2000 Legislative Session: 4th 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)

WEDNESDAY, MAY 17, 2000

Afternoon Sitting

Volume 19, Number 19

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The House met at 2:08 p.m.

Prayers.

Hon. G. Mann Brewin: Here in the gallery today to watch question period and other things and to have meetings is a group of people from the executive of BCGEU component 3, community social services. They are: James Cavalluzzo, Karen Wickham, Cherie Dobbie, Deb Wilson, Stephanie Seaman, Marie McNally, Joanne Dyck, Gale Engstrom, Barry Gauthier, Denise Strookow, Colleen Hutton, Gayle Flavelle, Fay Jolley and Dorothy Bartsoff, and staff person Daryl Barnett. Would the House please make them all welcome.

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Hon. C. Evans: The two invisible groups that actually run the province are, of course, the press gallery and government workers, and they're both sitting right over your head today. I'd just like to introduce, amongst that group: Sandy McLean, Lori Joaquin, Stephanie Johnson, Dorothy Barker, Catherine Scott, Elaine Brigden, Joanne Harder, Susan Wilkie, Louise Dunn, Rusty Blanes, Dolly Zawaduk, Roberta Scarrow, Russell Katzer, Laurel Niemi, Sheila Knight, Elizabeth Washburn, Leslye Nixon, Judy Hall, Janet Parkes, Dana Eklund, Shirley Giles and Robert Kary. Will the House please make these people welcome.

I. Chong: Today we have a number of guests who have come here from far away. They arrived about a week ago to participate in the Art 2000 gala on Monday evening.

Art 2000 is a project that was initiated 12 years ago, in 1988, and involves about 150 students from Australia, Canada, China and Northern Ireland. It was designed to follow these people through to the year that they would be graduating -- which is the year 2000.

So we have visiting with us His Worship Mayor James Curry and Councillors Kathleen Bribben, Alexis Totten and Martin Howell -- they're from Ballymena, the county of Antrim in Northern Ireland, which is just north of Belfast -- and Mrs. Angie Morris, who is on the Art 2000 committee.

I would ask the House to please make them very welcome.

G. Hogg: Today the Leader of the Opposition had lunch with some very special guests who have now joined us in the gallery. They are nine vibrant women who first met at normal school almost 60 years ago. They call themselves the Round Robin Group, and they have been writing a round-robin letter for some 42 years.

They are: Margaret Long from Burns Lake; Faye Eccleston from North Vancouver; Doreen Guillaume-Robinson from Trail; Percy Gray from West Vancouver; Margaret Bishop from Vancouver; Kathleen Heckman from Berkeley, California; Marion Acedo from Woodland, California; Dulcie McCallum from West Vancouver, who is the mother of the former ombudsman and of Judy McCallum, who is the administrative coordinator for the Minister for Children and Families; and their organizer, well-known community worker May Brown from Vancouver-Quilchena.

Would the House please join me in welcoming and congratulating these remarkable women.

E. Gillespie: There are two constituents of mine visiting from the Comox Valley that I would like to welcome today. Bill and Rhona Muir are making their first visit to this House. Would everyone please join me in welcoming them.

G. Plant: It would be difficult for me to identify very many people in this world who have been a better influence on me than May Brown, but luckily two of them are in the gallery. My mother Frances Plant and my son Graham are both here to watch all of us at work. I hope that members will make them welcome.

A. Sanders: In the gallery is Mr. Plaxton and his class of grade 7 students from St. James School in Vernon. I hope everyone will make them welcome. As well, this is a grade 7 class whose members are one of the best basketball teams in Vernon, so I congratulate them on how well they did this year.

I. Chong: I was remiss in not acknowledging another visitor to this gallery. I just found out that accompanying the group that I introduced moments ago is Councillor Carol Pickup from the municipality of Saanich, who is also part of the Art 2000 project. I'm hoping that they do enjoy question period. Perhaps after question period, the Minister of Forests, who I know comes from that area, will greet and meet with these visitors from Northern Ireland. Would the House please make Councillor Pickup welcome.

T. Stevenson: Today in the gallery is a friend of mine, Drake Smith; he's accompanied by Bob Trimbee. They are with VoicePrint B.C., a non-profit charitable organization which is based in my riding. VoicePrint B.C. provides reading services for the blind and low-vision people in over a hundred communities throughout British Columbia. Over the past few years I've been privileged to get to know this organization somewhat and see firsthand the very good work they do throughout B.C. I hope all members will make them welcome.

Also in the gallery today are 60 grade 6 visitors with five adults from Bothell, Washington. They're accompanied by Ms. Richardson from the Canyon Creek Elementary School in Bothell, Washington. I hope all members will make them welcome also.

[1415]

Oral Questions

SAFETY CONCERNS ABOUT

DAY CARE CENTRE BALLOONS AND PINS

K. Whittred: A few days ago the Ministry of Social Development declared May as Child Care Month and printed up bags of balloons and pins to celebrate the occasion. The problem is that the ministry then sent these balloons and pins to day care centres throughout B.C., even though safety regulations warn that balloons can break and lodge in children's throats and that pins should be kept out of children's reach. Will the Minister of Social Development tell us why her ministry sent materials to day cares that are specifically banned from day care centres because they are a danger to children?

Hon. J. Pullinger: Last time I checked, balloons were meant for kids. But out of respect for the kind of concerns that the member raised, we sent them to the adults, not to the children.

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Interjections.

The Speaker: Order, members.

The member for North Vancouver-Lonsdale has a supplemental question.

K. Whittred: This is a safety issue surrounding children, and I think it is a not a matter to be treated with any levity. If ignoring the choking hazard on balloons wasn't enough for the ministry, they've also ignored the Workers Compensation Board, which warns of latex allergies, saying they can cause severe health problems that are life-threatening. Will the Social Development minister tell us how her ministry could send items to day care centres that not only are a choking hazard . . .

Interjections.

The Speaker: Order, members.

K. Whittred: . . . but also pose a serious allergy risk?

Hon. J. Pullinger: I understand that the opposition wants to ban balloons and buttons, but we sent them to the adults, because obviously balloons should be used under adult supervision to make sure there are no problems. Having said that, if the opposition is very concerned about this, I will certainly consider sending something else or not sending something another year -- on the advice of the Liberal opposition.

The Speaker: The member for North Vancouver-Lonsdale with a further supplemental question.

K. Whittred: Will the minister tell us how much money she wasted sending balloons that are a choking and allergy hazard to day care centres?

Hon. J. Pullinger: I'm actually amazed at the concern that the opposition has just discovered about child care, given that they've made it very clear that child care is not a priority for the Liberal opposition at this time. Instead, a tax cut for their corporate friends is.

FAST FERRIES MECHANICAL PROBLEMS

C. Clark: No discussion of government waste would be complete without discussion about the most colossal government waste of all: the fast ferry project. I have here the end-of-month machinery reports for the Pacificat Explorer . It says that in January and February alone, the oil cooler failed, the starter had to be replaced, the elevator broke down twice, the sewage system continues to have problems and divers still have to remove debris from the water jet intakes on a regular basis.

Will the minister explain to us how she expects she's going to be able to sell the third fast ferry when the two that we've got operating have been in operation for a year and are still a mechanic's dream -- but a taxpayer's nightmare?

[1420]

Hon. J. MacPhail: There's always ongoing maintenance with all vessels, whether they be Spirit-class or C-class or fast ferries. The corporation and the workers who maintain the vessels are doing a good job of doing so as we put the ferries on the market.

The Speaker: The hon. member for Port Moody-Burnaby Mountain has a supplemental question.

C. Clark: Hon. Speaker, these ferries have been in operation for over a year, and they are still a nightmare mechanically. Let's go to the other ferry. Let's talk about the Pacificat Discovery for February of this year alone. There is a two-foot long crack in the outer hull. The deck was perforated in three places. Water jets are still being contaminated. And guess what: even the dishwasher doesn't work properly. Will the minister admit today, finally, that the maintenance problems in these fast ferries are so big, so serious that it is going to impair this government's ability to ever be able to sell even one?

Hon. J. MacPhail: These ferries are acknowledged as being well built. Too expensive? Yes. Do they service the routes properly? No. That's true -- all of those. What doesn't help is for the Liberal opposition to take what are regular problems that exist on all vessels and use those as examples of why these ferries can't be sold. We have confidence on this side that we will be able to sell the vessels. We've made the decision to do so, in order to restore the corporation to good standing, and we will continue to do so.

However, at the same time, we have a workforce that's recognized as being a well-managed workforce. Recent reports have said that the corporation is better managed than ever before, that the workforce is a skilled one. We will take care of every operational difficulty, whether it be on any vessel in the Ferry Corporation, and we will keep these vessels in service.

PASSENGER INJURIES ON FAST FERRIES

G. Plant: I want to return to the February monthly machinery report and bring another issue to the minister's attention. Quoting from the report -- the last page: "Another injury occurred on the forward stairwell tripping hazards." I want to continue the quote: "As is the norm, an elderly lady during the rush . . . . " As is the norm? Will the minister responsible for the fast cats tell us how many passengers have been injured on the fast cat ferries since they were put into service a year ago?

Hon. J. MacPhail: Hon. Speaker, I'll take that question on notice. But I would note that the B.C. Ferry Corporation has an excellent safety record.

FUTURE OF THIRD FAST FERRY

The Speaker: The member for Richmond-Steveston has a new question.

G. Plant: When I look at this month-end report and I look at the issues raised in it, and I listen to the questions being asked and the lack of answers, I wonder about the fact that the government claims that the reason the third fast ferry is not being put into service is because they want to sell it as a new vessel rather than as a used vessel. Will the minister admit that the real reason the third fast ferry is not being put into service is because she's holding on to it to sell it and use it for parts and to keep the B.C. Ferries exposure to litigation down below reasonable levels?

Hon. J. MacPhail: We understand the lack of success with the fast ferries, hon. Speaker. There's been an exceeding

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amount of candour in the last couple of months around the lack of success of fast ferries. And yes, we are selling them. However, there is also a recognition that the fast ferries are well built. That is not under question by any expert in the field. Yes, it is true that they are not suitable for this market and that they shouldn't have been built for these routes.

[1425]

However, for this opposition party to somehow stand up and intimate that the corporation isn't meeting the safety standards -- the federally regulated safety standards -- that the Coast Guard is not managing the safety standards, that people are at greater risk because it's a fast ferry is simply irresponsible. I would suggest that they should limit it to criticisms that are legitimate and not do all of this fearmongering.

SUSTAINABILITY OF

B.C. FERRY CORPORATION

M. de Jong: In spite of all these problems that B.C. Ferries is obviously having, life seems to be a bit of a party over there. I don't know how else to explain the fact that they spent thousands of dollars last year purchasing in excess of 25,000 balloons. The government seems to have a fixation with balloons. I've heard nothing to indicate that the Ferry Corporation, under this government's tutelage, has had anything to celebrate. I don't know if the balloons were bought to celebrate the launch of a fast ferry -- maybe the potential sale of a fast ferry. Or maybe the government just needs 25,000 balloons to keep them floating.

