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

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

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

WEDNESDAY, MAY 12, 1993

Afternoon Sitting

Volume 9, Number 24

[ Page 6161 ]

The House met at 2:03 p.m.

Clerk of the House: Pursuant to standing orders, the House is advised of the unavoidable absence of the Speaker.

[E. Barnes in the chair.]

Prayers.

G. Brewin: It gives me a great deal of pleasure to introduce some people who are in the gallery. There are eight members from the Victoria Native Friendship Society. They're here having a tour of the buildings. I would like all hon. members to make them very welcome.

Ministerial Statement

REPORT ON REDUCING ERROR IN SOCIAL SERVICES

Hon. J. Smallwood: Last week I stood before this House to update my colleagues on ministry initiatives to counteract fraud and abuse in the income assistance system. Today I rise to provide a similar update on our initiatives to identify and reduce administrative error in the Ministry of Social Services. I wish to assure the House, the taxpayers of British Columbia and our clients on income assistance that I take very seriously any allegations of waste or error which threaten the integrity of this crucial and important social safety net for this province.

As recently as 1991 there was a comprehensive audit by the province's auditor general, which reported its work in June, 1992. When dealing with the Ministry of Social Services issues, the auditor general observed that the ministry procedures for dealing with income assistant payments "appear to be reasonable" for minimizing incorrect payments. He goes on to state, however, that the ministry's lack of adequate capacity to accurately measure the extent of incorrect payments -- this lack of information -- makes it difficult to assess the cost-effectiveness of "procedures designed to reduce errors."

In response to the auditor general's recommendations, I have strengthened the ministry's audit team by expanding it from 11 to 27 people. They are expected to bring about a significant reduction in administrative error in the ministry. Also in response to the auditor general's report and recommendations, the ministry developed the draft administrative report that has come to public attention in recent days. Members can judge its relative merits or demerits for themselves. I can tell you that 16 of the report's recommendations have already been acted upon.

Many of them are related to anti-fraud initiatives which I announced last week. The remaining ones are directed at enhancing internal ministry communications, staff education and a range of other opportunities and improvements.

I acknowledge that I am concerned by the appearance of this draft administrative document. Does that mean that this draft document causes me to doubt the direction of our actions? No, rather, much of it confirms that we are on the right track. I am not here to defend the status quo. I am here to reform, to the best of my ability, the services to all citizens. That means all citizens, hon. Speaker, the people who are in need of income assistance and the people who pay for it.

Hon. J. Smallwood tabled the draft project to monitor administrator error and fraud, documents from the ministry documenting the initiatives and the auditor general's report, June 1992.

V. Anderson: I'm glad today that the minister is taking this issue seriously. I had an opportunity to watch the video from yesterday's presentation, and it confirmed that the minister, according to her appearance and her smile and her responses to us yesterday, was not at all taking the question seriously at that time.

We are very much aware that actions speak much louder than words. We are glad that the minister is now presenting the material which unfortunately was not presented earlier so that it could have been dealt with properly. It's also interesting that now she is presenting an increase, from 11 to 27 people, in her audit department. I'm sure the people in the community who are served by this ministry will be delighted to hear that she has increased the audit staff, but they will wish that the financial rewards to the people in the community might be served instead in quite a different way.

There's a question about how money is spent, and increasing the bureaucracy rather than meeting the needs of the people is a great concern.

Two illustrations about the kind of audit that our people are looking for.... Perhaps the minister will give us some response to these. It is my understanding that the majority of appeals against the decisions of her ministerial staff -- as they are directed to do by the regulations -- are won, meaning that the original decision was incorrect.

Also, I wonder about the ministry when I have on file a letter concerning a person in a wheelchair who is not a senior and whose only accommodation is a seniors' home. That person is advised that the only way they can get a wheelchair from this government is to make an appeal and they will likely win. How come this kind of appeal process has to be gone through? The inefficiency of this government is shown by its actions, rather than by the statements of the minister last week and this week.

R. Neufeld: It's interesting to listen in the House when for the second week in a row the Minister of Social Services finally stands up and talks both times about fraud within her department and a loss of funds that should rightfully go to people that need help. This caucus has asked and made this minister aware well over a year ago -- and it wasn't just us, it was the public at large -- that there was fraud within the system and it needed to be acted on. Up until yesterday, the minister

[ Page 6162 ]

-- and I listened to her in the media scrum -- was serious that there was only 1 percent fraud within her ministry. Today she stood up and tabled some reports that she said she apparently hadn't read before.

Hon. Speaker, I think it's time this government looked into the fraud within the Ministry of Social Services, a ministry that has increased in funding by $900 million over two years. We wonder how much of that is in fraud. We wonder whether maybe the ministry, in its internal reporting, isn't on track. But we also wonder whether the minister and her government are on track or not. I mentioned once before that a report went from the Attorney General's ministry to the Ministry of Social Services saying that there was fraud within her ministry and that it had to be cleaned up.

We wonder whether this isn't another part of finally having to have the Attorney General's ministry tell this minister that she has to get down to the basics and down to work to clean up the fraud in her ministry. We hope that with the increase in staff to look at fraud in the ministry, this will happen.

Oral Questions

LABOUR DISRUPTIONS IN SCHOOLS

J. Dalton: My question is to the Minister of Education. Yesterday the minister stated: "I want to reassure grade 12 students that their work to date will be recognized and their access to post-secondary institutions will not be jeopardized." My question to the minister: can you guarantee that students who are applying for post-secondary institutions will be allowed a lower grade point average if they come from a strike-bound district than those students who do not come from such a district?

Hon. A. Hagen: Hon. Speaker, that is a nonsensical question. What I said yesterday was that the students in grade 12 in the districts that are currently involved in labour disputes have completed most of their year's work. They are continuing, as we know through media stories and through reports of students, to be diligent students. Their work up until now and through to the end of the year will be counted.

The post-secondary institutions have assured us that the marks that are given to those students, based on that work, will be accepted in post-secondary institutions, and that they will therefore be able to continue with their studies as grade 12 students going on to post-secondary institutions, starting this fall.

[2:15]

J. Dalton: Again to the Minister of Education. I certainly don't have the assurance that she has expressed, and I know many grade 12 students certainly do not have that assurance.

However, the minister also stated yesterday that school children are an incredibly resilient group. I don't quite know how to interpret that. Does the minister mean that in spite of school district shutdowns -- and in the case of Vancouver Island north, six weeks and counting -- students will not be affected by the closure of their schools?

Hon. A. Hagen: I have said in this House that there is no disagreement among any member that children have the right and deserve to be in school. Adults have a responsibility -- teachers and boards -- to come to agreements within the economic and work situations facing them. Every person who is involved in these labour disputes has a responsibility to children. That responsibility starts in our local districts, and we have all been clear about that from the beginning. The issue of resolving those disputes for the benefit of children lies with the parties, with the assistance of the Minister of Labour.

I am continuing to work with that minister for that resolution, whether we are talking about Vancouver Island north or Vancouver.

J. Dalton: Again, to the Minister of Education, I think the minister and I do agree that school closures are unacceptable.

Will the Minister of Education consult with and impress upon the Minister of Labour the need to order a 40-day cooling-off period so that school closures will be ended immediately?

Hon. A. Hagen: The Minister of Labour can respond more fully to questions that may come to him in the course of this discussion. We have gone through a very trying time this year in difficult economic circumstances, where boards and teachers have had to face up -- as this government has -- to the reality of working with the available resources.

I challenge all of us -- and that goes first of all to the boards and teachers who are currently in those disputes -- to come to a resolution that is realistic in relation to the dollars that we have added, as no other province has, to provide for the education of our children, and to take that responsibility for the kids in their districts as boards and teachers must do if the people of British Columbia are to have confidence in our public education system. That belongs, first of all, with the districts and the people who must negotiate collective agreements, as those teachers and boards have the responsibility to do.

G. Farrell-Collins: The minister talks a lot about the responsibility of parents, teachers and school boards. What she is not talking about is the responsibility of this government to see that these students get an education.

Deputy Speaker: Would the hon. member please put his question.

G. Farrell-Collins: My question is to the Minister of Labour. Will he today bring a motion before this House to order a 40-day cooling-off period to get these students back in school so that they can finish their school year and their exams in order to have fair competition to get into post-secondary institutions in this province?

Hon. M. Sihota: A number of options are available under Bill 84, and we are exercising all of those options. Because we have exercised all of those

[ Page 6163 ]

options, in 50 school districts in British Columbia matters have now been resolved. A number of matters are outstanding. We announced on Monday that we would meet with Mr. Foley. As a consequence of that, we have taken some action, which we announced yesterday, and which the hon. member obviously missed. Based on the outcome of that process, we will make further decisions in terms of the options that the government wishes to exercise.

G. Farrell-Collins: The minister talks about the 50 districts that have already settled, but he doesn't talk about the districts that haven't settled. If the Vancouver dispute continues, and if Surrey goes out on Monday, we could have over 100,000 students out of school in this province. When will the minister take some concrete action -- not wimpy little steps but some real concrete action -- and set a 40-day cooling-off period and get these students back into school?

Hon. M. Sihota: I want to make it abundantly clear to the hon. member that this government has taken some firm decisions with regard to teachers. We have told the teachers very clearly that there is no more money. We have told the trustees that the envelope of funds provided to them provides sufficient scope for a solution to be found. We have told the parties that if they cannot arrive at a resolution, we will provide mediation. We then took an additional step and told the parties that given the fact that they could not agree on a mediation process, we would impose upon them a special mediator.

We have done that. The special mediator is meeting with the parties today, hon. Speaker. You talk about action; this dispute started on Monday. This government has taken a series of initiatives over the last three days, and if need be we will provide further assistance to the parties to help them resolve this dispute expeditiously.

G. Farrell-Collins: The minister talks about firm decisions and firm action. The North Island school students have been out for six weeks. The minister says there's no more money, yet they turn around with the health accord and jack up the increases there. We need to see some concrete action, solid action, that's going to get these students back into school, not a bunch of flimflam or labour relations rhetoric.

Hon. M. Sihota: The concerns of the opposition really ring hollow. It was only yesterday that they discovered there was a dispute in North Island. That's when they first raised it in the House. They should also know that last night there was a vote in the North Island. Teachers voted by 59 percent to accept the recommendations of the mediator. The board, subject to one issue, also accepted the recommendations of the mediator. There is one issue outstanding.

I can assure the hon. member that I have a high degree of frustration with the board taking the posture that it has, and as a consequence, hon. member -- if he would just listen, he might learn something -- I will be talking to the parties further in the next few days to try to resolve that one outstanding issue.

