(Concurrent Sections)

HEALTH

Mr. Deputy Chairperson (Ben Sveinson): Will the Committee of Supply please come to order.

This section of the Committee of Supply will be considering the Estimates of the Department of Health.

At this point, I would just like to inform committee members of some changes to the rules with regard to speaking times in Committee of Supply. Please note, the address of a minister introducing a new department and the corresponding opening address of critics from official recognized opposition parties are limited to a maximum of 30 minutes. After opening remarks, all speeches by any member or questions or comments are limited to 10 minutes.

Does the honourable Minister of Health have an opening statement?

Hon. James McCrae (Minister of Health): Mr. Deputy Chairperson, I propose to be brief in my opening comments today. I am pleased to be back with my colleagues in the Legislature to discuss the Estimates of Expenditure for the Department of Health. The last year has been extremely eventful for the health system in Canada, and certainly Manitoba is no exception.

The coming year, I suggest, will be eventful, as well, as we attempt with our partners in health to address the kinds of changes that will need to be made in order for us to rebuild a health system that would be sustainable for those who need the health system now, but also for future generations. The things we do now are extremely important for the future. The things we decline to do now may even be more important in that, should we decline to embrace the kinds of challenges that confront us, we will have given up, we will have said we just cannot do it, we just cannot sustain or we cannot preserve a health system for our country. To me as a Canadian, Mr. Deputy Chairman, that is not sufficient if we are to be doing our work.

I know that the staff of the Department of Health have been facing, along with honourable members and I and the rest of society, these challenges these past few years, and I would like to take just a moment to make a comment or two about the department itself, which itself has undergone and must still undergo change in order to be ready to address the challenges that confront us. I would like to pay tribute to the personnel in the Health department for the work that has been done, and perhaps, in my paying tribute to them, I continue the plea that they continue their good work for the future in health care.

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I think we sometimes tend to take for granted the good work that is done by people, not only at the level of community health or in our hospitals, but I am confining these comments to people who work in the Department of Health. Challenging times, even troubling sometimes, as we address gravely important matters, and we do it in an environment that sometimes does not seem to offer too much appreciation for what is being done. I would just like to place on the record, all the way from Dr. Wade, Deputy Minister of Health, all the way through the ranks of the Health department, and say thank you for services that have been rendered and thank you in advance for the efforts that will be undertaken as we go forward for the next little while.

Similarly, all of those in funded institutions and working in our communities, whether it be in the Home Care program or the long-term care program or for proprietary or nonproprietary personal care homes or wherever they happen to be where they are working day in and day out to provide assistance to their fellow human beings, I use this opportunity to say thank you for that and to ask that everyone take whatever part they feel is appropriate in addressing the changes that lie ahead and also to keep in mind the needs that our system is trying to address, all of which revolve around the client or the patient or the customer or whatever is the appropriate nomenclature for those who are consumers of our health care system.

That being said, Mr. Chairman, I think the government is trying to play a strong role as partner in our health system. Certainly this government is when you look at spending in health as a percentage of total government spending. Here in Manitoba we rank highest in our country in that regard, which talks somewhat eloquently, I suggest, of the commitment and the priority the Filmon government places on the health of the people of Manitoba.

Within that expenditure, which is the highest level in the country as a percentage of budget, about third highest as a per capita expenditure, we have some very important things to do. At one time I think it was felt that really the only responsibility the public system had was to insure services provided by doctors and hospitals. Certainly right across Canada that has expanded very, very significantly, in recent years especially. Even in not so recent years governments have seen the value of placing some emphasis in areas of prevention and health promotion and so on. Certainly as our so-called baby boom generation approaches our sunset years, the need for services for senior citizens is going to be on the increase, and we have to be geared up and ready for that.

My honourable colleagues from the other political parties I think share similar viewpoints when it comes to the greater vision or so-called bigger picture, but when it comes to the implementation of change it is sometimes easy to fall into the habit of responding to those who might be affected by changes in the workplace without perhaps thinking the whole thing through, and it is easy to do that when you are in opposition.

In government, I do not think any of the members, the New Democrats around the table had the opportunity to be in a position where they had to be accountable for their decisions and implementations, and the same is true of the Liberal members. They have not had to do that and sometimes, today, for example, when a very unfortunate strike situation occurs in one of our most important programs it is easier, I suggest, to be on the side that would simply level the criticism than it is to be on the side where the accountability rests, that being with the government.

I accept that responsibility, Mr. Chairman. It is onerous and I take it very seriously. I want honourable members to know that I will do everything I can during these Estimates to be as accountable and as forthcoming with information as I can realistically and reasonably be so that we can make some progress here.

It is important to engage in exchange of ideas, exchange of information. It is important to do that as public policy is being developed. Ultimately decisions have to be made. You get criticized for making them, you get criticized for not making them. Ultimately decisions do have to get made and we can be pretty well assured that there will not be unanimity on every move. In fact, there may not be unanimity on very many, if any, moves that get made in the health system, whether it is in this jurisdiction or anywhere else.

The only thing I ask, through honourable members, to the members of the public is that we remember that the commitment is there on the part of the government, and the efforts are being made on the part of the government and on the part of all of the people with whom we work and consult. Ultimately, the decisions get made, and that is the time when all of those who disagree with the decision make use of the opportunity to say, well, what about me, or, you know, you did not listen to me because you did not do it my way.

That is a difficult thing because those people have a legitimate reason for bringing forward their point of view, especially if the decision has a negative impact on them in some way, usually by way of employment or the way they do their work, and I think we certainly have to be sensitive to those people, but we cannot simply not proceed with change, which is what is being urged on us. If that were to be our role, well, we would really have cast aside the responsibility that we were elected to carry out.

So, with those comments, Mr. Chairman, I will stop and allow honourable members to proceed.

Mr. Deputy Chairperson: We thank the Minister of Health for those comments. Does the official opposition critic, the honourable member for Kildonan, have an opening statement?

Mr. Dave Chomiak (Kildonan): I thank the minister for his comments, and I will commence by echoing the comments of the minister with respect to commending and recognizing the work of all of those people in the Department of Health, both within the Ministry of Health itself and all of those extensions of the Department of Health through a variety of programs, services and institutions around the province of Manitoba.

I think that it is incumbent upon us to recognize that, in fact, they are doing the work of which we speak, and they are delivering the care for which we debate, and I think it is incumbent upon us to recognize their role and to compliment them on their activities. I also wish to indicate that any of my criticism, and it is considerable, directed toward the Department of Health is not directed toward those individuals and those people, but, rather, it is toward the policy makers at the Department of Health for whom I have a good deal of criticism.

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Normally, in this process, Mr. Chairperson, I do not make lengthy opening statements. I feel on this occasion the necessity and the need to make some extensive comments at the commencement of this Estimates process.

About a year ago, at this time, Mr. Chairperson, we were in the midst of a provincial election, and arguments have been made long and hard by all members that health care was discussed during the course of the provincial election, and, in fact, it was. Health care was undoubtedly one of the major issues attracting attention and interest during the last provincial election, but, you know, it is very, very interesting that prior to the last provincial election, the government was aware of cutbacks in health and social transfer payments from the federal government. Nonetheless, the minister went before the people of Manitoba and before the Chamber to announce a massive capital program.

Just days before the election, he announced a massive capital program. It signified this government’s commitment to the future of Manitoba and to the infrastructure of our health care system, and this was at a time when they were aware of the cutbacks in transfers from Ottawa.

At the same time, Mr. Chairperson, the minister went before the same audience, the same public of Manitoba and put together a program to reduce waiting lists because waiting lists were most extensive in the province of Manitoba.

Mr. Deputy Chairperson: Order, please. We listened intently to the comments of the minister, and I would ask all members to listen attentively to the honourable member for Kildonan while he makes his comments.

Mr. Chomiak: Thank you, Mr. Chairperson. The minister went ahead and made a commitment toward reducing waiting lists and found the time to do that, and the minister also went out and talked about a child strategy that was being put forth by the province, all his commitments. We went into an election campaign with all of these commitments.

We had the provincial election; members opposite were returned. It is interesting, all of a sudden, that commitment, that long-term commitment to the capital program, was not there. All of a sudden, the program to reduce waiting lists would not be renewed, and, all of a sudden, there is no plan or no strategy dealing with health strategy. What is more, programs like Pharmacare, that the government promised they would not touch during the campaign, have now been decimated by the policies of this government.

Programs like Home Care, which the government campaigned on and promised and committed to maintaining, are being turned on their head by the policies of this government--

An Honourable Member: What? Be honest, Dave.

Mr. Chomiak: The member will have his opportunity to speak. He could do me the privilege of allowing me to address my comments.

Point of Order

Mr. Tim Sale (Crescentwood): On a point of order, very clearly, you will have heard the member opposite asking the member for Kildonan to be honest. He is reflecting on the motivation of the member and is calling it into question. It seems to me, if we are going to get through this process with a minimum of nastiness, you are going to have to, as chairperson, recognize when members are using inappropriate language, and I would ask you to rule that the use of the language is inappropriate and ask the member to withdraw it unconditionally.

Some Honourable Members: Oh, oh.

