British Columbia Hansard — TUESDAY, APRIL 2, 2002 (37th Parliament, 3rd Session) (20020402pm-Hansard-v5n5)
20020402pm-Hansard-v5n5
British Columbia — Debates (Hansard)
2002 Legislative Session: 3rd Session, 37th 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)
TUESDAY, APRIL 2, 2002
Afternoon Sitting
Volume 5, Number 5
CONTENTS
Routine
Proceedings
Page
Introductions by Members
Tributes
HM Queen Elizabeth the Queen Mother
Hon. G. Campbell
Introduction and First Reading of Bills
Health Services Statutes Amendment Act, 2002 (Bill 18)
Hon. C. Hansen
Health Planning Statutes Amendment Act, 2002 (Bill 19)
Hon. S. Hawkins
Statements (Standing Order 25 B )
RCMP commendation awards
D. Hayer
Parkinson's disease awareness
G. Trumper
Smithers ski resort development
D. MacKay
Oral Questions
Impact on aboriginal rights of referendum on treaty negotiations
J. MacPhail
Hon. G. Plant
Cost of referendum on treaty negotiations
J. Kwan
Hon. G. Plant
Referendum on treaty negotiations
K. Krueger
Hon. G. Plant
Impact of air travellers security fee on northern and rural residents
W. McMahon
Hon. J. Reid
Hon. R. Thorpe
Lobbyists registry
J. MacPhail
Hon. G. Plant
Point of Privilege (Speaker's Ruling)
Motion on Privilege
Referral to committee: disclosure of
Education Committee draft report
R. Masi
J. MacPhail
Hon. G. Plant
Petitions
Hon. S. Hawkins
Committee of Supply
Estimates: Ministry of Health Services (continued)
J. MacPhail
Hon. C. Hansen
K. Krueger
D. Jarvis
S. Orr
I. Chong
S. Brice
R. Hawes
J. Les
B. Lekstrom
Proceedings in the Douglas Fir Room
Committee of Supply
Estimates: Ministry of Agriculture, Food and Fisheries
(continued)
V. Roddick
Hon. J. van Dongen
B. Belsey
Estimates: Ministry of Human Resources (continued)
J. Kwan
Hon. M. Coell
[ Page 2349 ]
TUESDAY, APRIL 2, 2002
The House
met at 2:03 p.m.
Introductions by Members
Hon. M.
Coell: In the House today there are 13 members of the Victoria Newcomers
Club, the graduate club from Sidney. I ask the House to please make them
welcome.
MacPhail: I think these people are members of a renewed newcomers club.
They're the Malahat–Juan de Fuca NDP club: Kevin Logan; Christine Heal, who is
Kevin's wife — and they have their six-month-old daughter, Eileen; Herb Strom;
Manuel Roussy; Evelyn Roussy; Richard Hughes; Don Cropp; Faye Kemmis; Lorne
Tomalty and Peggy Tomalty. Would the House please make them welcome.
Hon. J.
van Dongen: I rise today to introduce to this Legislature a large group of
farmers and ranchers from all parts of British Columbia. They're here today to
tell us a little bit about their industry as part of Agriculture Day.
[1405]
Before I do
that, I also want to mention the good news that, having been locked in a trade
dispute with the United States on our tomato shipments for the last year or
more, we're very pleased today to have an announcement by the U.S. Trade
Commission that by a 4-to-1 decision they're issuing a finding of no material
injury to the U.S. industry and no threat of material injury. Effective ten days
from now, there will be no duty on tomatoes going to the United States. I truly
want to congratulate all those in the agrifood industry who worked very hard on
that case to ensure that the interests of British Columbians, Canadians and
consumers in North America were well represented. On that happy note, I want to
ask the House to welcome all of the farmers and ranchers here from all over B.C.
J. Bray:
Joining us in the members' gallery — and I can't actually see him from my
vantage point — is Mr. John Sanderson, who is the president of the Victoria
Harbour Authority. Mr. Sanderson is here today to talk about some important
issues on Victoria's harbour and making it a better and more environmentally,
aesthetically and economically viable harbour. I ask the House to please make
him very welcome.
Tributes
HM QUEEN ELIZABETH THE QUEEN MOTHER
Hon. G.
Campbell: As members of the House know, Queen Elizabeth the Queen Mother
died this Easter weekend at the remarkable age of 101 years. It was with sadness
that we learned of her passing, for hers was a remarkable life. She passed away
peacefully at the end of a long life that touched us all. Lady Elizabeth
Bowes-Lyon was born on August 4, 1900. Imagine that, Mr. Speaker: before the
advent of the airplane, before automobiles were ubiquitous, before many of the
challenges that we face became commonplace.
She was
born a commoner, the ninth of ten children. She witnessed a century of
unparalleled change and unheard-of calamity. But when we needed her, when
England needed her, when the Commonwealth needed her, she was there.
The Queen
Mother will be remembered with great affection for her unflagging sense of duty,
her strong and constant support of her family, her wonderful charm and sense of
humour. She was indomitable. In fact, the Queen Mother didn't decide that she
was going to marry the Duke of York until he'd asked her three times. She was
concerned that perhaps she didn't know enough of the royal protocols that would
be required for someone in her position. That's when she was going to marry the
Duke of York.
After the
abdication she became the Queen. Then came the war. For many it was the Queen
Mother's strength, it was her sense of duty, it was her commitment to the common
people of England that made her, in the eyes of Hitler, "the most dangerous
woman in Europe." Dangerous to Hitler. The foundation upon which victory
was built.
It was her
spiritual strength and, as I mentioned earlier, her commitment to family that
reflected herself in the strength of England as they went through that
incredible period. As we reflect today on her life and times, we know that
through the tumult of a century of change her example was a beacon of calm in
the turmoil. The Queen Mother's courageous leadership and support of her
husband, George VI, during the dark hours of the Second World War should never
be forgotten.
Here in
Canada we were very fortunate because the Queen Mother loved Canada, and
Canadians returned her love, as did British Columbians. Queen Elizabeth the
Queen Mother was the embodiment of grace. We shall not see her like again. I
have conveyed to the Queen and the royal family the deepest sympathy and feeling
of loss from the people and government of British Columbia. Members of the
Legislature and the public are invited to join me in signing our book of
condolence, which is on the main floor of the parliament buildings today.
[1410]
Introduction and
First Reading of Bills
HEALTH SERVICES STATUTES
AMENDMENT ACT, 2002
Hon. C.
Hansen presented a message from His Honour the Administrator: a bill intituled
Health Services Statutes Amendment Act, 2002.
Hon. C.
Hansen: I move that Bill 18 be read a first time now.
[ Page 2350 ]
Motion
approved.
Hon. C.
Hansen: This bill makes several minor amendments to two statutes: the
Hospital Insurance Act and the Medicare Protection Act. At present the Medicare
Protection Act provides flexibility for the Medical Services Commission to grant
coverage to individuals who would not otherwise be eligible for medical services
— for example, individuals who are close to meeting residency requirements.
The Hospital Insurance Act contains different
definitions and does not have that
same flexibility. This legislation amends the act to adopt the more flexible
definitions of residency and beneficiary, and thereby ensures consistency
between the two statutes.
This bill
also contains a number of minor changes to the Medicare Protection Act that are
related to the powers of the Medical Services Commission. Specifically, it
eliminates the commission's power to de-enrol physicians at age 75, a power
which may be deemed to be unconstitutional. It also allows the commission to
charge interest on inappropriate or fraudulent billings by medical practitioners
as determined by a commission review panel.
The bill
amends the Medicare Protection Act to allow for broader and more equitable
coverage of supplementary services for people on premium assistance who have
access to private insurance. Currently, private insurers cannot provide any
coverage for supplementary services to individuals on premium assistance,
because they are covered by the Medical Services Plan for up to ten visits per
year. This prevents those patients on premium assistance with private insurance
from being reimbursed when a practitioner charges more than what MSP will pay.
The amendment will allow private insurers to cover additional amounts that may
be charged by supplementary providers.
The bill
also improves the efficiency of the Medical and Health Care Services Appeal
Board by allowing panels of one to sit in the case of very minor issues and the
dismissal of cases in which a complainant has not further pursued the appeal.
Mr.
Speaker, I move that this bill be placed on orders of the day for second reading
at the next sitting of the House after today.
Bill 18
introduced, read a first time and ordered to be placed on orders of the day for
second reading at the next sitting of the House after today.
HEALTH PLANNING STATUTES
AMENDMENT ACT, 2002
Hon. S.
Hawkins presented a message from His Honour the Administrator: a bill intituled
Health Planning Statutes Amendment Act, 2002.
Hon. S.
Hawkins: I move that Bill 19 be read a first time now.
Motion
approved.
Hon. S.
Hawkins: I'm pleased to introduce these amendments. This bill demonstrates
our commitment to ensure that health- and safety-related acts are efficient, up
to date, and genuinely meet the needs of British Columbians.
I'm
introducing seven amendments today. They will strengthen public safety, improve
the governance of health professions, modernize or eliminate outdated
regulations and use resources more efficiently. All the savings that will be
realized from these changes will be directed back to patient care.
The first
amendment is regarding the Health Professions Council. It was appointed in 1991
to advise on self-regulation of health professions. It submitted its findings
and recommendations last March, and the changes to the Health Professions Act
will transfer the remaining functions of the council to the minister effective
December 31, 2002.
We are also
making amendments to the Health Emergency Act, which will establish a new
college for the regulation of emergency medical assistants, giving emergency
medical assistants the authority to effectively regulate their own profession.
The Hearing
Aid Act will be repealed, and a new arm's-length governance structure will be
established for hearing-aid dealers and consultants. This new self-regulating
structure will replace the existing licensing board, making them consistent as
well with other health professions.
[1415]
The Seniors
Advisory Council was established long before the creation of the Minister of
State for Intermediate, Long Term and Home Care, who now acts as a voice at the
cabinet table on issues that affect seniors. To reflect this change in cabinet
priorities, the Seniors Advisory Council Act is repealed, and the council is
replaced with a special adviser for seniors in the Ministry of Health Planning,
who will work with all four health ministers and the seniors groups across the
province.
The bill
also amends the Name Act to require adults applying for legal name change to
provide documentation of a criminal record check. Upon approval of a name
change, the Vital Statistics Agency will forward the information to the RCMP,
who will check it against the national database of criminal records. I want to
thank the Solicitor General for helping to close this loophole in the
legislation so that people with criminal records can't change their names and
hide their criminal pasts.
As well,
there are amendments to the Survivorship and Presumption of Death Act and the
Vital Statistics Act to make it easer for families and executors to conclude the
personal and business affairs of a person who is presumed dead but whose body
can't be found.
We're also
making changes to the Vital Statistics Act. It will be further amended to
include the particulars of a father on a child's birth certificate, where there
is a court order declaring the child's paternity, unless the court orders that
the father's particulars are not to be included.
[ Page 2351 ]
Lastly, the
bill will repeal a redundant requirement for the director of vital statistics to
provide a list of recent deaths to the district registrar of voters and local
government officers. The chief electoral officer already performs this duty.
I move that
the bill be placed on orders of the day for second reading at the next sitting
of the House after today.
Bill 19
introduced, read a first time and ordered to be placed on orders of the day for
second reading at the next sitting of the House after today.
