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

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

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, MAY 11, 1993

Afternoon Sitting

Volume 9, Number 23

[ Page 6107 ]

The House met at 2:03 p.m.

[E. Barnes in the chair.]

F. Gingell: It is with pleasure today that I introduce Ann and Lynsey Claggett, who are here from Delta, together with a friend from Toronto, Sean Cairney, who has been putting on a Scottish heritage event at the PNE before everybody tears it down. I would ask the House to please make them welcome.

P. Dueck: Visiting us today are 41 students from Bradner Elementary School, accompanied by Mrs. Christian and several other adults. Bradner Elementary School is, of course, from the world-famous Bradner Flower Show, and everyone here knows about the flower show.

I told these students they should come for question period, but they weren't sure they were able to attend, and I don't think they're here now. I told them they should come because the role model and the example that we would have for them is something that in future they would know not to follow. Would the House please make them welcome.

J. Doyle: Today in the gallery is a very good friend of mine, Talea Pecora, from Golden. With Talea is a friend of hers from Melbourne, Australia, Donald Storace. I'd like the House to make them welcome, please.

Hon. T. Perry: I'd like to welcome to the House Mr. Roger Welch, immediate past president of the Simon Fraser University alumni association, who is with us in the gallery. I ask members to please make him welcome.

I would also like to acknowledge the presence in the precincts of Dr. William Gibson, past chancellor of the University of Victoria. I ask members to make Dr. Gibson welcome as well.

Hon. D. Marzari: I'd like to introduce three generations of menfolk from my family visiting Victoria today. Up in the gallery are my very easily embarrassed son Robert, who's 13; my youngest son, Daniel; their friend Ryan O'Driscoll; in the back, my brother Douglas Smith, visiting from Toronto; and of course, the well-known Bill Smith, my dad.

Introduction of Bills

COMMERCIAL TENANCY ACT

Hon. C. Gabelmann presented a message from His Honour the Lieutenant-Governor: a bill intituled Commercial Tenancy Act.

Hon. C. Gabelmann: I am pleased to introduce this bill, the Commercial Tenancy Act. This bill repeals the current Commercial Tenancy Act and replaces it with an entirely new act. The existing act is very out of date. Many of its provisions are obscure, archaic and confusing. This bill, which is based upon recommendations of the Law Reform Commission of British Columbia, would modernize and reorganize the current statutory provisions. This reform will help to make the law of commercial tenancy simpler and more usable. I commend this bill for the consideration of the House and urge its passage.

Bill 10 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

LABOUR DISRUPTIONS IN SCHOOLS

J. Dalton: My question is to the Minister of Education. It will come as no surprise to anyone in this House or in this province that it's about school strikes. The minister has continually responded, when asked what she is doing about these ongoing labour disruptions, that she and her ministry are monitoring the situation. Well, apparently monitoring from the minister's point of view means watching but doing nothing. Specifically, we have a real concern that the senior secondary students are going to be cut off at the knees by their lack of opportunity for access to post-secondary education.

Does the minister have any specific plan in mind to allow these students to gain access as they have the right to do?

Hon. A. Hagen: All the students who are affected by this dispute are of concern to this minister and to this government. As for the grade 12 students, they have indeed completed a very significant portion of their year and their work will be recognized by the school district, by the ministry and by post-secondary institutions. It is my hope -- with the good offices of the parties and the Minister of Labour -- that this dispute will be settled very quickly and all students will be back to school. I want to reassure grade 12 students that their work to date will be recognized and their access to post-secondary institutions will not be jeopardized by this very unfortunate labour dispute.

J. Dalton: It's fine to speak of the grade 12 students, and there is a specific concern there, but I want to direct the minister's attention to all students who are affected by these ongoing disputes. Every student in this province has the right to an education without interruption. That is not happening, and it's because of the lack of action by your ministry. I put it to the minister: do you have any specific plan in mind so that all students who have lost class time can make up those opportunities?

Hon. A. Hagen: Every day that children are in school is important. I hope that children will be back in school in very short order. They are an incredibly resilient group of young people, and their teachers, in spite of this unfortunate action, are committed to their receiving an education that British Columbians continue to be proud of. All of us in this Legislature need to state that we are supportive of the teachers and

[ Page 6108 ]

the trustees -- with the assistance of the Ministry of Labour -- in finding a resolution to this dispute so that our children are back in school. That's something that this government is committed to doing.

G. Farrell-Collins: It's dismaying to hear these types of answers two days in a row. It's going to take more than magic and dreaming to get these students back into school. Will the Minister of Labour finally take action today to get the students in this province back into school where they belong, and not let this dispute drag on another week?

Hon. M. Sihota: The hon. member opposite is well aware of the action that this government is taking.

First of all, this government has assisted in resolving 40 of the 50 disputes in this province without any work disruption. Secondly, with regard to those areas where there has been work disruption, we have assisted the parties in resolving those issues as expeditiously as we possibly can.

More importantly, in the context of this current dispute, I want to make it abundantly clear that we have today asked Brian Foley to book in as a special mediator, to immediately reconvene the parties and to try to resolve the issue forthwith, so that we can get schools back in operation and children back in the appropriate learning environment. If there is no resolution through the normal collective bargaining process before this weekend is out, I have asked Mr. Foley to issue public recommendations before the weekend is out so we know once and for all where the solution lies. It can then be put to a vote, and we can get schools back in operation as quickly as possible.

G. Farrell-Collins: I'm sure the parties are quivering in anticipation of the lightning speed with which this minister is ready to intervene in this dispute and get students back to school.

The minister says he's acting as expeditiously as possible. Why then have the North Island students been out of school for five weeks? Are we going to have to wait another five weeks for Vancouver students to be out of school before this minister finally takes some action?

Hon. M. Sihota: I want to make a number of points. This government brought down a budget. It generally increased expenditures in education, but it also made it abundantly clear to the parties that there's no money over and above that which was placed in the budget by the Minister of Finance. Given those fiscal realities, we expect the parties to engage in tough bargaining. We as a government, through the Ministry of Labour, will offer whatever assistance we can to make sure that the parties see their way through that tough bargaining. There is no more money; there is mediation available.

The parties have been requested to go back to the table today, and they have been told very bluntly that if they can't resolve it on their own, there will be public recommendations before this weekend is out. That's action, hon. member.

Interjections.

Deputy Speaker: Order, please. A final supplemental.

[2:15]

G. Farrell-Collins: That's not action; that's rigor mortis on the part of this minister. The students in British Columbia are out of classes because of the inaction of this minister. He says there's no money left, yet he gave 6 percent to the BCGEU. How does he expect the people in this province to believe there's no money left -- if there really isn't -- when he is bringing in those kinds of settlements? What we need to see is some concrete action by this minister today -- not Friday, not Saturday or not next week.

Hon. M. Sihota: When this government took office, spending in British Columbia, on an average basis, was at 12 percent; teachers' settlements were coming in at 7 percent; and the deficit had been growing annually, to the point of $3 billion. From the day this government was sworn in, it has been taking concrete action. We have brought down spending in this province, from 12 percent to 6 percent; we have seen teachers' settlements come down from 7 percent to about 2 percent on average; and we have seen the deficit come down from $3 billion to $1.5 billion.

We have introduced progressive labour legislation in this Legislature that endeavours to resolve these disputes quickly. Forty of the 50 disputes have ended without any disruption whatsoever. In the case of the current Vancouver dispute, we have made it abundantly clear to the parties that if it is not resolved forthwith, there will be public recommendations to get children back to school immediately.

I want to make it abundantly clear that there has not been a government in the history of this province that inherited a financial mess like we did from the previous government and that has addressed it as expeditiously as we have.

RECALL AND INITIATIVE LEGISLATION

D. Mitchell: Mr. Speaker, a change of pace -- a question to the Premier. In light of comments made by the Premier last week with respect to recall and initiative -- two reforms that were overwhelmingly endorsed by the majority of British Columbians at the time of the last provincial election -- it has now become clear that this government has no intention whatsoever of implementing either of these reforms. In light of this, how can the government...?

Deputy Speaker: Order, hon. member. The member is raising a matter which is before a standing committee of the Legislature. The hon. member knows that that matter is being considered, and it cannot be debated at this time. The member should be guided by the practices of question period.

D. Mitchell: To the Premier: in light of the concern that I've expressed, how can the government

[ Page 6109 ]

justify spending thousands of dollars to have a committee continue to travel around the province in order to fulfil its political objective of delaying the democratically expressed will of British Columbians?

Hon. M. Harcourt: As the member fully knows, the previous government introduced the recall and initiative referendum. I voted for it, and we support it as a government. But they didn't do the homework. That's what we're doing now. I can say now that we do need recall and referendum legislation in British Columbia to protect the people of this province from governments like the last Social Credit government and all of those Liberal and Conservative governments with members having to resign, almost en masse, in this country.

We need recall and referendum legislation to protect our citizens from those kinds of governments. I can tell you that we will do our homework and we will bring it back before this House. But the citizens are getting a little tired of the member for West Van who quits every time he gets into a snit. He quit the Liberal Party to sit as an independent; he's quitting this committee. Quit quitting!

D. Mitchell: The Premier knows that the homework has been done. The homework has now been done; the groundwork has been completed. The committee on parliamentary reform is now widely derided as the committee of delay. Will the Premier commit today to take a look at the legislation on recall and initiative that is already on the order paper of this House, standing in the name of the Leader of the Third Party, and will the Premier commit today to passing such legislation in this current session?

Hon. M. Harcourt: I would expect somebody who was a deputy clerk of a legislature to know better than to ask a question like that on future policy. He should know better than that. He should also know that this matter will be back before this Legislature as soon as the committee that he's supposed to be sitting on -- I don't know if he's quit or is back on it yet -- reports back to this Legislature.

Deputy Speaker: The response by the Premier is well taken with respect to matters on the order paper, hon. member.

D. Mitchell: A final question to the Premier, then. The concern I'm raising is that the committee process itself has become a sham. It's now apparent....

Deputy Speaker: A question, hon. member.

D. Mitchell: ...that the New Democratic Party is stacking the committee hearings with witnesses who are opposed to recall and initiative.

Deputy Speaker: Order, hon. member. Would the hon. member please state his question.

D. Mitchell: Will the Premier agree to put an end to this blatant abuse of the legislative process, recall the committee on recall and agree to bring in legislation in this session on both of these democratic reforms?

WELFARE FRAUD

V. Anderson: It seems to me the government protests too much today. This is to the hon. Minister of Social Services, who brought out a report on good management.... The project on monitoring administrative error and fraud reported in November 1992, and made recommendations whereby the Ministry of Social Services might improve its administration to prevent the kind of loopholes that enable fraud to take place. Will the minister tell us today what action she has taken to follow those recommendations?

