Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, MAY 12, 1997

Afternoon

Volume 4, Number 22

[ Page 3279 ]

The House met at 2:05 p.m.

Prayers.

Hon. U. Dosanjh: Today in the members' gallery we have a very special visitor from Kenya. His Excellency Hasan Bagha is the newly appointed High Commissioner for Kenya to Canada, and is making his first visit to British Columbia. Would the House please make him welcome.

J. van Dongen: Today I have a number of visitors in the Legislature: Dan and his wife Miriam Wiebe; his son Dion Wiebe and his wife Julie; their daughter Erin Hiebert and her friend Andrea Chatwin. Dan and his family operate a very progressive chicken and turkey farm in the city of Abbotsford. As an illustration of that, a couple of years ago they won a B.C. Hydro Power Smart award for their efficient operations. I ask the House to please make them very welcome.

Hon. L. Boone: Today in the Legislature we have two very distinguished guests: Mr. John Ratel, director of the British Columbia Automobile Association; and with him, Mr. Bill Bullis, president and CEO of the BCAA. Would the House please make them welcome.

B. McKinnon: I would like to introduce to the House, Jerry and Ines Pape. They live in Surrey and are the parents of Lisa Pape, who is the legislative intern for us. I bid the House make them welcome.

G. Plant: I'm delighted to be able to introduce five important people in my life: my wife Janet, my mother-in-law Daphne Read, and my three sisters-in-law, Lesley Dukowski, Jo-Anne Midmore and Shirley Ross. Shirley Ross has come all the way from Aberdeen, Scotland, to watch us misbehave here, and I ask that the House make all of these important people welcome.

M. de Jong: In the gallery today are 20 grade 10 government and history students from Abbotsford Junior Secondary School, with their teacher Mr. Born. They have travelled from sunny Abbotsford, and I can assure you, Mr. Speaker, it was sunny this weekend. I hope the House will join me in making them feel welcome.

E. Gillespie: For the following introduction today I had to arm-wrestle the Minister of Agriculture, Fisheries and Food, and I'm happy to say that I won. I'm happy to introduce today a constituent and friend, Mr. Cliff Boldt, from Union Bay in the constituency of Comox Valley. Would the House please help me make him welcome.

I. Chong: Visiting today in the gallery is a constituent of mine, the past president of the UVic Students Society, Mr. Ian Flemington. Along with him is a friend visiting from Australia, Mr. Dean Griffiths. After an exhilarating weekend of bungy jumping, I assured them that the House question period would be just as exciting. Would the House please make them welcome.

F. Randall: In the gallery this afternoon we have 25 grade 5 students from Stride Avenue Community School, which is a school in the constituency of Burnaby-Edmonds. They are accompanied by their teacher, Ms. Freeman, and some other adult guests. Would the House please make them welcome.

Tabling Documents

The Speaker: Members, I have the honour to present what is entitled the "Ombudsreport 1996" -- i.e., the annual report of the ombudsman.

Orders of the Day

Oral Questions

USE OF FOREST RENEWAL REVENUES

G. Campbell: My question is to the Minister of Environment. When Forest Renewal B.C. was established, it was established to help the lot of all forest workers in all forest communities in the province of British Columbia. When it was introduced, plans were explicit and left no room for question about how funds from Forest Renewal would be used. To quote the government's own plan: "By law, all the net revenue will go directly into renewing our forests. No money will go into general government revenues."

However, an

article in the Northern Voice reports that the Assistant Deputy Minister of Environment said: "Funding from Forest Renewal B.C. and the habitat conservation fund for specific projects should help offset the reductions in the region's base budget."

Will the Minister of Environment confirm that FRBC funds are being raided to offset reductions to the ministry's base budget?

Hon. C. McGregor: FRBC funding is used and accessed through our ministry to provide a number of services around the province, including watershed restoration. There are large numbers of dollars that come through that, and we use that money to provide watershed restoration programming through our ministry.

G. Campbell: The story in the Northern Voice is quite straightforward. The people in region 6 are concerned about the reduction in funding for the base programs of the Ministry of Environment. In that story, the Assistant Deputy Minister of Environment said "internal budget transfers are being made at present," and he goes on to add that funding from Forest Renewal B.C. should help offset these reductions.

Can the minister explain why, contrary to the NDP's promises, the government continues to raid money from Forest Renewal B.C. to pay for general government operations?

Hon. C. McGregor: We use FRBC revenue for a number of projects throughout the ministry, including watershed restoration, resource inventory, and recreation and research programs -- all of which support our objectives as a government to restore the damage that's been caused by long-abusive policies of the forest industry. In fact, we are restoring those forests through those programs, and yes, they are partly delivered through our ministry.

G. Campbell: This government was clear to people in forest-dependent communities across the province of British Columbia: Forest Renewal funds would not be used to fund the general operations of government. The question is to the Minister of Environment. If she first reduces the base budget for Environment and then uses Forest Renewal funds to in fact cover up the reduction in funds, she is using those dollars

[ Page 3280 ]

exactly contrary to the government's own position. Can the minister explain why anyone in a forest-dependent community should trust this government, which consistently breaks its word?

[2:15]

Hon. C. McGregor: There are a number of proponents who deliver watershed restoration programs and restore our forests. As a result of long-abusive practice . . . . Government agencies, including the Ministry of Environment and the Ministry of Forests . . . . First nations are also a large proponent group, as are community groups and licensees. So there are many different agencies that deliver watershed restoration dollars, including our own ministry.

WORKER ELIGIBILITY FOR FRBC FUNDING

T. Nebbeling: The NDP have once again devised a plan to pay off their friends and insiders. The Minister of Forests . . . .

Interjection.

T. Nebbeling: There's the prince of polyester again.

The Minister of Forests has now admitted that the NDP is looking at ways to deliver FRBC funds to companies that only employ union workers. Can the Minister of Forests explain . . .

Interjections.

The Speaker: Please, members -- both sides. I do want to hear the question, as I'm sure you do.

T. Nebbeling: . . . to the thousands of non-union forest workers why this government is planning to exclude them from any FRBC-funded projects only because they choose not to be IWA members?

The Speaker: Excuse me, member. Sit down, please. I believe you asked your question.

Hon. D. Zirnhelt: Hon. Speaker, I think I know what the question was. The answer is nothing different from I said in this House a year ago, when we introduced . . . .

Interjections.

The Speaker: Members, order, please -- on both sides of the House. I'm having real difficulty from both sides, hearing either commentary.

Hon. D. Zirnhelt: The answer is that I have nothing to add to what I said in this House a year ago, when we brought in the bill that said we would give first priority to displaced forest workers. We stand behind that commitment, and we intend to find ways to do that so that we consider the need to hire locally and the need to hire from within both unionized and non-unionized sectors of forest workers.

T. Nebbeling: Well, let's see what happened with that bill that was introduced a year ago. IWA president Dave Haggard, who is also a director on the board of FRBC, wants all of FRBC's $200 million for land-based programs to be spent on union workers. In a speech given to the Northern Forest Products Association, he stated: "You continue to say those workers have got to have a choice, and I'm saying that's bull. We want them unionized and we want them organized."

Can the Minister of Forests tell the thousands of displaced students who depend on summer tree-planting jobs to pay for their education whether their jobs will be gone for the IWA agenda?

Hon. D. Zirnhelt: I think there are a lot of statements in that, but there also seems to be a question.

This year there will be more spent on silviculture in the province than last year, and students will have opportunities to be employed in silviculture jobs as they were last year.

J. Wilson: When the NDP created Forest Renewal B.C., they promised to help forest workers upgrade their skills. Last year FRBC spent $1.3 million to train 150 workers through the Central Interior Logging Association. This year well over 500 forest workers have signed up to receive the same training. Unfortunately for these workers, FRBC has rejected this application for funding. Can the Minister of Forests tell us why skills upgrading was a priority for FRBC last year but not this year?

Hon. D. Zirnhelt: Well, that was quite a question, hon. Speaker -- it was. What this question reveals is that there is demand far in excess of what we can deliver. Every program exceeds our expectations. In the Williams Lake and south Cariboo area, we had a program to train some 150 people, but over 200 went through it. We are putting more people through every program that we set out to . . . .

The opposition seems to think that everybody who applies for any project should be funded. The demand for projects exceeds by about twice what the annual budget of FRBC is, and we're exceeding the expectations every year and in every project.

J. Wilson: Mr. Speaker, the minister should be aware that most of these workers who have been affected by the cuts to this program are non-union workers.

In light of comments made by the IWA president that "we want all FRBC funding programs to go to union workers," will the Minister of Forests tell us why FRBC is singling out non-union forest workers for program cuts?

Hon. D. Zirnhelt: Hon. Speaker, if this member thinks that a successful program to train 150 people last year, which all of a sudden became a 500-person program this year, is a cut, he should do the math again. That program was designed to train loggers in things like the Forest Practices Code so they can go out and do their job. It was very successful.

I can say that not every project is going to be funded every year. In that region there is no singling out of non-union forest workers.

GOVERNMENT POLICY ON GAMBLING

AND SECURITY AGAINST CRIME

K. Krueger: Mr. Speaker, in March this government announced plans to increase revenues from casinos by 1,800 percent. In April the Attorney General admitted that he had done nothing to prepare for either increased crime or court and policing costs flowing from this massive expansion

[ Page 3281 ]

in gambling. Today we learned that in February the gaming audit and investigation office reported ongoing theft by a single casino employee of up to $1,300 per night for almost a year.

My question, therefore, is for the Attorney General. Given the timely report of the gaming audit and investigation office, how could he allow the Deputy Premier to blast ahead with gambling expansion when the present security system is so obviously weak?

Hon. D. Miller: I'd like to first of all thank the member for his question and say that I've missed his critical voice in the last short while. Hon. Speaker, I think he continues to overstate issues, but perhaps through time . . . .

There were some issues that arose at one casino. That was investigated very quickly. The results of that came to us. That was turned over to the Attorney General's ministry. There is a report. We released that report last week. We've taken action already on some of the recommendations with respect, for example, to random inspections. They were monthly; they're now weekly. We've completed a new volunteer orientation program.

I think any objective analysis of the security available around gaming would indicate that in British Columbia we have a very good, secure system. It can always . . .

The Speaker: Thank you, minister. Would you please wrap it up.

Hon. D. Miller: . . . be improved, and as a result . . . .

The Speaker: Minister, please.

K. Krueger: Mr. Speaker, isn't it interesting how whenever a gambling question comes up in this House, the Attorney General isn't allowed to speak about crime, the Women's Equality minister isn't allowed to speak to speak for women . . .

The Speaker: Excuse me, member. I do want a question.