Statements
(Standing Order 25
b) RCMP COMMENDATION AWARDS
Hayer: I rise today to speak of courage, of duty and of selfless acts that
have made our province and our communities a better place to live. I want to
speak today about individuals who have risen above fear, who have done the right
thing and who in some instances, by putting their own lives at risk, have saved
others.
I speak of
those individuals who on March 27 received certificates of appreciation and
commendations from Jamie Graham, the chief superintendent of the Royal Canadian
Mounted Police at the Surrey detachment. I attended the ceremonies along with
Mayor Doug McCallum of my city of Surrey, my MLA colleagues from Surrey–Green
Timbers and Surrey-Whalley, and many others to honour these brave people and to
recognize their heroic deeds.
Many of
these people put their lives at risk to save the lives of others. One young lady
is accredited with saving the life of a stabbing victim. Another woman put her
discomfort aside at a vehicle accident and rendered CPR in the pouring rain
until the ambulance crew arrived.
It was not
just the general public who were honoured. There were RCMP and municipal police
officers and Canadian customs officers. These officers acted in a manner that
was above and beyond the call of duty. In effect, one officer, Constable Scott
Marleau, received three separate citations for commendable action.
The people
recognized in my riding of Surrey-Tynehead last week are just a few of the
unsung heroes who walk our streets every day. To them I would like to say, on
behalf of all members of this chamber, a grateful and very appreciative thank
you.
PARKINSON'S DISEASE AWARENESS
Trumper: The month of April is dedicated to Parkinson's awareness.
Parkinson's disease is a neurological disorder which causes involuntary movement
of muscles, gradually affecting one's ability to walk, speak and swallow. It is
not contagious, and its cause appears to be a combination of genetic disposition
and environmental triggers. It is progressive, degenerative and presently
incurable.
This
cruelly debilitating disease appears to be affecting more people every year.
Although it is mainly an illness of middle age, it also affects younger people.
Parkinson's can develop slowly, or it can move quickly. For 10 percent of
Parkinson's patients, there are some very difficult complications such as
personality changes and dementia.
[1420]
Although
Leonardo da Vinci first described the symptoms of Parkinson's, this disease was
identified by a Dr. James Parkinson in 1817. Today, almost 200 years later,
there have been giant steps in treatment for Parkinson's, but we are still a
long way from a cure. Well-known individuals who have suffered from Parkinson's
include renowned artist Bill Reid, the Pope, Muhammad Ali, Katharine Hepburn and
Michael J. Fox.
For those
living with Parkinson's, keeping active is important to well-being. I want to
read an excerpt from a paper which was written by my late husband, a physician
who suffered from Parkinson's: "Learn a new truth at least once a day.
Smile inside and out. Never give in or give up or give out. Life is still worth
living." As you read and write, particularly this month, about Parkinson's
disease, remember those individuals and their families who need understanding
and assistance. Until a cure is found, we need to be generous in our support of
further medical research.
SMITHERS SKI RESORT DEVELOPMENT
MacKay: Today I am pleased to announce what I feel is one more good-news
story for the province. This good news is a result of our government's
commitment to attract private sector investment back to the province with tax
concessions, a reduction in regulations, faster access to Crown lands and, most
of all for the people in the northwest, new employment, new job opportunities.
Today I am
pleased to announce that Canadian Rocky Holdings, a wholly owned subsidiary of
Cliffs Communities Inc., has entered into an agreement with Hudson Bay Mountain
Adventures, also known as Ski Smithers, for the future development of the ski
area in Smithers. The first phase of the agreement provided that Ecosign
Mountain Resort Planners of Whistler, B.C., complete a ski operation study and
assessment. Developers expect the master plan to be completed within the next
six months for presentation to the provincial government. Approval will allow
the companies to proceed with upgrades such as new ski runs, new ski lifts,
additional on-site lodging and new amenities.
This speaks
highly of the course we have now set for the province: long-term sustainability,
long-term jobs, new opportunities, new private sector investment. That's what we
committed to. I'm pleased to report that this project has the makings of a new
world-class ski resort in the province. I am proud to support the pro-
[ Page 2352 ]
ject and excited for all those who live in the Bulkley Valley and, more
specifically, the residents of Smithers.
Mr.
Speaker: That concludes members' statements.
Oral Questions
IMPACT ON ABORIGINAL RIGHTS OF
REFERENDUM ON TREATY NEGOTIATIONS
MacPhail: To the Attorney General: does he agree with B.C. Treaty Commission
representative Jack Weisgerber that the land claims referendum is increasing
tension and may handcuff the treaty process?
Hon. G.
Plant: It's a great day for democracy in British Columbia. For the first
time in over a decade of treaty-making, the government is bringing all British
Columbians directly into the discussion about what their vision is for treaties
in British Columbia.
I think
it's a great opportunity for people to see and experiment in how we can expand
our conception of democracy to engage people in a discussion about issues. In
the treaty context, it's vitally important that we engage people in a discussion
about the issues that are on the table so that for the first time the province's
negotiators will be at the table informed by a public mandate that will allow us
to move forward and put an end to uncertainty in British Columbia.
Mr.
Speaker: The Leader of the Opposition with a supplementary question.
MacPhail: That's interesting, because B.C.'s Supreme Court ruled against the
now Attorney General and the current Premier in their suit against the Nisga'a
treaty. The case established that the Nisga'a have a constitutional right to
self-government under
section 35 that extends beyond municipal government. Will
the Attorney General confirm that in seeking a mandate to negotiate
municipal-style self-government, he's really attempting to take away rights from
aboriginal people that they won when the B.C. Supreme Court ruled against his
own court case?
[1425]
Hon. G.
Plant: Mr. Speaker, treaty-making is a political process. It's entirely
appropriate that we involve the people of British Columbia directly for the
first time and ask them the question: when the province's negotiators sit at the
table, what is the model, the principles of self-government, that they should be
advocating for to ensure that aboriginal communities can control their lives and
have authority over the decisions that affect them but also that there are in
place systems of democratic accountability and that there are appropriate
delegations of authority?
These are
important issues. There are choices involved for the people of British Columbia,
and there are choices involved at the treaty table. I think the referendum
engages the people of British Columbia in the discussion about those choices,
and I look forward to the next six weeks as we hear from the people of British
Columbia on their vision for negotiating treaties in the twenty-first century.
Mr.
Speaker: The Leader of the Opposition with a further supplementary.
MacPhail: Mr. Speaker, the Attorney General said that he would protect and
respect aboriginal people's constitutional rights. That's not political. The
Attorney General abandoned his appeal of the Nisga'a decision. What possible
rationale, then, does he have for seeking to diminish aboriginal constitutional
rights that were established by the failure of his own court case?
Hon. G.
Plant: As the member knows and as all British Columbians need to know,
nothing in this referendum will undermine constitutionally protected aboriginal
rights and titles. In fact, as the member knows, there was an argument made to
the contrary last week in the Supreme Court of British Columbia, and the
argument was completely rejected.
I intend,
as Attorney General and on behalf of a government that intends it, to protect
aboriginal rights and title as we are required to do by law and as we ought to
do as a matter of common morality. But treaty-making is about negotiating among
the choices to ensure that treaties give effect to constitutionally protected
aboriginal rights and title in a way that's workable, affordable and promotes
certainty, finality and equality for the benefit of all British Columbians.
COST OF REFERENDUM
ON TREATY NEGOTIATIONS
J. Kwan:
It's costing British Columbians roughly $9 million to destroy the treaty process
through this stupid referendum — money that could be spent fixing health care,
improving child protection or maintaining legal aid.
Can the
Attorney General tell the vast majority of British Columbians who don't want
this referendum how much money taxpayers will save on every ballot that is not
returned?
Hon. G.
Plant: Earlier today I heard the chief electoral officer say that as a
result of the work he's done with his budget, the original number that he put
forward for his responsibilities of $9 million may in fact be reduced by a
million and a half dollars. I think it's a great day when all people who are
part of the government of British Columbia recognize that we can deliver on the
important services and spend less money than we have to.
Mr.
Speaker, this referendum is a new way of doing democracy, and democracy does
have a price. This referendum will cost significantly less than a general
election, but what's far more important is this: if we spend $10 million on this
referendum, as against the
[ Page 2353 ]
billion dollars we have spent on treaty-making in British Columbia with only
one successful treaty to date, I think it's a very small price to pay to ensure
that we have a process that works, that is affordable and that produces good
agreements for all British Columbians in the years to come.
Mr.
Speaker: The member for Vancouver–Mount Pleasant has a supplementary
question.
[1430]
J. Kwan:
Again to the Attorney General: will he commit to British Columbians — who
think that the referendum is a dumb idea, that it's a huge waste of money and
that it sets back the treaty-making process when treaties have never been more
important to our economic future — that every penny British Columbians will
save the province by throwing their ballots in the recycling bin be spent on
more pressing priorities like health care for aboriginal children?
Hon. G.
Plant: I have so much more faith in the people of British Columbia than the
member opposite. The people of British Columbia want this opportunity to be
included directly in a conversation about the future of treaty-making. We have
embarked upon that conversation at a relatively modest cost.
You know
what I think is going to happen? I think that across this province people are
going to get their ballots; they're going to sit at their kitchen tables;
they're going to have a conversation with their family members about their
vision for reconciliation and respect with the province's aboriginal people;
they are going to fill out that ballot with pride that they live in a democracy
that gives them that voice in their future.
I think the
citizens of British Columbia will participate with enthusiasm. They'll
participate out of duty. They'll participate because they know this referendum
will help reinvigorate a treaty process that's urgently needed in the province
of British Columbia.
REFERENDUM ON TREATY NEGOTIATIONS
Krueger: Again, to the Minister Responsible for Treaty Negotiations. The
preamble to the referendum on treaty negotiations launched by the minister
states that the government is committed to providing — as the minister said
moments ago — certainty, finality and equality. At the same time, however, the
government admits that it cannot guarantee specific outcomes at the treaty table
based on the outcome of this referendum.
Can the
Minister Responsible for Treaty Negotiations tell us how he reconciles those two
statements?
Hon. G.
Plant: I think all parties in the treaty process are committed to
negotiating agreements that will produce certainty, that will give and create
finality, and that will lead to equality. Of course, all parties to the process
bring to the table their own set of visions, their own set of outcomes that they
want to work towards and their own set of principles.
It's time
for the people of British Columbia to be brought into the debate around what
those principles should be, recognizing that the province's negotiators will go
to the table and do the best they can on behalf of the people of British
Columbia to achieve agreement at a table that has two other parties that will
also be working hard to represent the interests that they're there to represent.
With three parties at the table working from a principle framework, we hugely
increase our chance of creating workable, affordable and just settlements.
Mr.
Speaker: The member for Kamloops–North Thompson has a supplementary
question.
Krueger: Many of my constituents welcome the opportunity through this
referendum for greater clarity on matters respecting aboriginal self-government.
However, can the Minister Responsible for Treaty Negotiations tell us why the
government has chosen to define self-governance as having the characteristics of
local government when some people argue that the Nisga'a model of
self-governance seems to provide a better understanding of the definition of
aboriginal self-government?
Hon. G.
Plant: We campaigned in the last campaign on a platform commitment to
negotiate self-government according to a vision, a model, that saw that
aboriginal self-government would have the characteristics of local government
with powers delegated from Canada and British Columbia. We think that is the
most workable model for aboriginal self-government.
