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

The following electronic version is for informational purposes only. The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, MAY 4, 1993

Afternoon Sitting

Volume 9, Number 16

[ Page 5815 ]

The House met at 2:04 p.m.

Hon. L. Boone: Today in the members' gallery we have some very special guests from Vietnam. Professor Tu, Secretary of the Central Committee of Vietnam, is leading a delegation across Canada focusing on socio-economic issues in the Canadian context, including the study of human resource planning in support of economic development. The delegation is accompanied by Ambassador Bai, Vietnam's ambassador to Canada, and Peter Boothroyd from the University of British Columbia Centre for Human Settlements. Please join me in giving them a warm welcome to our Pacific province, British Columbia.

V. Anderson: In the House today are three members of the Native Fishing Association, Alvin Dixon, Arnie Smith and Allan Okabe, who are here to visit with members of the opposition and the government. Would we please make them welcome.

B. Copping: I'm very pleased to introduce to the House today a long-time friend, one of my first patients and a retired faculty member from BCIT, Trudy Ramsay. Would the House please make her welcome.

R. Kasper: Visiting us in the gallery today are Pat Horler, Doreen Doucette and Councillor Gordon Maxwell from the district of Langford. Would the House please make them welcome.

Hon. T. Perry: I wonder if I could second the welcome of the Minister of Government Services to the Ambassador of Vietnam. Our ministry has a budding relationship with the Open University of Vietnam in Ho Chi Minh City, and I would also like to extend greetings.

I'd like to introduce to members of the House four students from the University of B.C. doctoral program in nursing, Lynne Maxwell, Rosalie Starzomski, Patricia Rodney and Janice McCormick, who are with us today to observe the debate.

L. Reid: It's my pleasure to welcome to the legislative precinct this afternoon Mr. D. Thomson, a teacher from Hawthorne Elementary School in Delta, and 44 grade 7 students. I would ask the House to please make them welcome.

Oral Questions

SALARY AND BONUS PROVISIONS FOR ORDER-IN-COUNCIL APPOINTMENTS

W. Hurd: My question today is for the Premier. Yesterday the Premier conceded to the auditor general's findings that 49 of 389 OIC appointments failed to disclose proper details of remuneration and salary bonuses. Having had 24 hours to review the report, does the Premier except in principle that his government should disclose all salary and bonus provisions when the OIC appointments are made?

Hon. M. Harcourt: Yes, the auditor general did make some recommendations on how we could improve the OIC information. But I understand that that information can be obtained through the OIC office, combined with the GPSD. If the opposition were to do their homework, they could get that information.

W. Hurd: The opposition has been doing its homework in the Premier's own office. I refer to some correspondence from the deputy minister addressed to Mr. Parasiuk, indicating that his annual salary will be $155,000 plus a performance bonus. The bonus details are to be negotiated in keeping with other Crown corporation performance bonus plans, but tailored to the mandate of the B.C. Trade Development Corporation. Does the Premier support these pay-as-you-go bonus provisions within the B.C. Trade Development Corporation, which is under his own mandate? How do they fit in with the recommendations by the auditor general?

The Speaker: The hon. member for Surrey-White Rock.

W. Hurd: Perhaps I could ask one basic question then. Will the Premier instruct all the ministers responsible for Crown corporations to table the bonus provisions for the heads of those corporations? Will he do that honourable thing today?

ESSENTIAL SERVICE DESIGNATION FOR SCHOOL TEACHERS

C. Serwa: My question is directed to the Premier. Welcome home, Mr. Premier. Given the number of teachers' strikes in the province and the pending strikes in the Vancouver School District, will you spare this unnecessary pain and amend the Labour Code to restore education as an essential service?

Hon. M. Sihota: As the honourable member knows,

section 72 of the Labour Regulation Act allows any school board to make an application with regard to the essential nature of education services. As I indicated in this House several days ago, an application has been made by one board, and I believe another one has now indicated it will make an application; so they are exercising the authority they have under the legislation.

C. Serwa: My question is again directed to one of the premiers. It is regrettable that this government is so beholden to the BCTF that it doesn't have the courage to simply tell the Labour Relations Board that education is in fact an essential service. When is this government going to learn that parents are sick to death of having their children treated as political footballs in the battles over teachers' settlements? Why doesn't the Premier do

[ Page 5816 ]

the right thing for once and restore education from kindergarten to grade 12 as an essential service?

Hon. M. Sihota: An astounding comment coming from a member whose party gave teachers the right to strike through Bill 20 in this Legislature. He should understand that if one looks at our experience with teachers' disputes, over the last couple of years the disputes have generally been resolved without labour disruption; and when there has been labour disruption, usually the disruption has lasted for approximately a week. In the last little while we've had some disputes that have gone on for some time. Quite frankly, that's a reflection of the fact that there isn't a lot of money in the system due to the government's difficult fiscal situation.

C. Serwa: Final supplemental to the Minister of Women's Equality. The minister has often expressed a great deal of concern for working women in the province, women who ordinarily can't find child space at the best of times. What does the minister expect those thousands of women to do when the schools are out on strike? Why isn't she standing up for women and children in this particular situation and demanding that education be treated as an essential service?

BUY B.C. PROGRAM

R. Chisholm: My question is to the Premier. Does the Premier realize that the Buy B.C. advertising program had no B.C.- or Canadian-owned firms in the final cut? In fact, all final contestants were American-owned. What message is the Premier sending when the Buy B.C. program has been bought by America?

Hon. B. Barlee: Again, I believe the member has not quite got his facts correct. First of all, the president of the firm -- if we're talking about Ravenwolf, and I imagine we are -- is a Canadian, I think from the Cowichan Valley. His major office is in Vancouver and he has an office in the United States. Part of our Buy B.C. is to concentrate on cross-border shopping. To do that effectively, we should be aware that our rivals in the United States have certain advantages. He is using mostly Canadian contractors, but he is also dipping into some contractors in the United States. We know exactly what he is doing. And he's doing it very well, by the way.

R. Chisholm: I think the hon. minister should check his facts, because all three companies in the final cut are American-owned.

Again to the Premier -- and hopefully he will answer this one -- how does the Premier expect British Columbians to Buy British Columbia when the provincial government is buying New York City?

Hon. B. Barlee: Perhaps the member has not gone downstairs into the members' restaurant. Everything there is British Columbia produce. Perhaps the member flies through his own riding, but if he goes by ferry he'll see that virtually everything on the ferry is British Columbia produce, with the exception of coffee. We have had some difficulty with the coffee, but that's processed in British Columbia. And the oranges are presenting us with some technical difficulties. If the member sometimes bothers to relieve himself from the boredom of this House, perhaps he would like to go downstairs and have a VQA wine.

The increase in VQA wines went up 200,000 litres last year -- 36.84 percent. I think it speaks for itself.

[2:15]

PREMIER'S ASIAN TRADE MISSION

A. Cowie: I trust the Premier had a crate of B.C. apples when he went to Asia as well.

While the Premier was on his quarter-million-dollar trip to Asia, I trust that he told everybody about beautiful B.C. and how wonderful it is. Did the Premier also tell the people of Asia, especially the corporate business people, about the corporate capital tax, the increased fees and the ill-fated property tax which was nixed while he was away?

Hon. M. Harcourt: The opposition finally asked a question that is appropriate to my office as Premier instead of asking the minister, as they should under our rules, who is responsible for Agriculture, or the minister who's responsible for Labour. But they finally have asked a question to which it's appropriate for me to answer, and that is my trip to Asia. Yes, I did talk about British Columbia and yes, we did eat B.C. apples while we were there. As a matter of fact, we served a whole variety of B.C. agriculture and fishery products in Tokyo, in Osaka and other parts of Asia.

They were very well received, hon. member, very well received. I can also say that they were aware of the fact that British Columbia had reduced its deficit 35 percent from last March to this March, that we were finally making a dent in the deficit we were left by the Social Credit government before us. They appreciate that there is finally a government in this country that's doing something about the deficit, not just talking about it.

The Speaker: Supplemental, hon. member.

APPOINTMENT OF AG DEPUTY MINISTER

A. Cowie: I'm glad the Premier ate apples while he was away.

Also while he was away, we had some discussion over senior appointments. I take it that the Premier is in agreement with the patronage appointment of Ms. Maloney and is in agreement with her radical left-leaning socialist viewpoints. Did the Premier tell the Asian business people that his government was hiring left-leaning socialist believers as senior public servants?

Hon. M. Harcourt: I take it that the member is referring to the dean of the University of Victoria law school. He is probably aware that there was a recent letter that was publicly published which said: "We would like to congratulate the Premier on his appointment of Ms. Maloney as deputy minister to the Attorney General. She is both an accomplished scholar and an acknowledged community leader." It was

[ Page 5817 ]

signed by Grant Bernyeat, who is a bencher of the Law Society; Justice Thomas Dohm; Mobina Jaffer; John McLaren; Kathryn Neilson; Sam Scully; Lynn Smith, the dean of the Law School at the University of British Columbia; and Brian Wallace, the treasurer of the Law Society of British Columbia.

A. Cowie: The Premier certainly must be worried about Ms. Maloney, having prepared himself well for that little speech. Will the Premier ask the Attorney General to table Ms. Maloney's contract in the best interests of open and honest government?

Hon. M. Harcourt: It was the Attorney General who was well briefed and prepared for that question, because it would probably have been more appropriate for you to ask the minister about the new Deputy Attorney General, a woman of great accomplishment who is going to serve with distinction the people of British Columbia.

PREMIER'S CONFIDENCE IN CONSUMER SERVICES MINISTER

R. Neufeld: My question is to the Premier. This is within your mandate, Mr. Premier. While the Premier was off on his junket to Asia, the Deputy Premier stated that the entire cabinet has the fullest confidence in the Minister of Consumer Services, without reservation.

Is the Premier equally confident that the Minister of Consumer Services will be cleared of any wrongdoing by the Law Society, and is it why he has refused to ask for the minister's resignation pending the outcome of the Law Society's investigation?

Hon. M. Harcourt: Well, after the track record of the Social Credit cabinet, it takes a lot of gall for that member to stand up and talk about investigations, conflicts of interest and resignations. Quite frankly, to stretch into an investigation a routine request by the Law Society for information on a lawyer -- when they receive hundreds of these requests a year -- is to do great harm to due process, which every citizen is entitled to, including cabinet members.

R. Neufeld: We're not talking about the Social Credit cabinet; we're talking about your cabinet, Mr. Premier; they're your ministers. Exactly how confident is the Premier that the Minister of Consumer Affairs has done absolutely nothing that would compromise British Columbians' confidence in him? Does he realize that he has staked the reputation of the entire cabinet on the presumption that the reputation of the Minister of Consumer Affairs is beyond reproach?

