Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JUNE 22, 1992

Volume 4, No. 24

[ Page 2837 ]

The House met at 2:06 p.m.

Hon. R. Blencoe: In the House today are a group of young people from Quadra Elementary School. As we all know, this is the end of the school year. Many schoolchildren are visiting the precincts to learn about how the process works. This group of young people were in my office this morning when I came back from a meeting. They had virtually taken over. It was good to see. They are accompanied by their teachers, Corinne Susut and Darlene Longridge. Would the House please make these young people welcome today.

L. Hanson: In the gallery today is Dr. Avigail Eisenberg, who is a political scientist from UBC. She will be speaking to the legislative interns later today. Would the House please make her welcome.

J. Pement: I'd like to introduce to the House today Mayor John Backhouse from Prince George. I knew John from previous times. At one time he was head of the regions for CNC, and I got to know him very well then. I know that he is well appreciated as mayor of Prince George. Would you welcome him to the House today.

Introduction of Bills

REVENUE STATUTES
AMENDMENT ACT, 1992

Hon. G. Clark presented a message from His Honour the Lieutenant-Governor: a bill intituled Revenue Statutes Amendment Act, 1992.

Hon. G. Clark: Bill 73 provides the government with the legislative authority to enter into agreements with the federal government under the Liquor Distribution Act and the Tobacco Tax Act to collect the provincial tobacco taxes and alcohol markups on personal importations at international border points.

I move the bill be introduced and read for the first time now.

Bill 73 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

FINANCIAL INSTITUTIONS STATUTES
AMENDMENT ACT, 1992

Hon. G. Clark presented a message from His Honour the Lieutenant-Governor: a bill intituled Financial Institutions Statutes Amendment Act, 1992.

Hon. G. Clark: Hon. Speaker, Bill 65 amends the Financial Institutions Act and the Credit Union Incorporation Act, which provide the regulatory framework for financial institutions operating in British Columbia. This bill corrects errors, omissions and problems in the practical application of the Financial Institutions Act and the Credit Union Incorporation Act. The amendments contained in this bill clarify the intent of the two statutes, but do not affect the underlying policy. I commend this bill for your consideration and urge its passage.

Bill 65 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

TAXATION STATUTES
AMENDMENT ACT, 1992

Hon. G. Clark presented a message from His Honour the Lieutenant-Governor: a bill intituled Taxation Statutes Amendment Act, 1992.

Hon. G. Clark: Hon. Speaker, Bill 69 proposes a variety of amendments to the Hotel Room Tax Act, the Motor Fuel Tax Act, the School Act, the Social Service Tax Act and the Tobacco Tax Act. For the most part, the proposed amendments to the taxation statutes are administrative measures. However, some more substantive measures are also proposed to close tax loopholes that have resulted in erosion of tax revenues. The amendments also reinforce existing enforcement provisions of the act. Bill 69 also amends the School Act by introducing compliance measures that will encourage municipalities to remit school tax amounts at the time required under the act.

I move the bill be introduced and read a first time now.

Bill 69 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

FOREST AMENDMENT ACT (No. 3), 1992

Hon. D. Miller presented a message from His Honour the Lieutenant-Governor: a bill intituled Forest Amendment Act (No. 3), 1992.

Hon. D. Miller: The bill amends the Forest Act to improve the Forest Service's ability to protect recreation resources and manage recreation throughout British Columbia's forests. This bill addresses more than a decade of public demand for better management of forest recreational resources. It enables regulation of public recreation anywhere in provincial forests to protect recreation resources. It enables designation and regulation of interpretive forest sites that are used as outdoor classrooms for discussion of the nature and management of forests. It identifies recreation offences and empowers forest officers to stop individuals and request identification.

Hon. Speaker, this bill will enable the Forest Service to address many of the public's concerns about the management of forest recreation.

Bill 79 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

[ Page 2838 ]

TOBACCO PRODUCT
AMENDMENT ACT, 1992

Hon. E. Cull presented a message from His Honour the Lieutenant-Governor: a bill intituled Tobacco Product Amendment Act, 1992.

Hon. E. Cull: The amendments to the Tobacco Product Act outlined in this bill focus primarily on restricting access to tobacco for children and youth. This will be achieved by the means of two legislative mechanisms.

[2:15]

The first of these is the addition of new controls respecting tobacco sales or the power to enact such controls by regulation. These controls directly reflect the recommendations of the British Columbia Royal Commission on Health Care and Costs. They involve forbidding the sale of tobacco to persons who are under a specified age; requiring proof of age prior to sale from persons who appear to be under the specified age; forbidding the sale of kiddy packs -- those cigarette packages which contain fewer than a specified number of cigarettes; forbidding the sale of one or more cigarettes from an opened package; forbidding the sale of tobacco from vending machines except where the machine is supervised and controlled to ensure that children and youth are excluded from using it; and requiring the display of mandatory health warnings at the point of sale.

The second legislative mechanism is the establishment of a mandatory licensing scheme for all persons selling tobacco. This scheme will be an effective means of enforcing restrictions on the sale of tobacco products to children and youth and will assist the Ministry of Finance in controlling theft and the smuggling of tobacco products.

These amendments are significant, as most persons who become smokers are using tobacco regularly by the age of 18. By introducing these measures we hope to be able to deter young people from smoking and thereby reduce the social and economic costs of addiction.

These amendments provide a framework within which regulations may be developed to address these important issues. I intend to introduce a motion to refer the development of regulations on these matters to the Select Standing Committee on Health and Social Services, and I have filed with the Clerk of the House a motion to refer, which will appear on the order paper tomorrow.

Bill 72 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

B.C. TRANSIT

G. Wilson: My question today is to the Minister of Finance, responsible for B.C. Transit -- a multiple-choice question for the minister today. Why did the minister fire the mayor of Vancouver from the B.C. Transit board: (a) because the minister thought the mayor was incompetent; (b) because the mayor criticized the removal of the supplementary homeowner's grant; (c) because the patronage list didn't include him; or (d) because Bob Williams, the real Premier, told him to?

Hon. G. Clark: I thought the Leader of the Opposition would congratulate me for removing his competition from a high-profile position.

The mayor of Vancouver has from time to time sat on the B.C. Transit board, but by no means is that the exclusive domain of the mayor of Vancouver. In addition, we have half a dozen members of the transit board from the city of Vancouver proper, and of course the minister responsible is from the city of Vancouver proper. We in this party believe in regional representation with some gender balance. We strove to do that. One of the ways of doing that is that the elected representative from Vancouver is now Libby Davies.

G. Wilson: Nice try, but the correct answer was (d).

Supplementary then. Who dreamed up the tax on parking spaces: (a) the former transit board; (b) the new transit board; (c) the minister; or (d) Bob Williams, the real Premier of B.C?

Hon. G. Clark: Prior to our attaining office on this side of the House, B.C. Transit commissioned a study by Mr. Jim Cosh and Peat Marwick to review all of the available options. A plethora of options were put forward by Peat Marwick for B.C.Transit. The former transit commission simply received that very detailed report. When we were looking at ways we could deal with the deficit left behind by the previous administration, it became apparent that the transit commission wanted the government of British Columbia to raise the gasoline tax. As we all know, members of the House, we have a serious problem in the lower mainland with respect to cross-border shopping. We chose not to raise either fares.... They also wanted fares raised. The mayor of Vancouver has specifically demanded that we raise the gas tax and bus fares. We chose to provide a couple of other options for the regional transit commission. We are not imposing the parking-lot tax. We have provided an option for the Vancouver Regional Transit Commission, should they so desire.

G. Wilson: Once again the correct answer was (d), and that might give the minister a clue to the answer of the following question. Why was the board increased from 12 members to 19: (a) because 19 is the minister's lucky number; (b) because the patronage list was too long; (c) to ensure that the board would be as unworkable as possible; or (d) because Bob Williams, the real Premier of B.C., told him to?

Hon. G. Clark: The previous board had only elected politicians on it -- although, in this case, they were almost all defeated politicians. We wanted to add more than just elected politicians, to add some people with some technical expertise in the area, like Setty Pendakur, who teaches transportation planning at the School of Community and Regional Planning at UBC. In 

[ Page 2839 ]

addition, we wanted to get better regional representation. The previous board had one person from outside the lower mainland, the mayor of Kelowna. We have the mayor of Prince George on this. We have a member of the council from Kamloops. We have someone on from Nelson, I believe. So we have better regional representation than ever before in history. We have lay people, as opposed to elected people, on the board for the first time in history. We have lay people, as opposed to elected people, on the board for the first time in history. We have gender balance for the first time in history, and we try to better represent the ethnic diversity of British Columbia with this board. I'm very proud of it. It is a bit large, but that's the price of trying to include more people in the planning process in British Columbia.

WINE INDUSTRY

H. De Jong: My question is to the Minister of Agriculture. First of all, welcome back, Mr. Minister. Given the excellent feature in Sunday's Province newspaper on the spectacular success of British Columbia's premium wine industry in the wake of free trade, can the minister tell us what steps he is presently taking to ensure that the industry continues to gain easier access to the American market?

Hon. B. Barlee: First of all, we're more concerned about our own markets. That wine trade has grown from about zero percent to 3.5 percent of the market, which is very good. Next month I am journeying to the Okanagan accompanied by two other ministers: the Minister of Tourism and the minister sitting in front of me, Small Business, Trade and Development.

We believe the VQA program is extremely successful. We have planted another 600 acres from the original 900, so we're up to 1,500. That's significant growth. We think there's room for more growth. We are aiming to double our capacity in wine-making. A lot of these small estate wineries in the Okanagan and elsewhere in British Columbia.... There are 25 of them all-told. There were half a dozen of them a couple of years ago. The growth there has been literally staggering.

As you know from that article, British Columbians are the greatest wine-tasters in the world per capita, so our own market is the first one we're concerned about. I think we'll do very, very well in that market. If you ask me this question next year, which I doubt you will, you will probably see that the figure has gone from 3.5 percent to 6 percent.

H. De Jong: The Province reported that, with the help of the previous administration I am sure, as well as the current administration, premium wine sales have doubled in volume and dollar amounts in the free trade agreement as consumers began to realize that British Columbia's high-quality wines are second to none. Can the minister explain when other commodities can expect a similar degree of support from this government to encourage consumers of all British Columbia products to buy B.C. because of its unmatched quality?

The Speaker: The hon. Minister, for a brief reply.

Hon. B. Barlee: Certainly, I will give you a very brief reply. First of all, I examined very closely, as I was travelling at 80 kilometres per hour just outside my riding actually.... I saw that the previous administration had made a valiant attempt. They put up a sign that said: "Buy B.C. First." That was 50 yards from the border. You would have needed a howitzer to stop the 50,000 cars going across the line every day.

We are taking a much more creative approach. We realize that it has to be a push-pull strategy. We've examined the strategies in five other jurisdictions. Only one has worked. That happens to be in the state of Oregon. It didn't work in Ontario. It didn't work in Alberta. It didn't work in British Columbia, obviously, because our traffic has grown staggeringly. It did not work in New Brunswick. We're getting all the stakeholders at the table, from the producers right through to the unions, processors and retailers. We've even had the mayors at the table. So I think that when we come out with our Buy B.C. program....

The Speaker: Order, please. Minister, would you wrap up your reply, please.

Hon. B. Barlee: Certainly, Hon Speaker.

I think that when we come up with our Buy B.C. program, it will be extremely effective indeed.

The Speaker: Final supplemental, hon. member.

H. De Jong: While many British Columbia commodity growers have trouble first of all finding workers -- such as the soft tree-fruit industry, the soft-fruit industry and perhaps even some of the vegetable growers -- has the minister determined what impact the government's planned minimum wage increase will have on the competitive viability of these commodity groups? Can he also tell us what specific steps he's taken to ensure that the industry's demand for workers is met?

The Speaker: Again I encourage the minister to be brief in his reply.

Hon. B. Barlee: I'm very brief. Thank you, hon. Speaker. I'm extremely brief indeed.

The minimum wage is $5.50 an hour. Virtually all the farmers I know are honourable men, and they pay somewhere between $7 and $8 or $9 an hour. I have not had one farmer mention that $5.50 an hour presents a significant burden to him. Even those farmers who are having some difficulty, and there are very few in our 175 commodity groups, can handle, I think, the $5.50 an hour, which is approximately $44 a day.

EFFECT OF CAPPING DOCTORS' INCOME

L. Reid: My question today is to the Minister of Advanced Education, Training and Technology. What effects would capping physicians' income have on British Columbia's ability to attract and retain medical specialists graduating from our universities?

[ Page 2840 ]

Hon. T. Perry: I'm sorry; I missed the first part of the question.

The Speaker: That's because there was not order in the House. Would the member like to repeat? We will extend question period to allow for this repetition of the question.

L. Reid: What effects would capping physicians' incomes have on British Columbia's ability to attract and retain medical specialists graduating from our universities?

Hon. T. Perry: I was so excited to get a question that it took me twice to hear it.

Any hon. member who takes the time to think for a moment will realize that British Columbia remains, and will remain, an extremely desirable place to live and to practise medicine, nursing or any other health specialty. In comparison with any other place in the world that one could possibly be working, this is probably the best place to work.

L. Reid: We already have difficulty retaining graduates in specialty medicine in British Columbia. What measures is this minister considering to stop the exodus of specialists from this province after they graduate?

Hon. T. Perry: First of all, with all due respect to the hon. member, there is no evidence that I'm aware of that there's an exodus of specialists. If anything, our problem has been that too many Canadian doctors from other provinces and doctors from the rest of the world want to work in British Columbia. That's what led to the former government's attempt to deal with the situation through Bill 41, a policy which, as we all know, failed miserably.

There are perhaps a few particular areas such as neurosurgery and geriatrics and certain areas of psychiatry where my ministry is working in very close consort with the Minister of Health to deal with those issues. We look forward to continuing cooperation with the faculty of medicine at UBC to deal with those problems.

The Speaker: A final supplemental, hon. member.

L. Reid: As the sole physician in cabinet and as the Minister of Advanced Education, was your insight sought at any time regarding Bill 13?

The Speaker: Hon. member, I regret to say that question is out of order.

[2:30]

NATURAL GAS EXPLORATION
AND STORAGE IN FRASER VALLEY

G. Farrell-Collins: I had a question for the Premier, but I see that he has packed up and gone home for the summer. I was going to then send the question to the Minister of Energy, but she's not here either.

I'll go down the seniority list to the Minister of Environment. I'd like to quote from a letter the Premier sent to some people in the Fraser Valley. He said: "I want a moratorium on natural gas exploration and storage in the Fraser Valley. I also want Anderson's 59 recommendations brought back to the Fraser Valley residents for full public consultation so all questions can be answered about the environmental and economic impact of drilling and storage." Why was that not done? Why did the Premier lie to the people of the Fraser Valley?

The Speaker: Order, please. I would ask the hon. member to withdraw that final comment.

G. Farrell-Collins: Sorry, I didn't meant to call the Premier a liar; I meant to say that he was just like Brian Mulroney.

The Speaker: Hon. member, I request again that you unequivocally withdraw the comment.

G. Farrell-Collins: I will withdraw the comment and the reference to the Premier as a liar. I will only say that perhaps he misled the people of the province.

Hon. J. Cashore: We are consistent with everything that the Premier has said. No further drilling has been approved. We have simply authorized the companies to seek such approval through a stringent and appropriate process that would involve more consultation with the public, more consultation with the citizens' advisory committee and the examination of the application by regulatory bodies, including the Agricultural Land Commission and the Ministry of Environment. We are consistent with what we said we would do. And yes, the recommendations of David Anderson are paramount in this process.

G. Farrell-Collins: Perhaps the minister is not aware that that community advisory committee is actually appointed and chosen by the industry itself, not by the people who live there.

My next question goes down the seniority list even further to the Minister of Municipal Affairs. I'd like to ask the minister why, in spite of two surveys in the municipality of Langley that said 80 percent of the people were opposed to gas drilling in the valley and numerous unanimous votes by Langley Township Council opposed to this proposal, he thinks it's fair for the Premier to ram this project down the council of Langley.

Hon. R. Blencoe: This issue is under full review and is being handled properly by the government.

The Speaker: The bell ends question period. I had suggested that question period would be extended to allow for the repeat. It is my understanding that it was done before the bell was rung.

[ Page 2841 ]

AIR AMBULANCE CONTRACTS

Hon. L. Boone: Hon. Speaker, I'd like to answer some questions from the opposition taken on notice last week. The first one had to do with Carson Air Ltd. The government has entered into a standing-offer agreement with Carson Air for air ambulance service over two years from three interior cities: Kamloops, Kelowna and Prince George. Under the agreement, Carson Air will provide these services on a needed basis. Carson Air won this standing offer through a competitive process, which included informing industry of government's requirements well in advance of issuing the standing-offer request. In order to provide the service in all three locations, Carson Air needed to establish bases in Kamloops, Kelowna and Prince George. An implementation and action plan has been put in place to ensure timely completion of these bases in Kelowna and Prince George by June 26 and in Kamloops by June 29. A preliminary on-site inspection of the proposed facilities in Kamloops and Kelowna has already been carried out.

The second question is in regard to the services of the charter operators that previously provided ambulance service. Seymour Air of Kamloops and Southern Interior Flight Centre of Kelowna have been used while awaiting satisfactory completion of bases in these centres by Carson Air. The agreement with Carson Air is based in large part on this company's ability to provide two-stretcher capacity in delivering air ambulance service. The previous operator was unable to provide this, although their management was informed of this requirement over a year ago; thus the company was unsuccessful in competing for the current work agreement. It is not unusual for a regional company which previously had limited markets for its services to need to expand its facilities when a large job of work has been won and is being done.

The final question has to do with the examination of the charters. The request-for-proposal process provides first for a complete examination of the records of an air charter operator who competes for government work; and an inspection of the operator's premises, the aircraft and the operating base follows. Any agreement between the government and an air charter operator is conditional. The contractor must meet -- and must continue to meet -- the standards of government air services and of the B.C. Ambulance Service. To this end, subsequent inspections are done as frequently as government officials feel necessary during the period of the agreement.

Presenting Petitions

D. Mitchell: Hon. Speaker, I beg leave to present a petition.

Leave granted.

D. Mitchell: I have the honour to present a petition to the House this afternoon. This is a petition signed by some 80 physicians from the North Shore of Vancouver -- North and West Vancouver -- who are alarmed at the prospect of Bill 71 being introduced in the House and are concerned that it might spell the end of medicare in our province.

Hon. D. Zirnhelt tabled the 1990-91 annual report of the Ministry of Regional and Economic Development.

Orders of the Day

Hon. G. Clark: Adjourned debate on second reading of Bill 71.

MEDICAL AND HEALTH CARE
SERVICES ACT
(continued)

V. Anderson: I would summarize what I was saying before we adjourned this morning: simply that I recommend before we proceed further that this draft bill which has been brought forward go back to the communities so that they may respond to and interact with it. I also recommend that it go to a legislative committee so there can be full input from the community at large.

Hon. T. Perry: I welcome the chance to speak to this bill, which I will support, not least because it gives me the opportunity to respond at some length and in some depth to many of the physicians who have written to me over the last two months expressing concern about the confrontation in which they and the government have found each other.

It's been difficult to respond to them, because the situation has evolved very rapidly. I've been through about five drafts of a letter trying to give a thoughtful and useful response to physicians who have been concerned, partly because I know many of them and have worked with many of them and respect their opinions and their concern. In the barrage of propaganda which has enveloped this issue, sometimes it's been difficult to know how to respond in a way that would be not only honest and forthright but also revealing of some of the complexities which the government has faced in attempting to ensure that we do preserve what's best about our medicare system. So I'm going to speak not only in support of the bill, but in direct communication with all British Columbians, particularly those in the medical field who have felt concerned about how things have gone in the last three months.

I note in today's Vancouver Sun a letter from a Dr. Caroline Wang in Richmond under the heading "NDP Tactics Can Only Damage Medicare System," which I think reveals a very limited understanding of the dilemma which the public and the government on behalf of all taxpayers face in trying to preserve a medical and health care system and sickness care system which has become the envy of virtually the entire world. Among other things, Dr. Wang says in her letter: "Most people don't realize that the fixed global cap translates into a progressive reduction in doctors' real net income in the future to about 50 percent after five years."

[ Page 2842 ]

If that was true, it wouldn't be surprising that so many physicians are concerned. Perhaps one of the reasons they're concerned is that they do believe that's true. I submit that the reality is quite different and that the public -- including doctors, who also, after all, are taxpayers and who have families that depend upon the administration of the province to maintain a sound fiscal policy -- will come to understand that reality is somewhat different.

I refer to an advertisement published in the Vancouver Sun on Saturday, June 20, which suggests that the new Medical and Health Care Services Act, the act that we are debating, will result in the following -- and there are six clauses in the advertisement. The first refers to longer waiting-lists for surgery and treatment. I will explain in a moment why I think the bill has nothing whatsoever to do with that and will in fact help us to alleviate the problems of unreasonable waiting-lists.

The second clause refers to the elimination of doctor-patient confidentiality because of the government's new access to your personal medical files. When I read the draft bill, I was concerned. I raised this issue in particular with the government officials responsible for drafting the legislation, and was assured in consultations with the B.C. Medical Association and with the College of Physicians and Surgeons that this issue was being addressed to their satisfaction, and I believe that it has been. If it has not been sufficiently addressed, the Minister of Health -- my colleague who's sitting here with us right now -- has made it abundantly and patently clear to the medical profession that she will entertain and is prepared to pass reasonable amendments to the bill at the committee stage.

So there is still plenty of time for those amendments to be proposed if there's legitimate concern about patient confidentiality. The government has absolutely no interest in reducing or diminishing patient confidentiality. It's quite the contrary, in fact. The Freedom of Information and Protection of Privacy Act, which will be passed in the Legislature this session, indicates our commitment to the protection of privacy.

The third clause here refers to restrictions on tests that doctors can order. I think that this is a major misunderstanding of the intent of the bill. The intent of this bill, very clearly, is to encourage a medical system -- a sickness care and health care system -- that is efficient and effective. Those words go back to one of the great pioneers in the post-war period -- Cochrane of the University of Wales -- who described the notion of effectiveness and efficiency in medical care at the end of World War II. He became a pioneer in the development of controlled clinical trials and in the attempt to apply knowledge to ensure that our medical care is not only useful -- does more good than harm -- but also efficient in the way that it spends the public's or anyone else's money.

Clearly the intent of the bill is to devise incentives with the cooperation of doctors, including but not limited to those who will be represented on the new Medical Services Commission; with the cooperation of the public, which will now for the first time be represented on the Medical Services Commission; and with the cooperation of the College of Physicians and Surgeons of B.C., the University of British Columbia faculty of medicine, specialty societies and advisory councils within the medical field. In fact, it's in cooperation with anyone who has useful knowledge to bring to bear on this subject, so that we waste less money on medical tests and can guarantee that those medical tests -- including the expensive ones which are really necessary for the beneficial treatment of sick British Columbians -- are available when we need them.

[2:45]

The fourth clause here refers to difficulty in obtaining new technology. I submit that, quite to the contrary, the Minister of Health, her officials, cabinet and caucus of the government side have all thought seriously about this issue. Their insight has been sought, along with the insight of many other British Columbians, including literally hundreds, if not thousands, of physicians who have communicated with the government and with whom the government has communicated directly, whose counsel the government has sought in various ways. It should lead to the protection of a system in which useful new technology is available.

I remind those members of the House who are veterans, and perhaps I inform those who are not, that I was one of the staunchest proponents of the institution of useful new technology. For example, I was a very strong proponent of the technology that allows people with chronic renal failure, through the use of a recombinant DNA human molecule called erythropoeitin, to have a normal or close to normal blood count and feel stronger, even when they receive chronic renal dialysis. I was a very strong proponent of that technology, and I will remain a strong proponent, as a member of the cabinet and government caucus, as a member of the Legislature, as a citizen of B.C. or in whatever capacity. Useful new technology can help people to lead healthier lives, lives of greater quality, and it can sometimes defer or even prevent death. That technology is something we strive to protect in this legislation by enhancing the efficiency to reject useless technology.

Some technology is useful for some people and useless for others. Some technology, although it's highly billed by doctors -- including prominent American doctors who make fortunes out of the promotion of a new technology, attempting to pawn it off on the rest of the world as if it were God's own medicine.... They would like us to rush into adopting that technology before it's even proven to be useful. The history of medicine is replete with examples. Gastric freezing: putting a probe into somebody's stomach to freeze it to try to treat ulcers. Internal mammary ligation: a technology to deal with coronary artery disease, subsequently proven to be useless. In its time, in the late fifties, it was championed at the Royal Victoria Hospital -- in those days, the greatest hospital in Canada and one of the greatest in the world -- as one of the finest technologies available. Those we can do without. This bill will help us to protect ourselves from useless technologies and protect our ability to pay for good ones.

[ Page 2843 ]

The fifth clause refers to a permanent loss of doctors. Perhaps that's what inspired the question from the hon. member for Richmond East. Perhaps she has been stampeded into believing that doctors will flee British Columbia in search of the balmier climes of California, where they can pay massive malpractice insurance because the medical climate is so fractious there. Lawyers dominate practice so much that doctors order hundreds of thousands of dollars of useless tests per person, per year. Doctors end up in private practice in a city like Seattle, condemned to continue practising past retirement age because they're still potentially liable for past practice and have to generate enough funds to pay their malpractice insurance. I'm less worried about that.

I share the member's concern that we can do better in certain specialties, because the specialties are so demanding and difficult, be it neurosurgery, or so relatively poorly paid, be it geriatrics. This bill may help us, paradoxically, to deal with the issue of the geriatrician, the person who in future will be responsible for the complex health and sickness care of a quarter of our population, or perhaps more, who will be over 65 in the not-so-distant future. They are now discriminated against by the fee-for-service system. Their services are undervalued. Their so-called cognitive services are sometimes made fun of by procedurally oriented doctors. I remember being in those discussions myself when a prominent procedurally-oriented doctor made fun of the whole idea of cognitive value in medicine. For those who aren't used to such big words, that means thinking before you act. That means listening to a patient carefully, thinking about what's wrong with them, looking for the non-technological solution where it will help -- like perhaps getting somebody to live on one floor without stairs, rather than designing an elevator to get them up the stairs.

The final clause here relates to a denial of the doctors' right to negotiate. The issue is much more complex than it looks. The doctors have argued that simply ensuring binding arbitration would fix all of our problems. This Legislature, as members well know, is elected to decide on the budget of British Columbia. We take a very difficult, onerous responsibility, but also a very solemn one. We are the people in whom the public puts its trust to determine how much money shall be spent and how it shall be spent. To agree irreversibly to binding arbitration would have transferred the power over a budget item of $1.27 billion this year into the hands, potentially, of one individual -- one individual with that much power, without any direct accountability to the people of the Legislature, as the Minister of Health and the Minister of Finance now enjoy. One may or may not like the conclusions they reach, but at least this Legislature has the power to question them, ultimately to disapprove or approve of their decisions. Ultimately the public has the final power to ensure they're accountable. A binding arbitrator has no such accountability to the public for her or his decisions.

Let me come back, before I forget, to the issue of the longer waiting-lists for surgery and treatment. In fact, one of the fundamental principles of this bill is one which I say with some sadness. Not all members of the medical profession have readily welcomed the principle that we should examine very carefully the use of protocols and guidelines to ensure that the surgery done in British Columbia is only necessary surgery, and ensure that we are operating on patients who need and can benefit from the surgery and eliminating those cases where the benefit -- although commonly accepted, perhaps, in medical parlance -- has not been proven scientifically or where benefit is questionable. By doing that we could, in fact, shorten our waiting-lists. We could ensure that people receive health care in a timelier way and that those people who might not benefit from surgery which they presently undergo are spared the pain, the cost, the suffering and the potential risk to their life.

That is a principle first put forward by a surgeon named Codman in Boston in 1909, or thereabouts. He was so unpopular with his colleagues that he was virtually driven out of Boston, then the leading medical centre of the world, because he dared to suggest that results should be evaluated. We've come a long way since then, thanks to Cochrane in England and others, but we have a long way to go. When the medical profession presented its final arguments to the Royal Commission on Health only a year and a half ago, and the commissioners asked whether the development of protocols would be a good idea, I regret to say that the College of Physicians and the B.C. Medical Association passed the buck. Neither of them were willing to assume the responsibility. They said it's not our problem. You ration if there must be rationing. Let the government ration. In effect, what they said was if there is a problem with money, make the decisions at the top. Don't consult us. Don't ask us, with our professional expertise at the bedside, to make the most efficient, rational decision in the patient's interest.

I disagree with that approach, and I argued it as a hard as I could when I was in the position of the member for Richmond East as the opposition Health critic. In living rooms, in medical offices around the province for two and half years, I argued that point, discussed it with doctors, pointing out that once the public understood what the real budget situation was in this province -- not the phony balanced budgets presented by the former, Socred government, but the real situation -- we would have to tighten our belts. We'd have to start spending smarter.

I argued that I would rather the bedside physician, who is best poised and best equipped with the most knowledge to make those decisions rationally in the interests of sick people, made the tough decisions if they have to be made, not those of us who sit at some further distance. That's what this bill is about. This bill is not only putting the responsibility but the power to make good decisions into the hands of those who are best equipped, not only through the commission but through the incentive to physicians that if they practise smartly and wisely, they can be well paid for their work. If they practice anachronistically, if they practise without respect to the ultimate ability of the public of B.C. to pay, it will cost them as well.

What are the alternatives? I realize this is a wrenching change for many in the medical profession who have been brought up in a tradition, frankly, of 

[ Page 2844 ]

profligacy. The medical schools have taught profligacy: order this and that test, never worry about it; if you don't order enough tests, your superior in the hospital ward will come down on you the next morning and say: "Why didn't you order that test?" That's the tradition we've grown up with in the period since the fifties when government finances and revenues were growing out of control. We have to change that profligacy; we have to teach and think smartly, because there's no such thing as a free lunch.

What's the alternative? The alternative is clearly higher taxes. Physicians are generally high-income earners in our society. The alternative for them if we do not respect the fact that we would have had a budget deficit exceeding $3 billion this year had the government not acted and that we still have a large deficit, even despite very tough spending decisions, is higher taxes. I don't think that the leadership of the medical profession has been as honest as it might have been with the doctors of B.C. as citizens in pointing out that there's a real dilemma that all of us face.

I want to address one other issue. I could speak all day on this, but I'm worried about running out of time. Many of my friends in the profession of medicine -- colleagues when I actively practised medicine, teachers -- have been concerned that the government acted arbitrarily, in haste, without consultation. I think that in the best of all possible worlds things might have been done more sluggishly. If there are bruised feelings on their part along with other members of the government, I regret that.

But to imply, as the advertising campaigns have done, that there was no attempt to listen to their concerns or deal with alternatives is simply not true. The Minister of Health has bent over backwards -- at night, weekends, weekdays, extra days of the month -- along with her colleagues. Virtually every MLA has taken to the consulting rooms to talk to doctors, brought the doctors into their constituency offices, read the mail, spoke to people over the phone, and I've done my share as well. I am well aware of the concerns of physicians. I have attempted to explain the dilemma in which the government must respect the interests of the taxpayer, must control the budget deficit and must guarantee that we protect what's best in the medicare system. Lest there be any British Columbian who feels that a full, careful, honest, sincere effort was not made by government to meet the concerns of the medical profession, let me assure them one could hardly have done more.

That story has not been told in public. In my view, the government has been remarkably restrained about describing to the public how carefully we have tried to meet the concerns of the doctors. Their concern was that ICBC costs were being offloaded onto medicare. In effect, they were talking about themselves offloading ICBC costs onto medicare. But we offered to discuss that with them.

They were concerned that the government would not back them up if patients came into their offices seeking unnecessary tests. The Minister of Health, the Premier, myself and all other members of cabinet made it clear that we would back up doctors if they practise -- and when they practise -- rational medicine, and that if politicians have not backed them up in the past, that will certainly change from now on.

We invited them to consider ways in which we could address the medical-legal issue and whether medical-legal pressures are driving doctors to perform unnecessary tests. We've showed the maximum possible openness to any suggestion they had as to how costs could be curtailed and the system made more effective. What's more, and much more important, we remain open to that.

The government will remain open not only because it wants to, but because it must. For our health and sickness care system to function well, we must have the cooperation of the physicians. We must ensure that they realize that they are not being victimized differently from every British Columbian who must come to grips with the fact that government has been outspending its resources for years -- not only federal, but provincial governments. Unless we get our house in order, our society is economically doomed. We will lose the ability to pay for essential services. We must come to grips with the fact that we were the party who founded medicare in British Columbia. We fought those battles when it was very tough to get elected, when it was very tough to be the government in Saskatchewan in the 1940s and when it was very tough and often painful to be an opposition CCF or NDP member in British Columbia in the 1950s.

We fought for a system that would guarantee that every citizen had equal access to high-quality sickness and health care, regardless of their economic status. Anyone who thinks we're going to back away from that one millimetre had better think again.

[3:00]

C Tanner: What's the rush?

Hon. T. Perry: I hear the member for Saanich North and the Islands asking what the rush is to pass this bill. There is a clear constraint on the government which the Minister of Health has enunciated time and time again. This government will operate under the parliamentary tradition by a legislated budget, not by special warrants passed in the backrooms in the middle of the night in secret to deal with whatever the overrun is.

The government offered, time and time again, the ability to negotiate within the budgetary means of British Columbians virtually any contract that the BCMA would have cared to settle, as long as it respected the ability of the taxpayer to pay. The government could not have gone further in seeking alternatives to a legislative solution, had the medical profession, through its leadership, been willing to do so.

Perhaps it was the advice to the BCMA of Mr. Kinsella, who would have no interest in the preservation of medicare, and who probably tried everything in his book while he was a member of the former government to bring down medicare, because he doesn't fundamentally believe in it. He believes in a 

[ Page 2845 ]

system where the rich get richer, the poor get poorer and the atavistic nature of people is enhanced.

That's what Mr. Kinsella stood for in government; that's why he worked for the former disgraced Australian Premier, Mr. Bjelke-Petersen. That's the kind of guy who has been advising the BCMA. If they would listen to the saner voices like Dr. Basil Bolton, who wrote in the Victoria Times-Colonist recently, and many of the people I have met with over the last two months, perhaps they would have accepted the hand extended by government to find an alternative solution.

The urgency to pass the bill is to make sure that the taxpayers of B.C. are protected, and that the medical system does not come into disrepute. If the Minister of Health did nothing, we would either reach potentially a substantial budget overrun or a point at the end of the fiscal year when doctors would have to be taxed back through proration such a substantial portion of their fees that they would find that situation much more unpleasant than what they face now.

Interjection.

Hon. T. Perry: I hear the fiscally responsible member for Saanich North saying one more overrun makes such a difference.

C. Tanner: I said one more overrun could make so much difference.

The Speaker: Order, please. Hon. members, only one member can have the floor for debate at one time. Please proceed, hon. minister.