Hon. J. Smallwood: First of all, let me put a couple of the member's comments into some context. The report that you're referring to is a draft report -- contracted by our audit division -- flowing from the auditor general's recommendations for improving and strengthening our audit provisions within the ministry. That particular report is currently in a draft status, because the ministry has some significant concerns around some of the speculative aspects of the report, some inaccuracies that are involved with the report and the fact that the report itself is incomplete. I have asked senior ministry staff to finalize the report and to present it to me once it has been.

Our ministry takes seriously the auditor general's recommendations, and as I have....

Interjections.

Hon. J. Smallwood: Mr. Speaker, if the opposition is interested in a serious answer, then I am more than prepared to give them that serious answer.

Deputy Speaker: Thank you, hon. minister. Would the minister please continue, as briefly as possible.

Hon. J. Smallwood: To the hon. members in this House, the issue of auditing a system such as mine is a serious one and deserves serious comment. When we are dealing with administrative error in particular, and the auditor general's recommendations, we take not only this report but all reports seriously. We have enhanced our capability by adding 16 people to our auditing function, and are preparing to report out to this House during the estimates process.

Deputy Speaker: In view of the length of the response, the Chair will permit one final question from the hon. member for Vancouver-Langara.

V. Anderson: The minister has to talk hard to talk out the clock.

The report that she acknowledged was done for her department indicated there was a 3 percent error in administration, which translates into $36 million, or the equivalent of 1,000 financial assistant workers. Given the increase, will the minister please explain what she

[ Page 6110 ]

has done to correct this ineffectiveness in administrative undertaking?

Interjections.

Deputy Speaker: Order, hon. members.

Hon. J. Smallwood: My comments earlier about the speculative nature of this report.... I know the member has a photocopy of that page, and if he will read closely, he will see that it actually refers to "suggestions" of administrative error. It goes on to say: "It can be translated...." Quite frankly, hon. member, I can only deal with facts. I can only deal with realities. I cannot deal with speculation. I cannot deal with suggestions. That is why we have enhanced the system to be able to deal with realities -- facts rather than myths.

This particular report was commissioned to help guide us in that audit process. We have enhanced our audit capabilities, and we will deal with the facts rather than speculation.

R. Chisholm: On a point of order,

article 47A(

b) states: "Questions and answers shall be brief and precise, and stated without argument or opinion." Hon. Speaker, I would wish that you advise the assembly of such.

Deputy Speaker: The point of order is well taken, and I'm sure that all members are aware that the guidelines are for the benefit of expediency and efficiency in question period. I suggest that all members read

section 47A, as suggested by the hon. member.

Orders of the Day

Hon. M. Sihota: Hon. Speaker, I call Committee of Supply A, Douglas Fir Room, for the estimates of the Ministry of Tourism and Ministry Responsible for Culture. In Committee B we will be dealing with the Ministry of Health estimates.

The House in Committee of Supply B; D. Lovick in the chair.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

(continued)

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

L. Reid: The hon. minister wishes the floor.

The Chair: I understand the minister wishes to begin.

Hon. E. Cull: Thank you, hon. Chair, and also to the member for letting me give this answer to the member for Prince George-Omineca. Before we recessed he had asked how many of the people hired in the community hiring efforts last year were from outside the province. By the time you actually calculate the jobs into FTEs, into full-time-equivalents -- because not all of those positions were full-time, so there were indeed more positions advertised than FTEs -- there was a total of 650 FTEs, and 60 of those were from out of province.

L. Fox: Perhaps just to follow that up, can the minister tell us how many dollars she spent on advertising and to cover the expense of moving those 60 employees?

Hon. E. Cull: The advertising cost was $106,000.

L. Fox: I'm sorry, did the minister say $106,000? That's a high price to pay to advertise for 60 employees, I must say.

[2:30]

Hon. E. Cull: Six hundred and fifty.

L. Fox: Well, with all due respect, through the Chair, we hired 60 employees from outside the province at an expense of $106,000, and I....

The Chair: Excuse me, member. I'm having some difficulty. There appears to be a dialogue going on across the aisle, and that is not allowed. I'll ask all members to please wait for recognition by the Chair. Please continue, member.

L. Fox: Thank you, hon. Chair. We'll try, I'm sure, to keep that type of dialogue to a minimum.

As I was saying, to spend $106,000 to hire 60 employees outside of the province -- we saw examples of the huge ads in the Montreal Gazette and other newspapers across Canada -- is in my view an extremely expensive program. Can the minister give me a breakdown of those 60 employees? I noticed that there was specific reference in the ad to minorities, several handicapped groups and women's groups. Perhaps the minister could give me some breakdown as to the makeup of those 60 people.

Hon. E. Cull: Let's just get this straight in terms of the costs and the number of people. There were 650 FTEs hired, for a total of $106,000. The majority of that advertising was placed in British Columbia. We advertised widely in B.C. We were having to advertise out of province for positions that we had an extremely difficult time filling, and which to this point are filled with auxiliaries in many cases -- for audiology, licensed psychologists, speech pathologists and environmental health officers.

Like you, hon. member, I would like to hire all of these people from within British Columbia, but you represent a northern riding, and I know that you wouldn't want your citizens to be waiting for speech pathology, audiology, licensed psychology services or any of the others if we were not able to find people in this province who were willing to move to those communities and take on those positions. For that reason, to hire for those very difficult-to-fill positions in communities that unfortunately are not as popular as some of the other communities, we have to advertise

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across the country. I think the evidence shows that we were able to place people in most of those positions and that the advertising worked well for us.

L. Fox: Just as a point of fact, those ads that were run outside of the province were run concurrently with the ads in the province. In fact, the minister will recall that when I brought that issue up in question period, the ministry had not yet identified where the shortages would be, through a selection process that was contained within the province at the time the ads were let outside of the province. So the minister is suggesting that the bulk of the $106,000 was spent in the province. Perhaps, then, I could ask for clarification as to how many dollars specifically were spent on ads outside the province.

Hon. E. Cull: With respect to the concurrent advertising, of course we advertised concurrently. Through our past hiring experiences we know which positions are difficult to fill, which ones remain unfilled for weeks and weeks. And if you're suggesting that we should do it consecutively and add another six to eight weeks to the hiring process, I will not agree with you, hon. member. We made it very clear that we were giving priority to British Columbia residents. If we had applicants from British Columbia, we were able to do so.

But if we didn't, then we didn't have to repost, go through the waiting period and all the screening and add another six to eight weeks onto the waiting period to get people into some of those communities.

I don't have the breakdown on the advertising costs inside and outside of B.C., but I know that we advertised in more community papers and papers in British Columbia than we did outside. I'd be happy to get that information once staff can provide the details on the $106,000.

L. Fox: I don't want to belabour it, but I do want to make the point that in fact I'm aware of two individuals who were eminently qualified for two jobs that were given to individuals outside the province. These people were in the northern part of the province, and in fact were located in Prince George. They did not have an opportunity to apply for that job, because they didn't fit into one of the minority groups.

I asked the question earlier: how many of these 60 people hired outside of the province were.... What was the breakdown and the makeup of those 60 FTEs, given the prerequisites that were stated in the ad as to who would be given preference during the interview process?

Hon. E. Cull: I consider the statements that the member has made to be very serious, and if he'd like to provide me with the names and the circumstances of individuals that he alleges were not allowed to apply for jobs because we indicated a preference for employment equity in our hiring policies, then I'd like to follow them up. I don't believe them, but if they are in fact true we will follow them up.

I don't have the breakdown of the 60 or the 650, in terms of how many were men, how many were women, how many were aboriginals or how many people of different multicultural backgrounds were hired. Certainly we can have a look at that and see if we can provide that information to you.

L. Fox: I just have one final point on that. The minister has that on record. I have copies of letters that were sent to her from those two individuals outlining their concern about the process. If the minister wants that information she should look in her files at letters from two individuals from Prince George, which clearly delineate their concern about the hiring process and how they were excluded from it. I will dig from my records copies of those letters and forward them to the minister in case she hasn't personally seen them.

L. Reid: In terms of Health estimates this afternoon, I want to continue the discussion of this morning. We were talking about regionalization. We had just covered, in terms of the election process, the one-third, one-third and one-third process in terms of being elected directly by the community, being appointed by the minister and appointed by an elected board or municipal authority. Following that, I want to touch on the compilation and creation of a workbook which the Ministry of Health has said is going to facilitate the process of constructing community health councils.

The workbook, which is based on a similar publication produced by the Saskatchewan government, will specify requirements for the composition of councils and criteria for the selection of individual members, as well as provide procedural guidelines. Could the minister please comment on the status of that particular workbook?

Hon. E. Cull: I believe that it has just been distributed. I have seen the penultimate draft of it and have just been handed the printed version, so I think if it hasn't been distributed, it's about to be distributed.

L. Reid: That warms my heart. I have not seen it. I trust I will see it in the next number of hours.

In terms of budget allocations, there are certainly ongoing discussions in the field about core facilities and the degree to which individual community health councils will have the ability to address funding. My question to the minister looks at criteria and guidelines for what will be defined as core facilities, procedures or services under the workbook. In that you have the workbook in front of you, perhaps it's already allowed for. I'd appreciate your comments.

Hon. E. Cull: The workbook is not to answer all of the different priority items that are in the strategic directions that we have outlined in "New Directions for a Healthy British Columbia." There is another document, which I believe the member does have, that takes the 38 different actions in the plan and indicates where they're at, who's working on them and what their priority is. This particular workbook is just to help communities start to set up a health council. It doesn't address all of the many other issues that are incorporated in our overall New Directions strategy. With

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respect to the establishment of the core services, that is something being addressed through the reference committee I mentioned this morning and others that are participating with us to define what should be the basic level of services that people should expect in any community in keeping with its size.

L. Reid: My readings suggest that the responsibility for defining core and discretionary services will rest with the ministry's implementation office. Is that the same group that you're now considering the reference committee?

Hon. E. Cull: No, the reference committee that I described in detail this morning is not the same as the ministry's implementation office.

L. Reid: With specific reference to the implementation office, where is their work in terms of defining core and discretionary service under the regionalization model?

Hon. E. Cull: The royal commission implementation office was wrapped up at the end of the process, so it no longer exists. I assume that's what you're referring to when you refer to an implementation office. There are staff working in many different divisions of the ministry that will be assisting with the development of the 38 actions that are in the New Directions strategy. There are people who will be working with external stakeholders and other people in the community to develop the core services that will have to be identified. The model that we're following throughout is to involve people both within and outside the ministry in making these decisions.

L. Reid: If the implementation office no longer exists, who will be responsible for defining core services and discretionary services? I appreciate that it may be some time before that is fleshed out, but who can I contact for definition of those two terms?

Hon. E. Cull: Assistant Deputy Minister Garry Curtis.

L. Reid: Regarding jurisdiction -- and I think that's where we left off the discussion this morning -- in terms of how regionalization will be understood by the average British Columbian.... My purpose in raising these questions is that there is tremendous consternation out there, in that this is not a well understood concept. I appreciate the minister's comments with respect to the evolution of the process, and appreciate that we will at some point arrive at something that will reflect each of the unique communities within British Columbia.