K. Krueger: . . . and the Aboriginal Affairs minister isn't allowed to speak for aboriginals?

But I'd like the Attorney General to answer this question. This government is increasing betting limits by 2,000 percent right now and is anticipating gaming revenues to increase by 1,800 percent. If we haven't detected theft with the present betting limits for almost a year, then how in the world are we going to protect British Columbians from crime when 20 times that amount of money is flowing through casinos?

Hon. U. Dosanjh: Hon. Speaker, the only voice that's been missing from question period has been that of the gaming critic.

I indicated during estimates, and I say it again: we have a beefed-up gaming enforcement branch within the Ministry of Attorney General . . .

Some Hon. Members: Where's the beef? Where's the beef?

The Speaker: Excuse me, members. Members, I would remind you that we have a relatively short time set aside for question period.

Hon. U. Dosanjh: . . . and the gaming enforcement branch is completely independent of the Gaming Commission or the minister responsible for gaming. I have indicated that in this modest expansion of gaming in British Columbia, the Ministry of Attorney General would continue to monitor the situation. If changes need to be made to the enforcement policy, that would be done.

The Speaker: The bell terminates question period.

Orders of the Day

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

[2:30]

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

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

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

Hon. J. MacPhail: I'm pleased to present to this committee the '97-98 spending estimates for the Ministry of Health and Ministry Responsible for Seniors.

Last year I did truly enjoy the estimates debate as an opportunity to talk about this government's vision for health, a vision that is the foundation for a publicly funded health care system that has been widely praised as one of the best in the world.

This year our vision for British Columbia's health system remains clear, and our commitment to that vision stronger than ever. The '97-98 budget estimate for this ministry is $7.3 billion, an increase of about $300 million or about 4.3 percent. At a time when this government is facing enormous fiscal pressures, we've kept our promise to protect and improve health services for British Columbians.

In fact, when it comes to standing up for health care, we've stood apart from the federal government and most other provinces, increasing the dollars we devote to our health care system by $1.8 billion over the past six years. And that really was at a time when other governments were cutting budgets and cutting programs and cutting people off from the services they need.

The increase in this year's Ministry of Health budget will mean more funding for all key areas in our health system, including hospitals, doctors' services, Pharmacare, community care, cancer treatment and reduced waiting lists. Health is the most important service people expect from government, and when it comes to this year's budget, we've got our priorities right.

We've made some very difficult and, I think in some cases, unpopular choices and sacrifices elsewhere in government. That's in order to keep our promise to protect patient care. We'll take our lumps on the cuts we've had to make in other areas, because they've given us the ability to invest more resources into the services that matter to B.C. families.

[ Page 3282 ]

We all want our kids to grow up healthy and our families to get immediate care or surgery in an emergency, and we want our parents to get the care they need to help them retire with dignity and security in their own community.

We will achieve this by investing more to fight cancer and heart disease, doing more to prevent injuries and illnesses that threaten our kids, working hard to keep prescription drugs affordable for all British Columbians, and sustaining emergency and hospital care as our health care system's number one priority.

These goals flow from the same values that have shaped five years of action by our government -- action to ensure that the people of British Columbia have a health system they can depend on, despite the pressures that we may face.

This budget shows our government's consistent dedication to sustain our medicare system despite massive cutbacks by the federal government to our health transfer payments that we've suffered in the past. They've been $345 million over two years; that's $213 million last year and $132 million this year.

B.C. patients will not pay the price for this shameful federal neglect -- neglect that has led many other provinces to simply throw up their hands in defeat, prop open the doors for the purveyors of private health services, and inch a little further down the road to an American-style, two-tier brand of health care, an approach that even Americans recognize as unacceptably costly both in dollar and human terms.

Indeed, our commitment for the most vulnerable in society is to care for them through the provision of high-quality health care services. This is our measure of our humanity and a testament to all of those who have paved the way for a system that would never turn its back on a person in need, regardless of their ability to pay.

Our government remains undaunted in our belief that medicare is an ideal that must be sustained. We believe that medicare with all of its flaws is a necessity, one that takes precedence over virtually every other service we deliver as a government. But unlike our federal counterparts, we know that a commitment to medicare is meaningless without the dollars to sustain it.

Our government will provide more funding in 1997-98 for all key areas of B.C.'s health system -- funding specifically targeted to meet our health care priorities this year. That includes an increase in B.C. hospital funding of nearly $83 million. This additional investment includes $6.5 million in new funding to help reduce waiting times for patients in need of cardiac surgery or kidney dialysis services, and $3.7 million to protect and improve cancer care, funding which will enable cancer clinics in Victoria, Vancouver and Surrey to extend their operating hours and ensure that cancer patients get care when they need it.

Hospitals remain at the heart of our health care system, and this year's budget increase will strengthen the ability of our hospitals to meet growing demands on their services.

We also recognize that our commitment to protect and improve patient care cannot be realized if we neglect those individuals on the front lines of our health care system who deliver the services B.C. families depend upon. So we're also increasing funding for the services of B.C.'s doctors by 2.4 percent over last fiscal year, bringing the budget for doctors' services within our Medical Services Plan to nearly $1.5 billion -- dollars which will enable doctors to provide the medical services British Columbians need.

Managing and reducing wait-lists is something we've worked particularly hard to address in recent years. In fact, since 1992 our government has invested over $120 million toward reducing waiting times for patients in need of cardiac surgery and treatment, cancer treatment, MRI scans, and hip and knee surgery. We've seen the proof of this added attention and funding, because it has made a difference for hundreds of British Columbians and their families.

We're also looking beyond the hospital setting and increasing spending on community health care services by 5 percent this fiscal year. This additional funding will open the door to vital services such as home care nursing and rehabilitation therapy to 3,000 more British Columbians. We'll be stepping up our emphasis on the PreventionCare program, giving people the tools they need to make informed lifestyle choices that can help them stay healthy longer and ease the pressure on our health care resources.

We'll work closely with our new regional health boards and community health councils to ensure that all of our health care spending reflects the needs and priorities of British Columbians -- because the additional dollars we're investing in our health care system this year represent only a part of the equation. We know the solutions to the challenges facing medicare. Those solutions must in part be realized by changing the structure of the health care system itself. We have dared to take aim at the corporate enemies of publicly funded health care, be it multinational drug firms or major tobacco peddlers who have for too long enjoyed a free ride to riches on the backs of Canadian patients.

We've been innovative, implementing smart new policies like PharmaNet and the reference drug program to provide B.C. patients with the drugs they need at a price taxpayers can afford -- a program that in its first two years of operation will save $74 million without affecting patient care. We'll continue to challenge the status quo, if it will result in better health for all British Columbians.

This is why we've moved forward with our Better Teamwork, Better Care approach to regionalization, moving health care decision-making out of Victoria and into the hands of community and regional authorities with their hands on the pulse of patient priorities; working together to break down the walls of bureaucracy by reducing the over 700 different boards formerly governing the delivery of health service in this province and forging a more cooperative and cost-effective relationship among all of our major publicly funded health care providers; taking dollars out of administration; eliminating waste and duplication and investing in those priority areas of patient care that B.C. families rely on.

In fact, we will realize at least $24 million in administrative savings throughout B.C. as a result of the streamlining of health care delivery through the Better Care approach in this year alone.

The ministry is also doing its part to keep the public better informed about the status of waiting times for surgery and treatment through a new monitoring system. It will

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provide quarterly public reports, with updates on waiting times for cardiac surgery, cancer treatment, MRIs, hip and knee surgery and organ transplants, and will set goals to ensure that B.C. patients get the care they need without waiting too long.

In this year of transition to our Better Care regionalization approach, we're providing both stability and flexibility to ensure that the highest standards of care are upheld.

I know that both sides of the House will recognize that there's still more work to be done. But the reality is that every day in this province thousands of British Columbians are receiving the high-quality health care they need and deserve. It's there when they need it, it's there where they need it, and it's available regardless of their income. Their stories may have escaped the notice of us in this Legislature, but their experiences offer legitimate proof that our publicly funded, universal system of health care can do the job it was designed to do. And for the vast majority of British Columbians it does that job very well.

Our challenge today, of course, is to make it work better. We're committed to meeting that challenge by investing both dollars and ingenuity to deliver better care to all British Columbia families in the future. The only bottom line that counts is patients and continuing to keep our promise to all British Columbians to preserve the high-quality health care services they depend on, now and for the twenty-first century.

S. Hawkins: I too have some opening comments. I'm looking very forward to engaging in these Health estimates with the minister and this government.

Hon. Chair, I want to just bring up that in 1991 the Royal Commission on Health Care and Costs, the Seaton report, was released, and one of its key observations at the time was the following:

"We are unanimous in our opinion that the system of health care in this province is one of the best, and quite possibly the best, in the world. We do not make this claim lightly or to soothe anyone's temper. We have talked to representatives from many different health care systems, and we have not found a system that we would accept in exchange for the one currently in operation in British Columbia."

That was in 1991, and that was the system that this government inherited: one of the best health care delivery systems in the world.

What has happened since then? In 1997 we have seen -- and I've mentioned this before -- the leadership of the Ministry of Health go through a revolving door. We've seen four Health ministers and five deputy Health ministers, each with a different vision, each going in a different direction. We're now witness to health care havoc created by this government. Health care in British Columbia has suffered a significant setback. There has been a sad lack of continuity and leadership in this Ministry of Health. There's been a lack of prioritysetting for health care programs.

There's been a lack of a provincial strategic plan. In fact, New Directions seems to be going in every direction -- and certainly in wrong directions -- and there's been a gross mismanagement of precious health care dollars.

Shamefully, we see newspaper headlines today like "Hospital Waits Get Longer," "Hospitals on the Edge," "U.S. Firm Cashes in on Surgery Delays," and sadly: "Toddler Dies as Ambulance Service Busy." Patients across this province are at risk under the NDP's mismanagement of our health care system. I travelled around the province, and what patients are telling me and what families are telling me and what health care providers are telling me is that patients are not getting the treatment they need when they need it.

[2:45]

I know from a series of meetings that the backbench committee the NDP had struck to review regionalization . . . . They met with so-called experts that they called in. When I talked to some of these so-called experts, they said that one of the first questions the backbench committee asked them was: "What is the objective of health care reform?" Well, if they don't even know that, why are they embarking on it? Why didn't they even know that the objective of health care reform is to improve health status? That's a very, very simple question. Health care workers around the world know that health care reform is about improving health status.

We measure health status in our communities, in our province, in our countries. We look at health status indicators. Those indicators include health care, housing, jobs, economy. We measure these by performance indicators. And those would be things like waiting lists for cardiac surgery, hip replacement, cancer treatment; length of stays in hospitals; admissions and readmissions. We've certainly seen the NDP fail in this regard, because we have seen waiting lists grow significantly. From last March 1996 to December of 1996, we saw an increase in the cardiac surgery waiting list of 30 percent. That's not a small increase. Somehow we've failed those patients.

