1998/99 Legislative Session: 3rd Session, 36th 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)

MONDAY, JULY 5, 1999

Afternoon

Volume 16, Number 16

[ Page 14109 ]

The House met at 2:07 p.m.

Prayers.

Hon. D. Lovick: I see in the precincts today an old friend and somebody who will

be well known, I'm sure, to all of us who have served in this chamber for any length of

time. I'm referring to Paul Nicholson, lobbyist extraordinaire. I'm going to blow his

cover a little bit and tell something about him that is not well known. Paul -- forgive me

for saying this -- is an avid reader of Hansard . Nevertheless, I want to ask all

members to please join me in welcoming Paul.

G. Campbell: It's a pleasure today for me to introduce Brian Aston, who is a

North Vancouver resident. He's joined in the House by his two sons, Craig and Grandt, who

are visiting us from Ireland. They are in grade 11 and grade 9. I hope that the House will

make them welcome.

Hon. M. Sihota: I notice in the gallery today a friend of many members of our

caucus: Diane Wood from the British Columbia Government and Service Employees Union. I

have no idea why she's here, but I'm sure that she'll enjoy the proceedings.

B. Penner: It's my privilege today to introduce a councillor from the district

of Chilliwack, Mr. Clint Hames. He'll be meeting with members of the B.C. Liberal caucus

later this afternoon to talk about children and families. I wish the House would please

make him welcome.

Hon. J. MacPhail: Accompanying Diane Wood in the gallery is a veteran caretaker

of pension plans, a super superannuation commissioner. I heard a rumour that he had

retired; I don't believe it for a second. We're joined by John Cook, the superannuation

commissioner.

[1410]

Introduction of Bills

PENSION STATUTES AMENDMENT ACT, 1999

Hon. J. MacPhail presented a message from His Honour the Lieutenant-Governor: a bill

intituled Pension Statutes Amendment Act, 1999.

Hon. J. MacPhail: I move that the bill be introduced and read a first time now.

Motion approved.

Hon. J. MacPhail: I am pleased to introduce the Pension Statutes Amendment Act,

1999, which will amend the Hydro and Power Authority Act, the Insurance Corporation Act,

the Pension (College) Act, the Pension (Municipal) Act, the Pension (Public Service) Act

and the Pension (Teachers) Act. This bill implements the pension components of the various

public sector accords between the government, employers and major public sector unions,

including changes recommended by the various public sector pension boards.

The first purpose of the bill is to provide a framework for considering the possibility

of moving the British Columbia Hydro and Power Authority pension plan and the Insurance

Corporation of British Columbia pension plan to joint trusteeship. Under this structure,

management of the pension plan would be shared between the plan members and the plan

employers. The second purpose of the bill is to implement specific changes to four

statutory public sector pension plans that have been agreed upon in various accords. This

information has been made available in the past. However, I will again detail the specific

changes at the next reading of the bill.

I move that the bill be placed on orders of the day for second reading at the next

sitting after today.

Bill 89 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.

PUBLIC SECTOR PENSION PLANS ACT

Hon. J. MacPhail presented a message from His Honour the Lieutenant-Governor: a bill

intituled Public Sector Pension Plans Act.

Hon. J. MacPhail: I move that the bill be introduced and read a first time now.

Motion approved.

Hon. J. MacPhail: I am pleased to introduce the Public Sector Pension Plans Act,

which replaces the Pension (College) Act, the Pension (Municipal) Act, the Pension (Public

Service) Act and the Pension (Teachers) Act. This bill has two primary purposes. First,

the bill modernizes pension statutes; this fulfils a commitment made to plan members and

their representatives in 1994. Second, the bill provides an option to move the public

sector pension plans to joint trusteeship. Under this model, management of the pension

plan would be shared between plan members and plan employers. This option is included as a

future possibility for the municipal pension plan, the public service pension plan and the

teachers pension plan. The terms of joint trusteeship for the college pension plan are

included in the bill. These terms have been agreed upon among the College Pension Advisory

Board, the College-Institute Educators Association, the B.C. Government and Service

Employees Union and the government.

This bill also provides the necessary infrastructure to enable pension plans to move to

a joint management structure, including the establishment of the British Columbia pension

corporation and the British Columbia investment management corporation, as the successor

organizations to the Superannuation Commission and the office of the chief investment

officer respectively.

This bill is the culmination of a lengthy dialogue and consensus reached among the

boards of the four statutory pension plans, the provincial and municipal governments and

the major public sector unions. The changes contained in the bill are progressive advances

in the way the pension plans and their funds are managed on behalf of plan members and

bring this legislation into line with legislation that exists all across the country

already.

I move that the bill be placed on orders of the day for second reading at the next

sitting after today.

[ Page 14110 ]

Bill 95 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.

[1415]

EDUCATION STATUTES AMENDMENT ACT (No. 2), 1999

Hon. P. Ramsey presented a message from His Honour the Lieutenant-Governor: a bill

intituled Education Statutes Amendment Act (No. 2), 1999.

Hon. P. Ramsey: I move that the bill be introduced and read a first time now.

Motion approved.

Hon. P. Ramsey: This bill amends the School Act to provide the authority for the

creation, collection and use of personal identification numbers, known as PENs, consistent

with the principles of the Freedom of Information and Protection of Privacy Act. PENs are

unique identification numbers assigned to each K-to-12 student.

The amendments to the School Act enable the Ministry of Education to accurately collect

and track information gathered through provincial assessments and student performance. The

bill also amends post-secondary legislation to enable implementation of the PEN project by

the Ministry of Advanced Education, Training and Technology. It will extend the use of

PENs to the post-secondary level.

The principal objective is to ensure and enhance the relevance and the accountability

of public post-secondary education in B.C. Through the PEN project, the Ministry of

Advanced Education will have the ability to track groups of students over time and across

institutions through the post-secondary system. The use of PENs will enable the ministry

to gather accurate and complete information about post-secondary students that will

contribute to more informed program decisions and enable more effective program planning

at both institution and system levels.

The amendments also provide for the exchange of student information between the

Ministry of Education and the Ministry of Advanced Education, Training and Technology.

This exchange is primarily for purposes of research and statistical analysis, to enable

both ministries to enhance the effectiveness of educational programs and initiatives. The

PEN permits the exchange of information without unintentional disclosure of the identity

of individuals, thus protecting their privacy.

Hon. Speaker, I move the bill be placed on orders of the day for second reading at the

next sitting of the House after today.

Bill 87 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

VANCOUVER TRADE AND CONVENTION CENTRE PROJECT

G. Campbell: Hon. Speaker, we now see that the government has incorporated the

Vancouver Trade and Convention Centre Authority in Ottawa rather than in B.C. According to

the government's own officials, this has been done to shift the taxpayers' liability off

the books and to hide the facts from the people of British Columbia. After all the

problems that this government has run into -- from the fast ferry debacle to the Hydrogate

affair -- why on earth is the Minister of Employment and Investment now planning to hide

even more information from British Columbians on the convention centre project?

Interjections.

The Speaker: Order, members.

Hon. M. Farnworth: Once again the opposition has shown us why you should never

rely on the sloppy scribblings that you sometimes see in a Friday edition of the Vancouver

Sun .

The Speaker: First supplementary, Leader of the Official Opposition.

G. Campbell: Unfortunately, what we in the opposition have to do is count on

government officials to tell us the truth. What government officials have said quite

clearly is that this government has already spent $54 million on the new trade and

convention centre expansion -- $54 million, at the rate of almost $4 million a month --

and still there is no business plan. Still we don't know how much the convention centre is

going to cost. Still we don't know how the convention centre's going to be paid for.

My question to the Minister of Employment and Investment is: has he got a business

plan? Has he not learned anything from the past? Why on earth should any British Columbian

trust him and believe that we are not going to run into hundreds of millions of dollars

more in overruns with regard to the convention centre?

Hon. M. Farnworth: Hon. Speaker, I find it really interesting that this

opposition finds that the only way they can attack a project that's supported by the city

of Vancouver, that's supported by the federal government, that's supported by the

Vancouver Board of Trade, that is going to bring untold hundreds of millions of dollars .

. .

Interjections.

The Speaker: Order, members. Order, members.

Hon. M. Farnworth: . . . of investment to the province of British

Columbia . . .

Interjections.

The Speaker: Order, members.

Hon. M. Farnworth: . . . is to rely on an inaccurate

article .

. .

[1420]

Interjections.

The Speaker: Members . . . .

[ Page 14111 ]

Hon. M. Farnworth: . . . in Friday's Vancouver Sun .

Interjections.

The Speaker: Minister, take your seat.

Interjections.

The Speaker: The question was listened to in some silence and some order. The

answer must also be listened to similarly.

Minister, finish your comments, please.

Interjections.

The Speaker: Members, come to order.

Hon. M. Farnworth: The authority is set up because there is a provincial asset

and a federal asset, and the two have to mesh together. They do it that way to work for

efficiency -- to save over a hundred million dollars on the cost of the project. Hon.

Speaker, this is required in the same way that authorities right across this country

operate facilities such as this. Whether it's an airport authority, whether it's E-Comm,

whether it's NavCan -- all those things where there is interjurisdictional involvement

have authorities like this to do that. They are subject . . . .

The Speaker: Minister, thank you.

Hon. M. Farnworth: The province's involvement is subject to

freedom-of-information . . .

Interjections.

The Speaker: Thank you, minister. Take your seat, please.

Hon. M. Farnworth: . . . and the auditor general of the province .

. .

The Speaker: Minister . . . .

Hon. M. Farnworth: . . . is the auditor for the project.

The Speaker: Second supplementary, Leader of the Official Opposition.

G. Campbell: Hon. Speaker, there is no business plan. The Premier announced that

this was going to cost $200 million. Then he announced it was going to cost $300 million.

Now we hear from the minister that it's going to cost $440 million at least. My question

to the Minister of Employment and Investment is quite straightforward. This government has

not managed one project properly. If you are going to have a convention centre expansion,

it's got to be done on a sound business basis. Why should any British Columbians trust

this minister or this government to bring this project to fruition in a cost-effective and

sensible manner?

The Speaker: Minister of Employment and Investment.

Interjections.

The Speaker: Order, order.

Hon. M. Farnworth: Thank you . . . .

Interjections.

The Speaker: Members will come to order. The minister will answer the question

when there is order in the House.

Hon. M. Farnworth: We have one of the best teams in place to bring this project

along, hon. Speaker.

An Hon. Member: Prove it.

Hon. M. Farnworth: We have the auditor general of British Columbia as the

auditor for the project, hon. member. Go question his qualifications.

Interjections.

The Speaker: Members, come to order.

Interjections.

The Speaker: It is impossible to hear either the questioner or the person giving

an answer when there is so much noise in the chamber. Minister, will you continue, please

-- briefly.

Hon. M. Farnworth: We have Henry Wakabayashi, the individual who oversaw the

construction of the Vancouver International Airport expansion -- brought in on time and on

budget. He is representing the province's interests on this. He has an excellent track

record of over 30 years in the private sector. We have one of the most respected former

deputy ministers in any province in the country -- Doug Allen -- involved in the project,

overseeing the province's interests, doing the negotiations. We have a first-class team in

place, and this project will be brought in on time and on budget.

