1993 Legislative Session: 2nd Session, 35th Parliament HANSARD
The following electronic version is for informational purposes only.
The printed version remains the official version.
(Hansard)
THURSDAY, JULY 22, 1993
Afternoon Sitting
Volume 12, Number 15
[ Page 9055 ]
The House met at 2:05 p.m.
Hon. M. Harcourt: I have the great pleasure of introducing two very distinguished visitors from Russia. Mr. Vasily Shupyro is Deputy Governor of the Nizhni Novgorod region, and Chairman of the Committee for State Property Management, more accurately described as property privatization. Would you please give a warm welcome to the Deputy Governor. Along with the Deputy Governor is Mr. Sergei Latyshev, who is the executive officer of the foreign investments department of the Committee for State Property Management.
Just for your edification, Nizhni Novgorod, which was previously named Gorki, is an ancient city east of Moscow and the Volga River. It goes back many centuries. It is a major industrial Centre that was converted by Stalin into a major military-industrial complex, and has over two million inhabitants.
Our two guests are key leaders in the economic reforms that President Yeltsin is carrying out, particularly the privitization programs. This is probably the most advanced area of Russia in this regard, and they are visiting British Columbia to pursue business opportunities and tap into the expertise of some of British Columbia's private and public enterprises. While in Victoria, they will meet with the land titles branch, the Ministry of Attorney General, the B.C. Assessment Authority, B.C. Systems Corporation, B.C. Buildings Corporation and the Crown corporations secretariat to seek advice on carrying out their basic land reforms. Would you please give a very warm welcome to our guests from Russia.
L. Reid: I would like to welcome Christy Clark and Mark Marrisen, who are both visiting from Ottawa, Ontario. Christy Clark was an outstanding researcher in the Liberal caucus, and it's very nice to have her back with us today, and to ask the House to please make her welcome.
Hon. A. Charbonneau: I have the pleasure of introducing some friends from the Kamloops region, Joyce and Al Stratton, who are here to see the buildings for the first time.
F. Randall: In the gallery this afternoon we have Joan and Fred Hess. Joan is president of the Burnaby Arts Council and purchased a trip to visit the Legislature and have lunch with the MLA for Burnaby-Willingdon, who is the hon. Speaker, as part of an event to raise money for the new arts facility in Burnaby. Would the House please make them welcome.
E. Barnes: I would like to ask the House to join me in wishing a happy birthday to someone who was sort of my twin for most of the year. We were both 63, but two days ago he got ahead of me and he's now 64 -- the hon. member for Okanagan-Vernon. Perhaps he's already been given his due respect by being wished happy birthday, but I wasn't here if he did. If he hasn't been, why don't we now wish the hon. member a two-day-belated happy birthday together.
Hon. E. Cull: I see in the gallery today Mr. Chris Causton, a councillor with the grand city of Oak Bay. I would like to ask the House to make him welcome.
B.C. HOUSE AND TOURISM IN THE QUEEN CHARLOTTES
C. Tanner: I have a question for the Premier. On Saturday, July 17, the influential Financial Times of London had an article extolling the Queen Charlotte Islands, which ended: "All in all, I cannot think of any place on earth more worth visiting." Unfortunately, the author also said that when he phoned British Columbia Tourism at No. 1 Regent Street in London, they said: "But nobody goes there." The question for the Premier is: will the Premier recall Mark Rose from London and replace him with somebody who will promote British Columbia?
Hon. M. Harcourt: I am sure that if they had contacted the Hon. Mark Rose, our agent general over there, he would not only have invited them to the Queen Charlottes, he would have given them the travel information and probably even helped them book the airplane to come here. I think what happened is that they got the numbers confused and actually called Newfoundland.
C. Tanner: Mr. Premier, the article was 19 paragraphs long by a highly respected writer. It promotes our beautiful Queen Charlotte Islands, and B.C. House was unable to help. Not only was B.C. House unable to help, in fact, it degraded our tourism asset. How does this government justify paying Mr. Rose his third or fourth government income if he only hinders promotion of British Columbia in London?
Hon. M. Harcourt: I will take that article under advisement. If it is true that that sort of information is being passed on, we will certainly act on it. When I visited the Queen Charlottes two years ago as a tourist, they had people coming from all over the world.
Interjection.
Hon. M. Harcourt: As a tourist, with my family.
I can tell you it is a beautiful experience, and people from all over the world are visiting there. I'm quite surprised by that information, but I will follow up on it.
B.C. RAIL LABOUR DISPUTE
L. Hanson: Just as an aside, the Premier might get Mark Rose to play his trumpet. It would help promote British Columbia.
My question is to the Minister of Transportation and Highways. Ray Callard, chair of the Council of Trade Unions, says that B.C. Rail employees are not going to bow to the belief that they are public sector workers.
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The Korbin commission has defined them as just that -- public sector employees. Can the minister confirm that his government regards B.C. Rail workers as public sector employees in the sense that Ms. Korbin defined them?
Hon. A. Charbonneau: I'm pleased to confirm that the employees of B.C. Rail are public sector employees.
L. Hanson: Excessive public sector wage increases ultimately hurt the communities most dependent on the services they provide, and B.C. Rail is a perfect example of that. Has the government instructed B.C. Rail to cap its wage offer at 2 percent, which is slightly higher than the average for private sector settlements since last fall? Can the minister confirm that a directive was given to the board to that effect?
Hon. A. Charbonneau: Coming from someone from the previous administration, which set all-time high records for settlements in the public sector of 7 percent each year over four years.... I'm astounded that you would have the nerve to stand up and ask the question. However, I would remind you that we do not carry out bargaining in public.
The Speaker: Final supplemental, hon. member.
L. Hanson: With the legislation before us, I would dispute that claim about bargaining in public.
The minister claims that the caboose issue is the main sticking point in the dispute. Both labour and management say that the only real issue is the wages, especially the extra cost-of-living allowance demanded by the union. Has the minister met with the union reps to convince them of the need to hold all public sector wage increases at or below those of the people who pay for their services?
Hon. A. Charbonneau: As minister, I do not bargain in this wage dispute issue. The negotiations would be carried on between the management of B.C. Rail and their unions.
[2:15]
COST OF PREMIER'S TOUR WITH AUDREY McLAUGHLIN
F. Gingell: The Premier is quoted as saying that the costs for his summer with Audrey will not be paid for by B.C. taxpayers. Does this mean that the Premier, while spending his time helping Mrs. McLaughlin take her approval rating from 5 percent to perhaps the low double digits like his own, will be on leave of absence, or will he be on vacation?
MOTOR VEHICLE SALES TAX
L. Stephens: The government budget in March increased taxes up to 10 percent on luxury passenger vehicles, and the sales tax trade-in was eliminated. These changes were estimated to produce $56 million. Dealer sales are down, and the Motor Dealers' Association estimates that the province is losing $63 million. People are avoiding the dealers, and they are cheating on their declaration of value for licence transfers. To the Minister of Finance: how much of this expected additional tax revenue does the government estimate has now been lost?
Hon. G. Clark: I am pleased to inform members that in the month of May, car and truck sales in British Columbia were the second-highest in the country, and in June they were among the highest.
L. Stephens: I'm sure the Finance minister has not seen the accurate estimates from the dealers themselves. If he looks at the comparison between April, May and June of 1992 and the same months of 1993, he will find that the number is more like 26 percent down on average -- domestic.
The tax measures in the budget are driving people to fraudulently declare a reduced price on vehicles purchased privately. Will the Attorney General commit to stop this abuse of vehicle registrations?
Hon. C. Gabelmann: If there is any abuse occurring, of course we would move to stop it. If there are particular instances that have not been drawn to the proper authority's attention, I would appreciate the member helping us do that.
The Speaker: Final supplemental, hon. member.
L. Stephens: To the Minister of Finance. The government and the Motor Dealers' Association has a joint working committee studying the issue of the curber market. The question to the minister is: will the minister take action to bring the curbers under the umbrella of the legislation affecting the dealers, or will he remove the punitive taxes on vehicle sales?
Hon. G. Clark: The dealers suggested to the government that some $50 million in lost revenue is a result of not policing private sales. As a result of the work done by the joint technical group of the Ministry of Finance and members of the industry, it was agreed that that statement was simply wildly exaggerated. In fact, the number that was mutually agreed to is around $10 million in tax loss.
In other words, we have the most effective system in the country except for Ontario. Ontario's system requires members to get an evaluation. Anybody who declares a value has to get a private evaluation. I don't think that kind of draconian measure is required in British Columbia, but we have agreed -- as I'm pleased to inform members -- to put on more auditors to police this situation. The gains to the taxpayers are much more modest than were previously estimated by the industry itself.
COMPENSATION FOR HIV-AIDS FROM BLOOD SUPPLY
L. Reid: My question is to the Minister of Health. On June 16 this minister resolved to finally settle the
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HIV-contaminated blood issue in this province. A month has passed. What has happened to those individuals who are waiting for you to resolve this issue?
Hon. E. Cull: I am pleased to be able to announce that my staff and others from the government have met with the B.C. chapter of hemophiliacs, and we continue to do so to come up with a negotiated agreement. That was my commitment on June 16, and those people are working to do that as quickly as they can.
L. Reid: I would suggest that the individuals who are HIV-infected have a vastly different sense of urgency at the present time than your bureaucrats, who believe they will not have another meeting until the last day of August. That is not acceptable. We have people who cannot pay their mortgages and are currently dying. What is your response? Surely there will be money in their hands prior to August of this year. Will you commit to that today?
Hon. E. Cull: I have instructed my staff to move on this as quickly as possible. If any delays that are happening are the responsibility of our staff, we will change that. But they know that this is a high priority, and we have committed to negotiating this with the B.C. chapter of hemophiliacs. This is not something that can be done in one meeting or overnight. We are dealing with millions of dollars and with a very complicated submission from the hemophiliacs themselves. But I have committed to doing that without being tied to the federal discussions, which are also underway at this point.
JUNEAU-ATLIN ROAD PROPOSAL
D. Symons: My question is to the Minister of Transportation and Highways. The Alaska government recently asked the hon. minister for permission to conduct a study for a possible road link from Juneau to Atlin along the Taku valley. Such a road would provide transportation access to thousands of square kilometres of British Columbia's northern area at minimal cost to taxpayers. Why did your ministry reject this request without at least some public input?
Hon. A. Charbonneau: The area in question is an extensive area of wilderness. The difficulty in building a road up to the Taku valley is substantial, and there would be substantial environmental impacts. There are members of an aboriginal nation in the area who have stated that they oppose this. If the member opposite is suggesting that the province of British Columbia should contemplate the expenditure, ultimately, of $250 million to $300 million to build a road to service some residents of Alaska, I would like to have that suggestion put forward publicly.
D. Symons: Since the study was going to be done by Alaskans, at their expense, there would be no out-of-pocket expense for British Columbia, and the economic potential for the area and the province should be taken into consideration. Access could lead to significant mining developments in that area that would generate tax dollars and jobs for people in this province. Land use decisions for areas as large as this shouldn't be made without prior public consultation. Was anyone consulted prior to this decision being made? Was the mining industry consulted? Was CORE involved?
Hon. A. Charbonneau: For the information of the member opposite, the mining possibility is a few kilometres inside the Alaska border and could be accessed much more easily from the water side.
MINISTER'S STATEMENT ON B.C.'S ECONOMIC PROSPECTS
L. Fox: My question this afternoon is to the Minister of Economic Development. In a recent interview the minister was quoted as saying that "'we might not be able to have the dream' of an ever-increasing, higher standard of living." Is this incredible statement the formal position of the Minister of Economic Development?
Hon. D. Zirnhelt: I would encourage that member to read the Brundtland report and the round table reports on the sustainability of some of our practices. I attended a press conference and commented that we may not be able to see our standard of living increase forever at the rate it has increased over the last three decades.
L. Fox: In the same July 7 article in the 100 Mile House Free Press, the minister was quoted as saying: "No one is going to star in economic development during a recession." We know that the minister is not a star by any stretch of the imagination, but is he telling his constituents that British Columbia is now in a recession?
Hon. D. Zirnhelt: I was in 100 Mile House, and I attended the groundbreaking for a new oriented strand board plant. As we come out of the recession, which we are doing slowly, there will be more start-ups. But my point is still that when an economy has been in recession -- and I am looking backwards a bit -- you can't expect there to be a lot of start-ups. I am trying as hard as I can, and this government is trying as hard as it can to encourage anyone who wants to start up a plant. But you know that when you are in a recession, which we have been, there aren't a lot of plant start-ups. As you start to come out of a recession, there is more activity, and I think that pattern has been repeated.
Interjections.
Hon. D. Zirnhelt: Well, the naivety of the opposition is coming out.
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PROTECTION OF PATIENT PRIVACY
Hon. E. Cull: Earlier this week I took a question on notice from the member for Richmond East, and I would like to now give a reply.
The member referred to a letter sent by the Medical Services Commission to a physician seeking patient information and citing section 34 of the Medical and Health Care Services Act as the authority for the request. The letter is part of an audit and inspection process for diagnostic facilities developed under section 34 of the act. This process is designed to ensure that diagnostic facilities are billing the Medical Services Plan appropriately, and that public funds are being expended in a proper manner.
The letter was sent following an on-site audit of a diagnostic facility, and it is intended to verify that the physician actually ordered the tests and received the results. The letter does not request any information from the patient's confidential medical records, but only confirmation that the work was requested and performed. The letter is not part of a random inquiry or cost study, as was suggested, but is an important step in an audit process to ensure that public funds have been properly spent.
Given that over $380 million is spent on diagnostic services each year, I am reassured that the Medical Services Commission has a system in place to ensure that the system is being billed appropriately.
H. Lali: I would like to present a petition on behalf of the Pavilion first nation, bearing 69 names, stating: "We, the undersigned, want a new school built at Pavilion reserve to replace the one that burned down."
WHITE PAPER ON FAMILY AND CHILDREN SERVICES
Hon. J. Smallwood: I rise today to table a White Paper entitled "Making Changes: Next Steps." This document responds to the two reports delivered to the Premier and myself last December by the community panel on B.C.'s family and children services. The report stressed that we need a system based on proactive support for families under stress rather than crisis intervention; a system which fosters community involvement in family support and the well-being of children; and a system that recognizes the need to return responsibility for aboriginal child welfare to aboriginal communities. Across the province, families, children and community groups have asked us to enhance the welfare of children in their own homes, to recognize extended families and kinship relationships where possible and to promote reunified families when temporary placement of children is required. I am proud to say the ministry is already proceeding in those directions.
However, fully implementing the community's wishes will require new legislation. It has been 12 years since the B.C. government passed the Family and Child Service Act. Much has changed since then: our society is more ethnically and culturally diverse; single-parent families are more common; aboriginal communities are reaffirming their status as nations; and our knowledge of family violence has grown dramatically. Many changes requested by the community panel have already impacted ministry policies and programs. But comprehensive changes will require new legislation. Communities and governments must have a legal tool to safeguard and strengthen our families, because a stable family is a child's most important resource.
This document is therefore submitted as an interim measure before tabling new legislation, to encourage public dialogue and comment. It outlines the shape of a new family-centred legal framework based on recommendations by the community panel. It raises those questions which must be properly and publicly addressed before the introduction of new legislation.
Principles outlined in this White Paper are consistent with this government's commitment to work towards the empowerment of people and communities. This document echoes the themes of "New Directions for a Healthy British Columbia," announced by my colleague the Minister of Health following the Royal Commission on Health Care. My colleague the Attorney General recently tabled a report by the family justice review working group, which also advocates a client-centred focus. These initiatives form the government's strong response to the wishes of British Columbians, who clearly state their desire to implement local decision-making and problem-solving.
[2:30]
Over the coming months I hope all members of this House and concerned British Columbians across the province give due consideration to this White Paper and continue their involvement in this exciting approach to developing new legislation.
Hon. J. Smallwood tabled a White Paper entitled "Making Changes: Next Steps."
V. Anderson: I wish to thank the minister for providing the White Paper ahead of time, so that we were aware of it. It is a paper that we've been looking forward to. We know it has been in process for some time and that the community has been involved in it. They have been waiting anxiously for it to come forward. They were afraid that the House was going to prorogue for the summer without it coming forward, so they will be delighted to know it has now come.
I'm delighted, as the community is, that families are being put first, that the services of government are being focused on the needs and the response to families, and they it will become proactive in prevention rather than doing crisis intervention after the fact. I think the community is pleased that there will be directions in community involvement. Certainly the aboriginal community is appreciative that at long last there is recognition that they can carry out their own responsibilities. We realize that new legislation will need to come forward, and we will have an opportunity to interact with the White Paper on that legislation in due course.
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One comment I would like to make is that sometimes we think as government that we are doing something to empower people. The reality is that we may be doing something not to empower people, but to cease taking power away from people. They will empower themselves, and we will simply support them in what they are doing if we're not, as has often been the case, preventing them. I commend the minister and the government for bringing this paper forward, so that we can respond to the community. The paper itself is a response to previous community interaction and will enable more interaction to take place.
H. De Jong: I'm pleased to rise and represent the critic for Social Services from the Social Credit caucus. I appreciate the minister bringing forth this White Paper, which has been roughly described in her statement. I suppose that this is a reply to the great response to a statement that the minister made earlier about the abolition of private adoptions. We've seen similar attacks made on the family, even though we all stand on this platform from time to time and say how great families are and how important family strength is, and how family strength relates to the community and to the Canadian nation as a whole. We have seen the attacks on the family by the government taking away a small bit of money from some people in British Columbia who do not agree with the B.C. curriculum and want a choice of education for their children. People are getting more and more fearful of a government that is taking little bits of money away which really build a strong family.
The minister referred to the more ethnically and culturally diverse society. We have a similar situation whereby some legislation this year -- and that should also have been in a White Paper -- stifled communication between the cultural groups in British Columbia, instead of enhancing discussions between cultural groups to become real Canadians. Those kinds of actions by the government are the kinds of things that people are very suspicious of. That's why the people spoke so loud and clear against the statement that the minister made about the abolition of private adoptions.
I applaud the minister now for bringing forth this White Paper, and I hope that the communities throughout British Columbia will respond very strongly to this White Paper for the guidance of government for future legislation.
Hon. G. Clark: I call committee on Bill 45, hon. Speaker.
HEALTH AUTHORITIES ACT, 1993
(continued)
The House in committee on Bill 45; E. Barnes in the chair.
On section 2.
L. Fox: I have a question on section 2. Earlier the minister suggested that the elections to replace these interim appointees would happen in 1996. My question with respect to section 2 is: why would there not be some time frame in the act which suggests that? Also, why is there not in this section how the transition will take place between this interim body and the newly elected body?
It's an important issue, because I think the minister would agree with me that the individuals who get appointed to this structure will have an advantage at election time, should they choose to run. They will have been part of the structure for the better part of three years and will have an advantage, should they decide to seek election in 1996. Perhaps the minister could address those issues for me.
Hon. E. Cull: In regard to the second part of the question about why there isn't some transition in here about how the people on the interim boards will go on to the final elected councils, that will be in the permanent legislation. Part of that will be determined by what the permanent legislation looks like. If we were to try to put it in here, we would have to know what that was going to look like. We have this transitional legislation so that work can take place.
The reason we haven't put any timing in here is that I expect to bring forward legislation in the next session of the Legislature, or at least in the spring session next year. But I don't have a crystal ball; if some unforeseen event comes up and we're spending more time working through with the communities, it might be a year later. If we were to put in a sunset clause -- because that was one of the things that I'd initially asked about -- I was advised by the lawyers that we would then have to put in a lot of legislative material to provide for the winding down of these bodies, which is not intended. It's just intended that there be transition. It's simpler to deal with it in the next piece of legislation.
L. Fox: I guess the only observation I have is that by not limiting this to November 1996, as the minister suggested earlier, in fact this legislation allows the appointees to be there longer than 1996. Subsequent ministers or governments may interpret it as something which allows them the flexibility; and it gives no assurance to the people that this is truly an interim structure. I guess if the minister is prepared to state now for the record that it is the intent that these appointees at the respective levels would only be there until the civic election time period of 1996, then I could be comforted.
Hon. E. Cull: It is clearly the intent of the government that in 1996 there will be direct elections to these councils, so legislation will have to be brought in between now and the fall of 1996 to allow that.
I might also point out to the member, in terms of his fears, that this legislation is not prescriptive; it doesn't force anyone to form a council. As the minister, I can't dictate that a council be formed. It is entirely voluntary. With the tremendous discussion that has gone on in communities about the approach we're going to take,
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should our or any government try to back down on this, you'd find that the communities would not voluntarily go down this road. This is voluntary legislation, so there would be no means to force them.
D. Mitchell: The explanatory note to the bill says that the bill creates the framework within which the transition process will proceed until 1995. This section 2 of the act, which describes the purpose of this very important bill, says that the act will create the first stage. I know this was discussed during second reading stage in the minister's remarks, but just for clarification in the committee here, and following up on the questions of the member for Prince George-Omineca: if this is the first stage, could the minister talk a little bit about the time frame, how many stages there are and where this is going? The explanatory note says that this bill creates the framework until 1995 only, but because it implies that there are other stages, could the minister describe that briefly?
[D. Streifel in the chair.]
Hon. E. Cull: I am going to be very brief on this, because this was discussed in second reading. The intent of this legislation is to be enabling and very flexible, to allow those communities that are right now in the process of forming community health councils and regional health boards to have a legislative framework to do so. We want those communities to do this quickly, to have some time to actually operate and sort through the problems, so that we can use them as pilot projects. We can't simply create pilot projects without any legislative framework to do so, so we're doing this to allow those ones to start; they're essentially going to be pilots. After they have been in place for a period of time, we will then be in a position to write legislation that will be far more prescriptive in terms of the voting structure, the responsibilities of the councils, the boundaries, how they're set, how they're mediated, etc. This legislation is there essentially to allow those pilots to get started, so we can go through this learning process that has to take place.
L. Reid: Specifically, after the creation of these regional boards, how will they impact on the subcommittees of the Medical Services Commission that we currently have in place in British Columbia?
Hon. E. Cull: There will be no impact on them whatsoever.
[2:45]
L. Reid: I appreciate the minister's comments in terms of the necessity to create a legislative framework for a pilot. We have some concerns about where we take that in terms of evaluation. I know we will touch on that in more detail as we move through the act in terms of where we're going and whether or not there will ever be an opportunity to evaluate the pilot. I understand that you want this legislation to go forward to enable some framework to be put in place. Because we have concerns about the future of this, once this legislation goes forward, we have serious concerns about evaluation and measuring outcome. When creating the purpose of the act, have you given any thought to the next step and what the next piece of legislation will look like? Based on the purpose, what are we to expect? Will the purpose remain the same for the duration until we reach 1996, as outlined in your explanatory note?
Hon. E. Cull: The purpose of section 2 is to make it clear to any reader that this act is temporary; it is just the first step, and subsequent legislation is coming along. I've used the word "interim," and that's exactly what this section is intended to convey.
V. Anderson: I understand the purpose is to explain the structures of regional and community health boards, but we generally think of a purpose as more than just the construction of a framework. It has a purpose to accomplish something that these community health boards will be putting into place.
What I'm trying to get at is: does it replace the present community health services -- community health nurses, public health nurses and public health programs? Are we expecting these community health councils to replace the present services that we have? We talked about it replacing hospital boards, but will it also replace all the other different facets of health care in the community?
Hon. E. Cull: It won't replace all of the services, but that is dealt with more extensively in the sections we're coming to. This section, which is entitled "Purpose of this act," does not describe the purposes of a community health council model or any of that. It simply says that this act is interim.
V. Anderson: That's part of the concern that we have. We're creating a new structure for a purpose. What I hear the community asking is: "What is the purpose for which the new structure is created?" Does it mean that all community health decisions are going to be made in the community and that this council, which is fundamental in the purpose, is responsible not only for hospital and clinic care but also for all the health-related care in a community?
Hon. E. Cull: I would suggest to the member that that question is better answered under sections 3, 5 and 15. They deal with the purposes of the boards and councils.
The Chair: Hon. member for Sunshine Coast-Powell River -- or Powell River-Sunshine Coast. It depends on whether you are coming or going.
G. Wilson: Thank you, hon. Chair. Some would say it depends whether you're coming from the north or the south.
The Chair: My apologies, hon. member.
G. Wilson: Right. The truth is that if you live there, everybody's coming there, and if you don't,
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everybody's going there. Either way, it's exactly the place to be.
Section 2 is what we're really here to discuss. I'm sorry I had to step out for a few minutes. If this has been answered, I will take my seat. I notice it says: "This act creates the first stage in the establishment of...." It's the question of the first stage that I'm interested in hearing about. Recognizing that we can't talk about future policy, or where we may be headed, the fact is that in terms of the purposes, this section of this bill talks about the staging of this system. Could the minister tell us what the completion of that first stage is likely to entail and where we are headed after that?
Hon. E. Cull: We did just have that question asked and answered, but very briefly, as the member knows, this is interim legislation intended to be replaced with permanent legislation once the communities that will be piloting the various models have done so sufficiently for us to draft the legislation.
K. Jones: The minister says in the act that this is the first stage. Just how many stages are there?
Hon. E. Cull: Two.
Section 2 approved.
On section 3.
L. Reid: I wish to spend a few moments this afternoon discussing section 3, and specifically section 3(3): "The minister must ensure under subsections (1) and (2) that health services in British Columbia continue to be provided on a predominantly not-for-profit basis." We are looking at this section, and we're believing that the provision of this service and the evaluation of it will rest with the Minister of Health. We have a concern about that. We have a greater concern, which has been shared with us by the B.C. Pricare Association, the B.C. Association of Private Care. In their correspondence, they suggest that they are encouraged by your reassurances and support of the private sector and that there will not be massive shifts in the existing mix of private and public health care providers. They go on to question the term "predominantly" in that clause, because they believe -- and as I would read from your correspondence, you also share the belief -- that we need to have both options available in the province. That's their position, and you appear to support that position. They write: "We appreciate your commitment and support of the private sector, and if the ministry is reluctant in deleting clause 3(3), perhaps you can consider wording that entrenches the principle that both the private and not-for-profit sectors will continue to be used to deliver health care services." I don't have any particular issue with the wording that they have provided.
I would move the following amendment, notice of which has been given to the table: "The minister must ensure under subsections (1) and (2) that health services in British Columbia continue to be provided by both the private and the not for profit sectors." The message is very clear in that it appears on paper that you do support that position, and in fact the wording in the act, under 3(3) -- "a predominantly not for profit basis" -- doesn't necessarily reflect the reality of where we are today. We have not-for-profit groups and facilities engaged in that kind of care delivery. It's only prudent to recognize the reality of that, and I would ask for your response on that particular amendment.
Hon. E. Cull: There was a great deal of consultation on this act, particularly around this section. For that reason, while I don't disagree with the intent of what the member is expressing, because it's very much the same as what I'm expressing, I am not prepared to amend this section because of the considerable consultation that went into arriving at this wording. But if I may explain, because the positions we hold are not too different on this, we do not want to use this legislation as a means of changing the mix of private, for-profit and public non-profit services and health care. There is a mix right now. It's weighted in terms of public sector, as is common with health care, but we do not intend to use this legislation as a way of changing that balance in any respect -- in increasing the public nature of the health care system or in increasing the private nature. Both the public sector and the private sector have an important role to play in providing health care.
There is room for all kinds of debate in the future as to what the appropriate mix should be, if it's not the mix we have right now, and whether it should move more in one direction or the other. But we did not want that debate, which would obviously be very lengthy and emotional, to be a part of this legislation. This section says, in language that has been through a number of different meetings and consultations, that we are not intending to change the mix of public sector and private sector as a result of this legislation. When Pricare received my letter, they understood that and were appreciative of the support that I have always given the private sector with respect to the work they do.
L. Reid: What this individual and this association is looking for is some recognition of current realities. They are not looking for a change. That is not their intention, and they have not stated that.
As for your comment regarding consultation, they thank you in their correspondence for the consultation prior to the formal tabling of this act. However, there is one new clause that has been added which causes their membership serious concern. Were they consulted about this new clause? They would say no, they were not part of that consultation process. Was it complete and thorough consultation? Again, they would suggest not. They appreciate the fact that what they saw was not the entire package. They wish to have this section debated. It is not about changing the mix of private care and public care. You and I agree on that point. It is about recognizing the reality of the current mix that we have in British Columbia.
This is not anything that moves away from accepting the significant role that companies and other areas in health care currently play. We all have private care
[ Page 9062 ]
facilities in our ridings. They play a significant role, and I don't think anyone would disagree with that. They wish the language of this act to reflect the fact that they play a significant role. I do not see that as something that would not receive support from the majority of members of this House. We could not survive without the current care providers we have in place throughout this province. We recognize that reality as an opposition. We trust that the minister will recognize that reality in the wording of this particular amendment.
Hon. E. Cull: Unfortunately, the amendment put forward by the member simply says that the services will continue to be provided by the private sector and the not-for-profit sector. You could dramatically shift that mix so that 99 percent of the services are provided by the not-for-profit sector, and 1 percent are provided by the private sector, and this amendment would not be violated. This amendment only says that there will be two players: private and public. It doesn't say that there will be any particular mix. It doesn't say there won't be a shift; it doesn't say there will be a shift. It's silent on the shift. Section 3(3) says that the mix that exists right now, which I don't think anybody would disagree with, is predominantly not for profit and will stay as it is.
[E. Barnes in the chair.]
L. Reid: If the minister doesn't wish to recognize the current realities, we must accept that, but in the final analysis they play a significant role in the delivery of health care in this province. You stated earlier that it is not your intention to use this legislation to change the current balance. It is not the intention of private care providers in this province to change the current balance. They simply wish to be recognized for the services they provide. I don't believe that's asking too much.
Hon. E. Cull: The section, as it is worded in the act, recognizes the current situation, which is predominately not for profit. The amendment is a very poor amendment, because all it says is that there will be two players. It doesn't say whether the mix will change or not. It's unacceptable on this basis
K. Jones: The amendment is very evidently trying to make this section of the act state the practice and desire of people who are presently in the health care area and say that they should have some assurance that they are not going to be taken over by government. When you say "predominantly not for profit," that means that the majority of it will be not for profit. That could be 99 or 100 percent pure not for profit, which is generally the trend of this government: to take everything into government control. That has been its practice in the past, both in this House and in other parts of the country. That's why the fear is out there.
When you put in predominantly not for profit, people take you at your word, and that generally means that you are going to move everything in that direction. I think that is very good justification for allowing this amendment to come forward, if that is not the direction you are going in. If you do not intend to go to an almost completely government-run, government-owned, eliminating the private sector process, then you have to make this change and accept this amendment. This amendment will be fair and will indicate that you are fairly looking at continuing the balance of government and private participation in the health care program.
[3:00]
[D. Lovick in the chair.]
Hon. E. Cull: I urge the members opposite to read their amendment. Their amendment says that the services will continue to be provided by both the private and the not-for-profit sector. Under this amendment, a government could change the mix to 99 percent and 1 percent, and still meet this amendment, which says there will be both a private and a public sector. That is not what we are trying to do here. We want to say we are not going to have a shift. If the member does not know that the present health care system is predominantly not for profit -- and it is more than 50 percent; the private sector is very small -- then I think he needs to do some more research. But section 3(3) says that the services will continue -- as they are now -- to be provided on a predominantly not-for-profit basis. I submit that if we accepted this amendment, we could change the mix, and we do not want to do that.
K. Jones: The present amendment -- yes, you're right -- could be taken to 100 percent not for profit, or it could be a 100 percent profitable or privately operated. But it gives an indication that there is a willingness to look at opportunities for private as well as public operations. The way this bill is written does not give that indication. In fact, it indicates that the minister plans to move predominantly to the not-for-profit, away from private operation. It is a typical NDP government that says: predominantly, the government will run everything.
L. Reid: The minister will make the point that this amendment would allow the shift. Let me share another concern from Pricare with you. Individual members have been concerned that regionalization and community health boards could eliminate their services purely because of an ideological preference for non-profit providers. How would you respond to that?
The Chair: Committee members, through the Chair, please -- the word "you" should be expunged from our vocabularies.
Hon. E. Cull: There could be equal fear out there on the part of public sector service providers that community health councils could change to a predominantly private, for-profit system for ideological reasons. We do not want the governance system to dictate a change in the mix of private and non-profit -- the balance it is in right now is serving this province
[ Page 9063 ]
quite well. This section is here to say that the system will continue as it is now, predominantly not-for-profit.
Section 2 approved.
On section 3.
The Chair: The hon. member for Powell River-Sunshine Coast.
G. Wilson: Hon. Chair, I was going to say thank...but I can't use the other part of that salutation. Having expunged "you" from my vocabulary, I will just say thanks, hon. Chair.
Section 3(2) says: "The minister may, by regulation, specify a health service, or the level or extent of health service, that must be provided in a region or community." The use of "must" is pretty strong. If it said "may," then clearly a distinction is there that one could look at. But there's a specification of "a health service or the level or extent of health service...." Perhaps the minister might tell us: what is the range of health services that this minister may be empowered to demand a region or a community provide?
Hon. E. Cull: Allow me to use a rather extreme example that I think will illustrate the point. We will ultimately be giving global budgets to regional boards. They will be getting the budget of the hospital within their region. We could not give that budget over to the regional health board and have the board decide that it was no longer going to provide acute care services, but instead it would keep all the money for the hospital, thank you very much. So the intent here is that when the money goes to those communities, there will be services established that will be very general, along the lines of the services that we now establish when we give a hospital board its global budget. We don't just give them $200 million and say: "Here, please run your hospital however you see fit." There are conditions, and things they are required to provide, and we have to be able to set some provincewide standards.
Another example -- and then I will sit down -- is that in giving over the money to communities, we could not have communities say: "Our children are not involved in any dangerous activities; therefore we don't need any sexually transmitted disease clinics in our communities, and we will not fund them." I would hope no community in British Columbia would do that. But as I said, I've used two extreme examples here to illustrate the point that we do have to set some basic standards for acute care services, public health services and basic services in community and family health: mental health, alcohol and drug, and the other services that we provide under that. But if you're suggesting that we might be talking about the kind of speech pathology service that would be provided in a region, that would not be within the purview of the services that would be standard and set by the minister.
You were absent from the House earlier when we talked about this, but the intention is to provide a balance between local autonomy, enabling communities to determine how to organize themselves and what services should be delivered, and the guarantee that the province must provide to a citizen of this province that no matter where they live, they can expect a basic level of health care services that are in keeping with the size of the community they live in. Where you live doesn't determine whether or not there are mental health services.
G. Wilson: The minister addresses that issue in a manner that puts a finger on one of the concerns that has been expressed to the Liberal opposition, and that is the provision for specification -- and I know we can come back and discuss that in a moment. The concern is that under this act the minister could demand that services be provided for which funds may not necessarily be adequate or available. I wonder if that's the case in terms of the provision of this basic health care. I don't take issue with what the minister just said, but it might be more prudent to say that if there's going to be a provision for specification of health services that must be provided, only those for which there is adequate funding will be provided, especially in light of the commentary we just heard with respect to the maintenance of non-profit or publicly funded services.
Hon. E. Cull: The nature of the services that will be specified will be so broad that only if budgets were totally inadequate -- half of what they are now or something like that -- would they not be able to provide them. As I said, it will say things like acute care services, public health services, mental health services, and alcohol and drug services, but it would not specify the details.
Even within a hospital right now -- and I think that's the best example, because it's the only case where we really do good global funding -- we provide funding to a hospital, and we don't tell them that they have to provide a whole range of services which they simply could not provide within the budget they are given. We certainly don't say that they can meet their budget problems by closing their emergency ward or by saying: "Gee, we don't do babies in this community anymore." There have to be some basic services that are established. The amount of service, the standard of service, the regularity of service and the hours that the service is available would all be variable to accommodate budget necessities.
L. Fox: On section 3(2), when we look at 24 different regions, does the minister envision an eventual regulation for all those different regions? Or are the regulations going to be so loose that they will be able to be flexibly applied to all the regions of the province?
Hon. E. Cull: As I said, we're striking a balance in the expectations of a citizen of this province to be able to receive the same services in Prince George as she does in Kamloops or Kelowna -- being cities of roughly the same size -- or in a smaller community of 5,000 like Vanderhoof, Burns Lake or some of the other smaller centres in the province. People will be able to receive similar services there. The standards that will be set under this section will be provincewide standards. It's
[ Page 9064 ]
not my intent to do the tailoring to individual community needs. That's what the community health council is there to do. It will be able to say: "Here are the standards we have to achieve; here are the resources we have to expend. This is how we're going to meet the needs of our community."
L. Fox: I want to go in a different direction, recognizing that this sets the stage for the later sections of the bill dealing with the regional health boards and community health councils. In the earlier discussion, the minister suggested that we would eventually see hospital boards done away with. Obviously, we will see regional hospital districts done away with. Given that those two structures played a major role in the capital financing of local projects, such as health board offices, hospitals or whatever, how does the minister envision using this section with respect to that? The reason I ask is that over the last couple of years I have lived with the frustration of a community trying to get an extended care facility, while seeing other communities, in the same regional hospital district, get one they didn't ask for. How are you going to use the authority? Is this going to do away with the political decisions that we've seen in the past? Will it allow for some consistency in applying those regulations on a provincial level? Will we see the areas that are actually in need, whether regions or communities, get facilities based on the input of their respective boards?