I don't take issue with that, but in terms of current jurisdiction I don't believe the minister and I always agree on what the current jobs are and what the possible ramifications of a shift in those jobs will be.

From my information, hon. minister, the provincial health officer now looks at all the province's medical health officers. I understand that that also takes in environmental health, and I believe that those same individuals are going to be involved in the new structure with a similar reporting process. Is that correct?

Hon. E. Cull: The question of environmental health probably needs a bit more thinking. I've had some discussions with people in environmental health, but we haven't yet reached conclusions as to the appropriate places to locate them. That may be a function that is better left at the regional level, as opposed to the community health council level.

L. Reid: I believe there is now some inconsistency with environmental health officers in terms of who they directly report to. Is metro treated differently than other areas of the province?

Hon. E. Cull: They all report to a medical health officer. It's just that the medical health officers in the metropolitan areas are employees of the metropolitan boards -- if you like to use the term in its broadest context -- as opposed to Ministry of Health employees.

L. Reid: I appreciate that they may report to different individuals. Will the metro environmental health officers be involved in a different reporting function under the regionalization model?

Hon. E. Cull: The two systems are a little different right now, just because of the nature of who is responsible. In the four metropolitan boards in the Vancouver area and the Capital Regional District in Victoria, some services are provided directly by those regional districts or metropolitan boards, that anywhere else in the province are directly provided by the Ministry of Health. We're not planning to reverse what is happening in the metro areas.

In fact, it may mean that in the future those people who are now direct employees of Health will become direct employees of regional health boards or community health councils, as are the people in the capital region right now direct employees of the CRD.

[2:45]

L. Reid: Will there be some consistency, once the regionalization process is in place, with respect to how it impacts or affects all environmental health officers? It was not clear from the minister's last comment.

Hon. E. Cull: I think the consistency can be enhanced by the new process. The only inconsistency right now is that these people are not employees of the province. They are employees of a municipality or regional district, but the rules that govern them are still provincial rules. The medical health officers are still appointed by order-in-council by the province. The provincial medical health officer is still the senior medical health officer, if you like, for all medical health officers. It's really a question of who issues the paycheque as opposed to the system of administration or regulation that applies.

In other words, the CRD can't have a different set of environmental regulations to apply for, say, a sewage disposal permit than any

[ Page 6113 ]

other part of the province, given that there are differences in different parts of the province. But they are not determined by the administration or the person who issues the paycheque to the

EHO.

L. Reid: If the regulations are going to remain the same and the reporting function is going to be streamlined in terms of its consistency, will there continue to be differences in remuneration for environmental health officers, depending on their employer, or will we be compensating environmental health officers based on competency levels, qualifications and years of experience across the province?

Hon. E. Cull: Right now there are differences in pay because there are different employers. The member is aware that the Korbin commission has recommended a single employer for direct service providers in the health care field, which would include this area. With a single employer agency -- it's an agency, not a single employer -- doing the negotiations over time, we should see convergence of those salary discrepancies. That would apply not only to EHOs but to public health nurses and others who are paid different rates, depending on who their employer is right now and who does the bargaining for them.

There are seven employers, 35 unions and three bargaining agents. It's a bit of a confused mess when it comes to labour-linked negotiations within the health sector. The work that's underway right now to create a single employer agency should start to give us the tools to address the problem. I'm not promising that the problem will be addressed overnight. It takes time to move those kinds of changes to close the gaps, and they have to be negotiated as part of collective bargaining.

L. Reid: I understand that the Korbin commission is still in progress. From the minister's comments as they pertain to environmental health officers, I trust that we will also be striving for some kind of consistency in terms of nursing staff in the province. Certainly there is tremendous variation in what a registered nurse will receive -- for example, a nurse who works in drug and alcohol treatment as opposed to a nurse who happens to work in another field of endeavour. That's a tremendous concern for individuals currently employed by this province, and I can support their concern.

I believe quite honestly that your remuneration should not be dictated by where you choose to practise your craft. If your craft is going to be applauded for the contribution you can make, it should not matter. Certainly that's my position. It should not matter if you wish to practise your craft in an environmental health office or in an alcohol and drug treatment centre. If you have skills that you're being remunerated for, I believe the skills should be considered more than the location. Is that also your feeling?

Hon. E. Cull: Yes, I certainly believe that people should be paid for the work they do, not necessarily the employer they happen to be paid by. One of the things this will achieve is greater flexibility in our being able to move skilled professional health care workers from one part of the system to the other, because there will not be artificial barriers created by pay differentials.

L. Reid: There has been much discussion today about community health centres. It's my understanding that we're going to move towards a provincial health council that, once it has been formed, will be responsible for assessing, prior to implementation, the impact on health of all new government initiatives, regardless of origin, and will thus complement the post hoc role of the provincial health officer. Is that a direction we will be moving in under the regionalization plan? Will our provincial health officers form a provincial health council?

Hon. E. Cull: No, they're not at all related. The provincial medical health officer is going to be given an expanded role, something like the surgeon general's role in the United States. Legislation will be coming forward this session to deal with that. The attempt here is to give this person more independence and a greater voice in speaking out on issues of concern to public health in the province. The provincial health council is quite separate.

It was a recommendation of the royal commission that a public body be appointed with a very broad mandate to look at health issues well beyond the Ministry of Health -- looking at the social determinants of health and being able to comment publicly on the policies of government and how they affect the general health of the population. Again, legislation will be coming forward in this session. This body will monitor health issues, promote public awareness and issue a report card to us on an annual basis so that we know whether we're making progress in improving the health of people in the province.

L. Reid: Certainly there has been much discussion in the field around the role of the ombudsman as it pertains to health care. This afternoon I would be interested in some comment on the additional cost for the ombudsman in B.C. to tackle health care issues, to tackle hospital-related issues. Is indeed that a reasonable assignment for the role of the ombudsman? Does the office have reasonable time at its disposal to attack health care issues?

Certainly I appreciate that it's important to have that function available to the public, but my understanding is that we have not decreased the wait-list for people receiving service from that office, and the number of individuals seeking counsel is mounting by the day. I'm not convinced, if the original intent was to reduce the frustration level of people not able to receive an answer on a particular health matter or facility, that we've solved the problem.

Are there plans in place to ensure that we are able to streamline the ombudsman process, if indeed we are going to make that available to the general public as a problem-solving entity? Will it be effective, and is it being funded to be effective?

Hon. E. Cull: When the Ombudsman Act was originally enacted by this legislature, there were sections that covered not only professional bodies coming under the ombudsman: hospitals, schools,

[ Page 6114 ]

colleges, universities, and a number of other organizations that were always contemplated as part of the legislation. Some of that has come into effect this April, some of it will come into effect in October and some of it will come into effect in later years. So it was always contemplated that the ombudsman would have a role in this regard.

In the discussions I've had with the ombudsman's office, I know one of the things they have been working with over the last year is to ensure that the institutions themselves now coming under the purview of the ombudsman have good procedures in place to deal with complaints that come forward -- hospitals having their own "ombudsprocess," if you like, in their own institutions.

Having a good process in place to deal with complaints initially can reduce the number of complaints that come forward to the ombudsman. You'll have to direct those questions -- what will be the cost, is there the staff available, what will be the impacts? -- when we get to the ombudsman's estimates. I had a quick glance -- there is certainly an increase in their budget, a significant increase this year -- but I would not dare to speak on behalf of the ombudsman's office when it doesn't fall into my area of jurisdiction.

L. Reid: I appreciate the comments. My purpose in asking was to reflect the interministerial nature of the health care enterprise, because I do believe that the ministry has some responsibility for the role of the ombudsman. I can concur with the minister when she talks about the regulatory bodies having the right to address the issue. Certainly that's my understanding: they will only step in once the professional bodies have exercised what abilities they have at their disposal.

Where that falls apart, where that breaks wide open, hon. minister, is in the case of John Evaniuk that we discussed late last week, because the role of the ombudsman in that particular case was simply to say that the regulatory bodies had met.

Let's use a specific example. In the case of the college of dental surgeons, I would expect that the role of the ombudsman would have more teeth, would have more weight behind it than simply to say: "Yes, those bodies have met and they did not reach a decision. Thank you very much for your letter." My question is: is that all there is? Is there some way we can direct some greater understanding of what kind of process, what kind of enablers the ombudsman's office has at their disposal?

Hon. E. Cull: The ombudsman will not have authority over professional bodies until the fall, so the review that the ombudsman did of the John Evaniuk case was not made with any authority to review the decisions of professional bodies. I have to assume that the involvement of the ombudsman's office was with respect to things they would have had responsibility over -- any ministry interface in the whole thing. Yes, when the ombudsman's authority is extended, they will be able to deal with issues, I hope, in a much more satisfactory way than in this particular case that you've brought to our attention.

But the ombudsman did not have any authority, and continues not to have authority until later on this year.

L. Reid: Am I hearing the minister say that there's not a lot of value in recommending people to that office until there's some teeth in the legislation this autumn, the autumn of 1993?

Hon. E. Cull: I'm not going to comment on whether there's value. Ombudsmen can't deal in matters that are beyond the jurisdiction granted them by legislation. If you want to take an issue to the ombudsman right now -- say a municipal council decision -- I don't know whether the ombudsman will hear that decision or not. But should they, they still have no jurisdiction in that area.

On the other hand, if you go to see the ombudsman on an issue that pertains to the Ministry of Municipal Affairs, the office has jurisdiction and can make recommendations that are very specific. It can get quite involved in resolving disputes between the individual and a body that the ombudsman has jurisdiction over. As soon as the jurisdiction has been expanded, I assume that a similar situation would apply.

Hon. Chair, I'm very uncomfortable about explaining the role of the ombudsman when it does not fall under my jurisdiction.

L. Reid: I appreciate the minister's comments. The role of the ombudsman was expanded, however, to include hospitals and statute based professions under the health care professions. There is some carryover to the Ministry of Health. Certainly that is the public understanding and the written understanding of the ombudsman's office. If that's not been translated clearly enough, we can certainly continue this discussion at a later time.

The Chair: Hon. minister, I don't want us to go on divergent streams here if we can avoid it.

Hon. E. Cull: I don't want to prolong this at all. For example, the courts have jurisdiction over professional bodies, hospitals and over things to do with health care. But even though the courts have jurisdiction, and they can say things about health care, it is the attorney to whom you have to direct your questions about the legal system or the court system.

Similarly, while the ombudsman now has jurisdiction over hospitals, and soon over professional bodies, queries for the ombudsman about the role of the ombudsman's funding, staffing or how they plan to carry out their activities, are not within my ministerial portfolio. I may have interest in it, but I would certainly be stepping well beyond my abilities.

[3:00]

It is being pointed out to me that we are dealing here with a specific vote, and this vote does not deal with the ombudsman.

An Hon. Member: That comes later.

