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)

THURSDAY, JUNE 24, 1993

Afternoon Sitting

Volume 11, Number 15

[ Page 7813 ]

The House met at 2:03 p.m.

G. Brewin: In the precincts today are students from Sir James Douglas Elementary School in my constituency, which is hosting Lloyd George Elementary School from Kamloops. There's a total of 36 students from grades 6 and 7. If the members of the Legislature see them in the halls, do greet them warmly in true Victoria fashion. Would you please make them welcome.

F. Randall: In the gallery this afternoon are three friends: Marion Brooker from New Westminster; Marlene Kroeker from Maple Ridge; and my daughter-in-law Sylvia Randall from Crescent Beach. They're in Victoria with their spouses to attend an investment conference on pension plans. Would the House please make them welcome.

Hon. J. Cashore: In the precincts today are 45 students from Coquitlam College School with their teacher, Ms. B. Hetherington. Would the House please make them welcome.

Oral Questions

HEROIN-RELATED DEATHS IN VANCOUVER

V. Anderson: My question is to the Minister of Health. On every welfare Wednesday heroin addicts pick up cheques and die on the streets and in the rooming houses of Vancouver's downtown east side. Dr. John Blatherwick, chief medical health officer for the city of Vancouver, has called on the provincial government for action as a result of the pure grade of heroin flooding our streets and the resulting deaths of our people. What steps is the government taking to protect heroin addicts from this game of Russian roulette?

Hon. E. Cull: I thank the member for his question. In fact, ten days ago, at the request of the medical health officer for Vancouver, we started a process under the guidance of Vince Cain, the coroner.

V. Anderson: The B.C. Ambulance Service initially granted permission to BCTV to cover the story as a way of bringing the information to light and warning the addicts of this situation. Could the minister explain why, to our understanding, the government refused permission for BCTV to follow and be with those ambulances?

Hon. E. Cull: I have no information on what the Ambulance Service may or may not have said to BCTV. As I said a few minutes ago, there is a process underway. Coroner Vince Cain is involved in it. I know that some of the concerns raised by the medical health officer involve education and information to addicts.

ENFORCEMENT OF DRUG TRAFFICKING LAWS

A. Warnke: My question is for the Attorney General. Given Dr. Blatherwick's call for action, and given that overdose tragedies are so predictable -- when and where they occur -- what is the Attorney General's ministry doing about combatting drug trafficking?

Hon. C. Gabelmann: First of all, I should say that within a very short time following the incidents -- initially on Vancouver Island and particularly in my home community of Campbell River, and then subsequently in Vancouver -- that have caused a lot of deaths and suffering in the last little while, we convened a interministerial reaction. As the Minister of Health has indicated, the chief coroner for British Columbia is overseeing that. As far as the drug trafficking question goes, you can be sure that the police authorities in this province are treating that seriously and continuing their work in their usual efficient manner.

A. Warnke: Again to the Attorney General: when and where is...? In relation to welfare Wednesday, is there any trend, and will we see any trend, as a result of police actions against drug trafficking?

The Speaker: Hon. member for Richmond East.

REVIEW OF DIAGNOSTIC LABORATORY SERVICES

L. Reid: My question to the Minister of Health refers to the Kilshaw report on diagnostic medical laboratories. In May this minister said that she was strongly in support of seeing laboratories continue in this province. Today we have laboratories that believe they are being squeezed out. Does this minister have any direction in terms of changing the billing for medical laboratories in the province of British Columbia?

Hon. E. Cull: I'm surprised that any medical laboratory should feel today that it's being squeezed out, because the report is still in progress. In fact, recently my deputy met with the B.C. Medical Association, and we have agreed to delay the work of the interim report from this committee for another four weeks so that more doctors can have input to the committee. No decisions have been made, and the report will continue, in consultation with physicians, laboratories and technicians involved in providing diagnostic services.

L. Reid: If that is indeed the case, will this minister confirm that the report will contain a full and direct cost-benefit analysis before it is released? We want to see some dollar values contained in that report. Will you confirm that that will happen?

Hon. E. Cull: I certainly can't prejudge what the recommendations in the report may be. The

[ Page 7814 ]

recommendations may be that the whole situation with labs and diagnostics remain the same. But costs are one of the primary considerations and are why we're doing this review. The costs of diagnostic services have outstripped inflation, outstripped population growth -- in fact, they've even outstripped any growth in utilization in medical or hospital services. So it is an area that we're very concerned about, and we will be addressing that issue in the report.

The Speaker: Final supplemental, hon. member.

VANCOUVER GENERAL HOSPITAL LEASING OF SPACE

L. Reid: Another fine bit of NDP business acumen, if I might. Why rent when you can own? Is it true that VGH is now renting space to house the programs from Shaughnessy Hospital?

Hon. E. Cull: I must say, I find that an interesting supplemental question. It's a bit of a leap, but I am unable to answer that question. I could get back to the member.

HOMEOWNER GRANTS FOR WIDOWS

L. Hanson: I have a question for the Minister of Finance. A couple of weeks ago the minister sent out a letter to homeowners advising them that windows... widows are now eligible for an extra homeowner's grant.

Interjections.

L. Hanson: For the sake of the record, hon. Speaker, that was widows, not windows.

In any case, the letter was not true. However, many property owners may have paid their taxes based on the assumption that the minister's letter was correct. Will the minister commit today that these people will not be penalized for that letter, which was in error? Will the province cover the cost of any penalties caused as a result of that letter?

Hon. G. Clark: Some 800,000 letters went out. The first few thousand letters that went out were a bit ambiguous with respect to widows. But certain widows do qualify for the homeowner grant, so we clarified that for the vast majority of the mailings. We've had about two or three letters from individuals concerned about that, and we have dealt with those concerns. We certainly plan to deal with any concerns people have as a result of that. We have not, as I said, had very many. The member may have had some directed to him, and I've been following up with further correspondence.

L. Hanson: I assume from that -- and I'd ask the minister to confirm it -- that he has mailed out the correct information to those people who had that difficulty. Secondly, I assume that the minister has agreed that if there are penalties or that sort of thing as a result of the misinterpretation of that letter, the minister would undertake to rectify that.

Hon. G. Clark: I don't think that's likely. An individual has to apply for the homeowner grant. If there was some confusion around that application, then I'd certainly be prepared to look at it. The part that the member is raising is not in error; there is just some ambiguity with respect to it. We've cleared that up for a majority of people. When individuals apply for the homeowner grant, if they are not eligible, then obviously they are told that. I'll certainly take up any concerns that individuals have, and if there is any ability with which to rectify the situation, I'd be happy to do so.

THE VICTORIA ACCORD AND ST. ANN'S ACADEMY

C. Tanner: This is to the Minister of Government Services. Would the minister undertake to table in this House the report undertaken by B.C. Buildings Corporation, in cooperation with Mr. Sam Bawlf, for the Crown corporations secretariat? The report concerns the Victoria accord and the St. Ann's Academy plan.

Hon. L. Boone: I will look into that, and I will confer with St. Ann's Academy. That report went to the Provincial Capital Commission. I will look at it and talk to them and see what areas can be released and what can be brought to this House.

CANADA-U.S. SALMON NEGOTIATIONS

R. Chisholm: My question is to the Minister of Agriculture, Fisheries and Food. Can the minister confirm that he has instructed his staff to take another look at the contents of the Canadian position on the Pacific Salmon Commission?

[2:15]

Hon. B. Barlee: I was speaking with the Hon. John Crosbie this morning, and I asked him if he would consider several different things that we are concerned about. One is that the so-called Montreal accord was signed by the two federal governments. This was a federal government treaty, of course. We're concerned about several things. We don't want the 1993 agreement to become a benchmark agreement for 1994. We would like the Americans to acknowledge their violations of the treaty in 1992. We have so informed the government of our stance.

R. Chisholm: Will the minister please explain to the House why he's doing this now? Was he not familiar with the Canadian position while negotiations were going on? Or has he simply forgotten the details since the talks broke down two weeks ago?

Hon. B. Barlee: I explained this to the hon. member at some length, two or three times, in estimates. I will explain it again. This is a government-to-government treaty between Canada and the United States. When there is a fisheries treaty on the

[ Page 7815 ]

east coast, it is handled by the federal government; when there is a fisheries treaty on the west coast, it is handled by the federal government. For the first time ever we have an individual, Bill Lafeaux-Valentine, seated at the main table as our observer there. He is listened to by the federal government. That is why the hon. John Crosbie phoned me this morning.

R. Chisholm: Unfortunately the minister didn't answer questions in the estimates; that's why we have to ask them now. It's unconscionable that this minister has been sitting on this issue and doing nothing. Is this minister going to do something to support the B.C. fishing industry, or is he going to sit on his duff and let the Minister of Social Services deal with it when the fishers end up on welfare?

Hon. B. Barlee: Our door is always open. We will let virtually anybody walk through that door, and the hon. critic is no exception. I'm really quite broadminded in this respect. Certainly if he wants to learn a little more about the treaty, I would be quite glad to have him talk with Bill Lafeaux-Valentine, who is a very knowledgable individual -- probably the most knowledgable individual in the province. He's quite welcome to use his good offices as well.

SOCIAL ASSISTANCE PAYMENTS USED FOR PURCHASING DRUGS

R. Neufeld: In the absence of the Premier, I will go to the real Premier, the Minister of Finance. Taxpayers are willing to support people's legitimate needs, but they're not willing to pay for illegal drug habits. Unfortunately, welfare Wednesday has become legendary on the mean streets of Vancouver, and the sad toll is shocking. What specific steps can the minister take to ensure that income assistance is used for the purpose for which it's intended, and not squandered on illegal drugs?

Hon. G. Clark: I'll take the question on notice.

MINISTRY OF FORESTS BUILDING IN NANAIMO

W. Hurd: I have a question for the Minister of Government Services. Can she advise the House how much BCBC is paying to acquire land and build a 44,000 square foot building in Nanaimo for the Ministry of Forests?

Hon. L. Boone: Had the member been at the estimates this morning, he would have heard that it is only in the very preliminary planning stages. There are no estimates involved in this at this time. It's strictly in the planning stages, and there are no dollars involved at this point in time.

W. Hurd: Can the minister confirm that the employees of the Ministry of Forests in Burnaby are going to be relocated by BCBC at a cost of more than $10 million?

Hon. L. Boone: BCBC does not move individuals. It would be the Minister of Forests who would be relocating his staff there. It would not be BCBC. We merely act on behalf of our clients, the ministries, to provide the buildings that are required for them, and that is strictly our service.