With regard to health care reform, it certainly doesn't seem to be meaningful in any way. If we're to do it, let's do it right. Let's make sure that we have a model for integrated and coordinated, full-scale health care reform that covers the spectrum, right from prevention to treatment. What we have here is halfway health care reform. It's just gobbling up money. There seems to be no direction. It seems to have turned from New Directions to another direction. And it's the NDP way or the highway. We've certainly seen that in the form of boards being fired and replaced with people who will support what this government wants done and not what communities feel that their needs are.

There are certain factors that indicate a good health care system. One is high quality, and when I travelled the province, I certainly saw that in the way of providers, in the way of services that were given. We do have the personnel and resources if we use them effectively.

[ Page 3284 ]

know that, because we've got problems with waiting lists; we've got a problem with capital funding -- proper capital funding over the last few years -- for programs and hospitals.

The third factor that indicates quality health care is stability, and we have seen a problem with stability. Providers, patients, administrators are not comfortable with what's going on. We've seen layoffs; we've seen firings; we've seen morale absolutely diminished. We've seen doctors, nurses, administrators and community people say that they're just fed up. They're telling us that we should just slow down, look at what we're doing and make sure we're focused on patient care. And I don't know that we are, hon. Chair.

I take my responsibility as a patient advocate very seriously. It's important that we as the official opposition carefully scrutinize any health care policies put forward by this government. It's also important because the people of this province -- especially those that have been touched by the painful consequences of health care reform and those who work within the system and know too well about the pain that this government has caused -- no longer trust the members opposite. The people of B.C. have lost faith in this government, have lost faith in this minister.

They simply don't believe the government promises that no more beds will be cut, no more jobs will be lost. The people simply don't believe that anymore, because this government has demonstrated over and over again that it will do that.

Let me just step back for a minute, hon. Chair. The members opposite -- and I think I brought this up last year at estimates -- say that they are the protectors of medicare. They say they are the ones that implemented medicare. For the record, I just want the members to be reminded again that it was a Liberal government in Saskatchewan that first proposed publicly funded hospital insurance, and it was a federal Liberal government that legislated medicare at the national level.

The members opposite continually tell the people of B.C. that they should trust their government, this government, to preserve medicare. I am going to say to this House, yet another time, that I can only hope that the members opposite will listen. It's no longer appropriate and it's no longer enough for this government to ride on the coattails of their Saskatchewan predecessors and claim that they are the solitary protectors of medicare in this province, because we know they have failed in the last few years. We're seeing the results of that.

It's clear that the people of this province no longer trust this government in the management of their health care system. They no longer trust the government. They promised to save Medicare, and they've thrown our health care system into unprecedented turmoil and instability. And I saw that as I travelled around the province.

The government did this without any clear indication of what the end result would be. When health care reform began, the government couldn't really quantify what was wrong with the system. Nevertheless, they jumped in and formed regional districts and regional health boards; then they decided no, we've got to step back; then they developed regional health boards and community health councils; now we've got . . . . We'll get into what they're planning now, with the sole objective of cost containment.

As I said before, we have yet to find out whether any of this is going to be of any benefit to the patient. We know they're tinkering with bureaucracy, we know that it's still sucking up money, we know that they wasted $40 million setting up this system, and we know that it's going to cost us in the next year, I understand, $8 million or $9 million for administrative costs.

So when the minister talks about $24 million in administrative savings, I would like her to break that down for us as we move into estimates, because I still have to wrap my mind around where we're going to find this $24 million in administrative savings, when we've wasted $40 million and we're still setting up bureaucracy.

It's very, very essential that the government begin to really listen to the serious concerns of the health care providers and the home care workers. Since the government hasn't been listening to these people, let me just share with the minister some of the concerns that representatives put forward to me as I was travelling.

The unions which represent health care workers in this province are concerned about layoffs. They are concerned about the shift away from full-time jobs towards more casual, part-time positions, the increase in the number of workers on layoff, the replacement of health care workers with volunteers or less-qualified people, the deterioration in housekeeping, lab and dietary service, and even more so, the more stressful work environment which is resulting in sick leave or, as some of the nurses put it to me, burnout.

They tell me that they are doing more and more with less and less; they get absolutely stressed out. It comes on them physically, they just can't take it anymore, they end up taking time off work, and it costs the health care system. This is the whole thing about instability that I'm talking about in the health care system.

The people and the patients of B.C. have become cynical, and they're discouraged. They believe that the main reason this government set up regional boards and community health councils was to protect themselves from the consequences of politically sensitive decisions. One example I can give is that the capital health region hired a past NDP cabinet minister, Elizabeth Cull. They paid her $1,000 a day, and people in that region raised their voices and said: "Hey, this is wrong. Why are we paying somebody who is connected to the NDP $1,000 a day when we should be using that money for services in the community?

We should be using that money for health care for patients. Why are we paying her $1,000 a day?" The minister sitting opposite said it was inappropriate; the Premier said it was inappropriate. But nothing was done, and she continues to collect $1,000 a day. So they've protected themselves a little bit from these kinds of decisions.

I did travel around the province, and I want to say that I honestly feel that people in different areas of the province are feeling like they haven't had fair funding. In certain parts of the province they feel that their health care system is underfunded, especially in the north. In Quesnel, patients continue to be cared for in hospital hallways. The day that I walked through Quesnel hospital there were four patients being cared for in the hallway. As an old nurse, it just pulled at the heartstrings, because that is not the kind of care I was trained to provide.

I thought the patients were waiting in the hallways to be taken to tests, but that's where they are cared for. That's where they're bathed; that's where they get their bedpans; that's where they're fed. That is absolutely appalling. Where is the privacy? Where is the dignity? Where is the quality of care that this government talks about? It was shameful.

Patients in Prince George find themselves strewn about a very crowded emergency room with not enough beds. The day I was in Prince George Regional Hospital there was a . . . . There is a 13-bed emergency unit; there were 26 patients in. So 13 of them were stuck in a back room, probably about 11 feet by 12 feet, gurney to gurney, male and female, bed to bed. They had pulled nurses and staff off the wards. We don't

[ Page 3285 ]

know what quality of training those people had, but they have to bear with patients, some who are critically ill, some who are very sick. They're making do. They're doing more and more with less and less, and I was witness to it.

Patients in Nanaimo find themselves sleeping on stretchers in the cast room for days on end. When patients come in to get their cast taken off, patients who are ill sleeping in those beds have to listen to all the noise of a cast being removed or . . . . Where's the privacy? Patients are being interviewed, and other patients are listening in. It's not right. This is not health care.

There are serious problems in the health care system, and this government must open its eyes to the mess that's been created and begin to do something very constructive to rectify the crisis the system is in. And it is in crisis. We plan to consult further with individuals and groups directly affected by the decisions with respect to health care that this government makes, and I suggest that the government start doing the same.

When this minister talks about waiting lists and alleviating waiting lists, I sincerely hope that there is some kind of plan in place, because I'm still getting letters. The saddest letters I get are from patients who tell me they are waiting for treatment for cancer, for surgery, for hip replacement, for a whole variety of things. Patients have been gravely affected. They've been gravely affected by a deterioration in ambulance and emergency services, by a shortage of hospital beds, and by a shortage of health care personnel to look after them.

I can't say it enough: this casts serious doubts on the stability of our whole health care system, and all in the face of a government that is implementing so-called cost-saving reforms.

Over the past few years, problems in our health care system . . . . It's been reported by providers, media and patients, and the minister knows, because I know she gets the same letters I do. People are dissatisfied with care in hospital due to shortages in nursing staff and other types of health care personnel. There are longer waiting times for surgery and for diagnostic testing and procedures. There is inappropriate use of hospital beds. I know the minister has a report that indicates that -- that finally quantified that there was an inappropriate use of hospital beds.

There is a lack of community home care support to cope with increasing needs of seniors. There is a lack of post-day care surgery requirements. In some places there are problems with early hospital discharge policies and with the trends in deinstitutionalization -- and Riverview certainly comes to mind with that issue.

[3:00]

I'd like to start, if I may, with health care reform, because I think that's on the top of everybody's mind. People are wondering what this Better Teamwork, Better Care approach is all about. The first place I would like to start is with the boards. Perhaps the minister can tell us how many boards, how many CHCs and how many CHSSs there are in the province, and what these CHSSs are.

[J. Doyle in the chair.]

Hon. J. MacPhail: I'd like to introduce the ministry staff who are with me. On my right is David Kelly, the Deputy Minister of Health. On my left is Leah Hollins, who is the assistant deputy minister of acute and continuing care programs. And behind me is Bob Cronin, who is the assistant deputy minister of corporate programs. It is with a great deal of regret -- and I'm quite annoyed -- that Mr. Cronin is retiring on us. He has been an invaluable contributor throughout the public service. So I say thank you very much to him.

Interjection.

Hon. J. MacPhail: I know. He doesn't look old enough to be retiring, does he?

There are 34 community health councils, 11 regional health boards, and seven community health services societies. The CHSSs are to form an employer association for employees that are being transferred from the Ministry of Health into the field but whose services cross over community health councils.

S. Hawkins: Getting into the boards in a little more detail, then, these boards were all appointed. There were provisions in the Health Authorities Act that these boards would be democratically elected. Unfortunately, that route wasn't taken by this government. Can the minister tell us how many appointees have been appointed to date?

Hon. J. MacPhail: Well, there are 15 for each community health council and regional health board. I think the Vancouver regional health board allows for an appointment of 18. We are almost at the maximum appointments in each and every area.

S. Hawkins: Would the total number be around 500, 600, 700 appointments, made by this ministry?

Hon. J. MacPhail: It's 15 times 45. So yes, probably.

S. Hawkins: Can the minister tell us how these appointees were vetted? Did they apply? What were their qualifications? What were they looking for when they appointed these appointees?

Hon. J. MacPhail: Many of the appointees had already served on community health councils and regional health boards. The range of qualifications we looked for were, first of all, a community base: experience within your community; experience in managing large sums of public dollars. There were considerations for aboriginal appointments, where aboriginal appointments were made in relationship to the amount of aboriginal population in the community. We looked for gender consideration, multicultural consideration.

There is a physician appointment on each and every regional health board and community health council, as there is a front-line health care provider appointment on each and every health board, as well.

S. Hawkins: Was there a committee that vetted all the applications? Were there applications? Was there a committee that chose, and who was on this committee?

[ Page 3286 ]

Hon. J. MacPhail: They're ministerial appointments, but I received much input from many sources across the province. Some health boards actually had their own appointment policy and submitted names to me for recommendation. The physicians themselves conducted their own survey and submitted names to me for recommendation, as did the front-line health care workers. But the appointments were made through my office.

S. Hawkins: Are all the appointments complete?

Hon. J. MacPhail: No, they're not all complete. There are a few communities where we still need community representation, but we're almost done.