There are
other visions of what aboriginal self-government as a political exercise should
involve. They include the Nisga'a model.
People who
think that the government of British Columbia should be at the table with a
broad sense — a virtually unlimited sense — of the potential models for
aboriginal self-government may want to vote no,
whereas people who think that
aboriginal self-government will be more practical and more accountable if it has
the characteristics of local government with delegated powers and local
accountability will vote yes. That's a real choice, and once made, it will guide
the province effectively as we move forward with treaty negotiations.
[1435]
IMPACT OF
AIR TRAVELLERS SECURITY FEE
ON NORTHERN AND RURAL RESIDENTS
McMahon: My question is to the Minister of Transportation. Many people have
expressed concern over the implementation of the federal government's air
travellers security charge which came into effect yesterday. This added tax not
only hurts the travelling
[ Page 2354 ]
public but also is a serious detriment to British Columbians who live in
isolated and rural communities where air travel is not a luxury but a necessity.
Can the
Minister of Transportation tell me what the government is doing to convey these
concerns to the federal government?
Hon. J.
Reid: While I agree that security is an important issue, I am concerned
about the flat fee that has been imposed. I have written to the federal minister
requesting that this be re-examined. It is a detriment to not only the smaller
airports but also the short-haul carriers.
Mr.
Speaker: The member for Columbia River–Revelstoke has a supplementary
question.
McMahon: My supplementary is to the Minister of Competition, Science and
Enterprise. The flow of tourism dollars into my region is dependent on
competitive prices for air travel, and this flat fee has serious implications
for smaller airlines and short-haul operators. Can the Minister of Competition,
Science and Enterprise tell me if he thinks this fee is fair?
Hon. R.
Thorpe: First of all, security is a top priority for everyone in our
government. We are working together with British Columbia's tourism industry. On
March 15 I sent a letter to the Minister of Finance, Mr. Martin, pointing out
some pitfalls that we thought were there. On March 25, together with nine other
ministers of tourism across Canada, we wrote Minister Martin and Minister
Collenette pointing out some issues of concern.
We are very
concerned about the impact on small communities, small airports and small
carriers. We are working hard. We have put forward solutions for the federal
government to consider, and we're going to continue to work on behalf of the
tourism industry, small communities, small airports and small carriers across
British Columbia.
LOBBYISTS REGISTRY
MacPhail: Last year the Attorney General said that he expected the Lobbyists
Registration Act to be proclaimed and operational by March 31. Last month the
Attorney General said he was working on it. In the meantime, the Premier and
ministers are moving ahead with the privatization of health services and the
privatization of ICBC and B.C. Hydro. We're seeing the expansion of private
liquor sales. We've seen the government back down on the smoking ban. That's
just to the benefit of special interests. What we can't see is just who the
government's meeting with, whether in their offices or in the Premier's living
room.
To the
Attorney General: how's it going?
Interjections.
Mr.
Speaker: Order, please.
MacPhail: Did you meet your deadline, or are you still stalling until after
the government…
Interjections.
Mr.
Speaker: Order, please.
MacPhail: …has sold everything off to its political supporters?
Interjections.
Mr.
Speaker: Order, please.
Hon. G.
Plant: We are, as I said the last time I was asked this question, working on
it. We have identified one issue that we believe will require a minor change in
the legislation to ensure that the legislation works to achieve its purposes.
We're moving forward on that. We are also, I think, very close to the end of our
discussions with the information and privacy commissioner about making sure that
he has…
Interjections.
Mr.
Speaker: Order, please.
Hon. G.
Plant: …in place in his offices the protocols and the processes that will
be required to ensure that when we bring this bill into force, it will be a
leader across Canada as this government continues to keep its commitment to be
the most open and accountable government in all of Canada.
Interjections.
Mr.
Speaker: Order, please. Order, please. Order, please.
[End of question period.]
Point of Privilege
(Speaker's Ruling)
Mr.
Speaker: Hon. members, on Monday, March 25, the member for Delta North rose
and reserved his right to raise a matter of privilege relating to a purported
leak of a draft report from the Education Committee. On Wednesday, March 27, the
same member rose and presented a matter of privilege for consideration by the
Chair.
I note that
the member has meticulously followed the practice of this House in presenting
his matter of privilege in that he briefly stated the matter, tabled the
newspaper
article which disclosed the possible breach of privilege and tendered
the motion he proposes to move should it be found that a prima facie case of
breach of privilege has been established.
[1440]
Wednesday, March 27, the member for Vancouver–Mount Pleasant stood in her
place and advised the House that she had shared the draft report with a group
[ Page 2355 ]
of people, prior to the report being tabled in the House, on what she
understood to be a confidential basis. To her credit, the member went on to
express her regret and apologized to the House for her
part in the matter.
Before
turning to the merit of the presentation of the member for Delta North, let me
briefly observe that the Chair considers matters of privilege and contempt and
alleged breaches in the most serious vein. It is a tradition as old as
parliament itself that members are entitled to conduct their deliberations
without inappropriate harassment or intimidation being brought to bear on their
work.
Let me
further observe that the release of a draft report from a parliamentary
committee prior to that report being tabled in the House has been held to be a
breach of privilege many times, particularly where the release of the report
interferes directly or indirectly with the committee's deliberations. See Parliamentary
Practice in British Columbia , third edition, page 51.
I have
examined with care the material laid before me in this matter, and it would
appear that the leaked report was used in such a way as to attempt to intimidate
members of the Education Committee. Among the materials filed was an extract
from the Vancouver Sun of March 18, 2002. If the allegations contained in
that
article are substantiated after an examination of this matter by a
committee of the House, the Chair would consider that a serious offence has been
committed.
The
precedents are clear. It is not within the Speaker's authority to make a final
determination, but rather I must satisfy myself that the materials and arguments
presented are sufficient to constitute a prima facie breach of privilege or
contempt of this assembly.
The Chair
finds that the materials submitted, combined with the admission of the member
for Vancouver–Mount Pleasant, establish a prima facie case. Accordingly, I
invite the hon. member for Delta North to move his motion.
Motion on Privilege
REFERRAL TO COMMITTEE: DISCLOSURE OF
EDUCATION COMMITTEE DRAFT REPORT
R. Masi:
In view of your decision, Mr. Speaker, I propose the following motion.
I move that
the matter pertaining to the premature disclosure of the Select Standing
Committee on Education report be referred to the Select Standing Committee on
Parliamentary Reform, Ethical Conduct, Standing Orders and Private Bills.
Mr.
Speaker: You've heard the motion. Debate on the motion, the Leader of the
Opposition.
MacPhail: The debate will be on the advisability of referral, as I
understand it. Before proceeding to vote on the merits of this motion to refer
this matter to committee, I believe it's important to consider some of the
observations about the practice of drafting reports in committees and the
jurisprudence that has evolved over the years.
Mr.
Speaker, you referred to some of that jurisprudence, but there is much more to
it. Firstly, I do want to recognize the gravity of the matter as reported to
this House by the member for Delta North. Certainly, the committee members —
and indeed all members of this House — must continue to have confidence that
the contents of draft reports remain the property of members until published by
the committee.
While
various investigations into so-called leaks in parliaments throughout the
Commonwealth continue to uphold the notion that publication of draft reports
prior to presentation in the respective House is a violation of privilege, it is
also not uncommon for members of committees to at times, on a confidential
basis, seek advice from experts on matters included in draft reports.
There are
many cases in parliamentary law dealing exactly with that point. Indeed, the
Committee of Privileges in the United Kingdom, in its second report of the
1984-85 session, found that members "naturally discuss the work of their
committees with other members, with their own staff or with others who may have
relevant advice or experience without intending publication." That's
parliamentary law as it exists today.
Of course,
the report also found that some of those experts who may be consulted, after
being consulted, may not have had the appropriate respect for the information
they'd been made privy to in such an exchange. We don't deny that.
[1445]
Mr.
Speaker, we have already had the benefit of receiving a full and, I say, an
unprecedented apology from the member for Vancouver–Mount Pleasant regarding
any part she may have played in this incident. Although the Government House
Leader may not have had the grace to recognize the significance of that event in
his response here on the floor, I know that many of the members of the public
that I spoke with over the long weekend certainly did.
Unless, Mr.
Speaker, the members opposite believe that there may indeed be other sources who
could have potentially become a source of the remarks made by Mr. Chudnovsky,
which then found their way into the Vancouver Sun , then it does seem
rather odd to now refer the matter to a committee. There is nothing to be
achieved unless there is other information that any member in this House has
about someone other than Mr. Chudnovsky receiving information through what the
member for Vancouver–Mount Pleasant has already admitted and apologized for.
Therefore,
it's my view that the matter has been sufficiently canvassed both in this House
and in the hallways and in the media, and the motion should be defeated as being
now irrelevant.
Mr.
Speaker: Thank you, hon. member.
Further
debate, the Attorney General.
Hon. G.
Plant: Well, I will urge the members to support the motion.
[ Page 2356 ]
The issues
raised by the member in her presentation of a moment ago are as much issues for
the committee that would be charged as a result of the passing of this motion as
they are issues for debate now. Indeed, the purpose of convening the committee
is to undertake an investigation into both the specific issues and the context
for those issues.
It is rare
in this House — certainly unique in my short experience — for an issue of
privilege to be raised and for a Speaker to determine that a prima facie case of
breach has been established. These are circumstances in which, to protect the
privileges of this Legislature, my view is that the appropriate next step —
not perhaps the final step, but the next step — is for this House to adopt the
motion and move to a process that will ensure that the very questions and issues
raised by the opposition leader are given the airing, the investigation and the
analysis they deserve.
For those
reasons, Mr. Speaker, I urge members to support Delta North's motion.
Motion
approved on division.
Petitions
Hon. S.
Hawkins: I seek leave to table a petition from concerned constituents who
oppose the use of animal leghold and body-hold traps.
Orders of the Day
Hon. R.
Coleman: In Committee B, I call Committee of Supply. For the information of
members, we will be debating the estimates of the Ministry of Health Services.
In Committee A, I call Committee of Supply. For the information of the members,
we will be debating the estimates of the Ministry of Agriculture, Food and
Fisheries, followed by the Ministry of Human Resources and, if time, the
Ministry of Attorney General.
[1450]
Committee of Supply
The House
in Committee of Supply B; H. Long in the chair.
The
committee met at 2:58 p.m.
ESTIMATES: MINISTRY OF
HEALTH SERVICES
(continued)
On vote 31:
ministry operations, $10,053,791,000 ( continued ).
The
Chair: The committee will stand recessed for another two minutes so the
opposition can enter the House. We have been in recess and have delayed this for
a previous five minutes.
The
committee recessed from 2:59 p.m. to 3:03 p.m.
[H.
Long in the chair.]
The
Chair: The committee will come to order. I'd like to remind the member that
when they ask for a recess of two minutes, we expect it to be two minutes, not a
15-minute delay.
The
committee will carry on.
MacPhail: Chair, I greatly respect your advice. I didn't ask for a recess,
though. I said I'd be back in two minutes. I assumed, given that this is the
third hour of estimates with a ministry budget that's $10 billion, that other
members of the chamber would have questions. I'm not challenging your ruling,
Mr. Chair, but that's specifically why I didn't ask for a recess. I said I'd be
back in two minutes. I wasn't — that's true — but it is unbelievable that
with 75 members in this chamber…
Interjection.