The Speaker: It seems that the hon. member is asking for an opinion of the Premier. The way the question is worded, it does not appear to the Chair to be in order. I will recognize the hon. member for North Vancouver-Seymour.

GOVERNMENT INVOLVEMENT IN CHINA'S THREE GORGES PROJECT

D. Jarvis: Surprise, surprise: my question's to the Premier. Sir, while you were away on vacation I asked the Environment minister whether he supported the Three Gorges project. He was blissfully unaware of the issue. Now that the Premier has returned, I'm wondering if you have briefed the Environment minister on the environmental massacre and also the loss of the river dolphins, cranes and 102 villages that will be removed, plus....

The Speaker: Order, please. When the House returns to order, I will ask.... Please state your question, hon. member.

D. Jarvis: I'm wondering if the Premier.... Sir, were you aware of the consequences of what is happening in the Three Gorges project when you decided to back up this project?

Hon. M. Harcourt: The opposition can't even get the ministers right, and now they can't even get the countries right.

If the hon. member realized the tremendous opportunities in Asia in an area where British Columbia is the best in the world -- hydroelectric sustainable energy -- instead of disparaging them, he would understand the advantage of having an environmentally sensitive, British Columbia Crown corporation helping developing countries like China to develop sustainable hydroelectricity for their people.

I take it that the two other alternatives the member is coming out in favour of are nuclear and coal. I can't think of two less desirable alternatives to hydro electricity than nuclear and coal.

Hon. L. Boone: I ask leave to make an introduction, which I neglected to do earlier.

Leave granted.

Hon. L. Boone: I take pleasure in recognizing an employee of the government. It's not very often that we get an opportunity to praise those people who work so hard on our behalf. In the gallery today we have John Pollard, who recently received the gold award from the Institute of Public Administration of Canada for improvements in the property registry system. Would the members of the House please give our thanks to John for the excellent work he does on behalf of the province.

Hon. A. Charbonneau tabled the annual report of the British Columbia Railway Group.

Hon. M. Sihota: I call Committee of Supply B. Committee A is sitting as well, dealing with Labour estimates.

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Orders of the Day

The House in Committee of Supply B; E. Barnes in the chair.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 47: minister's office, $419,400 (continued).

G. Wilson: I don't know if the minister needs some time to get staff in.

Perhaps I might commence my questions to the minister on a matter that was raised just prior to recessing at noon, which had to do with the new boards that are going to be established and how those boards are going to function in the interim period between now and 1996. One of the concerns that has been expressed by a number of people is that there won't be any election to those boards until 1996. Those boards will effectively operate by appointment, and in the interim period they will be involved in duplicative spending of hospital dollars that have gone forward.

[2:30]

I wonder if the minister might want to clarify, specifically on two counts: one, how these boards will interact with the existing union board of health system and how we're going to see that interaction take place; and two, why it would not be deemed to be useful to have those new boards to be elected prior to 1996. Why would we not move to full election sometime within the next year?

Hon. E. Cull: There are two reasons why we won't move to election in the next year. One is that we're going to need at least a year to establish some pilots on how the community health councils should be formed, what functions should come together and how we should deal with existing financing arrangements, which may already be in place. It is going to take some time to sort that out with the various players.

We also want to give the communities some opportunity to try out different models so that they can see what works in other communities -- some communities are not ready to get over the turf wars and move into the kinds of arrangements that are going to be necessary -- and those communities that aren't quite as ready as some of the more eager communities will have an opportunity to observe and learn from their successes and mistakes. So one part of the answer for the next year is that we're in a pilot phase.

The second part, quite frankly, is that it's expensive to run elections. The recommendation of everyone who has looked into this in terms of how to best move to an elected system from the hodgepodge of society boards, appointed boards and other arrangements that we have right now is to put it into the same cycle, process and administrative system as the municipal election. It will simply be cheaper to do the election in 1996 as part of the municipal elections, when there will already be voters lists, voting stations and all the rest that has to be done. It's the same reason that school boards tend to piggyback on municipal elections.

G. Wilson: Once again, as someone who has come off a regional hospital district and is looking at the allocation of moneys, I can accept what the minister is saying with respect to the union board of health operation and the operation of this new board in terms of being a pilot project to see the integration of those services. Would the minister comment then as to what the role is likely to be with respect to the provision and approval of budgets over the next several years with respect to not only hospitals but other ancillary services that exist in communities such as Sechelt, to use Sechelt as an example.

I'm very familiar with how that budgetary process works because I've been, at least in part, involved with it. We would be most anxious to see how prioritization of dollars will work under this new system. Where you do prioritize dollars, who is going to have the final authority in terms of what gets put forward for allocation? We have some serious requirements there obviously, and we'd like to make sure that scarce dollars are prioritized in accordance with community needs. How is it going to work?

Hon. E. Cull: The whole question of allocating dollars is not likely to...in fact, I'll say now that it will not occur until we get the elected boards in place in 1996. It is not feasible, even with the councils that are now forming, that in the next number of years they would be ready to assume the responsibility, with all of the details in place, and that we would have sorted out the capital funding arrangements, which are now being sorted out with the Union of B.C. Municipalities. Individual budgets will continue to be prepared as they are now, but in the transition period those budgets will be prepared in consultation and cooperation with one another, moving toward an integrated system.

The first job of any emerging health council will be to map out the plan for how to get from where they are now, with two, three, four, five, 16 boards -- whatever number they are amalgamating -- to where they're going to be in 1996. There will be a difference in councils and boards as a result of the different makeups of the communities that are coming together. In Vancouver we don't expect one community health council to run all of the health services in downtown Vancouver, but in Dawson Creek, that's not unrealistic. Different models will have to be developed over the next year.

That's part of what this transition phase is all about. In the interim period the boards that exist right now will continue to prepare budgets, but more and more in cooperation with one another.

Should a community advance to the stage where it decides voluntarily to amalgamate, as in the case of some of the hospital and long term care boards around the province, we will facilitate that amalgamation, and the responsibilities that each board had separately will then be held collectively by the new council. Those are steps that are yet to be taken. The whole process that we are engaged in right now is a community development process, which means there has to be some time for the community players to work together and sort out their

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own solutions and come back to the ministry for whatever assistance or guidance they need to put those solutions in place.

G. Wilson: As elated as everybody in Powell River was to hear before lunch that this budget is going to open 15 beds for extended care, people are going to be somewhat distressed by what they've just heard.

Notwithstanding the budgetary process for this year, which most people will recognize is now in place -- whether they like it or not, the dollars that are available, as scarce as they are, have been allocated at 3 percent -- what we're hearing is that this new regional system is going to be essentially phased in over the next little while, without any meaningful management of budget in terms of preparation or in terms of actual prioritization and allocation moneys, save and except for consultation -- whatever that means.

I don't mean to be facetious, but there are some that would argue that there hasn't been a great deal of consultation with some parts of the health care system -- whether that's right or wrong. It would seem to me that these new regional boards are going to be very duplicative in terms of the personnel to be brought in, in terms of the required consultation process and in terms of their ability to facilitate dollars. They're not even going to have final authority until after the next provincial election, when there might be yet another hiatus in the health care system or not, depending on circumstances.

What's the functional purpose of the board, if what we're doing is spending a long time deferring any meaningful use of it until after not only the next municipal election but, I would guess, after the next provincial election? Most people thought these were going to be in place soon.

Hon. E. Cull: It's been very clear since February 2, when we made the announcement, that we're looking at a transition period of three and a half to five years. You can't turn the direction of health care around overnight; you can't turn it around in a year. The point is these bodies exist right now. They are making decisions right now. Many of them are not democratic in any sense of the word -- in how they were put in place or in how they operate. Some of them are models of democracy in their community.

I would venture to say, though, that most people in most communities do not know who sits on their hospital board or who sits on their union board of health. In fact, there is a disturbing lack of knowledge about what a union board of health even is, not only from the community at large but from the other parts of the health care system, which don't seem to know who these individuals are and what they do. There are already a number of bodies in place, one way or another, that make decisions affecting our health care in our communities each and every day.

There's a multitude of boards all over the province, in different places, which got there by different means and with different mandates and different responsibilities, and with very little accountability in the public sense of the word -- people knowing who they are and what they are doing. These boards all exist out there right now. In the transition phase, we're talking about pulling significant players together in each community and having them work towards amalgamation.

Instead of independent decisions -- the hospital figuring out its budget over here and the union board of health setting its priorities over here, and the long term care facility making another decision in another board meeting -- they will now be required to come together and start making those decisions as a group. They will not necessarily at that point be a legal entity of an elected community health council, but in the transition period they can start to act like one; they can start to sort out the relationship.

I'll go back to the story I alluded to this morning, where I said a community had identified a problem and a solution, but they had no way to get there. Even in this transition period we should be able to start to break down those barriers. I will now tell you what the example is, because I think it's useful to illustrate this. We have a situation where there is a community that has a hospital. It also has an alcohol and drug treatment program which is open during the day, nine to five, regular office hours.

After hours, between five and nine, the people who would arrive at the doors of the alcohol and drug centre go to the emergency ward of the hospital. The hospital has calculated that on an annual basis it costs them -- I haven't got the number now, but $260,000 comes to mind -- to treat those people who show up there between five and nine. It would cost less to open the alcohol and drug treatment centre 24 hours a day.

In fact, if they could open it up 24 hours a day, and transfer over that money, the hospital would have money left over, to spend on something else, because it wouldn't be treating those people, and its emergency room would be less crowded.

It's a classic example of a problem and a solution that people can see but can't get to, because the hospital right now doesn't have an easy way to plan its budget in cooperation with the people who do the budgeting for the alcohol and drug treatment centre, and if they even could do the planning, it's very difficult for them to physically move dollars from one part of the system to another. So we all sit there looking at this solution, not having a way to get to it.

We're trying to create a way to make those solutions possible. In the interim, if the people who are creating the budget for the alcohol and drug treatment centre are able to do so in consultation, discussion and cooperation with the hospital board, and the hospital board can start to explore these things with the other agencies in the community, they can then say: "We're going to make a decision to change this service here, to reduce it.

We know that's going to create a demand over there, but we can now start to plan for budgeting so that that demand can be met over there." I think that's the best illustration I can come up with. There are many examples like that, but that's exactly what we're trying to do in the period between where we are now and where we want to be.

When we get to the point of an elected health council, there will be one body with the responsibility for overseeing budgets for all of those different parts of the system. A regional body will ultimately be responsible for receiving a global budget for health

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services and preparing that in accordance with standards set by the ministry and the wishes of the community in terms of where their priorities are. Not only can they start to make those sensible trade-offs, but they can say: "We've got a list of ten things we want to do in our community; we know we can only fund one or two.