[3:15]
Hon. E. Cull: I appreciate that the member is having some difficulty understanding how this is going to work, because this bill doesn't deal with capital financing. It quite deliberately doesn't deal with it, because there is a task force involving members of the Union of B.C. Municipalities, our ministry and Ministry of Finance officials to determine what to do about capital cost-sharing arrangements. Operating funds are and will continue to be paid entirely by the Ministry of Health, but capital facilities are cost-shared. There are a number of options being looked at right now. I have made a commitment not to change the existing situation until that task force has come back to us with recommendations. It's going to take a little bit more time before that's resolved -- a matter of months, I imagine. So there is no change to the capital financing formulas under this legislation. It is absolutely silent on that and allows it to continue as it does. You pointed to some interesting problems, and I hope we are going to be able to address those through the work of this task force.
L. Fox: The Liberal critic put forward an amendment to section 3 earlier. Now, I guess, we have section 3 as it was originally drafted. Notwithstanding what the minister has said about maintaining the status quo in the delivery of health care services, I have a lot of concern with the word "predominantly" in that section. Given the fear expressed by some private labs that there was a thrust by government to take them over.... At least, that is certainly a well-circulated concern or rumour -- depending on what you call it. I would much prefer this particular section being more certain about remaining with the status quo. I would be happy if the minister could assure me that this guarantees the status quo of those private sector services presently being provided to medical staff and hospitals, including lab and x-ray services and so on.
Hon. E. Cull: Hon. Chair, I've been discussing with my officials whether we can actually provide members with an estimate of the percentage of the health sector that is private. We don't have anything scientific over here, but we've just been thinking about the $6 billion budget, and we conclude that 10 percent private would be very high. So with the words "predominantly not for profit," even if there were to be a shift and a doubling or a tripling, those words would still cover this.
My intent is that there not be any change. I know you're worried that we are trying to squeeze it one way or the other. I'm saying that the amount is very small right now, and obviously there are going to be some minor adjustments in the short lifetime of this bill. We're not freezing everything and counting it up and making sure that all the private for-profit dollars are there at the end of it all or have not increased or decreased. But we want to make sure that in the move, boards do not suddenly decide that they can make a dramatic change in the mixture, and that a council can't be established and decide that it's going to eliminate all of those private sector operators and not contract with them any longer or, conversely, eliminate all the public sector on contract. If we allow that to happen as a result of the establishment of the councils, we will be in a huge fight that will not end, and we will accomplish nothing productive under the councils. That's why we have to essentially freeze it where it is now. That's why the minister is made personally responsible for ensuring that that happens.
K. Jones: According to the Baldrey predictions, after the cabinet shuffle your intent won't mean a thing. I think that's what we have the greatest fear of. You can have all the intent in the world to take a position or an interpretation on this, but if you're not there and somebody else is there with their own intent, then the whole story is different. Isn't it?
Interjection.
The Chair: I will allow the minister to respond.
Hon. E. Cull: Well, I just have to say I'm flattered by the power that the member attributes to the minister. But I don't speak on behalf of myself; I speak on behalf of this government.
The Chair: The member for Surrey-Cloverdale -- in order, I hope.
K. Jones: With regard to section 3(2), when you talk about being able to regulate and stipulate exactly what health services would be required in each of those
[ Page 9065 ]
areas, are you talking about schools and that you could order schools to provide certain services?
Hon. E. Cull: No, these are only the services provided by the health council or regional board.
The Chair: Just before I recognize the member for Surrey-Cloverdale, I can't resist the temptation to once again offer my brief lecture on the distinction between the second person and the third person. On the floor of the chamber when you are asking questions of the minister, you go through the Chair and you say: "Can the minister advise...? Will the minister answer...?" You don't say "you" to the minister. You can say "you" to the Chair, but you can't say it to the minister.
The member for Surrey-Cloverdale.
K. Jones: Thank you, you.
To the minister through you, since schools often have nurses and other health practitioners operating in them and have certain conditions and standards required for the schools set down by the Ministry of Health, is the minister saying that these will not come under the jurisdiction of these councils?
Hon. E. Cull: No, the services that are provided by health care professionals in schools are provided as part of the Health system, not as part of the Education system. So those would continue to be part of the Health system and would be part of the purview of a council or board.
K. Jones: The answer to the previous question, then, is yes, she will be setting the standards for the schools. That's exactly what she says -- that the schools are going to have conditions, which are being operated by the council, that are set by the Ministry of Health. Section 3(2) allows the minister to set regulations under those conditions.
Hon. E. Cull: Where we provide services in schools such as dental hygiene, some school nursing services or alcohol and drug prevention workers, those people do not work for the school. They work for the health unit, in most cases, or for the Ministry of Health, or they are an agency on contract to the Ministry of Health.
Those services, if they are taken over by a health council, would continue to be provided by those bodies, not by the school. Standards and services are not set for schools; we don't set conditions in schools. We might set a standard for a region that there be a school-based alcohol and drug prevention program, but that does not set standards or services for the school administration. It doesn't come out of the Education budget or under the purview of the school board.
L. Reid: Section 3(1) says: "The minister may, by regulation, establish Provincial standards for the provision of health services." If you are also going to be setting standards for the provision of those services, will we see a scenario where the person who sets the standard for the service is also the one who provides the service? I see some conflict in that situation, and frankly, it would be similar to teachers providing a service by coming in to do their own evaluations on their practice. What is your comment on that?
Hon. E. Cull: I would need more explanation from the member. I could not see how Ministry of Health staff who are setting standards would be in any way providing those services directly.
L. Reid: The act is being considered prior to any determination of what those standards might be. Would British Columbians ever have a concern that the standards will reflect the service being provided, as opposed to being a standard we should be striving for in the delivery of health care? Will the standards match the service? Are we on a drive to mediocrity in the delivery of health service? Putting both powers in the same individual certainly allows for that possibility.
Hon. E. Cull: A standard would be, for example, the target bed ratio per 1,000 population. I wonder if that is the issue in terms of your questioning, to get the idea of what a standard is as opposed to a service.
L. Reid: Will this minister be setting the standards for service as it relates to being the one who will also establish the evaluation? Will setting the provincial standard relate directly to the level of service that's established?
Hon. E. Cull: The standards are established by regulation. It's a ministerial function, not a staff function -- although, obviously, staff advise on the preparation of those standards. The standards will apply both to targets and perhaps, in some cases, existing things, because we have established targets and met them in some cases. We may not always be looking for changes in those targets. After we get to the 2.75 beds per 1,000, we wouldn't be wanting to move that. In some communities, they're well there.
L. Reid: For clarification, this minister will have the ability to set provincial standards for the provision of health services in British Columbia -- and that's taken right out of section 3(1). What are some examples of current standards in place? What will happen with this new ability found under 3(1)? In what other areas will this minister be seeking to create standards that we do not currently have on the record?
Hon. E. Cull: Right now, all the standards set for health care in the province are set by the minister. So this is not a new authority; the minister has that authority to set standards right now. Another example would be the staff ratio for the long term care facilities -- you know, we have staff ratios for IC 1, 2 and 3. That's another indication of a provincial standard the minister sets now that we would continue to set.
L. Reid: That's exactly my point. The minister does have the ability to set the standard. My question relates to the new ability to now determine the program or
[ Page 9066 ]
service that's going to be provided. "The minister may, by regulation, specify a health service, or the level or extent of health service, that must be provided in a region or community." Will the service provided under 3(2) be independent of the decision taken to establish the standard? That is our concern.
Hon. E. Cull: We have the authority to do both of these things now. Right now the minister sets the standards and specifies services. We do this through direct decisions through the ministry, through our own staffing arrangements, through contract arrangements, and through directions that we give to hospitals and long term care facilities when we give them their budgets. All these things are already part and parcel of the management tradition of the health care system in this province.
K. Jones: With regard to section 3(2) and the services, does that extend to private labs?
Hon. E. Cull: No, it doesn't.
K. Jones: Could the minister tell us how the council is going to establish services and standards without having some control over the private labs?
The Chair: Member, I just advise that, given the answer to your previous question -- that the private labs weren't covered -- the hypothesis about private labs that you've embedded in this question seems quite out of order to me. If I've missed something and the minister feels it would be relevant to answer, I'll give her the opportunity, of course.
[3:30]
Hon. E. Cull: I'll answer, in the hope that it will help in terms of future questions. This system doesn't cover every last health care service in the province. There will always be some services that are centrally administered and applied for and that do not come under the health councils: Pharmacare; the Medical Services Plan, which covers the labs; the Ambulance Service. It makes no sense to break down services which have a provincewide application into this kind of community and regional basis. That's why this doesn't have anything to do with private labs.
K. Jones: I'm glad the minister did answer that, because it does clarify that very clearly. Do private clinics run in the same category?
Hon. E. Cull: I'm assuming the member is talking about private medical clinics. It's a Medical Services Commission responsibility, not of these particular bodies.
K. Jones: Would a stand-alone clinic come under these regulations for setting of standards or provision of services?
Hon. E. Cull: No.
K. Jones: Therefore, under this provisioning regulation that could specify health services, the minister is telling me that she could not specify that a stand-alone facility would be required to provide an abortion service.
Hon. E. Cull: Yes. I am absolutely telling the member that the services provided in medical clinics -- and I assume he is talking about walk-in clinics or doctors' clinics -- are governed by the College of Physicians and Surgeons. They are not governed by this legislation. I remind the member that the services and standards that we are talking about here are only with respect to those services that will be provided by the community health councils and the regional health boards. When we get to the sections of the act that talk about responsibilities, it will become very clear that they can only use certain acts to get their responsibilities. Those are: the Hospital Act, the Health Act, the Hospital District Act and the Mental Health Act. So those are the services that they provide. They do not provide services under the Medical Practitioners Act or the Medical and Health Care Services Act.
K. Jones: Under this section 3(2), would the minister be able to order that every facility in the province that falls under the categories of ambulatory hospital facility, community hospital facility or full-fledged hospital facility would have to provide abortion services?
Hon. E. Cull: The responsibility of the minister with respect to hospitals and other like institutions is under the Hospital Act, not this act.
L. Reid: I move the amendment to section 3 standing in my name on the order paper.
[SECTION 3, to amend section 3(2) to read:
The minister may recommend a health service, or the level or extent of health service, that may be provided in a region or community.]
I believe that this amendment allows for some discussion of the respect we must have for the unique needs of some of the regions in the province. If indeed it is the minister's intention to move to the Closer to Home document to provide some of those services, are we somehow suggesting that during the life of this particular piece of legislation we will not respect the planning authority that this entire framework document is put in place to provide to those communities? The act currently reads that those decisions will be reached in Victoria. That is somewhat disrespectful of the process, which this Minister of Health has suggested to British Columbians through the media and through the New Directions policy delivered to their door, that some of these decisions will be reached in those communities. If she stands by the documentation in evidence -- in almost anyplace you would care to look in terms of advertisements, brochures and the like -- that there is some respect for the decision-making process in those communities, then this amendment will stand. If that is not the case,
[ Page 9067 ]
this amendment will fail. I ask for the minister's comment.
The Chair: The amendment does seem to be in order, therefore I will ask the minister to respond.
On the amendment.,
Hon. E. Cull: Throughout the considerable discussions that we had on this concept, particularly during my tour of most parts of this province in March and February of this year, at almost every public meeting, people got up and expressed concern about the consistency of standards from one community to the next. If we change this in the way that the member has suggested, which removes the ability to require that the level of service or the service be provided, and make it simply a recommendation, then this Legislature -- should they accept that amendment -- would be putting us in the position that we could recommend to a community that it have mental health services, and if they decided they did not wish to provide them because that wasn't a concern to them, then they could not be provided. I would not support such an amendment, because there has to be a guarantee to the citizens of this province. As minister, I have a responsibility to guarantee to the citizens of this province that there will be some standards of services that they can expect in any community, notwithstanding the local governance of that community.
L. Reid: I would draw the minister's attention to the wording "specify a health service," and the comments the minister just made in terms of establishing a level of health service. Looking at establishing a level, your comment is well taken. We believe that that will happen under section 3(1), where you are going to be involved with setting some provincial standards.
To specify a particular service seems to be disrespectful to the process of the direction in which you suggest this government will be moving. From your comments, I am not clear where you stand on this. It seems to me that specifying a health service is a dramatically different enterprise than setting a standard, and perhaps we don't need both. It seems to me that British Columbians wish to have the same level of service, no matter where they reside in the province.
We are not asking for a change in the standard. We are hoping to have some respect given to those communities that will be responsible for delivering these services as per the provincial standard. Surely there is some respect in the process -- which you have stated over the last number of months is your intention -- to have those communities reach those decisions. Has that position changed?
Hon. E. Cull: Section 3(1) -- where the minister can establish a standard -- would give the minister the ability to set a staffing ratio for the IC-3 level of an intermediate care facility. Section 3(2) would give the minister the ability to require that intermediate care be part of the services provided in that community. You can't establish standards for services that don't exist, and people want standards for services as well. These are two separate concepts: one is the criteria upon which the service will be provided; the second is the fact that the service will be provided.
If we make the amendment to section 3(2) the member has suggested, it would remove the ability for a minister to specify that as part of the global funding provided to a region -- that they are expected to provide, for example, continuing care services to their elderly population.
The Chair: As I listen to the minister, I am almost convinced the amendment is out of order. However, having ruled already, I will recognize the member for Powell River-Sunshine coast.
G. Wilson: Your initial ruling was correct; take it on my advice and word. It is probably as valid as that which you may be getting from the minister.
Speaking in favour of the amendment, let me say that one of the reasons we have difficulty with the way it's worded.... I alluded to this earlier, and I think we need to move on to more of the meat and potatoes in this bill; if we can try and clear up this section, we can do that. The difficulty we have is that if the services are specified -- notwithstanding the fact that we all want to set standards, and I understand the distinction between the two -- we run the risk of providing budgets on a global basis that state that you must provide X number of services. As generic or as broad as they may be defined, you may find within some communities that the provision of those services -- in any way that would adequately meet the demand -- may not be there.
Secondly, I would say that you run the risk of running counter to section 4, because in that section you say that under section 1 or 2 you can't act in a manner that doesn't satisfy the criteria described in section 7 of the Canada Health Act, and you define what that is. The Canada Health Act is fairly specific as to what we need to look at; one of them is universality -- (c). Of course, there's a lot of ambiguity as to what that means. Even in the Canada Health Act it isn't clearly defined. Under the provisions of that act, they attempt to define universality with respect to the entitlement of those insured to access provincial health care in a uniform way. In fact, it suggests that it "...must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan on uniform terms and conditions." I would submit that we may run into a problem with those uniform terms and conditions if you allow section 2 to stand as it is. Because notwithstanding the order of the minister, the regional body that's being created, and therefore the facilities that are going to be there, are going to be constrained in what they can provide to the population by the dollars that are available to them -- and constrained on the basis of those dollars in relation to the demography of the particular region and the characteristics of that demographic profile.
If you have a community with a large number of senior citizens -- because of the aging process and the demand for intermediate care and those kinds of things -- they may demand a different set of services than a
[ Page 9068 ]
community made up of a large proportion of young families. For example, with a decentralization of existing services, as we have seen with the facilities for people with mental illnesses, you move those people back into the communities. Communities like the one I live in, Sechelt, don't really have adequate psychiatric or medical services -- notwithstanding what the minister says the hospital in Sechelt, St. Mary's, should provide. It's one of the best hospitals in Canada, according to virtually every report I've read. That hospital is going to find itself constrained in trying to meet the criteria that you're asking for in section 2, if it is going to be held by what is required in section 4.
I think that the amendment serves to recommend that there be a movement that way. It doesn't prohibit the region in any way from moving into those services, but it says it's going to allow these new regional bodies that you're creating a certain amount of flexibility in terms of how they apply those moneys in relation to what the real demand is within the community itself.
Hon. E. Cull: Actually, I think the answer to the member's question is within the comments he made. The very fact that we have communities which are different.... We could have a community with a very large, vocal and politically powerful senior citizens' population. We would not want to see that health council decide to eliminate children's services because they were a minority group and because the other group's demands were larger and could consume all of the money that was available.
The other part of the answer that I think is within your own remarks is that because of the very nature of the concerns around universality, by definition, the services that will be stipulated under subsection (2) are going to be very broad. They will be services that are defined in very general terms. As soon as we define them in very specific terms, we either run into problems of universality or regional flexibility. The intent of this approach is to allow a community to provide services to all of its residents, but not to say to, say, White Rock: "You have to provide the same mix of children's services and seniors' services as we would expect to see in Prince Rupert, where there's a younger population." There will be different amounts and levels of services provided in the communities, and the standards and levels of services set by the minister will be broad, provincial-level services that will allow those communities adequate flexibility to vary and supplement them to meet the needs of their residents.
[3:45]
G. Wilson: I'll briefly state my last comments in support of the amendment. The minister may be correct in suggesting that to specify a health service may require that that health service be provided, but it doesn't require that it be provided in an adequate and appropriate manner to suit the needs of a particular segment of the population. I'm not sure we get around the problem of need if there is a very large, vocal and dominant group that demands of a particular region that greater funding go toward senior's care than toward children's care. I think the recommendation would clearly allow us an opportunity to have greater flexibility in health care delivery in light not just of universality but also accessibility. To give her advance notice, after we've dealt with this amendment I'd like to get the minister's comments on what she sees as universality in terms of this bill.
If we look at the accessibility criterion required of the province by the Canada Health Act, it says that you have to provide insured health services on uniform terms and conditions on a basis that doesn't impede or preclude others from directly or indirectly accessing these services. What we're looking at here is an opportunity for the minister to require that certain services be provided by a regional council. That regional council is going to look at the money that they have and say: "Look, this is what we have to do." It's like the college budget system, which I'm more familiar with. This is why the formula funding system is so bad. I think the Chair might allow me this latitude -- he might not agree with me, but he might allow me latitude to use this example. If your funding system says that you can't start to look at those areas where the demand is going to be driven, because you must have a broad and comprehensive program -- which from a general arts perspective is a good idea -- what you tend to end up doing is weakening the areas where specialization can occur. That's my problem here. We have to start to recognize that there are different needs within communities, and that specialization must be allowed to take place. Otherwise, I think you are putting the community more generally at a disadvantage.
Amendment negatived on division.
G. Wilson: On section 3(4), with respect to the provisions of the Canada Health Act and what has been provided under section 2, could the minister tell us a little bit about what is meant by two particular areas: one is comprehensiveness, as defined and provided for in the act, and the other is universality. What does the minister see there, given that there are generally confused ideas as to what they mean?
Hon. E. Cull: The concept of universality means that the services are available to all citizens without discrimination. The concept of accessibility is one that ensures that there isn't any financial barrier to being able to access that service.
G. Wilson: With universality, in terms of the entitlement of every insured member, we know that doesn't happen today in the province of British Columbia. We know that you might get the service, but you don't necessarily get it in your community. I think the minister would admit to that.
Hon. E. Cull: Universality doesn't mean that every service is provided in your community. Cancer treatment will not be provided in every community, but it is universally available to all citizens of B.C. We don't say that because it's not in your community, you don't get it. Some services are provincewide, some are
[ Page 9069 ]
subregional, some are regional, some are communitywide and, in fact, some are neighbourhood-based. The concept of universality is not tied to geography.
G. Wilson: If the minister accepts the reality of that, and in particular the fiscal reality of that, then why won't she recognize that the same level of flexibility with respect to regional funding should be in place? Why won't the minister accept that we have to have greater flexibility with respect to the provisions on a region?
Hon. E. Cull: We do accept that. In fact, later on, when we start to develop the global funding formula, you'll find that the funding will not go on a per capita basis to everybody in the region but will reflect the needs of the region. It will be adjusted to reflect age of the population and, I would hope, other things to do with health status. We're going to have to work our way through the global funding formula, so we will actually be able to recognize the differences in the population through our funding formula, because we'll expect communities to provide different services, as they do now. Obviously, White Rock has more seniors' services than Prince Rupert, and some of our isolated northern communities should have more programs around injury prevention, substance abuse and mental health to deal with some of the problems that people in those communities face.
G. Wilson: That causes some concern, because this is the promise of the new global funding, and the minister is asking us to just wait and see. They're going to be able to provide, possibly on a less than equitable basis.... That's not fair, because that's not exactly what the minister said, so let me correct that and try to be fair. The minister said that they will not provide equal funding for each service in each region, and I think that....
Interjection.
G. Wilson: If not, maybe she could clarify that.
Hon. E. Cull: I'm going to just take a minute to answer this, because this information may also provide answers to other questions. One of the things that we're in the process of doing right now is striking a deputy minister's advisory committee, which has representation from all of the major stakeholders and people who are concerned about health care services in the province -- not only providers but also some advocacy groups and other groups that have a particular interest. That group is going to be asked to do a lot of work with us over the next year, particularly with respect to developing regulations, working on legislation that will be coming forward next year, giving advice as to what it should look like and working on many of the different aspects with respect to things that still have to be finalized. Indeed, the global funding formula is just one of those things.
Right now, we provide global funds on an age-adjusted basis. We don't provide so many dollars per person for hospital funding; we do age adjusting and use other kinds of criteria where we look at the needs of the population. So rather than simply dividing up the dollars that are available in the population and saying that everybody gets $1,600 per capita or $100 per capita, whatever it happens to be, there is going to be some reflection of the needs of the community. But that is going to be done as part of the process that we're engaged in right now, because the strength of our hospital funding formula this year is that we involve the hospitals in helping us develop it. We will involve the health councils and, in the interim, while the health councils are not up and running, these other bodies in helping us to develop that formula.
G. Wilson: That indeed is very useful information. Much of it we can canvass in other sections as we start to get at it, so I don't want to unnecessarily prolong the debate here. But in light of what was said, and in light of the provisions under the Canada Health Act in terms of the universality provision, is the minister saying that these new councils that will be established with respect to the standards...? This section is supposed to be dealing with provincial standards; it shouldn't be dealing with services so much. That's what I'm hearing, although clearly the language provides for services to be determined. Is the minister saying that while those standards are set by the minister, there may be a difference in the way that each of the councils may try to provide those services, and therefore the funding levels will change, depending on whether one's looking at large institutionalized services within the hospital, dealing with small clinic-type services or dealing with neighbourhood services? If so, then what guarantee is there that you're not going to have a council that is going to embark upon a new delivery system and not have the money to be able to provide for it?
Hon. E. Cull: The funding will vary with the needs of the community, not with the way in which the services are provided. The councils will have to find the most effective way to provide those services in order to meet the needs of their population. We're not going to get in there and tie their hands and tell them they have to do it this way or that way, or get into a lot of specifics about how they go about providing those services. The funding won't depend on whether one region provides it institutionally and another does it through a community-based service. Those communities will have to make the decisions about how best to provide the services to meet their needs.
When we look at global funding, we will do it the same way we do hospital funds right now. We look at the needs of the community and the needs of the population in that area, and try to adjust the funding so that it reflects those needs. I think we have to be very practical and recognize that the beginning of the global funding is going to be putting all the funds that are already out there in that region together into a pot and seeing what's there. We're not going to start from square one and dramatically change the funding that's
[ Page 9070 ]
available in a region. That could have terrible impacts on existing institutions, which will have to continue to operate.
G. Wilson: I think they could potentially do that. Much of what we're dealing with.... I recognize that we can canvass a lot of this in sections 6 and 7, but I don't want to lose my opportunity to deal with it under section 3(4) with respect to the Canada Health Act, because that is the senior legislation that's going to ultimately determine to a large degree what can and can't be done. This body is not empowered to put in place or enact something that runs counter to the Canada Health Act.
My concern is that if you give this kind of latitude to these new councils and the minister is going to establish these standards, it is going to require that certain services be provided. Without giving any parameters to the details of that service -- because you want to keep it as broad as you can -- aren't we creating exactly the same problem we have with existing school boards right now? You're saying to the school board: "Here's a new curriculum. Here's the Year 2000 program. Here's the number of students you've got in your region, which you know. These are the services, and this is the quality of education we want. Go for it!" Then the district says: "Okay, we've put in these new programs. This is the number of teachers we've hired; this is the number of kids we've got in school." They then find on an annual basis that their budget doesn't meet the needs, and the next thing you know you've got teachers on strike and kids out of school, and you've got problems.
Aren't we creating exactly the same kind of problem? What comes first -- the money? Then the council says: "Okay, now we have to cut our cloth accordingly." Or does the council have a certain amount of latitude and freedom to determine health care service delivery, and then does the government match the dollars to the services that they've determined are required? How's that going to work?
Hon. E. Cull: It will work very much in the way hospital funding works right now. The hospital funding is voted on by the Legislature, in terms of the amount of money that's made available to hospitals. So a provincial decision is made as to what the resources are that are adequate to provide for them. There is a funding formula that determines how new money will be distributed to those hospitals.
Certainly there's a lot of interest on the part of the industry to work with the ministry and look at base budgets to see whether anything can be done there. Essentially, we're not going to be turning to the councils and saying: "Dream up the best health care system in the world, then tell us how much you need, and we'll write you a cheque." Obviously the provincial budget will determine how much is available.
L. Fox: I want to ask one question that has come to my mind and is on the mind of some of the smaller communities in my constituency. It falls under section 3(2), where it says: "The minister may, by regulation, specify a health service, or the level or extent of health service, that must be provided in a region or community." That led me and some of the people in the communities to wonder whether or not, within those regulations, there would be authority for either of these boards -- or perhaps both of them, depending on the level they're at -- to have control over the closure of acute care beds or over the phase-out of a particular initiative within a hospital -- for instance, pediatrics in St. John Hospital in Vanderhoof, which is presently at 8 percent occupancy. Would that community council be given the authority under these regulations to literally adjust those beds?
[4:00]
Hon. E. Cull: Right now the hospital board has the authority to close beds under the Hospital Act. If a community health council assumes the functions of a hospital board as part of its responsibilities when it is established, it would also have that authority. If a community health council in Vanderhoof, for example, runs the hospital and replaces the board, then it would have all the powers of the board.
L. Fox: I recognize that the hospital boards have the official functions, but what really initiates them and causes them to happen are the priorities of the funding to that respective facility. My question to the minister is: does the council have the autonomy to shift dollars? In effect, this could cause the closing of beds in an acute care facility, or in the case of one community, perhaps even the hospital being downgraded to a D and T centre. Would the council have the autonomy to create that shift in financial priorities from acute care delivery to Closer to Home programs?
Hon. E. Cull: Yes, they would. While you're correct in that it is often budget pressures that make hospital boards decide to close some beds, that's not the only opportunity they have. There are many things that a hospital board can do to realize economies in their budgets. Sometimes closing beds is the easiest one -- and the most dramatic one, which captures the attention of the community. In many cases, hospitals are electing to close beds which are either not used at all right now, or are used at such a low occupancy rate that there has got to be a more effective way of organizing themselves to provide those services. A community health council which has responsibility for -- let's use an example -- a long term care facility and an acute care facility can make decisions to reallocate money between the two facilities to achieve the best results for their community.
The examples that we constantly run into, which create problems for our health care system right now, are situations where the hospital is often having to deal with individuals, because a community-based service is not adequate to meet the needs of the people in the community. Unlike the hospital, often the service is not open 24 hours, and people who go to an emergency mental health facility or an alcohol and drug treatment centre between the hours of five in the afternoon and nine the next morning end up at the emergency ward,
[ Page 9071 ]
because there are no other options. In many communities they know it would be cheaper to shift the funding from the hospital to that other facility. The hospital would actually save money by getting those people into the right place to be treated, and it wouldn't cost all the money that it's costing them now to operate the community service. They can't even make a commonsense decision like that, because the budgets are separate, the bodies governing them are separate and there is no way to do that kind of sensible financial management. So the health councils can make decisions around their budgets for those things that they have responsibilities for, those functions that they have assumed.
L. Fox: One follow-up question to that. This section deals with both the region and the community, and with the drafting of the regulations which will give the autonomy to those bodies. How does the minister reconcile in her mind the difference in priorities between a community council or municipal structure and the regional health board? To express it in a way the minister understands, let's talk about my region. Say the community of Fort St. James, and therefore the community health council, decides that it is in the community's best interests to maintain the hospital beds and the designation as a hospital versus a D and T centre. The regional board, however, suggests that it's in the best interests of delivering a service that the hospital be downgraded, so that it can provide other services with the same dollars and give more value to those dollars. Who has the authority to make the final decision where there is a conflict between the priorities of the regional board and the community board?
[D. Streifel in the chair.]
Hon. E. Cull: That information comes up under sections 5 and 7, so if we could wait until we get to the purpose of the council, that will be dealt with there.
V. Anderson: Listening to the discussion, one question comes to mind. I'm still partly trying to understand.... I know it will come up later, but it's important here as we go through the standards and the funding related to those standards. A community council that is formed, as I understand it, will be able to take on whatever aspects of health care in that community that it feels it is able to cope with. They can include the facilities of the hospital within it, and the nursing care, the home care and the clinics for teenagers. Whatever the particular needs of that community are that are related to the health budget, all of those could come under the overview of that community council. The minister was talking a little while ago about the decisions that could be made within a hospital board and structure. There are certain parameters to things that are done in a hospital. It seems to me that we are now entering into quite a different field. When you have such a wide variety of options that will be done by one council, the decisions will have so many different parameters within them that I can see the complexity of that council having to deal with hospital care, clinic care, home care, teenage care and baby nurses, whatever it is -- all of them working through that one council. It is within that larger context that I begin to see the question of how the community council is going to be able to cope. Will the community council have staff? Is it going to have a director? Will there be subgroups within that community council? I am trying to get a picture of how they will be able to maintain all the standards that are presently there, plus the preventive standards that the minister has stressed.
Hon. E. Cull: Yes, the councils will have staff. This concept is not unknown in the province right now. We have societies that manage both hospital services and continuing care services, and other societies that manage both hospital services and homemaker services. We have umbrella organization societies that manage quite a variety of those community-based services you mentioned. So it's not that there are not already some examples in some communities of mergers that have already taken place. In the last year, in fact, there have been a significant number of mergers between hospital boards and long term care facility boards. I daresay it's been in anticipation of this, and also in recognition of the fact that some of their problems could be solved if they were dealing with one budget rather than two, because they can see what they need to do but they just can't make it happen between two discrete budgets.
If a community health council merged a long term care facility, a hospital board and the services the Ministry of Health provides right now in the public health units, let's say, there would be a reduction in the administrative staff. They're not going to need three chief executive officers to run the show. In fact, in those communities that are quite far along the line.... In one place, they've already made the decision that five small facilities will have one CEO instead of the five they have right now.
Staff will continue to be needed to manage different programs and facilities, though, as has happened in all of these other mergers in other communities. So yes, there will be staff, but they will be the staff who are already there in the organizations -- similar to what happened when a long term care facility and a hospital board amalgamated in the last year.
V. Anderson: I have two questions that come from your comment just now. I appreciate that the non-profit societies have been doing a great deal of the care on contract with the ministry. Does the community council in itself become in essence a large non-profit society? Will the council be contracting out to non-profit societies within the community? What's the relationship between the non-profit societies and the work of the council?
Hon. E. Cull: Councils can contract with other organizations. I think the best example to think about would be here in the Capital Regional District. The Capital Health Council is looking at taking over mental health services, which are provided not only directly by the Ministry of Health staff but also by a number of
[ Page 9072 ]
contracted agencies. They would become responsible for all of those services, should they take them over.
The answer is that if the health council assumes the responsibilities for an area which has contracts in it right now, obviously they would become the contractor instead of the Ministry of Health. We do a lot of our community health services through contracts to non-profit -- and sometimes for-profit -- agencies.
V. Anderson: I'd like just one further clarification, then. Am I hearing the minister say there are actually two choices for the community council in providing services? One is that they can hire and provide the services directly from the council itself; or they could contract these services out to a non-profit society.
Hon. E. Cull: Yes, that's the way it would work.
Section 3 approved.
On section 4.
L. Fox: I have an amendment to propose on section 4(2) which deletes paragraphs (a) and (b) from that section. It replaces (a) with "2/3 appointed by councils in the region from the members of those councils," and (b) with "1/3 appointed by the minister to represent the general public residing in that area."
I circulated the amendment to the minister and the opposition Health critic earlier. I can only suggest that I think it brings some certainty to the process. I drafted it purposely so that it respects the values of the government as seen in appointments to other commissions and boards. I think it provides some guidance and direction in the legislation, to where I think the structure would be supported by all the people within British Columbia.
[4:15]
Hon. E. Cull: I respect the intent of this amendment, and actually would like to propose a slight change to it. The concept of one-third of the appointees being made by the minister.... You're saying that there's some consistency with what we're doing elsewhere. The one-third are not so much ministerial appointees as they are public appointees. All of the people on this board are representatives of the public; none of them are representatives of any particular interest group. While the number seems consistent, I don't know that it follows through there. It was not my intention to appoint as many as one-third of this board, so I wouldn't want to be locked into a situation where we had to appoint one-third of the members.
I would like to propose an amendment which says that the prescribed number of members appointed by the minister not exceed one-third of the total appointees, so that there is a possibility to do that. I realize that there are some procedural issues here. I mention that amendment to the member so that he can see where I would be going. Should we defeat this amendment, I am prepared to table the amendment that says no more than one-third. But I don't want to be required to provide one-third.
L. Fox: Given the tone of the response from the minister, I withdraw my amendment.
The Chair: The amendment is withdrawn.
Hon. minister, do you have that amendment you proposed in writing?
Hon. E. Cull: Yes. I move an amendment to section 4: "In the proposed section 4(2), by deleting paragraph (b) and substituting the following: (b) a prescribed number of members appointed by the minister, not to exceed 1/3 of the total number of members."
On the amendment.
L. Fox: For clarity of the amendment, would the intent be that at least a certain number of the board would be members of the community councils?
Hon. E. Cull: Through you, hon. Chair, I am sending a copy of the amendment to the member so that he can see it. Subsection (2) of section 4 will now read that the board consists of a prescribed number of members appointed by each council in the region -- so members will get there by being appointed by their respective councils -- and a prescribed number of members appointed by the minister, which will not exceed one-third of the total members. So that will allow anywhere up to one-third to be appointed by the minister. As I said, I was surprised when I saw the amendment, because there had never been any intent for it to be that large.
Amendment approved.
On section 4 as amended.
G. Wilson: A couple of questions come to mind that speak to the intention of these regional health boards. When we get into the purposes in section 5 and when we get into talking about the health councils in section 6, we can expand on some of these questions. We have to ask why we need the two authorities in the manner in which they are constructed under this bill. The bill is saying that there will be a prescribed number of members. We don't know what that prescribed number is; maybe the minister can tell us. We know that the minister is not going to appoint more than one-third of the total, but we still don't know what that total is likely to be.
Secondly, we see that the balance of those members are going to be appointed by each council in the region from among the members of that council. So they are all the same people. We now have the same people coming from one local authority into a larger authority, and it seems to be the provision of an additional layer of government that isn't necessary or required. If you are appointing from among the same people and there is no prescription as to what the minimums are going to be, why do we need this? Why would we not simply have that decentralized form and put the authority and enact
[ Page 9073 ]
the authority granted to these councils into the health force?
Hon. E. Cull: Again, the member was absent from the chamber when we discussed that. The size of the regional health board isn't specified, because it depends on the number of councils in the region. That's why there is no prescribed number there. The number of councils would determine the size of the board.
There are two reasons we have the regional boards in addition to the community councils. One is that we went through an exhaustive process coming out of the royal commission recommendation, which was for regions only, with a senior civil servant running the show. The public didn't buy that one, but they liked the concept of more local autonomy. Through the process that we worked through over many months, the consensus arrived at was the need for community health councils not only to run the show at the local level but also to be part of a larger entity that would be responsible for coordinating planning services within the region.
One of the biggest problems we have in this province right now is that we have communities that are very close to one another, sometimes within ten, 15 or 25 miles, each with hospital services that will not cooperate and plan together. They often compete. Sometimes they deliberately don't do it; sometimes they just don't do it because no one has ever suggested that they should actually get together and sort it out: "We'll get the CT scanner and provide services to your patients, but you do this service, and we'll provide services to the patients in the region that way." We end up with duplication, competition and lack of coordinated planning, because there hasn't been a regional structure up until now.
One of the most encouraging things I've had coming back to me out of this process of forming councils that's now underway is that even the most cynical people who have participated in this have said to me: "I don't know if it's going to work, but you know what's interesting? This is the first time that we've ever actually all sat down in a room together and started to talk about what we're doing and to coordinate it." That's why we need to have more than just the community integration. There needs to be some regional integration.
G. Wilson: Let me come back to the first part of the question again. I heard the minister say that there is no proscription for the number of members, because this minister doesn't know what the number of councils is likely to be. That really doesn't answer the question. Does that then suggest that there will only be one member from each council? No, it doesn't. There could be two, four or five. Does it say that there is going to be a prescribed number on the basis of each region equally? No, there's nothing in here that says that at all. Does it say that there are not going to be various distinctions made because of regional geographic complexities? I would suggest the probable answer to that is yes. I would say that if we're going to go to this model, that's the logical way to go.