G. Farrell-Collins: We heard exactly the same song and dance about the Hydro

Pakistan project, exactly the same song and dance about the fast ferries, and both of

those were woefully out of control and unaccountable. You'd think that after Hydrogate,

you'd think that after the fast ferry fiasco that was engineered by the Premier of this

province, you'd think that after all of that this government would try to be more open and

more accountable with their megaprojects. But instead we have Chris Nelson, from the

ministry, saying: "If it was a Crown corp, it would impact on the debt of the

province. That's why the province decided to use this structure."

We now know there's no business plan. We now know that they're trying to hide it off

the books. We now know that the government isn't going to subject it to the

freedom-of-information laws. Instead of being more open, they're being more closed. What

does the minister have to hide from the taxpayers in British Columbia on yet another

megaproject that looks like its going to run amok?

[1425]

Hon. M. Farnworth: That member is straight wrong. The province's involvement, until

the authority is up and running

[ Page 14112 ]

after the project is complete, is subject to FOI. After that, Pavco, which holds the

lease, is subject to FOI. The fact of the matter . . . . The reason an

authority has been set up is because you have two agencies -- a federal one and a

provincial one. Get that through your head.

The Speaker: Minister, minister.

Hon. M. Farnworth: This is not just the province's own project.

The Speaker: Minister . . . .

Hon. M. Farnworth: In order to make the existing Trade and Convention Centre

work together and mesh with the new provincial one, there has to be a way of making that

happen. That's why you have an authority. That's what you're able to do with

representation from the federal government . . .

The Speaker: Minister, thank you very much.

Hon. M. Farnworth: . . . the provincial government and the private

sector in an independent authority at arm's length from government.

The Speaker: Minister, minister. Take your seat, minister.

First supplementary, member for Vancouver-Little Mountain.

G. Farrell-Collins: The minister got one thing right. Until this thing gets

incorporated in Ottawa, it is subject to FOI -- if you're a millionaire. That's because we

sent in a freedom-of- information request to find out on behalf of the taxpayer where

their $54 million has gone. You know what? We got a bill for $22,275. I would think that

this government, given its track record on boondoggles, given its incredibly incompetent

management of just about every Crown corporation in the province, would want more

openness. What is the minister trying to hide that it cost $22,000 just to find out what

his minister and his government are doing with their tax dollars?

The Speaker: Minister of Employment and Investment.

Interjections.

The Speaker: Members, come to order.

Hon. M. Farnworth: FOI requests are handled by the freedom-of-information

officer, who's independent of this Legislature. So deal with them.

But here's the issue: why doesn't this opposition get on board and start to lobby the

federal government on the benefits of this project here in British Columbia? Why don't

they for once stand up for British Columbia? Why don't they work with British Columbians

to ensure that this federal government's . . .

Interjections.

The Speaker: Members . . . .

Hon. M. Farnworth: . . . tax dollars flow to British Columbia to

participate in this project? Why for once don't they do that? Why for once must they .

. . ?

Interjections.

The Speaker: Members, come to . . . .

Hon. M. Farnworth: Why do they have to be selective in their quotations?

The Speaker: Time, minister.

Hon. M. Farnworth: Why don't they recognize the

article on Saturday, for

example, that laid everything out for them: why we have an authority, why it's subject to

freedom of information . . .

The Speaker: Minister, it's time to finish your answer now.

Hon. M. Farnworth: . . . and why everything is going to work? Why

don't they?

The Speaker: Second supplementary, member for Vancouver-Little Mountain.

G. Farrell-Collins: The answer to the minister's question is: it's because

you're the most incompetent government in the history of British Columbia.

The Speaker: Member . . . .

G. Farrell-Collins: After the election, he'll have the opportunity -- if he wins

his seat -- to ask many more questions of this side of the House.

I have a question for the janitor of the NDP cabinet: can he save the people of British

Columbia $22,000? Will he stand up in the House today and hand over the business plan? Or

isn't there one?

Interjection.

The Speaker: The members for Kamloops-North Thompson and Okanagan West will come

to order. I recognize the minister of the Crown -- Employment and Investment.

Hon. M. Farnworth: I guess on the question of competence, this opposition is so

competent . . . . That's why the leader's trying to see half of them replaced,

hon. Speaker.

Interjections.

Hon. M. Farnworth: Shake your head; you're one. So are you. You're another. So

are you.

Interjections.

The Speaker: Order, members. The House will come to order.

[1430]

C. Clark: Well, I can give the member this assurance: on this side of the House,

all these members will be here long, long after the voters have said goodbye to that

minister and the rest of that crew over there.

[ Page 14113 ]

Interjections.

The Speaker: Members, come to order.

C. Clark: Last March this minister and this government reneged on its commitment

to bring in the convention centre at zero cost to taxpayers. Now we're finding out that

taxpayers are going to be on the hook for up to half a billion dollars. But only if you're

a crony of the government will you be allowed to work on the worksite, because they're

limiting it to union workers only.

Will the minister stand up and tell the 80 percent of the construction industry in

British Columbia that's non-union why they're good enough to bankroll this thing for half

a billion bucks, but they're not good enough to make a dollar on the worksite?

Interjections.

The Speaker: Members . . . .

Hon. M. Farnworth: Well, I guess the first part of your question . . . .

Former members Bob Chisholm and Ken Jones would have liked your endorsement before the

last election.

On the second point, this project was put out to bid and was won by . . . .

Interjections.

The Speaker: Members, it's very difficult to hear the minister. Members, come to

order.

Hon. M. Farnworth: This project was bid on by Greystone in an open tendering

process. They were the successful bidders. All the proponents that bid on the project were

union companies. They're the ones that bid on it. It was put out in terms of it being bid

by the private sector or under financing arrangements with the province. So this project

has been bid by a union company, and they will be building it.

The real issue is: why won't this opposition get up and lobby Ottawa to ensure that we

get our fair share of federal tax dollars on this project?

The Speaker: The member was on her feet. I'll let her ask a question -- a brief

one, please, with a brief answer.

C. Clark: Well, maybe the answer to the question is in the business plan that

the minister won't give us. Maybe the answer to the question of whether we could have

saved $30 million on the cost of this project if we'd been able to open it up to both

union and non-union labour . . . . Maybe the answer to that question is in the

business plan, but the minister doesn't have a business plan. He's spending $54 million --

$4 million a month -- and he doesn't have a business plan.

When will the minister realize that British Columbians are fed up with a government

that wants to take care of its union pals and that wants to grease the palms of its

friends and insiders instead of taking care of the taxpayers of British Columbia?

Hon. M. Farnworth: You know, hon. Speaker, the only thing that's happening is

watching the opposition get up and criticize a project that is being built by a company

that bid it in a fair, open process. They're criticizing a project that has the support of

the city of Vancouver.

Interjections.

The Speaker: Members, members.

Hon. M. Farnworth: They're criticizing a project that has the support of the

board of trade.

Interjections.

The Speaker: Order, order.

Interjections.

The Speaker: Minister, the microphones have been turned off. Take your seat,

please, minister.

Interjections.

The Speaker: That's no help either. Some members keep persisting -- no help at

all.

Tabling Documents

Hon. H. Lali: I'm pleased to submit the 1997-98 and 1998-99 annual reports of the

Motor Carrier Commission.

[1435]

Orders of the Day

Hon. J. MacPhail: In this chamber, I call Committee of Supply. For the information

of the members, we'll be debating the estimates of the Ministry of Health.

The House in Committee of Supply B; W. Hartley in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 36: ministry operations, $7,569,524,000 (continued).

C. Hansen: When we were last on Health estimates, which was last Tuesday

evening, we were discussing Pharmacare issues. There was a survey that I referred to that

the minister was interested in getting a reference on. So I'll just start by passing this

on. But I'll also put on the record that it was from the second annual Hoechst Marion

Roussel report, titled "The Canadian Consumer Survey on Health Care." I'll send

that over to the minister so at least she has that reference.

[1440]

I want to continue with some of the regional issues that we had been discussing

previously. Specifically I want to start with the issue of . . . . We had been

discussing the CAT scan in the Comox Valley -- the issues of CAT scan usage. I'm wondering

if the minister could explain to us the guidelines for

[ Page 14114 ]

CAT scan operations. The understanding I have is that the ministry guidelines call for

one scanner per 125,000 residents in a region. I'm wondering if the minister could confirm

whether or not that's still the guideline that's used.

Hon. P. Priddy: I'm told by staff that that is correct.

C. Hansen: I want to move to the Cowichan Valley and the Cowichan District

Hospital, where a businessman by the name of Pat Carson donated -- a couple of years ago,

actually, going back to 1991 -- $861,000 for the purchase of a CAT scan. He did this in

memory of his wife, who was suffering from cancer and was put through trips back and forth

between Duncan and Victoria many, many times because of the lack of a CAT scan in the

Cowichan Valley.

The reason the ministry gave at the time as to why they couldn't install a CAT scan was

that it was because of the operating costs. Now we find that that particular donation that

Mr. Carson put in has grown to, I believe, approximately $1.3 million. The company that

would provide the CAT scan -- I believe it's Packard Bell -- made an offer that they would

provide the CAT scan to the hospital and fund the operations of this CAT scan for a period

of four years. Given that the ministry's guideline, as the minister just explained, is for

a CAT scan for every 125,000 people, we are now at a point where the Central Vancouver

Island health region has a population of 250,000 people being served by the one CAT scan

in that region. I'm wondering if it is time for us to revisit that issue, now that the

population has increased so dramatically and now that there is a commitment for the

four-year operating funds for that particular CAT scan.

Hon. P. Priddy: I don't think I'm ever in a position to say that nobody would

ever review a decision. That's foolish. What I'm told at this stage is that when one went

into Campbell River, the one in Nanaimo was upgraded to be able to do more work. As a

result of that, the wait-lists have come down to about three or four weeks. Victoria, of

course, has expanded its hours as well.

The region has not indicated it to be a top priority for them. While I am prepared to

have another look at it, it would seem to me that if the Nanaimo one has been upgraded,

and Victoria is doing expanded hours and the region doesn't list it as a priority, then

I'm not sure that it would change the decision. But I'm always willing to look.

C. Hansen: The minister was quoted in the Cowichan News Leader in Duncan

as saying that she would consider a CT scan to be located there when there are

"enough numbers to substantiate one." The argument that is being made is that,

given the ministry's guidelines, those numbers have now been reached. I appreciate the

minister's willingness to review it. I only hope that she reviews it with a bit more

optimism than the tone of her voice implied, because I think that's a service that

certainly those residents of Vancouver Island would be very anxious to receive.

[1445]

I want to move on to Houston, British Columbia. When I was in Houston earlier this

year, in March, a woman told me a story that really struck me as one that sort of

emphasizes the difference between urban and rural health care in British Columbia. This

was a single mother. Her daughter fell out of bed in the evening. She was concerned about

whether or not her daughter should be seen by a doctor. As a result of some of the Dobbin

issues not being resolved at this point -- which is an issue we'll get into later in the

estimates -- the doctors were not providing on-call services in that community, so she

phoned the health clinic in Houston. She got an operator who said that if she was

concerned about her daughter, she should phone the ambulance and have her daughter

transported by ambulance to Smithers, which, in the best of weather, is about a 40-minute

drive.