The
Chair: Order, member. Order, member.
MacPhail: …there's no questions.
The
Chair: On vote 31.
[1505]
MacPhail: You know, I have to tell you something. I had decided to conduct
these estimates in a way that would just get information out, but I find it
absolutely shocking that unless I'm here in this chamber, there is no
examination of a $10 billion budget. It's not as if people aren't sitting here
doing something. It is unbelievable. Once again, even though there are two of us
and this government is trying to do everything to make us one — why would that
be? — there is no examination of any of these issues. If I just sat down, it
would be very interesting to know what would happen here. What would happen in
this chamber?
Interjections.
MacPhail: I was absent. I was absent from the chamber. That member was
sitting there, and he said nothing — absolutely nothing.
Whatever
this government tries to do to silence opposition, to silence any questioning of
their agenda, it is left up to only my colleague from Vancouver–Mount Pleasant
and me to ask the questions. And yes, it does put me in an extremely cranky mood
— extremely — and quite unnecessary, if you ask me. Quite unnecessary.
On the
issue of health authorities, in terms of budget-making, is the minister
satisfied with the range of questions we've already had on that? If he is, I'll
move on.
Hon. C.
Hansen: I certainly want to apologize to the member if there was a
misunderstanding around the delay in the start. Clearly, there are many other
members in the chamber that do want to participate.
[ Page 2357 ]
The tradition we've had in this chamber, certainly in the six years that I
have been a member, is that the opposition — and the Leader of the Opposition,
in particular, or the appropriate critic, as the case was in years gone by —
gets the opportunity to lead questioning.
I was
certainly trying to defer to that tradition rather than encouraging other
members to participate. We recognize that the task she has in providing
oversight for a budget for the entire government, and particularly a $10.2
billion budget for the Ministry of Health Services, is an enormous challenge.
We're trying to accommodate that in whatever ways we can.
If the
member would like us to go to other private members and some of their issues,
I'd certainly be prepared to do that. It was only out of respect for her
position as Leader of the Opposition that we wanted to give her the first
opportunity in leading questioning around these estimates. That's the intention.
MacPhail: In the last six years there was a critic for every single
portfolio. The fact is that there are now two opposition members and 76 Liberal
MLAs. To somehow say that we carry on with the same practice is ridiculous —
absolutely ridiculous. My colleague and I stand every day in this House and do
our duty — every day, beyond the call of duty.
Government
members here say nothing — rise up and say nothing. Well, I'll tell you what.
I find this exercise completely unhelpful. I've asked my questions on the budget
for the health authorities, so I'll be moving on. If any other private members
have any questions, or any other members, feel free.
Krueger: I've been listening to the debate, of course, and if the member
would like government private members to do some of our questioning at this
point, I'm sure we can do that. We all assumed she would like to cover her
questions first, and as the minister said, normally we have waited to allow
formal critics to ask questions of government before members of government —
indeed, her government — asked their questions.
If the
member would like me to, I have a number of Kamloops issues and issues from up
the North Thompson Valley that I would like to canvass. If she'd give me a nod,
I'll proceed with those if she would prefer, or she can continue with her line
of questioning.
MacPhail: Mr. Chair, we agreed on an order. I'm fine to deviate from the
order, but we agreed on the order. The first order that I outlined this morning
— this is for information, for the member for Kamloops–North Thompson —
was that we agreed on an order. We would discuss health authorities, and in that
context we would discuss health authority budgeting and then health authority
appointments. What I'm saying is that I'm finished my portion of the agreed
order on budgeting for health authorities, based on this process that is
ridiculous.
So if you
want to change the agenda and the member wants to go in and ask about local
issues, fine.
[1510]
Krueger: Well, certainly there are some issues around health authority
budgeting for our interior health authority that I and probably other members
would like to raise. We don't want to interfere with the flow of the member's
agenda. I could do that now. I think it would probably be less of an
interruption to her preparations and order of delivery if we allowed her to
carry on. However, we are perfectly willing to have our private members step in
and do their questioning whenever the opposition member needs some time to
reorganize or attend to other duties.
MacPhail: Go ahead.
Krueger: She's indicating that I should go ahead.
One of the
questions that has come up repeatedly in our area — it's quite understandable,
with the change of organization and the beginnings of the major project of the
tertiary psychiatric facility in Kamloops — is the question as to which budget
pays for the tertiary psychiatric facility and which budget pays for the
operations of the tertiary psychiatric facility after it's established. I've
seen the minister answer those questions publicly, and I think I know the
answers, but I would like to have them on the record.
Hon. C.
Hansen: It is a very good question from the member for Kamloops–North
Thompson. The new TOKO psych facility, as it's being referred to, is made up of
two components. There's the acute care, which is 44 acute-care beds that will be
located on the property of Royal Inland Hospital. The actual operational costs
of that facility will be borne out of the budget for the provincial health
services authority. The operating dollars for the residential component, which
is the two 20-bed units that would be located elsewhere, is also going to be
funded out of the provincial health services authority.
In addition
to that, there is money that is part of the targeted moneys vis-à-vis the
mental health plan. Some of that targeted money will be spent through those
facilities. There is money that will be flowing to the interior health authority
as a direct result of these targeted dollars.
If you look
at the mental health dollars in total, the ongoing budget for adult mental
health as well as the mental health plan dollars that are specified, those will
flow to the health authority for their ongoing programs as well as the new
mental health plan programs. The operating dollars for the two facilities that
we're talking about in the specific question the member asked will come out of
the provincial health services authority.
Krueger: I understand, then, that on an indefinite basis, the funding for
service of the patients who make use of the tertiary psychiatric facility to be
lo-
[ Page 2358 ]
cated in Kamloops will come from the provincial health authority. It sounds
like not any of it is from the interior health authority itself.
Hon. C.
Hansen: That's correct.
Krueger: That's very clear.
We have a
brand-new hospital almost finished construction in Clearwater. The people of
Clearwater are tremendously grateful for this. It was longed for, for a long
time. It was probably one of the last hospitals in British Columbia where the
bathrooms actually weren't heated. Of course, the winters in Clearwater are such
that that could cause freezing of plumbing. Doors had to be left open so that
the plumbing in the bathrooms wouldn't freeze. Cellophane had to be put over the
windows.
This was a
good hospital from the point of view of the service provided by doctors and
nurses and other health care workers there. It's just the physical facility
itself that was something of an embarrassment and, worse, potentially a risk.
People there are thrilled to have this facility nearing completion.
[1515]
Again,
there have been some rumours in the community that the budget concerns of the
government are such that the hospital may never open. I'm confident that that
isn't true at all, but I'd like to give the minister a chance to answer that
question on the record.
Hon. C.
Hansen: My understanding is that this is a facility where the construction
and the capital cost are absorbed under the old model, which means that the
provincial government centrally will carry the debt-servicing costs because this
is a project that is already, as the member pointed out, close to completion.
Those projects that are either underway or are contractually obligated to are
going to be funded out of the old model, which means that the debt-servicing
costs will be paid for by the provincial government.
The
operating dollars will be covered by the health authority itself, which is
consistent with other projects of this nature throughout the province in years
gone by.
Krueger: Since the new facility is replacing an old facility which had an
operating budget, my information from the new chair and the CEO of the interior
health authority, Mr. Dolman and Mr. Ramsden, is that operating funds will now
be applied to operation of the new facility, and there is no threat whatsoever
that it won't open as has been rumoured.
Hon. C.
Hansen: Yes, that's the case.
Krueger: Under the new scheme of things where funding follows the patients,
insofar as that's possible, there's a question in my constituency and probably
in many where constituencies include a lot of highway. People from all over
British Columbia travel those highways and frequently, unfortunately, come to
grief on them and end up in local health facilities. The question is whether
some of the funding that accrues to those British Columbians in their home
constituencies will then be transferred to the local health authority — in our
case, the interior health authority — for the time that they spend in
facilities within that health authority's domain.
We have
very willing and able volunteers right through to the best health care
professionals to deal with these people. We have wonderful people from the
community who show up at motor vehicle crashes on a volunteer basis and extract
the victims with the Jaws of Life. They willingly give of themselves, their
time, their resources and their community resources to equip the emergency
vehicles that are used. Frequently, they themselves are injured in their efforts
to deal with the victims of motor vehicle crashes. All of this, of course,
people are more than willing to do. I was called to Clearwater on one occasion
where a doctor was meeting with a number of the emergency volunteers who had
been cut up while extricating people from a motor vehicle crash and then had
learned that several of the occupants of the car had hepatitis C. They were very
concerned that they may have been exposed themselves. That's just one example of
the things that local people do in providing this service to victims of highway
crashes.
I wonder if
we could have some enlightenment on whether funding that follows those
particular patients will be transferred to the health authorities which dealt
with the care of the victims.
Hon. C.
Hansen: It is certainly our intention to move towards a system of dollars
following patients in a more direct way.
As an
interim step, what we have in place as part of the funding formula that we were
talking about this morning is a system that reflects the volume of demand that
has been put on our health care system from the previous year. If we see, for
example, referral patterns that may cross a health authority boundary change in
one particular year, then that would be reflected in the funding that would flow
the following year.
[1520]
I certainly
feel that a more direct system of dollars following patients will actually
produce better results and better accountability within our health care system.
It's not something that we can simply snap our fingers and make happen tomorrow.
There is a fair amount of work.
One of the
biggest challenges is around how to cost cases. We do not do a good job of
determining, for example, how much an appendectomy costs or how much a multiple
fracture would cost to set. When you talk about the dollars following patients
and the dollars being transferred from the health authority where the individual
is resident to the health authority where the service is provided, we have to be
able to determine what is the appropriate dollar value for services. It's
something we do not do a good job of, and a lot of work is being done now to try
to determine how to put a proper value on particu-
[ Page 2359 ]
lar medical procedures. We're working towards it. That change is not
imminent, but it's my hope that we will get there over the next number of years.
Krueger: There's tremendous angst in Kamloops about a long history of
services, jobs, organizations and people that have migrated down the valley to
Kelowna instead of staying in Kamloops — which, we're convinced, is a much
better place for people to live and enjoy life. There has been some real anger
in the past about decisions that have been taken.
At one time
it was decided that Kelowna was to be the location of a cardiac excellence
facility. That predated my time in Kamloops, but I'm told by many medical people
that there was a deal, actually, between the two groups of medical people. Since
Kelowna would receive that facility, the cancer treatment facility, when it came
to the interior, would go to Kamloops. Indeed, there was an announcement by the
two Social Credit cabinet ministers of the day in the late eighties that the
cancer clinic would be built in Kamloops, and a sign was erected on the lawn.
Then the Social Credit government fell to an NDP government, and during the
election campaign the people with the NDP, as they campaigned, promised Kamloops
that they would go ahead with those plans and that the cancer treatment facility
would be built in Kamloops. In fact, it wasn't. It was also built in Kelowna.
There was a real outcry about that — and justified in my submission.
Now, with
the decisions as to who would be the chief executive officer and the chairman
and the chief financial officer, for that matter, for the new interior health
authority and with all of them being resident in Kelowna, a lot of fears have
been expressed that we're going down that road again.