Although people often haven't worked together, it could be accomplished without establishing another level of government, which is what this is, or another level of authority. I believe it can be done. As soon as you start to move toward the creation of a new entity such as this regional health board, you are going to have all of the trappings that the regional health board is going to demand. You are going to have all of the bureaucracy that will ultimately gravitate to it, because that's what happens. History is replete with it. I tried to argue that in second reading, about what the development of the regional districts has become, and what they were intended to be. There is going to be a movement of the bureaucratic system toward this board as sure as we're sitting here, from my perspective. It seems to me that if you are going to guard against that, we should be stipulating a prescribed number. If it's one per board, fair enough; then we know that in a region where there are a large number of boards, we are going to have a bigger group. I think we have to do that, and the prescription of that needs to be done here, because when you start to get into section 5, and when you start to talk about the community health councils in 6 and 7, it seems to me that we can make a very strong argument that the government is creating this new series of government agencies that an increasingly large bureaucracy is going to gravitate towards with a greater demand for power and authority, and therefore a greater demand on the tax base for financing. I think we are going to get a more expensive system that still may not get people working together.
I would argue that if you have ever served time on a regional district board.... Municipalities and unorganized areas sit on regional boards, and the jealousies of the jurisdictions are just as strong, just as widely held and just as obstructionist in trying to get cooperation on things like water and sewers, because they are protecting their turf. Just because you move them into a regional health board, I don't think you are going to get away from those areas that don't want or refuse to work together, or that jealously compete. They recognize that dollars in their community are what ultimately advantage the people in their neighbourhoods.
I would like to hear the minister's comment on that. I think this is a prescription for large, expensive health care that is going to cost the taxpayers a lot of money. It is going to divert money from the delivery of health care into more administration, and I think that is exactly opposite to what we should be doing.
Hon. E. Cull: First of all, I will remind the member that this is interim legislation. When we get to permanent legislation, there will be a specification of the number of members, or at least the range of the size of these councils. The largest union board of health we have right now has, I believe, 21 members, which seems large to me. So we obviously know what the outside is. If we go to smaller ones, we will become more efficient.
Right now we have 21 health units with their own union boards of health, governance structures and administrations, and all of the expenses that go with having a board of health that provides those services.
[ Page 9074 ]
We also have 29 regional hospital districts. So right now we have 50 regional authorities; they actually overlap one another. While there is no duplication in services, there certainly is in the geography. If we go from 50 regions to 25, we will cut the regional-level administrative bureaucracy in half in this province. That is probably pretty close to where we are going to be. There will not be any duplication of service, because those union boards of health will no longer exist as separate agencies, and the responsibilities that the regional hospital districts have added to the burden of regional districts will no longer be there. In addition to those 50 agencies we have councils of hospitals, area planning councils and all kinds of other layers out there on top of this. This is a much simpler and more rational system.
L. Fox: I want to follow up a bit on the comments by the member for Powell River-Sunshine Coast. I think he makes a good point. When I think back to the regional district structure, and the fact that weighted votes represent the population base -- which have caused horrendous problems in some regional districts; not all, because some of them are never used, but in others they certainly are used.... So the makeup of the board.... Even though it is a three-year interim board, there are going to be some dramatic decisions. At least, I envision that there are going to be some very important decisions made by these appointed individuals. Is it the minister's opinion that the number of board members may somewhat follow the population in the respective areas? You mentioned that a region could go around the health unit boundaries. I look at the Prince George Board of Health boundaries, which go all the way to or just shy of Burns Lake, Valemount, Mackenzie and so on in there, and yet Prince George, as a large centre within the hub.... In all of the community health councils that would make up that region and therefore make up the appointees.... There is a concern that if representatives from the councils were appointed to this regional health board on the basis of population, there could be -- not necessarily would be -- a lot of emphasis placed on the Prince George region, and very little placed on Valemount, Fraser Lake and Fort St. James. How does the minister envision getting around this issue in coming up with the prescribed number of board members?
[4:30]
Hon. E. Cull: My preference is that each health council have the same number of representatives on the regional board, rather than a number based on their population. Certainly that is the opinion of the associated union boards of health. I would imagine it is also the opinion of the smaller communities in the province. It is being discussed by the governance committee that is looking at all of these issues and providing us with advice. That is part of why we are piloting this, as opposed to simply imposing legislation without having tried it out.
When you make comparisons to the Municipal Act, I think the important thing to remember is that the provisions for weighted votes usually have to do with taxation and financial matters. The provisions for one person, one vote have to do with corporate decision-making, and the vast majority of the work of this board will be corporate decision-making. Therefore the decisions that may arise as a result of capital expenditures and taxation are very important with respect to representation. That is why this act does not deal with that. As I said some time ago, that matter is the subject of work being done with the Union of B.C. Municipalities, and the capital funding programs will not change in the lifetime of this act.
L. Fox: What we will see at the end of this process, with respect to the membership of the regional health boards, may be something totally different from what the minister is putting forward now, even with the amendment, in terms of numbers and representation. Is that correct? Is the UBCM review that is being done in cooperation with the ministry also looking at the structure of a board? Is the voting power of a board member part of the review? Is that what I understood the minister to say?
Hon. E. Cull: No. I am sorry if I added to some confusion there. The Union of B.C. Municipalities task force is simply looking at the taxation issues around capital cost-sharing, and it will make recommendations as to where that function should be. But if the function is transferred to the regional health boards from the regional hospital districts, it may have implications for the voting at those boards on those matters. There is great concern that we not have a body which is not totally representative of the population that will have to pay those taxes.
The first question you asked was whether it's likely that these regional health boards may look somewhat different in the end. The answer is yes, they may. This legislation says only that there will be designated members, of which no more than a third will be ministerial appointees; the rest will come from the health councils. With respect to all of the details that we are talking about right now, the legislation is silent. That allows us to work through some of these problems with those boards that will be up and running during the lifetime of this legislation, piloting this for us.
I mentioned a governance committee. It is a working group that we have established with stakeholders to look at many of these issues around this legislation, in terms of how many people there should be from each council on a board. What do we do when we have one council representing five communities, as we will have in Mount Waddington? Some of those things are still being sorted out through the work that the communities are doing. We are doing it as cooperatively as we can, through a process of working with the people in the communities. So again, this legislation is interim.
L. Reid: Much has been made of this piece of legislation being a creature of the NDP government's "New Directions for a Healthy British Columbia," and much has been made of its connection to the Seaton royal commission. I take some issue with the latitude in
[ Page 9075 ]
terms of.... We take the position that a number of sections in this bill, and particularly section 4, are not consistent with the commission's recommendations. I would ask the minister to pay particular attention to B-38, and I will quote from B-39. It recommends that the Ministry of Health be decentralized "into a number of manageable regional centres, assigning fiscal responsibility to the regional general managers." This is clearly not the intent of Bill 45, which establishes boards and councils that have these stated purposes. The royal commission was clear in several major recommendations on B-38 that the decentralization should be in the hands of the ministry, the deputy ministers, the regional assistant and, most importantly, an accountable regional general manager and a core complement of regionally placed staff. I see nowhere in this bill that this structure is in any way anticipated. Was that your intention?
Hon. E. Cull: It was not the intention of our New Directions strategy or the government to accept this recommendation from the royal commission. If the member has carefully read the report on the disposition of the 379 recommendations, the member would be aware that this recommendation was rejected by the minister's advisory committee, by the two health care forums that we held and by all the consultation that we went through.
I've had opportunity to talk to some of the commissioners about the recommendation. The concept was that we would appoint a senior government bureaucrat to act as a CEO of the region and be responsible for managing all of the services of the region as part of the ministry -- without any community involvement. All that would do is basically take the highly centralized system that we have right now in the Ministry of Health and decentralize it to the regions, but keep the authority clearly in the hands of the ministry without there being any community authority whatsoever. The process of consultation that we went through during 1992 soundly rejected this and recommended that there be councils to replace the existing myriad of boards, societies and ministry-run services.
L. Reid: That is the interpretation. Will this move to regionalization through the Health Authorities Act result in any downsizing of the existing staff within the Ministry of Health? I believe we're currently at 5,200 full-time-equivalents. Are we looking at a shift of those bodies into the communities or not?
Hon. E. Cull: The vast majority of the direct-service providers in the Ministry of Health are in the communities that they provide services to. We don't send our public health nurses from Victoria to provide services around the province. So in terms of our direct-service providers, we are actually highly decentralized.
But there are two ways that I can say yes to your question. One is that many of those employees will cease to be employees of the Ministry of Health and will become employees of a community health council. We will also be making some major changes to our headquarters functions because, when we are no longer primarily a direct-service health agency, we will then have the opportunity to reorganize ourselves to provide the support services that have to be provided -- and to provide those centralized services that will still have to be provided. So I would imagine that we would see a downsizing in the Ministry of Health both from a shifting of employees to other employers and from a streamlining that we will do as a result of getting out of the direct-service business primarily.
L. Reid: I began this afternoon's debate asking about direct service and direct medicine to British Columbians. From your comments about decentralization and removing some of the centralized bureaucracy in Victoria, I'm not clear if we're looking at any reduction in administrative bodies. That is my question.
Hon. E. Cull: I don't think you meant administrative bodies; you mean people doing administration in the ministry. Is that what you mean?
When we're talking about administrative bodies -- and I am sure the member for Saanich North and the Islands could tell you how many administrative bodies are going to be collapsed in his region under the community health council proposal up there -- we will see a dramatic reduction in the number of governing bodies in this province. Right now we have over 150 hospital boards, 21 union boards of health, I don't know how many long term care facilities and literally hundreds of non-profit societies providing all of the other services. If we just collapsed the first three in each community -- hospital boards, long term care facilities and union boards of health -- into one board, we would reduce it by three times. We would go from three times the number of bodies down to a much smaller number.
With respect to the administrative responsibilities of the ministry, if we don't have people who are doing direct-service delivery in an area, we will not need to have the managers or supervisors for that. If we have fewer employees on our payroll, we will have a smaller payroll department. There will be some reduction in our administrative overhead, but I would not want to mislead you and say that it is all going to be eliminated, because some of it will be moving to the community health councils. Those nurses are still going to be needed, and there will still need to be some administration there.
I see the member opposite saying that this means more bureaucracy. It doesn't, because it means that we will be able to use the capacity of our existing systems. If you take the simplest example -- merging a public health unit, a long term care facility and a hospital into one society -- you don't need three payroll departments, three purchasing departments, three human resources departments, three laundries and three kitchens. You can't cut it by three, because some are still going to have to be there. You are going to be able to reduce those services, because you can create the efficiencies of using the excess capacity remaining in that administrative structure.
[ Page 9076 ]
We are finding that out with the changes being made at Shaughnessy. We are not having to transfer all of the administrative dollars that go with each service to the receiving hospital, because the hospitals themselves have the ability to pick up a certain amount of that administration.
L. Reid: One of the largest concerns shared by the majority of British Columbians is that this will create a parallel level of bureaucracy. The comments from the Minister of Health do not suggest anything but that. We are looking at increasing administrative costs to the taxpayer in British Columbia. If we go with your comments, hon. minister, we can look at changing the name of those administrative bodies, but we are not reducing the number of dollars the taxpayers will pay for administrative costs. The only interest British Columbians have today is increasing direct service -- reducing surgical wait-lists, etc. -- not increasing administrative overlay. This amalgamation of service which you speak of, and which has been sold to British Columbians as reducing the cost of bureaucracy to the taxpayer, is not evident today.
Hon. E. Cull: Let me give you the most recent example I have. We had to make a decision about whether to leave the UBC site of University Hospital as a separate administration, with its own society and board and all of that, or merge it with VGH. The difference in cost was $5 million. These are not insignificant savings. You cannot tell me that hospital boards and long term care facilities that have merged in communities around this province have the same overhead costs that they had before they merged; they don't. They eliminate one CEO and some of their administrative overhead. They don't cut it in half, but they don't have the same level of administrative overhead they had before they merged. That's the reason these organizations are merging. They wouldn't be doing it for any other reason. If we take 21 union boards of health, 150 hospital boards and who knows how many long term care facility boards and reduce that to 25 societies, we will have less bureaucracy and less administration than we have now.
L. Reid: The question was specifically in reference to centralized bureaucracy in Victoria in the Ministry of Health. Do you anticipate any reduction in administration in the centralized bureaucracy in Victoria?
Interjection.
L. Reid: No, she didn't.
Hon. E. Cull: Well, I thought I answered that, but I'll answer it again. The answer is yes, I do expect a reduction in the administration. We will not be doing some of the things we are doing now, therefore we will not need to have people to do those jobs any longer.
L. Fox: I've been listening with some interest to the minister's comments about how she is going to reduce the bureaucracy through this process. The minister suggested that there are 21 union boards of health, and she is going to do away with that process. But they are going to be replaced by 22 to 25 regional health boards. We have over 130 communities, not all of which have hospitals. You probably know that better than I, being the Minister of Health. Now you will have a community health council in virtually every community in British Columbia, which will increase the number over and beyond the number of hospital boards.
[4:45]
I have one further point to make. I think it is all very pertinent in discussing the level of bureaucracy, because certainly that is one of the criticisms I have about this process. In many cases you have a volunteer society providing direction to the board on home care, intermediate care facilities, extended care facilities, and so on. In some cases the extended care facilities are joined to the hospital or are part of the hospital board. In intermediate care facilities particularly and self-care facilities, those have been initiatives by a society -- a Legion, an Elks Club or whatever. They initiated the original capital structure, and the ministry finances the operation. But that is being provided, by and large, for free. There's no cost to them at the present time.
For instance, in my community it is a non-profit society, and the Legion has played and still plays a major role in the day-to-day operation of it. I don't see that there's going to be an immediate rush by these societies to give up these structures and no longer be part of the system. In fact, I think many of them are going to hold onto that limited amount of control, based on the fact that they want to be part of the process.
You have 130 communities, which will give you at least.... In some cases you could have four, like the city of Victoria. The minister suggested earlier that it could have four community health councils. But in each case you will have 130 communities that will have at least one community health council, and some of them may have more. So I don't see how all this structure is going to decrease the bureaucracy, as the minister suggests. I suggest that it's going to increase the bureaucracy substantially. Therefore I'll leave that for the minister to speak to.
Hon. E. Cull: Hon. Chair, let me correct the error the member has just made with respect to Victoria. There will be four community health councils in the capital region. There are 11 municipalities and some unorganized areas here, but not every municipality is going to have a health council. There will be one council for the four core municipalities; one council for the Gulf Islands; one council for the Saanich Peninsula, which has three municipalities in it; and one council for the Western Communities, which has the remainder. Mount Waddington, at the northern end of Vancouver Island, has four municipalities and five facilities, including small hospitals and diagnostic and treatment centres. The four municipalities there have agreed to form one community health council and to go to one administrative structure to provide the services to those facilities, which right now all have their own
[ Page 9077 ]
independent administrative structures. So there is clearly a reduction there.
When you speak of free services provided by the Legion and others, I'm assuming when you say "free" that they are not paid for by the taxpayers, that there are no operating dollars given by the Ministry of Health to those agencies and that they're all paid for privately. If they're not privately funded, then in fact they are part of the public system.
Nonetheless, we don't expect every last agency and board that exists within a community to amalgamate. Even in a little community like Vanderhoof, there are probably two dozen health care societies. All I'm saying is that in a little community like Vanderhoof if there are two dozen societies providing health care services, and we amalgamate just the three big ones, we have made progress in terms of eliminating administration and bureaucracy. We have knit together an important part of our health care system which right now is fractured, even in a small town like Vanderhoof where you figure they probably wouldn't be able to find all the people to sit on all those different boards. A lot of services provided in this province have no local governance whatsoever; they're just dictated by the Ministry of Health.
Here in Victoria, when I count all the hospital boards and societies, the long term care facility boards and the Capital Regional District, which happens to be the health unit, and I throw in the Ministry of Health, we will be cutting them by at least half if we go down to four community health councils in one region. I probably haven't counted them all, because this is a region that's too complex for me to have all of them at the tips of my fingers. I haven't even started to talk about any of the societies, the homemaker agencies or the others.
G. Wilson: I want to come back to this one question about the number of members on the board, how this board is going to be set up and whether or not it's going to have anything remotely resembling a reduction in bureaucracy. I hear the minister say that there is a consolidation of boards and that through this process, somehow we're going to reduce the administrative bureaucracy and therefore the cost of administration of health care. I can concede on that first blush it looks that way if the union boards of health are going, the regional district boards are going and the hospital boards are going. Through an amalgamation and consolidation of this, it looks like you are going to be taking what is right now a rather unwieldy, large and unworkable set of interrelated groups of people and you're going to put them into this new regional health board concept, followed up by the community health councils, and reduce the bureaucracy. But experience has shown that whenever you set up a more rigidly structured set of authorities at the municipal level -- which I know the minister is well aware of, because I believe she has some experience in the Ministry of Municipal Affairs in her past life -- as soon as you have these kinds of authorities established, what happens.... Unlike a union board of health, which tends to be rather community-based and grass-roots, and unlike a regional health board -- which I have sat on personally and in fact have chaired -- and unlike a hospital board, which tends to be society-based in many instances in this province, you have now put in place a more rigid structure that is a functional part of a centralized health care system, and that part is the "decentralized authority." What will happen? I predict -- and I hope that at some future date somebody looks back on this debate and sees which of us is right -- that this is indeed a new bureaucracy, which the much wider base of representation that is going to be required in the communities will gravitate toward. The community health councils are going to proliferate, and you will find that despite this, there will be a demand for a greater degree of autonomy and control by hospitals or some form of hospital board. It is going to happen. It is going to funnel necessary dollars into its administration, because essentially, it will allow a bureaucracy to gravitate to it. That's why we're so rigidly opposed to what is being proposed here. It doesn't do what the Seaton commission said we ought to do. The minister at least was honest enough to say: "Well, we looked at that recommendation and decided not to go with it." At this point we need to agree to disagree, and from this section on, we will defeat it.
V. Anderson: I'd like to take the opposite side of this. We're talking about the bureaucracy and the increasing or decreasing number of people in it. We polled many of these agencies and societies, and the concern I have is that the minister has commented about these being available already. Already in the community where I am, I hear competing factors. There are a whole host of volunteers who are a part of these societies and organizations that have grown over the years. I'm reflecting on the danger of those volunteers being dispersed and lost. They're saying this belongs to some central structure now and there is no longer any place for them, and we lose the society input and volunteers, apart from the members who are a part of this council. I'm concerned that we may well lose that whole volunteer sector out there in the community. They'll be out of touch with this centralized -- as it appears -- approach.
Section 4 as amended approved on division.
On section 5.
L. Fox: We're now dealing with the section that I suppose in many respects we dealt with earlier today. I certainly have several concerns around the funding and so on. The minister suggested earlier that the regional hospital districts at this point would not be disbanded for the purposes of capital. Are the regional hospital districts going to stay in place until November 1996, when the election and the final structure of these regional health boards will be in place?
Hon. E. Cull: Unless there is a legislative amendment earlier than that, they could stay in place that long, but it is possible, and probably quite likely, that the permanent legislation next year will address
[ Page 9078 ]
that. The regional districts, as I understand them, for the most part would dearly like to be out of the hospital planning function, because most of them don't have the resources to do it -- a former regional district chair himself is saying that. The question of the taxation has to be resolved first, and it will be resolved, I understand, quite soon. We're looking at a matter of months to pull this together, and so we could work that into the permanent legislation.
L. Fox: Of course, the minister may know a lot more than I about when the next session will be. But a matter of months could mean that we will discuss that legislation around this time next year, which brings some concerns to the surface.
I'm sure the minister will be aware that the regional hospital districts provide some funding on an annual basis for small projects and equipment, as well as some initiatives taking place out there in terms of extended care facilities, hospital upgrades and so on. Given that in all likelihood the hospital district borders will not match the regional health board borders, there's a question in there, in the interim between setting this board now and such time as you have in place your financing authority that represents the regions: how are you going to handle that small project funding on an annual...? I realize it's minor capital, but there has to be some taxing authority to raise that over the course of the next couple of years. I know in our regional hospital district we will be split in half. Presently the taxpayers in one end aren't going to want to contribute tax dollars and have to pay them back over the next 20 years, when it's not going to be reciprocated in future years. That shift is going to cause some operating problems, in terms of how we handle the interim. Perhaps the minister would address that for me.
[5:00]
Hon. E. Cull: Because this legislation does not deal with capital financing, to answer these questions I'd have to be speculating at this point. The message that's been given to the regional hospital districts is very clear: there is no change in their status, responsibility or taxation authority. That will remain like that until the Union of B.C. Municipalities task force has made recommendations to us as to what should happen.
It is quite likely that things may not change at all, and that one of the options they're looking at is no change with respect to capital financing. So regional districts should not assume there's going to be a change. Certainly, for the regional districts change won't happen within the next budget year. Regional districts that are making decisions around their finances can do so with comfort, knowing that changes will not be made that will affect them immediately.
L. Fox: I know the minister said earlier this didn't affect capital. But it's going to, unless some specific statement or direction comes out of the ministry around the responsibility of the regional health boards with respect to capital or minor capital or whatever. My concern is that you're going to see a stop in regional hospital districts, because the structure could be so different.
To try to explain my case, I will talk about a capital project in the west end of the Bulkley-Nechako Regional Hospital District, where presently -- as the minister well knows because she has instructed it to move forward -- Smithers is looking at a capital improvement for an extended care facility. Presently you have the Vanderhoof initiative as well. Because of the uncertainty, you're going to have a situation where that regional hospital district is not going to commit funds which may be taxed on either end of that regional district over the next 20 years. Once the next year is up, they may no longer be part of that taxing authority. I'm concerned about these projects moving forward, and want some suggestion from this minister that gives comfort to those taxpayers in that interim time frame. If I were the chairman of the regional hospital district, I would put all my projects on hold, because I could get into a whole lot of discussion at both ends of that regional district. The Vanderhoof region will not want to pay for the Smithers region if the Smithers region does not have the opportunity to contribute when Vanderhoof has an improvement, because they will no longer be part of that taxing authority. That's my concern, and it's a legitimate concern. Even though this particular board may not at this time have the authority under this legislation to deal with capital projects, I think that not dealing with it, and not making some major statements around how those things may be resolved, will stymie capital construction for the purposes of delivering health care.
Hon. E. Cull: I thank the member for explaining the recent vote in his hospital district to me. The intent is that we will have the report of the task force available at the Union of B.C. Municipalities meeting.
Interjection.
Hon. E. Cull: I want the member to hear this, because he will find this information useful.
The convention of the Union of B.C. Municipalities will be held in mid-September. The intent is that we will be able to have the resolution of this matter available for discussion at that convention, so when I say a matter of months, that's two months from now.
V. Anderson: In developing the regional health plan, which the board is to develop, and the guidelines for the development that follows, I wonder where the authority lies. Take the municipal model. Each municipality has authority within itself, and then as it becomes a part of a greater regional board, it takes the authority with it from the municipal council to that regional body. So they get the authority from the municipal council to take it to the regional body. The regional body is then able to do planning on the basis of the agreement of the municipalities. So the power is in the municipal council.
Is the power for the regional board residing in the regional board, which develops a plan, which is then delegated to the councils? Or is the power residing in
[ Page 9079 ]
the councils, who upon agreement undertake to delegate their authority to the regional board?
If I hear the intent of the ministry in the Closer to Home document, they are trying to decentralize the power from the province down to the community, and have the power go the other way. Here we have a regional board which is in the middle, and which way is the power going? Where is the power? Is there really power or is it still in the ministry, delegated down? Which way is the power flowing?
Hon. E. Cull: The power of the community health councils and the regional health boards are established under this act, and they each have powers according to the various sections. The powers of the board are to develop and implement a regional plan -- I won't go over the rest of it, but there are five subsections there on things they have to do, and another seven sections of responsibilities for that. This is where their power comes from -- this legislation. It doesn't come from the fact that they hold it as councils and then bring it up to the board, as you say. It isn't delegated by the province down to the regions, except to the extent that this legislation in fact does that. It takes some responsibility that is now with the ministry and places it in the hands of other bodies.
But you have to recall that the regional health boards are composed of people who come from the councils. They are all going to come in knowing what the concerns of the councils are, because they are members of the councils. What we are asking is that a subset of council members get together and plan collaboratively at the regional level, and in some cases deliver services at the regional level if that is appropriate.
Subsection (2) of section 5 says that "a board must have due regard to (a) the Provincial standards and specified services," so they have to pay attention to the standards set by the province and to the community health plans that the community health councils have provided. A regional health board can't ignore what the community health councils are doing and do something different. But it would be rather hard to imagine them doing so, since they are composed of the same people.
V. Anderson: I appreciate the minister's explanation, but I am thinking of a constituted body with three different levels. The representatives are elected at one level, go up to the next level and then to the third level. In that kind of constituted body there are generally certain powers delegated in the constitution for each level, so that in certain areas of jurisdiction that level has the mandated power. As long as they use the power delegated to them at whatever level in their area of responsibility, then everybody operates and they feed back and forth. But the actual final decision-making for certain delegated powers is at each level. I don't see any delegated power for any particular function at any level, so that there can be....
You come to a regional board, for instance -- 25 people from community councils sit on the regional board, and they split on a 12-13 vote. Thirteen of those council members may be quite satisfied; the other 12 say no way. When the final decision-making on a particular issue is there, if one was to appeal it.... In a normal case, if you went to an appeal board, they would simply ask whether that body acted within the authority of its jurisdiction." If they did, fine -- that's what the authority is. If they acted outside the authority of their jurisdiction, then it doesn't pass. I am trying to get at an area of jurisdiction for the regional board, which is different from the jurisdiction of the community council, which is different from the jurisdiction of the ministry itself.
Hon. E. Cull: I'm having some difficulty with the member's questions. The regional health board, for example, has the responsibility to develop and implement a regional health plan. The ministry doesn't have that responsibility. The community health councils don't have that responsibility. The only body that can develop a regional health plan is the regional health board. In developing a regional health plan, if there was a split on the board -- as you have just described -- then the procedures of the board would govern that plan. Whether that plan came into being or whether you needed a two-thirds vote -- or whatever -- all those things are part of the procedures that would be determined. But it doesn't have to be vetted somewhere else; the power doesn't come from the council to the board to develop the regional health plans -- just how the people get there. The body constituted as the regional health board has these seven responsibilities and, for the most part, they are distinctive to the health board, not to the council.
You may want to question some places where it appears there is some overlap. I can assure you there isn't any overlap, although in some cases both bodies may be exercising the same function, but not in the same area. Just to explain that -- as I did earlier when we were talking about the services of a regional health board -- at first we didn't contemplate the regional board being a direct-service agency; we just saw them being more a funding and planning agency. But in working our way through it, a number of communities pointed out to us that there were cases that were quite defensible where we would want to have the board providing the direct services. Sometimes the service is better provided regionally -- environmental health officers is the example that has been brought to my attention most frequently -- and sometimes there will be parts of a region where there is no community health council and there needs to be a provision of services to the sparse population that may exist in that area.
V. Anderson: I'll ask one more question to try to clarify this. If there is a need for AIDS treatment in the region, and the AIDS treatment could be done better in a regional centre than in individual community centres, but there is strong pressure to have community-centred AIDS treatment programs, and only one is possible, where is that final decision made? Who makes it? What is the area of jurisdiction for that kind of decision-making?
Hon. E. Cull: The decision in an example like that would be made by the regional board. That is similar to
[ Page 9080 ]
the decision that I gave around the CT scanner. They're the ones that develop the funding allocations and decide whether the services should be provided centrally or in local communities.
[R. Kasper in the chair.]
V. Anderson: Does that relate to the powers in subsections (2)(b), (c) and (d), which have to do with developing the budgets to the minister? In essence, do those budgets include the budgets from the community councils, so that under subsection (2)(b) the regional board develops a budget to the minister? Does that budget include the budgets of the community councils, so the community councils within a region work out what that budget is with each other? Is the power of the final decision-making about what can be done in a community decided in the regional budget?
Hon. E. Cull: The simplest way to understand it is to go back to the "New Directions" document, where the roles of the two bodies are very clearly set out. The regional health boards are intended to be planning and funding agencies. They'll allocate the global budget and do the regional plans. The community health councils are delivery agencies, and they set local priorities for delivering those services.
L. Reid: I'd like to spend a couple of moments this afternoon reviewing section 5, the purposes of the regional board. The boards, as we understand it, can develop and implement plans for health care in the regions, including services and facilities -- exactly as it states. As part of their planning, the boards can also develop staff and program requirements, but these two are subordinate to the powers in subsections 3(1) and 3(2). Is it the hon. minister's belief that we are indeed decentralizing power? It seems to me that under section 5, where we talk about the purposes, we are creating opportunities to move some of the decision-making, but not the responsibility and the authority at the end of the day, which will remain centralized in Victoria. Is that your belief system?
[5:15]
Hon. E. Cull: No. As I said on a number of occasions this afternoon, the intent of the legislation is to balance the provincial responsibility to ensure that there are standards and a level of service that citizens can expect wherever they live, and the needs of communities to set their own priorities around how they deliver those services and what emphasis they put on them. If you look at services for children, there are many examples of decisions that are made in Victoria right now around budgets which could be made at the community level. At the end of the day, when you're looking at a health unit's budget and you know that you have a list of things to fund that exceeds the amount of money you have, and you have to decide among a speech pathologist, a public health nurse, a dental hygienist or more funds for some clinic or other, the decisions are made very centrally right now. The decisions under this system will be made by the community health councils.
L. Reid: To return to developing and implementing plans, the minister currently has final authority over both of those decisions. That is what this legislation allows for, and frankly, that is what this legislation demands at the present time. I make reference to your earlier comments, that this is legislation that will not be with us forever, that it will be replaced once we move through this transition stage. But at the present time, we are not moving toward decentralized decision-making. Certainly, what the act says does not allow that suggestion to be considered factual.
The boards that are developing policy are subordinated to provincial standards and budgets, which are submitted to the minister. Under section 5(1)(b), it says that the boards can allocate resources, which is a function of the budget and which requires ministerial approval. We are not shifting that level of decision-making from Victoria; it is still a centralized decision. Similarly, the boards can allocate grants to the community councils, but since the size and eligibility of these grants are determined by the minister, this again is a questionable level of authority. Was this your intention?
Hon. E. Cull: I am actually very surprised to hear the Liberal opposition arguing for these councils to set their own budgets. I thought that was exactly what they were opposed to. They were worried that there might be a possibility for these councils to raise additional funds -- beyond those provided by the government. There has never been any intention on the part of this government to do anything but provide the funding to those councils according to the financial management practices under the Financial Administration Act, and under the decisions of the budget. So there will be budgets established and given to those regions. The regions will not be able to change them, but the regions will be given responsibilities.
What the member is ignoring is that right now virtually every decision -- about the level and kind of service, the people who are hired in many cases, and whether the services that are provided are additional services in the area of public health, mental health or continuing care -- is made centrally by the Ministry of Health. We are saying that that has to change. We are not going to tell communities that they have complete freedom to make all of those decisions. We are not going to tell them that they have the ability to raise money or set their own budgets. They have to wisely manage the money that the government has allocated to these services. We are not telling them that they can decide not to provide continuing care services or public health because their interest is somewhere else. There has to be a basic level of services across the broad spectrum of health care. We are not telling them that they can set their own standards for how many staff you need in a child care centre or in an adult day care centre. Those types of things do require provincial control. But when it comes to how those services are organized -- whether the services are provided on an
[ Page 9081 ]
in-patient or out-patient basis, or whether the ability to economize by changing the way that they deliver service may not free up money to then do some things in areas that are not now well funded -- that is exactly what the ministry and this bill are trying to achieve.
The problem we have right now is that all of the budgets for all of the health services in this province are segmented and come to communities in little pipelines. You cannot move the money from the alcohol and drug program to the mental health program, no matter how sound that idea may be at the community level. You can't economize or do anything to free up dollars so you can spend it on something else that is desperately needed in that community. What we are looking for here is a balance between the provincial responsibility and local priority-setting. I think you have to be very careful not to tip the balance too much either way.
Right now, all of the decisions are essentially made by the ministry. We are not going to shift to a situation where all of the decisions are made by the community, because you can't make all the decisions if you don't have financial responsibility. They are spending the tax dollars of this province, so there has to be some financial accountability back through the government. That is why there is a balance.
L. Reid: It warms my heart that the Minister of Health is talking about achieving a balance, because that is what the official opposition stands for. However, under 5(1)(d) the boards have the responsibility to deliver services, but they lack the full authority to either define the services or to allocate the dollars. If this minister is truly interested in achieving some balance, we believe she's going to allow the regions to perform at least one of those functions. Right now they cannot perform either. They honestly have accountability without any authority. Again, is that your intention? I support the notion that we need to have some balance around this question, but I cannot support the notion that we don't allow them to define the service or finance the budget, but give them the full responsibility for the program. It's one or the other, hon. minister.
Hon. E. Cull: I think this discussion is starting to get quite repetitive, but I will not support any suggestion that we allow the councils to set their own budgets and just send the bill to the government.
V. Anderson: I found the minister's explanations very helpful. Whether I agree or disagree is irrelevant; what I am trying to do is understand. If I understand correctly -- and I think I do at this point -- the minister is saying that there is a global budget for health, which we all vote on here. That global budget can be allocated to the regions according to the plans that they present to the minister. Then the minister, dealing with the various regional budgets, will take into account the decisions, requests or needs of those regions. After that, the regions will essentially do the same with the local community councils, which will put their budgets into the region, and the region will be closer to the source of those making the decisions than the minister normally is. With that I would totally agree.
If I understand her correctly, she has transferred centralized decision-making to a body in the middle, which works up and down the scale as best it can to get around the province. If so, I can understand and appreciate it very much; it probably will have some difficulties, but from my personal point of view, it's worth a try. We'll find out what happens with it.
The question that I'm not sure about is with regard to extra funding for local communities and regional areas. Most of our community agencies -- hospitals and that -- are funding over and above the budgets available to them. In some communities they'll be able to do that because of the circumstances of their communities. Other communities will not be able to do that. Is there freedom for communities to do that, and what consideration does that have in this new planning?
Hon. E. Cull: The member has a very good understanding, as he has explained it back to me, of the intent with respect to the funding allocation, and I thank him for his summary.
There certainly are a number of communities where there is fundraising going on -- usually hospital foundations, but often through private societies and other things that happen in communities. There will be no change to that. Sometimes I think that creates problems, because some communities are more able to raise those funds than others. We can get into questions of equity, but I think that is part of the community spirit that is very important in some communities -- the fundraising that is done to buy a piece of equipment or to renovate something or to do some good work in their community with respect to health care. I would not want to get in the way of that kind of community spirit.
Because we're talking about additional funding -- and I know you haven't asked this question -- I feel I must state it again, should anybody misunderstand what we're talking about here. There certainly would not be any ability for these councils or boards to go out and raise extra money through taxation or through any form of fee, levy or anything like that. The normal fundraising that firefighters do to enhance the burn unit will continue, but no taxation authority is given to these bodies to say: "Well, our budget isn't quite adequate. We're a wealthy community, so we'll kick in another $200,000" -- or something like that. No, that doesn't happen.
V. Anderson: If I understand correctly, the key to this process working is the validity of the regional councils' ability to plan, organize and take into account the health needs of the area. But the planning key is in the regional councils. The service provision is primarily by the community councils, and the central government is now taking on only the role of supervisor. I just want to confirm that the regional role is the planning role, the community council is the service provider and the government is now taking on the supervision of that planning and service provision.
Hon. E. Cull: If I understand what your question was, the ministry or the government won't be
[ Page 9082 ]
supervising those services. We will just be setting standards in regulations, and then the agencies -- the boards and councils -- will have to give due regard to those when they're making their plans. The boards, as you pointed out, will be doing the planning. The councils will be doing the delivery and priority-setting. I hope I've answered most of that.
L. Reid: I speak to section 5(1)(a)(v). It talks about "the making of reports by the board to the councils in the region and to the minister on the activities of the board in carrying out its purposes...." Certainly I believe the minister and I agree on the need for some type of cost-benefit analysis and outcome evaluation. It seems to me that if we're to engage in a shift in how we receive and deliver health care in this province, we want to ensure that we have some measurement of success and some opportunity to evaluate practice, and to decide -- if this is an expanded pilot project -- that this is phase one, transition legislation. If this is an expanded pilot project, we need some mechanism to evaluate its usefulness -- and if it truly proves not to be useful, to return to some system that will allow direct-service health care to be the priority in this province.
I would choose to amend section 5(1)(a)(v) with the addition of 5(1)(a)(vi), notice of which stands in my name on the order paper. It seems to me that it's not sufficient to have "the making of reports by the board to the councils," etc. I would -- as I know British Columbians would -- want to know, if we are changing the way we provide services, that there is some accountability around those questions. If there is some clear measurement around a planning goal, I trust that individuals who are not able to access or receive service in any reasonable manner do know that a body is in place that they can appeal to and seek some responsibility and accountability from.
[5:30]
This amendment, I believe, speaks very strongly to the Seaton royal commission, which is about evaluating practice and establishing some accountability so that the taxpayers have some confidence and assurance that they can count on the system. Hon. Chair, I move the following amendment standing under my name on the order paper:
[SECTION 5, to amend section 5(1)(a) by adding (vi) to read:
the publication of an annual report that verifies, through the application of clear measurements, whether regional planning goals were met.]
On the amendment.
