Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, MAY 13, 1997

Afternoon

Volume 4, Number 24

[ Page 3339 ]

The House met at 2:05 p.m.

H. Lali: Today we have in the galleries two constituents of mine: Rory and Debbie Schwartz from Tulameen. Would the House please make them welcome.

Hon. D. Zirnhelt: Hon. Speaker, would the House please welcome Francesco Lurati, Delfina Lurati and Bobbie Weber-Smith. Francesco and Delfina are here from the U.K. Please make them welcome.

R. Neufeld: It gives me pleasure to introduce to the House a past longtime resident of the community of Fort Nelson. You'll remember that I don't very often get to get up and introduce anyone from the north because they hardly ever come down. This person has moved to Vernon, and I just scooped the member from Vernon. I'm sorry, I had to do that because I didn't think you were coming into the House. Would the House please make Buster Hannah welcome.

Hon. D. Miller: Mr. Speaker, joining the House in the members' gallery is a former MLA for Richmond, Nick Loenen, who I understand has recently published a book, Citizenship and Democracy: A Case for Proportional Representation . I can assure members that I am not advertising the book, but I would ask all members to give him a warm welcome.

Hon. J. MacPhail: It gives me great pleasure to, again, do what I did yesterday during my estimates -- to welcome to the House my mother Mary MacPhail. I want to assure the House that she is innocent and naïve and should have no questions asked of her, please. Would the House please make my mother welcome.

A. Sanders: I too would like to introduce Mr. Buster Hannah -- because he belongs to me now -- and welcome him here.

The Speaker: The member for Esquimalt-Metchosin.

M. Sihota: Oh, you remembered, hon. Speaker.

Well, speaking of remembering, Mr. Loenen is here. Sitting right behind him, of course, is one of the best spin doctors in the business, the former aide -- or media secretary, I guess it was -- to Premier Harcourt: Andy Orr. Would all members please give him a warm welcome.

Oral Questions

RESOURCES FOR CHILD PROTECTION

G. Campbell: The opposition has previously asked the Minister for Children and Families to work with all of us in the House to help resolve the problems of children in the province of British Columbia. Today the child, youth and family advocate in British Columbia issued her second annual report. From the report and the advocate's comments, it's clear that to do the job of protecting children, more resources are going to be required. The children's advocate said today that the job can't be done with what's on the table: " . . . with what is on the table, something will fall off." Unfortunately, often that something is a child.

Will the minister now take us up on our offer, and to sit down with members of this chamber and map out a comprehensive strategy to be sure that in the next year and the years that follow we will properly protect the children of British Columbia and allocate the appropriate resources to do just that?

Hon. P. Priddy: As I indicated to the opposition before -- and I think there are a number of issues, actually, we're working on that have to do with the safety of children in British Columbia -- I'm always pleased to do that, and we can continue to do that in an even more comprehensive way. I think that when we speak to the issue of resources, there are one or two points I would want to make.

One of them is that I don't suppose you'd have any minister who would turn down additional resources, but I think that before one went and did that, there are two things to consider. One of them is that we are looking at the whole child-serving system to see whether there is duplication. Are there efficiencies? Are there ways of saving money within the additional system in areas of duplication of services? We have already been able to find additional dollars for the foster care review, for case assistance, for social workers.

The other thing, I think . . . . I hear the child advocate's comment, and I think we need to respect her work. But Judge Gove himself said in his report that we have enough money in our system, and it is an issue of doing our work differently. So I think there are a variety of perspectives to bring to this.

G. Campbell: There are clearly a variety of perspectives to bring to this, and that's exactly what we're asking the minister to do -- not in the back rooms, not through briefings, but through an organized and appropriate response for all Members of the Legislative Assembly to sit down together and look at these issues one at a time and to look at what resources need to be allocated.

The children's advocate is very clear: this year's issues are last year's issues. Without appropriate resources, they will, unfortunately, be next year's issues. What we're trying to do is resolve some of these issues. My question to the minister is: is she willing to work with all of us to gather together the concerns of people on the outside, of the young people on the outside and of the children's advocate, and to work with members of the Legislature to allocate the resources that are necessary so that next year we can make real progress with regard to protecting children in the province of British Columbia?

Hon. P. Priddy: I think it is important to note that there is a standing committee on Gove in which the opposition members are represented and which seems to me to have been a format to raise issues on which both the child advocate and the ombudsperson -- ombudsman, ombudsperson or ombuddy, I think she prefers to be called -- have presented reports on progress, as we have as well. So there is a standing committee that exists.

Again, to go back to the issue of resources and the need for more resources, I think it is important that we first finish our examination of the system to know where those resources

[ Page 3340 ]

might be needed. Is there duplication? Can we find resources within the system, as we have so far been able to do with a number of new initiatives?

It's interesting to note that this is the second report in as many days, I think, or three days -- one from the ombudsperson and one from the child and youth advocate -- that said two important things. One of them is that the government is getting its priorities right, that it is moving ahead and that that effort should be sustained. And it recognizes the magnitude of change that is going on in this government.

G. Campbell: The challenge here . . . . As the minister herself has said, she needs resources. The children's advocate has said we need resources. On this side of the House, we recognize that we need resources, and we have to establish a forum at least, where we can discuss these programs fully and openly. Foster parents are saying they need resources. They need a place to come, a place to talk about the problems they face so we can come up with solutions to them.

The child advocate's report quotes the Federation of B.C. Youth in Care Networks: "To really have a voice, I need the opportunity to say it -- my way -- to someone who really listens and can do something about it." We do not have that in this Legislature, and I'm asking the minister to reach out to all members of this House, to all members of the child care community, to all the citizens of British Columbia who want to help in solving this problem. Will she not do that, hon. Speaker?

Hon. P. Priddy: Yes, I will do it, and yes, we are doing that.

I think, though, that for one thing it's important to note that this is a report that was completed when this ministry was 99 days old -- very much in its infancy. But in every region of this province -- and there are now 20 regions within this ministry -- there are mandatory -- I repeat, mandatory -- advisory committees to every regional operating officer.

[2:15]

And we have said, it is mandatory that there be youth voices on those advisory committees, because that is close to where those youth live, that is close to their communities -- not coming to Victoria. Those advisory committees are the committees that will help decide in regions: what are the needs? Where do youth voices need to be heard? Where do children and family voices need to be heard?

As well, with the task force that was established, three youth in care from the Youth in Care Network, who actually grew up in government care, are represented there. So we certainly have more work to do on youth and children's voices, but we have made a good start on that.

INCIDENCE OF REPORTS

OF CHILD ABUSE AND NEGLECT

M. Coell: The child advocate stated today that her office continues to hear from people who say they have reported suspected abuse and neglect of children to the ministry and nothing has been done. Can the minister tell us why -- after Matthew Vaudreuil, the Gove commission and the formation of a new ministry -- we are still hearing complaints of child abuse and neglect that are going unanswered by this ministry?

Hon. P. Priddy: I spoke with the child advocate last Friday about the issues she was going to raise in her report. It's interesting that the calls my office gets are that we overinvestigate, not underinvestigate. We've asked the child advocate to provide us with information about complaints not being investigated. If somebody does not bring that to me as a systemic issue, then I cannot work to change that.

I think the child advocate acknowledged in her report two weeks ago that what she was presenting to people in terms of the data, if you will, was anecdotal information based on phone calls to her office -- not necessarily some sort of research information, but any information she has about complaints not investigated. If you look at it through the eyes of the child, which is how we do our work in this ministry and what I ask everybody to do, then we need to be sure that children are safe. If people are concerned that children are not safe and we are not investigating, then I need to know that in order to be able to address it.

M. Coell: The child advocate states in her report that requests for assistance from her office by children are growing at the rate of 11 percent per month. Can the minister tell us how she intends to respond to these serious concerns that are repeatedly raised by the children's advocate?

Hon. P. Priddy: In terms of children calling, in some ways . . . . I don't know how to describe that. The children's advocate, I think, has done an excellent piece of work because she works in the region, she does a lot of development work, and she talks to a lot of children and youth. So they know that they can call her office, they can do that in safety and they can report concerns. What needs to then happen is that we need -- not just in a report but in a more regular way -- to hear those concerns that children don't feel their voices are being heard.

We have made some changes in the last legislation. For instance, children in foster care will be interviewed by social workers away from the foster family -- that's actually quite new; that never happened before -- so children can express their voices safely.

So if children are calling the child advocate and saying they have concerns, we are more than prepared . . . . I think we need to go beyond the Zenith 1234 number. There are a number of other initiatives we can take, and we have indicated to the child and youth advocate our willingness and our eagerness to work with her to solve that.

ROAD DISREPAIR IN PEACE REGION

J. Weisgerber: My question is to the Minister of Transportation and Highways. Rural roads in the Peace region are on the verge of disintegration as the result of years of neglect, inadequate rehabilitation and recent reductions in maintenance. This includes main arterial roads, where passenger cars and school buses are getting stuck in the middle of the road, and farm tractors that go out to pull them out are getting stuck in the middle of the road as well.

What steps has the minister taken to ensure that roads are made passable in the short term and to restore integrity to our rural road system in the long run?

Hon. L. Boone: Finally, somebody shows some interest in our highways in this Legislature -- the first question this year.

I'm really pleased to answer this. In fact, I was in discussion with your colleague -- your other member in the House, the member for Peace River North -- just this morning, advising him that I'm very concerned about your roads. I have

[ Page 3341 ]

asked my assistant deputy minister to go to the Peace, and he is making arrangements. We are reallocating some resources from other areas within the province into your area, because we recognize that it has been neglected -- not just by this government but by your previous government, hon. member.

J. Weisgerber: I guess that's what happens when you miss a caucus meeting. [Laughter.]

Supplemental, Mr. Speaker. Roads are essential to allow people to get to work and to school, and to access health care. A 92-year-old invalid lady was told recently to get a four-wheel drive to take her to a doctor's appointment. Farmers, forestry contractors and the petroleum industry depend on roads to support the economic activity that sends hundreds of millions of dollars a year to Victoria.

Will the minister agree today to commit the necessary funds to repair these roads, or are we going to allow them to continue to disintegrate until only complete reconstruction is the answer?

Hon. L. Boone: It gives me an opportunity to again say that I'm very pleased that today we have made arrangements for the assistant deputy minister to go into the Peace area. He's going to be meeting with the mayors; he's going to be meeting with our staff up there. We are in fact reallocating dollars from elsewhere in the province into the Peace, because we recognize the condition of those roads. Hon. member, I think that this should be a message to those in the Vancouver area that say that $70 million is not enough to put into the Lions Gate Bridge. The Peace would absolutely die to have $70 million invested in their communities.

SERVICES FOR TROUBLED YOUTH

B. Penner: A question for the Minister for Children and Families. The child advocate has voiced her concerns about the services to youth aged 15 to 19. For example, she states that the voices of young people have not been taken into consideration sufficiently when government is making decisions that affect them. Can the Minister for Children and Families tell the House what specific action she is going to take to address these concerns of the child advocate?

