Manitoba Hansard — 13 November 1989 (Sitting 69B, 34th Legislature, 2nd Session)

34-2-69b

Manitoba — Debates (Hansard)

LEGISLAT IVE ASSEM BLY OF MANITOBA Monday, November 13, 1989. The House met at 8 p.m. CONCURRENT COMM ITTEES OF SUPPLY SU PPLY-HEALT H Mr. Chairman (Harold Gillesh ammer): Will the committee please come to order. This afternoon the Committee of Supply considering the Estimates of the Department of Health had been considering item 2.(

g) Continuing Care :

(4) External Agencies $51 9,900-the Member for St. Johns. Ms . Judy Wasylyc ia-Leis (St . Johns): I am jus t wondering if I could ask for the indu lgence of the Chair and the Minister to go back to a line and ask a brief que stion that really falls under Health Promotion, but it is about an external agen cy. Mr. Chairman: Is there leave to go back to that line? (Agreed) Ms . Wasylycia-Leis: My questions very briefly are on the Gwen Secter Creative Living Centre . I am raising them.

This organ ization and centre have expressed some concerns about their long-term viability, and as the Minis ter knows, had undertaken a major expansion in the last couple of years. I belie ve they had the full support of the members in the Health Department and are now very concerned, because there has been no incr ease in base-line funding, only have received a small cost-of-living increase, have scraped by in '88-89, will just manage in this fiscal year but are facing a desperate situation in 19 90-91.

I belie ve they are in desperate need of an increase in base-line funding, which would bring them in line with other senior centres or they will face a very uncertain future. My questions are simply, what happened? Why did the Gwen Secter Living Centre not get the anticipated base-line increase that was commensurate with its expansion? What are the plans for dealing with this critical situation, and what is the formula that is now in effect for funding such senior centres? Hon. Donald Orchard (Minister of Health): Mr . Chairman, my honourable friend, the Member for Kildonan (Mr.

Cheema), brought up this issue in the afternoon and there are two groups, Gwen Secter and Winkler Senior Ci tizens Asso ciation, who find themselves in the same position where there were expectations created through discussions. Somehow both of those organizations had their expectations not materialize, and we have been dealing with them for approximately six weeks now and are close to resolution to their satisfaction. Ms. Wasylycia-Leis: I thank the Min ister for that information and look forward to the res ults of that 2783 dialogue with Gwen Secter and I guess Winkler Senior Centre. Is there a formula?

There used to be a formula for funding of such centres. Is that formula still in effect? Is there a new formula? What is the general policy for funding of such seniors resources centres? Mr. Orchard: The qua lification and the criterion for qualification are essentially the same, because support services for seniors have not been changed in terms of the approach to funding. The Gwen Secter and the Winkler group had, if my memory serves me correct, in going into the issue with staff, wanted to expand fairly sign ificantly over their present capabilities and were given indica tion that would be possible.

It simply was not followed through on, and as a result of what they thought were quite favourable discussions with staff they went ahead and made some of the arrangements on an enhanced service del ivery level, enhanced the financial squeeze on both of those organizations. *

(2005) As I say to my honourable friend, both of those situations are in discussion, because it came to my attention about seven weeks ago and staff are undertaking discussions, and we hope to resolve those in the very near future. Mr. Chairman: Shall the item pass-pass. Item 2. (

h) Medical Equipment and Supplies: provides for the purchase, storage and di stribution of medical supplies and home care equipment to facilitate the care of patients in their own homes. Also provides equipme nt ser vicing and assistance to clients in the use of equipment and supplies.

(1) Salaries $6 75,400-pass;

(2) Other Expenditur es $2,980,300-pass.

(3) External Agencies $651 ,800-the Member for Ellice. Ms. Avis Gray (Ellice): Could the Minister tell us, the amount of money, $65 1, 800, which external agencies are funded? Mr. Orchard: Mr. Chairman, that is on page 3 of the grants listing that I handed out this afternoon. There are just two in this instance so I can give them to you : the Canadian Red Cross (Manitoba Division) at $24,200 is the req ue st for this year and the Society for Manitobans with Disabilities at $62 7,600.00. Ms . Gray: What is the nature of the funding to the Society for Ma nitobans with Disabilities? Is it to cover certain programs or- Mr. Orchard: Wheelchairs. Ms . Gray: Equipment specifically, okay.

Mond ay, November 13, 1989 Mr. Chairman: Item 2.( h)(3)- pass. Item 2.(

j) Dental He alth: provi des dental treatment and prev entive serv ices to specific age groups of childr en throughout rural Ma nitoba. Also provi des dental treatment and prevent ive serv ices to citizens in remote areas and some inst itutions. ( 1) Salari es $2,383,300-the Member for Thompson. Mr. Steve Ashton (Thompson): Just a few questions in regard to the dental - Mr. Orchard: The Canad ian Red Cross Society also, the pri mary use of the ir money was wheelchai rs as we ll. Mr. Ashton: I just have a couple of questi ons.

First, I would like to ask the Mi nister whether there had been any di scussion in the department as to extend ing the program. First of al l , it is not available in Brandon and Winnipeg, and I know it does come up in di scussions. I am sure the Member for St. Johns (Ms. Wasy lycia-Leis) and other MLAs in the city are aware of the inqu iries that are made in terms of the programs availability. Of course, it is offered in di fferent gr ade leve ls in other communities. I know in Thompson it is not offered for the fu l l range of the program.

I woul d just like to ask the Mi nister if there had been any considerat i on for expa ndi ng the program into some of the under- serv iced areas and, in

part icular, whether there had been any considerati on of the fact that

part icu lar communities, in Winn ipeg , for example, Brandon, and particular communities within Thompson, do not have the same access to dental insurance that perhaps others do. There are a lot of people out there who do not have proper access to even the most basic children's dental programs. I am wonderi ng if there have been any plans, on the part of the department, to look at any possib l e expansi ons. Mr. Orchard: Mr . Chai rman, the program has been stable at its current deli very level since 19 84.

I guess we go through each year on the same criteri on that the previ ous ad min istration has gone through in terms of try ing to dec ide how much resource and whether to expand the program. To date, we have deci ded to maintain the program at ex isting levels. One of the add itions we are undertak ing th i s year is in terms of a sealant program where we are testing the effect iveness of a sealant program.

Appr oximately $1 00,000 of new fundi ng has gone in to give us a clinical trial on sealants, whereby we have control groups in both the dental nur ses de livered program and the private dent ist del i vered program. *

(2010) We think we will have a pretty good trial at the end of the expe nd itures, as to whether we can expand the program in that regard to prov ide sealants as a cost effective method of prevent ion of tooth decay. That is the sign ificant new add ition to the program this year. Mr. Ashton: Is the Mi nister contempl at ing the expansi on of that program to the ex ist ing communities where dental health serv ices are provided through the department, or is that going to be ava ilabl e prov incially if the tests are successfu l? Mr.

Orchard: The first objective is to prove what we think is the cost effect iveness of the program. Should that materi a lize as anticipated, then because it is cost effective we would move it to the balance of the program in the prov ince. We are still faced, however, in the second part of my honourab le friend 's quest ion, with the de ci sion of expand ing the ent ire program to the rest of the province, and those are two separate issues.

The sealant test, if it is an effective tooth decay prev ention methodol ogy, obviously we would be penny wise and pound-foo lish if we di d not expand it to the ex isting program if anticipated resu lts are achieved as expected. Mr. Ashton: I was real l y looking forward to seei ng the resu lts of the tests and would suggest-and I rea lize there are two separate questions, but obviously we already have, within the existing Dental He alth Program, a di stinct ion between di fferent communities via age.

I be lieve it is six to ten in Thompson, and I believe Portage is the other communi ty that is involved, and other communities it is six to 14. We have already accepted the pri nciple that di fferent communities have di fferent needs.

What I am suggesti ng though is that in a sealant program, whether or not there is an expan sion of the overall program, which I suppose coul d be argued as well , I am wonderi ng if the Mi nister would consider it for, not only the communities of Portage and Thompson and the other rural northern communities, but also in Winnipeg, or particularly in certain areas of Winnipeg where dental health insurance is not that common.

I think we are ru nning into the situation-and I think it is fairly obvious to anyone who looks at it-that many kids in Winnipeg, and I suppose Brandon as well, do not have access to even the most basic dental serv ices. I am just wonderi ng if there is some way of getting even with the sea lant program, which if it is successful in the test could make a substantial di fference, as I understand it, in terms of red uction of cavities, and could make a major change for the children and the families involved in terms of future expe nd itures. Mr. Orchard: Mr.

Cha irman, as I mentioned to my honourable friend ear lier, the deci sion as to whether to make this-I believe it is in four school di visions. That is what our pi lot is, two of them private, two of them dental nurse, so we have the balance of servi ce de livery modes. Of course, the balance of the school di visions are in effect the control s if you will. Pend ing the outcome of the resu lts, if they are as ambi tious and as good as we believe then it would become, I would expect, an offered program throughout the ex isting servi ce to school di visions, be they served by private denti sts or the dental nurses.

Even this program, to be moved into school di visions outside of the currently serv iced ones is the same deci sion that has been before Government since 1984. 2784

Monday, November 13, 1989 *

(2015) I simply cannot indic ate as to whether, at this stage of the game, we would be offering that expanded service. The one thing that I think is rather interesting about the pi l ot project is the abi lity with resu lts. These are probably going to give us as good resu lts as there are anywhere on a dental sealant program in North America.

Now, having that kind of information at one's disposal , through insurance programs as my honourab l e friend mentioned in Winnipeg where some students are covered under for instance the MGA benefit package, it may become standard offering there as a cost-saving procedure in dental health.

That is really what we are hoping to prove through this tria l, so that although it wi ll not be offered necessari l y or the decision to offer in school divisions other than those that we curre ntly serve is a separate decision, I think it is fair to say that if we can, through the control trial within this program, we can show that there is a cost-effective way of preventing tooth decay in the sealant project that I woul d think we would have the statistical offerings that a lot of dentists would be interested in pursuing.

Parents wou l d be interested in pursuing in some of the Blue Cross and others who offer the insurance pr ograms so that it coul d be the vehicle by which it becomes expanded. We have exce llent co-operation of the Faculty of Dentistry on setting up this project in terms of setting up the mechanics of it to make sure that the information we get back is good. So the faculty is quite interested in it as we ll. Mr. Chairman: Pass.

(2) Other Expenditures $2 ,663,600 -p ass;

(3) External Agencies $1 72,600- pass; (

k) Environmental Health: Provides medical public hea lth input to departments and agencies in the del ivery of environ mental health services; i.e. medical expertise in the assessment of health hazards and deve lopment of preve ntive measures.

(1) Salaries $2 12, 700-the Member for Thompson. Mr. Ashton: I am just wondering if the department has had any role in the analysis of the explosion at the chemical plant in St. Boniface a number of months ago, in particul ar in assessing whether there was any ongoing health hazard to individual s. In terms of the regu lations of such plants, I do not know if it would fall under Work place Safety and Health. I am wondering if the Department of Hea lth through this particular

section had any ro le in, first of all, looking at the impacts of that exp losion and, second of all, looking at the safety questions that surel y have to be raised as a re su l t of what was a pretty scary explosion in Winnipeg. Mr. Orchard: Mr . Chairman , I will have to beg off a more definitive answer until my ADM gets here. My sense of it would be, no, that the follow-up was left to the Department of Environment. The activities here are not the same or para llel to those undertaken in the Department of Environment.