L. Reid: It always comes later, hon. minister.

I believe the discussion was relevant because there are tremendous frustrations out there resulting from what the public perceived as something new. If those

[ Page 6115 ]

powers aren't in place yet, that message needs to be relayed to the public. Does this minister have any plans to do that? I understand now that the ombudsman's office has some role in hospitals. Will the general public be made aware of the ombudsman's role once it's expanded in the autumn to include other jurisdictions?

Hon. E. Cull: The role of publicizing the services of the ombudsman is the ombudsman's job. It's in the ombudsman's budget; I can't comment on whether they're going to spend money to advertise or provide information on this in any way. Certainly I will encourage them to make their newly expanded services known. But I can't answer your question. It has to be put to the minister responsible for the ombudsman.

L. Reid: On Thursday, April 29, 1993, the Leader Post, the paper in Regina, Saskatchewan, touches on probably what we are immersed in in debate today. It begins by: "Following the longest and fiercest legislative battle of 1993, the Saskatchewan MLAs have passed the Health Districts Act. Wednesday was the last day for MLAs to debate the bill under a time allocation motion.... That motion required a final vote...."

There's an interesting comment in here. It says: "'The government can muzzle the opposition here in the Legislature, but I don't think the government can muzzle the people of Saskatchewan'." This is a comment with respect to what is currently happening in Saskatchewan in terms of regionalization. It certainly is the discussion on this coast in British Columbia in terms of whether or not we're going to be replicating similar approaches to the delivery of health care.

We have been in debate most of the day on regionalization. I can appreciate your earlier comments in terms of where we are. I would appreciate a comment about whether or not, in your judgment, there's any similarity between what is currently being proposed for British Columbia and what has obviously been passed in Saskatchewan.

Hon. E. Cull: I'm very familiar with what we are proposing to implement here in British Columbia; I'm not particularly familiar with the details of what they have just passed in Saskatchewan. But as I said the other day in the estimates, unlike Saskatchewan, we are not closing 51 small hospitals; unlike Saskatchewan, we are not raising the Pharmacare deductible for families to $1,700 a year; and unlike Saskatchewan, we have not delisted services under the Medical Services Plan.

I fail to see any similarity between what we're doing here and what they're doing in Saskatchewan, except that we're both pursuing health care reform and regionalization initiatives. This is British Columbia. What they do in Saskatchewan, I suppose, represents their viewpoint of the needs of their citizens and province.

L. Reid: I'll make one last reference to the

article of Thursday, April 29. It says that there are many unanswered questions in the province of Saskatchewan about "job losses, the economic impact of the cuts on communities and the future of long term care of the elderly...." Certainly those are the same frustrations and concerns shared by the majority of British Columbians surrounding what this Minister of Health intends to put in place in this province.

I believe that we have touched on the first aspect of that: the economic impact. We've looked at the HLRA. If we can shift into the future of long term care for the elderly population.... Admittedly my hon. colleague for Prince George-Omineca touched on that this morning, but I still think there is tremendous confusion in terms of the public's perception of how this Minister of Health can separate out the housing costs from the health care costs.

The minister continually makes the comparison between seniors' housing and extended care. I would submit for the record that there is no reasonable comparison to be made there. One is an issue of people who are fairly independent and mobile; they are able to come and go and make some choices for themselves. In a lot of extended care situations, that is simply not something they have at their disposal. I'm not convinced we're comparing apples to apples when the minister makes those comments. I see them as very distinct and separate services. For discussion purposes, I would submit that we need to be more involved in the

definitions of housing and health care. I'm not convinced that it's possible to separate out those two entities as they currently exist. Can the minister shed some light on that?

Hon. E. Cull: I'd be very pleased to do that. We are able to estimate accommodation costs. In fact, the total accommodation costs in long term care are $1,241,902. If you divide that by the number of beds available and by the number of days that accommodation is provided, you would come up with $34.02 a day as the average cost of providing accommodation. That accommodation includes dietary; housekeeping, laundry, maintenance and relief staff, and benefits for those staff; and food, utilities and supplies. So we can very easily separate out the housing component from the health care component in a long term care facility.

With respect to the comparison between a senior living in a long term care facility and a senior living in B.C. housing, which is subsidized by the taxpayer, I agree that the individuals will be different in terms of their mobility, the kinds of things they are able to do for themselves and the things they have to have others do for them. That is precisely why there is such a high level of social and health care programs provided to those in long term care facilities, in addition to basic accommodation.

If you take a B.C. senior citizen who is over 65, who is making $20,000 a year as their gross income, who is not disabled, who does not have a spouse over the age of 65 and who does not still have dependent children -- a senior citizen with the fewest number of possible deductions under our criteria -- and put that senior citizen in a B.C. senior citizens' complex where they would be paying rent geared to income, they'd also be responsible for their other day-to-day living expenses such as food, laundry, utilities, insurance, transportation and, where applicable, Medical Services Plan

[ Page 6116 ]

premiums. That individual will be paying $32.22 per day for those services, for their room and board, the utilities, food, etc. that are calculated in the $34 a day figure I just indicated to you.

Take that same senior citizen earning $20,000 a year, having the same circumstances -- no other deductibles except for their age being over 65 -- and put them in a long term care facility where they're paying $34 a day. For that they're receiving not only their shelter, food, laundry, utilities, insurance, transportation and MSP where applicable but they're also receiving other services like available social programs, transportation on outings, etc.

It's also important to note that the person who is living in the B.C. housing project, paying $32.22 a day, may have additional costs that I have not here calculated into their concerns: for example, home support, attendance at an adult day care, Meals on Wheels, and recreation and entertainment, all of which would be provided to that individual living in the long term care facility.

By taking those two individuals and working through the calculations of their income and their costs in each case, I think you can see that they are being treated very fairly, recognizing their difference in mobility. The senior in the long term care facility, for pennies more a day, is getting all of the additional services that might be provided through Meals on Wheels, adult day care, trips, outings, social programs, bridge, painting, and all the kinds of things that go on in long term care facilities.

L. Reid: The confusion and frustration in the field looks at the small extended care facilities. From your comments, you see separating out those costs as something that's very easy to do. The smaller health care facilities do not concur. Frankly, they are now not able to separate out the housing costs from the health care costs, and they base it on a number of different points. There are issues arising from the private sector where we already have individuals paying a room differential; $6 on top of the existing $23 for a semi-private room and a room differential of $9 on top of the $23 for a single room.

Those individuals in private extended care situations are, I believe, currently receiving $58 a day. Under your breakdown, that would allow $43 a day to go to accommodation and $15 a day left for health care. For those individuals who require ongoing health care, $15 a day is simply not enough.

The minister's comment is that they don't pay for it. At the end of the day somebody does pay. There has to be some consideration for the folks who have the room differential built into the process. If the minister is frustrated, appreciate the individuals in extended care who do not understand where you wish to go with this. I'm sure the minister has received a number of letters on this question from people who do not understand and do not see the direction you have taken to be fair or just. I'm interested in your comments.

Hon. E. Cull: I've actually received very little correspondence on this issue. I have been monitoring it because I am concerned about it. I have a number of long term care facilities in my riding and have visited all of them. I made a point of talking to the president of the residents' association where that person was available. The presidents of the residents' association and indeed the residents I have talked to have raised very little concern with me about this.

With respect to particular institutions determining their accommodation costs, they're not asked to do so. They don't have to do so. We're dealing with a provincial average.

With respect to the amount of money left over to pay for health care for somebody living in a long term care facility, let me repeat again: they do not pay for their health care. It is universal. It is provided 100 percent by the taxpayers of this province.

In fact, the person who lives in a long term care facility is better off in terms of health care than the person who lives in a long term care facility is better off in terms of health care than the person who lives in a seniors complex or lives on their own in private market accommodation, because they don't have to pay for any of their medication -- prescription or otherwise -- incontinence pads, laundry and all kinds of things that the person living alone or in another complex without a health care component would have to pay.

But let's again look at what the impact is at the end of the day. The senior citizen who makes $20,000 a year and pays $34 a day in a long term care facility -- and you have to make $20,000 with the least number of deductibles to be able to pay that $34 a day; otherwise you have a much lower rate, reflecting your lower income -- has $382 left over at the end of the month for personal expenses. That is after they have had their accommodation, food, all incidental necessities, health care and social and recreational issues covered.

I dare say that there are very few families in this province that have that kind of money left over at the end of the month, after covering all of those incidentals, that they can spend on things.... I have to say that people living in those facilities don't have a great need to spend lots of money at that point.

So in terms of disposable income, I think we've been very, very fair. Indeed, the situation improves for people who have higher incomes or, if they happen to have a spouse or are disabled, have more deductibles. I think that it is a very fair situation. It certainly puts that person in much better circumstances than previously when the senior who was living on old age security and guaranteed income supplement had $126 a month left over and everyone else had considerably more.

Now we're asking people to pay for their accommodation based on their ability to pay for housing, for the room-and-board portion they would have to pay no matter where they lived. The vast majority of seniors that I've talked to, including the representatives of the six seniors organizations that met with my staff prior to the implementation of this decision and the representatives of the three health care facility organizations that we also consulted with, agree that this is a fair approach to providing these services to seniors.

L. Reid: In that the minister has cited an example, let me cite an example as well where the numbers are

[ Page 6117 ]

vastly different. Perhaps comment on this particular example will shed some light on the confusion that's in the field. The individual seniors in this province are not reassured, and the individuals attending conferences are not the ones this directly impacts, hon. minister.

[3:15]

The provincial government has hiked the daily rates for residents of long term care facilities by 47 percent. That's certainly the understanding in the field: the rates have gone up by 47 percent. Most folks cannot abide by that. Certainly that impacts heavily on those folks with an adjusted net income in excess of $17,000. You based your comparison and comment on a $20,000 income. Let's take the $17,000 and work it through.

The studies here indicate that the rate increases will impact on 40 percent of the seniors, and 95 percent of those will have to pay the single accommodation rate of $34 a day. The provincial government's daily rate has increased from $23.10 to $34.00 for those with an adjusted net income in excess of $17,000. If that is not a true statement, we can certainly have that discussion, but I think that is a very valid comment. This is an increase of 47 percent. The adjusted net income, as stated by the provincial government, is the subsidized rate used for MSP, which has remained unchanged for a number of years.

This would leave the resident with $1,464 annually to cover living expenses. You were citing the case that $126 a month was not a great deal of money. This is $122 a month. This is not a reasonable exercise, and it bears little comparison to the example you have just given.

We are looking at $17,000 and an entire list of items that are not currently covered. This individual with $1,464 in a calendar year would not have the dollars at his disposal to cover a majority of these items. Certainly you and I have discussed the Pharmacare situation, where a number of items are now going to require hard cash to purchase. Medical expenses not covered include: a podiatrist, non-prescription drugs, dental, physiotherapy, prescription glasses, hearing aids, orthopedic shoes. The list goes on in terms of things that people may need to purchase on their $122 a month.

Perhaps we can begin the discussion at the 47 percent increase. Are you somehow suggesting that that is not a valid comment?

