1994 Legislative Session: 3rd Session, 35th Parliament
The following electronic version is for informational purposes only.
The printed version remains the official version.
FRIDAY, JUNE 24, 1994
Volume 16, Number 23
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The House met at 10:05 a.m.
D. Mitchell: This is a special day for me. I promise to be on my very best behaviour today, because for the first time since I entered this chamber, my mother is visiting in the public galleries. Would members please welcome Margaret Mitchell, who is visiting Victoria from Abbotsford today.
THE CARIBOO ECONOMIC ACTION FORUM
F. Garden: It gives me great pleasure to rise this morning to talk about a group of people from the region that I am involved in as their MLA -- as is my colleague the member for Cariboo South, the Minister of Agriculture, Fisheries and Food. Over the past year or two this group of people has worked together in bringing about some very historic achievements in the Cariboo -- the Anahim Round Table being one of them, and that magnificent park that was created at Chilco.
There is a forum being created in the Cariboo called the Cariboo Economic Action Forum. This is a group of people, as I've said, who have worked together before on such projects to bring forward solutions or suggestions for the economic well-being of our area from the people in the Cariboo themselves. It is with great pleasure I joined with the member for Cariboo South in asking these people to form this group. Our region needs to have the tools necessary to adapt to the major economic changes we are experiencing. That will be one of the functions of the Cariboo Economic Action Forum in Williams Lake, Quesnel, 100 Mile House and the surrounding areas.
The steering committee of this forum held its first meeting on May 10 in Williams Lake and established its mandate. The committee will identify economic priorities for the Cariboo by working with people who work and live in the Cariboo. These priorities in turn will be forwarded to the government to help in the delivery of economic and skills development initiatives like Forest Renewal B.C. and Skills Now.
The forum is receiving substantial support from the Ministry of Small Business, Tourism and Culture, through the Prince George regional management unit. They've been very helpful in getting this steering committee off the ground.
The steering committee is chaired by Muriel Dodge of Big Lake and Wade Fisher of the IWA Local 1-425, but it's also made up of local residents, business people, representatives of local government, aboriginal people and others. Once the steering committee gets an advisory group in place with wide representation from a variety of municipal and regional sources, it will be in a strong position to speak for the Cariboo on economic matters.
The steering committee is seeking forum members' ideas for economic priorities until September 1 of this year. While this is going on, there will be a review of past and current economic development work that has been undertaken in the region. Working together, members of the forum will look at the ideas of Cariboo people for improving the regional economy and will set realistic goals.
I feel that this committee could not have been brought on stream at a more historic time. As I mentioned earlier, they will be helping us make suggestions to the government on our historic Forest Practices Code bill, our forest renewal plan and the Skills Now program. Instead of having a bunch of ad hoc ideas coming from all different parts of the Cariboo, this will be a concentrated effort to vet these ideas, discuss them at this committee, discuss them at the wider forum and then present them to government. In October of this year, the forum will be brought together for a workshop to talk about economic opportunities, constraints and the shape that the Cariboo economic plan should take. The committee will then draft a plan, and after long consultation with forum members, the plan will be submitted to the provincial government in December of this year.
As partnerships like this are required, this government made a pledge when it came to office that it would be consulting with the people in the regions. We've shown that we're able to do that through our CORE process. We didn't get the unanimous agreement we wanted in that process, but we did bring people together in a way that they've never been brought together before and we got ideas for major initiatives of this government. We've taken these ideas and suggestions, and one of the results of that is the plan announced by the government this week for Vancouver Island. We're expecting to see just as successful a plan for the Cariboo shortly.
This month the Minister of Small Business, Tourism and Culture joined the member for Cariboo South and myself in lending his full support to the Cariboo Economic Action Forum. The minister has said that he sees the forum as a partnership between the government and the people of the Cariboo. I see the forum as yet another example of our government's commitment to forming partnerships with the people of this province.
Through this economic plan, our government will be better able to apply economic initiatives in the Cariboo, combined in the forest renewal plan and in Skills Now. The forest renewal plan will invest billions of dollars in the future of our forests. This isn't just a government initiative; it's a partnership between business, labour, environmental groups, aboriginal people and ordinary British Columbians. Together with the Forest Practices Code, this partnership will ensure that there will be a healthy forest and forest industry for future generations.
Skills Now is another partnership, including representatives of business, labour, education and training providers, and government. It will keep British Columbia on the leading edge of job training and retraining. The Cariboo Economic Action Forum will have its place in this planning process. What's more, Skills Now includes partnerships with small business and key sectors, in sharing the costs and responsibility of retraining workers and updating their skills.
Finally, the Cariboo Economic Action Forum combines many of the goals that the government has set, and it seeks to coordinate our government's programs in a way that will best meet the needs of the people in the Cariboo.
F. Gingell: Well, I was going to respond in nice, non-political terms, but that was a politically charged speech, so I think that gives me a little more licence.
The program that the Cariboo Economic Action Forum is commencing is a critically important part of economic growth in our province. I wish them very well, and I wish them all the best. The problems that British Columbians face tend to be regional in nature, and it takes regional solutions
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and cooperation between the various interest groups within those regions to create solutions.
What governments have to do -- whether they be this government or the federal Liberal or Conservative governments -- is recognize that their job is to create an environment in which free enterprise can grow and flourish. Government has to set the groundwork and lay the foundation, but government doesn't need to go and do everything. Government needs to ensure that the tax, licensing and permitting regime allows business to move reasonably quickly and do the things they need to do to get started without being all tied up in red tape. Then it must stand aside and allow business to get on with the job. This government talks about Closer to Home, and I think this is a good example of where Closer to Home can work very, very well.
It is with sincerity that I wish the Cariboo Economic Action Forum all the best. I truly hope that their endeavours do bring economic activity to their region. I hope they work towards improving the lot of all of their citizens and improving their standard of living. At the same time, governments must recognize that it is the incentive of the human being to create a better world. It isn't government that can legislate all these things. Government must set the tone and work with these kinds of organizations to make them happen.
F. Garden: I thank my hon. colleague for his remarks, but it's pretty hard for a politician to stand up in a legislature and not make a political speech. I just want to say at this time that this Cariboo Economic Action Forum will bring certainty to the land use plans that this government is bringing down. As I said, it's hard to be non-political.
The federal CCF will go down in history for their fight for the Canada Pension Plan. Tommy Douglas will go down in history for introducing health care to Saskatchewan. Dave Barrett has his place in history for the agricultural land reserve. This government will go down in history for its forward-looking Forest Practices Code and its forest renewal plan that will provide a sustainable economic future for our people and new skills for our children. It's just a little unfortunate that our colleagues in the Liberal opposition are being so negative on these historic issues.
But we can't stop there. We must now empower people in the regions to play their part in building a great future for our province. This is what the Cariboo Economic Action Forum is all about. It's a non-partisan representative group from all over the Cariboo, and I wish them every success.
THE AVAILABILITY OF CORNEAL TISSUE FOR TRANSPLANT
L. Reid: I rise today on the topic of the availability of corneal tissue for transplant. This is a significant issue today. I wish to quote from the Canadian Medical Association Journal:
"Many patients today are referred for transplantation because of the procedure's success. However, waiting lists in Canada are increasing because there are not enough organs to meet the growing demand. Since 1990 the number of organ donors in Canada has decreased, from 516 donors in 1990 to 332 donors in 1992, whereas the waiting list of potential recipients has grown, from 1,520 in 1990 to 2,076 at the end of 1992."
These statistics are taken from the Canadian organ replacement register, which is kept in Don Mills, Ontario.
The decreased donor rate is an issue for British Columbians today. There must be an avenue that this Legislature and British Columbians can pursue to ensure that that tissue is available for transplant. This is not an issue of hospital bed closures. Often this procedure is done in a single day or in two days. This is an issue of availability of tissue that we must deal with, because we have significant numbers of British Columbians today whose sight is impaired. I'm not just speaking of the elderly population; I'm speaking of individuals of all ages. Young people are on wait-lists in this province. There are six-, seven- and eight-year-olds who have suffered some kind of trauma, injury or motor vehicle accident, all the way up to elderly people whose eyesight is failing but whose quality of life is being jeopardized by the lack of the actual tissue for transplant. That, I think, is a problem that can be solved. With some commitment and dedication, we can create an eye bank that makes that tissue available to British Columbians.
I would like to see this Legislature commit to that process today. I would like to suggest that the cost of ensuring that that tissue is available is far less than compromising the health care of British Columbians. In fact, when individual sight is compromised, particularly those who are in their older years need services from the Ministry of Social Services and the Ministry of Health because they're not able to take care of themselves once their sight has been compromised to that extent. In fact, we have people on the wait-list for two and three years who require home support and in-house care. That is a cost to the system. It is an inhumane cost, if you will, when those people's true desire is to continue to provide for themselves and to have their faculties in place so that they can do their own shopping, make their own telephone calls and do their own gardening. A lot of those are personal issues that have been brought to me as the Health critic in this province.
It seems to me that this problem does have a solution. I would quote again from a letter written by a Jane Addison to the Minister of Health. This woman is writing because she is concerned for other individuals who will come after her in the process. It says:
"I am writing to you as a concerned citizen who received a corneal transplant in January 1994. Citizens of this province wait two to three years for corneal tissue to be made available through the B.C. eye bank when our American counterparts need only wait a month to six weeks. I wonder about the efficiency and management of the B.C. eye bank, the agency responsible for collecting and distributing corneas. Corneal transplant surgery has restored my vision, and as a result, the quality of my life has been enhanced. Individuals requiring this very effective procedure should not have to wait years because of inefficiencies in our health care system that may have nothing to do with escalating medical costs and hospital bed closures. As a preventive health care manager, I feel that organ donor awareness campaigns are sadly lacking, and would personally like to see more information available in the community.
"My request is that you review the operation of the eye bank. Many citizens may be suffering needlessly due to policies and procedures that do not meet the needs of individuals on the waiting list. I look forward to hearing from you."
Jane Addison is a registered nurse who received the transplant.