Which are the most important things?" Maybe in Powell River, it will be a program targeted at young men in the community or working people in the mills or woods in your community; maybe in White Rock, it will be something targeted to seniors; and maybe in a native community, it might be targeted at young mothers and helping them have healthier babies. It gives them all more of an opportunity to start to set those priorities to reflect their needs, not just some greater provincial understanding of what the needs are.

G. Wilson: That sounds great. From our perspective, where we've been advocating the creation of a ministry of community development -- where you can in fact have an integration of full services at the community level; not just health services, but all other aspects where they can be integrated at the community level -- I would argue that that really is the final analysis. That's certainly where I would like to see things go: a ministry of community development to look after all the needs of the individual, not just a portion of their needs, in which you have to have various files and agencies.

My involvement in many interagency meetings in my own community on the Sunshine Coast certainly underscores the need to try and get that kind of work together. The more we start to put that kind of system in place, the more everybody recognizes the extent to which the health needs of one individual may well be a product of their housing requirements or lack thereof, their dietary issues, their transportation problems, or whatever else may be creating stress, tension or physical difficulty.

Coming back to these boards, because there seems to be some contention.... Again, I come back to a letter -- and I trust that I'm not catching the minister off guard here -- that I know was communicated on April 15 to the minister. This letter -- with a copy to myself and Debra McPherson of the BCNU -- is from Ann Bakewell, a registered nurse on the Sunshine Coast. I don't think Ann would mind me raising these issues, because I think they are very relevant to the current debate.

She talks about the tri-union agreement with the government, and the extent of this model of movement toward integrated agreements within the health care system as a part or product of this kind of general sense toward regionalization and centralization within the communities of control over health care financing. We look at your budget and we see that this is a very substantive part of the cost of delivering services is the salary and collective agreement portions of your budget.

[2:45]

I wonder if you might want to comment on some of the concerns here, because it would seem on the one hand that there is a fairly good argument that this notion of moving toward tri-union agreements is really not the most fiscally responsible way to deal with that. It could be argued -- and I would like to hear the minister argue against it -- that greater flexibility between the bargaining units is better. It positions those people in the communities to effectively negotiate agreements that look after the diverse needs within communities rather than coming up with a standard model for solutions. That's point one.

There are, I think, another six points in the letter. Maybe we could get some feedback on that, and in particular talk about how that may be related to the overall concept that's being promoted here as fiscal accountability.

Hon. E. Cull: The member might know that there are seven employers and, I think, 35 unions involved in health care in B.C. Having so many different players does create real problems for a system that's in transition. The difficulty in having skilled nurses and other health care professionals move from, say, the hospital setting to the community setting is not only training but is often contractual barriers.

A whole variety of things -- wages, benefits, portability of seniority, working conditions -- create some very real and sometimes very impassable barriers for people to move to one sector from the other, even when they want to do so. A situation like we're in right now, where there is a lot of transition and shifting, does create major difficulties that we're striving to overcome.

With respect to your comments on the tri-union arrangements, we are not in any way amalgamating contracts. Under the accord worked out over the last number of months, the contracts for the three unions remain separate. Even the application of some parts of the accord are interpreted differently for each of the three unions involved, recognizing the points you make about flexibility, different working conditions, different working situations, the different people represented by the unions.

Like centralization versus decentralization, this whole question of how we organize ourselves in bargaining and collective agreements is very much like the situation of Closer to Home. There are two forces at work here. On the one hand it would be nice to have everything as standardized as possible. On the other hand you want to make sure that you have maximum flexibility to represent the needs of different groups in different communities. So you're striving for a balance all the time. It's not a black and white situation; it's not either/or.

You're trying to find your position along the spectrum that is most advantageous to the reform of the health care system and to the people who make their living from it and depend on it.

G. Wilson: We can debate that point at another time as we get into the longer philosophical question on the whole Closer to Home business. I understand the desire by government to try to work out some kind of system to make the negotiation and ratification of collective agreements simpler in what is a very complex set of jurisdictions. I understand the complexity of it. The difficulty here is that we end up with a deal that's been signed, or hopefully ratified and taken care of, and we move toward a collective agreement without the

[ Page 5821 ]

funding provisions to allow the hospital adequate resources to honour that agreement without layoffs. Yet the hospital doesn't have any proposition to be able to direct those layoffs at the feet of the government, which is where they really should be. What we end up with is the ability to lay off being taken away. As a result, you end up with hospitals looking really bad when they have to move toward their only other alternative, which is basically to cut service in an attempt to reduce the cost of labour.

It seems to me that it's less than forthright, frank and honest to say that the tri-union agreement is good for the province because it allows for the centralization of the negotiation process to a degree -- and granted, it's only to a degree -- even though you're not amalgamating collective agreements, unless you're prepared to fund the hospitals to the letter of the agreement, which is a very expensive proposition. It's one that I would argue the minister can't do. Can the minister talk about those problems?

Hon. E. Cull: I regret the member didn't join the debate on this subject earlier, because we did have quite a thorough canvassing around the cost arrangements with respect to the accord and what the hospitals will be getting in their budgets. I'll just state two things about it. You can't cut service to save labour costs in the hospital sector; 80 percent of the hospital costs are labour costs. You really don't have a lot of other places that you can look to for significant cuts.

The hospitals that have done their budgets this year, both with and without the accord, will tell you that it is to their financial advantage to have the accord. It will give them more money to maintain services than if they had to honour the collective agreements that have already been negotiated, stand and require a 4 percent increase in wages as of April 1993 and parity with the BCGEU for the HEU employees by October 1994. HLRA estimates they would be somewhere between 9 percent and 11 percent increases at that point. The accord is cheaper to the hospitals when you go through your budgets and do that analysis.

If you add the reduction of 4,800 FTEs across the system to that, you come up with what is relatively a flat-wage bill across the industry for the three-year term of the agreement. The cost of the agreement has been estimated by the HLRA and the government at $57 million over the three-year period.

G. Wilson: With all due respect to the minister, when you say you can't cut costs because 80 percent is absorbed in salaries and benefits, that may be true, but 20 percent isn't.

When you're looking at cost savings of anywhere from 3 to 7 percent, you can find that within 20 percent of your operating costs, and that's being done -- certainly in the hospitals in my own community, I know, because they don't have a choice and find themselves in a situation where they are now starting to have to make decisions with respect to the provision of services at the hospital that they can adequately afford to staff and run and whether or not they should be taking beds out of service -- or even shutting down floors, if it comes to that -- because of the inability to meet the agreement requirements that have been signed without major layoff.

I put to the minister that the other alternative is obviously to change the structure by which the makeup of workers in the hospital is established and move away from part-time or casuals into full-time contracted workers, which removes certain flexibility. I can tell you again that this has been a very hot and contentious issue in our local hospital in Powell River, because it removes the flexibility of the workforce for service in hours that are less desirable for work, especially for women who have families and are health care providers who feel that they want to apportion some of their time there.

I think it's wrong to say that you can't take it off the service end, because you can, and they are. It's important to recognize that in the agreement, as has been pointed out very effectively by Ms. Bakewell in her letter, you end up providing a fairly significant problem for local communities where the number of health care workers who are there and working is finite. Once they leave the community, they're gone -- to the point that you can't reclaim them if your budget's increased. It's not like you can simply say, "Well, we're going to downscale or downsize, and when things look better we're going to hire you back," because if people can't get work, they leave.

I've told the minister that Powell River is an isolated community. If we lose health care providers, they're gone from the community, and it becomes a major problem to attract people back into the community. You can argue the same thing for St. Mary's Hospital in Sechelt.

I wonder if it wouldn't be better to recognize that within this system of financing there are regional needs that are going to be driven by the geographic location and demographic operations within these hospitals, so that we can diminish the loss of service and the potential loss of health care workers through a more flexible system of funding that could be available to hospital administrators. I wonder if the minister would comment on that.

Hon. E. Cull: If hospitals that you're aware of are starting to close beds or reduce services due to their budgets this year, they're doing it as a result of the collective agreements they negotiated in past years, which apply now to those hospital workers because the accord has not been ratified. They are dealing with the contract they negotiated with the nurses, the arbitrated settlement they have with HEU and the contract they negotiated with HSA. So you can't tie what's happening now to the accord. Those are the things that are going to happen without the accord.

In fact, the accord may facilitate the retention of those workers in the community, because the hospitals -- instead of having to face a 4 percent wage bill on April 1 this year without the accord -- would be facing a 1 percent wage bill, which gives them 3 percent more room to retain those people and do some of the flexible things that I think you were alluding to.

I don't have the full figures here for the Coast-Garibaldi health unit, but I just looked at the mental health services. Last year we added 29 mental

[ Page 5822 ]

health positions in that region. One of the things we have to recognize in all of this debate is that we are talking about a reduction of 10 percent of the acute care workforce over the three-year period. That is our objective, so that we can redeploy those people into other parts of the health care system or, if they leave the health care system entirely, be able to use the money that funds those positions in other parts of the health care system. There are new people coming along all the time. There are people graduating from training programs, and there will be some reallocation. But this is not a temporary layoff situation with these people to be hired back, as you suggested.

We are looking for an industry-wide reduction in acute care services of 10 percent of the employees in the system right now. That will vary from community to community because some communities are growing and will need more resources. Some communities are declining or remaining fairly static and have a very high level of resources compared to the provincial average. When you weren't in the House we were talking about the range which in some communities is as high as seven beds per thousand, which is a very high level of acute care bed resources.

It will be higher than any provincial average across the country right now, but certainly much higher than the B.C. average, which is about 3.3 or 3.2.

G. Wilson: I appreciate the minister's patience, in that I have not had a chance to review the Blues from earlier on. If this discussion has been dealt with or canvassed, I will yield to my critic to let me know.

Maybe the minister can correct some facts if I'm incorrect. It would seem that this government would argue that the contract currently underway, which it seeks to have ratified, is going to be cheaper for hospitals. Where 10 percent of workers are going to be laid off and can't be dealt with through an early retirement program, this contract provides that comparable jobs will be found for them within the community. I understand that some of that has been discussed earlier on, and I don't want to go back through it.

[3:00]

With respect to comparable jobs, using Sechelt as an example, the jobs that are likely to pay what a registered nurse or hospital staff member could expect to be paid working for St. Mary's Hospital in Sechelt are nonexistent. In fact, I would ask the minister to give me some definition of where on the Sunshine Coast -- and I'll give you the opportunity to include Gibsons through to Pender Harbour -- you are going to find comparable jobs when you lay off these workers.

Hon. E. Cull: One of the things that always distresses me whenever I go into a community, and particularly if I'm talking to a community group about Closer to Home and community-based services, is that somebody will always stand up and say: "There aren't any community-based services in our community." I invite you, hon. member, if you haven't done so, to go down to the Coast-Garibaldi Health Unit and talk to the staff, the nurses and the other professionals there, many of whom make as much as the people you're talking about.