We do consultations for the Department of Environment, Clean Environment Commission, but they are on the medi cal side in such things as epide miologica l su rveys, water qual ity program, and risk assessment of ana l ysis of various pu blished works, et cetera, and of cou rse the deve lopment of the Pub lic He alth In formation pamphlets. So that we operate as a I guess a separate, not a similar function to the Department of Environment. To my knowledge we have not taken any follow-up surveys in general area of that explosion. Mr. Chairman: Pass-the Member for Ellice. Ms .

Gray: I wonder if the Minister coul d tell me in the objectives it refers to looking at environmental factors affecting physical and menta l health. Does this particul ar

section of the department deal at all with environmental health in regard to the actual staff in the Department of Health in terms of their health, i.e. physica l and mental what may be affecting the workplace, whether it is stress, poor physica l conditions, et cetera? Mr. Orchard: If my honour able friend is asking about stress analysis, that type no, but we have upon occasion asked for air quality testing from Workplace Safety and Health. I think Workp lace Safety and Health is proba bly the more appropriate area for some of my honourab l e friend's questions. Pers onnel management in terms of stress ha ndl ing wou l d be the other area where assistance could be provided. *

(2020) Ms. Gray: Would the Minister know or have information avai lable this even ing as far as asking for testing of air quality? Is that something that is re gularly done by Government offices in the Department of Health? Mr. Orchard: No, it is not a regu lar one but from time to time you will run into staff complaints in terms of air quality. We are getting Government Services to do the monitoring for us but it is through this area that we generall y receive and proceed with the request for testing. I do not be lieve there is a routine check every office once every six months, it is upon request to do so. Ms. Gray: Would the Minister then have information in this

section as to for those instances where there has been a request for testing, how many of the concerns for air testing have there been actually va lid reasons or resu lts which in fact show the air quality as poor? Mr. Orchard: I guess we have on l y tested Eaton Place and 1200 Portage. Ms. Gray: What were the resu lts there? Mr. Orchard: They met guide lin es but you can appreciate 12 00 Portage, in particu lar, I think there was some substantial renova tions. As a re su l t of those, we were within Government guidel ines in terms of air qua lity. Mr. Chairman: Pass. 2.( k)( 2) Other Expenditures $1 5,500-pass. 2785

Monday, November 13, 1989 2.(

m) Health Information Resources : Provides for professional libr ary services, maintenanc e and distribution of audio -visual materials, pamphlets and posters. (1 ) Salaries $252,000 .00 . Shall the item pass the Member for Ellice. Ms. Gray: I do not have a question, Mr. Chairperson, I just have a comment to put on the reco rd .

When I worked for the provincial Government, but even more since I have become an ML A, I would just like to say that my personal experience and the experience of other individuals that I have spoken to in this building that we sometime s forget about Health In formation Resources but they do provide an excellent job. Any information I have ever had to ask them for, the information that I got back has always been very comprehensive and I have found them very, very helpful. I do not have a question but I did want to put that on the record . Mr. Chairman: Pass . 2.( m)(2)-the Ho nour able Min ister. Mr.

Orchard: Thank you very much on behalf of Health Information Resources . Mr. Chairman: 2. (m)

(2) Other Expenditures $228,500- pass. Resolution No. 66: RESOLVED that there be granted to Her Majesty a sum not exceeding $72, 167 ,400 for Health, Community Health Services, for the fiscal year ending the 31s t day of March, 19 90-pass. Item 3. Community Health Services (Operations), (

a) Regional Ser vices: consists of departmental field resources in 10 regions for the deli very of Community Health Programs encompassing health promotion, communicable dis ease control, maternal and child health, heari ng conser vat ion, continuing care, community mental health, support services to seniors and northern primary health care. 3.( a)

(1) Salaries, $26,434,600-the Member for Ellice. *

(2025) Ms . Gray: Mr. Chairperson, earlier on in the Estimates we were speaking of the pending reorganization of the Winnipeg Regional Services and I believe the Mini ster had ind icated then that there had been some work that had been done over the past year and a half, meetings with staff, et cetera, et cetera, and that now we had a consultant who was hired, a Mr. Toews, who was further dealing with this reorganization. I am wondering if the Minister could ind icate for us what stage the reorganization is at . Mr. Orchard: We are hoping to have a report from Mr . Toews by the end of this month.

I full well realize that from time to time I have ind icated things will be happening in three weeks time and they take four or five, but that is the projection at this stage of the game. Ms. Gray: What is the responsibility of Mr. Toews and his committee? Mr. Orchard: It is basically Mr . Toews who is head manning the reorganization, the rew orking of Winnipeg re gion . My honourable friend has requested through FOi the consulting services agreement between Mr.

Toews and his employer, Ed en Mental Health Centre and the Government, I will give that to my honourable friend this even ing, it was drawn up the 14th of August, 19 89 . Here is basically the kind of criteria that were placed before him in his deli berations in the Winnipeg region: To familiarize hi mself fully with all issues, problems, concerns and background data/ information pertinent to the current status of the three Winnipeg regions.

To consult broadly as requir ed with executive management, progra m and field staff of appropriate departments, for input to issues and concerns as they relate to the organization and service del ivery network of Winnipeg re gions .

To develop, for review by executive management of Mani toba Health and Ma nitoba Family Services, a final report in writing and satisfactory in form and content to Manitoba, containing options, implications and recommendations for a single restructured Winnip eg reg ion, incorporating the following elements: centralized program responsibility to ensure co-ord ination ; centralized admin istration functions to avoid dup lication and to strengthen financial and admin istrative capacities; service co-ordination at all levels in the regional network; office management functions in each office located vested with a single position .

To iden tify and recommend the implementation strategies for the revitalized service deli very model in Winnipeg . To furnish Manitoba with such other reports with respect to Services, in addition to the progress reports req uir ed un der sect ion 5 of this Agreement and the final report referred to in this schedule, as may be requested by Manitoba. I will get a copy of this made so my honourable friend has it. Ms. Gray: I thank the Mi nister for that information. I am assuming from what he has read then that when Mr.

Toews was hired on contract that a decision had already been made, that in fact the three regional system should be changed so that we would go back to one regi on . I would ask the Min ister, who made that decision, and what was that decision based on, what data or information? Mr. Orchard: Esse ntially my honourable friend is correct . That decision or general dir ection was arrived at pr ior to the re tention of Mr . Toews through consultation by senior staff with the Winnipeg region staff.

As my honourable friend knows, this is one of the more complex issues in terms of organization that has been before the department . I did not expect our progress to be this quick this evening. I have some information in the office, and my honourable friend will 2786

Monday, November 13, 1989 just have to give me the patience of relying on memory to give a general ind ication of how we got here. *

(2030) Winnipeg regions were operated as a single entity, I think it is three years ago or maybe four years ago now three and a half say, a reorganization was proposed. The reorganization plan was not-I cannot answer for the genesis of it. I am just giving you sort of the after fact information. It was done apparently without discussion with the Treasury Board in terms of the implications for making three separate regions in Winnipeg. Apparently there was no dis cussion with the Civil Service Commission.

That led to some red circling, some staffing issues which have really troubled the management and service del iverers in the Winnipeg regions since implementation. That reclassification has been the subject of gr ievances, I think if my memory serves me correct possibly up to a do zen grievances most recently -(inter jection)-arbitration , not grievances. Both. I have to tell you that my deputy upon assuming the office in July of last year attempted to come to grips with the issue using his new found position as a vehicle for expediting di scussions.

I think it is fair to say a lot of positive direction emanated from his time spent on it. it was a consid era ble amount of time, as my honourable friend may well know. We ended up in an intractable situation again where, to put it in no other blunter terms than , we appeared to have maybe some competing factions that had emerged. Clearly there was a disi ntegration of the level of trust between individuals there. The situation was not going to be easily rectified.

It was at that stage of the game back in July of this year that the deputy was made aware that Reg Toews was coming back from-I guess an assignment in the midwestern U.S. is where he was and that he would be working out of Ed en Mental Health Centre. He had experience in the past within the regional services of the depar tment, I believe about 12 or 15 years ago, and was very effective in resolving not as large or as complex an issue but a similar issue in Eastman region as regional di rector.

I was informed he enjoyed a fair bit of respect within the depar tment, within the various individuals working in the regions and that he would be viewed as an honest broker, if you will. Maybe the terminology is not exactly the right one, but that is the best I can make the analogy on because as my honourable friend might recall I indica ted earlier just a few minutes ago that there were factions developing and a far little bit of competition which was harming the implementation of change.

Reg Toews was brought in as, if you will, the honest broker to report on fairly short notice a plan of action to bring the program flow together. As I say, that is the report that we expect to have before us in the very near future, hopefully by the end of this month. Mr. Chairman: Pass-the Mem ber for Ellice. Ms. Gray: The Mi ni ster has spok en of recommenda tions from senior staff, I assume of the 2787 regions in terms of an ind ication that it would be more advisable to go back to a single region. When he says senior staff who is he referring to? Mr.

Orchard: In the reg ions, and also discussions with other regional dir ectors as well, in terms of what their outsi de perception is of program del ivery in the Winnipeg reg ion. Ms. Gray: A further question to the Min ister, and I am certainly pleased to see that obviously some of what senior staff had to say was considered in the move to go back to one region. Certainly it was not considered when they decided to move into three regions.

Were there other pertinent or points or structural issues or particular recommendations that could be seen as being fairly consistent throughout what senior staff said , other than the fact that there should be a structure which was one region. Were there sort of other recommendations that the Minister can ind icate were sort of identified by senior staff? Mr. Orchard: Again, I am going to go by memory because this is several months ago that we had the discussions emanating to the retention of Reg Toews to take on the overvie w.

There was the concern of program uniformity across the regions and hence the one deliv ery model or reinstatement of, if you will, the one regional development or regional del ivery model for Winnipeg , was probably one of the more frequent recommendations I gue ss and I do beg off that I am going by memory which is some time ago, I did not expect the progress tonight that we have managed to achieve.

Clearly, there was identified-how would I put this in understandable and not to highly critical ter ms, there was concern at del ivery, staff del iverer levels of who is in charge, who is in charge of the program , et cetera , et ceter a, and that is where the effort of trying to bring three regions and uniformity of program del ivery and flow-back has emanated to the discussions and that seems to be a fairly consistent recommendation. Ms. Gray: Was there any recommendation about the concept of retaining or getting rid of the multidisciplinary team concept and or the single unit del ivery system? Mr.

Orchard: No, not that I am aware of, at least not it may have been recommended maybe by an individual , but it was not an often given recommendation , if that is what my honourable friend is after. Ms. Gray: The Min ister is ind icating that in fact any concern about retai ning a single unit del ivery system was not a concern. I am wondering then if the Minister can indicate-he said that there was a concern about who is in charge. Is he referring to regional dir ector level or district office level? Would he repeat that? *

(2040) Mr. Orchard: I have to apologize to my honourable friend because I was tied up in other discussions. Could I have my honourable friend go through that again, please?

Mond ay, November 13, 1989 Ms . Gray: The Min ister spoke about who is in charge. Cou l d he elaborate on what the concern was? Was it who is in charge as in a regional dir ector or as in office manager or area manager? Mr. Orchard: I cannot give my friend any specific quotable quotes, but between the three regions there was some concern that there was not necessari l y a uniform approach on some program areas , where some adminis trative patterns were somewhat dif ferent, et cetera. Also, there were some programs, and again I am going by memory, where there was some centra l focus crossing three regions.

My honourab l e friend probab l y knows what I am ta lking about. There was one area-it sticks in the back of my mind there was one program which was staffed out of one of the re gions, I think it was Winnipeg West, and offered services throughout the other two reg ions in one specific pr og ram area and that encountered some di fferences in terms of appr oach as you went from region to region. Again I am going by memory.