Hon. T. Perry: Hon. Speaker, all overruns are important. Perhaps physicians in their angst, feeling they have been somehow peculiarly singled out, fail to recognize what happened in the budget to other ministries through necessary cost-containment measures. My colleague the Minister of Agriculture would have liked to have had an increase in his budget, and he took a substantial chop; my colleague the Minister of Economic Development the same. My colleague the Minister of Tourism would have liked to have been able to spend more money to promote B.C.'s second-most-important industry and was not granted the power to do so by the Treasury Board, the cabinet and the Legislature ultimately. I wouldn't have minded having a few more pennies in Advanced Education. We could have brought a few more students into the universities this year. In fact, although we got a 4.3 percent increase, members on the opposite side and on this side have pointed out that it would have been very nice to have more. All of us are facing that dilemma, hon. Speaker. This bill will give us the tools to flexibly begin to address the dilemma of financial accountability and at the same time rationalize our medicare system so that we get the absolute maximum for our money.

Let me come back again to some of the issues the doctors have raised and the key issue for the public. Is this bill eroding medicare? Absolutely not. This bill, in our judgment, is essential now to preserve the key characteristics of medicare: equal access regardless of one's economic status; equal access, whether you are rich or poor, to good treatment; not to be dependent upon the goodwill of a physician, as the physicians have always had traditionally; not to be in the position where one must rely on being a charity case. That's the fundamental characteristic of medicare that has made it so popular with the Canadian public. It's so popular that all political parties, even the Reform Party occasionally, endorse that concept.

Through the new act we have the potential, if the physicians will come along with us, if they will stop to think for a moment and recognize that they are not being singled out for punishment, that they are citizens like all other citizens and that we rely on them to make the system work well for British Columbians including themselves, their children, their families, their heirs, their neighbours, their friends and everyone around them in their community.... If they will come along with us, we will make the system work better than it ever has. It will be a more rewarding system to work in. It will be one in which the efforts of a physician who tries to get a teenage girl to stop smoking or to not take it up in the first place, who tries to prevent an unwanted pregnancy or who prevents AIDS through careful counselling or who does the most difficult job of all in dealing with a patient with terminal AIDS or Alzheimer's disease is fairly rewarded and has redress against the erosion of their income, which took place under the previous existing system, where fees went up regardless of the true overhead.

There are reforms in this bill which, if the doctors and others will look at them, will be seen to provide the potential for a more effective, healthier health care system. Hon. Speaker, not only do we need it, but we clearly need the physicians of British Columbia to take a look, wake up, smell what's happening around the rest of the country, get in step with the rest of society facing the kinds of challenges that the Premier's summit on our economic future faced last week and realize that we've got to go forward now. This is not the time for recriminations; this is the time to get on with building a healthier and better province.

H. De Jong: I seek leave to make an introduction, hon. Speaker.

Leave granted.

H. De Jong: It gives me great pleasure to introduce to the assembly this afternoon 30 students from the Upper Sumas Elementary School, together with their teacher, Mr. Hardington, and several parents. This is a country school, which is extremely well supported by the parent body. I would ask this House to give them a hearty welcome.

A. Warnke: I would like to rise and make some comments on Bill 71. I listened with interest to the previous speaker, the Minister for Advanced Education, who I know, and I think we all know, has a special interest in this field. There were occasionally a few phrases in there that, upon further reflection, could be applied to the government's approach to this bill. For 

[ Page 2846 ]

example, the hon. minister said, quite correctly, that we should think before we act and that, indeed, you consult with the patient. Well, let us consult with the public.

I don't doubt for a moment that the Minister of Health really worked and bent over backwards, as the previous minister mentioned, to consult with the medical community. Hopefully she has done that. But as late as eight days ago -- and as I reflected on the press reports, and so forth, throughout all of last week -- members of the British Columbia Medical Association had very serious reservations as to where this government is going with regard to legislation.

As far as bending over backwards is concerned, this bill was introduced on June 16. It has 52 sections within it. It's not a small bill; it is quite comprehensive. All my colleague from Saanich North and the Islands was pointing out is that given the comprehensive nature of the bill and given the view of the BCMA and others in the medical community on it, perhaps it would be prudent for the minister and the government to consult more with the public and the professions, and to reflect a bit more and think before they act. That little phrase "thinking before acting" is certainly appropriate in this particular case.

Another point that the Minister for Advanced Education raised is also worth reflection. The minister did say that he and other members, especially the Minister of Health and the cabinet -- he included the cabinet -- had put forward that all the medical profession has to do is apply rational medicine. What is rational medicine? As advanced from that side of the House, it seems to be that if you agree with this government, that's practising rational medicine; if you disagree, that's irrational medicine. That kind of logic fails the test of how to put forward legislation. I think there are some very valid concerns about backing up a little and thinking about the legislation that is put forward here.

For example, I have some concerns in this particular bill with regard to confidentiality. We're into second reading right now, and at the committee stage we will explore section 43 much further. But I will say that when I take a look at that particular section, the preamble seems to cover many different areas, but then one has to recognize that there are exceptions, and these exceptions create a problem in terms of the administration of the act.

When we begin to reflect more on confidentiality, as members of the medical community have expressed, there is a problem with it. When we are talking about the possibility of releasing files or having certain members -- I guess the term is "bureaucrats," but they're government officials of various sorts -- have access to very sensitive information, I will say this, hon. Speaker: there are members of the public who are extremely nervous and sensitive about any government official, any government, regardless of party, having access to that kind of confidential information.

We in the government always have to be very sensitive about the prospect of having sensitive material available to members of the government. Patient files do contain extremely sensitive information, whether it involves someone who has HIV, someone having an abortion, someone perhaps having a record of psychiatric care. This is very sensitive material that individuals in our society are very sensitive about. To just pass legislation and open up that process is something that we have to be concerned about.

Mind you, the Minister of Advanced Education qualified it in such a way that.... Alongside Bill 71 there is yet another bit of legislation before the House, the Freedom of Information and Protection of Privacy Act. Presumably, if that is passed, it will be sufficient to protect the individuals. The last thing we want to do now is debate Bill 50. We will get to it sooner or later. On that point, the provisions protecting the individual in Bill 50 are irrelevant to the protection of the individual in Bill 71. In that context, it is a fallacious argument to say that we are protecting the individual here in Bill 71. No, we're not, hon. Speaker. We have to have that protection for the individual in Bill 71. That is most critical; it is most important.

Therefore what we need is a procedure that if there are these documents, there is a procedure for obtaining access to such sensitive information. We have to protect that in order to protect doctor-patient confidentiality. Indeed, a cynic might well say: "Why is the government so inquisitive?" It doesn't show up only in this legislation but in other legislation as well. The government has introduced bills from time to time that are kind of inquisitive as to what documents and what files professions in our society have.

[3:15]

[H. Giesbrecht in the chair.]

There is a pattern here as well of yet another profession in our society being the target of this government, a supposedly very affluent profession in our society that can afford to go through some radical changes. Oh, the government has argued, the Minister of Health has put forward that we are now going to create a new consultative process; we are going to establish a particular commission in the context of co-management. I would say this: as I see this bill being presented before this House, I see this fancy term "co-management" as nothing but window-dressing of a concept I see in another jurisdiction, particularly that of the Federal Republic of Germany, and the term is "co-determination." It is a concept I know quite a bit about. I'm not going to bore the chamber here with another elaboration of Germany....

Interjection.

A. Warnke: I guess some people do in fact want us to talk about it.

Co-determination in Germany is a process by which various groups do come together in a particular committee. In fact, the input of those various groups does help to shape public policy, and it is a move in the right direction. However, in this particular situation there is this concept, and then it's window-dressed under the context of co-management. But does it really resemble the model of co-determination? On closer examination, no. What the Minister of Health has introduced here is that there are three elements in-

[ Page 2847 ]

volved in this new co-management model: the public, the providers -- which is another way of saying the medical profession -- and the government.

How does one become a member of either one of these three sectors, to become part of this co-management model? That's not in here, and the reason why it's not in here is because this bill has not been thought through. Once again -- and this has happened over and over again, as we've seen, in certain legislation brought forth -- there's not something called "follow-through" in the legislation that's before us. What constitutes the public body? It's appointments. Who does the appointing? Who represents the medical profession? Who represents the providers? Appointments, hon. Speaker. And appointments is a way for a government to develop a stacked deck to push forward its agenda, its public policy views, and force them on the rest of the public. Not really true members of the public, because the public at large.... And one hon. member says that they're all going to be elected. The members of the public body are going to be elected. By whom? All of the electors of British Columbia? That's simply not true. This is not the way it goes in this legislation. Members on that side don't even know their own legislation.

The process is flawed. The process does not involve a really thorough follow-through. It therefore goes back to the original point that I raised: this government must think before bringing forth legislation. I will use the phrase of the Minister of Advanced Education: thinking before acting, consulting with a patient. Yes, that's so true. Consult with the public, consult with the medical profession, consult with the people who are really affected, and not some adviser set up by this government.

H. De Jong: I will speak very briefly on Bill 71, the Medical and Health Care Services Act. This is not, as I see it, a doctors' bill. It's not a specialists' bill. In my opinion it looks like it could be a black-cap act.

A member on the government side said this morning that this bill recognizes the conclusion of discussions over the past 25 years. I've been told that it's quite different; I've been told that little or no consultation was held prior to the drafting of this bill. British Columbians and politicians have, for many years, spoken about our health care system proudly. I suppose the reason for the general public support has been that it is affordable. The government is very quick to blame the current problems it faces on the previous administration. While medical premiums have gone up over the years, I vividly recall the voices of the now-government members, who were then in opposition, opposing premium increases for the continuation of good health care services. Little did they realize, or at least want to admit, that when all other things go up in cost, it includes the cost of providing health care, which then necessitates the revision to premiums.

I realize that this bill is not specifically about premium increases and so on. This bill goes to the heart of the delivery of medical services. This bill, like a number of other bills that have been presented in this House by this government, is another attempt to move the Ministry of Health totally under the control of a commission. I can see why the government is moving this issue, because health care delivery has had some controversy over the past years. I can see that they wish to move it into a commission. That then leaves it at arm's length from the government and, in particular, from the Minister of Health.

Health care is, without a doubt, difficult for politicians to deal with, but it is particularly difficult for a socialist government. The reason I say that is that on the one hand it is a social type of service, with very limited premiums attached. When somebody visits the doctor's office, there is no cost attached; it's free. On the other hand, though -- this, of course, is difficult for a socialist government to comprehend and work with -- the doctors and the professionals delivering the services are independent. They are private enterprisers.

Unlike previous governments, which perhaps had some difficulties but always finalized negotiations satisfactorily to both parties, this government does not appear to be doing that or to wish do it. They wish to do it through an act in this House. This government has chosen a different route. First they introduce Bill 13, a bill primarily capping the doctors per se. Now this bill does basically the same thing, except in a more subtle way. It is a subtle approach to remove, first of all, the reality of the difficulties from the minister responsible. This minister and this government, when in opposition, have made all kinds of statements with respect to health care and its delivery, and those statements are now coming to haunt this government. That's why it's so difficult for them to deal with it. This is why they are presenting this bill. This bill is just a bill to avoid the reality.

One of the government members referred to this bill as a bill for wellness. This is not a bill for wellness. This is a bill by a government that knows how sick it finds itself to be. This bill is another example that this government is not capable of representing the people for the most essential service: health care. So why the rush for a bill on which depends a good health delivery system, which the people of this province have enjoyed for so many years?

I know -- or at least I hope I know -- that most of the members on the government side of the House are still interested in the best delivery of health care. This, however, is not going to be achieved by rushing this bill through the House. This government appears to have no problem placing moratoriums on a number of other issues for government to "get a better handle on it." Why not place a moratorium on this bill and allow the people to speak and to negotiate about it in a proper way so that proper health care, which the people of this province have enjoyed for so many years, may continue? After all, every elected member to this House is ultimately responsible for the best-run health care system, now and for the future, a system that is undoubtedly difficult to make perfect, however essential for those who deliver and, above all, most important for all British Columbians.

G. Farrell-Collins: I too am pleased to rise and participate in this debate on Bill 71 and make a few comments. It's been interesting to listen to the debate as 

[ Page 2848 ]

it has progressed through today and hear some of the comments that have been made by the NDP backbenchers in support of their minister. It's an unusual procedure in this House when we have the NDP back bench supporting the ministry and actually getting up and speaking to a bill. It makes for interesting reading in Hansard afterwards, and it makes for interesting comment, to finally get some lively debate in the House.

Earlier today the member for North Vancouver-Lonsdale made a rather lengthy speech and a presentation where he talked about a number of things. One of the cornerstones of his discussion and his debate had to do with the idea that we had to create a wellness in the community, and we had to start to deal with preventive medicine as opposed to curing the ills after they had already occurred. That's a very good point and a very good proposition. It's something that we would all like to see. We've all talked about healthy communities and trying to get people well before they even get sick. If that were truly the intent of the government, I have to ask myself why the same government recently cut $2 million from the Sport B.C. budget, virtually gutting the organization.

Sport B.C. is a group that is funded and uses that money to encourage amateur sports in British Columbia. Amateur sports for people: children, adults -- people of all ages -- participating in their communities in baseball, softball, soccer, swimming, and whatever types of sport there are that people get involved in. Those are the types of things we want to encourage. We want to encourage people to be physically fit. We want to encourage people to be participating in an active way and have a good, healthy lifestyle. Fitness is one part of it.

[3:30]

Why is it that this government, which speaks so strongly of preventive medicine and a health care system that encourages people to participate and to become healthy before they even get sick, would turn around and cut $2 million from the budget of a very good organization like Sport B.C.? When we look at that sort of issue, and we look at the motivations of this government, we start to question the dichotomy. Is one part of this government talking to the other part? Was there any consultation with the Minister of Health when the decision to cut this $2 million from Sport B.C. was made? Did cabinet discuss it?

Of course, members won't tell us whether they did or not, but it really begs the question: is one part of this government talking to the other part? When we have a bill like Bill 71 come along, and we have members opposite speak so strongly in favour of it, I wonder where the voices of those people were when the opposition rose in this House and questioned the government on the spending of that money and on the cancellation of that money. Where were those members? Where were their voices when the opposition was questioning the government about that decision? They were probably quite quiet.

We have before us now Bill 71. It was brought in towards the very end of this session of this Legislature, and it incorporates a number of things. Among them, it incorporates Bill 13 almost in total. This bill, the one that dealt with the capping of doctors' salaries and the capping of payments to doctors in this province, is no longer before this House. The government brought that bill off the order paper and is going to let it die, just let it sit there and disappear into thin air. We all hoped, when it did that, that the government had realized it had made a mistake, that that was not a way to go, that it should not be forcing some sort of an agreement like that on the physicians of this province.

This is the same government that speaks and cries so loudly about free collective bargaining. I always thought that when members meant free collective bargaining, they meant that all British Columbians had the right to get together in a collective and negotiate a contract or a deal with the government to receive remuneration. People get together and form unions; they negotiate with the government, or they negotiate with private corporations for their salaries, for their remuneration. Why is it that doctors can't get together and negotiate in a collective way with the government?

I question that. I asked the minister: why does that occur? Why would the ministry choose to not negotiate with the doctors, to say that doctors don't have any collective rights, whereas unions in this province do? Why does somebody in this province have to belong to a union before this government will give them the rights that they deserve?

We asked that question in this House some time ago; we asked the Minister of Finance. He said very clearly: the doctors are not part of a union; therefore they don't have collective rights or any right to collective bargaining. That's just fundamentally wrong. We have in this country a Charter of Rights that deals with freedom of association, and those people can band together, form a collective group and do as they would in this case. Why is it that doctors are being excluded from this?

We now have Bill 71, but we've had other bills before this House that the government has, upon second glance.... The other day we heard the Attorney General say: "We've taken a second look at this bill. It isn't any good, and we've decided to get rid of it." I believe it was Bill 32. I would suggest that the government take another look at Bill 71, take a hard second look at it, and see the flaws that exist in it. Let it die on the order paper also. Or, if the government doesn't want to do that, then perhaps members can let this bill go through second reading, if they so choose, and send it to the standing committee that deals with health and social services. Give this committee of the Legislature some time to tour the province, to go into the communities and talk to the people who have health care delivered to them, to talk to the doctors, the patients and the other health care workers -- all the users of the system -- and give them a chance to contribute and comment on Bill 71.

We just had an instance today in this House where the Minister of Health stood up and referred a bill that dealt with the positioning of tobacco-vending machines to a standing committee of the Legislature to tour the province and seek input. Why can we do that on the positioning of cigarette-vending machines, but we can't do it and we can't expend the money on an omnibus bill like Bill 71? Where are the priorities of this government? Where are the backbenchers from this NDP 

[ Page 2849 ]

government, whose one job -- if a backbencher has a job in a parliamentary democracy -- is to reach up and shake the cabinet ministers when they start to get out of line. Where are the backbenchers from the NDP standing up and saying that this bill has some problems with it, and it should be...?

Interjection.

G. Farrell-Collins: Here is one of the backbenchers now, the most prominent one. I wish he could enter the debate again and explain why he doesn't think this bill is important enough to go before a legislative committee. Yet the bill that was tabled today, the tobacco bill that had to do with vending machines, is important enough to go before a legislative committee. It's extremely unusual, and I think the government really has to take a serious look at this and decide what their priorities are.

Bill 71 has a number of flaws in it, which have been reiterated by members of the opposition and members of the third party a number of times. They've looked at various sections in Bill 71, and we've had some serious concerns with them. One of the main parts of Bill 71 is the fact that it incorporates what was in Bill 13, which no longer exists as far as we're concerned; that deals with doctors' salaries and a cap on their fees. It also deals with the way in which we would hope this government would be negotiating with doctors to come to some sort of an agreement.

[The Speaker in the chair.]

Some statements were made by the parliamentary secretary to the Minister of Advanced Education -- I'm not sure what his exact title is -- the member for Burnaby North. He read into Hansard sections of two letters that were sent by the British Columbia Medical Association to the Minister of Health. As we've come to expect from this government, the information that was forthcoming was rather selective. It didn't include what the real facts were or the whole context of the letter. It only included those parts that said, in fairness to the BCMA, that some parts of what the minister was doing were good. The member, in quoting that letter of May 21, forgot to quote a part which I'll quote now for the benefit of the House, so that people have a bit of context in which to put all of this. One of the paragraphs says: "...I wish to assure you that the British Columbia Medical Association is prepared to devote every ounce of its energy and whatever resources are required to bring about a satisfactory, long-term conclusion to this matter. To this end we are prepared to meet with you at any time." Why didn't the member read that part of the letter into the record?

Hon. E. Cull: We're still waiting.

G. Farrell-Collins: The minister says we're still waiting. If the minister would agree to deal fairly with the physicians of this province, I'm sure they would be more than glad to consult with the minister and to negotiate on a fair basis, just as we would hope the government would negotiate with all groups on a fair basis.

We move down the letter, and there's another paragraph that the member forgot to mention when he read this letter and was making his statement. I'll read it for him, so we have some balance in the debate and we know exactly what was in the content of these letters. It goes on to say: "I am concerned, however, that your letter of May 19 does little to advance the current state of our mutual understandings. It would appear that the contents of the letter are directed more towards public consumption than towards heightening the awareness of the BCMA's executive." I wonder why the member forgot to read that portion of the letter into Hansard

We have another letter, dated June 2, to the Minister of Health, and there are two paragraphs that, again, the member for Burnaby North forgot to read into Hansard. I'll do that for him:

"The innovative approach of expanding the Medical Services Commission into an equally represented tripartite board -- government, public and medical profession -- with appropriate authority certainly presents a concept that can be built upon. However, the principle of empowering such a commission with the authority to arbitrate on fee disputes and deinsurance of services requires careful examination.'

That was what the physicians were calling for. That was the intent of what they said, and it was the intent of the letter that was partially read into the record earlier. It goes on to say:

"The specifics involved in the selection of commission members and the chair, the full terms of reference of the commission, the conflict-of-interest issues that may arise in an arbitration environment and the integrity of the commission as perceived by all three stakeholder groups also require detailed scrutiny. In sum, while the framework is there, a careful and painstaking craftsmanship will be necessary to ensure a mutually satisfying and lasting solution. Your ultimatum, however, that this tripartite agreement be written into the new Medical Services Act, and that this act be introduced, debated and passed and enacted prior to the end of June...is simply not appropriate."

I have to agree very strongly with the comments that are contained in this letter as it pertains to Bill 71.

There are some directions that the government is taking in Bill 71 that have merit. Numerous people in the community have said that; the opposition has said it too. We are a constructive opposition. There are some good things in this bill. But we cannot rush a bill of this importance and significance through the House in one or two days of debate. It's simply not responsible. It's simply not feasible. It is irresponsible of the government to try to do that, and we will not allow that to happen. We will ensure that this bill gets proper scrutiny.

If this government had its priorities straight and was concerned that this be a good bill, that it last for the long term, that it make some significant improvements to health care that will last throughout the next few years, that it, indeed, set us in the right direction, then the government would not be afraid to take the time to commit this bill to the Select Standing Committee on Health and Social Services and allow that committee to 

[ Page 2850 ]

consult, to call witnesses and to take it around the province and discuss it.

This House will more than likely sit in the fall, and at that time the people of this province would know, when this bill came before the House for third reading, that it was vetted. It would have been taken around the province, and they would have had a chance to comment on it, rather than having a bill that was rushed together, cut and pasted from some other bills that didn't look very good, weren't working or weren't publicly palatable, putting it together and bringing it before the House in this fashion. I think it's simply irresponsible of the government.

If the backbenchers who spoke so vociferously against some issues in this House and who talk about decency, honesty and good government would speak as strongly against the process by which this bill is being brought before the House, the minister might sit up and take notice. In the end we would have a better bill that was going to stand the test of time and serve this province and the people of this province better. I think that's the direction the government should take, and they should listen to their own comments.

There are some concerns with Bill 71. My personal concern -- it's one that the member for North Vancouver-Lonsdale spoke about, but didn't seem to have any concern at all about -- is the fact that personal medical records can now be accessed under this bill by adjudicators or inspectors -- I love that word "inspectors" -- who happen to be physicians. Well, so what? It doesn't matter whether they're medical practitioners or not. If someone is inspecting my personal medical records, I want that to be the doctor that I know, that I've chosen to go to and that I've chosen to consult with and confide in, not somebody appointed by the ministry to come in and rummage through my medical files in the hope of digging up and saving a few dollars here and there somewhere down the line. I have a real problem with that, and I think there are a lot of people in this province who would have a similar problem with government-appointed inspectors, whether they were medical practitioners or not, inspecting their personal files. I have a strong feeling about that. I would hope that the government would come to its senses and would not allow that to happen. It's the thin edge of the wedge, when one starts having government poking its nose into the personal affairs of the people. People's rights to privacy and confidentiality should not be violated; they are sacrosanct. Those rights belong to the people, and it's up to them to decide when personal information about themselves, especially medical records, will be given to government-appointed inspectors. The government should not be determining whether that happens, when it happens or how it happens. A recent Supreme Court ruling, if I am correct, said that in fact medical records belong to the physician or to the person. I don't remember which it was; it doesn't matter. Certainly government inspectors were not people the Supreme Court decided that they belong to. They belong to the patient and the doctor, who are to consult between themselves, and not with the government.

[3:45]

Why does the government have to stick its nose into every single thing we do? Why is it that the government has to look into our personal medical records? A famous politician who just happened to be a Liberal said that the government has no rights in the bedrooms of Canadians. I would say that the government has no rights in the doctors' offices of the people of the country, either. This bill is certainly going to see that that happens on a regular basis. It's something that's distasteful to me. I believe that if the government were to consult with the people of this province through the public process -- public hearings, the legislative committee -- it would find that most people feel exactly the same way.

It seems that the opposition -- or the government, I should say; they'll be the opposition soon -- has been talking and dwelling on the expense that's going into pay for the doctors of this province. Whenever I hear that, it sounds exactly like the political position of the past Social Credit government with regard to teachers. When we look at the histories and biographies of members of the government -- how many are teachers or have been teachers or are married to teachers -- I really question how those backbenchers and even cabinet ministers, for that matter, can take the stance that they have on medical practitioners' fees, when this government spoke so strongly when it was in opposition against the Social Credit position against teachers. At that time the NDP opposition called that political position teacher-bashing.

Interjection.

G. Farrell-Collins: Oh, it's not the same. I guess that's because the member isn't married to a doctor or doesn't deal with the medical community.

Interjection.

G. Farrell-Collins: The member talks about Liberal-bashing. Nice try!

The Social Credit government, according to the NDP, bashed teachers and used teachers as political pawns.

An Hon. Member: Are teachers in Bill 71?

G. Farrell-Collins: We're talking about legislation that deals with doctors and this government's stance on doctors, and how they want to treat doctors in this province. It relates very well to the way the Social Credit government treated teachers. It's amazing how quickly the song changes when a member switches sides of the House and goes from opposition to government. I guess the Social Credit government had their scapegoats and the NDP has their scapegoats. That's the way it works.

Interjections.

The Speaker: Order, hon. members. Please proceed, hon. member.

[ Page 2851 ]

G. Farrell-Collins: I guess there are some teachers in the government who are starting to feel a little warm. We're hitting close to home. This room happens to be air-conditioned, for those people around the province who are watching. If they're feeling heat, it's merely because of the political debate, not the temperature.

The budget for medical services in this province is made up of all sorts of things. Doctors' expenses are only one part of it. Why is this government concentrating so hard on beating up the doctors of this province to keep health care costs down? They quote at length all the things in the Seaton report. My reading of the Seaton report, and the general gist of it, is that there's enough money in the health care system right now to pay for it. We don't need more money. This government has already contributed a bunch more money. I don't know where it went. Maybe it went to the HEU settlement; I'm not sure. The Seaton report said that we needed a new, constructive approach to health care; we needed to spend the money we had more wisely. What is creative about slapping a cap on doctors' salaries? That's as bland and unimaginative and narrow-sighted and myopic as the Social Credit position of keeping education costs down by slapping a cap on teachers' salaries. It doesn't help. It doesn't do anything.

Interjections.

G. Farrell-Collins: Hon. Speaker, members are babbling once again. I wish they would participate in the debate and come up with something intelligible, that would make sense. Perhaps if they would read their own remarks in other debates in this House, they would have a different position on this bill.

It's becoming very clear, with the things that are in Bill 71, that this government is really no different than the last one. Bill 71 wasn't on the agenda at the beginning of this session. Bill 71 was cut and pasted and stuck together and brought in two days after they pulled Bill 13. Where was the long-term planning? They say that they've been consulting for years. Why did they then have to slap this bill together at the last minute and bring it into the House? If they had been consulting for years, they would have come up with something a little better. Having done all that consultation, they would know that the people of this province enjoy consultation. They want to be consulted. They would like to see this bill brought before a standing committee of the Legislature and taken around the province so people can have a chance to comment on it. Why would the government, towards the end of the session, rush headlong and try to ram through in one or two days an omnibus Medical and Health Care Services Act that changes the way we do health care business in this province? It's ridiculous.

This government said that they had the intention of getting out of the House by the end of this week. If they bring in pieces of legislation like this, there's absolutely no way that we'll be out of the House by the end of this week. There's a lot of work that needs to be done, and we intend to stay here as long as it takes to see that that work gets done.

Interjections.

The Speaker: Please, the House must come to order if we are going to have debate in the House.

G. Farrell-Collins: It's always more than welcome when the government backbenchers choose to participate in the debate, but more often than not they choose to sit there and holler and do whatever they're told. They clap when they're told to clap and holler when they're told to holler. But I'll get back to the bill, because I know that that's the reason we're here.

We heard this morning from the member for North Vancouver-Lonsdale. I'm always fascinated to listen to what he has to say, because it has absolutely nothing to do with reality. He talked about the misrepresentation of Bill 71. I would challenge the member to sit down and read his own comments in Hansard today and see exactly who's dealing with reality in this bill and who is not. Perhaps the government needs to take this back to the public for a little bit of a reality check.

This bill has some merits. It has some good things in it. It has some potential. There are a lot of things in this bill that need to be fine-tuned. There are a lot of things that head us in the wrong direction. We must treat all health care workers in this province fairly. We must treat the patients fairly, and we must treat the doctors fairly. I would hope that this government would take the positive things in this bill back to the public, and let the public have a chance to comment. Once we've talked with all of the people who deal with health care, once the physicians have had a chance to negotiate with the minister -- in good faith, I hope -- then this bill could come back to the House for third reading. At that point in time, we would be more than willing, if it's an improved bill, to pass this bill and see that it takes this province into the future, with a health care system that is substantially improved over what we have now.

J. Dalton: We've heard many concerns expressed today on this bill, and I'm sure we're going to hear many more. Of course, we haven't heard concerns from the government side, but they're just parroting what they've been told. We can expect nothing from them of any substantive nature to improve upon this or hopefully give some proper thought and reflection on the content and the implications of this bill.

I'm not going to specifically deal with the concerns about the bill, other than to make some comments about the climate that this bill has created. However, before we get into that discussion I want to point out that you have to wonder: what is the rush on this bill? This bill was introduced June 16, and here we are, less than one week later, and we are now rushing into second reading. The government is hoping that we will collapse, and the media too seems to hope that we're going to collapse, for some strange reason -- get out of here by the end of the week when school closes, and everyone will start the summer. Well, this opposition is not going to start the summer; you can be assured of that, hon. Speaker.

What is the rush? I just wish to restate this before I talk about the climate that this bill is creating. Why not, 

[ Page 2852 ]

after second reading, allow this bill to be left on the order paper; allow the general public, not just the doctors and the people in health care delivery, but all of the people of this province who are affected by this, to give it proper consideration over the summer months? Put this to committee. Let's use these other vehicles for good use. Let's try and slow down this very important piece of legislation. It's very detailed; there are a lot of implications in here that everyone must properly study.

I wish to make some comments about the unsettling effect that this and other legislation has had on the medical profession. When I make these comments, I'm not just speaking of recently, as of the day that this bill was introduced, or even back when Bill 13 was brought in -- which of course is presumably going to die an honourable or other death, and may it rest in peace. People in the medical profession whom I've talked to, not just recently, had a very strong suspicion that this type of legislation would be coming in; and of course it has proven to be correct.

I wish to take the members of the House back to last October. Everyone here will fondly remember last October. The 17th was the day when all of us were elected to this House. It was four days later that.... It is very vivid in my mind, October 21. It's very vivid because that day, unfortunately, my elder daughter was hospitalized, and as it turned out, she was diagnosed as having diabetes. I can tell you, as a personal aside, that that week of October was rather an exciting one in our household, for obvious reasons.

The day my daughter was admitted to Lions Gate Hospital, my wife and I had a lengthy discussion with one of the neurosurgeons. I had not met this doctor before, but I did know him by reputation, and he's also a good friend of my brother's. He made a point of coming up that afternoon while we were waiting for my daughter to be attended to. He introduced himself, and he went into a lengthy discussion and questions and answers with my wife and me on the whole climate of medical care and where health care was headed in the province. His comments were in particular, I think, reflecting a concern about the new government, the NDP having been elected just four days earlier. He and many others back then, in October, were expressing concerns about where health care and the delivery system of health may be headed in the province. What we are seeing now is a reflection of that: the bills that are coming forward, and the difficulties that doctors and others in the health care system are encountering. They are not just problems with salaries, or capping expenses and things of that nature. There are many concerns that people in health care are expressing.

Hon. Speaker, I would like to point out to the House that doctors, in particular -- certainly the doctors that I've known over the years -- do not tend to be politically motivated. They do not get worked up by politics, generally speaking.

Of course, there are two medical doctors on the government side, one of whom has spoken today: the Minister of Advanced Education. There are no other doctors of that sort in the House who I am aware of. Maybe we should also make passing reference that the Liberal Party in Nova Scotia, in its wisdom, has now elected a doctor as the leader of that party. However, that has nothing to do with the climate in this province.

The point that I'm making, hon. Speaker, is that more and more doctors -- I'm referring again to the discussion that my wife and I had last October right after the election -- are getting worked up by the politics of underfunding, of capping salaries, of longer and longer lists for people to get into operating rooms. These are all related problems with health care. It's not surprising that the concerns that people.... I'm sure every member of this House has had phone calls and letters from doctors recently. It should not be a surprise to members that that is so.

[4:00]

Hon. Speaker, Bill 71 -- this legislation that is now in second reading -- reflects that whole climate. Doctors tend to be fairly conservative. Of course, they're very professional, and nobody would quarrel with that. Doctors over the years have not tended to be involved in the political process; now they are very involved in that process. That's an unfortunate circumstance. I don't mean to say that it's unfortunate that doctors get involved in politics. I think perhaps, like any other profession or identifiable group in our society, they should become more involved in politics. But it may be a little unsettling for people to think that instead of your doctor concentrating on your health problems, he's concentrating perhaps more on his or her political problems. That's not a happy thing for the state of medicine or for the professional nature that doctors and others in the health care system have always reflected. Without question, this bill has added a great deal to this unsettling political climate that doctors are expressing.

I'm sure many, if not all, of the members on the government side have seen the recent BCMA ads with the picture of the Premier, indicating that once he gets out of medicine they'll get out of politics. I think that's a very true statement. As I'm saying, doctors are now into politics, and I'm sure....

Interjection.

J. Dalton: It's not of their own choosing. They don't want to be worked up in this way, any more than any other group chooses to be, or feels that it is, in a sense, forced into that circumstance.

I'm hoping that once we get through second reading, we can pause to reflect more on this legislation. I hope that all parties affected, not just those of us in the House but doctors, nurses, other people in the health delivery system and the people of British Columbia -- the patients, the people for whom we're all speaking -- will have the opportunity for significant input into this very important piece of legislation.

If that is so, then I think that when and if this bill is finally passed through this House, we will all feel much happier. We will have had the opportunity for full discussion and amendments, if warranted and if the government chooses to consider amendments. If we're going to have the gun put to each of our heads this week, into next week or whatever dealing with a very significant piece of legislation like this one, it will not serve anyone any use. It certainly will not serve the 

[ Page 2853 ]

delivery of health care any good whatsoever. I trust the government will allow for more reflection, debate and thought on this legislation. I can assure the government members that if you don't, if you think the doctors of this province are angry now, I'm sure they're going to be nothing but angrier as each day goes by. Let us all reflect on those considerations. The next time I go to my doctor, I don't want to think that this person is all worked up about the politics that are created by such a bill as Bill 71. I would like to think that my doctor, who is a professional, will concentrate and not have to be worried about the implications of things such as Bill 71.

That's the climate that has been created by this legislation. It's a very unfortunate circumstance. We all need to have more time for consultation, second thoughts and more debate. That's what I would certainly ask the government side to give serious consideration to.