S. Hawkins: Can the minister explain why it was more important to appoint than to let the communities choose and elect?

Hon. J. MacPhail: Yes, and I will only say this once. We conducted a review across this province in the summer, which the opposition didn't participate in. That review was thorough; it consulted widely with all of the people that the member opposite listed in her opening remarks. We put questions to them such as, "What do you think health care reform should be all about?" -- not asking them about what we should think . . . . We put it to them -- what their opinion of what health care reform was all about.

It's unfortunate that particular question got twisted in the member's opening remarks, because that was where we received from people working in the community a great deal of very valuable input about what they were looking for in health care reform. It was as a result of their opinions that change occurred. It's unfortunate that, by virtue of just reading and not participating, that kind of question got twisted.

When we actually asked people in the communities themselves about how we should proceed with selecting people to represent the newly formed community health councils and regional health boards, we received feedback in three areas. First, there was a majority of opinion that said the system is so complex that there should be appointments to the health care board but that we should have community input -- that the appointments should be from the community.

We received input from the elected officials who were mandated to sit on the regional health boards, such as school trustees and councillors: "Please don't appoint us, because we've got a big job already. We don't want to do this work. It's a job all unto itself, so please don't do that for us." And the third situation where we received feedback across the province was: "Keep the voluntary aspect of appointments. We do not want our health care system to be governed by people who are remunerated for those jobs. There is a tradition of volunteerism in the health care sector."

When we then put to them the question, "How do you conduct elections and ask people to run for office and invest in that; how do you then ask them to do that in the context of standing for a voluntary position . . . ? " People then came to the conclusion that it makes sense to have an appointment system in order to get the most diverse number of people ready to stand and not be precluded by the expense of an election.

I have committed that in the next two years -- actually, it will be in about a year and three-quarters -- we'll be receiving input from our communities around the province about a community input process for reappointments or new appointments to the community health councils and the regional health boards. I've already received some very valuable input from people who sit on the UBCM, from individual councillors, from smaller communities, and then also from our regional health boards and community health councils themselves about how we need to have input for a community process.

S. Hawkins: It's unfortunate that the minister . . . . She talks about twisting words around. They're the ones that appointed an NDP backbench committee. There is a Select Standing Committee on Health in this parliament that's never met; I sit on that committee. I would put to the minister that that was the appropriate committee to review health care. Health care doesn't belong to one party in this province. Health care is not a partisan issue. Health care is something that affects all of us.

We were elected -- just like the members opposite -- from different parts of the province to represent different people in the province, to represent different points of view. And it's unfortunate that the government sitting opposite here chose not to include in a direct way this side of the House in their review of health care -- in the mess they made of health care in this province. They made a mess of regionalization. We have always been very open and have said we want to participate.

[G. Brewin in the chair.]

There is a committee that sits in this parliament that probably should be reviewing some of the government policy, should be listening to groups, providers and interested parties around the province. But we've never met; we've never been called to meet. There are problems; there are very serious problems. I travelled around the province and I spoke to people, because as a responsible critic in the area, I needed to go out and see for myself what kind of care is being provided in communities around the province.

I took the opportunity to do that; I would have taken the opportunity to travel with the backbench committee, but we were never asked to do that. We were asked to make a proposal. Well, I don't think that's proper participation; I don't think so. The right way to have done it was to put it to the Health committee that sits in parliament; that's the way to have done it.

To say that we never participated . . . . I think that's very crass and that's very misleading.

Interjection.

S. Hawkins: Well, I participated. The minister asked if I participated. I participated by doing a six-week tour of the province. Actually, I didn't go with promoters. I didn't put up backdrops and have photographers take a picture of me shaking hands or ribbon-cutting. I didn't do that. I actually walked around with physicians; I walked around with nurses; I walked around with X-ray techs; I walked around with patients. I actually heard firsthand what was going on. I didn't go to ribbon-cuttings and then say, "There's nothing wrong with this hospital," when 40 feet away, there are three patients sleeping for three days in a cast room. I didn't do that.

I recall that the minister accused me of taking secret tours of public places. A hospital is a public place. Accusing me of taking a secretive . . . . I didn't wear a mask; I didn't wear a disguise. I didn't walk around and say: "Hey, what's going on here?" I didn't do that. You know what I did? I walked around, and I made sure that I listened to people. I talked to people, and I asked: "Look, what's your workload here? What

[ Page 3287 ]

kind of care are you getting? Is it adequate? Is there treatment getting to patients that need it?" I went and toured the beds that were empty, the beds that weren't being funded. I went and saw patients lying in hallways, being treated with no dignity -- lack of care and lack of privacy. I saw that; I saw that firsthand.

I went to Quesnel hospital. I understand that it's going to be awhile before this government gets to that hospital. I went to that hospital and toured their kitchen area. They were supposed to get an expansion and a new kitchen area. You know what? You know what's running through the top of the food service area of the kitchen? Sewer lines -- and they've backed up more than once. Now, I would think that was kind of a priority. But, you know, it doesn't seem to be for this government.

So when you say we're not participating in health care, I think you're very wrong. I think that's very misleading, because I think we have been constructive. I think we have raised the issues on behalf of British Columbians. I think we've actually got the government to move on a few things this year. We raised the issue of waiting lists. We actually got the government to put some money into funding. Hopefully, it's getting there. We have raised the issue of ambulance problems. Out of that, we got a review. Sometimes it takes that little bit to get these guys moving. But good -- we'll keep on doing that, and we'll keep them moving.

With respect to the boards, we'll try and get back to that if we can, if I don't get sidelined with some of the other stuff. I'm just wondering, again, with respect to the boards that were replaced . . . . There were a lot of boards that had guns held to their heads -- that's what they tell me -- and were told that they either had to amalgamate with the regional health boards and community health councils that this government appointed or be fired. We found that a lot of boards bucked the trend. They said they didn't trust this government.

They didn't trust the way health care reform was moving along in this province. They felt that too much attention was being focused on administration and bureaucracy and not enough on the patient and the health care needs of the community.

These were people who had served the community well. These were people that had worked in the health care system, that were good community people, that came from elected, accountable positions, that came from municipal councils. You know what? They said: "Just a minute. Things aren't moving along the way they should be. There's money being wasted here. We don't trust that this government is actually going to focus on health care here. We think that they were more interested in tinkering with bureaucracy and taking control when they promised that health care was going to move closer to home.

What's happening now is that we're getting mandates from the ministry to do things instead of us deciding what's best for our community."

[3:15]

They decided they weren't going to amalgamate. You know what? They got fired. I've got a list in front of me of some of the boards that got fired. These were good community people. Vernon Jubilee Hospital board gets fired; Kelowna General Hospital board gets fired; Chilliwack General Hospital board gets fired; MSA General; Fraser Canyon; Royal Inland Hospital board in Kamloops gets fired; Langley Memorial; Lillooet District Hospital; Dr. Helmcken Memorial; Queen Victoria in Revelstoke; Richmond Hospital; Lakes and District Hospital; Ashcroft and District General; St.

John Hospital in Vanderhoof; Stewart General Hospital board gets fired; McBride and District Hospital; Valemount. The list goes on: Fraser Lake, Cowichan District Hospital, Powell River General, G.R. Baker Memorial, Sparwood General get fired.

I notice that the minister's heading was "Better Teamwork, Better Care." You have fired the team. The minister has fired the team, hon. Chair. I notice in the press releases in the last few months I haven't seen "Better Teamwork"; I've seen "Better Care." Maybe she doesn't refer to it as teamwork anymore, since the team that she has comprised is totally an NDP-backed team, not necessarily coming from the community.

Why was it so important to fire these boards instead of working with them, making them comfortable and maybe giving them time to move along? Why did everything have to move on a deadline? Why was there no time to build relationships with these boards to make them comfortable with what the government was doing?

Hon. J. MacPhail: On November 29 our government announced Better Teamwork, Better Care. At that time we said to every single health care society in the province that April 1 would be the day that regional health boards would be put in place, that we expected amalgamation to occur by that time and that we would work with them in a voluntary way during that time. We said that for community health councils there would be a few months after that when resolution and amalgamation would take place.

The vast majority of boards of the 700 health care societies worked with us. In fact, of the list that the hon. member reads, it was about less than a quarter of the boards that actually had to be dissolved. No one was fired, actually; they were dissolved. The notice was sent out at the end of November, and on April 1 we had to get on with it. The fact of the matter is . . . . I don't think that the opposition can talk out of both sides of its mouth and say that the system is in crisis and yet that it wants to carry on with 700 boards and not get on with bringing resolution to the system.

Many of the areas that have moved forward in a cooperative way are well on their way to working with all of the health care providers in the community in a concerted, integrated way, and it's working.

S. Hawkins: I want to talk about a letter that I received. It's interesting. When these appointments were made, obviously a letter had to be sent out from the minister to the appointees. Someone handed me one of the letters. This is a letter appointing an appointee to a board in Nanaimo, and it comes from the Minister of Health. Frankly, I find it a bit lacking, because nowhere in this letter does it say that this appointee has a responsibility to ensure that responsible health care decisions are made for people in their area and that quality of patient care and safety should be a priority concern.

Nowhere in this letter does it say that; nowhere in this letter does it say what is expected of the appointee on that board. I would think that certainly when the hospital societies appointed and elected people to their boards, that was a priority: quality of patient care was a priority, and safety of patients was a priority.

[ Page 3288 ]

It's interesting. The last paragraph of this letter from this minister says:

"It is not necessary for you to report to me on the day-to-day-activities of the board. However, I would anticipate that you would advise me or my deputy minister on any matters of special significance that come before the board, such as issues relating to severance settlements."

You wonder why people are so cynical and angry about the appointees. When people got to elect, when people got to decide in their own community who sat on those health boards and made decisions for health care in their communities, they got to say: "Well, you know, I think that person is a good person." A community would do that; a hospital society would do that. They'd say: "I think that person is a good person. They're going to stick up for us, and they're going to make decisions that are good for patients in our community. They're going to make decisions that are good for the health care needs of our community."

Isn't it comforting to know that the minister says nowhere in this letter that that should be a priority of the appointee she has put on this health board? It doesn't say that, and I was very, very disappointed to read that. But she wants to make sure that she has people on these boards that will report to her on issues such as those relating to severance settlements.

That's why I was saying before that people have been telling me that the reason they think these boards are appointed rather than elected is so the accountability from these boards will flow to the ministry, not necessarily to people in the community. The appointees will basically be puppets of the ministry; the ministry now has more control.

We saw before that people who served on boards were accountable to the community, because you know what? If they didn't do their jobs, they didn't get elected again. That's just like each one of us who sit in this chamber. If our constituencies don't like what we do, if we don't represent them fairly, if we don't represent them effectively, they have the option to get rid of us. Not on these boards, because they are appointed. The minister has the option to get rid of these people -- and she did, because she fired a whole bunch that didn't go her way.

