1993 Legislative Session: 2nd Session, 35th Parliament HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, JULY 22, 1993

Afternoon Sitting

Volume 12, Number 15

[ Page 9055 ]

The House met at 2:05 p.m.

Hon. M. Harcourt: I have the great pleasure of introducing two very distinguished visitors from Russia. Mr. Vasily Shupyro is Deputy Governor of the Nizhni Novgorod region, and Chairman of the Committee for State Property Management, more accurately described as property privatization. Would you please give a warm welcome to the Deputy Governor. Along with the Deputy Governor is Mr. Sergei Latyshev, who is the executive officer of the foreign investments department of the Committee for State Property Management.

Just for your edification, Nizhni Novgorod, which was previously named Gorki, is an ancient city east of Moscow and the Volga River. It goes back many centuries. It is a major industrial Centre that was converted by Stalin into a major military-industrial complex, and has over two million inhabitants.

Our two guests are key leaders in the economic reforms that President Yeltsin is carrying out, particularly the privitization programs. This is probably the most advanced area of Russia in this regard, and they are visiting British Columbia to pursue business opportunities and tap into the expertise of some of British Columbia's private and public enterprises. While in Victoria, they will meet with the land titles branch, the Ministry of Attorney General, the B.C. Assessment Authority, B.C. Systems Corporation, B.C.

Buildings Corporation and the Crown corporations secretariat to seek advice on carrying out their basic land reforms. Would you please give a very warm welcome to our guests from Russia.

L. Reid: I would like to welcome Christy Clark and Mark Marrisen, who are both visiting from Ottawa, Ontario. Christy Clark was an outstanding researcher in the Liberal caucus, and it's very nice to have her back with us today, and to ask the House to please make her welcome.

Hon. A. Charbonneau: I have the pleasure of introducing some friends from the Kamloops region, Joyce and Al Stratton, who are here to see the buildings for the first time.

F. Randall: In the gallery this afternoon we have Joan and Fred Hess. Joan is president of the Burnaby Arts Council and purchased a trip to visit the Legislature and have lunch with the MLA for Burnaby-Willingdon, who is the hon. Speaker, as part of an event to raise money for the new arts facility in Burnaby. Would the House please make them welcome.

E. Barnes: I would like to ask the House to join me in wishing a happy birthday to someone who was sort of my twin for most of the year. We were both 63, but two days ago he got ahead of me and he's now 64 -- the hon. member for Okanagan-Vernon. Perhaps he's already been given his due respect by being wished happy birthday, but I wasn't here if he did. If he hasn't been, why don't we now wish the hon. member a two-day-belated happy birthday together.

Hon. E. Cull: I see in the gallery today Mr. Chris Causton, a councillor with the grand city of Oak Bay. I would like to ask the House to make him welcome.

Oral Questions

B.C. HOUSE AND TOURISM IN THE QUEEN CHARLOTTES

C. Tanner: I have a question for the Premier. On Saturday, July 17, the influential Financial Times of London had an

article extolling the Queen Charlotte Islands, which ended: "All in all, I cannot think of any place on earth more worth visiting." Unfortunately, the author also said that when he phoned British Columbia Tourism at No. 1 Regent Street in London, they said: "But nobody goes there." The question for the Premier is: will the Premier recall Mark Rose from London and replace him with somebody who will promote British Columbia?

Hon. M. Harcourt: I am sure that if they had contacted the Hon. Mark Rose, our agent general over there, he would not only have invited them to the Queen Charlottes, he would have given them the travel information and probably even helped them book the airplane to come here. I think what happened is that they got the numbers confused and actually called Newfoundland.

C. Tanner: Mr. Premier, the

article was 19 paragraphs long by a highly respected writer. It promotes our beautiful Queen Charlotte Islands, and B.C. House was unable to help. Not only was B.C. House unable to help, in fact, it degraded our tourism asset. How does this government justify paying Mr. Rose his third or fourth government income if he only hinders promotion of British Columbia in London?

Hon. M. Harcourt: I will take that

article under advisement. If it is true that that sort of information is being passed on, we will certainly act on it. When I visited the Queen Charlottes two years ago as a tourist, they had people coming from all over the world.

Interjection.

Hon. M. Harcourt: As a tourist, with my family.

I can tell you it is a beautiful experience, and people from all over the world are visiting there. I'm quite surprised by that information, but I will follow up on it.

B.C. RAIL LABOUR DISPUTE

L. Hanson: Just as an aside, the Premier might get Mark Rose to play his trumpet. It would help promote British Columbia.

My question is to the Minister of Transportation and Highways. Ray Callard, chair of the Council of Trade Unions, says that B.C. Rail employees are not going to bow to the belief that they are public sector workers.

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The Korbin commission has defined them as just that -- public sector employees. Can the minister confirm that his government regards B.C. Rail workers as public sector employees in the sense that Ms. Korbin defined them?

Hon. A. Charbonneau: I'm pleased to confirm that the employees of B.C. Rail are public sector employees.

L. Hanson: Excessive public sector wage increases ultimately hurt the communities most dependent on the services they provide, and B.C. Rail is a perfect example of that. Has the government instructed B.C. Rail to cap its wage offer at 2 percent, which is slightly higher than the average for private sector settlements since last fall? Can the minister confirm that a directive was given to the board to that effect?

Hon. A. Charbonneau: Coming from someone from the previous administration, which set all-time high records for settlements in the public sector of 7 percent each year over four years.... I'm astounded that you would have the nerve to stand up and ask the question. However, I would remind you that we do not carry out bargaining in public.

The Speaker: Final supplemental, hon. member.

L. Hanson: With the legislation before us, I would dispute that claim about bargaining in public.

The minister claims that the caboose issue is the main sticking point in the dispute. Both labour and management say that the only real issue is the wages, especially the extra cost-of-living allowance demanded by the union. Has the minister met with the union reps to convince them of the need to hold all public sector wage increases at or below those of the people who pay for their services?

Hon. A. Charbonneau: As minister, I do not bargain in this wage dispute issue. The negotiations would be carried on between the management of B.C. Rail and their unions.

[2:15]

COST OF PREMIER'S TOUR WITH AUDREY McLAUGHLIN

F. Gingell: The Premier is quoted as saying that the costs for his summer with Audrey will not be paid for by B.C. taxpayers. Does this mean that the Premier, while spending his time helping Mrs. McLaughlin take her approval rating from 5 percent to perhaps the low double digits like his own, will be on leave of absence, or will he be on vacation?

MOTOR VEHICLE SALES TAX

L. Stephens: The government budget in March increased taxes up to 10 percent on luxury passenger vehicles, and the sales tax trade-in was eliminated. These changes were estimated to produce $56 million. Dealer sales are down, and the Motor Dealers' Association estimates that the province is losing $63 million. People are avoiding the dealers, and they are cheating on their declaration of value for licence transfers. To the Minister of Finance: how much of this expected additional tax revenue does the government estimate has now been lost?

Hon. G. Clark: I am pleased to inform members that in the month of May, car and truck sales in British Columbia were the second-highest in the country, and in June they were among the highest.

L. Stephens: I'm sure the Finance minister has not seen the accurate estimates from the dealers themselves. If he looks at the comparison between April, May and June of 1992 and the same months of 1993, he will find that the number is more like 26 percent down on average -- domestic.

The tax measures in the budget are driving people to fraudulently declare a reduced price on vehicles purchased privately. Will the Attorney General commit to stop this abuse of vehicle registrations?

Hon. C. Gabelmann: If there is any abuse occurring, of course we would move to stop it. If there are particular instances that have not been drawn to the proper authority's attention, I would appreciate the member helping us do that.

The Speaker: Final supplemental, hon. member.

L. Stephens: To the Minister of Finance. The government and the Motor Dealers' Association has a joint working committee studying the issue of the curber market. The question to the minister is: will the minister take action to bring the curbers under the umbrella of the legislation affecting the dealers, or will he remove the punitive taxes on vehicle sales?

Hon. G. Clark: The dealers suggested to the government that some $50 million in lost revenue is a result of not policing private sales. As a result of the work done by the joint technical group of the Ministry of Finance and members of the industry, it was agreed that that statement was simply wildly exaggerated. In fact, the number that was mutually agreed to is around $10 million in tax loss.

In other words, we have the most effective system in the country except for Ontario. Ontario's system requires members to get an evaluation. Anybody who declares a value has to get a private evaluation. I don't think that kind of draconian measure is required in British Columbia, but we have agreed -- as I'm pleased to inform members -- to put on more auditors to police this situation. The gains to the taxpayers are much more modest than were previously estimated by the industry itself.

COMPENSATION FOR HIV-AIDS FROM BLOOD SUPPLY

L. Reid: My question is to the Minister of Health. On June 16 this minister resolved to finally settle the

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HIV-contaminated blood issue in this province. A month has passed. What has happened to those individuals who are waiting for you to resolve this issue?

Hon. E. Cull: I am pleased to be able to announce that my staff and others from the government have met with the B.C.

chapter of hemophiliacs, and we continue to do so to come up with a negotiated agreement. That was my commitment on June 16, and those people are working to do that as quickly as they can.

L. Reid: I would suggest that the individuals who are HIV-infected have a vastly different sense of urgency at the present time than your bureaucrats, who believe they will not have another meeting until the last day of August. That is not acceptable. We have people who cannot pay their mortgages and are currently dying. What is your response? Surely there will be money in their hands prior to August of this year. Will you commit to that today?

Hon. E. Cull: I have instructed my staff to move on this as quickly as possible. If any delays that are happening are the responsibility of our staff, we will change that. But they know that this is a high priority, and we have committed to negotiating this with the B.C.

chapter of hemophiliacs. This is not something that can be done in one meeting or overnight. We are dealing with millions of dollars and with a very complicated submission from the hemophiliacs themselves. But I have committed to doing that without being tied to the federal discussions, which are also underway at this point.

JUNEAU-ATLIN ROAD PROPOSAL

D. Symons: My question is to the Minister of Transportation and Highways. The Alaska government recently asked the hon. minister for permission to conduct a study for a possible road link from Juneau to Atlin along the Taku valley. Such a road would provide transportation access to thousands of square kilometres of British Columbia's northern area at minimal cost to taxpayers. Why did your ministry reject this request without at least some public input?

Hon. A. Charbonneau: The area in question is an extensive area of wilderness. The difficulty in building a road up to the Taku valley is substantial, and there would be substantial environmental impacts. There are members of an aboriginal nation in the area who have stated that they oppose this. If the member opposite is suggesting that the province of British Columbia should contemplate the expenditure, ultimately, of $250 million to $300 million to build a road to service some residents of Alaska, I would like to have that suggestion put forward publicly.