M. Farnworth: I'd like to rise not to address all of Bill 71, but some of the comments that have been coming from the opposition, in particular the Liberal opposition, over the last hour or so. They're criticizing this legislation. They're saying that what we're doing is wrong. They're saying that what we're doing is bad, and it's not right. They're saying that we should be doing this, and we should be doing that.

I wonder what the Liberals would do. I think we should take a look at some of those other provinces in Canada that have Liberal administrations -- New Brunswick and Newfoundland -- and see what they're doing. As we all know, Liberals are very fond of saying "a Liberal is a Liberal is a Liberal" except, of course, when they've been offered a cabinet post by a Social Credit government. Then they can change. On the whole, they like to do this "a Liberal is a Liberal is a Liberal." Why don't we go to New Brunswick? I'll save Newfoundland for last. In New Brunswick they not only have a global budget cap; they also have caps on individual salaries. That's not in Bill 71. In New Brunswick they have regional fees. They are imposing freezes and caps. Bill 71 establishes a commission.

We reserve the right in this province to set the global budget for health care. The Legislature's duty and responsibility is to manage the people's money. We're setting the cap -- a global budget. We will be setting up a new commission composed of three members of the BCMA, three members appointed by government and three members agreed to by both the BCMA and the government. They're responsible for determining the priorities within that global budget. That is their responsibility. That is a first in Canada. It's something that other provinces are doing.

The opposition is saying that you shouldn't be imposing caps on doctors' salaries. We're not doing that, but they do that in New Brunswick -- a Liberal government. I find that really interesting. If we go to Newfoundland, which to this Liberal opposition is at the head of the pantheon of Liberal saints, St. Clyde Wells has introduced perhaps one of the most restrictive, arbitrary controls on doctors of any province in Canada. Again, that's a Liberal Premier, a head of a Liberal government. That's who they look to. We're not doing that. Again, we've set up a commission with three from the doctors, three from the government and three members agreed to by both the public and the doctors. They don't wish to recognize that. Instead, they're unnecessarily attacking and creating fear in people by distorting the truth. The truth sometimes hurts, and maybe that's why they're not here to hear it.

They introduced an audit system in Newfoundland. It saved 2 percent, or the equivalent of $50 million here in British Columbia. Fifty million dollars could be put to really good use in the health care system in this province. If we could save 2 percent, we could address an awful lot of things that people want done. But they don't want us to do that. I don't know why they don't want to save 2 percent, but it seems they don't. Or they say they don't. Maybe they're saying that for political expediency, because as we know, a Liberal is a Liberal is a Liberal, so we have to look to Newfoundland and New Brunswick.

The important thing is to realize that the public is saying: "Look, you've got to get a handle on costs, not just in education, not just in transportation, but everywhere." They recognize the need for that in health care. They recognize that it's the government's right to set the global budget. The Liberal opposition has been scaring people, saying that you'll have teams of inspectors going into doctors' offices and seizing files. Well, that's simply not true. They fail to say, for example, that at the present time audit committees function on two.... They can already investigate doctors' patient records. What we're saying, and what the Medical Services Commission will be doing under an audit system, is that it will be a medical practitioner -- somebody bound by the oath of confidentiality to the College of Physicians and Surgeons. They're the only people who would have access to doctors' records -- nobody else. For the Liberal opposition to imply that anybody else could go in there is totally wrong.

I think they ought to reflect a little more and do a little more research, because they're trying to play on people's fears, and that's just not right. If they have a point to make, they should make the right point. The fact is that these people who do the audits are medical practitioners and are bound to the same oaths as the medical practitioners a patient is going to see. I think that that's a really important point that needs to be made: that the confidentiality of patients' records is not compromised.

I also think that the Liberal opposition needs to say what they would do. But no, they don't want to do that; they just want to criticize. I pointed out a few of the things that are happening in Newfoundland and New Brunswick, and I think that's a good indication of where the Liberals are coming from. Bill 71 has been part of a process that's seeking to improve our health care system. I think, given time, the people will see that Bill 71 is a responsible bill.

D. Jarvis: My hon. friend over there was saying "a Liberal is a Liberal is a Liberal." I would have to remind him that "an NDP is an NDP is a friend is an insider," one of the 4,000 about to get more jobs. Their salaries range from $76,000 to $400,000 a year on contract. If you 

[ Page 2854 ]

took the 4,000 and multiplied it by $80,000, you get $320 million.

M. Farnworth: Point of order. We are debating Bill 71, not the boards and commissions in the province, hon. Speaker.

C. Serwa: Point of order. I am confident that the hon. member was getting to his point. He was merely setting the stage. It's important in the Legislature, especially during the philosophy and principles of second reading, that a member be allowed to set the stage to make his point accurately and clearly, not so that hon. member can understand, because he should, but because of the people watching these proceedings.

The Speaker: The Chair has reminded members from time to time on this debate that one must attain a balance between setting the stage and addressing the principles of Bill 71.

D. Jarvis: That's exactly what I was intending to do.

It appeared that when this government introduced the Freedom of Information and Protection of Privacy Act, it was assumed that the government was truly serious. However, what really appears from Bill 71 is that the intention of one bill does not follow onto another. How else could we interpret this flagrant abuse of people's confidentiality?

[4:15]

This government contends that Bill 71 will allow them to manage the taxpayers' dollars better. Yet in order to do so they want the ability to invade your privacy, to come into your doctor's office, to seize the files and make copies of them -- exactly what it says in section 6. For what reason could this be other than for an invasion of our privacy? They say it's for proper management. Management of what? This could compromise the Charter of Rights and is subject to the government's wishes, not ours.

We have Bill 71 before us submitted by a government that professes, in a very sanctimonious way, to have our best interests at heart. Yet it is an indirect violation of every citizen in this province and their right to confidentiality. How can the citizens of this province accept the fact that this government can, at any time, invade their doctors' office -- and ostensibly, that's what they're going to do -- to obtain information given to the doctors in confidentiality? The doctor would end up in jail if he gave out that information on his own. But the government can use this information for anything they feel is necessary for their benefit.

It is not legislation by a government that cares, but legislation by a government that feels that when they govern for a few, it's good for the majority. The Minister of Advanced Education said that the government is prepared to accept amendments. We'll see how well this government cooperates later on, this evening or tomorrow.

I was also interested to hear from my friend over there from North Vancouver-Lonsdale, saying that he had a few friends down to his living room the other day to discuss this bill. I hardly think these friends were really what one would expect. I would like to discuss here a letter from physicians in his riding. Here are three physicians writing under the name of one gentleman on their letterhead. He said:

"I have delayed writing this letter for several days to allow time for your government to clarify and perhaps counter information that I have received from the B.C. Medical Association. However, it now appears that the unbelievable news is absolutely true. The 'open' and 'honest' NDP party, for whom 'a deal is a deal,' has actually unilaterally legislated out of existence at least two deals with the BCMA. These agreements were signed in good faith by the doctors of B.C. and the government after a long period of careful bargaining and consideration from both sides."

I want to say, before I go on, that this letter from physicians in the riding of the member for North Vancouver-Lonsdale was not written to me; it was to the Minister of Finance of your own party.

"I know that you have problems that there is no more money available and cuts need to be made. Even caps may have to be applied. However, in a non-totalitarian country like Canada it is completely repugnant for a provincial government to strip away the bargaining rights of any group with a poorly considered stroke of the legislative pen. It is particularly disturbing and hypocritical when this is done by a party that professes to be the defender of such rights. No consultation, no negotiation, no appeal, for all we know, forever."

This medical doctor goes on to say:

"I have almost always voted NDP in the past, so my disillusionment is particularly painful."

Then he goes on to another group of his friends:

"A teacher friend of mine, who has been a longtime NDP supporter and campaign worker, used the term fascist when he heard about it."

I hope the member for North Vancouver-Lonsdale will at least read this afterwards. He's gone out for a walk, I guess.

"The question is being asked: 'If this is how the NDP behaves in power, who do they represent?' Who is your constituency? You need to know that the reaction from my patients, who I am keeping well informed...."

The Speaker: Order! Could I ask the member to take his seat for one moment.

Members from both sides of the House have, throughout this debate, made great use of letters. The Chair has no means of knowing who those letters are addressed to, who they come from, and whether in fact -- although they may be related to the subject at hand -- they were written related to this bill. Hon. members understand that brief reference to letters can be worked into debate, but I would really urge hon. members to use those at a minimum, because again, the Chair has no way of knowing if they're directly related to Bill 71.

I would ask the hon. member to continue, keeping in mind those comments and relating it to the second reading debate of Bill 71.

D. Jarvis: I have all these letters, so I guess I'd better not talk about them all. Perhaps I could table the letter I'm reading right now. Would that be in order? Thank you; I guess it is.

[ Page 2855 ]

Briefly, I wanted to tell the members in the House that my doctor friend here who wrote to your Minister of Finance stated:

"It is not too late to admit that a mistake has been made. I urge you, for the sake of our enviable system of health care, and for the future of the NDP in government, to examine this issue very carefully."

No wonder Sweden, the heartland of socialism, gave it up. Socialism just doesn't work, and this is more evidence of it. You cannot expect that a good government is a government that requires access to its citizens' private lives.

There is a better way to govern a populace -- not a compromise of its citizenry, but a governing by trust. Bill 71 does not govern by trust. It is a logical evolution to a socialist Big Brother system of government, not a logical evolution to a good medical system. It is a radical step away from democracy. It is the NDP way: surging ahead backwards. This government has a myopic sense of can-doism. What they are doing with Bill 71 is an utterly sincere belief that they can do what is best, that the controls they are putting in will also be controlled by the individual's code of ethics -- code of ethics of doctors. If this be the case, naive as it is, why, therefore, is the clause necessary?

This government's motives are now suspect by the people. Imagine how suspect they will be when this bill does pass. People of this province will not accept this abuse of their personal rights. Part 6 of Bill 71 states that the government inspector, at any reasonable time and for a reasonable purpose.... This smacks of a totalitarian system. This is not acceptable to us or to the citizens of this province. If we think back to what this holier-than-thou government used to stand for, it is a mockery of their past idealism. Their true colours are coming out. They are marching to a melody alien to the majority of society's ears at this time.

This government is rushing through an ill-prepared bill without full consideration of the professionals in the medical health field. This is a movement of socialist solidarity, and it is a solid deficiency of the principles of good government. It is lacking in the knowledge of what is right. This section of the bill could be the start of government interference.

Who is to say that it will end here? The NDP do not realize that the fate of all cannot be mortgaged for the comfort of a few, and this is a bill that compromises and will be detrimental to all. My constituents are very concerned, and I got elected partly on the basis that I would be accountable to them. I have all these letters here, and I felt that if I was to be accountable to them it would be your privilege to let me read them to you. I'll just read a few highlights. I am quite prepared to table these letters, if necessary, because they are pertaining the bill.

This one citizen says: "With regard to the recent events surrounding the proposed health care bill, I am angry, frustrated and becoming politically cynical and certainly tired of the lack of respect shown by the government towards the medical profession." That's just one example.

Another letter said: "I am writing to forcefully object to the contents of Bill 13 and to the manner in which it was derived." Now it is Bill 71, and that is what they were referring to when they wrote that they cannot accept the statements of the Minister of Health that she is committed to exploring longer-term solutions through a full, open dialogue with doctors and the B.C. Medical Association. That's from the Minister of Health.

In any event, Madam Speaker, I don't think it's fair to you that I go on and on with these letters. At this time I will say that it's quite obvious that I am against this bill. I wish to thank you for the opportunity to speak.

W. Hurd: It's always a pleasure to rise and debate in this chamber. I wish I could say the circumstances were happier than the debate on Bill 71, which the opposition regards as a tragic mistake for this government and a bill that will only do more to foster the kind of ill will in the medical fraternity that was previously the case with Bill 13.

One of the advantages of participating in this debate after so much has gone on is to note some of the comments that have come from the government benches on this particular bill, comments from the hon. members for North Vancouver-Lonsdale and for Burnaby North about the amount of consultation that's gone on with the medical fraternity leading up to the introduction of Bill 71. They've suggested to us that despite the million-dollar advertising campaign by the B.C. Medical Association, despite all the rancour and bitterness that's gone on, what was happening behind the scenes was a high level of consultation; the government and the doctors knew exactly what they were doing all along.

If you believe that one, we on this side of the House have a used car that we'd like to sell you, because it's pretty obvious that there hasn't been any meaningful consultation. The lack of consultation that gave us Bill 13 has resulted in the logical outcome of Bill 71, which has enshrined many of the same points that we noted in Bill 13. They were merely dusted off and changed with the same lack of consultation.

I was particularly moved by the remark from the member for North Vancouver-Lonsdale about the history of medical insurance and medicare in the province and how Bill 71 fits into the grand scheme of things. In fact, I was so moved that it is my intention to clip that section of Hansard and send it to the doctors on the North Shore and invite their comments on the medicare insurance in the province -- just so they are aware of how much thought has gone into this particular bill from the members opposite. I'm sure they'll appreciate receiving that correspondence when it goes out in due course.

It's rather interesting that we sit here in the summer solstice, with the first heat wave of the summer taking place around us. The government is desperately anxious to get this session over with and get out into the summer playland, and it has come out with one of the most contentious bills introduced in this session. Bill 71 promises to be divisive and to engender more ill will in the medical community. It will simply not produce the kind of consensus the government claims that it's trying to achieve by introducing this bill in the first place.

[4:30]

[ Page 2856 ]

We on this side of the House have to ask ourselves why the doctors in this province have been singled out. Why is it they who have been identified as being part of the problem with our medical health insurance system? Doctors' billings have been the villain all along. As I reflect on the reasons that they have chosen the doctors, I am forced to remember the remarks from the Minister of Finance during the estimates debate previously in this House. He pointed out that such high-income earners as doctors and lawyers had not been paying their fair share in the province, and we were going to make sure that they were. I really believe that that's the kind of philosophy from the government that has produced these types of bills which identify physicians' billings as the major part of the problem. All we have to do is cap them, and we're well on our way to solving the crisis in medical insurance in this province.

I want to assure the government that everyone in this chamber recognizes the critical situation we're in with medical health care in this province. We're not shirking any responsibility by suggesting that the system of medical health care, as we've known it for these many generations, has to undergo some restructuring. We have to look at costs. We recognize that the fees, the medical insurance and the costs of medical practice are surging beyond the ability of provincial governments to meet. We understand all that, hon. Speaker. But why single out one group of people who are part of the system and suggest that they are the reasons why the system is running the way it is? It just doesn't make any sense.

We on this side of the House continue to be amazed that we're somehow expected to deal with a bill like this, which is so contentious and is going to engender so much ill will in the medical fraternity, in a time constraint at the end of a session. It defies all logical reason, unless this government really believes that it has to introduce something after Bill 13 has foundered, because to do otherwise would be to acknowledge that the people -- the patients and the medical doctors -- in this province were right all along. I suspect, hon. Speaker, that this bill is nothing more than a face-saving effort by this government, which has completely bungled its relationship with the physicians in this province.

The hon. member for North Vancouver-Lonsdale referred to letters that he has received from doctors in his own riding. I want to report that I've received many calls and letters from doctors in my own riding, who are working seven days a week in many cases to meet the patient load. They are dedicated physicians who cannot understand why the government has singled them out and chosen them to bear the brunt of responsibility for a health care system which we know is becoming more costly all the time.

Hon. Speaker, the doctors of this province are willing to be part of the solution. They've indicated that to the official opposition many, many times. They are willing to sit down and negotiate a fee schedule that will retain the sanctity and the economic future of our medicare system. They're willing to do that. To suggest otherwise is to argue that doctors will willingly bill the system into oblivion without a single shred of concern about whether or not our health care system is sustainable. The government is asking us to believe that doctors in this province have no social conscience, that they regard the provincial treasury as a trough to be dipped into and that they are not prepared to even consider alternatives. They just want to bill the system every month and get their pound of flesh. That's the message; that's the burden that doctors in this province are carrying around as they ponder Bill 13 and Bill 71. They're saying to themselves that this government doesn't understand what it is to be a doctor; they don't understand that the doctors in this province want to be dealt into the process. They don't understand that doctors are not the type of people -- as the hon. member for Vancouver-Point Grey well knows -- who will petition or bill the system into oblivion. They want to be part of the solution, and this government has not given them that opportunity.

As we sit, at the end of the session, debating a bill that will affect every aspect of doctors' relationship with their patients, the way they do business and their future in this province, we have a week to two weeks to deal with the ramifications of this bill. Why in the world couldn't this situation be considered by a legislative committee in this Legislature, so at least we could produce some sort of all-party support for the position that comes forward from this House? Surely, hon. Speaker, the doctors of this province are worth that kind of consultative process that we've seen absolutely none of from this government. This bill, by the sheer weight and oppression of the government majority, will undoubtedly become law. It will not solve anything in this province; it will not solve the dispute between the doctors and the government. It will only delay the day of reckoning for our health care system, because it fails to address the other issues that are so important to doctors in this province.

Again, I hark back to the remarks of the Minister of Finance, who, I'm convinced, believes that as high-income earners the doctors have somehow ripped off the system. They haven't possessed the honour of their profession in dealing with the Medical Services Plan in this province. That's the message being sent forth by this bill: doctors have not been honourable and are not the kind of people who can be trusted to deal with the government in an open and honest manner. That's the reason the opposition will be voting against this bill and will be proud to do so.

R. Neufeld: Hon. Speaker, I rise to make my comments on Bill 71 and to say what I think it will do to the health care system that all of us enjoy today. I think it's widely known that we have the best health care system in the world; everyone wishes they had a system like we have. I think all of us in this Legislature would like to continue enjoying that system.

Having said that, I also understand that it's difficult to deal with the problems that government is faced with today in the costs of health care. It's not a phenomenon that just started last year; it has been going on for a while. The health care budgets in every province are increasing at a dramatic rate, and at some point we have to deal with them.

[ Page 2857 ]

Simply dealing with doctors' salaries by capping them and trying to portray to the public of British Columbia that this is going to solve all the problems in health care is not fact, and it's not true. That's not a good message to send out to the people of British Columbia. It's much the same as the message that was sent out about taking half the money from the lottery funds; that was going to solve all the ills of health care also. It's amazing how they tried to drive that across during the election, but that is not true either.

Somehow, collectively, we have to deal with the health care budget and the doctors. If we have unhappy doctors, we're going to have an unhappy system. That doesn't mean that we have to give the doctors everything they wish, but we have to negotiate with them fairly, openly and honestly.

If I recall correctly, during the election that was one of the major platforms. I guess that's why the government likes to advertise, because every time I opened a newspaper -- it didn't matter where I was -- they talked about open, honest government. Let's see some of that openness and honesty with everyone in British Columbia, including the doctors. Just because they're not a union doesn't mean that they should be dealt with differently. They are a very important and integral part of British Columbia; I would say they are one of the most important parts of our health care system.

We have Bill 13, introduced on March 26. It sat on the orders of the day until just the other day, when the Minister of Health introduced Bill 71. It's much the same bill; maybe it's a little more lengthy. But basically the philosophy was almost the same. With the response that the government received when it first introduced Bill 13, you would think that they would have had time in that three months, from the latter part of March until now, to work with the doctors and come up with a bill that would be palatable to most British Columbians. You're not going to have every British Columbian running around and patting you on the back, but at least you wouldn't have the animosity that is still here today. You would think that in three months they'd have been able to do that.

I think the problem was that the government and the minister saw that there was going to be a lot of opposition to Bill 13, so they left it alone. They reintroduced it a little bit differently -- different paper, different typewriter -- at the end of the session. They want to push it through just like so many other bills that they want to push through. I don't think that's fair to the opposition. I don't think it's fair to the government backbenchers. I don't think it's fair to the government. I don't think it's fair to the people in British Columbia. And it's definitely not fair to what we're affecting most -- our health care system.

Some of the problems that people have spoken about today are, of course, the glaring ones to do with confidential files -- who has access to them and who doesn't, what was done before and what should be done now. Those are items that should be discussed for a while. They should be dealt with with the doctors, with the health professions. The legislative standing committee could do some work on it. We're going to totally change the way health care will be delivered, and this government wants to introduce a bill in the latter part of June and ram it through the House within one week. That's not a good way to do legislation.

If we go to some of the other problems with the bill, we see a budget increase of about 2 percent, which apparently covers only the population increase. In fact, what the doctors feel, I believe, is that they will probably be taking less. They're going to have to eat the inflation factor and all the other increased costs in delivering the service. We're going to put more onerous decisions on the doctors as to what is covered. They're going to have to sit there while looking at their patient and decide whether it's covered or not -- should I really do this test, or should I not do this test? I've heard a number of members opposite talk about the tests and all the problems with them. Obviously if they feel that the whole problem in the health care system is the cost of tests, then that's exactly what they should deal with, and be upfront about it, instead of trying to make out that every doctor is on the take, trying to get some extra tests so he can make a few extra bucks.

The Seaton report dealt with a number of things in health care. One of them was that the budget set for health care was sufficient. The only thing that had to be done was that there should be some changes within the budget so that we would spend the money a little differently on home health care; but the $5.5 billion in health care was sufficient. This government chose to increase the health care budget by about $400 million. It's easy to understand why, when you have a look at the newspaper advertisements for health care workers all the way to Quebec: $9,000 a page -- one day, one page. I think some of that money could be spent here at home a little more wisely in trying to deal with the problems that we have with health care, in trying to retrain some of the people we probably already have in our health care system so that we can keep those people employed. We do have a problem in British Columbia with unemployment; it is going up, even though some of the members opposite have never really been out there looking for a job and have always been in a system that looked after them quite well. Maybe they should go out in the real world and try to make a payroll or go out and find a job. Get out of the public domain. In fact, I understand it's $1 million that they're going to spend on advertising for new health care workers, another 700 of them. Why don't we look within our own budget and spend that money a little more wisely?

I also noticed that the member for Fort Langley-Aldergrove spoke earlier about the past administration's Bill 82. In fact, we're almost there, to Bill 82, aren't we? But he obviously was not all that aware of what Bill 82 was designed to do, which was to keep public sector wages and private sector wages about the same. In the past, public sector wages have outstripped private sector wages. That's all Bill 82 was designed to do.

I believe doctors today would agree that it might not be all that bad. If they could see that they were going to get the same increases in their salaries as the private sector, maybe there wouldn't be all this furor today about what's going on in part of this bill. Maybe they would be kept quite happy. I believe that when you tell doctors -- and they're private entrepreneurs in their 

[ Page 2858 ]

business -- that they're going to have an increase that will only take care of the population increase, and if their costs go up for heat, light, water, rent and taxes.... My goodness, I think all of us know.... In fact, the members opposite know how the taxes have gone up. I mean, taxes in British Columbia have increased phenomenally in this past six months, so obviously they're going to have some increased costs. But the members opposite don't realize that, and they're not addressing it.

[4:45]

They continually sit over there, as the member just spoke about, making hundreds of thousands of dollars, but they haven't.... Why don't they specifically get up and tell people that maybe doctors do make $250,000 or $300,000, but that that isn't their total wages? They have to pay all their expenses and rent their buildings out of that. When you finish figuring out all the costs that they have, they're really not all that highly paid for the trust that we place in them. I think all of us, if we're lying on the operating table, would want a competent doctor looking after us.

I've just listed some of the problems with Bill 71, and a lot of other members have talked about it. We really haven't had that much time in our caucus to seriously look through all parts of the bill to find out just exactly how bad it is going to be on the health care system. We would appreciate some time to do that. By that, I don't mean that we want to stay here for another year, but if we have to, I guess we will. There's no problem. But just bringing in a bill at the very end of the session and saying, "We know it's the end of the session; we're going to have the House collapse, and we want this bill to pass in a hurry," is not being fair to the opposition parties or the doctors.

There's no reason that this bill couldn't be referred to the parliamentary committee so that they can discuss it and bring it back in the fall. As I understand via the grapevine, there is going to be a session in the fall. It's not all that long from now -- another three or four months. It could come up then. By then everybody will have had a chance to really look the bill through and will be able to negotiate with the Minister of Health. The doctors can negotiate with the Minister of Health. British Columbians will understand -- or should -- what the bill is all about, and maybe it will bring a lot more positive comments if it's given some time. But obviously when something is as large as this bill and you try to push it through the Legislature in less than a week, the public perception is that there's something in there that they're trying to hide; they want to get it over on us. Why don't we just leave it?

We're told that the minister has said that the tax meter is ticking. That's entirely true. The tax meter will continue ticking after the bill is passed, even if it's next fall rather than now. As I understand, the budget has been prepared so that this meter will start changing some time in October anyhow. Why the rush? Why not wait until this fall and give everyone time to look at the bill and deal with it properly? Why do we want to foist something on our doctors and the people of British Columbia that makes them unhappy? Everybody understands that there are problems in the health care system, and that we have to deal with it, as I said before. Let's do it in a slower manner. It's not the end of the world. As I say, the tax meter is ticking today, and it's going to tick in October, and it's going to tick next year. What they have already designed will take care of it.

The part that worries me is that I understand from the member for Prince George-Omineca that a lot of our doctors who are training in Canada are leaving Canada, and some doctors from British Columbia are leaving British Columbia. I hope that not too many do, because I come from a part of the province that has a hard time getting doctors. We have to go to foreign doctors to get them to come to Fort Nelson, Fort St. John and those areas. It has always been a problem in the north. When I hear that doctors are unhappy with the system and unhappy with the government because they backed out on some of the promises that they made -- the way that they were going to deal with the doctors -- it worries me all that much more, because I know that some of the people in the north, as soon as the doctors start moving out, are not going to receive the services that they should.

We talk about doctors and salaries. We have to realize the hours that those doctors put in. We need good doctors who are ready and capable. We don't need doctors who aren't highly qualified. I don't want to see us get into the position where we have the second-best health care system in the world. If we continue sending our doctors and newly trained doctors south of the border, we will end up with the second-best health care system in the world, and that's not good enough for British Columbians. British Columbians have afforded the best health care system in the world, and I'd like to see that continue, although I know that it's hard to deal with, and that we all have to work together.

Good legislation will stand the test of time, so why rush it through? Why don't we give it some time? Why don't we wait until the fall? Why don't we deal with everyone concerned in a fair, open and honest manner so that everyone knows what is in the bill and how it's going to affect our health care system? If we gave everyone a chance to critique the bill fairly, it would possibly not bring all the negative comments that it's bringing today. I think some of those negative comments are predicated because we know that the government is trying to push it through in a hurry. If it's given some time, and it's good legislation, it will pass the test of time.

Hon. L. Boone: It gives me pleasure to rise in support of this bill, which has been the result of numerous hours and yes, I'd say, days of consultation that the minister and staff have had with the BCMA. I think it's fair to say that, when it came to the negotiations, there wasn't necessarily good faith shown on the other side. As the minister was meeting with the BCMA the last time, it already had an ad which was canning the minister's response or the minister's Bill 71. This ad was put in place -- it was already filmed -- prior to their meeting. I don't think that shows a tremendous amount of good faith.

I'm surprised that the opposition has taken the view that this bill will destroy medicare, hon. Speaker. What 

[ Page 2859 ]

this bill is doing is saving medicare. This bill and the actions that this government is taking are necessary to make sure that medicare is here for the future, for our children and our grandchildren. Let me tell you: without a bill such as this, it will not happen.

Interjection.

Hon. L. Boone: Yes, hon. member, I have two grandchildren, so for my grandchildren as well.

We all know that our physicians provide a valuable service, and nobody is going to argue about that. Nobody is going to argue that our physicians don't provide a valuable service. That is recognized by all of us and certainly by the public at large. However, we must also recognize that our medicare system would break if the burden that has built up over the past five years was allowed to continue.

Over the past five years there's been a 40 percent increase in the MSP budget. That's an incredible burden on the taxpayer; that's an incredible burden on a system that really can't stand that much of a strain. From our perspective, from the perspective of anybody who is caring about the taxpayer out there, who is suffering tremendously right now, I think it's only sensible that one should try to gain a handle on this, to try to understand and try to control these costs.

The number of physicians in this province is growing faster than the population. We can't really blame them for wanting to come to this wonderful province, but it does create a problem for us when our costs are increasing as a result of the number of physicians who are coming here. We must have control of our budget; we must have control of the medicare costs in this province. This bill will allow us to do that.

One of the things that we don't hear mentioned by the members opposite is that, in fact, this budget provides a 4.7 percent increase in the Medical Services Plan budget -- the budget that pays the physicians out there. That is a reasonable amount. Reasonable people should have reasonable minds and should accept a reasonable amount, such as a 4.7 percent increase. That's not bad, considering some ministries were slashed right down to the bare bones. Some had no increases, and some had substantial decreases in their budgets. Physicians in this province have not been singled out. Everyone has been asked to take a share of this budget; everybody has been asked to share the pain. There has been some pain with the budget, as we know, as we try to get our financial house in order. Physicians have not been singled out. School boards are not all that happy with their budgets. Municipalities and taxpayers -- the ratepayers out there that you talk about -- have not been all that happy. Health care workers, highway contractors and numerous people out there feel the pinch of the budget at different times, but know that they have a responsibility to bear some of the burden and to accept the responsibility that the taxpayers have.

The taxpayers cannot afford to pay more and more and more, as the opposition seems to want to do. All ministries have taken cuts and substantial reductions, and are bearing with those things. For this minister to implement a cap of 4.7 percent really is not that much of a burden. The bottom line is that the taxpayers really cannot afford it. If we are to maintain our medicare system, if we're to make sure that we can support our services in the future, then we need to make sure that our services are there. We need to make sure that the dollars are there, and we need to control costs.

Unfortunately, bargaining with the BCMA is not the same as bargaining with a union. I get a little tired of hearing people say: "You haven't bargained. You wouldn't treat anybody else this way." No union has the ability to hire as many people as it wants, which is what happens with the physicians. A union, when it negotiates, knows that its increase is how much it's going to get. The employer that's negotiating knows that the bottom line is going to be a salary, which is going to cost that employer a certain amount of dollars. That's not true with physicians, because physicians can bill as much as they want, as often as they want, and they can have as many physicians as they want coming from any number of provinces into this province. There is no control on the number of physicians, there's no control on the amount they can bill, and there's no control on what that salary is going to be.

[5:00]

It seems like a reasonable thing to expect that any government is going to want to know what the bottom line is for their budget. We cannot afford to do what previous governments have done, which is to come along and bring in a special warrant to cover the costs of excessive bills. We cannot afford a special warrant to cover excessive billing when we need to put in place the necessary abilities for the government to recognize the restraints that we're under.

This is a bill that I don't think any of us like to bring in. Everybody would certainly like not to have this bill, but the reality is that it is required, it is necessary and it will see the taxpayers well cared for.

D. Symons: I'd like to make a few comments. In part, I'd like to respond to some comments made considerably earlier by the member for Vancouver-Little Mountain to the effect that some amendments would be brought in. He then went on to comment on how important it was that this bill go through quickly. It bothers me considerably that this seems to have happened again and again in this House during this session: a bill is brought in and then they decide that maybe it needs some cleaning up, and they're going to allow it to be amended; or we make suggestions and they withdraw bills, as they have with a few already. That seems to be the case.

Why is this so hastily put together that they have to make amendments? Why could it not have been dealt with beforehand through proper consultation, rather than by finding out afterwards what all the objections are and then deciding that maybe there's some truth in those objections and adjusting the bill to make it fit where it should? This seems to be a pattern that has gone on over and over again in the legislation that has been brought forward.

I find it very difficult to understand the reasoning behind this way of doing business. The province of B.C. 

[ Page 2860 ]

deserves better, Madam Speaker. The province of B.C. demands that we have proper, thought-out legislation brought before the House -- legislation where there is true consultation, not where the consultation takes place after the affected body sees what the legislation is going to be and then has to respond to it. Proper consultation should take place before the legislation is drafted, not after. That's the case in this bill. We saw Bills 13 and 14 brought forward -- again, without real consultation prior to those bills being put on paper. After they were, the doctors were terribly upset about it. Obviously they had some valid points, because those bills have not come back before this House.

What has happened is that they have been rewritten; they've been changed around. We now call them Bill 71, which we're discussing today. Again, it seems that they've done exactly the same thing: "They didn't like the other two, so we'll give it to them in this bill." That's not the way good legislation should come before this House. I would suggest that the government should consult first, rather than reacting. If they do a proper consultation process, they should not need to admit to the House that they're going to amend things as they go along. It seems a very poor way of doing business.

Another phrase that the hon. member for Vancouver-Little Mountain used in his talk, as he rambled on, was "only necessary surgery." I must say that I have some concerns, unless we are going to define what necessary surgery is. I have concerns about somebody saying that, because it could be quite amazing what "necessary" could include or exclude. For instance, I have a person writing to me concerning some eye surgery which is not presently covered under the Medical Services Plan but which could improve his sight; whereas now he can't get a driver's licence because his sight is so poor. There is the possibility of having his sight restored, but it's not covered.

What other operations of this type might be considered unnecessary? How far will it go? I would like to see something firm in there. When you use these terms, let's have some definition of them so that we all know exactly what is meant and don't find out later, to our dismay, that it might be more exclusive than we want.

Interjection.

D. Symons: With his present qualifications, even the hon. member for Vancouver-Little Mountain would qualify to be one of the people who would be an inspector and would be allowed to go and look at doctors' records. I'm very pleased that that member is qualified for this, but I don't believe it is a function he should be allowed to do. There is going to have to be some sort of restriction on who is doing it and on the rules they'll operate under. Again, I don't think that's properly covered in this bill.

Section 10, which we will get to during third....

Hon. T. Perry: On a point of order, I have enough work. I'll be glad to volunteer not to accept that assignment, hon. Speaker.

The Speaker: That's hardly a point of order, hon. member.

D. Symons: The people of B.C. will be pleased to hear that promise today. But they have heard other promises from this government, and they haven't always been worth what they've been saying.

An Hon. Member: Broken promises.

D. Symons: Another broken promise, possibly.

We have another problem here. This bill will allow the government, if somebody -- be it doctor or patient -- does not respond to a request for certain information, to withdraw that doctor or patient from the Medical Services Plan. The doctor won't receive the payment, or the patient won't receive coverage.

This becomes fairly dangerous sort of legislation here. They use the term "reasonable cause," again undefined. I think we have to be much more careful with terms in there so that we know exactly what will form reasonable cause. I think many people could be hurt by that at some later date.

The previous speaker spoke about a 4.7 percent increase, and again I have concerns with that. Does that imply that each doctor is going to get a 4.7 percent increase in his earnings this coming year? I don't think the member meant that, but that's what the implication to people out there might be. She certainly is not saying that at all. That increase was on the total MSP global budget, but they're cutting back on what the doctors are going to receive -- not giving them 4.7 percent more.

Hon. L. Boone: That's the doctors' portion.

D. Symons: That's the doctors' portion. But it's being apportioned, is it not? So you aren't guaranteeing each doctor a 4.7....

Interjections.

The Speaker: As members know, we cannot have debate across the floor. Only one member has the floor.

D. Symons: Thank you very much, but I'm seeing that there is some hanky-panky in the number when they use the 4.7 percent.