Hon. J. MacPhail: Hon. Speaker, I won't take that question on notice.

The Speaker: The member for Matsqui has a supplemental question.

M. de Jong: Well, a new question, actually. Having taken the question on notice, maybe I can assist the member. Maybe with this new question, Mr. Speaker . . . .

Maybe the balloons were for another special occasion that we've heard about. Apparently, one night this summer, after the last ferry has been put to bed and the last pigeon has been put to sleep, B.C. Ferries is going to turn the Swartz Bay terminal into a drive-in theatre. So now passengers who are going to face longer lineups at the terminal during the day will have an excuse to hang out there at night.

To the minister: instead of spending time deciding whether or not to show The Poseidon Adventure or Ship of Fools , maybe the minister will explain to the public how long it is going to take them to pay off this titanic debt that they have inherited, thanks to this government's incompetence.

Hon. J. MacPhail: Earlier this week the member for Comox Valley asked a very serious question about whether our government was truly committed to the sustainability of the B.C. Ferry Corporation. The answer is yes, we are.

I worry about what would happen if the New Democrats are not in government. I have very serious worries about the B.C. Ferry Corporation. I worry about those communities that rely on the Ferry Corporation. I worry about those communities that have had hundreds of millions of dollars invested in their transportation system. Over the last ten years our government has invested a billion dollars in the maintenance and refurbishment and building of new vessels that provide better services to the communities that are ferry-dependent.

Just the same way that we respect the highways as an economic transportation system, so do we the ferries. To somehow suggest that those investments are not on behalf of the economy is simply ridiculous, and I rue the day that they would ever be in charge.

POTENTIAL TAX INCREASES

FOR TV AND RADIO STATIONS

K. Krueger: Certainly the minister has reason to expect there will be a change in government. I think all of British Columbia is longing for that.

Not least among those longing for the change are small business people, because this government's ten-year assault on small business continues. Due to a recent reclassification of broadcast transmission sites, rural radio and TV stations throughout the interior are facing huge tax increases. For example, radio station CHNL in Kamloops received a 335 percent tax hike on its 2000 assessment. Will the Small Business minister tell us why his government is targeting broadcasters in small markets for huge tax increases?

[1430]

Interjections.

The Speaker: Order, members.

Hon. C. McGregor: As the minister responsible for the B.C. Assessment Authority, I rise to answer the member's question. In fact, I met very recently with the same broadcasters that the member makes reference to. We are taking very seriously the concerns they've raised, and I will be continuing to meet with them and representatives of the B.C. Assessment Authority in the coming weeks.

The Speaker: The member for Kamloops-North Thompson has a supplemental question.

K. Krueger: Well, this government always takes the concern seriously, it says. But the government creates the causes for the concerns in the first place.

This year CHNL's 30-year-old brick transmission building and five aged radio towers had their assessment tripled to a whopping $250,000. If the government continues to pursue this tax grab, CHNL and other radio and TV stations throughout the province will be forced to cut back their broadcast services. Can the Finance minister explain why the British Columbia Association of Broadcasters was never consulted prior to this massive hike in taxes?

The Speaker: The time for question period is over. I'll ask the minister to make a brief answer.

Hon. C. McGregor: Well, I think it's fair to note that the B.C. Assessment Authority is a very well-run quasi-judicial organization that acts independently of government. It's given the role to assign fair assessment market values, hon. member, and in fact, it is held in high esteem not only here in British Columbia but internationally. Around the world there are

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assessment agencies that come to British Columbia to model their systems after the systems we have developed here in British Columbia. So I stand in high regard of the work that the B.C. Assessment Authority is doing.

Having said that, I gave my assurances to the member opposite and to those representatives of the broadcasting industry who I recently met with that we would meet and talk of their concerns at some length, because I share some of those very same concerns.

The Speaker: The bell ends question period.

Orders of the Day

Hon. D. Lovick: Mr. Speaker, I call Committee of Supply. In Committee A, we will be debating the estimates of the Ministry of Advanced Education; in Committee B, we will continue our debate on the estimates of the Ministry of Health.

The House in Committee of Supply B; T. Stevenson in the chair.

[1435]

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 36: ministry operations, $8,125,203,000 (continued).

C. Hansen: I just want to give the minister an overview as to where I see us in this process of estimates and also where we'll be going today and tomorrow as we continue on this process.

Last Thursday when we started, we had the opportunity to deal with mental health issues. We then got into some of the capital issues. There is a document that I am still anxious to see, and that is the appendix to the performance plan that was circulated. It was the appendix on the capital plan, which was not appended. Is that the word -- appended? I would certainly be interested in seeing that, if possible, before we get into the remainder of some of the capital plan issues, which will be tomorrow.

While I'm on that subject, the other documents that I was hoping to be able to see before we got to those sections were the information management plan that was also one of the appendices to the performance plan, which would also be helpful for me to be able to review tonight, before we get into that

section tomorrow. There's also an outstanding memorandum of agreement on BCBC that the minister had offered to me. If those could be made available at some point this afternoon, that would be helpful to me.

This afternoon what I would like to do is proceed through the various divisions within the ministry. Over the last two days, as we have canvassed some of the constituency issues that my colleagues have had, we've had the opportunity to deal with a lot of those subjects that I would have dealt with otherwise at this time. But I think it's much more effective that we deal with them in the context of constituencies and real people. Certainly I know that the feedback and answers that have come from the minister have been appreciated.

This afternoon I want to start by talking first of all about regionalization under the general subject area of regional programs. From there I want to go on to talk about some of the funding issues in terms of regional programs and funding for health authorities. I want to talk about acute care issues. From there I want to move into the performance plan itself.

On page 6, where we start out with the "Key Program Objective" and the performance measures against each one, in looking at that I thought that was a logical sequence for us to follow through, starting with regional operations and basically working our way through the regional plan. I'll try to organize my files according to those subject areas as they come up.

[1440]

The first area that I want to embark on today is regionalization. There has been a lot of discussion about the model that we have before us today. I know the minister chaired a committee a few years back that looked at the regionalization model in place as of the spring of 1996. It was the recommendations of that committee that led to the distinction between the CHC-CHSS and the regional health board model. I'm wondering if we can perhaps start with the minister giving us some reflection of where we're at in terms of the process of implementing regionalization in British Columbia.

Hon. M. Farnworth: In the sense of the report as it was presented three or four years ago and the recommendations of the report, the view is that basically the report has been implemented and regionalization has taken place in a way that was envisaged in that report.

C. Hansen: Do I take it from the minister's answer, then, that he sees this process of regionalization as being a completed process and that what we have before in terms of a model in terms of relationship between the regions and the provincial government, is the model that we should expect as a finished product?

Hon. M. Farnworth: In terms of the implementation and in terms of what was envisaged in the report, I would say that, yes, that is complete. But having said that, it's like any process or change that takes place. It's implemented, and it brings some stability. But I think there's also a recognition that things constantly evolve and change in response to changes -- all kinds of pressures or changes that happen over the long term.

C. Hansen: I want to make reference to a

section in the environmental scan that was made available to me yesterday. Before I do that, I just wanted to compliment the ministry on the environmental scan. I thought it was a very helpful document. I managed to burn a little midnight oil last night digesting it in advance of today and figuring the areas that we would want to work into our discussion.

On page 30 of the environmental scan, under "Health Service Delivery Issues," it notes that regionalization and the establishment of health authorities funded on a global budget basis has established the administrative framework for the development of integrated systems of care. I gather that essentially is saying -- in other words, from what the minister just said -- that the restructuring phase is finished. It goes on to say: "The next challenge will be to achieve integration at the service delivery level." I wonder if the minister could explain what is meant by that particular reference.

Hon. M. Farnworth: It's a question of ensuring that you have a continuum of care so that patients, when they access

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the system, don't have to go in and out to get the services that they require. In terms of a global budget, you are able to access mental health; you are able to access acute care services; you are able to access long term care services over the continuum. So there is better integration of the existing services. I think it's fair to say that that will be the next step. It's also the ability to take advantage of advances in technology -- for example, around information technology. That will allow better communication not only between institutions but also between physicians and institutions and facilities.

[1445]

C. Hansen: I wonder if the minister could tell us whether it's his opinion that the CHC-CHSS model that we have in half the province is in fact working.

Hon. M. Farnworth: One of the challenges in regionalization was the issue of what happens in rural areas, where in many cases you are dealing with a number of geographically defined areas and the ability to work together. I would say that, by and large, I think the process has worked. Having said that, I also recognize that in terms of trying to get different CHCs and CHSSs to work together, in some areas there have been some questions. I have said that if there are issues or concerns in those areas and ways that they can see to improve the situation, to improve communication or to improve the ability to work together, I'm quite happy to look at measures to do that.

C. Hansen: There is a study that was prepared for the Health Association of B.C. last November. It was presented at their annual general meeting that took place on November 7. What they did in this was that they surveyed or contacted and sought feedback from the chairs and CEOs of the various CHCs and CHSSs around the province. Just to remind the minister, these are all individuals who have been appointed by the Minister of Health. In many cases, whether they are or aren't, they are at least not being perceived as independent of the interests of the minister's office. Yet they were very critical of the structure.

Just to give you some of the numbers that came back from this survey; 86 percent of the CEOs and chairs indicated that the present structure was not the correct structure for rural B.C.; 96 percent felt that it should not be the structure for the future; 56 percent felt that regional boards were the preferred authority, while 40 percent felt that the CHSSs should be divested to the CHCs.

In terms of the size of the councils, 96 percent of the respondents felt that the council size of 15 was too large for these small communities. The average size preference was between seven and nine. Many expressed frustration about the appointment process, which they feel is cumbersome and takes far too long. Several communities complained about the questionnaires being too detailed and personal and in fact turning off potential volunteers that may wish to put their names forward for these committees.

I just wonder if the minister has met with the chairs of the CHCs and CHSSs to discuss the results of this particular report.

Hon. M. Farnworth: A couple of points. I have met with the CEOs of the CHCs and CHSSs not specifically on that particular report but to discuss issues of interest to them. This issue was raised by, I think, one CEO -- that was it. I have said that I'm quite happy to look at making the relationship work more efficiently. That's not a problem. I've said that my door is open in that regard.

[1450]

I think what's important to note, too, is that in terms of the CHCs and how they were structured, that came very much out of what people in rural communities have to say. It was very much an attempt to recognize the geographic, community and distance issues that exist in rural British Columbia. It was very much a reflection of what we heard. It did not take place in a predetermined fashion, but rather it was an effort to recognize the concerns of rural B.C.

The member raises some concerns in a report, and I'm quite happy to look at that and to look at some of those issues. Some of them seem to me a matter of either refining processes or making changes to make things more flexible. If there's a problem with 15, I wouldn't see moving to nine or seven being a particularly problematic issue to solve.

