I want to know in fairly short order is whether or not the minister thinks that doing something similar in Manitoba would have value. Has she ruled it out?

Is she willing to consider it? That's really as far as I need in terms of an answer. Ms. Oswald: Madam Chair, in fact, the word "sustainable" exists in our mission statement. So, yes, we care about sustainability. It has to happen through innovation, through partnerships. It's a shared responsibility. I certainly don't think that the issue of sustainability has to always involve a conversation about private health care and the privatization of health care.

Certainly, I can say with absolute commitment that my energies are expended every day in ensuring that we have health care available for people when they need it and that we invest in programs that will assist people in taking that very personal responsibility in staying healthy so that the health-care system has a little bit more breathing room for those that need help the most. But being accountable, being sustainable and being accessible to the people that need it are commitments that we make every day.

We also know that we face some challenges in different areas like the recruitment of human resources or in bringing down our wait times. We know that we have been pragmatic in the past in looking at ways that we can address that, whether it was indeed, the politically very unpopular sending of cancer patients to the United States so that they didn't have to wait for unacceptably long times for treatment or looking at our relationship with the Maples and finding a way to build a relationship there that would help people. We have principles and we're pragmatic.

I think we need to be thus in order to do just what the member is suggesting, and that is to work toward a sustainable health system. Mr. Goertzen: I know the minister doesn't need a dictation on the difference between a mission statement on legislation and the weight that it carries in law, but I think that the move by British Columbia, again not to ascribe motives to them, was to ensure that there was a legislative responsibility and thus have a legislative accountability for ensuring, measuring efficiencies within health care.

I don't imagine that a province the size of British Columbia, really any province, regardless of its size,

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1573 would take that sort of a measure without some serious thought. I guess al l that I'm asking from the minister today–I'm not expecting any sort of grand policy announcement today or at any time during the Estimates–Madam Chair, I'm just simply looking for acknowledgement that she will discuss this with her colleague in British Columbia, then weigh the merits of it and how it might be applicable in Manitoba. Ms. Oswald: I'd be quite happy to have a conversation with George Abbot on a variety of subjects, so, sure. Mr.

Goertzen: Thank you, I appreciate the brevity and the clarity of the answer. I'm just going to move very quickly to a different topic, shortages of oncologists at CancerCare Manitoba. I think the most recent information, at least that I have, there might be more recent information available, on shortages dates back to 2006, about a year and a half ago. At that time there was, I think, 43 FTEs, oncologists at CancerCare, and there was a vacancy of about five.

Could the minister provide updated information on the current funded FTEs for oncologists and how many of those positions would be vacant at CancerCare Manitoba? Ms. Oswald: Madam Chairperson, I can inform the member that my most recent update is from early March; I would want to do my homework to get him the most up-to-date information possible. We know, according to that note, that at that time there were no vacancies for radiation oncologists. I know the member knows that there are different kinds of oncologists.

We do see at that time a listing of oncologist vacancies at CancerCare Manitoba at 5.57; it may be that those are medical, but I need to double-check that to be sure. * (12:10) I do know that we had some improvement since the posting of these numbers which is very encouraging. We also know that we have had good success with the strategy to grow our own oncologists and that CancerCare will have three oncologists returning within the next two years. We have, of course, secured funding for four additional FTE medical oncologist positions.

There is some flexibility to fill some of these with family physicians in oncologists, physician assistants and nurse practitioners; so we're working diligently to do that. We are working very diligently to make sure that we have an increase in seats in medical oncology, and we know that this is going to work very well to support the supply here in Manitoba.

I think it's also worthwhile to note that recruitment and retention initiatives are top of mind for the people at CancerCare, and the member is quite right in pointing out that any vacancy at all in our spaces at CancerCare, you know, is one vacancy too many and so we need to ensure that we are working very hard to make s u r e t h a t w e h a v e t h a t complement of Health human resources filled.

We've increased, broadly, the number of oncology positions at CancerCare from 37 to 43 since 1999 and again I'd reiterate that the investments that we continue to make in training will be very important in maintaining those number of positions to serve the people of Manitoba who need that care as quickly as possible. Mr. Goertzen: If the minister, I guess for Monday, if she could provide the up-to-date vacancies, whether it's medical radiation or pediatric, I believe it is, that would be great, for Monday it'd be fine. I know that there was some discussion around the topic in fall of last year.