L. Hanson: It's interesting to listen to the Minister of Labour say that he can't get his message across to the teachers that there's no money. If he was dedicated to do that, he would have a manner of doing it.

Mr. Premier, a question: students in this province are being treated as political footballs. This government is standing on the sidelines while children get kicked around in these school strikes. Are the Premier and his government so beholden to the BCTF that he's unwilling to restore education as an essential service?

Hon. M. Harcourt: Thank you, hon. Speaker. I will be quite pleased to refresh the memory of the member for Okanagan-Vernon with statements he made when he was the minister in government who brought in Bill 19 and Bill 20. He said: "We listened to what the BCTF wanted, and we gave them the right to strike." Now he's hoisted on his own petard.

Deputy Speaker: Supplementary, hon. member.

L. Hanson: Well, that's very interesting, Mr. Speaker. The Premier should do a little research on his own, so he would know that the Minister of Education brought in Bill 20, not the Minister of Labour. We know that the Premier voted against Bill 20 in that debate. If he is of the opinion that it's such bad legislation, is he now prepared to repeal Bill 20 and ban the right to strikes and lockouts in our education system? Is he prepared to repeal the system of district-by-district negotiations on teachers' salaries and move immediately to implement provincewide bargaining?

Hon. M. Harcourt: Hon. Speaker, the member had an opportunity to do that and didn't do it. As a matter of fact, I would like to quote the hon. member for Okanagan-Vernon from May 7, 1987, page 1002 in Hansard. He said: "The B.C. Federation of Labour, the Teamsters, the United Mine Workers and the Steelworkers all have the right to form a labour organization to negotiate their wages, salaries and conditions. But that is not a mandatory right by legislation, and what we've done is given the teachers the rights that everyone else has in the province of British Columbia."

Hon. member, what I have heard from both sides of the opposition is that they would like to see back-to-work orders, and they would like to see these matters go to binding arbitration. As somebody who has seen binding arbitration, I can tell you that the people who suffer from binding arbitration are the taxpayers. The taxpayers have told this government, "We can afford only so much money," and we have listened. There's only so much money we can afford. There is enough money to settle these disputes in the budget that this government has brought down.

Deputy Speaker: Final supplementary, hon. member.

L. Hanson: It's interesting to hear the reversal of the field. The Premier was a basketball player, but it sounds like he's a football player.

[ Page 6164 ]

In any case, even though they owe a debt to the BCTF, is the government prepared -- in view of the fact that they have appointed Brian Foley as a special mediator -- to at least ask the teachers to go back to work until there is a resolution, or at least a report from the mediator?

Hon. M. Harcourt: I didn't hear the members opposite ask that that happen in North Island, Powell River or in some of the other districts that have followed the consequences of Bills 19 and 20.

I think that this government, as you have heard from the Minister of Labour, has acted quickly to appoint a mediator. When the parties could not respond, a special mediator was appointed, who was asked by the Minister of Labour to meet with the parties. They are meeting at this moment.

LIONS GATE BRIDGE REPAIRS

D. Schreck: My question is to the Minister of Transportation and Highways. The Buckland report on the Lions Gate Bridge offers assurance of safety for five or six years, if the necessary repairs are made to the deck surface. Will the minister assure this House that every effort will be made so that the process for replacing or rejuvenating the bridge will be completed within those five years?

[2:30]

Hon. A. Charbonneau: That's a tough question, but a fair one. First, I would like to assure the hon. member that the Lions Gate Bridge is safe and will be kept in a safe condition. Second, I will assure the member that the ministry will take all steps necessary to replace or rehabilitate the bridge within five years.

Deputy Speaker: On a point of order, the Opposition House Leader.

J. Dalton: I would direct the hon. Speaker and the government ministers opposite to standing order 47A, which clearly has not been followed. The repetition of answers and the extent of those answers are completely unacceptable.

Deputy Speaker: Order, please. The Chair would agree with the hon. member that all members should study.... The standing orders are there for all members. It is advisable that all members particularly pay attention to 47A with respect to question period.

Hon. A. Charbonneau: I rise to answer a question taken on notice. On April 13 the hon. member for Prince George-Omineca asked a question, and I apologize that the answer got lost in my papers. I will deliver it at this time.

The question was: "My question this afternoon is to the Minister of Highways and the minister responsible for ICBC. Can the minister confirm that ICBC will be charged the new provincial tax on labour by autobody repair shops?" The answer is yes.

The second question was: "Can the minister then tell us just what the impact of this new GST is going to be in total dollars on ICBC, and has it been factored into the grandiose profit picture that this government projects for ICBC in this fiscal year?" The amount of the impact will be $4,213,000. That specific amount had not been taken into account; but due to the dramatic turnaround of this corporation under this administration, we will probably do better.

Orders of the Day

Hon. M. Sihota: Before I call Committee of Supply, I advise all hon. members that Committee A will be meeting to discuss the estimates of the Ministry of Tourism and Ministry Responsible for Culture. With that said, I call Committee of Supply.

The House in Committee of Supply B; H. Giesbrecht in the chair.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

(continued)

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

G. Wilson: Hon. Chair, in light of the absence of our Health critic today, I've been asked to shepherd some of the opposition questions through this process for this afternoon. Just to enlighten the minister so she may prepare for the range of discussion topics, I'll just outline some of the areas that we will be canvassing this afternoon so she might get in the appropriate personnel if necessary.

We would like to look at matters that relate to the establishment of the cancer clinic in Kelowna and operational expenses around that. There will be additional questions with respect to the UBC Hospital operation. We have some questions with respect to aboriginal health and the involvement of this ministry in aboriginal matters. We also have questions with respect to fee increases for medium term care facilities. As well, we have questions relating to financing and advertising. There will be a series of questions related to mental health.

I know that has been canvassed to some degree, but I think these are more specific riding concerns with respect to custody within mental health, air ambulance, travel assistance, orthopedic and wait-list problems, as well as residency requirements for MSP premiums, etc. With that, what I would like to do is perhaps turn over the first set of questions to the Leader of the Opposition.

Hon. E. Cull: I want to thank the member for his list. Unfortunately, I got a list yesterday which included continuing care and hospitals. I don't have staff available for mental health custody issues, MSP or aboriginal health, and I can't call them in on such short notice. We can probably arrange for them to be here on another day. Originally we were getting advance notice a day ahead of what was going to be happening; somehow, that seems to have ceased, Mr. Chairman, but

[ Page 6165 ]

I'd be most happy to arrange for appropriate staff if they give me some warning.

G. Wilson: I'm sure that we'll attempt to work around those areas as best as possible. With that, then, I would yield to the Leader of the Opposition.

F. Gingell: I've been reading Hansard on the issue of the increase in the daily fee costs of long term care facilities for those persons with an income in excess of $17,000. I noted that in your responses you continually referred to an income of $20,000, and I wondered if there was any reason for that.

Hon. E. Cull: It's important that you recognize that what we're dealing with here is net adjusted income. So one then has to ask the question: what is net adjusted income? How do we derive net adjusted income? Net adjusted income is determined by a number of potential deductions. You take the net income reported in the last income tax return, and if you are over the age of 65, as the vast majority of these people will be, you subtract $3,000. If you have a spouse, you can subtract another $3,000. If you have a dependent, which may apply in some cases, you can subtract another $3,000.

And if you are disabled, you can subtract yet another $3,000. So theoretically you could, from your net income as reported on your last income tax return, subtract $12,000 off that to arrive at the income that we use for calculating the long term care fee. It's very unlikely that anyone would be eligible for all four, because it's difficult to be over the age of 65 and still have a dependent -- although it is possible.

The reason I'm using $20,000 is that I'm taking the most conservative approach here and saying: "Well, what if the only deduction you have is one -- because you're over the age of 65? You don't have a spouse, you don't have a dependent, and you're not disabled. You're just 65 years of age or older." It is confusing just to refer to the net incomes. So, to show what the income would actually have to be before you started to pay the very highest fee -- applicable now under these policy changes -- of $34 a day, I'm adding that $3,000 that we subtract.

Seventeen thousand dollars certainly isn't a lot of money, $20,000 isn't a lot more, but it is $3,000 a year more which is available to that person. We have to be careful what we're talking about here, so that we're making direct comparisons.

Also, the reason I've used $20,000 is that I wanted to ask the question of my staff for calculation purposes as we were working our way through this policy: what income do senior citizens have who don't require continuing health care? What are they paying in B.C. Housing-subsidized senior citizens' accommodation. We could look at two seniors who are very similar, except that the health of one has gotten to the stage where even home care and Meals on Wheels and adult day care -- all of the things we do to keep people as independent as possible in their own communities -- are not sufficient.

That person has crossed the threshold from being able to be supported at home with appropriate care to needing to be in an institution. That's the other reason I've been using the $20,000 figure. In any case, when you have a look at it, you have to ask what other deductions that person might have.

I'm going to take this opportunity just to comment as well on the question of spouse. I was very concerned about the impact on people in long term care facilities under different circumstances. You have a spouse, and they share a room with you. You have a spouse, but they're in another room in the same institution. You have a spouse, but they're in another institution. You have a spouse, and they're at home. You have the prime income -- the pension income or whatever -- and you're maintaining your spouse at home, or the spouse is at home with the income and is maintaining you in the long term care facility.

You can see that a wide variety of situations could be out there. We instructed our staff to put in place a policy that where those situations existed, we would calculate the rate both ways -- combining the incomes and treating the couple as combined income, separating them and treating it as if you have your own income -- to make sure that they get the lowest rate that applied. We really didn't want to put people in a situation where, by the fact of having a spouse in whatever circumstances, you were worse off than if you didn't have that spouse.

We have done the calculations in a number of different ways so that the client receives the best rate possible.

F. Gingell: You've actually answered a series of questions that I was going to move to, because it isn't difficult to think of examples. I must admit that what I thought had happened was that you hadn't recognized that income taxes have to be paid, and they had not been calculated in. Are you telling us that when there is a couple, the calculations will be made as though 50 percent of the combined income belongs to each of them, as one imagines in joint returns? Let's say that the wife has an income of $6,000 and the husband has an income of $20,000. You would add those together and divide by two, which is $13,000, take the adjustments and determine the daily charges on that basis.

[M. Lord in the chair.]

Hon. E. Cull: I appreciate that this is a fairly complicated administrative issue. I have a briefing document here that's 25 pages long and answers all kinds of questions about this particular issue. I appreciate that it's very complex.

Under the Income Tax Act, I believe -- it might be under the guaranteed annual income supplement requirements -- senior citizens who are married and for all intents and purposes would normally be treated as a couple and have their taxes treated as a couple's income can declare involuntary separation for health reasons when one is institutionalized and the other is still at home, or any of those other variations that I just gave where they're separated from one another.