The issue I bring to the table today concerns the individuals who sit on wait-lists in this province for two and three and four years and who are not able to participate in society, work or enjoy quality of life. That's a significant issue. It's not about dollars at this point. Either we choose the transplant now, or we pay many associated costs for the services those individuals will require. It's an issue of good management. I trust that, together as legislators, we can
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bring some good efficiency practices to bear on the Eye Bank of British Columbia.
D. Schreck: I thank the member for Richmond East for drawing attention to a matter that should concern us all and that is raising consciousness for all types of tissue donation. It is clearly very stressful on families if the issue of donating -- whether it be corneas or other human tissue -- is not raised until the time of a tragic accident. The emergency room is hardly the time to be confronting grieving relatives with a decision that has to be made within minutes of that tragedy.
The issue of human tissue donation extends not only to corneas, but to hearts and a variety of human tissue. We should use this opportunity to invite members of this Legislature to look at their driver's licence to see if clearly says "organ donor." I would hope that would be all of us. Since the program has been available -- I think it's been over 20 years now -- I know that I've taken advantage of it. Many of the members here and many of the people that we deal with have.
There is some resistance, and there has not been the sort of take-up that we would all like to see. I believe that this is a question which clearly draws the line on how far government can go in intruding into personal choices. My belief is that the most government can do is make people aware of the opportunity to improve someone else's life by giving the gift of life -- whether that is by giving a cornea, a heart or any other form of human tissue. But for those who have religious beliefs or are facing moments of trauma, we cannot have the state or health professionals intruding on those beliefs and insisting that the donation be made, or putting undue pressure on at a time when people cannot give informed consent.
The opposition Health critic, in introducing her comments, said that the Canadian Medical Association Journal referred to the Canada-wide problem of a reduction in the number of donors to the eye banks across Canada. Furthermore, she pointed out the Canada-wide problem of an increase in waiting lists. I'm happy to see that the opposition Health critic has recognized that the challenge of increasing the number of donors and dealing with the increase in waiting lists is a Canada-wide problem.
Why is it that we have that difference between Canada and the United States? Part of the difference is that in the United States there is a market in body parts. That sounds as terrible as it is, but the fact is that in the United States, compensation can be made for donations. We have to come to grips with that reality. There are disastrous social consequences of paying people for this form of donation. The implications are so horrific that I do not want to get into the discussion, which should be obvious to any adult thinking about what can happen when you start paying people for donating human tissue.
The suggestion that British Columbia or any Canadian province should enter into purchasing human tissue from the United States, and therefore encouraging that sort of market, may relieve those who desperately need that tissue, but the social policy implications of where that can lead -- in terms of the exploitation of people who are in ghettos or who are in the developing world -- will affect tens of thousands of people. They have implications that we should all reject. Therefore I say that we should all share concern for the need to increase voluntary donations. But we must be clear that we draw the line on not intruding into people's personal religious beliefs, and on not intruding on people's sorrow and grief and tragedy.
The time to think about human tissue donation is now, when we are healthy, when we can put the decal on our driver's licence, and when we can do so with informed consent. If we all make that decision now, many people will live a healthier life.
L. Reid: I would like to thank the hon. member for North Vancouver-Lonsdale for his comments. But I think we must move to the practical need we have today, and certainly people on the wait-list have a practical need today. So perhaps we can come to grips with some solutions to the problem.
Perhaps another way of pursuing this issue would be to establish effective programs within each hospital. Perhaps we can ensure that each hospital effectively tackles this issue. I can appreciate that there are some complexities around family and grieving and all of those issues, but if we waste organs that are available for transplant.... Oftentimes that happens because hospital issues are not carried forward, and sometimes it's because of miscommunication. Sometimes a family just does not effectively communicate what they would like to happen with some of that tissue, some of those organs. That is a concern.
The hon member talked about putting "organ donor" on one's driver's licence. I think the best focus for this is that perhaps it would allow families to focus on the discussion about being an organ donor. That is the issue, because oftentimes people who are not able to give consent don't have adequate documentation with them. So your family must be aware of your wishes and must be prepared to carry them out.
I think we need some leadership on this question. I think we must ensure that the Eye Bank of Canada and the Eye Bank of British Columbia do work. Certainly I support the contention. I know there are a number of people today in my riding who are waiting for a corneal transplant. We must support the contention, as legislators, that every time we waste someone's possible donation, someone's potential donation, we are in fact putting one more person on the wait-list and are not able to provide them the services they need to enjoy some quality of life.
That is a huge issue today. All of us must come together to meet that challenge, and I think it must go well beyond putting "organ donor" on your driver's licence. As legislators, we must build awareness. We must ensure that every functioning health care facility in this province has a program that supports and promotes organ donation, because it is an issue of awareness that will allow us to tackle the problem of people on the wait-list. It's not just a philosophical discussion; it has to be a practical remedy to a huge problem for many British Columbians whose only wish is to have their sight restored.
F. Randall: I rise today to make a statement on workplace health and safety. As I'm sure all members of the House are aware, June 20-26 has been proclaimed Occupational Health and Safety Week in British Columbia.
The cost of workers killed or seriously injured on the job in British Columbia every year, in both human and economic terms, is staggering. Last year alone, 169 workers were killed on the job; 3,700 were permanently disabled; 195,170 new injuries were reported to the Workers' Compensation Board; 75,000 people took time off work because of their injuries; and 3.2 million days were lost because of workplace injuries, not including fatalities. Each month, the Workers'
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Compensation Board issues 26,000 cheques totalling more than $12 million. This money goes to workers who have been injured, workers who have permanent disabilities, and to survivors of those who have died as a result of industrial disease or fatal workplace injuries. These are hard numbers, but accidents in the workplace are a harder reality for the families involved. Behind each of those statistics is a real person, and a family whose personal reality has been altered by an injury or a disease.
I'm sure all members would agree that the best way to pay tribute to these workers is to improve health and safety conditions in British Columbia workplaces, upgrade compensation delivery, and enhance services to workers who suffer workplace injuries. I am distressed by these statistics. It is completely unacceptable that people should lose their lives on the job or be seriously injured. We can do better; we must do better.
I am proud of our government's achievements in improving working conditions for working men and women. Since forming government, we have introduced sweeping new agricultural safety regulations protecting 30,000 British Columbians working on farms and ranches. There has been no greater injustice in British Columbia than the absence of basic health and safety regulations for men and women who work on our farms and ranches. While workers' compensation has existed in this province for 75 years, unbelievably -- until just recently -- farmworkers have been excluded.
There have been too many deaths, and too many farm families have suffered. Last year, agricultural labour was found yet again to be among the most dangerous occupations in Canada. According to the Canada Safety Council, the accidental death rate on Canadian farms is estimated to be 20 percent higher than the national average. On average, farming claims five lives every year in British Columbia. Farmworkers are being injured, maimed or killed when they work on machinery that doesn't have proper guards, when they are not wearing the right protective clothing or when they just don't know or understand the proper safety procedures. Farmworkers are being poisoned by improper handling of chemicals, because of ignorance or carelessness. They are putting themselves at risk every day because they don't know the proper health and safety procedures.
I have heard of some frightening accidents; all of them could have been prevented. Last spring, prior to the introduction of the new regulations, a young horse trainer was killed when the tractor she was operating overturned and rolled. Although she tried to jump clear, the wheels twisted and the tractor fell sideways, and she landed on her face on the ground. Just a few weeks later, a farmer died when his tractor hit a rut, flipped into a ditch and crushed him to death. At least two other tractor-related fatalities were reported in 1993 alone.
Statistics show that half of all farm fatalities in the province are caused by tractor rollovers. As a result of the new regulations, the WCB now requires newer agricultural tractors to have rollover protection structures, known as ROPs. In addition, operators of tractors with ROPs will be required to wear seatbelts. Ask anyone in agriculture about the safety value of ROPs, and the answer is clear. Farmworkers, employers, equipment manufacturers and WCB officers all agree that ROPs do save lives.
Our government has initiated a plain language program to assist workers with their compensation claims. All materials regarding the new safety measures are available in Punjabi, Cantonese, French, Japanese and Portuguese. The wording on the warning signs is in the language of the workers.
I would like to make mention of the other significant gains made in these areas since we formed the government, many of them over the past year. Our government has extended workers' compensation services to cover virtually all workers and employers in the province, including those not only in the agricultural area but in the service sector as well, an addition of nearly 150,000 workers and 18,000 employers who previously had no protection. Universal coverage is a right for all workers in B.C. It keeps one of the fundamental labour laws of the province in sync with the changing workplace.
In the past year, we have eliminated gender discrimination from survivor benefits. Spouses of workers killed in the workplace are no longer cut off from benefits if they remarry or form new common-law relationships. An extensive regulation review has also been undertaken. As a result, new regulations are in place to protect British Columbians from violence in the workplace. We have also introduced regulations concerning improved safety for the use of industrial chemicals.
In the past year, we have established three workers' adviser offices in regional areas around the province: Victoria, Kamloops and Nanaimo. These offices meet a real need for injured workers by providing them with independent information and advice about the workers' compensation system. Advisers also hold training seminars to help workers understand their rights and responsibilities under the Workers Compensation Act.
More recently we have made improvements to the Workers Compensation Act through Bill 13, which received third reading on June 2. It will provide a fairer system for workers and their dependents who make occupational disease claims, by giving them more time to apply for benefits. It ensures that workers with occupational disease claims are not penalized for filing late in cases where the medical evidence linking the disease to the workplace was unavailable. In the past, if a claim was filed more than three years after the worker's disablement or death from occupational disease, compensation benefits could be paid only from the date of application. The new legislation means workers or their dependents could be entitled to full benefits from the date of disability or death regardless of when the application was filed.
I know I speak on behalf of all members of the House when I say we mourn the 169 workers killed in 1993 in British Columbia. Their deaths are a tragic loss not only for their families, friends, co-workers and employers....
The Speaker: Hon. member, I regret to advise you that the time for your initial statement has expired.