The concerns expressed were that I guess to put it bluntly that the old management system of one point of accountability as you move up the chain was a more effective methodo logy of program del ivery in Winnipeg. There was not the opportunity for enhanced service de livery by sp litting into three reg ions. I think that was a fairly consistent observation made by a number of people involved in program de livery. Ms. Gray: The Minister has said this even ing , and again I can appreciate he is going by his memory, that the concept of multidisc iplinary team was not brought up a lot.

I know the Minister himself has oftentimes mentioned the benefits of multidisci plinary team. Can the Minister ind icate in this new structure which is a programmatic model as he has referred to it, is the multidiscip linary team concept? Will that be retained or will that be disbanded? Mr. Orchard: No, the expectation of a multidiscip linary approach is expected to continue. Ms. Gray: Can the Mi ni ster ind icate in the new structure, is there going to be an aspect of a sing l e unit del ivery system where there is one poin t of accountability at the community dis trict leve l? Mr.

Orchard: That is not a rec ommendation that is current l y before it, not to say that it might not be in the final report , but it is not one that has been brought to Government to date. Ms. Gray: The Min ister refers to pr ogrammatic structure. Perhaps rather than me asking all these specific questions, maybe he could just explain to us what exactly is a programmatic model ? Mr. Orchard: Mr . Chairman, my honour able friend knows it better than I do.

It is to attempt to have some consistency on programs such as Continuing Care or Menta l Health Services throughout the Winnipeg region consistentl y del ivered and with reas onable consistency del ivered to the client throughout the City of Winnipeg. As my honourab l e friend may well appreciate , there are always jud gement calls with staff and clients because circumstances vary substantially in practically all of the programs that are being del ivered in regional services. There are certainly guidel ines, if you will, maybe the wrong ter minology, but they are certainly suggested approaches.

I think my hono urab l e friend can appr eciate that we may well have a slightly dif ferent approach to it depending on the indiv idual that is del ivering the program. As much as possible we are attempting to achieve some consistency across the board so that there is not the accusation that in XYZ region something is done dif ferent l y than in ABC re gion , that it seems to me was the genesis of some of the ind ication that having three separate regions you enhanced rather than decreased the opportunity to have that.

The program mode l basically is attempting to provide some consistency in program throughout the regions in Winnipeg and then opera ting in Winnipeg essentia lly as a unit. Ms . Gray: The Min ister says I prob ab l y know better than him the programmatic model, actually I do not. I do no t un derstand what you are meaning by programmatic model which is why I am asking the questions, although given that last answer I have a bit better idea.

Can the Mini ster indicate, is he saying then that as an example when the regions go back to one region that Continuing Care staff in a particular area of the city then will report to a supervisor, who will be a supervisor in Continuing Care , who then reports to a co-ordinator of the city and, i.e. , Mental Health would be the same, the community services piece , because that in part and parcel would be the same? Is that what he is saying then, it is a strict l y ver tical structure in regard to program? Mr. Orchard: Essentia lly, my honour able friend 's ana l ogy is correct.

The program will be streamed , if you wi ll, or managed in terms of the continuing care flow of program de livery. Our Mental Health Progr ams, our Pub lic Mental Health Progra ms, the Pub lic Hea lth Program itself and the services to the disab led in the City of Winnipeg , those four major program streams will be de livered I guess in a programmatic model a la reporting function my honour able friend has outlined with one reg ional di rector. Ms . Gray: How does the multidisc iplinary team then function when you have each staff?

I mean you coul d actually have all the Mental Health staff in one of the district offices , you would not have to have Public Health staff and Continuing Care staff even in the same office because they are all reporting to specific supervisors who are different. So how do you ensure that team concept, i.e. , programs working together and what I wou ld consider one point of community or team accountability? How does that work? *

(2050) Mr. Orchard: Well, I think what my honour ab l e friend will find a reaso nab l e distribution of those staffing 2788

Monday, November 13, 1989 disciplines across the city, although they may not be physically located in the same office in some cases. In a lot of instances they will be because some of our major offices will have all four streams, if you will, of pro gram deliv ery within the same office.

I think what is more important is whether on a client basis the accessi bility, the report abilit y, the co ord ina tion between the multidis ciplina ry team re gardless of whether they are housed next door in the same office occurs, and that is the objective that I think can be achieved with the prog ramming flow and the report in g structures fairly consistent so that a problem that involves continuing care to a disabled Mani toban with both public health and, say, mental health needs, crisis interve ntion, in terms of stress or whatever, will be able to be co-ordina ted not necessarily initially at the individual care deliverer's level but certainly at the supervisor or the next level where they co-ordina te the approach for those individuals.

Let me tell my honourable friend in many cases that happens now. My honourable friend shakes her head no. It does not happen consistently, that is the di fficulty and that is what we are try ing to achieve. Ms. Gray: I do not think the co-ordination is happe ning now, is occurring now the way it should be , and I am wonder ing how this new structure repairs what is now existing , becau s e we have clients phonin g and we have people who are concerned because we do not have pro grams wor kin g together . Mental Health is not workin g with Home Care and Home Care is not working with Community Services.

There are instances of where the pro grams and the su pervisors are not work ing together, and I am wonderin g how this new structur e repair s or compensates for that. Mr. Orchard: Mr. Chairman, I cannot describe to my honourable friend the mechanism under which it will work and be delivered. I do not sit up in my office and write prog rams on how these things-that is why we retained Re g Toews. That is why we have done some substantial consultation with staff over a year and a half in terms of tryi ng to resolve in an equitable fashion the difficulties that appear to be in the Winnip eg reg ional system. Mr.

Chairman, I simply tell my honourable friend that is the approach that we are taking, and that is the approach that the reorg anization and the prog ram delivery is bein g crafted around. I cannot tell my honourable friend how we are going to functionally achieve the objective , the broader policy objective. I am sure my honourable friend would not expect me to be a prog ram and management deliv ery specialist. Ms. Gray: The Min ister does spend time in his office though and is aware and actually has I believe initiated or at least has responded in Estimates last year.

His colleague , the Minister of Family Services (Mr s. Oleson), said that there actually is interdepartmental committees that have been established to specifically look at some of the prog ram di fficulties between prog rams , such as Mental Hea lth, Continuin g Care , Mental Health and Community Services. So the Minister is actually, by being Minister of Health, has sai d that those committees are on goin g, are attempting to do work to look at some of these dif ficulties, so there is an adm ission that in fact there are diff iculties.

I am wonder ing how the work that the committee is doin g and those difficulties how that is bein g reflected in the type of new prog ram structure. I am sure, as the Min ister says Mr. Toews, one of his first tasks was to identi fy issues , and I am sure given he knows there are interdepartmental committees he must be aware of those issues , how or has he been given any responsibility to specifically look at that issue in terms of gaps in service? If the Min ister will remember as well, and I am sure the Min ister responsible for the Status of Women (Mrs.

Hammond) has briefed him on this, when the committees on the Status of Women went around the province talking about services , and when they came to Winnipeg and even in rural Manitoba as well, one of the main complaints that was very consistent in those briefs and presentations was a probl em with co ordination of services between prog rams. It was clearly identified. I would think that this would be an issue that Mr . Toews would be aware of and I guess my question is, how is that bein g add ressed in this new structure? Mr. Orchard: Mr .

Chairman , that is the same question that my honourable friend just posed. I cannot tell you the mechanical way in which that will be achieved , nor can I tell my honourable friend that it will be successfully achieved because I do not think that is an easy task. In my estimation it is a much easier task to achieve in Winnipeg where everybody is relatively close in terms of proximity of office, telephone, et ceter a, et cetera.

It gets even more di fficult as my honour able friend rig htfully ident ifies when you have the circumstance of a Camperville being served out of Swan River, where you have prog ram people passing each other on the road and one not being able to deal with the problem because it was not within the pro gram manda te, et cetera , et cetera. Those are very si gnificant issues that are going to re quir e a sig nificant amount of interdepartmental co-operation to come around and devise an equitable solution.

Surely my honourable friend would want us to take first steps first because my honourable friend has posed the que stions in the House , what about the griev ances, what about the staff difficulties in Winnipeg region? I can assure my honourable friend that we have been workin g on that now for approximately 14 months and in a concerted effort for a substantial number of those. We hope to have that issue of reorg anization guided or the guiding principles for resolution before us by year end , by the end of this month, by year end .

That is first step, but my honourable friend is not going to soon see the whole system change. She worked within the system and probably when working, there was as resistant to chan g e as anybody because that is the nature of wor kin g in Government. You have to protect your turf and make sure you do not have anybody crowd your territory, you stay out of my 2789

Monday, November 13, 1989 backyard and you do not bother me. That does not always lead to an effective service del ivery, and I think the Women's Directorate identified some difficulties in prog ram del ive ry, inde ed some inefficiencies and some ineffectiveness in terms of how various Government prog rams are brou ght to the people.

Those kinds of issues neither develop overni ght nor are resolved over night, but I think my honourable friend would have to concur that un less you have a management structure in place particularly in Winnipeg re gion that is condu cive to that kind of plannin g of pro gram deliv ery, you are not goin g to accomplish it. We are takin g the first step hopefully with Toews, et cetera. Ms . Gray: The Minister uses the phrase "protect your turf" and that is the very issue I am raisi ng.

When you have, and I think sometimes the problem is more compounded in Winnipe g as opposed to rural Manitoba because you have your pro gram staff who are closer to the seat of power, i.e., their di rectorates and i.e. the Le gislature.

It is natural that where you have a pro gram content whether that be Continuin g Care or Mental Health Services, and you get a certain amount of bud g et and then you have resp onsibil ity, at least a staff relationship responsibility to staff in reg ional offices that you want to ensure that they are del iveri ng the services within that prog ram mandate whether it be Continuing Care or Me ntal Health. Because there is only so many amount of dollars, God forbid that they would ever be del iveri ng a service for someone who did not strictly qua lify to their prog ram criteria.

What oftentimes happened , and not because of the staff but because of the way the system is established, is that territoriality results and everyone is fighting for limited dollars. If Mental Health feel that particular elderly person should be the responsibility of Home Care and just because they happen to have a mental illness they are not the respo nsibility of Mental Health, what happens is the client falls throu gh the cracks and there is weeks and weeks and weeks spent arg uin g about who is goin g to provide the service and who is going to come up with the dollars.

I do not think that a reg ional director of one reg ion who has over 400 staff will be able to deal with all these cases specifically. * (210 0) Each supervisor in each pro gram has very much a vested interest and it is nice to say that, yes, staff and supervisors are the main concern as the client, but that does not always happen in reali ty. What happens is they have to be concerned about being accountable to their program dir ectorates and their reg ional dir ector in reg ard to ensur ing that their del ivery and services to clients who are elig ible for their pro gram.

I think my concern is if you do not look at a structure and you do not formalize a structure that deals with that, you are going to have further problems because rig ht now there are a lot of difficulties and have been over the last three years with somewhat of a pro gram model where you have clients that are falling throu gh the cracks. I think that the main concern in any type of structure needs to be services del ivered to the client. Oftentimes, I think unfortunately that always is the last thing that is consider ed as what is best for the clients in the community.

The Mi nis ter referred to in some of the in itial comments he made ab out what Re g Toews was responsible for that he would also be look ing at an office management function. Can the Minister elaborate on what he means by that? Mr. Orchard: I beg your pardon, that Re g Toews is looking at an office management? Ms . Gray: You had mentioned office management functioning as bein g one of the areas that he was to be lookin g at as well as central admin istration, service co-ord ination, and a central prog ram focus; you also mentioned office management function. Mr.