IMPACT OF WATER LOSS IN LAKE KOOCANUSA

D. Jarvis: My question is to the Minister of Environment. There has been a considerable amount of devastation in the East Kootenays, especially in the riding that the Minister of Mines is from. The United States is drawing water from Lake Koocanusa and the devastation is becoming irreparable. After all this time and all the symposiums you've had in that area, what are you going to do about repairing the problems that are happening with the fish being drawn through the sluice gates? The water level has dropped 150 feet now. What do you intend to do as far as environmental considerations go?

Hon. J. Cashore: The Ministry of Environment, the hon. Minister of Labour, who is responsible for B.C. Hydro and the Minister of Energy, Mines and Petroleum Resources are working together to address the issue of mitigating the impact on fisheries. We would be glad to make documentation on that available to you.

HOMEOWNER GRANTS FOR SENIORS AND THE DISABLED

Hon. R. Blencoe: I rise on behalf of the Premier to respond to questions taken on notice.

On June 15 the Leader of the Third Party asked the Premier a question concerning the eligibility of seniors' complexes registered under the Society Act for the homeowner grant, and homeowner grant administration comes under my ministry. To qualify for a homeowner grant the applicant must meet the eligibility requirements laid out in the Home Owner Grant Act. There are no provisions in the act or in the bill that was recently tabled that would either allow or disallow grants based on registration under the Society Act. Seniors' complexes are subject to the same eligibility requirements as other applicants.

Registration under the Society Act is not a factor in the determination of eligibility under the Home Owner Grant Act.

The second question to the Premier on homeowner grants concerned homeowners with disabilities being asked to submit a new form, a certificate of physically handicapped person and property owner. According to the Leader of the Third Party, that move was seen as onerous. The answer is that the certificate of physically handicapped person and property owner was redrafted as a prescribed form in the homeowner grant regulations to combat potential abuse. The new form is virtually unchanged from the previous one; however, the declaration to be completed by the medical practitioner includes a reference to the

interpretation

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guidelines. Physicians who were not familiar with the requirements often signed the certificate without understanding the eligibility criteria set out in the homeowner grant regulations. Tax collectors rarely, if ever, questioned the eligibility of an individual once the certificate was acquired.

This change was made to encourage greater compliance with the regulations. There have been no changes in eligibility requirements. For the 1992 taxation year collectors were advised to use the new form for all applications; for '93, all individuals applying for the additional grant for the physically handicapped are required to complete the new form. In subsequent years, a new form will only be required at the discretion of the municipal collectors.

Hon. L. Boone: I ask leave to make an introduction, please.

Leave granted.

Hon. L. Boone: Hon. Speaker, on your behalf I would like to introduce a visitor to our Legislature: a fellow legislator from Australia, a woman who was the former Premier of the parliament at Victoria and who is now the Leader of the Opposition, the Hon. Joan Elizabeth Kirner. Would the House please make her welcome.

Orders of the Day

Hon. C. Gabelmann: By agreement, I call the report on the estimates of the Ministry of Energy, Mines and Petroleum Resources.

REPORT ON COMMITTEE A ESTIMATES

R. Neufeld: First of all, I would like to thank the minister for responding to the questions to the best of her ability, and to the staff for their participation in the estimates.

It became evident early in the estimates that the minister is not knowledgable about her ministry. In fact, as we continued through estimates, my deepest concerns about the minister's lack of knowledge and understanding of the working of her ministry became painfully clear. The minister states that her government is a friend of the mining and petroleum industry. I'm sure the resource industries are wondering who their enemies are. The industry knows this ministry and this government are averse to resource development in British Columbia. In fact, this minister would be better named the minister of economic development for Chile.

Her lack of knowledge of the ministry after 18 months is painfully evident in her inability to be an advocate for the mining and petroleum industry. Evidence of that is the shameful payoff to the environmentalists on the Tatshenshini decision. This also shows the minister's inability to be heard and taken seriously at the cabinet table.

A further deterioration of the employment situation in the Kootenays and Princeton and the minister's lack of ability to understand, or even comment on, the displacement of workers in Cassiar are further evidence of the government's inability to keep people employed or to care for them after job loss. Jobs and economic development are obviously two items this government is not interested in.

The ministry's own report on mining strategies in British Columbia states that B.C. has the highest government costs, through excessive taxation and escalating hydro costs, of any province in Canada. Even though that report states our tremendous opportunities in the resource sector, it also states our weaknesses: excessive taxation -- a new corporate capital tax, corporate tax and water tax increases and fee increases of every kind -- and skewed labour legislation, to mention a few. It also mentions high government deficits, yet this minister has defended massive deficits in this government.

The provincial debt load increased by 45 percent -- $6.4 billion -- over two years, and this minister supported that. The shutting down of the independent power producers and the harm that's causing the Peace River and the Peace Canyon Dam is deplorable. It shows that this minister does not understand.

The really scary

part is that this ill-informed minister stated that she is the chairperson of the committee struck to negotiate the Columbia River Treaty, yet her knowledge of the issue, which is central to her constituency, was absolutely zip. Hon. Speaker, this minister, and in fact this socialist government, must be replaced if we are to create jobs in the private sector and economic wealth for all citizens in British Columbia. Let's all pray that the damage and destruction put upon the people of B.C. by this administration are not so great that they cannot be reversed. It will be a looming challenge for any political party after the next election.

The Speaker: Comments from the hon. member for North Vancouver-Seymour on the estimates debate.

D. Jarvis: Rather than being repetitive.... The member for Peace River North has pretty well said it all. However, the Liberal Party was hoping that there would be a change of attitude in this government and in this ministry, but it has pretty well been emasculated. Except for a bit of gas that's saving their necks, there's nothing left of this ministry. As I said, we were hoping for a better attitude from this government. We felt that the mining industry needed a positive sign of encouragement.

But a signal was sent out around the world, as a result of the Windy Craggy decision, that this province was not a friendly place to do business in. There is no healthy climate in British Columbia. This is a government with special interests, and that was their first concern.

[2:30]

This government has mishandled yet another issue. Every issue they've handled appears to come into conflict, no matter what it is. Again, they have failed to provide leadership to an industry that would have provided jobs in this province. This government is the classic Murphy's Law. However, they excel in platitudes

[ Page 7817 ]

and indicate a complete lack of understanding of how to create wealth in this province.

We are all concerned about the overall aesthetic values of the Tatshenshini and the Haines triangle area. You will hear from the government that the Liberals support the fact that the Tatshenshini should be a wilderness park. Well, right on! We do. However, we also support the fact that we can work hand in hand with the environment. That's what is basically going on in this province. It should be a multiple use, just as the CORE people have suggested. We're aware that there could be appreciable damage to the wilderness, wildlife, fisheries and the land, but that is what the mine development assessment program and Bill 32 are for, which they are so proud of and are just starting on.

We have to be realistic. No mines have started up in this province over this last year. They won't come into this province because of the heavy pre-profit taxes and normal taxes, which are the highest of 24 jurisdictions throughout the world. No one is going to come into this province and gamble millions of dollars when land issues are, in effect, at the whim of this government. It can change them at any moment.

For example, three months ago this minister came up with a mining strategy that was to solve all the problems in her ministry. Part of this strategy was the formation of a new land management mineral act that would impact land use and designation. She said at that time: "It will let us be proactive in planning for high-potential areas." If there was ever a high-potential area, it was in the Haines triangle of the Windy Craggy proposal. It's probably the highest mineral reserve in North America. Therefore this mining strategy that she's come forward with is ostensibly a joke. Jobs are leaving this country by the thousands; developments are leaving this country by the thousands.

I don't quite understand the attitude of this government. A few days ago, when we were discussing investment in this province, the member for Nelson-Creston said that investors and developers in this province were "cowboy capitalists." I sometimes wonder how this party over here thinks. Let me say this. In the future, as in the past, we will be better off in this province with cowboy capitalists than with these -- and I quote again -- "Cadillac commies" over here.

As I said before, we have a government that has no comprehension about how to create wealth. We are concerned for the future of this province. We won't see the effects this year, but down the line we will see a future without investment and development. This government has no idea what is going on; members of the community and the mining developers also do not understand what's going on in this province. It is strange that investors in the mining industry throughout the world are on a level playing field and they can do so with any dictator below the Rio Grande, but they can't do it with British Columbia.

Hon. A. Edwards: It's amazing what a television camera will do. We have just spent eight hours in debate over the estimates of Energy, Mines and Petroleum Resources, when a couple of pussycats stood across the way and asked questions. Actually, I thought they were getting relatively pleasant and almost reasonable, but that's not the case since they were dealing on the basis of asking questions....

The Speaker: A point of order has been raised.

C. Serwa: I think the minister has to retract several words, when she referred to hon. members of this chamber in the manner that she did. I would ask that the minister retract those words.

Interjections.

The Speaker: Order, please. Did the minister intend to impugn the motives or behaviour of any other hon. member in the House?

Hon. A. Edwards: Hon. Speaker, I would gladly withdraw the term "pussycats." It was not accurate.

The Speaker: Thank you very much, hon. minister. Please continue.

Hon. A. Edwards: Since our debate in Committee A, my critics have obviously found themselves a thesaurus that is well thumbed through in the poison terms, put them together and pumped themselves up with a foot pump, I believe, and come in here to make the statement. I am pleased to see them come to life. I am delighted to see that they are willing to make statements which are contradictory to some of their policy statements and which are very different. But at least they have come to life. The Liberal critic is now saying that he supports mining in a class A park.

His own party said very clearly and campaigned on a policy of making the Tatshenshini area into a wilderness area, so I find it very interesting to hear what the Liberal critic has to say.

Hon. Speaker, to tell you what did go on in the committee, we started off with a good debate on the mining industry. We talked about our mineral and coal strategies and our focus for the future, not only for the mining industry but also for the rural areas and urban areas which equally depend on the mining industry in British Columbia. The government supports that industry, and we have been very clear about that.

We have also discussed the decision that was made this week on preservation of the Tatshenshini-Alsek area, which is a land use decision that was made under very difficult circumstances and is not likely to be repeated in that way. The same kind of decision is not facing the government in any other area in British Columbia. The value of that ecosystem, which has to be preserved for the future generations of British Columbia and for the people of the world, does not exist in the rest of British Columbia.

However, that wasn't all we talked about. We talked about cogeneration and independent power producer opportunities. We discussed how the government sees a role for the independent power producers for domestic power when a demand is shown and for export policy, which will be announced in a very short time. The argument was made in debate that there should be a

[ Page 7818 ]

cushion or a built-in energy supply in the B.C. Hydro supply plan to offset weather-related reservoir fluctuations. We are very clear that this could be extremely expensive. Nevertheless, we recognize that the drought conditions of the last several years will require, and have required, us to examine cost-effective adjustments that can be made to offset the implications of cyclical changes in the operating system for B.C. Hydro. We will do so, and we expect that these issues will be examined in even greater detail under the electrical systems operation review, which has been announced and is beginning its progress.