K. Jones: It's very timely for us to talk about health and safety in British Columbia, particularly in the workplace. With it being Occupational Health and Safety Week, I think it's very appropriate. Indeed, all sides of this House mourn those persons who have lost their lives; 169 deaths are 169 too many to be allowed to occur here in British Columbia. We need to find ways to stop these needless losses, both the deaths and the serious injuries that occur.
In touring the province with the Workers' Compensation Board hearings that the official opposition has been conducting -- we've been to six cities in B.C. now -- we talk to the Workers' Compensation Board staff, and we hear that more serious accidents seem to be coming forward now than there were in the past. This is very troubling. There are
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several factors. It means that workers are not being properly trained. They're not cognizant of or not being renewed in their awareness of the risks attached to their jobs. They're becoming overconfident, or some other factors lead them to not take the safety precautions that are necessary when working in hazardous locations and with hazardous products. All these factors need to be accounted for and need to be changed.
According to WCB statistics, $16.5 million was spent in the past year on the prevention side of the Workers' Compensation Board operations. That is just a beginning in the aspects relating to health and safety and to preventing accidents. Most of the real message has to come from a joint effort of the employers, the unions and the workers working together to bring a different approach to how they do their jobs and how their jobs are directed to be done. There has to be a new awareness and positive thinking about the safety programs among some who probably think that productivity is more important than the safety of their employees. I must assure those people who think that way that the most successful companies are those that have the most successful safety programs. Those people get the benefits, in that they don't have the lost time or the high compensation costs, and they don't have employees who are dissatisfied with the workplace. Therefore they bring a very positive approach to both the job and the relationship between employees and employers. There is a multiple benefit that comes out of a good safety program and a good health program.
Lost time for occupational diseases is something that we're concerned about. That still seems to be a serious problem. We thought that most of this would have been addressed, but when we addressed the need to be concerned about asbestos and some of the obvious chemicals in the workplace.... Those have been addressed fairly extensively. Major renovations of job sites and general public contact places have been made at extensive expense. We now have many other hazardous products, and we have to address them. It's up to the people, both employers and employees, to identify those risk areas and bring them forward to be addressed. This can be best done with the full support of the public and government through joint health and safety committees, to make sure that these issues are really brought to completion and that that type of problem is eliminated.
F. Randall: I would just like to thank the hon. member for Surrey-Cloverdale. I know that his comments were very sincere and that he's very understanding of this problem. I would just like to add that although we have made progress in reviewing and updating our safety regulations in the past few years, there is still a significant amount of work ahead of us. Our government -- and I'm sure every member of this House will agree -- believes that the statistics I mentioned previously are clearly unacceptable. It simply isn't good enough to say that fewer people died on the job this year than last year. It's the responsibility and obligation of every British Columbian to try to improve that and help prevent accidents on the job.
We have made good progress in reviewing and updating safety regulations in the past few years in the industrial, forestry, fishing and construction areas. The Workers' Compensation Board is doing more than ever to crack down on unsafe worksites and unhealthy work environments. They are doing more safety inspections than ever before, and they are issuing more compliance orders and penalties against employers who fail to meet their compliance obligations. But the best way to save lives and prevent injuries in the workplace is to give workers the skills, knowledge and direction to prevent accidents. Prevention starts with education and getting the message out to employers and workers.
C. Tanner: I have to make my usual disclaimer that I make occasionally when I get up to make my statements. I am speaking for myself, not for my caucus or for my party. Hopefully they share my views, but I find occasionally that they don't. It comes as a surprise to me, but that's a fact of life.
An Hon. Member: That's their fault.
C. Tanner: As one member suggests, it's probably more their fault than mine.
I speak as a long time campaigner and constituency organizer who is concerned about the lack of control in our B.C. elections. The provincial government promised for this year a new election act that sets campaign finance limits and requires full disclosure of contributions made to political parties and politicians. Unless something unexpected happens very soon -- or, alternatively, unless we have a fall session -- it looks to me like it might not happen before the next election. Alternatively, it might happen under pressure just prior to the next election, and in my view that's not a good time to make important decisions.
There's a need to look at our election procedures from another point of view besides the financial necessities, which are outstandingly bad, and I will discuss that later. In the meantime, the government intends to legislate the reporting of donations by companies and unions -- and individuals, I hope. Hopefully there will be some upper limit. I suggest that a $5,000 donation might be reasonable upper limit and that there should be complete disclosure of who makes a donation over a minimum of $100.
We require campaign spending limits in each constituency. It is my feeling that $50,000 would be that figure. We also need limits on the party provincial campaigns, and I would think that should be 75 times the constituency limit -- $3.5 million, say. Those figures are all lower than the expenditures in many constituencies last time, and lower than two parties in the last provincial election in 1991. Those four conditions -- donor limit, donor disclosure, constituency spending ceilings and political party ceilings -- would themselves bring B.C. into line with the rest of Canada. It will be the final touch to the political and electoral reform started by the Vander Zalm government, which in my view was one of the few worthwhile accomplishments of the previous administration.
I think it's time to look at how we elect our MLAs. The majority of members sitting in this House represent less than 50 percent of their constituents, quite frankly. Most of us were elected by a minority of voters, because in most ridings there are a minimum of three contestants, and in the last electoral race, there were at least four in most ridings. I would suggest to this government that if they do ever bring in that election reform act, they should consider the French system of runoff elections. Unless the winner in the first election wins by a clear majority -- that is, 50 percent of the votes plus one -- there will be a runoff. Here, in brief, is how it works.
Case one: an election is held, and there is a clear majority winner -- i.e., 50 percent of the votes cast plus one. That person is the MLA. Case two: an election is held, and there is no clear majority winner. The two candidates who receive
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the most votes have a runoff one week later, and whoever receives the most votes is the MLA, in which case we again have 50 percent plus one, and probably higher. The election machinery is held over for the second balloting.
In my view, the results of such a system would be the following: every MLA would represent a majority of their constituents; the second election would clarify the issues and confirm public choice; and there would be little or no need for recall, because in my opinion, any member who is elected by 50 percent or better represents the majority of constituents in his constituency. Although I'm not saying that we shouldn't bring in recall, I am suggesting that it would be seldom used. Also, the government party, the majority, would have the confidence to fulfil its mandate, and the voters would have time to review their initial decision and confirm or change it. Admittedly, there are greater costs incurred using my suggestion, but the expense is warranted by the resultant definitive decisions.
There are two or three other minor amendments required in our election procedures. First, the candidates' position on the ballot is presently the government first, the opposition second, and third, the rest of the candidates in alphabetical order according to their political allegiance. I think that is wrong. I would prefer to see a ballot that is made up by a random selection, which is not difficult with today's computer technology.
Second, I believe the interpretation of the Income Tax Act by our election bureaucracy or the Department of Finance -- whichever -- is wrong. Political donations by credit cards should also be permitted. After all, in today's world it is common to conduct business without cash or cheques. Why can't we make donations that way?
Third, I believe it is time to be investigating whether or not we should be using electronic telephone balloting. My party successfully initiated a relatively straightforward leadership vote last year, and since we are prepared to buy goods, do our banking and have our medical records by computer and over the telephone, I think it's time we should look at it -- if not for this election, then for the following one.
M. Farnworth: It's a pleasure to respond to the member for Saanich North and the Islands, who, as usual, raises interesting, thoughtful and sometimes controversial ideas in his statements. That makes them all the more enjoyable to respond to.
In terms of an election reform act, I don't want to touch on that too much, because I'm quite confident that that will be coming before this House before we go to the polls. If you like, that would be future policy. But I am fascinated by the member's comments regarding reforming the actual way we elect members to this House. That is something I would like to focus on in the time I have available to me.
In his ideas concerning runoff elections, he is talking about a system that is currently in use in a number of European countries: France, the Netherlands, Spain and Portugal. As he correctly states, if an individual does not receive 50 percent of the vote on the first round of balloting, a second round of balloting is held, and the top two candidates run off against each other. The also-rans drop off the ballot, and you end up with a candidate assuming more than 50 percent of the vote. I think that is an idea that has some merit and would be worth looking at, because the member is quite correct: it would confirm that a majority of the voters did support you. I disagree with him, though, that it would not mean that we would need recall and referendum -- that should still be there for the voters to make use of if they so desire. But it does have the effect of establishing majority support for a candidate.
You need to go a little bit further than that, and examine a system of proportional representation. If you are looking at making the election system even fairer, that's an even better step to take. It would be an extra step, whereby a party is represented in the Legislature in accordance with the percentage of the popular vote that party received. If a party received 35 or 40 percent of the vote, it would have 35 to 40 percent of the seats. That system is in existence in a number of other countries -- most European countries and most other democracies, with the exception of New Zealand, the United States, Canada and Britain. Most other democracies operate on a system of proportional representation, and that's an area that we should be looking at.
I don't like telephone balloting. There is something fundamentally important about making a trip to a polling booth and marking your X on a piece of paper. It signifies some sort of a commitment. One of the problems with telephone balloting is that it's too easy to.... It's not accessible to everybody, it costs money, and there is a greater opportunity for misuse. It's possible for individuals to gather up PIN numbers and punch in other people's PIN numbers. Voting is such a fundamentally important thing that you should be the one who makes that mark, because it's your choice.
Having said that, there are other things we need to look at besides proportional representation. The member's idea about the 50 percent runoff has merit. We need to look at the way in which parties run election campaigns -- the length of time, for example. Do we need to shorten the length of time for campaigns? There is merit in spending limits, and all those sorts of things.
I look forward to hearing the member's response.
C. Tanner: For the first time in two and a half years of being here, it's encouraging for me when a member from the other side is moving a little bit my way, in response to one of my statements. I might be able to one day stand up in this House and not make my disclaimer, and be able to say that I'm representing the point of view of my caucus and my party, as well as somebody else's. Obviously the member who just spoke is of the same view as I, and he was searching for some reason to argue with it.