D. Symons: Since the study was going to be done by Alaskans, at their expense, there would be no out-of-pocket expense for British Columbia, and the economic potential for the area and the province should be taken into consideration. Access could lead to significant mining developments in that area that would generate tax dollars and jobs for people in this province. Land use decisions for areas as large as this shouldn't be made without prior public consultation. Was anyone consulted prior to this decision being made? Was the mining industry consulted? Was CORE involved?

Hon. A. Charbonneau: For the information of the member opposite, the mining possibility is a few kilometres inside the Alaska border and could be accessed much more easily from the water side.

MINISTER'S STATEMENT ON B.C.'S ECONOMIC PROSPECTS

L. Fox: My question this afternoon is to the Minister of Economic Development. In a recent interview the minister was quoted as saying that "'we might not be able to have the dream' of an ever-increasing, higher standard of living." Is this incredible statement the formal position of the Minister of Economic Development?

Hon. D. Zirnhelt: I would encourage that member to read the Brundtland report and the round table reports on the sustainability of some of our practices. I attended a press conference and commented that we may not be able to see our standard of living increase forever at the rate it has increased over the last three decades.

L. Fox: In the same July 7

article in the 100 Mile House Free Press, the minister was quoted as saying: "No one is going to star in economic development during a recession." We know that the minister is not a star by any stretch of the imagination, but is he telling his constituents that British Columbia is now in a recession?

Hon. D. Zirnhelt: I was in 100 Mile House, and I attended the groundbreaking for a new oriented strand board plant. As we come out of the recession, which we are doing slowly, there will be more start-ups. But my point is still that when an economy has been in recession -- and I am looking backwards a bit -- you can't expect there to be a lot of start-ups. I am trying as hard as I can, and this government is trying as hard as it can to encourage anyone who wants to start up a plant. But you know that when you are in a recession, which we have been, there aren't a lot of plant start-ups.

As you start to come out of a recession, there is more activity, and I think that pattern has been repeated.

Interjections.

Hon. D. Zirnhelt: Well, the naivety of the opposition is coming out.

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PROTECTION OF PATIENT PRIVACY

Hon. E. Cull: Earlier this week I took a question on notice from the member for Richmond East, and I would like to now give a reply.

The member referred to a letter sent by the Medical Services Commission to a physician seeking patient information and citing

section 34 of the Medical and Health Care Services Act as the authority for the request. The letter is part of an audit and inspection process for diagnostic facilities developed under

section 34 of the act. This process is designed to ensure that diagnostic facilities are billing the Medical Services Plan appropriately, and that public funds are being expended in a proper manner.

The letter was sent following an on-site audit of a diagnostic facility, and it is intended to verify that the physician actually ordered the tests and received the results. The letter does not request any information from the patient's confidential medical records, but only confirmation that the work was requested and performed. The letter is not part of a random inquiry or cost study, as was suggested, but is an important step in an audit process to ensure that public funds have been properly spent.

Given that over $380 million is spent on diagnostic services each year, I am reassured that the Medical Services Commission has a system in place to ensure that the system is being billed appropriately.

Presenting Petitions

H. Lali: I would like to present a petition on behalf of the Pavilion first nation, bearing 69 names, stating: "We, the undersigned, want a new school built at Pavilion reserve to replace the one that burned down."

Ministerial Statement

WHITE PAPER ON FAMILY AND CHILDREN SERVICES

Hon. J. Smallwood: I rise today to table a White Paper entitled "Making Changes: Next Steps." This document responds to the two reports delivered to the Premier and myself last December by the community panel on B.C.'s family and children services. The report stressed that we need a system based on proactive support for families under stress rather than crisis intervention; a system which fosters community involvement in family support and the well-being of children; and a system that recognizes the need to return responsibility for aboriginal child welfare to aboriginal communities.

Across the province, families, children and community groups have asked us to enhance the welfare of children in their own homes, to recognize extended families and kinship relationships where possible and to promote reunified families when temporary placement of children is required. I am proud to say the ministry is already proceeding in those directions.

However, fully implementing the community's wishes will require new legislation. It has been 12 years since the B.C. government passed the Family and Child Service Act. Much has changed since then: our society is more ethnically and culturally diverse; single-parent families are more common; aboriginal communities are reaffirming their status as nations; and our knowledge of family violence has grown dramatically. Many changes requested by the community panel have already impacted ministry policies and programs. But comprehensive changes will require new legislation.

Communities and governments must have a legal tool to safeguard and strengthen our families, because a stable family is a child's most important resource.

This document is therefore submitted as an interim measure before tabling new legislation, to encourage public dialogue and comment. It outlines the shape of a new family-centred legal framework based on recommendations by the community panel. It raises those questions which must be properly and publicly addressed before the introduction of new legislation.

Principles outlined in this White Paper are consistent with this government's commitment to work towards the empowerment of people and communities. This document echoes the themes of "New Directions for a Healthy British Columbia," announced by my colleague the Minister of Health following the Royal Commission on Health Care. My colleague the Attorney General recently tabled a report by the family justice review working group, which also advocates a client-centred focus. These initiatives form the government's strong response to the wishes of British Columbians, who clearly state their desire to implement local decision-making and problem-solving.

[2:30]

Over the coming months I hope all members of this House and concerned British Columbians across the province give due consideration to this White Paper and continue their involvement in this exciting approach to developing new legislation.

Hon. J. Smallwood tabled a White Paper entitled "Making Changes: Next Steps."

V. Anderson: I wish to thank the minister for providing the White Paper ahead of time, so that we were aware of it. It is a paper that we've been looking forward to. We know it has been in process for some time and that the community has been involved in it. They have been waiting anxiously for it to come forward. They were afraid that the House was going to prorogue for the summer without it coming forward, so they will be delighted to know it has now come.

I'm delighted, as the community is, that families are being put first, that the services of government are being focused on the needs and the response to families, and they it will become proactive in prevention rather than doing crisis intervention after the fact. I think the community is pleased that there will be directions in community involvement. Certainly the aboriginal community is appreciative that at long last there is recognition that they can carry out their own responsibilities. We realize that new legislation will need to come forward, and we will have an opportunity to interact with the White Paper on that legislation in due course.

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One comment I would like to make is that sometimes we think as government that we are doing something to empower people. The reality is that we may be doing something not to empower people, but to cease taking power away from people. They will empower themselves, and we will simply support them in what they are doing if we're not, as has often been the case, preventing them. I commend the minister and the government for bringing this paper forward, so that we can respond to the community. The paper itself is a response to previous community interaction and will enable more interaction to take place.

H. De Jong: I'm pleased to rise and represent the critic for Social Services from the Social Credit caucus. I appreciate the minister bringing forth this White Paper, which has been roughly described in her statement. I suppose that this is a reply to the great response to a statement that the minister made earlier about the abolition of private adoptions.

We've seen similar attacks made on the family, even though we all stand on this platform from time to time and say how great families are and how important family strength is, and how family strength relates to the community and to the Canadian nation as a whole. We have seen the attacks on the family by the government taking away a small bit of money from some people in British Columbia who do not agree with the B.C. curriculum and want a choice of education for their children. People are getting more and more fearful of a government that is taking little bits of money away which really build a strong family.

The minister referred to the more ethnically and culturally diverse society. We have a similar situation whereby some legislation this year -- and that should also have been in a White Paper -- stifled communication between the cultural groups in British Columbia, instead of enhancing discussions between cultural groups to become real Canadians. Those kinds of actions by the government are the kinds of things that people are very suspicious of. That's why the people spoke so loud and clear against the statement that the minister made about the abolition of private adoptions.

I applaud the minister now for bringing forth this White Paper, and I hope that the communities throughout British Columbia will respond very strongly to this White Paper for the guidance of government for future legislation.

Orders of the Day

Hon. G. Clark: I call committee on Bill 45, hon. Speaker.

HEALTH AUTHORITIES ACT, 1993

(continued)

The House in committee on Bill 45; E. Barnes in the chair.

section 2.

L. Fox: I have a question on

section 2. Earlier the minister suggested that the elections to replace these interim appointees would happen in 1996. My question with respect to

section 2 is: why would there not be some time frame in the act which suggests that? Also, why is there not in this

section how the transition will take place between this interim body and the newly elected body?

It's an important issue, because I think the minister would agree with me that the individuals who get appointed to this structure will have an advantage at election time, should they choose to run. They will have been part of the structure for the better part of three years and will have an advantage, should they decide to seek election in 1996. Perhaps the minister could address those issues for me.

Hon. E. Cull: In regard to the second part of the question about why there isn't some transition in here about how the people on the interim boards will go on to the final elected councils, that will be in the permanent legislation. Part of that will be determined by what the permanent legislation looks like. If we were to try to put it in here, we would have to know what that was going to look like. We have this transitional legislation so that work can take place.

The reason we haven't put any timing in here is that I expect to bring forward legislation in the next session of the Legislature, or at least in the spring session next year. But I don't have a crystal ball; if some unforeseen event comes up and we're spending more time working through with the communities, it might be a year later. If we were to put in a sunset clause -- because that was one of the things that I'd initially asked about -- I was advised by the lawyers that we would then have to put in a lot of legislative material to provide for the winding down of these bodies, which is not intended.

It's just intended that there be transition. It's simpler to deal with it in the next piece of legislation.

L. Fox: I guess the only observation I have is that by not limiting this to November 1996, as the minister suggested earlier, in fact this legislation allows the appointees to be there longer than 1996. Subsequent ministers or governments may interpret it as something which allows them the flexibility; and it gives no assurance to the people that this is truly an interim structure. I guess if the minister is prepared to state now for the record that it is the intent that these appointees at the respective levels would only be there until the civic election time period of 1996, then I could be comforted.

Hon. E. Cull: It is clearly the intent of the government that in 1996 there will be direct elections to these councils, so legislation will have to be brought in between now and the fall of 1996 to allow that.

I might also point out to the member, in terms of his fears, that this legislation is not prescriptive; it doesn't force anyone to form a council. As the minister, I can't dictate that a council be formed. It is entirely voluntary. With the tremendous discussion that has gone on in communities about the approach we're going to take,

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should our or any government try to back down on this, you'd find that the communities would not voluntarily go down this road. This is voluntary legislation, so there would be no means to force them.

D. Mitchell: The explanatory note to the bill says that the bill creates the framework within which the transition process will proceed until 1995. This

section 2 of the act, which describes the purpose of this very important bill, says that the act will create the first stage. I know this was discussed during second reading stage in the minister's remarks, but just for clarification in the committee here, and following up on the questions of the member for Prince George-Omineca: if this is the first stage, could the minister talk a little bit about the time frame, how many stages there are and where this is going? The explanatory note says that this bill creates the framework until 1995 only, but because it implies that there are other stages, could the minister describe that briefly?