This is a matter of law that is available to seniors so that they can get the best rate for tax purposes generally when coming to apply for various government programs that might be income-related.

[2:45]

[ Page 6166 ]

What we are doing with the long term care facilities is that where a spouse is involved in any of the many circumstances that I listed, we calculate the room or accommodation charge twice. We calculate it once as if the senior was separated from their spouse and had only the income of that individual. Then we calculate it as if they were a couple. We pick the lowest rate. In some circumstances it will be better to calculate the income as a couple.

The instance would be if you were the one with the income, you're in the institution and you're supporting your spouse still living outside the institution at home, and that individual doesn't have an income, or has a very meagre income. Certainly it would be better to be able to claim the spouse deduction and get a lower income there. If the situation were reversed you'd probably do better not to have to deal with the spouse's income, and you can then deal only with your own income and get the lower rate.

We tried to be sensitive to this because it doesn't make sense that someone should either benefit or not benefit by being married. It puts an incredible strain on people to have that happen. So we bent over backwards to do the calculations twice in those circumstances so that the individual would get the best rate, the lowest rate.

F. Gingell: It seems to me that, just on the face of it -- and it may be an unusual set of circumstances -- if somebody in a home was earning the $17,000 and was under the age of 65, then they would probably have only about four dollars a day. But I do accept the previous explanations that shed some light on the issue. It would seem here that you do have an answer on what the circumstances are for a single individual who's not over the age of 65.

Hon. E. Cull: You're quite right. Until these changes were made the rates were calculated on 85 percent of OAS-GIS, on the assumption that that would be the lowest income that anybody living in such an institution would have. For the most part, that's probably a fairly reasonable assumption. All seniors are eligible for the old age pension, and if they have no other source of income they're eligible for GIS as well.

But obviously there will be cases -- some of them may be seniors who are receiving pensions from other countries; some of them may be people who are not seniors yet and have income from other sources -- which put them at lower than that amount. No one in those circumstances ends up paying more than 85 percent, and obviously nobody is forced to pay more than they have. We do allow, I guess, exceptional circumstances to be dealt with on a case-by-case basis. They're quite small but they're obviously very important and very critical to the individual.

I'm also going to take the opportunity -- and perhaps you may or may not be going in this direction -- to say that one of the things that we did look at in making these policy changes was the 85 percent rule of thumb, because it does seem like that leaves very little money left over for those very poor seniors who are on OAS-GIS. As I mentioned, I don't have the list of associations we consulted with here in front of me, but I know it's in the record from our earlier debate on this.

We consulted with representatives of six major seniors' organizations in the province and three organizations that represent the facilities. We did suggest to them that one of the many things we could be looking at -- because we gave them some options to consider before making this change -- was to make a slight reduction in the amount, from 85 percent to 80 percent, for poor seniors.

After a fair amount of discussion and debate on that option, they recommended against it and said: "No, there are other things...." They thought that that amount, while very tight, was reasonable -- people were working with it right now, were making do with it, was one way of putting it. They saw that for the small benefit that change might make, there were other benefits that they would rather trade off. We did have rather a good discussion about the particular options available to us in continuing care and long-term care this year.

F. Gingell: One of the problems opposition members have is that we sometimes feel like mushrooms, and there is a whole bunch of information that has come out to me in this regard. Would it be possible for us to have copies of your briefing notes so that we could have them in our constituency offices, particularly where we receive lots of phone calls. It's much easier for us to calm their concerns early on than it is for us to go through this exercise. I would appreciate it.

Hon. E. Cull: The note that I'm looking at is addressed: "Dear MLA." I was assuming that all MLAs had received it. It is pretty straightforward. It is just questions and answers about how you work your way through the system, so there's no reason why I can't make this available to members who didn't receive it.

Interjection.

Hon. E. Cull: The member is asking for the date. It's April 22, 1993.

W. Hurd: I have a series of questions relating to some issues in my riding. Some of these issues may have been canvassed in the broader debate, but because they have occupied such attention and detailed response within my riding office, I was hoping to get some specific answers.

In particular, the minister may be aware of a strike at a residential care facility in my riding which created serious hardship to the residents, who were paying a significant amount of money for the privilege of not only living in residential care, but receiving a health care component for a portion of the price they were paying. The facility -- Sunnyside Manor -- is now on strike. It was difficult for me to ascertain what role the ministry had in ensuring that levels of care were maintained during the strike, and what levels of reporting existed during that strike period.

My conversations with and letters to the Boundary health unit did not produce a firm idea of exactly what monitoring or auditing was in place to ensure that these people in private residential care facilities were getting the health care they were paying for, and whether the

[ Page 6167 ]

ministry has any role to play in ensuring that standards are maintained during a strike situation.

Hon. E. Cull: As the member is fully aware, there is provision for essential services designation under the Labour Relations Code. So the employer in this case -- and I would assume it would be bargained for under CCERA, although it could be HLRA -- would have approached the labour board for the essential services designation. Those levels are set and determined. They are negotiated before the strike goes into effect so that those levels are there.

The ministry does have a role. We have a quality assurance unit in our continuing care and long-term care section, which monitors the care in all facilities, and not only during strike periods. We would have the ability to monitor and to assure ourselves that appropriate standards of care for the safety of the residents were established and were being maintained. Should we think that the essential services designation was inadequate, we would then have the right to approach the IRC and ask for a reconsideration of that.

W. Hurd: I suppose this raises the broader philosophical issue that if the ministry's strategy is to foster the growth of more medium and long term care facilities, even private facilities, this might be a significant problem in terms of the overall ministry budget. In the case of Sunnyside Manor in my riding, my office received numerous complaints that the quality of the health care component that they paid for had been slipping badly. There had been difficulties at the picket line even getting these residents out to access their doctors.

Can the minister tell us, maybe not in this specific case but in general terms, what type of auditing would be done in the event of a strike situation? Would it be on the basis of phone calls, or of inspections of what was taking place? How would the ministry make this kind of essential services assessment, and how would it determine whether or not standards were being maintained?

Hon. E. Cull: The local continuing care manager would be able to make an assessment based on a site visit, on being there on the premises and talking to the management that would still be in the facility, to the staff that were there or, indeed, even to the residents. Often a residents' council exists, and that would be a useful contact as well.

W. Hurd: So if these complaints do come in, the minister would normally expect the senior official.... Is there a group of auditors or people in the community care division with the specific responsibility to do inspections? I guess I'm a little confused, because in the case of Sunnyside Manor it appeared to me, anyway, that numerous expressions of concern about the levels of health care, including letters from my office, were met with some vagueness by the community care division as to what role they played and what they actually monitored.

Can the minister give me an idea of exactly what type of services in a typical health care facility or a long term care facility that's private.... Would they be auditing, for example, whether prescription drugs were administered at regular times? Would they be looking at sanitary standards? Do they have a mandate to review the operations of the facility? I think it would be helpful if I had some idea what these residents could expect in the way of audits by the Ministry of Health.

Hon. E. Cull: The local continuing care manager is the individual who's initially responsible. There is also the quality assurance group within the division of the ministry, which can be brought in to provide particular assistance should the continuing care manager feel that additional assistance is required. The criterion that's applied is patient safety. I'm afraid I can't give you the details as to all the things they would look at, but I'm sure some of the things you listed would be considered.

These are professionals whose job it is to go into continuing care facilities and make sure they are meeting the needs of patients and meeting basic standards. They have wide experience working in a number of facilities in their region and would be probably the best people, being local people, to assess whether the designated essential services levels were sufficient or not.

I could say in general -- because again, I'm not particularly familiar with Sunnyside Manor -- that when there are strikes in the health care sector, the essential services designations, the percentage of employees designated as essential and therefore to be on the job, are very high. I've heard in a number of cases from the unions involved that sometimes essential services get designated higher than the original staffing. I can't confirm that, but certainly I've heard that story enough that I don't discount it.

[3:00]

W. Hurd: Perhaps I can just generalize this question and ask the minister: given the mandate, which is to move health care into the community and to encourage more medium and long term care facilities in the province that might be provided by private companies, is there any intention in this year's budget to actually increase the funding for this type of auditing or monitoring of long term care facilities in the province, given the fact that in the years ahead, it would appear that we're going to see an increased need for the ministry to enter facilities other than hospitals to make a designation or assessment of essential service health care provisions?

Hon. E. Cull: It just goes to show that if you do enough questions on any particular subject, somebody in your ministry who is watching this will send in the appropriate information. Sunnyside Manor is not funded by the government, so our continuing care managers wouldn't have a role in this case. It is a totally private institution. The only application that the government would have would be through our licensing board, which licenses facilities. They would have similar authority to ensure that essential services were being maintained during the strike. We don't fund

[ Page 6168 ]

this particular institution, and of course, there are many private institutions around the province which are simply beyond the responsibility of the Ministry of Health. They are private businesses, and people purchase those services. The government's role in that regard is to license and inspect them and ensure that they are providing adequate services. With respect to the kind of intervention that might be more appropriate to government-funded institutions, this doesn't apply here.

W. Hurd: I assumed we were talking about facilities which don't receive any government funding, but provide a level of health care to the residents involved, by the very nature of the fees they collect. These are elderly patients who are taking advantage, I suppose, of a form of health care in the community which obviously lessens dependence on the ministry to provide for them. In some case they're paying $3,000 to $4,000 a month for a combined residency and long term care setup in the community.

I guess the question I was trying to address, and obviously not too well, is: looking down the road, is the Ministry of Health recognizing the fact that these types of facilities are going to proliferate and it may have a role in ensuring that standards are maintained, or is it strictly a situation where residents are on their own in terms of a strike situation? It just seems that we're dealing with a trend here towards seniors adopting different options for providing health care.

When a strike does occur -- I believe that in this case Pricare is the owner of the facility and the Operating Engineers are the union representing the employees of the facility -- there's a mistaken impression on the part of the residents that when the standards slip badly during a strike and their welfare and health is affected, somehow the Ministry of Health has role to play in this, given the fact that it's encouraging this type of community-based health care to develop to lessen dependency on the system.

Is the Ministry of Health anticipating providing more funds to audit this type of activity to ensure that if we are going to see this proliferation in private long term care facilities, the maintenance of standards for these residents is of paramount importance?

Hon. E. Cull: We're not encouraging this kind of facility in terms of our new directions. When we're talking about increasing the number of multilevel care beds in this province by almost 3,000 over the next five years, by over 400 in this capital budget, we're talking about those facilities that are supported in part by government funding. Some of them are public institutions; some are private institutions which we provide funding for under our program. I want to make it clear that I am not promoting the proliferation of privately funded, independent facilities for seniors.