The one suggestion that he made that was different from mine was proportional representation, and of course, we tried that in British Columbia in '54. It was successful in bringing Mr. Bennett to power, and as soon as he got in he threw it out. I would also point out that in a number of countries where they have it.... In Italy it has created 21 parties and havoc, and I think my suggestion is a good balance between those two situations. The other thing about proportional representation is that I don't think it's clearly understood by the electorate. It's difficult to explain, and it's very difficult to show a quick and simplified result.
The suggestion that I am making would be a benefit to the voters, to the Legislature and to the representatives who stand here in this House and represent their constituents.
The Speaker: That concludes private members' statements for the morning.
The hon. member for Matsqui rises on a matter of...?
M. de Jong: On a matter of personal privilege.
The Speaker: What is the matter, hon. member?
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M. de Jong: I have had occasion to review the proceedings from question period on Wednesday of this week, and it has occurred to me that my conduct on that day may have extended slightly beyond the line that I think all members understand to be the line of decorum that is to be followed in this House. Inadvertently -- and I do want to say inadvertently -- I may not have shown the respect for the Chair that the Chair requires in order for this House to function properly. In my zealousness, or perhaps overzealousness, to point out several things to members opposite, I think the impression would have been left that I was not showing proper respect for the Chair. That was not my intention. The House clearly can't function if members aren't going to show that respect, and I wish to extend my apologies to the Chair and to hon. members.
The Speaker: Hon. member, I am quite delighted to have you take your place and express those concerns with regard to behaviour. I'm sure that all members recognize that it is something that we would like to see more of in this assembly. Perhaps it's an indication that we'll be moving in a positive direction in the future, and I want to thank you.
Hon. D. Marzari: I call the estimates debate on the Ministry of Health and Ministry Responsible for Seniors.
The House in Committee of Supply B; D. Lovick in the chair.
ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
On vote 42: minister's office, $436,943 (continued).
L. Reid: I would like to continue yesterday's discussion. I believe I have scanned the Blues with some thoroughness in terms of the issues that were canvassed yesterday evening, so allow me to apologize in advance if I speak on an issue that has been canvassed. I will attempt to contain my remarks.
I want to ask the minister to refer to a press release from his ministry on April 28: "New Funding Plan to Encourage Better Efficiencies in B.C. Hospitals." It makes this statement: "To meet this challenge, [the minister] introduced a series of specific management targets for hospitals, including a reduction in administrative and support costs of 10 percent over two years...." I would like some comment on the definition ofsupport costs. What might that contain?
Hon. P. Ramsey: As we presented hospitals with their budgets and a new model of cooperation and partnerships for achieving efficiencies, we said very clearly that the work that we and others have done suggests that there are great savings to be made in the administration and support areas. In fact, if we just asked various peer groups of hospitals of equivalent sizes with various categories of administration and support to move to the average for their size of hospital -- not to the best practice but just to the average -- the potential savings in administration and support could be as much as $60 million, which could go into patient care rather than administration and support.
The member asked for a listing, or definition, of the support areas. Aside from the obvious ones -- such as the administration of a hospital, human relations, labour relations functions and purchasing, and all those things that go on -- it also includes things like the diagnostic facilities that are available, lab testing and the like. It includes essentially the things around the edges of what happens between the care deliverers and patients in the hospitals.
L. Reid: From the minister's comments, we're to understand that administrative support costs include the kitchen and laundry, as well as the diagnostic areas. What do you envision as being possible in terms of a 10 percent reduction? I have some concerns about moving to the average. I think there are some variations in how hospitals fund those. I have some concerns -- and certainly concerns have been shared with me by hospitals in this province -- that when you say "just the average," the expectation in your ministry is some drive toward mediocrity. I'm wondering about that. I can see some real benefit in aligning some of those services in order to hopefully find some cost savings. But are we compromising quality as we move to "just the average"?
Hon. P. Ramsey: Hon. member, what we're talking about here is an average of efficiency that we expect from those who are responsible for delivering public services and using tax dollars well. This is not a drive toward mediocrity; it's a drive toward excellence in the administration and delivery of health services. We're saying to hospitals that we expect them to use tax dollars increasingly well and that we want to work with them in identifying ways of doing that. This a not drive towards reducing the quality of care delivered through hospitals; instead, it's a drive to ensure that more money is available for direct patient care and that less money is spent around the edges of what is done for British Columbians when they require hospital services.
I don't see this as something that is designed to impact on the care people experience when they go into British Columbia's hospitals. For example, hon. member, if there are ways -- and I believe there are -- of amalgamating purchasing operations of hospitals, there are great savings to be made. I think the member is aware, as I am, of hospitals that are already making efforts to form collectives for purchasing services. One study some years ago suggested that we could perhaps save as much as $50 million by amalgamating purchasing decisions made by acute care hospitals in the province. Hospitals have gone some way toward that already, by combining their purchasing decisions, and there is more ground to be made up.
I would also suggest, hon. member, that in many cases there are efficiencies to be made by looking at combining or sharing operations. For example, I think the member is probably aware of an initiative between Lions Gate Hospital and Burnaby Hospital, I believe, to look at a combined food service arrangement. That's a wonderful example. Having sampled some of their products, the quality of food is pretty darned good. As a matter of fact, I've paid considerable money for food of considerably lower quality in commercial establishments. Yet they are going to be able to do that at a reduced cost, by looking at ways of delivering that service more efficiently. Here in Victoria, there's a proposal among institutions for reducing the costs of laundry services. There is a capital outlay associated with it, and we're funding the planning for that capital outlay this year. That, too, will increase efficiencies, without compromising the quality of patient care.
Hon. member, those are examples of the initiatives that can be made in areas of administration and support. We can save tax dollars in those areas and put them into
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direct patient services rather than into administration and support. The initial target we've set of 10 percent over two years, I believe, is a modest one. I also recognize, though, that hospitals have done different things already in this area, and applying 10 percent to all is clearly treating the virtuous and the sinners the same. So we have to make sure that we're recognizing those who have already taken good steps.
L. Reid: One of the other comments that's contained here talks about a requirement that hospitals not implement reduced service levels before consulting the ministry. I'm sure that the minister has received many comments, because I have many, many letters addressing that topic in terms of what that consultation looks like; what kinds of directives these facilities will receive from the ministry; and if indeed this moves beyond the discussion of core service, whether they all will be required to provide some kind of core service, and then the other items are negotiable. There seems to be a lot of confusion around that particular comment, and I need some guidance today on what the minister intended by it.
Hon. P. Ramsey: What we've said very clearly to hospitals is that we recognize these are very challenging budgets. We are asking them to take steps toward the coordination of health delivery in communities and regions -- in some cases, without the structures that are going to be there in the future to make sure that coordination occurs.
So we're saying to them that we think there are efficiencies to be gained here. We recognize these are challenging budgets. We believe that if proper work is done with other institutions in the area and with service deliverers who deliver their service in clinics or homes, and if ways are looked at to use the Closer to Home fund to build up the services delivered on an out-patient or home rather than in-patient basis, these budgets will allow hospitals to deliver the same set of services, though in a different mode perhaps, as in the past. If that is not the case, we want to hear very clearly from them where they see the problems. We also want to hear clearly from them and discuss with them whether the steps I've identified have been taken.
It's not enough for a hospital to say that just looking within their walls, they don't think they can provide the same set of services. We're telling hospitals that the land is changing; the nature of health care is changing. They must look at these cooperative efforts with other institutions and other care providers, and use the new money that the ministry is providing for home-based services.
L. Reid: So if I'm hearing you clearly, you are simply saying that if a hospital.... If hospital X comes to you and says that they cannot provide X service, whatever that may be, your ministry officials would then have the task of walking those hospital administrators through the process in terms of what other services are available, in order to reach some kind of determination of whether the hospital itself will offer reduced service and may be aligned with some other agencies in the community. Is that a decent summation of your comment?
Hon. P. Ramsey: I think your question largely reflects your understanding of the process we've set up with hospitals. I think you and I could both give examples of services that are now delivered in an acute care institution that may be overlapping or ill-coordinated with services that are delivered in the community. If there's proper coordination, perhaps the in-patient set of services can be reduced while maintaining the level of services to the people who depend on them.
But the clear message here to hospitals is: if there are service reductions in an institution which are clearly not being picked up and are resulting in a real reduction of services to the people of the province, we want to know about it and we want to be able to analyze it to see if there are ways of dealing with it, before those reductions take place.
L. Reid: I thank the minister for his comments. I would like to ask two or three questions around the accord. Very briefly, minister, I simply want to know the numbers. In canvassing the Blues, it was still unclear exactly where we are today. I appreciate that you have canvassed the issue extensively, but all l want is the short number-answer. Originally, the documentation suggested 4,800 people were going to leave the acute care sector. Current documentation does not support that. What happened to that 4,800 number? Your press release today talks about 2,000. How did we get from 4,800 to 2,000?
Hon. P. Ramsey: The target for the first year of the accord was 800. The target for the second and third years was 2,000 FTEs each. The total is 4,800.
L. Reid: How many today have accrued? What is the total? If you want to break it down into retirement and realignment, I don't mind. From what you've said, we should be at 2,800 and the expectation for next year is an additional 2,000. My understanding is that we should have 2,800 people who have left the acute care sector. Can the minister tell me what the actual numbers are today?
Hon. P. Ramsey: Very briefly, our target through the first year of the accord was 800. We believe we are close to that, through some of the numbers that were canvassed extensively last night. The target for the second year of the accord is 2,000. That's the target by the end of the year not the beginning, obviously. So we are continuing to make progress. The Healthcare Labour Adjustment Agency, I believe, is working with increasing sophistication and efficiency. Those are our targets and one of the factors in designing hospital budgets for this year.
L. Reid: When you say you are close to the 800 target, could you just narrow it down for me to within a hundred bodies?
Hon. P. Ramsey: Yes, I can. We're between 700 and 800, as of the end of the year. The figures that I have, as I said last night, are a couple of months old. At that time we were over 700, but less than 800.
L. Reid: At the end of the '94-95 year we will be looking to you for some report on where we are in terms of the 2,000 target. I will certainly revisit this topic at a later date. So I thank you most sincerely.