Hon. P. Priddy: As I acknowledged a few minutes ago, there is a lot more work to be done about what we can do to make youth voices heard. To begin with, as I mentioned, there is mandatory involvement on all the advisory committees that direct the work of the regional operating officers in the 20 regions in our province. When we are establishing task forces that affect youths' lives, we have youth, particularly youth in care, involved in that, and their view is critical to us. We are developing a children's lens, so that when we look at policy and legislation it is looked at through the eyes of a child.

We are working at developing a youth participation model to see where else we can have youth voices influencing the work that we do. Yes, there is more work to be done. There has been a start made. We will take any suggestions from the opposition or from the children's advocate about how we can do that specifically.

B. Penner: A supplemental, Mr. Speaker. The minister mentioned a few issues that the government is working on. However, the advocate highlights concerns for older teenagers and street kids, who all too frequently fall through the cracks and are forgotten by the ministry. The advocate specifically says that the government has not taken a leadership role in helping communities develop and sustain programs aimed at troubled youth.

Will the minister tell us what specific resources she needs to provide these services? What specifically does the minister need to live up to the mandate of her ministry?

Hon. P. Priddy: In terms of youth 16 to 19, which I think is what the advocate is referring to in her report -- again, which was done 99 days into the ministry -- youths from 16 to 19 get their income assistance money -- and have historically -- from the Ministry of Human Resources, and there has been no way to coordinate support services and programs to those youth. With the proclamation of

section 9, which influences youth 16 to 19 -- which we have agreed to do -- we will have the funding resources for them. We will also develop a plan of action with them that looks at providing those additional supports of school . . . maybe it's child care, maybe it's respite -- whatever it is. There are currently 1,900 youth in this province receiving assistance from the Ministry of Human Resources, and that will come over to us. Of those, 80 percent are 18- and 19-year-olds, and the rest are 16- and 17-year-olds; one-third are single parents.

The Speaker: The bell ends question period.

Tabling Documents

Hon. C. McGregor tabled annual reports of the Ministry of Environment, Lands and Parks for the fiscal years 1993-94, 1994-95 and 1995-96.

Orders of the Day

Hon. J. MacPhail: In Committee A, I call Committee of Supply. For the benefit of the members, we'll be debating the estimates of the Ministry of Aboriginal Affairs. In this House, I call Committee of Supply, and for the information of the members, we'll be debating the estimates of the Ministry of Health.

The House in Committee of Supply B; G. Brewin in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 40: minister's office, $462,000 (continued).

S. Hawkins: We're still on the subject of regionalization. I just want to go back to the regionalization assessment team's terms of reference. There are four that they were asked to keep in mind when they were reviewing New Directions and regionalization in the province, and I just want to read them.

The first one, as listed in order, is "optimizing the value of public dollars spent on direct service delivery," the second is "maintaining provincial standards of quality and access to health care," the third is "achieving administrative and clinical efficiencies," and the fourth is "reducing bureaucracy, waste and duplication." They were asked to undertake consultations and seek written input as necessary with respect to those four objectives.

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[2:30]

I'm wondering if the ministry . . . . First of all, does the minister treat each of those equally, or will she prioritize them in any certain order? Were they asked to look at those in any certain order, or were they looked at equally?

Hon. J. MacPhail: In terms of what my priority is for regionalization of health care, patient care is first and foremost -- delivering better patient care.

S. Hawkins: I'm actually referring to the terms of reference that the recommendations for the Better Teamwork, Better Care model came out of. These were the four objectives that the RAT team -- I hate to use that acronym, but that's sort of what stuck -- used to make the changes to ensure that their new model would work. Those were the four objectives.

If there wasn't any one that took priority over the other, I'm wondering what the ministry has done or put in place to demonstrate that each of these objectives have been met.

Hon. J. MacPhail: I think the Better Teamwork, Better Care announcement has encompassed our view of taking into account the recommendations of the regional assessment team's report. I'd be happy to answer specifics on . . . . I have gone over the objectives of how the system can deliver better patient care, administrative cost savings, accountability. I would be happy to answer specific questions on what I've already reported.

S. Hawkins: The system was redesigned. There were four objectives -- they were specific in the terms of reference -- that this team used to set up this new model. That's what they were supposed to use to make sure the new system actually had something that it followed, and it was apparently these four objectives. Those were the objectives that the consultations were supposed to be derived from.

My question, then, to the minister, is: if you're not using these objectives, is there another set of objectives now in place that you're using to evaluate how the system is going to work?

Hon. J. MacPhail: The terms of reference were for the regional assessment team. If the question is, am I satisfied that the regional assessment team addressed all of the terms of reference? the answer is yes. Do the recommendations address all of the terms of reference? Yes. Did we act on all of the recommendations? The way we announced Better Teamwork, Better Care took into account all of the recommendations made by the regional assessment team.

S. Hawkins: What objective measurements are now being used, then, to measure and evaluate the boards and regionalization as it stands now?

Hon. J. MacPhail: Hon. Chair, I addressed that yesterday. If there's further clarification needed, maybe the member could be more specific. I did address it yesterday.

S. Hawkins: Okay, what ongoing assessment tools, then, are being used to demonstrate that optimum value is being spent on services provided by these boards and councils?

Hon. J. MacPhail: I honestly do not mean to be cheeky about this, because I don't want to use the reference "if the member could read the Blues ," but the accountability framework for health authorities was discussed at length yesterday. I outlined specifically how that accountability was going to take place, including the measurements, how we were going to determine the measurements and what follow-up there would be for that accountability. So I'm a little bit at a loss as to what more I could add to the discussion -- unless the hon. member wasn't present for that.

S. Hawkins: Hon. Chair, we're told that there's going to be a streamlined bureaucracy, that there's going to be more money put to direct service and that these are actually going to be measured -- there are going to be measurable outcomes. Are there assessment tools developed? If there are not, then there are not. And if there are not, are they being developed? How is the ministry going to evaluate if the regional health boards are actually going to do the goals that have been set for them to do?

Hon. J. MacPhail: This is what I read into the record yesterday, hon. Chair, and this is why I'm referring the member to the Blues from yesterday. Benchmarks for performance in specific areas will be established by the Ministry of Health in conjunction with the industries. These benchmarks will be made public, and the performance of providers relative to those benchmarks will be documented.

Among the specific areas where benchmarks will be established are: waiting times for selected procedures; quality-care indicators such as readmissions, infection rates, postoperative mortality -- stop me if this is sounding familiar -- length of stay for selected admissions; availability of appropriate services, such as preadmission clinics, postoperative community care, appropriate community day care services; and patient satisfaction. I will publish an annual report on the regional authority's performance. Is any of that sounding familiar?

S. Hawkins: I would say that that does sound familiar in generalities, I guess, and we're looking for specifics.

You're talking about benchmarks. Well, what tools are being used to measure those benchmarks? Do you have anything in place, or are they just being developed?

Hon. J. MacPhail: My frivolity has nothing to do with our debate. My apologies for that.

The benchmarks will be decided by the . . . . Well, first of all, benchmarks exist now in the industry. Some have been used in this province, and others have not. But we will make the benchmarks public, and the industry is working with us on those benchmarks right now -- the specific tools that are being developed for them right now.

The areas that we have put forward for the industry to consider are budgets and expenditure plans, payments for physicians and other practitioners, beds and program seat slots. Those are the input measures. Input measures have been extensively reported in our annual report and also in the Public Accounts for many years. Those tools are already within the industry.

What is done with the inputs is an important aspect of accountability, but it also . . . . What has to be an output is the accomplishment after these inputs have been measured.

S. Hawkins: I'll get on to the Better Teamwork, Better Care model, then, because there were areas of priority that were listed in that document. There were eight priorities, and the first one was "ensuring access to the service you need

[ Page 3343 ]

when you need it." We know that in cancer care in British Columbia today, the B.C. Cancer Agency goal is that the time from referral to first assessment will be no longer than four weeks, and that the time from the first assessment to treatment of a cancer patient will be no longer than eight weeks.

I want to know what measures have been put into place to ensure that these kinds of guidelines will be met, in terms of performance standards by regional boards. What are they doing to address those kinds of guidelines?

Hon. J. MacPhail: Without commenting on the specifics of the numbers put forward by the hon. member, those are exactly the kinds of matters that will be addressed in the quarterly reports for waiting times and health outcomes as a result of our waiting times.

S. Hawkins: The next area of priority was "providing the best possible quality of care." I'm wondering again what the ministry has put into place for these regional health boards. Or are they just developing their own standard of quality? What is the ministry using to accept or demonstrate that this objective is met by the boards and councils?

Hon. J. MacPhail: Those are the accountability measures that I read about three or four minutes ago. The determination for the way in which those are assessed, in terms of performance outcomes, will be on best practice -- and then published in the annual report.

S. Hawkins: We will be looking forward to that report and to reviewing the accountability framework and whether the boards and councils are meeting quality objectives as outlined by the ministry.

The third objective was "keeping hospital lengths of stay as long as needed, but as short as possible." In this context, the measure which is used in hospitals to determine workloads and budgeting is the concept of patient-days per thousand population per year. This measure, as I'm sure the minister knows, has been steadily declining since the report of the Seaton royal commission. So I'm wondering: what target is being used as the optimal number of patient-days per thousand in the province today?

[2:45]

Hon. J. MacPhail: A few years ago we actually exceeded the Seaton commission patient-day-per-thousand benchmark. Now our goal and our own benchmark is to assess that appropriate care is given in the appropriate institution. That is part of the accountability measures that will be put in place.

S. Hawkins: Does that mean each region will differ in patient-days per thousand population?

Hon. J. MacPhail: Just as the Seaton commission averaged the patient-days per thousand because of the recognition that different care levels are given in different hospitals and with different population bases, I would imagine that the measurement would differ from region to region, just as it now differs from institution to institution.

S. Hawkins: How will we determine that those targets are appropriate? How will the ministry determine that?

Hon. J. MacPhail: I've already listed the input measures and the output measures, which are the service measures. The appropriateness measures will consist of a comparison of appropriate care, compared to the guidelines and protocols. In some larger organizations, they will go beyond even guidelines and protocols and into care maps. The quality measures will be the performance on those as against established standards which are now measured through accreditation procedures and can be built upon but are in place now.

S. Hawkins: Does the ministry foresee that these targets will be reflected on an optimal level of care or an adequate level of care?

Hon. J. MacPhail: Optimal.

S. Hawkins: Will the regions be financially penalized if they fail to reach targets for length of stay in patient-days per thousand that are set for them?

Hon. J. MacPhail: Actually, I don't believe the language is intentionally being adversarial, because I know the opposition's concern for patient care. We're taking a positive approach to this: that never will there be funding penalties that affect patient care, ever; that there will be a reward for meeting targets in the form of funding levels. But if we ever reach the state where even after much assistance measures are not met, then the penalties would be on administration and not patient services.