[D. Streifel in the chair.]

Hon. E. Cull: I am going to be very brief on this, because this was discussed in second reading. The intent of this legislation is to be enabling and very flexible, to allow those communities that are right now in the process of forming community health councils and regional health boards to have a legislative framework to do so. We want those communities to do this quickly, to have some time to actually operate and sort through the problems, so that we can use them as pilot projects.

We can't simply create pilot projects without any legislative framework to do so, so we're doing this to allow those ones to start; they're essentially going to be pilots. After they have been in place for a period of time, we will then be in a position to write legislation that will be far more prescriptive in terms of the voting structure, the responsibilities of the councils, the boundaries, how they're set, how they're mediated, etc. This legislation is there essentially to allow those pilots to get started, so we can go through this learning process that has to take place.

L. Reid: Specifically, after the creation of these regional boards, how will they impact on the subcommittees of the Medical Services Commission that we currently have in place in British Columbia?

Hon. E. Cull: There will be no impact on them whatsoever.

[2:45]

L. Reid: I appreciate the minister's comments in terms of the necessity to create a legislative framework for a pilot. We have some concerns about where we take that in terms of evaluation. I know we will touch on that in more detail as we move through the act in terms of where we're going and whether or not there will ever be an opportunity to evaluate the pilot. I understand that you want this legislation to go forward to enable some framework to be put in place.

Because we have concerns about the future of this, once this legislation goes forward, we have serious concerns about evaluation and measuring outcome. When creating the purpose of the act, have you given any thought to the next step and what the next piece of legislation will look like? Based on the purpose, what are we to expect? Will the purpose remain the same for the duration until we reach 1996, as outlined in your explanatory note?

Hon. E. Cull: The purpose of

section 2 is to make it clear to any reader that this act is temporary; it is just the first step, and subsequent legislation is coming along. I've used the word "interim," and that's exactly what this

section is intended to convey.

V. Anderson: I understand the purpose is to explain the structures of regional and community health boards, but we generally think of a purpose as more than just the construction of a framework. It has a purpose to accomplish something that these community health boards will be putting into place.

What I'm trying to get at is: does it replace the present community health services -- community health nurses, public health nurses and public health programs? Are we expecting these community health councils to replace the present services that we have? We talked about it replacing hospital boards, but will it also replace all the other different facets of health care in the community?

Hon. E. Cull: It won't replace all of the services, but that is dealt with more extensively in the sections we're coming to. This section, which is entitled "Purpose of this act," does not describe the purposes of a community health council model or any of that. It simply says that this act is interim.

V. Anderson: That's part of the concern that we have. We're creating a new structure for a purpose. What I hear the community asking is: "What is the purpose for which the new structure is created?" Does it mean that all community health decisions are going to be made in the community and that this council, which is fundamental in the purpose, is responsible not only for hospital and clinic care but also for all the health-related care in a community?

Hon. E. Cull: I would suggest to the member that that question is better answered under sections 3, 5 and 15. They deal with the purposes of the boards and councils.

The Chair: Hon. member for Sunshine Coast-Powell River -- or Powell River-Sunshine Coast. It depends on whether you are coming or going.

G. Wilson: Thank you, hon. Chair. Some would say it depends whether you're coming from the north or the south.

The Chair: My apologies, hon. member.

G. Wilson: Right. The truth is that if you live there, everybody's coming there, and if you don't,

[ Page 9061 ]

everybody's going there. Either way, it's exactly the place to be.

Section 2 is what we're really here to discuss. I'm sorry I had to step out for a few minutes. If this has been answered, I will take my seat. I notice it says: "This act creates the first stage in the establishment of...." It's the question of the first stage that I'm interested in hearing about. Recognizing that we can't talk about future policy, or where we may be headed, the fact is that in terms of the purposes, this

section of this bill talks about the staging of this system. Could the minister tell us what the completion of that first stage is likely to entail and where we are headed after that?

Hon. E. Cull: We did just have that question asked and answered, but very briefly, as the member knows, this is interim legislation intended to be replaced with permanent legislation once the communities that will be piloting the various models have done so sufficiently for us to draft the legislation.

K. Jones: The minister says in the act that this is the first stage. Just how many stages are there?

Hon. E. Cull: Two.

Section 2 approved.

section 3.

L. Reid: I wish to spend a few moments this afternoon discussing

section 3, and specifically

section 3(3): "The minister must ensure under subsections (1) and (2) that health services in British Columbia continue to be provided on a predominantly not-for-profit basis." We are looking at this section, and we're believing that the provision of this service and the evaluation of it will rest with the Minister of Health. We have a concern about that. We have a greater concern, which has been shared with us by the B.C. Pricare Association, the B.C. Association of Private Care.

In their correspondence, they suggest that they are encouraged by your reassurances and support of the private sector and that there will not be massive shifts in the existing mix of private and public health care providers. They go on to question the term "predominantly" in that clause, because they believe -- and as I would read from your correspondence, you also share the belief -- that we need to have both options available in the province. That's their position, and you appear to support that position.

They write: "We appreciate your commitment and support of the private sector, and if the ministry is reluctant in deleting clause 3(3), perhaps you can consider wording that entrenches the principle that both the private and not-for-profit sectors will continue to be used to deliver health care services." I don't have any particular issue with the wording that they have provided.

I would move the following amendment, notice of which has been given to the table: "The minister must ensure under subsections (1) and (2) that health services in British Columbia continue to be provided by both the private and the not for profit sectors." The message is very clear in that it appears on paper that you do support that position, and in fact the wording in the act, under 3(3) -- "a predominantly not for profit basis" -- doesn't necessarily reflect the reality of where we are today. We have not-for-profit groups and facilities engaged in that kind of care delivery. It's only prudent to recognize the reality of that, and I would ask for your response on that particular amendment.

Hon. E. Cull: There was a great deal of consultation on this act, particularly around this section. For that reason, while I don't disagree with the intent of what the member is expressing, because it's very much the same as what I'm expressing, I am not prepared to amend this

section because of the considerable consultation that went into arriving at this wording. But if I may explain, because the positions we hold are not too different on this, we do not want to use this legislation as a means of changing the mix of private, for-profit and public non-profit services and health care. There is a mix right now. It's weighted in terms of public sector, as is common with health care, but we do not intend to use this legislation as a way of changing that balance in any respect -- in increasing the public nature of the health care system or in increasing the private nature.

Both the public sector and the private sector have an important role to play in providing health care.

There is room for all kinds of debate in the future as to what the appropriate mix should be, if it's not the mix we have right now, and whether it should move more in one direction or the other. But we did not want that debate, which would obviously be very lengthy and emotional, to be a part of this legislation. This

section says, in language that has been through a number of different meetings and consultations, that we are not intending to change the mix of public sector and private sector as a result of this legislation. When Pricare received my letter, they understood that and were appreciative of the support that I have always given the private sector with respect to the work they do.

L. Reid: What this individual and this association is looking for is some recognition of current realities. They are not looking for a change. That is not their intention, and they have not stated that.

As for your comment regarding consultation, they thank you in their correspondence for the consultation prior to the formal tabling of this act. However, there is one new clause that has been added which causes their membership serious concern. Were they consulted about this new clause? They would say no, they were not part of that consultation process. Was it complete and thorough consultation? Again, they would suggest not. They appreciate the fact that what they saw was not the entire package. They wish to have this

section debated. It is not about changing the mix of private care and public care. You and I agree on that point. It is about recognizing the reality of the current mix that we have in British Columbia.

This is not anything that moves away from accepting the significant role that companies and other areas in health care currently play. We all have private care

[ Page 9062 ]

facilities in our ridings. They play a significant role, and I don't think anyone would disagree with that. They wish the language of this act to reflect the fact that they play a significant role. I do not see that as something that would not receive support from the majority of members of this House. We could not survive without the current care providers we have in place throughout this province. We recognize that reality as an opposition. We trust that the minister will recognize that reality in the wording of this particular amendment.

Hon. E. Cull: Unfortunately, the amendment put forward by the member simply says that the services will continue to be provided by the private sector and the not-for-profit sector. You could dramatically shift that mix so that 99 percent of the services are provided by the not-for-profit sector, and 1 percent are provided by the private sector, and this amendment would not be violated. This amendment only says that there will be two players: private and public. It doesn't say that there will be any particular mix. It doesn't say there won't be a shift; it doesn't say there will be a shift. It's silent on the shift.

Section 3(3) says that the mix that exists right now, which I don't think anybody would disagree with, is predominantly not for profit and will stay as it is.

[E. Barnes in the chair.]

L. Reid: If the minister doesn't wish to recognize the current realities, we must accept that, but in the final analysis they play a significant role in the delivery of health care in this province. You stated earlier that it is not your intention to use this legislation to change the current balance. It is not the intention of private care providers in this province to change the current balance. They simply wish to be recognized for the services they provide. I don't believe that's asking too much.

Hon. E. Cull: The section, as it is worded in the act, recognizes the current situation, which is predominately not for profit. The amendment is a very poor amendment, because all it says is that there will be two players. It doesn't say whether the mix will change or not. It's unacceptable on this basis

K. Jones: The amendment is very evidently trying to make this

section of the act state the practice and desire of people who are presently in the health care area and say that they should have some assurance that they are not going to be taken over by government. When you say "predominantly not for profit," that means that the majority of it will be not for profit. That could be 99 or 100 percent pure not for profit, which is generally the trend of this government: to take everything into government control. That has been its practice in the past, both in this House and in other parts of the country. That's why the fear is out there.

When you put in predominantly not for profit, people take you at your word, and that generally means that you are going to move everything in that direction. I think that is very good justification for allowing this amendment to come forward, if that is not the direction you are going in. If you do not intend to go to an almost completely government-run, government-owned, eliminating the private sector process, then you have to make this change and accept this amendment. This amendment will be fair and will indicate that you are fairly looking at continuing the balance of government and private participation in the health care program.

[3:00]

[D. Lovick in the chair.]

Hon. E. Cull: I urge the members opposite to read their amendment. Their amendment says that the services will continue to be provided by both the private and the not-for-profit sector. Under this amendment, a government could change the mix to 99 percent and 1 percent, and still meet this amendment, which says there will be both a private and a public sector. That is not what we are trying to do here. We want to say we are not going to have a shift. If the member does not know that the present health care system is predominantly not for profit -- and it is more than 50 percent; the private sector is very small -- then I think he needs to do some more research. But

section 3(3) says that the services will continue -- as they are now -- to be provided on a predominantly not-for-profit basis. I submit that if we accepted this amendment, we could change the mix, and we do not want to do that.