It was either at the end of summer or near the end of summer regarding the cancellation of the breast cancer fundraising walk and one of the reasons Dr. Dhaliwal cited in a news story at that time was that, even if the money could be raised, they really couldn't use it toward improving breast cancer treatment in Manitoba because of a shortage of oncologists and technologists. Could the minister provide an update on the current shortage of technologists that Dr. Dhaliwal was referring to? Ms.

Oswald: Again, there is no doubt that in Manitoba and in every province in Canada and, you know, no different from doctors and from nurses, we know that there's an intense competition for technologists to do the very, very important work that they do in supporting our doctors and our nurses in our care of patients. I will, first of all, commit to the member to find for him the exact status of technologists related to CancerCare specifically.

I'll endeavour to do that the next time that we meet, but certainly I can say broadly that we know that we need to build that complement of Health human resources on the technologists front. Around this time last year we committed to hire an additional 60 technologists. We have already been

1574 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 able to hire 32 of them. So we're a little bit more than halfway there in what we committed to do during this mandate. We know that part of what we can do is ensure that salaries are competitive. There was a new agreement that provided substantial increase to reflect the important work that they do in Manitoba. We know that this some 23 percent increase is going to go a long way to assist us in doing that recruiting. We know that we also need to be investing in state-of-the-art facilities in which these individuals can work.

So I thank the member for the question concerning technologists. We know how important they are to the system a nd are aggressively working to train and to recruit them so that they're there to support our oncologists and really everybody that is working so hard to win the war against cancer. Mr. David Faurschou (Portage la Prairie): I really listened intently to the minister's response to my honourable colleague fro m Steinbach about new facilities and ones that can attract and retain staff. I know that she knows what's on my mind in regard to the Portage and District General Hospital.

I want to perhaps address what is even of more paramount concern. Having had a presentation from the Central Regional Health Authority in regard to potential staff retirements over the course of the next five years. Absolutely al arming; 40 percent expected retirements in some areas of the health-care professions, which is leading to my question about rural training. We have the licensed practical nursing training program that was and continues to be a vital resource for licensed practical nurses' training, and an absolute stellar record of rural retention of the graduates from that program.

We have started in Portage la Prairie, as exists in Winkler, the health-care aide, or health-care assistant programming in the high schools so that their dual accreditation with a Red River certificate and high school certificate is availing graduates. I ask the question, firs t off, the rural licensed practical nursing and the licensed practical nursing program in Brandon and Winnipeg offered by Assiniboine college, what is the waiting list time? Ms. Oswald: Just as a point of clarification, did you say Brandon and Winnipeg? Okay. Mr.

Faurschou: Point of clarification, Madam Chairperson, Assiniboine college has program instruction in both Brandon and Winnipeg, but it's all under Assiniboine college. Ms. Oswald: Good. Thank you for the clarification. I'm aware of that. I just was regrettably unfocussed looking for an answer before you asked the question. I will commit to the member to find for him that exact information in the coming days when we meet again.

I don't know the answer to what the precise number is today, at this hour, but I think that the member raises a really important point in that we have many individuals across our province that have dedicated many years of thei r lives to the health-care profession, whether it's working as a licensed practical nurse, as a registered nurse, as a doctor, as a health-care aide, as a technologist, as the member earlier was citing, and we know that these people are getting to a time where they may wish to not be working anymore and we do look at those retirement figures very, very closely.

We know that we have to commit to not only increasing the number of educational opportunities that we have in Manitoba throughout Manitoba, but that we have to be very aggressive on the recruitment front for those folks that may not have been educated here but want to put down roots here. I know the member's aware that we have committed, during our mandate, to hire 700 more nurses and we've committed to adding a hundred training spaces, 40 of which we just announced last week.

We know that we need to make sure that every single person–no stoned unturned, if you will–that wants to engage in the profession, that we need to work as hard as we can to provide those opportunities to them as quickly as we can. We know we're on the right track and the numbers will tell us that. We're training almost three times as many nurses as were trained a decade ago.

We know that in making our commitments in the previous mandate, we were able to surpass our previous election commitments and increase the number of nurses in training to about 3,000, so we know that we're moving in the right direction and we have to continue to provide those opportunities.