On the issue of the return of B.C.'s entitlement under the downstream benefits of the Columbia River Treaty, we had a very constructive session on the options. I appreciated the discussion about these negotiations and the sensitivity that is there. Obviously this is an extremely valuable asset owned by the province, and we are going to do what we can to ensure we maximize the value of that asset to the people of British Columbia. We will pay particular attention to the regional needs of those in the Columbia-Kootenay region. That is the region that bore the brunt, the social and economic costs, of constructing the treaty dams.

The quality of debate on Vigas was somewhat less than it might have been had the member realized that this government inherited an extremely messy financial situation in connection with that pipeline. We have recently renegotiated the agreement to reduce the risk to the people of British Columbia by more than 100 percent.

I was particularly pleased to be able to discuss the role of the B.C. Energy Council. The questions on the Energy Council gave us the opportunity to discuss how that council's work will proceed and how the work complements, rather than substitutes for, the activities of the B.C. Utilities Commission and the ministry itself. The work of that council on energy exports has been extremely important, and the advisory work on an energy plan for the province will continue into the next year and be extremely valuable as well.

Regarding Fraser Valley, I was very interested to agree with the member for Peace River North. It was amazing, but we do agree on some things. He shared my view that all British Columbians should share in resource development opportunities -- opportunities that are carried out, of course, in a socially and environmentally acceptable way. I know the member also agreed -- as did the official opposition critic, I believe -- that the natural gas sector is the true bright spot in British Columbia's economy right now, and it is certainly a bright spot in the continental natural gas industry.

It's very exciting to talk about the activity in the northeast, which is very clearly responding to higher gas prices as well as to a stable natural gas royalty and domestic gas and export sales policy in the province.

As the MLA for Kootenay, I was very disappointed it took so long to get down to the very important issue of the Elk Valley. It is an issue of such great importance that this government has committed untold time and effort to ensure that those two mines, which were owned by a company that went bankrupt, are back in operation. We continue to put our efforts into dealing with what's left over in the wake of that bankruptcy. The support of this government, including that of this ministry, has been consistent and extensive.

In

summary, I felt that we were able to show that this ministry works to advocate responsibly for both the energy and mineral sectors in British Columbia. Thanks to the members for their comments. What came forward were the activities of a ministry that is overworked perhaps, but extremely active. Besides revenue regulation and recording, we have been very inventive and active in policy and public involvement. Every one of these activities takes time and effort, and we are doing that with fewer people in the ministry.

[2:45]

Despite being so busy, members of my ministry have been able to perform an array of work on the mineral strategy and theoretical and practical work promoting important issues such as conservation, energy and public involvement in every area. We will continue to do so. I certainly look forward to the coming year's activities that have been provided for in this year's budget.

Hon. E. Cull: Committee of Supply A is called for the Douglas Fir Room to debate the estimates of the Ministry of Government Services. In this House I call adjourned debate on second reading of Bill 45.

HEALTH AUTHORITIES ACT, 1993

(continued)

V. Anderson: Before the debate adjourned this morning, I was trying to put in context what we are discussing when we talk about health planning within B.C. I was bringing to the attention of the members of the House a discussion about healthy communities which seems to be fundamental when we talk about health planning in B.C.

In 1984 the World Health Organization proposed a definition of health which extended the concept, beyond that of a healthy relationship of a person to themselves and to the environment, to a uniquely broad concept of health. I'd like to quote that definition. Health is defined as:

"...the extent to which an individual or group is able, on one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, a dimension of our 'quality of life' and not the object of living; it is a positive concept emphasizing social and personal resources, as well as physical capabilities."

When we look at a broader definition of health that includes not only the person but also the health of the whole community and the relationships in which people are involved with one another, we go into a far broader understanding than this Health Authorities Act attempts to put before us. It is only restructuring the health part of our community living. It ignores the other aspects of the environment, community organizations, the workplace and recreational time. It is ignoring the whole aspect of developing a healthy community which enables us all to have healthy lives.

[ Page 7819 ]

It's also ignoring the preventive, educational aspect of health and is dealing with an organizational administrative structure without getting at the quality that must be taken into account within health fields.

The UBC Centre for Human Settlements had this to say when it was discussing healthy communities and in the process pointing out a new direction for dealing with health planning: "...a dissaffection with top-down technocratic planning and treatment in all fields inevitably led to the notion that broadly defined health planning had to take place at the local level, that is, through some combination of local government -- especially municipalities -- non-government organizations -- such as service clubs -- and ad hoc community committees." This is what sparked the idea of a healthy community.

As I mentioned earlier, this same government has sponsored the process of Healthy Communities discussions throughout the province. Unfortunately, in discussions with people within our community, I have found that these two streams, health reorganization through the Health ministry and health community planning through the communities, were operating on two different tracks -- and never the twain seemed to meet. So we have a Health Authorities Act which deals only with a structure that has to do with personal health, not with the health of the community as a whole.

What must be taken into account is a whole community planning for itself. It is not enough to just pull together a few persons who are dealing with one aspect of community life, "the health aspect of community life," and having them talk to each other apart from the rest of the community. We need to look at a healthy community in which the whole community is involved, not just some aspects of it.

The paper from the UBC Centre for Human Settlements has the following definition: "...a healthy community is a community in which all organizations from informal groups to government are working effectively together to improve the quality of all people's lives." That very aspect of working together with all the organizations of the community is being neglected in this Health Authorities Act. It's not working effectively together and involving all the community organizations, which is so important in this process.

I quote again from that paper: "If a healthy community is one in which people, through their organizations, are working effectively together to improve the well-being of themselves, their neighbours and future generations, then a health community project is one that facilitates such cooperative work."

That involvement of where people live, where people exercise and where people work, that involvement of dealing with the whole life of a person, is so important. When I worked in the inner city projects with summer students not so many years ago -- and the Premier was also a part of that -- the university's school of medicine had some of their first-year medical students take part. When we asked about this, the comment was that in the medical school they were taught to deal with illnesses, but first they had to deal with people in the wholeness of their lives.

I was reminded of this when I remembered the first-term students in Boston school of medicine. You could always tell when they came to that first essay, because it was on what is a healthy person, not on what is a sick person. They weren't to describe that person simply as being without disease. A healthy person has a full life and is able to take all of their characteristics and share them with others in the wholeness of community.

A healthy person lives in a relationship with other people in which there is a concept of body, mind, soul and spirit, in which the wholeness of a person is undertaken to be a part of the whole concept of community life. That undertaking to deal with the whole of the community and to discuss health in this broader context is missing in this Health Authorities Act.

It has set up an administrative structure. It has set up a process which is from the top down. It says that it involves community people, but it involves community people in a structure that is established from the top. It tells the community people within that structure what topics they are to discuss. It says to them, even before they meet, that they are to do away with their hospitals as we now know them; they are to restructure their hospital boards as we know them; and they are to look at whatever is here at the moment as inadequate, and replace it with something new.

It's not a question of asking them whether they're happy with their present hospital facilities. It's not a question of asking them whether they're satisfied with the present hospital board and its undertakings. No, it's a question of saying that it's pass� because the government has a new vision, and it's this new vision into which they are compelled to fit.

We must challenge this kind of top-down approach and say that we must work from the community up. We must work from a community base in order to bring the opportunity for all of the informal groups of the community, not just the health groups, to come together. We must enable the community to plan together so that the children have the opportunity to grow up in happy relationships and with an educational system that meets the needs of their whole person, and so that families have the same privilege, whatever their economic background, to participate in community, recreational and educational undertakings.

We find that in much of this discussion we are asking about budget and financial situations rather than asking about the health responsibility that a community holds -- not that the minister holds or the government holds -- the health responsibility and opportunity of the community to enable the community to come together and define the process that they have in mind.

I challenge the minister to take a new look. She has said that she wants to listen to the people and respond to them. I appreciate and respect that. But I want her to listen again, because it is my sincere belief that what she first heard is not what the people were saying. It's like two people who are having a conversation. It's only when you feed back what the other person has said to find out if that's what was intended that you clarify any misunderstanding. That process is not fully taking

[ Page 7820 ]

place at this particular point between our communities and the minister and the Ministry of Health.

[3:00]

As we look at the Health Authorities Act.... I would hope that it would be called instead something like the health cooperation act. Even the terminology gives the kind of framework structure into which, as I said earlier, the ministry expects the people to fit. Categories are provided for them, rather than having a health cooperation act, with the ministry saying to the people: "Here is a possible way to go." Put it out to them and let them feed back, as if it were a study paper, and then come forward with the regulations or the bill after hearing back from the people.

That two-way conversation is missing, and I would encourage the minister to reinitiate it so that the community at large can have a cooperative approach, not the authoritative pressure approach which currently we feel and see.

A. Warnke: It's very difficult to follow my colleague, the member for Vancouver-Langara, who is always so eloquent on these matters. I paid very close attention to his remarks, and I would join with him in suggesting that the minister have a sober second thought about the legislation that is before us.

I have quite a few remarks to make, but at the outset I have to compliment the member for Comox. This is the first time I've spoken on this bill, and the member for Comox said something that I'd really like to know more about. She said that the member for Richmond-Steveston -- myself -- was harping and carping on this bill. This would indicate that she has a tremendous crystal ball before her. Perhaps I will be harping and carping on this particular bill, but it's something I'm not aware of, considering that I haven't spoken on it yet. We'll see if in fact I harp and carp.

I'm not exactly sure what that means, but perhaps by the time I finish today I'll find out. It's amazing to know the future. If the member has an accurate crystal ball, I would like to possibly spend more time with the member to find out what else is in the future for us.

Health care is an emerging challenge, obviously. It's a very serious issue, not only to this government but to all governments, simply because health care is facing a series of crises, especially with an aging population and all the rest of it. So naturally every government is faced with the problem of extending health care service to the communities of British Columbia -- in particular, in the north. Many northern communities have expressed how necessary it is to extend health services and health care to their communities.

[H. Giesbrecht in the chair.]

Incidentally, it was not that long ago that I inquired of some people from northern communities as to what some of the answers may be to this very question. As a matter of fact, I was told that the Minister of Health herself would be going through to at least one of the communities; I believe it was Burns Lake. I hope the minister gained some knowledge of this area, because they had some particular concerns there with regard to health care problems. I know one question I put was: what about regional government? Northerners told me that this is not necessarily the answer, and I suspected as much.