C. Hansen: It is my understanding that there was to be a formalized review of Better Teamwork, Better Care at a three-year juncture -- I believe was the date -- which has now come and gone. I'm wondering if the minister could tell us if there is in fact a formalized review of regionalization that has taken place or will be taking place.

Hon. M. Farnworth: I'd draw the member's attention to the strategic directions plan, which is on 723. It is part of the plan that in the year 2000, there should be a comprehensive third-party evaluation of the structure, governance, management and operation and results of regionalization.

C. Hansen: Could the minister advise the House what stage we are at in that process now?

Hon. M. Farnworth: We are in the preliminary stages in terms of the planning approach of the direction that we will be taking on this.

C. Hansen: I also appreciate that we've crossed from what is really a discussion on regional operations into one of planning. If the minister would sooner do this discussion in that context of planning, I'd be prepared to do that. My question would be: when could we expect that report to be completed?

As I say, if the minister would like me to stop going down this road and defer it to a planning

section . . . .

Interjections.

C. Hansen: That's fine. We will carry on, then.

I would like to ask the minister: when we can expect that completed review?

Hon. M. Farnworth: We're probably looking at about the fall to be able to get the actual physical ground work underway.

C. Hansen: To pull us back into questions that are more related to regional operations, I would like to ask the minister specifically about the relationship between the Ministry of Health and the regional health authorities.

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One of the subjects mentioned in the environmental scan is a reference to a criticism that there are no established best practices for health authorities to learn from. If we also look at another reference to this report on the CHC-CHSS model that was done by the Health Association, it talks about the planning process that health authorities have been asked to follow and that this progress varies greatly from one region to the other. While there was some general direction in terms of planning process, it did not flow from a planning process of the Ministry of Health.

[1455]

The other concern that I hear time and time again . . . . In fact, I'd like to just read to the minister a couple of resolutions that were put forward at the annual meeting of the Health Association. To quote one

section here: " . . . to petition the minister to respect the ability and integrity of existing health authorities' governors . . . by allowing health authority governors to meet the policy objectives without the current micro-management practices requiring that detailed instructions be followed and all documentation be duplicated for submission to the Ministry of Health." It talks about another resolution that says: "Whereas the current CHC-CHSS structure is cumbersome and lacks direction from the Ministry of Health, and

whereas the current CHC-CHSS structure duplicates both administration and services . . . . " It goes on to talk about a resolution that the Health Association of B.C. petition the Ministry of Health to discontinue micromanagement of annual operating funding allocations.

The message I get from reading through some of these resolutions is that on one hand, they feel there is a lack of direction in some critical areas such as planning and the structure in which they have to structure best practices. On the other hand, when it comes to the administrative decisions that it is felt could best be made locally, then the word that comes up time and time again in both this document's resolutions and the discussions I've had with various health authorities is the word micromanagement.

I'm wondering if the minister sees a change in the relationship between the Ministry of Health and the health authorities now that we are at this stage in the evolution of the regionalization process.

Hon. M. Farnworth: I think the member raises some interesting and good questions. Certainly in terms of best practices and planning for health authorities, we want to encourage that and work with them to ensure that it's taking place. We recognize that there is a different level in some of those things around the province in terms of what planning is taking place, but we are working in terms of assisting. I'll give you an example. We are trying to ensure that there are best practices around the delivery of mental health services.

That's why the implementation framework that's coming out in a month is part of that -- so that health authorities will be able to see exactly what is expected. Part of the innovation forum that is coming up is the ability to see what is happening in terms of best practices in some of the health authorities around the province, so that we can start to get that information out there.

Around the issue of micromanagement, I guess my response to that would be that I don't want to see us micromanaging individual budgets. I don't think that is a particularly positive thing. But having said that, there are also funds from the ministry that are targeted to specific areas within the health authority's purview, which is set up to be at arm's length from government. So there is the accountability question in terms of ensuring that those funds are going to where they are targeted. Sometimes that can be perceived as meddling on the part of the ministry, but that accountability is important.

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C. Hansen: One of the concerns is that the health authority should be held accountable for the results achieved by those funds, as opposed to micromanagement or being dictated from the central provincial government, in terms of every aspect of how they manage the affairs within the region. One of the questions may be, if I can restate it: is this the model that the health authority should get used to? Or at some point will the apron strings be cut, and they will be allowed to manage the affairs of their area? The expression that comes up is: "Let the managers manage, but hold them accountable for their results."

Hon. M. Farnworth: I think one of the ways we have to look at this particular issue and the question the member raises is in the scope of contact between the ministry and the different health authorities in the province. In terms of the large RHB authorities, there is far less contact in terms of what you could perceive or say, in that micromanagement sense, than there is in the smaller areas around the province with the CHCs and CHSSs. Many of them are still in the three-year planning development stage, where there is a lot of contact between the ministry and the authority.

We often have the services, the ability or the staff, in terms of technical expertise, that they may in fact need to access. So there is a fair bit of that contact taking place, and I would expect that as those plans are done and as those plans are completed, then the everyday contact . . . . The potential for the micromanagement issue lessens. In fact, there is more authority, and they know the direction that they're going. They have the plan in place, and they're implementing it accordingly.

C. Hansen: Just in response to the minister's previous answers, one of the problems that a lot of the regional health authorities are facing is that they are now redoing their planning process. If you go back a couple of years . . . . For June of last year, all of the regional health authorities were expected to deliver their three-year strategic plans. There is a document that the minister may be familiar with, which is called the "Accountability Framework." On page 8 of the "Accountability Framework" is a

section on the accountability cycle. In last year's estimates we visited that particular document. I'm not going to go through it in great lengths today, but the planning cycle was to start with the ministry's strategic directions and from there was to flow into the strategic plans of the various health authorities. But the problem was that we didn't have the strategic directions available at that time. So many of the health authorities were in fact flying blind when they were doing their own plans, and what we've seen is a great inconsistency from plan to plan around the province.

Also, if all of those plans were to be implemented as had been set out last summer, we would truly wind up with a real patchwork of health care around British Columbia, because each region was approaching it within a different framework. What we were moving away from were those provincial standards of care that we have to in fact move closer toward.

Now that the strategic directions document has been finalized and circulated, many of those health authorities find

[ Page 15737 ]

themselves revisiting that whole planning cycle they had to go through -- at a lot of time, in particular volunteer time, of individuals that are serving on the CHCs, regional health boards and CHSSs around the province, not to mention the staff time and the cost of facilitators and others who get involved in that planning process.

I want to ask the minister a fairly specific question about what happens in the case of institutions that get pulled into the authority of the regional health authorities. If you have an institution such as a hospital that is brought under the auspices of the health authority, is there a policy today in terms of what happens to bequests or other long-term fundraising initiatives that that particular facility may have initiated before they were brought under a health authority umbrella?

[1505]

Hon. M. Farnworth: I'll give you a specific example to answer the question. If I bequest something to Eagle Ridge Hospital, for example, it goes to Eagle Ridge Hospital.

C. Hansen: I appreciate the example. But is that in fact a policy directive of the ministry? The minister's nodding his head, so I will accept that.

I would like to turn it over to my colleague from Okanagan-Vernon. She has some specific questions about fundraising as well.

A. Sanders: The fundraising industry in the area of health care these days is in a boom. Certainly in the North Okanagan region the Vernon Jubilee Hospital has a full-time fundraising individual who has an office in the hospital and a staff and does a very excellent service for the community. How much of the capital or operating budget -- well, it would be the capital budget -- in my hospital, for example, would be contributed solely by funds that have been raised in the community and not provided by government?

Hon. M. Farnworth: No fundraising is for operating in B.C.

A. Sanders: How much is for capital purchases?

Hon. M. Farnworth: We don't have the figures on a year-to-year basis. The latest figure that we have, which is for 1997 from the Canadian Centre for Philanthropy, is that about $73.6 million was donated by British Columbians to health care organizations in the province, and it was primarily for equipment.

A. Sanders: If we look at a hospital like Vernon Jubilee, what percentile of that budget would be donated dollars?

Hon. M. Farnworth: About two-tenths of 1 percent would be a typical percentage.

[1510]

A. Sanders: When we're talking about $73.6 million, we're talking about a sizeable sum of money in the province itself. What efforts has the government made to quantify the amounts of hospital dollars that have been raised by charitable organizations, and how has that been done?

Hon. M. Farnworth: Each hospital does its own fundraising through its own foundations. They do it independently of us, so we don't keep records on the fundraising that they do. To use a phrase that the member used before, we try not to micromanage it.

A. Sanders: Does the ministry have any interest in knowing what those figures are?

Hon. M. Farnworth: As I said, we have had very little specific involvement in the fundraising by hospitals that takes place, other than we like to encourage them, because we know that people in the community like to donate and that during the discussions around regionalization, there was a lot of sensitivity around fundraising. The view of the foundations and the hospitals was that they did not want government involvement in that. They wanted to ensure that their ability -- or the foundations' -- to raise funds for a particular institution would not be hindered in any way.

Basically it has been the view of government to leave that to hospitals and not to be involved, other than to encourage them, and to recognize that people like to donate. They have been donating over the years and, we expect, will continue to.

A. Sanders: I was quite thrilled to see Jimmy Pattison donate $20 million to the Vancouver General Hospital and encourage research on prostate cancer, a subject that is very important to me personally. I would like to propose a hypothetical situation and understand what the machinations of that situation would be within the ministry. If a philanthropist left $20 million to the Vernon Jubilee Hospital, what kind of things would happen in the ministry as a fallout from that? Would our operating or capital budgets be cut? Would that money be in any way seconded by the ministry?

Several years ago, there was a very vigorous attempt to expropriate land and property from hospital societies. Along that same line, my interests, although they be hypothetical in this case . . . . I'd like the minister's feedback on that situation.

Hon. M. Farnworth: I can tell the hon. member that, for example, in the hypothetical situation that someone left Vernon Jubilee $20 million, they would not be penalized in any way on their operating budget, nor would they be penalized in their capital budget, nor would they penalized in terms of any of the services and activities they're doing that are currently funded by government. That bequest would not be taken into account in terms of the funding that the hospital normally receives.

A. Sanders: What I hear the minister saying is that there's no active or aggressive component within government to start micromanaging the funds of foundations. In our hospital this year, for example, we raised $435,000, I think it was, for routine cardiac monitoring equipment -- nothing fancy, not buying something exotic or esoteric -- trying to replace outdated equipment in the ICU that was costing more to maintain than it was to buy new equipment.

[1515]

The medical society this year had a calendar that won a national award in the health care area for communication skills, which raised $30,000 for the hospital foundation as well. There are a number of incentives in our communities, and we

[ Page 15738 ]

have had a very active community with respect to raising dollars for health care. People have been relentless in their ability to support health care causes in the Vernon and North Okanagan region in general.

I would like to hear from the minister a commitment that the ministry has no interest in the coming years in delving into the funds raised by hospital foundations and to assure those who live in fear that the ministry will cut back funding proportional to the success of the fundraising, that those people can hear from the minister that that is not an area that he feels is top on his priority list.