S. Hawkins: The fourth priority was "keeping wait-lists as short as possible"; that was in the Better Care model. Does that mean the regions will have the budgetary certainty to treat patients who are wait-listed within the recommended time periods that are acceptable clinically as adequate but not optimal?

Hon. J. MacPhail: If the question was, will the funding meet the optimal standard? the answer is yes.

S. Hawkins: I'm sure the minister understands that the adequate wait-period for heart surgery is 12 weeks, and for cancer treatment it is eight weeks. As it stands now, those aren't being met. Those are adequate. If you're saying optimal, then do I understand the minister to say that she's going to be giving more money to the regions to meet their optimal wait-list needs?

Hon. J. MacPhail: We're taking time with this answer because we want to be careful. This is of as great concern to us as it is to the members opposite. I know how sometimes these things get used outside this forum.

The funding levels that we're providing are, just as we said, in better teamwork care so that patients receive the services when they need them and have access to those services where they need them. We will be providing the funding for that. To distinguish between adequate and optimal is a health outcome that's only determined by the physician.

I am not a health care professional, and I admit this on record. If somehow there is an industry standard to say that every single heart patient needs their heart surgery by 12 weeks, this is not something I have ever been told by a physician -- any physician. If you're asking whether we're working with the physicians, the medical community, to make sure that the funding is in place to deliver the care when people need it, then yes, that's exactly what we're doing. Are changes taking place in the way that care is delivered amongst

[ Page 3344 ]

surgeons in this province? Yes, as recently as last month different protocols were being established to make sure that things which interfere with waiting times of patients are eliminated as well. But the funding will be there; the funding will not be an issue for delivering the care when people need it.

Hon. C. McGregor: I seek leave to make an introduction.

Leave granted.

Hon. C. McGregor: It's my very great pleasure to introduce the first class visit that I've had, actually, from a school in Kamloops. It's Aberdeen Elementary School. A longtime friend, John Dittrich, is their teacher. These are grade 6 students, and they think the Legislature is pretty cool. They think it would be even cooler if they had their names written in Hansard , so I am going to read their names aloud at this time to introduce them all: Grant Taillieu, Casey Wiffen, Gordie Henderson, Kyle Lawhead, Joselyn Franklin, Justin Gill, James Walsh, Zach Loxterkamp, Matt Fredrikson and Lindsay Stobbe. Would the House please make them all welcome.

S. Hawkins: We will probably be discussing the wait-list issue later. I was just clarifying whether the regions would have the budgetary certainty to deal with wait-lists within the recommended periods of time, as they fall within the regions.

I'll just continue with the priorities for Better Teamwork, Better Care. The fifth priority was "encouraging and providing innovative new services." I'm wondering if these will be accompanied by new funding.

Hon. J. MacPhail: We have already given a lift to funding, in every area of health care this year, the responsibilities that are being transferred to regional health boards and community health councils. I hope that they use this lift in funding in innovative ways. But they also have the flexibility to innovate amongst their current services -- and some regional health boards are already doing that -- knowing that if their innovation results in cost savings, they will get to keep that money and use it in patient services again. So there are two areas: increased funding as well as the guarantee that they get to keep whatever savings result from innovation.

S. Hawkins: I appreciate that answer. The new therapies or the new innovative services: how will it be determined that they demonstrate any kind of superiority? What kind of guidelines are going to be used to decide yes, that's a good, new innovative service or therapy, before the ministry gives another funding lift to them?

Hon. J. MacPhail: There are three parts to the answer: one is that innovation will have to be science-based, evidence-based; secondly, any innovation put forward will have to be subject to the same accountability measures as current services; and then thirdly, the innovation . . . . Actually, I would welcome the innovation from the community, because we know now that the Ministry of Health, while doing a very good job of trying to meet the needs of all of the community in terms of the appropriate services, are not all-knowing. So it will be good for the community to come forward with ideas -- based on those criteria, though -- and then we can work in partnership to determine funding.

S. Hawkins: The sixth priority was "ensuring patient satisfaction." I'm wondering what tool is in place right now that does that.

Hon. J. MacPhail: The accreditation process for institutions now requires a form of patient satisfaction. The larger organizations have developed sophisticated surveying for patient satisfaction. It will be on that that we will build to use across the system.

S. Hawkins: So just for clarification, there is no universal tool in place right now. Is that correct?

Hon. J. MacPhail: There's no universal mandate. Previously there wasn't, and there's no single tool. In fact, I would suspect that there may not be a single tool in the future but there will be a single mandate.

S. Hawkins: I would just bring up an issue here. The minister mentioned that institutions that are accredited . . . . That is included in the accreditation process. Is the accreditation process something that the ministry will encourage in institutions that fall within regions?

Hon. J. MacPhail: Yes.

S. Hawkins: Accreditation costs money, and there are cash-strapped institutions out there. In fact, I heard from one; I believe it was G.R. Baker in Quesnel. They didn't have the money to do their accreditation this year. Is that something the ministry is encouraging and will give a funding lift to do? This is an issue of whether facilities and institutions are meeting standards, and certainly the Canadian accreditation process has a good standard of quality -- it keeps people on their toes. I know that personally, having gone through the accreditation process as a nurse running a ward in a facility.

Is the minister aware of that situation, and is that something that the regions can expect to get funding for so that patient standards are met?

[3:00]

Hon. J. MacPhail: Yes. I want to make sure that accreditation is a process that is recognized in the global funding. The way hospitals choose to participate in accreditation -- whether it be annual or every two or three years -- is a determination of their own. The global funding does take into account an accreditation process.

Just very briefly on the G.R. Baker Memorial Hospital funding, I did meet with representatives from the community two weeks ago, and I had good input from the member who represents Quesnel, as well. They have brought forward their issues, and the ministry continues to work very carefully with them, as it has in previous years. I have committed to getting back to the delegation by the end of this month. They weren't necessarily asking for a solution, but they're just making sure that I was on to it by the end of this month. We're working very closely with them on their concerns.

S. Hawkins: I totally understand that hospitals spend the money the way they choose. This hospital chose to spend it on patient care, because that's where they felt the greatest need was. I think the minister is quite aware that this hospital has been running on 44 beds and, as I mentioned yesterday, patients are being cared for in the hallways. So if they don't have the money to spend on accreditation, I think it's because they have judiciously spent it on patient care.

I guess as a follow-up to what the minister was saying about accreditation, I would say that it is obviously something that the ministry appears to value. Is it going to be something

[ Page 3345 ]

that will be nice for institutions to have or something institutions must have in looking at the quality or the standard of care that they provide?

Hon. J. MacPhail: It will be strongly encouraged as we continue . . . . I don't want to belabour this, but the G.R. Baker Memorial Hospital has made significant progress in providing the appropriate level of acute care, and that's what I discussed with them. They've reorganized nursing and administrative staff, and they've strengthened their board policies. They're actually now rescheduling operating room times and making operational alterations to accommodate what they admit is very much a fluctuation in the workload or care demands because of the resource-based economy they have.

But even after all this, the hospital and our ministry agree that the utilization rates are still 20 percent above the provincial average. So that's the issue we're continuing to work on with the hospital.

S. Hawkins: I'm sure the delegation that came to visit the minister also visited our side, and I hope they get satisfaction from their discussions and meetings with the minister.

I'll just carry on, then. The seventh priority was "ensuring we make the changes needed that will keep our public health system." I'm just wondering if the minister can tell me exactly what that seventh priority means? If she can just clarify that for me.

Hon. J. MacPhail: Well, there's always a concern amongst health care providers that public health is key. Many would say that it is the key to the future of our health care system as well and that a shift needs to be made from acute care, which grew out of medicare. I'm choosing my words carefully here, because I very much value the acute care system and know that we have to sustain it. But the public health system takes as great a priority as does our acute care system.

S. Hawkins: I wasn't sure if that was the public health system or the publicly funded health care system, so that's why I asked the minister to clarify.

The last priority just says "affordable for the future." I'm wondering what the projections for the rate of increase for health care utilization or spending are in broad terms by the ministry. Does this ministry foresee an increase per year? Is that the assumption of growth for health care spending in the future?

Hon. J. MacPhail: It would be inappropriate for me to predict what next year's spending would be. It would be beyond my mandate or the mandate of these estimates. But we do know that the pressures on the health care system will change as a result of the aging population.

S. Hawkins: Are there any other priorities, other than the eight listed in the "Better Teamwork, Better Care" document, that have been recognized now that the boards have been set up and are up and going? This document was released back in November. Are there any other priorities the communities recognize that should go on this list?

Hon. J. MacPhail: The boards haven't formally agreed on adding any priorities, but we've certainly had very interesting discussions around community involvement -- making sure that the boards agree that their highest priority is patient care from a community perspective. It was a little bit surprising in that they also wanted to ensure that there was a strong ministry role in terms of provincial standards and that there would be equity across the province -- no matter where you live -- in terms of standards being set, etc. It was interesting feedback, because when the regional assessment team went out . . . .

If there was one villain, it was the ministry, and that villain had been recognized decades ago. Now that we've made the change, though, the regional health boards and the community health councils were very interested in confirming that there was a presence for a legislative mandate, and a policy and standards-setting mandate.

The other priority that arose out of the community health councils and regional health boards themselves was that they very much wanted to work together. Even though they had regional responsibilities, they wanted to join together regularly as a group in order to share in the designing of the system. I have committed to that and will be meeting regularly with them, as well.

K. Whittred: As the minister knows, I have partial responsibility for this ministry. Hopefully, I will be addressing the concerns of continuing care and seniors in a block at a later date. For the moment I would like to address some of the issues arising out of continuing care that I see as being paramount and that are particularly affected by regionalization.

The first thing I'd like to do, if the minister doesn't mind, is to return to the CHSSs and the role that they play. Do I understand correctly that these CHSSs are the employers, if we can use that word, for the people who do not have a regional health board -- that is, for the amalgamated CHCs?

Hon. J. MacPhail: Not in continuing care. In continuing care, the employer is this community health council.

K. Whittred: I am now going to just quote for a moment from a document from your ministry, the Ministry of Health, about the regionalization implementation. Where I'm going with this is: who has the responsibility for continuing-care planning? Like my colleague, I have been out around the province and I have spoken to a great many of these people. One of the principal issues that seems to have arisen is regarding the planning and strategy, if you like, for continuing-care services, particularly in areas that do not have regional health boards.

So my first question to the minister, then, is: who has responsibility for long-term continuing-care planning in areas such as the West Kootenays, where there is no regional health board?

Hon. J. MacPhail: Can I just offer this to the member? I'm going to talk about two aspects of long term care planning: the institutional planning and then also the service delivery in the community that's outside of the institutions -- unless it's just the institutional planning that the member wants me to address.