I have a number of questions that relate to specific hospitals. I know the minister can appreciate that this correspondence comes to me, as I'm sure it goes directly to the minister. If we could for the next few moments canvass some specific questions around specific hospitals, it would certainly allow this information to be communicated.
I draw the minister's attention to Royal Inland in Kamloops. They're preparing for some staff reductions related to the '94-95 budget. If I can phrase my comments more broadly, my concern touches on the accord, as it will
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touch on each of these hospitals. Thinking of today's news coverage on St. Paul's, it seems to me that there will be some bumping moving through the process. Let's take the example of St. Paul's as probably one of the largest collections of health care professionals in the province. In the minister's opinion, will the bumping that occurs as a result of the Shaughnessy shift -- and from today's news, there will be bumping at St. Paul's -- have an impact on some of the other hospitals in the region? What's the next step for the health labour adjustment strategy? I think the original understanding of the people at St. Paul's was that they would not be bumped as a result of the process. It seems that that has changed. Perhaps the minister would kindly comment.
Hon. P. Ramsey: As the member knows, Vince Ready was apprised of this matter and recently issued an interpretation of the accord and its effect on bumping at St. Paul's. Mr. Ready clearly found that the employer did have the right to lay off under the collective agreement. To quote from his ruling, he said:
"Therefore the definition of displacement under the accord does not prevent a receiving facility from issuing displacement notices. The protection provided to employees transferring with a service or program or placed by the labour adjustment agency is protection from being moved to yet another facility. It is not protection from movement within the facility itself."
That was clearly the ruling here. Obviously, on that issue the union representing the workers was not pleased. They have an avenue of appeal, if they wish; but I believe that this and other matters around the accord and this interpretation are being dealt with. When issues like this dispute over the meaning of it come up, they've been resolved by appropriate tribunals, such as this one with Mr. Ready.
L. Reid: I appreciate Mr. Ready's ruling. My question was whether or not that was the understanding of the individuals at St. Paul's. You are saying that his ruling is the answer to the question. I don't doubt that for one moment. But from what I have heard, as I'm sure your office has heard, they do not believe that was the scenario. Was it simplymiscommunication, or did they simply not accept the original intention, which was that bumping would occur within the institution? Is that perhaps the answer?
Hon. P. Ramsey: In issues like this, which involve labour relations, obviously there are times when words put on paper have different interpretations by the two parties that have signed that piece of paper. I think this reflects one of those situations. All I can say is that the people who agreed to the accord had their various interpretations of it. Obviously those interpretations had to be reconciled. It's been done appropriately through a dispute resolution mechanism, and I suspect that all parties to the accord will live with the results of these sorts of arbitrations and interpretations of issues resulting from the accord.
L. Reid: I thank the minister for his comments. I'm sure it's going to be a very complex issue over the next number of weeks. But I'm sure your comments will shed some light on that topic.
I made reference earlier to Royal Inland Hospital. I would ask the minister to comment on some of the early retirement incentives. Apparently a number of individuals in the province are somewhere between 55 and 59 years of age. Will different aspects of the accord, or even separate from the accord...? Are there new initiatives or incentives in place to encourage people in that age range to enter into a retirement package?
Hon. P. Ramsey: Back in late February I was able to announce the enhancement of the early retirement part of the accord and the funds available to the Labour Adjustment Agency to facilitate early retirement of workers who might otherwise be displaced. There was an additional $15 million provided for those incentives.
Initially, early retirement was simply being offered to those closest to retirement and working their way down. What the Labour Adjustment Agency is now doing, as I understand their representations to me, is looking at how close a person is to retirement, but they are also considering whether this is a position that is likely to be subject to displacement. So there are really two factors going into these early retirement decisions right now: the likelihood that displacement is going to be necessary, and the age of the person seeking early retirement.
L. Reid: Again, I thank the minister for his comments.
Is there any special arrangement, special criteria, for the 55-to-59-year age range? I fully accept the two criteria that you have listed. If they are the only criteria, I will accept that.
Hon. P. Ramsey: I have clearly heard that they are starting to work their way down and are looking at people in that age range of 50 to 59. I am unaware of any special arrangements targeting that particular age group.
L. Reid: I want to ask a question about the severance package that was brought forward for the president of Ridge Meadows Hospital and Health Care Centre. I have a great assortment of correspondence on this topic, and if the minister would kindly assist me in answering this correspondence, I would be delighted, I can tell you. It seems to me that when taxpayers read press suggestions that budgets allocated to hospitals are used for issues other than direct care, it causes them great concern. I have tremendous sympathy with that concern. It seems to me that issues other than this particular case cause concerns over severance packages for people moving in and out of hospital administration. I'm not asking for a specific comment on this particular individual, but I would like a comment on the guidelines for severance that the ministry intends to put in place -- some kind of grid for how a decision is going to be reached in an equitable fashion. This is a huge concern, and I cannot justify this to the taxpayer. I would ask the minister to comment.
Hon. P. Ramsey: I think the member opposite is correct. This is obviously a matter of great concern to taxpayers in British Columbia. While they expect that highly qualified and highly skilled public sector employees should receive good benefit and salary packages, they do not expect excesses and abuse. I don't want to comment specifically on the particular instance here, but the perception for some people has been that it is an example of an excessive benefit.
Let me just briefly go over what this government's response to this situation in the broad public sector has been. A few months ago the Premier and the Minister of Finance jointly announced several initiatives that are being taken to deal with the issue of executive compensation in the broad public sector. First, they said: "There's a freeze -- right now. Don't go changing broad compensation for executive or excluded positions in the hospital sector, in the health sector broadly or in the general public sector." Second, clear
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instructions were given to the Public Sector Employers' Council -- as the member knows, that covers all employers in the broad public sector -- to come up with guidelines for what executive-excluded compensation levels and benefits should be. Recently the Public Sector Employers' Council considered some broad guidelines on what those levels might be. They have now asked each of the major employer groups to come forward with some guidelines on levels of compensation and benefits that might be included in a compensation package -- including matters like severance and perks -- for consideration and approval by the Public Sector Employers' Council.
I have just a general comment to conclude. This is an issue that I think reflects the fragmented nature of health delivery. Until very recently there wasn't even a body that could deal with this sort of issue in a coherent, comprehensive way covering all hospitals and executive compensation in the province. We now have those vehicles in place. The instructions have been given to come up with guidelines that make sense to the elected members who sit on the Public Sector Employers' Council and to the broad public of British Columbia. Until those come forward and are approved, a freeze on matters of compensation and benefits is in place.
L. Reid: If I can just conclude this particular line of questioning in terms of Ridge Meadows Hospital.... This taxpayer has asked whether any investigation will be ongoing at that hospital, whether it's ever possible to set aside any kind of severance decision and whether there's any accountability around the board of directors of that hospital that agreed to that particular severance package. I appreciate what the minister has said in terms of guidelines and the freeze that's on currently. But in terms of ongoing accountability once the freeze is lifted, will the ministry have any ability to hold boards of directors -- and let's say any board of directors or any health care decision-maker -- responsible for what this taxpayer has deemed to be incredibly irresponsible handling of the taxpayers' dollars?
Hon. P. Ramsey: First, once the guidelines are in place, organizations falling under those guidelines clearly are going to be expected to adhere to them. These are not going to be either formulated or approved lightly. Once they are formulated and approved, adherence is expected.
What the member speaks about, as far as auditing or an inquiry or holding the board of the hospital to account are concerned, is currently beyond the abilities of this ministry. The board operates independently. It arranges compensation with its senior executives according to guidelines it sees fit.... While you and I and the taxpayers may find some of these less than respectful of wise use of tax dollars, the responsibility currently rests with the board of that hospital.
Without straying too far afield, hon. member, I might say the sort of closed nature of current decision-making around these sorts of issues, through hospital societies that are not broadly chosen and not widely representative of the community, is an example of the lack of accountability in current governance structures, and one of the reasons why I think those governance structures need change.
L. Reid: I have a number of questions regarding the situation at Langley Memorial Hospital and their uncertainty over their $3 million shortfall. It seemed earlier that this government was committed to putting resources into areas where the population was indeed on the rise. Certainly I don't think there's been any dispute by any member of this Legislature that the Fraser Valley has a growing population. Langley has a growing population. Individuals at that hospital posed a number of questions to me, but certainly all the questions come back to the $3 million shortfall. In fact, the CEO, Pat Zanon, has said she is greatly concerned about how they will be able to manage reduction in the magnitude of $3 million, even over two years. That has seemed to be a response that somehow the ministry is going to give them the second year to come to grips with that financial dilemma. Her concern and certainly the concern of the residents of Langley is that even over two years, $3 million.... For where they believe their operation is at currently, they're not clear they can find any more opportunities to streamline the service, because this is a growing region of the province. Does the minister have any particular comment about Langley Memorial?
Hon. P. Ramsey: We surely do recognize that Langley and some of the other suburban areas around the lower mainland are experiencing very rapid population growth, and this is placing increasing demands on health care facilities in the area. Similar situations exist in the Okanagan and in the central Vancouver Island area as well. I think hospitals in those areas are facing severe pressures. I would remind the member that over the last three years we have been able to increase funding to Langley Memorial Hospital by close to 25 percent. In 1991, their budget was about $31 million; this year their budget is just over $40 million. They have received a substantial increase in funding over the three-year period. I surely recognize that there are increasing demands. I would also remind the member that in Langley, as in other areas, we are making the increase that we said we would in community continuing care, mental health and other community-based programs.
I'd just like to read a couple figures into the record. For community programs in the local health area that includes Langley Memorial Hospital, there has been a 55 percent increase over three years. That's a substantial increase. Similarly, the mental health area -- an area that I think the member and I would agree has been traditionally neglected -- has been nearly doubled; there is a 98 percent increase. Finally, I would point out that we have provided about $1.2 million in Closer to Home funds for the area to continue that buildup of community-side services.
Langley Memorial strikes me as a hospital that is responding appropriately to the funding framework we presented to hospitals. They have said that maybe they need to take advantage of the minister's offer of a two-year planning framework, and that maybe they need to look at other ways of gradually doing this phase-in as they deal with tight budgets. I want to assure the member that we will be hearing what this hospital and others have to say as they present their budgets for the coming year, and that we will be working with them to ensure that services to the people of Langley are maintained and indeed improved.