Whether there's a direct comparability and whether there might be some retraining -- we'd have to look at individuals to see what can happen. You will find many individuals within the community sector who earn very good wages providing health services, and they do an excellent job for the people in our communities. They're not as visible as those who work at the hospitals. I just wish those people were more visible to the people in their community. It's unfortunate that they're not. I think that their work needs to be better recognized.

The figures were given this morning, and I urge you to have a look at the Blues. At least a third of the reduction in this year's share of the 4,800 FTEs will be achieved through attrition, early retirement and transfers to other programs that are hiring. In terms of the positions of people who are having to move somewhere else in the community and who require relocation or retraining, one-third of those will be done simply through attrition, early retirement and other voluntary transfers.

G. Wilson: I appreciate my colleague from the third party giving me this morning's Blues so I can look at the horrendous figures my critic raised earlier today. I won't have to go through them again to remind British Columbians how horrendous the figures are.

Let me come back to this, because I am actually quite familiar with the Coast-Garibaldi Health Unit. As I said, because of my background -- having spent some time on the regional hospital board, having been involved with the community services society board and having been an active member of my community and an elected member at the regional level of government -- I'm very familiar with how it works.

I can say with some confidence that in theory there may be some comparable jobs, and one might even argue that on paper there might be some comparable jobs, but in practice and in reality, the nature of the workforce on the Sunshine Coast -- and I would guess that Powell River would not be much different; and if those two areas are in fact that way, I would suspect that I could find many other areas in British Columbia -- is such that people do not have the flexibility to travel or relocate without a fairly significant disruption to families.

You might argue that that is tough if you're in a profession and you're downscaling.

When it becomes a strategy for managing hospital financing, you suggest that as part of that strategy we're going to provide the expectation -- I can't think of any other word to describe it -- that there are going to be additional jobs in the community. I can tell you that in the area I'm most familiar with and in which I've been involved politically at the local level for some time, those simply don't exist.

That raises another matter that Ms. Bakewell mentions in her letter to you. I'm sure you have given, or will be giving, a detailed response to her letter. She suggests that when the community is unable to provide those kinds of services and people are unable to get those additional jobs, it will mean that the financially strapped or nonexistent hospitals will be forced to

[ Page 5823 ]

continue paying for laid-off employees. If that isn't correct, then I'd like to have it corrected.

If it is correct, then I would ask the minister what kind of analysis has been done on the administration of this contract -- on the potential additional costs that hospitals are going to have to absorb as a result of the administration of arbitration in many grievance disputes. On top of that, if hospitals find themselves in a layoff position and have to absorb continued costs, how much planning has gone into that form of administration, given that they're financially strapped now and can't provide services to patient care?

Hon. E. Cull: A number of things have to be considered here. First of all, without the accord the hospitals still have a 3 percent budget increase, which for most of them means considerably less than 3 percent. There will still have to be reductions in the hospitals this year -- in fact, more of a reduction than with the accord, because they'll have to deal with the 4 percent wage increase. They won't have the flexibility of some of the other provisions that have been agreed to in terms of contract changes.

Even laying off people will take longer than it would with the accord, which means more people will have to be laid off if they're to balance their budget, because they'll have more people in the system waiting to go through the process that was negotiated freely between the hospitals and the unions to deal with layoff, bumping and all of those kinds of provisions. The accord makes it easier for hospitals to deal with this.

A significant downsizing, in the order of 10 percent, is taking place in this industry, and if you're suggesting that we shouldn't accept some responsibility for helping those employees move from where they are -- hopefully they'll stay in the health care system, but if not, be retrained or somehow reabsorbed back into the workforce in appropriate places -- then we have a philosophical difference. We can agree that this philosophical difference is a difference between your party and mine. In the past, governments have just axed budgets and said: "Workers, you're on your own. Good luck. There's the UIC office.

If you don't qualify for UI, head down to social assistance. If you don't like it here, move somewhere else."

We're taking a different approach because we value the people who work in our health care system. We're saying that there has to be a better way of making these changes, and recognizing that you can't do it all on the backs of the workers. We have allowed for retraining, relocation and early retirement. We're trying to facilitate preferential hiring; a hospital that is hiring people because it's got 25 new beds coming on stream can hire people from a hospital that may be closing beds. The whole system can work better and more humanely, and I think it has to be done that way.

We recognize that not all hospitals will have the same amount of flexibility to deal with the requirements of the accord. In this morning's debate we discussed the fact that the vast majority of layoffs will be in the large urban centres, because that's where the vast majority of institutions and workers are. Fortunately, it also happens to be where the vast majority of the new jobs are, because all of these things tend to flow with the population; so in the larger centres, where we have the biggest problem, we also have the most capacity to deal with it.

Notwithstanding that, we've protected the very smallest hospitals with a 2.4 percent budget increase this year, which is higher than Powell River got, as I'm sure you know, and higher than most hospitals in the province will get. The very smallest hospitals got that protection because if you're a diagnostic and treatment centre and you lose one person, you have to replace that person. You don't have the flexibility to deal with attrition. It's not really usable in a small centre.

We've recognized that the next category of hospitals up from the very smallest ones may need some assistance, so the accord provides a $3 million budget for the hospital employers to assist those smaller hospitals to meet the terms of the accord and perhaps get the little bit of extra time that they may need to live up to the agreements. But if you look at the HLRA figures and the costing they've put out, no matter what assumptions you make about the way contracts will go in the future, in all cases it is cheaper overall to the hospitals to have the accord than it is to not have the accord.

If you have not seen the HLRA document on that, which does the calculations, I would be very happy to provide it to you.

G. Wilson: On the surface and at first blush this sounds great, but when you start to think about it in practical terms, in terms of the smaller communities that have an existing health care worker pool, what we're looking at here, in the judgment not only of myself but of many who are professionals in the field, is that we're likely to have one of three things happen with this new system.

The first is that the number of jobs will remain constant in some areas, and there will either be a slight increase in nurses because of the lift that is going to be administered by these hospitals, or an expectation of a greater amount of work done for the same number of hours worked. There's a fear that this might be a product of it. I think that will be an extremely small percentage and probably isolated to one or two areas that have been brought to my attention.

The second thing is more likely, and I'd like the minister to comment on this. When you have a small community such as Sechelt, where a number of people moved into the region and were unable to bring portable seniority rights in and are essentially working as part-time staff, when those positions are increased and vacant ones come forward, they are going to find themselves in a situation where people in the displaced pool that's been created by this downscaling of workers can come into the community and take them instead of the local workers without seniority rights who were already there.

Whether this is a fear that's been discussed with the minister or not, it has certainly been discussed with me by a number of people. There is a growing concern that those people who have found that they are casual RNs -- they moved in, have been working for a couple of years and have become disadvantaged because they are casual -- would very

[ Page 5824 ]

much like to move toward full-time employment. It's likely that because they were unable to transfer their seniority rights, they are simply going to be bypassed in this process. If that's so, it's likely to create some concern in the local communities; if it isn't so, then maybe we should clarify it right now.

S. Hammell: I'd like to ask leave to make an introduction.

Leave granted.

S. Hammell: I'd like to introduce to the House about 60 students and their adult supervisors from Bonaccord Elementary School in Surrey. They are here as part of their grades 4 and 5 social studies program. Would the House please make them welcome.

Hon. E. Cull: To the member: the information you have isn't correct. If the hospitals have a position that's 0.4 right now and they want to expand it to a 0.8 or full-time position, they have the ability to allow the person who's an incumbent in that position or other employees at the hospital to fill that position before they designate it as a vacancy that is available to the hiring pool.

G. Wilson: As I understand it, the portability of seniority will not apply even to those people who are casual RNs who were unable to take seniority into the community they are currently working in. In other words, given that there's an existing job that is going to be moved from casual to increased hours, possibly full time or whatever that might be, this new displaced pool is not going to allow somebody from outside the region to move their portable seniority rights in and take that job. Is that correct?

Hon. E. Cull: It's correct if I'm understanding how you're phrasing this. Let me have another try at it. The seniority that's coming in with someone doesn't apply until there's a vacancy; the vacancy doesn't apply until the hospital says that there's a vacancy, so if there's somebody in there working part-time who may have a couple of years experience as a casual, that person can still be allowed -- if they want to and the management agrees that the person is a suitable candidate for the job -- to take the full time position, and the seniority of someone else coming in will not affect it.

But once the position has been determined to be vacant and the hospital says it has a vacancy, because there isn't anybody in the hospital who wants to increase their part-time hours to full-time, or there is no one who is able to do that, then that position goes into the vacancy pool. Someone coming in -- it may be an operating room nurse with 20 years of experience who has some seniority when she comes in -- doesn't come in the way she does now, with no seniority whatsoever. That allows for the portability of seniority, but it doesn't allow that to displace people who are already employed in hospitals.

[3:15]

G. Wilson: I understand that it's not going to necessarily displace this individual, but it is likely to terminate their ability to move from.... Let me be specific here, because Ms. Bakewell, who is a registered nurse and is operating in this system, knows better than I do. If I could just read this paragraph, it might clarify this point.

"At my hospital there will be several casual RNs who have been here, some for two years, in hopes of getting a regular position. Now, for over two years they are at a disadvantage for posted jobs, as nurses from the other institutions can port their seniority. This is seen as grossly unfair by our casuals, who couldn't port their B.C. seniority when they moved here.

"In addition, as a slap in the face, they will be asked to cover vacant positions while someone from the displaced pool moves and is oriented. You may have bought labour peace on the big scale, but within institutions there may be a considerable degree of unrest."

If that isn't so, then we need to clarify that position. As I understand it, once a person is able to port their seniority, that seniority will apply for the longevity of their employment. People who were building seniority within the community are going to be disadvantaged, because they will have new employees coming in with much more seniority than they could ever hope to gain by their years of service in that community. Is that not right?

Hon. E. Cull: This is starting to get very complicated. As you have indicated, you are reading from a letter that was sent to me on April 15. I will be replying to it in detail, so there will be a specific answer to that. The vacancy has to appear before the seniority is ported into a new institution. If there is a casual in a part-time position and the hospital wants to increase that to a full-time position, until they declare it a vacancy that casual employee can apply for and fill that position.

It doesn't become a vacancy in the pool that is then open to other people coming in under this arrangement, until the hospital has declared that there isn't anybody they wish to hire from within the system to fill that position.

The same thing works with different positions in the hospital. If there's a full-time vacancy and somebody else who is full-time in the hospital wants to move into it, they have the opportunity to do so. The original vacancy may not be the one that ends up in the pool at the end of the day. As I said, this is starting to get very complicated, and I will send you a copy of the response to that.

G. Wilson: It gets more complicated. Having experienced the maintenance and management of seniority rights and collective agreements in another life -- especially when you get into collective agreements affecting "professionals" and the whole nature of job specialization, job training and everything else that gets into it -- I know that it does get a bit complicated.