K. Whittred: Both.

Hon. J. MacPhail: Both, okay. The Kootenays is a good example to deal with this, because this is an area that's in transition from . . . . They had a regional health board that did look at a bed study for long term care, and now their community health council model.

Two things will occur. The institutional planning for continuing care will be at the community health council level. We

[ Page 3346 ]

had an interesting discussion this morning -- and I would just refer the member to the Blues on that -- about regional hospital . . . . Oh no, that's not for continuing care anyway, unless they're attached to a hospital. That will rest with the community health councils.

How long term care services that are outside of institutions, such as home support services, are shared will be under the auspices of the CHSSs, as they are now, under the community and public health division that used to report directly to the Ministry of Health. Those services are being devolved to the CHSSs.

I am aware of the problem in the Kootenays about "Where are the beds?" and "Are the beds being planned in the right areas to meet the community needs?" We recognize that in the transition to community health councils in the Kootenays, we need to get people back to the table to reassess that, and we're doing that quickly.

K. Whittred: In looking at the document that was sent out on regionalization implementation, it goes through -- and I certainly won't go through all of this -- the role of the ministry, the role of RHBs, CHCs, and so on. And then the rest of it is just . . . . The continuing-care part appears to be a mimeographed

section that's taken from the old documents and simply says: "Responsibility for continuing-care programs and field staff will be transferred to regional health boards as part of the New Directions initiative." And it goes on to say: "The transition services branch is engaged in the transition process . . . . " Now, that would lead me to believe that, at this point in time at least, there really is not a system in place. I wonder if the minister could comment on that.

[3:15]

Hon. J. MacPhail: We're trying to recognize the document, and we'd be happy to analyze . . . . We think it's an old document. If the member is saying, "What about the transfer of responsibilities where there is no regional health board?" all of the new planning accounts for CHSSs and the transfer of those services to the CHSSs. Maybe that's an old document. I would certainly be happy to get the member the current information on that.

K. Whittred: It's really not that old; in fact, it's really quite recent. But we'll leave that for the moment. I want to return to my original position about the situation in the Kootenays. It is not unique by any means; it also exists in the Cariboo and other areas that do not have regional health boards. I think I understand the process when it comes to the planning of facilities. What I do not, or cannot, get my head around is which of these levels of organization . . . . And I'm assuming that it's the CHSS, although I am told by the people in the field who live there that the CHSS has no planning component.

So the problem still remains that if each community health council is responsible for its own long term facility planning, what we end up with is no regional picture. We have no agency, no forum for any kind of regional planning. That is the essence of the problem.

Hon. J. MacPhail: Let me offer this to the member: my view of exactly why we put in place CHCs and not regional health boards in these non-urban communities. We heard over and over again, when the regional assessment team was out, that the community diversity is such that the local control of services such as acute care and continuing care should remain within the community, that there was no reason to justify planning between Castlegar or Trail, for instance, on these matters.

Please don't hold me to the communities, because I keep confessing I'm an urban person and I may use the wrong names of communities -- my apologies if I offend anyone. There was a distinctiveness to each community, and they themselves wanted the planning for long term care. That was exactly the reason why community health councils were established and have responsibility for long term care planning.

There has not been a regional approach to these communities in the past because of the very argument that each community deserves to be considered on its own. That argument was successfully put forward to the regional assessment team.

K. Whittred: If that is the case, then, can I go on to the next logical question? If in fact long-term care is a community matter in areas that have community health councils, and continuing care is a provincial registry . . . . So what we find, of course, is that -- to use the example that you gave -- people in Castlegar are being moved to New Denver or to Nakusp or to some other place for extended care because there is no bed in Castlegar. I am told by the local people that nobody at the local level has the authority to redesignate the beds. I'll leave it at that.

Hon. J. MacPhail: That is exactly what I was referring to earlier when we had to redo the bed allocation in light of the fact that there is no regional health board and that it is strictly the community health councils that are going to determine the needs of the community. Again, I just want to make it clear for the members that in all of these allocations of resources, there is a fiscal side to the allocation of the resources, as well.

K. Whittred: Do I understand the minister correctly that in areas such as the East and West Kootenays, the Cariboo and the Peace, areas that do not have regional health boards, the planning of long term care resources will remain with the ministry? Is that what the minister is saying?

Hon. J. MacPhail: The community health councils and, where appropriate, regional hospital districts will work in concert with the Ministry of Health to make sure that . . . . We had a good discussion yesterday on how we allocate resources. We'll work as a tripartite group to determine the allocation of resources. But the entity for the community will be the community health council, in determining the allocation of resources.

K. Whittred: I don't want to dwell on this forever, but I do have a really serious concern about this. Perhaps it has to do in this instance with the definition of community. A community, if we use the East Kootenays as an example, might mean Creston, if that is where you live. However, in terms of one's health needs, the community becomes larger, because if one wants any kind of specialized care, you have to go to Trail. So I will make the comment that to me, this doesn't make sense. I'm hoping that this is something that the minister will take note of.

I think it is essential that in geographic areas, regardless of whether there are regional health boards in place, there has to be some sort of mechanism for the communities that are close geographically to get together and make some sort of sense out of the allocations of things like intermediate care beds, extended-care beds and so on.

I will leave that topic now. I want to move on to a more specific one, and that is, of course, my own North

Shore

[ Page 3347 ]

health board. I am reading from a September 1996 regional newsletter that is put out by the health board. It states "the board highlighted the successful amalgamation with Lions Gate Hospital, North Shore Home Support Services . . . " and so on. That was in September. Since then, we have seen the firing of the second hospital administrator, I think, in about a year. We have seen a community petition for the head of the regional health board. This saddens me somewhat, because the North Shore health board was one which was a bit of a flagship for the province.

It had been humming right along; it was the model that was held up. I am worried that this is a little bit of a stormy time for the whole process of regionalization.

I'd like to mention that I have no quarrel with the general reform of the regional process, nor the general concept of moving closer to home. Both of those things, I think, are international movements in almost every country. I think where my quarrel is with this government is with the implementation of this process. So I would like to address that just for a moment by looking a little bit at what went on in North Vancouver, because I have been involved in that process very intimately.

Beginning last fall, at some point the North Shore health board embarked on a number of focus groups. This appeared to be the right thing to do. It seemed that the North Shore health region was doing what was required. It was consulting with the community; it was drawing people together. They were getting large numbers of people out to these particular groups, and it seemed as though things were going along very smoothly.

The first meeting I went to, we were presented with a model. It was said that this is what the future model might look like. A few weeks later, we got exactly the same picture, saying: "This is the model." I think my point here about implementation is that there was a sort of preconceived idea of what was supposed to emerge at the end of it.

More recently, we have been delivered of a model. Again, this is part of the whole regionalization process; it's supposed to cut down on bureaucracy. This particular model has 60 different boxes on it, and it looks like it would rival the D-Day invasion plans. I read from the instructions things like:

"The triple boxes represent members of the regional executive group, and shaded boxes represent members of the larger regional senior management team."

It goes on to say:

"Dotted lines indicate where relationships exist . . . . The role of the community health planning coordinator has been deleted with the appointment of the incumbent . . . to the position of regional community health director. Four positions of community developer have been created."

My point in going over this is to try to illustrate that where regionalization is supposed to make less bureaucracy, it seems like what we're getting is more bureaucracy. Out of this whole thing, I do not see an elimination of jobs. What we've had in our own community is the firing of one extremely popular health administrator, but I can count, just from this sheet, six new positions that have been created.

With that little

summary as a background, I wonder if the minister could comment on how this process is reducing bureaucracy.

Hon. J. MacPhail: I think your point is well taken. I also appreciate that there is intellectual support from the hon. member for regionalization. Without commenting on the specifics of the good illustration that the hon. member makes, let me assure you that some regions are doing very well at putting their management plan in place and others are not. We are working with both very carefully to share the good and work toward eliminating the not so good, and service contracts will be signed and put in place on a regional basis when the good is achieved.

[3:30]

[E. Walsh in the chair.]

K. Whittred: I would like to take a few moments to look at what is coming out of the new regionalization process. I'm not sure whether this is actually part of regionalization, but I think it probably fits into this section. I was going to suggest to the minister that I think the ministry has taken on a huge task. At the present time the ministry is not only reforming the governance of health through regional boards, it is reforming the delivery of service by moving into the area of community health centres at the same time as it is amalgamating with the new Ministry for Children and Families. It is this massive integration that I want to speak about for a moment.

We have recently read in the press about the community health centres in Vancouver -- these are also underway in North Vancouver. These are to be massive integrations, not only of health services but of a number of services from Children and Families. Nothing I have been able to read convinces me of what these are going to look like. Could the minister give me her impression of what one of these community health centres is actually going to look like?

Hon. J. MacPhail: Right now I can only offer my opinion as a mom, which I would assume is not nearly as valuable as Minister of Health. As a mom, I know exactly what people want, which is to be able to have access to health care that meets their family needs in the way that best makes them healthy. Literally every time I go and talk to people, whether it be nurses, health care providers or health administrators, that's the intent.

What will that look like? At this stage, there is no concrete plan in place that has been signed off by the ministry or that in any way has had a cost-benefit analysis from patient or consumer care done on it. That is exactly what the regional health boards are working on right now. Frankly, I think that the editorial in the Vancouver Sun yesterday was right on: that the idea is wonderful, but as we move toward the model of community health centres, we have to make sure that we're doing it in a way that best meets patient care from a cost-effectiveness point of view as well.

The complaints that have been made to me by British Columbians in terms of the health care delivery system would suggest that maybe a good, working community health centre is the right answer. One is: is there a necessity for us to have to visit several different offices dispersed across the community to get our health care? Or could you have those services located in one place? Is there any way you could offer me my health care services at a time when I'm actually available to take my kid or my mom or dad to be treated, in terms of hours of operation?

Physicians say to me: "Is it appropriate that people use the emergency rooms as the equivalent of a community health centre? Isn't there a better way that we could offer those services to people who don't have a stable relationship with a family physician?" Those are some of the questions that I think are appropriately answered by working on a design of a community health centre.

[ Page 3348 ]

To address the point about "the times have changed" that we are going through, the member is absolutely right. There are times of change, and I know that change, on its own, brings about anxiety. Whether that change be good or bad, change brings about anxiety. We're well aware of that, and we're doing everything to mitigate the anxiety but at the same time move forward on much-needed change.

I work very closely with the Minister for Children and Families, as we both move forward on reform, to make sure that we do so in a way that best meets the needs of our children. It's gratifying to know that the debate on both sides of the House recognizes that many of the needs of a child are health care needs, even though we may describe them in some other fashion.

K. Whittred: Continuing along the same vein, one of the things you mentioned was that it's often said about the delivery of health care: "Why should we go to several different spots?" I think all of us on both sides of the House would agree with that. My question to the minister is: under our system, what is to prevent people from doing both? Is there a danger that the community health centres will become an add-on rather than the main source of delivery?