Mr. Deputy Chairperson: Order, please. Could I have order, please? There were comments made of which I am not sure, and I am not sure if they are on Hansard either, but, if they are, I will have the wording. If it is there, I will peruse it, and I will come back with a ruling on this, but I would in turn also ask all members and caution them to use their words cautiously and try to do it in a nice fashion if we can. I would like to see these Estimates proceed in a good manner and would ask the co-operation of all members. [interjection]

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Mr. Chomiak: If the member for Assiniboia (Mrs. McIntosh wants to continue to comment, maybe she can explain something the minister has never been able to explain, the home care. Perhaps she, at some point in this Estimates process, can try to do something that has never been done by the Department of Health, and that is explain their rationalization of their privatization of home care.

Mr. Chairperson, as I was indicating earlier, this government--it is very, very difficult, in the context of change and in the context of this environment, for members on this side of the House or for indeed the public of Manitoba to attach credibility to the capacity of this government to bring about meaningful change and meaningful, adequate reform in the Department of Health, given the track record with respect to how frequently and how often the government has gone back on its word with respect to what they have said in health care.

It is very, very difficult for us on this side of the House to attach credibility to the statements of the government when they fly in the face of government actions over and over again. I am sorry to say, Mr. Chairperson, that one of the difficulties in health reform is the inability of the public and the opposition representing the public to accept at face value the comments and the arguments put forward by the government on a whole variety of subjects as concerns health reform.

The overriding issue presently facing us--we just came from the Chamber dealing with this--is the area that concerns the home care dispute that is now before us. We are in a situation facing a strike, in a strike situation, because of the inability of the government to consult, to study, to indeed provide one single, rational argument in favour of their move to privatize.

Mr. Chairperson, I am convinced that if we had not leaked the cabinet document to the public of Manitoba, the government would have, by stealth, introduced this privatization home care in the summertime without even allowing for the limited public discussion that we have been able to invoke by virtue of releasing the document. This government has not been able to provide one single study, one single expert, one single official, either inside or outside the government, who can rationalize or can provide a justification for their plans to privatize home care.

If we just take a step back from this issue, and we argue it on a rational policy basis, and we say, let us put our cards on the table--and let us try to do that in the course of these debates. Put your arguments forward as to why you are privatizing home care. Perhaps you can convince the public. Perhaps you can convince the opposition about the validity of your arguments, but if you cannot even put forward arguments, are members opposite surprised that we do not believe them when they talk about their plans to privatize home care? Are members surprised when the public attaches absolutely no credibility to their statements concerning home care when they have not put together any arguments whatsoever, any policy arguments, any studies, any rational thought, any objective viewer who can justify their decision to privatize home care?

In light of that vacuum of argument, is it any wonder that people speculate outside this Chamber and inside this Chamber as to the reason and the rationale behind the government’s initiative to privatize home care? Is there any doubt that there are rumours rampant, that there are all kinds of allegations being made concerning the privatization of home care, in light of a complete absence of evidence, absence of data and absence of information justifying the government’s move to privatize home care?

Mr. Chairperson, the members opposite who sit back and make arguments about home care should come forward. They should provide the studies; they should provide the policy initiatives. Then we could have a debate. One of the reasons that we have not had a debate is because there have been arguments only on one side because the government side cannot put forward any meaningful arguments justifying the decision to privatize home care.

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Since we have met last, the government has also decimated the Pharmacare program as we know it, the Pharmacare program that the government campaigned on. In fact, it is ironic that the Minister of Health spends more time talking about Saskatchewan, I dare say, on occasion, than he does talking about Manitoba. They put out a pamphlet during the election campaign saying that the Manitoba plan was so much better than the Saskatchewan plan, and what did they proceed to do after being elected? They put in place a program that is even more, that is even worse now, than the Saskatchewan plan.

You know, again, at the stroke of a pen, without warning to the public, without consulting with the public, without consulting with seniors, without consulting with individuals who require this care, they decimated and virtually eliminated the Pharmacare program from the vast majority of Manitobans. Again, if they were being intellectually honest--[interjection]

Mr. Deputy Chairperson: Order, please. I am having trouble hearing the comments of the honourable member for Kildonan. Could we restrict our conversations at the table until you are recognized.

Mr. Chomiak: Thank you, Mr. Chairperson.

I understand the sensitivities of members opposite when you are given very little to defend your policies. I understand how difficult it must be, how very difficult it must be to try to defend these initiatives.

So we have had the situation since last year of the virtual elimination of the Pharmacare program, the decimation and the turning on its head of the Home Care program. We are in a strike situation with regard to home care, Mr. Deputy Chairperson, and what do we come out of? We are coming out of a situation of a debacle in the emergency wards strike. What other jurisdiction in this country has had the debacle that we saw the last few months with respect to the emergency wards where they were being opened, they were not being opened, they were justified opened, and the lack of studies and the lack of justification and the complete flip-flopping of policy and the lack of direction from this government as respects the emergency ward? We have had that since the last time we met, and is there any wonder that, again, members on our side of the House and indeed the public question the competence of the minister to deal with health care in the province of Manitoba?

Further, Mr. Deputy Chairperson, we have before us recommendations from an urban advisory committee recommending the closure of a number of health care facilities in the city of Winnipeg, more specifically, Misericordia Hospital and Seven Oaks Hospital. Now, the minister argues that these are only recommendations, and that he is looking at them. Is it not interesting that we have had recommendations made for the closure of facilities prior to financial data and a financial evaluation being done on those specific proposals? Is it not typical of the pattern and the mismanagement by the minister at the Department of Health that we would have recommendations for closures of hospitals prior to the financial data and the financial cost benefit analyses being done? Is there any wonder why the public and why members on our side of the House question the credibility of this government and the ability of this government to manage health care in these very difficult times, to manage the change that is necessary, that all agree is necessary in health at these times, when you look at instances of mismanagement over and over and over again at the Department of Health?

Mr. Deputy Chairperson, I do not know how many times the Province of Manitoba has spent the money that has been cut back from Ottawa with respect to health care. When they froze the capital plan several months ago after promising in the election campaign and saying it was a firm commitment, they said that was the federal transfer payments. When they decimated the Pharmacare program, that was the federal transfer payments. When they could not proceed with the cancer institute, that was the federal transfer payments. When they got rid of eye care examinations, that was the federal transfer payments. You know, that money has been spent more often, I dare say, than probably fourfold--fourfold that money has been spent. When they cut $53 million at a hospital budget this year, that was the federal transfer payments. At some point they are going to have to stop relying on that crutch in their arguments. They are going to have to face up to their own responsibilities as they relate to health care, and they are going to have to take the responsibility on their own.

This brings me to a very significant concern about the minister’s and the government’s approach to health care--that is, the constant finger pointing that is being made in the health care field against those individuals who have disagreements with the government policy. First, it was the nurses that were causing all of the trouble in health care; then it was the doctors that were the straw men of the government; then it was the federal Liberal government that was the straw man of the government, that was the person causing all of it; then it was the home care workers that were the problem in the system; then it was the hospital administrators that were a problem in the system, and then it is the opposition that is the problem in the system.

At some point, the government is going to have to take responsibility for its own policies, and it is going to have to stop finger pointing and blaming groups and blaming individuals and blaming others for what is happening in health care and accept the responsibilities for which they are elected and at least have the intellectual honesty to admit that these policies are their own policies.

There is much change that is going on in health care. There will be much change that will be going on in health care in the future. It certainly is not helped when the government is not prepared to be forthcoming and provide adequate information and data to the public to allow them to discuss the issues in front of us. I cite the example of the physical examinations. There is an agreement entered into between the MMA and the government concerning the MMA agreement that was to last for a number of years. As part of the agreement, there is a negotiation between the government and the MMA and the setting up of a committee that was to determine cost savings in medicare, et cetera. One of the recommendations was for the elimination of physical exams every five years. Now, when that was revealed publicly by us again that in fact this was a policy consideration, how did the government respond? Did the government come back and provide its arguments as to why? No.

The minister said he had only conditionally approved the recommendation. Heaven knows what “conditionally approved” means. It is new in the lexicon that I have heard, but he has conditionally approved those recommendations and that they were waiting for more studies. Could the government not have said this is what we have been advised, this is what is before us, this is what we want to save, this is what the rationale is, and this is what we are looking at? No. It was deep-sixed. The information was not provided to the public, and the minister, because he was caught with the memo that said he had approved it, came back and said, well, this was not real approval, this was only conditional approval. Is it any wonder that when we hear about closures and potential closings at hospitals that we question the government and the minister when he says he has not finally approved it, when we have the games played with respect to conditional approval and nonconditional approval?

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There is much change occurring in rural Manitoba, as well. As we speak, the government is trying to set up its regional bodies and its regional boards. Again, it has been poorly administered, it has been poorly put into place, and we have the very unfair situation of having some boards appointed, some boards not appointed, gaps in boards appointed, a lack of representation, and like so many initiatives of the provincial government, the regional health boards are up in the air, and it is unclear as to where they are going and what they are doing.

We do know one thing, Mr. Deputy Chairperson, that these boards are going to be charged with the responsibility and are to be given envelope funding to make major changes--read that cuts--from the Department of Health, major cuts with respect to services and health care in the communities that they serve. It is not helped when the government, again, is not forthright and is not able to provide the public with directions and ideas.

