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)

WEDNESDAY, JUNE 23, 1993

Afternoon Sitting

Volume 11, Number 13

[ Page 7711 ]

The House met at 2:05 p.m.

Prayers.

D. Streifel: It's my pleasure today to introduce to the House Joy and Erich Jensen, residents of Squamish. I make this introduction on behalf of their son John, one of our legislative interns. I bid the House make these folks very welcome.

N. Lortie: It is with great pleasure that I introduce a visitor from our neighbouring province of Alberta, that hotbed of social democracy. This visitor is a veteran of the Gainers wars in the labour scene in Alberta, a friend and my son, Lance Lortie. He is accompanied by my wife, who has been introduced before. Would the House please make them welcome.

J. Pullinger: It is with a great deal of pleasure that I introduce some very special people from the community of Lake Cowichan. Marie Bergstrom, who, along with her sister, was chosen citizen of the year for that community, is here today. Accompanying her are three young women who were recently chosen in the Lake Days celebration to represent the community of Lake Cowichan. Those young women are Nicole Bonenfant, Karen Reid and Kari Lingren. Would the House please help me make these people very welcome.

Hon. A. Charbonneau: On behalf of the member for Kamloops-North Thompson, I would like to welcome to the assembly some visiting members of the Kamloops Indian band, including some members of the council of the band: Dennis Coates, Marny McGuire, Shane Gottfriedson, Colleen Anderson and Evelyn Gottfriedson. I would ask all members to make them welcome.

F. Randall: In the precinct today are a group of 18 students from John Knox Christian School in Burnaby-Edmonds. They are accompanied by a teacher from the school, Janice Vandergraaf. Would the House please make them welcome.

Introduction of Bills

FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY AMENDMENT ACT, 1993

Hon. C. Gabelmann presented a message from His Honour the Lieutenant-Governor: a bill intituled Freedom of Information and Protection of Privacy Amendment Act, 1993.

Hon. C. Gabelmann: The Freedom of Information and Protection of Privacy Act passed one year ago today covers the ministries, Crown corporations, agencies, boards and commissions of the provincial government. The bill before the House extends the same principles of freedom of information and protection of privacy to municipalities, school boards, hospitals, police, universities, colleges and self-governing professional bodies.

Bill 62 contains provisions which address a range of issues unique to local public bodies. The bill also contains a number of housekeeping amendments for provincial public bodies.

Bill 62 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

PHARMACISTS, PHARMACY OPERATIONS AND DRUG SCHEDULING ACT, 1993

Hon. E. Cull presented a message from His Honour the Lieutenant-Governor: a bill intituled Pharmacists, Pharmacy Operations and Drug Scheduling Act, 1993.

Hon. E. Cull: This bill repeals and replaces the existing Pharmacists Act, a statute which has become outdated and inadequate particularly in the provisions that authorize the College of Pharmacists of B.C. to investigate and deal with complaints relating to pharmacy services.

The overriding intent throughout this bill is to protect the public from the harm that could result from, for example, a pharmacist who is incompetent, a pharmacy that lacks essential equipment or an animal feed dealer who is selling substances that are detrimental to human or animal health. The bill therefore provides for setting the qualifications required for registration as a pharmacist, establishing high standards of practice which must be maintained, monitoring the continuing competence of pharmacists, investigating complaints and disciplining those who contravene the legislation.

In very serious cases the college has the authority to suspend the registration of a pharmacist or the licence of a pharmacy if the action is believed to be necessary to ensure public safety. In order to maintain high standards of operation, both pharmacies and outlets selling medicated feed or veterinary drugs must be licensed, and the licence may be revoked if the requirements of the legislation are not met.

I'd also like to point out that the bill is consistent with the Health Professions Act, which significantly advanced the legislative framework for self-regulating professions in B.C., and includes many public accountability measures, in particular the requirement that one third of the college council be public representatives. This is consistent with the ratios that will be established for all health professions.

The bill is also consistent with the Freedom of Information and Protection of Privacy Act and will

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ensure that personal and other information in a pharmacist's records is protected from disclosure.

Bill 61 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

MUNICIPAL AFFAIRS, RECREATION AND HOUSING STATUTES AMENDMENT ACT, 1993

Hon. R. Blencoe presented a message from His Honour the Lieutenant-Governor: a bill intituled Municipal Affairs, Recreation and Housing Statutes Amendment Act, 1993.

Hon. R. Blencoe: This legislation gives local governments new powers to increase the supply of affordable housing. It constitutes the most significant measures ever taken in our province to support the role of local government in the provision of housing. Bill 57 contains amendments to the Municipal Act and the Vancouver Charter that give local governments clear authority to provide density bonuses to developers in exchange for meeting specified conditions for affordable housing, customized comprehensive development zoning arrangements for large projects, and legally enforceable housing agreements to ensure that affordable housing commitments are carried out.

[2:15]

The legislation also offers local governments optional powers through regulations that will allow them to lease land for affordable housing units at below market value, to establish housing reserve funds for housing purposes and to enforce standards of maintenance for rental housing within their communities. This makes the legislation flexible and responsive to the unique circumstances and needs of individual local governments.

These amendments implement seven more recommendations of the Provincial Commission on Housing Options. This brings to 15 the number of provisions that have been implemented in the five months since the report was released. Work has been completed or is underway on 38 of the 57 recommendations made by the commission.

Hon. Speaker, these changes are practical and specific. The legislation provides much-needed flexibility and allows local governments and developers to craft win-win trade-offs. The result will be more affordable housing for British Columbians.

Bill 57 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

MUNICIPAL AFFAIRS, RECREATION AND HOUSING STATUTES AMENDMENT ACT (No. 2), 1993

Hon. R. Blencoe presented a message from His Honour the Lieutenant-Governor: a bill intituled Municipal Affairs, Recreation and Housing Statutes Amendment Act (No. 2), 1993.

Hon. R. Blencoe: This legislation contains a number of amendments to the Municipal Act and related local government legislation, as well as one amendment to the Assessment Act. The amendments are a continuation of our government's initiative to modernize all the legislation administered by my ministry. This modernization program involves ongoing consultation with the stakeholders in local government, particularly, of course, the Union of B.C. Municipalities.

The amendments relating to the Municipal Act in this bill give local governments more authority to protect, from local development, environmentally sensitive areas which have been designated in their official community plans. It gives authority to all regional districts to provide more services, including transit and 9-1-1 emergency telephone service, rather than requiring each district to apply individually for these services.

It clarifies and updates the rules governing the way local governments provide remuneration, expenses and benefits for councillors while at the same time requiring that local council members' remuneration and expenses be reported annually in an open meeting. In keeping with one of our goals of modernization, it increases local autonomy in decision-making by eliminating or modifying numerous requirements for ministers' approval in relation to land use planning by local government.

The amendment to the Assessment Act clarifies the definition of industrial improvement in order to preserve the stability in the tax base of local governments.

Bill 58 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

VANCOUVER CHARTER AMENDMENT ACT, 1993

Hon. R. Blencoe presented a message from His Honour the Lieutenant-Governor: a bill intituled Vancouver Charter Amendment Act, 1993.

Hon. R. Blencoe: This legislation contains a number of amendments to the Vancouver Charter that were requested by the city of Vancouver and that are part of my ministry's ongoing program to modernize all of the legislation that it administers. This modernization program has three goals: to empower local governments with the authority they need to deal with today's challenges, to streamline the legislation that governs their day-to-day operations, and, of course, to update obsolete provisions.

The Vancouver Charter governs the administration of the city of Vancouver, and it parallels the Municipal Act, which applies to all local governments in the province. The proposed amendments ensure consistency between the charter and the provisions of the Municipal Act; they also provide additional powers to the city to deal with issues of particular concern in this large metropolitan area. For example, they will enable the city to manage its debt in a more fiscally prudent

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way by being able to refinance it over a longer term, thereby receiving more favourable rates. They will give more flexibility to the city in regulating the subdivision of land where a heritage building is located. They also give council the authority to hold a property manager, rather than just a property owner, responsible for complying with building bylaws.

Bill 59 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

WINDY CRAGGY DECISION AND MINE DEVELOPMENT ASSESSMENT PROCESS

D. Jarvis: Windy Craggy was stalled for over three years at a cost of millions of dollars to the taxpayers and investors of this province. It became a symbol of the future to the mining industry of British Columbia. This government has ignored the rules and bypassed its own assessment process to make a politically expedient decision. My question is to the Minister of Mines: did she herself participate in this final decision, and does she accept responsibility for it?

Hon. A. Edwards: Yes, this is a government decision to set aside this portion of British Columbia, the Haines triangle, as a preserved wilderness area. Yes, it was a government decision, and every member of the cabinet was right there.

I would like to suggest that government has made an excellent decision. It was a very difficult decision, particularly for those of us who appreciate the value of the mineral body there. But I would like to remind the questioner that the Liberal Party itself made a promise during the last election. The promise was: "We will set aside at least 12 percent of our province as parks, wilderness areas and ecological reserves, including the Tatshenshini River watershed." I am pleased to know that the questioner also agreed with us previously.

D. Jarvis: In the Liberal Party, we actually believe that you can mine in parks in a responsible manner.

Interjections.

The Speaker: Order, please.

D. Jarvis: The minister has made a decision to bypass the proper process, which she knew full well would seal the fate of the mining industry in this province. She has also destroyed her own ministry. She no longer has claim to represent the mining industry; she is not an advocate of the mining industry. She has lost the confidence of the mining companies and the people in her own riding. I would ask her at this time to do the honourable thing and resign.

COMPENSATION FOR MINERAL CLAIMS

W. Hurd: I have a question for the Minister of Energy, Mines and Petroleum Resources. Does she accept the principle that mineral companies should be entitled to recover at least their costs of exploration when their mineral claims are expropriated?

Hon. A. Edwards: We accept that there should be fair compensation to the holders of claims when government does the taking.

W. Hurd: In light of the wide discrepancy in compensation claims between the Minister of Finance and Geddes Resources, has the minister actually sat down with the companies that are having their claims expropriated to discuss fair compensation?

Hon. A. Edwards: The government will be in touch immediately with the holders of the claims in order to achieve some agreement on a process to reach fair compensation. We're certainly not going to be bargaining in the Legislature or in the media.

The Speaker: Final supplemental, hon. member.

W. Hurd: How can the minister expect the mining industry to have faith in the mine development assessment process when she won't accept the principle in one of the most important mining areas of the province? Is she prepared to defend the mine development assessment process, or does she accept the fact that it's out the window in this province?