As a matter of fact, when we get into the details of it, the northern communities have special kinds of problems involving costs and distances that one just does not see in the lower mainland and other parts of the province -- even the Okanagan Valley and the Kootenays -- which are obviously much more populated. Therefore the answer is not necessarily to artificially impose some regional government model in this area.

Indeed, my colleague from Richmond East put it very well, I thought: what we are seeing in Bill 45 is the imposition of a top-down approach. That is the very thing that people in the eastern and northern parts of this province.... I dare say even those in the lower mainland suggest that that approach, that perspective and that attitude must be done away with. It is an approach where the minister, the ministry and the chief bureaucrats are still fully in charge. It's interesting to note that yes, a third of the boards may be appointed from within the community.

But it's offset by the third of the board that is appointed by the ministry, which suggests -- and this is what my colleague for Richmond East put so well -- that it still leaves the minister and the ministry in charge. That's the problem. There's a whole approach here that essentially says: "What we in the ministry define as good is the way it's got to go." Of course, we understand that ministers and ministries should take the approach that if they make a key decision that has financial costs, there may be conditions attached to it. But don't suggest that what we are really doing is decentralizing.

This is not really decentralizing anything.

Indeed, after looking at the components of Bill 45, the question has to be asked: does the administration really decentralize the ability to define the needs and wants of the community? No way. The ministry is still in charge of defining the needs and wants of the community. Decentralization is not really taking place here. Does the administration really allow supervision by the community or other approaches to take place? No. Does the administration really facilitate the members of the community defining the needs themselves? No.

So I'm not sure exactly where the notion of decentralization is actually taking place. The minister and the ministry, the bureaucracy, are still in charge. Therefore decentralization is not really working; it's not there.

It's good rhetoric. It's an imposition, I suppose, of what I would call an artificial sort of administration that says yes, we are allowing some decision-making to take place. Part of the decision-making, supposedly, is from the local community. But who is actually in charge? Who defines the needs and wants of the community? Who imposes the direction, the supervision and the financing? That is still all done by the ministry, so I'm not sure exactly just where the ministry is going on this.

I believe it was again the member for Comox Valley who stated, in an attempt to criticize my colleague for Richmond East, and myself specifically, that there is a remarkable success in the community of Richmond. I think my colleague for Richmond Centre was slighted.

[ Page 7821 ]

I'm sure he's not too pleased about that, because the hospital is actually in his riding. I'm sure he'd want to share some of this criticism of us, as well. The criticism was totally unwarranted. The member for Comox Valley, in defending the minister's bill, said that in Richmond it is a tremendous experiment, there has been a testing of a new health care policy and it is well received. On closer examination, all that has occurred so far is that the terms of reference have been developed for a steering and planning committee to be in place this month. We haven't even established a steering and planning committee.

There has only been one meeting, as I understand it. Indeed, there has been no test of this representation from the community by multicultural, labour and service groups as described by the member for Comox. All I can say is that the member for Comox is, I guess, one of those people for whom one swallow makes a summer and one snowflake makes a winter. That's fine and dandy perhaps in the area of forecasting weather. Perhaps the member uses her crystal ball. When we take a look at what has happened in the community, we find that member claiming that this has been a tremendous experiment and saying: "Wow!

We're way off the ground and it's just rolling along very nicely." After one meeting? Talk about making a summer out of a swallow.

Interjections.

A. Warnke: I think one member said: "We haven't even started talking about it." That's right. We haven't even passed this bill yet, so how can one claim that the experiment is off the ground and just rolling along very nicely when we haven't even passed the bill yet. But there you go, hon. Speaker.

From the comments made by the member for Richmond East, as well as other members, in examining and thoroughly criticizing this bill -- indeed, I thought my colleague for Vancouver-Langara put this bill in proper perspective -- it's quite obvious that what this bill needs is a heck of a lot more work. It needs a lot more work to put together a well-thought-out bill.

Mind you, this is not the first time we've had a bill presented in this House which we have said lacks a number of things and needs to go back to the drawing board for rethinking. Maybe that's where the harping and carping comes in. If in fact that's the definition of harp and carp, I think government members, and ministers in particular, would be well advised to have a thorough look at the nature and implications of their bills before they present them in this chamber.

This is another bill that requires more thought. Indeed, according to the minister herself, this creates a first stage in the establishment of regional health boards. But we really don't know what the subsequent stages are. Perhaps that's the problem. To present a bill that has wide support, not only from members of this chamber but from a variety of peoples and communities, you start by thinking in terms of the implications of how you apply such legislation. We need to think beyond the first stage.

It is not convincing in the slightest that what we are seeing is a shift towards more local autonomy. I think the member for Richmond East hit it dead on: what it really does is download financing onto the local community. That's hardly shifting authority. That's hardly what should be meant by extending local autonomy. Certainly local officials do not have in mind bearing the burden of whatever the provincial government does. This so-called New Directions policy is really an artificial presentation of where local autonomy is supposed to occur.

In actuality, especially in a financial sense, it is really a downloading of the burden onto local communities. That's not shifting responsibility and autonomy to the local communities at all. It's not what communities have in mind.

[3:15]

Communities in the north and the east and the more remote areas of our province have been complaining for a long time that they always have to argue with Victoria. In the lower mainland, they put forward an argument and people in the ministry listen to it. Maybe there's a bit of an argument, but at least they're listened to. Communities in the more remote parts of this province feel that they have to constantly battle and argue and get groups together and come down to Victoria and so forth to get their point across.

Again, it stems from an attitude that extends across many ministries, I suppose -- but this one particularly -- that they know what's best: "We've made a decision. This is the model you're working with, these are the directions you're working in, and in that context you have to make decisions." That's entirely inappropriate to some of these communities.

When we begin to understand where the communities are coming from and the kinds of problems and issues that they face, then we will begin to responsibly pass on local autonomy. In that context we really appreciate where the communities are coming from. The ministry needs to be encouraged to understand the meaning of community, especially as it is applied to the more remote parts of this province. The communities have to be assured that they will have access to the services that are perceived as being extended to the lower mainland.

The problem is that too often in the past decisions and directions -- and here again in the New Directions policy -- have been perceived as imposed on the communities. The communities want to be assured that services and health care will be available and that material and resources will be offered to them.

What was it that the member for Comox Valley talked about? Harping and carping and what not -- I've forgotten. She wants to accuse me of that even before I've given my speech. I would suggest that it's rhetorical puffery and artificial arguments developed by the ministry to put forward an argument in favour of this bill. There are a lot of problems with the bill, and it requires more thought. In the case of Richmond, the member for Comox Valley alluded to one meeting that somehow was a successful experiment.

That member and this ministry and members of the government have got to understand what it means to consult the community. It's not just one little meeting to set up some sort of a committee.

[ Page 7822 ]

Whether it's the north, the Kootenays, Richmond or Vancouver Island, one little meeting to set up some sort of a vague process is not enough. Consultation is a constant dialogue. There are some members who don't understand that, and the result is that there is no consultation at all. We've seen evidence. If the member for Comox Valley thinks that was consultation, that's how badly we need to go back to the drawing board and consult more with those people in the communities who have some stake in the future of health care. That, of course, means the people of British Columbia.

I really have some concerns about whether the minister has consulted extensively with the people of British Columbia. I have my doubts about that.

In this context, then, the so-called New Directions policy in provincial health care has clearly not taken into account people in those communities who want to say more, who believe that the Ministry of Health is somewhere off the rails on this. Since it is so absolutely essential for the ministry to go back and consult with those communities, I would therefore move an amendment to the motion, seconded by the member for Richmond East, that the motion for second reading of Bill 45 be amended by deleting the word "now" and substituting therefor the words "six months hence."

Interjections.

Deputy Speaker: You may proceed, hon. member, while we review the motion.

On the amendment.

A. Warnke: In presenting the motion that the word "now" be deleted and replaced by the words "six months hence," the reaction of members across the way -- and I won't comment on how many members -- is a bit surprising. If I were to be really negative, I would say let's go ahead and defeat this once and for all; let's just kill it now. I didn't say that. I moved a very reasonable motion, based on some of the arguments I presented before, that we delete the word "now" and substitute the words "six months hence."

Perhaps some members opposite need to hear why the six months hence. Six months hence would allow a pretty adequate time frame in order to have more than just one meeting. I think it would provide a sufficient amount of time for the minister, her ministry and, it appears, other government members to get in touch with the various communities -- maybe their own ridings -- throughout this province and with some of the people they claim to have been in touch with, people who have concerns regarding multicultural interests, labour interests and what not. It would be very nice if those communities were contacted as well, as to the application of this bill.

In particular, I would like to see municipal governments and city governments contacted -- those people who will have imposed upon them the ominous responsibility of administering this policy. I'm not asking for a lot of time, such as one or two years or something really unreasonable. I'm not saying let's kill the bill. I'm just saying that there should be a reasonable amount of time during which the communities can be contacted. Surely that would give the members opposite an adequate amount of time to ask questions and hear from their various communities whether they like this particular model.

I strongly suspect, just as the member for Richmond East has said, that the answer from these various communities would be: "No, we do not want to be burdened any more than we are now." They don't want to be in a situation where a few representatives on a board can be vetoed by the ministry, and yet be co-opted into a situation where they have to live with it, because the ministry can turn right around and say: "Oh, you were represented on that board." I don't think communities appreciate it. I know that northern communities certainly don't appreciate it. They're fed up with that attitude.

They are saying that it's about time the ministry and the bureaucracy understood that this attitude of going into the communities and imposing models, directions and decisions should be a thing of the past.

Interjections.

A. Warnke: I am shocked that a member across the way would have that as a definition of democracy, that decisions imposed on communities by the executive somehow defines democracy. I find that very incongruous with what I would determine as the definition of democracy. That clearly illustrates why we need this amendment of deleting the word "now" and substituting the words "six months hence." It clearly illustrates how that member and other members have got to go back not only to the communities to understand where the communities are coming from, but to their local libraries, I suspect, to look up a few

definitions of democracy. There's the problem, hon. Speaker. This is what I would like to encourage those members to do.

As a matter of fact, I realize the numbers in this House, and therefore I appeal to all members on the government side to get behind this motion, because I know it's in their interest. I am doing something that actually favours the government; that will make all government members understand the needs of the community. I am actually giving them some time to go back to their constituencies and get in touch with the communities. If they support this motion of substituting the words "six months hence," I hope they will be grateful.

But of course I'm in the opposition; I understand that they cannot extend good words to me. I think it is really in the interest of all members, and therefore I strongly urge the minister and the government members to seriously consider this motion and support it; to allow that breathing time of six months hence; to go back and consult the communities and have more meetings. I would like to see more meetings. Go back and take a look at the implications as well as the nature of the application of this bill.