Hon. E. Cull: For some individuals the increase has gone from $23.30 to $34.00 a day. If the member tells me it's 47 percent, I'll accept her figures; I haven't done the percentage calculation. It does affect about 33 percent of seniors in long term care facilities. The figure she quotes -- $122 a month being left over -- is incorrect. Even the poorest senior citizen in this province who is receiving only old age security and guaranteed income supplement -- which is an income of $10,021.08 per year -- has, at the end of it all, $126.38. So your calculations are in error, and I would be happy to have my staff sit down and work through the examples with you.

With respect to the person who lives in the long term care facility who is not eligible for the things that have been delisted, let me point out to the member that those who live in long term care facilities are covered by plan B, not by plan A. Plan A is the seniors' plan, and some drugs which have been delisted will affect seniors and families under plan E. Plan B provides not only many of the things that you or I could get under the Pharmacare program, but a whole list of other things that are provided through a different payment

schedule to the pharmacists who work in long term care facilities. Nonprescription drugs are covered under that plan.

Some of the services she mentioned that would not be covered would not be covered outside of the long term care facility either. In many cases long term care facilities arrange for dental hygienists to be available, sometimes for dentists to be available and for the services of other health care professionals. I would rather not spend a lot of time arguing here about the numbers, which I have spent considerable time going over with staff, making sure that we understand the exemptions, working through the examples. I do know for a fact that $126 is the amount that existed prior to the change.

I can't give any credibility to your lower figure. Rather than belabour that here, I'd be happy to have staff sit down and walk you through the financial calculations on this.

L. Reid: I appreciate the minister's comments, but if the minister would even calculate one month -- 30 days at $34 a day -- that exceeds the $10,000 that you just indicated was a reasonable exercise. And I was really disconcerted to hear you suggest that you weren't aware that it was a 47 percent increase. When is 47 percent ever justifiable? I'm not convinced that you've reassured anyone this afternoon. You have simply contributed to the frustration around the issue. Why would 47 percent ever be a reasonable increase in health care costs in this province?

Hon. E. Cull: First of all, we're not talking about an increase in health care costs. Let's be very clear about that. We're talking about housing, meal preparation, food, utilities, transportation, insurance and the like. Health care in this province continues to be universal -- 100 percent paid for by the taxpayers -- and the health care that's provided to people in long term care facilities falls into that category. It's of extremely high quality. No one earning the minimum income of OAS and GIS -- $10,021.08 per year -- is paying $34 a day, hon. member.

You don't seem to understand the concept of a sliding scale on ability to pay. Those people at the lowest level continue to pay the rate of $23.30 a day. In fact, when the MSP premium increases on July 1, there will be considerable improvement to people in that category, because there will be more people paying the lowest rate available. The $34 only applies to seniors who have in excess of $17,000 net adjusted income. For a senior to have $17,000 net adjusted income, they have to be earning $20,000 gross. If you happen to have a spouse, you have to be earning $23,000.

If you happen to be disabled, you have to earn $26,000. We are talking about incomes which are not excessive. Given that the people who are living in those facilities have all their needs met with the exception of clothing and toiletries, gifts for family members and perhaps the occasional

[ Page 6118 ]

non-prescription item that they may decide to purchase for themselves, I think $382 a month left over at the end of the month isn't bad.

I think there are a lot of families out there that would like to have that kind of money left over at the end of the month after they have paid for all those things. If you're suggesting that asking these seniors to pay their fair share so that we can continue to provide expansion in home care, in home nursing, in long term care facilities; so that we can continue to provide education for kids and make sure that we're not wasting our dollars -- if you're asking us to make those kinds of decisions, then I don't think you're listening to the people out there.

L. Reid: I'm asking the minister to think this issue through very clearly. She was very adamant moments ago, saying: "No, no, no. These aren't health costs; these are living costs." Again the same question: if you're going to say living costs, why is it ever appropriate to give a senior an increase in their living expenses of 47 percent?

Hon. E. Cull: Because we consulted with six seniors' organizations and three health care providers' organizations, gave them the problem that we faced this year in our health care budget, and this was their recommendation.

L. Reid: I have extreme problems with that. You have difficulties, in terms of priority, that somebody's housing is going to be increased to pay for someone else's health care. You are trading off here. If you're going to trade something off, trade off the fair wage package for the construction industry. Do not trade off on the seniors.

Because I can assure you -- and I'm happy to share the correspondence with you -- that there are a number of individuals in this province who are not reassured by your comments today, who do not have $17,000, do not have the $10,000 that you speak of, and who will be living on appreciably fewer dollars. The issue is far from being resolved, hon. minister. I would ask you to somehow address a means test. How are you going to decide? Is there a means test in place that determines the rate between $23 and $34? How is that decision reached by your ministry?

Hon. E. Cull: I'm actually glad the member asked that question, because it is being determined by either having them apply for Medical Services Plan subsidies -- whether they need them or not, we can get them to go through the application and determine that -- or having them fill out an income tax form.

One of the benefits of having this procedure come into place is that we've discovered that there's a whole pile of seniors out there who are not making tax returns but should have been because they would get money back; who were not getting a guaranteed annual income supplement because they didn't know they could apply for it; and who were not getting subsidies on medical services premiums because they didn't know they were eligible for them. In many cases we've uncovered benefits for seniors by having our continuing care staff help them work through their financial situation.

So some of these people are better off as a result of having gone through the calculations than they were in the first place.

L. Reid: If indeed the justification for a means test on seniors in the province of British Columbia is to indicate that they may have benefits at their disposal, I can only submit for the record that the Ministry Responsible for Seniors has not been covering off their jobs. If indeed their jobs were to ensure that the individuals knew what benefits could accrue to them and how best to apply for those benefits, obviously there are communication links that are just not happening that we need to ensure are put in place. I would trust that there are stronger communication links than a means test for seniors in British Columbia. Comment. Question.

Hon. E. Cull: I don't know the number of senior citizens living in British Columbia, but if the member is suggesting that it is the responsibility of the government to meet with each and every one of them to ensure that they are filing income tax forms and getting all of the benefits that they are eligible for, I disagree. I don't think we have the budget to do that; I don't think that's the mandate. The member doesn't understand the role of the office for seniors in the Ministry of Health.

It is to coordinate seniors' services between ministries and to work with seniors' organizations to make sure that their needs are met. We are not a direct service agency that provides services to seniors. Indeed if you want to see a large increase in the FTEs in the Ministry of Health, start promoting that.

L. Reid: What I would like to see is reasonable service delivery with a reasonable rate of increase. Forty-seven percent is not reasonable; 47 percent has not been justified here today. We've seen this minister walk around the issue, but we have seen no justification for an increase to that extent.

The minister will have us believe that somehow the means test is going to turn out to be a good thing. There are a number of individuals in this province who will not support that notion. If that is where the discussion stops today, please know that I will be happy to provide the minister with all the documentation that does not fall into the neat, clean, tidy, precise categories that she listed today, in terms of individuals who'll have no issue surviving on the dollars they will have at their disposal. There are sufficient numbers of individuals in this province who will have serious problems, and the fact that we are not ensuring some comfort zone for seniors is reprehensible at best.

K. Jones: I have a series of questions that I'd like to address to the Minister of Health on these estimates. A lot of them are related to my own riding area, but some of them are of a general nature. One of the ones that's of a general nature is with regard to the first-responder, first aid training program that the minister made a decision through her ministry to curtail. Could the minister tell us what the current status of that program is at the present time?

[ Page 6119 ]

Hon. E. Cull: The training, both for paramedics employed by the B.C. ambulance service and members of CUPE, and first-reponder trainees who are fire department employees of municipalities and members of the firefighters' union, has been suspended for six months to prevent layoffs in the ambulance service. This is a result of the budget increase this year, which is about 3 percent -- 103 percent over last year's. So there's a 3 percent increase in funding to the ambulance service, but that is not sufficient to deal with the inflation and population growth without trying to find some efficiencies.

We looked at service curtailment and decided that was not acceptable. We looked at reallocation of dollars from other programs within the ministry and found that, in terms of priorities, we didn't have an awful lot that we could accomplish there. In the end, we dealt with the employees and arranged a six-month suspension of training to effect cost savings. It will resume in six months' time: people who are now in the process of training, who are ready to write exams, will be able to complete. There are 200 trainers and many hundreds, if not thousands, of firefighters who have been trained in the first-response training, and after a six-month period, they'll be able to resume that training.

[3:30]

K. Jones: I'm not quite clear on what you were saying about the reason for having the curtailment. I understand that it was generally going to be a year-long curtailment, and that you've reduced it now to six months. Are you saying that the curtailment is to accommodate a cost saving? What is happening to generate this cost saving? Have you laid off the training staff at the training institute?

Hon. E. Cull: It's the Justice Institute of B.C. that you're trying to find the name for. It is cost-saving; it was always six months. Some confusion about first-responder training was clarified as a result of it coming into some discussion between the firefighters and the ministry. The decision about the curtailment of training had always been six months, though, and we cleared up the confusion. With respect to what the savings will be: the money will be saved because we will not be paying for the courses to be offered. We won't have to pay the course fees to send firefighters to first-responder training for that six-month period.

K. Jones: Does this mean that the people who were also doing the training at the Justice Institute are also being laid off for that six-month period?

Hon. E. Cull: No.

K. Jones: If there isn't any layoff, you're making the saving by not sending staff on the course. Most of the people on those training courses would be from the lower mainland area, because that's where the largest number of professional firefighters are located, so the costs are really minimal. I think that's self-evident. Many of the communities around the province don't get this type of training, because they don't have professional firefighters on staff. Most of them are manned by volunteers, and therefore the real saving is fairly small.

Do you have a figure that you can actually say was saved by not sending professional firefighters to the Justice Institute for class training in the first-aid program?

Hon. E. Cull: The savings for the first-responder portion, which is a smaller portion of the training, is $75,000. That's a six months' saving. You will appreciate that I could hardly suspend training for the employees of the ambulance service while continuing to fund training for municipal employees, so we're treating them all the same. The total savings for suspending the training is about $850,000. It's not an insignificant amount.

K. Jones: Minister, I can't agree with you in your decision that you figure you can't....

The Chair: Excuse me, member. Just before you proceed, may I remind you that your comments should be directed through the Chair. We don't deal directly with members across the aisle.

K. Jones: To the Chair, I have difficulty with the minister's response that she can't make separate decisions between two groups. There is a very different status of the first responder and first-aid training that our firefighters are getting. In most cases they are the first people on the accident site or at somebody's home. They're the ones who need to be trained to give the type of treatment that will carry them until the ambulance people get there with their much greater training and more highly skilled talent and the equipment to go with it. I think it's very important that this program not be curtailed.

I really want to impress upon the minister the fact that she is not gaining a single thing out of cutting this back. It's interesting that her ministry's response to the fire chiefs' association of British Columbia was not on the basis of cost saving; it was, as they say, as a result of a review of the current program to be undertaken in concert with an overall review of paramedic training programs that is taking place at the present time. Once this review has been completed, first-responder training by the paramedic academy will once again commence. This seems to indicate that it's just for a study.