Can the government not provide a listing and a public documentation as to what constitutes core services for these regional boards, what services are to be provided by the regional boards, what are not, whether or not there will be government home care services available for these regional boards to choose to offer to patients in their regions, or whether or not the only option for these boards will be privatization? Can government not at least offer to these boards and to these communities the opportunity of knowing what the parameters are in terms of the government approach?

I dare say that either it is not available, and if it is available, the government is neglecting to make this information public, to provide it to the public and to provide it to the people of Manitoba to allow them to make adequate decisions as to what is happening and what is to happen in the future health care of Manitoba.

Mr. Deputy Chairperson, we have seen in this budget the most massive cut to hospitals ever in the history of the province of Manitoba. We have seen the institution of a transit of some kind of a fund, of a $38-million fund, to deal with changes in health care. Again, we have no information whatsoever about what is entailed by these changes, why the government is so precise in terms of the $53-million cutback, but why they cannot provide us information as to how and where these changes are being made.

We do not have any ideas as to who administers this $38-million fund. We do not have any understanding as to how it is to be applied. We do not have any understanding as to what the future direction is of urban hospitals in Winnipeg. Again, it shows up, and it appears to be like so many other things that I have seen by the Department of Health. It seems to be hodgepodged on and more an effort to gain public relations credibility rather than to deal with meaningful public policy initiatives by the government.

Mr. Deputy Chairperson, we will probably spend a good deal of time during the course of these Estimates dealing with the home care initiative of this government and dealing with the government’s headstrong attempt to privatize completely home care in Manitoba. I hope for the sake of the public of Manitoba that the minister is prepared to provide the rationale behind--you know, the minister keeps talking about his $8-million initiative in home care, and we recognize that the government is providing $8 million in home care this year. You know what, it is very interesting for the past three years we have been using statistics with regard to home care that--[interjection]

Perhaps the member for Assiniboia (Mrs. McIntosh), who is so versed in health care policy with respect to 1986-87, can enlighten this House by telling us what Connie Curran recommended with respect to home care, a report that was done as recently as two years ago, but is afraid or unable to provide the recommendations for that, Mr. Deputy Chairperson. I doubt very much that we will hear from members opposite what was in the Connie Curran report, and I welcome the opportunity for the members opposite to provide us with the details of that so that we can discuss the home care issue.

But, Mr. Deputy Chairperson, the government has provided $8 million to home care this year, and I ask the government, is that money directed towards profit? This is the first significant increase in home care allocation and funding, the first significant increase. Now that they have provided the first significant increase, is that money going to be directed towards--

Point of Order

Hon. Linda McIntosh (Minister of Education and Training): On a point of order, Mr. Chairperson, I distinctly heard the member offer to give the microphone over to me, but then he did not pause in his speaking to allow me to take up his challenge. I do not believe it was a bluff; I hate to think it was a bluff. But he did not then follow through on his offer--

Mr. Deputy Chairperson: Order, please. The honourable Minister of Education and Training does not have a point of order; rather a dispute over the facts.

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Mr. Chomiak: Mr. Chairperson, I want to close by indicating that we will be looking for the government to provide some kind of information and some kind of rationalization for their privatization initiative with respect to home care. We will be looking for the government to provide us with information and with justification for their move, and we will be pressing the government to do the right thing, to put the privatization plan completely on hold, to stop that program, to permit the changes to occur in home care within the public system that can and should occur.

Members on this side of the House have never suggested that changes cannot and should not occur in home care, but to continue in the public sector to allow for the improvement in home care, not to take a system that is recognized as one of the finest in North America and turn it on its head and not permit the public, the caregivers, the patients who receive home care to have any input whatsoever into this ill-advised policy. We will be looking for members opposite to try to justify that decision, and we only hope, for the goodness of Manitobans, that they will see the light and recognize the danger of what they are doing, that they will recognize the fallacy of their decision and they will put the plan for privatization on hold and permit us to go continuing to offer to clients in the home care system the best possible service available to them, and allow us to change and reform the Home Care program along the lines that ought to be undertaken to permit for a variety of service, to allow for those additional individuals who require home care, to allow them to develop in the system, to allow for a more expanded system, to allow for a more flexible system and to permit that under the auspices of the present home care system as it operates now. Thank you, Mr. Chairperson..

Mr. Deputy Chairperson: I believe at this point the honourable member for Inkster has a request of the committee.

Mr. Kevin Lamoureux (Inkster): Mr. Chairperson, I would request leave to be able to give some sort of opening remarks to this department.

Mr. Deputy Chairperson: Is there leave for the member for Inkster to make opening comments? There is leave? It is agreed?

Mr. Steve Ashton (Opposition House Leader): Mr. Chairperson, it is certainly agreeable to our caucus. We are not setting any precedent now, but given the importance of a lot of the issues here, I think it would be only appropriate for the member for Inkster to be given leave.

Mr. Lamoureux: Mr. Chairperson, there are a number of things that I would like to say. Health care is indeed a very passionate issue. It was just under a year ago that I was appointed the Health critic for our party, and there is no doubt a fairly significant learning curve that is applied whenever someone is given a new responsibility. This is a portfolio that has proven to be most challenging and interesting at the same time, and we notice that there has been a lot that has happened over the last 11 months since the last provincial election in health care that is having a very dramatic impact. As a result of that, what we see is emotions, as I say, running high on a number of different areas.

What I want to do is take this particular opportunity to comment on five or six different areas in which there has been a lot of profile publicly on issues in health care and right at the beginning to start off by giving the government somewhat of a compliment, a compliment in the area of what I would classify as a good idea, that of course being the SmartHealth contract. We do have some concerns with that particular contract, the primary one being that of secrecy, ensuring confidentiality. We will, no doubt, want to question the government in terms of what is being done to ensure that that confidentiality is not going to be breached at any point in time, but we recognize, having said that, Mr. Chairperson, that when we look at the concept or the idea as a whole that it is a step in the right direction.

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This is, in fact, not the first time where the Liberal Party has supported health care initiatives, whether it was mental health a number of years ago or the action plan back in 1992 when we had supported the concept of deinstitutionalization of health care. We are not reluctant to say to the government when they are doing a good job that we appreciate the efforts and so forth, but there are a number of areas in which I believe and the Liberal Party believes that the government has to rethink what direction they are taking the province of Manitoba. I would suggest to the government that it is not bad for government per se to reflect and change their minds if they in fact recognize that a statement or a recommendation or a policy position does need to be changed.

I tried to refer to this earlier during the MUPI and the Members’ Statements and in previous questions whether it was in this spring session or last fall’s session that we have to make sure that we have our priorities right. The priority that we have and will maintain is in fact the patient or the client of the services that are in fact being delivered. That is why, Mr. Chairperson, when the government does do something good, relatively well, we will applaud them in that area but, as an opposition party, our primary responsibility is to look at where government is not doing things properly and to try to rectify that problem.

I want to pick up on a few of those points.

One of them which I believe is ultimately just a real bad idea is the whole way in which we are handling our hospitals, our urban hospitals in particular in the city of Winnipeg. Last November, we had the Minister of Health (Mr. McCrae) put together a committee which was chaired by Mr. Wade, the Deputy Minister of Health, and before I get into this I should, in essence, compliment all members of the civil service within the Department of Health for no doubt the amount of effort that they put in to providing a system of health which en masse a vast majority of Manitobans are quite satisfied with, but, in some cases, I would have to indicate to some, in particular the current Deputy Minister of Health, that I am going to have to agree to disagree with the direction that is being taken.

Why do I say that? Well, primarily, what we have seen is a number of recommendations that are going to change the direction of the way in which we are administering our health care through our community hospitals, a significant change which is going to be extremely difficult to reverse once we find, and I believe ultimately that we will find, that there is a need for expansion of community hospital facilities, that in fact we are moving in the wrong direction.

I would go back to the former Minister of Health, Mr. Orchard, and the former deputy minister, where they in their action plan talked about how wonderful the community hospitals and the concept of community hospitals were to the province of Manitoba, again focusing a lot of that attention on our urban hospitals.

Well, our Liberal Party had supported that concept, as I earlier had alluded to. That is why we were quite surprised when we saw a recommendation--that recommendation was chaired by the Deputy Minister of Health--that saw the Seven Oaks Hospital converted over to a geriatric centre and the Misericordia Hospital converted into a glorified, if you like, walk-in clinic as opposed to its current role.

Mr. Chairperson, I find it very difficult to understand how it is that recommendations of this nature could have come into being, given that I have had discussions with individuals that have sat on that particular committee in which they feel that there is very little merit to these recommendations, and these are individuals that participated in the decision-making process for these recommendations. I am talking about, in particular, a number of CEOs, not only from community hospitals, that in fact a number of individuals have implied to me that vested-interest groups around the table won the day.

Our community hospitals need to be addressed in such a fashion in which the best interests of the community as a whole, not only the city of Winnipeg because our community hospitals service more than just the city of Winnipeg, but all Manitobans are in fact going to be addressed. What we have seen is a 180-degree turn from the action plan.

(Mr. Frank Pitura, Acting Chairperson, in the Chair)

Because the government has said that they have not accepted this recommendation, I would like to see the Minister of Health (Mr. McCrae) hold, in particular, this committee which was chaired by the deputy minister, more accountable. That is why we as a Liberal Party felt that if we were provided the opportunity to challenge the recommendations put forward by the deputy minister and his committee, we would be able to demonstrate that in fact these recommendations were not in the best interest of Manitobans. At the very least, what we should have seen is a number of options provided to the Ministry of Health, provided to the elected officials that said, here are different visions, if you like, that are quite viable, one that would have seen community hospitals playing a more significant role. We ultimately believe that there was very little financial accountability or analysis that was done, and we have seen recommendations that were based on speculation in most part and turf protection.