This was a mother who was basically placed in the dilemma of not being able to obtain

some of the most basic medical advice without a very expensive ambulance ride and the

prospect of leaving her other children or finding somebody to take care of them. I'm

wondering if the ministry has looked at all at providing that kind of advice to a parent

or to anybody in this province via telephone. What this mother lacked was the ability to

phone a doctor and get a doctor's advice as to whether or not she should be concerned

enough to call an ambulance to transport her daughter to another community. I'm wondering

if the ministry has looked at any provision of that kind of advisory service that could be

available by telephone in remote communities that are not served by acute-care hospitals.

Hon. P. Priddy: I would agree that not being able to get advice, particularly

when it's your own child, is very frightening.

A couple of things have happened. Those were extraordinary circumstances, where doctors

were not providing or were refusing to provide after-hours service. But the Bulkley Valley

health council, with the Houston diagnostic and treatment centre, is actually hiring

additional nurses and working with doctors to provide 24-hour-a-day, seven-day-a-week

care. I know your question is broader, but you raised the issue in the context of Houston.

We have not looked at a physician referral service. I'm told that there's not another

one in the country -- except a private one back east, which was not successful. But we do

have a very large project here in the capital health region, which has been going for two

years. It is a line that runs from 6 o'clock at night till 8 o'clock in the morning. It is

answered by a nurse, and it's called self-care: the TeleCare project. As a result of that,

emergency room visits are down significantly since the project began. Are we looking at a

way to do TeleCare around the province? Yes, we are.

C. Hansen: I want to move over to Prince Rupert, which has recently been faced

with the departure of six doctors from that community. Certainly there are doctors who

have left many communities in this province recently, and I know the minister has talked

about the number of new doctors who are being recruited. But when you start adding up all

these numbers, it's more than cause for concern, particularly when you start looking at a

community like Prince Rupert, where six doctors have departed in recent months.

I'm wondering if the minister could give us some assurance that the recruitment of new

doctors to northern communities is actually going to be able to keep pace with the number

of doctors who are departing.

[1450]

[ Page 14115 ]

Hon. P. Priddy: Can I assure you that nobody will leave and that they will all be

replaced in a way that we'd like? No, I can't provide that assurance. I think the member

would know that I'm not able to do that.

But I am able to assure the member that the ministry and the recruiting agency, through

HEABC, are doing everything they can to recruit new physicians. As I think I talked about

earlier, we have recruited new physicians into some remote and rural parts of British

Columbia, where six months or ten months ago people were extremely concerned because they

believed, quite correctly, that their physicians were leaving and they would not have

someone there. We have been able to replace a number of them.

I know that over the last four years, say, the ratio overall of physician to

population, if you will -- the number of residents per physician in rural and remote

communities, which are the ones that would be assessed for the NIA allowance . . . .

Prince Rupert wouldn't be one, but if you're talking in the broader context of remote and

rural communities, it has improved somewhat in terms of the number. There are now more

physicians for residents in those communities than there were four years ago. At present

we have approximately 326 general practitioners and 60 specialists in the NIA communities,

compared to about 300 general practitioners and 18 specialists four years ago. So there

has been a significant increase.

That doesn't mean -- and I'm not trying to suggest -- that we still won't see

situations, like Prince George or Prince Rupert, where a number of people have left at

once. The places where we have been most successful either in ensuring that it doesn't

happen or in being able to provide support when it does are those communities where

there's a really strong partnership between the Ministry of Health, the recruiting agency

at HEABC, the local community -- which often provides additional supports or incentives,

if you will, as they might to anybody else they needed to come to their community -- and

the local health authorities. So those four partners -- I think that's where we've been

the most successful.

C. Hansen: Certainly, when you start looking at the challenge of ensuring that

there is an adequate number of doctors for rural communities, retention is an awful lot

easier than replacing or recruiting physicians. When you start looking at communities like

Prince Rupert and Prince George, which have lost a significant number of doctors -- or, in

the case of Prince George, are about to -- the ministry has been very quick to put

troubleshooters into different areas where there have been particular problems. But I

don't see any effort by the ministry to start looking at those particular communities and

asking the question: what is it about the way we are working our doctors that results in

so many leaving those communities at the same time?

I'll quote one doctor out of Prince Rupert. He says that the departure is a result of

physicians being run ragged by overwork. I'm wondering if the minister is looking at the

particular working conditions that we are subjecting doctors to in some of these specific

communities where they are seeing a very large number of doctors departing.

[1455]

Hon. P. Priddy: Well, it's a yes and an ongoing answer. When we've looked at

communities that have lost . . . . I think that in some ways it's harder to

retain than recruit. Recruitment often gets a lot more attention than the retention part

does. Whether it's nurses or physicians, the retention part may actually be harder to do

than the recruitment part. We could have that discussion, but we probably don't need to.

If you look at the kinds of things that physicians talk about or at the reasons that

are talked about by, for instance, the BCMA when physicians leave communities, there's no

question that on-call hours, etc., are a factor. Some people leave because they had gone

to a smaller remote community in order to start a practice, and then they decide they'd

rather be somewhere else. Some people leave when their children get to high school. There

are a variety of reasons, but I'm not in any way underestimating what the workload is.

When we've looked at that with the BCMA or with the College of Physicians and Surgeons .

. . . That's the reason we have a northern isolation allowance. That's a financial

incentive, if you will, to stay in a community. I'm not suggesting that all the things are

financial, but some of those are.

As a result of the Dobbin report, doctors -- general practitioners, anyway -- who are

providing year-round emergency medical coverage in, again, the NIA communities with

hospitals are eligible to receive compensation for that service. That's another sort of

remuneration incentive. The northern and rural locum program is an incentive, because it

means that . . . . Now, we could have a discussion about whether it's enough

time, but we provide subsidized locum coverage to primary care physicians so that they can

get away for up to 28 days. Actually, it's in five-day blocks, so they can't do that for

28 days at a time. But they can get some support so that they can go to continuing medical

education or get away with their family or whatever it is. Again, it's a financial

incentive as it relates to the ministry, but it's a lifestyle incentive to be able to have

28 days of locum a year and the continuing medical education program, which provides

additional resources for physicians -- again, as a result of Dobbin -- to be able to

upgrade their skills. One of the things that health professionals -- maybe any

professional but health professionals, including physicians -- in smaller communities will

say is that it's very hard to keep their skills up. There aren't a lot of other physicians

to work with. They need to get away to do that skill upgrading. We do that.

There are just a couple of other things that I would mention. The UBC family practice

rural and remote program -- which we support -- at least enhances the preparation of

physicians for rural practice so that you don't get somebody . . . . If

someone goes through the UBC program, they have a sense of what rural practice is like,

because they've done a placement. So you don't have someone who moves to a rural

community, has no idea what it's like and gets there and says: "I don't think so.

I've had no preparation for this, and I don't think it particularly is where I want to

be." We also have the enhanced skills program for post-MD training positions at UBC

where rural and urban physicians can upgrade their skills.

There is more. I could go on -- the Prince George teaching unit, etc. Some of that is

about remuneration; some of it is about being able to upgrade skills. I think there are

some pieces over which we probably won't ever have control, because they're about people's

preferences for personal lifestyle.

[J. Doyle in the chair.]

[ Page 14116 ]

C. Hansen: Certainly when we get down to the issues of the Medical Services Plan,

we'll be talking about the Dobbin report and where we're at now, 13 months later. I raise

this specifically in the context of Prince Rupert and also, to a certain extent, Prince

George. In the case of Prince George, there is some attention being paid to the reasons

behind doctors leaving. I don't see that kind of attention being paid to Prince Rupert

today. I think it comes down to the kind of formulas that we're using in order to

determine how the northern isolation allowance is quantified, how locum support is

allocated in certain regions and how on-call payments are made, based on the number of

doctors. It's that one-size-fits-all around the province that doesn't necessarily apply

when you get into a specific community.

I would urge the minister to take a look at Prince Rupert to try to determine the

reasons why these doctors are leaving in such numbers and to see if there are issues

specific to Prince Rupert that we need to address in order to ensure that there is

adequate health care for the residents of that community. The minister may wish to respond

to that. Otherwise, I'll move on. I'll give her a chance to respond.

[1500]

Hon. P. Priddy: I think that Prince George . . . . The member is

correct. There has been a fair bit of focus around Prince George for a variety of reasons:

the size of the centre, the activity around the Northern Interior regional health board,

etc. But I do know that there have been some preliminary discussions in Prince Rupert with

a number of groups -- including aboriginal health, the alternative payments branch in our

ministry, regional programs in the Ministry of Health, and the local health authority --

around the establishment of a community health centre for the provision of primary care in

Prince Rupert with outreach to surrounding communities. That may make some difference,

too, in terms of the workload and the time, for physicians.

C. Hansen: I want to move to Terrace, which has been one of the areas where the

minister has seen fit to send in an individual to try to deal with specific problems.

Certainly that has led to some concerns about what this individual's mandate is. The

ministry has dispatched Tom Novak to go in and look at their budget issues. I guess that

one of the things that has come out, as a result of the work that Tom Novak has been

doing, is questioning whether or not his mandate is to ensure that there is better health

care in the Terrace area -- at Mills Memorial Hospital -- or whether his sole mandate is

just to make sure that the budget gets balanced at all costs. Specifically, there was talk

about longer wait-lists. One of the quotes that was made is that his measures to balance

the budget may in fact create longer wait-lists for patients at the Mills Memorial

Hospital. I'm wondering if the minister could enlighten us on exactly what Mr. Novak's

mandate is when it comes to health care in the Terrace area.

Hon. P. Priddy: The person who is in Terrace -- although, I mean, we certainly

recommended a name -- is actually hired by and is working for the health authority, not

for us, so his mandate comes from them. But I'm still pleased to speak briefly about the

mandate. If there's a need for someone to go in, you try and have someone go in on the

basis of at least initially being a mentor, not somebody who goes in with some kind of

heavy hammer or whatever. They go in to be a mentor to the people who are there. His

mandate is to look not only at the budget but at the way that health care is being

delivered and if it's being delivered in a way that meets the needs of people in Terrace,

and to work with the board and to work with the CEOs up there to be able to do that.

While cost is very often a consideration in terms of people who may need more resources

in one place or another, we have often found that it is also about how people are managing

the resources they have. Sometimes people just need some assistance to actually manage the

resources in a bit of a different way. He's doing both: he's looking at how they manage

their budget as well as at the most effective way of delivering services to patients

there, to meet their needs.

C. Hansen: Again continuing on the area, on Terrace issues, the chair of the

regional health district recently expressed concerns about the number of times that

northerners who are transported to Vancouver for emergency surgery are left stranded in

Vancouver. There have been two incidents recently where individuals have had to come to

Vancouver for surgery, and they were basically left to their own devices to get back to

Terrace. I'm aware of the specific cases in terms of Terrace, but certainly it's an issue

that affects all communities throughout northern British Columbia. In one situation a

patient with a broken leg had to endure an 18-hour bus ride in order to return home to

Terrace, because that was the only means he could afford, and even that was at some

hardship.