Hon. A. Edwards: We accept the principle of fair compensation. We will meet with the claim holders, and we will achieve the goal of fair compensation.

TOURISM IN THE TATSHENSHINI

R. Neufeld: My question is to the Minister of Tourism. Can that minister tell us how many tourists visited the Tatshenshini area last year and how much revenue that raised for the province? Can she tell us how many jobs she expects to be created by the new park in that area?

Hon. D. Marzari: I cannot give the hon. member specific numbers as to the number of tourists that frequented the area, but I can tell the member that there is a very active river rafting program that is licensed by British Columbia in the area.

The Tatshenshini decision, which was arrived at by cabinet and by government, was not made on the basis of the number of dollars that are spent now or might be spent by tourists in the region. It is not a reasonable place to hang any argument about the preservation of the Tatshenshini watershed, that very fragile ecosystem in the Haines triangle. So if the member is attempting to hang a decision based on tourism revenues, I do not believe the quantity of tourists in the Tatshenshini area is any argument for the decision that was made, with some difficulty, by this cabinet.

R. Neufeld: Does the minister have any idea of what it costs to charter an aircraft to get into the Tatshenshini area? Doesn't the minister understand that

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the area is only accessible by the super-rich? Or is this park supposed to be the private domain of the Clintons, the Kennedys and the Gores?

Hon. D. Marzari: I am delighted that the third party would be so interested in equity within the tourism business or interested in bringing in the full spectrum of tourists to this province. In fact, Tourism is attempting to do everything it can to reach the richest possible tourists who will leave in this province the most money possible. However, that begs the question of whether the decision around the Tatshenshini was based upon the number of tourists, rich or poor. I will repeat the answer to his previous question: the number and wealth of tourists was not one of the determining factors in the decision that was made.

NOMINATION OF TATSHENSHINI AS WORLD HERITAGE SITE

A. Warnke: In the absence of the Premier, I want to address my question to the Minister of Environment. Yesterday the Premier announced that the Tatshenshini region will be nominated as a world heritage site, the Premier announced that the Tatshenshini region will be nominated as a world heritage site to be known as the St. Elias-Tatshenshini World Wilderness Reserve. To qualify as a world heritage site, the region must be linked to parks in the United States. What negotiations are taking place between this government, the Canadian government and especially the American government to achieve a successful nomination?

[2:30]

Hon. J. Cashore: Yesterday the Premier announced that he was nominating the area as a world heritage site and that he was seeking to nominate a very competent and high-profile committee to address that issue on an international basis, given the international aspects of the dedication of that area as a park.

Given the tone of some of the comments being made by the opposition, let us remember that several generations ago there were people who had a role in setting aside Yellowstone National Park and Banff National Park. This generation is thanking those people for having had the courage and the foresight to consider future generations. That's what this decision is about.

A. Warnke: My supplementary question is also to the Minister of Environment. The Premier also announced that he wants a special international advisory body to manage this area, a concept identical to Vice-President Gore's call for a stewardship council, a supranational organization to control and manage such a region that will obviously be run by the United States and obviously could still be in charge of economic development in this area. Why is this government giving up control and management of this region, including possible future economic development, to such an organization run by the United States?

Hon. J. Cashore: This member should be ashamed of himself for besmirching the concept of international cooperation. There is no....

Interjections.

The Speaker: Order, please.

Hon. J. Cashore: Settle down.

There is no question that this is a B.C. park, and it will be managed by British Columbia. But the international opportunity to foster goodwill on a global scale is something for which the Liberal Party should at least have some basis of understanding.

WARD SYSTEM FOR VANCOUVER

J. Macphail: My question today is to the Minister of Municipal Affairs. On three separate occasions over the last 15 years, the voters of Vancouver have cast majority ballots in favour of the ward system.

Interjections.

The Speaker: Order, please. I would call for order in the House while an hon. member is asking a question. Please proceed.

J. Macphail: If a ward system is to be in place for the 1993 civic election, the city of Vancouver is going to have start planning for the implementation of that now. Has the mayor of Vancouver approached your ministry about the feasibility of establishing a ward system for Vancouver under the new local government reforms?

Hon. R. Blencoe: As you know, under Bill 35, we brought Vancouver into the sphere of the rest of the province, and with a bylaw the Vancouver council can, of course, adopt a ward system now. It's my understanding that Mayor Campbell has on occasion said he is in support of it. But I have to say that Mayor Campbell has never approached me to discuss....

Interjections.

The Speaker: Order, please. I would call the House to order and ask the minister to conclude his reply.

Hon. R. Blencoe: Mayor Campbell has not approached me about implementation; he has never approached me on this issue. If Mayor Campbell were to approach, my ministry would assist. We believe that there is time and that the citizens of Vancouver would like to see a ward system. We will help where we can.

BRITISH COLUMBIA MINING INDUSTRY

J. Weisgerber: My question is to the Minister of Mines. The mining industry has been twice betrayed by this minister: first, when she abandoned her responsibility for the mine review process; and now, when she has destroyed the multi-use option for the Tatshenshini.

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Bad news comes in threes. What else have you got planned for the beleaguered mining industry?

Hon. A. Edwards: The mining industry has the support of this government. This government has moved quickly to bring certainty to land use in this province so that it is sure where the boundaries are -- so that we know where mining activity can occur, and where it can't. The mining industry has asked for that. We have moved on a number of other areas. Most particularly, all of those things are wound into our mineral strategy, on which we are working with the mining industry. The president of the Mining Association of B.C. has been most moderate in his response on the Tatshenshini.

We know they are disappointed that the Windy Craggy mine and other mines can't go ahead, but certainly it is not the end of the mining industry.

J. Weisgerber: I suppose the energy and petroleum industries will be praying that they don't get your support as well.

The decision on the Tatshenshini was made before the ink was dry on the Clayoquot decision. This is simply a sellout of the mining industry to pay off the preservationists. How does the minister possibly square her decision to kill Windy Craggy with her so-called strategy to promote mining in B.C.?

Hon. A. Edwards: The decision on the Tatshenshini-Alsek area was a land use decision. It was a decision that this government took in order to protect a unique area in the world ecosystem. That is an area of specifically important biodiversity. It is unusual, it is different, it is very special in that regard. It is global. This government followed the recommendation of Stephen Owen, who said that he believed consensus was not possible on this area. He gave us three choices, and this government chose one.

Orders of the Day

Hon. G. Clark: I call Committee of Supply A, the estimates of the Ministry of Energy, Mines and Petroleum Resources. In the House I call second reading of Bill 45.

HEALTH AUTHORITIES ACT, 1993

Hon. E. Cull: The Health Authorities Act plays an essential

part in enabling communities and regions to move in new directions in health care. It has been four and a half months since I announced the government's response to the Royal Commission on Health Care entitled "New Directions for a Healthy British Columbia."

Since that day in early February we have seen some exciting steps forward. As our health system has begun the gradual process of change, the new directions are all around. Many British Columbians now have a good idea of the need to change the province's health system to keep pace with our changing needs. They know about the work of the royal commission: how it concluded that our excellent health care system has to change if it's going to be financially sustainable in the future.

They know that we need to bring health care services closer to home, and that we have to make sure that everyone who lives in this province has fair access to health services and a fair chance to be healthy. They recognize the benefits of adjusting our system so that it places more emphasis on promoting good health, and on the prevention of illness and injury. They are looking forward to more local decision-making for health care. That's what this bill is all about. The Health Authorities Act provides the means by which health decision-making and service delivery can be decentralized all over British Columbia.

The legislation establishes the framework necessary to begin the transfer of authority to new agencies at the regional and community levels.

It is important to note, however, that this is transitional legislation which is to be replaced with comprehensive legislation by 1995. We are into a period of three and a half years of transition. Community health councils and regional health boards will be formed at different times over this transition period. Those councils and boards, which start out early -- and there are a number of them already underway -- will provide very valuable lessons to those communities that will be following along later. We intend to learn from those lessons and make sure that the permanent legislation reflects the lessons that we learn.

Consistent with the New Directions strategy, the bill provides for the establishment of community health councils and regional health boards. Let me talk about each, in turn.

A community health council has a number of purposes. Firstly, community health councils will develop a community health plan that will specify the terms to provide health services in the community and to set out reporting and accountability provisions and coordinate and integrate the delivery of health services at the community level either through direct employment or contracted services, but predominantly on a not-for-profit basis as in the current health care system.

They will also operate hospitals and other designated facilities; undertake various planning, priority and budgeting responsibilities; develop and implement community standards for health service delivery; and monitor, evaluate and comply with the applicable health service standards established at the regional and provincial levels. Community health councils will be the key mechanism for increasing local decision-making and will play an essential role in bringing health care services closer to home.

The regional health boards, which will be composed of people from the community health councils within the region, will be responsible for developing and implementing a regional health plan that specifies health services to be provided in the region. It will set out the particulars of the facilities in the region, program delivery issues, human resource requirements and reporting and accountability features. The regional health board will also develop policies and set priorities, allocate resources for the delivery of health services and allocate and administer grants to community health councils within their region.

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Regional health boards will have the power to deliver regional services and also to exercise the power of a council in those parts of a region which are not served by a community health council. Regional health boards will implement regional standards for health service delivery, and they too will be required to monitor and evaluate their services and to comply with service standards set at the provincial level. Regional health boards will bring together the community councils to ensure that there is a rational and coordinated set of services in a region and to make sure that there is a fair and sensible distribution of health resources throughout the region.

In most cases -- but not all -- community health councils will be established in an area before the corresponding health board is formed. Initial appointments to councils will be made by the minister, in the absence of any other practical short-term method of selection. However, in the longer term, one-third of the council members will be elected directly by the community, in the same manner that school trustees or municipal councillors are now.

Another third will be appointed from persons who have been elected to that community at the regional district board, municipal council or school board levels, as the union boards of health are now. The final third will be appointed by the minister. As I said a moment ago, regional health boards will be made up of people appointed from the community health councils to go to the board level, from the membership of the councils within the region.

[2:45]

Consistent with the provisions of the Municipal Act, under this legislation board and council meetings will be open to the public, except in specific circumstances which will require an in-camera session. The intent is that the vast majority of the business of these councils will be public and available to members of the community to come in and observe what is happening.

The authority of boards and councils to exercise statutory powers will be set out in the regulations under the legislation. Powers and duties that are currently assigned to such bodies, such as the local board of health or a hospital board, will be assumed by the health board or the council as they are formed. This means that there will need to be full and active cooperation between these agencies during the transition period, while the board or council gradually takes over full responsibilities in the various areas.