They may be responding to a market need. Many of the seniors that live in some of these institutions would not qualify for institutional care under the ministry's policies. We have to be very careful what it is we're talking about here.

In general, what guarantees does the government give to people who find themselves in those circumstances? There is the essential services designation under the labour code. The institution, the employer and Pricare have the option at all times, as do all health care employers, to return to the IRC and ask for an increased level of essential services designation if they feel that the original decision was too low. That was done by hospitals during the labour dispute in 1992, and changes were made. So it can be done.

The ministry, through the community care facilities licensing board, licenses all adult care facilities whether they are funded by the government or not. Standards have to be maintained. They are inspected. We occasionally withdraw people's licences because after receiving the original licence the standards have not been maintained. The community care facilities licensing board would have the authority to investigate during a strike situation if there were complaints made to it with respect to standards slipping.

I think there are a number of avenues available. I'm not familiar with this particular institution. My executive director responsible for hospitals and care services has had some experience in the long term care sector as well and is not aware of it. I don't know whether the complaints were made to the community care facilities board or to my office. We would certainly have directed them into the appropriate places so that the standards could be investigated and maintained. I think there are a number of options available to that employer to make sure that they are able to carry on in the event of a labour disruption.

W. Hurd: Perhaps, then, I could ask a question about hospice societies and palliative care, which is another issue that has come up in Surrey. Can the minister give us an idea of what direction the ministry is taking when it comes to funding palliative care in hospitals versus what the demands are on societies which are attempting to provide the same service? Is there a formula at work here?

Is there a long-term strategy by the ministry to move this important health care function from, for example, a hospital setting into the community via hospice societies that are attempting to acquire funds but have not always met with success? Can the minister give us an idea of the direction we're going with that?

Hon. E. Cull: The whole area of hospice and palliative care is one that I support and the ministry supports in its programs. There are a number of ways that we do that. Individual hospitals are encouraged to recognize the need for palliative care as part of their overall operating budget. Many hospitals do provide palliative care beds or units. People are employed on staff to be able to assist patients and their families through dying. Hospice and palliative care programs are also funded under both the hospital-community partnership program and the continuing care community partnership program.

There are a number of these that have been supported by the ministry around the province. I'm sorry that I don't have a listing for you. There are a number that have been supported, and some that are supported through other funding from the ministry.

[ Page 6169 ]

W. Hurd: I guess my question is on the funding of this particular health care service. Is there a separate budget or a separate allocation for hospice societies or are they in competition with hospitals for funding for this particular service? In the representations made to me by hospice societies, there is the impression -- in error or not -- that somehow, if the service is being provided at their local hospital, that reduces their ability to access funds to provide their own private services. What I'm asking is whether or not funding for hospice societies is independent of what the ministry may be providing through the district or regional hospital.

Hon. E. Cull: No, there isn't a separate hospice or palliative care budget, if that's what you're asking for. But I'm disturbed to hear that hospice societies would see themselves in competition with hospitals, or hospitals would see themselves in competition with hospice groups. I know that happens; in fact, it doesn't happen only in this instance. We see hospitals competing with one another and with community care facilities. Unfortunately, we see this kind of competition going on in too many instances around the province. We have to change that.

That's part of what the New Directions strategy is all about: moving away from fragmentation existing right now in the health care system -- structured in such a way that it doesn't foster cooperation between different institutions and organizations -- to a system managed at the community level so that there is no competition -- in fact, there's cooperation.

A community health council will be able to look at the need for palliative care services within a community, prioritize those needs with respect to other needs in the community, determine whether they should be provided at the hospital or somewhere else in the community, and make the appropriate planning and budgeting decisions around that. And that's what we have to move towards.

What we have right now, though, is a step in the right direction through the hospital-community partnership program. The whole concept of that program is that a certain amount of the hospital budget is actually frozen and cannot be spent until the hospital develops a partnership with a community agency to spend that money on a community health program. Many palliative care programs are funded under the hospital-community partnership program. It works relatively well, because it does bring agencies together to access money that's there but can't be accessed by them competing with one another and can only be accessed by them cooperating.

W. Hurd: If I hear the minister correctly, what she's advocating is that in the event of one or more hospice societies they should be making joint representation to the continuing care

section for funding rather than, say, sending in their applications individually. That leads me to a logical question: how many of these hospice societies in the province are actually being funded? Are we dealing with a relatively large funding component here? Is the funding for hospice societies up, down or even in this fiscal year? Is there room for growth in the number of societies, or are we over-subscribed now in terms of the applications that might be on file?

Hon. E. Cull: I don't have the list of the number of hospice societies, but I can certainly get that for you and we can have a look at how many of them exist and how many of them are funded through various arrangements within the Ministry of Health.

With respect to whether there is the ability for a lot of growth in that area this year, there are two things that have to be considered. One is that the overall growth in the hospital budget is very limited this year at 3 percent, so it is going to be a real challenge for hospitals to be doing much in the way of new programs -- in terms of finding efficiencies or changing the way they are doing things right now. A 3 percent budget increase for hospitals is challenging, to use the softest word I can use. It's really very difficult for some of them to sort their way through their budgets.

[3:15]

With respect to funding that's available under partnership programs, we're reviewing that program right now, and we'll be bringing it back in a new format later on this year. Existing programs will be funded. The ability for growth in that area is marginal this year because, again, the increase of 4 percent in overall funding to the Ministry of Health doesn't allow us to do a lot of new work in a lot of new program areas.

The money has been targeted, in terms of this year's budget, to community and family health, particularly to mental health, which we canvassed the other day, and to continuing care services to assist people who are not in hospital to maintain their independence longer in their own homes. Those are our priorities. We had to set priorities, and those are the ones we have established for this year's funding.

If a group in a community is interested in developing palliative care programs, certainly they should approach their hospital to inquire about partnership funds. They should also approach the ministry's care services division, where we can evaluate applications and help them look for funding to do those programs.

W. Hurd: I was quite interested in the last comment that societies should approach their hospitals for some sort of partnership. The point being made by the hospice society is that their primary orientation is palliative care within the home setting. Their whole purpose for existing is to enable people to be at home for as long as possible. Sometimes the impression exists that that's not necessarily the major thrust of a program run through a hospital. The recommendation holds, then, that a society should be approaching their hospital to dovetail programs and apply jointly for funds.

Is that what I'm hearing -- that you could actually participate with the hospital in applying to continuing care?

Hon. E. Cull: The other alternative is the continuing care division staff in the region. Until quite recently there were two partnership programs, one with hospitals and one with continuing care. They are being pulled together and reformulated, so it will be

[ Page 6170 ]

changing in the future, but there are two groups that can provide direction. If the focus is on a home-based program, obviously continuing care is home based and therefore would perhaps be the group to start with. But there is a number of places the group should approach, and I would encourage them to try all the possibilities.

Even with home-based or community-based services, we are looking for integration between the acute care system, the institutional system and the community-based system. We can no longer continue to act as if there's a dividing line between them and there isn't flow across, because of course there is. People get sick; they move into hospitals; sometimes they move out of hospitals to die. Sometimes people go backwards and forwards between a home setting and an institutional setting for some time in the end of a terminal disease.

There is a need for a continuum of care, and therefore the hospital, the continuing care manager or directly to the ministry.... We could do a bit of the traffic cop stuff if they need further assistance.

W. Hurd: I just have a couple of other issues to canvass in Surrey. One is the provision of psychiatric beds in the two Surrey hospitals. It appears obvious from the number of calls to my office from the relatives of people who have recently been discharged from Riverview, for example, that there's a critical shortage of psychiatric beds within hospitals in Surrey. Indeed, you've got a small ward at the Peace Arch Hospital and a small ward at Surrey Memorial.

When it comes to this critical issue in community health care, is the Ministry of Health taking any direction towards consolidating this service in one hospital and providing greater access? I can recount one case that came to my office where there was actually an apprehension order that the RCMP could exercise but wouldn't exercise because they had made a determination that there was nowhere for that person to be placed within the existing hospital in Surrey. You can imagine the stress the family was under in recognizing that the RCMP had an apprehension order but couldn't actually exercise it because the wards were full.

My question to the minister is: what direction are we taking in Surrey, one of the fastest-growing regions in the country, where this problem is already of critical magnitude and can only get worse?

Hon. E. Cull: Thank you for your patience while I got a few questions answered here. I can't give you any of the specifics in terms of the psych beds in the area you are talking about. Obviously there is a growing need for all kinds of acute care hospital services and other health services in the Surrey area, because the population there has been growing faster than the system's ability to keep up.

There are a number of things underway. First of all, there is the mental health initiative: the whole planning system around Riverview and the need for an appropriate number of acute care beds distributed around the province. As you know, Riverview has been downsizing over a number of years. The plan calls for there to be, I believe, 500 beds at the Riverview site and then other acute care beds in different parts of the province to provide acute care psychiatric services closer to home. There is an overall strategy underway that is assessing what's available in an area to meet those needs.

I don't know about the specific case you mentioned, but I'm puzzled, and I'll have staff advise me on this. Unfortunately, as I said earlier to the member for Powell River-Sunshine Coast, the list I was given did not include mental health, so I don't have my mental health person, my family and community health person, here today. The overall strategy under the mental health initiative is to look at the distribution of beds. With respect to that particular case, it seems surprising to me that somebody would not be apprehended in Surrey when Riverview is available reasonably close by in the region.

The beds may not have been available there in Peace Arch District Hospital or Surrey Memorial Hospital. But certainly, if somebody needs to be in a psychiatric bed in the lower mainland, Riverview is available. So again, I'm not disputing your story, but it does seem somewhat surprising.

Individual hospitals are also doing their own planning about how to meet their needs -- whether they have the right number of medical and surgical beds, specialty programs, etc. They do planning to try to meet the psychiatric needs of their population. Surrey Memorial is developing a master plan, as I'm sure you're aware, and part of their master planning process would include evaluating the need for psychiatric beds.

W. Hurd: I appreciate the answer. I'll have to check the facts. When it came to my office, it was my understanding there was nowhere for this particular young person to go. But if Riverview is always available, I will certainly communicate that to people who call my office.

I had one other additional comment or question about the psychiatric situation, recognizing that we don't have the staff here to get into a full discussion. Another issue that was certainly mentioned by the people who contacted my office was the fact that many psychiatric patients who are released from Riverview do have rather rigid regimens of prescription drugs that are required to arrest their symptoms and allow them to continue to function in a community setting. One of the biggest complaints of residents is that there's no way of enforcing or controlling the access to prescription drugs.