L. Reid: I appreciate the minister's comments that the funding for Langley Memorial Hospital has grown over the last three years, but it certainly is the understanding of the majority of British Columbians that the funding is commensurate with population growth. There's no anticipation that fewer people are going to live in Langley. I appreciate the comments that the minister made in terms of funnelling those dollars into other community-based agencies; I don't take any issue with that. What Langley is facing -- and what hospitals in the Fraser Valley are definitely facing -- is that as its population increases, fewer and fewer resources will be available. The minister certainly recognizes that, I think;
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whether or not he chooses to confirm that has yet to be seen, but I would ask him to comment.
Hon. P. Ramsey: We have not cut hospital funding in this province, unlike the situation facing the hospital sector in many other provinces, and that needs to be recognized. We have clearly targeted spending on health, and within that we have made sure that we continue to fund increases in hospital budgets. In the three budgets that have been presented by this government, funding for hospitals has increased by over $300 million; that is a substantial amount of additional funding for hospitals.
We recognize also that as we ask hospitals to work with other partners in health delivery in their community, they must shift funds to those other resources. We ask hospitals to be involved in designing services that are delivered outside the walls of the institution as well as those delivered within.
We are going to continue to make sure that we are moving resources where they are needed. Just for example, I know that the debate around the closure of Shaughnessy Hospital occupied a good deal of time in this House in the last year, but I remind the member that part of what we did there was to consciously shift resources to hospitals in the regions surrounding Vancouver. Indeed, Langley Memorial Hospital received about $1.5 million of additional funds and services from that closure. Peace Arch District Hospital received about $1.6 million. Surrey Memorial Hospital, again in the same area, received $3.7 million. This is funding for services that are going to be provided in those hospitals. We are very consciously shifting resources where the population growth is rapid. I recognize that sometimes the shifts may not appear to be enough at a particular time, but we are very conscious of the necessity for meeting the needs of high-growth areas.
L. Reid: I think the issue is perhaps one of miscommunication or misunderstanding on the part of the public. They look at the press that is there, and they see a $3 million or $4 million shortfall -- whatever it happens to be -- which they perceive as a budget cut. You're suggesting that you're not cutting the budget. There has to be some way for you to communicate that more effectively to these hospitals, because, as it stands, it's a black-and-white discussion in the eyes of the public.
Hon. P. Ramsey: Clearly, there is not a $3 million cut in funding for Langley Memorial Hospital. I believe Langley administration and board are saying that if they were to deliver the same services in the same manner with the same sort of administration and support overhead without looking outside their walls to other health providers, without looking at cooperative efforts with other hospitals, without looking at a two-year phase-in of efficiencies and without looking at support that might be available from the ministry -- essentially, if it was the status quo -- they might find themselves having to spend $3 million more this year than they did last year, or $3 million more than is available to them. But we are very clearly saying to hospitals that status quo operations are not good enough. We require them to look at administration and support efficiencies; we require them to look at continued work in coordinating their services with services provided in the community.
The message to the hospitals is a twofold one: hospitals are a crucial cornerstone of our health system; we will not be cutting their funding, but we do require them to work more carefully and in a coordinated way with other health providers to ensure that the same set of services is available to people who rely on them.
L. Reid: Could I ask the minister what the most recent communique has been around core services? Have you reached a decision on that? I think that's part and parcel of this discussion. You have to talk about cutting budgets in hospitals and about those services being replicated in some other venue in the community -- I don't take issue with that. But I think we have to have some understanding of what core service delivery will be and where constituents, who are taxpayers, will be able to find it. I understand the notion that it may be different in different regions. But when we talk about budget cuts -- and that seems to be the message that most of us in our constituency offices are inundated with -- the answer has to be some direct message about what core service will be available, what services will be funded and what services they can expect to receive in a community agency as opposed to a hospital and what that service will look like.
Hon. P. Ramsey: As the member is aware, the ministry prepared a draft document in late 1993 for consideration by planning groups involved in working towards the establishment of community health councils and regional health boards. That document said: "Here is a tentative read of what core services are. This is a preliminary discussion paper of what services anybody in British Columbia should expect to receive from the health system, in the province as a whole, in their region and in their community." We asked the groups involved in the regionalization initiative: have we got it right? Is this right for you? Is this the level of specificity? Have we identified the services accurately? Give us your best information.
We had, as I think the member is aware, stacks of responses. There was a great deal of interest in the issues and in how they were going to be defined. Without belabouring the point too much, there are a variety of issues in defining core services. Should people be expecting to receive them in every community or in a broad region to which they have access? Should they be expected to specify so many dollars for particular services like physiotherapy; or should they have a broad definition, say rehabilitation services available in a person's community or region? I just asked staff, and I understand that we are well on our way to publishing version 2 of this core services document. The expectation is that it is going to be available for distribution by the end of this month.
L. Reid: If it were available in the next week it would add a tremendous amount of information to the debate, because there seems to be a lot of uncertainty. There seem to be growing amounts of correspondence, because people are not clear about where you are headed. If the answer is a week away, I will wait the week out and see what comes back to the table for discussion.
I want to ask the minister to comment on the issue of whether Williams Lake will have a second surgeon for the summer, or a single surgeon for the summer when the other one is away. I have received tremendous public comment on that issue, and if the minister believes it is an issue of miscommunication between the hospital and the public -- which is what I'm gleaning from reading the various reports; your contention is that the hospital does have the money and can put someone in place -- I would simply ask him to confirm or deny where the decision is headed.
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Hon. P. Ramsey: I have no specific information to provide at this time. This is an issue on which I have asked staff to work with Cariboo Memorial, and to provide assistance to them in order to make sure those services are available. I don't have any specific information to report. Perhaps later today or Monday I will have some for the member.
L. Reid: I will be happy to pass on the answer, whenever it might be forthcoming.
I want to spend a few moments this morning on the stages of governance, because I believe we now have eight health councils. At some point there was almost a report card, if you will, that listed where the various regions in the province were in terms of their development of a health council. I wonder if the minister could comment on whether that framework has changed, if the criteria have changed, and the status of the remaining health councils in the province. I know that eight are established, but we are looking at July, August and September, and from my gleanings, there are upwards of 100 that still need to be established. Could the minister comment on the status of where we might be over the next 60 to 90 days?
Hon. P. Ramsey: We have been working with the steering committees for community health councils and regional health boards around the province, asking them to come up with a projected date for designation. The community health councils vary from.... I recently signed off on St. Bartholomew's Health Council in Lytton. That was number eight in the province, and I suspect that by the end of the July we will have approximately another eight community health councils and/or regional health boards up and running. The regional directors recently met with members of my staff to review the situation and the establishment of interim regional health boards, and they are going forward. The expectation is that the October deadline is doable for the great majority of regional health boards in the province.
L. Reid: I have a number of questions around the status.... I appreciate that the minister has stated that in another 30 days there may be eight additional boards, bringing us to a total of 16. If the total of upwards of approximately 100 boards has changed, I would certainly like the minister's comment.
Hon. P. Ramsey: The projections have not changed. We project there will be between 85 and 90 community health councils. We're saying that by July of '95 those should be in place throughout the province. Our estimates are that we'll have 20 or 21 regional health boards, and we are asking them to be designated by this October. As I said in debate last night, the assumption by those boards of operational authority for health facilities in their region is going to be phased in as the boards become ready to assume those responsibilities.
L. Reid: I thank the minister for his answer. Of the approximately 90 councils by April of '95, my understanding of the minister's comments was eight councils now and another eight by the end of July. So we have 16 en route to approximately 90 councils.
In terms of regions which are to be designated by October 1, could the minister comment on the status of those 21 regions?
Hon. P. Ramsey: My expectation is that two or three regional health boards will probably be designated during the summer months. The great majority of regional health boards are aiming at designation in early fall.
L. Reid: I appreciate the minister's comment that two or three regions will probably receive their designation during the summer. What I'm interested in is the status of all 21. Where do they sit? Are we saying that three out of the 21 will be ready in the next two or three months? I need to know what kind of progress has been made on the other 18 fronts. Could the minister comment?
Hon. P. Ramsey: I'm not sure it would be very useful to you at this point. I could ask staff to sit down with you in the future to go over what organization has taken place in any particular region. I'm reluctant to start getting into things like: who's sitting on a steering committee in this region now; where are they in terms of formulating a plan for designation and nominations; how are they addressing the issue of voting patterns and other issues; and have they signed off on boundaries?
Remember, they have a clear set of steps they have to work through. First, they form a regional planning group, and those are going in all regions. Second, they are to define the boundaries of the CHCs within those regions. The third is to confirm the regional boundaries. That work is well underway. I expect by the end of this month, with the exception of perhaps two or three regions, boundaries will have been determined for regions and for most CHCs within them. Step four is to propose a model for governance. So they're working through these. They have to nominate and appoint members to the interim RHBs. Then I'll be adding the ministerial appointments and designating the interim RHBs. So they have a seven-step process there.
As I explained last night, what has been established is a framework for doing the detailed work of setting up appropriate administrative structures and links to community health councils in their region. They're getting ready to assume the difficult tasks of health planning, resource allocation and delivery of health services in regions throughout the province.
L. Reid: Hon. minister, you may be reluctant to share that information, but that's information the taxpayers want to know. They're looking to see who will be allocating the budget for the Ministry of Health, and when they can expect varying degrees of organization to be evident in each of those communities.
I appreciate that you have offered your staff. This information has been requested from your office many times, because this is the information.... I'm certain it's not just myself as the MLA for Richmond East or my constituents who are concerned with it. I'm sure there must be some interest from all MLA offices in the province and, frankly, from the majority of British Columbians. This is the crux of the shift you are anticipating. I believe people have the right to know what level of organization has been reached in various parts of the province. I'm convinced that the ministry has that information. It seems to me that there must be some way for us to reach an agreement on communicating it effectively.