K. Jones: The present amendment -- yes, you're right -- could be taken to 100 percent not for profit, or it could be a 100 percent profitable or privately operated. But it gives an indication that there is a willingness to look at opportunities for private as well as public operations. The way this bill is written does not give that indication. In fact, it indicates that the minister plans to move predominantly to the not-for-profit, away from private operation. It is a typical NDP government that says: predominantly, the government will run everything.

L. Reid: The minister will make the point that this amendment would allow the shift. Let me share another concern from Pricare with you. Individual members have been concerned that regionalization and community health boards could eliminate their services purely because of an ideological preference for non-profit providers. How would you respond to that?

The Chair: Committee members, through the Chair, please -- the word "you" should be expunged from our vocabularies.

Hon. E. Cull: There could be equal fear out there on the part of public sector service providers that community health councils could change to a predominantly private, for-profit system for ideological reasons. We do not want the governance system to dictate a change in the mix of private and non-profit -- the balance it is in right now is serving this province

[ Page 9063 ]

quite well. This

section is here to say that the system will continue as it is now, predominantly not-for-profit.

Section 2 approved.

section 3.

The Chair: The hon. member for Powell River-Sunshine Coast.

G. Wilson: Hon. Chair, I was going to say thank...but I can't use the other part of that salutation. Having expunged "you" from my vocabulary, I will just say thanks, hon. Chair.

Section 3(2) says: "The minister may, by regulation, specify a health service, or the level or extent of health service, that must be provided in a region or community." The use of "must" is pretty strong. If it said "may," then clearly a distinction is there that one could look at. But there's a specification of "a health service or the level or extent of health service...." Perhaps the minister might tell us: what is the range of health services that this minister may be empowered to demand a region or a community provide?

Hon. E. Cull: Allow me to use a rather extreme example that I think will illustrate the point. We will ultimately be giving global budgets to regional boards. They will be getting the budget of the hospital within their region. We could not give that budget over to the regional health board and have the board decide that it was no longer going to provide acute care services, but instead it would keep all the money for the hospital, thank you very much.

So the intent here is that when the money goes to those communities, there will be services established that will be very general, along the lines of the services that we now establish when we give a hospital board its global budget. We don't just give them $200 million and say: "Here, please run your hospital however you see fit." There are conditions, and things they are required to provide, and we have to be able to set some provincewide standards.

Another example -- and then I will sit down -- is that in giving over the money to communities, we could not have communities say: "Our children are not involved in any dangerous activities; therefore we don't need any sexually transmitted disease clinics in our communities, and we will not fund them." I would hope no community in British Columbia would do that.

But as I said, I've used two extreme examples here to illustrate the point that we do have to set some basic standards for acute care services, public health services and basic services in community and family health: mental health, alcohol and drug, and the other services that we provide under that. But if you're suggesting that we might be talking about the kind of speech pathology service that would be provided in a region, that would not be within the purview of the services that would be standard and set by the minister.

You were absent from the House earlier when we talked about this, but the intention is to provide a balance between local autonomy, enabling communities to determine how to organize themselves and what services should be delivered, and the guarantee that the province must provide to a citizen of this province that no matter where they live, they can expect a basic level of health care services that are in keeping with the size of the community they live in. Where you live doesn't determine whether or not there are mental health services.

G. Wilson: The minister addresses that issue in a manner that puts a finger on one of the concerns that has been expressed to the Liberal opposition, and that is the provision for specification -- and I know we can come back and discuss that in a moment. The concern is that under this act the minister could demand that services be provided for which funds may not necessarily be adequate or available. I wonder if that's the case in terms of the provision of this basic health care.

I don't take issue with what the minister just said, but it might be more prudent to say that if there's going to be a provision for specification of health services that must be provided, only those for which there is adequate funding will be provided, especially in light of the commentary we just heard with respect to the maintenance of non-profit or publicly funded services.

Hon. E. Cull: The nature of the services that will be specified will be so broad that only if budgets were totally inadequate -- half of what they are now or something like that -- would they not be able to provide them. As I said, it will say things like acute care services, public health services, mental health services, and alcohol and drug services, but it would not specify the details.

Even within a hospital right now -- and I think that's the best example, because it's the only case where we really do good global funding -- we provide funding to a hospital, and we don't tell them that they have to provide a whole range of services which they simply could not provide within the budget they are given. We certainly don't say that they can meet their budget problems by closing their emergency ward or by saying: "Gee, we don't do babies in this community anymore." There have to be some basic services that are established.

The amount of service, the standard of service, the regularity of service and the hours that the service is available would all be variable to accommodate budget necessities.

L. Fox: On

section 3(2), when we look at 24 different regions, does the minister envision an eventual regulation for all those different regions? Or are the regulations going to be so loose that they will be able to be flexibly applied to all the regions of the province?

Hon. E. Cull: As I said, we're striking a balance in the expectations of a citizen of this province to be able to receive the same services in Prince George as she does in Kamloops or Kelowna -- being cities of roughly the same size -- or in a smaller community of 5,000 like Vanderhoof, Burns Lake or some of the other smaller centres in the province. People will be able to receive similar services there. The standards that will be set under this

section will be provincewide standards. It's

[ Page 9064 ]

not my intent to do the tailoring to individual community needs. That's what the community health council is there to do. It will be able to say: "Here are the standards we have to achieve; here are the resources we have to expend. This is how we're going to meet the needs of our community."

L. Fox: I want to go in a different direction, recognizing that this sets the stage for the later sections of the bill dealing with the regional health boards and community health councils. In the earlier discussion, the minister suggested that we would eventually see hospital boards done away with. Obviously, we will see regional hospital districts done away with. Given that those two structures played a major role in the capital financing of local projects, such as health board offices, hospitals or whatever, how does the minister envision using this

section with respect to that? The reason I ask is that over the last couple of years I have lived with the frustration of a community trying to get an extended care facility, while seeing other communities, in the same regional hospital district, get one they didn't ask for. How are you going to use the authority? Is this going to do away with the political decisions that we've seen in the past? Will it allow for some consistency in applying those regulations on a provincial level? Will we see the areas that are actually in need, whether regions or communities, get facilities based on the input of their respective boards?

[3:15]

Hon. E. Cull: I appreciate that the member is having some difficulty understanding how this is going to work, because this bill doesn't deal with capital financing. It quite deliberately doesn't deal with it, because there is a task force involving members of the Union of B.C. Municipalities, our ministry and Ministry of Finance officials to determine what to do about capital cost-sharing arrangements. Operating funds are and will continue to be paid entirely by the Ministry of Health, but capital facilities are cost-shared. There are a number of options being looked at right now.

I have made a commitment not to change the existing situation until that task force has come back to us with recommendations. It's going to take a little bit more time before that's resolved -- a matter of months, I imagine. So there is no change to the capital financing formulas under this legislation. It is absolutely silent on that and allows it to continue as it does. You pointed to some interesting problems, and I hope we are going to be able to address those through the work of this task force.

L. Fox: The Liberal critic put forward an amendment to

section 3 earlier. Now, I guess, we have

section 3 as it was originally drafted. Notwithstanding what the minister has said about maintaining the status quo in the delivery of health care services, I have a lot of concern with the word "predominantly" in that section. Given the fear expressed by some private labs that there was a thrust by government to take them over.... At least, that is certainly a well-circulated concern or rumour -- depending on what you call it. I would much prefer this particular

section being more certain about remaining with the status quo. I would be happy if the minister could assure me that this guarantees the status quo of those private sector services presently being provided to medical staff and hospitals, including lab and x-ray services and so on.

Hon. E. Cull: Hon. Chair, I've been discussing with my officials whether we can actually provide members with an estimate of the percentage of the health sector that is private. We don't have anything scientific over here, but we've just been thinking about the $6 billion budget, and we conclude that 10 percent private would be very high. So with the words "predominantly not for profit," even if there were to be a shift and a doubling or a tripling, those words would still cover this.

My intent is that there not be any change. I know you're worried that we are trying to squeeze it one way or the other. I'm saying that the amount is very small right now, and obviously there are going to be some minor adjustments in the short lifetime of this bill. We're not freezing everything and counting it up and making sure that all the private for-profit dollars are there at the end of it all or have not increased or decreased.

But we want to make sure that in the move, boards do not suddenly decide that they can make a dramatic change in the mixture, and that a council can't be established and decide that it's going to eliminate all of those private sector operators and not contract with them any longer or, conversely, eliminate all the public sector on contract. If we allow that to happen as a result of the establishment of the councils, we will be in a huge fight that will not end, and we will accomplish nothing productive under the councils. That's why we have to essentially freeze it where it is now.

That's why the minister is made personally responsible for ensuring that that happens.

K. Jones: According to the Baldrey predictions, after the cabinet shuffle your intent won't mean a thing. I think that's what we have the greatest fear of. You can have all the intent in the world to take a position or an

interpretation on this, but if you're not there and somebody else is there with their own intent, then the whole story is different. Isn't it?

Interjection.

The Chair: I will allow the minister to respond.

Hon. E. Cull: Well, I just have to say I'm flattered by the power that the member attributes to the minister. But I don't speak on behalf of myself; I speak on behalf of this government.

The Chair: The member for Surrey-Cloverdale -- in order, I hope.

K. Jones: With regard to

section 3(2), when you talk about being able to regulate and stipulate exactly what health services would be required in each of those

[ Page 9065 ]

areas, are you talking about schools and that you could order schools to provide certain services?

Hon. E. Cull: No, these are only the services provided by the health council or regional board.

The Chair: Just before I recognize the member for Surrey-Cloverdale, I can't resist the temptation to once again offer my brief lecture on the distinction between the second person and the third person. On the floor of the chamber when you are asking questions of the minister, you go through the Chair and you say: "Can the minister advise...? Will the minister answer...?" You don't say "you" to the minister. You can say "you" to the Chair, but you can't say it to the minister.

The member for Surrey-Cloverdale.

K. Jones: Thank you, you.

To the minister through you, since schools often have nurses and other health practitioners operating in them and have certain conditions and standards required for the schools set down by the Ministry of Health, is the minister saying that these will not come under the jurisdiction of these councils?

Hon. E. Cull: No, the services that are provided by health care professionals in schools are provided as part of the Health system, not as part of the Education system. So those would continue to be part of the Health system and would be part of the purview of a council or board.

K. Jones: The answer to the previous question, then, is yes, she will be setting the standards for the schools. That's exactly what she says -- that the schools are going to have conditions, which are being operated by the council, that are set by the Ministry of Health.