There are other areas, such as the home care services, which we find is more conservative philosophically being driven than anything else. We have an ideological government that is saying, look, we want to privatize this area, and they have not demonstrated to the clients, to Manitobans, to the workers, that this will in fact save tax dollars or this will in fact deliver a better quality of services.

The government has failed to do that, and we have to impute a number of motives as to why the government has been unsuccessful in providing that information so that they would be able to allow for good, healthy debate. We as a party look at it and fear that this so-called privatization will have a very demeaning impact on the health care profession as a whole in terms of those individuals who provide this service, that the quality of service that is going to be delivered is in fact going to deteriorate quite significantly.

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In addition to that, we are going to see the establishment of a two-tier health care home service delivery, one for those who are more economically well off compared to those who do not have the same sort of financial resources. The whole idea of preferential treatment, for example, given to nonprofit organizations so we could factor out the health care for profit I think has not been given the time of day or the allowance for debate and, hopefully, we will see a very healthy discussion about that, because I like to think that I am somewhat of an eternal optimist. Hopefully, we will be able to convince government that the system as it currently stands is working quite well relatively compared to other jurisdictions across North America.

We will be looking for the government to demonstrate that it is not working. If they are successful in demonstrating that, then to what degree have they looked at the nonprofit roles such as the Victorian Order of Nurses, who have been highly successful, who have been providing this service before the government was providing the service in part? Why are they excluding or why are they making it difficult for these organizations to be able to be more involved in this so-called privatization?

It scares me, the privatization for profit, for home care services, because Canadians feel so passionately for this service. That is the reason why the individual I alluded to earlier felt so strongly about, I am not going to allow the We Care individual to come into my unit. I do not have any hesitation if the minister wants the phone number to talk to this particular individual, I encourage the minister and government backbenchers to talk and hear what the home care clients are actually saying, the people who we are supposed to be servicing.

(Mr. Deputy Chairperson in the Chair)

There is a better way, and that is what the Liberal Party wants to say, that there is a better way in terms of providing an opposition to what this government is doing and that the direction that the government is taking home care services is very scary.

I want to talk about the Pharmacare card program. The government announces a program in which they say, well, look, if you are really poor, you will benefit under this. Sure, if you are rich, you can afford the higher user fee or deductible. Quite frankly, the bottom line is that this whole health care reform of the Pharmacare card is nothing more than to save millions of dollars for the government, and they have come up with a scheme in which they believe they can come across as compassionate because, if you are really poor, you will benefit by it.

Mr. Chairperson, this has worked out to be a tax grab, if you like, at the expense of health care, and for those individuals, the working middle class, the working poor, if you like, these are the individuals who are going to be hit and they are going to be hit hard by this action taken by government.

Let us look at the Cancer Research Foundation. I had a tour of that particular facility, and it is somewhat depressing in terms of what it is that the individuals are expected to work from within. Quite frankly, the Premier (Mr. Filmon) of the province agreed to that. That is why, leading up to and during the last provincial election, there was a commitment from this government, from the Premier himself, and I understand that the Premier was being recorded where he made this statement. It was a tape. The New Democratic critic actually has the tape, and maybe what we should do is allow leave and bring in the tape so that we can play that for all members of the committee, where the Premier said that the capital dollars would be there for the Cancer Research Foundation. That was a commitment that was given when the Premier knew full well what sort of transfer deductions were coming from Ottawa. In fact, the transfer reductions were greater then than they were actually today. They were greater then being forecasted than what they are today.

So, to use the federal government for this particular issue, Mr. Chairperson, is strictly manipulative, and the government is intentionally trying to deceive Manitobans on this particular issue. I have to be very careful that I do not go against the rules of the Chamber, and, if I did go on the other side of the line and offended some individuals around the table, I will take that back.

Mr. Chairperson, I do believe that there was a commitment that was made in good faith, and Manitobans have expectations for this government to make good on this expectation. It was interesting that I heard one of the backbenchers from the government allude, well, it is only on hold. As they build this Fiscal Stabilization Fund, I have this vision in the back of my mind, as we get closer to a provincial election, that we will get a retake of this commercial that the member for Kildonan (Mr. Chomiak) made reference to, just in time for the next provincial election.

Maybe I should not be overly suspicious of the government, but I would like to see this government make good on the commitments that it made to Manitobans in the last provincial election, given their commitments. The regional boards that are being established, what we are doing is, we are creating another level of bureaucracy, if you like, at a cost of approximately, from what I understand, somewhere in the neighbourhood of $3 million, and, hopefully, we will get a better idea of exactly what sort of a cost that is going to be. That $3 million, if you like, is going to be taken out of the same budget that the rural hospitals are being given today, so they have to come up with the money in order to establish this new level of bureaucracy.

Mr. Chairperson, we, and many rural Manitobans, are very dubious and concerned in terms of why it is that this government is establishing these regional boards, what is the primary purpose for this establishment, because we do know that money could be better spent in many, many different ways, and hopefully we will get a better idea in terms of what it is the government is doing.

We are concerned about health care professions as a whole. One of the professions in particular is the LPNs, the treatment that the LPNs have had to go through over the years. I listened to one LPN who made a presentation at one of the rallies. She said, you know, over at the Victoria Hospital, this is what we do, and she read off a list of things. It made it sound as if the Victoria Hospital was making good use of the LPNs. I often wonder, you know, are we making use of the many different health care workers who are out there, and what role is this government taking to ensure that that is, in fact, taking place?

Mr. Chairperson, I believe ultimately that the government’s role has been one of being a negative one in the sense that you have LPNs that are being phased out of our health care facilities, in particular, our hospitals. They might be increasing in some other areas, but in terms of our community hospitals and our tertiary hospitals or teaching hospitals as a whole, they are in fact being phased out. I am not convinced that is in the best interests of the patients of the province of Manitoba.

There are many things in which no doubt I am missing out, and we will get into those as we go through the number of hours that we will be discussing health care. But, finally, I wanted to comment on something in which the minister--and the minister has been somewhat better over the last few Question Periods, I must admit, and that is bringing in the federal government. I have noticed that he is starting to drop that particular point.

We as a provincial Liberal Party feel very strongly on the federal government’s role in the future of health care in the province of Manitoba. That is why quite frankly we were pleased when the federal government made a commitment to block cash funding to health care for the provinces well into the future. We are concerned in terms of some of the decreases that are going to be occurring over the next couple of years, but as a provincial party we will lobby where we can at the national body. I encourage the New Democrats, as I am sure they will, and the Minister of Health (Mr. McCrae), as I am sure he will, lobby equally. But the bottom line is the province of Manitoba, through equalizations payments, is in fact receiving more money that could be allocated out towards health care than we are actually supposedly being reduced.

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Let us not try to pass off responsibility. Let the provincial government or the Minister of Health take full responsibility for what is happening in the province of Manitoba because ultimately--and this is the note that I would like to end on--the greatest threat to health care in the province of Manitoba is not our health care workers per se; it is not the federal government. It is the ministry of Health; it is this government and the direction and the cabinet, if you like, of this government. It is the direction that this government is taking us on health care change and reform.

We appeal to the government to be more sensitive to the many different issues that are there; that, yes, there is a need for change but there is a better way in which to implement that change; and, I ask the Minister of Health to open his mind and not to fear reversing some of the directions that this government has signalled and to not stand on a philosophical stand and make a decision strictly on ideology. Thank you, Mr. Chairperson, and I thank members for allowing me leave.

Mr. Deputy Chairperson: We thank the critic for the official opposition (Mr. Chomiak) for his comments, and we also thank the member for Inkster (Mr. Lamoureux) for his comments.

Under Manitoba practice, debate of the Minister’s Salary is traditionally the last item considered for the Estimates of the department. Accordingly, we shall defer consideration of this item and now proceed with the consideration of the next line.

Before we do that, we invite the minister’s staff to join us at the table and ask that the minister introduce his staff present.

Mr. Sale: Mr. Chairperson, I wonder if the minister has any other additional copies of the Estimates, the additional Supplementary Information Estimates.

Mr. McCrae: Mr. Chairman, I think we can find copies to make available for honourable members. We made a copy available to the honourable member for Kildonan and the honourable member for Inkster, but I will make arrangements. I cannot just get it immediately, but I can have copies available for tomorrow’s session if that is suitable.

Mr. Sale: I thank the minister for that. Mr. Chairperson, there are a couple of extra copies there. Would it be possible to borrow those for the time during this meeting today?

Mr. Deputy Chairperson: We have one other copy which we will pass on to the member for Crescentwood, and the minister will make available other copies for tomorrow in committee.

Mr. McCrae: Mr. Chairman, immediately on return of the Page, I would ask if something could be done about that sooner. We might be able to do something this afternoon.

Mr. Sale: I thank the minister for the courtesy, Mr. Chairperson.

Mr. Deputy Chairperson: The honourable minister, to introduce his staff present.