[1505]

I'm wondering if the ministry has looked at programs to allow individuals to get

transportation back to their communities again. Will the health care system in British

Columbia take responsibility for these individuals not just from the time they pick them

up in an ambulance until they're finished surgery, but actually responsibility to ensure

that they have the means and ability to return to their communities without a great deal

of suffering?

Hon. P. Priddy: I'll try and answer the question. I'm not absolutely certain of

the circumstances. This someone who came to Vancouver was not treated and was sent back .

. . ?

Interjection.

Hon. P. Priddy: Okay, thank you. I know of one, and I don't know if that's one

of the two. There may be others. What happens under normal circumstances is that the

hospital has a responsibility to notify the patient that their surgery has been cancelled.

If they do not do that . . . .

Interjection.

Hon. P. Priddy: Oh, so they didn't cancel the surgery. They completed the

surgery. Okay.

Then the resource that that person is able to access, at least to some degree, is the

travel assistance program. It is true that if you are sent by ambulance or air ambulance

or whatever to a hospital and your treatment is completed, the health care system doesn't

then take someone who's ambulatory and pay the cost of their returning home. I'm not sure

we would be able to do that in every circumstance. This sounds like it may be a bit

different, and I'm prepared to look into that case -- whether someone was sent home in

very uncomfortable circumstances. We're not typically able to do that if we have

[ Page 14117 ]

somebody who is ambulatory and who has completed their treatment. But they can access

the travel assistance program, and hospitals and social workers should let them know that

it's available.

C. Hansen: Let's be clear as to what the travel assistance program is all about.

That's basically by the good graces of a few of the airlines which offer a discounted

rate. So instead of paying $1,000 for an airfare that can't be booked on a charter-class

basis, because there's never time, they might get an airfare that's perhaps 30 percent

less, or something along that line.

But still, in urban centres we often talk about seamless care, and we often talk about

the continuum of care in health care in British Columbia. Well, when you talk about a

patient who is picked up by an ambulance and then sent down by air ambulance to Vancouver

for surgery and who then is basically dumped out on the street and left to their own

devices to get back to their own communities, that is a tremendous hardship on many, many

families. I certainly think it's something that warrants a review by the ministry. While I

have the example specifically from Terrace, I know there are cases exactly like this from

communities all over rural and remote British Columbia.

I will move on. I will give the minister an opportunity to respond; otherwise, I will

move on.

Hon. P. Priddy: I would not attempt to minimize at all the fact that if you are

not from an urban area, it's harder. The tertiary care centres are in urban areas, and

you're not, if you live in a rural or remote community. There are far greater challenges;

there's no question about that.

We do note that with the travel assistance program, about 90 percent of the people who

ask for assistance actually ask for ferry assistance, for which, of course, there is no

cost to them. We administer the program, so we have some administrative costs that we

provide for, and -- you're right -- the rest is as a result of discounts provided by the

airlines.

It is a challenge; it continues to be one. I would not for a moment suggest that it's

as easy or as seamless for people who live in very northern communities as it is for

somebody who lives in an urban centre. There are really big challenges to that. I don't

know if we'll ever have a system where it's absolutely as easy if you live in Valemount as

it is if you live in Victoria. But we'll continue to work with the airlines and with

people, to try and make it as accessible as possible.

[1510]

C. Hansen: I want to move on to Kitimat. On June 2 we raised some of the issues

around Kitimat health care in question period. The minister's response was basically to

say that they're getting a new $35 million hospital and that they should be happy. That

certainly doesn't address some of the real, fundamental problems that the community has in

the confidence they have in their health care system and the community health council.

Several issues arise out of that, but if I can just pick up on question period itself.

The minister made a comment . . . . Actually, there are two comments that I

highlighted. She said that the government delivered on $35 million for a new health care

centre in Kitimat. I had to break the news to some of the residents in Kitimat that given

the ministry's track record on making promises and then stopping construction before we

actually see a completed structure, there's cause for them not to be too optimistic until

they actually see the ribbon being cut and the front doors being unlocked.

The other issue, though, that I flagged out of that Hansard discussion was the

minister's comment. She said: "This government delivered on not moving orthopedic

care out of Kitimat, which we promised." I'm wondering if the minister could explain

how the ministry has actually delivered on that promise.

Hon. P. Priddy: With the greatest of respect, I don't think I said they got $35 million for a health

centre and that they should be happy. I think my answer was around a question of:

"People in Kitimat have been neglected, so why should people believe that you would

do something?" Well, there was an increase in the Health budget, and they have had

their health centre approved. So I don't think I said they would be happy. I was trying to

indicate -- and I think I did -- a couple of promises that were kept.

Let me move on to the orthopedic one. By the way, I am aware that they don't currently

have an orthopedic surgeon in Kitimat. But there had been some discussion about moving the

orthopedic service from Kitimat to Terrace. There are people who would make the argument

or take the position that it should be in Terrace. It's currently certified or agreed to

be in Kitimat. They are recruiting a new orthopedic surgeon with HEABC and the health

authority, and our commitment is that that person will go to Kitimat. That's what I meant

by saying that I've not said: "Oh, you're right. You should worry. We're going to put

this person into Terrace." They're being recruited for Kitimat.

C. Hansen: I think that until such time as there is a new orthopedic surgeon

serving Kitimat -- working in the Kitimat hospital -- there is an enormous amount of

suspicion. The words ring a little bit hollow until that person is actually hired. I

wonder if the minister can give us a time line as to when the residents of Kitimat are

going to be able to see an orthopedic surgeon engaged and working out of that hospital.

Hon. P. Priddy: No, I'm not able to do that. We are using our best efforts; so

is HEABC; so is the local health authority. I can't promise you when there will be an

orthopedic surgeon who is prepared to work in Kitimat.

C. Hansen: Generally speaking, I'm sure I don't have to tell the minister that

there is a huge amount of anxiety about health care in Kitimat. She's been getting the

letters, and I've been getting copies of them. There are some that I just want to

reference.

This is a letter that I actually referenced on May 2, when I raised it during question

period. It's signed by the mayor; the CAW representative; an HEU representative; a B.C.

Nurses Union representative; a physician representative; Health Watch; the Home Support

Service; first nations; the KAHC, which is the Kitimat and Area health council, I believe

-- I may have that wrong; a retired spokesperson; the Health Sciences Association

representative; and an industrial community representative, which this signature is.

[1515]

It's a letter that is very strongly worded, and it was addressed to the Premier on May

28. It says: "The citizens of

[ Page 14118 ]

this community have, over the past eight years, witnessed a progressive deterioration

in the level of health care available within this community." It goes on to say, a

little later on: "The citizens of Kitimat have been denied care within the community .

. . . " These are pretty strong words coming from that group of community

leaders.

Another letter which I received a month ago today, actually, is from an operating nurse

at the Kitimat General Hospital. She says that she has worked in the community for 25

years, and this is a quote from her letter: "For over six years, medical services

have been unstable and declining for our townspeople." These are strong words.

I understand that the minister has asked a few individuals to go into that community on

behalf of the ministry. Again, I'm assuming that they're engaged by the ministry, but the

minister could correct me on that. These are issues that I think go back to some of the

fundamental structuring of who represents the community when it comes to the delivery of

health care.

I would like to ask the minister about the appointment process for representatives on

the Kitimat and Area health council. Specifically, there were three new appointments made

very recently, effective May 31. There is an appointment process that the ministry puts

out, a document entitled "Appointment Process for British Columbia Health

Authorities: Implementation Guide for 1998-99." It says quite clearly that community

health councils will lead an open, publicly inclusive nomination process. It says that

there will be a nomination review panel composed of ministry staff, the minister's

delegate, the manager of agencies, boards and commissions and a representative from the

Health Association of British Columbia.

There's also a process in there for nominees to be put forward from the community. My

understanding is that, as happens in most communities, they put an ad in the Kitimat paper

calling for nominees to come forward. Several names came forward. Yet it appears that the

names that ultimately got appointed on May 31, which is only a small portion of the board

-- I think there are only eight active board members on that community health council

today, out of the 15 that will be the full quota -- did not come out of that nomination

process that has been set forward. I'm wondering if the minister could explain to us where

these names came from and how they came to be appointed to this community health council.

Hon. P. Priddy: The member is correct when he talks about the typical process,

which is the process that this board went through in January. When the board was left with

only four people and no chair, I think the options became somewhat more limited. To do a

full public process -- ads in the paper, etc. -- and have a board that is not large enough

to function and does not have a chair almost says that you have to take some other kinds

of steps. As I've said in the Legislature before, I am always very loath to put in a

trustee if there are any other options available.

These are minister's appointments. I have chosen as minister to do these in the way

that we did them in January, which is the way that the member has described. But I think

that in this particular circumstance, there was not time to . . . . I mean,

this usually takes a three- or four-month period of time. I don't think the Kitimat board

had that length of time to appoint new members.

[1520]

The members' names that went forward . . . . Certainly the physician's name

has come forward from the community on a number of occasions. He is the physician that was

appointed. It's come forward, as I say, on a number of occasions from Health Watch and

people in the community. Some names would have come through the agencies, boards and

commissions branch. Some names may have been recommended in other ways. It needs people on

the board -- always, on any board -- to make sure that there's leadership to keep the

health system functioning.

Without trying to totally dance on the head of a pin -- but a little bit -- the letter

that the member refers to, signed by representatives of the unions, was signed primarily

by people who -- it certainly doesn't discount their concerns, by the way -- are members

of those unions. But it was not initiated by the union; it was initiated by those people

who happen to be members in those unions. It doesn't take away from their concerns, but it

does mean that their provincial union didn't take that perspective.

I can only speak for the next five minutes, but I think that currently things are

quieter there. People are pleased with the physician who's come on to the board, and I

think that at the moment it's quieter and people are trying to find ways to move forward

together.

C. Hansen: The appointment process had started, though. It wasn't a case that

when there were mass resignations from the community health council, suddenly everyone had

to scramble. The ads had already gone into the paper. There were individuals that had

already been appointed or had put forward their nomination papers. And yet it appears that

the people who put their names forward from the community were ignored and that instead,

through some other process or some other route, they went out and found three other people

to appoint to this board. I'd like to know, since we have a document that talks about the

appointment process . . . . It's the guidelines that are to be followed by all

health authorities in this province. That process was ignored by this minister, and there

were three people whose names came from somewhere else.

You get a community where there is enough anxiety about their health care system, and

then there are individuals being appointed . . . . I have no criticism of

these individuals. I've never met them, but I've heard people tell me that they are

respected members of their community. So I don't want to cast any aspersions on their

credibility as members of their community. But what is key is the community's sense that

there are representatives there who are going to speak for them and advocate for them in

terms of health care in that community. I'd like to find out from the minister: where did

these three names come from? Who submitted them? They certainly didn't come through the

process of individuals submitting their own nominations in response to the ad that was in

the community newspaper.