Section 3(2) allows the minister to set regulations under those conditions.

Hon. E. Cull: Where we provide services in schools such as dental hygiene, some school nursing services or alcohol and drug prevention workers, those people do not work for the school. They work for the health unit, in most cases, or for the Ministry of Health, or they are an agency on contract to the Ministry of Health.

Those services, if they are taken over by a health council, would continue to be provided by those bodies, not by the school. Standards and services are not set for schools; we don't set conditions in schools. We might set a standard for a region that there be a school-based alcohol and drug prevention program, but that does not set standards or services for the school administration. It doesn't come out of the Education budget or under the purview of the school board.

L. Reid:

Section 3(1) says: "The minister may, by regulation, establish Provincial standards for the provision of health services." If you are also going to be setting standards for the provision of those services, will we see a scenario where the person who sets the standard for the service is also the one who provides the service? I see some conflict in that situation, and frankly, it would be similar to teachers providing a service by coming in to do their own evaluations on their practice. What is your comment on that?

Hon. E. Cull: I would need more explanation from the member. I could not see how Ministry of Health staff who are setting standards would be in any way providing those services directly.

L. Reid: The act is being considered prior to any determination of what those standards might be. Would British Columbians ever have a concern that the standards will reflect the service being provided, as opposed to being a standard we should be striving for in the delivery of health care? Will the standards match the service? Are we on a drive to mediocrity in the delivery of health service? Putting both powers in the same individual certainly allows for that possibility.

Hon. E. Cull: A standard would be, for example, the target bed ratio per 1,000 population. I wonder if that is the issue in terms of your questioning, to get the idea of what a standard is as opposed to a service.

L. Reid: Will this minister be setting the standards for service as it relates to being the one who will also establish the evaluation? Will setting the provincial standard relate directly to the level of service that's established?

Hon. E. Cull: The standards are established by regulation. It's a ministerial function, not a staff function -- although, obviously, staff advise on the preparation of those standards. The standards will apply both to targets and perhaps, in some cases, existing things, because we have established targets and met them in some cases. We may not always be looking for changes in those targets. After we get to the 2.75 beds per 1,000, we wouldn't be wanting to move that. In some communities, they're well there.

L. Reid: For clarification, this minister will have the ability to set provincial standards for the provision of health services in British Columbia -- and that's taken right out of

section 3(1). What are some examples of current standards in place? What will happen with this new ability found under 3(1)? In what other areas will this minister be seeking to create standards that we do not currently have on the record?

Hon. E. Cull: Right now, all the standards set for health care in the province are set by the minister. So this is not a new authority; the minister has that authority to set standards right now. Another example would be the staff ratio for the long term care facilities -- you know, we have staff ratios for IC 1, 2 and 3. That's another indication of a provincial standard the minister sets now that we would continue to set.

L. Reid: That's exactly my point. The minister does have the ability to set the standard. My question relates to the new ability to now determine the program or

[ Page 9066 ]

service that's going to be provided. "The minister may, by regulation, specify a health service, or the level or extent of health service, that must be provided in a region or community." Will the service provided under 3(2) be independent of the decision taken to establish the standard? That is our concern.

Hon. E. Cull: We have the authority to do both of these things now. Right now the minister sets the standards and specifies services. We do this through direct decisions through the ministry, through our own staffing arrangements, through contract arrangements, and through directions that we give to hospitals and long term care facilities when we give them their budgets. All these things are already part and parcel of the management tradition of the health care system in this province.

K. Jones: With regard to

section 3(2) and the services, does that extend to private labs?

Hon. E. Cull: No, it doesn't.

K. Jones: Could the minister tell us how the council is going to establish services and standards without having some control over the private labs?

The Chair: Member, I just advise that, given the answer to your previous question -- that the private labs weren't covered -- the hypothesis about private labs that you've embedded in this question seems quite out of order to me. If I've missed something and the minister feels it would be relevant to answer, I'll give her the opportunity, of course.

[3:30]

Hon. E. Cull: I'll answer, in the hope that it will help in terms of future questions. This system doesn't cover every last health care service in the province. There will always be some services that are centrally administered and applied for and that do not come under the health councils: Pharmacare; the Medical Services Plan, which covers the labs; the Ambulance Service. It makes no sense to break down services which have a provincewide application into this kind of community and regional basis. That's why this doesn't have anything to do with private labs.

K. Jones: I'm glad the minister did answer that, because it does clarify that very clearly. Do private clinics run in the same category?

Hon. E. Cull: I'm assuming the member is talking about private medical clinics. It's a Medical Services Commission responsibility, not of these particular bodies.

K. Jones: Would a stand-alone clinic come under these regulations for setting of standards or provision of services?

Hon. E. Cull: No.

K. Jones: Therefore, under this provisioning regulation that could specify health services, the minister is telling me that she could not specify that a stand-alone facility would be required to provide an abortion service.

Hon. E. Cull: Yes. I am absolutely telling the member that the services provided in medical clinics -- and I assume he is talking about walk-in clinics or doctors' clinics -- are governed by the College of Physicians and Surgeons. They are not governed by this legislation. I remind the member that the services and standards that we are talking about here are only with respect to those services that will be provided by the community health councils and the regional health boards.

When we get to the sections of the act that talk about responsibilities, it will become very clear that they can only use certain acts to get their responsibilities. Those are: the Hospital Act, the Health Act, the Hospital District Act and the Mental Health Act. So those are the services that they provide. They do not provide services under the Medical Practitioners Act or the Medical and Health Care Services Act.

K. Jones: Under this

section 3(2), would the minister be able to order that every facility in the province that falls under the categories of ambulatory hospital facility, community hospital facility or full-fledged hospital facility would have to provide abortion services?

Hon. E. Cull: The responsibility of the minister with respect to hospitals and other like institutions is under the Hospital Act, not this act.

L. Reid: I move the amendment to

section 3 standing in my name on the order paper.

[SECTION 3, to amend

section 3(2) to read:

The minister may recommend a health service, or the level or extent of health service, that may be provided in a region or community.]

I believe that this amendment allows for some discussion of the respect we must have for the unique needs of some of the regions in the province. If indeed it is the minister's intention to move to the Closer to Home document to provide some of those services, are we somehow suggesting that during the life of this particular piece of legislation we will not respect the planning authority that this entire framework document is put in place to provide to those communities? The act currently reads that those decisions will be reached in Victoria.

That is somewhat disrespectful of the process, which this Minister of Health has suggested to British Columbians through the media and through the New Directions policy delivered to their door, that some of these decisions will be reached in those communities. If she stands by the documentation in evidence -- in almost anyplace you would care to look in terms of advertisements, brochures and the like -- that there is some respect for the decision-making process in those communities, then this amendment will stand. If that is not the case,

[ Page 9067 ]

this amendment will fail. I ask for the minister's comment.

The Chair: The amendment does seem to be in order, therefore I will ask the minister to respond.

On the amendment.,

Hon. E. Cull: Throughout the considerable discussions that we had on this concept, particularly during my tour of most parts of this province in March and February of this year, at almost every public meeting, people got up and expressed concern about the consistency of standards from one community to the next.

If we change this in the way that the member has suggested, which removes the ability to require that the level of service or the service be provided, and make it simply a recommendation, then this Legislature -- should they accept that amendment -- would be putting us in the position that we could recommend to a community that it have mental health services, and if they decided they did not wish to provide them because that wasn't a concern to them, then they could not be provided. I would not support such an amendment, because there has to be a guarantee to the citizens of this province.

As minister, I have a responsibility to guarantee to the citizens of this province that there will be some standards of services that they can expect in any community, notwithstanding the local governance of that community.

L. Reid: I would draw the minister's attention to the wording "specify a health service," and the comments the minister just made in terms of establishing a level of health service. Looking at establishing a level, your comment is well taken. We believe that that will happen under

section 3(1), where you are going to be involved with setting some provincial standards.

To specify a particular service seems to be disrespectful to the process of the direction in which you suggest this government will be moving. From your comments, I am not clear where you stand on this. It seems to me that specifying a health service is a dramatically different enterprise than setting a standard, and perhaps we don't need both. It seems to me that British Columbians wish to have the same level of service, no matter where they reside in the province.

We are not asking for a change in the standard. We are hoping to have some respect given to those communities that will be responsible for delivering these services as per the provincial standard. Surely there is some respect in the process -- which you have stated over the last number of months is your intention -- to have those communities reach those decisions. Has that position changed?

Hon. E. Cull:

Section 3(1) -- where the minister can establish a standard -- would give the minister the ability to set a staffing ratio for the IC-3 level of an intermediate care facility.

Section 3(2) would give the minister the ability to require that intermediate care be part of the services provided in that community. You can't establish standards for services that don't exist, and people want standards for services as well. These are two separate concepts: one is the criteria upon which the service will be provided; the second is the fact that the service will be provided.

If we make the amendment to

section 3(2) the member has suggested, it would remove the ability for a minister to specify that as part of the global funding provided to a region -- that they are expected to provide, for example, continuing care services to their elderly population.

The Chair: As I listen to the minister, I am almost convinced the amendment is out of order. However, having ruled already, I will recognize the member for Powell River-Sunshine coast.

G. Wilson: Your initial ruling was correct; take it on my advice and word. It is probably as valid as that which you may be getting from the minister.

Speaking in favour of the amendment, let me say that one of the reasons we have difficulty with the way it's worded.... I alluded to this earlier, and I think we need to move on to more of the meat and potatoes in this bill; if we can try and clear up this section, we can do that. The difficulty we have is that if the services are specified -- notwithstanding the fact that we all want to set standards, and I understand the distinction between the two -- we run the risk of providing budgets on a global basis that state that you must provide X number of services.

As generic or as broad as they may be defined, you may find within some communities that the provision of those services -- in any way that would adequately meet the demand -- may not be there.

If you have a community with a large number of senior citizens -- because of the aging process and the demand for intermediate care and those kinds of things -- they may demand a different set of services than a

[ Page 9068 ]

community made up of a large proportion of young families. For example, with a decentralization of existing services, as we have seen with the facilities for people with mental illnesses, you move those people back into the communities. Communities like the one I live in, Sechelt, don't really have adequate psychiatric or medical services -- notwithstanding what the minister says the hospital in Sechelt, St. Mary's, should provide. It's one of the best hospitals in Canada, according to virtually every report I've read. That hospital is going to find itself constrained in trying to meet the criteria that you're asking for in

section 2, if it is going to be held by what is required in

section 4.