The Central Regional Health Authority is paying very close attention to their potential retirement numbers and, of course, we have had these discussions with them on numerous occasions and that's why we have to continue to provide these opportunities in rural Manitoba, in urban centres, in the north, whenever we can and wherever we can. * (12:20) Mr. Faurschou: I thank Madam Minister for the response, and do appreciate everything of what she

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1575 says, although much of her response is in print right before me through the budget papers. So if I could just ask to have answered the specific question without a lot of prewritten information that was already here. I believe the licensed practical nursing program in certain spots, locations, is in excess of two years, and that is of concern be cause persons, if they are interested in that program, will go out of province and most likely stay out of province. That is of a concern. The registered nursing program I understand was approaching five years.

The health- care aide, though, is something of a partnership that I believe is a model that could be duplicated in other locations throughout Manitoba, partnering with high schools for the health-care assistant programming and training. I would like, though, to ask the minister very specifically about a statement emanating from a third party, the Manitoba Nursing Research Institute, that more than 90 percent of the nursing graduates stay and work in Manitoba. Could the minister give me specifics of how that number was obtained? Ms.

Oswald: I think in terms of the specific arithmetic on that answer, it's an independent body. You would have to ask them. Broadly, I can say I know that our numbers are very good in terms of our retention rate, but I can't sight specifically where their math came from. Madam Chairperson: Just prior to recognizing the member, I just want to remind everyone in the room that if cell phones are being used, they need to be turned to vibrate. Thank you. Mr. Faurschou: I would maybe want to ask that question and not take the bottom line information verbatim without knowing how it was obtained.

I believe it was a very small sampling that this number was derived from. I would suggest that accuracy is very important in this area. We have to know if we as taxpayers here in Manitoba are getting value for our investment in training, and if we are losing significant numbers of our graduates to other jurisdictions, I would say that our investment is definitely being diluted.

From a layperson's perspective, Madam Chair, I would believe that the college of nursing would be able to provide you with that information because every nurse has to be registered with that organization, dovetail that over the graduation information from our instructional institutions, and we'd be able to find out how many are actually practising here in the province. I believe that the department has the capabilities of answering that question . I encourage the minister to do so because I believe she will find that our retention numbers are not as stellar as is indicated by this small sampling. Ms.

Oswald: I'm just informed that, in fact, the answer to the question is on their Web site, and it explains how it's calculated. It's a survey of their graduates, so I think it's right. Also we know full well that the college numbers of actual nurses that are registered in Manitoba and that are working today in Manitoba today are very instructive in our planning when it comes to going forward and building our complement of nurses.

Our promise to bring 700 more nurses to Manitoba is a very, very bold one, Madam Chair, and we know that we are in a time of intense national and international competition and that those numbers show us that there has been a net gain of nurses since 1999 of 1,789. That's a remarkable achievement for the people who have been doing the teaching and learning and recruiting and retaining of nurses in Manitoba, and you're quite right that we can refer to these calculations as a signpost of how we're doing in building those complement of nurses.

I would say that just looking at the total from this time last year to now with a net increase of 200 more nurses that we're moving in a direction that's very positive. Mr. Faurschou: Well, it may be the direction we're moving in but I've had two different occasions, regrettably, to view first-hand, whether it be in the Portage and District General Hospital or St. Boniface General and the areas of the hospital where I was, was significantly short on nursing staff.

To look at the intensive care cardiac area of which the province has invested significant monies to provide for 24 state-of-the-art recovery areas for cardiac surgery patients and to see only six actually being used, when, unfortunately, my father-in-law had to go through and ultimately passed away. But the nurses that were at those nursing stations for the post-recovery operative re covery were all double- shifted, working on their 13th, 14th, 15th hour on their feet and I'm asking the question of the nurses: Well, why can't you–is this a common occurrence? The answer was yes.

We're getting to a point where we don't want to say, yes, we'll come into work because we know we can't get away from work

1576 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 because once here they can't find anyone else to come in. This is something that if we're making progress it's where the rubber hits the road. It's not that obvious, but, anyway, we can move on from this. I would like to ask the minister about the Portage and District General Hospital. Is it anywhere in her department's queue for a replacement as it remains a top priority of capital expenditure for the Central Regional Health Authority? Ms. Oswald: First of all, please let me express my condolences to the member on the loss of his father- in-law.