Orchard: Office management function, I do not know whether I used those words or not, but I am not goin g to arg ue with my honourable friend, but in terms of one auditing management system across the region, across country reg ion. Ms. Gray: The Minister is ind icating it is one auditing management system, that is what he is refer ring to? Mr. Orchard: Financial management system. Ms . Gray: So, in this new structure, is there any notion that as far as the district offices that there needs to be some type of co-ordination or management in dis trict offices, is that for grabs? Mr.

Orchard: One of the uncovered difficulties, I guess of the thr ee Winnip eg reg ions, was or ganizational structure that featured double and triple accountability. I think my honourable friend can clearly see that is not an effective use of scarce resource in tryi ng to brin g some similarity and consistency to that for the Winnipeg reg ion by offering one financial system throu ghout Winnipe g reg ion. Ms . Gray: The Minister ind icated that Mr. Toews was charg ed with this responsibil ity.

Does not Re g Toews also have a committee, a group of individuals who work throu gh Winnipeg regions who have been working with them on a re g ular basis? Mr. Orchard: There is a committe e that provided advice and input to Re g Toews. Ms . Gray: What is the nature of the advice and input they provide? Mr. Orchard: Well, I guess we cannot expect Mr. Toews after be ing out-of-province to have every sin gle und erst and ing of every sin gle undert aking in the whole Winnipeg re gion.

People are there to assist him in provid ing information and in assessment of where things work, where thing s do not work, where thing s need improving. That is the nature of the committee, and his experience in the past has been one of an effective problem solver manager. That is what we are hoping 2790

November 1989 he continues to do for us, but the committee of staff are there to give him whatever advice and input and assistance that he needs to come up with chan g es , come up with ident ification of problems, and indeed to test ideas on how new approaches might be received and how inde ed they might work. Ms. Gray: So each Member of this advisory committee then would be represe nting a particular, I would assume pro gram , i. e., would be talkin g from a pro gram perspective? Mr. Orchard: I think that is a fair assumption. There is a good cross

section of ind ividuals involved across the three regions. Ms. Gray: Does the Minister know who represents the Continuing Care Pro gram on that committee? Mr. Orchard: We will have to get that for my honourable friend. Ms. Gray: The Minister also ind icated in this discussion that there were some concerns at the last reorganization in reg ard to Treasury Board had not been notified, Civil Service Commission had not been notified, et cetera.

The Min ister, I believe and he can correct me if I am wrong, ind icated this eve ning that his deputy had spent a considerable amount of time dea ling with some of the classification and personnel issues that have been a result of what had happened in the past, or am I incorrect in that? Mr. Orchard: What I indic ated is that over the past, we will say for a time frame from approx imately September-October until May-June, the deputy had under taken a substantial amount of discussion.

They were not narr owed into grievances or reclassifications or anything, it was attempting to find out how we can make the Winnipeg region deliv ery sys tem, management system, more effective. That is what he spent some considerable time, it was not narrowed to any reclassification, red circling, or grievances althoug h there is no question that was part of the dis cussions. Ms.

Gray: The Minis ter is probably aware that the Civil Service Commission, in re gard to his staff in the Depar tment of Health, have admitted that in fact the first point rating system that was done over two years was flawed, and in fact that process was invalidated. that I know the Minis ter would have an interest in his own staff in the Winnipeg reg ion plus he would also be concerned about his Hu man Resou rces Department, given that the Civil Service Commission has admitted that, was there any review condu cted to find out first of all who bun gled, and why was in fact that whole process that was set up considered later on by the Civil Service to be flawed and therefore invalidated?

Mr. Orchard: Mr. Chairman, we did an audit apparently on the process and again I am going by memory. This has been a rather difficult scenario because there have been mistakes on all sides of the issue and that has made it an extremely frustrating process , one where 2791 there has been -I think it is fair to say some animosities developed because of the process. Certainly there are indi viduals who have felt di senfran chised and/or threatened by the whole process and it was a circumstance, and I simply have to offer this as an example of maybe the challen g e the issue presented.

My Deputy Minister has a background in personnel, and he said it was one of the more interes ting ones he has ever been involved with. That is why we brou ght in the fresh outside perspective of a Re ginald Toews in order to give an impartial overview with the guidelines that my honourable friend has attached on the contract to try to get to a reasoned resolution of the problem because there was in terms of reclassification, if my memory serves me corr ectly, even in comple te information presented by personnel in Health and by Civil Service Commission people represe nting at the hearin g.

I am going by memory on this. * (2 11 0) It has been a very, very difficult issue and we are dea ling with the careers of a number of people as a result of it. It has not made their circumstances rosy, if you will, having this issue go unresolved. Ms. Gray: The Minister said that there were errors and mistakes on all sides. I am assuming he is meanin g the Department of Health and the Civil Service Commission when he says all sides. Am I correct? Mr. Orchard: That is my recollection in community services, but that was a given that I think my honourable friend- Ms.

Gray: Can the Minister ind icate, and I am askin g these questions because we are goin g into another reorg anization and I know the Minister would agree that we do not want to see those mistakes again, but were people in his department then held accountable for those errors that they made? Mr. Orchard: If my honourable friend is asking , has anybody been disciplined or demoted or dis missed, not to my kno wled ge. Apparently there were some verbal di scussions with the individuals. Ms.

Gray: Is there sufficient information from the review or what happened in the past to ensure that these mistakes are not made again, given that we are going in to another reo rg an ization? Were there some particular- lesson is not a good word -b ut were there particular pie ces of information or recommendations from this review that the Minister's staff has so that they know these are the things that we need to do in this upcoming reorganization in reg ard to staffing and classification and job postings, et cetera and these are the things that we make sure we do not do. Mr.

Orchard: I think that is probably a fair analogy my honourable friend makes. We might have erred in the same manner that the ori ginal error, had we moved quicker early this year because thin g s were pointing in a given direction and had we moved in that dir ection I think we would not have resolved the issue. That is

Monday, November 13, 1989 why we pulled back and did an imp artial re tention of Reg Toews. From what I understand of the issue, and appreciate that all I am doing is reading words on paper, sometimes I have not the fastest ability to comprehend. I think what is emerging from here is that (

a) there was a decision made without the normal , what one would consider to be the normal process of discussion and consultation, i.e. through Tre asury Board , i.e. through the Civil Service Commission. As a result of that, some errors were made, perceived and real , and ended up stirring the pot and boiling the issue for far too long and causing disenchantment with the system and dis satisfaction with the way the issue was dealt with. I want to tell my honourable friend I recall bringing this issue up some three or four years ago in the House.

There was a certain amount of consternation raised at the senior staff level and Min isters level when I raised the issue because I think the process sort of gained a momentum and a life of its own when it happened , but I simply cannot ind icate what that was or how that happened. Currently we are advertising for a regional dir ector and we wish to follow the reorganizational checks and balances of Treasury Board and Civil Service Commission so that we do not have staff feeling di senfranchised or improperly treated. Ms.

Gray: The regional director position that is being bulletinned , I would assume that there is a position description that would go along with this job bulletin so that a potential individual knows exactly what job they are getting into. Mr. Orchard: I am informed that is correct. Ms. Gray: Can the Minis ter tell us, and he may not have this information , as in most bulletins it says affirmative action will be a factor in the selection process, what exactly does that mean in regard to this particular job? Will there actually be points assigned to target individua ls or what does that mean? Mr.

Orchard: I am told that all criterion being equal , in terms of the selection process , benefit would be given to an affirmative action candidate. Ms. Gray: Is it correct that as well as once the regional dir ector is hir ed when you get your hundr eds of applications of people who will be applying for this job , that in fact there will then be program co-ordinators and the Minister referred to the four streams so that there will be program co-ordinators, and that may not be the terms used , but will then be hir ed for the one Winnipeg region , is that the next step? Mr.

Orchard: Bear in mind, that presumably will be one of the central focuses of the Toews report. To prejudge and to prespeculate what that might do in terms of individual co-ordinators' positions, et cetera , et cetera, I simply am unable to do at this stage of the game. Ms. Gray: The Minister can correct me if I am wrong , but are not the staff in the Winnipeg re gion , particularly supervis ors, have they not already been made aware that in fact there will be these positions and a lot of them are thinking about their next step as if they should apply for the jobs? Mr.

Orchard: I am informed that the ind ication has been their four positions, but they have not been advertised . Ms . Gray: Now a few more que stions in regard to these four positions so that again we do not repeat history. I am assuming that these positions will be open only to individuals in the Winnipeg regions. Or, are these co-ordinated positions or will they be open to internal civil servants in any departments? Mr. Orchard: The advertising process will be open to anyone , I mean qua lified individuals from inside and outside Government to apply.

There is no magic to it it is an advertising and we hope to select the most appropriate person from that. Ms . Gray: Will there be position descriptions for these four positions develop ed , and will these jobs be point rated so that people know what the classification will be before they apply? Mr. Orchard: I am informed that is correct. Ms.

Gray: As an example with, let us say the continuing care co-ordinators, program managers , whatever they are called , we have three positions in the Winnipeg re gion, if that continuing care co-ordina tor for the entire re gion-and let us say the bulletin is there and someone other than those three who are currently in those jobs gets the job what is going to be the process to ensure that these other individuals who would be at an HS6 level , what will happen to them? Are we going to go into the situation we are going to be into red circling again? Mr. Orchard: Mr.

Chairman , I cannot answer that today as to what would happen because what we are dealing with is a hypothetical question-w hat if?

Until the hiring and the reorganization is complete I cannot answer what happens to specific indi viduals within the regional organization and I do not think my honourable friend would expect me to, because that would mean that I had a prejudgment of who ought to go where and that is not the case. * (2 12 0) I simply go back to what I indica ted to my honourable friend , is that we intend to follow the appropriate procedures in the Civil Service Commission and with the Treasury Board to assure a reasoned reorganization that is not found wanting as the previous one was.

I am not going through this whole exercise of 18 months and taking this long to come to a plan of action to not hopefully do it correctly. If we simply wanted to forge ahead I guess we could have made some decisions in Janu ary of this year, but in retrospect some of those decisions may not have been proper, and I think the prudent course of action 2792

Monday, November 13, 1989 we are following will prove itself and its effectiveness when in place. Ms. Gray: Mr . Chairpers on , it is a lot more than "what if," because the Mi nister would be aware that with the amalgamation of the three re gions into one, hopefully one of your objectives is to move towards greater efficiency.

I recall the Min ister himself when he was in the Opposition Party very severely criticizing the then Government about the move into three regions because they went from 11 supervisory positions to 41 , so I am assuming that one of the reasons we are going back into one reg ion is the hope that in fact there would be achieved more efficiency. Because there are so many supervisors who are heads of pro grams in each of the three reg ions, one would have to assume by simple mathematics that there are some individuals who will everybody will not be able to get those four or so jobs.

I guess my question is , what process has been put in place or what has the staff been told in re gard to should they not be successful, if in fact they even apply for the jobs. Mr. Orchard: Mr. Chairman , I do not know how many more times I can say it, I cannot tell my honourable friend any more that the Civil Service will be involved , Treasury Board will be involved , so that individuals will be treated properly in the process whether it is throu gh promotion or any other means that emanate from the reor ganization. We are not here to create another area of concern that we inherited.