I think that the amendment serves to recommend that there be a movement that way. It doesn't prohibit the region in any way from moving into those services, but it says it's going to allow these new regional bodies that you're creating a certain amount of flexibility in terms of how they apply those moneys in relation to what the real demand is within the community itself.

Hon. E. Cull: Actually, I think the answer to the member's question is within the comments he made. The very fact that we have communities which are different.... We could have a community with a very large, vocal and politically powerful senior citizens' population. We would not want to see that health council decide to eliminate children's services because they were a minority group and because the other group's demands were larger and could consume all of the money that was available.

The other part of the answer that I think is within your own remarks is that because of the very nature of the concerns around universality, by definition, the services that will be stipulated under subsection (2) are going to be very broad. They will be services that are defined in very general terms. As soon as we define them in very specific terms, we either run into problems of universality or regional flexibility.

The intent of this approach is to allow a community to provide services to all of its residents, but not to say to, say, White Rock: "You have to provide the same mix of children's services and seniors' services as we would expect to see in Prince Rupert, where there's a younger population." There will be different amounts and levels of services provided in the communities, and the standards and levels of services set by the minister will be broad, provincial-level services that will allow those communities adequate flexibility to vary and supplement them to meet the needs of their residents.

[3:45]

Amendment negatived on division.

G. Wilson: On

section 3(4), with respect to the provisions of the Canada Health Act and what has been provided under

section 2, could the minister tell us a little bit about what is meant by two particular areas: one is comprehensiveness, as defined and provided for in the act, and the other is universality. What does the minister see there, given that there are generally confused ideas as to what they mean?

G. Wilson: With universality, in terms of the entitlement of every insured member, we know that doesn't happen today in the province of British Columbia. We know that you might get the service, but you don't necessarily get it in your community. I think the minister would admit to that.

Hon. E. Cull: Universality doesn't mean that every service is provided in your community. Cancer treatment will not be provided in every community, but it is universally available to all citizens of B.C. We don't say that because it's not in your community, you don't get it. Some services are provincewide, some are

[ Page 9069 ]

subregional, some are regional, some are communitywide and, in fact, some are neighbourhood-based. The concept of universality is not tied to geography.

G. Wilson: If the minister accepts the reality of that, and in particular the fiscal reality of that, then why won't she recognize that the same level of flexibility with respect to regional funding should be in place? Why won't the minister accept that we have to have greater flexibility with respect to the provisions on a region?

Hon. E. Cull: We do accept that. In fact, later on, when we start to develop the global funding formula, you'll find that the funding will not go on a per capita basis to everybody in the region but will reflect the needs of the region. It will be adjusted to reflect age of the population and, I would hope, other things to do with health status. We're going to have to work our way through the global funding formula, so we will actually be able to recognize the differences in the population through our funding formula, because we'll expect communities to provide different services, as they do now.

Obviously, White Rock has more seniors' services than Prince Rupert, and some of our isolated northern communities should have more programs around injury prevention, substance abuse and mental health to deal with some of the problems that people in those communities face.

G. Wilson: That causes some concern, because this is the promise of the new global funding, and the minister is asking us to just wait and see. They're going to be able to provide, possibly on a less than equitable basis.... That's not fair, because that's not exactly what the minister said, so let me correct that and try to be fair. The minister said that they will not provide equal funding for each service in each region, and I think that....

Interjection.

G. Wilson: If not, maybe she could clarify that.

Hon. E. Cull: I'm going to just take a minute to answer this, because this information may also provide answers to other questions. One of the things that we're in the process of doing right now is striking a deputy minister's advisory committee, which has representation from all of the major stakeholders and people who are concerned about health care services in the province -- not only providers but also some advocacy groups and other groups that have a particular interest.

That group is going to be asked to do a lot of work with us over the next year, particularly with respect to developing regulations, working on legislation that will be coming forward next year, giving advice as to what it should look like and working on many of the different aspects with respect to things that still have to be finalized. Indeed, the global funding formula is just one of those things.

Right now, we provide global funds on an age-adjusted basis. We don't provide so many dollars per person for hospital funding; we do age adjusting and use other kinds of criteria where we look at the needs of the population. So rather than simply dividing up the dollars that are available in the population and saying that everybody gets $1,600 per capita or $100 per capita, whatever it happens to be, there is going to be some reflection of the needs of the community.

But that is going to be done as part of the process that we're engaged in right now, because the strength of our hospital funding formula this year is that we involve the hospitals in helping us develop it. We will involve the health councils and, in the interim, while the health councils are not up and running, these other bodies in helping us to develop that formula.

G. Wilson: That indeed is very useful information. Much of it we can canvass in other sections as we start to get at it, so I don't want to unnecessarily prolong the debate here. But in light of what was said, and in light of the provisions under the Canada Health Act in terms of the universality provision, is the minister saying that these new councils that will be established with respect to the standards...? This

section is supposed to be dealing with provincial standards; it shouldn't be dealing with services so much. That's what I'm hearing, although clearly the language provides for services to be determined. Is the minister saying that while those standards are set by the minister, there may be a difference in the way that each of the councils may try to provide those services, and therefore the funding levels will change, depending on whether one's looking at large institutionalized services within the hospital, dealing with small clinic-type services or dealing with neighbourhood services?

If so, then what guarantee is there that you're not going to have a council that is going to embark upon a new delivery system and not have the money to be able to provide for it?

Hon. E. Cull: The funding will vary with the needs of the community, not with the way in which the services are provided. The councils will have to find the most effective way to provide those services in order to meet the needs of their population. We're not going to get in there and tie their hands and tell them they have to do it this way or that way, or get into a lot of specifics about how they go about providing those services. The funding won't depend on whether one region provides it institutionally and another does it through a community-based service. Those communities will have to make the decisions about how best to provide the services to meet their needs.

When we look at global funding, we will do it the same way we do hospital funds right now. We look at the needs of the community and the needs of the population in that area, and try to adjust the funding so that it reflects those needs. I think we have to be very practical and recognize that the beginning of the global funding is going to be putting all the funds that are already out there in that region together into a pot and seeing what's there. We're not going to start from square one and dramatically change the funding that's

[ Page 9070 ]

available in a region. That could have terrible impacts on existing institutions, which will have to continue to operate.

G. Wilson: I think they could potentially do that. Much of what we're dealing with.... I recognize that we can canvass a lot of this in sections 6 and 7, but I don't want to lose my opportunity to deal with it under

section 3(4) with respect to the Canada Health Act, because that is the senior legislation that's going to ultimately determine to a large degree what can and can't be done. This body is not empowered to put in place or enact something that runs counter to the Canada Health Act.

My concern is that if you give this kind of latitude to these new councils and the minister is going to establish these standards, it is going to require that certain services be provided. Without giving any parameters to the details of that service -- because you want to keep it as broad as you can -- aren't we creating exactly the same problem we have with existing school boards right now? You're saying to the school board: "Here's a new curriculum. Here's the Year 2000 program. Here's the number of students you've got in your region, which you know.

These are the services, and this is the quality of education we want. Go for it!" Then the district says: "Okay, we've put in these new programs. This is the number of teachers we've hired; this is the number of kids we've got in school." They then find on an annual basis that their budget doesn't meet the needs, and the next thing you know you've got teachers on strike and kids out of school, and you've got problems.

Aren't we creating exactly the same kind of problem? What comes first -- the money? Then the council says: "Okay, now we have to cut our cloth accordingly." Or does the council have a certain amount of latitude and freedom to determine health care service delivery, and then does the government match the dollars to the services that they've determined are required? How's that going to work?

Hon. E. Cull: It will work very much in the way hospital funding works right now. The hospital funding is voted on by the Legislature, in terms of the amount of money that's made available to hospitals. So a provincial decision is made as to what the resources are that are adequate to provide for them. There is a funding formula that determines how new money will be distributed to those hospitals.

Certainly there's a lot of interest on the part of the industry to work with the ministry and look at base budgets to see whether anything can be done there. Essentially, we're not going to be turning to the councils and saying: "Dream up the best health care system in the world, then tell us how much you need, and we'll write you a cheque." Obviously the provincial budget will determine how much is available.

L. Fox: I want to ask one question that has come to my mind and is on the mind of some of the smaller communities in my constituency. It falls under

section 3(2), where it says: "The minister may, by regulation, specify a health service, or the level or extent of health service, that must be provided in a region or community." That led me and some of the people in the communities to wonder whether or not, within those regulations, there would be authority for either of these boards -- or perhaps both of them, depending on the level they're at -- to have control over the closure of acute care beds or over the phase-out of a particular initiative within a hospital -- for instance, pediatrics in St.

John Hospital in Vanderhoof, which is presently at 8 percent occupancy. Would that community council be given the authority under these regulations to literally adjust those beds?

[4:00]

Hon. E. Cull: Right now the hospital board has the authority to close beds under the Hospital Act. If a community health council assumes the functions of a hospital board as part of its responsibilities when it is established, it would also have that authority. If a community health council in Vanderhoof, for example, runs the hospital and replaces the board, then it would have all the powers of the board.

L. Fox: I recognize that the hospital boards have the official functions, but what really initiates them and causes them to happen are the priorities of the funding to that respective facility. My question to the minister is: does the council have the autonomy to shift dollars? In effect, this could cause the closing of beds in an acute care facility, or in the case of one community, perhaps even the hospital being downgraded to a D and T centre. Would the council have the autonomy to create that shift in financial priorities from acute care delivery to Closer to Home programs?

Hon. E. Cull: Yes, they would. While you're correct in that it is often budget pressures that make hospital boards decide to close some beds, that's not the only opportunity they have. There are many things that a hospital board can do to realize economies in their budgets. Sometimes closing beds is the easiest one -- and the most dramatic one, which captures the attention of the community.

In many cases, hospitals are electing to close beds which are either not used at all right now, or are used at such a low occupancy rate that there has got to be a more effective way of organizing themselves to provide those services. A community health council which has responsibility for -- let's use an example -- a long term care facility and an acute care facility can make decisions to reallocate money between the two facilities to achieve the best results for their community.

The examples that we constantly run into, which create problems for our health care system right now, are situations where the hospital is often having to deal with individuals, because a community-based service is not adequate to meet the needs of the people in the community. Unlike the hospital, often the service is not open 24 hours, and people who go to an emergency mental health facility or an alcohol and drug treatment centre between the hours of five in the afternoon and nine the next morning end up at the emergency ward,

[ Page 9071 ]

because there are no other options. In many communities they know it would be cheaper to shift the funding from the hospital to that other facility. The hospital would actually save money by getting those people into the right place to be treated, and it wouldn't cost all the money that it's costing them now to operate the community service. They can't even make a commonsense decision like that, because the budgets are separate, the bodies governing them are separate and there is no way to do that kind of sensible financial management. So the health councils can make decisions around their budgets for those things that they have responsibilities for, those functions that they have assumed.