Eventually there will have to be substantial amendments to legislation such as the Health Act, the Hospital Act, the Hospital District Act and the Mental Health Act, to clarify that a board or council will have then assumed the complete responsibility. I should also note at this point that there will be a regulation under the Ombudsman Act that will confer jurisdiction of the ombudsman with respect to health boards and health councils.

During the consultation process that preceded the release of the New Directions initiatives, there was considerable interest in the impact of this legislation on people who are employed in the health sector. The legislation states that the Public Service Act does not apply to a board or council unless specifically ordered by cabinet. That means that people currently employed by the Ministry of Health, such as public health nurses, dental hygienists, audiologists or others who are employed directly by the ministry, will in future be employed by a council or a board.

Under labour laws governing successorship, existing collective bargaining arrangements will simply be assumed by the new employer. Existing unions will continue to represent the employees who will be transferred.

With respect to pension benefits, these employees will be governed by the Pension (Municipal) Act. The pensions are fully reciprocal, and there are only very minor differences between the existing pension scheme for Health ministry employees and the new plan.

I'd like to take a few minutes to emphasize a few additional provisions of the legislation.

Section 3 sets out the minister's authority to establish standards and specify health services and requires that the minister ensure that the health system continue to operate on a basis that is predominantly not for profit and one that is consistent with the principles of the Canada Health Act.

I should also clarify again at this time -- because there has been a fair amount of misinformation on this issue -- that neither a board nor a council will have any additional taxation authority beyond that which is currently held by the bodies whose responsibilities they will be assuming. What I mean by that is that regional hospital districts right now do have a taxation authority for capital projects. If the work currently underway with the Union of B.C. Municipalities concludes that regional health boards should assume that responsibility, they will do so.

The decision has not yet been finally made, so it may remain with the regional districts. In any event, there is no additional taxation authority accorded to either of these bodies.

Also, consistent with the provisions that cover the hospitals and the community care facilities, the act provides for the appointment of a public administrator if it is necessary to do so in the public interest.

Members may be aware that considerable progress has been made in the last number of months toward establishing community health councils and boards. It's indeed encouraging. When we originally released the New Directions strategy in February, we thought modestly that six to ten councils or boards might be underway in the first year. We have well over 30 communities actively forming health councils and boards right now. Communities, such as those in the Regional District of Mount Waddington on Vancouver Island, have joined together to plan cooperatively for their health future.

These five different communities have been meeting since last fall to develop a model for an integrated health system, and they've reached consensus on the forum they would like for local decision-making, on the consolidation of management functions, rationalization and coordination of the services. They've begun planning for five community health centres and have settled on an efficient management structure that will employ a single chief executive officer to oversee the operations of all five centres.

They've also reached consensus on an interim governing structure and have already forwarded to me the names of nominees for appointment to an interim

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council. So the people of Mount Waddington are certainly ready for this legislation.

The same is true in Port Alberni. Their health service providers, agencies, community representatives and others have been meeting since 1991 to develop a model for an integrated health system. They've developed a community health profile, reached consensus on the governance structure and put in place a planning group. I think if there were any question about the community interest in Port Alberni for this approach, it was answered with an information and planning conference that I had the privilege of attending. Over 200 members of the community came out for this full-day workshop to discuss how they would move into the formation of a health centre and a community health council.

There's also lots of progress in other areas of the province. Planning has been underway for a year now in Bella Coola, where a cross-section of providers, elected representatives and local residents have been meeting regularly to develop a model and an integrated health service delivery system. The current planning group has 22 members. It includes people from the first nations, the school board, hospital board and municipal councils. Planning is also underway there for a community health centre.

In Lytton a steering committee has been in place for some time, and the local government and service providers are committed to participating in a process to establish a community health council based on a unique perspective that integrates mainstream health care with traditional aboriginal approaches to healing.

In Abbotsford, Matsqui, Langley, Hope and Richmond, committees have been formed to ensure broad community representation in the formation of their health councils. Issues such as governance and integration of services are being evaluated, decisions are being made and community health plans developed. In Vancouver, eight local communities are planning meetings. At the regional level there is also plenty of progress to report on.

Here in greater Victoria, the Capital Health Council is planning to take over mental health services by 1994. In Burnaby a major regional operation is involving seniors, youth and multicultural representatives as well as school boards and municipal councils. In the West Kootenays nine communities are involved in developing community health councils and a board. In the Simon Fraser region, two major town hall meetings have been held to determine how they are going to take over responsibility for their health services.

I could list many more communities all over the province, but I think I've made my point. Communities are ready to assume responsibility for delivering and managing their own health services, and they need the powers of this legislation to be able to take the next step. This legislation is the first step in helping communities -- not telling them how to deliver health services and how to set their priorities but giving them the tools they need to be able to find their own answer. Communities are looking to this legislation. They need it if they are to move forward.

They are waiting for us in this Legislature to give them the tools they need to take control of health needs and health services in their own region.

I encourage all hon. members to assist these communities throughout British Columbia through thoughtful debate and prompt passage of this legislation. I move second reading of the bill.

L. Reid: I rise today in debate on Bill 45, the Health Authorities Act. We finally see the plan. Two years after a royal commission, after months of speculation on the Closer to Home strategy, Bill 45 is brought before this House as a plan to make it all work.

As a planning document, it fails on the fundamentals. It fails to pass the most elementary, basic tests of a viable plan; it is a planner's folly. It doesn't set clear lines of authority, it doesn't include any results measurement, and it doesn't get near the main objective of better health care. What does this bill do? It moves political risk for health care down to the communities. It creates expectations in communities that will not be met. It entrenches centralization in layers upon layers of new bureaucracy.

The minister will undoubtedly say that any opposition to this bill is opposition to the concept of Closer to Home. This has been the strategy of this government. It finds some universal truism, some cliche that makes a great bumper sticker, and uses it to enact sloppy, ill-conceived, disruptive, doctrinaire legislation. Then, if the opposition, the media, or even the general public objects, the government points to the bumper sticker and asks: "How can you possibly object?" Well, the opposition does not object to the concept of moving health care closer to home. This bill does not accomplish that.

Let me touch briefly on some flaws in this legislation. These are not technical imperfections; they are, as the saying goes, deal-breakers. The legislation purports to give planning authority to regions and to communities, but the minister retains the absolute authority to define the types of health services, where they will be delivered, by whom and for how much. Not only has the minister the right to define health services, but the legislation establishes that as much as possible such services should be offered on a not-for-profit basis. That opens an interesting door.

The minister can also determine the geographic boundaries of regions and communities for the purposes of this act. Communities, to be defined by the minister, can make appointments to regional boards. But guess who can determine how these appointments are made? Are we beginning to get the sense that this bill may not be the great egalitarian exercise of power-sharing as it's described? Regional boards can allocate grants to community health councils, but since the eligibility criteria will ultimately be determined by the minister, this is hollow authority.

It is interesting to note that among the so-called powers granted to a community council is the power to report to a minister. That in itself is a statement that would do a sun king proud. Since when is the requirement to submit something called a power? The act also confers on community health councils the power to integrate and coordinate health services at the

[ Page 7718 ]

community level. I'm not sure if that's planning language, but in politics, "coordinate" and "integrate" are called weasel words.

The act will give us a plethora of health standards. Every community and region will have the power to create them, with provincial standards having the final authority. Nobody would argue with the need for provincial standards, but the question is: why set up this production line for health standards if only one set is going to apply? It's called appeasement. This act makes only a cursory reference to accountability -- meaning cost. Here again the format and frequency of accounting are to be determined right here in Victoria.

In conclusion, we have a badly flawed attempt to make communities believe that the promises of the Royal Commission on Health Care will be met. The minister has consistently evaded the real issues in debate, and now we have another instalment of health care charades.

The opposition will continue to insist that real, meaningful actions be taken to unclutter decision-making in health care. We will insist that adequate resources are brought to pressing needs in our community, and we will insist that health care be given the priority and serious attention it deserves, as the most important value of British Columbians. This bill fails on all counts.

In the field, the response to this piece of legislation has not been promising. A number of individuals refer to it as strictly smoke and mirrors. It's an opportunity to download the responsibility -- and conceivably the blame -- but not any of the decision-making authority. There is a suggestion that it will have no impact on outcome. Regionalization -- what it is, what it isn't, what it could be -- is the intent of the Health Authorities Act. To move in that direction without an adequate cost accounting is foolhardy, at best.

It is wrong to do so without reasonable research in place to suggest that this will work. At the end of the day, this has not worked to the satisfaction of a great many communities in different parts of this country, in different parts of North America and in different countries. This is not the panacea that this government would have us believe.

As applied to health services, regionalization has been variously compared to decentralization, delegation, devolution and rationalization. At the end of the day, we are simply playing with terminology. We are not ensuring that health outcomes will improve as a result of this move to regionalization. This legislation cannot be defended at this particular time. It alarms me that every person on the government bench will stand up and suggest that this is the answer to improving health care in this province. I will say again and again: show me the research that defends this move to regionalization. It's not cheaper.

It's not going to be more effective. There is nothing to support that it is improved health care. We are not at that stage.

I have some real issues, and I am supported in this by an

article which says that regionalization, in whatever form, is not uniformly successful in other jurisdictions. We are looking to sell this to British Columbians as something that is going to improve their access to health care and improve the cost of health care for British Columbians. It is not supportable. All the fine words in the world and all the people who are prepared to say yes cannot provide the documentation or any cost-benefit analysis to support that.

When the New Directions document was released, this minister rose many times and said: "This is a cost-efficient way to deliver health care." I'm not buying it, hon. Speaker. There is nothing to suggest this will be cost-effective. There is a great deal to suggest that this will simply add another layer of bureaucracy. This is not a grass-roots movement in health care. At the end of the day, it is only a top-down government initiative.

Let's take two examples. Let's take the committee currently looking at the Mental Health Act: that's a top-down government initiative, and it's not working. Let's take the committee that looked at the questions surrounding adult guardianship. That was a grass-roots initiative, a movement of community groups that said: "This is where we'd like to be." There is some success around that initiative.

[3:00]

This government did not learn from the disasters of the mental health restructuring committee. They are simply not able to reach consensus. This Bill 45 is an actualization of the New Directions regionalization model. It's not well supported, and it doesn't make sense. The minister's comments were that it is the framework. It's the architecture that is going to allow New Directions to go forward. But at the end of the day, British Columbians have to ask themselves if this is what they want their health care system to look like. They are not being given any information upon which to base that decision. We have smoke and mirrors and lots of glitz, but very little promise.