Hon. J. MacPhail: That's an interesting point and, in terms of community health centres, I appreciate the member's comments. I have heard that concern expressed in other areas of health care delivery, but I do take her point.

We monitor utilization in terms of different methods of delivery of health care. We monitor utilization both statistically and demographically, but -- not identifying any patient -- we also monitor in terms of Medical Services Plan billing, for instance. If your point is that that should be an indicator of success or that proper utilization of our health care services be a requisite for a community health centre, I would absolutely agree.

K. Whittred: Continuing on the same theme, I would like to have a little bit of a dialogue with the minister, perhaps sharing some of the concerns that I have picked up about the regional health centres. One of them is basically focused on the theme: are we trying to do too much? Are we trying to deliver too many services in one place?

I will try to give some specific examples: the services to youth who are being treated for drugs and alcohol in the same place as youth who are going in to get their inoculations; youth perhaps being treated for forensic psychiatric problems along with programs for the frail elderly. What I have heard from a great many people in the field is a caution about whether or not people will use these services. I hear this particularly in the case of seniors. Will frail seniors actually go into the same location as youth who are being treated for drug and alcohol problems?

Hon. J. MacPhail: I do want to caution that drug and alcohol programs have been transferred to the Ministry for Children and Families. So with that caveat, I will certainly let the Minister for Children and Families know to expect your question in this area as well.

Let me reassure the member, from the area for which I have responsibility, that the public health system will still deliver for the frail and elderly in the most absolutely appropriate fashion for their needs, regardless of the transfer of alcohol and drug programs to the Ministry for Children and Families.

K. Whittred: I brought that up as an example. I'm well aware that Alcohol and Drugs has been transferred to the Ministry for Families. I'm also very much aware that these programs are going to be part of the community health centres. The community health centres are going to be a physical location, such as this House, which is going to be shared for both the programs of the community health centre and the programs of the Children and Families ministry. So that is where that particular question came from.

Now, to go on a little bit, in terms of the amount of things -- if I can use that expression -- that the ministry is trying to reform at this time, one of the questions which always comes to my mind is: why has the ministry been so reluctant to first pilot the concept of regionalization and/or the idea of community health centres in one place to get some of the bugs worked out before moving on to the whole province?

Hon. J. MacPhail: I was well aware that that was the opposition's point of view, both during the last election and as we had the regional assessment team tour the province. This matter has been discussed in our own province since 1990, with the Justice Seaton commission. We have had experience ourselves, actually taking the bull by the horns in 1993 with New Directions, and we have learned from that. And we have the experience of, frankly, what is an industrialized-world trend in this area, including other parts of Canada. People said to us, "Get on with it; get this issue put in place," and we chose to listen to those people.

If I could, just on the issue of community health centres, I hope that the hon. member understands that nothing has been signed off in terms of a community health centre in any region of the province to date, save for the nursing centre in the Comox Valley. I certainly believe quite clearly that we should proceed cautiously and make sure that all of the accountability measures and the performance outcome measures are in place as we move toward community health centres.

I do know, though, that I had a . . . . It was just an interesting perspective. I only note it; I don't comment on whether I agree or not. In a meeting with the Registered Nurses Association of B.C. a couple of weeks ago, there was a delegate there from Quebec. He had just moved from Quebec and was very surprised at the differences in our health care delivery system because of Quebec's emphasis on community health centres, and he noted the absence of any here in British Columbia.

K. Whittred: In fact, that was going to be my next question. The minister anticipated me. What specific models or programs can be offered as part of the research that the ministry did in preparing for this particular model of service delivery?

Hon. J. MacPhail: For clarification, is the member referring to the model of community health centres?

Interjection.

Hon. J. MacPhail: Oh, okay.

The Vancouver regional health board and the North Shore health board are the boards now proposing community health centres. I just want to make the member aware that the ministry is well aware and monitoring the situation closely and participating where needed in the development of the models. But there are models of community health centres that exist in other parts of the industrialized world, which I

[ Page 3349 ]

expect the Vancouver regional health board will be looking at. One is in Quebec. There are models in Ontario, as well. There are models in Saskatchewan. Without ever giving any credit to these models, there are models that exist in the United States, as well, and in France.

[3:45]

K. Whittred: Do any of these models show that there is, in fact, a cost saving? Now, I know that money is not always the bottom line, and I know that there are certain bits of conventional wisdom that go into this. But I have also tried to acquaint myself with the background of this, and so I'm asking: where is the research that shows that this is more effective in either delivery or in cost?

Hon. J. MacPhail: If you're asking me if I have those studies at hand, I don't have them available. I can certainly make that research available to you, in terms of the research about the effectiveness of community health centres. Our indicators of effectiveness will be based on the best health outcomes in the most cost-effective way.

K. Whittred: I look forward to getting those studies.

I will leave this now with just the comment that I know that our respective sides of the House have disagreed about implementation, with our side, of course, favouring a more cautious approach. I guess I would just conclude that if perhaps a more cautious approach had been used, we would have had a smoother delivery, and in the case of my own region, where we've spent almost a million dollars on severance and had great amounts of upset to the community, perhaps that might have been avoided.

I would like to move on now to another area that I think regionalization applies to in terms of the continuing-care system. This is the area, in many, many long-term care facilities . . . . What we have is that 20 or 30 years ago, for the most part, all kinds of organizations -- namely, the Kiwanis, the Moose, the Elks, the Lions and all those good people -- built care facilities. Since that time, of course, they have played a very, very active role in the delivery of services, both in housing and in long term care. What we're seeing now is the amalgamation of those facilities, including the assets, into the regional health boards.

My questions on this issue have two parts to them. I know how the present system is administered. If we take just North Vancouver as an example -- and this could be multiplied all over the province -- we have one, two, three, four, five Kiwanian facilities that I'm aware of. These are being amalgamated. At the present time, these facilities are administered by one person -- a caretaker -- a secretary and a great deal of volunteer labour. My question is: how is the regional health board going to provide that same level of administration that has been given for some 20 or 30 years for free?

Hon. J. MacPhail: I'm sorry for the member's misunderstanding. The organizations such as the member has described will not be amalgamated. There will be service contracts developed with the regional health boards to carry on that expertise just as she outlined.

K. Whittred: Could I just make sure that I understand correctly? Perhaps I have been mistaken. When we speak of amalgamation of facilities, are we only speaking of the administration of that?

Hon. J. MacPhail: Amalgamation means the transfer of assets to the regional health board. The assets that will be transferred are hospital assets and continuing-care institutional assets, where the continuing-care and hospitals are not run by a denomination or a service club. We have made that agreement with both those entities.

K. Whittred: I'm going to continue to pursue this, because I think I understand correctly that in North Vancouver and in other areas, two intermediate care facilities have been amalgamated into the North Shore region. Now, does amalgamation include the transfer of assets and the responsibility for the administration, or not?

Hon. J. MacPhail: I'd be more than happy to investigate a particular situation, either in this chamber or afterwards, if the member would like to bring the specific details to me.

K. Whittred: Yes, I would be happy to discuss this with the minister, but it does point out . . . . This is something I have been approached about from all over the province, and therefore it cannot be just a local issue. This issue of the transfer of assets has been through service clubs, through home care societies, through all sorts of people who are concerned about how this is working. If I've had that many inquiries about it, it concerns me that the minister does not seem to be aware of it.

Hon. J. MacPhail: I appreciate the member's comments. As I said earlier, I certainly understand that with change, even if it's positive, there's anxiety. I suspect that these concerns may be based on fear rather than fact, because as I've tried to make clear, voluntary service organizations will not be required to amalgamate, nor will denominational institutions -- formerly known as churches.

K. Whittred: I did not mean to imply that anybody I had spoken to was afraid. Nobody is afraid. In fact, as far as I know, the amalgamations that have occurred have occurred voluntarily.

My original question was, and remains: how can the regional health board provide the same level of administrative service as the service clubs did? The service clubs did it for free. That is something I do not understand. Could the minister clarify that for me?

Hon. J. MacPhail: It's good that staff are able to provide the expertise on this.

There have been service organizations that have voluntarily amalgamated. They are mainly outside the lower mainland. They have come forward and voluntarily asked to amalgamate. Nobody is being forced to; in fact, nobody is being asked to. But some organizations have said: "We want to amalgamate."

On the question around administrative costs: are there increased costs because of that amalgamation? No. Previously, if an organization provided administration, the ministry basically funded that to the service organization. That administration will now be done by the health authority of the area. So it's a zero-sum cost.

The volunteer aspect came through board members, just as there was a voluntary aspect to former hospital societies,

[ Page 3350 ]

etc. But none of the volunteer aspects of the societies precluded administration costs, which are now being done by the health authorities.

All of these amalgamations that have occurred to date have been strictly by the request of the service organization.

K. Whittred: Thank you for clarifying that.

Continuing along the line of the amount of service that has been given by volunteer organizations . . . . I'm going to limit myself here to the organizations that largely financed and contributed to the building of facilities. Has the ministry tried to do any research that puts a value . . . ? I'll use the Kiwanians as an example, because a number of years ago the Kiwanians made senior housing and care facilities their particular mandate. I'm wondering, in this move toward regionalization, whether or not the ministry took that into account. Have they attempted to put any kind of value on the amount of work and service that went into providing those particular facilities?

Hon. J. MacPhail: If you're asking whether the ministry has quantified that value in some sort of academic study, I would suspect the answer is no. But certainly we value, hour for hour, the contribution made by every single volunteer in the system. I've actually met with the service organizations. The provincial organization of auxilians has made representation to me. They expect that their contribution will continue -- in some situations in a different form. They may be concentrating less on actual administration and more on the direct service delivery of their volunteer hours.

Some have actually welcomed that change of duty. All I can offer is this: the work is seen as invaluable, and we hope it will continue. We'll give full recognition to that voluntary contribution.

[4:00]

K. Whittred: I will simply again share with the minister a concern that has been brought to me. On a great many fronts the whole contribution of volunteerism has been overlooked in this process, and there is the suggestion that without ownership in some instances, perhaps volunteers will not be quite so willing. I do not know if that is true or not. I simply raise that point.

The second thing I want to address is regarding the movement of what are considerable assets from non-profit societies and service organizations to the regional health boards. I wonder if the minister can clarify for me what is happening to those assets.

Hon. J. MacPhail: When a society voluntarily asks to amalgamate, it is to transfer their assets to the regional authority: the community health council or the regional health board. So where there was voluntary amalgamation, the assets went to the new authority.

K. Whittred: Then do I understand correctly that once assets have been amalgamated . . . ? Just let me get this absolutely clear in my mind. In the case of a Kiwanians intermediate care facility that's now been amalgamated, the regional health board now owns that property and can sell that property.

Hon. J. MacPhail: Because of the voluntary nature of this, they may have reached an agreement on amalgamation about the future disposal of assets, etc. I would prefer to deal in specific examples, if I may, just so I don't rock the boat unnecessarily by a hypothetical question.