Mr. McCrae: I have with me Ms. Susan Murphy, our Director of Finance and Administration. Dr. John Wade, Deputy Minister, I expect will join us momentarily.

Mr. Deputy Chairperson: We thank the minister. We will now proceed.

Mr. McCrae: I would ask honourable members to bear with us. We are attempting as a department to ensure appropriate services to our clients in the Home Care program. I am not offering to make very many officials available for the duration of that strike because department staff are required to make sure services are provided to the people who are the clients of our program. So I may not be very forthcoming depending on whether I can answer the questions or with the assistance of Ms. Murphy answer the questions, but we will be taking note. Hansard will be recording all the questions, and if I am not very responsive to some of them, it is because we are trying to provide services to our clients.

Mr. Deputy Chairperson: We thank the minister. We will now proceed to line 1.(b) Executive Support (1) Salaries and Employee Benefits on page 71 of the main Estimates book. Shall the item pass?

Mr. Chomiak: Mr. Chairperson, this section of the Estimates dealing with Executive Support deals with the implementation of a “restructured health services system” and I think it is appropriate that we discuss some of the initiatives undertaken by the government, specifically the home care initiative and as it relates to the restructured system. Just in response to the minister’s previous statement, I can indicate the kind of questioning will be--we recognize the minister’s responsibility during the course of the home care dispute and we accept the minister’s comments. I can indicate our questions will be of a nature that I am sure many of them will be directed towards the minister in policy initiatives to permit the minister to answer those questions and to outline to the public policy initiatives that the department has undertaken.

I would like to specifically ask the minister with respect to the home care initiative, in regard to the home care privatization plan as proposed in the Treasury Board document that was submitted and has now been made public by us in the opposition, there is a category in that particular document that indicates home care services are scheduled to be categorized, and I wonder if the minister might outline for members of this committee what sort of categorization the government is considering with respect to home care services as outlined in the government document, the Treasury Board submission, concerning the privatization of home care.

Mr. McCrae: Just by way of background, I have had brought to my attention a document entitled Review of the Manitoba Continuing Care Program, and I have in front of me an executive summary of a report put out by the company Price Waterhouse. This is by way of background for the honourable member.

I understand that this review was ordered by the previous government prior to the present government taking office. I guess there was some perception at that time that there were some problems in the Home Care program and in the system for the delivery of home care services to our clients because the government of the day ordered--I do not know if they tendered for this or not, but they ordered a review of the Manitoba Continuing Care Program. Price Waterhouse produced the report.

I am reminded that earlier today the honourable member for Kildonan (Mr. Chomiak) said, leave everything as it is, and he said this earlier in Question Period, even though--and I know he must have reviewed this report--he knows that the report revealed a number of things, for example, potentially--

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Point of Order

Mr. Chomiak: Mr. Chairperson, I specifically asked the minister a question concerning government policy and a categorization of home care services.

The minister has chosen to discuss a report that came out in 1986 that bears no relationship whatsoever, not only to my question but to the relevance of the government's initiative to categorize home care services and, indeed, I think you ought to call the minister to order and he may choose not to answer the question and he may choose to go on in some different subject, but that report bears no relevance in any way or means to the specific, and I was very specific in the question that I asked the minister. I specifically asked the minister the question on the Home Care program, the future of the Home Care program as it relates to the government document.

Mr. McCrae: Mr. Chairman, as I understand the rules, the honourable member for Kildonan asks questions and then I answer the question, and that is what I thought I was doing. The honourable member may not like the answers, but he cannot use bullying tactics to try to get members to do just what he wants them to do. Surely those kinds of tactics are not becoming of a member of the Legislative Assembly.

Mr. Deputy Chairperson: I have allowed both the minister and the member for Kildonan a little extra space, if you will, in their comments on a point of order. I will rule that the member for Kildonan does not have a point of order in this way; that, in fact, the minister has said that in offering the information that he had there that, in fact, he was giving some background information on the question that was asked.

* * *

Mr. McCrae: Mr. Chairperson, as I was saying, the previous government ordered a review. I have not found out whether they tendered for this or not, but it was a review by Price Waterhouse of the Manitoba Continuing Care Program, and this report found, and I quote, potentially unsafe client situations.

The honourable member says, leave things as they are. He wants unsafe client situations--[interjection] It is in the report. It is in the book ordered by the previous NDP government. [interjection]

Mr. Deputy Chairperson: The honourable member for Kildonan has asked a question. The minister, I believe, is attempting to answer it. The honourable minister, to complete his answer.

Mr. McCrae: Mr. Chairman, I am attempting to answer the honourable member’s question. I believe that the kind of demeanor that he is displaying today demonstrates the total desperation of a party that puts itself into the pockets of union leaders and then tries to do the bidding of the union leaders in this Legislative Chamber, which is here for the purposes of the people and not for the union leaders. If the honourable member does not want to hear what it is he wants to leave as is, that is his problem, but I am going to put it on the record.

The report revealed significant inefficiencies during the review of the intake process. Indiscriminate and inappropriate use of the joint nurse and social worker assessments in Winnipeg, deficiencies in the panelling process including inconsistencies in the panel’s make-up, appropriate use of panels, incomplete case preparation for panels and inadequate case presentations. This is what the honourable member for Kildonan wants to leave as is. This is what he asked us to do earlier today, Mr. Chairman, in Question Period, and I am continuing to refer to this report ordered by the NDP, and it is here by way of background as I approach answering the honourable member’s question.

The review also established that when home care service costs are calculated to determine whether they are less than those of alternative forms of care, significant costs such as case management, daycare, respite care, equipment and supplies are not taken into account. In many instances, home care costs actually exceed the costs of alternative forms of care. In these instances, one of the fundamental service conditions of the program is not being followed due to the lack of consideration of all costs.

With reference to the Victorian Order of Nurses, the report commissioned by the New Democratic Party says that the VON is placed in a potential conflict of interest situation where VON both order and provide services. Additional concerns were identified regarding mechanisms to ensure VON accountability to the program. The department has failed to establish a service contract with VON and lacks systems to monitor VON services adequately. In fact, because such mechanisms are lacking, a situation has arisen where VON is relying on service philosophies and standards that may result in the provision of richer service levels and mixes than intended by the program.

The report which the NDP commissioned goes on. The review identified a long list of problems at the operational and service levels. These problems pointed to inadequate structures and mechanisms to ensure service quality and consistency. Workload management is problematic. Some clients are overserviced and others receive services that are outside program scope.

Later on, Mr. Chairman, in the report commissioned by the NDP, it says: The program should give consideration to introducing measures that would serve to encourage clients to meet their needs through their own resources. For example, user fees, waiting periods prior to receiving nonprofessional services; user fees during the initial period of service and limiting hours in which services are provided. This is by way of background where we are brought today.

I will refer to this more later as we go through this discussion, but the honourable member for Kildonan told me today in Question Period to leave everything as it is, and I simply cannot in the light of the kinds of reports that were commissioned by the New Democrats, not acted on, but they did not have a chance. They were thrown out of office.

So they really could not bring in user fees that they seem to be supporting here. They could not introduce waiting periods prior to receiving nonprofessional services. They could not introduce user fees during the initial period of service, and they could not limit the hours on which services are provided. Indeed, we have gone quite the other direction,and it seems a little unseemly to me that in 1996 the NDP might be spreading rumours and innuendo and falsehoods with respect to user fees, for example, when they themselves were about to do it. That is really the height of hypocrisy.

Mr. Deputy Chairperson: Before we proceed, I would like to encourage all members to keep their questions and/or comments within a 10-minute period, which I have already stipulated. Nobody has passed that point. I just want to encourage you to do so.

Mr. Chomiak: Mr. Chairperson, the minister is so incompetent. He is so incompetent. At least Don Orchard was aware this report existed. I do not think the minister knew this report existed until today, and he is uncovering it with such glee. The minister is so incompetent that he does not know within his own department that there was a review committee to study the aspects of this particular report and deal with it. He does not know that. I am very discouraged that a specific question relating to home care that I asked the minister about the government policy, the minister has to fall back and read--probably the first report I have seen him read in this committee for some time--a report that is 10 years out of date and to attempt to use that report to defend against his particular policy of privatization of home care.

I again return--not to reports 10 years ago which, I know, the minister will continue to read--but I again return and I ask the minister, I challenge the minister to for once try to defend your own policies, try to defend your own documentation. I am looking at your own Treasury Board submission that says, and I quote: Services to be categorized under home care: core services, government funded; core services, government/customer share costs; noncore services, customer funded.

Now, Mr. Deputy Chairperson, I would not have said when we initially released this document that the prospective user fees were going to be upon us had this document said “core services, government funded; noncore services, customer funded,” although I resent the use of the word “customer.” It just evokes marketplace and everything that I abhor about the government’s move towards privatization. But the document does not just say: core services, government funded, and noncore services, customer funded. It says: core services, government/customer share costs.

* (1640)

What does that mean? Why does the government document on the privatization of home care say that core services are going to be government/customer share costs? Why has the government put this into the document, made it part of their policy? Not only have they refused to answer this question, not only does the minister seem incapable of answering this question or unable to answer this question, but the minister relies on 10-year-old reports, 10-year-old recommendations of which he has finally learned about today. I commend him. At least he learned about the report today. Don Orchard at least knew about the report and regularly referred to it.