Is this an opportunity to put health care in the regions in a cost-effective manner? Will it be credible? This government is asking us to take a stab at it. But for my tax dollars, for my health and the health of my family and constituents, I want more than just a walk in the park for this legislation. If we're going to make significant changes, I and all British Columbians need to see that this is in fact going to make a positive difference -- not just make any difference but a positive difference. I'm not convinced, hon. Speaker.

I state again that Bill 45 demonstrates an abominable lack of planning expertise. None of the issues I have brought forward are reconciled in this legislation or receive any kind of accountability or authority. That's the mark of a well-planned document. We talked for many weeks about the Seaton royal commission being a discussion document. No one took issue with that. It was a discussion document. It was a good read. This was supposed to be the implementation. This was supposed to be the next step. There are more unanswered questions and more muddle in this than there were in the original document.

Let me take a moment to share some of the concerns of other communities that have been in touch with my office. They have talked about the balkanization of health care. They look at this and see an opportunity for communities to receive an envelope of funding at some point in the future, and to have two tiers of health care

[ Page 7719 ]

in place. The minister will stand up and somehow defend that saying: "No, we don't currently have two tiers of health care." We absolutely do. Is this going to improve that situation, or cause more problems for British Columbians? The discussion in the communities is that this is not going to help. This is going to create more problems in communities around this province.

There are individuals in this province who have remarkably come to the conclusion that this is another opportunity for this government to hammer the taxpayer one more time; to hit on property owners one more time; and to download increased taxation on some municipal levels of government. That is a huge concern. The minister's comments have not addressed their concerns. If the minister would stand up and address them, I would welcome her comments.

We're talking a lot about whether or not we can maintain universality and equal access in health care. We have to ask whether this piece of legislation aids or deters us in that endeavour. My thinking, and the thinking of a great many British Columbians, is that it's smoke and mirrors; we're clouding the issues one more time. We're not addressing surgical wait-lists. We're not addressing urgent medical priorities. Frankly, I have to agree with them. There are issues in here that are unresolved. There are

definitions that are wide open to

interpretation. If you're going to rise in this House and present something that you suggest will somehow improve a service-delivery model -- and let's take the health care system in our province as a service-delivery model -- then you had better be in a position to back it up. We've seen nothing to back it up, save for glossy brochures delivered to every single door in this province, again at taxpayers' expense. Some glossy brochures, a lot of rhetoric, smoke and mirrors, but not a lot of research and planning.

And this is not an issue just for members of the opposition. It's an issue for British Columbians. It's an issue for individuals in small communities around this province who do not believe they will be provided with the resources to make reasonable health care decisions for their community members. This government has left them high and dry more than once. Your trust ratio is not great at this time, so the fact that they have cause for concern is understandable. It makes sense, because there are issues that remain unresolved.

People would look carefully at a new direction if there was some cost-benefit analysis in place and an ability to examine outcomes. People would look at this if it was defensible and they could ask whether it will improve the level of health care and what the costs attached to it are.

This is not contained; it is flinging open the barn door and somehow suggesting that we may or may not be able to improve the situation. If it's our tax base, we want an assurance that it will make a difference. Otherwise, what we have now can be improved upon without creating a second, third or fourth layer of bureaucracy where no

definitions have been reworked. There are communities out there that believe this government talks a good line in repeatedly denying downloading onto municipalities. In fact, it treats the municipalities in the same way that the province believes they've been treated by the federal government. They see this as just an evolution of bad planning all the way down the line, and there's no opportunity to evaluate it. That's a huge issue, and one that has not been addressed today with any sincerity. It is a tremendously large issue when we're talking about something as fundamentally important as the health care of British Columbians.

We all have an interest in this. We all have a stake in it. The majority of us are healthy most of the time, but we are investing in this health care system on a daily basis. We have to ensure that some standards and

definitions are in place. We've looked many a time at this bill in terms of a definition of region, of service, of the powers of this minister to make appointments. All of that is unsettling to the average British Columbian who wants to know what they're buying before they put their dollars down. That's the issue. If members on the government bench can stand up and tell us what it is we're investing in -- against our will at this point, I believe -- I think people will take a second look at it. But as it stands today, it's not a saleable commodity.

Quite honestly, I think if this government were in a position to take it on the road and attempt to sell it, there would be no buyers. People don't like buying the unknown. This is not the great grab-bag of health care. It's okay at a country fair, but it's not okay when you're talking about somebody's health care.

I'm sure every member of this House has individuals who come to their constituency office and say: "What about my urgent health care priority? Where do I sit on the list?" And they say: "I understand New Directions is coming. Is that going to help? Am I going to get service in an efficient manner? Am I going to receive improved service as a result of Bill 45?" No, because it's not defensible. You might, if you happen to be in the right community with the right envelope, but there's no guarantee. There's not even any assurance. I'm willing to concede that we're not looking for guarantees; we're looking for some reasonable cost-effectiveness.

We have seen this minister more times than not stand up and talk about dollars and health care and say, "there's no more money," and then come back and say: "No, we just haven't allocated it appropriately." It's not a high confidence ratio. Either there are dollars that we're going to spend appropriately.... Again, people will invest if they believe in what they're getting. There's not a strong basis for what they're getting here today, because they have no idea what may or may not evolve.

Could this be fantasy legislation? Absolutely. The definition

section leaves much to be desired; provision and evaluation of service leaves a tremendous amount to be desired. Frankly, it's in the hands of one person.

[ Page 7720 ]

I'm not comfortable seeing any one person make decisions that determine what's going to happen with this legislation until 1996. That is a number of years off. This government hasn't made tremendous headway reassuring the general populace that this is not just another patronage plum floating out there.

If we are going to see layer upon layer of bureaucracy added.... Is anything being taken away? No. Are we saving any administration dollars? No. We are simply adding to our cost, and that is a huge issue for British Columbians, because they are being asked on a daily basis: "Keep those dollars. Reduce your service. Reduce your expectations of this government." It's shocking. This government has never once said: "We're providing fewer services; we'll reduce your taxation level." We're taxing British Columbians to death under the guise of responsible management by this government. It doesn't make sense.

I'm frankly surprised that they believe they can sell this. This is a numbers game, and it will pass in here because of a certain number of individuals on the government bench -- not because it's decent legislation, not because it's well thought out. It's a huge issue for me.

Let's take the issue of the ratio of bureaucrats to direct service providers. We're well off the mark in this province. There is definitely a trend across this country in terms of how many people you can put in place without providing any direct service. How many people can you possibly put in place without examining who provides direct service? That's an issue for me, it's an issue for members of the opposition and, frankly, it is an issue for people of the province. This is top-down legislation. This is not a grass-roots initiative; this is not well-thought-out legislation.

This government and all members on the government bench will stand up and talk about the importance of communities generating ideas. We have today legislation that will determine whether or not communities can fit into these boxes without any authority or money, but all of the responsibility and, frankly, all of the blame. At the end of the day, this does not address someone who has an urgent health care priority. This doesn't address what we perceive as health care. If this minister wants very much to change, we need to do some things in education.

Frankly, we could start the education on the government benches, because there's a sad void in terms of understanding what British Columbians believe they're paying for when they pay for health care. It's a huge issue, and this government has not addressed it. This government has gone back and done the patronizing thing: "We know what's best for you. We will put it in place. You fill in the slots underneath. Somehow we'll have two or three more levels of bureaucracy, and we'll all be happier for it." I don't buy it, and British Columbians don't buy it.

If this is going to be reasonable -- and I'm prepared to take a look at it -- I need to see a cost-benefit analysis. What are we spending, and what are we getting for it? This government is prepared to suggest that they know something about business. It's not evident in this bill. We have a health care industry in this province. Let's recognize it as that. Let's do the business plan and the cost-benefit analysis. Let's ensure that people who invest in this health care system get some reasonable return for their dollars. That's not happening under this piece of legislation, and it needs to happen.

If it doesn't, we are not doing anything about improving health care. We are simply rejiggering the pieces. It's smoke and mirrors -- don't look too closely, because you won't find anything underneath that -- and it's not acceptable.

[3:15]

Frankly, if this were to become the government's next road show, if they were to take this on the road and try to sell this, they would be hard-pressed to sell it to anybody but potential NDP patronage appointments who are coming to this province looking for work. I suggest we will see a number of people travelling from the province of Alberta and seeking jobs, because they now find themselves unemployed. There will not be an opportunity to sell this to thinking British Columbians. The majority of people will not support a carte blanche approach to reforming health care without a cost-benefit analysis.

Think business; think of health care as a health care industry. Come back to the table with a cost-benefit analysis. It hasn't happened, and it needs to happen. I can only trust that members of this government are capable of generating some dollar numbers and a framework that makes business sense. This has to be more than a walk in the park. This has to provide some concrete answers to how we are going to improve health care and what it will cost British Columbians. That's not been provided.

Frankly, it's distressing that it hasn't been provided, because we are now 13 or 14 weeks into this legislative session; we've had ample opportunity.

Since November 1991 this government has had the Seaton royal commission report in their hands, and they've looked at it as a bible. If that's the case, if they believe fundamentally in what that document has to say, they should cost it out. That is all the opposition is asking for today: an opportunity to look at a cost-benefit analysis. No matter what you buy in this province, no matter where you go to purchase a service or a product, you want to know what it costs and you want to know what you're getting for your money. It's not happening under this piece of legislation.

It's a concern for me because there is no research. There are no examples from other countries where regionalization has worked particularly well. We haven't learned from what has gone wrong in other jurisdictions. Why not? Why does this government have to fall into the same huge traps? Other people have looked at this and evaluated it. They've said the best way to proceed on an issue such as this is to analyze it in some detail. Why don't we see that today?

This government has been here more than a year and a half. Why don't we see some opportunity to evaluate? If indeed they're looking at this as a program, why don't we see some incentive, some cost accounting, so that people might understand it a little better and wish to buy in? I think that is what the average British Columbian is looking for. I know that's what the communities that have come to me have been looking for. What does it cost? What are we going to get for those dollars? Two very basic questions -- and surely,

[ Page 7721 ]

with 50 members in this House, somebody can find the answers to those two questions. I'll leave it with them for their future consideration.

