1994 Legislative Session: 3rd Session, 35th Parliament
HANSARD
The following electronic version is for informational purposes only.
The printed version remains the official version.
(Hansard)
TUESDAY, JUNE 28, 1994
Afternoon Sitting
Volume 17, Number 1
[ Page 12411 ]
The House met at 2:06 p.m.
L. Reid: I would ask the House to join me today in welcoming a colleague of mine, Mr. Ian McEown, who's visiting from Vancouver. Please make him welcome.
L. Boone: Today the caucus committee had the honour of meeting with a variety of representatives from some very important groups. Along with representatives from the B.C. Federation of Labour, there were representatives from the Canadian Farmworkers' Union, the West Coast Domestic Workers' Association and the Committee for Domestic Workers' and Caregivers' Rights. They are joining us in the House today, and I'd ask all members to give them a very warm welcome.
D. Mitchell: A constituent of mine, Mr. Bob Mussio from West Vancouver, is with us in the precincts this afternoon. Would members please make him welcome.
APPEAL PROCESS FOR MOTOR CARRIER COMMISSION DECISIONS
W. Hurd: I have a question for the Minister of Energy. We understand that a U.S. transportation consultant was quoted earlier in the week, or last week, as saying that he was hired by Kimber Cabs to review its proposed operations, and he informed them, upon review, that in his opinion they were not profitable with their handicapped service. Could the minister inform the House whether, during her cabinet appeal, she reviewed this information from the consultant and why she would determine that the service was viable when this international consultant had determined that it was not?
Hon. A. Edwards: The review that I did was of the decision. A limited amount of information was put before me. No, I did not review that. I'll be very clear, again, that my decision was to look at the weight of evidence, and the weight of evidence I saw indicated that the decision of the commission could not have depended on the evidence it saw.
The Speaker: The hon. member has a supplemental?
W. Hurd: With respect to the weight of the evidence, the weight of the opinion of the U.S. consultant.... He was quoted as saying that his services were no longer required by Kimber Cabs once the new government was elected in British Columbia, as they were assured that their licence would proceed. That was the message from south of the border. Has the minister made herself aware of that opinion and is she now concerned about those allegations, in light of the decision she made, on appeal, about Kimber Cabs?
Hon. A. Edwards: Any of those statements -- any allegation that was made about what was needed and what was not needed by Kimber Cabs -- was certainly not something that I examined, that I knew about, or that I should have known about. Those are allegations that are currently being brought forward, and that's interesting information.
W. Hurd: Clearly, an opinion has come forward from a U.S. consultant who produced a report for Kimber Cabs which found that the service was not profitable. Can the minister explain why Kimber Cabs evidently did not produce this information at the hearing that she held, at which she granted a licence to this cab company? What happened to that report from the U.S. consultant?
Hon. A. Edwards: I don't know what happened, because obviously that information was not put to me on appeal. I would say again that the information that came to the appeal was very clearly weighed, and I made a decision which I stick by.
EMPLOYMENT MINISTER'S ROLE IN SPONSORSHIP OF SCIENCE CAMP
G. Farrell-Collins: I have a question for the Deputy Premier. For the last three years, the UVic Engineering Students' Society has organized a summer camp for students called Science Venture. It's cooperatively funded through a number of government agencies and corporations. Some of the sponsors of that program are Industry Canada, Xerox, Northern Telecom and Science World, among others. But it's interesting to note that the only member with an ego big enough to have his name splashed all over the back of the T-shirt is the Minister of Employment and Investment. Can the Deputy Premier tell us why the Minister of Employment and Investment's ego is so big that he has to put it on the back of kids' T-shirts, when all the CEOs of all these other corporations and agencies don't seem to feel that need?
Hon. E. Cull: I'm appalled that again the Liberal opposition doesn't support a very worthwhile initiative, which is one that happens to be in my riding. I think it's an excellent initiative, and I think everyone should be supporting it, including this opposition.
DELETIONS FROM DOCUMENTS OBTAINED THROUGH FOI PROCESS
J. Weisgerber: My question is to the Minister of Finance. As the minister knows, under freedom of information, three months ago I asked for copies of ministry budget submissions. At the request of the Ministry of Finance, I agreed to start with the Ministry of Social Services. I now have a response that is 370 pages long. Would the minister tell me whether or not she has had an opportunity to review this material and if she agrees with the degree of censorship that is in that document?