It doesn't take long for the person suffering from a mental illness to stop taking them on a regular basis. That in turn creates a vicious circle of making the symptoms worse. Without the support at the community level, they soon end up back where they came from.

A general question is: would there be any funds dedicated under the continuing care program to assist families and psychiatric patients in making sure that they continue to take their prescription drugs on a regimented basis, recognizing the fact that a failure to do so soon renders them incapable of functioning in a community setting and we end up in this vicious circle?

Hon. E. Cull: We actually canvassed this issue at some length a couple of days ago when we did mental

[ Page 6171 ]

health and I had my mental health staff people here in the chamber. But I can tell you there are two things that apply here. One is that under law, we cannot compel people who are not committed to an institution to follow a treatment program. While there are people who are mentally ill who can have their illness held under some kind of control or in check through the use of medication, we can't force people to take their medication. Unfortunately, part of the problem with mental illness is that people sometimes make decisions that lack judgment and don't always act in their best interest.

The only way that someone can be forced to follow a treatment program is to have them committed into an institution. That's part of the problem. When you talk about how you enforce this, there isn't any way of legally enforcing it. You have to try to use other measures.

We talked the other day about -- and I'm not going to go into a lot of detail about it, because we did spend some time on it -- the plans for releasing people from Riverview and placing them in the community. We have made a commitment that people will not be released from Riverview until there are appropriate services matched up to them in the community that they're going to. If that means slowing down the mental health initiative plan which has been agreed to by consumers and mental health providers, we will do so, because it's irresponsible to do otherwise.

It doesn't mean that there aren't people already in the community who don't have access to services. There is a tremendous backlog of services to the mentally ill. Mental illness has been neglected in this province for decades. We have failed to provide for the needs of these people. Every time the government in the past had to tighten its belt, services to the mentally ill were one of the first things to be cut. This government has changed that. Last year we increased funding to mental health services by 25 percent.

It made a tremendous impact in terms of the availability of community health services to the mentally ill. I urge you to read the Blues, because I read into the record the additional number of people who are able to receive services as a result of the enhancements that we started last year and are continuing this year.

Mental health continues to be our number one priority in the area of community and family health. We will do our very best, under trying financial circumstances, to make sure that the plan stays on track and that people who are being deinstitutionalized have the services they need. This means that those people who come out of Riverview get the ability to have follow-up support from health care providers. They will refuse it in some cases and that's where we get back to my first point: you can't insist.

But with the 400 or 500 semi-independent living units that we created last year, people who are released and become independent again have workers who are available to make sure that they have the necessary living skills to be able to carry on independently and the follow-up support so they get encouragement to take their medication and continue with whatever treatment program is considered to be appropriate to meet their needs. We have dramatically increased services in that area. We still have a long way to go, but we know where the priority is and we're committed to following through on it.

[3:30]

W. Hurd: I just have one final question which has come through the door and, again, may have been canvassed previously. It relates to the deductible portion of a Pharmacare cost, which patients must pay upfront to acquire their prescription drugs, and, in particular, to the concern about the wait to be reimbursed. Again, I'm sure that every member of the assembly has had a few of those calls to deal with over the past year. In some cases in my own riding, which contains 50 percent seniors, I've had it reported to my office that seniors are out of pocket by about $1,500 or $1,600 for a period of time. So, if the answer lies within Hansard, I apologize for that, but that was my final question.

Hon. E. Cull: There are, I believe, five or six plans under Pharmacare; all have different rules that apply to them in different populations. It's easy to start to get confused about what applies to which individuals. Seniors are not out of pocket, ever, for Pharmacare, because they don't get reimbursed: seniors pay none of the drug costs; they pay a portion of the dispensing fee. The dispensing fees in British Columbia are the lowest in Canada, averaging somewhere around $7. The seniors pay 25 percent of the dispensing fee, so 25 percent of approximately $7 is what they pay.

They pay that up to a maximum of $125 in the year, and when they reach $125, everything -- 100 percent -- is paid for them beyond that.

The ones who do have problems being reimbursed -- and these may not be seniors -- may be people who are not eligible for plan A, the senior's plan, people like you and me who have to save up our receipts until we have reached our deductibles. Then we have to mail off those receipts and receive 80 percent payment back until we reach $2,000 paid out in the year, and then we get 100 percent back. I don't know about you, hon. member, but I never seem to be able to find those receipts at the end of the year anyway; they somehow have gotten lost in the filing system in my desk and we generally don't seem to be able to find them all to make those claims -- it is a problem.

Interjection.

Hon. E. Cull: The member for Power River-Sunshine Coast is suggesting a shoe-box; I have one of those fabric things with pockets that hang on the wall, but all the pockets seem to have the same things in them, and the system has long since escaped me.

Back to the question that we have at hand here. We are introducing something called "Pharmanet," a computer network that will link pharmacies together with the Pharmacare program, so that when you go in and buy your prescription, you will be able to present your identification to the pharmacist, who will call up your account and know what benefits you are eligible for right there. The pharmacist will know whether you have reached your deductible and whether you have

[ Page 6172 ]

reached your annual limit. You will receive your benefits at the cash register, so you will only pay what you are eligible for and you won't have to save up those annoying little receipts and hope that you will find them at the end of the year. In addition to that, it will provide all kinds of other benefits to us, because the pharmacist will also know what other drugs you've been prescribed, will be able to immediately see whether there might be any contra-indications and will be able to spot those people who are getting the same prescription from three or four doctors.

A pharmacist will be able to do a lot more with the patients in those cases, particularly with seniors who may have a huge number of prescription drugs that they are taking. The pharmacist may have a look at that and realize that it's time somebody reviewed exactly what these people are taking cumulatively and start to deal with the health impacts of having too many prescription drugs. So we are working on that right now; it should be implemented early in 1994. The computer work is being done, the network system is being put in place, and we've been working with the B.C.

Pharmacists' Society to speed this up and have it working as soon as possible.

W. Hurd: Just one final plea -- a logical suggestion from one of my constituents regarding medical premium costs. Perhaps the Ministry of Health would give consideration to automatically debiting bank accounts, rather than sending out premium notices every month. I just wonder whether or not that type of streamlining has been talked about within the ministry; whether any cost savings have been identified, rather than this exchange of bills and cheques every month; and whether an automatic debit system like you have for other government accounts might be something that could be pursued by the ministry?

Hon. E. Cull: Just before answering that, I want to correct the record. Seniors pay 75 percent of the dispensing fee, not 25 percent. I flipped them around.

I don't know what the answer is to that. It probably isn't a bad idea to pursue. I would be surprised if it hasn't been raised in the past. There may be some reasons why it isn't done; perhaps with respect to subsidies and calculations and the fact that things change. But I agree it would be a lot more convenient for the person paying that amount on a regular basis, and you'd think it would be more cost-effective for the ministry to cut down on the paper work and the issuing of cheques. So I thank you for that suggestion and will ask for a reply from my staff.

A. Cowie: Yesterday the minister very kindly answered some questions about UBC hospital, which is almost in my riding. I've got a couple of questions that I would like clarification on. UBC is a teaching hospital. The minister clarified it's also going to be a community hospital. I would like to know just how that's going to be directed. Is there going to be a community council that would direct both the teaching portion and the community hospital portion? Or how would that be operated?

Hon. E. Cull: All teaching hospitals have a community aspect to them. As with VGH and St. Paul's, the UBC site of University Hospital doesn't only provide teaching opportunities for students in training. It's not just a tertiary or higher level care facility; it's a hospital for people who live in that area in many cases, and regular primary and secondary care to a certain extent takes place there as well.

As you mentioned yesterday, if you live in that part of the city and think you need the services of a doctor in an emergency, you head for UBC. So it does provide the kinds of services that any community hospital would be providing in any other community. But it does have these additional roles and responsibilities and it does tend to specialize in some of those areas.

The former board of University Hospital was managing in the interests of the teaching aspects, the tertiary care level aspects and the community aspects to strike the appropriate balance.

As I said yesterday, we have been reviewing two possible options for University Hospital, UBC site. One is a merged option with Vancouver General; the other is a stand-alone hospital that would have its own board. In either case, the board of the institution would be required to balance the needs of the teaching facility with the needs of the residents in the community.

I think one of the best ways to achieve that would be to have some community representatives on the board, people who represent not only the provincial level needs but also the needs of the west side of Vancouver.

A. Cowie: I think this is also part of the regional board for the overall Vancouver area, as I understand it, which will have five elected people on it, five appointed by the government and five from the community councils. I believe that's the way the regional board is set up.

I would guess that the west side of Vancouver would have some 150,000 people that this hospital would service, something like that. Just as a general guideline, I was wondering if that's pretty typical of a community hospital?

Hon. E. Cull: That would be a very large population for a community hospital. As a community planner yourself, hon. member, you know how many municipalities in British Columbia would have 150,000 people, or even how many regions of the province would have 150,000 people. Many community hospitals, of course, serve much smaller populations.

A. Cowie: If it was a stand-alone and not connected with VGH, then it would probably have more community people involved with it. The worry I would have is the balance between the teaching role. Doctors and professors quite often don't like to be told what to do by citizens, so I would think that might be a difficult option. However, since that decision hasn't been made, I won't press that point.

I want to know a little bit more about the regional directors who are appointed by the government to manage or direct the regional hospitals. I believe these

[ Page 6173 ]

regional directors are appointed by the government to manage. Do they have the right to veto council budgets?

Hon. E. Cull: There aren't any executive directors appointed to oversee, manage or direct hospitals, so I have to assume you're talking about the six individuals we have recently assigned to look at regionalization. These individuals are seconded from other parts of the ministry. Their jobs are temporary. We did canvass this extensively yesterday, hon. member. Their responsibilities are to facilitate the development of community health councils within various regions. With six of them, you can imagine each is working in large chunks of the province.

Their job is to initially work with those communities and provide them with guidance and assistance. Things like the report -- the book that we talked about yesterday, the guide for developing community health councils and regional health boards -- will assist them to work their way through that. That's who those individuals are, if that's the group that you were referring to.

While I'm on my feet, I'll just comment on the five appointed that you mentioned. There isn't any such plan. I don't know where those numbers came from, but they certainly did not come from the ministry. There may be a community proposal that such a combination of individuals be formed into a board, but that's not agreed to by us.

A. Cowie: The minister is correct. I believe that was part of a proposal from Vancouver for the regional board, so there would be a community role there, which the minister speaks about.

The executive directors are appointed. Those are temporary jobs, I guess. My understanding is that they are definitely political appointees. The one in Vancouver definitely is a political appointee -- Sharon Martin.

Interjection.

A. Cowie: I know, but she's very political.

Interjection.