I cannot tell you , because I am not a personnel manager, how it will happen or what will happen. We have a conceptual model which we think is moving in the ri ght dir ection in terms of its development. There will be adver tising of future positions that are in need of filling in the reorg anized deliv ery structure. I simply indic ate to my honourable friend that we will accept the guidance of the Civil Service Commission in terms of any decisions, the likes of which she has just hypothetically speculated as occurrin g. Ms. Gray: Mr . Chairp ers on , well, they will occur.

Since we still have the three re gions, and going back to the three reg ions now in reg ard to service delivery-and I am not sure how up-to-date I am but just to clarify the Minister still has public health co-ordinators or program managers in each of the three reg ions , and my question is , because I am assuming he does have that, are these jobs similar in the regions? Mr. Orchard: I am informed that there is one in each reg ion , yes. Ms. Gray: Are the jobs similar? Mr. Orchard: Appa rently there is similarity in the job, yes. Ms.

Gray: Can the Minister tell us what the dif ference would be between the co-ordinator in Winnipeg North and the co-ordinator who had a similar job a few months ago in Winnipeg South, what the dif ferences were in that job that led to one job be ing an HS5 and one job being an HS6? Mr. Orchard: Mr. Chairman , no, I cann ot, but I will attempt to provide my honourable friend with that information. If it is involved with the reorg anization three and a half years ago, and if she has given me enoug h detailed information, as to what the position is, I will attempt to find that out for my honourable friend. Ms.

Gray: How much responsibility or latitude do the current reg ional dir ectors have, in terms of determ ining what the responsibilities will be of the various prog ram supervisors? Mr. Orchard: I am sorry, I was giving off a note there. What was that again? Ms. Gray: Can the Minister tell us how much latitude do the current reg ional dir ectors have in any reg ions, Winnipeg or in rural Manitoba, in reg ard to determ ining the specific responsibility and roles of the various prog ram managers or su pervisors? (Mr . Edward Helwer, Acting Chairman , in the Chair) Mr.

Orchard: I think it is fair to assume that each of the reg ional dir ectors is basically following the same policies and procedures manual.

I think it is also realistic to assume that the way certain policies may well be undertaken and implemented in a Winnipeg re gion versus the Norman re gion , or the Interlake reg ion , may vary significantly in terms of deployment of staff and how they unde rtake their duties, simply because of the physical challenges of a dif ferent client area , dis tance, remoteness , even dif fering needs, in terms of what the various prog rams need , and the vary ing levels of resource available, in terms of community support , throu ghout the province.

To my knowled ge, they all follow the same sort of central manual or manual administration, and they get the job done as effectively as they can. Ms. Gray: Good. Can the Min ister ind icate that with the reg ional dir ectors , do they have any authority at all to add on job-I know they have authority to add on job responsibilities and chan g e job responsibilities to a certain exte nt, but do they have the authority to add on job respo nsibil itie s and chan ge job resp onsibilities that ultimately affect the classification of those individual positions? Mr.

Orchard: I can answer the question in this reg ard that if there is a-I think my honourable friend is asking, can a regional di rector unilaterally change the position, the staffin g, and the classification of one of his employees? No, she is stoppin g short now. Ms. Gray: Perhaps it would not be the classification, but it could lead to an ultimate classification change. I am talking about changing job responsi bilities that ultimately affect the classification, whether an upward movement, or a downward movement. What is the process the reg ional director follows? Do they have 2793

Monday, November 13, 1989 authority to do it unilaterally, or do they have to follow a process, or can they do it at all? Mr. Orchard: I will tell you what, in order to resolve this burning issue I am going to have a report, a one page criterion, written up and given to my honourable friend hopefully tomorrow so that the process of flexibility involved is explained. Then if my honourable friend needs more explanation, we will try to explain more tomorrow, because I cannot answer that tonight. Ms . Gray: Mr.

Acting Chairperson, can the Mi nister indic ate to us, in regard to the move into one region in Winnipeg, I know there also had been some concerns expressed about the service del ivery system or the structure of a number of other regions, Eastman I believe was one of them, in regard to that structure, or there has been in the past couple of years? Is there any review or any movement, in terms of change in structures, in any of the other regions of the province? Mr. Orchard: No. Ms.

Gray: Is the system in Eastman still that when you have a program co-ordi nator, such as a continuing care co-ord inator, that person also assumes admin istrative responsi bilities for a particular district as well? Mr. Orchard: I am informed that is correct. Ms. Gray: Is that system working well, or has it been reviewed? Mr. Orchard: There has been no formal review, and I am advised it appears to be working well or working reasonably well. Ms. Gray: Is there still an assistant executive dir ector that the regional dir ectors report to? Mr.

Orchard: As long as I understand what happens here, apparently there is a position open for secondment of assistant to the executive di rector, not assistant executive, but assistant to, and it serves as the basis of allowing an opportunity for management training of those people brought into the assistant to the executive dir ector position to give them a little better feel for the management structures in the region. * (2 13 0) Ms. Gray: Where does the SY come from, or does that person have to bring their own SY with them? Mr.

Orchard: Can my honourable friend explain, or ask her question again, because I think we are talking about two dif ferent things? Ms. Gray: With his position that is assistant to the executive di rector and the Min ister has said that it is a position where someone is seconded, so I am asking does whoever gets seconded, and I think someone is in that position right now, do they bring their own position with them? Mr. Orchard: I think I under stand my honourable friend's qu estion now.

Essentially the position is the same one that was freed up when under the re organization there were two executive dir ectors, John and John. Now there is only one John, and the second position was freed up to provide that assistant to the executive dir ector position. Ms . Gray: That assistant to the executive dir ector, is that particular position-is that part of the review that Reg Toews is undertak ing, in regard to the necessity for that position? Mr. Orchard: I am informed that this -(inaudible)-. Ms .

Gray: Has it been determined, because this is a new position, is this position seen to be something that will be a permanent part of the organizational structure of the department where you have an assistant to the executive di rector , then the executive di rector, then the ADMs? Mr. Orchard: Run through what you think is going to be. Ms . Gray: I am wondering if this assistant to the executive director-is that seen as being a permanent feature, i.e., a position that should always be there because it is needed? That is my question. Mr.

Orchard: At the present time, because it was not part of the Toews investigation, we anticipated it would remain as part of the organizational structure and the management structure, but you know it is not written in stone. If it has served a useful purpo se, and there are more effective uses of that SY within the regions, that decision could be made. We are not bound in the long haul to it but it is going to continue, at least for the immediate time period, after the reorganization period. Ms.

Gray: Rather than me asking the dif ferences, or what that assistant does versus what the executive di rector does, does the Min ister have or could he provide us with job descriptions for us so that we could unde rstand the two positions? Mr. Orchard: That will be done. Mr. Ashton: Mr . Acting Chairperson, I feel like I know this

section of the department inside out after the last series of questions and I feel I should be applying for some of these jobs when they come up. I would probably do very well at the interview, thanks to the -(interjection) well, that one in particul ar . I may not have the qua lifications in other regards, but I could probably ace the interview after this last hour- An Honourable Member: Do not get your hopes up. Mr. Ashton: -and 15 minutes for that exchange, well, the Mi nister- Mr. Orchard: Mind you, you could be une mployed after the next election. 2794

Monday, November 13, 1989 Mr. Ashton: -trade technologies-do not get your hopes up, it is ok ay, I will not be applying for this job, I do have another job in mind for-Well, to see how many more years the people of Thompson are willing to hire me for. I would like to raise a couple of questions in terms of regional services, in terms of rural and northern communi ties, recog nizing the variety of services provided in each particular region.

I know we are dealing with every thing ranging from Communicable Disease Control to Audiological Services, Maternal and Child Health, Health Promotion, the whole series of health related areas, as well as of course the community services side, which works in tandem. I would like to ask the Min ister for an upda te on the current situation, in terms of speech language pathology. I know it is something that has been raised with myself dir ectly by constituents.

I know there is very little, if any, service available particularly to people outside of the City of Winnipeg and I would like to ask the Minister for an upda te on the current availability of speech pathology in the Province of Manitoba at the current time. Mr. Orchard: Speech pathology is one of the more difficult areas in terms of recruitment and program del ivery that we inherited. Manitoba has an interesting system wherein the school di visions have essentially got on staff, throughout a number of school divisions, speech language pathologists to assist students in the school system.

I have to tell my honourable friend I have a rather well, I do not know whether you would call it amusing farmer logic or what, but it seems to me that the area where we ought to focus the resource is not necessarily ldnde rgarten and on, as is predominantly the system within the school system tod ay. Rather the earliest intervention possible to me would be the most effective, therefore I am a believer that we ought to be moving very, very briskly in terms of service provision for preschoolers. (Mr . Chairman in the Chair) Now there are several issues I want to share with my honourable friend.

First of all, we did that to some degree last summer, in terms of the Health Sciences Centre. We provided some additional resource to the Health Sciences Centre, which allowed them to hire some additional speech pathology, audiology , staff. It was quite successful. I think it is fair to say quite su ccess ful, in terms of the aud iology side for preschoolers, but the announcement, which was greeted quite optimistically by concerned parents, created an impression unfortunately that all the problems are being solved.

Instead of the waiting lists, in terms of numbers and waiting time, going down they in fact went up at the Health Sciences Centre for speech pathology. Now that hides the fact that there are more children being served, because the additional staffing positions have allowed us to do more assessment and do more speech pathology in terv en tion, but it created expectations. The waiting lists have grown and the waiting times have grown.

From my standpoint, I think it is an appropriate dir ection that Government ought to try to, as quickly as possible, refocus the system so that we deal with preschoolers, because if we-it only makes sense, and in my discussions with the speech language therapists of the Province of Ma nitoba and their association, they ind icate that the earlier intervention is (

a) the most effective, (

b) requires the shortest length of time, in terms of remedial therapy, and I do not und erstand what all they do. I am simply not able to discuss clinically what services they provide, but I am told that the earlier intervention takes less time, and has a greater degree of success than the kindergarten and later service provision. I think it is a wise dir ection of Government to move as quickly as possible towards provision of preschool services. In that regard, as I said already, we enha nced the resources of the Health Sciences Centre and Dr. Alexander's shop. That helped but it did not resolve the problem.

I do not think anybody expected it would, certainly we did not. Then we had a study undertaken on the therapies by Dr. Bill MacDiarmid wherein he gave us some recommendations on occupational and physiotherapy . We have exceeded his recommendations, in terms of additional slots at the faculty, so that aspect of the therapies appears to be now coming on track, but we still have a significant challenge in speech pathology, (

a) because we do not have a training program in Manitoba. There are two things that have happened, in terms of hopefully helping our recruitment efforts. Firstly, the MacDiarmid Report has made some recommendations, in terms of student support in return for service, and we are actively considering that as a new initiative and policy of Government. Again financial resources are going to determine how far and how quickly we can move. Secondly , it did not receive a great deal of attention, but the Premier (Mr . Filmon) signed a reciprocal agreement with the Governor of Min nesota.

That reciprocal agreement allows Manitoba students to enroll in the universities of Min nesota without what was once a fairly onerous increase in the tuition fees. They do have speech language pathology training programs at at least one of the universities in Minnesota, and we see that initiative as being yet another opportunity to, in the short term, get some students in there so that we can create a made in Manitoba solution. * (2 14 0) I simply say to my honourable friend, and I have said this to my honourable friend, the Member for Kildonan (Mr .

Cheema), who has raised this issue, we have got a significant challenge in providing speech language pathology services in the province. We are not going to achieve an overn ight resolution of the problem, but clearly, Government understands the magnitude of the problem and we are prepared to take pro-active steps to try to resolve it. Mr. Ashton: It did not outnumber the initia tives the Minister outlined, and I certainly see them as being 2795

Monday, November 13, 19 89 positive. We are in a situation essentially where virtually anything that can be done is going to result in an improved system when we are dealing with rural and northern communities, because essentially this is a service that if it is existent it is next to non-existent, as far as rural and northern Manitobans are concerned. What I would like to ask is what areas of the province outside of Winnipeg receive any speech language pathology service at all. Mr. Orchard: We are very sparse. We have half a position through Family Services in Dauphin and a position in the Interlake region.