Hon. P. Ramsey: I must say that my experience is a little different. As I travel around and talk to those who are working on steering committees and planning groups for regional health boards and community health councils, I find that there is a great willingness to make sure that the media in an area know what is going on. The regional directors,
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who are employees of the ministry and are facilitating the establishment of regional health boards and community health councils, comment regularly in the media on the stages of development of boards and councils in the communities and regions around the province. So that information is there; it's not hidden. There's no hidden agenda here.
Quite frankly, I think it would be impossible to have a hidden agenda when you have literally thousands of British Columbians involved in these planning groups and steering committees. There is a broad awareness among those interested in health governance of what is going on, and that information is regularly available at regional and community levels throughout the province.
L. Reid: The issue is one of communication and very similar to your responses to me this morning: "We're close to our target; we believe we may be there at some point." That's the kind of documentation you find in the press. That doesn't give people a clear indication or clear message of the status of the level of organization. Everybody appreciates that we're moving toward something. But to give some kind of concrete status report, I don't think is asking too much. I truly do not believe that.
This is a ministry with $6.4 billion. This is about measuring outcomes. I'm not asking for a status report of 90 future councils; we're talking about 21 regions. I would hope that the information can be provided in some kind of concrete fashion. Certainly a number of health agencies in this province have done a report card on what they think the status of each region is. I'm simply trusting that the ministry has also done one and would be willing to share that information.
Hon. P. Ramsey: First, I'm thankful the member is acknowledging that indeed those report cards are being done in regions and communities around the province, and that the communication from planning groups and steering committees to members of the public is going on, as they report to the public on their progress toward establishing regional health boards and community health councils.
Let me tell you what I see as a difficulty with the sort of grid that the member proposes, which says that by July 15 this council will have its model for governance done, by August 30 it will have all its nominations in, by September 15 it will have its regional health goals set and by the end of October we'll have decided which services are going to be delivered and managed by a regional health board and community health council -- every time the report card is issued. I think there's a great concern among those involved in the process that the ministry is not setting guidelines and time lines, but trying to impose on the work of these planning groups and steering committees that are doing the hard work of getting on with the job.
So I recognize the member's desire to have the specifics of every regional board and every community health council planning group in the province. I suggest to her that the fact that two months ago we had zero community health councils designated, now we have eight, and by the summer we will have doubled that number, suggests that the progress is ongoing, significant and real. We will be achieving our targets of having most, if not all, community health councils designated by April 1995. As I say, we expect that regions will have completed their work toward getting interim regional health boards designated by October of this year.
L. Reid: Perhaps my administrative background is catching up with me, but what the minister is saying is somewhat illogical. If you're going to set deadlines of October 1 and April 1, there must be a decision-making critical path to follow. We're not talking moment-by-moment machinations within the Ministry of Health in terms of where these 21 regions are. But right now, hon. minister, we're talking 21 regions. This is not asking for the moon.
It seems to me that if you can set a deadline, you must have some expectation about time lines, about a critical path for how those decisions will be reached and how that time line will be met. If there's no critical path, the time line is useless. You must have some way to measure progress as we proceed to October 1. I have to be convinced that this ministry measures progress in the growth of these regions. If we're looking at allocating $6.4 billion in a different allocation framework, there must be some way to measure the progress of those agencies.
The Chair: I want to thank the member for Missouri, and I now recognize the minister.
Hon. P. Ramsey: Thank you, hon. Chair. I'm not sure the member opposite will thank you.
Ministry personnel regularly monitor what is going on with each regional planning group, with each steering committee, with the formation of CHCs. We have said very clearly to them: "Here is where you've got to get to." Different regions have said: "Okay, we think the boundaries are easy; it won't take us any time on that. But getting the model for governance may be more difficult; we'll need more time for that."
Again, the problem is: can we have one set of critical paths for all regional health boards? No, that's not on. Frankly, the challenges differ from region to region. Are they making good progress? Yes, they are. As I said, there was a meeting of regional directors as recently as yesterday, with very positive reports from around the province on establishment of interim regional health boards. So the work is ongoing. Real time lines have been proposed. They vary greatly, but progress is ongoing.
I would remind the member that as recently as a few months ago, people were saying: "Golly gee, there's no progress at all here toward the establishment of community health councils. They've been at it for over a year now, and there's just no evidence that anybody's adhering to any time lines and that anything is actually ongoing." I suggest to the memberthat the evidence now is otherwise. There has been real progress. Steering committee groups have been doing the work that needed to be done. Increasingly, people are in a position to be appointed to community health councils and do the health planning for their communities.
[G. Brewin in the chair.]
L. Reid: All I'm asking is for that evidence to be shared more broadly. The minister has obviously stated that it exists.
We do not communicate clearly on a critical path, and I'd like to walk the minister through what I'm asking. This is not about creating a template for all 21 regions. I'm not asking for that, and I'm not wanting the ministry to proceed in that way. What I'm suggesting to you.... I think you alluded to this earlier when you talked about the criteria, the number of stages or steps, such as creating community awareness and soliciting steering committee membership, all the way to active or pre-existing interagency coordination, steering
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committee establishment, a defined mandate for the steering committee, etc. Those steps have been communicated fairly well. This is not about an identical template for the 21 regions; this is about your ministry being able to indicate where each of those 21 regions sits in relation to having met those steps and those criteria. I'm not asking this minister to impose something on the 21 existing regions; I simply want to know where those regions sit in relation to these categories and stages. I don't believe that that is a complex request. Could the minister kindly respond to my request?
Hon. P. Ramsey: I'll be responding in a couple of ways. If the wish is that I simply say that here are eight steps for establishing regional health boards and these are the tasks that have been completed to date, I suspect that we could produce that information relatively quickly. However, it would probably not represent the complexity of the work going on. Because each area is different, because the issues people are grappling with differ considerably and because they may be doing these things at the same time as they approach the task of being designated, it's not a clean template. It's fine to say that this is the flow chart -- and we've clearly told planning groups forming regional health boards that we expect them to complete the following things before they are designated -- but it is not steps (a), (b), (c) and (d). Sometimes it's a little bit of (a) and some of (d), work on (c) for a while and then go to (e).
Let me just give you one example. I don't know whether it will assist or whether it will create further difficulties for you. With the interim regional steering committee for Vancouver, there was a formal nomination selection process to choose the individuals who put their names forward. They represent a cross-section of interests and populations. They have no authority over the present system, nor should they, but they have agreed to oversee the development of a plan for the governance of a regional health system. From October through to December 1993, they spent timefamiliarizing themselves with what the system looked like. In January they developed a work plan as to how they were going to get where we wish to go. The work plan that they are going to bring forward will come to me this August. It will include items such as what the reporting relationships should be and the scope of responsibility of that board in its relationship to councils. It will also include the management support required for both the regional board and community health councils and a transition plan for them to assume responsibility in addressing governance, representation and management -- all the issues that need to go in there. They expect to have that work come forward by August of this year.
There is a huge range of issues in Vancouver, as you can imagine. Somebody told me the other day that if you added up all the health dollars going into that municipality, given that many of the provincewide services and tertiary facilities are located there, you might have a health budget of one billion dollars in Vancouver. They clearly have some complexities they need to address, such as what the role and function of the boards of large health care organizations are going to be, particularly for tertiary care, in relation to the regional health board. Those discussions are ongoing. How many community health councils should there be? What is their function going to be in an urban setting, as opposed to a more rural, remote setting? We look at the identification of potential areas for rationalization and integration of the present system and at what the obvious targets are for the first year of work of the regional board. Of course, in a city as populous as Vancouver, we look at addressing the real inequities of health outcomes in Vancouver and taking that into account as they do health planning. So there is a huge range of issues, and I haven't even touched on things such as the relationship with health services provided by the city of Vancouver.
There are a substantial number of issues that they need to deal with. They expect to present their workplan to us by August. They expect to propose their model for governance, regional boundaries and stuff by late this summer. They expect to be nominating members and appointing members to the inter-regional board, and I think that they expect to be on time for getting on with the task of being an interim health board by this fall.
Does that mean they will have immediate responsibility for spending $1 billion of tax money on health services in Vancouver? No. Will they have a representative group of individuals from the range of concerned organizations who reflect the diversity of interests in health care in Vancouver and are willing to sit on an interim board and do the hard work of the transition that must occur? Yes. Will they be ready to take on those challenges? I believe they will be.
L. Reid: It seems to me that we have less than a hundred days to October 1 to get us up to speed on 21 regions. I appreciate from your comments that Vancouver is proceeding -- I think that's fine -- but I need to know what that looks like and if indeed the minister can respond directly, because this is not just the official opposition asking the question; this is the majority of people who come to me as taxpayers wondering what steps have been taken in each of those regions to give some indication as to whether or not they will be in place by October 1. I don't think I'm asking a complex question here; I think it's very straightforward.
In his opening remarks, the minister suggested the seven steps to give some sense of what stage each of those 21 regions is at, based on his own criteria. I don't think it's a complex question, and to suggest that things are going well in Vancouver really doesn't give me a great deal of information. We can certainly have a similar discussion about each of the other 20 regions, but it's not particularly useful. If the minister could perhaps focus his comment on where each of them sits in terms of the seven steps he outlined, that would be helpful to me.
Hon. P. Ramsey: The detailed information on what stage regional development of regional boards is at is widely available in regions throughout this province. The people serving on these planning groups make no secret of what they're about. The media in those regions are interested in what is going on and report regularly on both successes and difficulties. I'm sure members opposite hear both. What the member opposite is asking could be done, I suppose, but I do not think it would be terribly informative for her. Regional planning groups are formed, almost all boundaries are defined, models for governance are being developed, CHC boundaries are mostly accomplished, and that's broadly in the province. Planning groups are getting on with the challenges of proposing models for governance and the hard work of figuring out how communities and health providers are going to work together. I suggest that the level of detail that could be put on a spreadsheet would not be terribly useful. We could surely do step one to seven -- check, plus, minus or whatever -- but I doubt that the member opposite, or the general public, would find it a useful bit of information about what is going on in their communities and their regions. If they wish to know that information, and many do, the appropriate people to ask are the regional coordinators. They are doing the work of assisting and talking to the people who are actually serving on regional
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planning groups. They know; they talk regularly about it. They're not shy, nor are they secretive.