Hon. M. Farnworth: We have no intention -- none whatsoever.

C. Hansen: I want to continue on this issue of the relationship between the ministry and the regional health authorities. I wanted to read for the minister a copy of an

article from the Northern Sentinel in Kitimat dated December 15, 1999. It's titled: "NDP Leadership Hopefuls Outline Their Health Care Positions." I gather it is an

article that flowed from a debate that was held in Terrace the previous Monday night.

It refers to, at that point, the then Attorney General -- currently the Premier -- and it says that he "blames the region's current health care problems on the growing bureaucracy that's seen a quadrupling of management positions. 'People are upset because the bureaucrats won't let them build two operating theatres, and I think people should be allowed to do what they want to do in places like Kitimat,' he said. 'People on the ground make the best decisions.' " I'm wondering if the minister can comment on that.

S. Hawkins: I request leave to make an introduction.

Leave granted.

S. Hawkins: It gives great pleasure to introduce 70 grade 7 students from the Kelowna Christian School. They're accompanied by 14 parents and three of their teachers: Bruno Rossi, Laura Cassidy and Brent MacArthur.

It gives me extra pleasure to recognize the Friesens, who are neighbours of mine and who are here, and their children. Actually, I look forward to the summer, because they sell lemonade for those of us working away in our gardens. They're showing entrepreneurship at a very early age, and I encourage that; I think that's great. So would the House please make them all welcome.

Hon. M. Farnworth: One of the roles that the ministry has . . . . Sometimes I can understand local frustration in terms of local decisions. In this case, I would point out that the two operating rooms are in fact being built. The ministry funds 60 percent of the capital expenditure, and so it has a responsibility to review those expenditures as they're taking place. That requires the involvement of the Health bureaucracy. That's an important function. We need to remember that.

I recognize the need to ensure that when we make decisions at the local level, they're implemented as quickly as possible, with a minimum of red tape and hassle. But at the same time there are also legitimate interests of the ministry which have to be recognized. There are processes which have to be followed in order to ensure that the funds that the ministry is expensing are, in fact, being spent the way they're supposed to be, and that the project fits in with the overall sense of priorities in government.

[1520]

C. Hansen: I want to also quote from another

article from the Northern Sentinel on a related but different subject. It makes reference to a study. It says: "No decisions on regional health care services will be made until a study on regionalization undertaken by consultants from Alberta is complete in June of 2000." I'm wondering if the minister could explain. Is this part of the study he referred to earlier that was going to be completed in the fall, or is this a purely regional study that's being done for that particular CHC?

[S. Hawkins in the chair.]

Hon. M. Farnworth: It's certainly not provincial in nature, so I'd have to look into that particular

article and try and find out where it's coming from. It's certainly not coming from within the ministry.

C. Hansen: I want to move over to the Queen Charlotte Islands, where there has been some real instability in terms of health care governance. In the last two years, they have gone through seven CEOs for the community health council. There is certainly a great anxiety on the Queen Charlotte Islands about how health care is being delivered and how it is being governed. It seems that there are some real regional differences between different parts of the Queen Charlotte Islands. I'm wondering if the minister can give any reassurance to people living on the Queen Charlotte Islands that they are going to see some stability come to health care governance in that region.

Hon. M. Farnworth: The hon. member does raise a valid issue. We are aware of the situation up there, and we are trying to ensure that there is stability. We are working on that particular issue.

C. Hansen: The minister will undoubtedly be aware that many residents have called for the CHC to be dissolved. I'm wondering if the minister has given any consideration to that?

Hon. M. Farnworth: I'm aware of the question, in terms of the calls in from some quarters to replace the board or to dissolve it. What I'd like to say at this particular point in time is that we are aware of the issue and we're trying to resolve some of the problems that they are facing. Ideally, we would like to make the board stronger and bring stability, as opposed to having to take very draconian measures. However, that having been said, we want to make sure at the end that the decisions or the actions that the ministry can take will bring stability to the region and will ensure that it functions as it should. That is our primary goal, and we are working to accomplish that.

C. Hansen: A couple of years ago, the auditor general did a review of the appointment process to the regional health authorities. He was very critical of how that appointment process manifests itself in some parts of the province. It strikes me that in the case of the Queen Charlotte Islands, at face value at least, some of the recommendations that were made by the auditor general at that time have not been implemented

[ Page 15739 ]

when it comes to the appointment process. As I say, that is at face value. I'm not going to try to claim that the appointment process was inappropriate, but there's certainly speculation on the Queen Charlotte Islands that that process was not properly followed. I'm wondering if the minister has looked at this issue from that perspective and whether he is comfortable that the appointment process on the Queen Charlotte Islands is in fact in keeping with the recommendations of the auditor general?

[1525]

Hon. M. Farnworth: I am aware that whenever there are issues or community concerns around the way that a board or agency such as this is functioning, there is a desire to look and say: "Okay, that's the problem" or "This is the reason why something has happened."

Rather than say that that particular process was at fault, I think what we're trying to do is to find out how we bring stability into it. How do we stabilize the situation at this particular time? Make that our first job. Then we can look at, you know, if we need to change the way things are approached in a particular region. Maybe it's not working there, but it is working in other parts of the process. Generally we try and find people to fill these positions who are interested in making the board work. In fact, in 98 percent of the cases, that is what happens. As I said earlier, right now our first goal is to try and bring stability to this particular region.

C. Hansen: I want to move on to some of the funding issues. Maybe as an introduction to this particular section, I can share a quote with the minister. Then perhaps, as I read the quote, he can take a guess as to whom I am quoting here. It says: "Government shouldn't be spending money until it has figured out precisely what needs to be done. I am not convinced that we as government have got a handle on it yet." This is from January 7 of this year, and that's a quote from the minister's own House Leader, the member for Nanaimo. Yet what we see, of course, is additional funding going in.

There's still not a sense that the minister and the government have a handle on how those increased dollars into health care are going to start producing better patient care.

I want to talk about the funding that is made available to each of the health authorities and how that funding is made available. But in opening, perhaps the minister could explain to us what is referred to by the expression "their 1999-2000 restated base." I just want clarification on that. I am assuming that it means not the budget that was applied to each health region, but what they wound up being allocated in terms of funds for the fiscal year that ended April 30.

[B. Barisoff in the chair.]

Hon. M. Farnworth: Just in terms of your question, I want to clarify: are you talking about the portion, or are you talking about special warrants?

C. Hansen: What I'm referring to and what I want to quote from as we go on is a letter from the deputy minister that was sent out to health authorities dated April 10. The opening paragraph says: "As you are aware, the Minister of Health provided all health authorities with information concerning their 1999-2000 restated base via letter on March 17, 2000." Before I start into some of the other points I want to make in this letter, I want to understand better what we're talking about when we use the expression "restated base."

Hon. M. Farnworth: At the beginning of the year you start out with your allocation. But then during the course of the year there may be additional moneys allocated to you, and that becomes part of your base. So that becomes the restated base.

[1530]

C. Hansen: One of the concerns that I have is the process that we go through in advising health authorities what their budgets are for the year. I know that the minister was asked about this on a TV program called "Voice of the Province" a few weeks back -- the fact that health authorities, at the start of the fiscal year, still don't know what their funding is. His comment was, "Well, this is traditional" -- that it's tradition for health authorities not to be advised for several weeks and indeed months into the fiscal year. I just want to start by pointing out that the tradition that he refers to only goes back three years, and in fact it has been the case every single year.

I understand why it's happening, in terms of the directives not coming from the Ministry of Finance early enough to start this process earlier on. But I would like to ask the minister why that is the case. Why is it that the Ministry of Health does not get its funding information in time to start a realistic process with the health authorities in a timely fashion so that they actually know what their budgets are before the start of their fiscal year on April 1?

Hon. M. Farnworth: Part of the issue is in terms of the planning that needs to be done going into the budget process and in terms of if we're providing levels of service comparable year to year. Then part of that required information is to know what the run rates were -- what procedures were done over the course of the year. We can get a lot of that information at the end of the fiscal year. So there's planning work being done. Then we want to -- we've met with the health authority -- sit down with them and go over that information. Once that's been done, then we can release the budget letter. That takes some time.

C. Hansen: This letter says that the restated base represents the starting point for the development of a detailed funding allocation for the fiscal year 2000-01. In essence, what we have is a letter that went out to the health authorities on March 17 -- 14 days before the start of the fiscal year -- stating that this is the starting point for the development of detailed funding allocations. I must say that it's, I think, putting a totally unrealistic expectation on health authorities to be able to manage their expenditures in a reasonable way when their whole budgeting process doesn't even effectively begin until they're already into the fiscal year.

This letter goes on to say: "Although it is too early" -- like, here we are, ten days into the fiscal year, April 10 -- "to provide details concerning the incremental resources to be provided to each health authority, the ministry can confirm that certain items, particularly the negotiated wage settlements, will be funded." In other words, what we're saying here is that you can take your restated base as a starting point and add into it the collective agreement requirements, the wage settlements, that will be funded. This commitment is made in this letter.

[ Page 15740 ]

It also goes on to say: "Life-support programs, defined as cardiac, cancer and renal services, will also receive additional funding." But then it goes on to say: "Inasmuch as these items collectively represent significant spending pressures and have relatively immediate impacts in terms of resource demands, the ministry will amend its payments to health authorities immediately." We've started with the restated base, and now we have added to it.

[1535]

The next is the point that I think is quite critical to where we're going on this thing. In the next paragraph, it says: "The ministry expects you to maintain current volumes pending receipt of your detailed funding allocation." So we're taking the restated base, we're adding to it, and we're also saying: "Maintain your current programs."

My concern is the deficits that are being run up by health authorities all over this province. I have tried to piece this puzzle together from a couple of different directions. I am aware, for example, from a document from the Okanagan-Similkameen health region . . . . It's a press release they put out that states: "Until the region receives word on the allocation, it is operating under an interim budget which assumes the region will receive the same amount of extra funding as last year." It then goes on to say: "The region needs about 24 million more operational dollars to continue to provide the level of service now offered."

Here's just one health region that's saying that if they do what is set out in this instruction letter of April 10, they're going to be incurring a deficit of $24 million, unless there is a significant increase in their budget. To go to another example from a CHC, just to look at the other perspective, a small community health council in Cranbrook says that in order for them to maintain their current level of programs, they're going to be running a $1.78 million deficit.

If you start extrapolating some of those numbers across the province . . . . We have 52 health authorities. If each health authority was to be running a deficit only equivalent to what Cranbrook is anticipating, we're looking at close to $100 million. But of course Cranbrook is one of the smallest health authorities that we have in the province, or one of the smaller ones. If we look at the $24 million that Okanagan-Similkameen is looking at as a typical regional health board, then we're looking at significantly higher dollars.

I wonder if the minister can tell us: if the health regions fund their negotiated wage settlements, increase funding for life-support programs and continue to maintain current volumes, what kind of deficits are we expecting from the 52 health authorities, collectively?