L. Reid: I'm pleased to rise in debate today to second the motion of my hon. colleague for Richmond-Steveston. He moved we consider this more carefully over the next six months and return to the

[ Page 7823 ]

table at that time with some sense of where this bill is going and whether or not any cost accounting or cost-benefit analysis has been done.

[3:30]

I spoke at great length yesterday about a research base and how necessary accountability is to this question. I'd like to refer extensively this afternoon to the June 1993 issue of Medical Post. It looks at what has transpired in Saskatchewan. The title of the

article is "Saskatchewan's Plan for Cheaper Health Care Just Doesn't Add Up."

I have a number of points. At times, conventional medical economics has almost become a religion. It defines many of its tenets; it holds them with catechistic fervour; it proclaims them as revealed truth; it espouses a trinity of cost control: nurses are cheaper than doctors, salaries are cheaper than fees for service and home care is cheaper than hospital care. The

article raises the question: is this dogma valid? Does it indeed make sense?

Recently the Saskatchewan government accidentally provided an opportunity for evaluation. To rein in the straw man of runaway costs, it turned health care over to its regional boards. As one of its first actions, the Saskatchewan board decided to control obstetric costs without reducing service by early hospital discharge and home care programs for postpartum women. They looked at the idea of how much they were spending on home birth and on birth in hospitals, and they said: "There must be ways to reduce that." This is what transpired in Saskatchewan.

The idea is promising, but the board did not provide a pro forma to show that theory and practice coincided. Unfortunately, they often do not. So the doctor ordered a six-month checkup. They went back and looked at the data and said: "On the surface this appears to be a reasonable idea. Can we, after evaluation and analysis, decide there is a benefit to directing dollars in this manner?"

This is what they learned. They got this data without much delay, and the daily number of postpartum women receiving home care in this community was 3.5. The average number of nurses employed was 2.75. The daily cost for mother and child was $147.09. The board measured daily cost in the two local hospitals as $144 and $181. The cost in the two hospitals averaged out at $162 a day. Finally, it subtracted $147 from the $162 and said: "The program saves money." Most would laugh at this analysis. They would call it tricky or deceptive accounting.

The program actually costs money, because the price at home is greater than the price at one of the hospitals. Furthermore, instead of averaging costs, the board should find out why one hospital charges 25 percent more than the other. If the excess is unnecessary, reduce it. If it is not, make greater use of the low-cost facility.

This was Saskatchewan's attempt to analyze what was happening in regionalized health care, in the shift to community to take these services out of hospitals and look at them. This

article directly impacts on my comments yesterday, because I stood in this House and said that reasonable cost accounting was not happening anywhere in our country. Saskatchewan, which has had it in place for a long time, can't provide the data to determine whether or not this is a useful exercise. They will tell you as we proceed that it is not a cost saving, nor can they suggest in any way, shape or form that it has somehow improved health care. Those issues have not been resolved, and they have been at this a lot longer than we have.

They asked a number of individuals who work directly in the field. According to working obstetrical nurses, the cost discrepancy is even greater than this. Home care replaces the end part of the post-delivery stay, but the earlier

part is more expensive. They say much more nursing time is required on the first and second -- especially the first -- days following delivery, rather than the third and the fourth. Thus this early discharge saves on days when the cost is below average. You're putting the most expensive service in a more condensed time frame, and you're ensuring the hospitals are responsible for higher costs.

The adverse fiscal result is even worse than this. Elimination of hospital costs for the discharged mother would require simultaneous discharge of hospital staff, and this is not possible. Thus there is a residual added cost for the unoccupied hospital bed to be included in the total cost of postpartum care.

This is just one example -- one aspect of hospital care that this community and this province have discovered is not cheaper. We can certainly have the discussion whether this is the more humane way to deliver health care. But this minister came to British Columbians and said: "We're proceeding in this direction because it will ensure the dollars are spent in a more cost-effective manner." We haven't seen that. Again, the closest province to us that is engaged in this activity has not been able to defend it -- not at all.

Another example. While the program is more than a house call, it is not more than a physician provides free when he or she makes a house call. For such a house call, government medical care in this province pays $33.50.

Deputy Speaker: Order, please. On a point of order, the Minister of Health.

Hon. E. Cull: Hon. Speaker, I appreciate that there is considerable latitude given in second reading debate, but the member is debating whether a home- and community-based health care system is more cost-effective than an institution-based system. The Health Authorities Act only deals with the governing structure of our health care system and makes no comments or directions as to whether we go to a more community-based system or stick exactly with the institution-based system we have right now. We debated this extensively in estimates, and I think we'd be more productive here today if we stuck to the point of the bill.

L. Reid: The exact intent of the bill is whether or not this is a reasonable direction to proceed for this province. The direction I raised in debate yesterday was cost accounting and a cost-benefit analysis. This minister stood in this House and said it was a reasonable program based on research. On the point of

[ Page 7824 ]

order, hon. Speaker, I'm indicating today that the research does not exist.

Deputy Speaker: The Chair would observe, though, that we are on the amendment. The debate should in some way focus on the appropriateness or the propriety of a six-month hoist. Perhaps the members of the House could focus on that, in adherence to standing order 61. Please proceed, hon. member.

L. Reid: I'm delighted to continue in debate this afternoon, hon. Speaker, because I do believe the points are salient. I take your comments; however, this is a broader picture in terms of whether or not we reform health care. Speaking directly to the hoist motion, I'm entering these comments in debate today for the sole purpose of providing British Columbians with an opportunity to evaluate this bill, and what support there is for it, over the next six months. Six months is a very small time line compared to the enormity of the changes that are being proposed.

I am happy to speak to the six-month hoist, and I believe my comments speak directly to that. If we are going to support a six-month hoist, it has to be on the basis of what we're going to do in that six months. My position is that we evaluate this proposal over the next six months. It's important to support the motion because this requires evaluation, which is exactly the intent of my comments this afternoon.

Certainly in the province of Saskatchewan -- and that is, frankly, an interesting province to be considering at present, because there is a lot of carryover from that province to British Columbia at this time.... There is a lot of westerly movement of directions that have not been well supported and, given this research today, not well documented as being cost-effective. That is the issue with which I began, and that is the issue with which I will probably finish today, because that is the only goal for debating this legislation over the next six months: to determine if indeed there is any way to evaluate this practice.

Certainly the New England Journal of Medicine will tell us that the 1990s is the era of accountability. People wish to know whether their dollars are going to provide reasonable service. That is the intent of a six-month hoist: to ensure that British Columbians have some assurance that this will provide them something useful at the end of the day. Six months for a change of this magnitude is not asking for a great deal.

I think the comments from Saskatchewan are well taken. They talk about the savings produced by salaries, nurses and home care being illusory. We have a bill that's looking at restructuring health care, and the province of Saskatchewan is saying: "It's an illusion. You're not going to save money." This minister brought in this bill on the premise that it would save money; it would be a better use of the taxpayers' dollar. It's not supported, and begs the bigger question of how important it is to hoist this piece of legislation so British Columbians can have a very careful look at it.

We do not wish it to proceed at this time unless there is an opportunity to examine it in some detail. That is the reason we are calling for a six-month hoist.

John Kenneth Galbraith explained it better than anybody. He said: "In some human endeavours, especially banking, there is no more certain road to the top than failure and proven incompetence." Health care is becoming one of those endeavours. That's a significant issue. Look at the president of the Saskatoon Health Board. He had no health care training or experience: a doctorate in philosophy and stints in the civil service, finance and education got him his job. Despite this background, he has now moved to British Columbia to become our Deputy Minister of Health. Has this individual brought expertise? It's not reflected here.

We need to ensure that this program is evaluated in some detail over the next six months, so that British Columbians can be assured that they are getting a reasonable product. It hasn't happened. It's a significant concern, and it is the only reason I am standing in support of a motion to hoist this piece of legislation for six months. It's really important that British Columbians understand what they are getting and actually get something for their tax dollars.

I have said many times in this House that there is no such thing as government dollars; it's tax dollars. It's our money that's being allocated. If British Columbians see it as important to examine this change over the next six months in tremendous detail, I applaud that. I would welcome that, because we have not found an opportunity to evaluate this as provided here today, or over the last number of days. Individuals in the communities have not had an opportunity to look at where we wish to go with this piece of legislation. That is a huge concern.

I have concerns, and I know that the individuals who come to my office have tremendous concerns. In terms of how important the hoist motion is, yesterday the Minister of Health talked about how closely this ties to the Seaton royal commission. It does not. Parts of it correspond, but there are parts of it that do not at all reflect the direction of that document. For a better example for the hon. members across the floor, let's take what happened when we did a similar process in education. Parts of it reflected the direction of the commission; parts of it did not. We have issues with significant comment today.

I will refer specifically to particular sections, again drawing in the need for a six-month hoist, because it's really important that British Columbians understand where we are headed. Six months is a reasonable time in which to examine this legislation in some detail. This is significant health care reform and needs very clear attention.

If you look at

section 3 -- "...are consistent with the commission...." I will refer you to page B38 of the Seaton royal commission report. Sections 4 through 8 are not on page B38. On page B39 of the Seaton report, it is clear that the commission recommended that the Ministry of Health be decentralized into a number of manageable regional centres, assigning fiscal responsibility to the regional general managers. This is clearly not the intent of Bill 45, which establishes boards and councils which have these stated purposes. There are several major recommendations on B38 that the decentralization should be in the hands of the ministry,

[ Page 7825 ]

regional assistant deputy ministers and, most importantly, an accountable regional manager and a core complement of regionally placed staff. Nowhere in this bill is this structure in any way anticipated, and I think that's intentional. That's an issue. Again, there are issues here that need to be explored in more detail for all members of this House -- and certainly for all members of the province, because they have some significant issues surrounding a change in health care in this province. I have some concerns.

To speak directly to the hoist motion, if individuals in this province have concerns and if they're not clear about where this government is headed, it makes perfect sense to ensure that they be provided with an opportunity by their government to examine in more detail how this is going to happen. The six-month hoist is nothing but an invitation to British Columbians to participate more directly in this process. To deny that participation -- a government that said: "Open government. Let's communicate.

We'll ensure you have the information in your hands before you're required to make a decision" -- does not make sense. So I stand with my colleagues in calling for a six-month review of this legislation and calling for it on behalf of members of communities. It's really important that we ensure that people are on board. If they don't understand it, if it's unclear or if it does not make sense.... The opportunity exists for individuals to be brought onside, to ensure that they're provided with some reasonable cost analysis.