A. Cowie: And she's a nurse -- and very well qualified as a nurse. I just assume they are political appointees. They are temporary until a more professional system is set up -- is that the idea?

[3:45]

Hon. E. Cull: I'm laughing because I'm thinking of what some of these individuals will be saying when they read Hansard and learn that they are now political appointees. I'm getting all the names of them here now. We are dealing with people who are -- with the exception of Sharon Martin, whom the member singled out -- all employees of the Ministry of Health. Sharon is an employee of the Vancouver health board, and we've seconded her to assist us, because of her knowledge in working for the city of Vancouver in the health area.

We have Garry Olsen, who is with the alcohol and drug program -- he was the director for the Kootenay region; Ron Crawford, also with alcohol and drug programs for the north region; John Mullin, who is the head of continuing care in Victoria; Pat Wolczuk, who is the executive director of our health promotion branch here in Victoria; and Karen Abrahamson, who I believe also came from the alcohol and drug branch. These are all people who have been working in the Ministry of Health for some time. The deputy looked for people who understood the regions and who understood the New Directions in health care.

He has reassigned those individuals to these tasks, as is the right of a deputy minister: deploying his staff where he sees fit.

A. Cowie: I'm just trying to find out how politicized the bureaucracy is. In this particular case, Sharon's sister is the ADM for Housing. It gets very political in those sorts of situations. I note also that in Vancouver...

Interjection.

A. Cowie: There are political people within all bureaucracies. Vancouver has lots of NDP people within it, and they're well accepted within the system. All I'm saying is simply that, in the housing report, this person was definitely picked because of their political alliances. I would have thought that this was the situation with Sharon Martin.

That will be my last question. Thank you for answering them.

L. Fox: I was listening with great interest to the discussions with the member for Surrey-White Rock around the tertiary care issue. The minister suggested, in an almost promissory way, that no further removal of patients from Riverview or those institutions would be made until there was alternative housing available to them in the communities that they were going to.

That was of particular interest to me because when this initiative was tabled back about four years ago -- I wasn't a member at that point in time -- the north had been promised that beds would be located in the northern part of the province. That has not yet come to be. In fact in some communities there are significant incidents of increased violence and increased crime because some of these individuals have not taken their medication as they should. As the minister pointed out earlier, she hasn't the authority to force them to take their medication. It's becoming a very large concern among municipal leaders in northern British Columbia and as well among health care deliverers.

Would the minister, not necessarily make an announcement, but give us some assurance that before we deal with the existing patients, who are still in those institutions, we deal with the ones who have already been released and are presently in a situation that (

a) is not good for their health and (

b) does not consider the interests of the rest of the community.

Hon. E. Cull: I want to tell the hon. member that there has been considerable time and effort over a number of years -- on the part of providers of health care to the mentally ill, groups that advocate on behalf

[ Page 6174 ]

of the mentally ill, people who suffer from mental illness, the ministry and others from the larger health care system -- spent on developing the mental health initiative. There is agreement. If not total consensus, there's a very large majority of opinion coming from families and consumers themselves that they want to move out of Riverview and get back to their own communities. They want a life that is as normal as possible.

Deinstitutionalization in and of itself is not a bad thing. It's a bad thing if it's done without planning and without preparation. In the past, not only in this province but in other jurisdictions across North America, promises have been made to people about thoughtful deinstitutionalization and have not been followed through. I have instructed the head of Riverview Hospital and our mental health staff to ensure that all patient transfers go with appropriate staff and services.

It's not just housing; in some cases it is housing, but in other cases it's making sure that there are the appropriate resources in that community for the individual to have the best chances possible to retain their health.

That is looking at the people who are coming out of Riverview right now. People don't want to see that slowed down -- with the exception of the conditions that I've just talked about. Putting it on hold and saying that we're not going to de-institutionalize anybody else from Riverview until we've fixed all the problems out there for people who never went to Riverview, were discharged years ago or somehow come into the community without adequate services would enrage people who have spent a lot of time working on a very thoughtful plan. We have to work along on both streams.

We have to ensure we don't make the problem any worse by moving people out of Riverview without appropriate services. At the same time, we have to start to systematically pick up the people in the communities who are not getting adequate services right now. The reasons for that are complex. They're not simply funding problems, although we have made a significant commitment through the 25 percent funding increase to the mental health budget to try to deal with what can be dealt with by putting money to the issue.

But we also have -- and you know this full well, being a member from the north -- incredible problems with psychiatric services: getting psychiatrists into the north to deal with the patients who are in crisis, as opposed to those who are well enough to do office visits. We have some real difficulties in getting the appropriate human resources in the right places. That's not simply a problem of money; it's a much more complicated problem.

You particularly talked about beds in the north. The mayors of Prince George, Quesnel, Dawson Creek, Fort St. John, Williams Lake and probably a few others have all raised with me their concern about the plan having no tertiary care beds for mentally ill people in the north. I was surprised about that, too. I recently asked staff when this decision was made. It was made two years ago.

As a result of the fact that the decision is two years old and an awful lot has changed since then -- including the government, but certainly the strategy around health care, the royal commission talking about Closer to Home and our new focus on making sure that services are where the people are -- I've asked for a complete review of that decision. It is underway right now.

Some of the analysis that was originally done may not be applicable any longer. I have made a commitment to the people in those communities who I've talked to and who have written to me that we will reconsider that decision and let them know what our outcome is. The decision is out of date, and the world has moved on considerably since it was made.

L. Fox: I appreciate the need to review decisions that are made and not acted upon from time to time, but it's of very little comfort to the communities who at the same time are seeing increasing acts of violence and disruption in the community itself, certainly to the point that it has increased costs of policing and all those different areas. There are concerns, at least three in Quesnel and three or four that I'm aware of in Prince George, that these particular patients are wandering around the community without support staff and the proper spot to live and are becoming a huge concern to the families of those individuals and to the community at large.

In Quesnel they've had acts where an individual has hitchhiked. A logging truck driver picked that individual up and that truck was literally destroyed by that individual. The individual was coming from Alexandria, and that is where he was sent back. Yet there's no way to offer that individual the help he needs, so he takes it out on whomever he comes in contact with. These acts are extremely concerning. I've spoken to the mayor of Quesnel on the issue, and he is frustrated. I've spoken to other health care deliverers in that community, and they are frustrated.

Really, I guess the minister's words are reassuring, but in the interim period some kind of action is necessary to deal with individuals who are in need of care now. Another study is fine, but the delay is really not meeting.... In the view of municipal leaders in the north, it's not taking a step in the right direction. It may very well be, from the ministry's point of view, but in their view they need some kind of interim direction to handle these particular people while the study is in process.

One further question I might ask is: what kind of money is allocated in your budget this year to deal with those issues, particularly in the northern two-thirds of this province, which I recognize has something less than 360,000 people in it but geographically is very large?

Hon. E. Cull: Hon. Chair, we're not talking about doing another study. This government has done more to improve services to the mentally ill than any other government in the history of this province. I urge you to read the Blues; we went over this the other day. We have provided in one fiscal year, last year, a 25 percent increase in funding, $52 million going into mental health. If you want more -- and I don't disagree that there should be more funding put into mental health --

[ Page 6175 ]

I have to tell you that that kind of increase was as much as the system could absorb in one year. It takes time to hire people, to get programs in place and to get those services out there. Notwithstanding that, last year we were able to provide mental health services to an additional 5,000 children and youth affected by serious mental disorders. Five thousand children who were not receiving those services in 1991 received them in 1992. We provided emergency services to an additional 2,000 people, including homeless people, who were not getting services. We provided additional services to another 5,000 seniors.

So we have made a dramatic improvement and increase in the level of services. We are not doing another study.

The whole program around Riverview, which has been in the works for a number of years, has not yet been completed. Not only has a decision not been made about them going to the north, they haven't gone to the interior or to the Island yet. There is more work underway. There is a process in place that involves the people who are most concerned with mental health services, and we have got to let those processes take their course. They have pretty well come to the end of it. But part of the planning that took place in the past under your government was that no tertiary beds would go to the north.

I'm saying we should review that. That decision was brought to my attention in February this year -- that that had been decided two years ago and that decision was being pursued. There's no reason why staff would act in any other way; they don't throw out all decisions made by a former government when a government changes. But when the mayors of those communities brought that to my attention, we agreed that we would review it.

When it comes to housing, again, last year -- in one year -- we increased housing spaces available to the mentally ill by almost 600 new living spaces.

[4:00]

L. Fox: How many in the north?

Hon. E. Cull: I'll have to look at the total numbers here. There were 85 self-contained living units with B.C. Housing Management Commission. Some of those would have been in the north, but I don't know exactly which ones. There were 11 self-contained living units targeted directly to the north, 44 to the Thompson, Okanagan and Kootenays. I'm just looking here to see what else might be in the north. Again, short-term assessment and treatment facilities for the northern two-thirds for the province, as you point out, includes a very large area. Yes, there is a need for beds in the north. I don't deny that.

There is a need for beds everywhere. The bulk of the population, unfortunately, isn't in the north. We provide our services according to where people are. There are people in Vancouver, on Vancouver Island, in the Kootenays, in the Thompson-Okanagan area, who require more services. By the increase in funding that we did last year, we have made a commitment. We're making progress on it, but you cannot reverse decades of neglect in mental health in one fiscal year or in 18 months.

We have made it our number one priority, we will continue to fund it as the number one priority, and we will start to make a difference in the lives of the mentally ill in this province. But we're not going to do it unless we continue to provide a commitment towards the funding. I think we have shown that.

Last year, when we had an 8 percent increase in the Health budget, it was easier to give money to those projects. This year, when we have half the increase in funding, we have maintained funding to mental health, and we have increased funding to mental health. There is $22 million in additional funding going in this year. It's a very tight budget year, but we have maintained our priority there. I think it's very clear that we are going to support the work done by health care consumers and providers in the mental health area. We will continue to advance this plan in a way that meets the needs of patients in this province.

L. Fox: First of all, let me just talk a little bit about the decades of neglect. I realize that society today looks upon mental health patients a lot differently than we did even ten years ago. The thrust to mainstream these people is very similar to, and followed a little behind, the thrust to mainstream handicapped children into our school system. That started some 20 years ago, when I was on the school board. I think the minister was on the school board in or around the same time.

Interjection.

L. Fox: Oh, you weren't. I thought it was that long ago.

I do recognize that there has been a thrust. I think the problem that the people and community leaders in northern British Columbian have is that they always feel -- as a community leader myself in the north for eight years, I felt similarly -- they are the last to see the results of any program initiatives. We are less populated. We recognize that the money has to be spent where the majority of people are.