Hon. M. Farnworth: I think it's important to recognize that those issues and services the member's raised are fully funded and that that commitment has already been made. What we're also doing is recognizing the different challenges that exist and occur in each health authority. That's why we're meeting with them on an individual basis, so we can sit down and work with them on exactly where the pressures are in their particular regions -- what their run rates are, what services they're providing -- so that we can ensure that when we're doing the allocation, we're doing it with those issues very much in mind. That's what we're trying to manage for.

There's a significant recognition already of the pressures that they're facing -- okay? And what we're doing is confirming that we are going to be funding those pressures, such as the member raised, around the wage increase, life-support services and cancer and suchlike.

C. Hansen: I guess what I'm asking is . . . . If health authorities continue to maintain the volumes that they had in previous years, if we're not going to see cuts happening in hospitals across British Columbia and in regional health authorities and other programs, there has to be a fairly significant increase over the restated base that was communicated to the health authorities on March 17. It is my understanding that the minister has a number to expect in terms of what the deficits of the health authorities would be collectively, if there is not significant additional moneys put into their budgets in order to maintain services.

[1540]

Hon. M. Farnworth: I think there's a number of things that need to be taken into account. First off, it doesn't mean what you are providing at the end of the particular fiscal year. It's a question of looking at the utilization patterns as they occurred throughout the year and taking them into account. It's also ensuring that the utilization management practices that are in place are carried through into this coming year.

I repeat: that's why we are sitting down and working with each health authority to ensure that those things are taking place and that we can nail down exactly what the financial pressures are, so we can have as concrete an understanding as possible of what the fiscal challenges facing each individual health authority and region are.

C. Hansen: In addition to this letter from the deputy minister which asked health authorities to maintain volumes, it's my understanding that the minister has verbally told CEOs and chairs of regional health boards that they should not cut programs, because he is expecting additional funding to come from Ottawa. That strikes me as: "Nudge, nudge, wink, wink; carry on as we were. Don't cut any services. Don't worry about running your deficits in your regions, because the minister thinks he's going to get more money from the federal government." I wonder if the minister could advise the house what instructions he has given health authorities with regard to maintaining services.

Hon. M. Farnworth: We know that during any given year there are a lot of pressures placed on a system, which are in part related to the ability to provide particular services, for example, such as overtime costs or equipment or the ability in terms of resources targeted -- some key areas which impact on institutions.

It's been no secret, as I've said, that we have been working with the federal government to look at ways financial resources could be applied to the health system that can have an impact. So that's what we're trying to do, in terms of developing the framework with Ottawa in terms of where money could go; it can be targeted and targeted very quickly. That in turn has an impact on institutions of a wide range, including hospitals, and has an impact on their utilization of their particular services.

C. Hansen: How confident is the minister that we're going to see increased dollars flow from Ottawa in this current fiscal year, in addition to the $8.3 billion that he has in his budget?

[ Page 15741 ]

[1545]

Hon. M. Farnworth: That's what the province and the other provinces are working towards -- an agreement that will see Ottawa come back into the health care funding field closer to the 50-50 partnership that we used to have, as opposed to the 85-15 right now. The indication we've had from discussions that have taken place is that they're going very well, and there's considerable interest in a number of areas that can provide relief to British Columbia around equipment, for example, and around facilities.

So we are making good progress, and as I have said earlier in the House, B.C. is taking a leadership role in terms of cost drivers on the system -- in terms of three of those areas. We have had two meetings so far, and my anticipation is that we will be meeting again in the near future. This is something there is a great deal of effort on in terms of trying to get to an agreement.

C. Hansen: It strikes me, though, that if the minister is giving instructions to health authorities that it's "okay" to run deficits in their health regions over and above the funding that would be provided for out of an $8.3 billion health budget that we have before us . . . . If he's making those indications to health authorities that it's okay to run those deficits, and his excuse for doing that is that he thinks there's more money coming from Ottawa in terms of this fiscal year, I would suggest that that's a rather irresponsible approach to funding health care in British Columbia.

I'm wondering if that is in fact what the minister is doing -- that he's banking on money to flow from Ottawa in this fiscal year in order to fund the maintenance of services by health authorities over and above what's covered in this current budget of $8.3 billion.

Hon. M. Farnworth: That's not what I'm saying. What I'm saying is that it's no secret that everybody knows that the province is negotiating with Ottawa for more money and more money that I expect can be targeted to key areas of health care that we need to look at.

I am also saying, and have said, that in terms of this year's budget, we expect sound management and sound management decisions to be taking place. That's why we have said we want to work with health authorities to identify where the pressures are. We want to ensure that, in terms of the formulation of the allocation, we have a good understanding of what each of the pressures are in each of the individual health authorities. That's why we're working closely with them in terms of looking at their run rates, and the services that they're providing to ensure that all those decisions are taken into account and that the allocation can be made on the basis of that best information.

C. Hansen: I have had conversations with a variety of individuals who have given me estimates as to what they think the magnitude of the deficit problem would be. I guess in these discussions there was a sense that the ministry had compiled the magnitude of this problem of what the health authority deficits would be if there is not additional money flow from Ottawa that would flow into the health regions and if we simply had to rely on the existing budget that's before us.

I am told that in the four regional health districts comprising the capital health district -- South Fraser, Simon Fraser, and Vancouver Richmond, which I think it's probably fair to say are the four largest ones -- the magnitude of the projected deficit to maintain services would be $140 million. The other specific example I mentioned earlier was Okanagan-Similkameen, which is projecting $24 million.

I am also told -- and again it is a projection or an extrapolation -- that provincewide, we are looking at $225 million of collective deficits by the health authorities if we're to maintain existing services and if they have to fund their operations based on what would flow from the existing budget that's before us.

My question to the minister is: what happens if additional dollars do not flow from Ottawa in the current fiscal year or if, in fact, they flow in a targeted way -- such as equipment -- which does not help the health authorities with their operating budgets?

[1550]

Hon. M. Farnworth: That's why -- and I follow up on the member's comments, because there is speculation . . . .

When you're comparing one region to another region, I think what is important is that we get a sense of exactly what the pressures are on the different authorities, exactly what the programs are that they're offering in terms of the services and their run rates, exactly the utilization measures that are in place to lessen pressure on individual authorities, and to meet with them on that basis to get a sense of exactly what the service pressures and the financial implications of those service pressures are. On that basis, then, we can formulate a much clearer picture of an allocation that is required.

C. Hansen: The minister's right; this is speculation. But there are a lot of people who take their responsibilities as health care administrators very seriously and are quite fearful as to what the ramifications might be if the ministry suddenly, halfway through the year, discovers that, first of all, they've given instruction that there should be no service cuts in the region and secondly, they've been told that there may be some federal dollars flow and suddenly they realize that those dollars are not going to flow in this year or in a way that helps the operating budgets of the health regions.

These administrators are going to be told, as they have been told in years gone by, that halfway through a fiscal year they have to start making serious cuts that could have been spread out over a year, but they suddenly have to make up those cuts in the remaining few months of a fiscal year.

I think the minister is very aware of the ramifications in terms of collective agreements, where you have 80 percent of the Health budget going into wages. Administrators today do not have the flexibility to start laying people off immediately; they can't save money from that, because they can't realize the benefits because of the notice that would have to be given. There is a great concern that given the minister's indication that there should be no service cuts in the region, they should in fact be running deficits at this time. There could be some very serious ramifications on their ability to deliver patient care halfway through this fiscal year.

I would like to ask the minister: if we get to that position, is he in fact going to authorize significant deficits being run by health authorities?

Hon. M. Farnworth: I understand that the member's comments are on speculation. I want to assure him that we are concerned about patient care. That's our primary objective. At the same time, we expect to see sound fiscal management.

[ Page 15742 ]

That's why we are meeting with the health authorities individually -- to ensure that we know exactly what the pressures are, how those pressures impact on them, the impact on their budgets and their requirements in terms of the allocation. That's why we're working closely with the ministry to ensure that the utilization management measures that they have in place are continuing to be in place and that there is recognition of the facts around what the services were last year, run rates and how we deal with those things. It's so we can ensure that we have a concrete allocation when it comes out.

I recognize the issues the member is raising, and that's how we're dealing . . . in terms of ensuring that what comes out has been based on solid information.

[1555]

C. Hansen: What we have in the province today are 52 health authorities that are essentially flying blind. They have a baseline budget from the previous year; they have a couple of indicators, in terms of the collective agreements that are going to get covered. But aside from that, they're flying blind in terms of how they have to manage a budget for a fiscal year that actually started on April 1. Here we are -- let's see, what would it be? -- seven weeks into the fiscal year, and so far the health authorities don't even know when they're going to get their budgets finalized for this particular year.

In the meantime, if there are adjustments that have to be made, they're going to be left with only a fraction of a year in which to make those adjustments.

Can the minister tell the health authorities, in response to questions here today, when the funding allocations for this year will in fact be finalized so that they know with certainty what they're dealing with in terms of their budgets?

Hon. M. Farnworth: The allocations won't be done until . . . . First off, we have to finish meeting with the health authorities, and it's expected that that will be completed within the next two and a half weeks.

C. Hansen: So do I gather from the minister's comments, then, that it would be, say, within three weeks that the health authorities will in fact know what their budgets are?

[T. Stevenson in the chair.]

Hon. M. Farnworth: I think it's important to make a couple of points. First, we are in fact meeting with the health authorities, as I said. That has got to take about another two and a half weeks. After that, we can take the information and deal with it and move forward. So I don't have a specific date for the hon. member.

I also think it's important to note that it's not a question of health authorities flying blind. They have been given significant information to date around last year's budget, for example, in terms of the restated base being confirmed. Issues around wage increases have been confirmed, and again, issues around the provision of some services have also been confirmed. So they have significant information already. The question now is building on that, and that work is taking place.

C. Hansen: But I think the concern is that everybody saw the budget that came down. Everybody had a chance to start pulling those numbers apart as of the end of March, when the budget was tabled. And what they saw in there was that yes, there was an increase in funding for health care in British Columbia, the majority of which is consumed by the collective agreements, wage settlements and the other issues surrounding wage costs within the budget.

So then when they start looking at the increased utilization within their regions -- they start looking at population changes, demographic changes generally -- they start suddenly realizing that there just is not enough money collectively in that $8.3 billion budget for them to maintain services.

Has the minister given a directive to the health authorities that until such time as they see their budgets, they are not allowed to be cutting services?

[1600]

Hon. M. Farnworth: What they've been told is to deliver their current volumes of service and to also continue in terms of current utilization management practices to ensure that we can manage the system in a way that meets the requirements that have to be met.

C. Hansen: I know that two years ago the health authorities were not advised of their budgets until into June. I've forgotten the date exactly. But I noticed last year -- in fact, I had a copy of the cover of the letter that went out . . . . It was just a notice that went out to the chief executive officers of the health authorities. It was dated May 18, 1999, which, ironically, of course, is exactly one year ago tomorrow. This letter was to advise them to anticipate that their operating budgets would be communicated to them on Friday, May 21. I'm wondering if the minister can tell us: why is it that we seem to be significantly behind that

schedule this year?