L. Fox: One follow-up question to that. This

section deals with both the region and the community, and with the drafting of the regulations which will give the autonomy to those bodies. How does the minister reconcile in her mind the difference in priorities between a community council or municipal structure and the regional health board? To express it in a way the minister understands, let's talk about my region. Say the community of Fort St. James, and therefore the community health council, decides that it is in the community's best interests to maintain the hospital beds and the designation as a hospital versus a D and T centre.

The regional board, however, suggests that it's in the best interests of delivering a service that the hospital be downgraded, so that it can provide other services with the same dollars and give more value to those dollars. Who has the authority to make the final decision where there is a conflict between the priorities of the regional board and the community board?

[D. Streifel in the chair.]

Hon. E. Cull: That information comes up under sections 5 and 7, so if we could wait until we get to the purpose of the council, that will be dealt with there.

V. Anderson: Listening to the discussion, one question comes to mind. I'm still partly trying to understand.... I know it will come up later, but it's important here as we go through the standards and the funding related to those standards. A community council that is formed, as I understand it, will be able to take on whatever aspects of health care in that community that it feels it is able to cope with. They can include the facilities of the hospital within it, and the nursing care, the home care and the clinics for teenagers.

Whatever the particular needs of that community are that are related to the health budget, all of those could come under the overview of that community council. The minister was talking a little while ago about the decisions that could be made within a hospital board and structure. There are certain parameters to things that are done in a hospital. It seems to me that we are now entering into quite a different field.

When you have such a wide variety of options that will be done by one council, the decisions will have so many different parameters within them that I can see the complexity of that council having to deal with hospital care, clinic care, home care, teenage care and baby nurses, whatever it is -- all of them working through that one council. It is within that larger context that I begin to see the question of how the community council is going to be able to cope. Will the community council have staff? Is it going to have a director? Will there be subgroups within that community council?

I am trying to get a picture of how they will be able to maintain all the standards that are presently there, plus the preventive standards that the minister has stressed.

Hon. E. Cull: Yes, the councils will have staff. This concept is not unknown in the province right now. We have societies that manage both hospital services and continuing care services, and other societies that manage both hospital services and homemaker services. We have umbrella organization societies that manage quite a variety of those community-based services you mentioned. So it's not that there are not already some examples in some communities of mergers that have already taken place.

In the last year, in fact, there have been a significant number of mergers between hospital boards and long term care facility boards. I daresay it's been in anticipation of this, and also in recognition of the fact that some of their problems could be solved if they were dealing with one budget rather than two, because they can see what they need to do but they just can't make it happen between two discrete budgets.

If a community health council merged a long term care facility, a hospital board and the services the Ministry of Health provides right now in the public health units, let's say, there would be a reduction in the administrative staff. They're not going to need three chief executive officers to run the show. In fact, in those communities that are quite far along the line.... In one place, they've already made the decision that five small facilities will have one CEO instead of the five they have right now.

Staff will continue to be needed to manage different programs and facilities, though, as has happened in all of these other mergers in other communities. So yes, there will be staff, but they will be the staff who are already there in the organizations -- similar to what happened when a long term care facility and a hospital board amalgamated in the last year.

V. Anderson: I have two questions that come from your comment just now. I appreciate that the non-profit societies have been doing a great deal of the care on contract with the ministry. Does the community council in itself become in essence a large non-profit society? Will the council be contracting out to non-profit societies within the community? What's the relationship between the non-profit societies and the work of the council?

Hon. E. Cull: Councils can contract with other organizations. I think the best example to think about would be here in the Capital Regional District. The Capital Health Council is looking at taking over mental health services, which are provided not only directly by the Ministry of Health staff but also by a number of

[ Page 9072 ]

contracted agencies. They would become responsible for all of those services, should they take them over.

The answer is that if the health council assumes the responsibilities for an area which has contracts in it right now, obviously they would become the contractor instead of the Ministry of Health. We do a lot of our community health services through contracts to non-profit -- and sometimes for-profit -- agencies.

V. Anderson: I'd like just one further clarification, then. Am I hearing the minister say there are actually two choices for the community council in providing services? One is that they can hire and provide the services directly from the council itself; or they could contract these services out to a non-profit society.

Hon. E. Cull: Yes, that's the way it would work.

Section 3 approved.

section 4.

L. Fox: I have an amendment to propose on

section 4(2) which deletes paragraphs (

a) and (

b) from that section. It replaces (

a) with "2/3 appointed by councils in the region from the members of those councils," and (

b) with "1/3 appointed by the minister to represent the general public residing in that area."

I circulated the amendment to the minister and the opposition Health critic earlier. I can only suggest that I think it brings some certainty to the process. I drafted it purposely so that it respects the values of the government as seen in appointments to other commissions and boards. I think it provides some guidance and direction in the legislation, to where I think the structure would be supported by all the people within British Columbia.

[4:15]

Hon. E. Cull: I respect the intent of this amendment, and actually would like to propose a slight change to it. The concept of one-third of the appointees being made by the minister.... You're saying that there's some consistency with what we're doing elsewhere. The one-third are not so much ministerial appointees as they are public appointees. All of the people on this board are representatives of the public; none of them are representatives of any particular interest group. While the number seems consistent, I don't know that it follows through there.

It was not my intention to appoint as many as one-third of this board, so I wouldn't want to be locked into a situation where we had to appoint one-third of the members.

I would like to propose an amendment which says that the prescribed number of members appointed by the minister not exceed one-third of the total appointees, so that there is a possibility to do that. I realize that there are some procedural issues here. I mention that amendment to the member so that he can see where I would be going. Should we defeat this amendment, I am prepared to table the amendment that says no more than one-third. But I don't want to be required to provide one-third.

L. Fox: Given the tone of the response from the minister, I withdraw my amendment.

The Chair: The amendment is withdrawn.

Hon. minister, do you have that amendment you proposed in writing?

Hon. E. Cull: Yes. I move an amendment to

section 4: "In the proposed

section 4(2), by deleting paragraph (

b) and substituting the following: (

b) a prescribed number of members appointed by the minister, not to exceed 1/3 of the total number of members."

On the amendment.

L. Fox: For clarity of the amendment, would the intent be that at least a certain number of the board would be members of the community councils?

Hon. E. Cull: Through you, hon. Chair, I am sending a copy of the amendment to the member so that he can see it. Subsection (2) of

section 4 will now read that the board consists of a prescribed number of members appointed by each council in the region -- so members will get there by being appointed by their respective councils -- and a prescribed number of members appointed by the minister, which will not exceed one-third of the total members. So that will allow anywhere up to one-third to be appointed by the minister. As I said, I was surprised when I saw the amendment, because there had never been any intent for it to be that large.

Amendment approved.

section 4 as amended.

G. Wilson: A couple of questions come to mind that speak to the intention of these regional health boards. When we get into the purposes in

section 5 and when we get into talking about the health councils in

section 6, we can expand on some of these questions. We have to ask why we need the two authorities in the manner in which they are constructed under this bill. The bill is saying that there will be a prescribed number of members. We don't know what that prescribed number is; maybe the minister can tell us. We know that the minister is not going to appoint more than one-third of the total, but we still don't know what that total is likely to be.

Secondly, we see that the balance of those members are going to be appointed by each council in the region from among the members of that council. So they are all the same people. We now have the same people coming from one local authority into a larger authority, and it seems to be the provision of an additional layer of government that isn't necessary or required. If you are appointing from among the same people and there is no prescription as to what the minimums are going to be, why do we need this? Why would we not simply have that decentralized form and put the authority and enact

[ Page 9073 ]

the authority granted to these councils into the health force?

Hon. E. Cull: Again, the member was absent from the chamber when we discussed that. The size of the regional health board isn't specified, because it depends on the number of councils in the region. That's why there is no prescribed number there. The number of councils would determine the size of the board.

There are two reasons we have the regional boards in addition to the community councils. One is that we went through an exhaustive process coming out of the royal commission recommendation, which was for regions only, with a senior civil servant running the show. The public didn't buy that one, but they liked the concept of more local autonomy. Through the process that we worked through over many months, the consensus arrived at was the need for community health councils not only to run the show at the local level but also to be part of a larger entity that would be responsible for coordinating planning services within the region.

One of the biggest problems we have in this province right now is that we have communities that are very close to one another, sometimes within ten, 15 or 25 miles, each with hospital services that will not cooperate and plan together. They often compete.

Sometimes they deliberately don't do it; sometimes they just don't do it because no one has ever suggested that they should actually get together and sort it out: "We'll get the CT scanner and provide services to your patients, but you do this service, and we'll provide services to the patients in the region that way." We end up with duplication, competition and lack of coordinated planning, because there hasn't been a regional structure up until now.

One of the most encouraging things I've had coming back to me out of this process of forming councils that's now underway is that even the most cynical people who have participated in this have said to me: "I don't know if it's going to work, but you know what's interesting? This is the first time that we've ever actually all sat down in a room together and started to talk about what we're doing and to coordinate it." That's why we need to have more than just the community integration. There needs to be some regional integration.

G. Wilson: Let me come back to the first part of the question again. I heard the minister say that there is no proscription for the number of members, because this minister doesn't know what the number of councils is likely to be. That really doesn't answer the question. Does that then suggest that there will only be one member from each council? No, it doesn't. There could be two, four or five. Does it say that there is going to be a prescribed number on the basis of each region equally? No, there's nothing in here that says that at all.

Does it say that there are not going to be various distinctions made because of regional geographic complexities? I would suggest the probable answer to that is yes. I would say that if we're going to go to this model, that's the logical way to go.

Although people often haven't worked together, it could be accomplished without establishing another level of government, which is what this is, or another level of authority. I believe it can be done. As soon as you start to move toward the creation of a new entity such as this regional health board, you are going to have all of the trappings that the regional health board is going to demand. You are going to have all of the bureaucracy that will ultimately gravitate to it, because that's what happens. History is replete with it.

I tried to argue that in second reading, about what the development of the regional districts has become, and what they were intended to be. There is going to be a movement of the bureaucratic system toward this board as sure as we're sitting here, from my perspective. It seems to me that if you are going to guard against that, we should be stipulating a prescribed number. If it's one per board, fair enough; then we know that in a region where there are a large number of boards, we are going to have a bigger group.