Royal
Inland Hospital is the third-largest trauma referral centre in the province, and
that's because it is force-fed that work by the calamities that happen to people
on the highways and in heavy industry. We're confident in the level of expertise
that we have and the service that's being provided, and — with the fact that
the work comes to us by nature of our location and the location of the people
when they receive those unfortunate traumas — that we will continue to have
the status of regional referral centre. Yet, there has been so much concern in
the community that again I would like to put it on the record to the minister
that Royal Inland Hospital is a centre of excellence for trauma care in British
Columbia.
We believe
that by virtue of all those things I discussed, it should be the second major
hub of the interior health authority with regard to referral of patients. We
have a critical mass of medical expertise — a body of very well qualified
health care professionals. We're anxious that we not lose any of that and that
we continue to attract medical expertise to Royal Inland Hospital.
I'd like to
have the minister's views on this ongoing concern about the status of Royal
Inland Hospital.
Hon. C.
Hansen: As the member knows, we have asked all of the health authorities to
review all facilities in the province. Every hospital should be challenged in
terms of where it fits into the delivery of health services for British
Columbians. As I mentioned this morning, that is really what is driving this
agenda. It's not how to best utilize the facilities we have but rather how to
deliver the programs that are expected of us and services that are expected of
our health care system.
[1525]
I do not
know yet what specific recommendations will come from the health authority with
regard to Royal Inland Hospital, other than an acknowledgment that Royal Inland
has always been a major hospital in this province. It's an important part of the
network of health care facilities in this province. I have every expectation
that it will continue to be so as a result of the service redesign that's
currently underway.
Krueger: I appreciate the minister's answer and the fact these decisions
have been delegated to the health authorities themselves. Being that this is a
time of transition, I hope he'll continue to indulge us with his patience in
dealing with some of these issues that really concern local people.
One is the
fact that the radiology and emergency room areas of the hospital are
significantly outdated. They were built for a much smaller population a long
time ago, with different equipment. I'm advised that the interior health
authority has told our doctors and many people in the interior health authority
region, including our health service delivery area, that the reconstruction of
those facilities is the number one capital project for the interior health
authority. Yet, they're unable to commit as to what that means insofar as the
dates that construction for those renovations is likely to commence. I wonder if
the minister would update the House on how he sees questions like that being
resolved and how he sees such matters unfolding.
Hon. C.
Hansen: As we went at some length this morning talking about the change in
how capital dollars will be allocated, this is a transition time for us in terms
of a new way of approaching capital projects. I think the good news for people
in Kamloops is that finally they're going to have the ability to make those
decisions regionally to meet their priority areas. In the past, hospitals and
health authorities generally had to come begging Victoria to put their projects
on a priority list. Now, under this new model, the health authorities themselves
will be able to determine their priorities and allocate their capital dollars as
they see fit, which gives the ability to get on with the projects in a much more
timely way compared to the last number of years.
Krueger: Prior to the reorganization of health care, I was receiving
lobbying letters from medical people, including doctors in the Revelstoke and
Salmon Arm areas, essentially saying they expected we were going to reorganize
health care and that when we did, they did not want to be obliged to refer their
patients down to the Okanagan Valley. They would like to continue what they
consider to be the natural and
[ Page 2360 ]
historical method of referral to Kamloops along the Trans-Canada Highway,
which we all service.
Since the
health care reorganization, the doctors in those communities are understandably
keeping their cards a little close to their chests because they don't know where
they're going to end up. My understanding is that they still wish to do their
referrals in the direction of Royal Inland Hospital. This is deemed to be an
important question in our health service delivery area because we understand the
200,000 population number in the catchment area to be significant in the
question of regional hospital referral status. I wonder if the minister can give
his views on the matter of which direction patients will be referred by their
doctors.
Hon. C.
Hansen: We are not going to be telling doctors where they have to refer
their patients. Clearly, in the past doctors have used their discretion and
their knowledge about where they think their patients can best get access to the
care they need. In some cases you would have doctors who would refer patients to
Vancouver. In some cases it might be Calgary, Edmonton, Kamloops or Kelowna.
There may even be cases out of Revelstoke where a doctor would think it
appropriate to refer a patient to Prince George if that's where that patient's
family network is, for example, and support.
[1530]
In all of
the redesign we're doing, we're not going to change that prerogative of the
doctor. What we are going to do is look at how we can ensure there is stable
provision of core specialty services. Too often throughout British Columbia now,
you will have a group of maybe fewer than five specialists in an area. They
can't provide consistent coverage. If you only have three specialists in an
area, they may try to provide the one-in-three on call, which is pretty draining
on a specialist. In some cases where you've got only three specialists, they've
said they'll only do one in five, which means there will be two nights out of
five where there will be no coverage at all. When you get a physician from
another community wanting to refer patients into that specialty group, the big
problem we then get is the uncertainty as to whether that specialty group is
available in a stable, 24-hour-a-day, seven-day-a-week manner.
Part of the
redesign is to say: how do we ensure that these core specialties are going to be
provided in a consistent way 24 hours a day, seven days a week? Part of when
they're looking at where these specialty services should be located is to ensure
that there is a critical mass of specialists to ensure that we don't get the
physician burn-out we've seen in the past, but we also give a certainty to the
GPs who are referring their patients that in fact there is the competency there
24 hours a day, seven days a week. This, in many cases today, is inconsistent.
That's part of the redesign that's going to be coming forward.
Krueger: Just one more question, and then I'll defer to some of my
colleagues across the way who wish to ask some questions.
The Speaker
of the House and I have received a very concerted lobby by a number of employees
of Royal Inland Hospital who have been employed in the finance area. They have
presented a very well reasoned proposal establishing their argument of why
centralized billing and accounts receivable functions for the interior health
authority should remain and be located in Kamloops. Essentially, the argument
is: "We are your resources. We're fully trained. We do this job already.
It's largely done electronically. It can be done anywhere within the interior
health authority. We have the equipment; we have the offices. Everything's in
place. It costs nothing to allow us to continue to do the work here."
They have
been alarmed by some statements by the financial officer, Mr. Mazurkewich, and
there have been some suggestions that people who wish to retain that type of
work will have to be relocated to Kelowna. There has been discussion of leasing
a building in Kelowna to put all these people in one place, and so on. Of
course, that has played right into the fears I discussed earlier as to Kamloops
losing jobs, economic activity and indeed expertise to Kelowna.
I know that
Mr. Dolman and Mr. Ramsden are working through that, and I'm confident they'll
make the best possible use of all resources and be very respectful of families'
needs, and so on, and not do unnecessary moves. If it does work out that there
is some need for an arbitration — using the term in a very generic sense —
of disputes like that between Kelowna and Kamloops, is there any provision for
that as far as appealing to the ministry if, within health authorities, there is
significant dissension over decisions that are taken?
Hon. C.
Hansen: Part of the challenge we've given to the health authorities is to
find the most cost-effective way of providing the services necessary, first of
all, in terms of patient care but then, secondly, in terms of the support
services the health authority needs to make sure it operates efficiently and
effectively. Those are the kinds of decisions that are clearly not political
decisions. These are administrative decisions around cost-effectiveness.
I know the
management team in the interior health region is aware of the issues that have
been put forward by staff in Kamloops, and at the end of the day they're going
to have to make their determinations on how to run the health authority most
cost-effectively. If they can do that with the existing configurations, then
they have the authority and the flexibility to do that. Also, if they feel that
in order to deliver good patient care, it is necessary to consolidate services,
then they also have the power and the responsibility to do that. We're not going
to dictate those kinds of decisions from the ministry, but we're going to
basically ensure that they make good decisions based on the best use of every
health dollar available so that we get the most cost-effective provision of
services possible.
[1535]
Jarvis: I want to ask the minister a few brief questions in regards to
structuring in our hospital sys-
[ Page 2361 ]
tem. As you know, I am from the North Shore. We are now included in the large
health authority of Vancouver coastal — North Shore, Coast-Garibaldi, along
that vein. Also, just recently there was a supposed document leaked with regards
to certain particulars as to how the North Shore region was being handled. I
appreciate the fact that this document, which was supposedly released, was
really just a working paper on the part of the health region, but my following
questions are necessary so that I can get some clarification on the situation.
As you
know, the North Shore health region was rated by Maclean's magazine as
the number one health region in Canada for the past two or three years. So, I
guess, a lot of people in my riding are real concerned at the fact that it's now
being taken away and included into a big behemoth running from Delta almost up
to Prince Rupert or up into the Bella Coola area. One of the questions is: what
is going to happen to our area?
Then, all
of a sudden, we find we have a pseudo-leaked document coming in which states
that they are going to refocus the direction of care in my riding specifically,
all the North Shore. They're going to reduce the intermediate care beds by 200
and some odd. I was told by one of the directors of the region that this was
being done so that they could give more quality home care. Then you go further
down on the "leaked memo," and you find that home care is being
reduced as well. It doesn't jibe. It doesn't fit.
First of
all, I wanted to know: the funding for the area that you have absorbed — the
North Shore, now absorbed into the Vancouver coastal, North Shore, Garibaldi,
etc., etc…. I don't know what the exact name is really, because on one of the
papers I have here it says Vancouver coastal health authority, and then another
one says the Vancouver, North Shore, Coast-Garibaldi, Vancouver and Richmond
authority. It does get confusing for a layman. I'd like to know how the funding
is going. Are we going to be short of funding now that we're part of a large
group or several different health regions that have been combined? Or are we
looking at equivalent funding to what we had before, with an additional amount?
That's my first question, if you wouldn't mind.
[T. Christensen in the chair.]
Hon. C.
Hansen: Every health authority in this province has seen an increase in
their budget from what was there last year. Actually, the correct term is the
Vancouver coastal health authority. Just to give the member the restated base
budget, last year for the Vancouver coastal health authority it was $1.536
billion. In this fiscal year, which is just starting, that increases to $1.647
billion, so we see an increase of about $110 million over what was there last
year.
[1540]
That's not
to say that's the panacea to all of their problems. They still do have cost
pressures that they are going to have to manage. There's not enough money to
continue with the status quo the way we were doing things. What we have asked of
all authorities is not to…. You can't look at the health care system as being
a collection of isolated and disjointed programs and facilities. There has to be
an integration and a determination to make sure the facilities and the programs
meet the needs of those living in the region. That's the challenge we give them.
I am aware
from the news reports of the leaked document that the member's referring to. I
have no idea yet whether that is or is not — or whether part or parts of it
have been — accepted by the health authorities in their recommendations to
come forward, because I haven't seen what their recommendations are yet.
The bottom
line is that throughout all of these changes that we will see, we will be
holding the health authorities accountable for the delivery of better health
outcomes. There may be changes in home care, changes in terms of home support,
but what changes in one area may be enhanced in another area. The Minister of
State for Intermediate, Long Term and Home Care is looking at some of those
innovations, as to how we can better provide for those needs.
But at the
end of the day we are holding the health authorities accountable — it's in our
service plan; it is a measurable item — to ensure that we actually get better
home care for more people in all of the health regions throughout the province.
At the end of the day that's what they're going to be held accountable for. It's
not just about balancing a budget. It's about ensuring that we actually get
better health outcomes at the end of this change process.