I wonder if we could move on to a couple of other subjects, and then I'd yield to our Health critic. One has to do with the union board of health. The minister

[ Page 5825 ]

brought up a very important point with respect to the general lack of knowledge. I don't have any empirical evidence to support what I'm about to say, but certainly from my working experience in this field, I think that there is a general lack of knowledge in the public about three things:

(1) I don't think most people understand the role of the union board of health in the provision of health care service in the community; (2) as a result of that, they don't understand the substantial powers of the union board of health; and (3) they don't understand the degree to which the union board of health may act as a preventive agency or move toward preventive action in certain areas.

Under this new scheme, I wonder whether we are gong to have the same kind of provisions in whatever new system comes in. It would strike me that one of the things the union board of health has been effective in doing is starting to put in place at a local level some governance over some of those areas, especially when you get down to the whole question of community safety, community health hazards and those general provisions for liveable society kinds of regulations.

Hon. E. Cull: Yes, indeed. In fact, the Associated Union Boards of Health have been involved in the development of New Directions right from day one. They've had a representative on the minister's advisory committee. They were very actively involved with a number of members through our working groups and in all of the forum that we created to discuss the royal commission recommendations. They have been working with us since the launch of the New Directions paper to continue to provide input, advice, guidance and lots of good help to the development of health councils and regional health boards.

I consider them to be key players and leaders in bringing about the kinds of changes that we want to see.

G. Wilson: One of the areas that might be cost-effective in reducing the overall demand on community health dollars is a greater degree of integration or liaison between community-based services -- certainly non-profit services -- and the union board of health so that they can interface much more directly. I know that within my own community there are several areas in which that can be effected right away. I wonder if the minister has a comment on that, because it seems we could implement some significant cost savings with very little disruption and a greater enhancement of these two areas.

One has to do with inspection regulation on community-based health services -- especially those that are run by non-profit societies. I can refer to one example, which is the overall regulation and maintenance of a home that has been established for people with mental handicaps, where people are brought from institutions back into the community -- which I think most of us would applaud. The second is with respect to local non-profit societies that are operating on the regulation of substance abuse, and also the pseudo -- and I use the word very liberally -- transition house.

I'm not talking about homes specifically dedicated to women subjected to violence; I'm talking about safe houses -- that's the correct word. There doesn't seem to be -- and maybe it's just my own experience in the communities that I'm working in -- the same level of integration on those two levels -- inspection and regulation.

Hon. E. Cull: I'm going to have to keep my comments on this somewhat general. Earlier this morning when we were discussing the format of today's debate, I agreed with the opposition critic that we would not get into community and family health issues today, so I don't have staff here that will be able to support me on this. But in a very general sense I agree with you.

I think that the fragmentation, particularly in the area of alcohol and drug, was a result of the former government's TRY program, whereby a whole variety of agencies were set up or funded and created to deliver programs without a lot of evaluative criteria or monitoring being established in the first place. We end up with a whole variety of different groups out there doing things, often not well integrated with one another.

One of the things that we have done is try to use the union boards of health to assist us to make some sense of the variety of services that are in their communities. In some cases, they act a bit like mediators on issues of whether groups should continue to provide services or continue to be funded, and whether they are providing adequate services. Last year in the estimates we had a debate on a particular alcohol and drug program in the Fraser Valley.

The union board of health there was very effective in bringing the community together with the agency and the ministry staff to work out a solution that in the end satisfied us from a funding and criteria point of view, and satisfied the community from a service point of view. So I do see an ongoing role for the union boards, in their current format and in the revolving format as part of the community health council, in starting to pull these services together.

[M. Farnworth in the chair.]

Here in the Victoria area, the Capital Health Council, an outgrowth of the Victoria Health Project, has been in operation for some time, and they are indeed doing that. They began under the VHP doing it with seniors services. They are now doing it with mental health services, which is really very exciting. I would hazard a guess that there's probably something like 45 different agencies in the Victoria area providing services in some fashion to people who are mentally ill. Imagine trying to make some sense out of all of that and to keep it coordinated.

If you look at the administrative duplication, the potential for overlap and gap, it's quite frightening. What the Capital Health Council is doing here now is starting to bring that together and make some sense out of it so the duplication can be eliminated. And by eliminating it, those funds can then be redirected to the areas that are being missed right now and sorely neglected.

G. Wilson: I won't continue on that line of questioning. I apologize if I wasn't aware there wasn't a prior agreement with respect to those particular

[ Page 5826 ]

questions. I would be happy to return at the time that you have the appropriate staff here, because I do have a series of other questions on that.

Let me very briefly then come to the last question, and hopefully you have the appropriate staff to answer this. It has to do with capital construction in health. I wonder if there is an estimate of the number of dollars that would have been expended through your ministry this year, prior to the creation of Build B.C., that will not be expended should that legislation pass. Within the budgetary figures this year, how much of the capital expenditures under construction will in fact be administered through this new Crown agency that traditionally, or last year, would have been spent in your ministry?

Hon. E. Cull: The entire capital budget that has been approved for the Ministry of Health will be administered by the Ministry of Health.

G. Wilson: I understand that. I understand that what's in here as capital expenditures will be expended through this ministry. What I'm curious to know is whether the minister is aware of additional projects that under normal, traditional circumstances would have been funded through the Ministry of Health but will be administered through Build B.C. The reason I'm asking this -- because it's not a trap or a trick question, or I wouldn't tell you if it was -- is that I'm trying to get a handle on where federal dollars are going that generally come into the province for the construction of hospitals.

Are they still coming into this ministry, or are they going elsewhere? Where are the federal transfer moneys that come into this province going this year?

Hon. E. Cull: There's actually very limited funding coming in from the federal government, and it's tied to specific projects where there is some federal cost-sharing of capital, like the long term care facilities for veterans or things like that. But that's a very small amount, and I'm only aware of one project right now. There may be more, but I'm aware of one project in the Victoria area that falls into that category.

The funds in our capital budget are the funds available for hospital and other health care facility construction this year. It's the total amount of money; there isn't any more money anywhere else, and there wouldn't have been any more money. I appreciate you're not trying to ask a trick question here, and I'm not trying to give a trick answer. But the money shown in the estimates is the total amount of money available for hospital and other health-related construction this year.

G. Wilson: I'm a little confused now, because in the debate on Bill 3 the Minister of Finance said the opposition's holding up passage was going to stop construction of hospitals in the province of British Columbia. But what I'm hearing the Minister of Health saying is that there is no money allocated in Bill 3 to the Build B.C. corporation, or whatever it's going to be called, and that all of the capital construction is going to be financed out of the Ministry of Health. Is that correct?

Hon. E. Cull: There are four elements to the B.C. 21 program. One of them is the acceleration of social capital, and the acceleration of social capital with respect to the Ministry of Health is in the Health ministry's budget.

[3:30]

G. Wilson: Could the minister help me out here for a moment? Could we see how that's reported here? If it's one of the four elements under B.C. 21, Bill 3, how is that identified in this budget? How do we know where this accelerated social capital is in this budget?

Hon. E. Cull: I'm getting confused with this line of questioning, but it's under the debt-servicing amount that is provided in the ministry's budget. It allows for an acceleration of some projects that would normally be built over the next number of years to be built sooner rather than later. I assume you're looking at page 166. You'll see there hospital construction and renovation under the ministry operations.

G. Wilson: Again, I'm only trying to understand. Please don't think I'm trying to create trouble where trouble isn't warranted. Believe me, there'll be enough trouble in areas where it is warranted. My understanding is we're looking at $112.7 million. Is that the estimate figure we're looking at here? On page 166, if we look under hospital construction and renovation....

Interjection.

G. Wilson: Okay. Excuse me: $121.2 million is the figure we're looking at. Is the minister saying that is to be apportioned as the accelerated social capital and administered under Bill 3? Is that correct?

Hon. E. Cull: That is the debt-servicing portion of our operating funds that will allow us to carry out our capital budget this year, and it will be combined in some cases with other capital projects that will be coordinated by the B.C. 21 program. The B.C. 21 program -- and I'm not going to get into the debate on that, because I know we're having a thorough and exhaustive and exhausting, and sometimes some would say tedious, debate on that particular bill -- has four components. One is the acceleration of social capital, and the social capital that applies to the Ministry of Health is here either in our operating fund for debt servicing or in our capital budget.

The Chair: Member.

G. Wilson: Thank you, Mr. Chairman, and I certainly won't forget you. After all, one experience with you in the chair is unforgettable, I can assure you.

If we could come back to the minister, the $121.2 million is the debt-servicing portion of the operating funds. That is only a partial amount of what will be coordinated through Bill 3? What I'm trying to work out

[ Page 5827 ]

here is: in terms of the actual expenditure of these dollars, where is the administration of that money going to be? Where is the authority to spend that $121.2 million going to be made in terms of the actual allocation of dollars? Are we only looking at basically the cost of the debt that's going to be created under Bill 3? In other words, is this real money being spent on money that is committed through your ministry, or is that debt servicing of moneys that are going to be borrowed under Bill 3? That's my question.

Hon. E. Cull: There are two aspects to this. We have a capital budget, and this is the debt-servicing portion for our capital budget which appears in our operating budget. You're still with me on this? I can see you nodding and saying yes. Okay. This money will be entirely approved through the regular approvals, but initially by the ministry and the Minister of Health, and then it goes through the normal Treasury Board approvals. It will not be borrowed by the Crown corporation which is created under Bill 3, which is created to deal with transportation projects, not with health projects.

G. Wilson: So then all of this comment we have had in the debate on Bill 3 about not wanting to be building hospitals is just.... It appears that the minister is saying that any capital construction on hospitals is going to be administered through the capital budget that we see here. No additional money -- money that is not reported in this budget through this ministry -- will be borrowed on behalf of the people of British Columbia for the construction of health care facilities. Is that correct?

Hon. E. Cull: The answer is yes, but it doesn't preclude us from doing our capital construction in cooperation with other ministries that also do capital construction, or from doing other parts of community capital projects in a more integrated way. That's what we're looking at. I really don't want to get into the B.C. 21 debate, but I'll remind you again that there are four components to it. One component is to accelerate the building and improving of key social capital facilities, including hospitals, education facilities and the like.

B.C. 21 allows us to accelerate our capital investments in these areas and to cooperate, as part of a five-year planning process, with other ministries that are doing this so that we have a coordinated and focused approach to our capital investments, not one that is segmented into individual ministries.

The Chair: I would just like to bring to the attention of members of the House that we must be careful not to stray into legislation that is currently under debate. There's a fine dividing line, and I would ask members to bear that in mind when we're doing estimates.