[3:45]

I have a tremendous number of details -- and I will spend many hours, I'm sure, in committee stage on this bill -- from reviewing all the sections that do not support where this minister wishes to go with Closer to Home. Frankly, I don't believe that this minister can provide a reasonable cost-benefit analysis. If one exists, why is it not in the hands of British Columbians or in the hands of reasonable decision-makers? Why are we wondering if this is a more reasonable way to provide health care? It's a huge concern that has to be addressed by both sides of this House.

Asking for six months to review this legislation is an appeal on behalf of the health care system in this province and on behalf of the individuals who now sit on surgical wait-lists and wonder where they're going to get their care from and how it's going to be provided. I see nothing wrong with spending six months to ensure that a framework is in place that makes sense to them and that will indeed improve the delivery of health care in this province.

Right now we have a process and we're heading down a road, but this government cannot tell British Columbians whether or not it is going to be of benefit to us to make these changes. We can surmise and speculate. British Columbians have asked my office for some assurance that this will indeed improve their individual lot. They need to assure themselves, their families and their friends that their health care is somehow going to be better.

This legislation doesn't do it. Frankly, the comments I've heard in the House from the government members do not do it. It's simply another indication of this government ramming something through the House without legitimate analysis from the communities; and no legitimate analysis has been provided in this chamber. As I asked earlier, if the nineties is indeed the era of accountability, particularly as it relates to medicine and medical practice, why no cost-benefit analysis? That has not been addressed.

If the information doesn't exist, what finer opportunity than to hoist this for six months, evaluate it in more detail and come back to this House with a defence of this particular piece of legislation?

All British Columbians need to be concerned about this. If we reform without knowing if we're making improvements, we haven't done anything to improve the health of future British Columbians in this province. We're not taking particularly good care of the ones we have right now. I'm sure all MLAs in this House have had individuals come to their offices and ask when they're going to be up for surgery or when they can expect to receive a particular procedure. I know it happens, and I'm not sure what the government benches suggest to their constituents.

H. Lali: Blame it on the Socreds.

L. Reid: The hon. member suggests blaming it on the Socreds. How disgusting that after 18 months, that would still be an answer you could give to British Columbians who need health care. It is simplistic and pious in the extreme. Hon. Speaker, there has to be an opportunity for members of this House to be directly accountable to their constituents.

Deputy Speaker: Order, please.

L. Reid: It's not happening on the government benches, and it is a huge concern for the opposition, because we believe that taxpayers pay dollars for reasonable service. Taxpayers in this province believe that they are paying for a service. Now they're going to see something change. They're not sure what that is and they're not clear if the services are being diluted beyond recognition or not. To again speak directly to the hoist motion, people need some understanding of this legislation. Put it out in the field for six months and have communities and individual British Columbians

[ Page 7826 ]

who currently sit on surgical wait-lists take a look at this and decide for themselves if that is going to improve their level of health care.

Frankly, hon. member, we had a situation a year ago where this government created a health special account, and the people who it was created for believed it would help them and somehow address their urgent medical priorities. That was a year ago. It did not happen. At the end of the day, this bill must assure British Columbians that they are finally going to get some service. It doesn't reassure me; frankly, it doesn't reassure the individuals who seek support from the offices of my colleagues.

We need to have this legislation scrutinized in the full light of day. It hasn't happened. That is what this opposition is asking for, and I would hope that this government can see the wisdom of that and have the grace to ensure that all British Columbians are prepared to buy into reform of their health care system. Six months is not asking for a lot, because there is nothing that Canadians value more highly than their health care; there is nothing that British Columbians value more highly than their health care. If this government is truly committed to a grass-roots process, why not allow those British Columbians to be part of that decision?

L. Fox: I can see that the minister wants to close debate on this particular issue, but I welcome the opportunity to stand up and speak in support of the hoist motion. I agree that in many instances a hoist motion is a delay. In this instance it's not. I want to try to explain why I suggest that it's not a delay. When we look closely at the bill and at the fact that it's so open-ended and that the minister has such extraordinary powers, that really concerns me and concerns the electorate of British Columbia. When we look first at

section 4(1), it says: "The minister may, by regulation, designate (

a) a regional health board, and (

b) an area of British Columbia that constitutes the region for the board." Therein lies part of the problem. When I talk to my constituents about the thrust from the hospital or acute care system that we're used to into a new Closer to Home process, there's a considerable amount of support for the concept. Many individuals understand and would much rather be recuperating from their illnesses at home than lying in a hospital where they don't have the availability of their family or friends on a regular basis.

The problem with the statement that the minister may, by regulation, designate a regional health board and an area of B.C. that constitutes the region of the board is the fact that people would view it much differently depending on where those borders are struck.

Hon E. Cull: If they tell me, I'll appoint them.

L. Fox: The minister says: "If they tell me, I'll appoint them." Well, that's precisely the reason that I'm supporting the hoist motion. Six months would give the minister an opportunity to go out there and listen to the people, so that they could have input into structuring those particular regions and perhaps into structuring what the autonomy of those boards should be.

I believe it was the member for Powell River-Sunshine Coast who talked about the original concept of the regional district. When that was put before the electorate in those respective regions there was a mapping and a plan. There was virtually a job description of what was expected from regional districts, how the election process was going to work and how APCs should be appointed. As well, the major thrust of what the objective of that elected body would be was outlined. We find none of that in this bill. In fact, what we find in this bill is the ability of the minister, by regulation, to designate.

When we look at what could happen in different jurisdictions around the province, there's a lot of fear out there. There has to be a process, and a six-month time frame is reasonable enough for the minister to identify, to some degree, the very broad kinds of management powers of these regions. As well, for discussion purposes, she and her ministry might identify what they feel are legitimate borders and delineations of the respective regions. But we find out, should we pass this legislation, that the minister has the powers to do that. That has to be a concern.

We find a similar process with respect to the community health councils in

section 6(1): "The minister may, by regulation, designate (

a) a community health council, and (

b) an area of British Columbia that constitutes the community for the council." Here again, through this legislation, you have a body over which the minister has total autonomy to designate what it should consist of, what community should be involved in it in respect of regions of the province and perhaps what their responsibility should be.

Therein lies some more problems and the reason for more dialogue with the taxpayers and the people concerned about the level of health care in all corners of the province. They should know that what they're supporting is, in fact, going to deliver a product that will provide more dollars to the patient and less dollars to administration. But the perception I have of this bill is that it does just the opposite: it has the ability to put up two more bureaucracies which will eat up health care dollars and take away from the ability to spend dollars directly on treating the patient.

That has to be a very large concern. I'm sure that it's a concern for the minister, because she has stated several times that she wants to see administration decreased and more of the health care dollar going to the patient. I think it behooves her and this government to put together more than just a concept to bring forward to the House for approval.

They have to put together a package so that we can see what the directions of this government are, one where it's not all left up to the minister to designate or appoint and where, in fact, the public feels that they will have an ongoing opportunity, through some evaluation process that is not built into this particular bill, to be a partner in the process and improve upon the system as it moves forward. I'm sure there will always be a need for that particular happening.

[4:00]

When we look at some of the purposes of the bill, the statements are very broad. It leaves a lot to

interpretation and, once again, to the minister and the

[ Page 7827 ]

powers of cabinet. Yesterday evening I complimented the Minister of Municipal Affairs on the process that he entered into, where some seven or eight months prior to bringing in legislation he provided a discussion paper that had some very specific information in it from interested parties in the province as to how the legislation should be changed in order to reflect what was in the best interests of local elections. What we've seen from other ministers, and certainly from this minister, is that legislation is brought in and hurried through the process to third reading stage, usually within two weeks.

It gives very little opportunity for interested parties throughout the province to give their input into this kind of legislation.

Another concern that we have, certainly one that I have as a rural MLA, is that under this legislation there's a real possibility of having different levels of health care in different parts of the province. The individuals involved in and presently building on the concepts of Closer to Home are very dedicated, committed and well-meaning individuals. I believe they're trying to act from the perspective of what's in the best interests of their particular regions.

But I do not believe that we've heard from the average taxpayer, the individual picking up the bill, as to whether or not they believe that the structure outlined within this bill is in fact something they would choose. In talking to those people it's obvious to me that the concept, as I said earlier, is supportable, but what they're looking for are the nuts and bolts of the system. How is it going to function? How is it going to affect my individual treatment?

As the member for Richmond-Steveston, I believe it was, said a few moments ago, I get calls from individuals who are being put on long waiting lists for particular procedures and want help to get higher on the priority list. In fact, I had a call yesterday where a young lady wants to go back to work but has been told she has to wait until September for her particular operation.

People are asking me: will this new process help shorten those waiting lists? I can't tell them that, because we have no idea what the process is going to be or how it's going to deal with those concerns. In passing legislation such as this, I believe we should have given consideration to those major areas of concern and shown within the legislation what the structure is going to be, so that we can evaluate whether or not it's going to be in the best interests of British Columbians to proceed along this road.

The minister will be aware, and I'm sure the House is aware, that I have always supported the Closer to Home concept, but I wanted the minister and her ministry to enter into some pilot projects around the province. We could develop models based on urban structures, semi-urban structures and perhaps on small communities and extremely rural settings. There could be some assistance to those groups wanting to develop this process and improve the delivery of health care in their regions, so that they wouldn't all be trying to re-invent the wheel -- which is what is happening in the present process.

The minister spoke yesterday about 30 communities and how they made some marvellous progress in developing their systems. I can appreciate that input. I'm sure those people are working very diligently and very hard, trying to meet the deadlines required within the system. But that's 30 out of 180 communities. Many communities out there are really groping with what it is they're trying to set up. Some regional managers, department heads or directors -- whatever we call them under this system -- are also having great difficulty trying to figure out how this giant puzzle is all going to come together and how we're going to have an efficient delivery of health care services.

I believe it's incumbent on this government to look very seriously at supporting this amendment and bringing back legislation which addresses many issues that have been put out by both opposition parties. This legislation certainly addresses the issue of centralization. It puts more powers in the minister's hands than were ever there before. That is an extreme concern, when the minister is suggesting publicly that she is decentralizing powers and putting the decision-making process back in the community, closer to the delivery of care. That certainly isn't happening with this bill, because all the powers are right there within the minister's purview.

Nowhere in the process is there an evaluation of what the costs are going to be to deliver a respective service. This concern has been addressed by myself, members of the Liberal opposition and our opposition. Nowhere in this process do we have a procedure that allows us to evaluate what the expense of this new initiative is going to be versus the delivery of acute care in our hospitals, as we have at present. Members of the government stand up constantly and say: "Look at the Seaton royal commission." I've done that, and I've done so at considerable length.

I agree that there are many good recommendations of concepts, but none of them has really been proven to be efficient, none of them has been costed out and none of them has been balanced with the affordability to pay and what the quality of service will be within that respective recommendation.