Politically sensitive decisions are going to be reported back to the minister and not necessarily to the community. These are supposed to be health care dollars. The decisions that are going to be made by these boards are supposed to be for the community, on behalf of the community, on behalf of patients in the community. But who are these boards accountable to? Perhaps the minister can answer that question for me.

Hon. J. MacPhail: The health boards are accountable to the government -- to me. But they also have a series of guidelines and principles -- we announced Better Teamwork, Better Care -- for patient care that's first and foremost. The principles were read into the record earlier -- but perhaps the member missed them -- in terms of patient satisfaction and reduction of wait-lists, and that the care be affordable, accessible and there when and where they need it. It's all about patient care.

Certainly the board members understand that. They have had that communicated to them not only in the announcement around Better Teamwork, Better Care but when I've met with them, as well. I have a different view from the member, I guess, on what's an important matter in times of transition, when there will be staffing changes, especially at the administrative level. If the member somehow, because she objects to the fact that I asked board members to make sure that the matter of severance is brought to my attention . . . . That has nothing to do with patient care. Is the member somehow thinking that's not an important issue to take into account in transition?

S. Hawkins: I'm not saying that's not an important part, but it seems interesting that that's what's highlighted in the letter. We know that was a politically sensitive issue for this government, considering all the kinds of severance disclosures we've been receiving from freedom of information and from other sources in the last few months -- that is embarrassing for this government. It's interesting that it's highlighted in an NDP appointment to a board -- that that is one issue. It would have been even more understandable if she had highlighted an issue relating to waiting lists, surgery lists or whatever.

No, the highlight here is something that's politically sensitive, and that's why I just found it a little disappointing and interesting that that's the main thing that jumps out of this letter that this minister wrote to this appointee to report back on.

I would like to know if there is an accountability framework or if the accountability from the boards flows straight back to the ministry, and how the reporting is conducted. I'll leave it at those two questions for now.

It was also indicated that results and progress would be made public through an annual report; I also indicated that earlier, in my opening remarks. The establishment of an accountability framework is in keeping with my ultimate responsibility for health care delivery in a decentralized system and is a continuation of the Ministry of Health's role in assuring accountability in the health system.

Accountability will be a three-step process. The province funds the provision of services. Health authorities report how they have used the funds and what they have accomplished. The ministry takes action to ensure that service quality, efficiency, appropriateness and effectiveness are met. The health authorities will be required to report specific types of performance measures similar to the types of measures that health agencies have traditionally reported to the ministry. Some new performance measures will be implemented to better reflect health service outcomes.

The ministry is interested in obtaining information on the following types of measures that are new: input measures for budgets and expenditure plans; output measures, such as volumes of services such as caseloads -- contacts and visits; appropriateness measures -- provision of appropriate care as compared to guidelines, protocols and, in some sophisticated organizations, care maps; quality measures -- performance against the established standards, often measured through what is now the accreditation procedures; and outcome measures, such as patient-client satisfaction, relief of pain and suffering, mortality rates and birthweights.

S. Hawkins: Is there any accountability that flows down to the community? And if so, where?

[ Page 3289 ]

Hon. J. MacPhail: I just outlined those, hon. Chair.

S. Hawkins: Somewhere in that answer I missed that. I'll go back to the Blues and have a look at that, I guess.

My next question is regarding the liability issue around these boards. Are these boards liable in any way for the health care decisions they make and the services they provide?

Hon. J. MacPhail: Well, it's ultimately me who is liable, and that's the way it should be. I don't mean corporate liability, in the sense of a corporation; there is collective liability but no personal liability.

S. Hawkins: What kinds of things would these boards then . . . ? Do you have specific examples that they might be liable for if they were to attach liability to the boards?

Hon. J. MacPhail: I need clarification: are you talking about legal liability?

S. Hawkins: Yes, I am.

Hon. J. MacPhail: Just as it was before with the health care societies that were in place, there is a legal obligation to act in good faith. So it's only the legal liability. Again, I qualify this because I'm not a lawyer, but there is no legal liability unless they are not acting in good faith.

[3:30]

S. Hawkins: The reason I asked that question is that I've been following some of the cases in Saskatchewan where health care societies or health care regional district boards have faced liability, but I'll deal with that later.

There were advisory committees set up in the old structure. I understand that there are some groups -- one that comes to mind is the registered nursing group -- that are quite concerned that advisory committees may not . . . . It's at the discretion, I guess, of the boards. It's advisable that they be set up, but it's not mandated that they be set up. Who is going to advise these boards, and what kind of committees will be set up?

Hon. J. MacPhail: Actually, I'm aware of the concern of the registered nurses, having met with them just last week or the week before. What many of the registered nurses suggested was that they would like a separate seat on each community health council and regional health board, and we had some interesting discussions about that. But the advisory committees will now be structured according to what each regional health board and community health council needs in its own community. The provincial advisory committees are still being designed and are under discussion.

S. Hawkins: When the minister says that advisory committees will be set up as needed in each health region, are there any that the ministry is proposing that are mandatory for these boards?

[J. Doyle in the chair.]

Hon. J. MacPhail: No, other than the medical advisory committee.

S. Hawkins: The minister mentioned annual reports just a short time ago, and I understand that when the announcement first came out about regionalization, there was going to be a quarterly report. I could be wrong about that. If there is going to be an annual report, can we be advised when we might see that report?

Hon. J. MacPhail: The annual report will be at the end of the first year that the system has been in place. April '98 will be the completion of the first year, so I would expect that the report would be in the quarter following that. I think that what the member is thinking about in terms of quarterly reports are the wait-list reports that, for the very first time, will be done. We can expect the first wait-list report in September.

S. Hawkins: The minister also mentioned audits with respect to health regions and community health councils. I wonder if she can comment on what they're going to audit, what they're looking at, how often the audits will be done and who is going to conduct the audits. If she can give us some information around that, I'd appreciate it.

Hon. J. MacPhail: There are two aspects. One has to be held accountable, and then you audit according to that accountability. We've already reviewed the accountability principles, but there are also contract principles that are the nuts and bolts of what the ministry will embed in the funding and transfer agreements. The contract principles speak to the quality and cost-effectiveness of care. The auditing will be done according to the meeting of the effectiveness of these contract principles.

When we sign funding and transfer agreements with the regional authorities, we make it very clear to them at the time they're entering into a contractual agreement that they are agreeing to participate in the quality and cost-of-care review exercise, including the provision of the requested information. When their patient outcomes or other health outcomes fall below a specified level, they'll be obligated to participate in an approach that will lead to improvements in that particular area.

If the result of the audit has them coming up short, they then have to put in a program that would bring them up to the contractual principles, and this could involve changing a particular technique, tool or approach. The results of the audits will also be part of the annual report, and that annual report will have a comparative nature to it, as well.

S. Hawkins: The minister mentioned contractual principles. Are those outlined right now?

Hon. J. MacPhail: They are being developed right now. The contractual principles are per contractual arrangement with each regional health board and community health council.

S. Hawkins: I wonder if the ministry will commit to getting them over to us as soon as they are developed.

Hon. J. MacPhail: Yes, I will. They are public information.

S. Hawkins: I may have missed it in the minister's answer, but who is going to do the audit?

Hon. J. MacPhail: The government, as the funding agency, through the Ministry of Health.

S. Hawkins: The audit will be done according to these contractual principles. Will there be a boilerplate tool

[ Page 3290 ]

developed that will be used throughout the province? Will everyone have to meet a certain mark? Is that what's being developed?

Hon. J. MacPhail: There are standards that are per program. Each program area has its own standards that are developed in conjunction with the industry itself. We will then audit whether these standards are met. Separate and apart from that, we're all subject to the auditor general coming in and auditing.

S. Hawkins: Just as a matter of public interest, is there money in this budget being set aside for those audits if they're going to be done for the report next year? How much money is being set aside for these audits?

Hon. J. MacPhail: Perhaps when we get to corporate programs, we can explore that. It is part of our regular corporate programs, and we don't anticipate any increased cost doing it.

S. Hawkins: I believe I heard the minister talking about provincial health goals. We talked about that last year in estimates, and I'm wondering if they have been developed. If they aren't, where are we at with them? I think those are the measurements that were going to be used to determine and evaluate health care in the province. If they are developed, will the minister make a commitment to get them to this side of the House?

Hon. J. MacPhail: Yes, the provincial health goals are developed. They're very comprehensive -- so comprehensive that I think it will break ground. The provincial health officer has done an excellent job. The hon. member made a comment in her opening remarks about the health outcomes -- the indicators of good health -- being beyond just hospital care. She talked about employment, housing and nutrition as well, I think. All that is included.

We have started the process -- well, we haven't just started it; it's well on its way -- of informing the other ministries that will be affected by the establishment of these provincial health goals. We're on the verge, actually, of completing that notice period for other ministries, and we'll be releasing the provincial health goals very shortly.

S. Hawkins: I'll get back to the boards for a minute. Can the minister lay out the structure of the boards? We know that we have board members. We have a chair; we know that. What administrative support does each board have in the way of CEOs, vice-presidents and that kind of stuff? What structures have been set up for these boards and community health councils?

Hon. J. MacPhail: The boards themselves have 15 appointees. In Vancouver, again -- Vancouver and Richmond -- I'll just say 18. The chair is selected from among those appointees. The regional health board is then responsible for hiring their executive. Typically, I would suggest there would be a CEO, and then they'd put together an executive team that goes across all the services that are provided in that particular area. There would be someone responsible for patient care, and that may go across continuing care as well, and there would be corporate services and financial services.

Each regional health board is responsible for putting its own administrative structure in place. We are there to assist them, but one of the goals in putting the administrative structure in place is to eliminate the duplication that exists across individual institutions now.

S. Hawkins: I have heard concerns from different regions about CEOs being fired prematurely -- being fired and being paid severance. I guess we'll get to the severance issue now. How much has been paid out in severance to date, and how much is expected to be paid out?

Hon. J. MacPhail: I actually have to go to my question period book. I thought that would be a question period question.

As of April 20, 1997 -- and I don't think there's been any action since then -- 14 displaced CEOs have secured new permanent employment, and three are in alternative temporary employment. For instance, one has been assigned as the project manager for the teleradiology project, one has been assigned as a public administrator, and one has been assigned to work for the Ministry for Children and Families as a regional operating officer. So far, the severance via salary continuance to the end of last month has cost $97,000.

S. Hawkins: The $97,000 doesn't sound right; perhaps you're just talking about since April 1, when the ministry took over the boards. But before that, we understand there were some major severance pay-outs that amounted to more like $1.2 million and counting. Am I correct in understanding that these CEOs were fired, got severance and now are working for government again? Am I correct in understanding that the CEOs that were fired -- the minister likes to say displaced, and I've used the term "dehired" when I've had to do that; we try to couch these in nice terms -- are now working for government again?