[G. Brewin in the chair.]

The Chair: Hon. members, I wonder if I might interject here with a brief introduction.

In the gallery today are 40 and more grade 5 students, several parents and their teacher, Mr. Carr, from the Catlin Gabel School in Portland, Oregon. Would the chamber please make them welcome.

K. Whittred: The minister has asked for a specific example. The example I will use is the West Vancouver Kiwanis Lodge.

Hon. J. MacPhail: The Kiwanis Seniors Housing Society of West Vancouver operates the Kiwanis Lodge of West Vancouver. That's the example that you're referring to?

Interjection.

Hon. J. MacPhail: Okay. They want to shift their focus onto just seniors housing in the future, as opposed to continuing care. The plan is to combine the operational funding of Kiwanis Lodge with that of Kiwanis Lynn Manor, which is operated by the Kiwanis Care Homes, and have this funding transferred to the new Parkway multilevel care facility on the North Shore, scheduled to be completed in '97.

Interjections.

Hon. J. MacPhail: Is it in an opposition member's riding? Let me take that into account. [Laughter.]

The Seniors Housing Society is asking us to expedite the process of developing the Parkway multilevel facility, and I'd be happy to hear from the hon. members opposite about their points of view on that. They therefore want us to transfer the day-to-day management of the operations that are now providing the multi-level care, as opposed to just housing, to the North Shore health board. Then they want us to pay the monthly rent to the society for use of the Kiwanis Lodge prior to the completion of the Parkway facility, and then reimburse them $320,000 to upgrade the Kiwanis Lodge to provide seniors housing.

This is a complicated set of negotiations, where the Kiwanis are doing exactly their job -- what they're supposed to do, which is get the most bang for the buck in terms of delivering services to their community -- but in no way is this an . . . . Well, I shouldn't say it; maybe there are all sorts of interesting negotiations going on around this across the province. I think this is an example where the Kiwanis wants to turn over to the North Shore health board the health care services, and they deliver the housing services separate and apart from those that require health care services.

[ Page 3351 ]

So we're in discussions with them, along with the health board and the Kiwanis Seniors Housing Society, around how we best carry on with the development of the Parkway facility, and around amalgamation and the best facility utilization. The negotiations are complex -- and they're more complex by virtue of the fact that everybody's got a lawyer involved. No formal agreements have been signed yet, but I really think there's interest on all parts in moving forward on this rejigging of a business agreement.

K. Whittred: Again the minister anticipated what was going to be my next question, because I had been involved in some discussions around this. What have been the legal costs of this particular negotiation for both sides, if the minister has that information -- if not, from the ministry's perspective?

Hon. J. MacPhail: We can get that information for you.

K. Whittred: I will move now to another issue. I alluded earlier to the problem of planning for residential care for continuing-care facilities through the regionalization process, and I believe we addressed the idea of who is responsible for planning.

There are one or two other things that I want to address in that section, and that is, first of all, the status of the private institutions. I'm sure that the minister is aware that continuing care is basically a blending of many, many private functions -- society services and so on -- and I know that one of the concerns of the private care institutions is that they are ultimately going to be left out of the process. I'm wondering if the minister can comment on what role she sees for the private institutions.

Hon. J. MacPhail: I actually had a very good meeting with Pricare yesterday. They were having their annual general meeting on the 20th, actually; it was a great celebration. I gave them complete reassurance of their continued involvement in the system and referred to all of the areas, certainly in capital construction, where our interests would meet. I would be happy to provide the member opposite with my remarks in that area. But it was a good meeting of reassurance of our continued, and perhaps even expanding, relationship. Pricare is the association of private care operators.

K. Whittred: Moving now to another concern that I have, which I believe is an outgrowth of the regionalization process . . . . It has to do with contracts and people's places in the formula. I would like to offer the minister a sort of composite. This is another issue that has been brought to me many times and shared with me on many occasions. As the team-building occurs in the regions, people are brought in on these teams from a variety of sources.

Perhaps I can give you an example. In geriatric outreach, you might have a person assigned to a new position somewhere in the community care program who has previously been a hospital nurse; you might have another one that has worked for community services; you might have someone else who has worked for public health. Now, these people are all similarly qualified, and they are all doing similar or the same work, but they have previously all been on different contracts, some earning significantly more than others.

The scenario, as it has been painted to me, is that you now have this group of people who are all doing the same job but being paid significantly different amounts of money. Of course, my question is: has the ministry assessed this either upward or downward movement of personnel as this process takes place, and secondly, how much is it going to cost?

Hon. J. MacPhail: This is a complex area of negotiations that is going on right now, as a matter of fact. We hear about it in the public -- the changing role of health care providers from an institutional setting into the community setting. You may have read about the complexities of the negotiations and whether to strike or not to strike.

Let me just say that this issue consumes a great deal, if not the majority, of the time of the Health Employers Association of B.C. The matters are negotiable, though, in terms of transferring from one employer to another and what, if any, change there is in the wage rate. There are a series of estimates in terms of the cost or savings in this area. Ultimately, though, it's a matter of negotiation and therefore an agreement reached between the unions representing the workers and the Health Employers Association of British Columbia.

K. Whittred: Following along on the same topic, I'm wondering about any guidelines that the ministry may have put in place regarding this particular issue in the planning for the movement toward community care. I think, as a rule of thumb, that in the past hospital personnel probably would have been at a higher pay scale than community personnel, and if we have a movement in that direction, I'm wondering . . . . Well, I am simply giving the benefit of my experience; I have never in my life seen a downward scaling.

What I have seen is a grandfathering, on occasion, where people who have been on a higher scale are grandfathered in until the salary scale catches up. So I am wondering whether the ministry had any guidelines in that direction.

[4:15]

Hon. J. MacPhail: Again, the complexities of this matter consume a great deal of time and have also consumed, for instance, the Dorsey report that was done in '95 about how the employer-employee relationship should take place for a bargaining structure throughout the health care system as it goes through changes. There are methods by which one determines the value of the job when one is reassigned the job -- classification issues. There are ultimately ways of resolving classification issues. What is the real work that you do, and how do you classify that through to the arbitration procedure? That has taken place as well.

Ultimately, given all of the academic information about who the new employer is; what the job duties are; the new job duties, if any, as a result of the new employer and the new health care system; what the proper classification of those job duties is; how one determines the proper rate for those job duties . . . . Ultimately, these are all issues for the bargaining table and are in fact on the bargaining table as we speak.

K. Whittred: I just have one or two other points, as I go through my list of things, that I felt were issues that had grown out of the community care area that were particularly appropriate for the regionalization.

I alluded earlier to what I saw as the enormous task of consolidating the new community health clinics with the responsibilities of the Ministry of Health. What I'd like to ask the minister about now is an even broader sort of integration

[ Page 3352 ]

that always comes up when we talk about community health, and that is integration with school boards, family ministries and so on. What I see in the governance is an absence of this sort of integration. I would like the minister to address that particular issue.

Hon. J. MacPhail: Again, the reason for the new Ministry for Children and Families is to ensure the integration of services around issues that affect children and families. That integration is unprecedented, in terms of the setting up of a new ministry. In fact, services from the Ministry of Health that are particular to children have been transferred to the new ministry.

Our relationship with schools is an interesting one, and I know the member opposite has a wealth of experience in this area. I believe that our community health care system -- public health system -- works well within the context of our school system, but if there are areas of improvement there, I would be more than happy to gain from her experience.

Certainly the regional health boards and community health councils themselves see the new model as a much better way of ensuring coordination of services than the old model, where decisions on a community basis were made in Victoria instead of within the community.

K. Whittred: I thank the minister for those particular remarks. I won't pursue that particular aspect any further.

The final thing I want to mention is simply to follow up a little bit on the remarks that my colleague was making this morning about representation and balance. I know the minister did comment on that. I want to just give an example of that from the urban perspective. In North Vancouver -- and I don't think this is anybody's fault; I think it's just the way it worked out -- at least half of the representatives on the board are from West Van. This leaves the impression that although West Van has a third of the population, it has half of the representation.

Although there is supposed to be this community focus and so on, I think that sort of thing sometimes does get a little bit miscued. So I'll simply leave that, and I know the minister addressed it this morning.

D. Jarvis: I have to get up and say a few comments to the minister and ask a couple of brief questions, because I know there are lots of people here that want to ask her some questions. You were mentioning a little while ago about the Kiwanis getting the most bang for the buck. I think generally most people are happy with what's going on with the closing of the facilities in West Van and Lynn Valley and then going out into Seymour.

The two big problems I can see are that there are going to be less beds, less accommodation with the amalgamation -- and it's not a great number, but there's going to be less than there was -- and there's the aspect of where it's located, the transit end of it. It's just impossible for the seniors and for the workers to get there. Workers can't get there, they have to drive -- you know, the staff and all the rest of them.

So there are a few problems that have got to be ironed out, and I know this government intends to pump up our transit system in the North Shore to such an extent that we won't have to worry about it in the future.

Because we're talking about regionalization, what I really want to say is that we're not all against change, especially if it's going to benefit patient care. That would be sort of the results from the duplication and communication costs, etc. Sometimes I wonder if this government is not throwing out the baby with the bath water when they tend to meddle in functional areas that I think have been going on fairly well, and most people I talk to in my area seem to think that it's going well. Regionalization is threatening some of the more functional areas we've had, one being the Lions Gate Hospital -- from what all the people have to say about it.

I feel that maybe we should have had a model, and I think I've said that before, even in the media, that we should have had a model situation of regionalization before you plunked it down upon us. Look at -- I'm not sure what the word is -- what has been happening to, say, the Lions Gate Hospital because of this regionalization and through this government's trying to change the health care delivery system on the North Shore. At Lions Gate Hospital, we fired one president or CEO, and that has cost us God knows how much money -- $300,000 to $400,000.

We now have a second CEO that's been fired -- for $118,000 basic salary, plus there will be . . . . Now they're going to do a study to see how to run the Lions Gate Hospital, and that's going to cost $35,000. We see that the Lions Gate Hospital is now being run by three people, with two directors being paid $75,000 and one $90,000. That all adds up to about $600,000 to $1 million. How you can divide that into a salary of $118,000 and make it responsible, I find rather difficult.

But that's socialist financing, and we know how that works: seeing that we're so far in debt now and that we're going deeper and deeper and deeper.

Improvements are measured by performance, as has been said before. I think we have definite problems on the North Shore, and that's been demonstrated over and over again with the Lions Gate Hospital and other functions that are going on. Staff are in turmoil, there's no question. Wherever you go on the North Shore, the people that are delivering care are upset. They don't know where they're coming from, and they honestly feel that this government is doing a bad job, to tell you the truth. But we have an appointed board, which is appointed by this government in a sense, and they say things are all right. But they're looking after their own bailiwick, it seems.