Hon. P. Priddy: My understanding -- at least with the names that I can recall --

is that those did come through the agencies, boards and commissions branch. They didn't

come out of nowhere. We do canvass the community, and the community submits the names. For

the most part, those are the folks who are appointed. But we also canvass the agencies,

boards and commissions branch to make sure that we have some kind of blend on the board in

terms of -- and we've had this conversation before -- ethnic representation, gender

[ Page 14119 ]

representation, youth, etc. We don't always meet all those criteria, but we work hard

to at least meet some of those. That's my understanding. The name of the physician, I

understand, came from the community or from Health Watch.

C. Hansen: Actually, I'm going to deal with the physician appointment in a

moment, because that's another whole story unto itself.

Maybe I'll ask the minister this: what role did the member for Skeena have in coming up

with the three names or in screening the three names that were finally approved?

Hon. P. Priddy: The role that the member for Skeena played is not much different

from what another MLA would have played. They are asked -- as I hope any MLA would -- to

pay attention to their health board appointments and to submit names. That's not much

different. But would he have had a role in submitting names? Of course he would have.

[1525]

C. Hansen: I think what's important here is that you have a community that was

lacking confidence in its community health council and that you wound up with appointments

coming forward, which are not the names that the community put forward through the regular

nomination process that was in place. Then you wind up with individuals who are being

appointed -- two of the three, I understand . . . . The perception in the

community is that their loyalties to the New Democratic Party are far greater than they

are to the delivery of health care. I emphasize the word "perception."

That's what's key, because I think it's a question of: who in the community do you have

confidence in to serve on community health councils and regional health boards? There has

to be a perception that those individuals who are appointed are there to serve the

community, to serve health care and to advocate on behalf of residents of those

communities. Quite frankly, I don't believe that that kind of partisanship should have any

role in the appointment of members of the health authorities. That's why we have this

appointment process that has been put forward. I believe that some accountability is

needed in terms of why this particular appointment process was abandoned so dramatically.

To say that they were left without an adequate number just doesn't cut it, because the

voluntary nominations were already in. People had already submitted their names, and there

was not an opportunity to have the community put in place the people they wanted to see

represent them.

I want to move on to the medical representative, and I'm pleased that there is finally

a medical representative appointed to this community health council. I'm wondering if the

minister could explain: why is it that it has taken two years to get a medical

representative on this board? It appears to me that there have been lots of excuses, in

terms of correspondence that went astray. There was one name put forward, and that name

was finally withdrawn in frustration. A new name was put forward, but it has truly taken

two years in order to get a medical representative on this board. I wonder if the minister

could give us some assurance that medical representatives will in fact be appointed with

much more haste than we have seen in this case, so that this doesn't become a practice in

other community health councils around the province.

Hon. P. Priddy: I can't respond to the length of time. I mean, I guess I could

if I got someone to check. I think the member has raised a point that is a challenge for

all of us as it relates to Kitimat. There have been more issues around the dynamics of the

community than there might be in some other places; that happens. But normally I can't

think of any appointments this year where the medical representative was not appointed at

the same time as the rest of the board. So yes, I can assure you that it happens with

haste or at least at the same time around the rest of the province. There may be an

exception, but I can't think of one offhand.

I appreciate the comment from the member about partisanship, although I guess if there

are four new members and two are seen as being pro-NDP, then the other two are seen as

not. So I'm not sure that's a really big problem. But I have not met anybody, whether they

are Liberals or New Democrats, who doesn't hold a partisan position for a party that is

currently elected in British Columbia and who aren't doing their work on the health

authority, because their first concern is about health care.

You know, the last time I met with a group of health care chairs -- just because I

happen to know them -- out of the people there, two-thirds would not be seen as pro-New

Democratic Party in any way, shape or form and are active, actually, with other parties.

That's fair enough. They're the health chairs, and they're concerned. Around the

partisanship, I think that you will find chairs of health boards who are Liberals, chairs

who have no political affiliation and chairs that are New Democrats. But I don't think

that you will find a partisan imbalance.

[1530]

C. Hansen: I think what's important is the perception in the communities. The

communities have to perceive that these individuals are there to serve the communities.

That's where it comes back to the importance of protecting the integrity of the

appointment process; that's the point I want to leave the minister with on that.

Going back to June 2, in question period the minister referred to the new facility in

Kitimat as a health care centre. There are also other references that talk about the

health centre in Kitimat, as opposed to the hospital. I'm wondering: why the distinction?

Why is this new facility being called a health centre rather than being referred to as the

Kitimat General Hospital?

Hon. P. Priddy: I must admit that we have a lot of terminology in the health

care profession, and sometime we use them interchangeably. But the intention here in using

"health centre" is to have all of the services, including acute-care, under one

umbrella, if you will.

C. Hansen: Actually, I understand that to a certain extent the opposite is

happening -- that the current facility actually has doctors' offices in it that they can

lease from the hospital, from the health council. The new facility doesn't have that

opportunity for fee-for-service doctors. So in fact the new plan -- the new blueprints

that are there for this so-called health centre -- where it has doctors' office in it

actually has the words "salaried doctors," which is quite a departure from the

way that particular hospital is operating today.

I'm wondering if the minister could, first, give assurance to Kitimat that their

acute-care designation is not and will not be jeopardized. Secondly, why is it that we're

looking at blueprints that show positions for salaried doctors in that community as

opposed to the current situation that's there?

[ Page 14120 ]

Hon. P. Priddy: I can absolutely guarantee that their acute-care status, if you

will, or definition is not in any way at risk. The comment about the blueprints, I'm

afraid, is too technical for . . . . I mean, I don't know. We can check for

you and get back to you on that one. But I can absolutely assure that their acute-care

status is not at risk.

C. Hansen: There are several other communities in British Columbia where there

is growing anxiety about whether or not their acute-care status will continue, and two

others come to mind right off the top of my head. One is Quesnel; the other is Princeton.

There are other communities as well. I'm wondering if the minister could define for us

what a minimum standard would be for the number of beds at an acute-care hospital in

British Columbia.

Hon. P. Priddy: Although many of these decisions are made at a health authority

level, I can tell the member that I'm told that there is no place in British Columbia that

is in danger, if you will -- that's your phrase -- or is considered to be not having their

acute-care status in the future. There isn't a bed count, if you will. We have hospitals

with three beds occupied that have an acute-care status. They may have ten beds, but they

have three occupied the majority of the time and are not full. They still have an

acute-care status. The health authority might choose to add beds or subtract beds or use

them differently, but they still act as an acute-care centre.

C. Hansen: I was asked to raise an issue specifically. This is coming from the

Kaslo and District Health Planning Society. They are extremely anxious about the site plan

evaluation for the Kootenay Lake District Hospital and the Mount St. Francis Hospital in

Nelson. I'm wondering if the minister could give us an update on the status of that

particular project.

[1535]

Hon. P. Priddy: To the member: is your question about the status of St. Francis? Is

that it? I want to be clear.

C. Hansen: It's specifically regarding the Kootenay Lake District Hospital and

the Mount St. Francis Hospital or facility. My understanding is that there's a site

evaluation that has been approved. I'm just wondering if the minister can give us a time

line as to when that project is going to move forward.

Hon. P. Priddy: I do know that the Ministry of Health supports this particular

project and is working out the logistics of completing the project. I have staff just

checking the time frames. It will take a couple of minutes, if you want to move on to your

next question, hon. member -- through the Chair.

C. Hansen: We'll move over to the Kootenays, specifically to the Elk Valley,

which is another area where there has been some concern and anxiety regarding whether or

not the community health council was truly able to represent some of those concerns.

There was a letter sent to me a few months ago by an individual resigning from the

community health council. I'll read just a portion from that letter, because it's

certainly much more powerful than what I could put in my own words. It says: "I

hereby resign from your community health council, a council that, in the matter of

physician on-call services, is so tied by your ministry's terms that it is creating

divisions in the Elk Valley far deeper than any that existed previously. I am very tired

-- tired of constantly having to put out fires, trying to stop the erosion of basic

services."

This letter goes on to talk about Closer To Home and about how emergency health care

for 3,000 people is in fact being moved farther away from the community than what they had

previously. The mayor of Elkford, Bill Wilcox, was quoted -- referring to the Dobbin

report -- as saying that the on-call formula for physicians in Elkford was inappropriate.

I think that, again, it's an area where one size doesn't necessarily fit all. The programs

that are in place today aren't meeting the needs of that particular community. I'm

wondering if the minister could tell us how those particular concerns are being addressed.

[1540]

Hon. P. Priddy: I am aware of this particular circumstance, although I have not .

. . . Although I know I read every one of the thousands of letters that come, I

don't recall seeing more from the Elkford area expressing that concern. But I am aware of

the situation.

The member's right: there is no such thing as one-size-fits-all in the province of

British Columbia. That's just not what we look like here. I don't think that Dobbin has

answered every single concern out there that people have, although I have letters written

to me by mayors that were incredibly outspoken at the time this was happening, saying how

well it's working for their communities. I know the member is not suggesting that it's not

working well in other places as well.

In Elkford, I think the mayor's concern is that there is a difference, for an

acute-care hospital, in the on-call paid if the community has a diagnostic and treatment

centre, not an acute-care hospital. That was the Dobbin issue that in the end Lucy Dobbin

did not resolve and that we still have not been able to resolve satisfactorily. I don't

have an answer for how we're going to resolve that. We've still talking about this issue

in our advisory committee on rural and remote health care, which has representation from

rural communities and from mayors, but I don't have a resolution at this stage. I do know

that the CHC up there is recruiting another physician -- and I think they've been able to

do that -- in order to at least provide better coverage so that people aren't doing the

same amount of on call as they have been doing.

I expect you'll canvass this, so you probably don't need to do it now. I'll just note

-- I expect you'll canvass it under Dobbin anyway -- that some of this is about what a

general practitioner is and what a specialist is. That's one of the issues that we hear is

still not satisfactory for people.

C. Hansen: I'm going to move on to "Strategic Directions," a document

that has been circulated in draft form. But before I do that, I don't know if the minister

has an answer now in terms of Kaslo. Now would be a good time to deal with that.

Hon. P. Priddy: I think that I have as much as I'm going to be able to provide

to the member. I think he referenced earlier -- no, maybe not -- that there has been a

planning study done to accommodate 20 multilevel-care beds in the Victorian Hospital of

Kaslo -- so in Kaslo, as well, looking at additional multilevel-care beds. I didn't know

if there was

[ Page 14121 ]

more beyond this. I knew this piece. The West Kootenays have just completed -- this is

our undertaking, but I think it's actually completed -- a comprehensive review of service

requirements in their whole area. I think the timing of the next steps is contingent on

what the West Kootenay plan and recommendations are -- which, I will tell you, we haven't

seen as yet. I think the plan was just completed. We have not seen it at all, but part of

that future direction will be dependent on what the West Kootenays recommend in their

review of service requirements.

C. Hansen: I'd like to move on to "Strategic Directions for British

Columbia's Health Services System," which is in draft form. The minister has

circulated it, I believe, to health authorities around the province for input. If we go

back to the Hansard debate of last year -- in fact, last July 16 -- when we were in

the middle of Health estimates . . . . I want to read a quote from the

minister at that time. She said: "Yes, we do have a strategic vision, which we've

actually just finished developing." That was a year ago, and the minister at that

time actually quoted from sections of it and promised that it would be tabled in the House

as soon as it was printed, basically. The implication was that it was virtually finished

at that time. Here we are, just two weeks short of a year later, and the document still

hasn't been released, still hasn't been finalized. I'm wondering if the minister could

tell us what has transpired over the last year in terms of moving this document forward.