Why would you cut a program that is vital to the safety of the people of B.C. just to handle a study?

Hon. E. Cull: While the programs are in suspension, we are going to be evaluating them and restructuring them, making sure that the money we spend on training paramedics and first responders is indeed being spent in the right way and giving us the best value. This program is suspended for a six-month period. It means there will be no new starts in a very short period of time. As I said, 200 trainers are still available to train people. Over 4,000 firefighters have already received first-responder training, and there are thousands of ambulance attendants who have very high levels of training.

[ Page 6120 ]

We would like to restructure the training programs and make sure that they are as beneficial as possible to the people being trained and to the people who require their care. The alternative was a reduction in service this year. I didn't find that acceptable. In taking that to the paramedics union, they agreed that it was an acceptable arrangement, that it was a reasonable tradeoff.

I think that for that amount of money -- which, as I said, is not insignificant -- if we can keep those paramedics working and saving lives for a short period while we have another look at the training and while we save the money by not training for six months, that is a desirable option. I have discussed this at length with the firefighters' association and with fire chiefs, and I don't find a lot of disagreement there.

Everyone would like to see the training going on. Sure we would. Nobody wants to see any cuts anywhere. Everyone tells us that we should be saving money, spending smarter and cutting taxes. "But don't cut the area that affects me." If we're going to do that, we have to make some decisions. The cuts have to come somewhere. I don't have several million dollars worth of administrative overhead that I can cut without having any impact on anybody. It does have to come out of services and programs like this. We're trying to find the ones that will have the smallest impact for the shortest period of time. In the scheme of things, I don't think this is an unreasonable decision.

K. Jones: The ministry is quite capable of looking in their budget for the small amount of money that we're talking about. There really isn't a lot of benefit to curtailing a program that will be restarted in six months' time. It just creates a bit of a scheduling problem for the program, more than anything else. There's no cost saving with regard to this particular provision for the firefighters. Going to the ambulance union to ask them whether they're in favour of a cut to the firefighters training program is really irrelevant. It has no bearing on them whatsoever, nor should it.

Surely a reduction in the Premier's travels for a day might provide all of the necessary funding for this program, if you need that kind of funding. Or maybe you should stop one of those straw-building programs that the Minister of Women's Equality had for her staff. I'm sure that there are plenty of programs within the ministries of your colleagues, if not within your own ministry, that could provide plenty of funds to accommodate a program that is vitally essential to the people of British Columbia. The minister really needs to look closely at this one and come back with a much better response than we've heard today.

I'd like to go on to another area that I want to clarify. Does the ministry provide the funding for the Boundary Health Unit?

Hon. E. Cull: Yes.

K. Jones: Does the minister know the per capita level of funding for the Boundary Health Unit, and does she know the status of that per capita funding in relation to rest of the province?

Hon. E. Cull: I don't know the specific per capita amount of funding for the Boundary Health Unit. I do know that because it is one of the fastest growing parts of the province, on a per capita basis it is underfunded relative to other parts of the province.

K. Jones: Would the minister agree that the boundary health area, the Surrey-White Rock area, receives the lowest per capita funding in the province?

Hon. E. Cull: I just said that I can't confirm that. I do know that it's lower than the average in the province because of the rapid growth rate there.

K. Jones: Reports that I've seen indicate the Boundary Health Unit is the lowest of any health unit in the province on a per capita basis. What is the minister going to do to rectify that and allow accommodations for the Surrey area in the way of health needs? We have serious problems in health needs that the Boundary Health Unit is forced to address with an understaffed unit. There are serious problems of growth. We have serious problems of urbanization and encroachment into the agricultural areas.

These have brought along with them the need to test extensively for the ability of the groundwater to maintain a healthful water supply for individuals. A large number of people throughout our municipality still rely on wells because of the inability of the area to extend water services to every part of our community. There's a real need for the Boundary Health Unit to have the staffing to be able to accommodate the demands on them. What is the minister doing to try to rectify this?

Hon. E. Cull: In the fast-growing parts of the province it's quite clear that staffing in the past has not kept pace with population growth. Last year, when we made a 25 percent increase in funding to community and family health, including the public health services that are provided by Boundary Health Unit, we were able at long last to start to address some of the population discrepancies -- what we call the demographic portion of our funding -- not having been able to keep pace with the growing population. This year the increase in the Ministry of Health's budget is 4 percent.

We have been over it in these estimates that 7 percent would be necessary to keep up with population growth and inflation. That isn't in the cards this year.

Obviously the opposition is in its spend mode today instead of its cut-programs mode. We're not able to make a significant difference in rectifying that problem in a budget year that sees us with an overall increase of 4 percent to the Ministry of Health. Nonetheless, we do recognize the tremendous pressures that are on health units such as Boundary, and the increase in funding to community and family will be 8 percent this year.

[3:45]

We have reallocated money out of hospital budgets and the Medical Services Plan budget once again to try to address those very real needs that I certainly know full well in that area. I agree with you, hon. member, that they need to be addressed. That community has been struggling to catch up, but it's something we're not

[ Page 6121 ]

going to be able to change around rapidly this year. The priority is the community and family health area, but an 8 percent increase isn't going to fix that problem.

K. Jones: The minister says that the Boundary Health Unit will get an 8 percent increase over last year. Is that correct?

Hon. E. Cull: No, I said that the overall funding to community and family health is 8 percent. I don't have here with me the actual funding that goes to Boundary Health Unit, but it would be based somewhat on population and certainly on maintaining the services that already exist.

K. Jones: Could I ask the minister to provide to this House the actual figures for the Boundary Health Unit with regard to its position within the province -- percentage and total increase over last year's budget allocation -- at the next sitting, if she can, or as early as possible within the period of the estimates? Also, can she give us some indication of how she perceives these fast-growth areas can play both catch-up and deal with the rapid increase of their area at the same time as she tends to be balancing the money around the whole province.

It would look like she should possibly be reallocating the money from other parts of the province into the areas of need. I think that Boundary Health has to be identified as an area of need.

Hon. E. Cull: I'd be happy to get that information provided to the member. Since he has joined us rather late in the estimates, I'll point out that the critic did give me a list of topics that we were to cover yesterday and today. This one was not on the agenda, so I don't have staff here that are able to deal with that. Unfortunately we haven't been sticking to the list that has been provided, so it's not possible for me to have staff available to cover all of the various parts of the ministry at all times.

With respect to Boundary Health Unit, as I said, last year when we were able to provide a 25 percent increased in funding to the community and family health, including the health unit services, we did direct the additional funding to those high-growth areas that had the biggest catch-up to do. So Boundary got quite a healthy increase last year in terms of their additional funding.

With respect to this year's funding, I know that it may seem very easy to suggest we reallocate funding from one community to another but all communities are struggling, and I'm not willing to start taking resources away from one community. What we have to do is start to target our funding to those communities that are in greatest need and indeed we will do that this year. But it doesn't make sense to start laying off people in other communities so that we can start addressing that need. We don't have a surplus of these services anywhere in the province.

K. Jones: I'm in agreement with the minister's response that we shouldn't be taking from one community to look after another community. I'm suggesting you're going to have to take from almost all of the communities in the province and put them into a few that are really desperately in need. We have to bring them up to a standard that the other communities are already achieving. Where we've got communities that are well up the ladder, perhaps in the top half of the per capita grants, those communities, I think, are going to have to take some cuts. It may require laying off some people.

I think the minister is going to have to come to the realization that you cannot continue the size of the government services the way they are today; they're going to have to be cut. I wish the minister would come to the realization that that's what's going to have to be done and get on with doing it. You can't keep running the deficit and debt increases without doing some serious cutting of the size of government.

I'd like to address another area, and that's with regard to hepatitis B, the virus which was discussed earlier. I'd like to extend into some of that discussion at this time. Is the minister aware that 50 percent of those who are infected with the hepatitis B virus are unaware of that?

Hon. E. Cull: No, I'm not aware of that.

K. Jones: Documentation does indicate that that's the case, and that is the reason why a proper immunization program, particularly for our children, is so vital. The minister has been asked to do something by my colleague from Richmond East and she has pointed out that the details and the need that's been addressed by the Vancouver Health Unit.... There's a really serious problem there. Our grade 9s and grade 12s, who are coming to a point where they are at high risk from this infection, need to have the protection given to them.

The protection is a rather small-cost item when you look at the benefit that it gives to protecting our children and our future workers. Why is the minister unprepared to take some of the $100 million that has been allocated to her ministry from the Lottery Corporation to provide direct funding of a program that will help protect our community rather than use that money so much for administrative roles and other things that are not directly related to administration?

Hon. E. Cull: The hep-B program was funded from lottery dollars last year, and it continues this year. I'd like to point out that we are the only jurisdiction in North America that has a universal hepatitis B program in place. Prior to introducing it, I don't remember hearing anything from your members about the need for this program and how urgent it is. Now all of a sudden not only do you support the program, which is great -- lovely to have the support -- but you're anxious to see it expanded, even though it has only been in place in the one year.

Hon. member, I'd be quite happy to have another look at the Boundary Health Unit budget to see what we can maybe shift over to hepatitis B programs. I think perhaps that's somewhere that we should be having a look. You can't stand here and ask for more money for this and that and something else without recognizing.

[ Page 6122 ]

Interjection.

Hon. E. Cull: Yes, and then call for cuts in spending and taxes and all the rest of this. This money doesn't come out of thin air.

Anyway, we last year funded the hepatitis B program, and it continues this year for grade 6 plus all at-risk populations, for a total cost of $3.5 million. The proposal from the Vancouver health department would cost an extra $6 million in '93-94, another $6 million in '94-95 and then back to $3 million in '95-96. It's a reasonable proposal -- I don't disagree with what Dr. Blatherwick is promoting -- and certainly I would like to see this program expanded more rapidly than it is right now.

But as I said, we only introduced it last year -- in fact, late last year, in September. The B.C. Centre for Disease Control is currently reviewing that first year's experience, and we will be coming forward next year in our budget proposals with the enhancements. We've been talking about evaluation here and making sure we know what we're doing. It's important that we take this one year and make sure that we are providing the vaccines at the right place. There's actually some discussion that it might make more sense to be providing the vaccines to younger children as part of their overall vaccine program, but some of those things still have to be determined.

I think the fact that we have taken this initiative -- the only jurisdiction in North America to do so -- speaks very well for the province of British Columbia in this regard. We have already begun to protect our young people from a fatal disease and we'll continue to do so. When we finish the review for this year, I'm sure we'll be able to expand it appropriately next year.

K. Jones: One of the residents of Surrey, Bobbi Bower, has taken the tragic loss of her 16-year-old daughter from hepatitis B as a cause c�l�bre and is bringing this to the forefront. I think it's because of her hard work that the ministry has reacted and started a program. That program is a good start, but it needs to be extended. All of us should be willing to accept that this is good use of money. Not necessarily all of the expenditures within the ministries of this government are good forms of expenditure, but this is the kind of expenditure that benefits society and immediately benefits our children.