Hon. M. Farnworth: I think what the member's two examples indicate is that there's a general indication. It's around the May 20 to mid-June period that in fact the letters go out. In many cases there are circumstances each year that allow things to go out earlier; sometimes they go out a little later. But this is generally the time -- around this time over the next several weeks -- that the letters go out.

In terms of looking at building budgets and things like that and taking into account the pressures on a system -- whether it's nursing shortages or staffing shortages -- all those types of things have to be looked at. This year is a little later than last year, but it's certainly not out of line if we look at when the allocation went out two years ago.

[P. Nettleton in the chair.]

C. Hansen: I was told by a senior health administrator in the province that he estimated they could save 3 percent from their operating budget if they were to go to a three-year budgeting cycle. I found that a rather astounding number, especially when you think of an $8 billion budget. We're talking about a quarter of a . . . . What does that work out to? I guess about $225 million could be saved by a longer time frame. I really questioned that number when I first heard it, because I found it quite difficult to imagine how simply a longer horizon would result in those kinds of savings.

It's when you start realizing that the system we are operating under today -- that suddenly, the only time they really have in which to manage a budget is within such a short time frame . . . . It's not even a full fiscal year; you're talking nine

[ Page 15743 ]

months in which they have certainty with which to manage their budget. That kind of uncertainty leads to decisions that are much more expensive -- whether it's decisions to make staff permanent, whether it's decisions in terms of the term of contracts or whether it's decisions in terms of procurement. I know that all of that goes on regardless of the budget being finalized. Certainly the more I start to understand the cycle we go through every year on this, the more I start to realize that the 3 percent number certainly wasn't far-fetched.

I'm wondering if the ministry has done any kind of evaluation like that to determine the costs that are incurred because of the short-term budgeting cycles we work on.

[1605]

Hon. M. Farnworth: I think the issue the member raises is an important one, and we've touched on it briefly in some of the other discussions over the last couple of days. It's that, one, we are governed by the Financial Administration Act, so the ability to change that rests with Finance. But certainly in terms of how budgeting takes place and in particular areas, longer-term planning may in fact be the way to go; it may in fact enable savings to take place. I also recognize, too, that part of that is a question of how you . . . .

In terms of the speculation about what you can save, it depends in many cases on when you get those funds. If you are able to have access to them up front -- which may not be possible for a government to do -- that allows you great flexibility in being able to make some changes earlier on that pay a dividend later on down the road, even though that funding is earmarked for that particular time. I think there are all kinds of ways of looking at how you can manage or how you can fund the system, whether it's a short term or a longer term.

I think one of the key things -- and it comes back to what we discussed earlier -- is around ways to be innovative, and certainly changing the Financial Administration Act is one possibility. But it also reflects on other areas of the system where we're at, where we're trying to be innovative, to make changes. Information technology is one that allows us to get a better handle in terms of managing information and all those kinds of activities that go with that, where we could make strategic investments that could also pay dividends. Work in that area has been ongoing, but of course, you can always do more, and it's certainly the intention of the ministry to do more.

C. Hansen: On the issue of funding generally, I've got a couple of more things that I want to deal with. One is WCB; the other is population-based funding, which I know has been covered extensively. But there's a few wrap-up questions that I want to ask on that. I then indicated we would go to acute care.

In terms of available staff, at this point a few questions on acute care would not be disruptive, I trust. My colleague from Saanich North and the Islands is anxious . . . . He was hoping to get these questions in last night, and unfortunately, we didn't have an opportunity because of other meetings -- if that's okay.

M. Coell: Just a couple of issues for the minister. The first one is that on Saltspring Island, at Lady Minto Hospital, which is a small rural hospital, the physicians have been requesting funding for on-call services. There are approximately ten physicians and as the minister knows, many of the rural hospitals have had on-call funds made available since the last year -- the northern doctors and the Dobbin report. I wonder if the minister could update me as to the status of on-call funding for physicians at Lady Minto Hospital.

Hon. M. Farnworth: The Ministry of Health and the BCMA have agreed on discussions on this particular issue to look at ways about resolving it. I know the hospital is anxious to get going, but these discussions will be taking place a little later in the year. We have in fact agreed to do that and to work to try and find resolution to the issue.

[1610]

M. Coell: I would encourage the ministry to act swiftly on this, in that it's very difficult to attract doctors to rural hospitals, as you know, and to keep them. Right now there are a number of physicians whose practices are up for sale. If we're going to keep attracting . . . and have a vibrant hospital there, you've got to have the doctors funded, for one, and also the on-call services. So I would encourage the minister to act swiftly on that.

The other issue that I wish to share with the minister was an issue that . . . . Almost a year ago I wrote to former Minister Priddy and also the hon. Minister of Human Resources -- what would now be the Ministry of Social Development and Economic Security. I had a constituent share some of the experience that she'd had dealing with the capital regional district -- our capital regional board -- and the Ministry of Human Resources, now Social Development and Economic Security. She has a 32-year-old daughter who was in extended care in the Gorge hospital and received a comfort allowance from Human Resources.

Her daughter had recently had to replace the wheels on her wheelchair and could not afford to do that. Unfortunately, both the capital health region and the ministry refused, suggesting that the other one was responsible. I realize this is a small amount of money, but for a lot of British Columbians that isn't a small amount of money.

Eventually, the Ministry of Social Development and Economic Security paid the bill -- a matter of a few hundred dollars. There was an assurance given that that problem would be worked out for people and they wouldn't put someone through, literally, months of going back and forth to ministries and applying for funds, appealing decisions, working with hospital social workers and resources of the law centre -- all to get the wheels of a wheelchair paid for through one of the ministries. I just wonder whether that situation has solved itself and there's an agreement between the ministries to cover allowances for capital costs such as replacement of wheelchair wheels.

Hon. M. Farnworth: I'll be happy to look into that specific case for the hon. member and see if we can get a resolution to it.

M. Coell: It isn't that specific case; it's more the policy that would solve other problems, so that we're not tying people up with bureaucracy; we're actually solving their problems.

The other issue is that of extended care beds for youth and young people. Right now in the region, when someone is like this person was at the Gorge Road -- and still is -- they're in with people who are very old and people who are dying. Yet they're in their youth. It seems to be that they would be

[ Page 15744 ]

spending a great deal of time, or maybe years, in that facility. Because there has been a reduction in the beds and because of the problems at Gorge Road Hospital, I wonder if there is an opportunity to put together a facility or beds for the 30 to 50 youth we have with extended health care needs?

Hon. M. Farnworth: On this specific issue, we do recognize the problem, and we're working with CHR and in Gorge, in terms of preliminary-stage work and of how we address that problem there. So we are in fact involved in it. In terms of the broader picture, the continuing care review and then the implementation framework around that is intended to also address the general issue around the province.

M. Coell: I think that's an important issue for youth, with younger disabled youth in the Gorge Road facility.

Just to follow up on that, there have been a number of suggestions made for the Gorge facility, with its problem with mould and its aging infrastructure. I know that a former chancellor of UVic, Bill Gibson, has put the proposal forward to the capital health board -- I've spoken to their CEO, as well -- of actually rezoning and demolishing the Gorge, selling the property once it's rezoned and taking the money to the University of Victoria, where you would have free land. You would also have a nursing school, a centre for aging and in the future probably a medical school.

Whether that would be a more appropriate place for a facility like Gorge Road, whether the ministry is even thinking or considering that option as put forward . . . .

[1615]

Hon. M. Farnworth: We are aware of the proposal and certainly prepared to consider it. Any solution like this for a facility, in relocating it or dealing with particular issues in it . . . . If there's a community-driven one or one that's certainly acceptable to the community, I am more than happy to consider that and evaluate it.

M. Coell: Finally, there are two issues that I want to emphasize. The one that our critic has . . . . The facilities like Lady Minto and Saanich Peninsula Hospital in my riding find it difficult when their funding authority, the capital health board, doesn't have a finished budget. I would encourage the ministry to act swiftly on that. It is a real difficulty for smaller, rural hospitals to try and keep their budgets intact if they don't know what their funds are until August or September.

The other issue that I just wanted to put my support behind is the Vancouver Island Head Injury Society and the work that they do. I know that a number of people in the Legislature have met with them and other societies throughout the province who deal with people with head injuries, and I know the need for community services and community backups. I don't need an answer from the minister. I would just like to let him know that I personally think they're doing a great job, and I think the community services provided to people with head injuries is very important.

I thank you for your time.

C. Hansen: I want to pick up our discussion with regard to funding and some of the implications of it. One particular issue that came up just around the start of the fiscal year was the pediatric intensive care unit at Victoria General Hospital. I think the minister at that time made a commitment that that pediatric care unit would stay open and operational. The speculation that it may have to close was something that flowed from the projections of what budget dollars might flow to the capital health region. I'm wondering if the minister could advise us whether or not that pediatric care unit is in fact still open and fully operational to the same level that it had been in the month prior.

Hon. M. Farnworth: Yes, it is. I would also add that it is continuing its work with the Women's Hospital and Children's Hospital in terms of developing a children's health network here on Vancouver Island, so that the primary focus remains the health and well-being of children and patient services for them.

C. Hansen: In the case of the capital health region, is that funded, in terms of the funding commitments that have been made to the capital health region in advance of receiving their full year budget?

Hon. M. Farnworth: The funding for it is in their base, so it is funded. I think what's important is that they are working with Children's Hospital to ensure that we have a good network of patient services for children. That's what I think needs to take place, and that's the message that we've been trying to communicate.

C. Hansen: In terms of the budget concerns that led to the proposal being put forward that the pediatric care unit was going to be closed, if I'm hearing the minister right, what he's saying is that the care unit's going to stay open and they have to cut services somewhere else in order to provide for those dollars.

[1620]

Hon. M. Farnworth: This was not a specific budget issue. This was a question of whether this unit is operating as efficiently as it could. There was miscommunication that took place, and I think that's how the controversy erupted -- in part. When you asked your question, I was at that point able to answer it and say: "No, this is not. This is a priority in this area for this region, and we don't want to see it closed."

C. Hansen: There has been a concern raised among health authorities with regard to the significant increase in WCB premiums that health authorities are facing this year -- in fact, the entire health sector in British Columbia, whether or not it's employees directly or people who work for the health authorities or whether it's private care facilities. It's basically across the board. I was debating at this point whether or not to raise this under the issue of compensation issues. I'm going to raise it now; we can defer it to that later

section if the minister would prefer. It's my understanding that instructions have gone out from the ministry to the various health authorities that they should not be paying the increased WCB premiums that are being assessed. Is that correct?

Hon. M. Farnworth: That, in fact, is correct, in that we wanted to have a meeting first with the WCB to discuss this issue with them to ensure that worker safety is our paramount concern and discuss how we can address some of the injury rate by bringing it down.