The balance of the positions are primarily on the education side. There was just recently, I am going by memory, a position filled through education in southcentral. I ran into the individual there, she is working out of Morden. Mr. Ashton: What is the situation in Winnipeg? I know the waiting list was fairly extensive at one point in time. I assume the initiatives were taken to reduce the waiting list somewhat. I would like to ask how many speech pathologists there are in Winnipeg, and what the current status of the waiting list is. Mr.

Orchard: We may not be able to access that information quickly so we will provide that tomorrow, if my honourable friend is agreeable. Mr. Ashton: If memory serves me correct, I believe the waiting list had been as high as a year, and I was assuming that the new initiative that had been taken in Winnipeg had reduced that somewhat. I would certainly appreciate the information. I know it has been a concern in Winnipeg although, as the Minister identified, the service is virtually non existent outside of the City of Winnipeg.

It is a major concern, As I said I have had di rect contact with parents who virtually pleaded for this type of service from the school district, for example in my area. It is a service that is not readily available. It is sad, because it is a type of therapy that- speech language pathologists were very successful in some cases, in terms of getting in and making a huge dif ference at an early age. I think the Minister is quite correct, the earlier the intervention the better.

I have known some individuals personally who have had children of theirs who have gone through some of the therapy that is available now, speech language pathology that is available, and it has had a dramatic impact on their children. I certainly hope it is a service that is made available. I would certainly appr eciate that information, if the Min ister has it, in terms of the Winnipeg situation, to see if there has been-you know for the people of Winnipeg who I suppose are more fortunate in some ways, obviously the service has not been at the level of the demand in Winnipeg even.

I am hoping that the situation will improve. I wanted to just shift over to another area, in terms of the

section of this department's operations, and ask the Min ister if there have been ongoing problems, in terms of recruitment into the various regions, for positions for the various activities of this particular section. I know in the case of my own community once again, there has been as many as eight positions that have not been filled. There has been a serious problem, in terms of filling a number of the vacancies in the department.

What I would like to ask the Minister, as a quick upd ate on the status of the various regions, whether they are having any recruiting problems and specifically what areas the recruiting problems are. Mr. Orchard: We have difficulties in recruitment in three regions, Thompson, Norman and Parklands. The other regions are-they are never without problems, but they are not unusual problems. In Thompson, Norman and Parklands there are di fficulties, and I think-I am informed that right now inclusive of Thompson, Norman and Parklands that we are very close to a full complement right now.

Recruitment is more difficult into the three regions I mentioned, or more challenging I guess is the word. Mr. Ashton: I know in the case of Thompson, they recently had advertised, althpugh they were on a second go-round in terms of the number of positions, because the first competition had not resulted in a sufficient number of qu alified people being identified. I am wondering if the department has done any analysis of why there is the problem. We have di scussed the situation with doctors, for example, at length and there is a shortage of nurses in some fields particularly in northern communities.

I am wondering if the department has looked at why there is a problem. Is it because of the level of qualification that is being asked for? Is it because of perhaps the salaries not being competitive? What are the basic bottom line reasons behind the shortage of ind ividua ls for the department in Thompson, the Norman, and the Parkland region? Mr.

Orchard: To try to come to grips with the issue, the department does not do exit interviews to determine what circumstances have lead the individual to move from the region, and I guess there is, as my honourable friend could appreciate, quite a variety of reasons given , from housing, from lack of professional support, and remoteness, to other personal reasons. The two departments, Family Services and Health are working right now on a strategy, with the hopeful outcome of improving our ability to recruit into difficult to recruit areas like Parklands, Norman, and Thompson. Mr.

Ashton: I would certainly suggest the Minister look into those concerns. I think there probably are a number of reasons. I think in some cases the salary has not been competitiv e, or at least not seen as being competitive, for individuals with the qualifications that have been requested given the relative isolation. I think that is going to become a more difficult problem, incide ntally, with the removal of the Northern Tax Allowance in the Thompson, Norman, and even in part of the Parkland region because communities down to 2796

Monday, November 13, 1989 Sifton, for example, have been eligible for the Northern Tax Allowance previous ly, so I would expect there would be continued problems. In fact additional problems now, because one of the incentives for attracting staff has been removed. In my dis cussions with people in the department, and I am not just talking about those that are leaving, but also the successive competitions, there has been some concern about the qua lifications that have been required. I think some concern about the starting salaries not being sufficient to attract people with those qua lifications.

So I raise that for consideration by the department. I am not in that field myself. I am not claiming to be an expert, but that has been raised with me. I think perhaps one thing that may assist in the Thompson region would be the new facility. I think that is something that certainly is going to be very appr eciated by the staff. The conditions were certainly overcrowded. It was certainly a top priori ty, in terms of the need, the capital needs, and I think that will make something of a significant dif ference in itself, because that had I think a very strong negative impact on morale.

The growth of the department has long since outstripped the facility available. So I certainly would appreciate information, if the Min ister is able. I would also appreciate some ind ication of the turnover in those communities, and if there is any variance between the different positions that people have in those communities whether there is a specific problem in certain fields. These I know for example, one of the areas of shortage recently has been in the area of mental health workers. In fact, I would ask the Minister if there has been a greater or lesser problem in the various sections of Regional Services.

Have the shortages of staff been concentrated in any particular areas? • (2 15 0) Mr. Orchard: Mr. Chairman, I am told that the specific area, and particularly as it applies to Thompson, is in terms of social workers who are being recruited on both the Family Services side and the family division as well as to provide service in the de partment, specifically in the mental health worker field. It has been social workers that we have had some additional difficulties in terms of recru iting, but I also reiterate we are very close to a full complement now. We have had a fairly successful recruitment dr ive. Mr.

Ashton: In terms of dealing with this

section as well, I just want to deal briefly with a couple of other items. One is in terms of the Northern Health item. I note that despite the exchange in last year's Estimates the Min ister has continued to decide to identi fy the Northern Health

section separately from the other aspects of reg iona l services, the Northern Health Program, in particular, providing programs to registered nur ses and community health workers. Obviously, it is not the entire part of the budget directed towards Northern Health, in fact, it is only a very small part of it. I would like to ask !he Minister what initiatives have been undertaken in terms of the Norther n Health

section that is identi fied in this particular

section of the Estimates. Mr. Orchard: Mr . Chairman, I was dis tracted with a little side comment. In terms of Northern Health the removal from a separate line to here is reflective of two things:

a) this is where the services are delivered, and

b) as my honourable friend can see, there is a significant change in the emphasis if one wants to consider resource on Northern Health issues. I think that is demon strative of an increased emphasis in terms of Northern Health as an issue this Government takes serious ly. Mr. Ashton: Once again looking at the discussions last year -although there has been a shift in terms of this item being put under this particular item it still appears as a separate item, perhaps contrary to what the Min ister was suggesting he might do last year.

Since it is a separate item I would like to ask the Min ister, once again, what activities are being included as part of this separate budget line under the Regional Services

section of the department. Mr. Orchard: The Northern Health line provides primary care and public health services in difficult-to-access areas in northern and rural Manitoba. It includes service del ivery in nine provincial nur sing stations in the following communities of Moose Lake, Easterville Easterville being the nursing station we have committed to new construction that my honourable friend will be pleased to know-Conrad, Sherridon, llford, Thicket Portage, Pikwitonei, Wabowden and Grand Rapids. Mr. Ashton: What shift has taken place?

Obviously, the Min ister has moved the item over, kept it as a separate item under the Regional Services Department. What activities have been shifted over from Regional Services itself to form part of this Northern Health line in this particular section? Mr. Orchard: I think the answer to my honourable frien d's que stion is, approximately $34,000 of a service shifting from Regional Services in terms of physician services specifically. Mr.

Ashton: So the $231 ,400 is in terms of program di rection, which was previously the focus where it deals with a broader range of areas now as an identifiable item, because that was the previous focus of this particular

section that appeared inde pendently , and that was program direction essentially to the nurses and Canadian health workers in the North. Mr. Orchard: I am sorry, I have to get my honourable friend to repeat that question. I was just going through some of the explanation here. Mr. Ashton: I ind icated previously that this

section provided program di rection to nur ses and community health workers in that particular field. It appears that the Min ister has broadened the scope of this particular

section by rolling in other activities. I was just trying to get a clear idea of-and we are dealing with Northern Health now-wha t it deals with, 2797

Monday, November 13, 1989 because essentially previously it was more program dir ection. It ran various seminars. It was educational for people in the field in the North. It was not an operational item, if you want to use that terminology. I am just trying to get some sense of what the Minister when I read the Northern Health item now-what essentially the focus is. Mr.

Orchard: It is a combination of both now in terms of providing the in-service training costs for community health workers and northern nur ses, the operating supplies and equipment in part for northern nursing stations and of course the books, publications that are used by the nursing stations, as well as, contractual arrangements for physician service deliv ery in a number of communities, the largest portion of it being a commitment to the Northern Medical Unit for the services they provide in a number of communities. Mr. Ashton: I appr eciate the information.

As I said, I find it interesting that the Min ister, after his statements last year, has moved the item over but not eliminated it, in fact, has probably enlarged it by bringing in various other activities. I know he went into some great length in last year's Estimates. I was not here, but I did read the Min ister's comments. It seems the Min ister had a bit of a change of heart in terms of trying to eliminate this line of the item, in fact, has gone to some extent to try and enlarge it.

So while it does not necessarily involve any major increase in terms of programs, it is certainly interesting that the Min ister has seen fit to recognize the North certainly as an item that should, perhaps if not have an independent line in the budget should have a dependent line under Regional Services, but a bigger one, or what appears to be a bigger item, although in fact it is various other activities. I find that interesting too, because we talked about creative budgeting earlier when we were talking about Continuing Care.

It seems the Min ister, to my mind, has maybe mastered the art when it has come to northern services, because when I look at the change from the past year to the current year it is certainly interesting to see the transformation of the Minister in terms of now being very creative in his budgeting. I am not saying it is going to do us, in the North, much good, but it certainly, I am sure, will be interesting to see how this Minister deals with- Mr. Chairman: Shall the item pass? Mr.

Ashton: In fact, I would suggest that if the Minister wants to be really cr2ative in terms of Northern Health services we cert ainly would not mind additional resources being put in a number of areas in the future in northern Manitoba. That is probably the most appropriate way to go. I did, however, want to ask a question. I raised it very briefly before and that is in terms of the-this was a couple of weeks ago actually-in terms of the relationship between medical services and the provincial Government.

In fact, in 1988 I know Manitoba Health had been involved with Swampy Cree Tribal Council in a tripartite discussion on transfer of control. I would like to ask the Min ister if there has been any further development from that particular discussion with Swampy Cree and whether the department has been involved with any other dis cussions with other tribal councils or other Native organizations. *

(2200) Mr. Orchard: Mr. Chairman, the department is in process of di scussions with Swampy Cree to determine what we can mutually do together in service del ivery, but we do not have anything written, signed or anything like that. We are in the di scussion stages. Mr. Chairman: What is the will of the committee, the hour being 10 p.m.? Mr. Orchard: Mr. Chairman, my regional dir ector has a funeral tomorrow and if we were to spend another bit of time tonight we could possibly get through the issue and pass it. Mr.