In light of the fact that it only costs $10 a dose, and it takes three treatments, three inoculations, is the minister prepared to provide this to individuals who wish to pay for it themselves if the minister can't find it in her budget? Will she let private individuals have the right to inoculate their children for $30? That's the very least she can do if she can't find the money any place else.

Hon. E. Cull: I can't confirm the $10 a dose. It sounds somewhat low to me, although I know that through our bulk purchasing we certainly have brought the cost down. The vaccination is available to individuals who wish to purchase it. It is not available through the Ministry of Health. It is not available on that subsidized basis on the advice of Dr. John Blatherwick and in consultation with Mrs. Bobbi Bower, whom I know quite well and who certainly deserves credit for being tireless in pushing this issue not only to our government but to other governments across Canada.

K. Jones: I would like to follow up on the good work that was done earlier this morning by the member for Prince George-Omineca concerning your knowledge of the extent of hepatitis B. From your responses to him you indicated that there appeared to be not much in the way of information available. Is that what you were trying to get us to believe at that point?

Hon. E. Cull: No, I think we were talking about if certain populations were more likely to have hepatitis B. I simply indicated that I didn't have that information. I would be happy to get it for the member and I'm sure staff are working on it.

K. Jones: I'd like to just help you out a little bit, hon. minister, with some information that I have from the Vancouver health department. It relates to the Canadian incidence of hepatitis B and then states that as British Columbia has 12 percent of Canada's population, this translates into approximately 18,000 carriers in the province. They've got it. This figure could be low because of our ever-growing population of Asians: 90 percent of all Asians have had or do have hepatitis B and 12 to 15 percent are carriers. Considering the huge population of Asia, this translates into an extremely high number. Now B.C. is accepting more and more Asians into the province.

The lab reports each month indicate approximately 100 new cases in the province. Ten percent are acute, and 90 percent are carriers. The interesting fact is that 95 percent of the 90 percent are Asians. Doctors in every community are screening this group. Just looking at the city of Vancouver alone, which has nearly 84,000 Asians who speak Chinese, this means that 8,000 to 10,000 are carriers. Does the minister wish to comment further on those figures?

That information is available through the Vancouver health unit and health department. I certainly encourage your staff to make themselves aware of the information that's available there. The dosage figures were also available through them as were several other bits of information, such as the mortality rate and that sort of thing. I think it would be very useful to be aware of that.

[4:00]

The Chair: The minister chooses not to comment, and I gather that the point is now on the record, hon. member. I ask you to please continue, perhaps on something else.

K. Jones: On another subject hon. minister, just a short while ago the ministry or the government had the opportunity to change some of the membership of the Surrey Memorial Hospital. I believe that some of the

[ Page 6123 ]

members of the NDP, members of the minister's party, were appointed to that hospital board. Is that correct?

Hon. E. Cull: I didn't ask their party affiliations when I appointed them. We consulted with a number of people in the community with respect to people who would be suitable for service on the board, and they were reviewed by the commissioner for appointments and appointed.

K. Jones: Let it be said, for the record, that several of the people appointed were known members of the NDP.

Interjections.

K. Jones: The question I would like to ask of the minister is: what role did the NDP play in forcing the chief executive officer of Surrey Memorial Hospital to resign?

The Chair: Excuse me, minister. Before you respond, I would just suggest that this is rather beyond the pale in terms of talking about the minister's estimates for the administrative costs of her ministry. I certainly have no intention of stifling debate, and, indeed, we have proceeded rather swimmingly thus far. But I would remind members of the committee that we are moving into dangerous territory, so please be cautioned.

Hon. E. Cull: No involvement.

K. Jones: Thank you, hon. Chair, and I accept the fact that you didn't quite follow where I was going -- or would have liked not to have been able to follow -- with this question.

Interjections.

The Chair: I would just caution the member not to tempt the patience of the Chair. Carry on, please.

K. Jones: Yes. The question was very apropos when you look at the next area of concern. Could the minister give us some indication of the amount of severance that the chief executive officer of Surrey Memorial Hospital is going to receive as a result of his forced resignation?

Hon. E. Cull: Just in case the member or anybody else is under the illusion that the Minister of Health operates the hospitals in this province, I will tell him, for the record, that I learned of the termination of the chief executive officer, as a courtesy, only hours before it became public knowledge, so certainly I had no involvement in that and neither did my staff. The severance is a contractual matter between the board and the chief executive officer, again not something that the ministry is privy to, not something that we have any say over.

K. Jones: Well, it may not be privy information to the minister, but it's certainly the headline in the Surrey Leader; it says it's going to cost $200,000. I'd like to just find out from the minister what the average cost is per bed in British Columbia.

Hon. E. Cull: For acute care hospital beds, the cost ranges between $400 and $800 per day.

K. Jones: Four hundred to $800 a day. So I guess a $200,000 settlement would certainly pay for a lot of patient care, wouldn't it? It's a question of where does Surrey Memorial get the money that was decided by this NDP-changed board that chose to create this expenditure, basically by forcing the retirement of the CEO. Is the minister going to provide additional funding to match that $200,000 so that the hospital board there doesn't have to take it out of its funding? Will money be provided to the board so it will not have to take it out of their operating expenses?

Hon. E. Cull: First of all, any severance package required in this case would be part of a contractual arrangement between the CEO and the hospital board. Despite the fact that I think the member is quite off the mark when he talks about party affiliation and the board, it would have been the board members of the day, when the CEO was hired, who determined the contract and the severance package, in any event. Those are matters between a board as an employer and a CEO. They unfortunately appear to be standard in many contracts of senior executive officers. No, the ministry will not be providing additional funding.

K. Jones: I just want to take a moment here to get some further information. Could the minister please give us an indication of how many beds Surrey Memorial is going to get? When I say beds -- and I want to get it clarified -- is she talking about operating funds for beds or is she talking about capital funding for beds, or both, from the close-down of Shaughnessy Hospital?

Hon. E. Cull: As I said earlier today, the list of agenda topics that was given to me by the opposition critic did not include hospitals. I don't have the hospital person here so I can't tell you the number of beds. But my funding is given both for capital and for operating.

[E. Barnes in the chair.]

K. Jones: Is 30 to 37 beds an indication of what you think would be the right figure for operating costs for Surrey Memorial Hospital from Shaughnessy?

Hon. E. Cull: You were referring to the Shaughnessy transfer in your question just before?

K. Jones: Yes.

Hon. E. Cull: I'm sorry, I thought you were just talking generally because there is a major hospital expansion going on at Surrey as well. Yes, 37 beds is the number of acute care beds, and there will also be 20 extended care beds added to Surrey Memorial. There will not be capital funds transferred because we're not

[ Page 6124 ]

building new beds. There will be operating funds as necessary to provide those beds, and there may be staff and equipment transfers and a number of things that are involved in that. The transition report, which we've exhaustively canvassed earlier today and earlier in the estimates, is not yet available. Until the final decisions are out, I can't do much more than indicate what I've done right now.

K. Jones: Is it correct that the unions and the HLRA are having trouble getting a decision on the social accord agreement? That appears to be causing an impact on finalization of hospital board budgets throughout the province. Is the minister aware that this is seriously affecting the boards in their ability to finalize their budgets?

Hon. E. Cull: Yes. Hospital boards have been given an extension, and this matter has been extensively canvassed. I would urge the member to read the Blues.

K. Jones: You mentioned that there were operating funds for 37 beds from Shaughnessy. Where are the capital funds for those 37 beds coming from? Are they up here or are they still to come?

Hon. E. Cull: There is a major expansion planned at Surrey Memorial Hospital, so any capital funds will be coming out of the capital decisions that have been made around the expansion. In the transfer of beds that may be coming to Surrey from Shaughnessy Hospital, there will also be operating funds, staff, and other support necessary to operate those beds, because that money is needed as well.

I don't know the specifics of Surrey but there may be closed beds at Surrey that would be reopened as a result of the transfer of operating dollars.

K. Jones: Does that mean that when the capital program was originally put forward -- there was no funding for operating, and that they were just building a structure, like the Vancouver General, without any way of operating the facilities that were being provided for in the capital program?

Hon. E. Cull: No. Operating funds are identified at the same time as capital funds are provided.

K. Jones: I'll defer to the member for Prince George-Omineca at the moment.

L. Fox: I apologize if I wander into areas that were outside of the agreement. I see that there's only one staff member, and I recognize without staff in specific areas we can't expect the minister to be right on top of everything and have all the pertinent details on the top of her mind. If I do get into areas that you're not familiar with or not comfortable with because of the lack of staff, I will accept an answer at a later date.

The minister will recall I talked a little bit about the Cinnamon Lodge issue at Kamloops. I've done a little more research on that. I'm not going to talk specifically about that, but I did want to understand the process of how these lodges become licensed and at what time they are recognized by the federal government in transfer payments -- or whether or not they are recognized -- because there seems to be some difference of opinion with respect to that. When a private facility such as this lodge is applying for a licence, is part of the criteria of them applying for their licence dependent on the need for beds within that particular community?

Hon. E. Cull: No. Facilities can be built in any number of ways -- privately, with public dollars or a combination. The role of the licensing board -- you'll have to forgive me, because I think the name has just recently changed, the community care facilities licensing board, or as close to that as the name may be -- is to license the facility to determine that it meets certain standards.

If you are placing your mother in a long term care facility, you obviously want to be assured that certain standards are being met, that such a facility is regulated by government inspectors and that people are checking to make sure that services are being provided adequately. So the licensing is around standards, control, inspection and certification of quality of service.

The ministry purchases services for continuing long-term care in a number of ways. We can purchase services from such a facility; we could purchase a number of beds. We would have a contract and agree to pay for the costs, and those would then be subsidized by the provincial government. We can build them ourselves or we could have a contract to have them built. We usually use a tender process. There isn't a direct correlation between receiving a licence to operate and being subsidized by the Ministry of Health to provide the services to clients.

[4:15]

L. Fox: So as an entrepreneur, if I perceived a need out there, I would go through a licensing division of the ministry. But that clearly does not tie the ministry into funding of any beds.

Interjection.

L. Fox: That's correct, okay.

Do these beds ever become recognized in how the formula for transfer payments is developed between the federal government and the provincial government?

Hon. E. Cull: I'm not sure what the member is referring to in terms of transfer payments. In the past there has been some funding through CMHC for some facilities, but that's for capital. There aren't any transfer payments for operating. There is no direct correlation there, so there isn't any federal funding. We did go over this somewhat yesterday, and I was working from memory at that point. Maybe I could provide a bit of extra information on this, which might assist the member. The owner of Cinnamon Lodge requested operational funding following the construction of the facility. In evaluating it, we determined that we do not

[ Page 6125 ]

need additional beds in Kamloops at this time. The owner of the lodge filed a petition with the British Columbia Supreme Court to have funding arrangements with the Ministry of Health reconsidered. The petition was not supported by the court, which ruled that the ministry had in fact treated the owner fairly. So this has been reviewed by the courts.