If the minister is so convinced that their policy is not going to have a user-fee component, then can he perhaps explain to me and explain through me to the public of Manitoba what this document says where it says core services government/customer share costs? Why did they put it in their cabinet document? Why did they put in that particular line? Does that not indicate to an objective observer--and I have placed this in front of a lot of individuals. In fact, Mr. Deputy Chairperson, I might add that before we leaked this document to provide it to the public of Manitoba, I went to individuals, and I said, look at this document, tell me what you think the government is going to do with respect to home care. People, time and time again, pointed to that particular aspect of the document and said, it certainly reads as if user fees are going to be charged.

Now, this is not an academic question. This is not a question about past reports. This is not a question about ideology. This is a question about a government cabinet submission that says core services are going to be paid for by the client, by the patient. Why does it say that, and why does the minister consistently insist that there are not going to be user fees in their privatization of home care when in fact their own government document states it in black and white and can be no clearer.

Now, if the minister can explain it, if the minister can rationalize and explain it, then I will accept his argument that perhaps in the future, under their plan, there will be no user fees, but, until the minister can explain in this document why the cabinet submission says that, then we have no choice but to conclude that the government is intending to put in user fees with respect to their Home Care program that they are instituting and that they are proceeding to institute.

Mr. McCrae: It does not matter what I say or what any leaked or unleaked or any other document says, honourable members in the New Democratic Party will put whatever construction they jolly well please on whatever happens in the health system. They are not above telling people things that are not true. They are not above doing that. They have demonstrated that over and over again, and when it comes--

Point of Order

Mr. Chomiak: On a point of order, Mr. Chairperson, I believe saying that members opposite are not above telling people things that are untrue is unparliamentary, and I ask the minister to withdraw those comments.

Mr. Deputy Chairperson: I believe the honourable member for Kildonan does have a point of order. Would the honourable minister remove the word “untrue” from the record, please?

Mr. McCrae: Mr. Chairperson, if it is unparliamentary, of course I would do that. I am simply lost for words.

Mr. Deputy Chairperson: I thank the minister for the withdrawal of that word.

* * *

Mr. Deputy Chairperson: The honourable minister, to continue his comments.

Mr. McCrae: Thank you. I am simply lost for words to describe what it is. The honourable members in the New Democratic Party have certainly used the word “fraudulent” quite often, so I guess I could say that they are being fraudulent. Would that be parliamentary, Mr. Chairman? Could I seek your direction on that?

Mr. Deputy Chairperson: I would ask all honourable members to pick and choose their words reasonably. We are trying to go through these Estimates in the best way possible. If we pick and choose our words reasonably, I am sure that we can do this without breaking in or getting off the line of questions and the comments that we wish to make.

Mr. McCrae: Mr. Chairman, you can understand my frustration. I do not wish to break parliamentary rules. I do not even wish to offend honourable members. I do wish, though, to make sure my point of view and that of my colleagues in government is well understood by the public. Maybe this Estimates process is some way by which we can get through the message, unsullied by the meddling and mischief of members of the New Democratic Party, that we can get the message through, if anybody is going to be reading Hansard or in whatever way learning about what is going on in this particular process, what we want to do.

I have done this in writing to the clients of the Home Care program to make sure the record is clear, because it does not take very much to get a New Democrat out there twisting and distorting, and I guess being fraudulent is close to inappropriate language to use, but engaging in the kind of language massage that would lead people to believe in a state of being that does not exist. Maybe that is another way of putting it, Mr. Chairperson.

It does not stop by word of mouth over the public media. It is carried out by members of the New Democratic Party and their union boss friends right to the doorsteps of our vulnerable clients of the home care system whereby clients are being told that tomorrow, not next week or six months or a year down the road or some other time or maybe on the re-election of the NDP, which is what seems to be their policy, but tomorrow you will pay user fees and if you do not pay, you will have your services cut or both.

That is what I am up against, Mr. Chairperson, and I regret that. I resent it very much, not for my own purposes but for the purposes of people who are in such a circumstance in their lives that they might relatively easily be led to believe that such things are true. I find it extremely offensive to those clients that otherwise so-called well-meaning people would be out fighting the daylights out of people when there is absolutely no reason to do so unless they were so close to doing it themselves they thought maybe we would. There appears to be evidence that that is exactly where the NDP were going.

Now, the hypocrisy of it all is almost astounding. It is mind-boggling, the hypocrisy of New Democrats who go out with their holier-than-thou and sanctimonious approach to things, meanwhile carrying in their hip pockets reports that suggest that they ought to be imposing user fees and cutting services.

So honourable members in the New Democratic Party might forgive me if I attempt to respond to these scurrilous sorts of allegations. They have stood idly by and allowed other rumours and innuendo to be spread about that work in favour of them and their union boss friends.

Well, we are not going to stand idly by or sit idly by and let them scare the clients of our home care system like that without making one heck of a noise about it, Mr. Chairman. Sometimes if we breach the line of parliamentary nicety, we will just have to be stopped from doing that and pull back somewhat. But I see it as my job, I am told repeatedly that what we need is dialogue, communication, and when we try to communicate, we are asked not to do that by members of the New Democratic Party.

You see, only if it is their twisted message that gets out, then it is all right. That is where the hypocrisy is so mind-boggling. If the ordinary Manitoban could only witness as I do the mind-boggling hypocrisy of the New Democratic Party, I dare say they might not have one member left after the next election.

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Mr. Chomiak: Mr. Chairperson, I can see we are not proceeding very directly in this process. The question was very specific and I will pose the question again.. I think any objective reader of these debates would have to conclude that the minister is refusing to answer the question.

I will pose it again. In your cabinet submission with respect to the privatization of home care, it says, quote, What will be: Services to be categorized. Core services, government funded; core services, government/customer share costs; non-core services, customer funded.

What is meant in your cabinet submission by the phrase, core services, government/customer share costs? What constitutes core services, and what do you mean by customers share costs of core services?

Mr. McCrae: Mr. Chairman, you know, if someone accused me of being a hypocrite, like I did the honourable member a little while ago, I would want to defend myself. I really would. The honourable member has made no effort to defend what I said about him, which is that he is a hypocrite or that he and his party engage in a lot of baldfaced hypocrisy. So--

Point of Order

Mr. Sale: On a point of order, you have tried very hard to establish the notion that we can have a fruitful dialogue by asking members to choose their words. I think that this is rather akin to four-year-olds learning how to swear, when the minister has to say over and over again a mantra of hypocrite, hypocrite, hypocrite.

It is not appropriate, it is not getting us anywhere, and I wish you would call the minister to order and ask him to get on with either answering the question or simply saying, I refuse to answer the question. Lectures about hypocrisy are not very seemly for a Minister of Health.

Mr. Deputy Chairperson: On the point of order, I would like to say to all members, I have heard comments from the opposition critic and from the minister, words that actually could anger the opposite person.

I would ask all honourable members to choose their words carefully. I would also say that on both of these situations, we have both been getting close to where you would be called as using unparliamentary language.

I would also like to say that there are a number of words that have been ruled parliamentary and unparliamentary, and dealing with it in the context of a particular sense or, in fact, a tone of voice, I could rule it either way. I would ask all honourable members to choose their words carefully.

At this point, the honourable member does not have a point of order.

* * *

Mr. McCrae: Mr. Chairman, I will try to watch my language for honourable members and for this committee and for this Legislature. I do not like being scolded for acting like a four-year-old. I do not take it too well coming from the honourable member for Crescentwood, knowing him as I do, but I will refrain from using that language because it may not promote the dignity of the Legislature.

I would like honourable members to know though that I take some offence or certainly I disagree with the honourable members opposite in the New Democratic Party when they tell Manitobans that the Home Care program has been cut or that only in 1996-97 do we finally see an increase in spending for home care.

The reason I have to disagree with that is as follows. In 1988-89, the annual expenditure for home care was $39,012,300. At that time, there were 23,403 people served in that program. There were 3,398,819 units of service. In 1989-90, the annual expenditure was $42,204,600. That was an increment of $3,192,300, or 8.2 percent. The number of people served that year dropped slightly to 22,922, or 481 fewer clients that year. That is a minus 2.1 percent change in the number of clients. Nonetheless it was an expenditure increase of 8.2 percent.

One might be led to ask, are you getting value for that 8.2 percent when there has been a minus 2.1 percent reduction in the number of clients? You might want to ask that. But then, wait till I tell you the next thing. Well, the number of units of service increased to 3,501,213, an increase of 102,394 units of service, a 3 percent increase in units of service even though there were fewer clients.

What does that mean? One might be led to conclude that people were more seriously ill and got more service. One might be led to believe that from reading these numbers, which is what I believe, and I am advised is exactly what happened. But do not stop there, because there are a few--[interjection] Well, just wait, you will see. In 1990-91 that--hang on to your hat, Mr. Chair. Oh, you are not wearing one. Well, somebody ought to brace themselves because, in 1990-91, expenditures in the Home Care program were $50,890,700. It is an increase of $8,686,100. In percentage terms, that year 1990-91 over ’89-90, that percentage increase was 20.6 percent.

An Honourable Member: I wonder what the inflation was at that time.