A. Warnke: I want to follow up on some of the interesting comments made by my colleague for Richmond East, who is pursuing this subject, and the minister. This is in the context of trying to develop a strategy throughout the province. I'm interested in these community health councils, and yet I'm wondering about the different strategies that are applied throughout our province. One strategy can be applied in the city of Vancouver, but there are other regions where one cannot impose a particular model. Perhaps the strategy can vary from community to community. I'd like to pursue with the minister what kinds of different strategies are applied to the many different regions throughout our province.
Hon. P. Ramsey: There are indeed different strategies in place in different parts of the province. If you have a specific question about a particular region, let's explore that.
And I welcome the member for Richmond East on her return to the chamber.
L. Reid: I reached a pressing point in debate.
I'm not clear if you answered in my absence the question of whether or not you are in a position to provide information about the progress of each of those 21 regions. I trust you answered in my absence; I hope so.
Hon. P. Ramsey: I think I have answered this. If you want a simple checklist, sure, but it's not going to be terribly informative -- step 1: yes, yes, yes; step 2: yes, yes, yes; step 3: in progress, in progress, in progress. You'll have a spreadsheet that will indeed tell you where the 21 regions are, but I suspect it will not give you the level of detail to make you comfortable with what is actually going on.
That level of comfort can only be obtained by talking to the people doing the work around the regional health boards. Their strategies differ, the aspects differ and the challenges they face differ. They are not secretive about it. They regularly make both their successes and their problems public. The member is aware that both their successes and problems are visible in the public press and are a matter of public debate. To suggest that this is going on behind closed doors is simply contrary to what's going on.
We have initiated a process that is highly community based, highly public and highly involving of those concerned about health care. The people involved in these planning groups and steering committees speak regularly and loudly about what they are doing.
L. Reid: The checklist the minister refers to, if he chooses to call it that, may not provide me with the level of detail I'm interested in, but I have no detail now, so that would be a fine starting point. I thank you for broaching that point.
I appreciate the complexities around what's happening in Vancouver. Up to this point we have always defined a region as a geographic area and a council as being a geographic area within a region. In speaking specifically of tertiary care hospitals and some of the specialty referral centres in the province, I'm wondering whether any discussion has occurred around the large centres and hospitals in the lower mainland -- let's say St. Paul's and Vancouver General Hospital -- becoming a council. A set of tertiary care facilities may have more in common than other hospitals or other health care facilities in a region. Their commonality is with a hospital that may not be geographically in proximity to them, but the needs and desires and perhaps the budgets of those hospitals have far more in common. Perhaps we need to expand the definition of a council, if we can. Maybe it's not always going to be geographic. Has any discussion occurred around that?
Hon. P. Ramsey: I will speak to the issue the member raises, but I want to go back to an issue that you raised earlier, hon. member, concerning Williams Lake. I had staff gather some information. I'm pleased to be able to report that we had a search committee meet yesterday and interview candidates for that surgery position in Williams Lake. There were five candidates for it. The situation looks very positive, and I anticipate that the problem will be resolved for Cariboo Memorial Hospital in the very near future.
On the more general issue, let me say a couple of things. First, there may be a need for the coordination of the activities of tertiary care and acute care facilities, but that is not a community health council. Some sort of planning body or interagency group may look at what's appropriate in tertiary care, but community health councils are based on the people who occupy a particular patch of geographic space, whether that's a neighbourhood in Vancouver or a village in one of the more remote regions of the province. It is the essence of community health councils that they are representative of the people, not the institutions. Their job is to plan and administer health services for those people; it's a people-centred process, not an institution-centred process.
The suggestion that a health council would be an appropriate vehicle for coordinating the activities of tertiary facilities is at odds with that concept of what community health councils will be and their role in an integrated health system.
L. Reid: I certainly appreciate the minister's comments. Perhaps I wasn't clear. I wasn't thinking of community health councils; I was simply saying "councils."
I appreciate that there are some agencies today that do reflect the needs and desires of tertiary care facilities. Perhaps I can ask the minister to extend his thinking into what role those current agencies may have and how they will interact with the community-based councils.
I don't mean to take issue with the minister's language about institution-based and people-based agencies. For me, it's all patient-based; it's all about delivering the service to the patient. I'm not clear that we're gaining anything by separating community health councils and saying that they're people, and then saying that institution councils over here are somehow institutions. I mean, they're all about the patient.
So in terms of the bodies that currently govern tertiary care facilities and advise the minister and the ministry, what's their role once the 21 regions are in place? Will it change?
Hon. P. Ramsey: First, let me just take issue with something the member said, and then we can find some points of agreement.
I see a great deal of difference between some sort of interagency committee that has been formed by care providers -- those who run and govern particular institutions -- and community health councils, which reflect the diversity of their own communities, are chosen democratically to represent that diversity, are based in the community and represent those who are going to be receiving health care. The entire method of selection, composition and areas of responsibility differ significantly.
As the member is aware, though, there are a number of coordinating bodies for hospitals and other institutions. The Council of University Teaching Hospitals, for example,
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coordinates the services offered through those hospitals with the training of medical practitioners. The Greater Vancouver Regional District performs a role in coordinating capital projects and authorizations for the broad Vancouver area. There are a whole variety of coordinating bodies for health activities in the lower mainland and elsewhere in the province. While they may be changing their role, I think the need for those bodies will continue.
The member particularly mentioned tertiary facilities in the Vancouver area. The tertiary facilities perform an interesting dual role. On the one hand, they service community hospitals for the people living in those communities and as such need to be responsible and accountable to the people in those communities. On the other hand, they serve a role for the broad population of the province. There are some services for which I, from Prince George, would be looking to Vancouver Hospital or St. Paul's as the hospital or care facility that would serve me. So they also need to be broadly accountable to the people of the province.
As I said when I was reporting on progress in Vancouver, that is one of the clear issues that that interim regional health board must deal with: how it makes those institutions locally accountable while preserving their broad provincial accountability. We've said very clearly as a ministry that we see this as a very important issue and are not prepared simply to say to a regional board in Vancouver that they have all the authority over services that are provincial in nature.
L. Reid: Certainly there is a dual role for a lot of these facilities. Let's take the Council of University Teaching Hospitals. My question is: will their role change under the move to regionalized health care and the creation of these boards? They do perform a very useful function. Their role is evident in terms of keeping British Columbia's teaching hospitals on the forefront of research, medical practice and scope of practice. All of those issues are their bailiwick, and they do an extremely good job of that.
How will that expertise tie into the new structure? Certainly you continually come back to the regions and the councils. There will be a lot of other agencies in the same category, if you will, as the Council of University Teaching Hospitals. How will they interact with the new process?
Hon. P. Ramsey: I can advise the member opposite that those discussions indeed are ongoing with CUTH and with the hospitals. I'm not in a position to say: "Well, this is exactly how the CUTH's role will change." It will change, both because we will be asking the regional boards to assume responsibility and accountability for what happens in those institutions as they provide regional services but because the range of tertiary services that CUTH would be involved in may extend to regional hospitals outside the Vancouver area. So there will indeed be some changes in what CUTH is doing. All hospitals under CUTH are part of the provincial programs right now -- and will be, until this is thoroughly canvassed.
L. Reid: I can envision an entire estimates debate where your answer is that things are ongoing. I have some difficulty with that, if indeed this is supposed to be an opportunity to receive some specifics. I don't doubt these discussions are ongoing; it's absolutely essential that they are. If they were not, we'd be in difficulty. But my asking for some kind of update on the progress of those discussions is a useful question.
Hon. P. Ramsey: If you wish a detailed list of what issues and discussions are going on between CUTH, the ministry and the interregional board, I'll be glad to get you that sort of a list. I assure you that this is a serious issue.
I need to assure the hon. member that the answers to some of the questions she asks may well be that something is being studied or worked on. It is not an attempt to be evasive or to fudge the facts; it's a reflection of the reality that we are asking regions, communities and institutions to address some very serious issues about what the new health care delivery system will look like. Those are not worked out quickly, and we are doing it in a consultative partnership with institutions and regions.
I acknowledge that it would be far easier to be able to stand up here and say: "Well, this is how it's going to be, because I signed off on how it's going to be yesterday, and by God, that's how it's going to be." But that is not the process that we are involved in. We are involved in working with the hospitals and the regional planning boards to make sure that we have the answer that's going to work. We're respectful of our partners in planning the new health delivery system.
L. Reid: I would like to spend a few moments on appointments to councils and to regional boards. This is correspondence from you as Minister of Health:
"We are in the process of developing conflict-of-interest guidelines. Any person with financial interest in the decisions or operations of a CHC or RHB will not be eligible for membership. This would include employees of agencies funded by the CHC or RHB, employees of the Ministry of Health or health professionals who use CHC or RHB facilities or infrastructure in the normal course of their private practice."
The majority of British Columbians who have looked at that.... It certainly seems to be the interpretation from your office, so perhaps this is a simple issue of clarification. It seems that this excludes practitioners in the field -- nursing staff and the like. Is that the minister's intention?
Hon. P. Ramsey: Yes, that is the intention. We want to ensure that councils and boards are operating in an environment that is free from perceived conflict, and some of the details of regulation are being worked out now. As you can imagine, there is a variety of grey areas around the edges of any definition of who has pecuniary interest, and we're seeking to define those now.
Noting the hour, this might be an appropriate point to move that this committee rise, report progress and ask leave to sit again.
The House resumed; D. Lovick in the chair.
Committee of Supply B, having reported progress, was granted leave to sit again.
Hon. P. Ramsey: I think it's been a profitable week for those of us who sit here -- with a few nights that might have been a bit too long. But I think substantial progress has been made. With that, I wish everybody a good weekend, and I move that the House do now adjourn.
The House adjourned at 12:32 p.m.
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