Hon. E. Cull: I'm opposed to this amendment for a number of reasons. There are other sections in the act which require an annual report and evaluation. In addition, the wording of this amendment appears to require the board to evaluate itself. Particularly given that this legislation is interim, as opposed to simply a self-evaluation, we would want the evaluation to be done by an independent party with all of the credentials to be able to do an evaluation. Finally, because the legislation pertains to the establishment of health councils and health boards, the responsibility of the ministry itself is to do evaluations. I don't believe that should be in legislation in this fashion.
L. Reid: The minister makes the case that it's not appropriate to do a self-evaluation. Current research in the 1990s tells us that that is the most effective type of evaluation. If indeed this is about building something, the people who are closest to it are in the best position to evaluate the practice. It is not the intention of this amendment to do this exclusively, but rather to do it in concert with an external evaluation. I take no issue with that. But to denigrate self-evaluation, when it is a proven mechanism, does not make sense. If indeed your comments on outcome analysis, cost-benefit analysis, evaluation and how to determine success are to be believed, they all speak strongly for this amendment. I would ask you to reconsider the amendment in the light of the evaluation not being done in isolation but in concert with other evaluative tools.
G. Wilson: Very briefly, the amendment provides a clear opportunity for adequate reporting that would allow the direction of this new regional entity to be very clearly spelled out, so that the public knows exactly what's going on. In light of the fact that you've got under section 5(1)(b) that the authority set in this regional board is to develop policies and priorities and -- this is something that's important -- to prepare and submit budgets to the minister, I think it's imperative that there be some sort of provision with respect to the publication of an annual report, one that does have some measurement spelled out within it to see whether or not the development of these priorities, and the preparation and submission of these budgets, looks after the regional expenditures and the priorities set out in those expenditures, as was outlined.
History shows quite clearly that the filed reports are often generic. They're often very general, and not specific to the kinds of concerns that people have. The comment made by the member for Prince George-Omineca was right on target. On the question of these boards, he said that there's nothing in here to guarantee that once you get this regional system in place, you're not going to have considerable discretion by some board members with respect to expenditures into outlying regions, and a greater degree of control by larger centres at the expense of smaller communities. Such a report, as outlined in this amendment, would alleviate that, because it would set out clearly for all to see whether or not the objectives were being met.
Amendment negatived.
L. Fox: I want to address again the issue I addressed earlier. The minister suggested that I should address it at the appropriate section. It is the issue of closing acute care beds or downgrading a small hospital to a D and T centre, and the kinds of powers the regional health board may or may not have within that process. There's obviously a difference between my understanding of a community health council and the minister's understanding of one. That's probably because I see the
[ Page 9083 ]
concerns of the local communities with respect to their health care services in their communities, and I see quite a lot of parochialism coming out in terms of ownership of their facilities. So I want to know who has the autonomy -- the regional health board or the community health council -- to make the determination to downgrade an acute care facility from hospital status to a D and T centre. Who may decide to shift priorities even more, from acute care to the delivery of a home care service within a community or region?
Hon. E. Cull: If the community health council has assumed the responsibilities for the hospital under this act, then it will have the responsibility for all of those decisions. There may be some instances where regional facilities are the responsibility of the regional board. I mention that because it's a question.... I think it's not likely under any of the proposals that have come forward to us at this point. It has always been my understanding that the community health councils would have that responsibility. However, in order to do effective planning, one of the things that regional health boards may do -- as they have done in some parts of the province -- is start to sort out the roles and relationships of hospitals in different communities.
L. Fox: The reason I asked that question in this section is that if you look at section 5(1)(c), it will be the responsibility of the regional health council "to administer, and allocate among the councils in the region, grants made by the Provincial government for the provision of health services in the region...." I've always been used to the theory that he who controls the dollar controls the agenda. In that section, does the region have the autonomy to vary the priorities of a health council?
Hon. E. Cull: The responsibilities are not clear-cut, because we are dealing with councils that make up a region, and the region has the responsibility for establishing an overall plan that includes what and how acute care services should be provided in the region. So they do have a responsibility there. With respect to the authority of the hospital board being subsumed by the council, making decisions about closing beds or changing from in-patient to out-patient would be made by the community council. The real answer is that these bodies can't act in isolation from one another or in conflict with one another; they have to work cooperatively to sort it out. That's the whole thing that we're trying to accomplish with the regions, so that the hospitals in a region start to work together instead of competitively.
L. Reid: I ask leave to make an introduction.
Leave granted.
L. Reid: I'd like the House to acknowledge the presence in the gallery of an administrative colleague from the Vancouver system, who is also closely aligned to our member for Vancouver-Langara. I ask the House to please make Mrs. Joyce Anderson welcome.
L. Fox: I want to get back on that point, because it's an important one. It goes around the issue I talked about earlier about larger centres controlling a regional health board. I guess I'm not quite as optimistic as the minister that we're going to see small communities collectively decide to become part of one community health council. Being from a small community that is close to two other very small communities, I can already see a lot of parochialism setting the pace within those three small communities, each one of them looking for their own community health council. The minister suggested that the formation of these councils will take shape differently in different areas. In fact, the minister isn't going to put any pressure on any community or region as to how that should be structured. I can see that all of the smaller communities within my constituency will be fighting to form their own community health council.
If we take that a little further -- so I can explain my point -- one community which has one appointee to a regional health board would play a very small role in the planning and priorities on a regional basis. If we look at the situation now within a regional district -- even without the weighted vote; everybody voting on a planning issue within a regional district -- a community often has difficulty getting support for their initiatives within that structure. My concern is that the autonomy of the community health councils prevail in local community concerns, and that a region cannot come down with its planning or the process of administering the grants or development policies and override the policies and priorities of a community health council.
Hon. E. Cull: I don't share the pessimism of the member opposite, but perhaps the experience I have had in working with some of these communities leads me to be more optimistic. We have a situation in the north end of Vancouver Island where four communities have come together. It has taken them some time, but they have reached a level of maturity where they are not competing with one another; they are cooperating. They have voluntarily decided to change the roles of some of those facilities. That is what the outcome can be with communities that may not at first be as willing to work together as we'd like, but if they do start and there is a process for them to do it, then they will be able to.
[5:45]
We have another situation. I can't imagine three communities that were more at each other's throats, but they have now come together and are actually making decisions on a regional basis about changing services from one facility to the other and making some sense out of them. The reason that we're taking a three-year transition phase to do this is that communities that are like the ones you're describing, which will not cooperate with one another, will not be the first ones to start this process. We will work with those communities that have reached a greater level of cooperation between one another, and they will be the first ones that will be forming councils and regional health boards. We'll have to spend a bit more time on the other ones, and perhaps, when they see the benefits that the other
[ Page 9084 ]
communities have by moving in this direction, they too may be willing to do so.
L. Fox: Just one follow-up question. I only explained that structure because I was trying to get to the crux of the matter, and that is: will the autonomy of the health councils and their priorities and goals be respected? Or do they have to fall in line with the regional health board's plans and priorities? What autonomy does the local health council have? Does it have any controls that prevent the regional health board coming down on a community health council and enforcing a policy which the community health council may have problems with?
Hon. E. Cull: Section 5(2) says that the board has to give due regard to both provincial standards and the community health plans for the communities in their region, so regions cannot act without giving due regard to those plans and standards.
Section 5 approved.
On section 6.
L. Fox: I earlier distributed an amendment that I am proposing on section 6. I will read it for the purposes of Hansard and then hand it in, because I didn't get a chance to table it, hon. Chair. I respectfully submit the amendment.
[SECTION 6, by deleting the proposed subsection (2), paragraphs (a) through (c) inclusive, and by substituting therefor the following:
(2)(a) 1/3 of the members be chosen from lists of nominations by the boards of the regional districts and municipal councils within the community;
(b) 1/3 of the members be chosen from lists of nominations by health care providers in the community;
(c) 1/3 of the members be chosen from lists of nominations by school boards and post-secondary education institutions in the community.]
Once again, I think the amendment provides a mechanism which certainly has a cross-section...the opportunity to hit all interests within a community, irrespective of how that community is defined. If it does involve three or more municipalities, there is the avenue for each municipality to nominate individuals to the structure. If it is in one or more school districts, given the relationship between the health councils and the school districts, it provides them with the opportunity to make nominations. But ultimately in this amendment, the minister has the autonomy to select from a list of nominations provided from virtually every interest group within a community.
Hon. E. Cull: I appreciate the spirit of this amendment, but unfortunately, I can't accept it. The concept in the bill, which has been worked through extensively with a lot of consultation, is that one-third of the members will be elected at large. Right now, because there aren't elections, we are using a kind of.... We could have an electoral process in some cases, and I suppose that is provided for in the regulations, but we are going to have to appoint people through a public nomination process, and I will come back to that. One-third are to be elected, one-third are to be appointed by municipal councils, school boards and regional districts, and one-third are to be appointed by the minister. The elected one-third represents the society hospital board concept right now. The one-third appointed from regional districts, municipal councils and school boards represents the way union boards of health are put together right now. The one-third appointed by the minister represents a variety of agencies, some of which are 100 percent appointed by the minister, as well as our direct-service providers.
What we've really done is look at the governing systems of the bodies we're going to be amalgamating and then taken something from each of them. With respect to those members who are going to get onto the board by virtue of being municipal councillors, school board trustees or regional district board directors, we will be asking each representative body to nominate a person who will be appointed. The council in Vanderhoof will be asked for the name of the person to go on the council. It will not be selected by the minister. The council won't be asked to give us three names so we can choose one. There will basically be a direct appointment process, as there is right now with the union boards.
With respect to the one-third who will be elected in 1996, but in the interim have to get there some other way, we are proposing to go through a process of soliciting nominations from the community in a fairly public way. So there will be an opportunity not only for health care providers and advocacy groups but also for people within the community to either submit their own name or the names of other people. We will be soliciting that from community organizations.
With the final one-third, we will also be using a public process to get the list of names that I will then be nominating from. If a community wanted to do so, there is a possibility under the regulations that they could have an election even in the interim. You can imagine that that would be feasible in a small community. Basically, a very large society meeting is what it would come around to. You could probably have an election quite effectively in the local arena in some of the smaller communities. I think that they will probably do that.
However, your proposal gets us into dealing with health care providers being on the council or nominating people....
Interjection.
Hon. E. Cull: Just nominating them? Okay, but it gives a special provision to the health care providers that it doesn't give to other groups. The other groups just become part of the general public. If we consider that the vast majority of these are funded through tax dollars, perhaps we should ask the business community or the workers in a community who pay those taxes to also nominate people.
[ Page 9085 ]
I think the way we have done this means that we reflect some of your intent in terms of asking other groups, and we will reflect it in the way we're going to do this. If you have some concerns, I would be willing to share the material we are putting together right now to send out to people, so you can see exactly where our decision-making process on this is going. But using this amendment would tie us in too much and would move us away from the consensus that was arrived at through the process we went through to develop this legislation.
L. Fox: The minister contradicts herself to a degree, because she suggests now that it's quite feasible that a small community could have an election, when in the previous section the minister suggested that small communities should get together and form a community council collectively. I'm suggesting through my amendment that, since you touch on all the political organizations, you enhance the opportunities because of the communication that would take place. The fact is that this is an interim board. We are only talking about a process of structuring the interim board. When you reach out to the school boards and the health care providers -- and those health care providers could be your Healthy Communities societies, or all those different agencies that are involved in delivering health care and the organization of it -- you are reaching out through the mechanism provided within the amendment to virtually every agency and elected organization within a region or subregion. It provides a start for some communication among the various communities and encourages what the minister suggested, in the earlier section, she wanted to encourage. It encourages smaller communities to come together and form a miniregion as a community health council. In all fairness, I think the minister should look at what this amendment provides here.
Hon. E. Cull: As I said, the intent of the amendment is honourable and in fact would be reflected in the way that we intend to obtain the names for appointment to the boards from the various categories. But when we reflect where we're going to be in 1996, with one-third elected, one-third appointed from municipalities, school boards and regional district bodies and one-third appointed by the minister, we're trying to keep that symmetry in this interim legislation. The groups that you mentioned -- Healthy Communities and many of the others -- are actively involved in the steering committees right now. The steering committees and their membership will be one of the groups that we will asking for a list of nominees for both the community appointments and the ministerial appointments, but we will be using the same process. What we're intending to do is actually broader than what this would limit us to, because we're able to ask all kinds of other bodies that might not fall into the category of health care provider or educator to make those nominations in our communities. There are lots of other agencies out there that we might like to seek nominees from -- multicultural organizations, for example, or the aboriginal community, which wouldn't be listed in here at all. We really do want to make sure that we have as broad a spectrum as possible to select nominees from.
L. Reid: I stand in support of the amendment of my colleague for Prince George-Omineca, because if this government is truly committed to an open process, this allows for that and for some opportunity for different members in those communities to be represented. The minister made a comment that this would somehow impact negatively on businesses. Under subsection (2), where one-third of the members are chosen from the lists of nominations by the boards of the regional districts and municipal councils in the community, if those groups do their job there will be business interests reflected on those boards. I believe this amendment strengthens this section and allows for an open process. This is not just about broadening the process. This must be perceived as an open process. Having complete ministerial appointment does not in any way suggest open government, which is what this government has said they stand for since they took office 18 months ago.
L. Fox: Hon. Chair, I move the committee rise, report progress and ask leave to sit again.
Motion approved.
The House resumed; the Speaker in the chair.
The committee, having reported progress, was granted leave to sit again.
Hon. G. Clark: I move that the House at its rising stand recessed for three minutes.
Motion approved.
The House recessed at 6 p.m.
The House resumed at 6:06 p.m.
Hon. G. Clark: I call committee on Bill 45.
HEALTH AUTHORITIES ACT, 1993
(continued)
The House in committee on Bill 45; E. Barnes in the chair.
On section 6 (continued).
L. Fox: Prior to the very extended break we just had, we had a vote on the amendment, and the minister chose not to accept it. That's fine; I understand that. We now have a situation where, according to this section....
Interjection.
L. Fox: Perhaps the government Whip would either get to his feet and contribute or be quiet.
[ Page 9086 ]
Section 6(2)(a) suggests a third of the members will be chosen to represent the residents in the community. Given that the community is yet undefined, how will those community representatives be chosen? We could have one community or three communities involved in setting the community health care council. How are we going to define the community in order to select the one-third representation?
Hon. E. Cull: The communities themselves are having no difficulty in establishing their boundaries. They're doing it in a number of ways. Sometimes it is by municipal boundaries, sometimes it is by school district boundaries and sometimes it is by other geographical definitions that they have. But they're having great success in doing that. In this period, as with the regions, we're letting the communities determine where the boundaries should be rather than us prescribing them.
L. Fox: I'm sorry, I didn't get the last.... The minister turned away from the microphone, and I didn't hear the last sentence or so.
Hon. E. Cull: As with the regions, where we're not defining the boundaries at this point and we're working with the communities to define the regional boundaries, we're doing the same thing with the communities to define the community health council boundaries. But that is the least of the problems. In most cases the communities are having no difficulty in establishing those boundaries.
L. Fox: In trying to define the community boundaries, is the initiative taking place by the local societies that are involved in the delivery of health care now, or are there communiqu�s happening with respect to municipalities and school districts at that level? Where's the thrust coming from in order to develop these boundaries?
Hon. E. Cull: Over 90 communities have established steering committees, and about 30 of them are actively along the road in pursuing their community health councils. They involve health care providers, members from the governing bodies of the existing institutions and municipal, school board and regional district people where that is applicable. I don't know that they've had many regional district people involved. They involve the full cross-section of community groups.
We've put out a guide book for the communities to assist them in developing their steering committees; I encourage you to look at it. It has a full-page list of all the bodies, groups, agencies and types of people that should be invited to participate in the steering committee. In almost all cases the major players are involved, and -- in terms of community health care providers -- many others are being drawn into the process as well.
L. Reid: It's my understanding that this evening we're examining section 6, community health councils, in some detail. I refer to the definitions section which we were on earlier today: "council means a community health council designated under section 6." Perhaps the minister could elaborate in some detail and give us the model community health council and then the one that may not be in an ideal position to deliver this service as outlined in this piece of legislation.
Hon. E. Cull: I'm not sure what the member means by the model, so I'll ask her to rephrase that question or perhaps give me a bit more direction on it.
In the meantime, before I sit down, I wonder if I might ask leave to make an introduction.
Leave granted.
Hon. E. Cull: I'd like to introduce two people who are quite familiar to this gallery: Terry Wickstrom and my son David Wickstrom are here tonight. Also, a dear friend of mine is here from Toronto, someone I have known for most of my life, Joyce McLean, and her daughter Lillian. I'd like the House to make them most welcome.
L. Reid: "The minister may, by regulation, designate (a) a community health council." When I suggested the term "model," I was looking for the minister to describe the ideal community health council. It seems to me that there is constant reference to the communities in this province that are engaged in structuring such an entity, and there certainly seems to be much discussion as to how successful that will be. Frankly, there is not consensus around what a valuable -- as the minister would have us believe -- exercise it is to be currently involved in creating something that is very, very nebulous. If the minister can perhaps give us some guidance as to what, in her mind, the ideal community health council will look like, that may perhaps clarify the debate.
Hon. E. Cull: I think the fact that 90 communities around this province have established steering committees means that there are 90 communities that see a great deal of value in pursuing this approach to delivering health care. There isn't any one model, and that's why we have the interim legislation: so that we can try a number of models. I'm excited about some of the models I've seen. There's the one in Mount Waddington, which we talked about earlier today, where four communities have come together to form one community health council, to have one administrative structure managing all of their services, where they've made decisions about how they're going to change those facilities and provide more community-based services in their community. We have the Simon Fraser health region, which has two community health councils being proposed for it. The steering committees include upwards of 100 people who have been coming out to the meetings to help develop the concepts around that council. And we have many others, which I described earlier in the debate. The ideal community health council will have a number of community-minded representatives sitting on it, representatives who are dedicated to providing quality
[ Page 9087 ]
health care, efficient health care and compassionate health care in their community that reflect the priorities and needs of their community. That's what we're in the process of establishing.
[6:15]
C. Serwa: It's a pleasure to enter into debate on Bill 45. As a new entrant, I hope to bring some enthusiasm into this particular little debate. I understand it's going to go on for a while, but that's beside the point.
On community health councils, there's a big question in my mind on how many we're looking at in British Columbia. Are you going to designate community health councils on the basis of populations or a certain number that is to constitute a community health council? Are you going to designate it on the basis of geographical boundaries, for example, regardless of the population? When you talk "community," it's a very special word, and you're talking about some commonalities within that respective community. What is the minister's proposal to determine what these health councils will actually look like? What geographic size they will cover, or what population they will cover? Would the minister enlighten me, please?
Hon. E. Cull: It's always interesting when people come in and out of debates. They miss questions that have been canvassed earlier. This one has been canvassed, and at this point all I need to say is that the concept of "community" as it's understood by the people who live in that community will be respected.
C. Serwa: I'm not certain that that question has been canvassed. I asked several questions before I came in, and no one has been able to enlighten me with respect to the potential number of community health councils. If the minister is unable to answer, that's one thing; if the minister is unwilling to answer, that's quite another thing. But I did ask specific questions with respect to the proposed designation. Is it going to be based on a certain size or on the commonality of a community with similar influences and situations that occur? Or will it be based on some sort of standard population basis, as constituency ridings are, for example?
Hon. E. Cull: I just said that the community would be based on the community's concept of what constitutes a community. So it will not be based on a population size or a geographic area; it will be based on the people in that community agreeing to and accepting the fact that they are in fact a community. It won't work any other way. You can't say it's a community unless the people in the community feel that they are a community.
With respect to the number of health councils, that's still not clear. But it's likely to be somewhere around 80. It might be a little more or a little less. It will certainly be far less than the existing number of hospital boards, union boards of health, regional hospital districts, continuing care boards and non-profit societies that we now have in the province.
C. Serwa: That seems to be a very subjective interpretation of what community is, in that each community will come up with its own definition of community. Is that correct? That's what I heard the minister say. The minister nods. So we can have different definitions of what constitutes a community throughout the province. For example, in the Okanagan we might say that the Okanagan family of communities stretching from Salmon Arm to the border constitutes a community. We can say that the city of Kelowna is a community, or that it's a regional district, which is fundamentally a community. That makes it very difficult to understand if there is some sort of firmness in the direction, because the interpretation may be as variable as the number of communities there are, in the broad sense of it, throughout the province of British Columbia. Surely there has to be some tighter parameters and some designation of what constitutes a community. We could also say that we're a community of British Columbians, and that's true.
Hon. E. Cull: I think the people in the communities who have been working with this process understand full well what the concept of a community is. They would not come up with something that says the province of British Columbia is a community, or even the Okanagan Valley from Salmon Arm to the border. The other two examples you gave of the city of Kelowna or even the regional district might indeed be communities.
You have to remember -- again, I think this happens when people come in and out of debate on legislation -- that this is interim legislation. One of the reasons that this legislation has been created is to give communities enough legal authority to get a pilot project up and running. When we develop the permanent legislation, we will probably have the kind of specific definitions around the things that members have been asking about. But one of the things we're trying to accomplish right now is getting a number of pilots initiated throughout the province. For those pilots to actually take on the job and do something real, they need to have the legislative authority to take over the responsibilities for health care services in their community. So we will probably have a variety of communities in the next year, while different parts of the province pilot different models.
One of the communities, which I talked about earlier in this debate, is four municipalities on the northern end of Vancouver Island. I wouldn't have thought that that was a community if someone had asked me initially, but the people there see that they are a community, and they are in the process of forming a community health council.
C. Serwa: I can certainly appreciate that. Perhaps because of the remoteness in the example on Vancouver Island, and perhaps because of the population density, there are commonalities within that. Perhaps through the newspaper and other connections, whether they're in the same regional district.... But there are a number of things that express a common interest, and perhaps it's not that difficult.
[ Page 9088 ]
Who are the people chosen to make this decision with respect to the community health councils in the various communities? It seems to me that the choosing of these individuals....
Hon. G. Clark: On a point of order, hon. Chair. The member is canvassing ground which has clearly been canvassed at great length in the chamber, and I submit that he is clearly being tedious and repetitious.
The Chair: Thank you, hon. minister. The hon. member for Prince George-Omineca rises on a point of order.
L. Fox: I've been in the House all day, and I'm sure that while the information the member is requesting has been partially canvassed before, it has not been canvassed to the extent that this member is putting it forward.
The Chair: I thank all hon. members for their points of order. The Chair would just remind the committee that relevancy is the key guideline when we are in committee, which I am sure all hon. members know. With that in mind, I would ask members to be so guided.
C. Serwa: I certainly respect the reference to relevancy, but it is of utmost importance that I really understand the process in designating a community. It seems to be a very wishy-washy wide-latitude type of concept, and I'm trying to get some understanding of the determination of what will constitute a community. There are a number of parameters, as I've tried to describe, and without specific designation -- other than the minister telling me that there are individuals working who are deciding what a community is -- I don't know how that has been constructed.
But fundamentally, I have concerns with the type of communities that are designated for these particular councils, and I haven't been made aware of what will constitute a community, other than the individuals in that community who have been selected -- I presume by the Minister of Health -- to decide among themselves what a community is. And I am trying to get some idea of how the formulation of the approximately 80 -- the number that the minister offered as a potential -- is going to be acquired.
Hon. E. Cull: The communities that are forming community health councils right now have steering committees. They are not appointed by me. I only suggest the types of individuals and organizations that should be invited to take part in that process, the governing bodies of the existing institutions: municipal and school board people; health care providers; health care advocacy associations; and other groups which represent health interests in a community, like the healthy communities process that might be in a community, or other groups that may not necessarily have a specific health focus but might have something to contribute to this process.
Those steering committees are forming in different communities, and they are the ones that are sorting out among themselves and between their neighbours, who may be in adjacent communities, where the community boundaries should be.
In the capital region, as we discussed earlier in this debate, the discussion is going on right now about four community health councils in this region: one covering the four core municipalities, one on the peninsula, one in the Western Communities and one on the Gulf Islands. The precise lines that will be drawn between the peninsula and the four core municipalities is something that those steering committees will have to sort out. I can make guesses at where they'll be; I can make suggestions at where they'll be. There is a pilot process and a public process going on right now. The intent of this legislation, as I've been saying all along, is that it is permissive and it is interim. When we learn a little bit more, by going through with the pilots, we will then refine the legislation and be back here with permanent legislation that is based on the experiences of the communities themselves.
C. Serwa: For my clarification, is the final decision on what constitutes the community boundaries in the minister's area of responsibility? Or is it to the respective communities?
Hon. E. Cull: It's with the minister, because the minister has to designate them.
C. Serwa: Again, for my clarification, if there is some dispute with respect to the boundaries and, in some cases -- certainly in the northern areas of the province -- the areas of influence and overlap, then it will be the minister's responsibility to make the ultimate decision of what constitutes a community. That's part of the question I have. If the community is decided upon independent of population, is there going to be the funding in order to establish and carry on? Because obviously it will be a very heavy burden with our more remote communities that have small populations and great distances to travel. I can only presume that the communities will have to be very large indeed.
Hon. E. Cull: There will be some practical limitations on size. If you had too small a community, there would not be sufficient dollars, no matter how you provided them, to be able to operate effectively and efficiently. I believe that by working with those communities they will see that as well and will come to a consensus on what the boundaries should be. But yes, the minister will make the final decision. I think we have all kinds of possibilities, if there's a dispute, for resolving that. We have dispute resolution or the communities could be brought together. As I said, to date we have 90 steering committees formed. There are lots of questions about the boundaries and lots of interest raised on where the lines should be, but we certainly don't have any fights breaking out over where they should be. Wherever a community has said, "Gee, we don't think we're part of this region or this group,"
[ Page 9089 ]
people have generally said: "Yes, maybe we should have another look at that and come up with a solution that reflects the common sense of the community."
L. Fox: I guess I have a couple of questions. Given that this is kind of a trial-and-error process, where it's going to.... Some of the problems may not be identified initially. You may have three or four communities, as the minister suggested -- in the north Island, for instance -- initially believing that the community structure which makes most sense incorporates all four communities. What flexibility is there in this system, if somewhere down the road between now and the election process in 1996 those communities decide part-way into the process that in fact they want to split up and have two respective community health councils rather than one? Is that flexibility in the system to allow that adjustment between now and 1996?
[6:30]
Hon. E Cull: There would be flexibility in such a circumstance. We're not going to lock these communities into a decision now that they will never be able to get out of. One of the things we're trying to do with the interim legislation is narrow down the number of possible models. We want to use the strength of our communities. I would never have dreamt up the Mount Waddington example, where four communities form one council. I don't think anybody else would have come upon it either, unless they started it by getting together and working on it. We want to have a variety of models being looked at during the interim, pilot period. Then, when we come to the permanent legislation, we will narrow that down to a number of more standardized models, which should reflect the vast majority of needs in this province. We don't want to have a system where you have 80 councils that are all totally different from one another, but I don't know why we would want Pouce Coupe and Vancouver to have exactly the same model either. So there has to be some flexibility between one size fits all and some different models that would be available to different communities.
L. Fox: As I understand it, then, over the course of the next three years the minister will evaluate these community health council structures. From that, the minister may, through legislation, put a more formal type of structure in place, which may in fact require other councils around the province to conform to something more consistent. Is that what the minister is saying?
Hon. E. Cull: While we're looking at these models during the transition period, we'll be working with the councils. We'll be learning about how they're doing things and helping them to work with one another so they can see what's happening with other communities. Over time we will start to direct them toward some consistent models. We are going to be working with the councils and with the stakeholders to develop the new legislation. This is not something where the minister goes away and evaluates it and says: "Okay, folks, there are only three models; you've got to fit one of them, so you'll have to change." This is a process that's going to be done collaboratively with those health councils so that we can learn from them. They may say: "You know, we tried this. It's a mistake, and we'd like to be able to change things." Then we can start to learn through their experience and reflect that in the legislation that will replace this act.
C. Serwa: On section 6(2), why have you not designated a number, or at least specific parameters with a minimum and maximum, depending, I suppose, on the size and population of the community that is to be served? Other than specifying the proportions, it is left wide open at the moment. Why was a number not designated, perhaps from six to eight, six to 12, or whatever is reasonable?
Hon. E. Cull: As I've been saying all along, the legislation is to be enabling and not prescriptive. The advice that we received from the B.C. Health Association, the associated union boards of health, the Union of B.C. Municipalities and the many stakeholder groups that we consulted suggested that this format was the way to go.
L. Reid: To continue with my colleague's comments regarding a minimum or a maximum, since they're not stipulated, and since 6(4) says, "A vacancy in the membership of a council does not impair the power of the remaining members to act," it seems to me that at the very least a quorum is necessary so that British Columbians have some sense of who, in the final analysis, will be making decisions. Is there a recommendation coming forward as to a quorum?
Hon. E. Cull: Yes, and it's contained in a section of the act that we haven't come to yet.
C. Serwa: Again on that same section: "...1/3 of the members chosen to represent the residents in the community...." Can the minister advise me as to how that selection is going to be made? I note that the minister will be responsible for appointing these individuals, but how will the selection of community representatives be made?
Hon. E. Cull: Just before we broke for dinner -- and I can see the colleague of the member who just asked that question smiling -- we went through this in some detail, and I would suggest that the member have a look at the Blues on that one. It's a public process. It calls for nominations from groups and bodies, elected and otherwise, throughout the community to provide a list of nominees who can be appointed. We had quite an extensive debate; it took over half an hour.
C. Serwa: Thank you very much, hon. minister, for that information. I'll certainly read Hansard on that particular section. The concern I have with respect to this is that I notice that the boards, commissions and authorities that have been appointed by your
[ Page 9090 ]
government all reflect a very biased relationship. What is to prevent a similar partisan choice being made here in your appointment process? How will we truly know that those individuals will be chosen to represent the health concerns and interests of the community and not simply ideological interests expressed by your party?
Hon. E. Cull: I find it absolutely amazing that this member would make a statement like that when we have bodies that were set up by his government which were offensive to the community because they did not represent the community that they were set to represent. They just represented the government's decisions. In the last year, through the B.C. Seniors' Advisory Council, the AIDS secretariat and many of the different bodies we have struck, we have used a process that I intend to use here, which is to ask those interest groups that exist in that area to put names forward. In this case it's very broad: municipal councils and other bodies, governing agencies that are there and groups that represent the community in any fashion. In addition, there will be a public nomination process where people will be invited to self-nominate if they wish to do so -- a very extensive process.
Earlier in the debate, before we recessed, I offered to share the information that we're putting together to solicit that with the member's colleague, and I would suggest that he discuss that with his party's critic, because we did go through this at some length.
C. Serwa: I certainly welcome the remarks from the minister on this. Again, my specific concerns remain. We have an enormous number of public nomination processes, but as an observer of the resulting selection of those processes, I find that individuals who are chosen who are not card-carrying members or active supporters of the current government are probably as scarce as hen's teeth. My concern is that in something as important as health care, the process be such that the individuals be chosen on the basis of community background, interest and quality rather than ideological principles. I'm not saying that the minister would short that; the minister displays a type of commitment, but I'm not as confident in the executive branch of government and the demands of their specific constituencies out in the communities. If this is going to be successful, it's imperative that the representatives who are selected to represent the community truly have the support of the community and not simply the support of government.
L. Fox: Section 6(3) says: "Members of a council serve without remuneration but may be reimbursed for prescribed expenses necessarily incurred while discharging their duties as members of the council." The first question I would ask the minister with respect to this section is: will there be a regulation governing the control of that section of this legislation, or will it be up to the respective board to bring forth a policy on expenses?
Hon. E. Cull: When we get to the regulation section, I'll point out the section to the member. It's section 17(2)(c), and it is there.
L. Reid: I think this minister can appreciate that neither opposition party is convinced of the necessity of bringing forward Bill 45. If the minister were here, she would realize that her comments about 90 steering committees being underway.... Legislation was certainly not required to bring in those 90 steering committees. If this is pilot legislation -- and that would follow from the comments made by the minister earlier in the day that this is legislation in transition -- why is it necessary to have legislation? It would suggest to me that it's not necessary, because these 90 pilot projects the minister referred to more than four or five times in the last 20 minutes were able to proceed without enabling legislation. It seems to me that this project is going to proceed, and I think the most reasonable outcome is that they come back to the House and report on whether any of that was valuable, as opposed to structuring legislation and putting us through the hoops on what we believe to be extremely bad legislation, poorly thought out and probably not required. I would ask the minister to comment.
Hon. C. Gabelmann: Unaccustomed as I am to public speaking, I have taken note of the member's comments. The minister is out for a couple of minutes, and I will take notes of any other comments that members make.
C. Serwa: Perhaps we could recess for several minutes until the minister comes back, so that the minister can be apprised of the direct comments and questions.
Hon. C. Gabelmann: I think an informal recess would be quite appropriate, hon. Chair, if that's okay with you.
Motion approved.
The Chair: The recess was an informal one, and if the hon. member for West Vancouver-Garibaldi is prepared to proceed until the minister returns, that is his prerogative.
D. Mitchell: I know the member for Nanaimo also wants to hold forth on section 6, but I would like to take my place first. And I know there are other members in the committee who are also holding forth on section 6, which is a very important section of an extremely important piece of legislation. We have been on the bill for much of the day in committee and we have made some tremendous progress, noting that we are already on section 6.
Section 6 deals with community health councils. The minister has raised some interesting points during debate today about the distinction between boards and councils. Councils are extremely important, but we don't know how these community health councils are going to be appointed. For instance, in the area of the
[ Page 9091 ]
North Shore -- where part of my constituency is -- we don't know if we're going to have a council or a board, whether the North Shore is going to be one region or whether a council is going to be appointed. I have some concerns about that, and the minister obviously is going to want to hear this.
If the critic for the official opposition had a question on this, I would be prepared to entertain that question.
The Chair: Before I recognize the hon. member for Richmond East, I would suggest to the hon. member who just took his place that the content of his comments reflected on considerable debate which has taken place since I have been in the chair, so it isn't as though this matter hasn't been canvassed. I should take the time to remind hon. members that in committee, strict relevancy is key to proceeding in an orderly way in section-by-section debate. I think an hon. member should make a clear distinction between what we are doing here in committee and the approach and latitude that is permitted in second reading. The Chair is listening very closely to ensure that we can progress in an orderly way. That is critical to ensure that we get on with the public's business.
[6:45]
L. Reid: If I might return to the comments I posed to the Attorney General and ask that the Minister of Health respond. We are discussing section 6, community health councils, and the comments I will respond to directly were the comments the Minister of Health made in terms of the 90 steering committees currently underway in the province. Legislation was not required to create 90 steering committees. If section 6, which refers to the creation of community health councils, is part of Bill 45, the Health Authorities Act, 1993, and is transition legislation....
The Chair: Order, please. The difficulty that the Chair has with questioning the desirability of the legislation that is before us is that the bill was passed in principle in second reading. That, with the greatest of respect, hon. member, is a fait accompli. What we are doing now is debating the decision that the House has passed. We are now dealing with the specifics that each section contains. If the member could accept that clarification, it would be of great assistance to the Chair.
L. Reid: Your clarification is noted. In terms of the minister's comments earlier, and I believe she made them just moments ago in debate when she looked at the success of the 90 steering committees. I am posing a direct question that looks at the necessity for this particular piece of legislation. I am referring to section 6, community health councils. If those 90 steering committees could go forward without legislation, is legislation required? Is this section required, if indeed they could go forward? This enabling piece of legislation in this particular section is obviously not required, and I would ask the minister why we are looking at a section that has not at all curbed the creation of these 90 steering committees. I would ask for the minister's comment.
Hon. E. Cull: The member is right: we don't need the legislation to create the steering committees. We need the legislation to create the community health councils. The steering committees are simply the groups that are coming together to form the councils. Once they actually form a council, they have to have some authority. As I said earlier in this debate, we are not creating any community health councils that do not take on the responsibility of two or more boards in their community. To take on the responsibility of a hospital and the union board of health, for example.... There has to be legislative authority for that body to take on the responsibilities that now exist with other bodies under current legislation. That is why this act is needed, and why this section is needed.
L. Reid: I refer the minister to her earlier comments where she looked at this as transitional legislation at the first stage. It's not our understanding, and it is certainly not our belief, that any pilot project in the province requires legislative authority. That is the nature of a pilot project. Your earlier comments looked at these 90 steering committees as being just that -- pilot projects that would demand a revisit and a re-evaluation. If those earlier comments are unclear now, or were not intended as you presented them to us, I would again seek your clarification on that. It was said earlier by this Minister of Health that this was a pilot project, that this does not require legislation in British Columbia.
Hon. E. Cull: This member is very fond of putting words into my mouth and restating what I've said. For the record, 90 steering committees have been formed, and 30 are actively in the process -- they have had several meetings or they've undertaken some action that puts them down the road to forming community health councils. The number of pilots.... Unfortunately, hon. Chair, the member is not even listening, so I wonder whether there's any point in giving the answer. The number of pilot projects will be less than the 90 steering committees, or the 30 committees that are even out there right now -- we don't need that many pilots.
To undertake any pilot, which would see a community health council assume the responsibility of a hospital board, requires a change in legislation, because the Hospital Act gives that authority clearly to a hospital board, not to a health council. With all the power that the executive council may have, we do not have the ability, through regulation or fiat, to be able to move the power of a hospital board to a community health council without this legislation.
L. Fox: I know this is entertaining for the backbenchers. They are enjoying it. I can just see they're grabbing on to every...