Also, we have the same problems. While the numbers may be smaller, the significance in terms of disruption and what happens with the community is usually more significant and probably more noticeable because the communities are smaller. Obviously, the direct bearing on the individuals within those communities is a lot closer because everybody knows everybody. You have a relationship and perhaps an exposure to these kinds of people that not everybody in the city of Vancouver would have. There are some genuine concerns on behalf of those municipalities. We're really looking to see.... I did not ask.

Every time I stand up, the minister points at me and makes the assumption that I'm asking for more money. I've never asked for more money in any of the estimates or any of my discussions. I have from time to time talked about changing the priorities, but I've never asked for more money to be spent.

What we're asking for is that equal consideration be given to those communities with smaller populations and that their needs be recognized. I'm sure that's all those municipal leaders in northern British Columbia are asking for as well. I would like to know what new

[ Page 6176 ]

initiatives are in the budget for this year to address the concerns of the municipal leaders in northern British Columbia with respect to the tertiary care issue.

Hon. E. Cull: All of the mental health funds are distributed according to demographic formulas, so we do provide funding to communities based on their needs and on their populations. It does mean that not every community gets the same number of dollars -- that wouldn't be reasonable -- but we do recognize the needs of northern communities.

It's interesting to talk about the decades of neglect, because in the decades that mental health was being ignored in this province, your government was in power. Your government had the ability to do something about this. You say other places were doing that. Twenty years ago -- when you say we were just starting to think about this -- I left another province that had already started to recognize this problem. They knew they had a problem then with the way deinstitutionalization was occurring. It seems that British Columbia managed to stumble along for another two decades before they realized they had a problem.

The mental health initiative announced by your government wasn't funded, but they carried on moving the people out into the communities.

We have stopped that. Not only have we stopped it, we've said that we will fund it. We increased the mental health funding last year by $52 million. That was probably the first major increase in mental health funding that had ever been seen -- certainly in the last couple of decades. With respect to the tertiary level beds, the mental health initiative has a statement about the relocation of the beds from Riverview. The planning is still ongoing. Those beds have not been reallocated.

When I was travelling in the north in February, I met with a group of health care people who were very concerned about mental health services in the north. They provided me with an excellent strategy to deal with psychiatric and other services available to the mentally ill. We are reviewing that report. We're hoping that we will be able to use that as the basis for making some changes in the way mental health services are being provided in the north. I received that report a couple of weeks ago, and the fact that I met with the people who wanted to make that presentation to me indicates that we are taking this very seriously.

As part of our overall strategy we are also developing a policy for health care in the northern part of this province. While we have a lot of programs, we still have a lot of problems. And I will give credit to your government for putting in place a number of programs to allow specialists to travel to the north, to fund doctors in the north with additional premiums and to train people from the north so that they can go back and practise health care in their communities.

I know we have problems, because people like you keep bringing them to my attention, saying that we are not providing for the health care concerns of people in the north in the way that we can. For that reason, one of the actions in the New Directions strategy is to establish a task force of northerners and people from small communities to work out a policy for us so that we can provide better health care services to the north.

Mental health services in the north-central interior were enhanced last year by $718,700, so a significant amount of new money went into the central interior. The Prince George area is receiving enhanced emergency and urgent-response services following the hiring of six general practitioners who provide emergency standby and joint-recruitment effort between the Prince George Mental Health Centre and Regional Hospital.

There are outreach services. Community residential housing for people with serious and persistent mental illnesses has been increased by 50 percent. The rehabilitation services that go with them have been increased by 20 percent. We've contracted direct services in Burns Lake, and they've been increased from one and a half to two full-time clinicians. It's a small amount, but as you pointed out, we're dealing with small numbers. It is problematic in a small community, but in that case, even that does assist us.

For the first time we have a full-time mental health clinician in Fort St. James. We've increased the sessions available to general practitioners to provide medical consultation and support to a new mood disorders clinic. We have just this year opened an eating disorders program in Prince George, for the first time. I've got quite a list here. I won't continue to read it; I'll send it over to you, hon. member.

L. Fox: Thank you. I appreciate the litany of programs. Most of them were in place prior to this minister being in government and were obviously started by the previous administration in recognition of....

Interjection.

L. Fox: It seems strange that.... I wasn't here 20 years ago in government and neither was the minister. By her own admission, she didn't even live in the province, so I don't know how either one of us can go back and suggest that the government of the day didn't recognize the needs. I don't know what the needs were and neither does she. However, I'll leave that topic.

I know that if the needs are not met, the minister will be barraged by mayors of the northern communities. They will articulate their concerns extremely well. One suggested to me that he was going to bring a couple of his problem people and sit in front of the Legislature with a sign.

However, I want to get on to another aspect of the estimates. On page D-37 of the Closer to Home document, an issue that draws my attention is that the commission recommends that two separate bodies be created that would provide a clear separation of the membership and promotion functions from the licensing and discipline functions of the professional health care deliverers. When I look at some of the information.... Before I get into it, perhaps the minister might elaborate on whether or not she supports that recommendation.

[ Page 6177 ]

Hon. E. Cull: Yes, I do.

L. Fox: One area that I wanted to address, because it appears there are two associations: the Registered Nurses' Association of British Columbia and the BCNU.... The nursing association supplies the regulatory function and the BCNU looks after the advocacy function. As I understand it, the BCNU has a membership of about 20,000, and there are 30,000 in the nursing association, so I would suggest that there are 10,000 in management functions throughout our province who are not covered by the BCNU.

The union recently passed a resolution that would request that a third body be set up in the form of a college. I guess the intent was to include the 10,000 nurses who presently are not in the union. It is also my understanding that it would require an amendment to the Nurses (Registered) Act in order to accommodate that kind of body, but I'm wondering if the minister supports the union and its resolution requiring that a third body be set up with the nurses or whether she would support the association, which suggests that the two bodies that are in place are sufficient.

Hon. E. Cull: The 10,000 would not only include management nurses but also nurses who are not working, but wish to keep their registration so that they may return to work. It would include nurses who are working in non-union situations. There is a variety of possibilities there.

As I said, in answer to your first question, I do support the clear separation of the union advocacy function for the betterment of the nurse as an employee or as a person who provides a service and earns a wage for it from the regulatory function that licenses and disciplines nurses and holds them accountable to certain standards and standards of ethical conduct. The RNABC, which has existed for many years -- and which existed prior to the BCNU -- contains not only the college-like functions of registration, discipline and the like but contains some functions that are more of a professional advocacy nature.

That has given rise to concerns by the royal commission in looking at it, also by the BCNU and some nurses, and also by the ministry.

[4:15]

As I said very clearly, we support the separation, and that goes for all health care professionals. I've met with both the BCNU and the RNABC with respect to this issue. I've been working with them to pull the groups together and to look at two options. One is the creation of a third body that would create a college of nurses to take on the regulatory function of health care professional colleges; the other is for the RNABC to review its roles and responsibilities and eliminate those that take it beyond the confines of a college. Both of those options are in fact acceptable to both parties.

Certainly the BCNU has said they would look at either possibility. The RNABC is willing to look at the possibility of reducing some of its responsibilities; it's not keen to see a third body established.

Indeed, if two bodies are good enough for doctors and good enough for many of the other health care professionals that have both a professional association and a college, it probably should be good enough for nurses as well. But there are some problems with the functions of the RNABC in that they do blur the two. Both the BCNU and the RNABC have been advised that the matter has to be addressed. There are possibilities for addressing it, and we're working towards making the necessary changes.

L. Fox: I take it then that we have the commitment of the minister to work with both bodies in order to come to some kind of consensus as to what's in the best interests of the professional nurse.

Hon. E. Cull: Yes, and that's indeed what I've been doing in talking to the two bodies. There has been a suggestion that we all get together and start to look at it, particularly to look at the option of what would have to be eliminated from the RNABC functions to make it meet a college and to see whether that's acceptable to everybody who has concerns about this. Otherwise, we'll be looking at the other possibility. But yes, we will work together; we will try to achieve consensus on this. Given the discussions that I've had with the two associations, I think it's quite feasible that we'll be able to do this.

L. Fox: I've had occasion to meet with another group that has a similar concern. I know that the ministry received this particular document only within the last few days, I think. It's a presentation on behalf of the College of Dental Surgeons of B.C., which also has some concerns and wants to look at the structure. As one association, at least since September of last year, they have fulfilled both roles, but they have two separate identities. It has been a pilot project as to how these two separate identities can work within the college structure.

[E. Barnes in the chair.]

Another issue has come into play, and that's the issue of whether dental hygienists would function under the college or whether there was a need for them to develop on their own. The particular model that was presented to me only today -- I know that the minister, given her hectic schedule, would have had some difficulty in consuming this information -- provides the dental hygienists with a separate regulatory board -- under the umbrella of the Dentists Act -- that would function parallel to the college of dentists.

In between them, a dispute mechanism is set up that seems to be a very fair process involving three members from both parties and then some lay people, along with the registrars of both associations. Has the minister had a chance to look at this presentation? Does she agree that the College of Dental Surgeons of British Columbia should be able to continue to function without splitting off into two groups, as the Closer-to-Home document suggests should happen?

Hon. E. Cull: The hon. member is probably aware that it was his government, with the support of my party and opposition, that passed the Health

Profes-

[ Page 6178 ]

sions Act, which clearly established the requirement for the separation between these two functions. We have made a commitment not to put everybody under the Health Professions Act but to take the principles which are embodied in it and ensure that other acts that establish colleges are brought into alignment. We have been working with all of the health professions around what changes might be necessary to move them in this direction, and I think there is general agreement.

Certainly, the royal commission held that particular piece of legislation up as good legislation and as a good model to follow in terms of regulating health professions. I haven't seen the document that you're referring to. Last night I did discuss the hygienist issue in particular with members of the College of Dental Surgeons, who were here in Victoria meeting with government caucus members.

As the member may be aware, the Hygienists' Association has made an application to the Health Professions Council. The council has heard the application, held hearings and heard from all of the interested parties and issued its report. The report is available: I released it publicly some weeks ago. The government has not yet made a decision on the recommendations of the Health Professions Council to establish a separate college for dental hygienists.

The process that we have followed is to release the report, send it to all of the parties who made submissions to the Health Professions Council and ask them to write to the ministry if they have any further comments to make. Last night when I discussed this with the College of Dental Surgeons, they indicated that the time line we had set was a bit tight and asked for additional time, which we have granted to them. They will be taking a few more weeks to get their comments back into us.

When we receive the comments of all of the parties, we will then reflect upon them and on the recommendations of the Health Professions Council and decide what steps are necessary at that point. The steps could be taking a recommendation forward to cabinet to implement the recommendations of the Health Professions Council or going back and having more discussions with any of the parties to get further clarification on issues that may be in dispute. We're in the process; the Health Professions Council has done its work and made its recommendation.