Hon. J. MacPhail: I guess this is the appropriate time to distinguish amongst the areas of severance. The information that I just gave you is as a result of the bringing in of regionalization of health care and the collapsing of whatever may have been in place for regionalization of the 82 previous boards -- now down to 45 boards. Those are the stats that I gave you. So that has been the severance. The severance that I've outlined to you is what has been as a result of bringing in the final step of the regionalization of health care.

But I also know that there have been hospitals that, through their own volition and against our wishes, have severed people. In fact, they severed people who were offered jobs and were told there would be a place for them in the new system, perhaps even in the job from which they were being severed. So those severance costs are what the hospitals themselves have to be accountable for. We do not include it in the regionalization costs, because we actually advised against these hospital boards taking such actions. Against our advice, they went ahead and severed several people. I can name those hospitals for you.

So that may be where you're getting the $1.2 million: for people who were severed who had nothing to do with the regionalization of health care.

[3:45]

The third point I would like to make is that indeed there will be people who are dehired for the job for which they were hired, and they may choose that there isn't another job suitable for them in the new system. There may be costs or relocation that flow from that. Certainly those severances will be subject to the new legislation that we introduced last week.

[ Page 3291 ]

S. Hawkins: It was always my understanding and the understanding of different members who were involved in following the health care reform that there was going to be streamlined administration and compressing of the bureaucracy. I'm having trouble wrapping my mind around the fact that CEOs or administrative people are being dehired and then reabsorbed in the system. How do we get a smaller, more streamlined system if we're just recycling these people?

Hon. J. MacPhail: Well, the good news is that there's attrition and turnover in the system. And within the context of that, we're not adding new people and making up for the people who are leaving the system but reassigning and offering to keep the expertise within the system but in a very much smaller context, where attrition takes place in the downsizing. But at the end of the day, I expect that there will actually be fewer people in the system -- in fact, I know there will be fewer people in the system -- than there are now.

S. Hawkins: Back to board structure, because again it's not quite clear how things are set up. I understand that the boards now have a medical person and a union person. Now the minister might be considering a nursing person on the boards. At least, I hope she is, because they make up a large part of the health providers in the system.

Were the boards making decisions with respect to moving ahead with regionalization before all the appointees were appointed, as far as the front-line workers are concerned? And are all of the front-line workers on the boards now, so that they're involved with the decision-making?

Hon. J. MacPhail: Regardless of my personal bent towards nurses -- I'm a big nurses fan, coming from a family of them . . . . From the conversation I did have with the Registered Nurses Association, I understand fully the value of the input of the nursing profession in the context of designing the health care system, but I couldn't commit to saying that a nurse from their professional organization would be appointed on every health board.

I think that if we look at the boards that are appointed now, there's a nurse on almost every single one. She's not there on behalf of her professional association, but she is there in the context of being a practising nurse. As far as I know, the front-line workers are all appointed. I think almost all of the physicians are. There are sporadic appointments that still have to be made.

S. Hawkins: I guess that's a concern I want to raise on behalf of front-line workers appointed to these boards. They feel that the people who are appointed don't totally have a grasp of health care administration and of the health needs of the community. Certainly they might not be sensitive to the needs of people working at the front line.

It was promised . . . . Regardless, I guess, of how this has panned out, we now have appointed boards, much to the discontent and concern of communities. But, at least, we expect that the boards will have the expertise they need to make the very important decisions as they move ahead now in taking over and making decisions for communities. We expect that they'll have advice from people who actually work in the front lines in their communities, and we certainly hope that these people will find their way to the board in a reasonable amount of time.

The advisory committees that the minister mentioned before are going to be set up at the discretion of the board, and I'm wondering if a lot of these people who sit on the boards . . . . I'm saying again that I've heard concerns from around the province that not all these people have the expertise, and we hope that through the administrative support the boards have hired that they'll get some of this support. But is there no boilerplate plan for these boards to have a medical advisory committee, a nursing advisory committee or some kind of quality assurance committee? Are those not being set up? Or is that at the discretion of the board -- again, if it feels good we do it?

Hon. J. MacPhail: The medical advisory committee is mandatory. But in terms of the structure of board activity, there is a wealth of experience already in the health care sector -- about quality assurance committees, finance committees -- and that will continue. The reason why we're saying that it's up to each regional health board or community health council to structure their own advisory committees is because there is not the same boilerplate array of services offered throughout each region of the province.

We want to make sure that we're not foisting upon regional health boards and community health councils mandatory activities that don't have anything to do with patient care in their own community.

S. Hawkins: With respect to the board meetings, how often are the boards expected to meet?

Hon. J. MacPhail: It's standard corporate entity practice for the boards themselves to meet as a whole once a month, but committees will meet more frequently than that.

S. Hawkins: I understand that these are volunteer positions. That was the commitment that was made when these appointments were made. I understand that for some people, that's a bit of a hardship. I understand that there's at least one board chair, anyway, who has requested that the minister provide remuneration for employment-loss on the days they have to meet.

Some of these regions that make up a regional health board are fairly large, and people come from quite a ways away to meet. Certainly at this time -- when they're trying to get health care sorted out and meet all the requirements that the ministry expects them to meet regarding amalgamation and getting their house in order, if you will -- it makes it difficult for these folks to meet, say, two hours on a Thursday evening or whatever. What's being done about that? And are these people being remunerated?

Hon. J. MacPhail: Several things are happening. This is an important issue, and I did discuss it with the regional health board chairs and community health council chairs when we met for our first-ever meeting in March, I guess -- or in February.

I have asked the chairs to form a provincial health association and to advise me on exactly this question, because there's a debate on both sides of the issue -- amongst themselves as well -- about how you fairly compensate if you're going to compensate. What is the value of an at-home mom? What's the value of a retired person who may be taken away from other duties in her community? What's the value of a person who may be there representing an organization? All of these questions . . . .

[ Page 3292 ]

Now, we do compensate for expenses, including child care. And we've also asked the regional health boards . . . . Actually, we haven't had to ask. They've suggested, and we've agreed, that they want to travel for their meetings so that where it's a fairly large extended area, they actually travel amongst their various communities. But I've asked the newly formed provincial association to advise me on how best to proceed in terms of this issue around recompense. What they've agreed to do is take a few months to let it work out and find out where the successes and the failures are, and then they'll come forward.

S. Hawkins: Can the minister tell us how much has been put aside in the budget over the next year for these people to be compensated for their travel and meeting time?

Hon. J. MacPhail: I'll make that available to you no later than tomorrow.

S. Hawkins: I just want to tell the minister that we're going to be watching that, because the societies ran on a volunteer basis. Those were people in the community who put that time in for free. We've sort of thinned things out. We've got people from all over the place now trying to get together and meet in one place. When decisions were made closer to home, people lived in those communities; they met in their communities. Now we've got people from communities as far as 150 miles away, or farther, meeting to try to sort things out for a larger region.

I always get nervous when I hear that there's going to be cost savings, and later on we've found out that millions and millions have been spent on administrative waste and on spinning our wheels, trying to figure out how things are going to work. Health care dollars are precious right now, and they need to be well spent.

That is an area we will be watching to see that people are compensated fairly for the time they put in, but not necessarily to the extent that this is going to be costing patient-care dollars. Our first priority, again, is to make sure that health care dollars -- at a time when they're very, very precious -- are directed toward patient care and not tinkering with administrative waste and bureaucracy.

Right now I understand that as of April 1, the regions were supposed to take control of funding. But when we had our briefing for estimates . . . . I understand there was a special account set up to help administer funding for the regions. I wonder if the minister can explain to us how that works.

Hon. J. MacPhail: The special account that I think the hon. member is referring to is a transitional account that will maintain responsibility for the staffing until the new system is in place for the regional health boards and the community health councils, so that they're not going ahead and setting up a duplicate system just to take care of the transition.

S. Hawkins: When do you foresee that to be in place so that the regional health boards get that envelope of funding and administer it accordingly?

Hon. J. MacPhail: It won't extend beyond this fiscal year, and it should be in place before the end of this fiscal year.

Hon. Chair, could I ask leave to make an introduction?

Leave granted.

Hon. J. MacPhail: It's a good job, because it's my mother who just arrived. Mary MacPhail from Hamilton is here with my ministerial assistant, David Perry. I hope she hangs around so that all of you can behave properly toward me, in face of my mother. May the House make her welcome, please.

S. Hawkins: I want to say fat chance, but I won't. I'll be nice -- to the extent I can.

Right now, is this transitional account a general account, or is it split into regions and each region allocated its amount of funding as of April 1?

[4:00]

Hon. J. MacPhail: It's split into regions and is basically a duplicate of the payroll.

S. Hawkins: I won't ask the minister for details of each account if she commits to getting me the figures.

Hon. J. MacPhail: Yes.

S. Hawkins: I hear time and time again that the government expects to save $24 million in administrative savings because of this new process. I wonder if we could get the time line on how soon that $24 million is going to be saved and in what kinds of administrative savings. I wonder if the minister could break that down for us.

Hon. J. MacPhail: Well, 13.7 percent of the regional health budget is currently spent on services that are of an administrative nature. This equates to $514 million across the regions, so for every 1 percent reduction in administrative capacity a saving of $5.1 million can be achieved. In order to achieve a savings of $24 million, a reduction in administrative costs of approximately 4.67 percent will be required. We certainly anticipate that that can be easily achieved by the year 1999.

In fact, that's the minimum amount of savings; 4.67 percent in administrative savings across the system is well within any corporate target in the private sector, and we certainly think that our health care sector can meet exactly the same target.

The areas where services can be amalgamated for cost savings are areas such as finance, human resources, laundry, payroll, purchasing and material management, information services and health records. That will be between acute care institutions, for example, but as continuing care comes on board, there will also be an amalgamation of their administrative services in those areas. Our government has committed that all of the money saved will be left in the regions for patient care.

S. Hawkins: I always get nervous when I hear the NDP government talking about meeting targets, because it's the same old story that we've heard in the last three years. We were going to save money by implementing regionalization, and they admitted that unfortunately they wasted $40 million on regionalization. That was their figure. I've heard higher estimates, but they do admit to wasting $40 million. So when I hear them talking about meeting targets and saving $24 million, I'm very cautious, and I worry that we're actually going to be spending more money on administration rather than saving. We will keep an eye on that, and we will hold them to the numbers they're quoting.

[G. Brewin in the chair.]

[ Page 3293 ]

I'm just interested, again, in the funding of the regional health boards and the community health councils. I'm wondering if a funding formula has been developed and how it's going to be used.

Hon. J. MacPhail: I hope we don't get into estimates where we have to correct the record all the time, but there has been no admission by our government that $40 million was wasted on New Directions. In fact, I don't know where the hon. member gets the figure $40 million from.