The Chair: Hon. member, order, please. We're on section 6.
L. Fox: Earlier I asked a question about section 6(3), and the minister referred to a section that this could be discussed under. I've looked through this act again, and
[ Page 9092 ]
I have tried to come up with the section that deals with council members' travel and other expenses, but I can't see anything that specifically suggests the control mechanism for these. That was my question.
Hon. E. Cull: I believe the member asked whether the expenses would be prescribed by regulation or some other way. Was that not your question? If the member turns to section 17(2)(c), he will see that the Lieutenant-Governor-in-Council can make regulations prescribing the expenses that are applicable under sections 4(3) and 6(3).
L. Fox: Although I understand it now, I'm still concerned that I won't be able to discuss it in that area. I think the only time I can legitimately talk about remuneration for expenses is in this section. What I am concerned about reminds me of one president who in fact worked for absolutely no salary. He worked for expenses only, but ended up collecting more in expenses than he would have on his salary. I am concerned about the kind of expenses. Would they in fact have a meeting expense, for instance, given that the regional district structure is quite large? Would they allow out-of-pocket expenses without turning anything in? Or will this in actual fact be designed in a way that requires receipts for actual expenses and so on?
Hon. E. Cull: I don't think I can give a precise answer on that, because it is subject to regulations. So the member is right that the answer is not really going to be definitive whether he asked it here or there. But there are guidelines that have been established by Treasury Board with respect to expenses of board and committee members, and I would expect that those guidelines would be the basis of the regulations under this section. I don't see why we would do anything different than we do for other boards or commissions; but not being fully familiar with those guidelines, I guess we'd want to have a look at them and make sure that we were doing the right thing there.
L. Fox: Just for clarification, will there be a consistent regulation covering all regional and community health care councils?
Hon. E. Cull: Yes.
D. Mitchell: Not to belabour this, but while we are on this aspect, section 6(2)(a) says that one-third of the members are chosen to represent the residents in the community. I know that this is transitional, and the anticipation is that there are going to be elections at some point. I know that later on in the bill we will talk about this....
Hon. E. Cull: We talked about that half an hour ago.
D. Mitchell: Under section 17 we can talk a little about the plan for elections. I know that this is transitional, but the explanatory note says clearly that: "This bill creates the framework within which this transition process will proceed until 1995." It anticipates that these one-third of the councillors will be elected at some point. My question is: will there be extra costs at that point? There will be extra costs borne by the system. Are those costs borne directly by the council, or are they Ministry of Health costs? Where will those costs show up?
Hon. E. Cull: All the money comes from the same pot, one way or another, so whether we put it into a separate fund under the Ministry of Health, or include it in the health council's budget, it is not going to make any difference. But yes, when we are making our funding allocations, we will have to give consideration to the fact that there will be election expenses. That is part of the price that we pay to go to a partly elected model, which is the desire of many people in this province. But we are going to economize on that to the greatest extent possible by piggybacking the election onto the municipal election, so that we don't duplicate expenses.
D. Mitchell: Thanks to the minister for that answer. An issue was raised by the member for Prince George-Omineca with respect to those one-third of the members who are chosen to represent the residents of the community. They will have expenses that will be provided for, but I understand that they will not be receiving any other remuneration for their service on the councils. Will that also apply to elected councillors, or will they receive some payments other than the expenses that the appointed councillors will be eligible for?
Hon. E. Cull: Section 6(3), which says that members of council serve without remuneration, applies to all of the members of the council, no matter how they get there. There is no remuneration for being a community health council member, as there is no remuneration for being elected to the board of a hospital society.
L. Fox: That triggered something that I think should be clarified. There is an unfairness on the hospital boards. Regional district directors, municipal councillors and school district representatives who have been appointed to the hospital board don't get any remuneration from the hospital board, but their respective elected bodies pay them to attend those functions. It has been a problem in the hospital boards because there is some inconsistency. A director who is appointed by a body is paid by the regional district, let's say, to attend those meetings. He gets remuneration, as do the municipal and school board appointees. But the members who are elected by the society or appointed by government do not. Given that one-third of the members of this structure will be from the elected bodies, will subsection (3) limit those elected bodies from paying a fee while they attend the respective board meetings?
Hon. E. Cull: I am aware that some municipal councils and regional districts do pay additional money
[ Page 9093 ]
to their members who are serving on the union board of health or on hospital boards right now. Not all of them do; there is an inconsistency. It is certainly one of the things that we will want to address before we bring in the permanent legislation. That would be quite suitable for discussion with the Union of B.C. Municipalities.
D. Mitchell: Can the minister tell us if is there any prohibition on elected representatives of other bodies -- whether they be school boards, municipal councils or what have you -- serving with the one-third of the council members who are representing residents of the community?
Hon. E. Cull: No, there isn't any prohibition, and that's an interesting question. As it is right now, you can run to be on a municipal council and on a school board. I don't think you should be able to, but the law of the land allows us to. I think that a person who's elected should have one elected position, not two, but the laws of the land allow that to happen.
[7:00]
Theoretically, I suppose somebody who is a municipal councillor could run in the election when the elections are set up in 1996. We might want to look at that in the permanent legislation. It's something that perhaps we should discuss as we make the changes. Given my preference that people have one elected position only, I would not be inclined to appoint people who had been nominated from those categories, because they already have, by rights, one-third of the seats. I don't think that we would advance our intent here by giving them another opportunity to run for election and take more of the seats.
D. Mitchell: Of the one-third of the members that the minister will be appointing to represent the residents of a community, would the minister contemplate appointing any Members of the Legislative Assembly to those positions?
Hon. E. Cull: No.
Section 6 approved on the following division:
| YEAS -- 26 | ||
|
Perry |
Marzari |
Barlee |
|
Beattie |
Schreck |
Lortie |
|
Lali |
Giesbrecht |
Evans |
|
Farnworth |
Pullinger |
Lovick |
|
Copping |
Zirnhelt |
Cull |
|
Clark |
Gabelmann |
Smallwood |
|
O'Neill |
Doyle |
Streifel |
|
Krog |
Randall |
Garden |
|
Kasper |
|
Janssen |
| NAYS -- 16 | ||
|
Cowie |
Reid |
Gingell |
|
Dalton |
Farrell-Collins |
Stephens |
|
Hanson |
Serwa |
Mitchell |
|
K. Jones |
Jarvis |
Anderson |
|
Tanner |
Symons |
Fox |
| De Jong | ||
On section 7.
L. Fox: Section 7 is the purposes of the council and deserves considerable debate. Obviously one of the main issues that we're going to be dealing with in this legislation, as the minister has suggested time and time again, is the fact that this is interim legislation. The purposes of the council will play a large part in developing future legislation through policy and certainly through their implementations specifically around the regional borders. One of the first questions I have with respect to the regional council is: will the determination of the...? I know the minister talked about this briefly in section 1 under definitions, but what role will economics play in determining regional borders? When I speak about economics....
We're on section 7, purposes of a council, and the minister has suggested that.... Sorry, we're on community councils. I'll start all over again.
An Hon. Member: No, no, stay on section 7.
L. Fox: I was intending to ask the question around both, actually.
I know we talked about the structure of the council before and how we'll set up the definition of a community council through the election process and so on. But right now, what I am concerned about is the role economics will play in the development of the borders that this community council will be achieving as one of its purposes. When I speak of economics, I mean economies of scale in terms of how we might best deliver a service over what area and whether or not any economics are involved in terms of the home delivery. We have now created a community that may have a lot of travel involved in order to deliver the Closer to Home program. How is all that going to figure into the parameters of this council?
Hon. E. Cull: I'm not sure if the member thinks that the community health councils will establish their boundaries after they are struck. The boundaries will have to be established as they are created. It's not a process that continues after that. That's what the steering committees are doing right now; they're doing the groundwork for this. So when a community health council is appointed, it will be appointed for a specified area and will have specified functions. One of the things that's being....
The Chair: Order, please. Please take your seat, hon. minister. Hon. members, I think the decorum is deteriorating somewhat. I suppose it's due to the onerous task we have before us. I realize that members are tired, and I hate to have to remind hon. members that we still have business in the committee. If members wish to talk and carry on other matters, it would be helpful if they would do so outside the chambers.
Hon. E. Cull: The councils will be established with boundaries set for them as a result of the process we are going through right now with the steering committees. You're looking puzzled, and I don't know
[ Page 9094 ]
whether I should continue with this. Okay, I'll sit down. The member is going to clarify it.
L. Fox: The minister, in the earlier section, openly agreed with me that there would be some opportunity, between the structuring of the council in the form envisioned by the community of the day, to look at either splitting up that structure, making it larger in order to get into the economies of scale or, more importantly, looking at whether or not it's possible to offer a level of service regardless of the size. I would assume that this first council would look at those issues very closely. What role does the minister feel that will play?
[7:15]
Hon. E. Cull: The clarification has assisted. Yes, there is a possibility for changes to reflect economies of scale. We will work very hard with the communities to try to reflect those economies of scale in the initial setups. That doesn't mean there won't be things overlooked and that there won't be mistakes made in terms of the decision. There obviously has to be some balance between the desire of a small unit in our society to form its own community and the logistics of whether it can actually have any budget or services to deliver. If we picked a little hamlet, there might only be two or three employees that are actually entirely dedicated to the services of that little hamlet. The hospital in the adjacent town might be providing most of its acute care services, and they might not even have a doctor. They might at most have parts of FTEs that may add up to one or two whole people, but their services are really being provided by the adjacent communities. In that case, we would have to say that it wouldn't make a practical council, because it wouldn't have the services that it was really delivering at its own community level.
If we are looking at a community like Vanderhoof, which I'm assuming has a public health unit office in it and has employees there and a hospital that provides services not only to the citizens but to some people in the surrounding area, that is clearly a large enough community with some economies of scale that would be providing services.
This one might be interesting. I almost hesitate to use the example, because the community feelings may not work in this case, but Vanderhoof and Fort St. James could consider whether they might be one community council because of the pattern of services that are provided there. I'm not suggesting that; I'm just saying that it's a possibility that communities can look at. I'm sure that that's what has driven the four communities on the northern end of Vancouver Island to form one community health council. They only have 5,000 people in the whole end of the Island, which is a village size in the rest of the province. They actually form a logical unit for providing those services.
L. Fox: One of the reasons I wanted to get into this area was my concern with the geographical size. I can envision some of these communities being -- and I'm not sure how far apart the four communities on North Island are, never having been there.... I remember talking to Anne Fiddick about the travel distance she had, so I can actually relate to similar circumstances in northern British Columbia. When we look at a council that is offering a service over a larger geographical area with very sparse population, one has to be concerned that the health care deliverer spends more time on the road than they actually do treating patients or meeting health care needs. That was one concern I had. Obviously I hope those kinds of evaluations would be made over the course of the next few years, before the final structure is put into place. If the minister can give some assurance of that, I know it will put the fears of a lot of people to rest -- people in the rural parts of the province. That's one of the major concerns that I've heard from the rural parts of the province.
Hon. E. Cull: I understand the concerns of the member, because he has raised this issue a number of times during various debates. I appreciate and understand his concern that we have a look at the effectiveness of moving to a Closer to Home strategy as opposed to one that's more centralized.
This legislation deals with governance and doesn't say anything about whether the services will be provided closer to home or otherwise. It really says that the responsibility for delivering services will be vested in a local agency, as opposed to a ministry agency that might be in that locality. The difference being that in one case you've got a local governing body responsible for it; in the other, they go up through a line process through divisions to the ministry. So I appreciate what he's saying. Yes, there will be a lot of attention paid, through various programs, to the system of moving to a community-based health care system and having nurses travel around as opposed to a system of people coming into institutions or centres to receive it. That will be part of the evaluative process. In fact, there is already work underway to look at that.
D. Mitchell: I just have one question on section 7. Many of the same issues on section 6 will probably apply to section 7, and the minister may have already answered them, and they won't have to be asked.
There is the same issue with the regional boards. Section 7 contains a lot of responsibilities for the councils that will be established under this act. This is a lot of work for a part-time unpaid council. Certainly it implies that the staff of the councils will really be carrying on a lot of the work. I think we'll be able to address that under section 11, perhaps when we get into the duties of staff. Would the minister not agree that administrative staff, really the support staff, are going to have to do most of this work, which is a huge task given to the council under the purposes section. It's simply too much work for unpaid, part-time council members to be performing. These are very extensive powers that are being provided to the councils.
Hon. E. Cull: Of course staff are going to have to support these purposes. Just as the Minister of Health is responsible for delivering all the health care services in the province and managing a $6 billion budget, it's not done alone; it's done by staff. Executive council doesn't
[ Page 9095 ]
make decisions alone; they're made with tremendous staff support. These responsibilities, which do look to be quite an impressive list of responsibilities, are right now borne by a myriad of unpaid, volunteer boards. If you look at the responsibilities that a hospital board has for running a hospital, you'd be quite surprised.
You know, when you look at GVHS, which has a budget of over $200 million, their volunteer, unpaid board manages more resources with more life-threatening concerns than I think almost any school district in the province. I'm not sure if there is any school district with a larger budget than that; there wouldn't be many, anyway. It's certainly more than almost all municipalities.
This list looks somewhat daunting, but those boards are already doing it right now. Certainly they will have staff support; they have staff already. The hospital has a chief executive officer and all of the administrative staff it needs; the long term care facility has a similar arrangement; and the union boards of health have the staff of the Ministry of Health to provide the management and administrative services to their direct employees. So that staff is there right now. We see the possibility, as we heard through earlier discussions, for amalgamation and reduction of that administrative staff. But there's no intention that ten or twelve community-minded individuals will actually personally carry this out. They are governors, not managers.
L. Reid: I'll speak to section 7(1)(a)(ii), in terms of: "the making of reports by the council to the board and to the minister on the activities of the council in carrying out its purposes." In a previous section I spoke very strongly in support of some outcome analysis, some opportunity for British Columbians to take a look at this new structure and decide whether there is any benefit to the taxpayers of this province. Speaking as a teacher, I think there is tremendous value in having some measure to determine when you have achieved success. As it stands, this bill does not have a mechanism in place....
The Chair: Is the hon. member speaking to section 7? It sounds to the Chair as though you may be on the principle of the bill.
L. Reid: Section 7(1), hon. Chair. I move the amendment standing in my name on the order paper.
[SECTION 7, to amend section 7(1)(a) by adding (iii) to read:
the publication of an annual report that verifies, through the application of clear measurements, whether the goals defined in the community health plan were met.]
I would speak to this amendment for the same reasons outlined earlier. There needs to be an opportunity for British Columbians to evaluate this direction.
As it stands, "New Directions for a Healthy British Columbia" needs some mechanism for evaluation. Under the current section, the making of reports does not meet any of those criteria. It's nice that this group would come together and make a report, but I need to know -- as do British Columbians -- whether or not anything was achieved. Were those goals met? I am speaking specifically to this section, and I am speaking specifically to the amendment. I believe it needs to have some kind of legislative framework that will allow us to decide if this group does more than meet, that they actually achieve some goal, so that we can determine if any success is being reached along that continuum. As it stands, I don't believe it's reflected well in the act that there needs to be some mechanism for evaluation.
As someone who believes that it's only appropriate when you're spending other people's money to decide whether you are giving them a decent deal, I would ask the House to look carefully at this amendment. An evaluation mechanism is called for in this legislation and is necessary to give this legislation any kind of validity.
On the amendment.
L. Fox: While the amendment may be worded differently than what the minister would word it herself, I think the mover is looking for some evaluation of the process on an ongoing basis to evaluate whether the plan and the structure is meeting the objectives as they were envisioned, and whether it is delivering those services as cost-effectively as it can.
We have processes within hospital structures. We have processes within our educational systems, where we do accreditation of schools. It would only seem logical that we should also have a process for evaluating, on an ongoing basis, whether what we are doing is going to meet the objectives of the community health plan that was specified when the structure was set up. I haven't seen anything within this legislation -- unless the minister can suggest where I have overlooked it -- where there is an evaluation process. I recognize that this is only a three-year interim structure, but before we put it into place we would want to know whether it's meeting the objectives. While the minister suggested in other sections of this bill that there are going to be some pilots out there, it still doesn't give me -- and, I'm sure, the mover of the motion -- any comfort that an evaluation in all regions of the province is going to be done on an ongoing basis.
The other point about doing it on a regular basis is that it keeps the costs down. Rather than doing it every four or five years, where costs get extremely high, we could evaluate between now and when the structure is finally put into place. It could be extremely cost-effective and beneficial. The minister should find it within her heart to recognize that this is a friendly amendment. It is to help her in the delivery of her product. It is a mechanism that will help her understand at what stage each of these structures are over the course of the next year, as well as whether they are going to succeed or fail and whether or not they need a helping hand to achieve the objectives outlined in the legislation.
[7:30]
Hon. E. Cull: This is essentially the same amendment that was made to section 5 for boards. The
[ Page 9096 ]
objections that I have to that amendment apply equally here. We are dealing with interim legislation, and I would like to see them reviewed consistently in an external way, particularly the pilots that are going to be created. We will probably want to have one evaluation of them, not a number of separate evaluations of each individual project. The legislation requires an annual report and also requires that monitoring and evaluation take place. The commitment I have made in earlier debates about this is that evaluation has to be an ongoing part of all the things we do. We do not need a legislative requirement to have one body do that in a way that is different from what is going on elsewhere in the health system.
V. Anderson: Might the minister explain how this particular process relates to the healthy communities projects, which are also being promoted by the government within local communities? We have had healthy communities boards, councils and projects set up, and now these community councils. She might relate the differences and similarities between them.
Hon. E. Cull: I don't believe that's pertinent to the amendment that we're debating. Perhaps we should deal with the amendment first.
The Chair: Yes, we're on the amendment, hon. member.
Amendment negatived on the following division:
| YEAS -- 14 | ||
|
Cowie |
Reid |
Gingell |
|
Farrell-Collins |
Stephens |
Hanson |
|
Serwa |
De Jong |
Fox |
|
Symons |
Tanner |
Anderson |
|
Jarvis |
|
K. Jones |
| NAYS -- 27 | ||
|
Perry |
Marzari |
Barlee |
|
Beattie |
Schreck |
Lortie |
|
Lali |
Giesbrecht |
Evans |
|
Farnworth |
Pullinger |
Lovick |
|
Copping |
Zirnhelt |
Cull |
|
Clark |
Gabelmann |
Harcourt |
|
Smallwood |
O'Neill |
Doyle |
|
Streifel |
Krog |
Randall |
|
Garden |
Kasper |
Janssen |
C. Serwa: On section 7, I note that the purposes of a council are to develop a community health plan that specifies service levels in the community. I presume that this is more latitude than the present hospital boards have. Am I correct?
Hon. E. Cull: No, not really. Hospitals have considerable latitude to specify their service levels.
C. Serwa: The specification of service levels seems to imply that they can specify the service levels, and that the minister or the Ministry of Health will have to provide the funds to satisfy the service levels they have specified. I appreciate, as in all concerns, that health is a fairly competitive field. When you're looking at a community's wants rather than needs, there is a substantial amount of pressure to acquire certain facilities. Take, for example, an expensive mechanism such as a CAT scanner. There seems to be a bit of community pride associated with acquiring a CAT scanner and whether or not one community can utilize it in their community health plan to its full extent, so you will have a competitive level. The indication here is that they can certainly specify the service levels.
Hon. E. Cull: Hon. Chair, there's nothing in this section that allows the specifying of service level; that's in section 3 of the act. This section allows the council to provide a plan that specifies and provides for the delivery of health services, but not service levels.
The Chair: Thank you, hon. minister. Your point is well taken. I'm sure the hon. member will rephrase his queries in order to comply with the rules in committee. Please proceed, hon. member.
C. Serwa: It almost seems to be a little like splitting hairs. Section 7(1)(a) says, "to develop a community health plan that specifies and provides for (i) the delivery of health services in the community," and it goes on. It specifically says that it specifies and provides for. To me that implies a level of health services. I don't know if we need a ruling on that, but that's why I specified health services. I have a specific concern that it appears to give more latitude outside the scope of the Ministry of Health. I would presume that similar funding is required for capital expansion in communities, whether it's 60-40 or whatever the split is, but the operating funds will have to come from the Ministry of Health. What concerns me with the community health councils is the potential to specify a service level that perhaps is excessive. How is that going to be attended to by the ministry?
Hon. E. Cull: With all due respect, there is a difference between a service and a service level, but I'm not going to belabour that at this point. We have said in earlier debate that the budgets for the community health councils, which will come from the regional health boards, will be set by the ministry, not the other way around. The ministry will establish a global funding formula that will set the funding formula for those bodies, and then with that knowledge they will prepare their plans accordingly.
C. Serwa: It seems to me that that's virtually a parallel to the situation that exists with the hospital boards at present, where they have their aspirations, make them known and -- depending on the ability to finance or the ministry's assessment of the need of that service in the community -- either it's funded or it's not. It was my understanding that the community health councils would have the latitude to specify, but it appears from the statements of the minister that they do
[ Page 9097 ]
not have the ability to specify, and that control will be centralized with the Ministry of Health in any event. Am I correct in that?
[7:45]
Hon. E. Cull: Hospitals receive global funding right now. Within the standards set by the province, they make decisions about how they spend that money. They can make decisions about beds, staffing and the services they provide, and they have considerable latitude there. To change that, a community health council will not only be a governing body that can make decisions within one budget for one institution, but it will have a global budget for a variety of services in the community. It will be able to make decisions about allocating those dollars among those services. The example used earlier this evening was related to the alcohol and drug program. Everyone in the community agrees it would make sense to have that facility open 24 hours a day, but the funding cannot be moved from the hospital to the facility to do that under the current arrangement. A health council would have the ability to make those kinds of decisions.
So there will be global funding and provincial standards, but there will be the ability for the communities to set different priorities and make different decisions about how they deliver the services. I would suggest that the emphasis here is on the delivery of the health services.
C. Serwa: I appreciate that information. What provision is made so that the community health plans specified by the councils for the community are sort of integrated with district -- or perhaps regional -- plans? Obviously that type of hierarchy in the service level system will have to be built so there's not redundancy or unnecessary expense. What method is structured for those specific community health plans to be interrelated, so that they're efficient and provide a service level that is affordable?
Hon. E. Cull: The community health councils, in preparing their plans, have to give due regard to the regional bodies. That's the concern they have to give attention to there.
L. Fox: I just might pass on; I'm having a tough time. As it gets later in the day, the minister seems to be backing further away from the mike -- either that or my hearing is fading. I'm not sure which it is, but I'm having a tough time picking it up.
One of the things that occurred to me in the discussion throughout this bill -- certainly I think it's pertinent to this section -- is that presently the hospital administration makes up the HLRA. Will that change under this structure? Will the councils now play a role in that management structure? Or will it still be the hospital administrators, as we know it today?
Hon. E. Cull: As the member is probably aware, the HLRA and CCERA have recently voted to amalgamate into the new health employers' council of British Columbia, so there is a new body already being formed. The provincial bargaining which now exists in the health care system will continue to exist. We will not allow any fracturing of that system through this new approach. The relationship between the health councils and the new Health Employers' Association is one that will have to be worked out as these organizations move along. They're both in flux right now, with the HLRA and CCERA about to merge and these new bodies being created. But down the road I would see that.... Well, obviously, the Public Sector Act we are debating would require that.
L. Fox: When we look at the actual budgeting of the health council, the carrying out and delivery of service within the community obviously respects the budgeting process. As it is today under the hospital boards, that process is fairly lengthy. I understand that the funding will come from the provincial government, through the regional board and then down to the community health council. But in terms of the actual budgeting and the setting of priorities for the delivery of services, within the parameters set by the ministry regulations, what kind of flexibility will the council have in terms of moving dollars around within the community? One of the purposes of this structure was to provide some autonomy at the local level. Throughout debate on this bill, I've heard the minister speak on both sides of that. There's obviously a need for controls, and yet there's also a thrust to allow for local autonomy in decision-making. That leads me to the question: if we look at some of the present agencies that I believe will be part of the council, what kind of autonomy will there be for the council to evaluate local programs and then shift dollars from one program to another? I have sympathy for all programs. Most are well-meaning, but we often find that we spend money that we don't get a return for. Could the minister give me some examples as to how that would work?
Hon. E. Cull: The province will provide global funding to the region. There will be services and standards specified, as we have already discussed in section 3. When the regions allocate that money to their health councils, there will be considerable flexibility for those health councils to move money around and reconfigure the way that they provide services, provided that they don't fail to meet the requirements for standards and services that have been set for them. The kinds of things that we're talking about are, for example, are where a community decides that it could more effectively provide mental health care through more out-patient services. They could redirect their dollars to provide more out-patient services in mental health. There will be the ability for hospitals to shift money within the acute care facility, but also between acute care and other facilities. The best example I can think of is that in many of our smaller hospitals, where the utilization rate is very high but the bed occupancy rate is actually quite low. A lot of people in those beds really should be in the long-term care facility, but for lack of operating dollars they are not. There is a perfect opportunity to start to make some changes.
[ Page 9098 ]
L. Fox: I think I understood what the minister was saying. I understood that that could happen. I was more concerned about the local programs we see in different societies that have worked, whether they be programs for the blind, the disabled or the mentally handicapped -- all those groups.
One of my concerns is that we end up with a council that is immediately, even though part of the structure.... Initially, all these different societies are going to be part of the setting up of that structure. It appears to me that we will have a new group to which all these other well-meaning groups could lobby in order to improve their particular interests within that community. Is the structure going to be such that it limits or discourages that? Or is there going to be the flexibility at the local level that those lobbies have an opportunity to become successful? By and large, what we're going to have is another quasi-political body that will be able to allocate funds, perhaps depending on which wheel makes the most noise. That's a concern of mine. Maybe the minister would address that.
Hon. E. Cull: We have to consider the situation that exists right now in our communities. In the Ministry of Health we probably have a dozen different managers -- I use that word generically -- who make decisions about whether a service for the blind should get as much funding as it got last year, whether it should get any new funding or whether it should be funded at all; whether an alcohol treatment centre should be funded or not; or whether a Meals on Wheels program should receive funding. Those decisions are basically all made right now by people who are pretty faceless to that community.
There is certainly lobbying that goes on. I see it on my desk all the time. Agencies and good services in the community want to know why they are not getting their funding, or they lobby me to give them funding. Those decisions right now are made in a way that most communities could not describe to you. What we're going to do through the global funding is allow a publicly visible community-based council to start making those allocation decisions within the community.
While you are right that there is obviously some ability for groups to lobby the council, they lobby the managers and the minister right now too. There really isn't any accountability in that respect. When one of our managers in family and community health services makes a decision about whether a child development centre gets funded or not, there is really no accountability -- except through the political process that you and I are part of. Most people don't know how those decisions get made, in any event.
What we're looking for is a body that can start to bring those decisions together and recognize that there are trade-offs with fixed funds. We can't have everything we want; if we have more hospital service, we're going to have less of something else; and if we have more of something else.... It's a zero-sum game at the end of it all, when the budget for health care is set at $6 billion. You can't spend any more than that. Someone has to make those trade-offs.
[F. Garden in the chair.]
L. Fox: I recognize that the minister is saying that the people who are now being lobbied are a long way removed from the problems or the needs. That's a blessing as well as a problem. I have sat on a local council and a school board, and have been faced with different lobbies by very well-meaning groups. They can build a really good case -- in this case, to the health council -- on what they can achieve with very few dollars in the delivery of a service in your community. It is extremely difficult for local individuals to stand up and say no to that kind of lobbying. I guess I'm looking for some kind of measure of consistency within the process -- not that I don't have faith in people; I certainly do. But I also know that it's hard not to be sympathetic to the young man or young lady who happens to be in a wheelchair and is part of a presentation on a particular initiative.
I guess what I'm looking for is a situation where the decision-makers will be close to where the need is, and where they will know the community better than the ministry. But they are also going to be susceptible to a lot more emotion than somebody who isn't there. If the minister could tell me that we're going to make sure somehow that while there is a need to change and to shift our priorities from year to year, we also want to be very careful that we don't allow those things to go back and forth and probably hurt programs that we may have started. I'd like to see it done in a kind of planned way so that when we enter into something here, we know ten years from now what we're trying to achieve and how we're going to improve the situation.
Hon. E. Cull: I think we would all like the world to have perfect answers, but there aren't any in this one. I guess it depends on whether you believe that a benevolent dictatorship is the best way to go, or whether you want to go into a sort of more messy democracy situation.
Interjection.
Hon. E. Cull: The member opposite says: "It depends on who's the dictator."
I have to tell you that as a parent when I have lobbied a school board, I felt that I had more connection to those decisions than when I tried to call the Ministry of Education to get some explanation of why they were doing what they were doing. But that's just my personal experience on this.
[8:00]
I tend to believe that there will be bad decisions made by managers who are not susceptible to that kind of lobbying, and there will be bad decisions made by elected or community-based councils. There will be good decisions made by managers and councils. I'm not convinced that the manager in Victoria, divorced from the political system in some fashion or from the community, will make better decisions in that community.
We have two safeguards to try to improve upon the system that we have. One is the establishment of the
[ Page 9099 ]
provincial standards and services, which says: "Look, there is a floor here that has to be maintained." The other is the ability to ensure that groups, which might otherwise be marginalized through the process of direct elections or through the process of people coming from their councils and boards, can be appointed to those councils through the one-third appointments provision.
The mental health community, for example, is one part of the health care community. It's a little worried right now that they might slip back down to the bottom of the agenda. There are ways to make sure that groups which might otherwise not have a voice can have some voice at those councils, but it's not going to be perfect. There isn't a perfect system. I think you have to take your choice of whether you go for the benevolent dictator or the more messy elected body.
V. Anderson: Following up on the discussion that we've just been having, I want to clarify something. If I understand the minister correctly, once this council is in place, the functioning hospitals, extended care facilities and community health centres that are already functioning at the time the council comes into being will continue to function. Is it then up to the council to contact each of these groups, and to say whether they will continue as they have been? Or do they say to the hospital board or the extended care facility or the seniors' health care program in the community: "We are sorry. As of a certain date, you will no longer be in charge, and your program will be transferred to us." How does this changeover take place? Control goes from these independent bodies to the council, which has responsibility for everything going on within that community.
Hon. E. Cull: The councils are being formed as a result of voluntary decisions in the community to merge existing societies and boards. So first of all, those agencies that you just gave examples of are on the steering committee, and are actively part of the development of the health council. There isn't anyone out there who doesn't know that a health council is being created in their community, or wouldn't be part of that process. In fact, at this point in the legislation, while it is interim, it is also voluntary.
If a hospital board and a long term care facility board do not choose to amalgamate, the health council will not be created. The health councils are only being created where boards are willing to come together and merge their services. It will be entirely voluntary. One of the first things they will have to do is make sure that they have a transition plan in order to move the two separate societies into the council.
V. Anderson: We have quite a few seniors' health care programs in our community. Say that half of them decide to come together and be part of the council, and the other half that have been independent agencies and non-profit societies say that they are fine the way they are. Are we to believe that those who become part of the council will negotiate through the council, and the other bodies in the community will continue to negotiate directly with the ministry?
Hon. E. Cull: No. There are some fundamental misunderstandings in these questions about how this is going to function. Not every society that provides health care in a community will be amalgamated into a health council. But ultimately, when the global budgets are given to the regions, the regions will be responsible for divvying up the budgets to those councils. Existing agencies that still continue to have their own society boards will be funding those agencies through this process. But if those bodies merge with the council, they cease to have a separate society; they cease to have a separate body. They become part of the services that are provided by that health council.
So, for example, if you have ten senior citizens' societies providing services in your community, and five of them merge into the health council, you will then have the health council providing a number of direct services as part of their responsibilities. They would also be providing funding, through the global funding model, to those other societies that are part of that community.
So it is not intended that every society and board disappear. I don't think it would be realistic to suggest that they are all going to go away. We are looking at the major ones -- primarily at the institutions -- and at the services that are provided by the Ministry of Health through direct employment, or with the guidance of the union board of health.
I suspect that most of the non-profit societies will continue to function, and they will be funded on a grant basis through the regional process, but as they are funded now by the ministry.
V. Anderson: I am trying to clarify this. Let me use the example of some of the hospitals run by some of the religious groups within the community. They have been independent over their whole history, and I expect they will continue to be independent, because that is the very nature of their being. At the present time they contract with the ministry for services. As the health council comes into being in those communities, what is their status, and to whom do they now go for their funding for programming in their communities?
Hon. E. Cull: We actually have an example in Hazelton, where the United Church facility is actively involved in the development of the health council in that community and doing a very good job of providing leadership there. But the general answer to your question is that this has not been resolved, and we have struck a committee that involves members from hospitals run by religious organizations to meet with us to determine how best to fit them into the community health structure. We recognize their special status and historical concerns, so that's why we're going to sit down and work this one through with them.
V. Anderson: I understand the United Church hospital program, and they would very much be a cooperative part of that program, because they've worked in a cooperative system over the years. But I'm thinking of the Salvation Army Hospital, and the Salvation Army clinics, Roman Catholic hospitals and
[ Page 9100 ]
extended care hospitals in communities. There are some real questions about where these people fit into this program, because I'm sure they will want to maintain their independence -- and properly so. I'm hearing that joining the community council is voluntary, but it sounds like somewhere down the road you either join the council and have a say in where the budget money goes, or you don't join and take your chances on whether you get any money from the government through the council, because that's the only way it's going to come to you. Is that correct?
Hon. E. Cull: As I said, we struck a committee to work with the representatives of the hospitals run by religious organizations so that we can resolve their special cases. We understand their desire for independence; but I'm also extremely pleased with those hospitals that are participating in the community health council process in their communities, including the hospital in New Westminster, which I believe is a Catholic hospital. I said at the outset that the details, some of the answers for this, are not determined at this point. There is no intent to determine them at this point, but we are committed to making sure that those particular institutions have a forum to work with us to determine how they can best fit into the council approach.
V. Anderson: That's part of the difficulty of supporting this, because the really important issues that affect the people right in the community are still unresolved. It would be better if they were resolved first -- as even the Minister of Social Services is doing; they had the study, and now they're putting out a draft and having that come back in. It would be much better if the process were the other way round. We have a whole slew of senior citizen care programs, home care programs provided by the nursing facilities and community nursing programs. Are we saying that those home care programs that are both private and public -- where nursing facilities come out and serve people after hospital care, for instance -- are now all integrated into the responsibility of this council and that private agencies who are providing some of those services will either have to join the council or contract with the council?
Hon. E. Cull: If they are services that are funded with public dollars, then yes, they would. If they did not amalgamate with the councils -- and in that case I don't imagine they would -- then the councils will be responsible for contracting with them for their services.
V. Anderson: I have a concern here, because in talking to some of the community people who are involved and coming together to form these councils even at this point, the awareness that all of these community groups that are now giving health services in the community are in a whole new uncharted field is not really there at this point. So it's going to cause a great deal of concern to these people as we make them aware of this program. What is the minister doing to develop this awareness, and what kind of orientation and training is being given to these councils as they undertake what is really the management of a major business? Many of the people who are coming into this community council process have not been involved in health care professional management. What kind of orientation is being provided so that those people will understand the significance of what they're about?
Hon. E. Cull: I can say that these people are going to get considerably more training and guidance than do the members of hospital boards who are operating our hospitals in this province or the long term care facilities or, in many cases, the union boards of health. I think we fail to recognize right now that we have voluntary boards that are managing multimillion-dollar operations in some of the most important institutions and corporations in our province. While some of those people have considerable expertise at the business level, some of them come with basically very little expertise in running an organization of that size. However, we plan to do orientation and some training for the new council members so that there is some consistency across the province.
V. Anderson: My last question on this particular section is one I asked earlier. Is there a relationship between the health care model and the Healthy Communities model which people have also been working at within the communities?
Hon. E. Cull: There's great coordination between Healthy Communities and the health councils. In fact, the Healthy Communities programs are involved in all the health councils that I'm aware of. But the process is very similar. It's a community development process that brings people together to sort out for themselves how they can improve the health in their community. That's very much what a health council is all about. The steering committees that are coming together right now are in fact doing that.
G. Wilson: One of the problems with protracted debate in this House and when we run through dinner hour is that people have to step out and step in, and it's sometimes difficult to make sure that we are not covering ground that has previously been covered.
In section 7 -- my colleagues who have been in debate tell me that this has not been adequately canvassed -- one of the things we notice is that one of the purposes of the council will be the development of a community health plan. We noticed in the sections that we canvassed extensively with respect to the provincial standards that, essentially, the minister would be developing the provincial standards and within that the amount of health services that would be provided within a community. If the council is charged with the development of a community health plan and a regional board is going to be in large measure responsible for the development and setting of priorities and the preparation of budgets for submission of the health plan, then what confidence can we have that the provincial council will be able to effect it if the minister is responsible at the top level for setting out what those
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criteria are going to be, and that a senior regional health board is going to be able to develop that?
I ask that in sincerity because -- having been involved in a level of community government where you set out with the best of intentions for what you think is the interest of the taxpayers -- when you're subject to a senior government and the downloading from senior government, you are only going to be able to effect or not effect what you can do by the dollars you have. That's the reality of the bottom line. Yet it says here that the community health plan is going to be the key to what this body is all about.
[8:15]
Hon. E. Cull: With respect to the member's initial remarks, I think that if I can be in this House constantly for six and a half hours, other members who are really interested in this legislation can stay throughout the debate -- at least through the sections they're interested in.