G. Wilson: Thank you, Mr. Chairman. The only stray that I've ever had occasion to be acquainted with was a cat when I was child, and I certainly wouldn't want to end up with the same problem that that one had. I will keep to the straight and narrow, I can assure you.

I apologize if I'm being a bit pedantic on this issue, but I really do want to understand it. It's certainly important to me, and hopefully to the people of B.C., to understand how it's going to work. What exactly is the figure for capital construction that will be administered by the Ministry of Health under the authority of this minister, and what portion will be assigned through some kind of cooperative venture with other ministries? Could we have some definitive figures, like A, B and C, and the numbers?

Hon. E. Cull: The total capital budget is $317 million for '93-94. That's for major capital. There's another $76.95 million for minor capital. It's likely that the money that's in there for community health centres -- I'm sorry, I don't have the figure broken out at this point -- may be part of the B.C. 21 projects, because those facilities are more than single-ministry facilities.

But until the details are determined on which communities are likely to take advantage of the community health centre concept and what other opportunities are out there for co-locating with other ministry capital projects and other levels of government that may be doing capital projects, we're not going to be able to give you a more precise figure.

G. Wilson: I appreciate the clarity with which the minister has answered. I'm clear now on what the minister is saying. Of the $317 million for major capital projects, plus the $76.95 million for minor capital projects, there may be some that are more community based -- community oriented, presumably -- and might be administered through this B.C. 21 fund.

Interjection.

G. Wilson: The minister is saying coordinated through this fund. If that's so, is there somewhere in this budget where the administrative cost of those projects will be carried? Will it be carried through administrative support in this ministry? Will it be carried through administrative support in B.C. 21? Where do those dollars come from?

Hon. E. Cull: Administrative support in this ministry, with the dollars coming from our operating budget.

G. Wilson: I assume that community health centres would still be under major capital expenditures; they wouldn't be out of the minor $76.9 million. Or would they?

Hon. E. Cull: Minor projects are $1.5 million or under. So some of them conceivably could be, depending on the nature of the project.

G. Wilson: It brings to mind the Pender Harbour clinic, which is in need of a little expansion and some facilities. I'm sure it would come in just under $1.5

[ Page 5828 ]

million if the minister is keen to get rid of some of that money.

Interjection.

G. Wilson: That's good. High on the list, I hope.

More directly on the question of the expenditure of that money, the minister has said that the B.C. 21 dollars will be determined depending upon which communities take advantage of these opportunities. I'm paraphrasing what I think the minister said. I'm not quoting for Hansard's point of view, although it would be interesting to compare. If that's the case, who then directs the priorities on that spending? Is the priority on expenditure going to be made within the Ministry of Health, or will the priority be made by the new board of B.C. 21?

Hon. E. Cull: I'm sorry, hon. member, I've forgotten the first half of your question because I was focusing on the second half and your reference to Hansard.

The projects are determined by the Ministry of Health. We go through criteria, which you and I discussed earlier today in terms of long term care facilities and all the rest. We work through those projects.

Now I recall the first part of your question. It's not what the community needs and the shape of community health centres that will determine whether or not it's part of B.C. 21. What is needed in the community and what opportunities exist in the community will determine whether or not that community has a community health centre. We're not going around dropping health centres on communities. We're looking for opportunities for partnering: for hospitals to bring in health units; for health units to work with long term care facilities; for non-profit groups to work with municipal groups and ministry groups.

We're looking to provide a larger facility with more professionals in one location and a concept of teamwork that might not be available through separate, discrete facilities and rented spaces. We now deal with most of our health care space needs.

The determination of whether a community gets a health centre comes from the community, working with the ministry, working with our budget. We set the priorities for which hospitals will get extensions, expansions, new beds, new programs and more long term care facilities. The coordination of some of these projects will be B.C. 21, particularly the community health centres because they have the ability to involve not only the Ministry of Health but also Attorney General or Education or some of the other players.

G. Wilson: I know my colleague from the third party needs to get some questions in before 4 o'clock, so I'd certainly yield, although I would reserve the opportunity to come back at a later time.

[3:45]

Just one last question. It would seem to me that if the ministry is going to be maintaining and managing all of those funds to the tune of roughly some $400 million, or certainly $390 million, then why do we need the B.C. 21 to administer any of this construction? I realize that's slipping into the other debate. Having seen the Chair's anguish on that question, let me rephrase that to say: could all of this money be expended, or is it anticipated that all of this money will be expended, strictly on the priorities that are established within the Health ministry? Is the minister confident of that?

There is a certain suspicion out there that some other agency might be more politically driven, and therefore have the right of political reward prior to some hiatus event, like an election, for example. Could the minister tell us whether or not she is confident that all of those priorities will indeed be maintained and established through the Ministry of Health?

Hon. E. Cull: Yes, I am confident that the priorities of the Ministry of Health will be maintained. When I first ran for election to this Legislature, one of the things I was most concerned about was the lack of coordination between capital budgets at the provincial level: the fact that we miss opportunities to locate day cares at schools or integrate health centres with educational facilities -- in colleges, for example.

There are all kinds of potential opportunities which I felt the government was missing because they did not have the vision or the wisdom to put an umbrella over their capital projects and start to look at how they could better manage, coordinate and integrate them with one another. I think what we're talking about here is moving us into the direction of a better managed capital budget, which will allow me to feel that we're achieving some of the objectives I set out to achieve when I first ran for elected office.

G. Wilson: I have one last comment, and then I will yield. What the minister has just outlined -- and I offer it for future budget preparation and future estimates -- is the need for a ministry of community development. This has been long advocated by members in the Liberal opposition. It would integrate community services, reduce duplication, reduce cost to the public; not be a new Crown agency, which essentially increases debt and increases costs to the public. With that, I yield to my colleague.

The Chair: I now recognize the unforgettable member for Prince George-Omineca.

L. Fox: Thank you for recognizing my talents in that way.

I'm finding the debate really interesting, and the member from Sunshine Coast has entered into an area that I would like to ask one or two questions about. I found the debate about the total capital quite interesting. It seems to me that the partners in this particular initiative will be, by and large, the regional hospital districts, because they play a role in financing hospital extensions, extended care facilities, health clinics and so on. What is going to be the role of these agencies in the determination of facilities built and coordinated within your ministry, but also, as I understand it, partially coordinated within B.C. 21?

[ Page 5829 ]

Hon. E. Cull: The regional hospital districts continue to have a very important role in the planning around the facilities in their communities. As we move to a regional health board which will not only be responsible for hospitals but will be responsible for community health facilities, long term care facilities and other facilities which make up the total of the building stock for health care services in a community, that input from the regional level will be as important -- in fact even more important -- in starting to shape what the plan should look like.

As I said in answer to the member speaking just before you, the Ministry of Health has criteria. We have priorities, we work with communities to establish those priorities, and that is not changed by the way our capital budget is being managed this year.

L. Fox: Is there going to be any change in the funding with respect to some of the new health care needs for the community -- for the delivery of Closer to Home services and health care services? What share of the funding is expected to come from the regional health boards?

Hon. E. Cull: There's no change to the proposals for funding of health care services, either operating or capital, under the new scheme -- with one exception. The exception is whether the cost-sharing for hospital and other facilities that are cost-shared with the province will remain a function of the regional hospital district or move to the newly created regional health board. The answer to that question is now being determined through a committee that involves the Union of B.C. Municipalities.

So we're working directly with local government to determine what is the best location for that ongoing function of cost-sharing of capital facilities. Beyond that, the arrangements for the operating funds of health care facilities and other services remain as they are now: primarily paid for by the Ministry of Health through provincial revenue.

L. Fox: As I understand it then, the share ratio of 20 percent regional health board and 80 percent Health ministry with respect to some of the minor facilities and the 40-60 percent sharing will still be retained. Then I guess the argument could be made that the priority for which region gets this newfound money and newfound capital may very well be based on the ability of that particular taxation agency to tax and the willingness of the taxpayers within that regional hospital district to accept the taxation levy of 20 percent or 40 percent. Would the minister not agree that that might be a factor?

Hon. E. Cull: I agree that there is that element to it, but that is not a change from the system we've had in place for many, many years. If you're suggesting that the government pick up 100 percent of the capital cost to avoid the difficulty that some regional hospital boards go through when they have to face decisions about capital funding, then I think we're into a massive increase of expenditure at the provincial level.

L. Fox: The minister should know that assumptions are always very dangerous. She didn't know what I was suggesting. I was really suggesting that there may be disparities in the level of care and kind of facilities available dependent on the ability to pay of a respective region of this province.

I guess there I lead into another area that concerns me. I know there hasn't been a lot of dialogue between the ministry and the regional hospital districts as to what the ministry's expectations will be of those districts, given the new demand for services and the demand for capital to deliver those services, as well as what the liability on those respective taxing authorities will be.

Hon. E. Cull: The ministry will continue to work with regional hospital districts, and with regional health boards as they are created, to develop the priorities for health facilities in their community, particularly those that have to be cost-shared. But as we move to a system which sees us put more emphasis on community-based services and less on expanding the acute care system, I suggest that we will probably end up with things being less expensive for the regional taxpayer in the long run. We're talking very theoretically here.

But I suggest that since hospitals would be less expensive and indeed more cost-shared if we're starting to shift to community-based services -- which means that we reduce the need to expand our acute care sector -- that may be good news not only for provincial taxpayers but also for regional taxpayers.

L. Fox: Once again, those are very comforting words from the minister, but perhaps with a lot of assumptions in them, as there were in an earlier statement. I think one of the main concerns around this issue is the fact that there is no finite plan. There is no real direction coming from the ministry with respect to: (

a) how these new regional hospital districts should be formed; and (

b) what's expected of them in terms of the delivery of services, capital facilities and also, I guess, the formation of the boards.

A few months back I was amazed when I read in the newspaper the minister's response to a question from a press member on why these regional boards weren't going to be elected. In her explanation, the minister suggested that the public wasn't responsible enough to elect members who would necessarily reflect the interests of the government. While that isn't a direct quote, it's pretty much a paraphrase of the statement.

Interjection.

L. Fox: Perhaps, but those kinds of statements from the minister, the lack of direction coming out of the ministry and the fact that each one of these regional areas is in limbo.... Nobody even has a definition of where their boundaries are going to be, and at the same time we're seeing horrendous amounts of money shifted from acute care into home-based delivery. In essence, I think the people of B.C. feel that health care under this minister is a mess, and we're not sure where we're going. I had actually not intended to get into

[ Page 5830 ]

this area, because I can't conclude it, but as a general statement I guess that's a concern. The public and the health care professionals in B.C. accept that there has to be a change in health care. They accept the fact that we can no longer continue to support vacant beds and that we have to modernize in how we deliver health care. Our concern is that this change is not going to achieve the two objectives of supplying top quality health care at a lower cost to the taxpayer.

I'll leave it at that and allow the minister to make some responses.