These are very difficult times indeed for any family so I'm very sorry to hear that. On the subject of ICU nursing, we are aware historically it has always been a challenge. They are– you're very right in saying extremely hardworking individuals and we need to get them some help. We need to be educating as many more as we can. We know that the WRHA has added an additional 35-person ICU nursing course that started January of this year which is in addition to a 25- person class that's going to graduate or has just graduated. I'd have to do my math on exactly which month, if that was March or May.

We know that starting in that January course the full salary replacement is also being offered to nurses while they take that course. That has in the past represented a barrier for obvious reasons. So many of these dedicated professionals have wanted to up their skill set and to learn a wider range of skills and be able to lend a hand to their brothers and sisters in the ICU nursing complement but not being able to take time away from receiving a salary as they were supporting their families was a problem.

We have addressed that head-on by ensuring that full salary replacement is going to occur during that time, so certainly I would agree with the member that we have to keep really focussing the light on developing our ICU nurse complement and we're committed to do that. Madam Chairperson: The time being 12:30, committee rise. WATER STEWARDSHIP * (10:10) Mr. Chairperson (Rob Altemeyer): Will the Committee of Supply please come to some semblance of order. This

section of the Committee of Supply will now consider the Estimates of the Department of Water Stewardship. Does the honourable minister have an opening statement? Hon. Christine Melnic k (Minister of Water Stewardship): I do, Mr. Chairperson. I'm very pleased to present the 2008-2009 Estimates of Manitoba Water Stewardship. Last year was quite a busy and productive year in the department and numerous initiatives were undertaken and very many tasks were completed. I would like to take this opportunity to thank the staff of Water Stewardship for your tremendous work, for your tremendous commitment.

There are several staff members here today whom will be called up as need be, but please accept my gratitude for the wonderful work that you do and please pass that on to your staff, as well, because without a real team effort, there's just no way that we could accomplish what we do. I'm very, very proud to be the Minister of Water Stewardship knowing how dedicated our staff is and how important the work is, of course, around water, but, also, seeing how much we have accomplished in just one calendar year. I would like to touch on some of the highlights for this fiscal year.

The budget for Water Stewardship has increased by almost $1 million, which represents a 3 percent increase. This is the fifth year in a row that the budget for Water Stewardship has increased. Certainly, the fact that we are the only government in Canada with a Department of Water Stewardship, clearly states to the people of Manitoba how important we regard water. I know in discussions with Manitobans that they agree that this government has done the right thing by establishing the Department of Water Stewardship.

We have increased the budget for Ecological Services division by over $390,000 and increased the budget for the Regulatory and Operational Services division by almost $400,000. In the area of Water Quality and protection, we have introduced the proposed Phosphorus Reduction Act, restricting phosphorus content in dishwashing detergents to no more than 0.5 percent by 2010. I was very, very honoured to have the Canadian Consumers and Specialty Products Association leadership standing with me at that announcement, and I want to commend the industry for their foresight in recognizing that they have a very strong

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1577 role to play in reducing phosphorus content in our water and voluntarily taking the step to reduce. So, again, thank you very much to CCSPA. We were very, very pleased to see that our actions were very quickly followed up by the province of Québec. Canada currently is under discussion for regulations that, I believe, may mirror quite closely what we've done here in Manitoba. I'd like to thank the Government of Canada and the Minister of the Environment, John Baird. We have called for a national strategy consistently.

This is the way that we really believe we have to go, you know, living at the bottom of the ocean here in Manitoba. Having about a third of North America drain into Manitoba, we realize that interjurisdictional and, I would hope eventually, international co-operation will be there. In fact, we're seeing this on this bill. We know that there are seven or eight jurisdictions in the United States that have or are in the process of passing either in

an act form or regulation form similar legislation to what I've tabled in the House. We continue to place a priority on the health of Lake Winnipeg and its basins.

This year we have allocated close to $3 million support to Lake Winnipeg science, including assistance for the research ship Namao and the $250,000 that was announced–I believe it was roughly a week ago–to establish the first-ever research chair on water quality at the University of Manitoba from the research and innovation fund and I thank my colleague, Jim Rondeau, the Minister of Science, Technology, Energy and Mines, for working co-operatively with us around establishing that chair.