Another concern I have in here is this commission that they're forming. The membership is questionable, because it's going to be weighted in favour of the government. We find that also built into this is that they are going to have some subcommittees. How are those subcommittees formed? They are appointed by order-in-council; they are not even necessarily appointed through the committee. Here we have another glorious example of where patronage -- and this government seems very good at that -- could work very well. I very much doubt whether that is the form we want for subcommittees.

F. Garden: The Liberals invented patronage.

[ Page 2861 ]

D. Symons: Madam Speaker, I have the floor, but the noisy disruptive people over there -- NDP for short -- seem to be competing with me.

Interjections.

The Speaker: Would the House please come to order.

D. Symons: I have some correspondence here also from doctors. I'm just quoting from a letter.

The Speaker: Order! Would the member take his seat for a moment. Hon. members, please do come to order. In order to have wide-ranging debate in this House, we must respect the fact that only one member at a time has the floor to speak. Please continue, hon. member.

D. Symons: Hon. Speaker, I was just going to finish off with a few quotes from doctors who have concerns. If the legislation had been properly vetted with the stakeholders, then these letters would not have come, because they would have understood the legislation. What we seem to be getting back from the government side is that they're misinterpreting it. Well, if they're misinterpreting it, then there's something wrong with the legislation and something wrong with the consultation that's going on. If not, I wouldn't be receiving letters that say:

"In proposing this legislation you have left no room for discussion, consultation or negotiation. This is unacceptable in any democratic society and ensures confrontation. There may be no winner in the confrontation, but there are certain to be losers in the long run, namely those who are not only the patient at risk but are also the taxpayers and electors of this province. They will not readily forgive a government which, in an act of political tyranny, seriously damages a great institution such as medicare."

I think to close, I'll just read one more paragraph rather than read from the others.

"The problem is not so much with doctors' salaries taking away money from the system, because as you know, our salaries have hardly increased at all over the last ten years compared to the general sector and even with inflation. It is true that we have more physicians coming on stream compared to several years ago, and perhaps the manpower issue is something which has to be addressed in a fair way."

It has been mentioned before that our population has been growing, and our population has been an aging population over the years, and they do demand more medical services. So you must look forward when you are budgeting for these that those facts are there, and they cannot be ignored. The government seems to be saying, "Well, we'll look at what it was in the past," but the past is not the present, and that must be taken into account. Our seniors must be considered, and they are not being considered here. I'll be bringing up more of that during third reading of the bill.

U. Dosanjh: I was sitting in my office listening to the member for North Vancouver-Seymour participating in this debate. Our party has nothing to apologize for. It has historically throughout this country championed the cause of medicare. There is no doubt about that. I must submit, with all due respect, that we have nothing to learn from these opposition benches. However, I think we have to teach something to this opposition bench. I heard the word "fascism" repeated several times in the debate by the hon. member for North Vancouver-Seymour. I think the use of the term "fascism" in the debate on health care, which is one of the most sacred services and institutions across this country, is to belittle the memory of those who were terrorized and butchered during the rule of Hitler and Mussolini.

R. Neufeld: Point of order. What the member is talking about has nothing to do with the principles of Bill 71 -- nothing to do at all with Bill 71. I wish he would get back to the subject at hand.

M. Farnworth: Point of order. I believe the hon. member was using this as an illustration to make his point and was well within the latitude of the debate that we're allowed.

The Speaker: Thank you, hon. members. We have had several similar points of order during this debate, and I'm sure the hon. member who has the floor will take the points under consideration and address the principles of Bill 71.

U. Dosanjh: Of course, the principles are enshrined in the bill, and they are fundamental democratic principles: that the rule of parliament is supreme in any given jurisdiction in a democratic society. Parliament has the prerogative to set budgetary guidelines and budgets, either by legislation or by debate generally. That's essentially what this bill is trying to do. Those of us who have used that odious term that I have repeated in the House for other members' benefit are old enough to remember the tyranny of that system, but oblivious enough to forget that that system has no place in this democracy, in this Legislature or in this country as a whole. People of Canada will not tolerate the use of such expressions either here or elsewhere, because they've made sacrifices to bring health care into this country, and to fight fascism at the same time.

I'm somewhat shocked that if one responds to debate on an accusation so serious as the one that I have indicated, then one is met with members standing and raising points of order. It is in order to rebuff such an accusation, because it actually besmirches the sanctity of this institution, where we have been elected to come and represent the interests of British Columbians as a whole.

[5:15]

Talking about the bill, it is fundamentally a democratic bill. It says that parliament has the prerogative to set a global budget within which this medicare system would operate. It says that we will have joint management by laypersons -- people of British Columbia -- representatives appointed by the medical profession and representatives appointed by the government. If someone from the opposition benches objects to a 

[ Page 2862 ]

model such as that, then perhaps they believe in the system the term for which they were uttering in this House. This bill enshrines representation by the process of co-management; it enshrines the issue of accountability. When you have three levels of society -- the government, the medical profession and the public at large -- represented in the commission, you have an ongoing accountability. When the government sets the budget in the open through the process of debate in this House, there is openness and accountability, and above all, there is integrity, which the opposition benches can't boast of.

I want to close my participation in this debate by saying: let's not make a mockery of democracy by attacking this fundamental shift in direction as to where we're going in medicare. We're going to somewhere that is better. We have to take into account that there are limited resources available and unlimited needs. We as a society have to make an effort to get a handle on the total amount of money that we spend on health care, and to meet the needs of people at large.

F. Gingell: I appreciate the opportunity to speak today to Bill 71.

This medical service management plan is made up of a series of various parts. I would like to, if I may, deal with two or three of those parts.

There has been a great deal of discussion in the House today concerning the question of audits -- the sections of this act which give the authority for government agents, people who are employed by and represent the Medical Services Commission, the right to enter into the office of any doctor in the province and, having established their credentials, look into the personal and private files of the doctors' patients. It further gives these agents or auditors the right to make copies of information there, to write down names and to take this information away with them. I can appreciate that the purpose of this exercise is to give the Medical Services Commission the ability to investigate matters that they may consider to be fraudulent or improper in the delivery of services to beneficiaries, or people who perhaps aren't beneficiaries but are setting themselves out to be, or fraudulent billings by doctors.

I understand, hon. Speaker, as has been said before, that in one of the prairie provinces -- I believe it to be Manitoba -- where such draconian rights are available to the agents of government, the amount of the so-called fraud being discovered is something in the region of one-third of 1 percent. So if we are dealing with a medical services budget of something in the region of $1.2 billion or $1.3 billion for this particular area, the amount of money that we would be talking about would be somewhere in the region of $4 million. Now I'm not suggesting that $4 million is an insignificant sum. I'm not suggesting that it isn't proper for the government to protect the interests of the taxpayers. They certainly should, and they certainly have that responsibility. But I can assure you, hon. Speaker, that there are many other means and methods that the agents for the government can use to discover potentially improper billings without giving them this particular right.

For example, you can first determine whether or not there is a series of billings that seem to be inappropriate. You can easily set up a system, such as we used to have, whereby each beneficiary received, at the end of each year or quarter or whatever appropriate period, a complete listing of all of the medical services that have supposedly been delivered, just the way they do it now if you have dental insurance handled by MSA. You get a complete listing of all of the services. You immediately complain or advise them if they have been billed for something that has not been delivered to you. We used to get listings of all of the services that were delivered to us as beneficiaries under MSA. We got them under Canada Health Act arrangements for many years. We used to be able to claim them on our income tax returns. We were not allowed to claim the medical services' premium that we pay, but we were allowed to claim the cost to the plan of the services delivered to us by doctors. We used to get it all the time. I can remember questioning the people who prepared the report -- I think it was MSP -- because I didn't believe that we had received all of those services, only to be assured that we had. It was better than my memory.

There are better ways of solving these problems. Under the auspices of the College of Physicians and Surgeons and with permission of the medical practitioner, doctors do go in now and look at files when they have concerns. It is done on a voluntary basis. It's done by the college, and it's done in a manner in which patients are assured of the privacy which is their right. There are better ways of solving the problem. Let's find them.

There are two sections within this act which allow the minister, the commission or, in one case, cabinet to set up their subcommittees. I can appreciate that it makes good common sense to allow a fairly flexible arrangement so the commission can operate in the most effective and efficient manner. But I really fail to understand why they would set up a commission, arrange for it to have a co-management makeup, and then have a provision in the bill which allows the cabinet by order-in-council, I believe, to set up a rival committee and to instruct the commission that it must not deal with the matters that this committee has been given the responsibility of dealing with. The particular subjects that can be handed to this specially appointed subcommittee are the matters that deal with discipline, fraud, registration and those kinds of discipline-control factors. I find it unusual that this section -- I think it's 3(1)(b) -- would be done in this fashion: give all the rights to the commission, give them the responsibility, set up a co-management plan which allows them to look after all these discipline matters, and then slip in another little section which allows you to take those discipline responsibilities away. It not only allows the Lieutenant-Governor-in-Council to take those responsibilities away but also allows the Lieutenant-Governor-in-Council to direct that the commission shall not exercise the power, duty or function with respect to those disciplinary matters.

Surely those particular responsibilities under sections 10, 14, 28 and 32 of the act are very important functions and responsibilities of the commission. The 

[ Page 2863 ]

disciplinary responsibilities under those sections and then the responsibilities under the apportionment process -- which I think is sections 19, 20 and 21 -- surely are the meat and the potatoes and the vegetables of what the commission looks after.

So why, having determined that you need a commission, that this is what they should do.... You suddenly take a whole section of their responsibilities away from them if the Lieutenant-Governor-in-Council under section 3 so decides. It's like telling your child: "Yes, you can go to the movies, but as you don't have any money, you can't go." It's very easy to give permission for people to do things if you know that it is impractical for them to carry those things out.

I can understand where many of these problems come from and why this particular government feels that they should rush in and find some solutions. It was very interesting to hear the Minister of Government Services speaking about the subject of consultation. The minister said: "I know for a fact that there have been hours of consultation. I could almost say days." Well, that really gave you some idea of the number of hours that were involved. This kind of major change to the management and the operation of our medical services in this province requires there to be a lot of consultation, not measured in hours or days, but surely measured in months -- slow, thoughtful, careful, considered. All those things. It isn't something that just needs to be rushed in. It is fascinating to hear that it has been going on with this government for four years. We knew they were a government in waiting, but I didn't realize that they'd been waiting quite that long. This particular government has just come into office. They have been in office now for some eight months.

[5:30]

Interjection.

F. Gingell: I can believe that, and it feels even longer to the poor taxpayers of this province, Mr. Minister, I can assure you.

The need to have consultation needs to be real. People need to look at the options. They can't respond in minutes and hours. They have to think about them, talk to their membership and talk to the members of the B.C. medical profession. I know that government ministers have to speak to their caucus, and members of their caucus have to talk to doctors in their own constituencies. This is important legislation. It should not be rushed. We on this side of the House understand there are problems that have to be dealt with.

As we all know, British Columbia at this moment in time is a good place to live. People like to retire here. People who come here to retire tend to be older than the average in the population. We deal with the problem of inflation times population growth times an aging population -- multiplied by more medical procedures. As every year goes by, the science improves -- things that were unknown two or three years ago, processes and medical procedures that will lengthen life and make life more comfortable for us. We also have the problem that our medical profession and our health facilities in this province have to deal with new diseases. It seems that as medical procedures and skills improve, so does the other side of the coin, and they are challenged with even greater challenges. All these things add to the costs.

This government shouldn't just pass the buck. You can't just say that we are going to solve this problem by cutting down each individual doctor's remuneration. You have to find a solution that is acceptable to everybody. If a solution is not acceptable to government, the treasury and the doctors, you don't have a solution at all. All you have is confrontation and more and more conflict. This problem cannot be solved on the backs and out of the pocketbooks of our doctors. We need to find some real solutions, solutions that will lead us through the 1990s.

There isn't any magic solution, but we know that there are things that can be looked at. The question of protocols has been brought up, as has the question of deinsuring certain practices. I know that our Minister of Finance and our Minister of Health have been having conferences and discussions and an exchange of ideas and thoughts with ministers of finance and health from other provinces. British Columbia is not alone, not alone at all, in trying to find a solution to the growing costs of health care. From all of these talents, from all of these people whom we have entrusted with the responsibilities of health and finance -- not only from British Columbia but from the other provinces of Canada and the federal government -- surely will come the start of some ideas to produce solutions. All these things do take time. We should give them time, and we should help and encourage the search for solutions.

I see Bill 71 as a very heavy hand. This is our solution for this problem, and the doctors are going to bear the brunt of it. I find it very heavy-handed. I do suggest, with all sincerity, to our government and administration across this chamber that they take time, look for solutions and help from all walks of life and all people in this province to come up with solutions that will last and will not just increase the amount of conflict that this particular proposed legislation is bringing to this province.

C. Serwa: I'm going to enjoy the opportunity to speak on second reading of Bill 71, the bill that repeals and replaces the Medical Service Act and the Medical Services Plan Act. I regret that we didn't have notice that this matter was coming up today, because it is a very important piece of legislation.

Interjection.

C. Serwa: I didn't have any awareness, and neither did any of my caucus, that this matter was coming up. It's significant, because the issue itself is very important, and certainly the departure from where we are at the present time and where we're going to is worthy of well-reasoned, objective and well-informed debate in this Legislature. I'll proceed, although I have a great deal of difficulty speaking at length on the philosophy and principles of this particular bill because, I suggest, it's virtually devoid of good philosophy and good principles. The challenge in the principles is primarily threefold: comprehensiveness, universality and accessi-

[ Page 2864 ]

bility. Those are the principles that concern me most with respect to the Medical Services Plan and Bill 71.

I think it's fair enough to ask ourselves, as other people will: "What will Bill 71 do to enhance comprehensiveness?" I suspect, when I read into Bill 71, that it will not increase comprehensiveness; rather, it will reduce the services that the public has become accustomed to receiving from their medical doctors. That is certainly one of the areas, when we're looking at financial control: we will reduce the comprehensiveness of the range of services.

Universality. Will that be enhanced by Bill 71? No, hon. Speaker, it will not, because when we limit the range of services available to all people -- and decide arbitrarily, through a commission or the minister or the ministry, that these services will now not be covered -- we're decreasing that universal characteristic of our medical health services that we've grown accustomed to. Those who can afford the range will then have access to a two-tiered medical health system; those who cannot afford it, who have to utilize the public system, will be relegated to utilizing what services the minister perhaps, or the socialist cronies on all the boards and commissions that are going to accept the regulatory responsibility for these acts, will determine will be available.

Will accessibility be enhanced? I suggest, when we look at the arbitrary cap.... I've heard a few members on the government side speak about the fiscal responsibility in the placement of the cap. They've made light of the fact that the Ministry of Health budget is one that is open-ended, but that's a reality. That's a reality, as much as we would wish not to have that happen. It's a responsibility. It is an open-ended situation. So if we're talking about accessibility in terms of imposing a cap, then what we're doing is arbitrarily limiting the accessibility simply by the imposition of that cap. Later on, I'll stop in the generalities that I'm going to discuss with respect to the philosophy and principles of Bill 71, and I'll speak more specifically in areas of specific concern.

None of those three principles -- comprehensiveness, universality and accessibility -- will be enhanced by Bill 71. What, then, will repeal of the present Medical Service Act and the Medical Services Plan Act accomplish? It doesn't appear that very much will in fact be accomplished, other than an opportunity to attack doctors. That appears to be the focus of this legislation. It's another form of intimidation that will restrict doctors in the right that we have given others. The government of the day stands tall in what they believe to be the right of free and collective bargaining, except in special instances where the politics of the government of the day, which are envy and greed, strive to attack those whom society sees as doing very well. I lament that, because that in itself is not a foundation to make well-reasoned or present well-reasoned legislation through this Legislature.

[H. Giesbrecht in the chair.]

Why doctors? Health care costs are running approximately one-third of the provincial budget. Doctors' gross revenue is approximately 20 percent of the total budget of the Ministry of Health. The government says we're very short of money, and we have to cut corners in order that we don't have a deficit for this fiscal year and a legacy of debt for the unborn generations of the future. But the government of the day has made choices, hon. Speaker, that amount to about $2 billion -- choices it made voluntarily. The government didn't really care about saving money when it made those choices. I'm going to go over a few of them, because it's important to point out some of the fundamental weaknesses of the bill and the rationale for the bill being placed.

The first choice government made -- which was an election promise, and I guess it was well funded through its election campaign -- was the repeal of Bill 82.

Interjection.

C. Serwa: I couldn't have wished for a better reaction from the government. Thank you very much, government members.

This government has presented a $300 million bill to the public of British Columbia, to the taxpayers who have to meet that bill over the next two years. When you look at the BCTF, the teachers and all publicly funded positions.... We're looking for money. Construction trade unions and the fixed-wage policy will cost us $200 million over the next two years. A billion dollars has been spent for 1,500 new FTEs -- more people hired by government this year than in the previous ten years -- some $300 million for welfare rather than workfare, and hundreds of millions of dollars for the various pork-barrel boards and commissions that have been newly created.

[The Speaker in the chair.]

When we're looking for money for the Medical Services Plan to provide medical services to the growing population of the province, the government cannot cry poor. It has independently and unilaterally made decisions for a great deal of public expenditure.

[5:45]

I was in New Zealand in 1958. It had a socialist government and a socialist philosophy that all members of society should be paid equally. The government tried to impose that utopian idea, but I'll tell you what happened. When ditch-diggers found out all of a sudden that they could earn as much money as medical doctors by working a few more hours, the country started to get a preponderance of ditch-diggers and fewer doctors. So there's no sin in utilizing the God-given resources that the above-average and bright people in our society have been given and going on to some of the educational facilities that we the public provide. There's certainly no sin in commanding a high fee schedule and a return for that ability and service to the public, so that approximately 20 percent of the medical health budget is spent specifically on doctors.

When we look at the changing society in the province, we have to come to a certain awareness. It's no news to all of us that the population is increasing. 

[ Page 2865 ]

We've had the largest growth of any province in Canada. We've had migration from all other provinces. The concern here is one of funding. To previous administrations I have made a suggestion and to this administration I make another suggestion if I haven't already: we have to look towards the federal government to incorporate an element in that funding formula relating to the percentage of seniors in a province. The average across Canada at the moment is about 10.5 percent. In British Columbia at the present time it's closer to 13 percent. When I was first elected in 1986 in my own constituency of Okanagan West 17 percent of the population were seniors. Now approximately 23 to 24 percent of that population is comprised of seniors.

We all know of the heavy demands that seniors place on a medical health care system. At the present time, because of portability, I suppose, there is no opportunity to look to other provinces to assist us with our medical health care costs. It would be entirely appropriate if, through the government of Canada and the accommodation of another element in the equation on federal-provincial transfer payments.... If the government of Canada introduced a formula that would give a flexible or variable rate so that a province such as ours, which is growing dramatically in its population of seniors, had some special consideration.... There are many other provinces in Canada that are getting away scot-free from attending to those individuals who require medical health care and who have worked, earned and provided taxes for the operation of another provincial government of Canada. But they come here and demand -- rightfully so -- and expect the same standard of health care services. I think it would ease our load if such a formula were carried out or introduced.

There are other elements that medical doctors are faced with that perhaps this administration would look at. Malpractice suits certainly are a concern of doctors. In order to protect themselves, I believe that doctors require excessive vigilance in the determination of a series of tests. If they fail to specify enough of the very expensive and special tests, then they're subject to malpractice suits. There are a number of elements that the government of the day -- rather than us as legislators -- can actually look at to mitigate some of the concerns in a realistic manner. Otherwise, with the increasing knowledge and technology, there's no limit to the amount of tests we make. Even at the end of the day, we're not absolutely sure in any event, because the body is a very complex piece of machinery.

When we go through this, we have to realize that with a cap we're going to be rationing health care services. There is no other way about it; we're going to ration health care services. A few years ago AIDS came onto the scene. What was the government of the day going to say, when the realization came of the degree and magnitude of AIDS: "We're very sorry. We recognize you've got a severe problem. We'll certainly bring it up in the ensuing year's budget. If we're successful, we'll create some sort of a special funding allowance for those with AIDS"? The government can't do that; the Minister of Health can't do that. We have to provide a service, and that service costs hundreds of millions of dollars. There's no possibility of having the Ministry of Health altogether cut and dried, so that we're assured they are within budget.

Who will we ration health care to? The elderly? That would save a pile of money. In the last four years -- as I understand it -- of a person's life, they consume more than 50 percent of the cost of medical health care services. Perhaps the government of the day could save a lot of money by rationing health care services to the elderly. I don't think they want to do that. Are we going to ration health care services to the males in society? That's a particular thorn to some of the female members of the government caucus in one way or another: maybe we can get back at the males in society and ration health care services. What about cancer patients? In some societies cancer seems to be preventable. Here we have a high rate of cancer. Perhaps it's caused by our style of living. Perhaps it's caused by our environment. There are a variety of causes for the different forms of cancer. Perhaps we could save a bundle if we just wrote off cancer patients. What about the mentally ill? We could save a lot of money on the mentally ill. Perhaps little children. It may be something complex, or it may be something like speech impediments. We could save some money there in services.

I don't think the government or any member in this House really wants to do that, but when you do put a cap on, that is what you are saying. You have put on an arbitrary cap, and you're trying to make someone the gatekeeper. In Canada -- and probably in other jurisdictions in the world that have a similar type of system -- we've tried all sorts of tactics to find gatekeepers. We tried to make the hospitals act as gatekeepers to restrict the flow. We've increased waiting-lists: hopefully people will get tired of waiting and won't use the medical health care services. This legislation is an attempt to force the role of gatekeeper on doctors. We have to look at whether the creation of gatekeepers has created any limits on the demand for medical health care services. I suggest that no one -- neither the doctors, the hospitals nor government -- are going to work effectively or efficiently as gatekeepers.

This legislation, Bill 71, misses the mark by a country mile. We're just playing around like a dog chasing its tail. There are certain realities that the minister and all members in this Legislature are aware of. The only effective gatekeeper in the whole system is the consumer of the services. The consumer of the services has to be the gatekeeper in the system. We have to accept responsibility for our own wellness. That's a reality. Only then will we start to get health care costs under control. Yes, government can provide excellent leadership in preventive measures, and I think that through the public health system and various initiatives it is trying to do that. But altogether too small a portion of the budget is actually spent raising public awareness on preventive health. Some 40 to 45 percent of the acute-care beds in British Columbia are occupied by individuals who abuse one of two substances, or perhaps both. It's no revelation: 40 to 45 percent of acute-care beds are occupied, directly or indirectly, as a result of the abuse of alcohol and tobacco. Are we going 

[ Page 2866 ]

to do anything about that? No, we're not -- not in this bill, not in Bill 71.

Interjection.

C. Serwa: I've read the bill.

Interjections.

The Speaker: Order, please, hon. members.

C. Serwa: Thank you very much, hon. Speaker. This raucous crowd sometimes is unruly, and I lament that fact.

Nevertheless, we are not doing anything to raise public awareness and the acceptance of responsibility. I say that probably the greatest arousal of that personal responsibility will be through the personal pocketbook. I again lament that the Canada Health Act precludes the possibility of a charge for access to a medical practitioner.

Interjections.

C. Serwa: You may oppose it on philosophical grounds, hon. Speaker and other members who may be listening to this debate, but there are some realities that have to prevail. When we spend our own dollars we are far more prudent in how we spend them and what we spend them on. If I'm aware that I have a cold -- the hon. member was talking a little earlier about a cold -- and think that I can handle it, I will do so. As long as it doesn't cost me anything, I will continue to think about an expansion of that cold into pneumonia perhaps, or something else, and will go to a medical practitioner because it doesn't cost me anything. It costs an anonymous third party -- who is all of us, the taxpayers -- something. I really believe that that is a mechanism we will start to reinforce to those individuals.

Most people are responsible, but we certainly have to encourage all people to be responsible, because each one of us pays for that complete and collective bill. When we're looking at controlling costs in medical health care, that's another avenue that we can move towards. The fact of the matter is that I'm almost confident our medical health care costs in British Columbia would be reduced, even if we lost the federal return on the balance of payments from the federal government. So that's something that really has to be considered.

Wellness. Wellness is eating right and exercising right and....

Interjection.

C. Serwa: That's right, a balanced diet and the holistic approach. This is where the aboriginal people have won over us. Their concept of health was always the holistic concept. That's coming into the fore today -- thank heavens -- in our society. The holistic concept ties the mental, the emotional, the spiritual and the physical together. In the medical health field, through the process of reductionism, we've created specialists and specialties, where we divorce one part of the body from the other. We divorce the mind from the physical body, not recognizing that tensions, in fact, cause all sorts of medical problems.

Hon. Speaker, with respect to the lateness of the hour, it's my understanding that the Legislature will reconvene for the next sitting tomorrow.

Mr. Serwa moved adjournment of the debate.

Motion approved.

Hon. G. Clark: I move the House recess for five minutes, and sit tonight until no later than 11 p.m.

D. Mitchell: Speaking briefly to that motion, the government House Leader has asked for approval of a motion to sit late this evening. The official opposition has no objection to that. I think the debate has gone well on second reading debate of Bill 71, and if the government House Leader wishes to bring some other business before the House this evening, I know there is a lot of business on the order paper.

With respect to comments made earlier today at the commencement of today's proceedings, the government House Leader indicated that there may have been a desire to sit late. Certainly if this motion is fitting in with the spirit of that, and if it's the government's request, in particular, to sit late and try to get some of the business done on the order paper, the official opposition has no objection to that. We would wish to carry on and try to get some of the business done. In the spirit of not rushing things through here very quickly, though, I'd like to respect the motion of the member for Okanagan West to adjourn debate on Bill 71 and pick it up at the next sitting of the House, being tomorrow.

[6:00]

Motion approved on the following division:

The House recessed at 6:09 p.m.

[ Page 2867 ]

The House resumed at 6:16 p.m.

Hon. G. Clark: In keeping with the cooperative spirit, I've just informed the members of the House that we will do committee stage of Bill 50, Freedom of Information and Protection of Privacy Act, then committee stage of Bill 64, the Members' Conflict of Interest Amendment Act, 1992. At 8 o'clock, regardless of where we are in the proceedings, we will get started on the Health estimates until 11 p.m.

With that, hon. Speaker, I call committee on Bill 50.

FREEDOM OF INFORMATION AND
PROTECTION OF PRIVACY ACT

The House in committee on Bill 50; D. Streifel in the chair.

Section 1 approved.

On section 2.

A. Warnke: At the outset, I'm not sure exactly what the House Leader means by "in keeping with the cooperative opposition." I hope the government House Leader is not under the illusion that essentially some sort of deal is being made. We will cooperate, of course, and the Attorney General knows that as well as anyone. But the fact is that we intend to take a look at the various sections of this bill and in particular the whole host of amendments.

Indeed, hon. Chair, I think that when we take a look at the second section -- the purposes of this act and so forth -- it reminds us of some of the warnings we extended to the government at second reading. Perhaps we were quite justified in pointing out some of the shortcomings of this, insofar as there are so many amendments before this House. Naturally we will be as cooperative as possible, but at the same time, this doesn't mean we're going to proceed very quickly through these various amendments. I think that needs to be mentioned at the outset.

I would hope and am sure that the Chair will keep in mind the work that is in front of us, that there are a number of sections which have to be amended and that these will have to be examined closely. Indeed, I did receive a draft of the rationale but not the final draft; therefore I think it's extremely important, for questions on each of the sections being amended, that a rationale be provided by the Attorney General.

On the second section, the purposes of the act, there are a couple of questions I think should be raised, but I'll just start off with a general one. In terms of what legislation is being replaced, and so forth, I wonder if the Attorney General could outline the purposes of 2(1) and 2(2), and specifically what they do in providing change to the legislation. It's really not a change to the legislation. I wonder if the rationale could be given as to what kind of legislation is being replaced by the existence of section 2.

Hon. C. Gabelmann: The significant feature of this legislation is that it is not replacing any other legislation. We are now, for the first time in the history of British Columbia, going to have freedom of information and protection of privacy legislation. As I said in second reading, we are the third-to-last province in the country doing this, so what section 2 does is simply set out the purposes of such legislation. It does not replace anything else in the books at the present time. The purposes are clear, I think. If any particular questions are asked about some of the subsections, I'd be delighted to try to answer them if the plain words are not plain enough.

Section 2 approved.

On section 3.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper. [See appendix.]

On the amendment.

A. Warnke: Could the Attorney General provide us with a clear rationale for the first of what I believe are two amendments being proposed in this particular section?

Hon. C. Gabelmann: On the first amendment, which relates to material being placed in the archives of a public body, the purpose is to ensure that private donations to archives of public bodies, such as B.C. Hydro, are not covered by the legislation. I'll just repeat that. It's to ensure the privacy of private donations. Secondly, the record relating to the prosecution of all proceedings in respect of the prosecution not being completed is simply to ensure that well-developed, common-law rules of disclosure in prosecutions are not replaced by Bill 50. It's to protect the common-law provisions in prosecutions.

A. Warnke: That is my understanding.

There are a couple of follow-up questions. The Attorney General has mentioned that B.C. Hydro is not covered by this legislation. First of all, I was wondering if he could just provide a short description of why not. I think there are people who would like to know why.

Hon. C. Gabelmann: First of all, B.C. Hydro is covered, as are all other Crown corporations. Donations from a private source to an archive that a body such as B.C. Hydro might have are not covered by the legislation. If the hon. member makes a donation to B.C. Hydro of some private records that he may have in his possession with respect to power development in the 1880s in British Columbia, those will not be subject to this legislation.

A. Warnke: I think it's worthwhile. Given the number of amendments that we have here, it is unfortunately going to be a bit of a repetitive question. In the spirit of the public really wanting to know, I'm wondering why this was not included in the first draft, when the bill was presented before the House.

[ Page 2868 ]

Hon. C. Gabelmann: Which one?

A. Warnke: I'm talking about 2(f) that is being proposed on material placed in archives, etc. To shorten it up a little bit, it may apply to (g) as well.

Hon. C. Gabelmann: In developing the legislation, we didn't think of everything. It's new legislation. It goes further than legislation anywhere else on the continent. In developing this kind of legislation, some questions escaped our notice. The question of private donations to archives was an issue we hadn't picked up on. In reviewing issues in respect of prosecutions, we decided that in order to be clear that we were not superseding the common law, we needed to add this provision.

V. Anderson: With regard to archives, there's a lot of historical interest in collecting archives these days, including at the museum just down the street. Does that mean that if somebody puts a private collection into the provincial museum it's not available after that? As you explained it, it seemed to me that if somebody took part of their collection and put it into the private museum, it would no longer be available to the public.

Hon. C. Gabelmann: I should say this clearly at this stage, because it's an interesting question until you understand how the legislation works. Nothing in this legislation will detract from the normal availability of information that has been historically available. I say that in reference to archival material but also to other government material that has been traditionally available by just walking into a Forest Service office and getting a map or whatever. This doesn't restrict that availability. Government employees aren't able to use this legislation to try to find ways to prevent giving material which has traditionally and historically been available to the public. Archival material is generally available to the public and will continue to be. I can't think off the top of my head of the kind of information that may be included in there that would be covered, but what we're trying to do is.... If some material is provided to the archives -- let's say it wouldn't ordinarily be part of the archival display, record or information that is normally available; it's private material that's been donated -- then unless it's generally available, it wouldn't be covered by the legislation. That's all we're saying in respect to this.

V. Anderson: Just to follow up that one, if a private person wanted to give a stack of records to the museum, and they said these must be kept private for the next 50 years and opened after that, is that the kind of thing you're talking about that would be covered by this?

Hon. C. Gabelmann: I thank the member for giving me an example of something I couldn't think of on my feet. Exactly. If the member were to donate material to the archives, he could stipulate that the material be kept for a certain number of years -- perhaps until his death or whatever. At that point it would be publicly available, but in the meantime the privacy provisions of the legislation would protect that wish.

C. Tanner: Mr. Chairman, I'm always impressed with the fact that when the Chairpersons are sitting there, they can see me over here. I'm always surprised when you catch me. Thank you.

I have two questions. One is just a matter of how we're proceeding this evening. This is an unusual piece of legislation, in that you're bringing forward 50 amendments and introducing them. Are you introducing the whole 50 as a body? Or are you going to introduce each one as we go? Just to enlighten us. Then I have another question afterward.

Hon. C. Gabelmann: We contemplated actually incorporating all of the amendments, rewriting the bill and reintroducing it as a completed package. It was a flip of a coin really; we chose not to do that. We will debate each one separately. We may not need to debate each one, but we will introduce each amendment separately at the beginning of discussion on each section.

[6:30]

C. Tanner: Mr. Chairman, nobody who has been in this House for the last two months can fail to appreciate that this side of the House has introduced a number of amendments. We've managed to get two very small ones through, and that was almost like drawing teeth from the government's side. We got them to change their minds, because the mistake or the improvement was so obvious. One must wonder, where you're making 50 amendments, which is a considerable rewrite of the bill, why you would proceed in this way on this particular bill.

Hon. C. Gabelmann: It's not really in order under this section, but nonetheless I don't mind trying to deal with it. It was simply a choice. We thought it would be clear, in terms of the response we had, that the period between introduction of the bill and now would be an opportunity for people to view our original language and to see whether or not we actually incorporated the recommended changes by way of amendments. It's easier for people who are concerned about whether we have actually incorporated their suggestions. It's easier for them to pick that up from a series of amendments than it is from looking at a fresh bill which doesn't separate the amendments from the original bill. It was a judgment call. We could have gone either way on it, but we decided to go this way.

C. Tanner: I appreciate that we're talking about this bill from clause to clause, but this is the first amendment that came through and the first opportunity I have had to ask a question. I don't think it's really out of order, although, of course, Mr. Chairman will rule as he sees fit.

May I just ask one more question? A substantive change like this makes a new member like me wonder what the government was doing in the first place when 

[ Page 2869 ]

it drew up the legislation. If you've had to make so many changes so quickly, doesn't it illustrate that there was something wrong with the original bill? You have admittedly changed it now -- or you're attempting to -- but doesn't it give you pause to think that if you didn't get it right in the first place, you've maybe got it wrong again, because you've made so many extensive changes?

The Chair: Just before I recognize the Attorney General, I would remind the members that debates in committee must be strictly relevant. The Chair has allowed the question to be asked and answered in the first instance, but I would caution you to be on the amendment with your questions.

C. Serwa: Point of order, hon. Chair. I think in this particular situation -- because this is a most unusual occurrence -- that perhaps until we establish the foundation.... I have several questions as well. With so many amendments -- approximately 50 -- to an 80-section bill, I think it would be in order to allow a little bit of latitude in the early stages to build a foundation, and then we can continue. If we can ask the leniency of the Chair for a short while to establish the foundation, then we can proceed, I think, fairly rapidly.