When I look back in my short history in local politics at some of the mistakes made by the government over the years, I recall a couple of initiatives. I believe that the six-month hoist motion can help us resolve some of those concerns. I recall an initiative by the Ministry of Education back in the mid-seventies when we decided that we were going to build the open-classroom concept. We spent millions of dollars designing and building new schools around an open-classroom concept, only to find out by '78 or '79 that in fact that concept didn't work. In theory it should have, but in practice it didn't.

So then we spent millions of dollars redesigning those schools back to a typical classroom structure. Those are the kinds of mistakes the provincial government has made when they haven't taken the time to seek input into their policies and legislation.

When I go back and look at the Royal Commission on Education, at some of the recommendations that were implemented by the government and at the millions and millions of dollars spent on the Year 2000 program, I am convinced that within the next two to three years, the Year 2000 program and all the money we've spent on it will be in the trash can. There again,

[ Page 7828 ]

the philosophy and principles of that seemed to be something we should be able to achieve, but in fact, in principle it didn't work. And it won't work.

Now we look at the Seaton Royal Commission on Health Care. They have identified a Closer to Home concept for the delivery of services. In actual fact, that thrust probably started seven or eight years ago, or perhaps as many as ten years ago, with a shortening of the time you could stay in the hospital after surgery or a procedure. In fact, more and more encouragement was given over the years for day surgery versus admittance into the hospital. So that has in fact been evolving -- quite slowly perhaps, but in a natural and organized way.

What we have now reminds me of a kangaroo crossed with an ostrich: we take great leaps, but we still have our head in the sand. That's the concern. We're not listening to the public in this process, nor are we given specifics through this legislation or any other policy paper that allows the public to make the decision that this is the right direction or to evaluate whether or not they want to buy into this process or dump all over it. There's nothing they can read that outlines the structure of it. It's an airy-fairy system over which the minister has total power to structure.

We're not well enough informed as to the final objective, as to what the final outcome is going to look like and as to what their responsibilities are going to be. That's a concern. I believe the six-month hoist motion could allow the minister to do the kind of preparatory work that would inform us -- and through us, inform the people of our respective constituencies -- as to whether we should all be buying in to this initiative or, instead, fighting against it as not meeting the objectives the Seaton commission thought possible when it put forward its recommendations.

Hon. Speaker, with that, I'll take my place. I would like to say I'll be supporting the hoist motion. Due to this very enthusiastic presentation by opposition members, I hope the government will see fit to support the motion and do the right thing on behalf of all British Columbians.

V. Anderson: I rise again to speak to the hoist motion on Bill 45, the Health Authorities Act. One of the realities we're facing in this House at the moment, hon. Speaker, is that we were here for some 60 sitting days, and within that 60 days some 20 bills were brought in to be considered.

D. Lovick: There you go, whining again.

V. Anderson: I'm not whining, as the member says; I'm just describing the facts. If we assume that we will close for the summer sometime between now and the middle of July, the end of July or whenever it might be, some 20 or 30 more bills have been brought in, including the Health Authorities Act, bills on guardianship and many other related bills. We also understand, and properly so, that there is an interrelationship among these bills. None of them stands on its own, so they must be considered in relationship to each other. We have 20-some more bills to consider at the same time as this one.

We must not only consider the particular portions of each of those bills but consider them in relationship to each other.

Either by design or inability to get the bills done in time, we are being asked to consider all of these areas -- even to the point that we sit until 12:30 in the morning to try to deal honestly and fairly with the legislation before us, which is how it must be dealt with. But that's not only a difficulty for those of us who sit in the Legislature, because we sit here not to do our own will, although we have to take that into account; we are here to be responsive to the people of the province.

They need an opportunity to read all of these 60-some bills, to digest them, to discuss them within their communities and then to come back to both the government and ourselves with their responses. That's the way legislation should be undertaken: in consultation with the people.

[4:15]

This government, particularly, has said it consults with the people. So they say that these bills come forward as a result of consultation. We're simply saying, fine, we'll take you at your word. When you bring in the Health Authorities Act, or the other 20 to 30 bills before us, these should go out so that the community has an opportunity to discuss them and report back to us. That's what we are saying is fundamentally important.

Municipal government is another level of government that is fundamental to our democratic system. These bills have to go to the municipal government to be considered, examined and responded to before we put them into legislation, because they impact directly on municipal government in every community in this province. They impact financially and organizationally and from the point of view of meeting the needs of the people. Let me just give an illustration that came into the House and into our community today. The concern with welfare Wednesday was raised.

We discussed that with the Minister of Health, and she acknowledged the concern. Because of the system, some people who get money suddenly are able to buy heroin. As a result, over the last few months numerous deaths have occurred each month. Some 50 to 100 others did not die, because our services were there to meet their needs and to help them survive.

As I was saying earlier, a healthy community means that the Ministries of Social Services, Attorney General, Education and Health, along with the municipal governments and the community agencies, all have to work together in the planning of a community that can be a part of the care and concern we have for each other. The problem of people dying because of the heroin trade will not be solved by any one ministry, nor will it be solved by legislation we pass in this House, however good it may be. It will only be solved as we work together in daily consultation with the people of the community.

Even if -- and I say "even if" -- this Health Authorities Act were perfect, without the people of the community being able to buy into it and make it their own, it would never have the trust and authority to make it work.

[ Page 7829 ]

One of the phrases we have learned to understand very well is "I have a vision." Martin Luther King used that phrase and made it a watchword for people around the world, not because he was able to pass any legislation and not because he sat in the seat of power to make decisions that other people had to live by. He made that phrase important because he walked with the people, he met with the people, he listened to the people and he spoke on behalf of the people. Out of the recommendations of the people, he brought forth a vision which was caught throughout the world.

I know that the minister says that she has a vision of health for British Columbia. But that vision has not yet been caught by the community. The community has not found her walking in their midst on their streets or down in their mid-towns where they see her and hear about her and where they can talk to her face to face. She's been in committees and consultations with the select group of those who have come to talk about health, but the people in the community haven't felt that she has been a part of their life. So the Health Authorities Act doesn't come with that authority. It's a contradiction in terms.

The Health Authorities Act comes with uncertainty, with questions and with lack of conviction on the part of the people. That's why we say it should be put aside and sent out to the people so that they are able to say, "Yes, we agree with this process, and therefore we'll implement it," or "No, we don't agree with it, and these are the changes that must be made," which I'm sure the minister would be delighted to do.

The bill almost reads like "the minister may" bill. When you look at the creation of the health councils, you find that expression coming up again and again. The minister may, by regulation, designate a regional health board. The minister may designate an area of British Columbia that constitutes the region for the board. The minister may, in effect, restructure British Columbia. The minister may, in effect, direct people on how they will come together to deal with health in a region -- a region that she dictates and puts forth. Perhaps those people do not want to become another corporation, which is what the minister has done here. The regional health board is a corporation.

The people of the community have been used to working with each other in cooperative association, not being forced into a business corporation. Now the minister has set up 75 or maybe 100 new corporations in the province, with all of the machinery that goes with corporations. The minister is saying who the board of the corporation is. It sounds like she's establishing another Vancouver Stock Exchange board, only she's establishing 75 of them. It's a great way to increase the business corporations within this province -- by mandate of the minister. They're not elected; they're designated.

Under this board membership, the minister prescribes how many people will be on the board and who they will represent.

[E. Barnes in the chair.]

Having put all of these people in charge of new corporations, they are expected to fulfil this major undertaking without remuneration. People have been delighted and anxious to volunteer in associations that they were able to develop for themselves, that they were part of putting the meaning into and that were relevant to their particular community. Here, the corporation in every community will have the same stamp and the same profile. Underneath these corporations -- and I say underneath, because that's exactly what it is.... These corporations are run from the master headquarters, which is Victoria.

Victoria -- as the master, mistress or whatever the proper term will be -- runs the corporation; each of the small corporations has community councils underneath it. Here again, under the community health councils -- we might say community health directorates -- the minister may, by regulation, designate the health council and the area that it serves.

We understand what this means, because another bill before this House has the provision that wards may be created not by the will of the people, but simply by a vote of a community council. The will of the people has been taken away, and the control has been placed in the council itself. Again, the pattern is seen in these community health councils where the minister may designate a health council and the area that it serves, and will designate the council's area of responsibility, guidelines and regulations.

Indeed, the budget and finances of these councils and regional boards are all controlled from the master budget plan of the Minister of Health. It all comes down to one control. The regional boards and the regional health councils in this design become the puppet organizations of the Ministry of Health.

That's bad enough in itself, but we've seen the same pattern in Social Services, in Education and in all of the other facets of this government to, in essence, control and direct from a centralized point, rather than to decentralize and help the community to work together.

When we first heard the outline of this government, we thought they were moving in the same direction that the Liberals wanted, towards an integrated community development program where Health, Education, Social Services, Attorney General, Transportation and Municipal Affairs concerns would all work together in a community in a cooperative fashion, as I described earlier, to develop and decide what a healthy community means for them. Then the government at its various stages could support and interrelate between other communities who are doing exactly the same thing.

[4:30]

We have one more example of the social engineering of this government. The minister is at least honest enough to acknowledge that, because the bill itself says its purpose is to create the framework within which this transition process will proceed until 1995. It's a transition process; it's one stage in the planning, as the bill points out. In fact, it says this act creates the first stage in the establishment of regional health boards and community health councils across British Columbia. But what is the second stage? The third? The fourth? The fifth? This is like trying to put the foundation under a building without knowing whether you've got a

[ Page 7830 ]

two-storey, 40-storey or 100-storey building. You can't build communities this way; you can't restructure communities this way. You cannot restructure communities by building the penthouse first and then wait, hanging it in the middle of the air until everything else is available underneath it. That's exactly what we find happening here.

We all agree there should be provincial standards, but these are not standards that come from the community. "The minister may, by regulation, specify a health service, or the level or extent of health service, that must be provided in a region or community." The minister will decide the standards of community health care by regulation, and we do not know what that regulation is because that's somewhere down in the fourth or fifth -- or whatever -- stage of the process.

So people trying to build a process in the community don't even know what the building blocks are; they don't even know what it is that they are supposed to be achieving. We understand they are supposed to take over the hospitals and develop alternative community clinics. But we thought the hospital was a community clinic. There are no

definitions or directions here. We are left without understanding by this minister. There is no process here of being part of a total community planning process. The Healthy Communities project, which this minister also supports, recommends and suggests this must be necessary, backed of course by the World Health Organization, with all of its experience in other places around the world.

If it were possible, we might suggest that the hoist should be even more than six months -- because we do not think this community consultation can be done that quickly. The minister is bringing this document out of the Closer to Home study, which is an inch thick. It implies that the consultation did not cease when this document was provided to the minister and to the Legislature for guidance. The understanding was that how the minister responded and what came out of this would go back out to the communities for review before it became law -- so they had their input before the fact, not after the fact.