We have initiated partnerships such as the Federal-Provincial Lake Winnipeg Basin Committee to co-ordinate research efforts to reduce nutrients to the lake, and we have initiated action on 125 of the 135 recommendations from the Lake Winnipeg Stewardship Board to assist in restoring the health of Lake Winnipeg. I would like very much to thank each and every member of the Lake Winnipeg Stewardship Board. They have provided excellent work. They have given us an excellent interim report and an even better final report. A very, very valuable document for the history of water in Manitoba.

It is a new way of looking at water. We all agree we need to be better stewards and, certainly, I, as the minister, use the report to really help us guide the way to the future and making sure that the water of not only Lake Winnipeg but all of Manitoba will be clean and high-quality for our children and their children and their children to come, and all the generations.

We have completed or taken action on 95 percent of 29 recommendations in the Drinking Water Advisory Committee's final report, and on all the recommendations from the Auditor General's environmental audit report on the protection of well- water quality in Manitoba. On the areas of water sustainability, forecasting and climate change adaptation, we did continue to support the operation and expansion of the Conservation Districts program throughout a budget increase of a half a million this year. That brings the annual expenditures on conservation districts through direct grants to some $5.35 million annually.

We have increased the number of conservation districts and we have increased funding by 107 percent when you compare the number of conservation districts that have been established under this government. Funding is keeping pace. We recognize fully that conservation districts are partners in the delivery of local land and water programs and that they ensure healthy ecosystems and provide resilience to climate change which, unfortunately, we're all having to deal with. We continue to expand the integrated watershed management planning.

Last year, I believe, we brought in seven plans, including five conservation districts. This year we announced up to five new plans that will start to be processed this year. The watershed-based activities are a crucial component for adaptation to climate change, and I would like to take a moment to thank the conservation districts and the Manitoba Conservation Districts Association for their partnership, for their vision , for their commitment to water and land throughout the province of Manitoba, and again say how much I enjoy working with them as the Minister of Water Stewardship.

I look forward to working with them in the future. We have increased the budget in this area by some $60,000 and have hired three new staff to provide for improved flood forecasting and flood response co-ordination. Mr. Chair, we're purchasing a new, more powerful ic e-breaking machine for $1.25 million. This will be better designed to tackle our typical weather and ice conditions, to double our ice-breaking capacities. I think it's important to note that on my annual driving of the Amphibex, which is something I look forward to every spring, last spring

1578 LEGISLATIVE ASSEMBLY OF MANITOBA May 2, 2008 we went to Breezy Point just north of Selkirk, and the ice there was some 20 inch es thick. This year the ice was over 40 inches thick and, in fact, we had two ice breakers out there. Again I commend staff for the work they did around preventing any concerns around water and break-up this year, but also commend the consortium, which is made up of the partnership of the Province of Manitoba, the reeves and mayors from the Town of Selkirk, from the St. Clements area, and St.

Andrews area for their foresight and thei r work and their generosity in allowing other rural municipalities or cities around the province, who may be experiencing threat of flooding, the ability to use the Amphibex as well. So we will also be selecting the best ice-cutting technology available. This is a new component in our ice-breaking strategy and in our spring thaw and any other time that ice may be a problem in the province of Manitoba.

What we're looking at is using the ice- cutting technology to go ah ead of the ice breaker, to cut, not into the water, because we don't want refreezing to happen, but to cut the ice maybe 50, 75 percent, and then the ice breaker will come in and finish the job. I would like to congratulate the folks out in Selkirk who came forward with what was a very successful prototype this year, and hoping them every success in their area to help not only our community, but other communities who are dealing with water. I know we're all thinking of Saint John, New Brunswick, today.

I was very pleased to see our government sent EMO support there. I know that when we were struggling with our flood of the century here, we had support from many jurisdictions, and I think it's only fitting that we share the knowledge that we have. We've increased the budget for water control works and drainage licensing by $245,000. The new

section now has 24 staff, more than doubling the number of water resource officers on the land. We value these water resource officers and know that they will very much help in improving delivery of drainage programs and enforcement. I'll talk a little bit further about monitoring, modelling, and research; basin and trans-boundary partnership initiatives; and some of the other work that's been done in the Department of Water Stewardship this past year. Mr. Chairperson: We thank the minister for those comments. Does the opposition critic have an opening statement? Mrs.