The Chair: The Chair takes your words. I understand the necessity to establish, as you put it, the groundwork for this.

Hon. C. Gabelmann: In response to the question from the member for Saanich North and the Islands, I think members should know that in principle there have been no changes to the legislation. In respect of its major initiatives, its major thrust, there have not been changes.

The changes have occurred in four or five sections in what you might describe as a substantive way; I would describe it as substantive. The rest are technical, minor. They are issues such as the two that are under discussion in section 3, which escaped notice.

We constantly bring amendments into this Legislature, sometimes a decade or two after the legislation was first introduced, pointing out the errors that had been made in legislation way back. No one pretends to be perfect. We had a process that was open and pretty inclusive but not perfect. I said earlier, I think in second reading, that between now and the next spring session.... If other changes to further improve it come to our attention prior to the next spring session, I'd be very happy to introduce amendments to what will at that point still be an unproclaimed act.

Is it an indication that we didn't do a very good job the first time? I don't believe so, because the principle is intact. We made it very clear throughout this process that we intended to seek the very best advice and counsel we could obtain from the broadest cross-section of the community. We made more effort in this regard in this bill than has ever been made on any legislation ever in the history of this House. I don't have any problem with being wrong the first time and being wrong the second time and always saying that it can get better.

The members should know that we've only dealt in substantive terms with four areas. One is law enforcement. One is the public interest override, and we'll get to that section later. Another is time-limits in terms of when the response to an application for information has to be made. Finally, there is a process for a determining fees so the government can't play around with the fees to prevent access. Those are the only changes of a substantive nature. I know some members of the media have made the charge that we couldn't have done a very good job because you got all of these amendments. Those four are the only significant amendments. Even in those cases, it's only a refinement of what the bill originally proposed.

C. Serwa: For the purpose of my information with respect to the amendments, were the amendments submitted by Murray Rankin? Were some of the amendments from the ministry? Were some of the amendments from other sources? Just for my clarification, hon. minister.

Hon. C. Gabelmann: A very small number of these amendments were generated internally. There were a larger number generated from external sources -- from groups such as the Freedom of Information and Privacy Association, the media owners' legal counsel, a number of.... Perhaps we could go through other groups later. The Canadian Bar Association made some suggestions. I think the Civil Liberties Association made some suggestions. There were other groups as well. It would be very hard for me to identify each of the amendments as to their origin, during the course of this committee stage debate. In many cases they were common. I know in some of the amendments everybody suggested we needed a particular.... For example, I think it was universal that we do something about the time-limit issue, which we responded to.

So I repeat: the Civil Liberties Association, the Canadian Bar Association, FIPA and the media owners' group were the major contributors. We had other people provide commentary as well.

C. Tanner: I have one last general question like this, and a comment. The comment is that we have tried to make amendments on a number of bills, and we haven't had any success. I commend the minister in doing what he's done. What confuses some new members on this side of the House -- and I suspect new members on your side of the House -- is that in fact this is the only bill it has happened to, and this is a bill where it didn't need to happen, because you've got a year and a half before you're going to proclaim it. You could have brought in a White Paper. You could have had the input. You wouldn't have had to bring in the legislation and then stand and amend it in the House. I think that's a very genuine criticism of what you've done.

In spite of that, I still commend the minister for allowing us, first of all, the licence to speak now -- and you, Mr. Chairman. But the fact of the matter is that it 

[ Page 2870 ]

could have been done differently, particularly as we're waiting a year and a half for proclamation of this bill.

Hon. C. Gabelmann: I appreciate the comments from the member. I guess if this discussion is in order in any section, it's in order in the purposes section. I think we are not too far out of line to have this discussion. The reason we wanted to have the bill completed, reported out of the House and given royal assent -- short of proclamation now -- is simply in order to prepare the training and educational materials, and to be ready for implementation in a year and a half. We had to have some certainty as to what the Legislature's will was on the legislation. Without the Legislature having expressed its determination as to what the legislation should say, we would not be able to prepare all the necessary materials to begin the training and education the public service needs. So we really needed a year and a half from date of royal assent. If we delayed until next year, we would have put the whole process back another year. That's the answer to that question.

The Chair: The hon. member for Okanagan West, bearing in mind the caution from the Chair on an earlier question. We are on the amendment. Proceed, hon. member.

C. Serwa: Thank you very much, hon. Chair, and thank you for the caution.

On section 3, hon. Chair....

The Chair: On section 3, hon. member, or on the amendment to section 3?

C. Serwa: On section 3.

The Chair: We're on the amendment to section 3.

C. Serwa: Okay, I'll wait until we're on section three.

Amendment approved.

On section 3 as amended.

C. Serwa: A public body is defined as a ministry, branch or office of the government or one of 208 entities listed in schedule 2. A public body does not mean the office of an MLA, an officer of the Legislative Assembly or the Court of Appeal, Supreme Court or Provincial Court. Perhaps the minister can indicate to me the rationale that is being used to exclude the legislative branch of government from this legislation. Surely MLA constituency expenses, ombudsman's investigation records, conflict commissioner's office -- all of those deserve as much scrutiny as the Attorney General's ministry does. Why were these areas excluded from the Freedom of Information and Protection of Privacy Act?

Hon. C. Gabelmann: First of all, the members need to recognize the principle in this legislation: that is, we are covering government material. The Legislature has nothing to do with the government. I know many members of the public think they're the same, but the Legislature is not the government. Some members of the Legislature happen to be in the government.

What we're talking about here is legislation that deals with the government's business. The government's business does not include the ombuds office, the conflict-of-interest office, the auditor general's office, this legislative office nor, for that matter, MLAs' offices. That is not part of government. That distinction is found in every freedom of information statute in every jurisdiction where such legislation exists. We think it's an appropriate principle to continue.

As far as the courts go, administrative records are subject to the legislation. Notes regarding reasons for judgment and that kind of process in the courts would not be available, and I think the reasons are self-evident.

C. Serwa: It is my understanding that public bodies such as professional organizations -- perhaps the BCMA or the bar association -- would also be included in the future in this particular legislation. If that is the intent of government -- even though, as I understand it, private members are not members of government -- and in view of that being the ambition of government, why is it not included at the present time with respect to MLAs?

[6:45]

Hon. C. Gabelmann: This legislation was conceived to deal with government itself, and its Crown corporations and other direct agencies. I indicated in second reading that we would begin a process to look at expanding the coverage in the future to deal with such organizations as the Law Society, the BCMA and other professional bodies, municipalities, school districts, hospital boards and the like. We will go through a process to see whether or not this kind of legislation should apply there. In that process, I think it's fair game to have a good discussion about parliamentary institutions and what kind of legislative framework might apply in this institution. Dealing with the first question first, should it? If the answer to that is in the affirmative, then we will work out what kind of legislative regime should apply. I have no problem at all with having discussion about that in the coming year or so when we have the broader second-tier discussion.

A. Warnke: Actually, some of the comments made by both the member for Okanagan West and the Attorney General are quite appropriate, especially in terms of the distinction between government and Legislature. That distinction has to be made clear from time to time. I quite agree with the Attorney General that it is often confused. Indeed, in the debate earlier today some confusion was expressed as well. It is good to make that reference from time to time.

In section 3 there is no mention -- I think I understand why -- of the time-frame. To a certain extent this needs to be qualified a little bit in terms of when it applies to all records in custody and so forth. Is it all records, or is it only records for a certain time-frame? 

[ Page 2871 ]

I'm thinking that there must obviously be some time in the past where there are still confidential records and so forth under these various categories, and that they will not be available for release.

Hon. C. Gabelmann: The legislation applies to all records, including those that have been in the possession of the government for some time. A subsequent section deals with the limitations on that in respect of material that may have been given on an understanding that it was private. We will get to that in another section. Except for the limitations expressed in the act, it does apply to all and includes a retroactive capacity.

Section 3 as amended approved.

On section 4.

A. Warnke: One point I want to pursue is under section 4(3), where there is a reference to section 74. As I reflect on it a little bit more, section 74(4) outlines the excuses, essentially, for an applicant. If an applicant wants information and does not have the payment or whatever, the applicant may be excused from making the payment -- unless I'm not reading it correctly. I think I understand very clearly that the applicant normally makes a payment, but there are provisions under section 74 -- specifically section 74(4) -- whereby the applicant may be excused. It does raise this question, therefore: if there are conditions under which an applicant may be excused, what would be the purpose of insisting on a payment in the first place? I think this needs some explaining.

Hon. C. Gabelmann: The reason for having fees, I think, has more to do with the need to ensure that the opportunities provided by this legislation are not abused. For example, members may recall a news story earlier this year out of Ontario where an individual who has been given free room and board by Her Majesty for some number of years has made a career of applying for information at considerable cost to the government of Ontario -- costs that exceed hundreds of thousands of dollars. That kind of potential abuse -- I'm not suggesting it's necessarily abuse, but it's potential -- needs to be dealt with. We think that in writing the fee sections in this legislation -- both this one and section 74, and with another amendment -- that we've provided three free hours. We've said that in the particular case the member refers to, for somebody who really can't afford the fourth or fifth hour, the head of the public body can say: "Well, never mind. We're not going to charge you that fee." We just wanted to make sure that this was as accessible as possible without at the same time having the whole government grind to a halt while an organized group or individuals decided to make every bureaucrat spend every waking hour doing nothing but searching for information. There has to be some kind of deterrent, and that's the balance.

A. Warnke: I was going to follow up with a question, and the magic word that the Attorney General used was "deterrent." Indeed there was some concern that by applying a fee here it would at the same time be exercising some sort of deterrent. There is the argument that if it's based on deterrents, then there is a form of discouraging individuals from wanting to seek information. So I think it's quite essential for us to define a little bit better or make it very clear that, well, are we applying a system of deterrents here? And what about accessibility?

Hon. C. Gabelmann: There are two exceptions to the fees. One is for personal information, so there's no deterrent for obtaining your own personal information; and when we get to section 74, if it's clearly in the public interest, or fair, to provide that information without charge, that determination can also be made by the public body. What we're essentially saying is that if it's your own information, it's free. If it's not your own but government information, but it's government information that is of wide public interest, it too will be free. It's pretty accessible, we think -- more so than most.

In determining the fee schedule, our intentions are to publish it in advance of adopting it by regulation for discussion with all the groups interested in the subject, for the public discussion in general and for all members of the House to comment on. Following that process, a regulation would be enacted. That's slightly different from the normal process for regulations which don't have the kind of public exposure or discussion that we intend to employ in this legislation. You have my commitment on that issue.

K. Jones: With reference to the Ontario citizen who has room and board provided by Her Majesty and who has appeared to use the FOI legislation fairly extensively, how would that particular case be controlled under the existing legislation? As you say, it is important to control that type of possible abuse. This person perhaps doesn't have much in the way of an income.

Hon. C. Gabelmann: If the member would refer to section 43, it will provide part of the answer. I think we can discuss it at that stage.

Secondly, if this individual that we're talking about is seeking information with respect to his personal life, that will continue to be free. If this person is seeking information that would have a wide public interest, that could well be free. But if the individual is simply making requests to the public service or to the head of a body in order to thwart the system or to be a nuisance or for some other interest, which is just to kill time, then the fee schedule could come into play. If it's clear that the person's income isn't sufficient to pay a fee, then presumably no further information would be collected beyond the first three hours. At that stage the individual could go to the commissioner and say: "Look, I'm being dealt with unfairly by this bureaucrat." The commissioner could conceivably say, "Yes, you are; you're entitled to the information," at which point it would have to be provided.

K. Jones: We were really talking specifically about subsection (4). There's a fee procedure there which 

[ Page 2872 ]

relates to section 74. When we get down to section 74(4), it indicates that if the person doesn't have an income -- you're bringing this as an item that we're dealing with -- they're going to have to rule that the person doesn't have any means of income. Therefore they'll still have to proceed.

Hon. C. Gabelmann: Far be it from me to say that the member is wrong, but the interpretation would be different from that described by the member. The head of a public body may excuse an applicant from paying if that person cannot afford it. If the head of the public body decides that this is a legitimate exercise of searching for information, the head of the public body can waive the fee. If the head feels that it's an "illegitimate" purpose, they don't have to waive the fee, even though the person may be indigent. That person, though, has the recourse to go to the commissioner and say: "The head of the body has not been providing me with this information. I'm poor, and the head should excuse the fee." Then the commissioner can make a decision.

K. Jones: I'm just getting back to the point that the minister has already stated. He used that as an example to justify why he brought this legislation in, yet it would appear that this legislation would not prevent that case from occurring. Does the minister have some other example that would justify this section? Obviously that one doesn't really relate to it.

Hon. C. Gabelmann: There are instances, conceivably, where information is being sought that will require many hours of work by public servants. That search may not relate to personal information. It may not be in the general public interest. It may be of particular narrow interest to an individual. For example, someone preparing for a court case comes to mind. In that event, after three hours, we are able to levy a fee. We're also able to waive the fee. If we make the wrong decision, the commissioner can tell us what to do.

C. Tanner: I must admit to the minister that I wasn't in the original debate, and I might have missed something. I am more interested in the reverse of what you've just been talking about. It would influence my decision of whether I'd vote for this particular section. What is it going to cost the department to put this piece of legislation in?

Hon. C. Gabelmann: Our budget in this fiscal year is $6 million. That is primarily aimed at training and upgrading the records retrieval systems in government. Our expectation is that in the next fiscal year the amount will be in the $8 million to $9 million range, a couple million more than this year. That will be for a continuation of the records upkeep for an additional person or two in each ministry who will be responsible for directing traffic on FOI and education on the subject.

[7:00]

There are, no doubt, costs associated with this legislation. We think the costs, while large -- $8 million or $9 million dollars is a lot of money -- are small in terms of the principle involved. In the long term, it's my view that, except for the operation of the commissioner's office, this is actually free. Once the public service has been trained to deal with record keeping in an appropriate way and is able then to provide the information when requested -- and I'm talking a decade from now probably -- then it becomes a normal part of the daily routine of the public service. It's something that should always have been the case but never was. Whether you ascribe a budgetary number to it or not is arguable, but providing this information is, in my view, just a routine matter of providing service to the people whose government it is.

C. Serwa: On section 4, recognizing that the government has special powers and abilities to pull information in, if one assumes that an individual has a legitimate right of access to certain information, and the government is not able to provide all of the information but has the ability to go out and get it, would that individual be in order to ask the government to get this additional information that they have access to and then provide it to the individual?

Hon. C. Gabelmann: If I understand the question correctly, on the surface of it the answer is no. Where the government may have a better opportunity than the individual to get information, government has no obligation to go out and get it for somebody. That's the individual's responsibility.

Section 4 approved.

On section 5.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper. [See appendix.]

On the amendment.

A. Warnke: Once again, on this particular amendment I want some clarification, because obviously an applicant who is writing out the application for a request for information, and so forth, the person may do so.... When we get to discussing the section there's actually a further qualification. But a person who's making such a written request.... This amendment is not very clear. Is there any sort of help or assistance given to an individual to make that kind of...?

Hon. C. Gabelmann: Part of that is dealt with in section 6, but let me just say two things. First of all, what we're doing here is making it clear to the head of a body in the government or to people covered by this legislation that they have a duty to actively assist an applicant in preparing the written request, so the applicant can't be thwarted by failing to have described accurately the record which is being sought and then having the public service say: "Oh, you didn't ask for that." The head has an obligation to help the applicant, to make it clear that what he or she is really asking for is 

[ Page 2873 ]

in the written request. That's why this amendment is in place.

The second comment I'll make is that what I will do from here on in the amendments is give a brief explanation of the amendment first in order to save a little bit of time. I see now a pattern developing that I should respond to.

A. Warnke: I see no objection. It would be quite appropriate if the Attorney General could give a brief description of the amendment. That would be quite suitable.

Amendment approved.

On section 5 as amended.

C. Serwa: I note that the individual in Ontario that we were referring to earlier requested and received from the government of Ontario the blueprints for the prison in which he was being given the opportunity for free room and board. Not only was he given that opportunity, but he was also able to photocopy and circulate them to all of his fellow prisoners. What precludes that happening under this present Freedom of Information Act?

Hon. C. Gabelmann: In that particular incident the Ontario government applied the exception incorrectly. They made a mistake when they actually provided the blueprints. Neither blueprints nor files -- by files I mean the kind with which you saw through bars -- are available for these characters.

A. Warnke: There's one point which I think is most appropriate under section 5. As I was reviewing the various sections -- especially in this area -- through to section 11, there's not really been the opportunity. But perhaps here you could respond to the question of how one makes the obligation stick: that is, the obligation to ensure that the applicant, when making a request, can ensure that the request will be followed through in full. Perhaps the Attorney General could make a comment on that.

Hon. C. Gabelmann: I'm not sure I understand that. In making the request, the head will be required to provide assistance to the applicant to make sure the request is clear and understandable, and in fact says what the applicant thinks it's meant to say. There's a duty on the part of the government to provide that. In addition to that, there will be regulations, obviously. As we get to section 75, you'll see that's the case. The procedural questions in and around the question of the member will be dealt with by regulation.

V. Anderson: Just to clarify the last response. Would that mean, for instance if I go and make a request in writing, that I will be given a receipt or copy of the request that I've made to indicate that at a certain date and time I made a certain kind of request, so that I could follow up and could prove that I actually did it, and what I asked for?

Hon. C. Gabelmann: Yes.

Section 5 as amended approved.

On section 6.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper. [See appendix.]

On the amendment.

Hon. C. Gabelmann: Oh, I'm sorry. I didn't do what I said I would do. Can't trust a politician. Three minutes after promising something, he fails to deliver. My apologies to the members.

What we're doing here is adding the words "without delay," so that the response in this is to deal with the concern that was expressed by people who said: "Well, you've got this 30-day limitation. You can take 30 days before you need to respond, even though it may be that the material is available within a few minutes or within a day or two." So in order to prevent any suggestion that there would be an unnecessary delay, we simply have amended this to say that the response has to be without delay.

Amendment approved.

On section 6 as amended.

A. Warnke: A very quick question, because we touched on it briefly in section 5. It's most appropriate here, as the Attorney General pointed out. That is in drafting a request. Is the procedure yet defined? It's not clear just exactly what the procedure is. Or will the procedure be introduced later through regulations?

Hon. C. Gabelmann: In the regulations.

C. Serwa: On section 6, the head of a public body decides what is reasonable or unreasonable. Will any guidelines be set so that the ministries will be consistent in that determination?

Hon. C. Gabelmann: That consistency will be achieved by policy direction to all of the heads of public bodies so that there is a consistency throughout government. Two things can happen that the commissioner could deal with. One is that the commissioner could say the policy is not appropriate and needs to be strengthened or changed, and it would then have to be. Secondly, if the commissioner felt that a particular public body was not responding appropriately to the policy, the regulations or the act, the commissioner could then order that particular public body to get in line.

C. Serwa: If there's some question about the appropriateness of the decision in this case, will an appeal process be available on policy?

[ Page 2874 ]

Hon. C. Gabelmann: The appeal is to the commissioner. We'll get to that again later in this committee stage. The principle here is that justice delayed is justice denied, and access delayed is access denied. The court process can take years and be very expensive. On both of those counts we felt that we needed to have the final judgment made by the commissioner, who is, as you know, a unanimous recommendation of this Legislature. Everyone always has the right of judicial review through the courts, but those are on narrow grounds. The principle here is that the final decision will be made by the commissioner. There will not be an appeal beyond that, except for judicial review questions.

K. Jones: With regard to the term "head" of the public body that should provide this assistance, I could see a situation where a person demanded to have the head, as listed in schedule 2, come down and make it out for him. Surely it may be appropriate to amend the definition of "head" to include his or her designate.

Hon. C. Gabelmann: That is allowed for in another section somewhere. When we get to it, we'll have a chat about it. Here it is. Section 66(1): "The head of a public body may delegate to any person any duty, power," etc. That delegation has to be in writing and may contain conditions. We deal with it in that respect.

Section 6 as amended approved.

On section 7.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper on section 7. This amendment is to clarify that the head is under duty to respond within 30 days at the very latest. That is yet another way that we can insist that the whole process be speeded up where it can be. [See appendix.]

Section 7 as amended approved.

Section 8 approved.

On section 9.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper, section 9. This provision is again dealing with the delay question. If there's a delay in providing a record, there has to be a good reason for that delay, and that reason has to be provided. [See appendix.]

[7:15]

Amendment approved.

On section 9 as amended.

C. Serwa: Does the applicant have the right to challenge the authenticity of the copy? Will access to the original be permitted?

Hon. C. Gabelmann: Yes, on both counts. An applicant will be able to challenge the authenticity. If that continues to be an issue, the applicant will be able to see the original. It may be that the original is in such a form that they can't take it with them or do something with it, but in order to verify that the copy is in fact a true copy, that will be made available.

In case we haven't covered this appropriately through the legislation, I'll make sure that the issue is dealt with by regulation.

Section 9 as amended approved.

On section 10.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper. [See appendix.]

On the amendment.

Hon. C. Gabelmann: There are a couple of issues here. I believe members have been given these notes, but nonetheless the public record would benefit from me explaining that subsection (a) is in subsection (1): "...by deleting 'for a reasonable period' and substituting 'for up to 30 days or, with the commissioner's permission, for a longer period....'" So there isn't an open-ended period. On occasion when it's necessary in terms of the complexity of locating the information, a commissioner can in fact extend the period.

The second is (1)(c). The amendment is to clarify that a head may not extend the time for response, because it would be nice if they had more time, but rather that the need for consultation.... Let me just try that again. Do you know what happens when you read something and it doesn't make sense to you? I've just read this, and it doesn't make sense to me. I am reluctant to go with those notes.

The purpose here is actually straightforward. Reading the words of the amendment, I think, will be the clearest way to deal with it. In 10(1)(c) we're saying that we're going to delete all the way through to "deciding." It's the first two lines. We're going to substitute: "...more time is needed to consult with a third party or other public body before the head can decide." We've reversed the order of the sentence. I'm standing here trying to be able to tell you why we've reversed that. It makes it clearer: the only reason for asking for an extension is that the head of the public body can't decide whether it's appropriate to release it. I hope that makes sense. It's hard to think on your feet sometimes.

A. Warnke: Perhaps to assist, the rationale that is provided by the notes, I think, would be quite sufficient here. That would be quite all right in this particular circumstance. It seems to me that the note suggests that extensions because of a need for consultation will not occur unless it is impossible for the head to proceed without more consultation. Perhaps it does elaborate on that.

Amendment approved.

[ Page 2875 ]

Section 10 as amended approved.

Section 11 approved.

On section 12.

V. Anderson: I'm having a little difficulty with 12(2)(c)(iii). I'm just trying to follow the implications of "5 or more years." I'm trying to understand why that particular time-limit is in that section.

Hon. C. Gabelmann: I need to get clarification from the member. If he's asking about what the wording in 12(2)(c)(iii) means, it means that five years after a decision was executed -- I think that is a word that would summarize this as well -- the information then becomes available. This is confidential cabinet material that relates to background information or analysis. If, as part of the material that cabinet gets in respect to a decision it's making, it gets some background explanation or analysis, perhaps from the public service who are charged with that area of responsibility, that information will be made available publicly five years after the decision was implemented.

C. Serwa: With respect to cabinet confidences, I certainly understand the necessity for the reasons that the head of a public body must refuse to disclose to an applicant information that would reveal the source or the substance of deliberations of cabinet, but I don't understand why the information that cabinet used to make the decision is not available. Perhaps the minister could advise me. That would really provide not the substance for the deliberation but the substance for the specific type of information utilized. It may be recommendations or a report, that sort of thing, but objective information that surely should be available to the public.

Hon. C. Gabelmann: Okay, let me see if I can explain this. All background material and background explanations as described in (c) are made available publicly once the decision has been made public and has been implemented. If the decision is made, but the decision was no and nothing happened, then it's five years later. I think that's a way of explaining that.

In other words, if cabinet makes a decision -- let me try this on, and I'll be corrected if I'm wrong here -- to do something, and the initiative is made public and implemented, then the background material is made public. If cabinet has received this information and has delayed making a decision, can't make up its mind or makes a decision that it's not going to do that at this time, five years later that information is available.

Section 12 approved.

On section 13.

Hon. C. Gabelmann: On section 13, I move the amendment standing in my name on the order paper. [See appendix.]

Amendment approved.

Section 13 as amended approved.

Section 14 approved.

On section 15.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper. [See appendix.]

On the amendment.

Hon. C. Gabelmann: There's a whole series of issues on the law enforcement section, which is one of the four significant items I mentioned when we were discussing section 2 in respect of this legislation. What we've basically done is to narrow the law enforcement exceptions. We've made it more specific. I think the most important thing is that we've made it more harm-based, so that the information will not be able to be made public if it would harm an investigation by law enforcement initiative.

Originally, in the legislation, we had used the word "interfere" with law enforcement activity. The general feeling was that the word "interfere" was not the appropriate one, and that harm to the actual investigation was the important issue. We've had extensive discussion with representatives of the police who would be most concerned about this issue. These amendments, I think, have met general approval.

Amendment approved.

On section 15 as amended.

A. Warnke: I'm wondering if there has been any response by the law enforcement and police community as to whether this particular section is sufficient, so that they have confidence in conducting their work and so forth. I wonder if there could be some elaboration on that.

[7:30]

Hon. C. Gabelmann: Some of this escaped me, too, as we've gone through this exercise. Local police are not covered by this. This covers CLEU and provincial policing but not local policing, which is, in effect, municipally based. The people involved in those police activities which are covered by this have been consulted about this wording. I can tell you directly that the Coordinated Law Enforcement Unit, for example, is the one who would have the most concern, and they are satisfied with the changes in wording.

C. Serwa: The group has expressed the fact that in their consideration it's too broadly drafted. Under subsection (1)(a), disclosure may be refused because it would "interfere with a law enforcement matter." This could be broadly interpreted, and there has been some concern expressed about that.

[ Page 2876 ]

Hon. C. Gabelmann: If the member would turn back to the amendment, he would see that we changed the word in 15(1)(a) from "interfere with" to "harm." So 15(1)(a) would read: "harm a law enforcement matter." It's to go back to the basic principle that runs through the legislation, which is that this is harm-based rather than letting people say, "You're interfering with my activities," which is too general and too open to abuse.

[M. Farnworth in the chair.]

K. Jones: Speaking to the Attorney General with regard to (f), we are concerned that a decision not to prosecute is addressed. We've had some explanation given that there are certain circumstances under which it would be appropriate not to issue information when there's a decision not to prosecute, but there are probably many more times when there actually should be a reporting of a decision not to prosecute. Therefore I think the information should be made available and shouldn't be used as a reason not to issue that information. I would like to ask if you could address that particular part of the section.

Hon. C. Gabelmann: The member is aware, I think, of the amendment that deals with that issue, adding the following subsection (4) at the end of the full section. Members, I think, would be sensitive to an individual who had alleged sexual assault, for example, or sexual abuse or any number of other issues of that kind where an investigation was done but a decision was made not to lay charges for whatever reason. To have that information revealed publicly as a result of this legislation would, I think, subvert what we're trying to do here in terms of protection of privacy. The language is designed to attempt to protect an individual in that kind of situation.

K. Jones: What you're saying is absolutely correct. That was the case I was referring to. You would want to make sure that the information wasn't given out in that case; but as it's stated in amendment (4): "...must not refuse...if the applicant is aware of the police investigation." That's the only criterion, is it? If the applicant becomes aware, by whatever means, of an investigation, then the head of the public body is required to provide the information. I think there are lots of cases where we become aware of a police investigation without it being the most appropriate time to give that information just on the basis that they're aware of it. And what constitutes an awareness of an investigation?

Hon. C. Gabelmann: The principle here -- we may not have captured it precisely the way we intended, and we'll have another look at this, because I think the member raises a good point -- is that once the information is in the public domain, and a decision has been made not to prosecute, then you have to explain why. That was the principle, but on reflection I'm not entirely sure that we have captured the issue the member raises. I want to go back and have another look at that particular issue as we continue to review this legislation.

V. Anderson: I'm not sure, but as the discussion progresses, I think of a person, for example, who has been charged or at least been investigated, and the investigation has been dropped. yet that name still appears on a record and another part of a government agency gets it, and when he applies for a job or something, it's not available. Would that enable him to find out whether his name has been transferred to any of those other parts of the government agency? He can find out for himself if his name is on another part of the government record.

Hon. C. Gabelmann: That's part of the individual's personal record, and the person can make application to find out whether or not that information has been carried on. I suppose the example you're thinking about is this. Let's say an individual was investigated over a matter, and it turned out it was a false allegation and the investigation was without foundation. Should that record then be made available elsewhere in government, where it could preclude that person from getting a job or an appointment or could be used in some other nefarious way?

First of all, that information should not be used in that way, but if an individual feels that it might have been given to somebody, they have the right to apply for that information to see whether or not it was there. Subsequent to that, if it is there in an inappropriate way, it can then be removed.

Section 15 as amended approved.

On section 16.

A. Warnke: This is in some ways a very important section that does need some elaboration. With the Chair's indulgence, I don't think it's inappropriate at all to outline in some detail in the way of a preamble what I think is important about it. That is: when we begin to articulate that a particular person, such as the head of a public body, can actually refuse to disclose information, as this section reads, if it's perceived by that individual to harm the conduct of the relationship between the government of British Columbia on one hand -- I'm thinking now under subsection 1 -- and the government of Canada or the province of Canada.... I can see problems here, because it's a matter of perception. For example, a poll could exist, perhaps conducted by the government, that most people in British Columbia -- however the question is phrased -- do not get along with the people of Quebec, or in less dramatic terms reject something like the distinct-society clause, or something like that. Yet it could be perceived by that particular individual that this is going to create harm in relations between British Columbia and the province of Quebec or the government of Canada, and so forth, or it could be deemed as being harmful to the national interest, and all the rest of it. Nonetheless, it's a subjective evaluation by that particular individual.

While I'm on this, hon. Chair, I think it is also appropriate to subsection (iii) on aboriginal government, and of course, that aboriginal government's relationship to the government of British Columbia. 

[ Page 2877 ]

Once again, it could be perceived by this particular body that information is so sensitive that it could jeopardize the relationship between the two, when in fact it could be that it is in the provincial interest. It could even be in the national interest. It could be in the interest of all to have that kind of information revealed.

I think this is an extremely important area: the definition of a disclosure harmful to intergovernmental relations or a disclosure harmful to negotiations. Unfortunately, what enters into it, I can imagine -- using the examples I've used to illustrate this point -- is that it's a subjective evaluation. Perhaps in more objective terms, while it may appear to jeopardize those relations, in fact who knows? The revelation of the kind of information that's here could actually even enhance the national interest and enhance national unity, or enhance the relationship between native peoples and British Columbia.

To some extent, some elaboration is needed here to outline what is involved, particularly when we are dealing with subjective evaluations. We're not dealing with individuals or with sensitive information with regard to individuals; we're talking about something else entirely. I think it's appropriate for us to follow this in debate somewhat.

Hon. C. Gabelmann: It's important to remember that the head of the public body may release the information, and therefore if it is, as the member suggests, potentially in the best interests of both levels of government or several levels of government, it can be made available under those circumstances. This wording is better -- to put that value judgment on it -- than any legislation anywhere else in the country, inasmuch as this information has to be released after 15 years. In other jurisdictions it's at least 20, and longer in some.

In addition to that, the two bodies that I paid a lot of attention to in commentary about this legislation -- the Canadian Bar Association and FIPA, Freedom of Information and Privacy Association -- are both quite content with the proposed language of our bill, in the first place, and suggested that no amendments were needed. I take some comfort from the fact that both the bar and FIPA were supportive, and the fact that we've got the 15-year time-limit. If all else fails and the information is refused by the head, then the applicant can go to the commissioner and say: "Here's the situation. I don't think it's going to cause harm to intergovernmental relations. It should be released." If the commissioner agrees, the commissioner can order it released, and the government has no say in the matter.

A. Warnke: The Attorney General has made a statement that is really commendable and worth us taking cognizance of.

However, there is another point I want to raise. I suppose it's along the lines of my illustration of national unity. It's not hypothetical. Ten years have passed since the constitutional act of 1982 came into force. In that context, maybe it would be useful to have some revelation as to how people come to a decision to support particular arguments in cabinet and in forums that have been called confidential in the past. By way of illustration, perhaps knowing the background is extremely important. In certain instances, maybe 15 years is insufficient; ten years would be sufficient to know what the cabinet was thinking in order to arrive at the decision it did between 1980 and 1981 that led to the 1982 decision. The number here is 15 or more years. I probably would agree with that, but it's worth commenting on, especially by the illustration I've raised, as to why it's 15 and not ten years.

[7:45]

Hon. C. Gabelmann: On the intergovernmental protection, most other jurisdictions never release this information. So we've gone a long way along this road.

The member shouldn't despair about the '82 constitution, because a lot of the work leading up to that signing on April 2, 1982, took place in 1980 and 1981. This will be proclaimed in 1993. You'll only have a couple of years to wait.

K. Jones: This section really disturbs me in that it seems to be a bit too vague. Actually it's very broad-brushed in its potential usage. It could practically cover any aspect of government. I'm concerned that if there was anything that could be conceived as a relationship between our government here in British Columbia and the federal government, the United Nations, an international organization of states, Pacific Rim trade.... There are so many different aspects of this that it could cover.

Why is it important to have all of these so blanket-covered when the intent of this whole legislation was to open it up and make it very specific as to how restrictions can be placed upon the access to this information? This area seems to be much more broad, to the extent that it almost negates all of the other detailing of the act. Can you give us a justification for each of these sectors where this type of a broad approach needs to be taken?

Hon. C. Gabelmann: First of all, I don't accept that it's broad. This section, from the perspective of the advocates of freedom of information, is the best section in the country. The advocates beyond that say that the limitations contained in the section are appropriate. When you read the whole section as a unit, I think you'll see that it's only if it's going to do harm to the relationship between the bodies. In other words, if there was something between the government of B.C. and the United Nations that would be harmful to our relationship with the United Nations, then it wouldn't have to be released. I can't imagine that very many of the exchanges would be harmful. It has to be reasonably expected to harm.

The head is not going to be able to, in any capricious way, say: "No, that's intergovernmental affairs so you can't have it." I think there has to be a clear indication that there is a reasonable expectation that harm could be done to the relationship between the government of British Columbia and the government of Canada or a municipality or an aboriginal group or, for that matter, the state of Washington or the state of Alaska if we were involved in discussions with them that could be 

[ Page 2878 ]

sensitive, whether it's the raising of Ross Dam or whatever it might happen to be. I actually don't think there should be any concern about this section. The confidence section in (1)(b) should give some comfort, because if the information is broad in any general kind of way and not strictly a confidence, then it would be made available.

K. Jones: When you talk about this not being very open, how would a head of an agency or department be able to say that there is a potential harm that could be generated? How do they justify it to say that it should be included under this exception?