There is
change, and I have no doubt that the residents of the North Shore will continue
to have the best health outcomes in Canada. What it speaks to, which comes out
of the World Health Organization, is that the biggest determinants of health
outcomes are not so much the provision of acute care facilities or things that
you would actually consider health services, but the biggest determinants in
terms of health outcomes are around economic status and education levels. Those
are the things that really are drivers of better health outcomes. I think that
in the North Shore you see longer life expectancy and better health outcomes
partly because we do have a good health care service, which we're not going to
compromise, but we also have those other socioeconomic factors that drive better
health outcomes throughout the world.
Jarvis: If you have increased the funding for Vancouver coastal health
authority, are they the ones that designate now whether the North Shore coastal
area has funds reduced there that they have to make up by making adjustments?
When you say they have to be accountable, on whose authority? The minister says
that they have to be held accountable. You've given them directions as to how
they're going to operate, but what if they don't operate their system the way
that you feel is accountable or that the citizens in the North Shore feel is
accountable — whether they still have the same level of service? Do we come
back to the Vancouver coastal
[ Page 2362 ]
health authority, or do we come to the North Shore coast region, or do we
come back to the Minister of Health?
Hon. C.
Hansen: What we are putting in place, which is the first time in Canada that
any government has done this, is measurable outcomes when it comes to the
difference that health care services make in individuals' lives. In the past the
only measurement was whether or not a budget was balanced, whether there was a
deficit or no deficit. This is the first time that we've gone beyond that to say
there are measurable outcomes.
For
example, we will be measuring the number of seniors with high medical needs who
are being properly supported in their homes, and the reduced reliance of
long-term care residents on the acute care system, to ensure that they have
stability in their healthy lives. Those are measurables that we have built into
the service plans. The service plan for the ministry as a whole is there on the
website. We are currently working on the performance contracts with each of the
health authorities to make sure they assume their share of that responsibility
in meeting those health outcomes.
[1545]
It is a
fundamental shift. We're not simply going to measure the success of health care
in British Columbia by how much money you put into the system, how many programs
you have or how many employees there are in the system. For the first time we're
actually going to start measuring and reporting to the public the outcomes of
those in terms of how it actually results in healthier lives for British
Columbians. Those are measurables, and those are items that the senior
executives of the health authorities will be held accountable for.
As you may
know, there is a salary holdback for the CEOs of the health regions. If they
don't achieve their targets, then they're going to face the consequences when it
comes to their own pocketbooks as well as the ability of the ministry to give
them the latitude with which to manage their affairs. If they show that they're
delivering on their outcomes, that they're living up to their expectations, then
first of all they're going to be given the latitude to manage with less
oversight and less interference from the ministry on a day-to-day basis, because
they will have demonstrated that they're meeting the needs of the population.
We're going to give them the latitude to continue to do that.
Jarvis: I just have one quick, short question, and that'll finish my
questions for the moment. Maybe it's a softball question to you, but it is
loaded. There's a reason for it being loaded in the sense that I can now go back
to my constituency and tell them that although we may have had a lot of services
before, some of them were superfluous. We're going to move them aside because we
can't afford them anymore, but the overall service to the patients in North
Vancouver, whether they be emergency or long-term or acute patients, will be
better than it was before.
Hon. C.
Hansen: I would be reluctant to call any health service superfluous.
Although there may be examples, I think they're probably few and far between. I
don't think you'll find any doctors or other health care providers in this
province who are providing services that are superfluous, but I think it is a
question of priorities. We have to make sure that the health dollars we have
available are going to priority areas. We have to make sure that we deliver on
the needs of residents of all communities throughout the province, whether it's
the North Shore or northern B.C. — that we deliver on those services in a way
that ensures they get access to the urgent and emergency care they need and that
elective surgery is organized in a way that ensures that people get timely
access.
What is not
realistic is to say we're going to be providing that service on every street
corner in every community. We have to ensure that we provide those services in a
way that is sustainable; that can be counted on 24 hours a day, seven days a
week, if that's what's needed; and that no resident in British Columbia,
regardless of where they live, is going to go without necessary medical care.
That's what I think we see happening too often in British Columbia today. That's
what we will change. I believe that you're on firm ground in giving your
constituents that kind of assurance that the health care system will be there
for them as and when they need it where they live and that we're going to build
on the successes of the past.
S. Orr: I
first of all want to say that I just want to make a comment on the member for
Vancouver-Hastings's comments. I actually, as a rookie member, was being polite.
I was waiting to ask my questions, but I'm very happy to ask questions on a
budget of $10.4 billion. It is a very large budget, and it is of great interest
and concern to all of us.
Where I
want to ask…. A lot of the questions have already been asked previously, but
where I'm coming from is…. Now that we've consolidated and restructured the
regional health authorities, what I would like to ask you is: could you clearly
define to me what the ministry's relationship is going to be with the health
authorities in their performances and their contracts? I'd like to see that
picture, if you could explain that to me.
Hon. C.
Hansen: What we will be putting in place — and a lot of this work is now
already done, but we're sort of putting the finishing touches on it — are the
provincial standards of care that we expect to be delivered anywhere in British
Columbia so that regardless of whether you're in Dawson Creek or in Saanich, you
will be able to expect a minimum standard of care that will be consistent
throughout the province. Those standards of care have been delivered to the
health authorities. As they go through their redesign process, they will have to
meet those minimum standards of care.
[1550]
There are
many parts of British Columbia where that will mean they will have to provide an
enhancement to the existing levels of care. In many small com-
[ Page 2363 ]
munities, they may have health services provided but not for a consistent 24
hours a day, seven days a week. As everybody in this chamber knows, health
emergencies happen at all hours of the day and all days of the week. It's not
something that fits into the convenience of Monday to Friday, 8 o'clock to 5
o'clock.
The other
dimension of what goes to the health authorities is performance contracts. There
are certain requirements and certain guidelines that are being set out for them
there. When I talked earlier about our own service plan for the ministry and the
goals we have set of how we want to achieve better patient outcomes for the next
three years, that will be constantly extended by a year, so we're always working
on a three-year horizon. Those objectives, those measurable outcomes, will be
built into the performance contracts for the health authorities. They will have
to deliver on their share of those obligations so that we can meet the
provincial targets.
What is
changing is that we will no longer be micromanaging every single decision the
health authorities make. They are going to be given an envelope of money, and
they now know what those budgets are going to be. They're going to be given
flexibility to meet their regional priorities within those budgets. If that
meant reallocating dollars in the past, they would have had to come to Victoria
and ask permission, and there was a delay there. By the time it all got sorted
out, the problem got worse in many cases.
The health
authorities will have flexibility without us hanging over their shoulder. At the
same time, they're going to be held accountable at the end of the day for the
health outcomes everybody wants to see, which is an enhancement of better health
outcomes for individual British Columbians.
S. Orr:
On the consolidation of the health authorities, could you tell me what the
savings were? Do you have that figure?
Hon. C.
Hansen: At the time we made the announcements of the restructuring in
December, some of the preliminary work that was done by the ministry indicated
we would get administrative savings in the neighbourhood of about $20 million
over a three-year period. That took into consideration severance payments we
felt would have to be paid for administration staff and senior executive staff.
This obviously has been in the news, but if we're going to restructure and save
money, sometimes it costs money to save money.
What the
number doesn't include is the ability to consolidate services. There has been a
lot of work around shared services. We have also given the health authorities
the ability to consolidate services, particularly around support areas, and the
ability to contract out, if they think that's the way they can get the cost
savings, so there's another whole level of cost savings that will flow from the
restructuring announcements.
That will
be considerably more than the $20 million of direct savings. Clearly, I think,
it depends on how many years you want to go out. Initially, there are upfront
costs around severance payments that will be quite expensive, but by going
through that restructuring, it will allow us to save considerably more money in
the long term in ways that will allow those dollars to be refocused on direct
patient care.
We're not
talking about reductions in patient procedures. What we're talking about is
changes in how support services are provided, how administrative services are
provided, so we can get the most cost-effective support systems for the delivery
of direct patient care.
S. Orr:
I have just one more question, and I would be remiss if I didn't ask a question
that was directly related to my area. I happen to be privileged to live in an
area where we're well facilitated by hospitals, specialists and doctors. This is
the Vancouver Island health authority. I don't hear a lot of complaints about
the health care system in Victoria, because we have facilities, but I want to
take this a bit further. I want to take this up-Island.
[1555]
We have a
patient now who is up in Tofino or Ucluelet. If that patient requires a
specialist or requires medical attention, can you give me a picture as to how
that will change from how it is now to how it will be now that we've
restructured? Somebody in Tofino has had a serious injury. Where do we go with
that patient? Before, they would have probably gone to a local hospital. I'm not
quite sure how many hospitals there are up there, but with the restructuring,
what will happen now to that patient? How will it be more beneficial to him or
to her?
Hon. C.
Hansen: Well, first of all, I just want to say to the member that I'm very
reluctant to talk about any particular community. I have yet to receive the
recommendations from the Island health authority with regard to their
restructuring and their plans for any facility on the Island.
If we can
take that sort of one step back and talk about a hypothetical remote community,
our commitment is that when somebody's involved in an accident, we want to make
sure they can get access to emergency care as close to where the accident
occurred as possible. They need to be stabilized. We often hear about the golden
hour that people have if they're in any kind of a trauma situation, whether it's
an accident or something like a severe heart attack. They need to get access to
emergency care.
What is the
case today in many smaller communities in British Columbia is that they don't
have consistent 24-hour-a-day, seven-day-a-week coverage. We are asking the
health authorities to ensure that 24-hour-a-day, seven-day-a-week coverage is
there. That is, it has to be a priority for them. Then they have to have the
ability to stabilize the patient, to do the assessments, to do whatever
diagnosis is within their capacity. My hope is that within a few short years,
we'll be able to expand the amount of telehealth that's available so that
diagnosis around trauma can be rolled out into
[ Page 2364 ]
more smaller communities. Currently, it's being piloted in Cranbrook and
Terrace, but clearly there's an opportunity to put that technology into many
smaller communities around the province as well.
The next
stage is to ensure that the physicians who are attending that accident victim or
that heart attack patient know exactly, on a consistent and dependable basis,
where they can refer that patient to get the next level of care that's required.
That has to be within a radius of only a few hours in terms of what's
appropriate for them to get into an appropriate level of care for more serious
injuries.
As the
health authorities are doing this redesign, they have to make sure they can
provide emergency care, they can stabilize, they can begin diagnosis, and they
can then refer the patient to an appropriate facility they know is staffed with
the appropriate specialists 24 hours a day, seven days a week with consistency.
In fact, they would have access today to what's called B.C. Bedline, which is an
innovation brought in by this government last September I believe it was, where
physicians throughout the province can actually determine which hospitals have
beds available that can provide the specialized care that may be required for
that particular individual.
What we're
trying to move away from is a very disjointed level of care we've had in the
past where doctors would spend hours on the phone trying to find a hospital that
can receive their patient. Many times they can find a hospital that has a bed,
but they don't have the specialists on call who are required for that particular
need.
[1600]
What we
want to do is ensure that the new, re-designed health care system is in fact one
that is integrated and is truly a system, a network of dependable, predictable,
reliable, 24-hour-a-day, seven-day-a-week services so that the accident victim
you refer to is going to get the care they need within the time they need it. I
think people will see it as a significant improvement over the unpredictable,
disjointed system that we have today.
Chong: I want to begin by thanking the Leader of the Opposition, the member
for Vancouver-Hastings, for yielding the floor to many of us private members who
do have questions to ask.