C. Hansen: It's my understanding that any employer in the province that doesn't pay the premiums that are being

[ Page 15745 ]

assessed by WCB is in fact breaking the law. I'm wondering if the minister has any special dispensation from the WCB that in fact employers will not be penalized with some fairly high penalty rates for not remitting the WCB premiums that are being charged.

Hon. M. Farnworth: No, we fully understand that. It's not an intention of not paying; it's a question of . . . . We want a meeting with the WCB to ensure that we're addressing some of the issues around worker safety and that the health authorities and the CEOs are dealing with the issue. That's not intended to be a problem. What it is, is a recognition that there are a number of initiatives that we can be taking to bring down the accident rate within hospitals, which is unacceptably high.

A lot of that is primarily around lifting equipment, and there have been some steps taken -- for example, around the occupational, health and safety fund -- to deal with some of those issues. We want to ensure that those measures are taking place, and we want to work with the WCB to implement those particular issues.

C. Hansen: That almost leads us into another whole area about the lack of operating dollars with which to buy lifting equipment in a lot of these facilities. But I have another file we'll get to eventually, under equipment.

[1625]

To deal specifically with this, my understanding is that if the WCB were to make an exception in this case, for the health industry, to say that programs to reduce rates will result in lower premiums today, that would be pretty precedent setting -- that in fact the WCB, when they set their rates, are reflecting a track record of injury. I agree with the minister that injury rates in the health care sector have been unacceptably high. Certainly the costs that the WCB have been incurring are enormous.

My concern, though, is that when the minister is giving instructions to health authorities not to remit these increased premiums, they are in fact setting themselves up for some very severe penalties. My understanding is the penalties are 8 percent per quarter for premiums that have not been remitted, which works out to 32 percent per annum in penalties. There is no indication, first of all, that the ministry is going to fund those increased WCB rates and, secondly, that the ministry is going to fund the penalties if they were imposed.

Hon. M. Farnworth: First off, it's not our intention to put anybody in that position.

Second, what we have said is we want a meeting with the WCB. They have agreed to that meeting. What we are trying to do is look at ways that we can implement measures to bring the accident rates down. That's not saying that at the end of the day you're not going to be paying premiums. What we want to do is to ensure that we're working with the WCB to put in place initiatives that can bring those accidents down. Nor is it the intention to put anybody in any position of being in violation of the law.

C. Hansen: I'm not clear whether the ministry is trying to pursue a reduction in the premiums for this year or whether in fact they're trying to bring in new programs in order to reduce injury rates. I know for a fact that there are a lot of programs already in place to bring accident rates down, and a lot of people, through health and safety committees, are working on that very issue and have been for some time. But is the ministry's objective to actually get the WCB to roll back premium rates?

Hon. M. Farnworth: No. Our objective is to get the injury rate down; our objective is to get the accident rate down. Our objective is to get the WCB to assist us in getting that injury rate down. That's what we want to accomplish. That's our goal. That's why we're having a meeting.

C. Hansen: But that's not something new. That's been going on for some years, and I know there's been a lot of people working very hard to achieve those objectives that the minister just outlined. I'm surprised if there are suddenly new initiatives that are flying in the face of the ones that have been ongoing all along.

My question is: why is it, then, that the ministry has instructed the health authorities and, through the health authorities, the various health employers that are funded through health authorities . . . ? Why have the instructions gone out for them not to remit the increased premiums to the WCB?

Hon. M. Farnworth: I think one of the things it's time to recognize and realize is that the WCB and the employers have constantly been . . . . They have a very strong relationship where they talk to each other. But then, we are the funder, and it's important that as the funder, we are also talking to the WCB, because there are initiatives that we can take. The occupational health and safety fund, for example, is a way of dealing with some of the issues that are raised around equipment -- lifting devices, those sorts of things.

So what we want to say is: "We need to meet with you so that we are working together to reduce the injury rate. That's our primary goal. That's what we want to accomplish, and that's why we want you to assist us in doing that."

[1630]

There have been a number of issues that have been identified that contribute to that injury rate; for example, staff shortages and the issues around nursing and the aging of the nursing workforce is part of it. There are measures that we as a ministry and a government are taking. Those need to be communicated, and we want to sit down with the WCB -- in part because we're the funder -- and recognize that this problem needs to be solved with the cooperation of the WCB, the employers and also government.

C. Hansen: But that's not going to affect a premium rate in the current year. I think those efforts are honourable. Certainly it's not just from the point of view of saving scarce health dollars, but it's also from the point of view of ensuring that workers are protected, that injury rates are brought down and that people aren't being put through the kind of suffering and injury that they are today in the health sector, which is clearly unacceptable.

But if all of the initiatives that the minister just explained are 100 percent successful in starting to bring down injury rates, we're not going to see a reduction in the WCB premiums until at least a year from now. I'm wondering if the minister can explain why it is, then, that health authorities have been instructed not to fund the increased WCB premiums -- not to pay the increased premiums for this fiscal year.

Hon. M. Farnworth: We've been trying to get this meeting for quite some time, because we recognize that the key to

[ Page 15746 ]

bringing the injury rate down and the worker-injury rate down in British Columbia in the health care field requires all three to be actively involved. So it's not a recognition of saying that premiums aren't going to be paid, because I expect that at the end of the day they will. Actions by government can have a significant impact on those premiums in coming years. There are important initiatives that government can take in conjunction with the WCB and in conjunction with employers to make sure that those practices or changes that need to take place . . . . We want to work with the WCB to do that. We need to be part of that initiative.

We have got our meeting set up. It is going to allow us to discuss some of the things that we need to do and why we want their help in doing them. It's out of that that I think will flow the benefits which will accrue in future years.

C. Hansen: I just want to read an excerpt from an e-mail which went out from the executive director, regional operations. It says:

"Good afternoon. I am writing on a matter related to the increased WCB premium levy in this coming fiscal year, 2000-2001. There have been significant concerns raised about the amount of the sector-wide increase. There are discussions underway on this matter, and until further notice, I would suggest that you refrain from paying that portion of your WCB cost related to the above-referenced increase. I expect to be able to give you further information in the very near future."

That is an e-mail that went out on April 3.

What I'm wondering is: is that instruction not to pay the increased premiums? What has that got to do with what the minister just said about very good, noble programs that will reduce injury rates and hopefully, affect premiums in coming fiscal years?

[1635]

Hon. M. Farnworth: It comes back to why I mentioned that it takes all three in terms of reducing workplace injuries -- the WCB, the employers and the ministry. When you look at the magnitude in terms of dollars -- they're traditionally funded not by government but by the employer -- that's a significant impact on patient care. If we're to do that and provide the type of practices . . . and improve the safety record, then there need to be changes made.

We need to sit down with the WCB and make sure we understand exactly what we're trying to accomplish and to ensure that worker safety is a primary concern, as is patient care. We need for them to sit down and assist us in implementing a plan and to try and cooperate in terms of how we can implement the changes and what the changes are that need to take place, recognizing that it's not just the WCB and the employer, but it's the funder as well.

C. Hansen: I don't disagree with anything the minister has just said. It's just that we're talking about two different things. I support those initiatives, those discussions that are going to bring down injury rates and hopefully bring down premiums in the future. But why is it that health authorities are currently under instruction not to remit that increase? From everything the minister has just told us, there's really not much prospect of, or the discussions aren't centred around, bringing the premium rates down for this current fiscal year.

The minister used the words that the amount of dollars we're talking about has a significant impact on patient care, and that's why I'm belabouring this point. It is because it will have a significant impact on patient care if all of the various health employers in this province have to pay these fairly significant increases in premiums and then have to find those dollars out of their existing budgets.

If we're holding this off -- you know, it's now six weeks since they've been given that instruction -- and they go through a good chunk of the fiscal year holding off those payments, then all it means is that when you've got to start writing the cheques to the WCB, it's going to have an even greater impact, because it's going to be spread over a shorter number of months. I'm just wondering if the minister could explain why the health authorities are currently under these instructions.

Hon. M. Farnworth: What it comes back to is the point I made before about it being the impact that that would have in terms of making the changes that are required. The WCB needs to realize that we as a funder have to work with them and the employer. I was very concerned about the impact of taking those funds out of the system and then the ability to make . . . . In terms of the changes that are required, in terms of bringing injury rates down, that puts considerable pressure on us in terms of financial resources.

What we have said is: "Look, we need a meeting with the WCB; we need that to take place." That is now taking place. Out of that, I expect we will then be able to sit down and say: "Look, here's where our problem is. If we're making investments in here, this is what our goal is -- to bring down worker injuries in the health care field." If that takes place, then that should have an impact, and we can expect to see benefits from that. I'm confident that we can work with the WCB to achieve that and also that there won't be levies or fines for late payment.

I think that that's what we're trying to do -- to bring home the message of: "Yes, we need to make changes. But look, there's going to be an impact on what you're asking, and we need to see how we can manage through this, and then we think there may be ways of doing that."

[1640]

C. Hansen: It's analogous to . . . . If the minister has a car accident and suddenly finds that his ICBC rates are going up, he can go to ICBC and tell them that he's going to take a safe-driving course -- which is well and good; they'd probably encourage that. If they did that, it might result in a couple of years of safe driving, so that your rates are going to come down -- you're not going to have any more accidents in those years. It's certainly not going to affect your premium rate for this year.

I don't get the sense that we're going anywhere with this particular discussion, because I'm not sure that . . . . I don't think the minister has given me any assurance that the hope that has been extended to the health authorities that somehow these premium increases are going to be waived . . . . That certainly doesn't seem to be the case, from anything the minister has said. So somebody is going to have to pay these increased premium rates for this fiscal year.

Will the minister give us the assurance that the health authorities and the other health employers that are funded by the health authorities will in fact be fully funded for increased WCB rates that they will face in the current fiscal year, so that they will not have to cut patient care in order to find those resources?

[ Page 15747 ]

Hon. M. Farnworth: I cannot give that assurance, and I won't give that assurance in terms of the funding of the premium increases. One of the things that needs to change is workplace practices. We can't just keep going on funding 100-percent-a-year increases. So we have to put in place, on a tripartite basis, between the fact that there's the WCB, the employers and the funder . . . . Those changes have to take place. I think that's got to happen, and that's the key goal.

It also comes back to . . . . In terms of when you're looking at premium increases, and what is the problem, and how do we deal with the problem . . . . The member made an ICBC analogy. I too would make an ICBC analogy, and that is that ICBC, in determining risk, recognizes that there are certain areas -- for example, high risk intersections . . . . You fix it; you don't keep raising people's premiums. You go and fix that intersection, and it reduces the accident rate at that particular area.

One of the things that I think we need to start to look at is working with government in terms of identifying what the key problems areas are and dealing with them in terms of bringing down worker accidents. At the end of the day it is about workplace safety.

C. Hansen: I hadn't planned to spend as much time on this issue, but it is an issue of concern. Quite frankly, I thought we were going to be able to deal with it much more expeditiously. The point is that I agree with the minister that those initiatives are important. We have to bring down workplace injuries. We have to make sure that workers aren't off because of back injuries and all of the other injuries that we see happening in the health sector in British Columbia today.