Hon. C. Gabelmann: It's always tough to explain to an applicant that harm could come from releasing the information without saying to the applicant what the information is so they can make a judgment. I recognize that conundrum. One of the ways out of that, where there is that kind of difficulty, is to have the commissioner make the decision. The commissioner will be able to look at the information and say, "Yes, the public body is right," or "Yes, the applicant is right," and make a decision. So that's the protection through the commissioner that this House will select.

Section 16 approved.

On section 17.

A. Warnke: Since we're talking about the financial and economic interests of a public body, there is an argument that has been put forward that the public has the right to know about their public bodies. To a certain extent, we can exclude from that the argument of 17(1)(a), because when we're dealing with trade secrets of a public body, the public has a certain kind of common sense, I suppose, that recognizes when we're getting down to some technical features of economic behaviour and so forth, they have a patent or something like that on certain kinds of trade secrets and what not. Everyone understands commonsensically that that is understood.

The public is really quite concerned that they are their institutions and public bodies. When it comes down to the management and conduct of personnel on the job, especially in the administration of a public policy, because it is a public body, the public has a right to know. The public fears that this is a way of the bureaucracy potentially hiding indiscretions of management and personnel in the administration of public policy. Therefore I'd appreciate it if the Attorney General could comment on that.

Hon. C. Gabelmann: Section 17(1)(c) requires that once the decision that relates to the management of personnel has been implemented or made public, it has to be available. I think everybody would agree that prior to the decision being implemented or made public, there should be some protection for the individual, who may still be in another job somewhere, but also for the people who are working in the area where that person may end up becoming the boss or whatever. You might not want those people to find out about it by reading the newspaper. You might want to be able to sit down and explain to the employees why the change in personnel has happened, who it is and so forth. Once it's happened, it's publicly available.

A. Warnke: That is indeed a qualification by the Attorney General that I appreciate. Therefore we're looking at keeping secret those in-camera discussions where there are, let's say, four or five options that face a manager. In other words, we're at the pre-decision stage. Obviously we wouldn't want to disclose some of the other options, including hypothetical options that have been raised or various applicants applying for particular kinds of jobs and so forth. What the Attorney General is saying here is that we wouldn't want to have all of the reasons revealed. It's perhaps not even necessary for the public to know all of the reasons that a particular applicant was chosen over other applicants or why a particular decision was chosen over other decisions. It's sort of a pre-decisional thing, is it?

Hon. C. Gabelmann: His comments are right.

K. Jones: With regard to 17(b), I have a great deal of concern about the fact that we would be restricting information in that area or providing this opportunity where it's reasonable to expect harm to the financial or economic interests of a public body. We're talking about Crown corporations, for instance. The information they have should be public information. If there is information in that organization that would harm the financial interests of that body, then that should be public information. The public should know what's in their various agencies that could affect the financial bottom line. That should not be kept as a secret. The one thing that your party in opposition was always advocating was that we need to have open access to the Crown corporations. Yet this provides a vehicle to completely lock out all access to the public Crown corporations. They now have this vehicle to say that it could be harmful to their financial interests or bottom line. Harmful means that they may have a lesser bottom line than they've been telling the public they actually have. That may be because they've been doing some unusual things in that organization. The people of British Columbia have the right to know that, and that's what this freedom of information is intended to open up.

Hon. C. Gabelmann: Think about B.C. Rail and their competitive position in the marketplace in respect of a variety of initiatives they may be undertaking on behalf of their shareholders, who happen to be all of us and the other three million people in British Columbia. Information may, if released, enable one of their competitors to have a competitive, economic advantage. We wouldn't want that group of shareholders to have an advantage over this group of shareholders. Therefore that kind of information, if it reasonably could be expected to harm the economic interests of the public body, would not be made available. You couldn't do business as a Crown corporation such as B.C. Rail if it were otherwise.

[ Page 2879 ]

K. Jones: The purpose of Crown corporations is to provide services where there is no suitable competition being provided. Where there is suitable competition, why shouldn't the Crown corporations be able to open up their books and not be a competitor with those private organizations? Let's let the private interests look after those areas where there's a wide-open field. Let's keep government out of that area. Let's have government be involved in areas where there is not that competitive factor.

Hon. C. Gabelmann: That's a debate for another time: whether or not Crown corporations, or government itself, for that matter, should be involved in any competitive initiatives. The government of British Columbia directly developed a computer program recently for internal government purposes. It was so successful that we've been able to sell it to other organizations and make enough money to pay for the cost of developing it in the first place, and we continue to make money on behalf of the taxpayers of British Columbia with that computer program. If we'd been compelled to release that information, the first pirate to come along to get it would then have the competitive advantage and would make all the money that had been developed as a result of a great public service initiative on behalf of the people who work for the government.

[8:00]

K. Jones: They probably already have.

Hon. C. Gabelmann: In this case they haven't, but let me go beyond that. If a Crown corporation has information of which the release would not impair that Crown corporation's economic interest, then it would be released. There you look at natural monopolies. A great deal of what they do could be released -- more so than in a situation where there was not a natural monopoly. There is no prospect of the Crown corporations being able to hide their information from public scrutiny as a result of this section, except where it can reasonably be expected to harm their competitive position or the economic interests of the Crown.

K. Jones: I'd just like to reiterate that this section 17(b) is going to give Crown corporations and other agencies of the government a wide-open opportunity to not provide the disclosure that we have been asking for for many years.

Hon. C. Gabelmann: I try not to be combative or political or get into partisan debates, and I do try to resist taking shots at members. But the member simply doesn't understand. We're talking simply about those areas where there could be a competitive situation that could harm the interests of the government body or Crown corporation. The Crown corporation can't hide behind this to prevent material which is beyond that narrow limitation, because if they do the commissioner will order the material released.

Section 17 approved. On section 18.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper. [See appendix.]

On the amendment.

Hon. C. Gabelmann: This is what we describe as the marbled murrelet amendment. The amendment is necessary to ensure that we cover living organisms as well as endangered species, subspecies, etc. -- to make sure that we do include those in the original wording. It wasn't really clear, because we talked only about fossil sites and anthropological sites, etc. We want to make sure that animals and creatures too are covered by this.

K. Jones: I'd like to congratulate the government for bringing forward this amendment. I think it's an excellent amendment, and we will fully support it.

Amendment approved.

On section 18 as amended.

C. Serwa: The concern and the question I have relates to.... I'm not familiar with any other jurisdiction that has this type of exclusion to generally welcome information. It seems to me, if there was concern about a specific area, species or archaeological site or something, that one could restrict access until certain steps were taken, but to deny information pertaining to a species of plant or animal or something like that doesn't seem appropriate to me. I can certainly see it being necessary to restrict access. It is an unusual exception to the freedom-of-information legislation. Perhaps the minister could indicate to me the justification for this particular section.

Hon. C. Gabelmann: It's to prevent disclosure which could reasonably be expected to result in damage to a site. If you release the information as to site location, you'd have to have an army of police to prevent people from destroying it by going to it, and then it's too late. Our view is that if there was a reasonable expectation that a site or species could be damaged by the release of information about the location, we would not release the location. If you do, and it's damaged, you can't retroactively fix that up; but you can by preventing a release of the location. I appreciate that it's not very free, but it certainly protects these sites and species.

K. Jones: The Attorney General is absolutely correct. A prime example of this is the situation where we have very delicate structures in our caving areas, a few here on Vancouver Island. The knowledge of those caves by people who just want to go out of curiosity to see them not only puts the cave and its very fragile environment at risk, but also puts the people who are going there without adequate equipment, without adequate safety knowledge about caving, into a situa-

[ Page 2880 ]

tion where their lives are at risk or where an injury could occur.

C. Serwa: Whether one is going spelunking -- I believe it's called when you're exploring caves -- or looking around at other areas of our natural environment, I still have a great deal of difficulty with this particular section, because it's really in the public interest to know. I continue to appreciate people sometimes more for what they may be rather than for a way in which I would like them to behave. I believe that most people are responsible and should know and be informed. That's one of the reasons for this particular act. It seems to me in this particular case that you can certainly appeal to the inherent capacity and responsibility of citizens for that specific information. For me, this section is inappropriate.

Section 18 as amended approved.

On section 19.

Hon. C. Gabelmann: I move the amendment standing in my name on the order paper. [See appendix.]

Amendment approved.

On section 19 as amended.

A. Warnke: I might agree with the intent of what is to be accomplished here. I'm looking specifically at 19(2): "...disclosure could reasonably be expected to result in immediate and grave harm to the applicant's safety or mental or physical health." I understand the intent, and I think we can almost all agree with the intent. Yet there is still this nagging suspicion that certain individuals might want information. Indeed, there are individuals in our society who are tremendously brave. They want to know information even if it may cause them extreme harm of a variety of sorts. We know of people in our society who would even go so far as to risk life itself. So for those kinds of individuals, I wonder, how was this whole dilemma addressed?

Hon. C. Gabelmann: I don't mind admitting to members of the House that we had a long, involved debate about this particular section. The member for Burnaby North will remember our interminable meetings which lasted from 5 o'clock till 7 o'clock at least once a week. I think we spent a whole meeting on this particular subject. It's a tough one. We finally made the decision that we would bring in legislation that in effect was a wee bit paternalistic in some ways, because we are saying that some individuals may not be able to handle the information if it were released to them. They may not know the full extent of it, and if it were released to them, it could, in the view of the expert -- whether it's a psychiatrist or whoever else -- do irreparable and perhaps final harm to an individual. We chose a balance which said that that information would not have to be released.

Again, the commissioner can always come in and overturn that decision. Despite its paternalism -- and I don't mind admitting that -- I need to say that when you compare this provision to the provisions which exist in all of the other statutes across this country, it is not paternalistic at all. We've struck what we think is a fair balance in a very difficult issue.

K. Jones: I also have concern about the access of an individual to their personal information being judged by an expert. I'm concerned about who that expert is. Is that expert a person who is going to utilize the modern methods of empowerment for the patient or client, which are now being recommended in our training schools for medical people and for occupational therapists who are trying to give these clients decision-making opportunities in their lives? This does not allow them to have that choice. If you're going to have an expert indicated here, surely it has to be one who is going to be giving empowerment to the individual to run their life and to make the choices in their life. They have to have the right to choose how they're going to deal with their life and to try to be a part of society. We cannot take this paternalistic approach and continue this way.

Hon. C. Gabelmann: We anticipated what the member would say and brought in an amendment to deal with the member's concerns by taking out "in the opinion of an expert" in section 19(2). The issue will be clearly covered by regulations that attach to the legislation. What we're saying here is that the head will make the decision. The head may seek advice from an expert, but the applicant may also seek advice from an expert: the applicant's own doctor or psychiatrist, or whoever. That information can be provided to the head by someone if the head chooses to ask for it, or it can be provided to the applicant if the applicant chooses. In the final analysis, the commissioner would weigh the issue and make the decision if the applicant were turned down. We took out the words "in the opinion of an expert" to try to reduce the degree of paternalism that is always attendant on this kind of section.

[8:15]

K. Jones: The really critical word is "empowerment." I'd like to see the word "empowerment" put into this legislation -- that the individual who is being considered be empowered to make the decision; that the whole process be focused on their being asked how they think their life should be directed. Access to the information and the ability to choose their future -- I think that's what we have to do. We have to deal with those individuals who.... In the past we have taken the paternalistic view that a nurse or doctor knows exactly what's best for the patient. Today we know that the patient knows what's best for them, and the client knows what's best for them. Let's give them the right and the power to make those decisions.

Hon. C. Gabelmann: The head, in making the decision, will always be mindful of section 2 of the act, which sets out the overriding purposes. In 2(1)(b), 

[ Page 2881 ]

individuals have a right of access and a right to request personal information about themselves or to request correction of personal information. What it does essentially is give the individual the right, and then the right is tempered in some ways. We have tempered it -- or curtailed it, if you wish -- much less that any other legislation in the country.

What we're talking about here is information that may cause immediate or grave harm to an applicant's safety or mental or physical health. This is an empowering statute, once it's in place. I can't think of a single legislative intitative that has done more to empower people than this one.

Hon. G. Clark: It's frightening, actually.

Hon. C. Gabelmann: One-liners do people in.

I think the empowerment is great....

Interjection.

Hon. C. Gabelmann: No, I'm the minister responsible for this bill, and I'm telling you that I like the empowerment in this legislation. I think it's great stuff.

But there are situations where it is entirely conceivable -- and it has to be this kind of situation -- that a certain piece of information could actually lead a person to decide to commit suicide. I think that society has a responsibility to help people through those crises in their lives and to get them well enough again, so that when the information is given to them, they can handle it. That's the kind of purpose that's envisioned with this provision. If the member wants to suggest that the suicide doesn't matter, and that it's just one of the consequences of empowerment, then be my guest. I'm not prepared to go that route.

K. Jones: I think I would ask the minister to withdraw his suggestion of my condoning suicide by a person. I'm sure he did not intend that to be the case.

Hon. C. Gabelmann: I'm delighted to withdraw that suggestion, because in doing so it acknowledges that the member supports this wording as it is.

K. Jones: The minister is certainly trying to play partisan politics on a very serious matter. I'm trying to ask the consideration of the government in taking a stand so that this legislation will state that when the head is making that decision, it will be made based on a method that will give the choice to the individual to the extent that they're capable of handling that choice. They will make the choice, not somebody else -- be it an incurable disease...who can choose whether they get that information or not and many other factors, which is what this legislation permits. This is a very serious invasion of the privacy of the individual and the right to know about their own personal life.

Hon. C. Gabelmann: I guess we disagree. There are situations where information could be life-threatening to an individual. As long as that's the case, judged to be so and confirmed by the commissioner that it's so, then that information will await a time when the applicant or the affected person can handle that information. That's a judgment we've made after long and exhaustive discussion about it. I don't want to offend the member by suggesting what the consequences are of his position, but clearly, if releasing particular information about an individual to that individual causes that person to take their own life, or it can be reasonably assumed that that will be the consequence, then I think it's a pretty irresponsible government that would allow that to happen. I don't want to suggest that's what the member seeks to accomplish, but clearly that's where his commentary leads.

Section 19 as amended approved.

Hon. C. Gabelmann: I move the committee rise, report progress and ask leave to sit again.

The House resumed; the Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

Hon. G. Clark: I call Committee of Supply.

The House in Committee of Supply; D. Streifel in the chair.

ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS

On vote 48: minister's office, $365,941.

Hon. E. Cull: I am very proud to be presenting to the House the first Health budget of this government. This budget for fiscal year 1992-93 reflects the progressive principles and priorities of this government. It's a budget that strongly reinforces our belief that a truly responsive health care system is one that is managed in a responsible manner and puts the consumer at the centre while recognizing the fundamental value of all the caregivers.

Over six months ago the Royal Commission on Health Care and Costs presented its final report and recommendations to the government. The commission made several points clear. First of all, it said that we have an excellent health care system here in British Columbia, but not everybody in B.C. is equally well served by our health care system. The second point, which I think is particularly important, is that we must reform the health care system if we wish to preserve its quality and maintain access and universality for future generations. The royal commission said that was one of its major conclusions. The third point, which I think is very important for the context of the debate that we're getting into, is that there is sufficient funding in the system to support an excellent health care system, but some of those dollars are in the wrong place or are going to the wrong people, and they need to be reallocated. This budget starts the process of health care reform by beginning the process of reallocating those dollars.

[ Page 2882 ]

I'd like to talk for a few minutes on the economy and how that affects health care. We all know that we face a tight financial situation here in British Columbia. We know the economy is contracting -- by about one-half a percentage point last year. We are losing jobs in the resource sector -- some 18,000 jobs in forestry and mining over the last two years.

The economy has a significant impact on Health from two major perspectives. First of all, it means that we have to manage smarter with fewer resources. Secondly, we have to recognize that the loss of jobs and income places a greater burden on the utilization of health care services. When you have this combination of rising demands and finite resources coming together, you have the impetus for reform. It's very important that we not make the mistake of thinking that the reforms we're talking about here in British Columbia are being driven only be financial necessity. There has long been a need to make major changes in our health care system: what services are provided, where they are provided, who provides them and how they're provided. The current economic climate, I believe, has just given us that extra push that we need to do the right thing.

A critical infusion of funds is needed in many areas which have suffered from chronic shortages in the past, particularly in the areas of community-based health. This need has been recognized in the funding that we have provided in the budget, where a long overdue emphasis is now being placed on community and family health, on prevention and on health promotion. At the same time that we are providing additional funds to those areas which have been shortchanged in the past, the budget maintains adequate funding for hospitals, which will this year receive an additional $131 million or 5 percent more than last year; and also for medical services, where the fee-for-service budget for physician payments has increased by $57 million or 4.7 percent over last year.

Let me turn to hospitals for a few minutes. While the growth rate in hospital funding has been reduced from previous years, the previous level of funding -- the increases year over year -- were clearly not sustainable in this economic climate. While the growth rate has come down, we have been able to maintain certain funding principles to ensure that the hospitals in British Columbia continue to provide their vital function. This budget provides full funding for beds that were opened partway through last year, full funding for new beds and, in addition, funding for high-priority programs, such as heart surgery, cancer treatment, AIDS treatment and kidney dialysis. Extended-care beds in the very smallest hospitals have received increases to cover inflation. Funding for acute-care beds has been allocated on the basis of population and demographic profiles in the area served by the individual hospital, as well as taking into consideration the service level provided by each hospital in its community relative to the provincial average. We've been trying to treat hospitals equitably, recognizing that where we start from, not all hospitals are providing the same level of service to their community.

We've also introduced specific initiatives that are designed to ensure hospitals are being run as efficiently as possible. We've established special review teams to assist hospitals which run into financial difficulties or make operational decisions which are not in the best interests of the public. We recently announced such a special review team to look at the three hospitals in the northwest, to assist them and ensure that they are doing everything that they can to continue serving their public in the most effective and efficient way and maintain a high quality of health service.

We're also initiating an independent audit of waiting-lists to ensure that the public knows what's behind the waiting-lists, so that we can be very clear about what we can and can't take action on, so that we can direct our energies to where they will be most effective.

In the area of continuing care, our budget priorities have allowed us to provide a 14.6 percent increase over last year. Most significant is the expansion that's going to occur in the area of home support -- homemakers, home care nursing and adult day care programs. Residential care has also received a generous increase, which will allow almost 500 new beds to be added to the system this year.

[8:30]

The government is also committed to pay equality. Pay equality is somewhat different from pay equity. Pay equality recognizes that we have people performing essentially the same jobs in different parts of the health care sector but making different wages. Because we think that's unfair, we've put $21.3 million in this year's budget to allow the ministry to help achieve wage parity between low-paid employees in funded agencies and those who are in the public sector. This problem is not going to be eliminated overnight; it's going to take a number of years to reach comparable wages. We have started a program that will take us down that road. After continuing our commitment to pay equality over a period of time we will be able to ensure that whether you work in a funded or public agency, if you are paid by government dollars, you will be working at the same wage.

I want to talk a little bit about the medical services portion of our budget. Earlier today we were debating the new Medical and Health Care Services Act, which, as members know, is being brought in to replace legislation that has been around since 1968. You all know that this act creates a co-management model for the Medical Services Plan. The other key elements that will be fully debated and have already received, I guess, a considerable amount of debate today include the recognition of health care practitioners in addition to physicians. It establishes the authority of the Legislature to set the budget that we'll be debating; it clarifies the rights and responsibilities of beneficiaries and practitioners; it establishes the audit capabilities; and it establishes an independent appeal board. I believe this legislation is creating an innovative and creative framework for us to manage the difficult issues that we have to come to terms with in the future of medicare.

I think it's important to recognize that our doctors in British Columbia are among the best in Canada and the world. I think we have some of the finest physicians in 

[ Page 2883 ]

the world in Canada. It's also equally important to note that in B.C. they enjoy one of the highest fee schedules in Canada. Let me try to put this very clearly to you: according to the information that we have from Health and Welfare Canada, if physicians in B.C. were paid at the median Canadian fee level, to earn the same income that they do now they would have to provide 28 percent more services per year to achieve that. So our fees are almost the highest in Canada; I believe we're second-highest. They are such that it allows our physicians to reach an income by providing fewer services than a physician working in Ontario, New Brunswick or elsewhere in the country.

I think that helps to put into a clearer perspective our need to set an annual budget for medical services through a legislated mandate. By doing that, we will also be able to ensure a logical and progressive movement towards strengthening community-based health care services and health care initiatives that this year, because of our commitment to hold the line on increases to hospitals, physicians and supplementary practitioners, has allowed us to allocate an additional approximately $100 million to program and service enhancements in community and family health.

I'd like to talk about that for a few minutes, because I think it's the enhancements in that area which we are most proud of on this side of the Legislature. Perhaps the most significant part of our enhancement of community-based funding is our strong commitment to improving conditions for the mentally ill and mentally handicapped in this province. This budget will finally begin to reverse the neglect that has denied so many of our citizens needed care, access to services and lives of reasonable dignity and independence -- things that many of us take for granted.

Funding this year for mental health services has increased by 27 percent to $248 million. This also means that we have now put in place sufficient funding for 400 full-time positions to provide needed services and program provisions in the area of mental health. A very important part of that is in the area of housing and rehabilitation programs, which will see an increase of $11.3 million to provide for almost 400 semi-independent living units for the mentally ill in the communities in which they live. This funding will also go to cover quick response teams to assist people experiencing mental health emergencies, so that they will be able to reduce their dependence on psychiatric and emergency units in hospitals and receive that care closer to home. We estimate that an additional 2,000 people will be assisted through quick response teams alone.

As well, we've allocated an additional $3 million as transition funding to provide for the development of parallel community-based services for the eventual transfer of 100 patients from Riverview Hospital into the community -- again bringing those people closer to home and for the first time ensuring that when the people go out the door, the services go with them.

In the area of child, youth and family programming, we'll be able to extend services this year to an additional 3,000 children and youths -- and their families -- who are suffering from mental health problems such as suicidal tendencies, eating disorders and family violence.

Funding has also been enhanced for occupational therapy and physiotherapy services for children who have extraordinary health problems and severe or multiple handicaps. There is additional money for school nursing services and pregnancy outreach programs to assist women at risk of having low-birthweight babies or poor pregnancy outcomes. In addition, we've been able to provide funding this year for a hemophilus B immunization program. It's been expanded to reach 30,000 children this year. Other programs for children include a program to provide urgent dental care to children and additional sex abuse counselling.

Funds available for disease control through improved prevention, monitoring and surveillance have been significantly increased in this budget, particularly in the area of AIDS prevention, drinking-water testing, environmental health monitoring and protection, and laboratory testing. As well, British Columbia this year became the first province in Canada to introduce a broad-based hepatitis B immunization program for children.

An increase of $9.1 million has been provided for enhanced staff resources in many areas of public health, including nursing, environmental health protection, speech, audiology, nutrition and dental services. Thirty-two licensing officers will be hired with funding from the Ministry of Women's Equality to address specific child care health issues. As well, there are many other areas of special needs, such as native health, head injuries, family violence, kidney dialysis services and amendments to the Criminal Code, which came into effect in February of this year and will result in a significant increase in both assessments and remands for forensic psychiatric services. Additional funding has been provided to address these community needs. They didn't just arrive this year. They have been there all along, largely unmet. The areas I've briefly touched upon reflect the government's commitment to refocusing our priorities on consumers and on community-based care.

I want to say a few words about the B.C. Ambulance Service, because our ability to provide emergency response care is of critical importance in saving lives. This budget allows the B.C. Ambulance Service to maintain its high-quality service levels as well as to increase services where an aging and increasing population warrants such enhancements. In areas where it's required, Ambulance Service staffing levels will be adjusted to meet community and regional needs. As well, special funding has been provided for the purchase of more automatic external defibrillators, which will significantly increase the potential to save many more lives.

Turning now to alcohol and drug programs, which just rejoined the ministry last November for the first time in a number of years, this budget provides enhancements in several important areas. Adolescent community services will receive about $5.6 million in new money to develop an adolescent and family education program and specialized services for young 

[ Page 2884 ]

people at greatest risk. Assessment, out-patient counselling, after-care, follow-up services and specialized training for those working in adolescent treatment will continue to be supported through this budget.

Addressing native health services is also a priority, with about $3 million more being allocated for the implementation, management and coordination of prevention and treatment services for aboriginal people. The intent here is that we will be able to transfer the delivery of these services to aboriginal agencies. We are now working through a committee of people from the native community to develop this program, and to determine how services should be provided and what services should be provided. We're working directly with them to make this happen.

Much of what I've said underscores, I believe, many of the principles contained in the report of the Royal Commission on Health Care and Costs. As I think most members know, we're now actively reviewing the 379 recommendations contained in the report through a number of processes: consultation with stakeholders and with the general public, and through a special advisory committee that is working very closely with me and looking at some of the major recommendations. I want to make it clear that we are using the report now as a general guide. We have taken out of the report and its general direction some specific policy directions, which we are using to guide the decisions that we had to make every day in putting this budget together. The world cannot stop while we go through the process of reviewing the 379 recommendations. We have to move on; we have to make decisions every day.

We believe that the general direction of the royal commission was excellent, and one that deserved to be supported by our day-to-day decision-making. Let me touch briefly on five directions so that members will have an understanding of our policy thrust for the years to come. The first direction is one that we call "quality management for quality care." It recognizes that quality care is the ultimate objective. To do that we have to manage better. That means everything from doing more planning for health care services, particularly at the regional level, to better integrating our health care services at the community level, to even looking at how we're doing things internally in the ministry. It also means that we have to have a better look at outcomes to make sure that what we do in the name of health care is actually making people healthier. We do a lot of things in the name of health care that we're not even sure make people healthier; we're not even sure that they don't make them less healthy. We need to start focusing on those outcomes so we can be sure we're doing that.

The second direction is broadening the whole notion of what it means to be healthy. We believe that we have to take a more holistic view of what health is all about, and we recognize that income, housing, employment and a sense of self-worth in your community, your family and your job are probably as important to your health as the number of doctors or hospital beds you have in your community. We have to start focusing on these social determinants of health if we're to really affect the health of people in this province.

The third policy direction is simply to bring services closer to home, whether it's closer to the people by moving services out of the metro areas and into the regions or whether it's out of the walls of hospital and into the community. "Closer to home" was such an important theme to the royal commission that they titled the report with that phrase. I think everyone in this province agrees we have to pay much more attention to it.

The fourth direction is to create a more open system. Again, this was a central theme in the royal commission. They suggested we had to open up the decision-making process around health care and involve people in making the decisions that would affect how health care is delivered in their community. We're pursuing that actively this year through a number of pilot projects in local management and planning of health care services.

The final direction I want to talk about is the need to consider and respect caregivers. Health care is a people business. Eighty percent of this budget that we're about to discuss is spent on salaries, fees, wages and benefits for people. It's very important that we recognize, as we talk about health care reform, that the roles of the people providing those services are going to change, and their lives may be affected by the changes that we're talking about. So we have to work with those individuals and with their organizations to ensure that as we bring about the change, we do it in a way that respects those people as much as possible. We are working very closely right now with the hospital unions to talk about how we will ensure that the transition from an insititutional based system to a community based system can be made as smoothly as possible. I bring that up as one example.

[8:45]

In all these areas we are proceeding with conviction and with the assistance of many people in this province. The minister's advisory committee, which I just mentioned, is advising me on the major recommendations of the royal commission. I have to say what an excellent group of people this committee is turning out to be. They are extremely dedicated and hard-working. Right now they are meeting all day every other Saturday afternoon to make recommendations, and many of them are giving their time in between these formal meetings to work with staff on the recommendations. Many others are involved in the delivery of health care. They have spent hours giving me their ideas and suggestions on improving health care in British Columbia.

In summary, I wish to state that health care reform is something that every province, right across this country, recognizes as a needed activity at this point in time if we are to preserve our health care system and particularly those aspects that make it so cherished by Canadians. This is not a question of whether we would like to reform the system now or not. Could we wait? Could we do something different? Couldn't we just carry on for a little bit longer? Every provincial and territorial Minister of Health is saying the same thing: we need reform now, and the reforms have to be along the lines of those five basic principles I just outlined.

[ Page 2885 ]

We are beginning the process of health care reform with this budget. I believe that if we are to see medicare preserved for our children and our children's children, we have to continue along this road and not lose the momentum we have now established through this very progressive budget. If we continue on with these reforms, we'll ensure that we put people back at the heart of health care.

L. Reid: Hon. Chair, I'm pleased to rise today to debate the Health estimates for the fiscal year ending March 31, 1993. Today a national system of health care is a claim that Canadians make on their governments. A national focus ensures that these programs meet important objectives such as equity and universal access. As British Columbians, we are looking for a health care system in partnership. In the words of the Minister of Health: "one that puts the consumer at the centre." We must honour real partnerships. Allocating dollars to health care can no longer be done in isolation.

The Seaton royal commission is a discussion document. It discusses a different way to deliver health care. It makes recommendations. It does not offer anything more. The Seaton royal commission is a two-dimensional response to a multi-dimensional problem. Our health care system is complex; it will require a complex response. I do not believe that we can move from a discussion paper to the allocation of dollars without a plan. The Seaton royal commission is not a plan.

During this estimates process, British Columbians need to see how decisions were reached in terms of funding. What are the priorities of this government? Upon what research are these decisions based? Have these ideas been piloted? Have they been normed on British Columbia populations? Is the basic premise sound? These are huge questions, and there are huge misconceptions.

This government is floating the idea that a move to community care will somehow be less expensive to the taxpayer. On what do they base that assumption? Have they done any research? Do they understand the implications of creating a second system of health care? Community care will never entirely replace hospital care. In the meantime, you can't have people turned out in the streets while this new system is being discussed. Think of building a new house. Builders rarely tear down the old house until the plans have been approved for the new one. We've often seen two homes on the same property. Once the transition is complete, the old house can be torn down. The same applies to our health care system. We do not have the plans in place to build a new system. We have spoken to many people. We believe in many of the ideas put forward, but there is no plan. This government is simply not ready.

This government will be discussing their Health estimates over the next number of weeks. British Columbians need to scrutinize these estimates, because these are your tax dollars. Look carefully for a vision of health care in these estimates. Without a plan and without clear direction based in reality, this government will be experimenting with your money, and we know their penchant for gambling with other people's dollars. This government owes the people of British Columbia more than a discussion paper. This government owes the people of British Columbia a building plan for a health care system that is second to none and that they can rely on. A book of recommendations will not reassure patients on surgical wait-lists, will not reassure people dying of diseases with no known cures and will not reassure our health care providers being assaulted on the job on a regular basis.

What are the priorities of this government? Broad restructuring will be both necessary and inevitable. The Liberal opposition in this province sees a health care system in transition. Any new system must be funded at least to the level of the old system. The old system must be maintained until the new system is up and running. Health care is a people business, and people need ongoing services. Where are our health care dollars going next? Who decides? Why was the royal commission embraced wholeheartedly without discussion in this legislative chamber? Why was this discussion paper not referred to a legislative committee? Is the future of health care in this province going to be decided by order-in-council?

The province of Alberta took two years to examine their Rainbow Report to decide if they would proceed at all. This NDP government accepted the Seaton report as written and said: "Let's go." The Liberal opposition is saying: "Show us your plan; show us more than a discussion paper." We cannot afford another layer of bureaucracy. We cannot afford fragmented care.

We must pursue "Learning for Living" programs in our schools and communities. Citizens of this province must understand their responsibility for their own health. Health promotion has a plan. We need a plan for the frail and the elderly in our communities. We currently have many thousands of people in health care institutions. We need alternatives. This group of frail elderly is increasing in size. The population of British Columbia is expected to reach four million by the turn of the century. We need more than a government that waves around a discussion paper. It's a start; however, you've been in opposition for 17 years. Surely you've had time to do more than simply accept a discussion paper.

Let's examine the current situation involving federal transfer payments to the provinces. British Columbians have a right to know what the Minister of Health is doing to resolve this issue. What is her plan? Surely she has had time to do more than just accept the situation.

This government faces a huge challenge. The NDP must prove they are prudent fiscal managers, and, given their behaviour to date, they can only prove that as long as there are others to blame. When "the mess we were left by the Socreds" wears a bit thin, they moved on to bashing various groups in society: lawyers with their fax tax, corporations with the corporate capital tax and physicians with Bills 13, 14 and 71.

Is the member for Okanagan West correct? Is this the politics of greed and envy at play? Is this somehow supposed to impress the public so much that they stop worrying about the fact that there is no economic strategy in place? The public I speak to have only one question, and that is: who is next in line to be bashed? 

[ Page 2886 ]

Surely this government has had more time than to just make lists.

We need a government that believes it is in office to serve all people. We do nothing if we pit one aspect of health care against any other...

Interjection.

L. Reid: He'd like to be the Speaker. ...or one aspect of society against any other. We want a government that works in partnership with everyone, that stands back and looks at the forest, looks at the trees still standing and sees a mural and sees society as an integrated design. We can't handle any more whitewashing. British Columbians were promised open government. I didn't see any promises which said: "Bash Peter to pay Paul, and then bash Peter all the harder if he complains." Again, who is next?

These health estimates today must chart a clear course of action based on research and pilot projects and on more than a discussion document. I look forward to the minister's answers to the thousands of questions which British Columbians have asked about their health care system.

Recognizing that this is the first time the minister has addressed this House during the estimates process in her capacity as minister, and noting also that this is her first opportunity to clarify in this House in a comprehensive manner her goals for health care in B.C., I would like to begin by asking the minister to outline for us her vision for health care in B.C. and what she is trying to accomplish through this particular budget.

Hon. E. Cull: I tried to do a fair amount of that in my opening remarks by talking about the five directions that we have distilled to pursue while we go through the process of reviewing the Royal Commission on Health Care and Costs for decisions on the specific recommendations. But let me just quickly restate some of those for the member.

Our vision of health care is one that is of the highest quality possible within the ability of the taxpayers to afford, and it is one that respects the five principles of medicare. It is one that promotes access, universality, portability, public management....

An Hon. Member: Comprehensiveness.

Hon. E. Cull: And comprehensiveness. I need an acronym to remember those five. Thank you to the parliamentary secretary for help.

The way that we're going to go about achieving this quality health care system is really where the vision comes into play. Our vision, simply restated, is one that has those services provided as close to home as is feasible and possible so that people do not have to travel long distances to receive care. That may not always be possible. Some services will always have to be provided in major centres because of the nature of the service, but where possible, we want to provide services close to home.

We want to make sure that the system has the highest degree of local control possible. We're not talking about another layer of bureaucracy. We're talking about changing some of the management systems that currently exist to ensure that decisions about what kinds of health care services should be provided, what are the trade-offs, how should they be provided, and eventually providing them directly and budgeting for them, is done, again, as close to home as possible through local or regional health councils.