Having been
in opposition for the past five years, it was always a time where opposition
members were able to ask questions. Other members timed them so that we could
engage in the categories that would flow and make it relevant with the
minister's staff to be here at the time so that we didn't have too many staff
people here. Having heard that she yielded the floor to those of us who would
like to ask questions, I do want to thank her for this opportunity.
I want to
also follow along the lines of asking about the regional health authorities. As
the member who spoke just before me represents the same area that I do —
Vancouver Island health authority — I first of all want to say that I do
appreciate the fact that the new structure, the new model of governance, is
going to provide a better health care system for our constituents. I represent a
riding that is heavily populated with seniors, so in particular I am concerned
because their needs are much more demanding on the health care system, in
addition to the fact that they will be the ones most interested in knowing where
we are headed in terms of the long-term community care beds.
Before I
move on to that, I also want to say that for those constituents of mine who may
be paying attention to today's deliberations, they can feel assured that the
structure is now in place where ministers have been very receptive to members
ministers — that the Premier has instilled in all of us has been very
fortunate indeed. Many of the cases that come to my office, and indeed to many
of the members here, we are able to raise with the minister's office as opposed
to dealing with constituent after constituent in estimates debate, which used to
be the case in the past. However, I will have a couple of issues with
constituents' concerns that I will raise.
[H. Long in the chair.]
First of
all, I'll talk about the Health Services ministry and the service plan. I was
curious to see that a number of programs and services are being discontinued —
in particular, ministerial advisory committees. I have received some concerns
about these, and I'm wondering if the minister can advise how these are going to
be transferred where there will be a more direct responsibility.
[1605]
As noted in
the service plan, the advisory committees on HIV/AIDS, the seniors advisory
committee and the women's health and injury prevention advisory committee are
being transferred so that regions will be directly responsible. I am getting
questions on just how that direct responsibility will affect the constituents in
my area. In the context of those advisory committees, could the minister advise
how that responsibility will flow through to our local areas?
Hon. C.
Hansen: Just to back up a little bit, I think it's important to define the
framework in which a lot of this work is being done. The Ministry of Health
Services itself is getting out of the business of direct provision of health
services. It is the health authorities that have to take responsibility for
that.
Over the
last number of years there has been a significant transfer of responsibility
from the ministry to the health authorities. With our restructuring of the
health authorities, there's even a greater capacity now with the six health
authorities to assume full responsibility for the administration of the delivery
of health services. That provides for a much better integration of health
services at the regional level instead of the stovepipes that we had before.
We have
found that a lot of the issues these various advisory groups in the past had
been focusing on were
[ Page 2365 ]
operational issues in terms of the delivery of services. That is now rightly
in the purview of the health authorities. We are asking the health authorities
to establish the appropriate advisory committees that they think are needed in
their regions. Some health authorities are further along in that process than
others. That's really where a lot of these groups would want to make
representation and have influence around how services are actually delivered.
When it
comes to the provincial perspective around women's issues, which the member
mentioned specifically, there is an excellent policy capacity around the
Children and Women's Health Centre of B.C. in Vancouver, which falls under the
provincial health service authority. They have that capacity there.
Also, if
you start looking at the policy issues, the policy framework and the
accountability mechanisms that are needed in the longer term, we now have at the
cabinet table a minister responsible for intermediate, long-term and home care
who is actively ensuring that voice is heard around mental health issues.
Obviously, the minister of state there is actively ensuring that those voices
are heard when it comes to the policy development.
There is a
separation between the advice we would be taking on the policy front, which is
being championed by ministers at the cabinet table, and the operational health
service delivery issues, for which we are looking to the health authorities to
ensure they're getting those inputs.
Chong: I thank the minister for that because I think there were concerns in
our constituencies and certainly in mine, when there was the announcement that a
number of these advisory committees were being discontinued. The fact they can
still exist more focused in whatever region is much more important because, like
so many things, not all regions are the same. The entire province is not
identical in their cost pressures and their health demands. In those areas and
in my area where seniors are very important, I'll expect that they will go and
see their health authority and health regions to request they have input in that
area. That's very, very helpful. I think it was important to put that on the
record so people know that they still have a voice and that their issues will
still be brought forward.
In terms of
the restructuring and regional health authorities, I again want to thank the
minister. His staff have been very helpful in providing information to me. In
particular, a week ago I asked about funding to the capital health region, which
has now been rolled into the Vancouver health authority. I wanted to know how
their budget has fared over the past few years, because we were hearing through
the media and some fearmongering that was going on that the health budgets had
been cut and everything had been slashed.
[1610]
To express
to your constituents that a $9.3 billion budget has climbed to over $10 billion,
that over $1 billion has been put into the health care budget…. That message
seemed to have been missed. I've been wanting to ensure that my constituents are
aware and have it communicated to them that in fact we have put more money into
this area.
Your staff
— through you, Mr. Chair, to the minister — were very helpful in giving me a
breakdown of every year, and indeed health care funding had increased every year
for the capital health region. With the new Vancouver Island health authority, I
think there was still a misunderstanding about whether or not the combined
dollars from the upper Vancouver Island health region and the capital health
region — whether those two amounts, when combined — still created an
increase in that health region funding. I'll let the minister answer that first
before I follow up with a few other questions.
Hon. C.
Hansen: The answer is yes. If you take all of the budgets that were in place
for the capital health region, the Central Vancouver Island health region, and
add into that the Comox Valley community health council, the Mount Waddington
community health services society, Campbell River — all of those different
health authorities that have come together to make up what is now known as the
Island health authority…. If you combine all those budgets together and add in
the additional dollars that we put in during the year last year, you come up
with a restated base of $880 million for what was in those budgets last year.
What flows to them in this coming year is a budget of $974 million. There is a
fairly significant increase to the Island health authority over and above the
combined budgets of those various health authorities.
Chong: That's great news — in fact, wonderful news. I appreciate that for
the record. Constituents can now look at our debate and know that health care
funding in this area was certainly protected — in fact, enhanced.
The other
part of the restructuring is such that health authorities will now get
three-year funding, as I understand it. I think that also was a good move. All
too often, when I was in opposition, I would get calls in August and September
— sometimes frantic calls — asking what I could do as an opposition member
to get Ministers of Health to release their funding so that they could better
plan. It was always a problem for the health authorities, particularly in this
area anyway, that they were not able to know what secure funding they would
have. This process now allowing for the three-year funding envelope is indeed a
good move forward, a very positive move forward.
The
minister has already responded to a number of questions by other members in the
House regarding performance measures and performance contracts. I'm wondering if
the minister can share with us how performance contracts — and performance
measurements and performance targets — will be measured in light of the
three-year funding allocations.
Will one
year pass where an evaluation occurs and then a determination is made whether
that funding envelope has to change again — either increase or de-
[ Page 2366 ]
crease? Essentially, how often will that evaluation take place in the health
region? How are these performance contracts going to be evaluated? In fact, how
are they going to be developed, if the minister can advise, and how soon does he
expect them to be signed off? There's still some confusion, I know, amongst my
constituents about that.
[1615]
Hon. C.
Hansen: First of all, with regard to the three-year budget, it's a very good
question that the member asked. We do want to bring that kind of certainty on a
three-year horizon, so we will be constantly looking three years out.
It's not to
say that's locked in stone. We will want to reflect if there are significant
changes in patient referral patterns — for example, as we talked earlier, the
need to reflect when patients are crossing regional boundaries. Unfortunately,
that is still an after-the-fact adjustment that we make in the following year's
budget. I'd like to move to a more sensitive case, which is what will be worked
on over the next couple of years. We also have to reflect significant
demographic changes in regions.
So there
may be some adjustments from year to year, but generally we want to give
stability to those three-year budgets so that health authorities can plan with
certainty on that three-year horizon instead of the sometimes five- or six-month
horizon that they're reeling from in the past.
With regard
to the targets, they will be reported on annually as to the progress the health
authorities are making towards achieving those targets. We will not be punishing
the residents of a health authority if targets are not met, but we will
certainly be holding the executive and the individual CEOs accountable. One of
the things that's in place is a salary holdback for the CEOs. If they don't meet
their targets, it's going to affect them in the pocketbook in terms of what
their remuneration is.
With regard
to the signing of the performance agreements, we are in the final stages of
trying to work them out now. They're not something we're going to unilaterally
impose on health authorities; this is a negotiated agreement. They have to be
willing to accept those obligations before we sign them. We're in the final
stages of putting those in place, and I hope they will be signed soon. As soon
as they are signed, they will be made public and posted on the websites.
Chong: The minister did mention earlier, and just confirmed again, one of
the ways to hold health authorities accountable. That has always been a concern
in the past. Certainly, when I was in opposition, constituents would always
wonder how they would be held accountable. One of the ways the minister
indicated was by salary holdbacks for the executive and the CEO in particular.
That is certainly not information that was well known, and those following these
debates will find that there is definitely a monetary consideration there.
Can
the minister advise whether there are any other similar kinds of accountability
measures in that? Is this the only one, or are they still being developed as to
what kinds of things? If they are still being developed, how soon might we know
about that? Again, we hear a lot about wanting to hold these health authorities
accountable, but our constituents will ask us just what that means. How are we
going to hold health authorities accountable if they are not elected? In my
case, I'd like to be able to go back to my constituents and show them a list of
things that health authorities, CEOs and boards are going to have to adhere to.
that's all in the performance contracts, I guess I'll have to wait for that, but
if the minister can advise if he has a few others, I would find that helpful.
[1620]
Hon. C.
Hansen: This whole move toward performance contracts and accountability
measures is a real innovation that hasn't been tried anywhere else in Canada.
Many provinces have already approached us with interest as to what we're doing
and how it's unfolding.
The
performance measures that are in our service plan, which are now on the website,
are a first cut at accountability measures. There is always the opportunity to
add other measures if we think there's something particularly poignant that
would be of interest to the public. We want to be careful doing that, because we
don't want to wind up with just an exhaustive list of accountability measures
that everyone starts to ignore because it becomes too complex.
There is
certainly the salary holdback for the CEOs that is an important incentive, I
think, but it's also not the be-all and end-all. I think the most powerful
incentive for a health authority to ensure they get good outcomes is the fact
that this is all going to be public information and that health authorities and
individuals around this province will be able to compare how their health
authority is doing, compared to a neighbouring health authority, on any one of
those accountability measures.
That's not
to say there's a magic number indicating that one health authority is doing a
good job and another one is doing a bad job. What's important is the relative
difference. We may realize that if one health authority has lower health
outcomes that are publicly reported, we can then go in and start asking why this
is happening. Is it that they're not putting enough resources there? Do they not
have the right programs? Do other health authorities have better programs that
are getting better results?
So how can
we learn? Let's make room for innovation. Let's make room for success in health
care, but let's do it in a way that we can actually identify success when it
happens so that other health authorities can learn from those programs.
Chong: Just for the benefit of the minister, in case he needs staff, I'm
going to move on to some other ar-
[ Page 2367 ]
eas. I'd like to ask some questions on MSP, Pharmacare and wait-lists.
First
of all, I'll bring in Pharmacare, because within the service plan I know there
are some changes planned. One area in the service plan regards the income
testing that will come into effect January 1, 2003. Can the minister advise what
process we're going to be going through on that and how information received
from the Select Standing Committee on Health fits into that, where there's going
to be some input?