L. Fox: I'm pleased to rise and speak on the principles of Bill 45, the Health Authorities Act. Upon reading this, one thing became evident to me, and it's a theme that I think has been fairly consistent in the legislation brought forward by this government: it is drafted quickly, it is ill thought out, and it is brought forward quickly without the opportunity for input from all of the stakeholders. This legislation is no exception. In fact, in speaking to the BCMA this morning, who had been trying to get a copy of Bill 45.... One thing that I think both opposition parties do is involve the stake-holders in their investigation and

interpretation of what the impact will be of any piece of legislation. I don't apologize for that. I assume that part of my role as an opposition member is to discuss prospective legislation with those who will be affected by it, but to my knowledge, nobody involved in the delivery of health care and who will be affected by this particular act has had the opportunity to peruse it. The BCMA had not even received a copy until we faxed one to them this morning. I think that's appalling but certainly typical of this government.

There are many issues that I want to speak on, and I certainly agree with most of what the Liberal critic has said, but the number one issue is the fact that we are talking about instituting the Closer to Home concept in B.C. The government seems to take this concept as outlined in the Seaton royal commission to be something that is feasible and affordable and something that will in fact deliver the health care that British Columbians want. But it's not proven.

This government has done no evaluation in different jurisdictions around the province to see whether or not they can meet two objectives, one of which is to deliver a universal, top-quality health care product for less cost. They have done no examination of that. They are endorsing the process without knowing whether or not it's going to work in all regions of the province.

The minister said in her opening statements that 30 communities were involved in endorsing the process. I commend those well-meaning individuals; there's no question in my mind that they believe they're doing the right thing within their respective communities to help in delivering this product. But one of the problems is that each of them has a different idea of what it is they're trying to deliver, and there's no way, other than by the iron hand of the minister, that there can be any consistency in that process.

The other thing that really concerns me is that the bill contains no process to evaluate on an ongoing basis whether or not there's any accountability in the delivery of health care through the Closer to Home process. That has to be a concern, because any time we put together a new initiative we also should put into that framework the opportunity to evaluate it from time to time and examine whether or not it is achieving what we wish it to. That's missing from this document. In saying that, I recognize that this is an interim document to structure the process.

An Hon. Member: How interim is interim?

L. Fox: That's a good question. I guess we could only know that by looking at the history of the government, where we see amendments to the amendments introduced almost in the same sitting of the Legislature. We know one thing: this government is not afraid to bring more legislation forward, especially in the dying days of the Legislature, when there's so much pressure being placed on all individuals to go home and look after their respective constituencies.

We see a trend that all this legislation is brought in after the 60 days are up in order that it might be looked over very briefly and passed in a great hurry. But I can tell you, hon. Speaker, that we in the Social Credit Party are prepared to stay here until September. We don't have a problem doing that just to make sure that we go through the legislation in the way it should be dealt with: to the fullest possible extent.

I want to suggest that we support the objectives of the Seaton commission. After all, it was the Social Credit government that started that process. We certainly support the concepts, but we feel very strongly that we have to protect ourselves from a rather embarrassing situation, in my point of view: another Year 2000 initiative, which came out of another royal commission. Everybody endorsed it as being the thing to do, when on examination -- and certainly as time goes by -- we're finding more problems with not only the implementation of the program but also with what it is going to produce.

I'm concerned that the minister has put more emphasis on these concepts and more speed into the process than what is really right for British Columbia.

We see this bill creating two more levels of bureaucracy, and any time we do that we have to be extremely concerned about how many of our health dollars we spend in the administration area versus what we spend on actual treatment. I know that there is a lot of concern within the Health ministry and around the province about those ratios. The administration costs for delivery of our health care has risen dramatically in the last ten years, making fewer dollars available for the actual treatment of patients.

I'm concerned that we're going to have even more dollars going to administration, even though it may not be the intent of the minister. I'm sure it isn't, but I'm quite sure, having some experience in local bureaucracies, that we will see that as a result of this legislation. That is a concern to me and to most British Columbians, because they would like to see most of the dollars going into direct care of the patients rather than into the administration.

Let me expand upon that, because there's another issue here that a lot of British Columbians, certainly rural British Columbians, are extremely concerned about. Presently, when we look at the budget for treatment of cancer, for instance, it's a global provincial budget. We have a budget within the Health ministry as well that is allocated for.... I don't think that these are segmented, but obviously it's all part of a global budget for heart patients, treatments for bypass or whatever. All of these are presently global budgets. With the advent of regionalization, I'm concerned -- and I know

[ Page 7722 ]

the regions are concerned -- that we are now going to split those budgets into regional segments. In Vancouver and in the large metro areas, that's not a problem. Because of their size, there are some economies of scale and the variances won't be that high. But if you put that into a less populated region, what will happen is that there will either have to be a trust fund or an amount set aside to allow us to look after those peaks and valleys in the needs for treatment on a year-to-year basis, or else individuals will have to be refused health care because that particular region won't have the ability to pay.

That's a real fear out there, and I haven't heard anything from the minister, either here today or at any other point, that dispels that fear. If this process is going to work, there has to be some assurances in it that there will not be different levels of health care in the respective regions based on the size or population of that region. Those are legitimate concerns, and I don't see them addressed here.

There's another issue here that deserves pointing out and some discussion. Even though we have these two new bureaucracies -- for the sake of another word -- or administrative associations or assemblies, they have all the structure to make the decisions but in fact the decisions will be made by the minister. The minister clearly points out that she will directly or indirectly appoint all the members on the new regional health boards and community health councils. She has the ability to dictate what services they will provide.

So if new initiatives come up from the grass roots of the community, and the minister of the day does not believe that the concept is workable or affordable, she has the opportunity to nix it. In this legislation she has such authority that she can virtually direct those regional boards and community boards.

[3:30]

Another thing -- and I'm thankful for this one, hon. Speaker, and I think the Liberal member missed it a bit -- under this legislation at this time these authorities do not have any taxing authority. So the minister has autonomy over the funding of these districts. That appears to be enshrined within this legislation.

Now that we have this new thrust, if this regional hospital board takes over the responsibilities of the existing regional hospital board, which has the ability to raise dollars not just for capital projects but also for small repairs and small capital projects, in some areas it will be quite significant. I sat as vice-chairman of that council for eight years in the regional district that I'm most familiar with. Collectively, we annually solicited over $200,000 within that regional district from our taxpayers in order to contribute to small equipment purchases and minor repairs.

Given that they'll have that kind of authority, it really isn't much of a shift to become a taxing authority for operating purposes.

There's a real fear out there that what the member from the Liberal Party just stated will become a reality as the pressures are on this government for funds for the delivery of health care. We'll see more of what we've seen in the last two years, where they've looked at other jurisdictions below them to contribute and assume more of what was traditionally a provincial expense. Those kinds of concerns certainly haven't been addressed, primarily because this legislation comes through too quickly and without all the stakeholders, whether it be regional districts, existing hospital boards or municipalities, having an opportunity, collectively, to give input on this particular act.

Interjection.

L. Fox: The minister is talking to me directly from across the floor, and I appreciate the input. I know that the UBCM and the association of boards have had some opportunity to give input on this concept.

If in fact this legislation was seen in its finished form by us in the Legislature before any other group had seen it.... It was only tabled some three or four days ago, and I don't think that's adequate time for any group or association to give you legitimate comment on the finished product, as we see it here. That is one of the things we consistently find with regard to the legislation from this government.

The other concern I have -- and I think back to what this minister did to the Vernon and Shaughnessy hospital boards -- is that the minister has discretionary powers. If she doesn't like what this new regional board is doing, or for that matter what the community board is doing, she has the discretionary power to fire them. Given that some of these people are elected locally, she has the autonomy to go against the wishes of that area, because she can even fire individuals who were elected. I don't know of any other jurisdiction....

When I was elected as a municipal councillor, the Ministry of Municipal Affairs could not oust me from office, irrespective of what I had done, unless it was for an illegal act. The only people who could oust me from office were those who elected me. This minister has autonomy over and above that. If her autonomy pertained to the individuals she appointed, I could live with that. If the public elects individuals -- based on a slate that I'm sure they will run -- and they do not comply with the minister's wishes, she can axe them. I just don't understand how this government can have the autonomy to literally fire a locally elected individual under this new structure.

Interjections.

L. Fox: We're getting choruses from all over. I'm going to start singing pretty soon, and everybody can chime in. It's great.

With all this ministerial power, we wonder why we even have local boards. I think I have a good idea as to why. On the one side, the minister is stating that we're going to have local autonomy, have the decisions made locally; and on the other side, the minister actually has more power -- not less -- under this process than under the previous process.

Why all this process? Well, I'll tell you. It may even be easier for MLAs, because my phone rings when there's a problem with respect to constituents receiving a hip replacement or if they want to talk about the closure of beds or the long waiting lists. Presently they can go directly to the ministry and receive some kind of

[ Page 7723 ]

answer. Under this new bureaucracy, they will have at least two steps to take before their own MLA will even deal with him. His first line of approach will be: "Have you been to the community board, and have you sought advice from the regional board? And on and on it goes. I believe it will filter a lot of the sad concerns that are out there -- and will be out there -- under this process.

One of the largest concerns that I have -- and I talked about it very briefly earlier -- is that this particular structure will not offer consistent health care around the province. In saying that, I don't expect that there to be heart or liver transplants in Prince George. I recognize that we have to have some of those special services in the larger metro areas where we have the technological facilities and the expertise of doctors. I don't expect that we will ever see many of these specialized services in the rural parts of the province.

But people do expect consistency with respect to what should be given in Prince George versus what is given in Kamloops versus what is given in Kelowna. They are relatively the same size and should be able to offer similar services.

The other concern is that of regions. If the minister has the powers to draft those regions all on her own and implant them over the provincial map, should she incorporate the smaller communities such as Valemount, McBride, Mackenzie, Vanderhooof, Fort St. James and Fraser Lake in this new regional structure? There is a lot of concern from the smaller communities that all the autonomy will sit in Prince George; similarly elsewhere in the province, where there is a major centre and a bunch of smaller centres.

I have heard from two of my communities which have very small hospitals whose occupancy rate hasn't been very high. They are concerned that this new process will see them lose those facilities or downgrade them to D and T centres, because the emphasis will be on regional development rather than on the community.

I can put forward none of these things with hard facts, just as the minister can't deny them in hard facts, because she hasn't done any models. She hasn't done any tests to examine whether this whole Closer to Home process is going to work in all regions of the province. What I'm saying in this very long dissertation is that we in the Social Credit Party agree with the principle of Closer to Home, but we're concerned that the minister hasn't done her homework. She is not able to dispute all the concerns.

While there are 30 communities involved -- I think that's commendable and I'm sure they're all well-meaning people -- there are about 180 communities in the province. We are concerned about how these communities are going to differ in what health care they deliver, because no model is supplied as an example of what should follow. I'm not sure of their exact name, but we have all these individuals who are trying to facilitate the development of this process, and each one of them has a different concept of what the finished Closer to Home product is going to look like.