Mr. McCrae: In 1990-91? Honourable members will remember the circumstances of that year. The number of people served that year, Mr. Chairman, was 24,022. That was an increase of 1,100 or 4.8 percent. Now, a 20 percent increase in funding, a 4.8 percent increase in the number of people served. But wait for the rest of the story. Units of service that year rose by 367,116 units of service all the way to 3,868,329, fully 10.5 percent increase in units of service. Still not as much as the 20 percent increase in funding. For 20 percent increase in funding, you get 10 percent increase in units of service. Go figure, with all due respect. Well, just in case you think the story ends there, it does not. I want you to know that in 1991-92 the annual expenditures for the Home Care program in Manitoba rose by a further 11.6 percent to $56,783,600.

Hon. Jack Reimer (Minister responsible for Seniors): Where do we start?

Mr. McCrae: The honourable Minister responsible for Seniors asks, where do we start? We started in 1988, and these numbers are starting there. I just want to go through these numbers because--I only do this because the honourable member for Kildonan (Mr. Chomiak) says that this is the first year, the one we are in now, where we have increased spending. I need to put these numbers on the record, Mr. Chairman, because as I said a little while ago, in not so parliamentary language, I made references to the way that honourable members put information out, and I do not want to be unparliamentary. So I will just put the facts out, like Will Rogers said. Will Rogers, some have heard of Will Rogers. He said, I never make jokes about politicians. I just watch them and report the facts. That is what Will Rogers said.

An Honourable Member: Who is he?

Mr. McCrae: Will Rogers, for some of the younger members, I do not remember him either. [interjection] Could I have a show of hands who remembers him?

Mr. Deputy Chairperson: Order, please.

Mr. McCrae: In 1991-92, Mr. Chairman, the expenditure rose by 11.6 percent that year to $56,783,600. That was an increment of $1 million? No. Two million? No. It was an increment of $5,892,900. That year we served 25,116 people. That was an increase of 1,094 over the previous year, an increase of 4.6 percent. Again, an increase of spending, 11.6; increase in the number of persons served, 4.6; units of service in that year, 1991-92, 4,187,310 units of service, an increase of 318,981 or 8.2 percent--still not anywhere close to the increase in funding, 11.6 percent. Go figure.

An Honourable Member: It went up and up.

* (1700)

Mr. McCrae: Well, we had a pretty bad year in 1992-93 because expenditures only rose by 10.7 percent that year in the Home Care program.

Jumping from $56,783,600 in 1991-92 to $62,837,300 in 1992-93, a very paltry little increase of $6,053,700. These are the cuts that the member for Kildonan (Mr. Chomiak) goes out and tells the people of Manitoba about. Cuts, he calls them. That is why we have to use this opportunity in Estimates to set the record straight. [interjection]

Well, you are telling me, Mr. Chairperson, I am only going to have a couple of minutes left here, but I guess I will have to use that because this story has to be told. We cannot count on members of the New Democratic Party to tell it because their object is to scare people, and that is not my object.

Point of Order

Mr. Chomiak: I have listened to numerous comments of the minister imputing motive on the part of members opposite.

I think it is not only unparliamentary of the minister to suggest that members of this side of the House, our motive is to scare people, but I think it is undignified and totally inappropriate for the minister of a Crown to possibly suggest that. I suggest it is out of order for the minister to suggest that the motive of any member of this House would be to scare people.

Mr. Deputy Chairperson: I would ask once again all honourable members to choose their words carefully. I would also like to bring it to the attention of all honourable members in this committee that this particular phrase and/or words have been used in the Assembly many times of which I did not hear, although it might have at some time or other been ruled unparliamentary.

I would rule that in fact the member for Kildonan (Mr. Chomiak) does not have a point of order, but I once again ask members to choose their words carefully.

The honourable Minister of Health, to finish his comments.

* * *

Mr. McCrae: It is interesting that honourable members can take offence to someone who would accuse them of wanting to scare people when they do not mind suggesting that members on our side of the House have personal agendas when it comes to the Home Care program.

I see the honourable member for Kildonan has this mixed-up look on his face as if he does not understand what I am talking about, but the honourable members on his side would like to have it both ways all the time. They want to have one rule for everybody else and a different one for themselves.

Mr. Deputy Chairperson: Would the honourable member for Kildonan put his questions to the Chair, please.

Point of Order

Mr. Chomiak: I was just trying to clarify whether the minister was speaking on a point of order in his attempt to try to answer the question that I asked 10 minutes ago.

Mr. Deputy Chairperson: I am watching the time on each member. The fact is that the point of order that was raised before this by the member for Kildonan is not on the time that the minister is putting into the answering of the member for Kildonan’s question.

The honourable minister, to finish his comments please.

* * *

Mr. McCrae: I understand that I do not have very much time left for my answer, and I regret that because there is so much more to be said about this. I despair that I may not be able to have the opportunity. The opportunity may present itself in the future, at which time I will take advantage of that opportunity.

Mr. Chomiak: Mr. Chairperson, I again return to the question that was asked of the minister on two previous occasions and which I again am asking the minister to attempt to deal with. That is, the government cabinet submission, approved by cabinet, Strategic Redirection of Home Care, dated December 16, 1995, outlines within the course of that document the future directions of the Home Care program and underneath the category "What will be" states, and I quote: Services to be categorized: Core services, government funded; Core services, government/customer share costs; Noncore services, customer funded.

I am asking the minister for the fourth time to explain to the public of Manitoba, if the minister is so concerned about information, why is he so reticent and reluctant to offer that information to the public and try to explain? If the minister is so convinced that the message is not being communicated, can the minister not provide us with an answer and a response as to what was in the minister's own cabinet submission, the minister's own cabinet document? Why is the minister reluctant or unwilling or unable or afraid to answer the question which has been put to him concerning the privatization of home care, an issue that is obviously timely and obviously of some significance to the public of Manitoba, which has perpetrated a strike situation, which has caused the minister himself to indicate that the Department of Health staff are involved in trying to provide care and services to individuals?

You would think the minister would be prepared to answer a question concerning this fundamental issue and the government direction of policy. Instead the minister seems to want to play--and I will accept that the minister will have ample opportunity during the course of this Estimates to put on the record all of the information he wants about home care, to counter anything that we have said or may say in home care and to make all of the argument he wants. But we are asking the minister a specific question about his policy, about his cabinet document, about the future direction, and this is not a game in words and this is not a political game. This is a game concerning a government policy to privatize which has perpetrated and caused a strike to occur, which is affecting the lives of Manitobans as we speak, and the minister seems unwilling to deal with the policy and to deal with the very initiative that has resulted in a strike.

Why is the minister reluctant or afraid to answer the question of his own document, that is listed in his own document that deals with the issue of privatization? What is to be gained by the minister not answering the question? What is to be gained by this is a conclusion by anyone who reads this, by any observer to these proceedings that the minister either cannot explain it or is unwilling to explain it because the only conclusion that can be drawn from the written word is that the government proposes to have user fees on the provision of home care services in their privatization scheme.

That is the only conclusion that I can draw by the minister's reluctance to answer the question, that it is clear that the government will be imposing user fees with respect to home care services and the minister is unwilling to acknowledge that, and I can only conclude that the minister's unwillingness to answer the question therefore dictates the obvious conclusion that is written on the paper, that core services will be shared costs between the government and the client, and that is a user fee by any other name. They can call it a contribution, or they can call it a partnership. The fact is, your own cabinet document says, core services government, customer share costs. I am asking you why it says that.

If there are no user fees, if you can accept your word that you sent out in letters, explain to me why your cabinet document says that. Was it wrong? Have you reneged on that policy? What is meant in this document by the use of those words, because there is no other conclusion that can be drawn from this, except that you intend to pose a user fee?

* (1710)

Mr. McCrae: It has not been the intention of the department, the minister or the government, nor is it today the intention of the department, minister or government, to impose user fees. The honourable member can read whatever he likes into whatever he likes, but, if he wants to play that game, you see, of trying to put words into other people’s mouths or trying to attribute words to people that never had that intention, then the honourable member is going to have to explain his support for user fees and limiting hours in which services are provided and so on.

You see, if he wants to get into that game, I can play it, too, Mr. Chairman, but I do not like playing that game because what the honourable member is--well, he objects to being told that he tries to scare people, so I will not say that he tries to scare people, but he does scare people. I find that offensive on behalf of the clients of the home care system. I find it offensive. New Democrats, in the name of their sanctimonious platform of caring for people, they care for people and then order reports that ask them to impose user fees. They care for people, so they say, and then they ask for reports that impose the limiting of services on our home care clients.

So why does the honourable member not just strip aside all the veneer that he likes to put on himself, he and his colleagues, and deal with the real world that we all live in in this country? I know the honourable member for Crescentwood (Mr. Sale) understands there is a real world out there. Why will he not admit it? Is it because it is not to his political advantage to admit that there is a real world out there that we live in? Well, there is.

In that real world of 1992-93, the government of Manitoba, the Filmon government, put $62,837,300 into the Home Care program. That was an increase of a whopping $6,053,700 over the previous year, or 10.7 percent. The number of clients increased to 25,909, an increase of 793 clients, 3.2 percent. The number of units of service that year provided was 4,423,286. That is a very large increase of 235,976 units of service or 5.6 percent; 10.7 percent increase in funding, 5.6 percent increase in units of service, a lot of units but not enough to justify, I suggest, a 10.7 percent increase in expenditure. Go figure.