I think we have to do that, and the prescription of that needs to be done here, because when you start to get into

section 5, and when you start to talk about the community health councils in 6 and 7, it seems to me that we can make a very strong argument that the government is creating this new series of government agencies that an increasingly large bureaucracy is going to gravitate towards with a greater demand for power and authority, and therefore a greater demand on the tax base for financing. I think we are going to get a more expensive system that still may not get people working together.

I would argue that if you have ever served time on a regional district board.... Municipalities and unorganized areas sit on regional boards, and the jealousies of the jurisdictions are just as strong, just as widely held and just as obstructionist in trying to get cooperation on things like water and sewers, because they are protecting their turf. Just because you move them into a regional health board, I don't think you are going to get away from those areas that don't want or refuse to work together, or that jealously compete. They recognize that dollars in their community are what ultimately advantage the people in their neighbourhoods.

I would like to hear the minister's comment on that. I think this is a prescription for large, expensive health care that is going to cost the taxpayers a lot of money. It is going to divert money from the delivery of health care into more administration, and I think that is exactly opposite to what we should be doing.

Hon. E. Cull: First of all, I will remind the member that this is interim legislation. When we get to permanent legislation, there will be a specification of the number of members, or at least the range of the size of these councils. The largest union board of health we have right now has, I believe, 21 members, which seems large to me. So we obviously know what the outside is. If we go to smaller ones, we will become more efficient.

Right now we have 21 health units with their own union boards of health, governance structures and administrations, and all of the expenses that go with having a board of health that provides those services.

[ Page 9074 ]

We also have 29 regional hospital districts. So right now we have 50 regional authorities; they actually overlap one another. While there is no duplication in services, there certainly is in the geography. If we go from 50 regions to 25, we will cut the regional-level administrative bureaucracy in half in this province. That is probably pretty close to where we are going to be.

There will not be any duplication of service, because those union boards of health will no longer exist as separate agencies, and the responsibilities that the regional hospital districts have added to the burden of regional districts will no longer be there. In addition to those 50 agencies we have councils of hospitals, area planning councils and all kinds of other layers out there on top of this. This is a much simpler and more rational system.

L. Fox: I want to follow up a bit on the comments by the member for Powell River-Sunshine Coast. I think he makes a good point. When I think back to the regional district structure, and the fact that weighted votes represent the population base -- which have caused horrendous problems in some regional districts; not all, because some of them are never used, but in others they certainly are used.... So the makeup of the board.... Even though it is a three-year interim board, there are going to be some dramatic decisions.

At least, I envision that there are going to be some very important decisions made by these appointed individuals. Is it the minister's opinion that the number of board members may somewhat follow the population in the respective areas? You mentioned that a region could go around the health unit boundaries. I look at the Prince George Board of Health boundaries, which go all the way to or just shy of Burns Lake, Valemount, Mackenzie and so on in there, and yet Prince George, as a large centre within the hub....

In all of the community health councils that would make up that region and therefore make up the appointees.... There is a concern that if representatives from the councils were appointed to this regional health board on the basis of population, there could be -- not necessarily would be -- a lot of emphasis placed on the Prince George region, and very little placed on Valemount, Fraser Lake and Fort St. James. How does the minister envision getting around this issue in coming up with the prescribed number of board members?

[4:30]

Hon. E. Cull: My preference is that each health council have the same number of representatives on the regional board, rather than a number based on their population. Certainly that is the opinion of the associated union boards of health. I would imagine it is also the opinion of the smaller communities in the province. It is being discussed by the governance committee that is looking at all of these issues and providing us with advice. That is part of why we are piloting this, as opposed to simply imposing legislation without having tried it out.

When you make comparisons to the Municipal Act, I think the important thing to remember is that the provisions for weighted votes usually have to do with taxation and financial matters. The provisions for one person, one vote have to do with corporate decision-making, and the vast majority of the work of this board will be corporate decision-making. Therefore the decisions that may arise as a result of capital expenditures and taxation are very important with respect to representation. That is why this act does not deal with that.

As I said some time ago, that matter is the subject of work being done with the Union of B.C. Municipalities, and the capital funding programs will not change in the lifetime of this act.

L. Fox: What we will see at the end of this process, with respect to the membership of the regional health boards, may be something totally different from what the minister is putting forward now, even with the amendment, in terms of numbers and representation. Is that correct? Is the UBCM review that is being done in cooperation with the ministry also looking at the structure of a board? Is the voting power of a board member part of the review? Is that what I understood the minister to say?

Hon. E. Cull: No. I am sorry if I added to some confusion there. The Union of B.C. Municipalities task force is simply looking at the taxation issues around capital cost-sharing, and it will make recommendations as to where that function should be. But if the function is transferred to the regional health boards from the regional hospital districts, it may have implications for the voting at those boards on those matters. There is great concern that we not have a body which is not totally representative of the population that will have to pay those taxes.

The first question you asked was whether it's likely that these regional health boards may look somewhat different in the end. The answer is yes, they may. This legislation says only that there will be designated members, of which no more than a third will be ministerial appointees; the rest will come from the health councils. With respect to all of the details that we are talking about right now, the legislation is silent. That allows us to work through some of these problems with those boards that will be up and running during the lifetime of this legislation, piloting this for us.

I mentioned a governance committee. It is a working group that we have established with stakeholders to look at many of these issues around this legislation, in terms of how many people there should be from each council on a board. What do we do when we have one council representing five communities, as we will have in Mount Waddington? Some of those things are still being sorted out through the work that the communities are doing. We are doing it as cooperatively as we can, through a process of working with the people in the communities. So again, this legislation is interim.

L. Reid: Much has been made of this piece of legislation being a creature of the NDP government's "New Directions for a Healthy British Columbia," and much has been made of its connection to the Seaton royal commission. I take some issue with the latitude in

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terms of.... We take the position that a number of sections in this bill, and particularly

section 4, are not consistent with the commission's recommendations. I would ask the minister to pay particular attention to B-38, and I will quote from B-39. It recommends that the Ministry of Health be decentralized "into a number of manageable regional centres, assigning fiscal responsibility to the regional general managers." This is clearly not the intent of Bill 45, which establishes boards and councils that have these stated purposes.

The royal commission was clear in several major recommendations on B-38 that the decentralization should be in the hands of the ministry, the deputy ministers, the regional assistant and, most importantly, an accountable regional general manager and a core complement of regionally placed staff. I see nowhere in this bill that this structure is in any way anticipated. Was that your intention?

Hon. E. Cull: It was not the intention of our New Directions strategy or the government to accept this recommendation from the royal commission. If the member has carefully read the report on the disposition of the 379 recommendations, the member would be aware that this recommendation was rejected by the minister's advisory committee, by the two health care forums that we held and by all the consultation that we went through.

I've had opportunity to talk to some of the commissioners about the recommendation. The concept was that we would appoint a senior government bureaucrat to act as a CEO of the region and be responsible for managing all of the services of the region as part of the ministry -- without any community involvement. All that would do is basically take the highly centralized system that we have right now in the Ministry of Health and decentralize it to the regions, but keep the authority clearly in the hands of the ministry without there being any community authority whatsoever.

The process of consultation that we went through during 1992 soundly rejected this and recommended that there be councils to replace the existing myriad of boards, societies and ministry-run services.

L. Reid: That is the

interpretation. Will this move to regionalization through the Health Authorities Act result in any downsizing of the existing staff within the Ministry of Health? I believe we're currently at 5,200 full-time-equivalents. Are we looking at a shift of those bodies into the communities or not?

Hon. E. Cull: The vast majority of the direct-service providers in the Ministry of Health are in the communities that they provide services to. We don't send our public health nurses from Victoria to provide services around the province. So in terms of our direct-service providers, we are actually highly decentralized.

But there are two ways that I can say yes to your question. One is that many of those employees will cease to be employees of the Ministry of Health and will become employees of a community health council. We will also be making some major changes to our headquarters functions because, when we are no longer primarily a direct-service health agency, we will then have the opportunity to reorganize ourselves to provide the support services that have to be provided -- and to provide those centralized services that will still have to be provided.

So I would imagine that we would see a downsizing in the Ministry of Health both from a shifting of employees to other employers and from a streamlining that we will do as a result of getting out of the direct-service business primarily.

L. Reid: I began this afternoon's debate asking about direct service and direct medicine to British Columbians. From your comments about decentralization and removing some of the centralized bureaucracy in Victoria, I'm not clear if we're looking at any reduction in administrative bodies. That is my question.

Hon. E. Cull: I don't think you meant administrative bodies; you mean people doing administration in the ministry. Is that what you mean?

When we're talking about administrative bodies -- and I am sure the member for Saanich North and the Islands could tell you how many administrative bodies are going to be collapsed in his region under the community health council proposal up there -- we will see a dramatic reduction in the number of governing bodies in this province. Right now we have over 150 hospital boards, 21 union boards of health, I don't know how many long term care facilities and literally hundreds of non-profit societies providing all of the other services.

If we just collapsed the first three in each community -- hospital boards, long term care facilities and union boards of health -- into one board, we would reduce it by three times. We would go from three times the number of bodies down to a much smaller number.

With respect to the administrative responsibilities of the ministry, if we don't have people who are doing direct-service delivery in an area, we will not need to have the managers or supervisors for that. If we have fewer employees on our payroll, we will have a smaller payroll department. There will be some reduction in our administrative overhead, but I would not want to mislead you and say that it is all going to be eliminated, because some of it will be moving to the community health councils. Those nurses are still going to be needed, and there will still need to be some administration there.

I see the member opposite saying that this means more bureaucracy. It doesn't, because it means that we will be able to use the capacity of our existing systems. If you take the simplest example -- merging a public health unit, a long term care facility and a hospital into one society -- you don't need three payroll departments, three purchasing departments, three human resources departments, three laundries and three kitchens. You can't cut it by three, because some are still going to have to be there. You are going to be able to reduce those services, because you can create the efficiencies of using the excess capacity remaining in that administrative structure.

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We are finding that out with the changes being made at Shaughnessy. We are not having to transfer all of the administrative dollars that go with each service to the receiving hospital, because the hospitals themselves have the ability to pick up a certain amount of that administration.

L. Reid: One of the largest concerns shared by the majority of British Columbians is that this will create a parallel level of bureaucracy. The comments from the Minister of Health do not suggest anything but that. We are looking at increasing administrative costs to the taxpayer in British Columbia. If we go with your comments, hon. minister, we can look at changing the name of those administrative bodies, but we are not reducing the number of dollars the taxpayers will pay for administrative costs.

The only interest British Columbians have today is increasing direct service -- reducing surgical wait-lists, etc. -- not increasing administrative overlay. This amalgamation of service which you speak of, and which has been sold to British Columbians as reducing the cost of bureaucracy to the