[1545]

Hon. P. Priddy: I have learned the hard way over this last year not to use time

lines in quite the same way -- or not to accept them at face value. The strategic

document, when it was completed last year, was still not a satisfactory document for many

people. Albeit it was very close to completion, it turned out to be not satisfactory in a

number of ways. People went back out to communities, and you have the result of that

further consultation.

C. Hansen: That actually leads nicely into the next point that I want to raise,

and that is to get an understanding from the minister as to whose document this is. Is

this a document that was developed by the policy planning

section of the ministry, for

example? When the minister talks about people going out for further consultations, who are

the people? Who has put these words together?

Hon. P. Priddy: Much of the initial work was done by policy people in the

Ministry of Health -- that's correct. However, our understanding with health authorities

and others has been that this is not intended to be a strategic plan or a work plan only

for the Ministry of Health. It's intended to be something where there is investment by all

partners -- or as many partners as we can -- who are part of the health care constituency

group, if you will. It's not a phrase I like, nevertheless . . . . Therefore

it would include things that had to do with the Health ministry and would include things

that had to do with health authorities or physicians or nurses or whatever else that might

be. While the draft -- the words -- was initially put together, the work then went out to

the BCMA, the regions, the CHCs, the RNABC, the Health Employers Association of B.C., the

College of Physicians and Surgeons, pharmacists and unions concerned with people working

in the health care profession. All of those people then had input into it. So while it

started out originally as words put together with thoughts from those people, it turned

into a document that has words from those people in it as well.

C. Hansen: I want to read a couple of the lines just from the introduction in

this document. It says:

"This document is intended to provide a context for planning and as such will help

support the planning activities of health authorities, practitioners, professional

colleges and others involved in the delivery of health services."

It goes on to say:

"This strategic document will be complemented by the health service plans of the

health authorities and by the Ministry of Health workplan. The Ministry of Health workplan

will describe specific actions the ministry will take within the broad directions laid out

in this document."

When we started, we talked about the various accountability documents that were being

produced by the ministry. This strikes me as though you've got the cart before the horse

on this whole process. Strategic vision is not something that you do after you do

workplans; strategic vision is something that leads the process. In fact, later in here we

talk about the accountability cycle. I'm not sure if I can find it, but I'll certainly

come to it as I go through this document.

[1550]

The vision coming from the minister, which should be the vision that basically sets out

the direction that health care is going to go, should be the starting document. From there

the workplans of the health authorities flow and the workplans of the various divisions

with branches within the ministry flow. I'm wondering if the minister could explain to us:

why is it that we have this document coming at the end of that process rather than at the

start of that process?

[W. Hartley in the chair.]

Hon. P. Priddy: I suppose in the best of all worlds you'd have a start point for

everything, where everything would start on Monday. But that's probably not the way that

any kind of planning happens. This is not to suggest that there have not been other kinds

of planning documents. Of course there have been -- from health authorities, workplans as

part of the ministry, individual parts like the mental health plan, etc. All of them have

been, if you will, planning documents. What this looks at is: where do we go from here,

given that -- while people had seen a draft of this as they were developing their

community health plans -- this was not finalized?

So this is what we intend it to look like in the future. As I say, in the best of all

worlds everybody starts on Monday. But it is a much more dynamic kind of process than

that. The workplans that we see this year are partly based on this, because this was far

enough along for people in the ministry to at least have a sense of that vision. But next

year, with this absolutely complete, then the workplans and the health authority plans can

link very directly into this. Certainly the feedback I've had from the health authorities

about this -- because this is sort of a rolling three-year plan, if you will -- is that

they consider it to be very helpful.

C. Hansen: I guess the issue is that it's a rolling three-year plan, but three

years have already rolled before we've even got into this. Certainly a whole year has

rolled since the minister told us a year ago that it was ready for printing.

I want to get into some of the specific goals and strategies that are set out in this

document. If the minister is following it,

[ Page 14122 ]

I'm on page 3 under the title of "Health of British Columbians." There is

objective 2, which is: "To assist individuals, practitioners and health authorities

in planning for and responding to emergency diseases and changes in disease

patterns." Under "Strategies" it says that the ministry will maintain

robust and comprehensive surveillance and research systems so that diseases, disease

patterns and adverse health effects can be quickly identified.

I wonder if the minister could explain to us the capacity that health authorities,

practitioners and individuals have in order to deliver on that particular strategy?

Certainly if you look at the ability that regional health authorities have to put in

computer equipment, the common protocols for data management, there is still a lot of work

to be done. I'm wondering if the minister could tell us whether or not we even have the

capability within our health system to deliver on that particular strategy.

Hon. P. Priddy: As I reply to any of these, both goals and objectives, this will

be work, in part, that is still underway. One of the examples I would use is the British

Columbia Centre for Disease Control. We're now putting in a provincial system to manage

information, particularly to manage immunization -- or non-immunization, because that's a

concern I have as well. That means that there will be a provincial system for managing the

data around communicable diseases that we see are affected by immunization -- which is

primarily children but certainly some adults as well. We certainly have legislation on

reportable diseases, and it works well. That is reported not only to local health people

but to the B.C. Centre for Disease Control, and is entered into a database as well.

Every health authority doesn't have to have its own database to track disease control.

There is a funded B.C. Centre for Disease Control which marks those trends; so does the

provincial medical health officer. It's not that each health authority is intended to do

all that work on its own.

[1555]

C. Hansen: Thank you. I want to move along to objective No. 3. I'll just read it

out, because it's a very big issue in this province: "To reduce the inequalities in

health status among people in British Columbia. In particular, the health of the

aboriginal population and of those regions with lower health status should be moving

toward the level enjoyed by the general population."

That is a huge issue, and it is one where we certainly see some huge inequities between

the health outcomes within aboriginal communities and the health outcomes in other centres

-- particularly urban centres but even compared to other rural centres -- in British

Columbia. Yet the strategy that comes out of that objective is one sentence, and that is:

"Develop and implement a provincial aboriginal health services strategy." That's

it.

First of all, for something that is such a huge issue in British Columbia, I would

expect that there would be a lot more concrete action that would be planned to address

that issue. Secondly, perhaps the minister could inform us as to where we are in the

development of that strategy and when we can expect it to be made public.

Hon. P. Priddy: There are many things that already go on, so it's not that

nothing goes on in the area of aboriginal health. But the member is quite correct, as was

the provincial health officer in his report about the health of aboriginal people. Their

health outcomes are not anywhere near what we would want to see, compared to the

non-aboriginal population. So a number of those things will be reflected in the provincial

aboriginal health services strategy.

But there are a couple of other things -- and then I'll come back to that in a moment

-- that I want to state out loud. In large part, we have to go back to the social

determinants of health and look at the other ministries that have a role to play in the

health of aboriginal people. When you look at the health determinants and outcomes, it's

not only about health services; it's about self-determination. We know, for instance, that

the Nisga'a population, who've had control of their own health care system for a long

time, have better health outcomes than most other aboriginal people in the province. So

it's not only about what the Health ministry is doing; it's bringing together other

ministries that have a responsibility for the social determinants of health.

By the way, it's also a federal government responsibility, as I know the member knows

-- at least on reserve. That is a really unresolved question in terms of how the federal

government makes its contribution to that, whether it's enough and what they fund off and

on reserve. I mean, that's one of the other pieces to be worked out as it relates to this.

[1600]

The aboriginal strategy people have been meeting for about a year now, at least. I

think the member would understand that in the aboriginal community, it's not just one

group that you have to get to the table. There are lots of groups that you have to get to

the table. There's a meeting with staff this week, which is the first time that all of the

aboriginal organizations will be in the same room together talking about this. So it is a

much slower process than I would like, but I also know that it's the only way to do it --

because you can't impose it.

If I could give you an answer about when it would be ready, I would. I can't, and I'm

not sure that I can estimate. So much of that depends on what happens in the dynamics in

that room and what kind of agreement you're able to get. But in the meantime, there are

certainly things that we in the Ministry of Health are doing directly to make a difference

in health for aboriginal people. But you'll probably canvass that somewhere else.

C. Hansen: If I can move on to objective 4, I'm going to read out this

objective. I'll give the minister the opportunity to respond to it if she wants; otherwise

I'll move on. I just want to make the point on this particular objective that it's a very

big objective: "Use the provincial health goals to stimulate social, environmental

and economic actions to improve health in the broadest sense."

That is a huge objective. Yet if you go down to the strategies, the strategies don't

match the objective at all. You talk about implementing community- and neighbourhood-level

strategies that support the health and well-being of residents. The second one is:

"Encourage the population to understand the impact of social, economic and

environmental factors on health." The third one is: "The provincial health

officer will continue to report . . . . " When you read the objective and

the strategies, they don't match. I don't think they live up to the magnitude of what the

objective would present.

[ Page 14123 ]

I make that point only because it sort of ties into an overall approach that I have on

this document. But if the minister wishes to respond specifically, I'll give her the

opportunity before I move on.

Hon. P. Priddy: I'll try to be brief in my response. In the earlier documents

that you have, I think it says strategies; and in whatever the third edited version is, it

says subobjectives. This is not intended to be the workplan; this is intended to inform

the health care system. So what the health authorities or others will do is use these to

develop their own plans. A lot of the specificity will come because the health authorities

have used this to inform their plans or the CHCs or the physicians or another

organization's. This isn't intended to have in it every single piece that somebody will

do; it's intended to be something that informs the work of people within the health

profession.

C. Hansen: If we move on to page 6 . . . . I want to use this

opportunity to insert a question about the interprovincial relations rather than trying to

raise it under any sort of specific thing later on. In here it talks about wait-lists, and

it says: "Waiting time is influenced by a variety of factors: with few exceptions,

there are no widely used standardized criteria to determine whether or when a patient

should be placed on a list, nor are standardized criteria available to prioritize those

patients who are on lists . . . . "

I understand that out of the meeting of western Premiers, there was an agreement that

the western provinces were going to work cooperatively on coming up with standards for

waiting times and defining waiting times. Although it's not directly relevant to the

document, it's referenced in here. So I thought I would use that as an excuse to ask the

minister to give us an update on where we're at in terms of the development of those

standards.

[1605]

Hon. P. Priddy: This was referenced at the Western Premiers' Conference. This is a

project that has been underway for six or seven months now, using health transition

funding in partnership with the federal government. It's a two-year project, so it's due

to finish in . . . . I hate to even say these things, you know, but it's due

to finish in July of 2000. It's due for completion then. There are representatives from

the ministries of Health on them -- through the western provinces -- researchers, etc.

It's measuring five categories, if you will, for wait times and for criteria around

service: MRIs, cataracts, general surgery, pediatric mental health, and hips and knees.

Those are the five categories that the four western provinces are looking at.

C. Hansen: If we move on to page 8, there is . . . . I know the

minister is reluctant to give time lines on projects. But as I was reading through this

document, my pencil notes were: "By when and in what format will these documents be

made public? Whose input is being solicited?"