There were two factors, though. One, there was an investment of about $30 million over three years. I'm sorry, it was actually five years of investing $30 million toward regionalization, starting back under the Seaton report. That worked out to a cost to the health care system of about 0.07 percent of the entire health care budget over that period of time. And yes, there was an admission that some of the investment didn't work, and a great deal of the investment did work. I just hope that we don't have to rehash this ground. We have admitted that change needed to occur, and that's what we're getting on with.

The budgets for the regional health boards and the community health councils for this fiscal year are a continuation of the programs as they were funded prior to regionalization, with the increases given this year. This will be the year that the regional health boards and community health councils will work with us towards a formula of global funding based on population. But we're proceeding cautiously in this area, because that's what regionalization is all about. There have been certain components of health care that have never had to work together and decide what would be a good continuum of care, including funding. So we're working with the various boards this year to establish that.

S. Hawkins: Last year there was a formula that was raised, and I believe it was called "Jeet's formula." I'm wondering if that is a formula that's still under consideration for regionalization funding.

Hon. J. MacPhail: Sorry, I wasn't familiar with that formula. I said: "What does it stand for?" And someone said: "It's his name."

We were starting to do background work with the various regional entities. That was one formula that was proposed. That certainly will be on the table for discussion, along with some other formulas, as well.

S. Hawkins: I understand that the ministry was moving towards allocating funding on a population basis. Can we find out what kinds of factors they're going to take into consideration in designing the formula they're going to use to allocate funding to the regions?

Hon. J. MacPhail: I'm sure the hon. member is aware that this is a very complex area. We wouldn't want, through ill-informed comments by me, to mislead people in the community around this. But I will commit to this: as we develop the formula for population health funding, I will keep the member well informed of the progress as we enter into it.

I actually look forward to this process, because we will be breaking new ground in terms of giving recognition to certain health outcomes and health factors that have not been recognized before in funding.

S. Hawkins: The reason I bring that up is that when I travelled and went to different regions -- and certainly when I went up north -- there was a feeling that the unique factors affecting health in the northern regions and in other regions of the province . . . . In my region there is a high number of seniors. Those kinds of considerations and those kinds of factors haven't been taken into consideration with funding.

Yes, I would be very interested in being kept informed of how funding in the regions develops.

There has also been another concern that comes to mind. As I've travelled through the province, I've heard that the funding for a region will be based for that region. How will patients move in and out of a region, and how will they get services? If they live in one region but must be treated in another region because that region has programs that aren't available in their own region, how will that money flow from region to region, and how will patients be treated?

Hon. J. MacPhail: There will not be a transfer of money from region to region; instead, what we will do is actually fund the region for the work they do regardless of where the patient comes from. So it's the best for the patient in that area; the patient can't be used in a way that's a factor for an unpaid bill or whatever. Each region will be recognized for the contribution they make -- indeed, maybe for services beyond their own community.

S. Hawkins: On the issue of funding, again, we know now that there are multiple health care facilities. The regions have widened to include multiple health care facilities. How will those facilities be funded under a regional health board? Who makes the decision to fund the different levels of hospitals that are in that region?

Hon. J. MacPhail: Just to clarify a previous answer: the current funding will continue for this fiscal year in terms of program funding. The regional health boards will then work with us in the coming years to establish not an institutional base funding but a program funding -- for instance, acute care in the region. And then eventually we'll get to a stage where there will be discussions of funding across divisions of health care, as well. For instance, you mentioned the issue of the aging population and the shifting of funds. But initially, for this fiscal year, it will be funded as it has been, according to the funding methodology in the past.

S. Hawkins: Maybe I'll just refer specifically to hospitals. In a region where there are three, four or five different hospitals in different communities, the regional health board, I assume, makes the decision on how much funding goes to each facility. If the community is not happy with the funding they get for their hospital, what is their appeal? Who do they talk to?

Hon. J. MacPhail: It might help if I could understand what's behind the question. I'll tell you what my fear is in this area, my concern in this area. It is that somehow, decisions for funding are made . . . . It's an unfounded fear, I want to make clear, but I've heard from various communities that perhaps there would be favouritism -- or lack thereof -- shown in the funding formulas based on a community hospital.

That would be prevented on several levels. The first is that the funding methodology will always have the involvement of the provincial Ministry of Health. Secondly, there will be service principles, patient care principles and outcomes that have to be met through the auditing and accountability process. They will have to be met on an institutional basis, not

[ Page 3294 ]

on a regional basis. Thirdly, the first line of appeal for the institution itself will be to the regional health board of the community health council, but then it will also have an appeal to the Ministry of Health. The auditing process, which has never been done before, will, I think, probably point to areas of weakness -- maybe even before the community is aware of it -- and we can straighten that out.

S. Hawkins: I think the concern I've been hearing is about the amount of representation on the boards from varying communities and the way the appointments were done. Some communities feel they don't have the representation on the board that they're afforded. They understood that there would be representation by population, and certainly that hasn't panned out on different boards. You can appreciate that communities are very affiliated with their hospitals, with the health care in their communities, and when they see that somehow the control of it or the decision-making is being removed from them, they certainly do get concerned.

I'm just raising that point, and you're certainly right: that is where the concern is flowing. There are members on these boards who don't represent some communities in the region, and those regions do have health care facilities and clinics that will be affected. They're afraid that they're not going to have a voice on those boards, and that those boards will be making decisions on behalf of their community health centres or their small hospitals. They fear that health care in their community will deteriorate. That's why I was asking.

If they feel they're not getting their fair share of funding -- and the minister has said now that the province will be involved in those decisions -- if the communities, by way of their elected representatives or a group that is not happy with the funding they receive . . . how is that going to be addressed?

[4:15]

Hon. J. MacPhail: The appeal will be through the regional health board. If there's still a problem, it will be to the Ministry of Health.

S. Hawkins: Getting back to the accountability framework, then, is there an appeal process set up? Is there any accountability that flows from the regional health board back to the communities?

Hon. J. MacPhail: I'm trying to look for something that . . . . I'm sure it's a legitimate question, but I'm trying to look for something, because the question seemed to be based on an adversarial approach to community health delivery, and I'm sure that's not the intent.

Each region and community will have to develop a community or regional health plan, and it will have to have health outcomes in it. That community or regional health plan will be agreed upon by the Ministry of Health as well. In the context of developing that health plan, if there's a gap or an inappropriate concentration in the delivery of a particular health care service, then that will be brought to our attention in the health plan.

Certainly there is no mechanism for appealing the health plan other than us working with the regional health board to say: "You have to deliver all of these health care services in a way that meets the needs of your community."

S. Hawkins: I'm merely reflecting the concerns of people in the communities that I've heard from. What they're saying is that they feel they're losing some control over health care decisions that are made in their community. And with the board being totally appointed and with the accountability, as it seems now, flowing from the board to the ministry, when before there were elected officials and people from the community on the hospital society boards and facility society boards that had to answer to the public . . . .

It just makes sense that there should be some vehicle so people from the community can address the regional health board when they have concerns. When you talk about gaps or something lacking, it doesn't seem to be clear if there is a mechanism for people in the community to voice their concerns. Because right now, what seems to be happening . . . . And that's the perception right now; I'm telling you what the perception is. You may have a different view of reality. The perception right now is that the regional health board is making decisions that are not in congruence with the community.

If the community has a concern, if members in the community have a concern -- they do pay their taxes and they do help fund the health care system and they certainly donate to hospitals and to facilities; they try and make health care in their communities work -- is something being set up? Is something being considered? Is there an appeal process? Is there a committee, perhaps, that the regional health board will have that will meet with community groups and work through some of their concerns, instead of some communities feeling like they're totally left out?

Hon. J. MacPhail: I have actually travelled the province and met with some of the communities that are concerned as well, and the regional health board chairs have come with me. There has been agreement reached in several communities that there actually be a community advisory committee. In fact, in some communities they wanted it larger than just one community, because the communities share services.

And the regional health boards . . . . I'm finding, actually, that the regional health boards and community health councils are more than amenable to bringing in all of the various communities' concerns to the one table.

I have a different perception only to this extent. It's simply not the case that somehow in the past services were isolated to a particular community and there was no sharing across and amongst communities of health care services. But there wasn't any way in the past that various communities that had to share the same services could get together and plan for those on a cross-community basis. So I'm actually quite looking forward to seeing the process work.

But something that I am concerned about as well is that where there is a health care service upon which only one community relies, then we have to pay particular attention that that health care service is properly funded, adequately discussed and considered in a larger context.

S. Hawkins: I appreciate those comments, and I certainly hope that there will be some way to bring the community groups together. From my experience talking to groups in the last few months, it's been very difficult for the regional health boards to organize not only their own meetings amongst themselves to figure out how they're moving ahead with regionalization but in addition to work with groups in the community and try to get them sorted out. It's a challenge. It would certainly be advised, and it would certainly be accepted, that there were some kinds of committees involved in advising the board from community levels.

I want to talk a little bit about core programs. I understand that the province will keep some core programs. Some

[ Page 3295 ]

programs will go specifically to the Vancouver-Richmond regional health board, which has been referred to as a superboard. I wonder if the minister can share with us what programs the province is going to keep and what programs are specific to the Vancouver health region.

Hon. J. MacPhail: There are two aspects to the question that I want to offer the member. One is that the Medical Services Plan, Ambulance Service and Pharmacare will generally remain provincial entities across the province. But specific programs are offered in the Vancouver-Richmond regional area that go beyond servicing patients and clients. The reproductive care program, I'm sure, is one that would come to your mind.

For tomorrow, why don't I get you a list of those programs that are under the auspices of the Vancouver-Richmond regional health board, and then we can discuss those on a program-by-program basis, if you wish. But there are two distinctions there.

S. Hawkins: I certainly would appreciate that. There were several societies that were replaced with public administrators in cases where community health councils and regional health boards were dissolved. I'm wondering if the minister has broken down costs related to this. What's the cost of the public administrator taking over these societies?

Hon. J. MacPhail: These people were truly public servants in that they didn't get any extra money for doing the job they did. They were assigned from other duties, and there was no increased cost to the health care system.

G. Abbott: I don't know whether the minister's mother is still here, but I'll try to be very civil as well.

I'd like to begin by perhaps ventilating a couple of corners in the regionalization structure. Obviously the Health critic has done an excellent job of laying those questions out, but I just want to look in a little bit more detail at some of the issues.

Now, as I understand it -- and I hope the minister pardons my ignorance, if I reveal it here; I just want to make sure that I have a clear understanding of what the current universe looks like in terms of all the primary actors in the new health care governance model -- we still have the Ministry of Health at the centre of things. We also now have regional health boards and CHCs, on the one hand, but we also have in the new model of health care governance the continuation of regional hospital districts -- that adjunct to regional districts that has existed for some time. Is it correct that they will continue, and could the minister advise what their continuing role will be?