I believe that one thing the minister should do -- and she hasn't done, unfortunately -- is involve the medical profession. I know she has difficulty talking to doctors; that's been pretty evident.

Interjection.

L. Fox: The minister says that she met with them yesterday, and I appreciate that. But usually what happens after a meeting is that they each come out of the room with a different idea of what went on. Perhaps she has been able to overcome that; I'm not so sure. But I think that all these individuals -- whether it's doctors, nurses or the health care professionals who work for the union boards of health -- should be front and centre in this process.

Hon. E. Cull: They are.

L. Fox: The minister suggests that they are. I don't see any evidence of an endorsement -- certainly not from the doctors -- of this process. All I've seen is that they have drawn up a lot of concerns about the delivery of health care under the Closer to Home process.

I will sit, and I look forward to the minister allaying the many concerns I have put forward. I look forward to committee stage of this bill, when we can deal specifically on a clause-to-clause basis.

D. Schreck: I am pleased to rise in second reading debate today in support of the Health Authorities Act. This legislation reaches out a hand to the people of British Columbia to work in cooperation in a process of fundamental health care reform -- reform that will assure the preservation and extension of medicare; reform that makes me proud to be part of a government caucus, working side by side with the Minister of Health; reform that has finally moved us out of the fifties and into the nineties and beyond.

It is reform that stands side by side with the move to legalize midwifery and side by side with reform that allows for the comanagement of our Medical Services Plan by physicians, chiropractors, podiatrists and other health care providers; reform that significantly increases our commitment to mental health services and mental health group homes; reform that moves medicare beyond an insurance principle and on to a principle of good health care outcomes, working with people, beyond a needle in the arm and on to quality of life.

[3:45]

The opposition has offered little by way of alternatives. It gives me particular pleasure to follow the Health critics from both opposition parties, for we would have hoped that out of those two speeches we would have seen some alternative vision. This province went through a process by the Royal Commission on Health Care and Costs, which made the recommendations from which this legislation directly flows.

One of the most extensive consultative processes on health care that this province has ever seen was started under the former government, completed under this government and tabled at almost the same moment that this Minister of Health was sworn into office. It was not rejected by this government as a product of a commission established under a previous administration; it was embraced as a true community consultation process upon which we had the challenge to build. That challenge has resulted in a change to our health care

[ Page 7724 ]

system from being an insurance-based model to being a community-based, health-outcome, quality-of-care model.

[E. Barnes in the chair.]

What's the Liberal's alternative? I will never be able to forget the imagery of a bunch of Liberal MLAs stuck in a broken-down elevator in a hospital that's closing. That broken-down image of defending the status quo and special interests, and of throwing money at problems rather than working with people, is the alternative offered by the Liberal opposition. I say shame!

I came here to represent my constituents, not to represent special interests. I came here to be part of change, not to move backwards, not to defend the status quo. I'm proud to be part of a government that seizes the challenge of reforming, preserving and extending medicare rather than looking after the income levels of a few providers who want to whine and milk the taxpayer. We must work with all interested parties in the health care system, but they must understand that the system does not operate or exist in order to first and foremost line their pockets.

It exists primarily to serve the needs of over three million British Columbians. When we forget that the system operates to serve British Columbians rather than having British Columbians exist to pay taxes to service the providers, then we have the cart before the horse. When I go through the opposition speeches, I do not hear concern for over three million British Columbians; I hear concern for special interests. I hear naysayers out to preserve the status quo. I see no vision. I see a broken-down elevator with a bunch of Liberal critics stuck in a hospital about to close, saying: "Take me back to the past."

It's useful to go over the history of how we got here. Medicare began in Saskatchewan. It actually began long before Tommy Douglas, dating back to the World War I period around 1910 to 1912. Communities in Saskatchewan which could not get medical services any other way pulled together to organize their own delivery of health care with community-organized hospitals and community-organized schemes to pay physicians. Over the years, that long history, dating back to the World War I period, led to pressure for a proper provincewide medicare scheme. That scheme was introduced under Tommy Douglas.

It was fought every step of the way by the health care establishment to the point of shutting the system down with a strike.

I regret that medicare was born in conflict, but it is a fact of history that it was. The fact that vested interests will always resist change should not deter us from implementing it and looking after the interests of our constituents. We are not here to look after special interests; we are here to look after the public interest.

The medicare scheme implemented in the late sixties and early seventies reflected a time when the fundamental public concern was how to get health insurance, because the private health insurance market wouldn't insure you if you were elderly, if you had a chronic illness or if you were poor. So Canadians, starting in Saskatchewan, recognized the fundamental failure of the private insurance market and gave us universal public health insurance, which we came to call medicare.

That had its advantages and disadvantages. We can look to the United States where many people involved in health care reform say that they should adopt the Canadian model and they only wish they could have a system as good as ours.

W. Hurd: Why change?

D. Schreck: I'm about to explain that.

Universal public health insurance solved the failures of the health insurance market. It solved the fundamental problem that they have in the United States, where 40 million residents are uninsured; it solved the problem they have in the United States, where you can be denied care because you can't pay for it. But what it did not do is implement any change in health care organization or delivery systems.

In fact, it's somewhat ironic that in some respects, because of the insurance side, emphasis of our medicare system on universal public health insurance, we froze our health care delivery system in a model of the 1950s and 1960s. While our health care delivery organization was frozen without any significant change for the last 25 or 30 years, in the United States, because they were pressured by the failures of their private insurance market -- which is an incredibly powerful lobby standing in the way of reform and providing universal public health insurance in the United States -- they looked for other solutions.

They found those other solutions not by solving the enormous inequities of private health insurance but by looking at health care reform on the delivery side. Hence they developed health maintenance organizations in the United States. They developed community health centres. They developed the Kaiser community plans.

Members can take a short drive or ferry ride from here and see the Puget Sound Group Health Cooperative in Seattle. It's an excellent model that has existed since the 1940s but demonstrates community control and integration of health care delivery. Those different experiments throughout the United States show that even while money is being wasted on inefficient private health insurance, enormous savings of health care dollars and improvements in health outcomes can be achieved by a more effective organization and control of health care delivery through the integration of decision-making and the integration of service delivery.

The hon. members opposite turn to this legislation and say: where is the proof that this will work? I say: take an hour's drive; go to the Puget Sound health cooperative and see what's been done there. That's but one example. The hon. members opposite say we are forcing one model on the entire province. Not so. Again I say: open your eyes, look at the alternatives that exist throughout the United States and the world. Every place that an attempt has been made to improve health outcomes and health delivery and to save dollars -- not by reforming the insurance system but by going after a more efficient delivery system -- the solution has been

[ Page 7725 ]

localized and has reflected local needs. The one point that comes clear through any review of the literature on reform and alternative models of health care is that each model is unique to the community it serves. Gone are the days when in Victoria we decide what is best in Williams Lake. Gone are the days when in Victoria we decide how to implement a solution in Prince George.

This legislation says that the health care system exists to serve the people, and that the people should have more say in the design, the delivery and the planning of the health care system. This legislation completes the health care reform that began in 1910 in Saskatchewan. It returns the power to the people that existed in 1910 in Saskatchewan and that is being seized by communities throughout the United States when they reorganize their own health care delivery systems in a variety of alternative models.

If the opposition members are looking for an imposed solution in this legislation, they will never find it, because this legislation offers a hand of cooperation and opportunity. This legislation says to communities throughout British Columbia: "If you want to work to improve access to health care, health care outcomes and health care planning in your community, we will work with you. But if you are concerned about the concept, if you are listening too much to the naysayers on the opposition benches, if you have unique local problems, there's no rush. Let the other communities show the leadership.

See what they learn and see where they make mistakes that may need to be fixed, and we will work with you in the next year or the year after." True health care reform comes not top down but bottom up, and this is the legislation that provides the foundation for the community to solve its own problems.

I hear the heckling opposite, and I understand why those members can't understand this concept. I listened carefully to their speeches to hear what alternative they had to offer, and what is that alternative? The official opposition Health critic said: "Get out of the way, and throw more money to the providers. What about the interests of the industry -- we'll ignore the interests of the people." I saw a shameful apology for the status quo, for moving backwards and for wasting tax dollars.

The one clear message out of the royal commission report is that we do spend enough money on health care; the trick is to spend it more wisely. What wisdom did we hear from those benches opposite? We heard that giving people power will somehow clutter decision-making. I'll trust my constituents over Victoria bureaucrats any day. From those benches opposite we heard a call for spending more money. Where is the money going to come from, and how many hundreds of millions will they throw at the problem before managing it and trusting people?

We heard from those benches opposite that what is necessary is to give priority to health care. I'm proud to say that no government has given such attention and importance to health care as has this government. No government has taken the challenge and shown the leadership to bring health care into the 1990s as this government has done.

[4:00]

This legislation provides for consistent standards of health care throughout the province while giving local health councils the authority they need to see that those provincewide standards are implemented in their community. One point that came through very clearly in the Liberal opposition speeches is that they do not understand the enormous regional inequalities in health service access and outcome in this province. The lower mainland urban domination of the Liberal Party and the Liberal caucus was clear in the opposition analysis of this legislation.

The fact is, if you live in Williams Lake, Prince Rupert, Burns Lake or Merritt, you do not have the same access to health care that you have in North Vancouver-Lonsdale, the constituency that I represent. It's about time in this province that we say that if you live outside of an urban area you are not a second-class citizen. It's about time in this province that we say that those five principles of medicare are as important to you if you live in the north, in the Kootenays or in the interior as if you live in the urban parts of this province.

This bill gives people the power to plan their own access to health care, allocate resources in their communities and address the inequities that have been inherent in what was basically an insurance system designed for the fifties and sixties.

I am proud to see legislation that empowers the people, provides for process and offers opportunity to work with the community. I only wish those opposition benches would provide a constructive alternative. Going back to the fifties, defending special interests and ignoring constituents is not the way for reform. I'm happy that I'm on this side, hon. Speaker, and I support this legislation.

W. Hurd: It seems to be my fate to follow the hon. member for North Vancouver-Lonsdale in a debate about health care and health care legislation in the province.

I just want to talk a minute about that elevator incident at Shaughnessy Hospital, because I was one of the fortunate few to have been on that elevator. I had the opportunity to do something that the hon. member for North Vancouver-Lonsdale has apparently failed to do these many months, which is to actually talk to a health

[ Page 7726 ]

care provider in British Columbia. We had ample opportunity on that occasion to do just that. The closure of Shaughnessy is a relevant point to raise during this debate, because this is the kind of thing that we're going to see occur as a result of this changeover from the system we have now to a community-based health care model.