We're talking about developing standards for access. There's a requirement here to

provide regular reports to the public on services provided and to develop and implement

coordinated systems." Again, if you come down to the bottom on the page, it says:

"Define which services British Columbians can expect to receive in communities of

various sizes; develop and implement supports and programs to improve access in remote and

rural areas; develop strategies to ensure the recruitment and retention of service

providers in remote and rural areas of British Columbia." I know the minister is

reluctant to give dates, but these are obviously some pretty important documents that the

public is going to be looking for. Certainly there would be great anxiety if these were

years off as opposed to weeks or a couple of months off. I wonder if the minister can give

us some perspective.

Hon. P. Priddy: You're right. I don't have a particular date beside each of

those, though I think we can at least get closer to that once this has been finalized with

the health authorities. It is important to remember that this is all identified work. It

is a three-year dynamic or rolling plan, if you will. I'm not sure I can point to these

and say that in two weeks this will be done. I'm not sure there is anything in there --

and there probably shouldn't be anything in there -- that's a goal, objective or

subobjective that could be done in two weeks. And in that case, I would have hoped we

would have done it earlier, if it were only a two-week plan to be able to identify .

. . .

One of the questions you asked -- you said you pencilled it in the notes -- was: who

gets to have input, and so on? As far as this is concerned, the intention is to continue

with the current people who have had input and also to expand that input. For instance,

some people from UBCM have been consulted, because they're on other committees with us.

But I'd want to take this to UBCM, maybe even this fall. UBCM needs to be an important

part of that, and so do health authorities. We're beginning this process, but what we

would also do is take it to the public. That doesn't mean the work won't start until it's

been to the public. Again, this is about it being too bad we can't all start on Monday.

But that is the intention also: that the public will have input into this.

[1610]

C. Hansen: If we wind up going through Health estimates next year without an

intervening election, I will certainly be raising these particular reports, documents and

strategies that are outlined here. I think the public are anxious that we get on with the

job of delivering a secure health care system. I can see that the minister wishes to

respond to that, so I will allow her to do that before I go on to the next point.

Hon. P. Priddy: I just want to assure the member that I'm sure that regardless

of who is the minister -- certainly if it's me, but whoever it is -- the Health ministry

will have the information available to answer most of those questions in the estimates

next year that we will certainly have together.

C. Hansen: We could go down a lot of roads with that comment, but let me say

that I appreciate the commitment that the minister just made on behalf of the ministry:

that whoever is minister at the time will be able to deliver some of these documents one

year from now -- or, I would say, most or all of these documents and strategies that are

discussed in this particular report.

I want to move on to page 11, where we talk about accountability. Specifically, I want

to point out to the minister that under strategy 2.2 -- which is: "Ensure that

ministry annual reports include interregional performance comparisons and information on

what the system includes, how the system works, how the public can access services and

[ Page 14124 ]

activity levels within the system . . . . " I raise that, and I'm going

to flag it in two other places in this particular document where it talks about the annual

report of the ministry being the primary document for accountability.

Again, I raised this when we started the estimates process on June 28 -- that one of my

big disappointments is that we don't have an annual report that is more current than the

1996-97 fiscal year. If we're going to start using the annual report as a primary vehicle

for accountability -- which it should be -- it certainly has to be more timely. I point

that out. When we get into discussing communications issues, the one thing that I am going

to be looking for from the minister is an ironclad commitment as to when we are going to

see the next three annual reports that are due. But we'll save that until we get into

communications.

I also note that they talk in here about measuring public satisfaction with the system.

It says: "From time to time the provincial government conducts polls of public

satisfaction with the health care system." I'm wondering if the minister could

explain to us what kinds of polls the ministry has done over the past year to measure

British Columbians' satisfaction with the system.

Hon. P. Priddy: In terms of the specific ones done over the last while, I'd

prefer to refer that question to when we do communications, because I don't have that

particular staff here. I can talk to you a bit about the kinds of things we would ask but

not about the specific ones.

C. Hansen: I certainly appreciate that. We will probably be getting to

communications tomorrow, with any luck, and I will raise that issue at that time.

I want to move on to the issue of the various self-regulating professional colleges

that we have in British Columbia. In here it talks about ensuring that colleges conduct

their businesses fairly and transparently. This is an issue that certainly comes up from

time to time -- public concern about transparency at the various colleges. I'm wondering

if the minister could explain to us what she envisages seeing changed in order to ensure

that there is adequate transparency on the part of all of the colleges.

[1615]

Hon. P. Priddy: Some of this may be about change, but some of it may be about being

able to assure people that in any of the colleges there are processes, if you will, that

abide by administrative justice -- that people know how they make a complaint. How is it

handled? What's the transparency of the outcome of the complaint? You can read the

newspaper to know that people may have more concern in some areas than they do in others,

but if people have complained, they want to know what the outcome is. There may be some

information that people should not be privy to, but they need to know how their complaint

has been handled, that there's been an outcome to it, and so on. Those are the kinds of

transparency things that I would want to ensure not only are there in all colleges but are

seen to be there by the public.

C. Hansen: As we move forward through this document and come to page 15, there's

another reference to the accountability being through the ministry's annual report. I want

to flag that again, to highlight how that document is going to become important.

Moving onto the next page, there is a reference under objective 4 to the principles of

health reform. So I don't take it out of context, I'll read the whole sentence.

"Ministry of Health will require health authorities to develop health service plans

proposing changes to their health care systems to better align them with the principles of

health reform, including integration." I'm wondering if the minister could explain to

us what the principles of health reform are in this particular context. It sounds like

something very profound, but perhaps I'm reading too much into it.

Hon. P. Priddy: I guess the answers are profound in their impact on people, but

I don't think that they're anything the member doesn't know. Integration of services, very

particularly. I think that's something that the health system has not been particularly

effective at -- not for any reason; it's just the way it was designed initially. We don't

integrate services very well in communities between acute care and community care and

continuing care and so on. That integration of services is critical.

Closer to home. We know that not everybody can have all services in all communities;

that's not possible with lots of the tertiary services. But we can find ways, as we've

done with some of the renal dialysis treatments, to at least make sure that it's closer to

home for many people.

Looking at the cost-effectiveness of the system, I think that probably the member has

made this point before, but on the other hand, so have I. We talk a lot about the amount

of money we spend in this health care system, but we have to find ways to know whether we

spend it well. It's one thing to say we spend "more than," and it's another

thing that we must be able to say: "As a result of that, here is the outcome and here

is the proof that this has been spent effectively and efficiently." Integration,

closer to home, affordability for people and -- I probably should have said this first --

patient-centred, access -- which is a bit about being closer to home . . . .

Integration, effectiveness, efficiency, access, affordability, quality and patient

satisfaction -- or patient-centred, actually, I would say . . . .

C. Hansen: I want to move along to governance. There are some notes that I've

made regarding the appointment process being transparent. I think we canvassed that well

in our discussion under Kitimat, but certainly there's some room for improvement in the

transparency of our appointment process to health authorities.

It moves down under there to strategy 2.2 on page 18. It says: "In 2000, following

three years of experience with the health authority structure established in 1997, the

ministry will undertake a comprehensive third-party evaluation of the structure,

governance, management, operations and results of regionalization." Can the minister

tell us: is this budgeted for in this budget we have before us, and who will undertake

this third-party review?

[1620]

Hon. P. Priddy: When we are in estimates next year, I think we'll be closer to

having an answer for you on that. I'm sorry; I'm not trying to avoid the answer. The

answer is no, there's not money budgeted in this year's budget for this. This is something

that would be undertaken in 2000-2001. In terms of who would do it, I don't have any .

. . . Nor would I be the person who would know those people. I think the fact that

[ Page 14125 ]

we've said it's third-party is the key here. It's not an internal review to say how

good are we, or not; it's a third party coming in to look at that objectively.

C. Hansen: If you move on to objective 3, it talks about the establishment of

effective partnerships between health authorities and physicians. To make a comment, in

terms of the various health authorities that I've visited with around the province, some

health authorities are very good at this, and others are very bad at this. I think there's

a real discrepancy in terms of the relationship and the sense of partnership that exists

from community to community around the province.

Under "Strategies" in that area, there's something that I wanted to get some

clarification on, because I didn't know what it meant. It says: "Work with individual

physicians and the BCMA to align incentives faced by health authorities and

physicians." I'm wondering if the minister could explain what is meant by aligning

incentives.

Hon. P. Priddy: I wanted to respond, if I could, not to get into the debate. I

don't think there is a debate actually. As I have travelled around the province as well, I

have found communities where there are superb relationships. I think that is as a result

of physician groups that have an enormous capacity to work well with their health

authorities and health authorities that have a great capacity to work with their physician

groups. You're right: in some places, it works. I think it works well in more places than

it does not. Nevertheless, there is, I guess, room for improvement.

In terms of aligning incentives, obviously the goal of that is to provide the very best

care and to ensure -- well, not to ensure, to agree -- that health authorities and

physicians have a goal of wanting to provide the very best service to people. Sometimes

those incentives faced by health authorities and physicians do have to have, if you will,

a level playing field. That doesn't mean that everybody's are the same, but it does mean a

level playing field. That might, for instance, be around how people do recruitment. It

might be around continuing medical education. It might be around whether, if a community

needs a physician and doesn't have enough work for a fee-for-service physician to be able

to make a living to support herself and her family, you maybe put a paid physician in,

because that's the only way you'll have a physician who goes in there. I think it's those

kinds of things -- to make sure not that everybody has the same thing but that we're able

to align it enough that there's a level playing field for people.

C. Hansen: Before I leave the actual specifics of the document, I just want to

point out to the minister the last reference to the ministry's annual report on page 19.

In three locations in here we've got the annual report being used as the principal

document for accountability. We'll come back to that when we get onto communications,

which may well be tomorrow.

[1625]

This document is certainly presented as a document that is really to map out strategic

change over the next three years. As I read it, it's the document that in some ways will

become the blueprint or the bible in terms of strategic directions. It will be used by all

health care players in British Columbia. I certainly read it, in the way it's been set up

and presented, as being a very important document. I want to put it in a context. If you

put it in a context of where we're at in British Columbia today, there is a growing

anxiety about health care and a growing sense on the part of the public that perhaps the

health care system isn't delivering what they expect of it.

Just to reference a Marktrend survey that has asked the public about satisfaction with

medicare over the last number of years, if you go back to May 1992, some 77 percent of

British Columbians polled felt that medicare was either very good or quite good. In terms

of the negative side, there were only 5 percent that felt it was either quite poor or very

poor. If you fast-forward to December '98, which are the most recent numbers that I have

here, the satisfaction with medicare has actually declined to 43 percent in terms of very

good or quite good. Those who think it is just satisfactory number 33 percent, and 23

percent say it's quite poor or very poor. I think those numbers sort of point to what I

think we all hear from people we talk to and the letters we get: that the public is

growing increasingly anxious about the health care system that is there to serve them.