Ashton: I would rather the committee rise so that I can give notice that the other question I had was in terms of medical officers of health, so if the Min ister wishes to be briefed in terms of that. Mr. Orchard: What is the question? We can discuss it because the Assistant Deputy Minister will be here tomorrow for medical officer of health. Mr . Chairman, I am prepared to sit to pass the item if that is the will of the committee. Mr. Chairman: What is the will of the committee? Mr.

Ashton: I am not trying to not be accommodating, but I had ind icated to somebody I would be meeting them right after the adjournment. I had not anticipated sitting later. I would suggest we leave the line open, but I do not suggest it will take that long to pass it on Tuesd ay. I do not have any large number of questions. Mr. Orchard: If you do not have any large questions, we could pass it in fairly short order tonight then. Mr. Cheema: Mr. Chairperson, if the Member for Thompson does not mind , we can spend maybe 10 or 15 minutes more and go through the section, because tomorrow then we can start the next

section if the regional dir ector has to go to a funeral. Mr. Chairman: Is there will to continue and pass Regional Services? Mr. Ashton: I would ask that we not deal with it. We are past the normal hour of adjournment and I have suggested that committee rise. I am just trying to accommodate the Minister and staff by indicating it will not take any great length of time tomorrow. So committee rise. Mr. Kevin Lamoureux (lnkster): Mr. Chairperson, maybe if the Member for Thompson does have a 2798

Monday, November 13, 19 89 question that he would like to put on the record, I am wondering if we can then just ask a few questions so, while the regional co-ordina tor is here, we will get our questions on the record. After we have done that we just will not pass this particular line so the Member for Thompson can continue to ask questions. I think it is important that we ask our questions while this particular person is here to possibly facilitate in answering the question. Mr. Ashton: Mr. Chairperson, there was no indication that we might go past 10 .

Perhaps if the Member for lnkster had been here he would have seen that ample opportunity was given to his caucus members to ask questions. I try to be very accommodating in terms of that, but I had made commitments. I had assumed we were going to be rising at 10 . I am trying to be accommodating. I do not feel it is appr opriate to continue to ask questions of this type after the normal hour of adjournment. If the Member wants to give notice to the Minister again private ly, then we can deal with it fairly expeditiously tomorrow.

I am not trying to hold up the committee, but committee does normally rise at ten o'clock. Mr. Orchard: Can I offer a suggestion that the Liberal Health Critic (Mr . Cheema) is wishing to pose some questions which are more appr opriately answered by the executive di rector, and there is no prohibition for going past ten o'clock to do that? If my honourable friend, the Member for Thompson (Mr . Ashton), is unable to be here, then we will simply await his return tomorrow and answer his questions on medical officer of health which we can deal with retroactively, since we have already passed the

section under which we would deal with medical officers of health. We are willing to accommodate my honourable friend from Thompson in that regard. Mr. Ashton: I believe, Mr . Chair person, we were scheduled to adjourn at 10 . It has been five minutes back and forth on this. I feel we should stick to the adjournment of 10 . I receive no ind ication that anybody is willing to go past. I have some problems with this. It is not like the normal situation where if someone has to leave early you can obtain the Ha nsard in terms of following questions from other Mem bers' comments.

I think that is something we cannot accommodate by tomorrow, and I think it is important we stick to our adjournment hour of ten o'clock. Mr. Orchard: Mr. Chairman, my honourable friend is concerned presumably about a commitment he has at ten o'clock, and that we may pass this item in his absence. If it would help my honourable friend, I will tell him, my honourable friend from Thompson, that we shall not pass the item until after he poses his questions tomorrow which are not questions that are the respo nsibility of the executive di rector of Winnipeg regions.

However, the official Opposition have made a very reasonable request that they take 10 or 15 minutes this evening to pose questions appropriate to the executive dir ector since that indi vidual, the executive dir ector is not able to be here tomorrow because of personal commitments. I do not think that in any way obstructs my honourable friend, the Mem ber for Thompson, from carrying on his obligations past ten o'clock. We will not pass the item, we simply are able then to more appropria tely answer questions posed by the official Opposition. I do not think anyone is being unduly affected by that decision. Mr.

Ashton: Mr . Chairperson, we had it an hour, ten o'clock schedule. No notice was given to me by the official Opposition. I have some difficulties with sitting past ten o'clock with no other member of my caucus being here because I was not aware that such a requ est had been made. If I had even known five or 10 minutes before, I could have made sure someone was sitting here to make sure that I would be aware of the discussions that take place. I know that is a major concern in our caucus, to make sure that we have somebody who does have a current tab on what is happening in terms of the Estimates.

I still think we should adjourn at ten o'clock. If the Mem bers want to discuss the questions with the Minister and give notice so they can be asked here tomorrow I do not see any difficulty with that, but we have an adjournment hour of ten o'clock. Mr. Lamoureux: I believe after ten o'clock, in order for us to adjourn, there would actually have to be a vote. I think the Member for Kildonan (Mr .

Cheema) has some serious questions that he would like to put forward and have the regional co-ordinator here because for compassionate reasons, he is attending a funeral tomorrow, she is not going to be her e-I am sorry, he-tha t we be able to put forward the questions, we are not going to pass this section. It is only going to take 10-15 minutes. In fact, we would have been more than half way through it in all likelihood by now. I would suggest that we continue on with the question from the Member for Kildonan (Mr .

Cheema) because in order for committee to rise at this point in time there would have to be a vote. * (22 10 ) Mr. Orchard: Mr. Chairman, my honourable friend from lnkster makes a most reasonable proposition, and I have ind icated to the Member for Thompson (M r. Ashton) that if his concern is that we pass item 67, that will not happen. He can still pose his que stions tomorr ow. I cannot und erstand . why my honourable friend from Thomps on is wanting to deny the opportunity to the official Opposition to pose questions to an individual who is not able to be here tom orrow.

He does not have to sit here past ten o'clock to allow the official Opposition to pose those questions. I get the sense that my honourable friend is just being obtrusive in this move and obstructive, because what the Li beral Opp osition has proposed is a most reasonable, a most reasonable approach. I cannot see the difficulty with my honourable friend from Thompson acceding to it. Mr. Chairman: I would like to thank all Honourable Mem bers for their input, and cite you Rule (8): 2799

Monday, November 13, 19 89 Committee of Supply to rise at own di scretion. Where the Committee of Supply, or

section of the Committee of Supply, is sitting at 10:00 o'clock p.m. on any day, the Chairman, or the Deputy Chairman of the Committee shall not leave the Chair at that time but, subject to sub-rule (9), the Committee shall continue to sit and shall rise at its own discre tion. Mr. Ashton: I just want to indic ate that I take objection to the Minister's statement that I am denying the Liberal Party, the Opposition, their critic to ask questions. If you will check the time allocation today the Liberal Mem bers have taken about three-quar ters of the time.

I have deferred to them on several occasions and if the Liberal Party, because in this case as the Chair has pointed out, it would require a majority to follow what has been the standard practice throughout this Session of adjourning at ten o'clock, if the Liberal Party wants to stick ahead in terms of that, that is fine, but the Mi nister should not be suggesting that I am doing any thing other than following what has been the standard practice in Estimates throughout this entire Session which has been to adjourn at ten o'clock.

Now if the Minister and the Liberal Party have other ideas about that, that is their business but let the Min ister not suggest I am obstructing, because that is not true. Mr. Chairman: According to the Rules then, we will continue and by agreement not pass that line but simply go on with these questions. The Member for Kildonan. Mr. Cheema: Mr . Chairperson, I think it is reaso nable, it is not a major request when the person who is in charge of the program has to go to a funeral tomorrow. Why can we not just finish the business and ask 10 minutes to 15 minutes of questions?

It is not as if something-the world is not going to fall down. I just wanted to raise a couple of issues in regard to the Hearing Conservation Program in the northern and Native communities. Can the Min ister of Health tell us what specific program they have initiated to deal with the hearing impairment in the northern communities? Mr. Orchard: Well, to my knowledge the Hearing Conservation Program is available through Regional Services throughout the province. Flin Flon and Thompson are both areas where audiologists are available for the assessments to be accomplished. Mr.

Cheema: Can the Min ister of Health tell us how many speech pathologists and audio logists are available in that region to assess the number of children? Mr. Orchard: No speech pathologis ts, and an aud iologist in Flin Flon, as well as another one in Thompson. Mr. Cheema: Then can the Mi nister of Health tell us how they are managing the number of children who would require the speech therapy at the preschool level and how they are bringing them to Winnipeg and which hospital they are offering because we have a disparity between the two major hospitals, St. Boniface and Health Sciences.

The waiting list differs from hospital to hospital. There is one hospital that has an 18 -month waiting list, the other has one year. One has 257 children, approximately the number waiting, and the other has less than that. So what kind of program do they have in place to make sure that the childr en who require preschool speech therapy are di stributed in each and every hospital on the basis of where they can be given service at the earli est possible? Mr. Orchard: The two programs at St.

Boniface and Health Sciences Centre in terms of speech pathology are not any different than any other medical programs per se, wherein physicians from the referring region may choose to refer to either of the hospitals, and it is a referral pattern by physicians that is often exemplified in those two di ffering waiting times and lengths of waiting lists.

I cannot help but ind icate to my honourable friend that when we made the announc ement at Health Sciences Centre of the enhanced funding, enhanced staffing, we were able to move pediatric waiting lists in audiology from a year down to two months but the waiting time for speech pathology remained essent ially the same because even though we assisted more children, expectations were created and more childr en came in and were referred there for services.

So I think maybe adding more money created the kind of waiting list problems that my honourable friend refers to, a rather strange anomaly to happen when you try to increase the service, in fact, although you serve more children you have not decreased the length of waiting time. Mr. Cheema: Mr. Chairperson, I think we are dealing here with two issues. Number one is the shortage of speech pathologists and the aud iologists and the number of patients except Winnipeg. The second issue is the waiting list in two different hospitals, why it differs from one hospital to another.

I think if you are going to send more children to the Health Sciences Centre the problem is not going to get better, and by providing two more speech therapists, it is not going to the extent which we would all like to have it. At St. Boniface Hospital when you have a waiting list for a year, it makes sense that some of the regions are dir ected to send the children either to make sure they are sent to St. Boniface Hospital, and why it is not done, and why it is not being done at present.

The second issue, as the Minister has said by creating, gi ving them more funds they may have created expectation, that may be partially true. It is true that there may be an in creased number of assessments being done but the numbers of the children who were referred to speech therapy has remained almost the same in terms of the people who are waiting. Someone who needs speech therapy right now tod ay, if he is two and half years or three years of age, by the time his turn comes he will be in the school-aged group. The point that we want to make is very clear. 2800

Monday, November 13, 1989 It is not a political thing, it is an extremely important issue because if you do not provide the services right now they will end up using the most service in the school system. The school system is very adequate. There are a good number of speech pathologists in the school system, but outside the school system, even the Dr. MacDiarmid Report is very clear that they would at least need about 14 to 15 more speech pathologists just to reach the national average. Right now at Health Sciences about seven to eight and providing more, two to three physicians, may help in the long run.

We just are asking if maybe-it is a very tricky situation because funds are coming from the Ministry of Health now, but when the childr en go to school and it is from the Department of Education, as schools go, they are responsible. Ultimately, taxpayers are paying money anyway. I think what we want to make sure that something must be done in terms of giving you more resources to both these institutions as well as at Brandon so that all the childr en can get adequa te treatment in time.