[M. Farnworth in the chair.]

That is the problem with this. Regional health boards and community health councils are being created, hospital boards are being disenfranchised and the purposes that are being given to those councils and boards are being given to them. They have not been worked out with them, but are being given to them, mandated to them and directed at them. This is not the way people understood it would be done.

Then we look at the financial administration, and we find that each council and regional board is subservient to the Minister of Finance and the Minister of Health here in Victoria. They present their budget up the line, and then the word will come down to them. Indeed, a corporate structure is being proposed here, where one big health corporation, with many corporations and branches throughout the province, is unrelated to the total community needs. This is not what the people asked for.

Perhaps the minister and members of the government do not agree, and they would say: "Yes, this is exactly what the people asked for; this is exactly what they want." If so, let the hoist motion go through. Send the bill out to the hospital boards across the province. Send it out to the municipal councils that have not even had time to receive it yet, much less read it, since it only came in this last week. Send it out to the health boards and to the community agencies that have been meeting. Don't send it by fax; send it out so they can have time to read it, digest it and honestly respond to it.

Once they have read it and digested it, let the minister go out among them and hear them speak. Then when the bill comes back, it will have credibility and viability.

Again I ask: how does this particular bill, in planning for health within this province, fit into the planning for social services? We have never heard of an integrated plan between these bodies. How does this plan fit in with the educational plan of this province? Again, we have never heard of an integrated plan between these different bodies.

Let me give an example of something that happened in our own community. We had community health service centres in different parts of the community. At one point we used to be able to go to the community health service centre and all our concerns about health could be dealt with in that one centre. Then there was a reorganization, and instead of the community centre being able to provide all of the health services, they were specialized. One centre provided one type of service, another provided another type of service and another some place else provided a third type of service. So you were forced to go from service to service to service, and the whole thing just broke down.

It was like going to a group of medical specialists. If it was something to do with your foot, you went to one person; if it had to do with your head, you went to another person.. That was the process. Without integration between the ministries to bring the services of this government together.... That kind of process is not good enough for this province at the present time. There must be cooperation between the ministries, and there must be a community view of health care that takes in the whole community, not only the sick but also those who may become sick.

Interjection.

V. Anderson: Hon. Speaker, it's sometimes hard to resist the banter that goes across the floor in here. But it's nice to know that we have a healthy aspect to our discussion, even when we're discussing serious matters.

Another illustration is that in our community of Vancouver-Langara -- and it's an adjoining community -- we have been served very well and very effectively over many years by all the special and personal services that were in Shaughnessy Hospital. Now that's no more, because this minister has dictated that Shaughnessy Hospital will not succeed. The staff and doctors were not consulted, and the community was not consulted. Even the cooperative groups with which Shaughnessy Hospital worked -- Grace Hospital, Children's Hospital, the University of B.C. and

[ Page 7831 ]

Vancouver General Hospital -- were not contacted. The decision was made because the minister said it would happen and, apparently, the Minister of Finance said that she had to save $40 million. So this took place without consultation and without community support. When the community banded together, held public meetings and went to Vancouver city council, they asked the minister to come. But the minister was not there. She was not in the middle of the group to hear what people had to say, like Martin Luther King was in the middle of his flock.

That is why we're concerned about this particular bill. It is called the Health Authorities Act, and it implies quite openly in its title that the minister has authority and all the rest of us are subservient to that authority. I'm simply saying, on behalf of the people of this province, that we are not subservient to the Minister of Health. We are not subservient to this government, no matter how many seats they won with 42 percent of the vote. They promised to work with the people of this province.

They promised to work on behalf of the people of the province, not simply to implement their philosophy of social engineering. I would have no problem with their philosophy interacting in a dialogue where we come to an agreement between us. But I do have a problem when there's no dialogue or consultation, and when the acts of this Legislature do not go back to the people to get their response, so they can be a part of it.

Hon. Speaker, the Health Authorities Act is not ready to go forward to the people of this province, because the people of this province will not accept it in its present form. As we have discovered with Shaughnessy and other places, it will make our health care even worse than it is at the moment.

H. Lali: I request leave to make an introduction.

Leave granted.

H. Lali: I was asked by my good friend the member for Kamloops to make an introduction on his behalf. He threatened that if I didn't make the introduction, he would cancel a couple of highway projects in my riding, so I am forced to make this introduction under duress. It is my pleasure to introduce some grade 6 and 7 students from the French class at Lloyd George Elementary School in Kamloops. Would the House please make them welcome.

Hon. E. Cull: I am opposed to this hoist motion because the arguments that have been put forward by the opposition are clearly not based on facts. The two points they make repeatedly are that we have not consulted enough and that we are not putting in place a cost-effective system of governance. I'd just like to talk briefly to each one.

[4:45]

With respect to not having consulted enough, this process started in March of 1990 with the report of the Royal Commission on Health Care and Costs. That was over three years ago. During the course of doing that report they received 1,500 submissions from people throughout this province, and they heard from hundreds of people who came out to meetings. We didn't just take the royal commission report and start to implement it.

Contrary to the member opposite, who said as he held up the report, "We thought there'd be some consultation," after that report was completed, we sat through a number of processes and reviewed the recommendations of the report. We had an advisory committee that steered the process through a number of different working groups. Consumers and health care providers were involved.

We had two major forums with representatives of every group that has anything to do with health care -- not just health in the narrow sense of the Ministry of Health, but the broad concept of health that the member opposite has been talking about. We had community meetings. We met in church halls, community halls and high schools. We talked to people who, like all of us, are not experts in health care but simply consumers of health care services -- people who depend on them to be there when they need them.

After that process had been gone through -- it took us about a year -- we sat down and drafted the New Directions paper. That paper went through consultation with the people who had helped us put the report together. In fact, the paper was written by the 26-member advisory committee that did the work and reviewed what was finally going to be in it. When the paper was released in February of this year it contained 38 specific actions that had been worked out in consultation with the people of this province.

One of those specific actions was to change the system of governance for health care in this province so that we didn't have a myriad of boards all over the place, each looking at its own little narrow part of the health care system, but truly community-based boards that had a comprehensive mandate to look at acute care services, long-term care services and the community-based services that make up the backbone of our health care system.

The consultation didn't stop once the paper was released. I personally spent seven weeks in February and March travelling around this province, going to almost every region and talking to hospital boards, health care providers and community groups in high schools and community forums. People who were interested enough to come out in the evening everywhere from the Queen Charlottes to the Kootenays, up and down Vancouver Island and through the northern part of British Columbia talked about the New Directions strategy, and I gained more ideas about how we should reflect those individual 38 strategies both in the programs of the ministry and in the legislation we're bringing forward.

[The Speaker in the chair.]

When that process was completed, we started discussion with the groups about the draft legislation. We took the concepts to them. We met with a large number of health care providers and associations and talked about what this piece of legislation should look like when it was finally tabled in the Legislature. Again, I met personally with the B.C. Health Association, the

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associated union boards of health and with the Union of B.C. Municipalities representatives, so that I could be assured that they were satisfied with what we were planning on tabling in terms of legislation. I met with the representatives of the health care workers and all of the union representatives in the acute care and community care fields, so that they too could tell me how this might impact on the people they represent, both the patients and their workers. That process was completed when we tabled the legislation in the House.

But the process of consultation has not yet finished, because the very intent of this legislation is that it is transitional. It is aimed at getting the next step in the process underway. As we move forward with the pilot projects that the member opposite has called for, we will learn what changes have to be made so that next year we can come back with detailed permanent legislation. It will allow us to reflect on the models that have been developed in this transition period and to make the final decisions that no community in this province wants us to make this early, because they want some chances to sit down and sort it out for themselves.

The other argument around the consultation issue that I've heard is that we didn't take the royal commission recommendation. The member for Richmond East -- the critic -- stands up and reads out the recommendation on regionalization from the royal commission report, which recommends regional managers of the Ministry of Health being the regionalization process -- being in control of the budgets, the programs and the priorities.

That may have been a reasonable recommendation from the commission. But when we took it through the rest of this process that I've just described, the people in the communities didn't buy it. They said they didn't want that kind of highly centralized process; they wanted a community-based process made up of people who were elected and appointed to sit on boards and councils in their communities. They wanted a fair amount of scope in terms of what responsibilities they would take on, what their boundaries would be and how they would organize themselves in their own communities.

They told me very clearly that what fits in Victoria won't fit in Nelson, in Smithers or in downtown Vancouver, so we have to allow ourselves a degree of flexibility. That is what is now coming forward in those communities that are starting into the process, because they all look very different in the way they're organizing themselves.

I've heard arguments on both sides of this in the last two days. It's rather amusing to hear some members stand up and say: "There are not enough specifics in this bill. You're going to have things all over the map." Then the next speaker from the opposition stands up and says: "You're not allowing enough flexibility. You're trying to make everybody do the same thing." We're not trying to make everybody do the same thing; we're trying to give them a framework within which they can work, so that they can explore some of these models of community and regional organization.

When we have learned from those over the next year, we will be able to put the most successful models into permanent legislation.

We've also been told that there's no cost-effectiveness and that we don't know whether this process is going to cost more or less. I've heard a lot of arguments about a community-based health care system versus institution-based care. Members were talking about people being discharged from hospital and whether or not it was more effective to have moms discharged early. This legislation is governance legislation. It is not about whether we have a more institutionalized or a less institutionalized system.

In fact, if the communities wanted to, the nature of health care in their community could remain virtually unchanged with this governance system. That won't happen, because people want to see things change in their community, and they want the tools to make that happen. But this legislation deals with the governance; it doesn't deal with whether we have more community care, whether we merge institutions, whether we go to early discharge planning or anything like that.

It is more cost-effective, though. If you look at the system we have right now, in any community in this province we have two, three, a dozen or maybe two dozen boards. In most communities in the province that are managing health care resources in isolation from one another, we have hospital boards, long-term care boards, union boards of health and a myriad non-profit societies, along with services direct from ministries that are managed out of regional offices and delivered with no board or local organization at all. This system of fragmented governance is causing a lot of the problems. That's one of the things the royal commission said we had to change.

The interesting thing that's coming back to me four months after we released the New Directions paper -- even from the communities these members have been talking about, who are skeptical about whether this process is going to work.... The one thing they have been saying to me is: "We're not sure yet whether this is going to work in our community. But we're sitting down and talking to each other, and this is the first time that many of us have actually been in the same room talking about health care." I'm not talking about a very busy, complex system like in downtown Vancouver, where you'd think people might not be talking to each