So I want to just ask two brief questions with regards to the fact that we're going to regionalization and we're going to have east, central and west centres in the North Shore. That's what's being planned by the board. Do we see any future representation from the doctors in the Medical Association on the boards? And will we see any elections to health boards in the remaining years of the NDP government's life in this province?

Hon. J. MacPhail: I would actually refer the member to the excellent discussion we had this morning in his absence. I'm sure it had nothing to do with his absence, but it was an excellent discussion we had on this very issue of election. I would just refer the member to the Blues on that.

Actually, there is a spot on each health board and community health council for a physician. The B.C. Medical Association has had direct input into the recommendations on who that physician is. But in just the same way that no single employer organization got to choose or nominate a single person, the BCMA did make recommendations, many of which were followed by an appointment. I think virtually every health board and community health council now has a physician sitting on the board.

A. Sanders: I'd like to ask the minister some questions on regionalization, and I'd like to break them into two specific areas. The first I would probably call Vernon issues and the issues that I feel have arisen specifically from the model of

[ Page 3353 ]

regionalization. The second set of questions will be on what I have called broad principles and will look at those broad principles and see how we're functioning within those principles within regionalization.

I want to just read a little excerpt from a recent book that I found very interesting on health care. For the record:

"Canada's 9.8 million baby-boomers begin to turn 50 in 1997. Well before that important turning point in our demographic history, the rising cost of health care was already a major public policy issue. Every provincial government has been struggling to keep a lid on costs and to find ways to rationalize a system that has become the second-most expensive in the world, after that of the United States, as a percentage of gross domestic product. Yet if the cost of health care is a problem in the mid-1990s, demographics tell us that, as the saying goes, we ain't seen nothin' yet.

"By the second decade of the new century, when the baby-boomers are in their senior years, our health care system will be confronted with sharply increased demand. We need to find ways to satisfy that demand while keeping spending under control. Maintaining an excellent health care system is going to require a great deal of ingenuity and careful planning based on an understanding of demographic reality."

This is from

chapter 9 of a Canadian book called Boom, Bust and Echo , which is excellent. I recommend it for anyone who has an interest or an appetite for such subjects.

What I'm interested in here, from the minister, is what we're doing in regionalization at this point. Since 1991 the concept in British Columbia has been to take acute care and to downgrade the hospital circumstance just exactly at the time that the boomers are turning 50. Just as the boomers will be having their first myocardial infarction, just as they're admitted to the ICU for their very first time, we are in a decreasing-acute-services frame of mind. This is a group that isn't used to waiting in line: it is used to the best in services, and it is used to being served immediately. They aren't used to rationing. They aren't used to much of anything that has to do with them waiting.

[4:30]

One of the issues in terms of regionalization that we may run into problems with is the demographics of where we have done regionalization . . . . It is at precisely the same time that we now have a very large cohort of individuals who will not stand in line and who will not have services rationed. What I am interested in from the minister is this: has the minister incorporated the services and skills of demographers in looking at an overview of the B.C. health care system with respect to regionalization?

Hon. J. MacPhail: Population health statistics are always taken into account in the future planning of our health care system. As one of the group, though, that the member identifies . . . . I totally agree that the reference to the Boom, Bust and Echo book is appropriate in this discussion, and I can speak from personal experience. The need for the long-term care is about two and a half to three decades away, and that book itself specifies that. We are planning for that.

It's exactly the reason why, in the plans for developing into the twenty-first century, we know that there will be a shift in acute health care delivery and a shift to the continuing care health care delivery. That is exactly why there are plans where the shift is in terms of multi-level care within the continuing care structure.

I certainly don't understand at all the shift in terms of the provision of care over this decade. I don't understand the description by the hon. member in terms of the consumer of health care. The shift has been to make sure that we provide appropriate care in the best way possible. There has been no downgrading of care.

I think the best example of that is . . . . I visited the institution of Children's Hospital, where days-per-thousand bed utilization has decreased incredibly as more out-patient services or day-patient services are delivered. I know from personal experience that the way we deliver health care has changed radically over the course of the last decade in terms of the time necessary for hospital stays.

What we haven't done in our province is make use of that change of delivery to cut health care. We've made use of the change in the way we deliver health care to actually meet the needs of the changing population and fully fund the system as opposed to cut the system.

A. Sanders: In response to the minister's statements, there are a couple of points that I think are important. Number one, although there has been an increase in funding in health care, there have been some perceived cuts. These cuts are more in quality of care and have to do with waiting lists. We see, for example, individuals who have been brought to the attention of this House who have been waiting a considerable time for surgery. Specifically, we are not doing well in some areas.

The areas in which we are not doing as well as we could, and need to in the future, are: cardiovascular procedures, orthopedics, ophthalmology and cancer therapy. These are the areas where we are going to have to do a better job for all British Columbians, especially with the demographic bulge of the cohort -- that is, the boomers.

I would be interested in any information that the ministry uses in terms of its reference material -- what its deputy minister and assistant deputies are reading in their formulation of opinions. If the minister would be interested in offering me that, I would be most happy to take her up on that.

This week a constituent -- not a patient of mine, but a constituent -- wrote me a letter in Victoria asking me to help sort out a problem that has, I feel, resulted from regionalization. Specifically, she is an individual who is on dialysis for renal failure. She asked the dialysis services -- which, I believe, reported to St. Paul's originally -- if she could go to visit her family in Sechelt for several weeks in the summer. She asked considerably ahead of time, as she wanted to make sure that this was a possibility in terms of planning her holidays.

What she was told in response to that was that if she went to Sechelt, there would be a bed available for her to have dialysis Monday, Wednesday and Friday, and there were qualified people to do the dialysis. But she could not have the dialysis because the regional area of Sechelt is not willing to pay for what it would cost for her to have the dialysis. They say that she should have her dialysis in Vernon.

This is about a two-hour procedure; it occurs three times a week. And she is being told that she cannot go to Sechelt to visit her family.

To me this twice violates the Canada Health Act, and this is not the only example of this particular circumstance. I would like the minister's help in how I respond to this woman, my constituent.

[ Page 3354 ]

Hon. J. MacPhail: I'm just being advised that I should probably get the details of the specific case from you, because I don't want to give you the improper information based on the case. The program itself is a provincial program; it's a life-support system. The program is to operate on funding of the patient, and wherever the patient is, the patient will receive the service. The structure of the program would seem to be counterintuitive to what you're telling me; therefore we have a problem to resolve here. I can't comment on the specifics of the case, but we'd be more than happy to do that. I don't think we should do it across the floor of the House.

A. Sanders: It's important for the minister to realize that, first of all, I'm happy to solve this out of the House; but secondly, this is not an isolated problem. This is something that is brought forward quite often.

My view of any regionalization process is that the money should follow the patient, so if the patient is in any area in British Columbia, they would get the service. What I can tell the minister is that that's not happening. The money is staying with the area. This woman can have her dialysis as long as she's in Vernon. But that precludes her being somewhere else. That is a real problem, and it needs to be sorted out at the ministerial level, because it is not happening at the organization that plans for the entire province.

Another example of that same problem with regionalization is with cancer assessment. There are some problems with cancer assessment and psychiatric services in terms of those services going to adjacent towns. One example is getting cancer assessment for patients in Vernon, who have been treated in Vernon, and now we have no cancer specialist -- and those people going to Kelowna and the Kelowna system being unable to handle them because of budgetary circumstances and lack of bed time.

I received a comment from one of my constituents, who is an RN at Vernon Jubilee Hospital, which I found interesting and which I will share with the minister. She wrote, on Tuesday, May 12:

"Who knows the big picture? Who knows what will happen to Vernon Jubilee Hospital? Why are there so many changes happening, back to the way things were years ago in this area? I remember that Bob Ferguson used to be the administrator of Vernon, Enderby and Armstrong. That was in place for many years, and then it was abandoned for the concept of everyone for themselves. And now we're back into the regional concept! All of these changes cost money!"

So it's interesting to see that with regionalization, as with many things, including women's fashion, we're moving back into the place we came from. And if you just hold on long enough, you'll have seen it all.

An Hon. Member: Different sizes, though.

A. Sanders: Different sizes -- for some of us.

I want to share with the minister a couple of things that I think are working well in regionalization -- maybe because it's a circumstance that she might not hear of from this side of the House. Therefore I will tell her what those are before I take a round at her.

One of the things that's working really well is the quick response teams. These are the teams that work in the hospital to intercept people who come to the door of the hospital, kicking their suitcase in front of them, for admission through the emergency department. These teams are working extremely well in terms of keeping patients that could possibly be seen by other services and that the emergency staff do not have time to liaise with right at that moment. These teams do so. In many cases, where other services may have done just as well, we're having fewer hospital admissions.

The second one that's working very, very well is the mental health quick response team. And this, again, is another unified team that provides crisis-type services all the way through to psychiatric in-patient care. It is especially important in rural areas. This adjuvant that's come on board in the last year has been an excellent addition to how we keep people, who may not necessarily need to be there, out of acute care facilities.

The third one that's working very well is something called the home intravenous program. This is a program where now -- especially when we have what is called in the press "super bugs" -- we can treat people on intravenous at home, when they are reasonably capable of looking after themselves, except that they have to have intravenous therapy for ten days. Being able to treat them at home is an excellent program, which I feel is saving a considerable amount of money.

The fourth thing being done through regionalization that I think is working very well and that has helped to increase and coordinate services within my community is the inventory of services that came as a result of regionalization, where we had to look at the umbrella, see who actually sat under it, who wasn't sitting under it, and how to get all those services together. I think it's created a road map for a community, in terms of utilizing their health care, that has been beneficial. Whether it has been beneficial for the money spent is another question, but that is not the purpose of my talk today.

I want to talk about regionalization in terms of the roles and responsibilities. I have heard a lot of discussion over the last two days from other members in the House concerning this, and I will try not to spend time on those areas that have been covered. I am going to focus on Vernon specifically.

One of the questions I was asked by two members of the regional health board, when I phoned them to ask if they had questions for the minister on regionalization, was specifically: "If you can find out something about what's going on, would you let me know?" There has not been much happening, and I wondered if there was a deadline set up by the ministry to get regional health boards up, running and knowledgable about what they're supposed to be doing.

[4:45]

Hon. J. MacPhail: That's an interesting comment from a regional health board member. It's one that disturbs me greatly. They were up and running as of April 1, and there has been a great deal of communication amongst all regional health board members. So I too am disturbed by that comment.

A. Sanders: Well, I wouldn't want to get us all disturbed here. It's 5 o'clock, but nevertheless, hopefully, we'll look into that on both sides of the House and see what that means.

My second question in terms of roles and responsibilities concerns . . . . I guess power would be the key word. In the delineation of roles and responsibilities for the ministry, the minister is all-powerful in prescribing conditions under which regional health boards and community health councils operate, and she also has the power to revoke their power.