Hon. E. Cull: I can assure the member that we are not going to be able to provide top quality health care to people in this province if we don't start making some of the structural changes that we have proposed in our New Directions. If you look at what is happening across this country and what other provinces are doing, every province in Canada has recognized the need for major structural change in the health care system.

There was a very interesting editorial in the Globe and Mail, which I recommend to you -- I'm sorry, I don't know whether it was Friday or Saturday -- reflecting on the situation in Ontario and some of the comments that have been made around the Tory leadership race with respect to health care.

[4:00]

In Ontario, Quebec, Nova Scotia and Manitoba they're reducing beds. In Saskatchewan, they have decided to close 51 small hospitals. All across the country decisions are being made about the need to make structural changes in our health care system. If we think we can stick our head in the sand and not start to change the way our health care system is functioning, yet still provide quality care and not end up with a system that is totally unaffordable by our taxpayers, then we...you're wrong. It just can't happen that way. We do have to make some changes.

We are making changes based on the Royal Commission on Health Care that your party established, hon. member. It set in motion a credible panel of non-partisan individuals that listened to people in every part of the province and came up with 379 recommendations, which, for the most part, we're implementing -- the first province in Canada to actually implement a royal commission.

I'm not sure what the motive was behind the former government for establishing it; maybe they just wanted to put health care off into a commission for a couple of years so it would go away and not bother them, and intended to leave it there on the shelf. But we don't intend to leave it on the shelf; it's a good report, and many of the recommendations are worthy of our support.

You talk about the concern about how regional health boards will be formed, and what's expected of them. It's an interesting thing around consultation, hon. member, because on the one hand, if you want to have consultation about changes in the health care system, then you can't go to them with the recipe which says: "This is what the health board will look like; this is how you will create it; this is what a community health council will be." If you're going to have consultation, then you have to spend a little bit of time with the community asking some of the questions and letting them answer some of those questions.

We have deliberately not developed the recipe book for community health councils or regional health boards in terms of this being the only way it can be done. We don't want a cookie-cutter approach. We want the community health council in Vanderhoof to reflect the needs of Vanderhoof, not the needs of somebody who dreamt it up in Victoria. There is an opportunity for us to have some flexibility and some creativity around this. I can tell you that if we had gone out with a printed document that said, "Here you go, implement this," we would be hearing howls from the community: "Wait a second; you haven't considered our needs, and you haven't considered our reality."

Despite the fact that we haven't got the cookie cutter ready to stamp out these councils all around the province, we do have a lot of the answers. If the communities interested in this approach will work with the executive directors who have been established by the ministry to assist them in working their way through this process, they can get the answers quite readily. There are 22 health units within the province, and those are the initial boundaries for the formation of the regional health boards.

But we respect the fact that places like the Sunshine Coast or Fort Nelson, which may be part of a larger region, don't really feel like they're part of that larger region, and so we're willing to work with those communities to see if we can't move those boundaries to reflect the realities of the community. We're starting with the 22 health unit boundaries. If you don't have a map of those boundaries, I'd be happy to share them with you, and we will make adjustments as necessary to reflect the needs of the communities.

We are in the process of putting together a community workbook that will not tell communities what a community health board should look like and be like and all of the details of putting it together, but will give them guidance and advice to sort it out for themselves. That community workbook has been developed in consultation with some of the people who are very interested in how we go about this job.

The associated union boards of health and the BCHA made it very clear they didn't want us to go out the door and say: "This is how you do it." They wanted to have some input first, so we are trying to work through our ideas with them. But those guide individuals who will be able to go out there and work with communities and help them sort their way through this are, or soon will be, available.

As we go through the transition period, the communities will start to develop a health council and learn some things about how best to integrate the boards that are already there and how to overcome those hurdles. We will then be able to take that information, document it and provide it to other communities still struggling with the concept, still somewhat shy of getting into the concept, or maybe too busy fighting with one another to be able to enter into the concept, which unfortunately still happens in too many places in this province. But there certainly is guidance; there is not prescription. I think that at this

[ Page 5831 ]

point if we were to have a prescribed, detailed program that gave no flexibility to communities, we would hamstring all of the ideas we're trying to put in place.

I'm not even going to comment on your rewording of the remarks you've attributed to me, but I will say that in 1996, when these boards are in place, they will be two-thirds elected by people in this province.

The Chair: Before I recognize the hon. member, I'd just like to remind members that when remarks are addressed through the Chair, it makes them easier for the members to hear.

L. Fox: I thought I was addressing all my remarks through the Chair, as I'm sure the minister was.

I'll make a couple of observations, through you, Mr. Chair, to the minister. One really good quote, which I think suggests it more accurately than the last one, from the Rafe Mair show -- and we all know how fair that program is -- is: "Democratic society hasn't really worked particularly well for us in the past."

What I'm really amazed at is that this minister talks about the consultative process when in fact we've seen the history of the lack of it on her

part in the last two years with respect to the doctors; and the closing of Shaughnessy Hospital, where she openly suggested Friday morning that in fact any consultation would have been a sham. The minister makes a point that the royal commission suggested all these changes. I concur; they did. They suggested how to develop new directions in health care. They also suggested another thing, the structuring of a community health council to develop and implement a strategy for those kinds of things.

Hon. Chair, another issue here is that clearly you cannot allow 22 regional boards to do their own thing. There have to be some general rules and concepts as to what we're trying to achieve.

I'm very confident that had the minister decided that she was going to increase the health care budget for a couple of years, develop four or five pilot projects with the involvement of people from rural, urban and semiurban areas within the province and come up with a workable model that could be refined to meet regional needs, it would have been possible to develop a program to look after the displaced people within the acute care system. We wouldn't have had this huge sellout by the Finance minister to the health care unions' leadership.

We wouldn't have had to give away those kinds of employment guarantees, because we would have dealt with this in a very coordinated and communicative kind of way. We would have dealt with all the stakeholders involved to achieve these things for the interests of all British Columbians.

I just had to stand up and defend what I said earlier and show amazement with regard to the consultation and how that should work, when in fact we have seen no leadership from that minister with respect to consultation in the last two years.

Hon. E. Cull: If that member had a look back at the ministers who have been sitting in the Minister of Health's chair for the last 17 or 18 years, he would find that in the last 18 months there has probably been more consultation done by this minister and this ministry than was done over the sum total of those ministers' years. The process that we have put in place and that we have for the New Directions for health care is one that's inclusive and involves many stakeholders who couldn't even get through the door when the former government was in power.

The process that you're asking for -- of sorting out what the health council should do, how they should do it and who should be there -- is the process that we're engaged in right now. At some point you have to start that process. As you get into that process, there's a lot of discussion about how it goes and how it doesn't go. That's where we are.

If you're suggesting that we should have had a group of civil servants sitting in the Richard Blanshard Building sorting out all of these answers so that we could have come out in February with the announcement that this was what it was going to be, I don't accept that.

You talked also about a massive redistribution of funding to the community health sector, and I just wanted to check my figures before I came back to you on that. The shift this year has been less than 1 percent, and I wouldn't call that massive. In fact, I think it should be more than it is, but that's all we could do without disrupting the system more.

L. Reid: In response to your comment on more consultation happening in the last 18 months, this is not a drive to mediocrity. What we have seen in the last 18 months in terms of consultation is certainly not something we're going to hold up and applaud. My hon. colleague is absolutely correct: there has not been consultation around the doctors' question, and there has not been consultation around the Shaughnessy Hospital question. If that is something you're holding up as a benchmark to say that you are somehow doing better than a previous administration, that's completely unworkable for the opposition. That is not a point we can accept today.

In terms of where I wish to proceed in the next 20 or 30 minutes, I want to pay particular attention to Review of Diagnostic Laboratory Services from the Department of Health, Province of Saskatchewan, October 1992. This report was prepared by Dr. Miles Kilshaw for the Saskatchewan government. I believe we need to touch on a number of issues in this report, because I believe tremendous clarification is required before we can proceed.

My reading of this report, and certainly the reading of many individuals, suggests that many of the conclusions are based on inadequate or inaccurate information. We are essentially taking the position that the Kilshaw recommendation means the death of private labs in Saskatchewan, and we believe that similar recommendations would mean the death of private community labs in British Columbia. There is tremendous impact around this question, and it has tremendous impact in terms of a number of examples. Let me just begin with two. In understanding the impact of the report based on the province of Saskatchewan....

We're of the belief that a current report is underway in the province of British Columbia

[ Page 5832 ]

as we speak. They comment on diagnostic services being no longer available close to a doctor's office. They give the example of at least a half-hour to an hour's drive to the hospitals for tests after visiting your doctor and possible lineups to register at the local hospital. This is the direction of the report in Saskatchewan. Would you comment on the status of the report currently underway in British Columbia?

Hon. E. Cull: The report underway in British Columbia is composed of a team of individuals who have been assigned the responsibility of reviewing diagnostic services. They are in the information-collection phase right now. They are conducting interviews with interested people who have something to say or who have some stake in diagnostic services in this province. I'm expecting the report later this year. I'll get the termination date for you; I think it's September of this year.

L. Reid: In terms of the impact of this particular report, the opposition does have significant concerns, and we look at situations around the lineups for lab and x-ray services at hospitals. In-patients will get priority because they are sicker. There are issues surrounding some of these comments that must be explored by this minister, like the wasted time in getting the tests done -- at least one-half to a whole day, compared to the present time allotment of 30 or 40 minutes.

We are making the comparison between what is going to be the impact in Saskatchewan, a province that moves away from community-based laboratory testing to a hospital model.... We are all well acquainted with lineups in terms of acquiring a service in a hospital. Whether you move through a clinical model in the hospital or an emergency department, the waits are not of a minimal variety, shall we say.

We also believe that the report is going to touch on longer waits to receive test results from hospitals, and we're not sure that that's in the best interests of patient care in this province. And we are certainly looking at some of the results out today that say that a number of our community labs can make a report within 28 to 48 hours. That's superb service, and I don't believe it's something we wish to move away from. We also take a look at continuing impact and delay in receiving appropriate medical care. We believe that to move away from the current system will only introduce delays into the system.

No availability of in-home lab services will mean patients will have to stay longer in acute care beds until laboratory tests can be done in a hospital.

If indeed these recommendations come to pass in Saskatchewan, they will have the impact that I have just addressed. If similar recommendations are reached in British Columbia, we can only assume that the best services are not going to be provided and that the patient is once again not going to be considered a priority in this province. To introduce any change in the system that guarantees a longer wait is not a valuable exercise, in the eyes of the official opposition, and is one we would ask the minister to address. Can she guarantee that none of these possible recommendations will create added hardship for the patients in British Columbia?