The time will go on, and we'll get the reports in, and we'll make decisions as we receive these comments.

With respect to the proposal by the College of Dental Surgeons to do both under one organization with an administrative structure to separate them, I haven't looked at the proposal, but I believe the appropriate route for that would be also to refer it to the Health Professions Council to have it give us some advice as to this particular model. It would be different; it would not be in keeping with the act, but we would certainly ask them for their advice.

I'll take this opportunity to publicly complement the three individuals who are now in the Health Professions Council for the very fine work that they have done. Their responsibility is to adjudicate these applications in the public interest, so they are having to weigh off competing interests of different professional groups in making their recommendations. I think they have done a very good job in the three reports produced to date -- hygienists, opticians and midwives -- and I would like to publicly congratulate them.

L. Fox: Just one question before I let the member for West Vancouver-Garibaldi -- I think that's the correct riding -- ask some questions.

I understood the deadline for submissions to that is May 21st. Is that the extended deadline, or was that the deadline that was originally in place and you've extended it beyond that?

Hon. E. Cull: That was the original deadline, and in discussion with the college last night we agreed to a three-week extension.

D. Mitchell: I know that the minister has likely received lots of representation and a number of questions on the Closer to Home document over the last year or so. But I'd like to ask her a specific question on the philosophical underpinnings of a decentralized, community-based health care system, which I think the majority of British Columbians support in principle. I'm wondering in particular whether the government can both decentralize the delivery of health care in British Columbia and at the same time downsize the health care system.

The minister has spoken about that, particularly in the context of the closure of Shaughnessy Hospital, where there's been some discussion about downsizing some of the hospital services.

I wonder if the ministry has done any particular studies of other jurisdictions -- such as European models -- that have experimented with community-based health care systems. Has the ministry been able to determine in those other jurisdictions whether the general health of the community affected has been improved and whether or not the costs of decentralizing health care have been contained? So particularly in those two areas, where we've gone into these kinds of systems, has the health of the communities been improved and have costs been able to be contained?

Hon. E. Cull: I've always said Closer to Home means two things: out of Vancouver and into the regions, which means regionalization; and out of the institutions and into the community, which means downsizing of institutions, if you like, or restructuring of where care is provided.

Closer to Home can mean services that stay in Vancouver -- moving from a hospital to a community -- as well as services that move from, say, Prince George to Vanderhoof. I'm just trying to give you some idea of the two aspects of the Closer to Home strategy. A number of different studies have been done on regionalization and decentralization concepts as they have been introduced into other jurisdictions. One which I would recommend to you if you haven't had a chance to have a look at it was done for the BCHA, by a student writing her master's thesis. Her name is....

An Hon. Member: Alison Rualt.

[ Page 6179 ]

Hon. E. Cull: Alison Rualt. I will have to give Hansard the correct name later. But she had a look at other jurisdictions in Canada, New Zealand, Australia and, I believe, Britain -- and maybe Holland; I can't remember which European one she looked at. But she looked at all of these, analyzed what they had done and analyzed what the success factors were, because they were not all successful. I found that to be a very useful document in terms of providing advice to us as to what works and what doesn't.

But I guess the vast majority of the homework on this issue was done by the royal commission that was established essentially to do that kind of work on behalf of the ministry when it was appointed in 1990 by the former government. They did a lot of work in this area. They came up with recommendations, some of which we have decided to implement virtually as they were written. Others have been modified as a result of the extensive consultation that took place between November 1991, when the report was released, and February 1993, when we released our New Directions paper.

[4:30]

As you're aware, we had an advisory committee of 26 members representative of places around the province working with us -- half of them health care consumers, half providers. We had six working groups, including one looking at regionalization and another one bringing together the shift from institutions to the community. We had two health care forums.

In the forums we brought together for a two and a half day period -- one in July and one in October, if my memory serves me correctly -- about 150 people representing all kinds of groups that have interest in health care -- not just the health care providers themselves but the advocacy groups, consumer groups and also groups that represented significant portions of our society with particular health care issues, such as aboriginal people, for example.

The health care forums worked with the material out of the royal commission, then the material that was coming out of the working groups and out of the advisory committee, and really focused a lot on how to make a structure here in British Columbia that would represent the special needs of B.C. While you can look at everybody else's system -- and I think Alison's work was useful because she picked out the key elements or attributes that made it successful -- you're not going to be able to take anything from anywhere else and just slap it down on the province of British Columbia.

We all like to think we're unique and different, but our geography is pretty compelling if we're looking for differences. That and some of the particular problems we have with the way the population is distributed, the age of the population, significant ethnic and aboriginal populations, means that we do need something that's built for B.C. Those people really worked very effectively with us to come up with the ideas that we finally incorporated in our New Directions document.

D. Mitchell: I'm very intrigued by the answer, because she's indicated to the committee that there are a number of processes that were put in place before we launched into this brave new world of community-based health care, which we all hope is going to work out. But I'm intrigued, in terms of any international comparisons with other jurisdictions, that perhaps the major study is actually a master's thesis that was written here...

Interjection.

D. Mitchell: ...and the royal commission document, the minister says. The two main questions, though, remain unresolved: can we do this in a way that actually improves the health of communities in British Columbia? Can we do this in a manner that allows us to contain costs in the health care system? I guess there's a bit of a leap of faith that's taking place as we launch into this direction. The minister is indicating that that's the case -- that we don't have much experience to draw upon.

In terms of the closure of Shaughnessy, using the example the minister referred to, can the minister tell us whether...? We start looking at decentralizing and downsizing, and then we have an incident like the closure of a hospital, which is a major event in the history of any province. Is it possible for the ministry to give comfort to citizens, to taxpayers and to patients who were serviced by Shaughnessy Hospital, that they will still be able to receive treatment in the region? I'm particularly interested, of course, in Lions Gate Hospital.

I'm wondering whether there is now going to be extra pressure on a facility such as Lions Gate Hospital on the North Shore as a result of the closure of Shaughnessy -- whether that is going to have any impact and whether that is provided for in the budget that we're reviewing.

Hon. E. Cull: One of the more frustrating experiences of having estimates that take place over the course of a couple of weeks is that issues that were canvassed at length earlier on get recanvassed when members decide to drop in and to ask their questions. So I'm not going to give a full, detailed answer to this. I encourage you to read the Blues, because I think we spent a full afternoon with the opposition Health critic asking these questions.

The simple answer is that the services of Shaughnessy Hospital, those serving patients who required provincial-level or tertiary-level programs, are being redistributed to the other teaching hospitals and other tertiary facilities in the Vancouver area. So people who would have gone to Shaughnessy to receive a certain service that's only available in one or two hospitals in the province will be going to VGH or St. Paul's or perhaps Royal Columbian or some of the others that are in that area right now, so the services are being redistributed there.

The other services that Shaughnessy was providing -- the more community-based services provided to people who didn't live in the Vancouver area but couldn't get those services because the beds in Surrey and the Fraser Valley were full, because the population there has just outstripped any ability to be able to keep pace with the needs of those people are going to be

[ Page 6180 ]

repatriated to the communities that have the patients, and they will be provided there just as they would in other communities around the province which are able to meet the needs of their own regional population.

You talked about Closer to Home, and I think the major problem we have with costs in the health care system is providing the wrong care in the wrong place. We don't have a well-integrated system. We end up with people who can't move easily from one part of the health care system to the other. The best example I have -- one that comes out of a lower mainland community -- is a hospital that has calculated the costs of having alcohol and substance abusers show up at the emergency room after hours.

There is an alcohol and drug treatment clinic in that community which is open from nine to five, so from five to nine the people in crisis go to the hospital emergency room.

The hospital has calculated that it could save $90,000 a year if it just took the money that was needed out of its budget, gave it to the alcohol and drug treatment centre, and said: "Open 24 hours a day." People would be better served; they would be in the right place, getting the right treatment; the hospital would have its emergency room freed up somewhat; and the hospital would be $90,000 ahead at the end of the day -- if the calculations of the chief executive officer are correct.

It sounds great! Why don't we do it? It's really practical. It can't be done under our existing system, because we have one body over here and one budget over there that's the hospital. The ability to deal with another body that is funded in a different way, is part of a different system and managed by totally different people is very difficult.

I think that community will probably do it because of the power of the personalities involved and the management there. But we shouldn't have the system set up so that it is difficult for logical, practical decisions to be made around health care funding.

If we can facilitate a more integrated system by having the decisions made at the community level wherever possible, by having the decisions made by a body that oversees not just the hospital and acute services but continuing care and the community health services, so that priorities and budgets could be set across the system and resources deployed across the system, I can tell you we'll find lots of those $90,000 savings. And we will be able to provide a much more cost-effective health care system -- one where people don't fall between the gaps of the fragmented system we have right now.

D. Mitchell: I thank the minister for that answer, as well as her patience with the process. I'm aware of the discussion that took place earlier about Shaughnessy, but I think that her answer has clarified a concern I have. She has talked about rationalizing the health care system. If she can achieve that and at the same time contain costs, I think she will have the support of most British Columbians.

In terms of a community-based health care system, after looking through Hansard I'm still not comfortable that the issue of universality of health care -- that all British Columbians will have equal access to the same high-quality health care -- is going to be provided. For instance, the member for Prince George-Omineca was talking about some specific issues in his constituency.

Is there any way for the minister to allay any concerns that someone in the community of Vanderhoof will -- under the new system of community-based health care -- have access to the same quality of service as a resident of Vancouver, for instance? I don't think the issue of universality has been satisfactorily addressed in the public's mind.

Hon. E. Cull: The question of equal access is one of the major issues the royal commission presented to us as a problem that needed addressing. When they looked at our health care system, they told us that it was one of the best health care systems in the world.

Then they said: "But there are a lot of problems." One of the biggest "buts" that they raised for us was the fact that people are not equally healthy in British Columbia -- depending upon where you live, you have a greater likelihood of suffering from different diseases or becoming ill or having other health consequences that are not as positive as the average in the province -- and that we don't all have equal access to health care services.

Clearly, people who live in the north, in small communities, on the Sunshine Coast, in Powell River or in isolated places where travel is difficult don't have the same benefits that you have in West Vancouver and that I have in Victoria. I think that goes for a lot of the services, unfortunately, that larger centres are able to provide more easily to their residents.

It doesn't mean, though, that we can't try to overcome that. One of the things that we have been trying to do through the New Directions strategy is redirect some of those resources. Some of that money that's in Shaughnessy Hospital right now is going to go out of the Vancouver area. It's going to g