Hon. J. MacPhail: Regional hospital districts will continue to perform their function of planning and sharing in the costs of capital projects in that area.

G. Abbott: Could the minister advise, in the functional plan for these organizations, how the interests and concerns or thoughts of the regional hospital districts will be integrated with those of the regional health boards or community health councils, as the case may be?

Hon. J. MacPhail: The assistant deputy minister responsible for acute and continuing care met recently with the regional hospital districts -- it was actually sponsored through the UBCM. Our ministry will be engaging in a consultation process that will address the boundaries where community health councils exist and the cost-sharing ratios -- whether there would be any change there or the continuation of that -- and really ensuring a continuing partnership between the ministry and the regional hospital districts, even within the context of the regional health boards and community health councils.

Part of that will be that we will make sure that the proper communication lines between the regional hospital districts and their community health councils or the regional health boards are in place.

G. Abbott: That does help a certain amount. I'm still a little unclear as to what the lines of communication will be between the regional hospital districts, when they are being asked for -- or are offering, as the case may be -- their 40 percent toward a new capital project. Presumably, there has to be some line on which the concerns and interests of the regional health boards become acquainted with those of the regional hospital districts.

Hon. J. MacPhail: Several things will happen. One is that the planning committees for the regional health board's building committees should involve the regional hospital district as well; if not, we'll make sure that does occur. The moment we receive a proposal from a regional health board or a CHC for capital development, we will immediately ensure that the regional hospital district is notified of that and that the talks begin in that area.

I would expect this to be a transition phase; I would expect that eventually it will become clear what regional hospital districts have to work with what community health councils. Certainly it's much clearer in the area of regional health boards.

[4:30]

G. Abbott: That helps to clarify the situation a little bit more again.

My question is prompted by my own participation on a regional hospital district board for a long time -- 17 years, for ten of which I was the chair. Frequently there were sensitivities and concerns surrounding the requests from the province, as the case was then, for the 40 percent contribution from local government. Sometimes the local government felt as if they hadn't adequately been consulted prior to assumptions being made about a new physical facility being needed. I'm wondering what safeguards are going to be put in place in the new model to ensure that that kind of problem doesn't emerge. Has the ministry thought this particular one through?

Hon. J. MacPhail: We've certainly thought about it a great deal. I agree with you that this friction -- sometimes created, sometimes not -- has been around for a long time. I met with some UBCM representatives just a week or two ago -- they happened to be from my own regional area -- where again there were hurt feelings because they thought we were spending money without consulting them. It turned out we weren't, but nevertheless they were upset about it. It has to improve. The way we fund health capital projects has to improve. There are several suggestions on how that can improve.

That's why we're working with UBCM in this time of transition: to put in place a better working relationship in determining how we reach agreement on the priority of projects, basically.

[ Page 3296 ]

I think most of the area of friction comes from us having different priorities -- not necessarily the value of the project or the worthiness of the project but how soon it comes on stream. That is an area that needs improvement. Yes, we have put our minds to it, and that's exactly what we're working on in consultation with the UBCM. Frankly, any expert advice you could offer in that area would be much appreciated.

G. Abbott: Again, to make sure I've got it right here . . . . In the old days -- not too long ago, I suppose, but in the day of the hospital board -- the hospital board would conclude that, for example, a new extended care facility was needed for the community. They would so advise the Ministry of Health in Victoria, I guess hoping to get their 60 percent of the required capital. They would presumably also advise the regional hospital district that they thought the new facility was needed in hopes of winning their support for their 40 percent contribution. That is sort of a crude

summary of the old way things used to be done. Can the minister tell me what is going to be the new pattern for these things? Are the projects going to be identified by the regional health board, then the support sought of the regional hospital district? Or what kind of a pattern would the minister see evolving there?

Hon. J. MacPhail: Let me just try to run through it in the same way that you did, then. The regional health board will initiate requests according to their plan for the health plan. I expect that the regional hospital district will as well, because they exist and have authority. There will be a third party now, the Ministry of Health, to ensure the equitable distribution of capital. I would expect that the process could flow both ways: regional hospital district to regional health board, and vice versa, and then probably both of them ganging up to lobby the Ministry of Health.

G. Abbott: I do want to explore in a bit the question of how capital funds will be flowing from the province to the regional health boards. I still want to tie up some loose ends here in terms of the relationship between the RHBs and the RHDs. Again, the RHB believe they need, according to their plan, a new facility; the regional hospital district will presumably be invited at some point to endorse their 40 percent funding of that project. Do you see the lines of communication being developed locally through building committees or some other committees, rather than sort of indirectly through the Ministry of Health in Victoria? Is that a correct

summary of what you said?

Hon. J. MacPhail: That would be the mature relationship that we hope everybody would shoot for, and we'll assist in reaching that point.

G. Abbott: Again, just going back to my crude understanding of the actors in the current government's model, that leaves the CHCs and RHBs on the one side, regional hospital districts on the other. The one other formal element that I think the minister has mentioned, which is going to have to be a part of the health governance model, is a medical advisory committee. I believe the minister said that medical advisory committees would be the one consistent element, in addition, that would be found in each regional hospital board or CHC across the province. Is that correct?

[R. Kasper in the chair.]

Hon. J. MacPhail: Yes.

G. Abbott: Again, for certainty here, I understand that the union boards of health have now disappeared -- or will shortly be disappearing -- from the face of health care governance in British Columbia.

Hon. J. MacPhail: Yes.

G. Abbott: They have disappeared now, or they are still in the process of being wound down?

Hon. J. MacPhail: They actually report to a different area of the ministry. I believe that they have disappeared, but if not . . . . I'll make sure I get the answer on that for you tomorrow.

G. Abbott: Again, it's my understanding that health care societies across the province are winding down their operations as well. Or is that incorrect? Do they continue in a purely advisory capacity after the present changes?

Hon. J. MacPhail: There are several kinds of health care societies, so let me outline for you my understanding of . . . . Maybe you're talking about a different thing.

The health care societies dealing with hospitals are what we've already gone through in terms of dissolving them and forcing amalgamation in some areas, or there's been consensus amalgamation. Other health care societies, such as . . . . There may be some for extended care facilities or home support facilities that are non-profit societies.

How they amalgamate or work with regional health boards will be up to the regional health board. Does a model of affiliation work best -- perhaps for religious concerns -- or should they amalgamate? For cost efficiencies does it make sense for the societies to turn over their administration to the larger regional health board? That will be decided on a community-by-community basis. But the large institutional amalgamations have occurred, and the way that the other non-profit societies relate to the boards in the future will be decided on a community basis.

G. Abbott: I'm understanding from the minister's response that in some instances there may be a continuing role for health care societies across the province, depending upon circumstances, upon how they're structured, and so on. They may in fact continue to have a formal or informal advisory role in relation to the regional health boards in the future. And again, if my

summary of this is off, the minister can advise after.

I want to use the example from my own community. There is a Shuswap health care society that was the product of an amalgamation between the old Shuswap hospital board, the acute care society for one of the lodges, the extended care society for another lodge . . . . They all combined their resources into one health care society. In that instance -- and I hope it's not a difficult one for the minister to respond to -- where it's a kind of hybrid of a number of things, would that be one of the health care societies that in the minister's view might have a continuing role in the new health care governance model?

Hon. J. MacPhail: I don't want to give you a definitive answer. If you want us to give you a definitive answer, I'd be more than willing to on that as an example, but we'll have to check into the exact details of it. It sounds to me like the parts . . . . You say that they have an amalgamated hospital

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and an extended care facility, etc. For instance, the hospital part would be transferred to the regional health board, but the other responsibilities of the health care society could continue. Let me look into that as a specific example.

G. Abbott: That's fine, I appreciate the minister's offer, and I think that that will be useful.

I think it's an important question about what the continuing role, if any, of these health care societies will be. As the minister knows, there is -- rightly or wrongly from my perspective or her perspective -- a good deal of concern surrounding the evolution of health care governance in British Columbia. I think it may well be that in the year or two ahead, communities will look more and more to a continuing role of what was the local health care society in providing a mechanism for people to have a voice in the regional health boards.

Again, the minister may not have finely tuned her plans with respect to this, but it is certainly my suspicion, my view, that communities will want to see the continued existence of those health care societies -- even if it is in a purely advisory capacity -- because it will offer, potentially, a voice and a way in which to involve people in health care governance. Perhaps the minister would like to comment on that before I leave this particular area.

Hon. J. MacPhail: There is a wealth of experience across the health care system from a volunteer base, just as the hon. member describes. And it would make sense for any regional health board or community health council to rely on that experience and to incorporate it in a way that makes perfect sense. So advisory at a minimum, yes.

But what I see as the difference -- and seeing it as responsible for the system in Victoria -- is that what is truly going to happen at the community and the regional level now is real responsibility for the allocation of resources and for designing the health plan for that area. It makes sense for the individual areas of expertise to be relied upon, but we also need a body that oversees the integration of those resources across the community. And I see that as the real step forward. In the process of integrating those resources, it makes sense for the boards, though, to rely on the individual expertise built up by those smaller health care societies.

G. Abbott: Just to conclude on the actors in the new health governance model, we've talked about CHCs, RHBs and RHDs. We've concluded that union boards of health are gone and that health care societies, apart from a purely advisory capacity, will be gone. Are there any other formal structures in the current health care governance plan? Are there any other pieces that we failed to identify at this point?

[4:45]

Hon. J. MacPhail: Just let me answer a couple of your questions. One, the union boards of health had amalgamated with the regional health boards and the community health councils effective April 1. The good news is that we have kept their expertise flowing, because many of the members of the union boards of health have now been appointed to regional health boards and community health councils because they provide a very valuable perspective of the health care system.

The Shuswap Community Health Care Society in total, the whole society, voluntarily amalgamated with the North Okanagan regional health board on April 1, 1997; they have joined with the regional health board. The CHSSs -- community health care services societies -- are another structure that will be the employing agency for public health workers who were directly employed by the Ministry of Health and have duties that go across community health council boundaries.

For instance, in certain areas of the province, the new employer for the public health workers and the mental health workers -- not alcohol and drug workers, because that's been transferred to the Ministry for Children and Families -- will be the CHSSs, which are made up of community health council board members.

G. Abbott: I think that more or less completes the picture. I obviously may want to explore -- if I've got the acronym right -- the CHCSS.

Hon. J. MacPhail: No, CHSS.

G. Abbott: CHSS, okay. I've always found acronyms absolutely puzzling, unless you can work them into something very distinguished -- like, say, a RAT team, or something that's very catchy. It makes it so much easier to remember.

Interjection.

G. Abbott: Or cupcakes, yes. Anything that allows the acronym to become more memorable does make it a lot easier. I'm sure the minister will give her full consideration to that as she considers acronyms in the years ahead -- or