I've had
some questions in my riding. I've spoken to a number of seniors regarding this,
and there generally has been a wide acceptance of that — that this was long
overdue. They just wondered how that process was going to work — what kind of
inclusion would there be for their input, if any, and what groups may want to
make presentations? — or whether that is being worked on at this time. If the
minister can give us a little bit of an idea on how that's going to work, I
would like that.
Hon. C.
Hansen: Actually, at the start of estimates debate this morning with the
Leader of the Opposition, we determined a sequencing of issues. We're going to
try to deal with the health authority issues first; then go on, I believe, to
appointments and particularly the appointment process for health authorities;
then go on to public health, Medical Services Plan, Pharmacare, B.C. Ambulance
and health information systems; then deal with wait-lists, aboriginal health,
women's health and tobacco. That's the sequencing.
If you
don't mind, we can certainly try to deal with those when we get to those subject
areas. I will remember the questions, and even if you don't get a chance to
re-ask them, I'll make sure they get addressed.
Chong: That was perhaps part of the difficulty that some of us were having
in following the debates and participating in the debates. We weren't clear —
and I wasn't able to listen in this morning to follow — on the relative order
that the Leader of the Opposition had requested. Perhaps then, because I do have
those areas and those questions to ask, as does the Leader of the Opposition, I
will try to watch the proceedings and make sure I attend at those times and ask
my questions.
There is
one thing I would like to ask, and I don't know if this fits in that order. It's
regarding radiology services. Is that considered in order? The minister is
shaking his head. It's in the order, so I have to wait for that too — or no,
he's acknowledging that I could ask that question now. Thank you very much for
that.
[1625]
I wanted to
ask about that, because I did have a constituent — in fact, a doctor — who
had asked about radiology services and the fact that a number of doctors may be
housed, for lack of a better word, in one building where they are all desirous
of radiology services. They cannot have prompt access to radiology services
because they are required to attend at another location where they would send
out for those radiology services.
Of course,
the question that came back to me…. There were a number of these doctors in
this building saying: "Well, why is it that in our building, which has 20
or 30 doctors, we have to go out to this other location where there are only two
or three doctors and they have a radiology lab set up there? Wouldn't it make
more sense for them to relocate to our building?" There seemed to be some
confusion as to how radiology services would be permitted to be provided and how
they would be paid for through the health authorities and whether the ministry
would have some direction or control over that or whether those things would
also be delegated to health authorities.
Again,
where doctors are looking for economies of scale and convenience, as well as to
their patients, it would seem to make more sense that a building with 20 or 30
doctors…. As you may well know, it occurs quite often. They try to put as many
services in one building, whether they're pharmacies or whatever, on the ground
floors and have all their doctors' offices above so that everyone can take
advantage of better service for their patients.
It didn't
seem to make sense, and I was hoping that the minister can shed some light on
this dilemma that doctors in my area, actually, are facing. I had actually made
a call to his office, and there was a response back that there was a review
being undertaken. Still, I would like to know if the minister can provide any
additional information either about the particulars of that or whether the
review has started and how long we might expect that to take.
Hon. C.
Hansen: When the member indicated a question around radiology services, I
indicated that it was appropriate at this time as it pertained to health
authorities. Then she went on a slightly different direction which I didn't
anticipate, but I will try to answer it at this stage, even though it would
probably fit better under a discussion of the Medical Services Plan.
This
accreditation of facilities is one that is driven by the Medical Services
Commission. Those decisions are not made by government directly but rather are
made by committees of doctors, so basically it's their own peers. Certainly, any
doctors that are looking at ways of better rationalizing the way services are
provided…. As you outlined, for this group of doctors who think that radiology
services may be better provided in a different facility, the opportunity is
there for them to make representation to the Medical Services Commission. This
committee would certainly look at the logic of that. As I say, it is a committee
of doctors, and it would be their own peers that would be making those kinds of
evaluations.
Chong: I appreciate the minister answering that question, although it jumped
out of the queue.
[1630]
Back to the
health authorities, then. I just wanted to also confirm that for any savings
found through ad-
[ Page 2368 ]
ministration or whatever corporate reorganizations that occur, the health
authorities, I would imagine, would have to identify those savings. But after so
identifying, they would be permitted to redirect that back into patient care and
improving and bettering health care for our regions where — unlike in other
organizations — when savings are found, those are generally scooped up. I
would certainly like to have the assurance that if, within the context of
performance measures and targets and accountability, those kinds of savings are
identified, health authorities know they definitely remain within their budgets
and that their next year's budgets aren't necessarily going to suffer the
consequences of good, sound management and best practices.
Hon. C.
Hansen: The member has my 100 percent assurance that that is the case. I
think that is very much the beauty of the flexibility we're giving to the health
authorities. If they can find savings in an area of administrative support,
they've got all the flexibility they need to move those budget dollars out of
administration, where it's no longer needed, into direct patient care. Also, the
funding formula that's in place provides them with a fair share of the health
dollars for their region, given the demographics of their population and the
cost-drivers of their population. If they can find more cost-effective ways of
meeting the needs of patients, then they will be able to use the money saved to
expand programs and to ensure that there is in fact better patient care. Even
better than that, we're going to measure those outcomes so that the success in
one region can be replicated in another region.
Chong: Again, more good news.
relation to the provincial board, again, I think there has been some confusion
as to how that is linked with our regional health authorities. Can the minister
give me an idea as to what kind of input the Vancouver health authority, for
example, would have into this provincial board? What responsibilities does the
provincial board have that would not be duplicated or replicated in a regional
board? Again, that is the last thing we want to see. We want to know that there
are clearly defined roles. There is some confusion as to what that is, so if the
minister can provide more details on that, I would appreciate it.
Hon. C.
Hansen: The provincial health services authority is responsible for the
tertiary programs and the programs that are clearly of a broad provincial nature
and not specific to any particular region in the province. There is a very close
working relationship between the five regionally based health authorities and
the provincial health authority. They meet as part of the leadership council
which I was outlining earlier.
Also, on
the board of the provincial health services authority there is at least one
person from each of the regions in the province to make sure there is that
liaison there. The provincial health services authority has direct operational
responsibility for a number of agencies and facilities, including Children's and
Women's Hospital in Vancouver, the Cancer Agency, the Transplant Society,
Riverview and the forensic facility. In addition, there is a series of programs
that they are also responsible for. You've got your cardiac program, your renal
program, which are administered out of other facilities that may be under the
direct operational responsibility of a regional health authority. But they would
be doing that on a contractual relationship with the provincial health services
authority. The dollars would flow from the provincial agency to the regional
authority for the delivery of some of those programs where that's appropriate.
It is a
very close working relationship. So far there's been excellent cooperation and,
we think, a mutual sharing of responsibilities in a way that will ensure that
patient needs are getting met.
[1635]
Chong: Can the minister advise whether this provincial body is also required
to develop a performance contract to be signed? Will their accountability
measures be similar to the health authorities' — for example, the salary
holdback? Are they subject to the same kinds and terms that the health
authorities are, in terms of a performance contract?
Hon. C.
Hansen: The principle and the approach are the same — that there are
specific measures for the provincial health service authority. There are
measurables. There is the same kind of salary holdback for CEOs if they don't
meet those objectives, but clearly there are different kinds of measures that
are going to be put in place.
The ones
for the five regionally based health authorities will be focused on the programs
they're responsible for, and those five will look similar. We want to be able to
make the same kind of measures and compare them region to region. With the
provincial authority there are going to be different types of measures put in
place, but with the same general philosophical approach and the same intent, to
make sure they're publicly reported and that those executives and CEOs are held
accountable for them.
Chong: One final area in terms of the service plan. One of the highlights or
key projects in the service plan is to develop a response plan for
non-performing organizations. I'm not familiar with that or don't have much
detail on that. I'm wondering if the minister can shed some light on that
project and when its due date for release might be.
Hon. C.
Hansen: That particular objective was very much driven by a theme that goes
across government: to ensure that there are accountabilities in place. When we
look at non-performing agencies and health authorities, there will be
consequences. Part of it, as I mentioned earlier, is a salary holdback for the
CEO, but there's also the ability for the ministry to step in and restrict the
independence of a health authority if it's not
[ Page 2369 ]
performing up to the standards that have been set out and mutually agreed to
in the performance contracts. We will be holding them accountable for delivering
on those.
Health
authorities today are being given a considerable latitude in managing their
affairs. Part of the consequences — the response to a health authority that
does not live up to that obligation — is the ability of the ministry to step
in and take more direct responsibility for the day-to-day operations. That's not
something that we or the health authority would want to see, but it's clearly an
option that's available to us in the case of non-performance.
[1640]
I'm not
fearful that we will ever have to exercise it, because I think we have very good
people in place in terms of the CEOs and the senior executive teams. I think we
also have very good people in terms of the chairs and the new boards that have
been put in place. I have every expectation that we will not only see
performance up to a standard that we expect, but I also expect that every one of
the six health authorities will exceed those expectations, because that's the
nature of the personalities that are providing leadership at that level.
Chong: I appreciate that. I guess I just wanted to know about the
development of a response plan for my benefit, so that I can relay that to my
constituents. Is there a time line for your ministry for that to be out? I would
imagine, like everything else, it will be posted on the website so that we can
all refer to it as well.
Hon. C.
Hansen: In response to the member's specific question, this is not a
specific document that's going to come out. It will be incorporated into the
performance contracts that will be signed so that there are consequences for
non-performance, in other words.
We have a
division within the ministry that's been set up to monitor performance of the
health authorities because we see that the primary responsibility of our
ministry is to put in place provincial standards, to put in place the
performance contracts and then to hold them accountable for it. We're not going
to micromanage. We're not hanging over their shoulder telling them how to do
their job. They don't have to come to us cap in hand for every administrative
decision that they need to make, but we are going to be evaluating the
performance of the health authorities on an ongoing basis.
This is not
a capital-P plan that's going to be tabled. It will be a plan and an approach
that will be integrated both into the performance contracts but also into the
operations of the ministry. It's an ongoing project. It's not something that's
going to have a start and finish date to it.
Chong: I want to thank the minister for that clarification. I did
misunderstand what it was, so that helps. I want to thank the minister and his
staff for answering my questions. I will attempt to pay attention to which
sections come up, and as they do, I will return to this chamber to ask the
questions that I have on MSP, Pharmacare and wait-lists. At this time I'll yield
the floor to the Leader of the Opposition or other members who have questions.
MacPhail: For the benefit of the member for Oak Bay–Gordon Head, we will
be announcing as we move on to other sections.
I'm moving
to the area of the appointment of health authorities. How much money is budgeted
this year for the payment of chairs and board appointees?
Hon. C.
Hansen: Those individuals who will be serving on these boards will be
receiving a retainer, as it's referred to. The chair will receive an annual
amount of $15,000. The directors, the individuals sitting on the boards, will
receive an annual amount of $7,500. If you do the arithmetic on that, the total
for that compensation would be $450,000 per year.
[1645]
MacPhail: How much does each member and/or chair get for each meeting they
attend?
Hon. C.
Hansen: In addition, they would be receiving a meeting fee of $500 for
meetings of the board and committees of the board. For other meetings that
they're required to attend, they would be receiving $250.
MacPhail: What has the government budgeted annually for remuneration to the
health authorities for these meetings?
Hon. C.
Hansen: We don't do that budgeting centrally. Each individual health