So the next year is the year that led the honourable member to believe that as a matter of habit home care budgets are reduced. In 1993-94, our annual expenditure for home care only went up by $1,364,400. It only went up by 2.2 percent, up to $64,201,700 that year, but you see what happened, Mr. Chairman, is that the number of clients was reduced that year by 788 to 25,121, a reduction of minus 3 percent. There was a reduction in the number of units of service that year by minus 7.8 percent, 343,717 units of service, down to 4,079,569 units of service.

That would have been the result of adjustments in the Home Care program about which the honourable member is very familiar, about which there was lots and lots of debate, but it still represented an increase in spending that year, and it did represent, as the honourable member for Crescentwood (Mr. Sale) volunteered just a little while ago, must have meant more services for some people who needed them more and perhaps less services for those who did not need them more.

You see, people sometimes have reassessments and, in fact, quite often in the program that happens. People are reassessed up or reassessed down depending on their care needs. The honourable member forgets that some people’s needs decline. Some people pass away or they recover or they get placed in personal care or they end up in the hospital and their home care needs decline for those reasons, but, oh, no, we will not talk about that, we will only talk about the fact that in 1993-94 there was a reduction in units of service, and we will make the public think that this is a regular pattern, when in fact over the nine years I am talking about the units of service went up by 62.9 percent.

Why does not the honourable member for Kildonan (Mr. Chomiak) tell the people the whole story? Why does he not do that? Because it does not fit his particular objectives, that is why.

In 1994-95, the following year, expenditures in home care went up $1,970,800, or 3.1 percent, up to $66,172,500 and, again, there was a reduction in the number of people served down to 24,774, or 347 fewer, -1.4 percent in the number of clients. However, you have to wait for the rest of the story. The rest of the story is that that same year when there was a reduction in the number of clients there was an increase in the units of service by 3.8 percent, 155,459 units of service more than the previous year, or 4,235,028. So you see, one can be very selective.

I remember listening to David Orlikow when I was a Hansard reporter in Ottawa. David Orlikow was a New Democratic member of Parliament. He is now one of the spokespersons for the Manitoba Society of Seniors. He was a member of the New Democratic Party for Winnipeg North in those days. I remember listening to his speeches, recording them and trying like the dickens to make some sense out of them or to get the numbers that he would use to come together and actually support the argument he was making. It was a difficult, difficult job. Should I just leave it at that, perhaps?

So 1995-96--[interjection] Have you listened to yourself lately? Mr. Orlikow was a member of Parliament and is quite accustomed to having comments made, and the honourable member for Kildonan, maybe his skin is just a little thin, I do not know, but Mr. Orlikow is quite a capable gentleman and quite able to handle the slings and arrows of public debate. He is quite able to do that. For that at least I have some respect for him. [interjection] He is seen around this building quite often going in and out of the NDP office.

Anyway, in 1995-96, Mr. Chairman, the honourable member who tells people that home care has been cut, the increase that year was a paltry 24.8 percent--that was last year--from 66,172,500 to 82,572,300, a 16,399,800 increase, 24.8 percent. Well, maybe that was appropriate because there was quite an increase in the number of people served that year, 26,129, up 1,355 from the previous year, 5.5 percent. Now again, the rest of the story. The units of service changed that year too. They were up 30.7 percent over the previous year, 5,536,451 units of service, a whole 1,301,423 more units of service than the previous year.

So in summary, Mr. Chairman, from 3.39 million units of service in ’88-89 to 5.5 million units of service in ’95-96, pretty significant. Calls for increases, that is what happened, increases, every single year increases in spending, and 1996-97, $8 million more going into the Home Care program.[interjection] In ’88-89, 39,012,300. So honourable members should not allow themselves to be misled by information that comes out which sometimes can be incorrect and often is incorrect in the case of the honourable member for Kildonan (Mr. Chomiak).

* (1720)

Mr. Chomiak: Mr. Chairperson, four or five times I have asked the minister to comment and try to outline to the public what is meant by his own cabinet document which relates to user fees, and the minister failed and refused to answer the question. The minister failed and refused to explain why in this document it says there will be core services that are going to be shared funding between the customer, that is the patient, and the client and the government, and the minister refused to answer that question. I can only conclude that the government plan, as pointed out, will be for a future of user fees unless the minister is prepared to say that he does not agree with the documentation that was put forward to cabinet under his name and which justified the program of privatization that the government is now embarking upon. But unless the government--and the minister has continually refused--I mean, there is no use wasting the committee time by continually asking the question.

We will simply have to conclude that the minister is not--and we will continue to have to--I cannot accept the minister’s word that there will be no user fees when he is not prepared to defend and outline for me what is in the written word of the cabinet submission. How can I accept the minister’s contention that there are not user fees when in fact the wording that the minister has used in his letter to patients and to clients has been those receiving existing services. It has been very circumspect and very deliberately worded and can only lead to the--now therein lies the problem, because the government document talks about user fees. The minister sent out a letter saying there will not be any user fees for those services that are presently being offered. It certainly begs the question as to those coming into the program in the future, those requiring additional services, et cetera.

Can the minister not understand there is a legitimate question here when the government says no, there are no user fees for existing service, and if we accept that--and yet you have your government document here says the future will see core services government/customer share cost. How can the minister say that there is no intention to have user fees when in fact this document says there are going to be user fees and when in fact his written documentation that was sent out to home care clients is very, very precise in its wording and very, very circumspect. But the minister has refused and has been unable or unwilling to answer that question, and I can only conclude that he is unable to do that, he is unable to answer the question because the policy will be a user fee proposal in the future with respect to home care, because that is what the government document says and that is what the government policy is.

Mr. Chairman, the minister finally has some home care statistics that show some growth in home care. For the last couple of years we have been able to demonstrate over and over again in the Estimates process that, in fact, the number of clients receiving home care assistance has gone down.

I want to cite the stats that we have been using, because we have been using for several years now the annual report from the Department of Health. I went to the annual report and I tried to figure out how many people are getting home care services, and for the last several years in Estimates we have been using the figures from the Department of Health.

Let me cite the figures, and let me explain something to members here. The figures we used were total assessed for admission. What else could we use in terms? In ’89-90, 13,019; ’90-91, 12,509; ’91-92, 13,093; ’92-93, 13,139; ’93-94, 11,395. That is down 2,000. So that is the figure we have been using, and the minister, for the last two Estimates periods, has had no defence to that argument.

Now, in last year’s annual reports, they stopped putting these figures in the annual report, page 122. [interjection] No, ’93-94. In last year’s annual report, unless I am mistaken, those figures were not put in the annual report, so I still use consistently government figures and government documents that show the figures were down. [interjection] Well, it works so well. If the minister recalls the Estimates process, he could not defend it. He sat there, and he could not defend it.

The Supplementary Estimates book consistently showed 24,000 clients on home care, until this year, I admit. The minister said there is going to be 26,000 clients on home care. Correct. Yes, it looks like it is up 2,000. Finally the Estimates book reflects an increase in clients on home care, and finally we see an increase. Admittedly, yes, there is $8 million, and we welcome that. I have said that this year is the first significant increase, and I have said this year is the first significant increase because your own stats consistently show there was no increase for the past few years. So do not try to play the political game that we are making up stats when in fact your own documentation--I asked you in Estimates over and over again, and you made it very, very clear in Estimates that there was not an increase, so, yes, there is an increase this year. Yes, I said in my opening remarks--you might note if you go back and check the Hansard debate--the first significant increase in home care based on the data that has been provided to us by the Department of Health. For what it is worth, I do not expect the minister to stop his accusations, but, for the record, I want it to be made very clear that we are using government figures and government documentation.

Mr. Chairperson, to continue on the line of questioning, can the minister, who put together a proposal to cabinet dated December 16, 1995, on the strategic redirection of home care, the document and the policy paper that started this whole process on the road, that was signed by the minister, the minister’s plans that went under the minister’s guise and under the minister’s name--[interjection] Well, you have to sign it off. The minister asked if he signed it. The minister has to sign off a submission to cabinet. The document says: the Manitoba health policy is divestiture of all service delivery to nongovernment organizations.

Can the minister table for us today the policy papers, the policy initiatives the government justification, the reasons, the rationale behind--let us have an open debate on this. Let us have a debate based on facts. Can the minister table in this Chamber, for all members of the House, if not today, tomorrow when we get in this committee, his justification, his studies, his reports that serve the basis for why the government has made this massive change in policy or why this government has decided to massively change and turn on its head the entire Home Care program which has resulted, unfortunately, in a situation where we are faced with a strike which has dislocated and caused a tremendous amount of unease and anguish amongst clients and amongst caregivers, has been--[interjection]

The minister says it is fed misinformation. Well, the minister can set the record straight here today by simply tabling for us here the minister’s policy papers, the minister’s initiative, the minister’s justification. That is all we are asking for--justification, the policy papers, the reason, the rationale behind why you have made the policy decision to divest all service delivery of home care, why you have decided to privatize home care. If the minister can simply table the reasons and the rationale as to why they are doing it, then perhaps we in this committee and in the Chamber can have a debate as to what the future holds for home care.

Mr. Deputy Chairperson: Order, please. I would ask the minister to hold his answer until tomorrow when we reconvene this committee.

The time being 5:30 p.m., committee rise.