We are told that sometime If there is an urgent situation, then priority is given, but if you talk to the parents they are not satisfied. I could bring a number of parents to the Minis ter's attention but giving their personal name Is not going to solve the problem. We would like him to do that, make long-term planning so that we do not have this problem in the future. The second question which I raised during the House was the lack of the service in their own community.

It is not possible to have a speech therapist or audiologis t in each and every community, but at least in major centres with the population of 20 ,000. Portage is a place and an example. We do not have a speech pathologist there. Somebody who has to dr ive a four-year-old child from Portage to Winnipeg, it is not possible. It is very difficult for them to come five times a week. I think if you look at the salary structure of these indi viduals which is about $30,000 to start with, approximately, you can provide more speech pathologists and I think this solves the problem. *

(2220) The second thing, as the Min ister has pointed out, they do not have the numbers and now you have signed the agreement with North Dakota. If you look at Alberta and Saskatchewan, Alberta is another example where you have a large number of speech pathologists trained and they will probably be willing to work if you offer them reasonable salaries. I think that, by giving them some incentives to work in the northern and some of the und erserved communities, may help. We would encourage the Mi nister to look into that so that we do not end up with this problem in the future. Mr.

Orchard: My honourable friend, he and I are not at odds on this issue. I have to tell you that I was very close to having a press conference prior to the fall of the Government in 1988 on the issue of speech language pathology, because in terms of pediatric availability of 2801 service we have a serious problem. I do not argue at all that it would be much more effective for the child, let alone the taxpayer, to have the services preschool. I think if we had that we could reallocate probably a significant amount of the school deliv ered program to stroke victims and others who need rehabili tative services.

My honourable friend and I, we agree. All I say to my honourable friend is that I recognize the problem, and Government recognizes the problem. We have taken some initial steps in terms of some increased funding but clearly we still have the dispa rity of service across the province where we only have one and-a-half speech language pathologists outside of Winnipeg.

Clearly that is not adequate, particularly when you see, I believe it is a state law in the U.S. where states are manda ted to provide speech language pathology services because the American philosophical appr oach is that unless you can communicate you cannot achieve your maximum contribution to yourself and to society, I presume.

I concur with that, but I make no bones about the difficulty in terms of decision-making, because daily in the Department of Health I am literally inunda ted with requests for additional resources to go to a whole range of very genu inely held bel iefs that the programs proposed would be of a vast benefit, probably more benefit than any other proposal. I simply tell my honourable friend that in terms of speech language pathology, I consider it to be one of the hig her priorities for add itional service within Government.

That is demons trated by the additional resourcing at the Health Sciences Centre, which provided some relief but my honourable friend is right, the waiting list is still the same. Secondly , in terms of the MacDiarmid Report to focus on the training aspect, because we have had a longstanding arrangement with North Dakota, and as I ind icated earlier the Premier is cosigning with the Governor of Mi nnesota on educ ationa l exchange, will offer again another opportunity for training.

We have to, in the next number of months, take a look at some of the specific recommendations of the MacDiarmid Report in terms of numbers to see how achievable they are, to see what dedication of resource it requir es because naturally Dr. MacDiarmid did not attach a budget to his recommendations and then to consider some of the suggestions on return for service for support in the various training programs of students. Those areas are under active consideration.

I beg my honourable friend's indul gence that we will be making positive decisions in this regard but I simply say we will not be moving as quickly as those parents would like whose childr en unfortunately need service. I regret that, but that unfortunately is one of the realities of modern Government when you have to try to make as balanced a decision as you can on competing demands for resource. Mr. Cheema: Mr. Chairperson, we und erstand that there are a number of pressing issues, but some of them should have more prior ity. This one, I think, deserves more priority because the amount which is

Mond ay, November 13, 19 89 going to be spent on that is not a tremendous amount of money. Even though it is not free, it is not a tremendous amount of money that we have at least four to five in each hospital and have one or two in the regional hospitals, especially when they are trying to promote the Thompson hospital. It would be to their advantage because a lot of people do not have those kinds of resources to come back and forth. It is very di fficult, somebody making $20,000, how do you expect them to come back and forth to Winnipeg, make arrangements and stay here, or whatever, go back?

I think that is what our main concern is, and that is why we have been asking the Government to do that. It is not at some critical point but I think realistic. My second question is in regard to the community mental health in the northern regions. Can the Minister of Health tell us now how many mental health workers are working in the regions, what is the ratio as regards the total population? Mr. Orchard: I will provide my honourable friend with those numbers. I will give my honourable friend the first ind ication in terms of total numbers.

We have 10 9 and 10 weeks, I guess .1 0, throughout the department, all regions including Winnipeg, and we are down to six vacancies only in that area. I will give you the breakdown by region. Winnipeg in total is 43, if my numbers are correct, yes, 43. Westman is 11 , Eastman is 11 , Central is 10 plus 36 weeks, nine in the Interlake, 10 plus 26 weeks in Parklands, seven in Norman, seven in Thompson, for the total of 109 and 10 weeks throughout all the regions. In Norman and Thompson the department uses between 35,000 and 40,000 for population in each of those regions. Mr.

Cheema: Is the Minister saying that for 40,000 population we have one mental health worker? Is that true? Mr. Orchard: Seven in each region. Mr. Cheema: Mr . Chairperson, it is being worked in a rural community like Pine Falls, Powerview and a lot of the reserves. We found, and it is very common knowledge there, when you have even seven persons for 40,000 as compared to Winnipeg City that is very inadequa te, because for those people that may be the only one person they can talk. The communication problem is there, the geographical distribution, the di stance involved and the Jack of family care services.

Most times it takes about a few weeks for a simple assessment by a mental health worker. What criteria are being used to make sure that what is the adequate number to provide the mental health care services in those communities, and how are we doing as compared to Ontario, Saskatchewan and Alberta? Mr. Orchard: There are a total of 43 mental health workers in the City of Winnipeg, and with a population of roughly 560,000 that means one departmental mental health worker for every 13 ,000 individuals.

We use 35,000, and even if we used 40,000, as the population of Norman and Thompson regions respectively, the ratio dr ops from 13 ,000 in Winnipeg per mental health worker to between, say, 5,000 and 6,000 per mental health worker in the Thompson and Norman regions. *

(2230) Mr. Cheema: Mr . Chair person, 43 people are providing service to the 600,000 population of Winnipeg. Now you have the five or six major hospitals, you have a lot of primary care physicians, we have a lot of social workers here. We probably are more structured in terms of social services in Winnipeg as compared to some of the remote communities. It is very di fficult. That number is not adequate if we compare it with the rest of the province. It is very difficult for those people even to get a mental health assessment done. I think we should look at providing more.

It is very clear, because these are the only individuals at certain places that do not have any of the psychiatrists to give services to some of the regions. The point I am trying to make is, I think we should look at increasing the number of mental health care workers in those communities if we cannot have anything else. Mr. Orchard: That is exactly why the ratios are lower, in terms of those reg ions versus Winnipeg. Mr .

Chairman, that is entirely the thrust we will be debating, hopefully, tomorrow in terms of the mental health reform and reorganization, to move more services closer to the people in a more equitable level of service to the people in the various regions of Manitoba outside of the City of Winnipeg. That is exactly the dir ection we are moving in. Now, pardon me if I get a little testy. Mr. Cheema: Sure that is fine. Mr. Orchard: My honourable friend appreciates that. You do not instantly solve 20 years of pent-up problems, or 30 years of pent-up problems overnight.

I think if my honourable friend were to take a look at what has been accomplished in 18 months in mental health in Ma ni toba, he would find that no other jurisdiction, anywhere in North America, has made the strides we have made. Our path is clear. Our dir ection is clear. Our reorganization is on track, and we are very, very serious about moving in this regard.

For the first time in two or three decades Government is taking mental health issues very, very seriously . i take some personal responsibil ity for that, because it is not as if it was an issue that appeared out of magic when I walked into the office on May 9, 19 88. My honourable friend from Thompson is always dragging up the Hansards he wants to drag up to prove whatever point he is trying to make. One Hansard he will never bring forward is the debate for two or three successive years where I cajoled, urged, pleaded with the previous Government to try some decentralization, 2802

Monday, November 13, 1989 some deinstitutionalization, some reallocation of mental health services in the Province of Manitoba. I offered them the Parkland region as a pilot project, because had discussions with people in that region who were inter ested in doing just that in co-operation with Government. My honourable friend from Thompson sat in the Government that nodded their head very knowingly during Estimates time and did nothing after Estimates. One of the first agendas for reform and re organization was Mental Hea!!h in the department and in the Min istry of Health.

We are moving in exactly the path my honourable friend is urging us to. I simply say to my honourable friend that I will put the record of this Government in 18 months against the record of any other provincial admi nistration. I do not know of any state adminis trations that have been so pro-actively involved in terms of bringing services out of an institutional-based model to a community based model and spreading those services, as quickly as possible, throughout the province. Mr. Cheema: Mr. Chairperson, we have consistently put on the record that progress has been made.

Nobody can deny that, progress has been made. We are not saying that, but it is still not perfect. I think if we can improve that -(interjection)- we are saying it is not perfect, but still it could be improved. If the people were happy with the previous admin istration why did they kick them out? That simply is, people expect better things. They expect from this Min ister and the Opposition something solid, which is based on a scientific basis. They want us to do much better than they have done for the last 10 years. I think that is what we are trying to achieve here.

We are not being critical of the Min ister, we always say when he is doing something good. I still think we should look at improving the mental health care workers in some of the rural and northern communities, because, as I said earli er, the distance involved is number one; second, the primary health care is not available in many areas. The referral system is poor. It is not this Minister's fault, it has been there for a long time. Even for a person like me, who was not even born in this country, who has just worked in Manitoba for five years, I could even figure it out. It was a mess.

For a simple thing you have to go through five different procedures. There are three di fferent individuals in charge for the same program. It is getting better, but we would still like the Minister to continue to make progress on that issue. My next question is: what specific initiatives has this depa rtment taken in terms of Health Promotion in the northern communities? Mr. Orchard: I guess the most recent one is the Healthy He art Survey, which is in co-operation with the federal Government, the $2 million five-year survey program.

There is an enhanc ed component of northern and Native people participating in the survey, because we want to establish a better understanding of whether the re are unique risk factors among the Native population in terms of heart health. That is the most recent initiative. Other initiatives are in conjunction with the regular programs through Maternal and Child Health and other areas throughout a number of the departments, or a number of the divisions that we passed to date. I just had to search the name because I forgot the name. We have implemented throughout the regions the Nobody's Perfect Program.

We think it has specific potential of value for new mothers in northern and remote Manitoba. Mr. Cheema: Mr . Chairperson, as we are discussing Health Promotion, I think it was last week the Minister of Health (Mr . Orchard) ind icated that some of the programs are federal jurisdiction in the reserve areas. The problem still remains there. There is a lot of nutrition deficiency and vitamin deficiency in some areas also. What initiative has this admin istration taken? Are they doing any study to make sure that adequate nutrition is given to the pregnant women, the elderly age group and the younger children? Mr.

Orchard: Mr. Chairman, I guess that is one of the areas that needs certainly an improvement, not an improvement solely of provincial input and initiative. *

(2240) We attempt to do our

part in terms of the prenatal classes to emphasize the nutrition component there. In terms of new initiatives that my honourable friend wants, no, we do not have any new and focused initiatives targeted at Native northern and remote Manitobans. My honourable friend has to appreciate that we do not have that respons

Document details

Collection	Manitoba — Debates (Hansard)
Citation	34-2-69b
Type	hansard
Volume / chapter	34th 2nd hansardpdf 69b.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	dffe8e9440b699016e4e96509acf281b5e599b25

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