My question to the minister concerning this point is: from an ideological point of view, how do we put more power into the hands of a local community if, in fact, under roles and responsibilities, all power resides with the minister?

[ Page 3355 ]

Hon. J. MacPhail: Well, I actually view it as responsibility. It is the exercise of responsibility. And ultimately the responsibility lies with my government under any structure of service delivery, just the same way that I know the hon. member holds the Minister of Education accountable for a system, for everything that happens in the system. Ultimately, the collector of the taxes and the funder of the system is responsible for the outcomes.

But let me answer the question at another level. The system makes more sense, in my view, having those that are part of the community responsible for determining the needs of that community and how those needs will be met. I don't in any way assume the statutory responsibility for carrying out those duties in a way that's an exercise of power. It's all about patient care and making sure that patients get the best possible care for what the needs are in their own community -- which will differ from community to community.

A. Sanders: What I'm hearing the minister say is that the power the minister has will be enacted to ensure patient services, and not differentials between ideological drives of communities and government. Is that a correct

interpretation?

Hon. J. MacPhail: Well, of course the answer to that is yes. But I am sure the question isn't devious, so . . . . Ideological warfare has no

part in a health care system. The Canada Health Act makes that quite clear -- about what services are to be delivered and who pays for those services. However, our government is very committed to the current health care system, which is encompassed by the five principles of medicare. We're so committed to it that we entrenched it in provincial legislation.

A. Sanders: It would be very helpful to me, and I think to all of us, to know and understand that ideological principles do not drive decision-making processes, but I think the reality of politics is that in fact that often is the case.

There are two areas that for me should never, ever be partisan. One is education; the other is health care. As soon as we cross the line with those two particular areas of responsibility, we as government then can become suspect in terms of our decision-making ability, in terms of the amount of power we have.

The backdrop for that, which I think is really important, is that British Columbians are in a circumstance this year where education has come to be perceived as a partisan affair, with 11 schools going to NDP cabinet ministers' ridings and the Speaker's riding. One of the questions that was often asked of me, as an individual in this House, was: does that mean that in the future we can anticipate -- based on regionalization and especially with the minister being all-powerful -- that this too could become a forum where how individuals vote within their communities can determine the kinds of services they get?

I think what British Columbians need from the minister is the affirmation that in fact that will never be the case in British Columbia. We will not have "have" and "have-not" regional health boards, depending on who is the political power in that community.

Hon. J. MacPhail: Just as I don't accept the member's premise about the funding of education being an ideological matter for this government -- because it simply is not -- I commit to the fact that funding for and delivery of health care in this province is based on need and need alone.

A. Sanders: I appreciate having that on the record from the minister.

The question that I'm interested in with respect to regionalization revolves around what the ministry has outlined as the benefits of regionalization. My first question to the minister concerns MSP funding. Is it the will of this minister that the funds for MSP will become the responsibility of the regional health board? The addendum to that is: if yes, when?

Hon. J. MacPhail: I'd love to make a facetious remark, but I've learned that facetious remarks never appear as well in print as opposed to live, so I won't.

Generally, no, but allow me a little leeway. There are certain aspects of MSP funding . . . . In fact, I've already discussed them publicly: lab reform, for instance. That is MSP covered. I think there are ways of dealing with lab payments that lend themselves to some sort of geographic context. I don't want to get anybody panicked about it, and I don't want anybody to think that there's a grandiose scheme here. But we've already been approached by several of the institutions in a region, saying: "Hey, here's a way where some administrative savings and utilization savings could be made." That's part of the MSP budget.

A. Sanders: I'd like to carry on with that particular issue a little bit more. Specifically, the minister has mentioned lab funding, and that leads into another question that I have with respect to MSP funding and the lab.

Associated with one of the medical clinics in Vernon is a private lab. This is one of the oldest medical clinics in Vernon; it has been there for quite some time. Patients who go to that clinic, which is probably staffed by somewhere around 20 physicians, have traditionally gone to the lab because it is right next to the washroom in the building. It's exactly the right location, whether you are 70 or four, to go and have your tests done.

The lab in Vernon that is associated with the hospital is two or three kilometres away, up a very steep hill, with not particularly adequate bus service and not particularly adequate taxi service. What the clinic has been told by the ministry in the last couple of weeks is that the patients who go to the medical clinic are no longer allowed to be sent to the medical lab that is in the medical clinic.

The reasons they've been given for censorship of that private facility are: (1) because it's so easy for them to go to the lab, the doctor will order more tests; (2) the money should be going into the hospital rather than into the private lab; and (3) the government doesn't particularly like to have private enterprise facilities within health care, and therefore this private lab should be avoided.

There is a list of physicians, I believe, who have . . . . This isn't even tied to the patient; it's tied to the physician. There is a list of physicians who were originally at the clinic who have some kind of contractual arrangement that doesn't allow the government to remove their ability to use the lab, but all of the other physicians who are there now have patients who have to go up to the hospital to have the laboratory testing. I am interested in any comments the minister has on this particular issue, and then I will question her further based on that.

Hon. J. MacPhail: That kind of direction . . . . If it is coming from the ministry, I'd actually like to follow up on it and correct the source; the direction is not coming from us. What we are exploring, as in all aspects of regionalization of health care, is whether there are cost efficiencies that best meet patient care. If something is efficient for patient care --

cost-

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effective and community-based -- why would we change it? I'd be more than happy to investigate the source of this directive and get back to you on it with proper direction.

A. Sanders: That's a very important issue for a very large number of people in Vernon, and there is a significant . . . . There is an elderly patient who goes to this clinic because that's where all the original physicians were, so it's kind of a museum for doctors and patients combined. It's very important for that to be sorted out, and I appreciate the minister spending some time doing so and correcting what I consider to be a problem that did not exist.

My second question about regionalization . . . . Is this government, under this minister, still having its interest piqued by the Victoria model of health care delivery outlined by Dr. Kilshaw?

Hon. J. MacPhail: If I could just clarify from the member, I believe the report the member is referring to is the one done for the national committee looking into primary care. It was a national report. It was done by Dr. Kilshaw and therefore is called Victoria because he is out of Victoria. Is that the one?

Interjection.

Hon. J. MacPhail: Okay. That was an investigation done in terms of health reform; it was done for the provincial-federal-territorial ministers. It was in the second meeting that I attended that this issue was dealt with. Here were our comments -- and it was on the reform, if any, of primary care.

Our province was actually considered to be an important voice in responding to this report, and I think we disappointed several of our colleagues across the country -- particularly Newfoundland and Ontario -- because we said that our primary care system is not in need of the massive reform that was suggested in the report. The report indicated moving towards an HMO type of model, with much more emphasis on salaried physicians, as well. We indicated that at this time there was no consideration of us moving in that direction in any way.

We also offered to our colleagues elsewhere that any change in the delivery of primary care would have to be in partnership with the physicians delivering that primary care.

[5:00]

A. Sanders: In terms of looking at the regionalization benefits again, I'm interested in the integrative part, and I've touched on that briefly by looking at a vignette of a patient on dialysis not having the funding follow her. What I'm interested in now is looking at it as a bigger picture. Could the minister outline for me what structures are in place to assure that there is integration of interregional regions? In other words, what are we doing to make sure that a patient living in Vernon will be treated without any problems in other regions of the province if they require services there for any reason?

Hon. J. MacPhail: We discussed yesterday that the concept for funding is on the basis of where the health care service is delivered. We fund according to where the service is delivered, not where the patient lives. I do appreciate the particular situation that the member brought up. I am very much interested in looking into it and literally getting to the bottom of it, because we have to pay particular heed to provincially funded programs. Regionalization is funded on the basis that the area where the service is delivered gets the funding, not where the patient comes from.

Secondly, the regional health boards and community health councils themselves are coming together as a provincial health association in order to discuss exactly these issues. But that organization is just being assembled now.

A. Sanders: It pleases me to hear that there will be a provincial health association. That was the kind of body I was looking for. I think this is one of the areas where problems will arise in terms of the hybridization of one region with another, in terms of patients and the movement of the patients between those. So a provincial health association will help there.

I'd like to look specifically at regionalization with respect to mental health. As the minister knows, this is an area of extreme concern to me in terms of my patients, and an area of interest as well. What I'd like from the minister is for her to outline what the mental health circumstance is with respect to regionalization at this time.

Hon. J. MacPhail: Children's mental health has been moved to the Ministry for Children and Families. Adult mental health services are now the responsibility of either the regional health board or the community health services society -- CHSS. Riverview continues to be governed by its own board.

A. Sanders: To carry that point further, I'd like to understand from the minister what is, in one region, the delineation of the role of the mental health centre versus the psychiatric facilities within an acute care hospital.

Hon. J. MacPhail: I'm sorry. I failed to mention the acute psychiatric services that continue to exist as well.

Acute psychiatric services will still be provided through the hospital structure, and the community mental health services will be part of the regional or community structure. They were separate services before. Now, because they are under one auspice, I anticipate that there should be some coordination. I know that in my own community there is an issue of a need for better coordination, rather than having people with mental illness admitted through the emergency ward. The mental health services in the community need to be strengthened or better utilized to avoid the admission, which is not always in the best interest of the patient either.

A. Sanders: Does that mean that there will be an aspect of enforced cooperation? In other words, will some benchmarks be put in place to encourage cooperation between the mental health facilities and the psychiatric acute care?

Hon. J. MacPhail: I really appreciate these questions, because it is such an important area of our health care system, and sometimes the patients themselves get treated as second-class citizens.

The quick answer to your question, "Will there be strongly encouraged integration?" is yes, in fact, to the extent where some of our regional health boards are now actually putting in place a director or a VP responsible for mental health services who will have responsibility for both aspects of the care, both in-patient and out-patient.

In terms of how we determine whether it's working, there will be performance outcomes based on the best clinical practice outcome, which is probably a model that you're familiar with. It's an evidence-based model.

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A. Sanders: There are many visions for mental health around the world. I was hoping the minister would share the vision that this ministry is working on, so that I may interpret my questions within the vision the ministry has chosen.

Hon. J. MacPhail: I'd be more than happy to do that. I'm wondering if we could do that when we discuss mental health, because it is an area that I'd like to spend some time on myself. We could start it now, if you wish. Anyway, I leave it in the hands of the hon. member. I do expect that we should do it as a separate chunk, and I look forward to the discussion.

A. Sanders: I'm happy to do that, as I too feel that this is an important and somehow separate area.

With respect to regionalization, one of the things that fits in integrally for all of us who do not live in the lower mainland is Riverview. Riverview downsizing, albeit another separate topic, does fit into regionalization very importantly because of the increased demands that will be accrued on the areas outside the lower mainland, with changes in population at Riverview.

For the benefit of the record, Riverview had 1,200 beds and was decreased to 800. There were quite significant public outcries, specifically from patients' families and the media -- as the downsizing occurred. The hon. member from Prince George -- the member for Prince George North -- was the Minister of Health at the time, and at t