The opposition fully understands the intent of this legislation. We understand that we have to move some decisions on health care into the communities. We understand that community-based health care has some advantage and that there are communities -- because of the nature of their demographics and the fact that they have more seniors than other areas of the province -- that need to make some of these decisions at the community level. We understand the costs of maintaining people in acute care beds when other models of care in the community would be beneficial. We understand all that.

Then we look at this legislation and try to extrapolate how passage of this bill will in any way immediately meet the goals that have been identified in the principle. It clearly won't. This is another bill rushed in at the end of the session, which we on this side of the House call a fill-in-the-blanks bill. It's an enabling legislation rushed in during the dying days to try to get some legal authority for community-based health care initiatives in the province.

This is an ill-thought-out piece of legislation, hon. Speaker. It contains more blanks than hard facts. It is another example of legislation that just hasn't been costed out or thought through. The members on the government side expect that by virtue of its late arrival in the legislative session, somehow it is going to proceed through in an orderly and normal fashion with a minimal amount of debate. Well, it just isn't going to happen. It can't happen, because this is clearly a bill that the government has not adequately costed out.

The closure of the Shaughnessy Hospital and all the disruption and confusion it caused is the kind of thing that we're going to start seeing at the community level, because we have a system that functions at a certain level, and the government is attempting to shift over to a new system. So we have these parallel systems which in some ways will compete with one another and cause overlap and duplication of cost, initially. The government has not identified those costs; it has not identified those pitfalls.

The people of the province have to realize that this government is embarking on a radical change in the way health care is delivered in our province that will affect patients, health care providers -- as the hon. member for North Vancouver-Lonsdale is likely to claim -- and also communities. This is a radical change of direction which has no example of fact anywhere in the country. It does not exist anywhere in the country. For that reason alone we should be concerned about the pace of change. We should be concerned that this is only a model.

Other than a clinic in Seattle, the government has not offered a single example of where this particular concept is up and functioning and providing the kind of health care that's needed. It's a bureaucratic model that we are debating in the House today. The government side is saying that this is going to enhance the provision of health care in our province, but there's not one shred of evidence that that is in fact going to happen as quickly as anticipated.

Like many members of the Liberal side of the House, I received a lot of calls during the Shaughnessy closure. I can honestly tell you that I followed the directions from the Ministry of Health to the letter. I referred the callers down the bureaucratic chain, to have explained to them what happened to their out-patient services and where they might be going. I had calls from my local hospital, asking me to check and find out where their beds were, because they were advised that they were getting beds transferred from the closure of Shaughnessy Hospital. It was a paper trail. It was a vacuum.

There was no information available to these people, and they phoned back and said: "I'm going in for therapy at Shaughnessy Hospital as an out-patient, and I have no idea where I'm going to be going in six months' time."

What we're talking about with this transition is fundamentally changing the way health care services are provided to people. The change will be dictated at the community level -- and that's to be lauded -- but change has to occur at a gradual rate. Instead, we have a government rushing forward with a piece of legislation designed to set up these community boards without any idea of how these changes are going to be managed. It's a bureaucratic change and a bureaucratic model. I suspect we're going to see a duplication of costs.

There's no evidence of a cost-benefit analysis, as the hon. critic for the Liberal opposition has stated. There's no evidence that there's going to be money saved in the interim.

I've debated with the hon. member for North Vancouver-Lonsdale who, the House should know, is the chairman of the House legislative committee on health care. I would dare say that if we were to put forth a motion to refer this bill to his committee, as we have done on other occasions, he would be the first one to oppose it. It's a fundamental change of direction for health care in this province, and in the past that hon. member, as chairman of a select standing committee of this House, has opposed changes that would have accepted a role for his committee.

Instead, he stands up and talks about the Liberals opposing meaningful change. Well, I can tell you what the Liberal opposition does support: we support consultation. If that means getting stuck in an elevator for 45 minutes and actually talking to health care providers, then it's the most useful 45 minutes that the opposition has ever spent. I would advise that hon. member and the Minister of Health to try it some time.

I'd like to ask that hon. member how many tours of Shaughnessy Hospital he has been on. As the chairman of a select standing committee of this House on health, how many times has he visited Shaughnessy Hospital? How many calls has he received in his riding office from people who were receiving care through Shaughnessy Hospital? I wonder if they followed the paper trail that I sent some of my constituents on and whether they called him back a little while later, wondering what kind of new transition in health care we have in this province.

[ Page 7727 ]

There is no way in the world that this bill should have been rushed in as quickly and as thoughtlessly as it has been this late in the session. This is a bill you could drive a truck through; this is a bill that will create mass confusion by the very haste with which it was drawn and put forward in this House. Yet it is a bill that will fundamentally affect every British Columbian who has to gain access to health care in this province; it's a bill that will fundamentally affect the regions of the province, as the members opposite have stated.

It will affect the quality of health care in Williams Lake, in Prince George and in small outlying regional hospitals -- a fact pointed out by the hon. member for Prince George-Omineca, who I'm sure has some experience with small regional hospitals in this province.

We are involved in a system that needs change. There's no argument that the system we have now, with an aging population and the cost of acute care facilities, needs to change. Nobody's arguing about that. What we have to address, however, is the pace of change. The population isn't going to age by the end of this session; it's a process that has to evolve. This hastily contrived legislation will simply cause more confusion than it has already caused.

We are continually amazed by the kind of fundamental change proposed by this government, based on the bills we're seeing and the open-ended pieces of legislation that simply will put in place health boards and regional health councils -- with the public at large having a minimal grasp of what changes will result. The majority of the public, I suppose, takes the provision of health care service for granted. They assume that those services will be available at their regional hospital because they've always been there. But they are going to find, as this process evolves over the next few months and even over the next few years, that some services may not be available any longer.

The level of consultation and communication on this particular concept has been absolutely abysmal. That failure was evidenced by the confusion over patient services with the closure of Shaughnessy Hospital. It was a shining example of what can go wrong when you apply a bureaucratic model, eliminate an acute care hospital and say you're going to transfer the beds to the regions where the population growth is expected. You have the spectacle of administrators of these hospitals calling their MLA and asking: "Where are my beds?" And you make the inquiry and find out they're already there.

As members of this assembly, we have to deal with this kind of ad hoc decision-making every day. I have no doubts that with the passage of this legislation and the setting up of these regional boards, we'll be doing the job of the Ministry of Health -- trying to explain exactly what they mean. Based on the level of debate that I've heard in this assembly today, most of us will be no further enlightened as to exactly what changes will result.

The opposition certainly accepts the principles of community-based health care and the principles of moving people out of acute care beds into differing models of medium- and long-term health care, and that will vary from region to region depending on the relative age of the population. We understand the need to control costs. But what we will have with this legislation is a level of overlapping bureaucracy without a cost-benefit analysis attached to it. We'll have this transitional period of confusion.

We'll have this model being imposed on health care in this province, without the government being able to look at jurisdictions elsewhere -- other than some clinic in metro Seattle that the hon. member for North Vancouver-Lonsdale claims to have visited. We will have no idea of exactly what the impact will be.

[4:15]

Given the fact that this government is running a $1.5 billion deficit, which it claims it is running to preserve health care -- to preserve that institution, that social safety net that we hold dear -- that in itself should dictate the need for prudence in bringing forth this legislation. You would think that the government would have taken steps -- even zealous steps -- to bring forth a bill which really spells out the costs, advantages and nature of the structure of these community boards.

Given that the government is running this deficit and says it's committed to health care, we should have seen a bill with far more detail and cost attached to it than this. But no, in the true cynical nature of this government, they have brought forth this legislation in the dying days of a session -- without that kind of cost-benefit analysis attached to it, without having the loopholes closed, without explaining to the people of the province exactly what it's going to mean in the provision of health care -- and expect swift passage in this House. I can tell you that it's not going to happen.

The opposition looks forward to committee, when we can address the specific elements of this plan and pose the hard questions that will be asked: not by the doctors who have been attacked by the government as being people with greedy aspirations, avaricious people who want to bankrupt the health care system; not questions on behalf of the doctors who have never enjoyed the support of this government; but on behalf of the people in my riding, for example, who found that they were no longer going to receive care at Shaughnessy Hospital and wanted to know where it was going to be transferred.

Those people are just as concerned and confused about this legislative direction as are the health care providers and other people in our community. I welcome that debate in committee. At least then we will hopefully be able to get some answers, and we can do our job as opposition MLAs and try to communicate some of those answers to the people of the province.

G. Wilson: I rise to speak against Bill 45, but not because we as the Liberal opposition don't think that the Closer to Home concept has some merit. We do believe that we should start to move toward that Closer to Home and the provision of Closer to Home services. I speak against this bill because it is so badly drafted, it is so badly thought through, it is so poorly conceptualized, and it is so devoid of any substantive information as to provide the people of British Columbia with no comfort whatsoever. What we have created is nothing more than a blank cheque to this minister to set up

[ Page 7728 ]

whatever kind of new bureaucracy and bureaucratic system of administration of health care that she decides is necessary.

I don't put this to you in simple, idle rhetoric. I put this concept to you with a view to going back and looking at the last time a government in British Columbia introduced a new regional system of administration of services in the province. I go back to an elected member in this House who was then serving under the Social Credit government; someone who has proven himself through his years of service in the Ministry of Municipal Affairs. I am referring to Mr. Dan Campbell, who introduced the concept of regional districts -- a brand-new concept of governing unorganized territory.

The late Dan Campbell had a vision for how we could change the nature of regional municipal delivery -- if I can use that term -- or regional planning to unorganized areas in British Columbia. I would like to use this, because if we look at the principle under which this ministry is now starting to look at the development of this new regional health care system, I would like to compare what was put before the people in 1965 under a municipal amendment with respect to the introduction of regional districts.

I would like to demonstrate what the people of British Columbia had before them by way of statute to debate in that introduction, and compare it directly to what the people of British Columbia are being asked to accept now.

The other reason this is an interesting comparison, in terms of the principle of what we're debating here, is that we can look at and acknowledge what was conceptualized in regional districts when Mr. Dan Campbell first introduced the concept in the legislation he brought forward. We can look today at the aggregated debenture debt of roughly $4.3 billion that that level of government has now incurred on behalf of the taxpayers of B.C. It's important for us to make this comparison, because there has been no cost analysis done of the long-term or even short-term cost effect of what this government is introducing with this health care bill.