The point is that regardless of what is done today in terms of implementing new programs, and regardless of what is done in terms of bringing new equipment into health facilities -- in terms of lifts and other things to bring down those workplace injuries -- those will not result in lower WCB premiums for the current fiscal year. Therefore, the various health employers will have no alternative but to cut patient care in order to pay for the increased WCB premiums that they're going to have to start paying sooner or later, sometime in this fiscal year.

[1645]

Hon. M. Farnworth: I think one of the important things to remember is that this is not a single-year problem. It's a multi-year problem, because they're coming up . . . I think the key thing, in terms of dealing with this issue, is to make sure that we can make some significant, substantial changes in improving worker safety in our facilities and hospitals this year so that it can have a significant impact next year. It makes our ability to deal with the pressures this year . . . . It gives us more ability to deal with them this year, knowing that there is relief coming next year and the year after that.

C. Hansen: That is exactly my point. What do we do about this year? The minister himself said that the increased dollars that are involved would have a significant impact on patient care. How are the health authorities and the various health employers to fund their increased costs of WCB during the current fiscal year, when everything the minister is talking about isn't going to produce lower, or the prospect of lower, premiums until at least the next fiscal year?

Hon. M. Farnworth: This is a new policy. It's not based on the same practices as the old policy. What we want to do is ensure that in terms of the new policy and how it's implemented, there's an understanding by the WCB of its impacts on us and that we are also aware of potential options to address some of our concerns by sitting down with the WCB. We are meeting with them tomorrow, and I expect that after that meeting, we will then be able to move forward and move on from there.

C. Hansen: I guess there's a stubborn streak in me that tells me that I shouldn't quit just because I'm not getting an answer. In fact I'm getting the runaround from the minister on this thing. But I also appreciate that we're not making any progress on this subject, so I will move on. Let me just say that the minister has not given any health employer in the province any comfort that this issue is being dealt with in a way that's going to result in anything other than cuts in patient care. With that, I will move on, but I hope the minister will find a way of dealing with this as soon as possible.

I mentioned earlier that I want to touch on the issue of population needs-based funding. I know this has been well canvassed by my colleagues in terms of how it was going to affect their particular region. I am also familiar with the minister's answer to that point, which he repeated several times over the last two days.

My understanding is that there is in fact a model that has been developed, that the only thing that is preventing the implementation of a population-based funding model is a political decision and that the minister is concerned that some regions may in fact lose, and that may not be politically popular. Yet there are other areas that are significantly underfunded when you look at the population.

If you look at the allocation in British Columbia and the increases that have been applied to some very rapidly growing areas, the areas of the province that we see the biggest health care challenges come from -- whether it's central Vancouver Island, South Fraser, Okanagan -- are all areas that have had very, very significant population increases in the last few years. The health funding that has flowed into those regions simply has not kept pace.

[1650]

Going back to the Health Association's meeting last year, there is a resolution that was put forward in this area. If I can just quote from it briefly: "The association has written to the Minister of Health requesting an indication of when the government will implement the population needs-based funding model." It refers to the previous Premier, the previous Minister of Health and the previous deputy minister, as well as the then associate deputy minister: " . . . have all given verbal assurances that such a funding model will be implemented for fiscal 2000-2001."

So my question to the minister is: I know the reasons that he's given in terms of answers to other colleagues, but is there a time line in terms of when decisions will be made either to go ahead and implement the model that has been developed by his staff or to give an indication to the health authorities around the province that the population-based funding model will not be implemented?

Hon. M. Farnworth: Yes, we've been working on a model, as we were talking about yesterday. I guess the issue is: if we are going to implement a new model, then we have to know exactly what all the ramifications from it are. We're trying to work with the health authorities and are looking at

[ Page 15748 ]

how a model would impact upon them. What would be the specific impacts, whether positive or negative? We have been doing some fine-tuning in terms of moving to a population-based model, in terms of funding around margins and in terms of some new initiatives. But we have to remember that whenever you make a significant change, that can have dramatic impacts. And we need to know exactly:

1. Is there agreement on the foundation upon which the funding model has been developed in terms of the different factors and the waiting that's attached to those factors in terms of how it's done?

2. Do we have a full understanding of what the ramifications are if a particular model was to be accepted, to be able to say to the health authorities: "Here's how it's going to impact in certain areas negatively, and here are the actions that we are going to take to address those particular impacts"?

C. Hansen: I guess what I'm looking for is a time line in terms of when that decision might be made.

Hon. M. Farnworth: In terms of implementation there's some key things that need to be taken into account. Clearly one is the issue around getting the consensus, and we're not there yet. Second, if you're going to implement it, it's not the type of thing that you can implement in a single year. In fact it is going to take some time; it is going to take some transition. So you're probably looking at a multi-year process in order to do it.

C. Hansen: Is it still the policy of this government to implement a population-based funding model?

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Hon. M. Farnworth: It's the policy to see that we have a funding formula that's based on principles of equity, transparency, simplicity and meeting needs -- and that it's consistent. That's no small challenge when you're trying to work with regional health authorities and CHCs in different communities around the province and trying to get agreements around what that should be. But we are working towards it.

We are doing the work necessary to ensure that, when it does move to implementation, it can be as painless as possible, and that the steps have been taken to ensure it's understandable and can be implemented in a way that deals with any negative impacts that certain areas or regions of the province may experience.

C. Hansen: Before I leave this general area of funding and funding models, I just want to draw the minister's attention to page 29 of the environmental scan. There's a reference here to health care expenditures by province, 1998. It says that British Columbia's provincial government spent more per capita on health care than any other province. It references CIHI, the Canadian Institute for Health Information.

I'm just wondering if the minister is aware that this is no longer an accurate statement. Information that comes out shows that for the last two years British Columbia has slipped. I believe that the forecast for the fiscal year ending this last March 30 is that in fact British Columbia, on a per-capita basis, is probably going to rank about four or five among provinces.

Hon. M. Farnworth: No. I'm familiar that we are actually number two as opposed to number one. But I would say that, in terms of regular standard increases, we are alone amongst the provinces in having made them year over year for the last nine years

whereas other provinces have cut and then added in and cut and added in. We haven't gone that route. Those are statistics from 1998.

The other thing about the report that I would also put into account: it doesn't take into account the money that's added during the year or during the special warrants. That's not factored into their calculations either.

C. Hansen: I want to move on to some areas of acute care, if I may. One of the things that was brought to my attention is that British Columbia is the only province that is not on-line in national procurement, in terms of procurement for hospitals and other health care facilities around the province. I'm wondering if the minister could explain to us why that's the case.

Hon. M. Farnworth: I think the member's talking about the MASH sector, in terms of internal trade. The policy around that is under E&I . My recollection, just to answer the question, is that during the discussions we are not in fact the only problem. There now has been an agreement around some of the issues revolving around MASH; that has actually been resolved. There was an agreement that was signed off. But the specific details are in Employment and Investment.

I can tell you that one of the leading things around that concern were, for example, UBCM and Vancouver city council.

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C. Hansen: Other provinces have certainly been able to realize some savings in terms of procurement for health care. I'm wondering if the ministry has done any projections or at least had conversations with other provinces in terms of how much they've been able to realize in terms of cost savings by going to a national procurement policy.

Hon. M. Farnworth: Frankly, hon. member, I would just like to say that I think we should be going in the direction of national procurement policies. Those are the types of issues that I've talked about in the last couple of days, of greater cooperation between provinces in a number of areas. I think that's one of those areas that we could be looking at. You could look at that on a whole host of remedies. In terms of my discussions with other provinces and with Ottawa, that's certainly a direction that I intend us to be heading in.

C. Hansen: I wouldn't want the minister to get too hung up on the need for consultations with other provinces, though, because it's not sort of group buying. It's a case of allowing contractors that can offer the best price to a health care facility to meet or supply those needs. Certainly I have a great deal of confidence in the workers of British Columbia in terms of their abilities to compete on a national and in fact global basis to get contracts to supply goods and services to the health care sector.

I have no reason to believe that if we went to a more open system of procurement, in fact those costs would come down. I think we can learn from the experience of other provinces, but we certainly don't need to collaborate with other provinces in order to make this happen. I am just wondering if the minister has any comment on that.

Hon. M. Farnworth: I think the issue around the MASH sector, as I said, is best dealt with in E&I, because there they

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have the policies on internal trade and exactly what has been agreed to between the provinces. But in terms of the provinces, what we should be doing, the member . . . . There may well be opportunities that need to be looked at.

But clearly I also think there is significant room with the provinces in terms of looking at things such as bulk purchases. There may well be opportunities in terms of pharmaceuticals, for example, in doing that. What I'm saying is that I certainly agree with the principle that there is a lot to be gained from the provinces working cooperatively together, particularly in the areas where there are common costs -- things that we use on a regular basis -- that may in fact give us some leverage. I think we should be looking at those types of measures.

C. Hansen: I want to move to a nursing issue. At a later stage, when we get into discussions on planning, I will be talking about human resource needs -- the nursing shortage -- and talking about nurse recruitment. But this is a slightly different subject, so I think it probably best fits into this particular area. It's the role that nurses play, in our acute care sector in particular, and a concern that I hear expressed by nurses throughout British Columbia of the elimination of nursing positions from middle management.

There are not many people, I think, that argue that there is a need in health care for more management or more layers of management. But in the area of nursing, some real concerns have been expressed regarding the elimination of the role of a head nurse or a supervising nurse. I'm wondering if the ministry as a whole has a policy or a directive that goes out to acute care facilities in terms of how they structure those various managerial positions.

Hon. M. Farnworth: No, we don't. It's up to the local health authorities to determine what structure works best in their own particular area.

C. Hansen: Is there an opportunity, at least, to look at best practices? I know that different facilities have been using different models with varying success, and I would be surprised if there isn't at least a sense as to what model is working best. What I hear from anecdotal stories, at least, from around the province is that the model of eliminating the nurse supervisor or head nurse position clearly was not working in the best interest of nurses. They felt they had lost an advocate at the managerial table, which in turn led to a lot of the frustrations that we see today in terms of the role of nursing in acute care facilities.

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Hon. M. Farnworth: Certainly in terms of best practices I think that's something we encourage all health authorities to do. I can tell you that my understanding is that the issue that the member raises is a valid one and is in fact in many health authorities being rethought.

C. Hansen: Another concern that was expressed to me in one of the health regions as they went to multi-site administration, where they were basically trying to consolidate services from different facilities that weren't all under one roof but in fact were coming under one administration . . . . One of the concerns that was raised was that of liability insurance.

They had a determination that the liability insurance that was covering health care facilities -- acute care in particular -- in the province was only covering direct care and not, for example, advice that might be given over a telephone by a doctor that, while they might be in the same administration, would actually be working in different facilities. I'm wondering if this is an issue that the ministry has looked at.

Hon. M. Farnworth: We will look into the information from the hon. member an