Heather Stefanson (Tuxedo): No, I just want to thank the minister for her opening comments. We do have a number of questions we want to address with the minister today, and I do have a number of my colleagues who have a number of questions as well, so I think that in the interests of time I'm probably just going to not give an opening statement, but I do appreciate, certainly, some of the things that the minister said and especially, you know, we do pass on from this side of the House our very best to those in New Brunswick who are having great difficulty right now.

I think we've all lived through that back in 1997, and, prior to that, I know my mother first moved to Manitoba in 1950. That was her first experience, the 1950 flood, moving to Manitoba. She lived on Kingston Crescent, so they were particularly affected by those things. * (10:20) Certainly, it is very appropriate for us to offer our services, as we had services from many other provinces which came and helped us out during those very difficult times. I think that is wonderful; I will leave it at that. If we could maybe get into some questions, that would be great. Mr.

Chairperson: We thank the official opposition critic for those remarks. Under Manitoba practice, debate on the Minister's Salary is the last item considered for a department in the Committee of Supply. Accordingly, we shall now defer consideration of line item 25.1.(

a) and proceed with consideration of the remaining items referenced in resolution 25.1. At this time, we'd invite the minister's staff to join us at the table and ask the minister, once they've arrived, to introduce the staff in attendance. Minister, if you'd care to do introductions. Ms. Melnick: I'd like to introduce the Deputy Minister of Water Stewardship, Don Norquay.

We also have Steve Topping, Executive Director, Regulatory and Operational Services; Giselle Martel, the Acting Assistant Deputy Minister, Corporate Services; Dwight Williamson, Acting Assistant Deputy Minister, Ecological Services division; Joe O'Connor, Director of Fisheries branch. Mr. Chairperson: Very good, thank you. Does the committee want to proceed with these Estimates chronologically or have a global discussion?

May 2, 2008 LEGISLATIVE ASSEMBLY OF MANITOBA 1579 Mrs. Stefanson: I would love to see if we could go in a global fashion. Ms. Melnick: Sure. Mr. Chairperson: It is therefore agreed that questioning for this department will proceed in a global manner with all resolutions to be passed, once the questioning has been completed. The floor is now open for questions. Mrs.

Stefanson: Just with respect to enforcement issues, I was wondering if the minister could provide me with a complete list of all offences for which her department can lay charges, a complete breakdown of the charges that have been laid and the fines collected for each offence since her department's inception. Ms. Melnick: Unfortunately, I don't have that handy but I'll take that under advisement. Mrs. Stefanson: I appreciate that. That's what I was hoping for; otherwise, it would take a lot of time to go through that right now.

I know I have other colleagues that want to ask some questions in many different areas and certainly in the Lake Dauphin fishery area. I know we have brought forward some concerns of some local citizens in the area to the minister. Certainly, members on our side of the House are very much in favour of upholding treaty rights and sustenance fishing for First Nations. One of the issues that has been brought to our attention are–I'm wondering if the minister can just explain how many conservation officers there are monitoring the tributaries, the Lake Dauphin tributaries. There are seven or eight of them, I believe.

Especially during this time of spawning season, it is very important that we not extract the fish from the area during spawning season. It helps to increase the population of the fish in the lake and obviously helps towards the future sustenance for all people in the area. I know in the minister's Water Stewardship Estimates book it says that part of her purview is to manage the fishery resource and its habitat base in a manner that ensures that viable populations are maintained.

I'm wondering if the minister could just sort of update us to see, I mean, what we're hearing from the area is that there are many people that are concerned about the fish population in Lake Dauphin and its tributaries. I know that there were letters that were sent out, certainly, to us, and, as we understand from many people in the area, to the member for Dauphin and I believe, probably, to yourself and the Premier (Mr. Doer) as well.

I'm wondering if the minister could update us as to what her response has been with reference to these concerns and if there is any action that's being taken to ensure the viability of the fish in Lake Dauphin. Ms. Melnick: Well, I'd like to give a little bit of background, sort of draw a more complete picture than is possible in a QP response so I

Document details

Collection	Manitoba — Debates (Hansard)
Citation	39-2-34c
Type	hansard
Volume / chapter	39th 2nd hansardpdf 34c.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	a71d1a0f0b8a226779d9969ef901def2e408717a

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