[4:15]

Hon. E. Cull: I'm going to seek some direction here, because I don't believe it is appropriate for me to be answering questions about a diagnostic review in Saskatchewan. I don't see any similarity between what the Saskatchewan government is doing and what the government of British Columbia is doing with respect to health care services. We haven't cut budgets overall by 3 percent, we are not proposing to close 51 hospitals and we're not increasing the Pharmacare deductible to $1,700 for the average family. All of those directions have been pursued in Saskatchewan because of their unique budget situation and, presumably, the circumstances of their health care system.

The diagnostic services review team consists not only of Dr. Miles Kilshaw, who was involved in the Saskatchewan study, but also Sheila Gallagher, who is with the Attorney General in British Columbia; Deborah Shera, who is with our Medical Services Commission; Dr. Gary Tompkins, head of the department of economics at the University of Regina; Dr. Keith Walker, chief of the department of laboratory medicine of the Greater Victoria Hospital Society, but very recently from the University of Alberta, where he was head of medicine; and Dr. David Hynes, chief of the department of diagnostic imaging at St. Joseph's Health Centre in Toronto, Ontario.

I know there has been a lot of speculation about the Saskatchewan report. But the very preliminary information that I have from this diagnostic team is that the situation here is different, and I think we can expect results and recommendations consistent with the needs of British Columbia and consistent with the circumstances in British Columbia. Interviews with people involved in diagnostic services are underway. Until we've collected all the information, I think it's quite pointless to speculate about whether the Saskatchewan report will look anything at all like the one in British Columbia.

L. Reid: Private labs in all communities throughout British Columbia currently provide services to over 10,000 patients daily -- two million patients per year. Mobile lab services provide services to another 50,000 patients in their own homes or in extended or nursing care situations. This service not only helps patients stay in their homes, but also allows for early discharge from hospital. Our labs allow and help transport over one million patient samples to public facilities.

The Cancer Control Agency, Red Cross and provincial laboratories provide medical pathology and technical support to remote centres in British Columbia, including remote hospitals which do not have pathologists on site, and provide employment to B.C. residents in their own communities. Eighty percent of employees in lab and x-ray facilities are female.

My point in making the case for the current status of British Columbia lab technology is that it allows for greater clarification for this Minister of Health. Based on the Saskatchewan example, impacts will come to

[ Page 5833 ]

bear on this particular state of affairs in community lab work.

I appreciate the minister giving me the names of the individuals who are involved, but Dr. Kilshaw is neither a pathologist nor a radiologist. Again, my comment reflects on process. The diagnostic groups within our province were not asked to participate in any kind of discussion. We have some difficulty with the Kilshaw recommendation being transplanted, out of the blue, from Saskatchewan to British Columbia. There seems to be less opportunity for British Columbia laboratory technologists to be involved in this process. I did note the names you provided, regarding their backgrounds, etc., and it pleases me greatly that there are some economic folks involved in that process.

With respect to the implementation of the recommendations and the impact this will have in Saskatchewan, there will be carryover in British Columbia if the individuals who provide those services are not consulted. This is another sham with a fraudulent consultation process in place, because it simply has not occurred. If you can clarify in any way, shape or form why the medical community was excluded from this process -- it is ongoing without their involvement -- I would welcome your comments.

Hon. E. Cull: Let's clarify this, because we do have three medical doctors involved in a six-person review team. The medical community has not been excluded from the review team.

In addition, the lists of individuals or groups who are going to be contacted by the review team include just about everyone that you can imagine in the medical community who might have something to say on this, including all hospital administrators, the College of Physicians and Surgeons, the University of British Columbia faculty of medicine, the B.C. Health Association, the B.C. Medical Association, the B.C.

Association of Laboratory Physicians, the B.C. association of radiologists, the B.C. association of cardiologists, the Health Sciences Association of B.C., the provincial laboratory, the Health Labour Relations Association, the Council of University Teaching Hospitals, representatives of privately owned and operated diagnostic facilities and anyone else who feels that they have something to contribute to this particular review.

The specific question that I believe the member is getting at is: why was the BCMA not asked to appoint members to sit on this review team? The BCMA wrote to us as soon as we advised them that the review team had been struck and said they wanted to have three members on the team and approve the terms of reference before they would participate.

One of the difficulties that you have when you get into the health field, as you can see from this list, is that if I ask three members of the BCMA to sit on the review team, I should ask three members of the Health Sciences Association, whose members are the workers who provide the services in all of those labs and carry out the lab tests and much of the work that has been done. I think they have an equal right to sit at the table. I probably should ask the hospitals who operate the public labs to have three people -- so we're up to nine now.

We certainly could not offend the private labs by not having their representatives on there -- we're up to 12. You start to look at the various bodies that have a legitimate right to have input in this study and if you put them all on the review team, we're going to have to hold the meetings in this chamber just to have enough seats for everyone to sit around one area together. It's not practical.

I certainly learned that the hard way, I will confess, when we put together the minister's advisory committee on the royal commission. Despite the fact that we had four doctors, five nurses and hospital and community people there, there was always one group that felt it was just as legitimate as someone else at the table and really should have been invited to be there. We made a cut off at 26, because we didn't think a group much larger than that would be able to function effectively.

Instead of having a huge, unwieldy and unworkable review team, we have picked a team of people who have different expertise, are recognized in their field for the work that they have done and have said they will consult widely with all of the bodies that have an interest in this area. Indeed we have invited them to meet with us to share information to make representation, and they are.

We've gone one step further, because we are concerned with the points that have been raised by the B.C. Medical Association. We have suggested that rather than having the review team be this large 20- or 30-person body, we will create an advisory body that can review the draft results as they're coming along to make sure that the review team is reflecting the wishes of the organizations represented on the advisory body.

I'll just say a word about private labs. As I've said, we have some very preliminary information coming in right now. But from what we learn, private labs are very efficient and effective in this province, and I haven't seen anything yet to indicate that they will not continue to have an effective role in diagnostic treatment in British Columbia.

L. Reid: Dr. Kilshaw is not a pathologist or radiologist. Can you perhaps expand on the qualifications that allowed you to select him for this role?

Hon. E. Cull: I'm just looking for it here. I was going to ask her to go on, but I've just found it. Dr. Miles Kilshaw is a respiratory internist and medical administrator. He has wide clinical experience, as well as administrative experience in hospitals and with the Ministry of Health. He has recently completed the diagnostic laboratory services review in Saskatchewan, as you've already noted, and has served on many advisory committees and several boards in the health care field.

L. Reid: You made mention that a consultation process is going to commence with a group, such as the B.C. College of Physicians and Surgeons. I'm not convinced that all the parties you mentioned are currently part of that consultation process. Could you

[ Page 5834 ]

give a time line as to when it was initiated and when it intends to conclude its review?

Hon. E. Cull: The list of bodies that I have indicated have all been invited to participate. The committee has started its consultation. In fact, I think there's been some travelling to different centres in the province -- extensive travelling, I'm being advised by the chair of the Medical Services Commission. As of April 16 of this year, they had consulted with almost 200 individuals, including 72 physicians from 13 hospitals and several health care-related organizations. However, as I said, they are in the beginning phases of their work, and I'm sure they will make many more consultations and have much more discussion before they start putting pen to paper and writing out recommendations.

L. Reid: Will the committee's report, hon. minister, be submitted on time, or do you anticipate it coming in earlier than scheduled?

Hon. E. Cull: There will be an interim report -- I'm just learning from the chair -- that should be on time, and it's expected in early July.

L. Reid: We are basically discussing a report that looks at a decrease in service delivery in Saskatchewan. Certainly the minister herself has made reference many times today to the 51 hospital closures in that province. There will also be 20 closures of Saskatchewan community hospital laboratories. Given that, do you have plans to decrease the number of community laboratories in place in British Columbia? You made mention of maintaining the role, maintaining the effectiveness, and certainly I support that. Is it the intent of securing this report to decrease the number of community laboratories currently operational in British Columbia?

Hon. E. Cull: It's not the intent of the report at all.

L. Reid: Could the minister perhaps expand on the intention of this report? We have discussed earlier a model to streamline the process and to understand more fully whether or not there's duplication in the system. When the minister sought out Dr. Kilshaw to produce this report, what was the mandate given to him by yourself?

Hon. E. Cull: The terms of reference are to review diagnostic services in the province and recommend changes aimed at improving the cost effectiveness and the quality of the services. The scope of the work involves all diagnostic services, including diagnostic laboratories, medical imaging services, electro-diagnostic services and pulmonary function services, all as part of the review. The terms of reference go on for several pages, and I don't think I should take the time to read them into the record right now. But I would be happy to share them with the member if she hasn't already seen them.

L. Reid: I would appreciate the terms of reference, hon. minister.

I go back, in terms of requiring clarification, to the issues of homebound individuals, people in the communities, because I think there's a definite connection between the shift to community care and those folks who would require some kind of laboratory service in their own homes. If indeed the intent is to maintain community laboratories, we can only assume that the individuals who require those kinds of laboratory services in their own homes will be able to secure them over time.

Hon. E. Cull: I'm going to have to ask the member to repeat that -- I'm sure I heard her say it, I was just checking with my staff person here -- about laboratory services in your own home. You mean in your home community, I'm assuming, not in your own home, or we're talking about something that I'm not familiar with.

L. Reid: There are currently in place in British Columbia services for the homebound -- i.e., blood work, etc. -- that you can have done in your own home. I'm not anticipating any change in that; I'm wondering if the minister is. It seems to me that community laboratories, which provide services to long term care facilities, provide basic diagnostic workups in an individual's home. It's a service that we would like to promote in terms of shifting to community care. Correct or otherwise?

Hon. E. Cull: It's my understanding that it's just the blood or other samples that are required for the diagnostic testing that are taken in the home, but the testing isn't done in the home.

[4:30]

L. Reid: The minister is quite correct. We are talking about home visits to be involved in laboratory work at some point, wherever it begins in the process.

Is it the intention of the minister, in keeping with the royal commission Closer to Home, to continue that kind of service delivery, if indeed we wish to have people receiving medical care in their own home?

Hon. E. Cull: Clearly our intent is to continue to expand services that are available in people's own homes, but unless you have shifted off the topic of diagnostic services entirely, there is no connection between the diagnostic review and the home nursing services or other services that are available in the ministry. We are not intending, through the review of the diagnostic services, to impact on the taking of the test, whether they take place in doctors' offices or by nurses in people's homes, or where a community nurse and long term care facilities were indeed in the hospital.

Those services continue, and we would, as part of our overall efforts to expand community-based services, be enhancing those as part of a larger package of services that require enhancement.

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L. Reid: I believe the minister and I are in agreement that collection services will continue to occur in individual homes and in long term extended care facilities in this province. My question refers specifically to who will be making those collections of whatever sample it happens to be. Are we looking at that role being adopted by the new community employees, the ones that were advertised for to encourage more people to work in the community care sector in British Columbia,