The member for North Vancouver-Lonsdale said that this bill introduces a bottom-up administration and influence in health care delivery. Nothing could be further from the truth. First of all, let us attack that notion in principle, because this is one of the reasons why I and the members of the Liberal opposition cannot support this in principle. This bill essentially creates two new authorities in the province. The first authority that it creates is a community health council. What it also does is establish regional health boards over that community health council.

The reason I used the 1965 amendment was because the minister of the day, when introducing the concept of regional districts, had a notion that municipalities needed to have some other mechanism to be able to assist in the provision of services to unorganized areas. This is not, I submit, dissimilar to what the Health minister is arguing is necessary today if we are to provide additional health services to the areas and regions of B.C.

But look at the difference in terms of what we are being asked to do now and what was being asked then. When that regional plan came down, the incorporation of regional districts -- that is, the regional model of administration -- was defined in the statute under

section 766(1), where it states quite clearly that the division or distinction of those areas was tied to school districts or districts or any part thereof and the residents within them, and was tied into a regional district. There was no ambiguity back in 1965 as to how these regions were going to work. In 1965 when that introduction was brought in place, the minister wasn't saying: "This is what we're asking you do, but trust us, we'll figure out what the regions will be later.

We haven't thought that one through yet." They had decided, rightly or wrongly -- and I'm sure that was a subject of vigorous debate at that time, and Hansard would tell us what that debate was -- that the school districts and those regions were the areas that were in fact the appropriate districts.

There is no such provision in this bill. We have no understanding or knowledge of what the minister and those proposing Bill 45 have in mind with respect to the distinction in the division of regions. As a result, that is something that will effectively be put in place by the minister -- through consultation, we're told. We have seen time and again that consultation with this government means: "We go out and we ask for a lot of opinions, we bring them in and see how they jive with our government opinion, and if it doesn't jive with our opinion, we dismiss the opinion we've received, and we move forward and do what we want to do." That is unacceptable in the province of British Columbia.

We also see that these new regional health boards will have, by regulation and designation from the ministry, a series of powers that will be provided to a prescribed number of members appointed by each council in the region, and among them members to that council. The prescribed number is not stated. We know that the prescribed numbers will be appointed by the minister, and we understand that the makeup of this prescription is something that will be determined by the ministry. This is not grass-roots politics; this is not democracy at its finest at work.

This is top-down administration in the delivery of health care. In her opening remarks, the minister talked about the need to try to build greater community input and involvement in the health care system. I'm sure the minister would agree that the definition and distinction of these new districts that are going to be developed would best be done through regional mandates rather than by the heavy hand of the ministry.

We have to look at how it was done in the past. What other examples of regional development might we draw upon to gain some experience? We look back again to Dan Campbell's bill in 1965, when the new regional district model was brought in. It says there that before making the recommendation under subsection (1), the council or trustees in each municipality, as the case may be, upon receiving the recommendation of a bylaw -- I will now quote -- provide by obtaining "by referendum within 60 days the opinions of the owner-electors of the municipality or the owners of

[ Page 7729 ]

land if the municipality is an improvement district." What that tells us is that in 1965, when we went to a model of regional development, a referendum and community involvement through the basic form of democracy was acceptable -- that is, the right to vote yes or no. But in 1993, in the days of great democracy, it now will be done through the edict of the minister and through this government from on high. This is not democracy; this is not a democratic process. This is simply the invoking of a recommendation that this minister has deemed is in the public interest.

Let's also recognize that the purposes of this board are enormous. The regional health board has a number of very important purposes under this act. It is to provide essentially the type, size and location of the facilities in the region. Think about that: the type, size and location of facilities are now going to be controlled by this board. It is also there to provide for the prioritization of programs for the delivery of health services to the region. Then it says that this regional board is going to determine the human resource requirements. Those are the people you hire to provide health care.

It's a fancy way of saying: "We're going to determine who you do and do not have working within the regional health plan." It goes on to say that it will develop policies and set priorities. It will prepare and submit budgets to the minister, and it will allocate resources for the delivery of health care services. This is a very powerful regional board.

[4:30]

We go back and ask: how did they do this before? What kind of authority or mandate was there before? In the bill that was brought down in 1965.... Of course, the government of the day introduced a letters patent section, incorporating these districts and specifying the name and boundaries of the district and the member municipalities that would be included. It talked about the population deemed to be within the voting unit and therefore to have some right of control. It talked about the date by which municipalities would appoint representatives. It talked about the time and manner of the first election.

It didn't talk about making appointments until some subsequent municipal election years down the road, which this one does. It talked -- and this is the critical point in a whole series of provisions in the 1965 legislation -- about the sums that may be borrowed to meet the current lawful expenditures of that regional district in the year of incorporation and, if deemed expedient, for the year following. It set it out; it put in some restriction and control. It provided comfort to the people that there would be some control so that these new regions didn't simply have a blank cheque.

[The Speaker in the chair.]

It also spelled out the voting powers of the regional board members and how they would cast their votes. It was set out in

section 717 of the 1965 act, where sections (

a) through (

d) talked about the voting powers, about how the director may not cast a vote against it in terms of partiality and separate voting. It talked about vote entitlement with respect to functions. This is a clear and detailed presentation of how the system is supposed to work. We come back to Bill 45 and ask ourselves: where is such detail? No detail is spelled out in this bill.

It talks about development of policies, administering and allocating regional grants among councils, delivery of regional services, exercise of powers, implementation of regional standards and ensuring compliance with provincial and regional standards. But it doesn't say how this is going to be done. It doesn't say how the region is going to work or function or where the people in the community are going to have a vote.

There's a very strange little paragraph in here, which in principle is one of the reasons we have to say that we can't support this: "In carrying out its purposes, a board must have due regard to (

a) the Provincial standards and specified services, and (

b) the community health plans for the communities in the region." That takes us to the community health councils. You can't look at this bill and just go after the regional councils; you have to look at the community health councils. We're being asked to vote on this bill that introduces regional health councils without understanding how these councils are going to function. How will directors be appointed or elected? That kind of detail is not spelled out -- voting powers and the kinds of things that are important in a democratic process to understand how the functioning region is going to work.

The bill says that the minister may designate by regulation. We understand that ultimately the authority always lies with the minister. We're saying that a community health council and an area of British Columbia that constitutes the community for the council may be designated by regulation. The minister will determine those areas. This is not a prescription in the bill, as in 1965 when we set up regional districts under Dan Campbell's bill. In looking at the amendment to the Municipal Act in 1965, it was clearly spelled out how those regional districts were going to work.

We understood what the nature of that jurisdiction was going to be. We understood who was to be elected to them. We understood how they were going to be elected. We understood what the powers were going to be. We understood what their expenditures were going to be. We have no such assurance here.

There's nothing in this bill to give us any assurance that this is going to be a democratic process.

Indeed, what it does say is that a prescribed number of members will be appointed -- and appointed is the critical word -- by the minister as follows: "(a) 1/3 of the members chosen to represent the residents in the community; (b) 1/3 of the members chosen from persons elected or appointed to, and nominated by, the boards of the regional districts, the municipal councils or the school boards in the community;" -- we recognize that people involved in municipal government, regional districts and school boards have some understanding of the community and may be good candidates -- "(c) 1/3 of the members nominated by the minister." So we have until the next election.

We're not talking about the municipal elections of this year but in 1996. The minister is choosing the entire board.

[ Page 7730 ]

Where does it tell us what the voting weights and strengths of those people are going to be? For example, will those from a municipal council who may represent within their municipal council an electorate of a larger number than the people from, for example, an unorganized area where the population may be less have a greater weighted vote? Is it going to be one person, one vote?

Hon. E. Cull: Yes.

G. Wilson: The minister says that it will be one person, one vote. Why doesn't it say so? Why doesn't it stipulate what the voting weights are going to be? Why don't we know from the act exactly how this thing is going to be structured? This is the problem. This is why we have such difficulty with the legislation that this government brings forward. We hear that yes, this has been thought through, but no, they haven't stipulated what it's going to be. They haven't told the people what it's going to be.

They're asking the members of the opposition to stand up and say we're going to support this in principle, even if we don't know what the detail is. We go on to see that under the purposes of this council, we're going to be developing health plans; delivering, coordinating and integrating that health care service to the community; and operating hospitals and other facilities. The purpose of this council is to set out the criteria by which the operation of hospitals and other facilities is going to happen. This is not a simple advisory board to government. This is a new layer of government at the regional level.

When they were going to bring this in, why did they not go back and take a page from the introduction to the regional districts and understand how that was going to work? I want to come back to that, hon. Speaker, cognizant of the time, to talk about how the cost analysis might even be done with respect to that procedure, as we now look at this procedure.

There is something else that is really quite staggering. It comes back to the verbal commentary of the member for North Vancouver-Lonsdale, who talked about how this is grass roots and bottom-up. Hon. Speaker, I want you to hear that in terms of the powers and procedures, this council is going to be dealing with millions of taxpayers' dollars. I read this only because in principle it is one of the fundamental reasons why we can't support this bill. Let all British Columbians hear this in light of last night's debate in terms of freedom. Listen to this:

"Meetings of a board or council are open to the public but the board or council may exclude the public from a meeting if the board or council considers that, in order to protect the interests of a person or the public interest" -- now listen to this, hon. Speaker; let all British Columbia hear that this is where this government is coming from -- "the desirability of avoiding disclosure of information to be presented outweighs the desirability of public disclosure of the information."

You can have a closed meeting. Hon. Speaker, we're talking about some fundamental principles of open democracy. This is supposed to be an open government. These new boards and councils that are being established are supposed to be open to public scrutiny. We recognize that in the past if there were difficulties in resolving problems with these boards.... Again, I go back to the procedures enacted when regional districts came in, because it's a perfect parallel in terms of what we're trying to create here. It's a brand-new level of bureaucratic administration of health care that is going to be enormously expensive -- and I'll use some figures to prove that in just a minute.

Let's talk about procedure. When Dan Campbell introduced his bill, it was a new concept that was grown in the province. Some would argue that the regional districts have grown far too big, powerful and expensive. That's another debate. He set out what the procedures would be with respect to quorum, majority vote and how there would be a reconciliation if there was an impasse or irreconcilable position vis-�-vis this new region and the province. In Campbell's bill there was a process for local control and local conflict resolution. In this particular bill, how will they resolve the differences over priorities?

One line says the regulation of the minister prevails. That's how you do it -- if the minister doesn't like it, the minister says: "We regulate it and it's gone." This isn't grass-roots democracy, hon. Speaker. This isn't turning