We're also focusing on a system that is far better managed than it has been in the past. I mentioned outcomes as the primary focus that we have currently in this area. But we're going to look at how we deliver health care services, because we believe high quality services are ones that are delivered effectively and efficiently. The other aspect of our vision for health is that it is far more than a sickness system, and in fact it's far more than a sickness system plus a Ministry of Health wellness system. It has to look at a very broad range of social determinants that affect our health, and they are well beyond the capacity of the Ministry of Health to effect. I have to work with all of my cabinet colleagues to make sure that we address issues around employment, housing, education, even things like traffic safety and a number of other issues which impact upon our mental and physical health.

Finally, when we talk about the principles that we are applying, in addition to the four that I quickly talked about is the need to make sure that we create a system that respects the people who are involved in delivering that system, and that means recognizing that the roles of health care providers are changing and must change. We have to start working with those people to bring about the change in a planned and progressive manner. I am probably one of the strongest proponents of planned change in this House. I sat over there for many years talking about the need for a plan. Certainly the things that we are putting in place are going in place with a plan. We are not making decisions without a planned framework. We're working in the framework of those five principles right now. We're developing and implementing plans for some of the more detailed recommendations, and we have plans on many of the subjects that I am sure you are going to be raising with me later tonight and in the next couple of weeks, whether it's mental health, alcohol and drugs or native health. We are operating very much from a planning framework.

[9:00]

L. Reid: For the benefit of the members of this House, hon. Minister, I would be pleased to have you introduce the staff with you this evening.

Hon. E. Cull: Thank you for reminding me about that. Sitting next to me is my deputy minister, Mr. Doug Allen. Next to him is Les Foster, who is assistant deputy minister of management operations. Directly behind him is Dr. Kit Henderson, who is the chair of the Medical Services Commission. Behind me is Mr. Brian Copley, the assistant deputy minister for community and family health. Finally, Mr. Steve Kenny is assistant deputy minister for care services.

[ Page 2887 ]

L. Reid: I recognize that the task of examining the recommendations of the Royal Commission on Health Care and Costs is an enormous one. It will take long and careful consideration. While the present government did not implement the royal commission, I'm sure the minister agrees that this is the comprehensive study. A comprehensive study of health care delivery was absolutely needed for this province. I know the minister has given the recommendations of the royal commission a high priority for her term of office.

I would like to begin my questions by asking about the minister's advisory committee on the royal commission. What are the committee's terms of reference? What type of submissions will it be taking? Is its purview of the royal commission's recommendations limited in any way?

Hon. E. Cull: The minister's advisory committee on the royal commission has established terms of reference. They are to advise on the recommendations presented by the royal commission, specifically with these areas: to provide the minister with an understanding of the variety of perspectives to be considered in the government's response to the report and to advise on the most effective means of involving the public, major users and care providers in the review in the implementation process. Those are very broad terms of reference.

I'll remind you, in case you've forgotten, that this committee is composed half of health care providers and half of health care consumers. It is geographically and gender balanced and has good representation from aboriginal and ethnic communities.

This committee has been dealing with the broad questions, not the specific smaller recommendations. In 379 recommendations there are some that are quite specific and focused. We have given the advisory committee the responsibility to look at big things like regionalization, because, as you pointed out, the royal commission report was not a blueprint. We haven't accepted it as a blueprint. I do think it's a little more than a discussion paper. I think Justice Seaton would be somewhat disturbed to have it discussed in those terms. Certainly there are a lot of suggestions for what we need to do without specific road maps on how to get there. We're working with the royal commission advisory committee to develop some of those road maps. We've been looking at things like regionalization, the development of the continuum from acute care to community care, the governance of the professions, the parameters of what healthy public policy in this broad vision of health care is supposed to be -- just to name a few of the things that we've been discussing in the last number of months.

L. Reid: I agree. Justice Seaton is not disturbed. He's a very balanced individual. He quite honestly believes it to be a discussion paper. He and I have had that very discussion.

Will the minister's advisory committee be hearing submissions from stakeholders as part of its consideration of the royal commission recommendations? If so, will it be travelling, or will these be written submissions?

Hon. E. Cull: There is a separate stakeholders process that is now being put into place. It involves the round tables of the stakeholders coming together and discussing specific recommendations that affect them, plus the general recommendations on which they might care to have input. Those reports, particularly if we receive them in writing, will be going to the minister's advisory committee. If not, there will be minutes going to the committee. In some cases we will be involving both of those groups together, specifically through working groups that we have in the ministry.

If I could quickly sketch those three for you. We have an advisory committee looking at the big questions, doing a lot of the blue sky kind of work that has to be done around reform. We have five working committees within the ministry, tackling in some form all of the 379 recommendations. Then we have the stakeholders process.

L. Reid: What is the cost of this advisory committee, including support staff?

Hon. E. Cull: If we include all of the staff salaries for individuals who are already employed by the ministry and who will be seconded into working in the working committees, it comes to about $800,000. I believe I heard that $390,000 is the amount if I don't include those salaries. About half of that $800,000 comes from the salaries that we would be paying these people working in the ministry, but we are redirecting them into working specifically on royal commission implementation activities. Sometimes it's at things that they've identified interest in, and sometimes it's because it's part of their job.

L. Reid: For clarification, $800,000 goes to the five working committees for current staff in place. If indeed it also extends to the advisory committee, the 25-person board, I'd be interested in the remuneration for their work.

Hon. E. Cull: There is no remuneration at all for the advisory committee. They only get their travel costs and out-of-pocket expenses covered. It's very low-cost. The $800,000 is the budget to cover everything in terms of staff and all three processes that I just discussed.

L. Reid: What criteria were used in the selection of the committee's members?

Hon. E. Cull: As I just said, we made the decision to have half of the committee come from the provider groups and half from consumer groups. We wanted a geographic balance, gender balance and representation from ethnic and aboriginal communities. We had a look at the provider groups and tried to come up with a list. We had a look at the consumers, if you like, and tried to provide some categories to put consumers in. I think the list came up to a committee size of about 125, and we pared it down to something that we thought might be workable. The 24 people proves to be a very workable committee.

[ Page 2888 ]

L. Reid: Many groups in the health care field have told us that they are not adequately represented on your committee. They were not asked, or they were asked and their input was disregarded. Will the minister agree to outline a process? I understand your criteria, but once you had your criteria in place, how were the individuals selected beyond that?

Hon. E. Cull: We made it very clear....

Interjection.

Hon. E. Cull: There are a number of people on this list who would be very upset with that comment, I tell you.

We made it very clear to all of the provider groups that we were not asking for representation from provider groups to sit on the minister's advisory committee. For example, while we have four doctors on the minister's advisory committee, no doctor was asked to be a representative of the BCMA or PARI or the college. None of the nurses were asked to represent the RNABC or the BCNU. The reason we did that is that we wanted the expertise of providers at the table, not necessarily the expertise of their organization. We made that decision because we provided a separate process for the organizations. We think it's very important that we know what the physiotherapists' organization thinks about the recommendations in the report, but we also think it's important that people who provide direct health care services come and represent themselves strictly as a provider and not as an official delegate from an organization. By separating those two processes, I think that we have achieved a really interesting quality of discussion at the minister's advisory group. We never end up with a situation of official positions of organizations getting in the way of some pretty high-level and free-ranging discussions.

L. Reid: I now know who did not make it onto the committee. I need to know how the folks who are there were selected.

Hon. E. Cull: As I said, we drew up a list of provider groups and realized that we couldn't get them all around the table, so we made some decisions about them. We drew up some categories of consumer groups and did the same thing recognizing that we couldn't have everybody around the table. We then sought people through discussions with ministry staff and other individuals who were knowledgeable in the area of health care about who might be a good representative.

For example, when we were looking for somebody to represent the public health field, John Blatherwick came to mind. He is highly regarded by his peers. He represents a very dynamic and progressive public health unit. When we were looking for somebody from public health, there were a few other people we could consider, and they were on the list. We selected Dr. Blatherwick in the end because when we were looking at the other criteria I mentioned -- geography, gender, ethnicity, etc. -- he fit the needs as we were trying to do all the balancing.

We were looking for somebody from a large hospital, so we thought about some of the large teaching hospitals. There are only so many teaching hospitals in British Columbia. Dr. Lionel McLeod was selected to represent a large hospital. We were looking for a small hospital in a more rural area. At that time we were also looking for somebody from the Fraser Valley, so we went to John Tait of Mission, who's the board chair there.

It took us quite a bit of time. We've spent at least two months, maybe longer, going over these lists trying to make sure that we had people who would be respected by their peers for the category, if you like, that we were selecting them by. By and large, I think we did an excellent job.

L. Reid: I appreciate your opinion in terms of doing an admirable job. My sense is that it was somewhat hit and miss. It depended on who you had a discussion with and who you didn't in terms of whether or not that was balanced out. In terms of somebody who is going to be respected by their peers, I think you ask their peer group. I'm not clear that you've indeed ended up with the best mix.

We're also curious that you've appointed an advisory committee and then gone forward with the implementation of some of the recommendations prior to them reporting. Again, what is the necessity for a committee if your work will be done before the committee reports?

Hon. E. Cull: I haven't heard any group complain about any of the 24 individuals on my committee. If there are groups who don't feel that the individuals they think are representing them.... Let's remember, no one is representing an organization, and some of these people are wearing two, three, four hats, so I'm not even sure how, in some cases, people know who their representative is, because they're multipurpose. I haven't heard anyone saying that any of these 24 individuals are not of a very high calibre and highly respected in the area in which they work.

[9:15]

With respect to your second question about implementing the royal commission, we weren't going to stand still on November 12 when the royal commission came down. In fact, health care in this province has been standing still for the last 20 months in many ways. The royal commission gave the former government an excuse not to move forward on any of the major health care reforms that were starting to be put in place all across Canada. We were not going to miss this budget year or this legislative session, so we have started through a process of internally determining the general principles that the government can support that we think have widespread support in the general community -- and certainly when I talk about those five principles anywhere around this province there is support for those directions -- to use that as a guide for getting on with making the decisions.

[ Page 2889 ]

We had to make decisions about budgeting this year. We could have made decisions that froze everything at the status quo and left those people who have been starved for support, particularly in the areas of mental health and native health, out there for another year. We could have ignored the AIDS community, which was shut out by the former government, and said: "Sorry, but we're reviewing the recommendations. Come back to us next March, because we haven't got time to get the review done before this March." That was simply not acceptable, so we have started to use the principles that we've been able to distil from the report as a guide to our day-to-day decisions. I think that's prudent, because it's moving us in the direction we will ultimately be going in.

When it comes to those complicated recommendations, such as how you really make regionalization work or whether we could give regional budget envelopes, we haven't addressed them. We have wisely set those aside in order to consult with people, to work through a process and to find out what the options are.

L. Reid: What activities, what consultations, has the advisory committee undertaken so far? I'm interested in the consultations they've had, whether or not they've produced any papers for your perusal, and what you can possibly tell us about their findings or their recommendations.

Hon. E. Cull: The terms of reference which I very quickly outlined to you a few minutes ago did not include public consultation by the advisory committee. That is not part of their terms of reference. The advisory committee is designed to give advice about the recommendations to me and to ministry staff.

What has happened is that we've had six meetings of the advisory committee, of which I've attended all but one. We have gotten together to discuss quite an extensive list of things. We've had people come in and give presentations to us -- for example, at our last meeting we had Fraser Mustard come in and talk to us about population health. We've had presentations from some of the ministry staff who are working in the working groups. We've had presentations from other ministries about aspects of their portfolios that are relevant to our discussions, and we had a presentation at the very beginning by one of the commissioners from the royal commission, to set the agenda.

Just quickly, if I can run over the list for you, we've talked about government decision-making, attitudes towards health care and barriers to change. We've done quite a long section on the acute-to community-care shift, which was redefined by the advisory committee to strike out the word "shift" and to talk about a continuum of care. We did some work on a vision statement for the health system, which was started and has been set aside while we do some more work. We've talked about regulating the professions, governance and accountability, the healthy-public policy, principles of resource allocation, social determinants of health, and system management issues such as utilization, quality assurance and effectiveness measures. For the rest of this month we have on the agenda the beginning of the outline of the action plan, the vision for the health system and health goals -- we'll be doing that later in July -- and looking at the models for some of the governance structures, which gets us back to that regional question again.

L. Reid: In a press release on March 12, the minister said she would wait until after October to release the government's response to the royal commission's recommendations, which would set out the priorities and how they will be implemented. Since the minister has begun to implement some of the report's recommendations, we have to assume that she has decided on her priorities and how she will implement them, well ahead of her anticipated schedule. Can she tell us her government's priorities and how they will be implemented?

Hon. E. Cull: The school meal program was a recommendation of the royal commission. We have implemented that. Surely the member is not suggesting that because the royal commission made a recommendation, we not implement it while we do this study over the more complicated recommendations which do need further study. Surely the member is not suggesting that we shouldn't have gone ahead with the hepatitis B vaccination program, which again was a recommendation of the royal commission. There are many day-to-day decisions that had to be made, particularly when you're talking about spending $6 billion, which is approximately what the health care budget is. Unless we avoided the royal commission recommendations altogether, there would always be some that we would be implementing. It would have been ridiculous to have put together a budget representing a third of all provincial expenditures which deliberately avoided implementing any royal commission recommendations. That just doesn't make sense.

L. Reid: The question pertained to your priorities. You mentioned the school meal program and hepatitis B. If indeed those are the priorities of your government, admirable. I'm interested in the priorities that you wish to go forward with. I trust there are more than two items on the list.

Hon. E. Cull: Mr. Chair, I think I covered our priorities extensively in my opening remarks. I'd suggest that if I spoke too quickly and the member wasn't able to take down the notes about those priorities, the Blues will be out tomorrow and she can refer to them and we can go back to that.

L. Fox: Prior to moving off the advisory committee, I wanted to ask a couple of questions specific to this. I'm aware that many municipalities, regional districts and hospital districts in the north wrote the minister requesting that a northern individual be placed on the committee. I personally wrote the minister a letter along those same lines and as of yet haven't got an answer. So I'm asking now: was there ever a northern individual, and who might that be?

[ Page 2890 ]

Hon. E. Cull: Initially the committee had Pat Harris from Prince George, who -- if I can just tell you who he is -- is not on the committee right now. He had to drop off for other reasons, and we've replaced him. I'll tell you about that in a second. He's been employed by the B.C. Paraplegic Association for ten years as a regional consultant.

We also have Ruth Westcott from Dawson Creek. She's an occupational therapist who has worked in the field of adult and youth rehabilitation since 1958, working with seniors, children and adults, and she has extensive experience in both clinical practice and administration.

Because Mr. Harris had to leave the committee because of health or travel reasons, I believe, we have recently appointed Rick Sullivan from Kitimat. I don't have his CV in front of me, but I believe he is on the Kitimat hospital board, has been serving on the board for some time and is active in his community.

L. Fox: I'm pleased that the minister has responded to that surge of letters and, in fact, appointed another individual. There is one question that would satisfy me with respect to these commissions. Having served on several provincial-scope committees, I recognize the difficulty of appointing somebody to look after every interest group. I recall some of the arguments when I was first appointed to the Round Table on the Environment and the Economy, and specifically from the environmentalist point of view on who was supposed to be representing whom. I guess I could be satisfied if the minister could assure me that the recommendations that come to the minister from the advisory committees, where they have a direct effect on an organization, were going to be filtered through those respective organizations prior to any implementation or policy change by the ministry.

Hon. E. Cull: I explained the three-part process. The short answer to your question is yes, because of the way we have structured the process, recommendations that affect organizations, particularly the provider groups. It's a little more difficult with all of the consumer groups, because there are so many of them, to ensure that we've touched bases with every one of them. But the provider groups will certainly all have opportunity to comment not only on the royal commission recommendations but on the action plans that are being prepared by the ministry.

We have also tried a unique idea where these working teams that we have in the ministry are not just ministry staff. It would typically be the case that you just have employees do this work. We have invited in other individuals from outside the ministry -- from unions, from some of the organizations, from different health issue groups, if you like -- to sit on these committees. That's quite a commitment of time, and not everybody is able to put that many hours and days into this work. So the number of people -- because we're not paying -- is somewhat restricted. Still, I've been quite impressed with the number of individuals who have been willing to give up their time to work with the working groups.

The other thing that I hope will give you some more confidence about it is that all of the advice that is being sought right now is going into producing an implementation plan. It's not going to be a report of the advisory committee; they're not producing papers or anything like that. It's not a report of the stakeholder round tables or of the working teams. It will be a report that I will take forward and put out as our implementation plan next November.

As that report comes out, there will be all kinds of opportunity for people to react, reflect and make suggestions as we move forward. We want to take the report from 300-plus recommendations and say: "Here is what we're going to do; here is what we're not going to do. Here's what we've already done perhaps, and here are some things that require some more work because they are complicated and have unsure outcomes. This is the process that we're going to use to take them forward."

L. Reid: The Minister of Health has spoken a lot about her commitment to community-based health care, both now as a cabinet minister and when she was in opposition. The official opposition supports the concept of community-based health care. We agree with the thrust of the royal commission. We believe that bringing health care closer to home will help put a human face on our system of health delivery. We believe that everyone should have the opportunity to make choices about how they are cared for.

We have, however, serious concerns about the implementation of this shift -- or continuum -- in health care delivery. There must be adequate planning in place, and the money that is used to fund the change must be allocated appropriately. The minister has forged ahead and begun to implement her community health strategy. However, we are concerned as an opposition that there may have been a lack of planning before she started this process. Successful planning for government initiatives is much like planning in the private sector. One must look carefully at the feasibility of the proposal, ensure that appropriate support for the proposal exists, ensure that the capital to fund the project is secure, and then have a plan to ensure that the shift is smooth.

We in the official opposition recognize that a shift, or a continuum of community-based health care, is a major undertaking and will have ramifications across the spectrum of our health care system. In light of this, we are concerned that not enough planning has gone into shifting us to community-based care. We are aware of this minister's commitment to produce a plan outlining how her government will implement the recommendations of the royal commission, and we know that given the commission's emphasis on community-based care, it will include the government's strategy. However, since the minister has already started in this direction, can she outline her strategy now?

Hon. E. Cull: I have been accused by some in the past of trying to create employment for planners, being a planner myself. There are essentially two broad 

[ Page 2891 ]

schools of planning theory. To my mind, one of them is headed up in some ways by a man called Daniel Burnham, who had the motto: "Make no small plans." He was of the school of city planning that planned the grand boulevards and the whole major rescaled development of downtowns. The other school of planning says that life goes on, you try to do some incremental planning, you work with things as they evolve and you keep trying to.... You know where you want to go, but you don't have your plans fixed and etched in stone, and you don't make big plans.

[9:30]

I think there may be a time for both kinds of planning, but in a field like health care, where we are essentially trying to shift a supertanker, to turn it in another direction, we need to have a vision of where we're going. But we need a very flexible planning process that allows us to work sometime in advance, to see where we're going and then to stop and say: where is this going? How are we getting there? Is this successful? We need to adjust those plans and to keep monitoring and adjusting as we go along, because we can't just set the course over here and then, having done all our planning and everything, get there and discover that there's a rock in the way. We may not be able to set that course at all in the end.

The approach we've taken is to start very small. In our funding allocations this year, we have essentially made a 2 percent shift -- 2 percent from hospitals, 2percent from the Medical Services Plan. That is minute in the scheme of a $6 billion budget, when you really look at it. Some people have argued it should have been 1 percent; some people have argued that it should have been more. Perhaps as we go through evaluating it this year, we'll discover that it should have been somewhat different. But you have to start somewhere. We have responsibly started small so that we could address those priority areas that I touched upon in my opening remarks, knowing full well that we haven't done the job of community care this year, that we haven't completed everything that has to be done. But we've at least started in the right direction, and we're in a position now to be able to evaluate, monitor, fine-tune and retool the plan.

L. Reid: This budget shifts dollars from institutional care to community health care. Can the minister outline for us this evening what processes she has put in place to ensure that there are appropriate supports in the community for her health care plan? How will you know when you're successful? What possible outcomes are you going to measure?

Hon. E. Cull: We have started this year to put in place a consultation process that has involved union boards of health, regional hospital districts, hospital boards and other local community groups that have a presence in the community and can be consulted about the allocation of health care dollars.

We have moved very quickly through this budgeting process, because the longer we talk about how to spend the money, the longer it will take us to actually get those services in the community. There is a need to get them up and running, so that as the hospitals are making their budget decisions, there are services to start working with in the hospitals, so the integration of the shift from institutional to community care can be as smooth as possible. We plan to extend this process and improve on it next year. As soon as we finish this process, we'll be starting the budget-building process for next year. We'll be working with a broader range of groups this time around. We'll start doing some work in advance of budget-planning so that we have a very clear idea of the priorities for different services and where the money might go in different communities.

L. Reid: I appreciate the comment that you will put consultation in place. I need to know how you're going to measure success. Is there a vehicle? Is there some kind of measurement tool? Is there something beyond simple conversation that's going to determine whether or not this is a reasonable shift for taxpayers' dollars?

Hon. E. Cull: Part of that is in place, and part of that is being worked on as a result of our work around the royal commission. Let me talk about the latter half first. One of the things that I think we need in this province is a set of health goals, so that we know what we're trying to achieve. There will be a number of outcomes under those health goals that we would be attempting to influence. I draw your attention to the Ontario ministry paper as an example -- maybe not a blueprint, but an example -- of something we might have a further look at. We have started that work through the advisory committee and through the working groups in terms of looking at what health goals might be for British Columbia.

Right now we are already in a position to be able to monitor quite a range of health-status indicators -- everything from infant mortality through to death from various causes. You may have seen Geography of Death: the Mortality Atlas of British Columbia, which we just co-produced with the University of Victoria. There are a number of things that we can track over time to see where the problem areas are. In fact, we use that information, particularly where we are aware that the health status of a region or a local health area.... There are 79 local health areas in the province. That gives a fairly fine breakdown geographically. We can look at areas that have lower health status than the provincial average and target resources to them. We've done that this year to a considerable extent, but we are constantly refining the process. It is important that we direct resources to those areas that need them most. It's more than just simply population or demographics; it should also be health status. That will allow us to get at some of the underlying causes of why people are less healthy in some parts of B.C. than in others.

L. Reid: Speaking as an educator, I truly support the notion that goals are important. What I heard you say is that we don't have a set of goals yet. They're in progress, and we'll get there. Failing that, does the minister have any B.C. information to support her belief that an emphasis on community health care will be a more efficient model for health care delivery than one 

[ Page 2892 ]

that relies on institutional care? I too have read the Ontario studies. I want to know what has happened in this province to suggest that this is a reasonable direction.

Hon. E. Cull: By "more efficient" does the member mean less costly, as she said in her opening remarks?

L. Reid: No. My opening remarks suggested that this system will not necessarily cost fewer dollars. It will not necessarily be responsible for eating up more of the taxpayers' dollar. My question to you was on the efficiencies in the system. Currently we don't have any. We have no way to measure success. I heard you say that at some point we will have those tools, those vehicles. What B.C. information do you currently have that is allowing you to decide whether or not this is a reasonable direction to be heading in?

Hon. E. Cull: I'm still a little puzzled by the response to my question, because I'm not sure how the member is using the word efficient. If she means that community care is more efficient than institutional-based care because it is less expensive, I have never said that and I don't believe the Royal Commission on Health Care and Costs has ever said that. It's not a question of costs. The reason that we are shifting resources closer to home -- whether that's metro to the regions or institutions to the community -- is not to save dollars. In fact, we've put 4.7 percent more funding into health care this year than last year. The proportion of the provincial budget that goes to health has remained constant over at least the last five years. We're not trying to economize there.

We are trying to provide a higher quality of care. People generally want care closer to where they live. Seniors particularly prefer to have care in their own homes, if they can maintain their independence, rather than to have to move into an institution. It's a question of the quality of care that we're able to provide that leads us to have a commitment to community-based care. When you ask about the research that supports community-based care, I point you to the Royal Commission on Health Care and Costs, which spent 20 months, heard from thousands of individuals and received hundreds of reports. If you question that as being simply a discussion paper, then look at the six or seven other royal commissions that have been done on health care across this country over the last decade, and you'll see that every one of them recommended exactly the same general direction.

L. Reid: I'm going to be really precise, because obviously we do not have an answer to the question. How are you going to measure success for your new continuum of care? If you're not prepared to call it a shift, I have no difficulty with that. I understand that you're going to have goals in place at some point and that there's something we're going to look at. Is your ability to assess their effectiveness going to be based on conversation, dialogue? I need some discussion on this.

Hon. E. Cull: It's going to be based on things like the number of people who are served, the number of services that they are able to receive and the quality of those services. Because we're talking about a vast array of services here -- everything from pregnancy outreach programs, to women living in rural communities, through to senior citizens living in downtown Victoria -- the measures are going to change.

For example, if we take the latter group, we look at things like the number of months someone has to be on a waiting-list before they get the care that they need. We look at the number of senior citizens who are hospitalized. We look at the length of time that they stay in hospitals. We look at things like the age at which seniors have to leave their homes to move into institutional-based care. Those are examples of indicators that we can use to determine that we are having a positive effect through our program.

If we look at some of our preventive health measures, such as hepatitis B or.... Let's look at hepatitis B. We will be looking to see the number of reported cases of hepatitis B declining over time through our vaccination program. If it isn't, then we know our vaccination program isn't achieving the objective that it should be achieving. Generally, vaccination programs do have that kind of success rate. There's an example of something.

I could take up all the time we have for estimates going over each and every program and talking about which indicators we would use for each program, but essentially the program is designed to effect some kind of health status. There are indicators that it's designed to address, and we monitor those constantly.

L. Reid: Hon. minister, we heard you talk about the numbers served and the variety of services provided. I have no difficulty with that. But are you saying that the same measurement tools that are currently in place to examine the system we have will also be in place to examine this new community care system? If that's the case, what is dramatically different about your community care system?

Hon. E. Cull: I don't think the fact that you have an outcome or an evaluation program is the critical difference between what has been done in the past and what is going to be done in the future. The difference in our community care program is that we are going to increase services in communities, move services closer to home and have those services far more under the control of local communities than they have been in the past. That's the significant difference that we're bringing about through our reform of health care.

L. Reid: It presents us with a bit of a curiosity, hon. minister, because you are somehow suggesting that an evaluation process or an outcome process is not the only way to measure effective health care. Yet on the other hand, you're looking at an auditing process under Bill 71 and suggesting absolutely that you need to get in there and look at the details to decide if something was billed appropriately.

[ Page 2893 ]

The Chair: Hon. member, the examination of legislation is not appropriate in the minister's estimates.

L. Reid: If that example lends anything to my question, it's simply that I don't see -- and I certainly have not heard from your comments this evening -- that there's going to be anything dramatically different in how you evaluate this program. My earlier understanding was that it was going to be somehow different.

Hon. E. Cull: I'll repeat it again. The difference is not in our evaluation techniques, although certainly any progressive public service organization constantly looks at how it monitors and evaluates programs. If the Ministry of Health, prior to the change of government, had not been doing any program evaluation, then there would be a significant change being brought about by this government. Clearly program evaluation is essential in any organization, public or private sector.

We have, in the ministry, developed objectives for programs. We have programs designed to monitor outcomes to see whether those objectives are being met, and we are establishing them. The big change in this budget is not a new evaluation system; it's a shift in the emphasis in our health care priorities. As we make this shift to more services to seniors in their homes -- let's look at adult day care or quick response teams -- we will continue to monitor those to see whether they are being effective in achieving our goals and our outcomes.

[9:45]

The outcome, again, is not to save money, but to ensure that we provide a higher-quality of service to people in this province. We define higher quality service as being more readily accessible to them, closer to home and easier to get into. You can look at things we can do, where we take services from an institution which a smaller number of people may be able to access and convert them into either an out-patient or a community-based service, where many more people have access to the service. The quality of service should be the same or improved, but the access is greatly enhanced. Those are the kinds of indicators that we are going to be looking at as we evaluate our shift into community-based health care.

L. Reid: I have spoken with people from unions, hospitals and other sectors of health care. Almost without exception, they have expressed grave reservations about the lack of consultation. There is an unease, hon. minister, in the health care sector in general, because the stakeholder groups haven't got a clue what's going on and what the future holds for them. Most of them are worried because they weren't consulted or even informed about the changes the minister has begun to make in health care delivery. My colleague from Prince George-Omineca talked about advertisements for 700 new jobs. What retraining programs, hon. minister, will your government be putting in place for the existing health care workers in this province?

Hon. E. Cull: I'm pleased to get that question, because we're actively working right now with the three main hospital unions to develop a labour adjustment strategy. The components of that strategy include data collection as to the impact of the hospital budgets on employment in the various hospitals. We're looking at ways to access federal government relocation assistance. We're looking at retraining, particularly short-term retraining for those individuals who are currently in institutions who may need a little help to make the jump from institutional care to community-based care. We're looking at processes which would, I guess, be called underimplementing when we do the hiring, so that we hire people who may not have all of the qualifications that one might normally look for but are close enough so that with a little bit of training, on-the-job training or upgrading they might be able to adequately perform that job. We're also having a look at our qualifications to make sure that we're not requiring things that are unnecessary, so that we can ease the transfer of people from institutions to the community.

We're also working with the employers to look at the contracts that cover the various unions, so that there are not contractual barriers to people moving from one part of the system to the other. In many cases, some of the biggest obstacles that we have to overcome are contractual, but I think that there's a lot of goodwill on both the employer side and the union side to try to address them and reduce them to the greatest extent possible.

L. Reid: I thank you for your comments. However, I can tell you that the federal government relocation program will do nothing for the health care workers in place in this province. They are not all that enamoured with your proposal to hire out of province. They want some reassurance that there are some in-house, in-province training programs in place, and you have not reassured me in any way, shape or form that that's your intent.

Hon. E. Cull: When I answered the member for Prince George-Omineca the other day, I made it very clear that our hiring policy will be to hire first those individuals who are being displaced from British Columbia hospitals; second, people in the communities; and third, people from British Columbia. We will go fourth to out of province, because there are some occupations -- public health inspectors, if I'm correct -- where there are simply not enough trained individuals in this province to meet the need. We can either not provide public health services to the rapidly growing areas of the province while we train people over a number of years, or we can recruit outside. But we will certainly look everywhere within British Columbia to fill those jobs first. We are, as part of our labour adjustment strategy, ensuring that we have a clearinghouse to make certain that all of those jobs are funnelled through one point and that people who find themselves either wanting voluntarily to make the move or having to make the move because of hospital layoffs will have one point of entry to access those jobs.

H. Giesbrecht: I'd like to make a few brief comments on the issue of hospital funding, or at least to try to keep them as brief as possible. In view of the fact 

[ Page 2894 ]

that I delivered 8,000 post cards to the office of the Minister of Health today, I think I should make some remarks on the issue and how it affects my constituency.

Northerners value their health care service quite highly, especially in remote areas. When I came to Terrace in 1967, it wasn't uncommon to have people talking about going south for various services. For some time in those early years we had one surgeon in Terrace. Needless to say, the gentleman was very busy and the workload very heavy. In fact, the fund-raising foundation is named after him because of that. It's much improved, but not without the work of an awful lot of dedicated volunteers, medical professionals and staff. It wasn't always easy to recruit doctors in those days, because Terrace was still considered somewhat isolated. We value our health care substantially, because the option, of course, is to go south or to Prince George, and that's extremely expensive. It's estimated that it would cost a person about $1,000 to get special services in Vancouver. That doesn't, of course, include the inconvenience or the days off work. Depending on whether or not someone has to go with a spouse or a member of the family, it can be an extremely costly venture. Over the years, of course, many people have developed health care services in the Skeena area, and the results are obvious today.

Both of the hospitals in the Skeena constituency have received a freeze in funding. Of course, that has an awful lot of people distressed. Any freeze is considered a reduction and a backward step for people in Skeena. Once beds are lost, they are basically lost forever. I'll go into that in a bit more detail.

What I think makes the concern so acute.... I have to express this on behalf of my constituents. I'll read a section from a letter that I received a copy of. It's from the chairman of the board to the minister:

"In February of 1991 a Ministry of Health review team conducted an operational review of Mills Memorial Hospital, and although we have never seen the full and final text of that document, we have been told the final recommendations included a recommendation for increased funding.

"Then in the summer of 1992 the Ministry of Health and Mills Memorial Hospital mutually agreed upon an external consultant whose mandate was to review all areas of the hospital's operations. This review was fully funded by the Ministry of Health, and both parties agreed before the fact to be bound by the recommendations. The review concluded the hospital was providing services appropriate to the needs of the population it served and is a busy hospital with a higher caseload than other hospitals in its peer group because of the growing level of referrals from communities other than Terrace."

"The consultant concluded the hospital was underfunded by $229,500, and directed the Ministry of Health to provide an adjustment to its base grant of $145,375. The consultant was also very specific in the numbers and types of staff required to provide the services, and also recommended the hospital be funded accordingly. The Ministry of Health conducted a follow-up mini review on May 7, 1992, and concluded that Mills Memorial Hospital is efficiently run and that the extra funding recommended by the consultant be continued."

I read that simply because, having gone through that process one year ago, it makes the concern of the population quite acute. I would ask the minister to respond to some of those concerns when I'm finished.

Part of the difficulty, I guess, is that they see what we have now, and they're trying to look ahead to what we may have. It's certainly an old adage that a bird in the hand is worth two in the bush. That may be the cause of some of the heightened concern. I realize that there is a great financial dilemma. I must say that over the past six months, particularly on this issue, I've had many an unkind and uncharitable thought about the previous administration, its extravagant waste of resources and its financial bungling. I have had many unchristianlike thoughts about the federal Tories for their offloading of health care costs onto the provincial governments. All of that is fine and nice to vent...

Interjection.

H. Giesbrecht: Yes, I said unchristianlike. ...but it doesn't really deal constructively with the problem. It is, however, quite difficult to ask a constituent to accept a reduction in service based on some of those items, because health care is one thing that touches us deeply. There's a delicate balance which has consistently been talked about in my constituency, and I've received numerous letters from people about the delicate balance of a hospital in the north.

I'd like to read another paragraph of a letter I received from the chief of surgery of Mills Memorial Hospital. It's addressed to me, and it says:

"Beds would have to be closed. This would result in longer waiting-lists for surgery. The department of surgery is stable at the present time; however, by closing beds, the level of work would decrease. If that is the case, then one or both of the anaesthetists may well be forced to leave. Should that happen, then the department of surgery would collapse and disintegrate. This would result in a loss of surgical services at Mills Memorial Hospital."

I guess what it means is if you only have one anaesthetist, the other one doesn't want to work 24 hours or be on call 24 hours, so they might leave. That, of course, undermines the whole surgical wing of the hospital.

"All complex, high-risk surgery and the majority of elective surgery that is done here now would have to go elsewhere. It has been difficult to attract Canadian-trained graduates here, and the hospital has been fortunate in being able to recruit several well-trained foreign-graduate specialists."

It goes on to say:

"A bed closure may result in the closing of the pediatric ward. Should this occur, our pediatrician will be forced to relocate. All seriously ill children would have to be flown to the lower mainland for care. The same dilemma will occur with our cardiologist. There would be no one to look after people from this region with complicated heart disease or other internal medicine problems."