In any event, the community health councils are required to prepare plans for their sphere of responsibility and the regional health boards for their sphere of responsibility. We've had considerable discussion in this debate about the need for there to be a balance between provincial and local standards. There has to be some consistency throughout it. I would think that somebody who had been a member of a regional district board would understand that. As in the municipal field, where municipal councils can't make plans without giving due regard to provincial environmental standards, there's a balance there; but that doesn't prevent them from having their own local plan. Indeed, I'm sure the member was there in the days of regional planning. I think his tenure in municipal politics goes back that long. In those days there was a requirement that regional plans and municipal plans have some consistency with one another. Both sections 7 and 5 of the act give direction to the councils and the boards to have due regard for the standards and services that have been specified at the other levels. In the section we're coming to, we'll talk about resolving the differences in the priorities between the two.
G. Wilson: If I may be permitted just a brief latitude in response, I know that the hon. minister was elected by by-election and served only a limited time in opposition and therefore is not aware that the opposition not only has to be here for the Health minister's bill but has to be here a long time for every other bill that's before us. It isn't just a question of spending the six and a half hours here; we've been spending four and a half months here trying to fight the legislation that this government has brought down. Not that we begrudge that. After all....
Interjection.
G. Wilson: Interestingly enough, I hear the member sitting in the wrong seat over there in the opposition saying: "That's what they pay you for." I certainly don't begrudge that. That is the role that I ran for, and that I would like to duly discharge my obligation to the community to perform.
I was involved in the community planning process, and I know how difficult it is putting in place a community plan. You often don't have the resources to be able to effectively deliver on all aspects of the plan. When you're dealing with land use planning, it's a little less life and death than when you're dealing with health planning. I think the minister would acknowledge that, because I know she has a long background in municipal affairs -- and a rather good background; I understand her record was quite excellent, and I don't take that from her. But I'm saying that it's a little bit different when you're looking at land use planning as opposed to health planning.
I'm looking at the delivery of health services in a community, which is what is provided for here in section 7(1)(a), and "the making of reports by the council to the board and to the minister...in carrying out its purposes...." Then it says, if I can read section 7(1)(b): "...to coordinate and integrate health services in the community...." Then (c) says: "...to operate" -- it doesn't say to assist in, to plan for, to provide for; it says to operate -- "hospitals and other facilities...." Clearly these councils are to take the place of the hospital boards, and we understand that and we understand how that's going to work. Clearly their ability to function properly and effectively is going to be dependent upon the resources they have to do so.
Yet if you look at the way this bill is structured -- and this is what I was alluding to when I was talking to section 2 briefly, but also sections 3, 4 and 6 -- quite clearly there is little to give us confidence that this local level of planning is going to have effective enough control over the regional system of budget preparation and allocation to give them confidence that the plan they put forward, which will be in the best interests of their community, can be realized. Not only are they going to have to fight within the region, they're going to have to fight from that region to the province to make sure that the kinds of resources that are put in place are going to be effective. Where there is considerable difference of opinion.... And there is all over the province, because I've had opportunities since being elected in opposition to travel all over the province and talk with regional hospital authorities under the old system. There is enough concern between communities as to who should get what resources, who should be specialized in what delivery of service and who should be allowed to expand in what areas, that there is going to be a great deal of concern that each community gets what they deserve.
Secondly and more importantly -- and I'd like the minister to comment on this -- within the sort of collective psyche of those health care providers in the province, there is no consensus of how we should develop the regional plan in the first place. As a result of that, I suspect that there is going to be an awful lot of fighting over these local community plans, given that there are limited resources. We simply don't have the opportunity to open the gate and say there are unlimited amounts of money. I wonder if the minister could comment on how (a), (b) and (c) are going to be
[ Page 9102 ]
integrated to give us any confidence that these community councils are going to be able to effectively provide what they are intended to provide.
Hon. E. Cull: As it is now -- and I've probably talked to most of the organizations in this province that deliver direct health care services -- I have never had one body come back to me and say: "We actually have too much money; don't give us any more." Everyone could use more resources to provide better services for the people in their community -- or at least they all believe they could. And I am sure they believe that in good faith and very sincerely. But the fact is that our resources are limited by the decisions made in this Legislature.
At the beginning of every fiscal year, my ministry staff has to divvy up the provincial health budget to the various branches in the ministry, to the various hospitals in the province and to all of the agencies that we fund, and there is a decision made there about what is or what isn't adequate. It may not be the right decision, but someone has to make it, and that decision is made now. Unfortunately, most of those decisions are made without a lot of coordination. There is not a lot of coordination between the services that are provided at the community level. There is not even a lot of cooperation and consultation between the same kinds of services in different communities. It's a very hit-or-miss kind of approach. I don't mean to say that my staff aren't doing their job well; I think that they are doing an excellent job. But the way that we have set up this system does not allow us to coordinate and integrate within a community, across services or between communities for the same kinds of services.
When we are looking at the system and you say, "Gee, this is going to be really difficult to do because communities will fight with one another, and it's not easy to get cooperation," I will agree with the hon. member. But we have to look at the system that we have right now and say: "There isn't a perfect system. We're not going to be able to put something in place that's going to make it all work." As I said a few minutes ago, you either support the benevolent dictator approach -- "we'll make all those decisions, right or wrong" -- or you give some credit to communities; you have some faith in them, and say: "Yes, there will be some squabbling, but at the end of it all, they can probably make just as good decisions as we could."
G. Wilson: I am having a little bit of difficulty being aggressive in my reply, because I happen to be sympathetic with the minister's position. I think there is a real problem here in that we have limited resources, we have to find a better way of delivering health care, and we have to find it in a way that's going to provide for the communities and the people who need it. I understand all of that. I have also been on the other side of the coin -- sitting on a regional hospital board, where I understand the very real difficulties in trying to prioritize the expenditure of limited amounts of money, knowing that you don't really have enough money to do everything you want. In fact, you often don't even have enough money to adequately do half of what you want.
My concern is that when you start to look at the structure that is being put in place.... Let's face it, I think that once we get through the next couple of sections the balance of the bill goes without saying. That's just my opinion, but nevertheless, I think we are dealing with the real heart and soul of what we are debating, and that is whether these councils are going to provide a better system for decentralizing to the community, in an adequate and proper way, the decision-making powers over health care services in a way that is going to give them any greater degree of comfort that the money they are going to be putting into that system is going to be better spent than it is today. And that is what we are charged with trying to do. I understand, and I'm sympathetic with the problem, because I don't know -- I don't have a definitive yes or no on it -- but I have my own understanding of it.
But it seems to me that what we have done here -- and my question straight to the minister is on this -- is that, first, we are setting up some false expectations that somehow we're going to decentralize, and therefore cut administrative costs. We went through this and agreed to disagree on that point, and I don't want to revisit it. Secondly, in the purposes part of section 7, we are setting up these councils. In setting up these councils, we are saying that they're going to be given the authority to plan, and to coordinate and integrate these services. They're going to be allowed to operate hospitals as boards have previously done, and they are going to be given the powers of an employer in the sense that it says under section 7(b) "...(i) to deliver those services through its employees, or (ii) to enter into agreements with the government or other public or private bodies for the delivery of those services...."
To what extent is that authority actually going to be able to manifest itself in any way, into real flexibility and real powers for this local community board to actually do that? If you deal with it under in the Municipal Act -- and I hate to use this parallel because I know it's not always consistent -- there's a limited amount of power for local government. Why? Because they have only a limited authority to be able to develop a tax base from which they can be financed. That's the problem. I wonder if the minister can comment on that.
Hon. E. Cull: To some extent, the member is right. We are not giving all the powers of the provincial government to these local authorities. The first thing any body does when it is planning is to work from its budget. Municipalities don't provide, as you have just said.... They have a tax base. They provide their plan for the services they provide to their citizens, based on the budget that they're able to establish with their tax base every year. There is always a list of things that municipalities like to do that is well in excess of their ability to fund. The same goes for school boards and hospital boards, and the same will go for these health councils.
Within the health system, if I just stick to that, I have seen example after example of hospitals that could
[ Page 9103 ]
change the way they're doing things and have more money that they would then be able to spend on their priorities. We have seen situations in which communities, if they could pool their budgets, would be able to free up money and then make decisions to spend it on other services that otherwise would not get funded. I suspect that if we did even what we did in the first year of our government -- when instead of having our staff make all the decisions about what the public health services would be, we actually used the union boards of health to provide more guidance on those services -- or that if we could even start to move in that direction, it would be an improvement on the system we have right now. It's not a panacea. It's not going to be the most wonderful system in the world that we'll have no problems with at all, but it will allow communities to have a greater say than they do today over the decisions that are made about what services are provided, and how those services are provided in their community. That is going to be a significant improvement. The people we worked with over the last year, who include health care providers and the governing bodies, certainly believe that this will be a better system.
The Chair: Before the Chair recognizes the member to continue, I'd like to remind all members that in the Chair's opinion it sounds like we're getting back into a debate on the principles of the bill -- just a cautionary note to keep to clause-by-clause study.
G. Wilson: You surely don't want me to bring out a dictionary. It seems to me that takes me back to a debate last evening, and we wouldn't want to get into that.
Having heard that ruling, let me come straight to section 7(b)(i). To what extent is this authority going to have the powers of hiring, and to what extent is it -- because it says that delivery is through its employees -- actually going to act in the role of employer, as opposed to each hospital administration having that authority?
[8:30]
Hon. E. Cull: The member should bear in mind that we actually have five metropolitan boards of health that directly provide services the Ministry of Health normally would be providing. They act as employers through their municipal or regional district bodies, so we already have this model in place to some extent. Where the health council takes over responsibilities that the Ministry of Health is now providing, they may have those people as their direct employees. Or they could use the next subsection to contract with the government for the provision of those services. But it is intended that these councils will assume responsibility as employers for the people who work in those institutions or programs that have come directly under the councils. So if there's no hospital board or society, the health council actually would be the employer of those employees, and would receive responsibility for their collective agreements and all of the other provisions of labour relations.
G. Wilson: With respect to the delivery of those health care services through its employees, within any community it's intended -- if there is more than one health care delivery service, be it a hospital or some kind of diagnostic and treatment centre or whatever -- that this council will be responsible for all employees under each of the collective bargaining units affected within it, and as a result, responsible for the negotiation of those collective agreements. Is that correct?
Hon. E. Cull: No, it's not. They would only be responsible for the employees where the societies had merged. We just had quite a lengthy debate about whether all the societies would merge or not. If the society hasn't merged with the health council -- if it hasn't dissolved itself and become part of the health council -- then its employees are still employees of the society, not of the council. But because we expect there to be a merger of councils and boards to form the council, then the employees of those bodies that come together will be merged. We also said a few minutes ago, hon. member, that the Health Employers' Association of British Columbia would be responsible for the collective bargaining.
G. Wilson: I may be sort of wading out of my depth here, and if I am, maybe the minister could correct me. It seems to me that a few minutes ago we heard a rather eloquent discussion about how, through the merger of all these societies, we were going to actually reduce administrative costs. Now we're hearing that they're not all going to merge. I understand that; it is impossible to accomplish that in a short period. And this is an interim act, and I understand and don't want to revisit that.
But if you're talking about union boards of health and so on, to my understanding.... Certainly the regional district board I was a member of didn't have direct employees. So this is quite a change, because presumably a hospital administration is directly responsible for the hiring and maintenance of those staff. And there may be a hospital board charged with that provision, so where those boards are merged I can understand it. But if you're integrating regional hospital districts and union boards of health, I don't quite understand how that's going to fit.
Hon. E. Cull: The member is correct. The union board doesn't directly have employees. But the services they provide guidance to are provided directly by employees of the Ministry of Health.
Let's take a very simple example. It's conceivable that a health council, which might merge hospital board and union board of health functions, would assume those employees who provide the public health services in the community. They would become employees of the health council, no longer of the Ministry of Health. We already have situations where hospital and long term care society boards have merged. The employees have become the employees of the new society. When Brownsville Hospital and Green Long Term Care Facility merge to form Sunnyside Health Care Society, those employees become employees of the new society, not of the old ones. That's what I'm talking about here:
[ Page 9104 ]
where societies merge into the council, their employees would become employees of the council.
But we've said we're not going to merge every non-profit society providing recreational programs to seniors in their homes to help them maintain their independence; we're not going to do all of that in a health council. There will, necessarily, be a contractual arrangement between the councils and other bodies that have employees who will still work for them.
G. Wilson: For the purposes of the record, let's be clear that Brownsville and Greensville, or whatever they were, are fictitious entities. When one reads Hansard, I hope that if there are such entities, the minister wouldn't be held liable and accountable for what was said.
It seems to me that what we're dealing with is that these health councils will now become the principal bargaining agent for management.
Interjection.
The Chair: Through the Chair, hon. members, please.
Hon. E. Cull: Sorry, hon. Chair.
The member missed the second part of my answer to that question. We talked about this earlier. The Public Sector Employers Act establishes.... The work that has already gone on to merge HLRA and CCERA into the new Health Employers' Association of British Columbia would require that there be a central bargaining agent. The central bargaining agent would be that association.
G. Wilson: Okay, fair enough. Let's just leave that for the time being. We may want to pick that up under "powers and procedures" in the next section. Let's not belabour that one if we don't have to.
In section 7(D) it says: "...to project future need for health services, to set priorities...." I come back to the same questions that I asked under section 5(b), which said: "...set priorities, prepare and submit budgets...." If we are to project the future needs for health services, set priorities and prepare and submit budgets, it seems to me that what we're really looking at is a tiering of authority.
I can recall many occasions in late night meetings.... The regional hospital board usually used to sit after the regional district meetings had finished, when they would convene the regional hospital board. We'd sit and look at these budgets. Often, it didn't have a tremendous amount of relevance to what we were doing, because we weren't involved in a hands-on delivery of service. It was very frustrating, because if you're diligent and want to do your work, you like to find out what each dollar is being spent on.
It seems to me that what we're doing here is we're asking each of these councils to develop independent budgets. These independent budgets are now going to go up to a higher authority, which is the regional board. This regional board is going to sit, and it's going to somehow try and apportion those budgets to these community councils. At least, that's the way I read this act. If that's going to happen, it seems to me that now you've got four levels of prioritization, whereas currently we only have two or possibly three.
Hon. E. Cull: Thousands.
G. Wilson: You say thousands. I think that's an exaggeration.
Excuse me, hon. Chair. We don't want to impugn your level in any way.
Many different agents at one level come together to try and fight for money. Once that comes into the ministry, it is then in charge -- as it sits now -- trying to apportion out certain amounts of dollars. This seems to really download that responsibility in large measure. In fairness, the minister might say that that's decentralization, and I would support that, frankly. I would support the idea of the community having a greater control and say over how those dollars are going to be spent.
The problem is that you've got a community council and a regional board, both of which are trying to set budgets. Clearly the community council is going to argue for the maximum; the regional board is going to pare that down to try to prioritize within its region who gets what. There's going to be all kinds of regional jealousies as to what happens. I've been on a board where I knew where the moneys were allocated. Some communities will think that they're always on the short end of the stick; they never get enough. There are going to be complaints. It's going to be a difficult situation.
Then they're going to have to go and argue with a more senior person in the Ministry of Health to try and get those dollars delivered. When the money comes back, if the apportionment isn't somehow tied and aligned, then we're in for some serious trouble. I'd like that clarified; if I'm wrong, I would like the minister to correct me now, because it's important for us to know. It's certainly a concern in the community that I represent.
Hon. E. Cull: The member is not correct in how he imagines this will work. The province will establish global budgets that will go to the regions, and those budgets will be established on a formula basis. It will not be established by looking at a bulk budget submission and saying that we think we can fund this or we don't think we can fund that. There will be a formula that will determine how much money each region gets, based on criteria. In the same way, we use a formula to allocate part of the hospital budget right now, and we are moving toward that in the long run for the hospital budget. The community health councils will prepare their plans and their budgets, and go to the region. They will have to be sorted out at the regional level, where there will have to be trade-offs and decisions made. But those are really the two levels there.
In many cases what we have right now in the ministry and the system is a community preparing a budget, sending it up to a district level, sending it up to a regional level, sending it up to headquarters, putting it into the process that we go through at budget time,
[ Page 9105 ]
and trying to sort this all out -- and that is just for mental health. Then we have another process like that for alcohol and drug, and hospitals go through their own sets of processes. So again, the answer to your line of questioning -- and I understand where you are coming from -- is that while you are pointing to challenges or difficulties in this system, we have to be very cognizant of what we are operating with now. The system we have right now is very fragmented, very fractured, and it certainly doesn't make as much sense as this one does. One of the main things that was driving the people to this approach at the health care forum and in the minister's advisory committee was the concern about the disorganization, and the way funding comes into communities right now.
G. Wilson: My question is whether, within the establishment of this formula -- and I'm very leery of formula funding systems, because they often tend to be rather generic in their origin, and are not often very effective in delivery.... I come back to earlier comments that the minister made which, quite frankly, gave me some hope. In the setting out of that formula, presumably the differences between regions -- and each region is going to be different, because the communities are going to have, hopefully, lobbied hard enough for them to have established those differences within the minds of the ministry -- including things like isolation, the lack of contiguousness within the region, and all those kinds of things, are going to be component parts of any formula that would generate greater dollars to those needed facilities.
Let me think if I can come up with an example off the top of my head -- maybe Powell River. So we might actually see some additional dollars going into that facility, given that they're isolated by.... Is that part of this function? I'll tell you the concern. It has come to me in spades. If that community is in a region that includes Coast-Garibaldi, which is Squamish and Sechelt and is a very disparate kind of entity, it's going to be very hard for these community boards, under section 7 of this bill, to argue effectively if they have to compete within their own region to try to get the kinds of dollars they need. What you have essentially done is thrown very few scraps to a number of very hungry hospitals. They are going to be fighting like crazy to get them, given the limited amount of money the system has originally.
Hon. E. Cull: Yes, it is my intent that the global funding formula would include such things. Right now it's sophisticated enough to deal with just age-adjusted population, but we add criteria for geography. What I would really like to see added are criteria with respect to the health of the population. We would provide more funds to those regions that have the lowest health status, because obviously they have the most work to do; and where we have very healthy populations that don't have high rates of disease and hospitalization, those funds could be somewhat less. We're talking very minor adjustments here, but I think we do have to start to address those parts of the province which have very serious health problems, and part of that is the lack of resources that they have in their community.
[8:45]
G. Wilson: I only have two more questions on this section, and then I yield to whomever.
First of all, as the Member of the Legislative Assembly for Powell River, I want to say that I don't want to in any way equate my demand for greater dollars for the Powell River hospital district with some notion that we may have a health problem in that region; it's to the contrary -- although we certainly want to get our fair share.
I'll give you my last two questions at once so that I can terminate my questions on this section. One has to do with the specified services under section 7(1)(f). It's a fairly simple question. Are the specified services you're referring to the ones that were outlined in our considerable debate on section 3. Do they refer back to section 3(2), and the specified health services provided by the minister. Is that reference to that? If not, what does it refer to?
My second and last question is with respect to the coordination and integration of health services in a community. Is there indeed going to be some form of moneys provided for these councils where coordination requires movement and integration of services among areas where there are very disparate and widespread sets of community responses? Let me be more specific. If we were to deal with the interior and the north, where you have a number of communities that may be hundreds of miles apart, in a coordination of services would there going be some additional dollars provided directly to this health council to facilitate people getting to and from the areas where they need to be? It's a major obstacle to getting integration of those regions in place.
Hon. E. Cull: With respect to the first question, specified services are defined in section 1 of the act. So it actually means: "for a region or community, the health services, or level or extent of health service, specified under section 3(2)." So it is the section 3 services.
For the second part of your question, there wouldn't be health councils with areas 100 miles or more.... We are looking at communities here. So we're not....
Interjection.
Hon. E. Cull: Sorry. I'm not quite sure what the member is asking, then, in terms of the need for additional dollars to deal with services. If he's talking about the providers moving around in that area, and there being additional costs to service a widely dispersed area, then yes, that would be reflected in the budgets that would be made available to those communities.
G. Wilson: I'll just elaborate on that, and I don't want to protract the debate in any way if I can help it.
I'm talking about a community health council here. In a community such as, say, the lower Sunshine Coast, you're dealing with people from Egmont to Langdale. That's a fairly distant regional district, let alone a health
[ Page 9106 ]
district. If you're going to look at that, I can't imagine how that would not be one community council -- because it is one community, in a sense, and I don't think that's unique in the province. I'm sure there are many places in the interior and the north that are like that. If you're going to get people to come together to try and deal with that, there's going to have to be some form of budgeting to allow them the opportunity to come together to facilitate those services in each of those communities. That was my question.
Hon. E. Cull: Thank you for the clarification. That was answered earlier when we looked at the question of expenses that are available to help health councils do their job.
C. Serwa: This is obviously a very important section. It's central to the legislation and worthy of a substantial number of questions. The mechanics of it must work once this is under implementation.
In answer to earlier questions to the Minister of Health, the minister indicated that the community health council could specify services. When I questioned to what degree, it appeared that the Ministry of Health and the minister would have absolute control over the budget of that community health service. As I listen to the debate, I find that a global budget will be handed to the regional health councils, which will then distribute to the community health councils within the area. Am I correct in that statement?
Hon. E. Cull: You're correct in the second part of your statement. I don't believe I ever said that the ministry would be providing the direct budget to those individual services. We've been talking about a global budget all the way along. We can specify services and standards, but with respect to saying that service and that standard will have this budget, that's not the intent.
C. Serwa: It will be interesting to look at the determination of the formula. I know that in the Ministry of Education, the block funding has about 45 elements in the complex formula, and it's still under a substantial amount of attack and concern. So the establishment of a formula is difficult. When we look at the purposes of a community health council, they're very varied and obviously global, as are the Ministry of Health's concerns.
What we're talking about in the community health council is not only very competent and well-informed people actually serving on the council -- and the minister indicated that a training process would be necessary for these individuals, and that's going to be an interesting challenge -- but also the staff required in the community health council, which is going to have to be very competent and also very large in order to manage and provide the information so that appropriate decisions can be made. There is a lot of weighing if you talk about community concerns. We want something to happen in a positive way, not something.... I'm confident that the minister doesn't want it to turn into a big squabble and a lot of controversy within the community or a region. But the potential exists for precisely that. There are a number of varied concerns that have to be weighed. The professionals in the Ministry of Health have long-term experience and are able to weigh that. They have available all sorts of statistics accumulated not only in the province of British Columbia, but in other comparable jurisdictions. Then they come to assessments and base their decisions -- which are perhaps imposed on communities -- on their knowledge, experience and wisdom and on the current standards of service.
The community health councils, on the other hand, are not going to have this type of qualified staff or the number of qualified staff so that they can actually make those decisions. The minister says that it depends on what the community wants to do -- whether we want to divert more money from the acute care system into the continuing care system; whether we want to have more speech therapists, which is a vital concern to parents with young children who need that assistance; or whether we have to look more, as I might in my community, at services to seniors. It's very difficult to weigh those complex issues in a community and come up with a rationalization.
When I look at school districts, I note that the administration centres are very large, complex and expensive. But I see a redundant tier here, because the Ministry of Health is not going to be diminished in stature. The people are there, and they have to have very competent people. We have a redundancy in the region, which has a similar responsibility for allocation. Then we go to the other level of the community health council that we're talking about, which again is charged with making a large number of very complex decisions on the basis of community input, which I think is an insurmountable challenge. The more I listen to this, the more I become concerned about the ability of this to ever function at all.
Hon. E. Cull: The member is not giving full credit to the excellent staff who already exist in the organizations that will be amalgamated to form these councils. Some of the best administrative and health care expertise in this province is in our hospitals. Those staff will be available as part of the staff of these councils to carry out their functions. Some of the staff who are currently employed by the Ministry of Health may in the future be employed by the councils to do that.
Let me perhaps disillusion you a bit on two points. There isn't any science to a lot of the standards that are being set and applied by ministry staff. They do their very best to try to establish population ratios and to determine what the service levels are. But there's nothing scientific about it which says that it's right or it's accurate. It's subjective and based on the talents of the individuals. Unfortunately, under our current system, we put ourselves in a situation where there are so many different individual decision-making authorities providing health services to a community that we might not be funding the most critical services in a community, because there really isn't any forum right now to look at all the priorities for funding.
[ Page 9107 ]
If I could just take a second to give you an answer, let's say the minister said to a community: "We have an extra $50,000 for your community. Where should we spend it?" There is no mechanism in most communities to determine how to spend that. If we go to the existing spending decisions, alcohol and drug would tell you what their number one priority was; mental health would have their number one priority; the hospital would have its number one priority; and public health would have another number one priority. We wouldn't know which of those priorities is the most important to fund. In a given community, it might be that the top ten priorities in mental health were more important than any of the priorities anywhere else in the system. But there is no way to sort that out rationally under our current system. One of the things that this will do is improve our ability to make that decision, because through the merger the very talented staff who are in the regions right now will become the employees of these councils. It won't be absolutely perfect, but it will be better than what we have.
C. Serwa: As MLAs, both I and the minister are well aware of the various and diverse demands on the health care system in any community. I certainly agree that we have very competent administrators and staff in our hospitals, but they have a bias and an interest probably with respect to acute care in hospitals and the parameters of that. We have other specific interests in communities that have other biases. There's really no weighting mechanism. So there is the potential for a competitive element -- what I simply refer to as a squabble. A senior is not really going to be concerned with the need for speech therapists; at their particular stage of life, where they demand a very high percentage of the health care funds, they're more concerned about their lives and their needs. That's appropriate, because we are all like that -- we're all individuals.
It's very difficult for the Ministry of Health to weigh that, and we understand that right now. But it's an impossibility for community health councils to be able to weigh that in the community. They are too close and too emotionally involved -- they cannot be objective and realistic in the assessment. So I suggest that there are severe problems with the model, and the type of control that the community health council is supposed to have. It doesn't seem to me that it has the potential or possibility of working, if you think it through. The minister asked: "If we had $50,000, where would we spend it in the best possible way?" It's not a problem of spending it; we both know that. The reality is that it simply won't occur. The demands and expectations on the health care system are very high indeed. The expectations probably exceed the needs.
I am trying to get across that in a local community situation we can draw an analogy with municipal government. The accessibility, pressure and lobbying, certainly, is there, but the ability to satisfy those decisions on an objective, factual basis is diminished because of the emotional involvement. So I say that the theory is very good, and somehow there may be a meeting of ways that is more appropriate. I really don't know. But I would say,from looking and listening, as I have done this evening, that it is fraught with so many challenges that I don't think it has a chance of succeeding, regardless of the amount of goodwill that the minister and the government of the day put into it, because those decisions are entirely too complex to direct.
[9:00]
The minister mentioned drugs and alcohol. Currently in my community, there is an acute need for a detoxification centre, but there are other acute needs in there as well. How do you weigh one against the other? That's where we go back to the Ministry of Health, a complex organization that sits here in Victoria with schooled, trained professionals who have long years of experience and are able to make those decisions; whereas I do not believe -- and the minister hasn't convinced me -- that the community health council will have that ability.
Hon. E. Cull: Very briefly, the member does not understand that the ministry does not weigh the needs in a community. We don't have the ability within the ministry to take your community's request for a detox centre and its request for speech therapy services and decide which one we're going to fund. The way the budgets are created right now, the alcohol and drug budget is over here, the speech and language budget is over there, and we're not structured to be able to make those decisions. We couldn't make those decisions on every community's basis. We do them program by program. So we try to provide the dollars that are allocated to speech therapy to those communities that have the greatest need, but that doesn't necessarily mean that speech therapy is the greatest need in the community we give money to first because it's in greatest need, and if that community had the say, they might spend that money on something that they think is more valuable.
I believe the system will work. The alternative is a benevolent dictator that we would set up in Victoria to try to make all of these decisions for communities. It will be difficult, but I think that communities have the talents and the abilities, and I don't think they make worse decisions than bureaucrats in Victoria do.
C. Serwa: We'll just conclude very briefly. I think it was Plato who said that democracy will end in chaos, and while I am a strong adherent of democracy, what the minister sees as democracy is really not. I suggest that it will end in chaos. I guess it's a philosophical argument, and there is no end to this story. I won't continue to pursue it, but I have addressed my specific concerns, because with my experience in business and other occupations, I don't see how this particular model could succeed. The minister has faith and confidence, and that's simply great, but I just can't see it. I'll just leave it at that.
V. Anderson: I'll mention, only in passing, that we have been talking about the employees and professionals who are doing the service. At another time -- not right now -- I want to talk about the volunteers, because I am afraid we're going to lose them
[ Page 9108 ]
in the process unless they are also very much taken into account, as we are doing with the others.
But my main question at the moment is that I know that everybody who has been in any process of going to government has found the problem of having to go back year after year. Is there a provision in this for multi-year planning, if the people do planning? Will there be an opportunity for multi-year financing?
Hon. E. Cull: The Finance minister suggests that I will be advocating that. Decisions around multi-year budgeting are not made under this act. They're the purview of Treasury Board, and those decisions will be made by Treasury Board.
V. Anderson: I want to follow up on that. I know the minister is saying that it is up to Treasury Board, but it seems to me that when the government is bringing in a health package it has to do so within the context of the whole of government. There is a difficulty here with organizations, boards and hospitals. Like any business, they must have some assurances. You can't plan effectively if you have to do it one year at a time. I hope that there will be some indication that multi-year planning is coming in. Its absence will cause great difficulty in establishing this new program.
[D. Streifel in the chair.]
L. Fox: It's a pleasure to re-enter the debate on section 7. During the course of the last half or three-quarters of an hour on this section, the minister has talked about the opportunities here of doing away with the duplication of administration costs. I want to address that to some degree. Earlier, in other sections, the minister suggested that we were presently looking at approximately 90 local community councils and approximately 23 or 24 regional boards. It's my understanding that there are about 130 hospitals in the province and a similar number of senior citizen homes, whether these are extended care, intermediate care or whatever. Does the minister envision that this particular community health council structure will amalgamate the administration of the different facilities encompassed by the health council? Are we looking at a structure of perhaps one or two administrators for a number of facilities, versus what we have right now where virtually every facility has its own administrative team? Is that one of the objectives under this council?
Hon. E. Cull: Yes, it is. To again use the example of a hospital and a long term care facility that have recently merged, you'll find that there's one chief executive officer responsible for both facilities and an on-site manager at one facility. The CEO would usually be in the larger institution, the hospital in this case, and an on-site manager in the long term care facility. There is also the ability for an amalgamation of the supporting administrative functions, such as human resources, accounting and the like.
L. Fox: Obviously, then, there's going to be a need for fewer administrators. Like I said earlier, we have approximately 130 hospitals in B.C. and an equal or larger number of care facilities. During the transition period over the next three years, how will the councils deal with removing or laying off administrators and members the administration team? How will they be shifted and looked after in terms of re-education or whatever? Or is this going to cost the councils a horrendous amount of money for severance pay because of long-term contracts or whatever the case may be? Has any consideration been given to that aspect?
Hon. E. Cull: We have been talking to the Hospital Labour Relations Association with respect to adjustment for exempt management employees, and that would apply in this case. Part of the downsizing that will have to occur will take place as it has where other institutions have merged. This is not something new. This is happening on an ongoing basis, and if one of our objectives is to reduce administration costs, one of the consequences is to reduce the number of administrators that are employed.
L. Fox: I know there's a section later on where the minister, through the order-in-council, can put forward regulations. Is there going to be any kind of consistency as to how this is going to be approached within the various councils? Because this is a transition period, and given the fact that the board is totally appointed by the minister through this transition period -- albeit the minister gave her assurance that the community is going to be involved in the appointment process -- what kind of consistency is going to be used in order to examine the process and what the administrative team should look like in an area? Or is it total autonomy for this council with respect to what the final team will look like?
Hon. E. Cull: Hospital boards have complete autonomy in making decisions about how they structure themselves for administration. We would not want to fetter community health councils any more than we would fetter boards in this regard. I think we have to leave them with the ability to make their best decisions about how to structure themselves administratively.
L. Fox: Given that the minister suggested that the council would have total autonomy in this decision-making process regarding administration, that brings up another question. I know that we will be discussing section 8 very thoroughly, but will this interim council have the autonomy to close a small hospital, or perhaps dramatically change the structure of the local health care boards in terms of the delivery of service? Will they have that kind of autonomy while they are restructuring their administration team, to look at closing facilities within that structure?
Hon. E. Cull: Because the councils and boards have to conform to the standards set out in section 3,
[ Page 9109 ]
they would not be able to close an acute care facility, because under those standards they would be required to provide acute care services. However, should the community come to the conclusion that the best thing they could do is close their facility, and if in discussion with them and evaluating it we agreed that they were making the right decision, then we would change the standards that applied to that community.
L. Fox: In other words, the minister is suggesting that the ministry or the minister herself could not instruct a council to look at closing a facility -- similar to what happened with respect to Shaughnessy, where the minister actually fired the board and then closed the facility. Is the minister assuring this Legislature that a similar action is not available to her under this new structure?
Hon. E. Cull: The member's correct. We would not be able to direct the closure of the facility unless we eliminated the council in its entirety -- the same way we had to when we had to appoint a public trustee in place of the board at University Hospital. I can't image why any government would do that in terms of the flak that you would take with respect to having replaced an entire community health council that has responsibility for all kinds of other things. Obviously this approach is going to require that those kinds of decisions be made cooperatively within the community, within the regions, and with the ministry. In some ways it would end up being a much better system.
L. Fox: Earlier the minister suggested that this had no bearing at all on capital projects, and I respect that and won't go into that. Given that there have been initiatives -- and certainly I'm familiar with one, as is the minister -- towards a new facility.... This particular case was in the community of Vanderhoof. With respect to the extended care facility, that initiative has been in process for some time. Would the minister suggest that the structuring of this new network would stop the progression of that particular process? What involvement would have to happen with respect to this community health council, if any, in order for that to move forward?
Hon. E. Cull: You have to bear in mind that there are essentially two answers to that. Firstly, during the transition period, while we're moving from the system we have now to the new system, I'm assuming that the extended care society would be becoming part of the community health council in Vanderhoof. As a result, the council would take on the responsibilities and the planning for that facility in the same way that the hospital society has been up until now.
[9:15]
When we have this system in place in the future, when the transition period is complete, the councils will be responsible, through whatever the final decisions are around capital funding, for the planning of new facilities. In the meantime, the planning is going on in your community and should continue to go on. I don't have any indication that Vanderhoof is going to be one of the first community health councils formed in the province; it may be one of those that forms towards the end of the transition period. But the planning will continue, and if that society is merged with the council, the council will take on the responsibility.
Section 7 approved on the following division:
| YEAS -- 27 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Giesbrecht |
|
Smallwood |
Gabelmann |
Clark |
|
Cull |
Zirnhelt |
Barnes |
|
MacPhail |
Copping |
Lovick |
|
Pullinger |
Farnworth |
Evans |
|
Dosanjh |
O'Neill |
Doyle |
|
Krog |
Randall |
Garden |
|
Kasper |
Brewin |
Janssen |
| NAYS -- 16 | ||
|
Cowie |
Reid |
Gingell |
|
Dalton |
Farrell-Collins |
Wilson |
|
Stephens |
Serwa |
Hanson |
|
De Jong |
Fox |
Symons |
|
Tanner |
Anderson |
Jarvis |
| K. Jones | ||
On section 8.
A. Cowie: I have a few clarifications that I would like the minister to address. I think section 8 is an important section, since it deals with the powers and procedures. Subsection (1) states: "A board or council has the powers of a natural person of full capacity for the purposes of carrying out its powers...."
The Chair: The hon. member for Prince George-Omineca on a point of order.
L. Fox: There's so much noise in the assembly right now that I can hardly hear the member, and he's shouting.
The Chair: Thank you, hon. member. That's extremely relevant, and I agree. If we could hold the noise down, we would be able to hear the debate.
A. Cowie: I'd like to thank the member. That shows why we need proper procedures, which this section 8 deals with.
Subsection (1) states: "A board or council has the powers of a natural person of full capacity for the purposes of carrying out its powers, duties and functions under this Act." I feel that the wording might be a little awkward, and I'd like the minister to address it. Perhaps the wording is a little dated or legalistic. But the word "natural" seems rather weird. A "natural person" implies that there are unnatural persons. After that, it says a person "of full capacity," which implies that there are people of partial capacities and maybe of
[ Page 9110 ]
no capacities. So I'd like to know if the minister could address that wording.
Hon. E. Cull: I think the member is being somewhat frivolous, as this is very standard legal language that applies in many pieces of legislation to give bodies legal authority to carry out their responsibilities and act in the manner of a corporation.
A. Cowie: The minister is getting little tired, I think, and I can understand that. Maybe she could speak a little louder. What we've seen during this whole legislative period is a modernization of the wording. All I'm trying to point out is that this wording is not very modern, and the minister might at some point consider cleaning up the wording.
I will move on. Under subsection (2) it says that the community health council may determine its own procedure. I can envisage these 80 or 90 councils all determining their own procedure. I have been a party to a number of councils and boards over the years, and I can tell you that if you allowed 80 or 90 of them to all set up their own procedures, there would be absolute chaos in this province. I know that even with the Vancouver Parks Board, which is a very conservative organization, we have to bring a parliamentarian in every two years to straighten us out and figure out the procedures we should follow.