I just want to reference a couple of quotes that the minister has made. There's a

headline in the Vancouver Sun from last November 16, which says: "Health Care

System Needs Major Reforms" -- to quote the minister. "B.C.'s health care system

will not survive without major reforms, the Health minister believes." Again, on

"Voice of the Province" in December of last year, the minister said: "If we

do not do things differently, if we continue doing things the way we are for the next 20

or 25 years, medicare will not survive. We cannot survive that kind of economic

burden." I don't believe the minister is understating the magnitude of the problem,

combined with the public anxiety that is there. My question for the minister is: is this

the strategic document -- the strategic directions -- that she sees as fundamentally

addressing that need for major reform in terms of health care in British Columbia?

Hon. P. Priddy: Well, I think that it is -- certainly for the ministry and for

the system -- a particularly key piece. I don't think anything is the bible, with words or

interpretation never to be changed, but I think this provides an extremely important and

solid foundation on which to move forward. I have been honest enough to say that it won't

survive unless we do things differently. I think the concern that you reflect and the

polling I've seen suggest that this is not a British Columbia phenomenon, by any means.

This is something that we're seeing across North America in terms of people's concerns

about health care. I don't see that as happening only in British Columbia. Some of the

polls I've seen -- and we can all find a different poll -- actually have said that the

concern is somewhat less here in British Columbia but nevertheless very present.

So yes, I see that as a particularly important solid foundation on which to begin our

work forward. But you can put anything in words on paper. It is going to take creative

thinking and innovation on the part of people for us to be able to do this kind of work,

and it's going to take some real challenges for us to find the ways to . . . .

I don't know if it's to move away from the acute-care system, but it's to at least have

people focus on the whole system and understand how important prevention is. If we as the

public cannot have a greater focus on prevention than we currently do, then we will be

asked to provide exactly the same kinds of services that we currently provide, simply to a

greater number of people, in 20 or 25 years' time. It will take creativity and innovation

[ Page 14126 ]

terms of people's thinking to be able to move this document forward as well. But I see

it as a particularly good start. I don't quite see it as a bible.

[1630]

C. Hansen: I want to move more specifically to the issue of regionalization and

where we're at. When we embarked on these estimates debates a week ago, I raised the issue

of the three accountability documents that I didn't feel were in place. One of them was

the report card on Better Teamwork, Better Care. I'm just wondering if we will in fact see

that document come forward in the months to come.

From there I want to go on to talk about the accountability framework and some specific

questions I have about that document and also to get on to some of the broad issues of

health authority funding. But we could start with the issue of the report card on Better

Teamwork, Better Care.

Hon. P. Priddy: Will you see the report card in the next few weeks? I'm not sure

of the time frame you used. Probably not. But let me tell you a little bit about how that

is developing.

I'm not sure whether, when a report card was first talked about, people understood how

complex developing one is. You can't just go around to a region and say: "This is an

A, and this is a C." You have to base it on something. So in terms of the steps, I

think they are more complex than people may have originally anticipated.

In terms of where we are now, the ministry and health authorities are currently working

to both identify and agree on what are reasonable measurable goals and objectives for the

health system. Is it patient satisfaction? Is it how many surgeries you do? Is it how many

people have a post-op infection? Is it how many people are readmitted? I expect it would

build, but you have to decide where you're going to start in terms of what you're going to

measure and what you're actually able to measure in a finite period of time. I don't think

you want a report card that only measures over five years; you want something that can be

measured, probably, on an annual basis.

We are working with health authorities that have given me a fair bit of feedback at the

last meeting I had with them about that. It's much like the goals and objectives, but we

still have to reach agreement with health authorities -- and we're working on that -- on

exactly what the key performance indicators would be in their community. You also have to

think about: what does the community want to hear? In the end, undoubtedly we are

accountable to the people we serve in our own communities in health care, if you use that

particular example. So what are the key indicators that would indicate to a community

whether their health authority is doing well, not doing well, is in the middle, needs to

improve or whatever? We're working with health authorities on what those key performance

indicators would be in their communities.

If those are the key indicators, is that data readily available -- that we can access?

Or do you have to put a structure in place to be able to retrieve that data? I hope that

what we would find, and I expect what we would find, is that we'll have to select some key

indicators -- at least originally, in the beginning -- that have data available, because I

don't think we can afford the time before we do any of that to set up yet another data

collection process. But we do have to decide and find out if that data is available to be

collected or whether somebody has to put something in place.

Currently -- and the member probably knows this -- health authorities collect a variety

of data in a variety of ways about their own health services and how it's used. Once we've

developed those key indicators, it will be necessary, I think, to revise some of those

requirements, so health authorities can make sure that they incorporate that function into

their current planning and into their current reporting cycle if that's not one that they

currently are collecting. Then that would be information that, once collected, would be

disseminated to the public.

[1635]

The other organization we've been working with is called CIHI, which I'm sure you're

familiar with -- the Canadian Institute for Health Information -- because they've begun to

identify a number of performance indicators, as well, that you can compare nationally,

provincially and regionally. Even if you collect it here in B.C., people still want to

know and may need to know: how does that compare to western Canada? How does that compare

to central Canada? How does that compare to a Canadian average? We're working with them in

terms of indicators you can collect that you can actually compare currently. The Canadian

health information work probably will be finished early next year -- at least, that's the

target date they currently have.

I don't know if you want more. I mean, I can go on or not.

C. Hansen: I want to move on to the accountability framework for B.C. health

authorities, specifically. Let's see if we can take these in the order that they basically

arise here, which isn't necessarily in order of importance. There is reference to a

performance contract that is an agreement between the Ministry of Health and a health

authority with respect to specific tertiary care, which sets out the Ministry of Health's

performance expectations with respect to that service. I'm wondering if the minister can

give us a bit more information about the nature of performance contracts. I guess that's

about it; it was rather thin in terms of descriptive material.

Hon. P. Priddy: The performance contracts which are currently being developed

with the health authority . . . . But what they will include are such things

as . . . . We, for instance, will allocate X amount of money for cardiac care

or for a certain number of procedures in a health authority budget, particularly because

we're talking about tertiary care here. Then the performance contract would talk about the

number of procedures to be performed. It would talk about the cost per . . . .

Well, in the case of a procedure, it would talk in the contract about how much the cost is

per procedure, so you can measure at the end of the year whether each cardiac procedure,

each angioplasty or whatever, cost more than what was in the performance contract; and if

so, why, etc. That's the place where a performance contract would also look at whether

people are doing any interregional work; then that has to be factored in. Maybe some of

their work is done with another hospital or acute-care centre or tertiary care centre in

their region. That would have to be factored into the performance contract as well,

because maybe that work is going somewhere else. Those are some of the examples of what

would be specific in a performance contract.

[ Page 14127 ]

C. Hansen: If we move forward a couple of pages in this document, we have a

section

titled "The Accountability Cycle." I think it probably reiterates what I was

saying earlier about having the cart before the horse on this whole process. It says that

the accountability cycle " . . . begins with the Ministry of Health's

articulation of its expectations of health authority performance." And then it says:

"The Ministry of Health's expectations include both the enduring expectations, such

as compliance with legislation and policy, and those expectations that are subject to

periodic revision, such as strategic directions and priorities derived from the

government's mandate."

Again, I just want to make the point that I think the ministry has that backwards. The

accountability cycle is one that should start with the government's policies and

priorities, start with the government's strategic directions and then go into setting

performance expectations of the health authorities in the province.

[1640]

One of the messages I get from health authorities around the province is that they feel

like they're flying blind on a lot of this. They're asked to come up with three-year

strategic workplans -- yet in what framework, to accomplish what? What are the provincial

standards? What are the provincial goals? And I don't mean the health goals but where the

ministry, the provincial government, is taking health care over the coming years. Once

that is properly articulated, then all of the players in health care will be able to

identify where they fit in and what they have to do in terms of delivering on that broader

vision of health care.

I would just like to make the point that I think the way it's articulated in this

particular document puts it backwards. I think it goes back to the discussion that we had

on the strategic direction: that has to come first and be even broader and more

forward-looking than what currently exists. Then the health authorities and the doctors

and the nurses -- all of the health care professionals, all of those in British Columbia

who have an interest in health care -- can see where they fit in. Then it's going to be

much easier for them to deliver on their own regional perspectives and their own regional

strategies that they have to do to deliver on that broader framework. If the minister

wants to respond to that, I'll give her the opportunity. Otherwise I'll carry on.

Hon. P. Priddy: I'll try not to do that each time the member offers the

opportunity. The goal is to get through, as I regularly tell my colleagues who are in

estimates, and not to make speeches.

But I do just want to comment for a moment, if I might. Certainly I wouldn't take issue

with the points that the member is making. Again, this is a bit like anything else: you're

trying to drive the bus and change the tire at the same time. If we were starting fresh --

my Monday morning scenario -- you'd be able to do that, and that is what it will be like.

Nevertheless, we've had to have some accountability for people, even though this document,

with contributions done by health professionals, was not completed. You still have to have

some accountability going on. So in the ideal world and when this is complete, that's

exactly what should be expected. And you're quite right: it should come from the strategic

vision.

The one point I would mention, though, is that I'm not sure it's about where the

provincial government is going to take health care, although I guess we could say that.

I'd like to think it's where the whole health profession is going to take health care. I

think the provincial government has a very clear leadership role to play. But so do

physicians, so do nurses, so do lab technicians and so do a whole lot of other people out

there. I'm not sure it's for the government to say: "We'll decide where you're going,

and you fit it." But it's to say to all of us: "Where is it that we're going

together, as a province?"

C. Hansen: I'll resist getting into a long philosophical discussion on that. But

I do want to make the point that I think it is the role of a Health minister to set the

strategic direction for health care: to listen to the health providers -- the doctors, the

nurses, the physiotherapists -- and listen to the health authorities in the province and,

most importantly, listen to the public, and then to articulate that vision as to where

health care is going. The leadership has to come from the provincial Minister of Health

and then everybody else. One of the problems we have today is that there is a vacuum of

leadership in health care in terms of the direction that it is going. You have all of

these various groups within health care that are trying to provide the leadership that is

in a vacuum today. I think it's incumbent upon the Minister of Health to provide that

direction so that everybody knows exactly where they fit into that picture.

If you go out and talk to doctors in British Columbia today, you'll get multiple ideas

as to where health care should go in the future. Certainly their organizations -- whether

it's the BCMA or other organizations of physicians -- have their ideas as to where they

think health care should go. They obviously have very important input into that direction.

But ultimately, it falls on the shoulders of the Minister of Health to articulate that

vision and leadership and then explain to the health providers in this province where they

fit into delivering on that objective, which should be the objective that reflects the

public's will and wishes as to where health care should evolve in the years to come.

I won't go on to the next subject without giving the minister an opportunity to respond

to this one.

Hon. P. Priddy: I absolutely agree with you. Both the government and the

minister have a responsibility for leadership. As an only adopted child, I welcome it; I

love it. If people give it to me or I have those opportunities, I'm delighted to have

them.

[1645]

My only point about leadership or a vision is that I think it fails if you say:

"This is the vision, and you fit here." If you don't have buy-in from all the

people in the system, it won't work. You can't go and say to people: "This is where

you fit." Maybe that's your point about . . . . As we've done with the

document . . . . You know, having talked to the BCMA, UBCM