There's a difference of opinion between the owner and the ministry as to the types of beds that are needed in the area and the types of beds that are provided at Cinnamon Lodge. But as I said yesterday, if we require additional beds, the owner and other interested parties will be invited to present proposals. This is a very fair process, which we use in other communities, and it ensures that it's open to everyone. It also ensures that the ministry is not committed to providing operating costs to an operator simply because they were able to build the facility or open a facility.

L. Fox: I thank the minister for the response. She had given me a response in writing with respect to that. I was trying to get it clear in my mind what the process was for a home such as this to have its beds qualify as provincially funded or subsidized beds. Clearly the information this particular proponent has given me is different from what I received from the minister. I was trying to understand the process, rather than query about the particular lodge.

I asked the question about whether or not there were transfer payments involved with respect to the long term care beds because Statistics Canada lists the number of beds available and suggests that they are part of the equation for the transfer payments. That is, I think, the grey area and the basis on which this individual has come forward to me. Perhaps the minister wants to comment on that.

Hon. E. Cull: It's my understanding that early on in the EPF program there was some tie implied -- at least on the part of the federal government but never accepted by the provincial government -- for the dollars that come through. So they count them that way. I suppose if I were a federal politician and I were cutting back on funding to health care in British Columbia, I'd want to be trying to point to everything that I thought was good, to try to turn that image around. But the EPF, as you know, is gradually being reduced year by year; it will be eliminated by the turn of the century. It is not tied to any particular projects.

L. Fox: I will leave that. Thank you, that has helped me clarify those particular issues in my mind.

I want to get back now to the quality of care within the long term care facilities. We addressed this particular concern a bit earlier, with regard to the fact that the increase in the housing portion of the long term care and intermediate care facilities, up to $34 a day, is only for the housing portion. However, I'm sure the minister will appreciate that many people have difficulty separating what is a housing portion and what is actually for health care. They consider that the whole package is in fact a health care package rather than part of it being a housing package. I accept the minister's rationale with respect to that.

I think what concerns at least one writer I had a letter from is the level of service within a facility. Are there any specific guidelines as to the level of service? For instance, should an individual be able to have their teeth brushed twice a day, or have a bath twice a week, or is that a determination of the board at the local facility?

Hon. E. Cull: There are staffing guidelines, which I'm aware of, but whether they go down to such things as you've just mentioned in terms of frequency of bathing or teeth brushing or changing of sheets, I'm sorry, I can't give you that information right now.

Again, I appreciate your comments at the beginning of your questioning, recognizing that I was not advised we would be dealing with hospitals or continuing care issues today, so I don't have my hospitals person here. Yesterday, when I did have somebody here that I had been told would be questioned, that person sat here for three and a half hours and we never dealt with the topic. I think it's a terrible waste of tax dollars and of my staff time. I apologize that we don't have hospital people here, but we were not advised that we would be dealing with hospitals today. If there are some details like that, I'm sure I could provide them to you. I simply don't know the answer.

L. Fox: Perhaps the minister might clarify whether or not that particular staff resource person is going to be available tomorrow.

Hon. E. Cull: We canvassed hospitals earlier, but if the list appeared with hospitals on it again we probably would go back to it. I haven't seen a list for a few days, but we haven't even gotten to the three items that were given to me two days ago, although, as you know, I had staff sitting here yesterday afternoon waiting for questions. I'm waiting to be advised.

L. Fox: I'm not so much concerned about the level of care in hospitals. I'm more concerned with the level of care in the long term care facilities.

Hon. E. Cull: Same staff.

L. Fox: As I understand it now, we're going to be in estimates tomorrow afternoon again. I know that the critic from the Liberal opposition is suggesting that she's going to have some difficulty being here, so I expect to spend a considerable time on the floor tomorrow. Perhaps I could forewarn the minister. If we're going to have estimates, I would like to pose several questions along those lines.

Hon. E. Cull: In the interests of having a good debate tomorrow, if you have a number of questions, I can make sure we have the answers for you, as well as have the staff people here. Even if you just give us the subject area that you're going to talk about, it always helps. While it's understandable that I'm not familiar with every long term care facility and hospital in the

[ Page 6126 ]

province, my ADM may not be familiar with every last detail as well.

A. Cowie: I have some general questions that relate to my riding of Vancouver-Quilchena. I understand the minister's rationale for the way she's dealing with Shaughnessy. Whether I agree with it is another question, officially, but I understand what's going on. I also understand that Grace Hospital and Children's Hospital need some room for expansion and that only so much density can be put on the site. I'm trying to figure out what's happening to University Hospital, which is on the point side of my riding. It's going to mean more building and more services to that hospital. Perhaps the minister can just explain to me what plans she has for University Hospital, the teaching hospital.

Hon. E. Cull: Could I ask the member to clarify his question. Is he talking about services at University Hospital, the role of the hospital, governance of the hospital? I need a little more direction. Otherwise, I'll ramble on for hours.

A. Cowie: As certain services get transferred out of Shaughnessy, is there a changing role for University Hospital? Let's start with that question.

Hon. E. Cull: Potentially there's a changing role for University Hospital because, until the decision around Shaughnessy, UBC Hospital was part of a two-site organization and one site is no longer going to be there. Some services from that site may be relocated to the UBC site, so that would certainly change its role. We discussed this morning two options that are being considered with respect to governance: whether UBC site stays on its own as an independent institution or merges with VGH. That matter has not been concluded; in fact, there's a consultation process that is still underway on that. Either of those options might result in a role change for the hospital.

If you're getting at some of the rumours that have been going around that it will not be an acute care facility, it will not have an emergency room or it will not have the kinds of services it has right now, let me dispel those, because they are not at all under consideration. We recognize the role of the hospital as a teaching hospital, an academic hospital, and as a community hospital to the west side of Vancouver, and services such as the emergency room and the medical and surgical beds that are provided there will continue.

The configuration may change somewhat in terms of exactly what medical beds, what surgical beds and what comes to it from Shaughnessy. But will it remain as a teaching hospital, an acute care hospital, a community hospital? Yes.

A. Cowie: That makes it a little clearer -- for me, anyway. I wasn't referring to any rumours actually; I was trying to look at it logically. Here you have the hospital way out, some five miles away from where people live. Most of the people who will go to that as a local hospital live in Kerrisdale, Dunbar and the Point Grey area, which means they have to go through the Endowment Lands. Previously a lot of those people went to either the Shaughnessy site or other hospitals in the downtown core area. Certainly when one had an emergency, it was easy to go UBC; in fact, it was always easy to get in, as I recall.

There were always beds, and there were always people there. The hospital is an excellent facility -- that's not the question -- but it's not very centrally located, and I'm looking at it from that point of view.

We're also looking at trying to get people away from going into hospitals if they could go to clinics, as I understand it. If one could get a clinic in Kerrisdale -- let's say at the community centre -- and get another clinic maybe in the Kits area, people wouldn't have to go out to the hospital for a lot of facilities. Is that the general trend we're trying to move into? Can the minister find a question in that?

Hon. E. Cull: No, the minister detects a community planner in all of that. I don't necessarily have any argument with what you're saying. In fact, I think I should recommend that you get involved, as MLAs are being encouraged to get involved, with the community health council process that is going on for the west side of Vancouver. You might find it very interesting, and you would obviously have something to contribute.

We are going to be looking at the overall health services in the area -- not only the hospital services, which are important to sort out as a result of the decisions around Shaughnessy, but the relation between hospital services and community services along the lines that you've suggested.

[4:30]

A. Cowie: That's helpful, because our caucus is at this time grappling with the idea of trying to provide one-stop shopping for a number of services. That isn't my idea; it's somebody else's. But I do believe in it, and it would save a lot of time if those services -- say, health, libraries and all those sorts of things -- were centrally located in a community. So those were general questions, and I want to thank the minister for answering them.

L. Fox: I wanted to get into the area of the first response. I was interested in some of the minister's comments to some earlier questions from the member for Surrey-Cloverdale. It seems to me that one of the number one driving factors in the delay of this process and training procedure is concern by the BCGEU that it's going to have volunteers providing the services historically provided by the BCGEU members through the provincial ambulance service. I really did want to get the minister's response on that prior to continuing in that line of questioning, but if the Minister of Energy is prepared to deal with that question, I will take my seat.

Hon. A. Edwards: I might mention that this is definitely my first response to a question to the Minister of Health. But obviously I can't give you answers to this.

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The minister needs, for the moment, to take a break, so it's my privilege to be able to respond to you, only so far as to say that obviously, the first-response teams are important across the province, as you probably have well recognized. I think that your question may in fact deal with the wrong union. I think you may be talking about CUPE; I'm not sure. If you want to clarify that a bit more, I know that notes are being taken and the minister will get the question as soon as she returns. If you have other questions, of course, you could always get them lined up right now, so that when she returns she can give you some answers.

L. Fox: I do stand to be corrected on the union. Continuing along that particular train of thought, though, and while the minister is out for a brief moment, I can only suggest that this particular service is invaluable to British Columbia. The first-response teams are a very efficient way to meet the needs of British Columbians, specifically those who are in need of emergent care. In Prince George, for instance, I was surprised that the number of responses by the first-response team of the fire department was in the vicinity of 1,600 responses a year.

Obviously it is extremely cost-efficient in terms of a service given to the people of British Columbia for the costs of the dollars to train them. I am concerned about the six-month delay in the training process -- and I think many British Columbians are concerned about that -- and about the signal that delay is perhaps sending to those particular teams as to their value to British Columbia and their place in the long-term priorities on delivering health care to its citizens. I would really like the minister, when she gets in, to respond to those concerns.

But perhaps if the Minister of Energy wants to respond, I'd be pleased to have her do so.

Hon. A. Edwards: It's always a pleasure, of course, to talk about the first responders in our communities because they are our people who provide a really significant service, particularly in areas like mine. The member may not know that in my area we have 24-hour ambulance service but not 24-hour ambulance staff. In these cases, of course, our first-response teams are even more important. We were very happy when the recent firefighters' convention was here in Victoria, and we were able to talk to them about their experience and our experience with this. I know it's important to communities.

Since the Minister of Health is back, I will sit down and let you have an answer to your questions.

L. Fox: I'll just allow the minister a few moments to be brought up to date by her assistant.

Hon. E. Cull: I understand that we've had an interesting debate about first response in my absence. I agree, it is a very valuable service. I think the message we gave to the firefighters when we met with them a week or so ago was very clear. They seemed very satisfied with the explanation and responses that we gave to them. Your suggestion that CUPE was involved in the first-responder cancellation is absolutely wrong. I've got to the bottom of that one, and there was nothing involved with respect to the ambulance union.

L. Fox: I am pleased that the program will be brought back. It's my understanding that there is going to be a six-month delay and that