Will the minister be giving any guidance or any guidelines to these councils in order to help them set up contemporary procedures, rather than just let them go off helter-skelter?
Hon. E. Cull: Yes, there will be regulations to establish these.
D. Symons: I ask leave to make an introduction.
Leave granted.
D. Symons: I would like the House to please recognize the presence of two charming ladies in the gallery: Sally Pauer and Antoinette DeWit. Would the House please make them welcome.
A. Cowie: I am pleased that the minister is going to be giving some guidelines, and undoubtedly sending people around the province to help these councils get set up. I think it's the only way to get that going. I have no personal objection to setting up councils; I think that idea is a good one. I would just like to see it work, and my experience is that it won't unless it's given some guidance.
Under subsection 2(b), it says that it will provide for the control and conduct of meetings. Does that mean that these councils will be using Robert's Rules, or will they be setting up their own rules? Will they be going through a period of goals and objectives and then setting up where they want to go in the future? Is the minister going to help them go through that whole procedure? I recently attended an Islands Trust meeting where they were going through their goals and objectives. It took quite awhile, so I could envisage these groups taking quite a bit of time, unless a set of rules or guidelines is established which they can reject or amend. Could the minister make some comments regarding that?
Hon. E. Cull: The answer is the same as it was to the last question. Subsections (a) through (e) are subject to the regulations, and there will be regulations established to provide the kind of consistency the member is suggesting is necessary.
[9:30]
A. Cowie: I think it's important. Regulations are one thing, and earlier.... I have followed this debate all afternoon, and I felt that the minister was handling herself very well. It's necessary to clarify these things, and that's why I'm bringing them up.
In the next subsection it talks about the election of officers, including a chair -- and that's using the contemporary language of chair rather than chairman or chairperson -- and the acting chair in the absence of the chair. These are all regulations that have to be set up, but there again I take it that the procedures and guidelines.... The important thing is that the minister has been saying all along that she is going to give a great deal of authority to the local group. That's why I don't like the word "regulations." I would prefer to hear the word "guidelines" for helping these groups set up their procedures so that they themselves take part in it. I think that is important, so I would like the minister to clarify that, please.
Hon. E. Cull: It says "regulations" because cabinet passes regulations, not guidelines. So these are regulations pursuant to the act. It's the legal meaning of that term, and as with all the sections, regulations will be established. While there is a lot of intent in this act to give much scope to communities, there is also need for consistency, and that's why all afternoon and all evening I have been talking about a balance.
A. Cowie: Yes, I'll confirm that.
Referring to subsection (2)(d), I have to bring this up again for clarification, regarding the functions and duties of committees. What kind of committees would the minister envisage for one of these councils? How much work do they really have to do? Would you have to have a facilities committee, a finance committee and a personnel committee? How much work and how many committees would the minister envisage?
Hon. E. Cull: It will be up to the council or board to determine the committees they need, but they will have the ability to do it. The examples that the member just gave would be likely examples for any body such as this.
A. Cowie: Subsection (2)(e), which is the final one in that section, says: "...delegate administrative or management duties...." On the municipal scene, I know that while councils can delegate, they have to make the final approvals. They can't delegate the final decisions on a lot of matters. So I would assume that
[ Page 9111 ]
there are certain things that administrators can't do. I wonder if administrators can hire and fire. To what extent will the administrators be able to operate autonomously? Will they have to report back on every item?
Hon. E. Cull: No, they won't. This isn't the Municipal Act; it's the Health Authorities Act. Regulations, again, would be applicable. This section is needed so that the responsibilities which are actually given to the council in the act don't actually have to be carried out by only the council members. Otherwise we would have to have the council members doing everything, in terms of running the hospitals, doing their own planning through to delivering the services and all the rest of that.
A. Cowie: This is an important item, because all over the province you see different commissions and boards having meeting dates at different times. I know it's quite common now for municipal councils to have one council meeting and then have a committee meeting, and then they go back and have another council meeting. They might only have two meetings a month. Will this council meet six times a year, or 12 times a year? What would the minister envisage? And if that were the case and they weren't meeting very often, I would take it that the administrative work would be making most of the decisions, and these councils would essentially be meeting infrequently, confirming the decision of the administrator. Or am I being a little cynical on that?
Hon. E. Cull: I would imagine that with the heavy responsibilities that these councils and boards will have, they will be meeting on a regular basis, certainly no less often than hospital boards meet. The schedule of meetings will be determined by the board itself or by the council.
A. Cowie: I can see that I have only another two or three questions to ask, for clarification.
Subsection (3) deals with public meetings. There's a great deal of controversy over public meetings -- what is public and what's not. It is generally recognized that anything to deal with property purchase or personnel matters -- firings, and that sort of thing -- is in camera. Everything else would be in public, to cover the public interest. Would the minister confirm that? Or does the minister have another idea of what the meaning of "public" is?
Hon. E. Cull: No, I would think that the matters that would appropriately be in camera would be personnel matters, contractual matters or matters to do with the acquisition of property.
A. Cowie: This will be my final question, and then I have a short amendment. I can't understand the meaning of subsection (4). It says here that the councils will have the ability to acquire and dispose of "real and personal property owned or administered by the board or council, and this may only be done on the authority of a bylaw. I can't see where an advisory board -- and essentially, that's what these boards are, although they do have certain duties.... I can't see why the minister would want to go around the province buying and selling property for these particular boards. Why wouldn't they just rent property, or why wouldn't BCBC supply them with property? I can't understand why they'd want to buy and sell property.
I think I've heard 20 times today that this is a transitional process and that we're going to learn from it. Of course, our critic has commented a number of times that if you are going to do that, it would be better try it on two or three boards and work it out, and then apply it over the whole province.
I do have an amendment which I'd like to put forward, notice of which has been given to the Table. It very simply deletes section 8(4). That is my motion.
On the amendment.
Hon. E. Cull: I'm glad that the hon. member was listening to the debate with such attention all afternoon. Unfortunately, he somehow has missed the major responsibilities of this board, which are far from advisory. These boards will be running the hospitals in this province. If so, they are going to have to own the hospitals and own the property that the hospitals are situated on.
Right now hospitals can only acquire property or dispose of property as a result of a bylaw of their board. This provision will extend to the health councils so that they can carry on with that appropriate accountability. The amendment would be entirely out of order, I believe, with the intent of the bill, because it would then reduce the bodies to being advisory, which of course they're not.
A. Cowie: Could I speak to the amendment?
The Chair: The member could speak to the amendment while the Table reads it.
A. Cowie: I'm speaking to the amendment. This is in fact a transitional process that we're going through. I take it we don't know at this stage whether we're going to own property or not; we don't know whether we're going to buy hospitals. This implies that if we have this power, we will perhaps have even more closures. That may be the case; they may have to sell it. I would have thought, from all the wording that I have heard this government deal with in the different bills, that they would want to centralize this activity a little more so they could get a better grip of the properties and how they would be run and the cost. I would have thought that BCBC could do that, rather than having individual councils owning property. It seems to be ridiculous, as far as I can see.
The Chair: The amendment is in order.
Hon. E. Cull: The member is incorrect; the boards will have to own and manage hospitals. It is transitional only in that the legislation is transitional; the councils
[ Page 9112 ]
are not transitional. There will be permanent legislation brought in. In the meantime, we are going to have to run the hospitals, and the councils will have the authority to do so.
L. Fox: I am rising in support of the intent of the amendment. The minister herself said that this is transitional legislation. One would obviously assume that when the actual legislation is put forward, those powers would certainly be granted to the community councils. In the interim, given that this is very short-term legislation, in order to assure the people of B.C. that there isn't going to be wholesale change in terms of selling off assets or closing hospitals or other health facilities, I can't see why the minister would so adamantly oppose the amendment put forward.
Earlier today the minister suggested we could see the actual legislation, which would structure the long-term arrangements for the community councils, come forward as early as the next spring session. Unless she can envision a need between now and then for these councils to acquire land -- which I doubt, because the minister assured us that this is strictly operational -- community councils will not have the opportunity in the interim to enter into the construction phase. Obviously we are dealing with only the disposable part of this clause. She could assure a lot of people and allay a lot of concerns by accepting the motion, knowing full well that when the new legislation comes forward next spring, she has the opportunity to put those powers in place for the councils that will be the permanent structure.
Hon. E. Cull: When the first health council is formed later this year and a hospital society is eliminated as it is amalgamated into the health council, somebody has to own that property. It doesn't just go off into nowhere. If the hospital society, which owns the property now, no longer owns it, who is going to own it? The logical owner of the property will be the health council. In the time period between now and the permanent legislation, there is definitely the possibility, because no hospital board could be amalgamated if they did not have this responsibility.
Because there is a very active building program going on, there are plans right now for the acquisition of property to expand facilities. Those councils will be assuming the responsibilities of the hospital societies, and they will need to be able to finish the negotiations or the transactions to acquire that property. So without this section, hospital boards couldn't become a part of our health councils, and we would indeed have the duplication of bureaucracy that the opposition is afraid of.
V. Anderson: I think that's why this motion was put forward. One of the concerns in the Vancouver area was the closure of Shaughnessy Hospital. As we understand it, this would give authority to the council -- once formed in our community -- to sell that facility. We feel that until something is more permanent, that shouldn't go forward.
G. Wilson: I have only one question with respect to section 8, and there is a reasonably long preamble to it.
The Chair: Hon. member, we are on the amendment to section 8.
[9:45]
G. Wilson: I'll wait until after the amendment is dealt with.
Amendment negatived on the following division:
| YEAS -- 13 | ||
|
Dalton |
Farrell-Collins |
Wilson |
|
Stephens |
Hanson |
Serwa |
|
De Jong |
Fox |
Symons |
|
Tanner |
Anderson |
Jarvis |
| K. Jones | ||
| NAYS -- 28 | ||
|
Perry |
Barlee |
Beattie |
|
Schreck |
Lortie |
Lali |
|
Giesbrecht |
Smallwood |
Gabelmann |
|
Clark |
Cull |
Zirnhelt |
|
Barnes |
MacPhail |
Copping |
|
Lovick |
Pullinger |
Farnworth |
|
Evans |
Dosanjh |
O'Neill |
|
Doyle |
Krog |
Randall |
|
Garden |
Kasper |
Brewin |
| Janssen | ||
The Chair: The hon. member for Prince George-Omineca on section 8. Hon. member, the Chair will recognize you after those who wish to leave clear out.
L. Fox: Now that we're dealing again with subsection (4) in its original form, I have some questions about the fact that the council may dispose of or acquire property only "on authority of a bylaw of the board or council." When I think of this, I think of the municipal structure where a bylaw is in fact read twice within a council or a regional district and then goes through a public process between the second and third stage. Finally, after the third stage, it's sent to the minister responsible and signed off and then brought back for final adoption. Is the process envisioned by the minister in this legislation very similar to a municipal bylaw process?
Hon. E. Cull: It will be the same process that is used right now by hospitals. They pass bylaws, and I have to sign them before they can acquire or change property or enter into agreements. It would be the same kind of thing.
L. Fox: That's troublesome because presently I don't see those bylaws publicized outside the respective boardrooms. I hope that we will see a process here that
[ Page 9113 ]
allows for some public scrutiny of the decisions by this health council. In order to do that, we must advertise what the bylaw is doing so that the public can become aware. Does the minister not see it of value for the public to understand whether or not that health council is acquiring new property or closing a facility or deciding to dispose of some property within that respective jurisdiction?
Hon. E. Cull: The member is making some reasonable points with respect to public accountability on the decisions of the boards, and I think that would be one of the things that as we move through the process of looking at how the councils will operate, how the societies operate right now.... Certainly there's room for improvement. Hospital boards acquire and sell property, and you probably aren't even aware of it when that happens in your community, except for the announcements about the new facilities -- certainly not about the bylaws that are passed. We could take a look at that.
L. Fox: Just to follow up on that a bit, a lot of that is presently done through the regional hospital districts. There is a public process that in fact involves advertising the bylaw. But this new structure will eventually do away with that, and I hope that the minister would see a structure very similar to a municipal or regional district bylaw process that allows for a public hearing or time frame between the second and third reading. It's very important that the people within the jurisdiction know what their health council is entering into, specifically the disposal of real property. I would assume that within that bylaw when a property is disposed of, they would have to declare where those moneys are going and how they will to be utilized. That would be a very important part of that process.
V. Anderson: I'd just like clarification. For instance, if Shaughnessy Hospital -- about which there has been concern -- is closed by the council, is the minister saying that this council has authority to sell that land?
Hon. E. Cull: If the council owns the property, yes they would. But you've also pointed out something that is important: the decision to close a facility doesn't flow from the decision to sell or dispose of the land. It can be closed without the land being sold.
D. Symons: I am a little concerned about your answer to the member for Prince George-Omineca. He asked about the decisions being made public, and so forth, and you made a comment to the effect that you will be looking at how the council will operate. I am concerned that we seem to be bringing in a bill that's setting up councils and boards, and your words implied that you don't yet know how it's going to operate and it will be worked out in the future. I have real difficulty if that's the case. You're setting up a whole system, and it hasn't been thought through as to how it's going to operate, and the procedures aren't in place. It seems backwards -- the cart before the horse -- if you're going to end up bringing in the bill before all those things are in place and known, and they will be worked out at some future date.
Hon. E. Cull: If the member looks at the Hospital Act or any other act -- even the Municipal Act -- he will see that they don't spell out in this level of detail all the little individual procedures that have to be followed in all cases. Many things are left to regulation or to the councils or boards to establish on their own. Those safeguards in the Municipal Act with respect to third reading have to do with the impact on private property or on taxation, and those safeguards are rightly there. We would certainly have a look at those safeguards as we develop the procedures that would be put in place for these boards. If you look at the Hospital Act, you'll find that that level of detail isn't there either.
L. Fox: There is specific legislation designed to outline the bylaw process in municipal legislation, and it is in the legislation, as I recall, not in regulations. That's obviously a concern of mine.
Also, on another subject in subsection (3), it states that meetings of the board or council are open to the public. I would like to see in statute a structure where they set up specifically when public meetings should take place, because we're going to have broader powers and we're going to encompass a larger region in terms of these councils. We should have a process which demands.... I have no idea at this point in time whether it will be one public meeting every two weeks, as we see in municipal council, or one public meeting every month, as we see in a regional district. There's obviously a need to have a regular schedule for public meetings, and the public should be aware of when those meetings are taking place so that they can, without notification, attend those meetings if they so wish. If it's on an ad hoc basis, we will find that it will be very difficult for the public to get involved by attending these meetings if they so desired. I hope the minister would look at a process which would put into the regulations -- if she wishes -- that these public meetings be held on a regular basis, and that the public, through an advertisement process or whatever, be informed that those meetings are taking place and when.
[10:00]
Hon. E. Cull: I agree that the public should be informed when they're taking place. I expect that they will have regularly scheduled meetings and that those meetings will be publicized in local newspapers so that people can attend.
L. Fox: It's obvious that the minister is getting tired. It has been a long day. Seeing the hour, I move that the committee rise, report progress and ask leave to sit again.
[ Page 9114 ]
Motion negatived on the following division:
| YEAS -- 16 | ||
|
Cowie |
Reid |
Gingell |
|
Dalton |
Farrell-Collins |
Wilson |
|
Stephens |
Hanson |
Serwa |
|
De Jong |
Fox |
Symons |
|
Tanner |
Anderson |
Jarvis |
| K. Jones | ||
| NAYS -- 26 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Giesbrecht |
|
Smallwood |
Gabelmann |
Clark |
|
Cull |
Barnes |
MacPhail |
|
Copping |
Lovick |
Pullinger |
|
Farnworth |
Evans |
Dosanjh |
|
O'Neill |
Doyle |
Krog |
|
Randall |
Garden |
Kasper |
|
Brewin |
|
Janssen |
On section 8.
[E. Barnes in the chair.]
G. Wilson: I have but one question on section 8, and it's an important one. It deals with section 8(3) and the extent to which these new councils may exclude the public from meetings. I'm a strong believer that council meetings should be open to the public for all occasions, save and except for matters that deal strictly with personnel or property purchase. This doesn't stipulate that. It says that it can be done to protect the public interest in "the desirability of avoiding disclosure of information...." That may very well be a boilerplate kind of line, but I've looked through a number of other acts and don't find it to be so. I'll be satisfied if the minister could, just for the record, state that it is the intention that these board meetings will be open to the public, save and except for matters of personnel and property purchase. But I would have some very serious concerns if they have a discretion to exclude the public from these meetings, given that it's going to be more difficult under the previous sections for the regional boards to be accessed by the public because of the nature of their centralization.
Hon. E. Cull: I did give that commitment earlier in this debate, but I can't remember which member asked the question then. I agree that personnel matters, property acquisition and some financial matters like tenders and things like that might require the meetings to be held in camera. My understanding is that this provision parallels one that is in the Municipal Act right now, but the Municipal Act is going to have some changes made to actually reflect what I have just said is the intent for this act. When that happens, we'll bring this one into alignment with that, because we want to keep that consistency. But certainly there are very limited matters that would cause a meeting to be legitimately held in camera.
F. Gingell: As hospitals are merged legally with the councils, the assets will naturally flow into the councils. Originally, all the hospitals were funded through debt. At the moment the provincial government has gone out and borrowed funds, loaned this money to the British Columbia Regional Hospital Districts Financing Authority which, in turn, has loaned it to regional hospital districts, and regional hospital districts previously loaned it to hospital societies. In the last year there has been a major change in the way the accounting is done, that I quite honestly don't understand. I looked at it and decided that it was a subject I would deal with at some later date when I has time.
When you put these together, the debt will, of course, flow with the assets. So these regional councils are going to assume the debt that presently sits somewhere. I'm not sure if it is the debt that sits at the hospital society, or whether they will take over the regional hospital district's debt. I wonder if there are provisions in Bill 45, the Health Authorities Act, to authorize them to borrow money and assume debt.
Hon. E. Cull: The member is joining us after we have spent considerable time talking about the fact that this legislation does not deal with capital matters. It does not deal with the financing of capital facilities, because that matter is before a task force with the Union of B.C. Municipalities to resolve. They're looking at essentially three options: one of them is to leave the financing with the regional districts; the other is to move it to the regional health boards; and the third is to change the financing altogether. There are probably other variations. I've been assured by my staff that we're going to have recommendations on that available for the Union of B.C. Municipalities convention in September, but there is no change to the existing capital financing procedures, regulations and authority in this act.
F. Gingell: Are you saying that there won't be any merges or any bringing together of a hospital society with a regional council?
Hon. E. Cull: Yes, there will be, but the decision about what happens to their existing debt, as well as the decision about what happens with respect to new debt, is being passed on to a small committee that involves Union of B.C. Municipalities and Ministry of Finance officials, along with Ministry of Health officials. They are going to resolve how that actually takes place. There are a number of possibilities, including no change to the existing system. Although I'm not sure that that would be the most desirable route to go in the long run, we're not precluding the decision on that; the UBCM is helping us to arrive at a decision.
[10:15]
F. Gingell: I really suggest that the minister might do well to get some legal advice. The moment you merge these two organizations, the council has taken on the debt. It cannot vanish off into the ether, as it were, to sit and later on be dragged back to whichever board you
[ Page 9115 ]
decide to place it with. You have to deal with that. You have to know exactly what is going to happen. Surely that has been considered in the development of Bill 45. You can't just leave it.
Hon. E. Cull: The debt is with the regional hospital district, and what will be merged is the hospital society -- which is not the regional hospital district at all -- with the health council. If the matter of the ongoing debt has not been resolved before the first merger takes place, the regional hospital district continues with the functions and responsibilities for capital financing that it has right now. So there isn't any problem, because the society that runs the hospital is not the society that has the debt.
F. Gingell: I was saying that there have been some changes in the way the hospital societies -- which own the property, I think -- have recorded this liability that they will pay from future government grants and allocations. They used to be shown as just a debt. The hospital society that owned the real estate and bought the land owed the money to the regional hospital district -- and the regional hospital district owed it to the regional hospital district financing authority. That was relatively straightforward. But in last year's financial statements, they have all changed their debt to an advance of future contributions for capital. Was it with this and these mergers in mind that that change took place? Or am I completely off base?
Hon. E. Cull: No, that was not with this legislation in mind. That decision was independent of this.
L. Fox: I am back on section 8(4): "The acquisition or disposal of real or personal property...." I assume real property is land and fixtures and personal property would be equipment. I am right?
Hon. E. Cull: Yes, real property is real estate and personal property is everything from filing cabinets to desks, I assume, through to cars and other things that might be owned by a corporation that would be providing health care services.
L. Fox: Given that this new council can only dispose of personal property by the authority of the bylaw -- and obviously they wouldn't pass a bylaw to dispose of a filing cabinet -- does the minister have in mind a ceiling or limit, something under or over a certain value, that would have to go through the bylaw process?
Hon. E. Cull: I'm certain that those are the kinds of practical considerations that would be dealt with in regulations.
L. Fox: One further question on the disposal of that equipment or personal property of this council is: would the process be that it would be listed and available on a bid process, where it would be put out to tender or to an auction that would invite the public to bid on it? Is that the intent?
Hon. E. Cull: That's far too detailed for me to be able to answer, and it's not part of the legislation procedures here. I couldn't talk about the actual procedures of the tender.
C. Serwa: I was listening to the minister and the Leader of the Opposition. My question is with respect to a statement the minister made regarding regional hospital districts retaining debt and the responsibility to pay for debt. In our early discussions, it appeared that there would be no correlation with regional hospital districts in the new community health council areas. It seems that if that were to happen, then we would continue to place a heavier obligation on someone who was already in that regional hospital district, and the others in that community health council area who could utilize the facilities would not be contributing to the capital at all. It seems hard to imagine that the regional hospital district or the taxpayers would want to continue to assume that liability, on the basis that the new community health council boundaries are substantially different than the regional hospital district.
Hon. E. Cull: As I've said on a number of occasions this evening, the current situation with capital financing remains unchanged, until a task force involving the Finance and Health ministries and the Union of B.C. Municipalities reaches a conclusion as to whether the capital financing should stay with the regional districts, go to the regional health boards or change in some other manner.
L. Fox: It's probably because I'm not a lawyer -- and I know the member for Vancouver-Quilchena asked the question before, somewhat tongue-in-cheek -- but I'd really like to get an explanation of clause one: "A board or council has the powers of a natural person...." I have some difficulty trying to get clear in my mind the rationale behind that statement. I assume normal boards or councils are formed with bylaws or letters patent, but in this particular case: "A board or council has the powers of a natural person of full capacity for the purposes of carrying out its powers...." I wonder what the need for that clause is.
Hon. E. Cull: It is a standard legal expression that gives authority to bodies to be able to act in the manner we want these councils or boards to act. Without this perhaps somewhat inaccessible wording used by lawyers to do this, we wouldn't be able to have these councils or boards act as corporations.
C. Serwa: The wording is very similar to that used in corporations to indicate the powers of the corporation. The two act as an individual. Would the community health council then be incorporated?
Hon. E. Cull: Yes.
L. Fox: That being the case, would there be a letters patent or a set of bylaws which would lay out the powers and the authority of the incorporated body?
[ Page 9116 ]
Hon. E. Cull: I'm not sure about that. We are getting into some fine legal details here, and I would not be able to answer that. It would be something I would have to put back to legislative counsel.
L. Fox: The logical question is that if it were the finding of legislative counsel that letters patent or bylaws would be a useful tool in administering these councils, without that being referenced in this section, wouldn't it then make it necessary to amend this act in order to accommodate that structure?
Hon. E. Cull: This is a statutory incorporation, and the powers are set out in the statute. By reference to the Company Act, we can bring in the provisions that you have just talked about with respect to letters patent.
Section 8 approved on the following division:
[10:30]
| YEAS -- 27 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Giesbrecht |
|
Evans |
Farnworth |
Pullinger |
|
Lovick |
Copping |
MacPhail |
|
Zirnhelt |
Cull |
Clark |
|
Gabelmann |
Smallwood |
Dosanjh |
|
O'Neill |
Doyle |
Streifel |
|
Krog |
Randall |
Garden |
|
Kasper |
Brewin |
Janssen |
| NAYS -- 16 | ||
|
Cowie |
Reid |
Gingell |
|
Warnke |
Dalton |
Farrell-Collins |
|
Wilson |
Stephens |
Hanson |
|
Serwa |
De Jong |
Fox |
|
Symons |
Tanner |
Anderson |
| K. Jones | ||
On section 9.
D. Symons: I note that section 9(1) says: "If an order made or a standard set under this Act by a board or council conflicts with a regulation of the minister under section 3, the regulation of the minister prevails." If we look back at section 3, we find that the minister may, by regulation, establish provincial standards for the provision of health services. By these regulations referred to in section 9 that we're now looking at, the minister may specify a health service or a level or extent of health service that must be provided in a region or community. It goes on to mention all these things that the minister may set by regulation. My question to the minister is: what purpose do these councils serve if they are simply going to be flunkies for the minister, who is going to set all these sorts of regulations for them to carry out? It would seem to me that any self-righteous person would not want to serve on a council that's simply going to put them in a subservient position to the Minister of Health. I wonder if the minister might respond to that, because I think the calibre of the people we're going to get.... They have to be able to make some decisions, rather than be put into the position this seems to put them into.
Hon. E. Cull: We have canvassed this particular issue ad nauseam this evening. I think anybody who was paying attention to the debate will understand that section 3 has to prevail. The services that are specified by the minister are the guarantees to the public that individual councils or boards cannot take away their fundamental right to health care services in accordance with this act.
D. Symons: I guess that begs the question of what the boards are going to do that isn't already laid down for them by the minister? Certainly section 3 seems to imply very stringent provisions for the council. I wonder if there is any conflict. There doesn't seem to be much opportunity for that, because they are hemmed in by section 9(1).
Hon. E. Cull: If the member would care to check Hansard, he will see that there was an extensive debate on what the services and standards are in section 3 and what scope is left to the councils and boards.
L. Fox: I was here during those sections, I was in on that debate, and I recognize that there is a need for the minister to set standards throughout the province for the delivery of health care. But I believe that section 3 dealt with that quite well. I wonder why we need section 9, which appears to give the minister the autonomy to once again come down on a board or the council with her agenda. By regulation, not legislation, the privy council or the cabinet can change regulations to, for instance, bring forth another situation that, like the closing of Shaughnessy, the local health council or the regional board would not be in favour of. This particular clause appears to give the minister the opportunity, once again.... We have seen that this minister is not afraid to use her authority, and I give her that kind of credit. But we have seen examples before of how the heavy hand of government can go against the locally elected board -- albeit elected by a society -- and close a hospital facility. This particular section gives the minister the opportunity to change the regulations, and to come down on a board or a council however she may wish.
Hon. E. Cull: This section is cross-referenced to section 3, which only allows the minister to set provincial standards that have to be consistent across the province. A standard could not be set to close a hospital facility. We discussed very extensively what the level of those standards and services would be. It was made very clear in the debate under section 3 that the regulations of the minister must prevail. This section makes it clear, if there is any conflict, that they do prevail.
G. Wilson: When I read section 9(1), I suspected that the reason it was there was in order to have the Canada Health Act prevail, which is of course administered by the minister in this province. I thought
[ Page 9117 ]
that was the reason you would want to have ultimate jurisdiction lie with the minister under section 1. But that's not where my concern lies.
My concern actually lies with section 9.2. We've spent a fair bit of time this evening and earlier on this afternoon canvassing how the councils would interact with the boards and to what extent the local community councils would have some autonomy from a more centralized and regional authority. The member for Prince George-Omineca asked about whether or not there would be weighted votes. In the regional district system you have weighted votes on the basis of demographics. I think I heard the minister say that she did not favour weighted votes, but favoured a one-vote-per-representative system. What subsection (2) is saying is that if a community council wishes to set a health care standard that conflicts with its regional board, then the regional board prevails.
My question is: can it in fact be driven from the regional boards down? In other words, could there be an established community council provision put forward and accepted with an established budget, and then, through a change in one or two members or in the structure of the board, could the board essentially override provisions already in place? If that were to occur, the kind of conflict between communities that we've been talking about all evening is going to be exacerbated by this section of the act.
Hon. E. Cull: If you think about the operation of these councils and boards, it will become clearer. Standards and budgets are set for a fiscal year. A change of one or two council members during the course of a year couldn't automatically have things flipping around from month to month, if that's what you're concerned about. A good example would be if a region had decided that one hospital should be the location of the CT scanner, recognizing that not all hospitals have them, and that a population of something over 100,000 is usually required to make them truly effective. We could not have a situation where a local council with its own hospital said, "No, we're going to have a CT scanner too and we're going to devote our funds to it," and told the rest of the hospitals in the region that it was just too bad but that was how there were going to spend their money. If we're going to have effective standards set at a regional level -- and the number of CT scanners would certainly be a suitable standard for a regional board -- then there has to be some way of resolving a dispute between a council and a board on that matter. The regional standards have to take precedence over community standards.
G. Wilson: I can appreciate the problem, and I understand that this is the direction that the minister has decided to take by putting the power in the hands of the regional board. I can throw out another example that may very well exist in the near future given this situation. You may have a community council developing diagnostic and treatment facilities which are currently under a community facility. The community may be actively promoting the project and may have some base funding for it. As they expand that facility, it may be resisted by the larger central hospital authority in a neighbouring community. Once this system is in place, a representative from that council will have one vote on the board, unless there are more members. It seems to me that the centralized authority, given that they would have much more clout in terms of their fiscal argument for centralization of a facility, would be able to outweigh that community on virtually every vote. What would concern me is not so much that there are established procedures in place within the fiscal year but that over a series of fiscal years you would start to see a trend towards centralization of services that would provide for some communities at the expense of others, simply because of the way the regional board is set up, which is weighted against the opportunity for those communities to expand and succeed.
Hon. E. Cull: Given my knowledge of the communities, you could also imagine situations where the communities are so concerned about their own local situations that instead of having rational centralization of services which should be centralized, it could be driven the other way. There are fears both ways, and that's inherent in what we were talking about earlier regarding who you have making decisions. There has to be some ability to bring about resolution between different levels of the system, and we have elected to do it in this fashion.
[10:45]
C. Serwa: This is a very interesting section. To start with, I will speak on section 9(1) with respect to the standards set by the minister overriding the standards set by the local health council. I have listened ad nauseam to the minister as she has recited the merits of the community having a greater hand in determining their standards, and specifying the standards of health care in a community and the democratic process and merits of that.
In a previous section we found that one of the purposes of the council was to develop and implement community standards for delivery of health services. Now we find out, in section 9(1), that it's simply a facade. The minister -- not the community -- is going to set standards for the community. The community will have its own priorities. As the minister has expressed, either we have faith and confidence in the community to set its own standards or we don't. The minister has said it must be consistent throughout the province, but in this case it appears that if the community sets higher standards than the provincial standards, that's all right. Is that the case?
Hon. E. Cull: Communities could have higher standards than the provincial standards, because the provincial standards would be a floor. You have to remember that the standards set in subsection (3) are provincial standards, so the concept that there would be no ability or flexibility for communities to set their own standards or priorities -- that it would all be dictated from the minister -- is false. The minister doesn't deal
[ Page 9118 ]
with specific communities; the minister deals with provincewide standards.
C. Serwa: This is getting quite interesting, because we have the potential for a wealthier community -- let's say West Vancouver and their community health council -- to set substantially higher standards than provincial standards. If they are a wealthier community -- perhaps with a broader tax base on capitalization and more influential than another community -- and they set higher standards, why should the provincial government, through the Ministry of Health, pay operating charges for those higher health standards that that community sets? Either we have provincial standards that are consistent throughout the province or we have this floating variability of community and regional standards as well as provincial standards. It's sort of a mix-and-match and a conflict where some communities will have a variability.
As the minister suggests, the base would be the provincial health standards, but we are looking at the development of a have and a have-not -- a two-tier, at least, or multi-tier -- public health system in British Columbia. That appears to be the end result, because this can be taken two ways. It may have been set to look at the minimum that is acceptable, but when you can raise the standard on the basis of the community health council higher than provincial standards, that appears to be okay. That troubles me.
Hon. E. Cull: Let's be clear about the differences here. First of all, there is no taxation authority, so a wealthier community cannot provide more resources to fund a higher standard. If they're going to have a higher standard -- for example, if they decide to provide more speech language pathologists per thousand population -- then that might be a standard that would be set. They have to do that by reallocating dollars within their global budget. They will have to take it from somewhere else. They can't go out and tax more money just because they're a wealthier community.
When we talked about the global funding decisions, we indicated that one of the things we would be trying to build into the global funding formula was a recognition that some communities have a lower health status than others. I can tell you that they're not the West Vancouvers of the province; they tend to be the poorest areas of the province. There's a very direct correlation with the wealth of a region and its health. The wealthier they are, the healthier they usually are. If we are directing dollars to those communities which have the lowest health status, the reverse would be true, rather than what you have suggested. It is very important, whether we're talking about a standard or a service, that we allow communities to provide a higher level than would be mandated through provincial regulation. The provincial regulations will simply say that there should be alcohol and drug services of a certain nature. Communities that have very serious substance-abuse problems need to have a much higher level of that resource and probably need to be devoting more of their dollars to addressing that problem than to other problems. That's what the community health councils have the ability to do.
C. Serwa: Listening to the minister, she indicated that there could be a reallocation of minimal standards. The minister talked about a speech pathologist as one person per thousand of population, whatever the figure is, and that if they determine that they want 1.5 or 2, then they would have to reallocate health dollars. You're going to do one of two things, and that's all the community health council can do: either reduce the quantity of services -- the utilization rate -- or reduce the quality of service. They have no other option available to them. If you push in a balloon, you displace air and it bulges somewhere else. If you're going to take from one standard of service, you either lower the standard or you ration the service. There are only two things.
The demand on health care dollars exists and will continue to exist in spite of the bigger steps necessary with preventive health measures. The minister talked briefly about that, so I'll respond. In a wealthier or a poorer area, a lot has to do with the attitude, the knowledge and the daily living habits of individuals and their state of health. It's not simply a matter of economics alone, because there are some very poor people in many areas of the province who are very healthy, whereas there are other people with a higher income level who are unhealthy. There are a number of things the individual can do. That's not the question, and not the issue under debate at the moment. It's the reallocation.
When we're already pushed to the maximum, it's easy to say but it's very hard to do. What services do you ration? Do you go below the provincial health standards to have higher standards in some other areas simply because of the type of community that this health council is looking at?
Hon. E. Cull: The provincial standards will be very general. Councils will be able to meet all the provincial health standards without expending all of their global budget. How they go about spending the full global budget will depend on local priorities, but they will be required to provide some levels of service in their community in a number of general areas.
So it's not a question simply of rationing or reallocating; it's a decision about how you initially allocate those dollars. After you have funded the basics in your community, you then have to decide what you're going to provide more or less of. Rather than having every community in the province provide exactly the same level and standard of service, and deliver those services in exactly the same way whether that's a priority of their community or not, we are going to move to a system that allows communities to have greater control over that. Right now they have no control. They are not going to have full control; they're going to control and balance with provincial standards.
C. Serwa: I have one more example of what can occur, and what is occurring at Kelowna General Hospital. It's my understanding that we are looking at a
[ Page 9119 ]
14 percent increase in costs because of the protocol agreement with the health employees' union. They have no ability to get money from anywhere other than the operating fund of the Ministry of Health. So they're faced with what I've said earlier in this particular situation: either reducing the quantity or the quality of services. There are no real options.
You talk about a global budget and random standards. But again, if we look at section 9(1), it is very specific with an order made or a standard set under this act. I cannot believe, if you're looking for consistent treatment throughout the province, that the Ministry of Health would do anything other than set standards that have to be complied with -- not general standards, but specific ones to ensure fair and consistent equality of treatment for all people in British Columbia, whether they live on the northern borders or in remote communities or whether they live at the southern tip of Vancouver Island or in the Greater Vancouver Regional District. I think that's what we strive to do in education, and I'm confident that that's what the minister will strive to do in health.
I have listened to the words, but I can't quite fit it into the picture, because a reality prevails. With the pressure and the demand on the system, it's not as if you're going to be able to provide a global budget which will fund excesses. From her experience in the Ministry of Health, the minister knows full well that there are no such things as excesses of funds in the system. There's an insatiable appetite devouring all available funds.
[11:00]
Section 9 approved on the following division:
| YEAS -- 27 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Giesbrecht |
|
Smallwood |
Gabelmann |
Clark |
|
Cull |
Zirnhelt |
MacPhail |
|
Copping |
Lovick |
Pullinger |
|
Farnworth |
Evans |
Dosanjh |
|
O'Neill |
Doyle |
Streifel |
|
Krog |
Randall |
Garden |
|
Kasper |
Brewin |
Janssen |
| NAYS -- 15 | ||
|
Serwa |
Stephens |
Wilson |
|
Farrell-Collins |
Dalton |
Gingell |
|
Reid |
Cowie |
K. Jones |
|
Anderson |
Warnke |
Tanner |
|
Symons |
Fox |
De Jong |
On section 10.
L. Fox: Section 10(3) says: "The Minister of Finance and Corporate Relations may direct the Comptroller General to examine and report to the Treasury Board on any or all of the financial and accounting operations of a board or council." I wonder why the minister chose not to include the auditor general. It seems that this process shifts it away from the auditor general's control, and therefore from the auditor general's scrutiny.