Interjection.

[ Page 2895 ]

H. Giesbrecht: It addresses the issue of the delicate balance and basically the onion-skin theory: if you start peeling away from the outside, eventually some of the structure starts crumbling. It's a concern to my constituents up there. I don't have to tell you, hon. Chair, that the minister was up there the other week. We had some good meetings. I'll come to the results of those in a minute.

I want to read one other passage that came from Dr.Strangway, who wrote me. I should say here that Dr.Strangway happens to be my neighbour, so I know how hard he works. Also, throughout this whole six months, he has addressed the issue of hospital care above anything else. We don't talk over the fence very often, but occasionally he has bent my ear on the subject. He says:

"You should be aware of the delicate balance that we have in our region between good service and no service. The general surgery department at UBC has made a recommendation that there should be no solo general surgeons practising in B.C. and that ideally there should be four general surgeons working together to share the night call. Also, recent trainees wish to limit themselves strictly to the field of general surgery. Because of our limited subspecialty services, we will have difficulty for the long term in recruiting anaesthetists."

It goes on to say something basically similar to what I read from the other letter.

[10:00]

The problem is that it eventually wears away at the service that we presently have. We're a regional facility in Terrace. What's happened over the years is that they have divided up the specialists: Terrace specializes in one area -- the ENT specialist is in Terrace; Kitimat has just recruited an orthopaedic surgeon; and there's another in Prince Rupert -- I can't pronounce the term, and I won't try. There's been a division so that there isn't duplication of service. There is real fear that that is going to be eroded by not increasing the funding to cover the cost of inflation.

There's a community health focus, and I have not been anywhere in my constituency where somebody doesn't say to me that it's a good idea. Certainly the government can take a lot of credit for that. It's a good program, and it deserves support. Anybody would agree that an ounce of prevention is always worth a pound of cure. The service in Skeena is not yet in place in such a way as to reduce the acute-care demand, and so there's little reason for comfort among my constituents for that being the sort of saving in all of this. If their fears are realized -- and this is what concerns me -- there will be many more trips down south at very high cost and inconvenience.

What also has to be understood is that if you can't get the service in my constituency and you have to fly south, that's not always an option either. I don't want to go into sordid details about my travelling experiences over the winter months, when we couldn't get out for days at a time due to fog. As recently as a week and a half ago, a patient in the Kitimat hospital waited 48 hours for a Medivac that couldn't land because of fog conditions, and the patient died. Whether or not it was due to the 48-hour wait, I don't know, but it certainly is one of the things that has to be considered when we're cutting the cost of health care in the north.

I was extremely pleased last week that the minister came up to Terrace and met with the groups. We had some good, productive meetings, and out of that the minister announced that a special review team would be put in place and would make a report by August 15 on the hospital services in the Terrace, Kitimat and Prince Rupert areas. That has given us somewhat of a reprieve. People are still anxious, but it's certainly something that may alleviate the problem.

I have some questions I'd like the minister to address. I'd also like her to respond to some of my remarks. I have three questions here. Firstly, with the level of uncertainty which presently exists pending the report, what instructions could you give hospital boards in the meantime? Secondly, does the special review team's mandate include a review of the hospital funding levels, or is it only to consider how to meet the current funding level, or last year's level? Thirdly, a hypothetical question: if the review finds that additional funds are necessary, will they be made available?

[M. Farnworth in the chair.]

Hon. E. Cull: I'm very pleased to be able to have the opportunity to talk about the decisions that were made around hospital funding this year and to be able to respond directly to the member's questions with respect to his communities in the northwest.

Let me just start with the specifics. Some comments were made about a report that was done, I believe, over a year ago. It is known as the Walker report, and it recommended $145,000 in additional funding to Mills Memorial Hospital. The recommendation was that $145,000 be added to the hospital's base budget on a one-time-only basis, until they put in place other measures to change the way they were managing the hospital. That money was made available to them last year. We have continued that funding this year, so the $145,000 continues in the base budget for this fiscal year as well. I might add that in addition we've approved another $50,000 for the diabetic day care program. We are still working with that hospital on the recommendations that have to be addressed out of the Walker report before this money will be automatically continued in the base, so there's a bit of work that has to be done before that can go into place.

What I want to do is just step back a bit and talk about how the hospital funding decisions were made, because I think they are very important. I made the comment in my opening remarks that we provided a 5.5 percent increase in funding to hospitals this year. About half of that money right off the top went to new beds that are being opened this year, beds that were opened partway through last year and were not fully funded because they hadn't been there for a full year, and those high-priority programs that I mentioned: heart, cancer, AIDS and kidney dialysis.

We had to make a decision about how to allocate the remaining money across the acute-care facilities, and we could have made the decision to take that money -- approximately 2.5 percent -- and distribute it equally 

[ Page 2896 ]

across the acute-care hospitals. To do that, while it might have appeared to be fair from a very cursory examination, would have been really unfair, because it would have ignored two important factors. The first is that some areas are experiencing extreme population growth, and their services are actually falling behind every year if beds are not keeping up with the growth of their population. We have that problem right now in the Fraser Valley, particularly in Surrey. I recall one of the members who represents Surrey saying to me that if we could get the royal commission minimum bed amount of 2.75 beds per thousand, we'd be in heaven, because we don't even have two beds per thousand population in that area. So some parts of the province are experiencing a lot of population growth and therefore require extra resources.

The other problem with just giving an across-the-board increase to every hospital is that we'd also have to assume all communities were equally well served by acute-care facilities. That goes back to the example of Surrey. They have less than two beds per thousand and they are not served as well as Terrace, which has six beds per thousand population. We tried to make some adjustments that would recognize population growth and the relative level of services already there.

What we did was look at the average number of beds per thousand population in British Columbia today, which is about 3.3, and at the royal commission, which said 2.75. We came down pretty well in the middle and said: "Let's use three beds per thousand as a rule of thumb." If you translate those beds into patient-days -- the number of days of hospital care that exist in a community -- three beds per thousand translates roughly into about 900 days per thousand population. That allows for those beds not to be fully occupied all the time, but 900 days per thousand population was used as the guideline for what the average level of servicing was throughout British Columbia.

We recognize there are parts of B.C. that have special circumstances. The north clearly has special circumstances. I lived in Prince George for enough years to know that for a number of months of the year, getting around is not always the easiest. The geography is very difficult in some parts of the province. You're looking at areas that, from a mileage point of view, are very close together but on a map are going up and down a mountain range. There are some things that we have to consider in the outlying provinces.

Another aspect of that is the level of community facilities that are available there. We said, let's add an additional factor to those 900 days per 1,000 population. Let's add 50 percent to that and say that with 50 percent additional resources, those communities should be able to, despite the other circumstances, provide the same level of care. Maybe it should have been 40 percent; maybe it should have been 60 percent. Some kind of a percentage was struck as a guideline for funding this year. We selected 50 percent. We said that for those communities that have more than 1,400 beds per 1,000 population, there have to be some efficiencies that can be found in those hospital operations.

Terrace and Mills Memorial Hospital has 1,700 days per 1,000 population. Beyond that, they only have a 65percent occupancy rate of those beds. When we looked at a hospital like Mills Memorial, with 35 percent of the beds being unoccupied and with there being 1,700 beds per 1,000 population -- well beyond 150 percent of the provincial average -- we said surely there are some efficiencies that could be recognized in that hospital that would allow it to operate within a more limited budget but still provide the same quality of health care to its citizens. Clearly, if you increase the occupancy rate by 10 or 15 percent, which would not be unreasonable, which would not be a hardship on the hospital or the community, you could serve a lot more people with a somewhat smaller resource.

I understand that what's happening right now in Terrace is a proposal to close 16 pediatric beds and six psychiatric beds. Of the 16 pediatric beds, out of a total of I think 22 beds, only six were being used on average. So we're closing, if they go ahead with that decision, beds that are not being used right now. I think we have to be very careful when we talk about closing beds. We're talking, in some cases, about closing beds that are not in active use in the community. When you talk about people having to go on waiting-lists for a longer time, people having to travel for needed health care, if there are 22 beds and only six of them are being used, closing 16 of them is not going to cause any specialists to leave the community or anyone to have to travel for service. Quite clearly, those are areas where we can economize.

Interjection.

Hon. E. Cull: The member opposite said that I didn't think that when we were in opposition. The thing is that we did argue for those kinds of things when we were in opposition. What we argued for, what I argued for and what I am continuing to argue for is efficient use of our health care dollars. If we can become more effective and not waste money on beds that are only being used at a very low occupancy rate, we can start to deal with some of the other things that that community and other communities in the north desperately need. Most of the hospitals in the north do a very low level of day surgery. We could increase day surgery, which is a lot less stressful for most families, quite effectively by transferring some of the resources from having someone in a hospital bed for a few days to day surgery.

One of the things that most of the communities in the north need more of is detox centres. We could look at those people who have to travel. I accept, in the region that we're talking about in the northwest, that you sometimes have people coming in from outlying locations, coming by boat.... It's not always easy to show up for day surgery. One of the things we could do is look at providing some hostel accommodation for patients who have to come in a day or two in advance of treatment or who may have to stay around for a day or two after treatment so they can be near their doctor. We might even be able to accommodate families so the patient would be able to bring in a family member and not have that person stay in a hotel or, worse yet, stay behind.

[ Page 2897 ]

We are very concerned about the ability of small communities to retain their physicians and to retain specialists. For that reason -- all of those communities raised that question with me when I met with them a week or so ago; I met with the hospital boards and union executives in all three communities, and a number of other groups at the same time -- we announced a special review team. We think it's very important that the decisions that hospital boards make do not impact negatively on the public or on their ability to keep the services that they need there.

To get specifically to the questions that were asked of me, the first one was about what instructions have been given to the hospitals. The utilization review teams are going on right now in some of those hospitals, particularly in Prince Rupert, where it has made that board decide to hold off on making any decisions around this budget. The other two hospitals -- Kitimat and Terrace -- are making decisions within their authority to act as a board. We don't go in there and tell boards what to do or what not to do when making their decisions. In this case, we are providing them with a review team that will give them some recommendations. They will be public recommendations. But boards still have to act responsibly for their own communities.

[10:15]

You asked whether they can look at dollars. The answer is that a special review team's terms of reference are to look at the decisions the boards make and ensure that they are within budget. But I said to all of those boards and all of those people we met with that if we determine that the funding decisions have been made unfairly or on mistaken information, along the lines of what I just described about the number of beds and the occupancy rates, then clearly, if we find a mistake, we will correct that. There's no reason to continue with a decision that may have been made on incorrect information. If on that very narrow basis more money is recommended, then more money will be provided. But it is not for a review team to go in and have a look at overall funding, because what we're really talking about here is equity across the province. As long as the decisions have been made as equitably as possible, giving consideration to demographics, population and local considerations and needs, then that's what we're looking for in terms of funding decisions.

The special review teams are to make sure that hospitals are making the best decisions they possibly can. The review team will be a peer review team, an external review team. I don't think there's anybody who has to make decisions about complex organizations, who doesn't welcome the opportunity for a sober second opinion from his or her peers.

L. Fox: One thing I've noticed in this first session is that when the heat gets turned up at home for the government backbenchers, they provide themselves with a mailer by bringing forth, through estimates, the concerns that they're getting the heat on. The minister gives them the appropriate answer, and they have their mailer. Almost without exception, reference is made to the previous mess. With all due respect, hon. Chair, I just want to reflect on that for a moment, seeing as it was mentioned by the member for Skeena.

Oddly enough, the member for Skeena and I used to really promote services for the north together, as fellow mayors in the NCMA, so I'm not saying this with any.... I am speaking to the estimates, by the way, but I have to make the comment. I just want to reflect on the mess for a moment before I get to my specific question. In my limited knowledge -- and certainly it's been clouded somewhat by the last several months of dialogue from the opposite side -- the budget in 1991 projected a $1.2 billion deficit, when you put into place the BS fund; we could have fun with that some other time. In spite of that, this particular government had the reins for five months, plus they had to dredge up all kinds of old debts. They were still able to make it only a $1.7 billion deficit, even when they paid out all their friends and so on in the first five months. Yet this budget is $100 million more.

I draw that to the attention of the House and to the attention of the audience. I do, however, recognize some of the concerns of the member for Skeena, and I concur with them. I know, as a municipal representative, that we've fought long and hard to improve health services in the north, and it hasn't always been for the lack of money. Quite often it has been for the lack of professionals. That's when I get to my real question.

In talking about community health care, I understand there will be an evaluation process. We will evaluate the programs on an ongoing basis to see whether or not they're meeting the needs and the purpose that we designed them for. If I have one concern in all of this -- not being a professional in health care, I probably can't express it in terms that the health community might understand -- logic tells me that when you're designing a program that's going to displace employees as well as provide for new incentives, new programs and so on, you do it in very small doses. In fact, you might even want to identify two or three areas within the province -- different climates, different geographical areas, some urban settings and some country settings -- to see whether or not these programs really have an opportunity to succeed.

Government is famous for designing programs that fail, and I can talk about education. Even back during 1972-75, there were some programs -- believe it or not -- that failed during that era. Hon. Chairman, when we make this shift on a provincewide basis, it concerns me that we don't try trial areas and design it to use our staff that we're displacing, re-educate them and retrain them, in order to look after the opportunities that exist through the new programs.

The minister says she intends to do that. But I have some problems with that statement when I already see advertisements for individuals in Montreal and all across Canada. It makes me wonder. In one particular segment of this ad, it says "The Ministry of Health and the Minister Responsible for Seniors actively seek applications from qualified aboriginal peoples, visible minorities, persons with disabilities and women." The first thing I see in the ad is that if I'm a white male, don't bother to apply.

[ Page 2898 ]

The second thing I have to ask about the ad is: do we not have any of these groups within the province of British Columbia that we could train to meet the criteria that this government's putting forward, rather than bringing more in from outside the province and continuing to have a high level of unemployment? I'm really concerned with respect to nursing. In her opening statements, the minister suggested that funding for hospitals was adequate. Yet I see more beds being closed, nurses being laid off and HEU workers being laid off. I have to be concerned about what we're going to do with those individuals, recognizing.... I'm not faulting the shift into other areas, but I think we should be designing that shift to accommodate the individuals who are being laid off. If we did it in a phased-in way, on a trial basis in some areas of the province, we wouldn't have to float this big balloon and hire all of these people from outside of the province, and then find out somewhere down the road through the evaluation process that the program isn't working. Now we have all these professionals from outside the province, and we still have unemployed nurses from within the province.

Not only that -- one other aspect of this that bothers me extremely is that we've had young people go into the field of nursing not knowing that this shift was coming. They've now graduated, and they don't have an opportunity for employment, because they were not aware that this was where the ministry was putting its priorities. Consequently, although they're adequately schooled to be nurses, they don't have the qualifications to meet any of the areas you're advertising outside of the province for. Those are some of my concerns with respect to the shift in this program.

Hon. E. Cull: I'm really puzzled. I don't think you listened to the answer I gave about community hiring, when I said that we were first going to hire those people who are being displaced. As you said earlier in debate today, there are some places in this province where some occupations are very hard to recruit. Either you or your colleague sitting next to you said that we have to have foreign-trained doctors in the north because we can't get British Columbians to go and work up there.

Some positions are very hard to recruit in some parts of British Columbia. That doesn't mean that we're not going to try to do it. We are trying to do it through a variety of means. Besides advertising outside of British Columbia, we placed ads in the Vancouver Sun, the Province, the Times-Colonist, the Whitehorse Star and the Yellowknife News, papers that circulate in and around British Columbia and will hopefully attract people to go to those communities. We have made a commitment to try to find people who may be being displaced from employment in acute-care facilities and put those people first into the jobs where that's possible. But, as I said, there are some very specialized occupations -- and some of those are not employed at all in acute-care hospitals right now -- that we have to find and we have to bring into this province, if we haven't got them here. We can't wait and tell a child waiting for speech therapy to please wait for another couple of years while we increase the graduates coming out of there enough so that we can attract a graduate to go and work in Merritt or Fort St. John or wherever we need people.

In your particular area, in the northern interior health unit, we've increased funding for family and community services this year by $950,000. Let me tell you what some of the regional objectives are: to increase general nursing services to 1,100 children; hemophilus B immunizations to 1,300 infants; hepatitis B to 850 schoolchildren; testing of domestic water systems -- as an ex-Prince George person, I know it's a real issue up there; monitoring of the health and safety of children in licensed care facilities, another need that has gone unmet for some time in this province; and resourcing of historically underfunded public health services, particularly environmental health protection, nursing, speech, audiology and dental services.

When you talk about making the change, and maybe there should have been some pilots or something done in a more incremental way, the shift that we've made is pretty incremental. Two percent of the increase that might have been available to hospitals and 2 percent of the increase that might have been available to the Medical Services Plan being shifted into community services is not a major and dramatic switch from where we've been. I think the people in the community sector would say that while the money is welcome, it's not an awful lot in dollar terms.

I think it's important to recognize that the kinds of increases that were going on, particularly in the acute care sector, for the last number of years -- 10, 11 and 12 percent -- are simply not sustainable any longer in this province. They're not sustainable anywhere in Canada. The 5.5 percent that we've given to hospital care this year in British Columbia will be the highest increase in hospital care of any province in the country. Other provinces are having to give absolute freezes. Some are actually decreasing the funding year over year. Saskatchewan has had to cut theirs by 3 percent. Other provinces have had to give very minimal increases.

When you know that the 5.5 percent here in British Columbia is going to be less than what they got in the last couple of years, you know that there's going to be some adjustment. I think it would have been totally irresponsible of us not to start planning to put some of those community services in place immediately so those patients would be able to find care in the community, and some of those individuals in the hospital would be able to find jobs in the community.

L. Reid: I find it curious that you would admonish the member for Prince George-Omineca for not listening to the answer. You didn't answer the question when I asked it. I need to know, and the unions in this province need to know, why you would place an ad in the papers, prior to any consultation with them, about employing them in the province. You made some comment about public health inspectors. Correct me if I'm wrong, hon. Minister, but I can assure you this province is not hiring 700 public health inspectors. Shouldn't there have been some consultation with those unions? Absolutely. Again, I need to know the details of 

[ Page 2899 ]

the retraining programs you are putting in place. You did not answer that question.

[10:30]

Hon. E. Cull: I explained to the member that we are actively working with the hospital unions at this point to put in place the details of that program. We could have imposed it, I suppose, but it seemed a little more practical to sit there and work with them to come up with a solution that they would be able to live with, as well. Unlike some of the other groups that I've had to deal with in the last number of months, they were very willing to sit down with us, very willing to discuss common problems, and willing to come up with solutions for how we go about making that transition work better.

The trade-off that we continue to face today is.... When I talk to people in communities -- particularly the health care workers, because they know the situation the best -- they say to me: "We should not be doing any changes in the hospital sector until we've been able to staff all of those community positions." On the other hand, it's quite clear that if we want to staff those community positions with people who may be losing their jobs in the hospital sector, you can't do one.... You can't go out there and fill 700 positions in the community sector and then start dealing with the hospital. There has to be a matching, and that matching is taking place right now. The ads have been placed. The competitions have not closed, and they will not close for some time. We will be continuing to work with those people who are affected in their unions to ensure that we give first opportunity to people here in British Columbia. In fact, I understand that the greatest expression of interest in the ad so far has been from British Columbia, in any case.

The positions that we're recruiting -- if you want that information, I have the details on it. No, there aren't 700 public health inspectors being hired. In this case there's 24, but there are many other classifications that are being hired.

L. Reid: It pleases me that the consultation is going on. However, the question was: why did those ads go forward prior to consultation? I can table documentation for your reference that suggests that the first opportunity union members in this province had to learn of jobs being available was when they read it in the paper, not when you sat down with the unions prior to that. That is the issue of consultation, and that is what I need you to address.

Hon. E. Cull: I met with the major health care unions immediately prior to the budget on March 26. I met with some of them immediately afterwards and some more recently. We have been talking to them about the shift that is coming about in this province since March. We've been talking to them about the need for a labour adjustment strategy. I would have been happier if we'd had the labour adjustment strategy all in place and tied off in February, before anything even had to come about in terms of change in the community and institutional sectors. It hasn't worked out that way. We're working as hard as we can with them right now. I think we're making tremendous progress in terms of developing a strategy that will serve both the communities and the employees very well.

L. Reid: The concern I have and that the unions in this province have is not with a proposed labour adjustment strategy; it is with consultation and sit-down discussions before they see ads in a newspaper. My comment to you today, hon. minister, is that that did not happen. I'm sure they're prepared to discuss a labour adjustment strategy with you now, but I would submit to you that you have not contributed at all to the ease with which they work in this province. In fact, I would submit that you probably contributed to their unease as health care workers in this province. That is the comment. That is the issue. It's fascinating that there is now a labour adjustment strategy. I need to know why you felt it prudent to move forward with the ads prior to consultation.

Hon. E. Cull: The ads were placed quite shortly after the money became available in the provincial budget. The money has been available since April 1. The advertising process will take many months to complete. Even if we were not extending the closing period, which we have agreed to do as a part of the discussions we've had around the adjustment strategy, I don't think that we could have hired anybody any sooner than September 1. We're probably looking at at least a month to six weeks later than that now as a result of the proposals that we're making through our discussions with the unions. If we'd waited until we had the adjustment strategy in place before we even advertised, we would probably just be able to put the $100 million in community-care funding back into general revenue this year, because we would never have been able to spend it.

L. Stephens: I just have a few questions. I'd like to ask some specific ones about the community health care program. I would particularly like to know whether or not the public health nurse role at the community level will be enhanced. Will we perhaps see an expansion of the public health nurse role back into the schools for some counselling about sexually transmitted diseases, prenatal and postnatal care, some immunization, nutrition and drinking-driving programs -- something along those lines? I would like to know if you have an expansion within this particular budget for any of these public health initiatives to help communities in the north.

Hon. E. Cull: I'm just getting some of the figures for you. Overall, we have made a 26 percent increase in funding to public health programs this year. Let me try to give you some of the specifics that touch on the points that you raise.

There's an additional $1.8 million to provide public health nursing services in schools to 30,000 students, including 4,500 who have special health needs. The 

[ Page 2900 ]

pregnancy outreach program is a very successful program dealing primarily with young women and teenagers, who often have the risk of producing low-birthweight infants because of poor health habits. An additional half a million dollars has been allocated to expand that program to nine communities that have identified at-risk populations. The hepatitis B program is vaccines that are, as I'm sure you understand, targeted to children. If we can get in and vaccinate children, we can prevent some pretty horrible outcomes later from contracting hepatitis B.

We've also put $9 million into the public health area generally, which will include significant increases for public health nursing, speech, audiology, nutrition and dental services. I think you'll be interested in those, given the riding you represent. They're designed to increase the equity of public health services around the province. I believe Vancouver has the highest standard of public health services right now. We are trying to target dollars to those parts of the province which have significantly fewer resources. In the rapidly growing areas of the Fraser Valley, of course, the population growth has outstripped the public health service's abilities to meet all the needs.

In public health nursing specifically, an additional 73 positions have been added this year. If you're interested, I can also give you the regional breakdown of those.

L. Stephens: Are the 73 positions public health nurses who will be in the field, or are they administrative positions?

Hon. E. Cull: They're all in the field.

L. Stephens: Those nurses will be in direct hands-on programs within the communities. Are some services going to be offered to seniors? Are we going to be looking after some of the needs that a lot of seniors have?

Interjection.

L. Stephens: Yes, public health nurses.

Hon. E. Cull: The primary emphasis of the public health funding increase this year is on youth and young people. I draw your attention to the fact that our continuing-care program, which primarily provides services to seniors, has grown by over 14 percent this year. A number of the programs that affect seniors are operated out of that part of the ministry. In addition, mental health programs have received a 27 percent increase in funding. One of the areas that's been targeted there is seniors with psychogeriatric needs. Clearly, that's another area where we've been meeting seniors' needs. Home support services, again targeted very much to seniors, are increased this year by 16 percent.

L. Stephens: The other area that I want to talk a little bit about is palliative care. I don't know if that falls into the community health care realm. It's something that in our community is badly needed. We have two beds designated as palliative care in our hospital, and it's certainly not adequate. We have a large percentage of seniors in my community as well. We do have a community volunteer group that assists through the hospitals. I think we're all aware that the acute-care beds in the hospitals are something we want to use for other purposes. When the royal commission talked about palliative care, there were a number of categories. One is hospital-community partnerships, and there were a number of care pilot projects. I wonder if the minister would care to comment on this and whether or not it's something the ministry is going to continue and expand upon.

Hon. E. Cull: I'm just looking up some of the specific information on palliative care, but I can start by answering the last part of your question first. The hospital-community partnership program is one that we're continuing and enhancing this year. I don't know if you know much about it, but it's a program whereby a percentage -- and this year it's 1.25 percent -- of a hospital budget is essentially frozen, and they get access to it by working in partnership with the community to do something very much like palliative care. Many of the projects that came under the Victoria Health Project are good examples of the kinds of things that are being done through hospital-community partnership -- quick response teams, palliative care, seniors' adult day care programs, geriatric outreach services and the like. That program is continuing. We think it's an excellent program. Like all programs, it could always be improved in some fashion. We have been getting information on where those improvements can be made. It does allow us to address those kinds of needs.

While we're still looking up palliative care, perhaps I can go on and take some other questions. I'll come back and answer that one for you so that I don't have to keep talking while we find palliative care.

K. Jones: I was wondering if the minister could explain to us the reason for the sudden departure of her deputy minister and what at-home program was being administered in order to give her a suitable severance. How much is her severance?

Hon. E. Cull: Before I answer this question, I'll go back to the palliative care. I don't have the details with me here, so I will have to bring that back to you. I will endeavour to do that tomorrow, or whenever we get back into this again and I have had a chance to do it.

The Deputy Minister of Health left because there was a need to make some major changes in the ministry as result of the shifts that we're bringing about in response to the need for health care reform and the royal commission. As I said in my introductory remarks, the changes that have to be made include making changes not only to the health care system outside the ministry but inside the ministry as well. As 

[ Page 2901 ]

we change we sometimes need a new set of skills. That's the decision that was made around the deputy minister. As to whether the deputy minister has decided to take severance or another position in government, I have not yet been advised as to her decision.

[10:45]

V. Anderson: If I can come back to delve a little into that direction, a major focus is the community health care that you've been talking about. I would very much affirm the direction of this program. Community health care means many different things to many people. Even as you just indicated, the shift was necessary because of the deputy minister and different skills. Could you outline for us what, in some people's minds, community health care is? Community health care is having all the care that you need for every focus within your community. Then the smaller communities, as has been discussed by your own backbenchers.... There's one thing in the urban setting; then there are neighbourhoods and communities. Could you elaborate a little bit about what community health care means as you understand it and are developing it?

Hon. E. Cull: Let me start by defining again the Closer to Home concept, because that's very much part of what community health care means. I have always used two definitions around Closer to Home. One means bringing it out of the metropolitan areas of the province into the regions; the other means taking it out of the institutional care facilities and into the communities where people live. It's probably easier, having got that context of what it means -- community-based care that means both -- to then define what is not community-based health care. It's a shorter list, if you would allow me to do that. What is not community-based health care is the tertiary level services; we will always have to go to Vancouver, Victoria or perhaps Kelowna, Kamloops or Prince George for those kinds of higher-level services. It is not acute-care service, which we will always have to receive inside a hospital. Physicians' services and the services of other complementary health care practitioners have not been defined as community-based services for budgeting purposes. They've been treated as something different. But clearly the services that are provided by health care practitioners in their offices and in the communities are in fact community-based services. It's really those higher-level services and the acute hospital services which are not community-based services. I have a listing here of the major areas that we are addressing this year, if that will help clarify it for you. Would you like me to go over that quickly?

Continuing care. That is care that is provided in intermediate-care homes. We want to make sure those homes are close to the communities where people are living, have raised their families and spent their lives; also care outside institutions, in people's homes -- adult day care programs, homemaker services, home nursing services. That whole area has grown by 14 percent. Prevention and treatment of substance abuse is another major community-based program area, which has grown by 22 percent this year. Ambulance services really are community services. They obviously have to be decentralized. They have increased by 10 percent.

Environmental health programs have increased by 13 percent; family health programs by 25 percent; public health and other preventive programs by 26 percent; mental health programs -- again, very much a community-based program in the way we're delivering it this year -- by 27 percent; residential care -- again trying to provide those units in communities where they are most needed -- by 14 percent; group homes for the handicapped, by 17 percent; and home support services up by 16 percent.

V. Anderson: Two different directions -- possibly. First of all, in planning the community-based care, we talked about the development of regional or community councils of some kind that would be part of this planning. What kind of planning has gone on, or will be going on, with local community councils -- village councils, municipal councils -- that are planning the overall strategy of their own communities where they are the focal point? What kind of planning and interaction is going on with the actual community itself?

Hon. E. Cull: Not as much as I'd like yet, but we're certainly getting there. The primary focus of our consultation around this year's community health budget has been on union boards of health. As you may be aware, union boards are composed of elected people from municipal councils, regional districts and school boards. By working very closely with those union boards of health, we are, in effect, working with the communities, because one knows that those representatives then go back and work with their municipal councils.

I think one of the things that we have to address, as we continue to look at how to better plan for, manage and deliver health care services at the community level, is: what is an appropriate health care body to do that? I'm not interested in layering another bureaucracy or another board on top of what's already there. So what we're hoping to do this year is try a number of pilot projects, because there probably isn't one model that will suit all of British Columbia. We're a vast and varied enough province that what will work in Victoria may not work in Prince George or in the Kootenays. Here in Victoria we probably have the most advanced model with the Capital Health Council. It's not fully launched yet, but what we are attempting to do here is put in place a community-based council that will start off by doing planning for health services, and will do something that's very important in larger communities, and that's bringing together the coalitions of care around particular issues. One of the problems that metro areas have, and one that smaller communities might like to have, is that in some areas of care such as seniors, children or mental health, quite a number of agencies are not always working in total coordination with one another. So they will be doing that. We are looking at a regional health plan in the Cowichan Valley. We are doing something very similar in the Kamloops area, 

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and other communities have approached me saying: "We are ready to start looking at health care from a regional level. Please let us be one of the pilots."

It's also worthwhile pointing out that the Healthy Communities program that's been in place for a while is very much a community-based, take-control-of-your-health-and-your-community.... I think municipalities have been involved in that from day one; in many cases, municipalities are actually leading the process.

V. Anderson: One of my next questions was regarding the Healthy Communities. Perhaps you could elaborate about how many there are, how far they are going, and whether they've proven to be more successful in the smaller localities or in the urban areas -- whether the Healthy Communities projects have been more successful in the smaller communities where people are close together, or whether they've been more successful in the urban areas. I know they would be quite different in each case.

Hon. E. Cull: I'm going to recommend.... Perhaps I'll actually send the member a copy of our Healthy Communities 1991 Yearbook. Some 38 communities are currently involved in the Healthy Communities program. I can't honestly say whether they've been more successful in the smaller communities in the rural areas than in the urban areas, but certainly the smaller communities have grabbed hold of the concept and worked very hard to develop their plans. The ones that I'm personally familiar with tend to be the ones that are closer to home for me. Healthy Saanich 2000 is one that I know is tremendously successful and has widespread community support. A glance through this yearbook would give you a flavour for what each of the 38 communities is doing. I know that there is an incredible amount of energy and enthusiasm out there.

V. Anderson: One area that I am very much aware of is the kind of focal point that people in communities naturally focus around. Of course, one of those is the school, particularly where there are community schools. Families with almost any kind of need relate to the schools. What particular focus is being put upon not just the public health nurse working in the school, but using the already existing contact with family and children as a major input into community planning for health?

Hon. E. Cull: There are a number of things that we're doing around schools. There is a Healthy Schools program that talks about school health, again in the very broadest concept of what it means to have a healthy school. It's very much the way the Healthy Communities program works. We also, through a number of other initiatives.... The children-at-risk study that was done last year in Vancouver focused on the school connection between the health care system and the children and the families. The child and youth committees also provide that focus.

But you've hit on one of my pet themes from years ago, and I have to confess that in eight months I haven't had a chance to adequately address this area. But I firmly believe that schools, because they are located everywhere, in the heart of neighbourhoods, are the logical place for a greater focus on providing all kinds of community services.

As a school trustee, I fought hard to change the policies that said schools were only available to kids between the ages of five and 18, and ten months of the year between 9 and 3 o'clock. I agree that we really could be making much greater use of our school physical plant -- because that's where kids are, and where kids are is where families are -- to bring a whole range of health care services.

One of the real dilemmas that we have, which I struggled with as a trustee and struggle with now as we look at capital budgets, is that most schools in the province are already filled to capacity. There isn't extra space to integrate health services into a kind of community school model. Community schools either have to be built new -- we're not doing a lot of that, but there is certainly some happening in some parts of the province -- or they have bloomed in times when districts have seen sort of a decline in their population and there's been more space.

V. Anderson: We don't have much time, but I would like to follow up that discussion on the community schools, because I think it's an excellent place for the Ministry of Education, the Ministry of Health and the Ministry of Advanced Education to work together. I would certainly be interested in sharing that discussion, because we've been having it here on our side as well.

True, in the daytime there is no extra room, but after school, in the evening and on weekends, there is lots of room. With a combination of the ministries working together with local councils, the parks board and volunteers in the communities, I think it's quite feasible to do a tremendous program to benefit the whole health of seniors, children, adults and parents in a way that we could get at it most quickly, realistically, with the least amount of money and with the highest degree of participation. You might have a comment as to whether that can be done. I think it's a way for you to reach a wide range of people directly at this point.

I would suggest that we might adjourn the debate for this evening and continue the discussion at another time.

[11:00]

Hon. E. Cull: I'm very interested in the ideas that you're talking about, and I'm certainly in agreement with them. I have argued for a number of years that one of the things that we need to do is start pooling our capital planning so that when we're building a facility in a community -- whether it's a new public health building or a school or maybe part of a community college -- we have the opportunity for those ministries to work together to build multipurpose facilities and use them.

Your other comments were about the fact that there may not be space during the day. There certainly is space after hours. I agree with you. It's a really tough 

[ Page 2903 ]

one to get by the school boards. We have to keep working with school boards and teachers' associations to get them to agree to the co-use of schools. I'm in total agreement with your concept. It doesn't make sense for us to have single-purpose facilities when we have a shortage of dollars. We could be doing a lot more that way. I hope I have the chance to put those ideas in place over the next couple of years. I certainly have tried to work on them from the other positions I've held over the last couple of years.

Noticing the time, it's appropriate for me to move that we rise and report progress and ask leave to sit again.

The House resumed; the Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

Hon. C. Gabelmann moved adjournment of the House.

Motion approved.

The House adjourned at 11:02 p.m.

Appendix

AMENDMENTS TO BILL 50

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