Hon. G. Clark: The auditor general's function is consistent. His jurisdiction is over all boards and commissions that are 100 percent funded by the taxpayer. In fact, the auditor general has never audited a hospital to date, even thought it's 100 percent funded. But he has argued, I think correctly, that he can follow the money out the door, if you will, and to a hospital, but he has never chosen to exercise that option. That option exists here as well. However, in the normal course of events the comptroller general and Treasury Board scrutinize all funded agencies, and the auditor general looks at those audits. This is consistent with the entire administration of government. This is the government, through the executive council. The comptroller general and Treasury Board work for the government, not for the Legislature. This is a government bill that enables scrutiny of these boards by the agents of the government and of the executive council, in this case the comptroller general and Treasury Board. The auditor general's function is not changed; he continues to have the power, if he chooses to exercise it, to follow the money into the funded agencies and do audits, value-for-money audits or whatever he chooses. He has not yet done that in the health sector. I understand that he has been considering it for some time.
F. Gingell: I read section 10 with interest. It seems to cover a lot of subjects. It requires them to maintain an accounting system that's satisfactory and to keep books, records and documents, and it allows them to be open for inspection. It has a whole series of things, all of which I agree with. I am pleased to see that you made the decision to make the boards and councils subject to the Financial Information Act.
The only section I have a problem with is subsection (5)(b). I have a friendly amendment that I would like to move. I hope it will be seen in that light. It deletes the present wording and replaces it with: "a financial statement showing the assets and liabilities of the board or council at the end of the preceding fiscal year and the income and expenditures of the board or council for that year and a statement of changes in financial position of the board or council for the year then ended." I move the amendment.
On the amendment.
The Chair: Does the member wish to speak to his amendment?
F. Gingell: I am pleased and encouraged by the fact that this government has consistently improved the financial reporting. They've made great strides in the public accounts to produce better and more complete financial statements. I think that what has happened here is that the person who wrote this perhaps isn't as up to date on financial statement presentation as they might have been.
[ Page 9120 ]
The purpose of my amendment changes the word "operations" to "income and expenditures," and frankly, particularly when we're dealing with hospitals, I'm not quite sure what the word "operations" means. In the normal course of events in an annual report, there is a report on the operations by the chief of staff or the president of the hospital board. It basically talks about what they've done -- they've had so many patients and all those kinds of things -- but this clearly was intended to be the income and expenditures, the receipts and disbursements. So I think that the section will be much clearer if we just change the word "operations" to "income and expenditures."
There is one further matter. In this day and age, and in the last 20 or 30 years or so, financial statements are not considered to be complete and fully descriptive without another statement. It used to be called a statement of change in working capital and source and application of funds. In today's jargon, it's clearly understood to be a statement of changes in financial position. If any of the members or the minister wish to look through the public accounts, you will see financial statement after financial statement contain a statement of changes in financial position. In fact, if I were looking at the financial statement of a hospital board, a hospital society, a council or a board, and that statement of changes in financial position wasn't in there, I'd sit down with a pencil and paper and try to work it out, which might be quite difficult. It really is a useful piece of information; it's part of normal business practice and normal government practice. I hope that the minister will see this amendment as a friendly one. It is only intended to take out some uncertainty and ensure that the financial statements are in fact what you want.
Hon. E. Cull: I'm willing to accept this amendment.
Amendment approved unanimously on a division.
[11:15]
On section 10 as amended.
L. Fox: I don't see anything in section 10 that allows for public access to the records or even for them to be published on an annual basis so that the public can get access to them. Is that an omission on behalf of the minister, or is that contained someplace else?
Hon. E. Cull: Section 10(2) requires that all documents be available for inspection at all times by the minister, and freedom of information would make sure that these documents were available to the public in any event.
L. Fox: Going back a few sections ago, we talked about the fact that this was going to be an incorporated body. If we look at other incorporated bodies such as municipalities, school districts, regional districts and so on, they all have to publicize or make available through a public meeting their annual budgets and fiscal positions. The minister is suggesting that freedom of information is available. I don't believe that's good enough. In fact, I think all that is doing is adding costs to the process. There is no reason at all why the annual budget and the fiscal position could not be publicized or made public at an annual meeting, which would prevent the necessity for somebody to go through that process.
[H. Giesbrecht in the chair.]
Hon. E. Cull: The member is making some very good points, and I've noted them. We will certainly incorporate them into the permanent legislation.
L. Fox: I'm satisfied that the minister is prepared to look at the permanent legislation. But the fact of the matter is that this structure is going to be in place for three years, and it's going to be highly suspect to many community groups. I think it would be of great benefit during this interim period to look at some process, other than freedom of information, that would allow for a public report on an annual basis and for the financial position to be moved forward. I think perhaps it may even be able to be handled in the regulation process. A commitment from the minister that we would see some structure over the course of this interim period that would allow for that would certainly make me feel a lot better.
I tried to make my point well. I could keep reiterating. If the minister is tired -- and I appreciate that -- I would move that the committee rise, report progress and ask leave to sit again.
Motion negatived on the following division:
| YEAS -- 13 | ||
|
Reid |
Gingell |
Dalton |
|
Farrell-Collins |
Stephens |
Serwa |
|
De Jong |
Fox |
Symons |
|
Tanner |
Warnke |
Anderson |
| K. Jones | ||
| NAYS -- 25 | ||
|
Perry |
Barlee |
Lortie |
|
Lali |
Evans |
Farnworth |
|
Pullinger |
Lovick |
Copping |
|
MacPhail |
Barnes |
Zirnhelt |
|
Cull |
Clark |
Gabelmann |
|
Smallwood |
Dosanjh |
O'Neill |
|
Doyle |
Krog |
Randall |
|
Garden |
Kasper |
Brewin |
| Janssen | ||
Interjection.
The Chair: The section has passed, and that correction has been noted, hon. member. On a point of order, the member for Alberni.
G. Janssen: I call the Chair's attention to standing order 54.
[11:30]
[ Page 9121 ]
The Chair: Perhaps the member would like to elaborate.
G. Janssen: Standing order 54 clearly states that an adjournment motion can only be negatived once. It cannot be called again in the same session.
The Chair: Thank you, hon. member. The Chair has been informed that that does not relate to this particular motion.
Is the member rising to speak on section 10?
A. Warnke: Look under standing order 32.
On section 10 as amended.
L. Fox: I moved that motion earlier because the minister didn't appear to want to answer the question. I assumed that she was tired because she's been sitting in this assembly for 12 hours now. I wanted to give her that opportunity for a rest.
I get back to the question, then. The minister openly admitted I had made a point that would be worth considering in the drafting of the legislation that would replace this. However, that won't give me any kind of comfort over the course of the next three years. I thought I'd made the argument that this particular piece of legislation is designed to be in place for up to three years. In fact, the minister herself has suggested that the board structure and so on will not be replaced until the election of November 1996.
I think there's a very important concern here. In the interim years of this particular structure, we should have some mode or way that the public can have access to the annual reports and fiscal situation of the respective board or council. All I'm suggesting is that the minister commit here tonight that, either by regulation or some other process available to her, we will see a reporting procedure that would allow an annual general meeting to be called where the public accounts are made available, or that those same accounts and the financial position of that respective body be publicized a respectable time after the audit was completed and finalized. That could be a statutory date, perhaps 90 days after the end of the fiscal year.
All I'm looking for from the minister is that kind of assurance. I think the interest will be more prevalent in the first three years of this new structure than it will be thereafter. A lot of people will want to have a look at where this respective board or council is putting its emphasis financially. It's important that the public have the opportunity to access that kind of information, certainly so that it can get prepared, if nothing else, for the elections that will take place in November 1996.
Hon. E. Cull: In the time that we've had since the member first asked the question, I've had a chance to have a further look at this. I draw his attention to subsection (10), which references the Financial Information Act, and does in fact require that these boards report annually with the material that he is requiring. There is the requirement under the Financial Information Act for annual reporting of this information.
Interjection.
Hon. E. Cull: In subsection (7).
L. Fox: I don't have the Financial Information Act in front of me.
G. Farrell-collins: It's right behind you.
L. Fox: Well, it may very well be. But given the fact that we've had so many amendments before us this evening.... The minister assures me then that the Financial Information Act requires a public body such as this new structure.... It is identified within that act. We have now community health councils that are identified within the act. If that is the case, then I'm satisfied.
Hon. E. Cull: Section 10(7) says that the Financial Information Act applies to it. The provisions in the Financial Information Act require that: "Every corporation shall, within 6 months after the end of its fiscal year, prepare a statement of financial information for that fiscal year in a form and containing information prescribed by the Lieutenant Governor in Council that shall include...." It has a long list here, and goes on to make statements about where, how and during what hours that information shall be available to the public for inspection, and about filing with the Minister of Finance. This would apply to those councils because of the way the act is worded here.
L. Fox: I understand that the public can access the information if they wish to go to the respective office. I didn't hear the minister suggest that either an annual meeting, at which the financial records would be made available, or the financial statement would be advertised or publicized. But if it is going to be presented at an annual general meeting, or publicized so that everybody has easy access to it, then I'm satisfied. But I didn't hear that in that very brief dissertation.
Hon. E. Cull: The access to these financial statements will be exactly the same as they are with hospitals right now. They are presented at annual meetings and are available. They're not published in large quantities. Large numbers of the public don't really want to have a look at them, but they are available for them.
C. Serwa: For my clarification on this specific section -- because it is very important -- is the minister saying that an annual general meeting of the community health council will be called within six months after the conclusion of the fiscal year ending March 31? Is that the impression we're getting? There will be an annual general meeting, where individuals will be able to attend and obtain not only financial information but information on the operations of the
[ Page 9122 ]
preceding year. Will they have that type of forum -- as you have in any annual general meeting -- where you will be able to ask questions to ascertain if the feelings and the aspirations of the community are being met by the health council. Is that the conclusion?
Hon. E. Cull: No, there wouldn't be an annual general meeting. Those apply to societies that have large memberships with executives that run them, and that's not the case here. This is a council, like a school board. It doesn't have an annual general meeting, but it does provide its financial statements and reports at meetings appropriately at the end of its fiscal year, and this would do the same.
C. Serwa: But it is different. The minister has to appreciate that there is a substantial difference between the community health council and the school board. The school board is mandated to carry out a certain operation. It's all set out by the Ministry of Education. It has been longstanding, and they have very restricted parameters. The newly formed community health council is breaking new ground, and they have different parameters. If the confidence of the community is actually to be obtained, it is clear that some form of an annual general meeting is needed. Members of the public at large, such as those who turn out to the societies now -- the societies in my or your community -- gather to hold elections for members, to go over the financial statements of the society and to familiarize themselves with the operations of the society. In that type of forum, it's a question-and-answer type of debate. The community then has the ability to understand comprehensively both the fiscal picture and the operational picture of the community health council. I think that's what my hon. colleague was trying to get at -- that certainly even in its formative years, it's going to be important, if this concept is going to be fully appreciated and attain the confidence of the community, that this opportunity should be made available.
Hon. E. Cull: That's an excellent suggestion that the community health for councils to hold public meetings like this, and when we're giving guidance to them on how they should conduct their affairs, we will pass that on to them.
C. Serwa: I move the following amendment. It will be section 10(9): "Within three months after the end of the current fiscal year an annual meeting must be called by the Community Health Council for the express purpose of informing the community of both the financial and operational issues of the preceding year."
The purpose of the amendment is to strive to satisfy the public about the actual operation -- both the fiscal and the comprehensive operation and services that the community health council is responsible for. It seems clear to me that this new initiative must give that opportunity. It's certainly compatible with the concept of the freedom-of-information position the current government has taken and the pride the Attorney General has taken in that particular act.
It seems to me that the public should have the opportunity to attend an annual general meeting structured for the express purpose of a comprehensive review of the financial statements. But I would suggest that even more important than the financial review -- because it's subject to audit, as has been explained by the hon. Minister of Finance -- is the review of the type, quality and quantity of services that the community health council is providing to the community. With this amendment it is formalized through the legislation. It doesn't change the intent of the legislation. It's what I believe is called -- and is certainly intended to be -- a friendly amendment to enhance the opportunity for credibility of this section of the legislation. I believe it should transpire, and perhaps it was an oversight on the part of the drafters not to have it in this initial enabling legislation.
The Chair: The Chair is unable to accept the amendment unless it is on the proper form. If you would please do that expeditiously, we might proceed.
On a point of order, the member for Richmond Centre.
D. Symons: I've been listening very intently to the arguments by the members. I'm sure the Minister of Finance is listening with one ear, but his eyes are on something else. I don't believe it's proper to be reading the newspaper in the House when the debate is going on.
[11:45]
The Chair: Thank you, hon. member.
L. Fox: While the member for Okanagan West is drafting that on the appropriate docket, I want to suggest that I think his amendment is a very good one. The minister said a few moments ago that it was an excellent suggestion, and that she would advise the councils to comply with it in the reporting process. I think it's very important that the government recognize in legislation what the minister herself said was a good suggestion.
I think it's important, so I want to follow up on what the member for Okanagan West suggested. I tried to reiterate earlier in this debate that these first three years are going to be extremely important in changing this process. The more openness and public accessibility to the information, the better, from two perspectives: not only for evaluating where the dollars are being spent within the local council, but also for comparisons with other councils throughout the province to find out whether or not there have been equal standards and fair treatment throughout the province in the delivery of health care.
If that reporting process is not made available publicly, it will be very difficult for the more rural community health councils to examine whether or not they're getting fair treatment according to what other health councils are receiving in other parts of the province. I think it will be a very good tool for evaluating the level of care and the efficiencies between one health council and another.
[ Page 9123 ]
For those very reasons, I think it's imperative that this amendment be accepted in this legislation. It can probably be improved upon in the drafting of the legislation that will replace this in the coming years. I'm hoping that the government will see the wisdom of this amendment and will support it when it's drafted on the appropriate paper. I'm sure that either the Minister of Finance or the Attorney General will reply to that suggestion, and I'll wait for that.
A. Warnke: The amendment that has been put forward is an interesting one. I wonder if the hon. member would permit a question.
Amendment negatived on the following division:
| YEAS -- 14 | ||
|
Reid |
Gingell |
Dalton |
|
Farrell-Collins |
Wilson |
Stephens |
|
Serwa |
De Jong |
Fox |
|
Symons |
Tanner |
Warnke |
|
Anderson |
K. Jones | |
| NAYS -- 26 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Evans |
|
Farnworth |
Pullinger |
Lovick |
|
Copping |
Barnes |
Zirnhelt |
|
Cull |
Clark |
Gabelmann |
|
Smallwood |
Dosanjh |
O'Neill |
|
Doyle |
Streifel |
Krog |
|
Randall |
Garden |
Kasper |
|
Brewin |
Janssen | |
C. Serwa: I'll just wait for a moment for the House to quiet down. It seems pretty good right at the moment, hon. Chair.
One of the things that is really important for the credibility of members in the House is their integrity. In debate with the Attorney General -- and I'm speaking about section 10 -- he has kept his word. Here we've heard the Minister of Health concede that the amendment that was put forward is a very good idea. It has a great deal of validity with respect to the credibility of section 10, but when put to the test, I'm afraid the inferences were platitudes, and there was no real intent. The amendment was friendly and would have enhanced the credibility of this section of the legislation in the community.
I regret that the amendment was not accepted, albeit hurriedly drafted; it could have stood improvement. The intent of the amendment was very good, and it would have facilitated the community's understanding of the community health councils' activities. I continue to believe it would be a good thing. I hope that the Minister of Health continues to hold that as a serious concern, perhaps thinks about it and in the future looks at bringing it in as an amendment of her own.
[12:00]
Section 10 as amended approved on the following division:
| YEAS -- 37 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Evans |
|
Farnworth |
Pullinger |
Lovick |
|
Copping |
Barnes |
Zirnhelt |
|
Cull |
Clark |
Gabelmann |
|
Smallwood |
Dosanjh |
O'Neill |
|
Doyle |
Streifel |
Krog |
|
Randall |
Garden |
Kasper |
|
Brewin |
Janssen |
Stephens |
|
Wilson |
Farrell-Collins |
Dalton |
|
Gingell |
Reid |
K. Jones |
|
Anderson |
Warnke |
Tanner |
| Symons | ||
| NAYS -- 3 | ||
|
Serwa |
De Jong |
Fox |
On section 11.
L. Fox: It sounds like everybody is getting ready to go home.
The Chair: On section 11, please, hon. member.
L. Fox: I think there is a need for some clarification here in terms of how section 11(2) applies to the employees of a council or a board. I will read the section in order to make my point: "The Public Service Act does not apply to a board or council or to a member, officer or employee of the board or council unless the Lieutenant Governor in Council, by order, specifies that it applies to the board or council...."
I would have thought that an employee of the board would automatically come under the Public Service Act. Perhaps the minister can explain that for us.
Hon. E. Cull: This is one of the transitional provisions which recognizes that some of the employees who will be employed by the health councils are now covered by the Labour code, because they're in the public sector -- the hospital employees, for example. Others may be under the Public Service Act. They would be BCGEU members or other employees who are covered because they're employees of the Ministry of Health. This provision allows the Labour Code to apply unless cabinet designates it for employees who are currently Public Service Act employees, and we want to keep them as Public Service Act employees through the transitional period. It's simply to recognize the fact that some employees in health care fields right now are public service employees and some are public sector employees. There are two different laws that apply to them right now. For transitional purposes, those laws will continue to apply.
[ Page 9124 ]
L. Fox: It seems to me that it could be rather messy if the contract time comes up between now and the end of the transitional period. I recognize that the accord was signed and that it should go to 1996.
A couple of things concern me when we have this overlaying responsibility, and it's not clean and neat. Will we see some negotiations during this transitional period to bring all of these into one sector? If so, who would lead those? What will happen during the transition period to straighten this out, so that when the time comes to bring forth the legislation that would replace this, it will be a much cleaner process?
Hon. E. Cull: There are going to be extensive negotiations between the Health Employers' Association and the unions that represent the employees, both under the Labour Code and the Public Service Act. The member should be aware that the collective agreements go with the employees. The successor rights for those employees and their collective agreements would go with them, and they are individualized for each union or group of employees covered by an agreement. Merging their employers doesn't merge their collective agreements. We need this provision in order to sort that out over time. Those matters are really almost collective bargaining matters, because they would involve changes to collective agreements.
C. Serwa: The minister indicated earlier that we may have approximately 80 community health councils throughout the province. The employees now are transferred from the public health centre, for example, to the community health council as their direct employees. They are no longer direct government employees. Am I correct on that?
Hon. E. Cull: That is possible, but it's not the only option. Those employees could remain government employees during the transition period and be covered by this act. They could be there on secondment; they could be contracted services to those agencies. It's going to take a bit of time to sort out exactly which unions, collective agreements and employees would come over to the employers.
With respect to the collective bargaining, the Health Employers' Association of B.C., the new body, will be the responsible agency.
C. Serwa: It is my understanding, as we discussed earlier, that the community health council is a corporation. It now has employees, yet somehow it doesn't have employees; they are direct government employees. I fail to understand how this can be possible. If they have been transferred to and are working for the community health council, they are obviously employees of that particular council. That was made clear earlier. Being employees of the community health council, they will then bargain with the community health council through at least 80 independent bargaining units, which is not dissimilar to what transpires with the BCTF throughout the school districts in the province. That appears to be what will transpire. I don't know how you can avoid that reality in the transitional period.
Hon. E. Cull: The hon. member may remember some years ago when Riverview Hospital was removed from the provincial civil service and set up as a separate society and organization. The employees there, who belonged to the BCGEU and were part of the public service, were seconded in the transition period to provide for these contractual and collective bargaining arrangements to be resolved. They are now no longer part of the BCGEU master agreement and are treated separately. This simply provides us with the flexibility, so that when the council is appointed, everybody doesn't automatically switch to Labour Code because they're no longer part of the direct public service of the province. It is designed to provide some transition, which would be very difficult to do any other way with our own employees. I suspect that at the end of the period of transition these employees will become direct employees of the health councils. They'll be employees just like hospital employees are. Each hospital employs its own people; they're not employed by the HLRA or any provincewide association.
But there is provincewide bargaining. The unions bargain on a provincewide basis, as do the employers. The strength of the system is that that is what we have now in health care and will continue to have. With the health employers now having agreed voluntarily to form one employer organization, we're well down the road to having a very rational system that will avoid the problems we've seen in education.
C. Serwa: I guess that's a fairly big area, and it is pretty hard to anticipate what will transpire. I'm rather an advocate of one industry, one union. I often think that perhaps as the evolutionary process transpires, it would be appropriate to have not only provincewide bargaining, but also to have all the employees belong to one union in one industry, such as a hospital. I have specific concerns. Right now the HLRA bargains, and we have an agreement. I guess the unions are agreeable to that particular bargaining system as well as the employers, and that's why it functions.
But from what I understand, in this legislation the option is still open that there may be a philosophical change with the change in personnel -- with the community health councils, for example. The minister shakes her head, and perhaps she will advise me.
Hon. E. Cull: The member should keep in mind the Public Sector Employers Act that is before the House, which does require that there be a council of employers. When that legislation is put into place, it will provide that mechanism. We also already have the agreement of the existing health employers' councils to merge and form one organization. I don't know whether it would be possible to have one employer organization and one union organization. But certainly I think there will be some discussions around a council of unions in the same way there has been a council of
[ Page 9125 ]
employers created for the reason that there are benefits to the council of employers. Again, this particular provision allows us to move into this with some grace and latitude without creating problems for employees or collective bargaining that would impede the progress of the councils.
C. Serwa: Section 11(3) says that a board or council may engage or retain specialists or consultants that the board or council considers necessary to carry out its powers, etc. As we said in earlier sections, here's another opportunity for redundancy, duplication and additional cost in the system. At the present time the Ministry of Health can retain the services of specialists and consultants who can be accessed by all the hospital boards for their expertise. In this particular case it appears that we will have a number of similar challenges for the community health council, with all the community health councils hiring these specialists or consultants to assist them. It seems to me that rather than mitigate the cost concerns, this would accelerate the cost concerns. Is there no way that some sort of formula or process could be devised so that information is requested of the Ministry of Health, which has qualified personnel and staff in Victoria and throughout the province?
Hon. E. Cull: All that subsection (3) does is allow the councils and boards to hire consultants in addition to having direct employees. The Ministry of Health may indeed have the kind of expertise that councils and boards can use in some cases, but one of the services that is commonly hired by hospitals, which is not and could not be provided by the Ministry of Health, is utilization management experts, or management consultants, who are hired to come in and look at the efficiency of management operations. We simply could not maintain that level of expertise on a staff basis within the ministry. In fact, when we need those services as a ministry, we hire them on a contract or consulting basis. There's no point in having a permanent employee when what you need are services for a short and discrete period of time. This is intended to allow those facilities to continue to hire those experts, whether it's a personnel expert, utilization management expert or perhaps even a child psychologist to come and help them set up a new program.
[12:15]
C. Serwa: I enjoyed the remarks of the Minister of Health. At this hour of a quarter after midnight, there was a great deal of common sense in the last remark on the hiring of employees you only require for a short time. We agree wholeheartedly with that, and I think that's all part and parcel of the contracts.
Again, noticing the hour, I move that the House rise, report progress and ask leave to sit again. I say that knowing full well the repeated assurance of the Government House Leader: he assured me that his word was good that we would not sit after 12 o'clock. Here is an opportunity to test the word of the Minister of Finance.
The Chair: On a point of order, the Attorney General.
Hon. C. Gabelmann: The last such motion was only about 45 minutes ago, and it seems to me that we may have passed one section, the tenth in 12 1/2 hours. A motion of this kind may be in order in two or three hours, but not now.
The Chair: The point is well taken. The Chair rules that we are not going to entertain a motion to rise and report at this time.
L. Fox: On what basis?
The Chair: On the basis that we just had one a short time ago, and repeated motions to rise and report may in themselves be an abuse of the rules.
On section 11, the member for Richmond-Steveston.
A. Warnke: On a point of order. Standing order 34 states: "A motion to adjourn, except when made for the purpose of discussing a definite matter of urgent public importance, shall be always in order; but no second motion to the same effect shall be made until after some intermediate proceedings shall have taken place." The key here is "some intermediate proceedings." Some time ago I sought clarification of that phrase. As long as there has been some dialogue, any amount of time that has passed provides sufficient time to put forward a motion to adjourn.
The Chair: The Chair has ruled.
Does the member for Fort Langley-Aldergrove rise on section 11 or on a new point of order?
G. Farrell-Collins: I rose to make a submission on a point of order, which I believe was my right, and I was denied that right. I wish to make it now.
The Chair: Prior to the Chair ruling, that would have been an option, hon. member.
G. Farrell-Collins: That's when I was on my feet, hon. Chair.
The Chair: Please proceed.
G. Farrell-Collins: I just want to draw the Chair's attention to MacMinn's book. On page 42, under standing order 34, it says: "The term 'intermediate proceedings' means a proceeding that can properly be entered in the Journals." I assume that a passage of a section would fall under that category, which was the passage of section 10.
[ Page 9126 ]
The Chair: The member is quite correct, but when the motion is made repeatedly over the course of a short period of time, then the Chair would rule that it is an abuse of the rules.
We are on section 11. The hon. member wishes to continue debate on section 11?
C. Serwa: I move that the Chair do now leave the chair.
Motion negatived on the following division:
| YEAS -- 14 | ||
|
Reid |
Gingell |
Dalton |
|
Farrell-Collins |
Wilson |
Stephens |
|
Serwa |
De Jong |
Fox |
|
Symons |
Tanner |
Warnke |
|
Anderson |
|
K. Jones |
| NAYS -- 26 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Evans |
|
Farnworth |
Pullinger |
Lovick |
|
Copping |
Barnes |
Zirnhelt |
|
Cull |
Clark |
Gabelmann |
|
Smallwood |
Dosanjh |
O'Neill |
|
Doyle |
Streifel |
Krog |
|
Randall |
Garden |
Kasper |
|
Brewin |
|
Janssen |
On section 11.
D. Symons: I think this House has hit a new low in parliamentary procedure in the last few minutes. We certainly have it recorded in the books to find out where these people...
The Chair: Order, please.
D. Symons: ...stand on the proper use of the rules of the House.
Interjections.
The Chair: Order! We are on section 11, and the rules require that the debate be strictly relevant, hon. member.
D. Symons: I think it is relevant to what just happened, and that's part of section 11 here...
The Chair: On section 11, hon. member.
D. Symons: ...but I will move on to section 11. I'm concerned about some comments that the minister made earlier with regard to section 11(2). It deals with the Public Service Act and the possible transition period. From the minister's words, we may have two sets of rules under which these employees will be working, and possibly two wage scales. If this government believes in pay equity, as it is purported to, it would seem that you would want work of equal value to be paid equally. But from what she said previously, it would seem that this may not be the case, and it's going to allow for work of equal value to be paid unequally.
Hon. E. Cull: The wages, benefits and working conditions that council employees will work under are governed by their collective agreements, and we cannot amalgamate or bring in line all of those collective agreements through this legislation. That will take negotiation. It's part of the collective bargaining process, and those collective agreements still have to have authority under the legislation that they were signed under.
D. Symons: I'm gathering from what the minister said that she is saying that because of what they are bringing in here, it will now be possible to have two people working side by side, doing precisely the same job, being paid differently and working under different working conditions. Is that correct? Yes or no will do.
Hon. E. Cull: No.
D. Symons: With that answer, I'm wondering if the minister can explain to me why that's not going to happen, because certainly everything you've said previously would imply that it is going to be, or could be, be the case.
Hon. E. Cull: Individuals working side by side, doing the same work in the same institution, are covered by the same collective agreements. Right now, though, a nurse in the community working as a public health nurse has a different collective agreement than a nurse working in an acute care hospital. When their employers become the same person, they will still have their own collective agreements. Their jobs will be different and they will not be working side by side, but they do have different collective agreements.
[12:30]
Section 11 approved on the following division:
| YEAS -- 26 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Smallwood |
|
Gabelmann |
Clark |
Cull |
|
Zirnhelt |
Barnes |
Copping |
|
Lovick |
Pullinger |
Farnworth |
|
Evans |
Dosanjh |
O'Neill |
|
Doyle |
Streifel |
Krog |
|
Randall |
Garden |
Kasper |
|
Brewin |
|
Janssen |
|
[ Page 9127 ] NAYS -- 15 | ||
|
Serwa |
Stephens |
Wilson |
|
Farrell-Collins |
Dalton |
Gingell |
|
Reid |
Tyabji |
K. Jones |
|
Anderson |
Warnke |
Tanner |
|
Symons |
Fox |
De Jong |
Section 12 approved on the following division:
| YEAS -- 25 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Smallwood |
|
Gabelmann |
Clark |
Cull |
|
Zirnhelt |
Copping |
Lovick |
|
Pullinger |
Farnworth |
Evans |
|
Dosanjh |
O'Neill |
Doyle |
|
Streifel |
Krog |
Randall |
|
Garden |
Kasper |
Brewin |
| Janssen | ||
| NAYS -- 14 | ||
|
Reid |
Gingell |
Dalton |
|
Farrell-Collins |
Wilson |
Stephens |
|
Serwa |
De Jong |
Fox |
|
Symons |
Tanner |
Warnke |
|
Anderson |
|
K. Jones |
Section 13 approved on the following division:
| YEAS -- 27 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Evans |
|
Farnworth |
Pullinger |
Lovick |
|
Copping |
Barnes |
Zirnhelt |
|
Cull |
Clark |
Gabelmann |
|
Smallwood |
Dosanjh |
O'Neill |
|
Doyle |
Streifel |
Krog |
|
Randall |
Garden |
Kasper |
|
Brewin |
Janssen |
Serwa |
| NAYS -- 13 | ||
|
Reid |
Gingell |
Dalton |
|
Farrell-Collins |
Wilson |
Stephens |
|
De Jong |
Fox |
Symons |
|
Tanner |
Warnke |
Anderson |
| K. Jones | ||
On section 14.
A. Warnke: Basically what I want to pursue here is the term "public administrator," especially since the term itself is not defined in section 1. What is a public administrator? The term itself is vague as it stands, I believe, simply because when one is talking about a public administrator, one's talking about the public administration apparatus. In a sense, this means that any one person in the public service may be called a public administrator. This is extremely important insofar as the Lieutenant-Governor-in-Council and the ministry may appoint such a person, as section 14(1) states, "to discharge the powers, duties and functions of a board or council under this Act...." Just pursuing that phrase a bit, here is the board or council, as defined in sections 4 and 6 respectively, and yet, as this subsection reads, here is a situation where the board or council may be suspended in favour of a public administrator.
[D. Lovick in the chair.]
If we just continue on with this paragraph, there is also the other phrase: "...if the Lieutenant Governor in Council considers this to be necessary in the public interest." We want to see what the criterion is for determining what is deemed "necessary," and of course, for what is deemed "in the public interest." Maybe we could proceed with a few of those questions. Just what does the minister intend by "public administrator"? Perhaps she could provide a definition for us.
Hon. E. Cull: The wording here is the same as the wording in the Hospital Act and in other statutes that allow the Lieutenant-Governor-in-Council to appoint an individual to assume the administration of a public body, such as a hospital, and to discharge the powers, duties and functions of that body under the act, when it is necessary in the public interest. As the member is aware, it's a section that has been used from time to time.
Interjection.
Hon. E. Cull: It was actually used more often by the former government, when hospital boards were replaced. I don't disagree with the concept of doing that. In some cases that has been necessary, such as in the case of Kamloops. In the case of Vernon, the medical staff asked for the assistance of a public administrator to sort out the problems they had there. There has to continue to be a provision for that in this legislation.
[12:45]
A. Warnke: I just want to get clarification. In a sense the public interest here refers to any request by those involved in the management of health, I suppose -- by hospitals and so forth. In other words, these various public persons may request that a minister get involved. That essentially defines what is necessary in the public interest. Is that correct?
Hon. E. Cull: There are a number of different circumstances, which I'm personally aware of, where public administrators have been appointed in the past. But I certainly don't have the full list of all such circumstances. In some cases it has occurred where a hospital has run a considerable deficit over a number of years and has shown no ability to be able to get a grip on its budget and manage its way out of the deficit. In
[ Page 9128 ]
the interest of the continuing financial viability of an important and essential public institution, the government of the day -- not this government -- elected to remove the board and replace it with a public administrator.
In the case of Vernon Jubilee Hospital, which I referred to earlier, that hospital was in a dispute over a very emotional issue and had become dysfunctional to the point where none of the medical staff were willing to serve on medical committees. I think that the community in general felt that the board was not able to function and needed the assistance of the government. We put in a public administrator for a short period of time and reconstituted the public board.
From time to time there may be the need for the government to have this ability. That's why it exists in the Hospital Act, the School Act and in a number of other statutes, and that's why it has been picked up and placed here.
A. Warnke: I'm assuming from the minister's answer that the duration is for as long as is deemed necessary. Perhaps the minister could just confirm that in her next answer.
There's another aspect here as well. When we look at the Public Service Act, it makes it very clear that it does not apply to boards and councils. I would like to pursue a clarification here. When the ministry appoints a public administrator, the question is raised: does the public administrator come under the Public Service Act? Or like boards and councils, does the public administrator not come under the Public Service Act?
Hon. E. Cull: Public administrators are essentially retained on a contract, so they do not come under the Public Service Act.
The Chair: Prince George-Omineca.
L. Fox: I am a member, hon. Chair.
The Chair: I remind the member that the normal parlance of this chamber is to simply refer to the constituency. However, if he perceives a slight, I will say the member for Prince George-Omineca. Proceed, please.
L. Fox: Thank you very much. Perhaps it's something to do with the time of night.
I don't have any real problems understanding the appointment of a public administrator. I've seen actions by this minister which clearly give me an idea of what this process would involve.
My mere observation is that this is the second section within this bill that gives the minister the authority to crack the whip on both the community health councils and the regional health boards if they don't do her bidding. Throughout the rest of the bill, the minister has tried to impress upon us how important this structure and this process are -- to have public input at the local grass-roots level -- and how it should be an upflow from the grass roots to the ministry. Given the kind of dialogue we've had, it's rather unfortunate that the minister has seen it necessary to have two sections of the bill which allow her the autonomy to come down on these organizations if they do not do her bidding. But I am clear in the understanding of how the appointment of an administrator will work.
The Chair: Minister -- who is also a member.
Hon. E. Cull: Thank you, hon. Chair.
In the last ten years the former government used the provisions of this section on numerous occasions. We've just been putting together a short list of hospitals that the three of us can recollect, and there were at least ten occasions when hospital boards were replaced by the former government -- and of course, there were the two circumstances under this government.
While I have utmost respect for and faith in communities to make good decisions, the fact that I have that faith and respect does not relieve me or the government of its responsibilities for ensuring that services to the public are provided in an effective and financially responsible manner. If we have the situation -- as we've had with hospitals in the past -- where their finances get in a mess and they seem unable to get out of that mess, then it is the responsibility of the province to step in, sort that out for them, put them back on their feet and start them off again -- as your government and our government have done. For that reason we can't walk away from this responsibility. No one likes to use it; I certainly haven't enjoyed exercising responsibility under that section of the Hospital Act. But nonetheless, it has to be there as a safeguard to the public.
Sections 14 to 19 inclusive approved on the following division:
| YEAS -- 25 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Smallwood |
|
Gabelmann |
Clark |
Cull |
|
Zirnhelt |
Barnes |
Copping |
|
Pullinger |
Farnworth |
Evans |
|
Dosanjh |
O'Neill |
Doyle |
|
Streifel |
Krog |
Randall |
|
Garden |
Kasper |
Brewin |
| Janssen | ||
| NAYS -- 14 | ||
|
Serwa |
Stephens |
Wilson |
|
Farrell-Collins |
Dalton |
Reid |
|
Tyabji |
K. Jones |
Anderson |
|
Warnke |
Tanner |
Symons |
| Fox | De Jong | |
Title approved.
[ Page 9129 ]
Hon. E. Cull: I move that the committee rise and report the bill complete with amendments.
[1:00]
The Chair: Division is called.
An Hon. Member: Waive the time.
The Chair: Can we agree informally to waive the time?
Interjection.
The Chair: The motion before you is that the committee rise and report the bill complete with amendment.
Motion approved on the following division:
| YEAS -- 37 | ||
|
Perry |
Barlee |
Schreck |
|
Lortie |
Lali |
Giesbrecht |
|
Smallwood |
Clark |
Cull |
|
Zirnhelt |
Barnes |
Copping |
|
Pullinger |
Farnworth |
Evans |
|
Dosanjh |
O'Neill |
Doyle |
|
Streifel |
Krog |
Randall |
|
Garden |
Kasper |
Brewin |
|
Janssen |
Stephens |
Wilson |
|
Farrell-Collins |
Dalton |
Gingell |
|
Reid |
Tyabji |
K. Jones |
|
Anderson |
Warnke |
Tanner |
| Symons | ||
| NAYS -- 3 | ||
|
De Jong |
Fox |
Serwa |
The House resumed; the Speaker in the chair.
Bill 45, Health Authorities Act, 1993, reported complete with amendments to be considered at the next sitting of the House after today.
Hon. G. Clark moved adjournment of the House.
Motion approved.
The House adjourned at 1:02 a.m.
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