Hon. E. Cull: I'm very glad to be able to clarify this matter for the member, because I want to make it absolutely clear that when freedom-of-information requests come to my ministry, I do not personally vet them, and I do not make the decisions about what is in or out. We have staff in the ministry who operate under the Freedom of Information and Protection of Privacy Act. I trust those officials to carry out their duties in a responsible and conscientious manner in accordance with the act. However, if the member disagrees with their application of the act, there is a process in place. If the member disagrees with what's there, I would encourage him to take advantage of the appeal process.
The Speaker: Supplemental, hon. member.
J. Weisgerber: I would encourage the minister to have a look, because in this claptrap there's not one shred of information -- not one sentence, not one paragraph, not one set of figures. There are 375 pages of blank material. Will the
[ Page 12412 ]
minister look again at the commissioner's ruling on release of information under section 12 of the act and provide to me the information that I requested?
Hon. E. Cull: I encourage the member to use the act to determine that matter. In fact, if he carries out the appeal and determines that the sections that have been omitted from the information he requested were inappropriately omitted, then we will make sure that my staff understand that, and we'll apply the rulings of the commissioner.
EMPLOYMENT MINISTER'S ROLE IN SPONSORSHIP OF SCIENCE CAMP
G. Farrell-Collins: I have a supplemental to my last question. The Liberal opposition -- as does every party in this House, I'm sure -- certainly supports science and technology, and the education of young people. The question is: why does the Minister of Employment and Investment have some egomaniacal need to have his name plastered on everything, when all of the other Crown corporations, agencies and CEOs don't have the same need? Why are students being forced to advertise for the Employment and Investment minister?
[2:15]
Hon. E. Cull: It's really unfortunate the member regrets that his name is not on the back, but maybe we can take that under advisement next time.
FRASER HOPE BRIDGE
H. Lali: Mr. Speaker, I can assure you that my ego is not as large as that of the member for Fort Langley-Aldergrove.
My question is to the Minister of Transportation and Highways. Prior to this government being elected, the Fraser Region Transportation Task Force had identified the Fraser Hope Bridge as a number one priority in that region for a major overhaul. It was to be done in three phases.
The Speaker: The question, please.
H. Lali: Last year the former minister was able to find a million dollars' worth for understructure work....
Interjections.
H. Lali: Quiet down, will you? You'll get your chance.
The Speaker: Order, please. Would the hon. member please state his question.
H. Lali: The residents of Hope are waiting for phase two, $4.5 million, to do the top part of that bridge. The residents of Hope have been waiting for a long time. My question to the minister is: why is Treasury Board or cabinet dragging its feet on a decision? When can the people of Hope expect a decision on this project?
Interjections.
Hon. J. Pement: If I could speak over the member who keeps yelling, it would be nice.
Interjections.
The Speaker: Order, please. Hon. members, the practice in this House is to stand in your place and be recognized before you speak. The hon. member for Saanich North and the Islands has been speaking quite loudly from his chair. I would suggest to hon. members that if they read the statement that was presented to this House last week with respect to questions being put by parliamentary secretaries, they will realize that this is not unprecedented. In fact, over the years a large number of questions have been put by parliamentary secretaries. So if we are going to further the practices in this House, I think we have to respect that that is the basis upon which the Chair has to operate.
Interjections.
The Speaker: Order, hon. members. If members wish to make submissions with respect to the ruling of the Chair, they may do so.
An Hon. Member: I've done that.
The Speaker: Not from your seat, hon. member. I would request that you wait to be recognized before you proceed any further. The Chair has made it very clear that parliamentary secretaries have the right to ask questions. If members wish to change the rules or the practices of the House, there is a process by which this may be done. I would say to members in closing that while it is very rare that parliamentary secretaries have exercised this privilege, they have the right to under the practices of the House.
Hon. minister, please proceed.
Hon. J. Pement: Thank you, hon. Speaker.
First of all, I would like to say that the work we do with our regional and local governments and our task force is very important to the ministry. We work very closely in identifying the priorities and issues within a given region. Therefore the project that the member has brought up is definitely a priority of this government and of this ministry. We will be working very closely with that region to come to a positive result.
I'm really pleased that we had a question of some substance.
LEASE OF HANGAR BY GOVERNMENT AIR SERVICES
K. Jones: This question is to the Deputy Premier. A recent Treasury Board report points out that the air services branch recently locked into a ten-year lease, at $875,000 a year, for a hangar that is too big and that is now destined to be empty. The Treasury Board review estimates that this new, empty hangar will cost $7.1 million over those ten years -- a price tag that is 55 percent more expensive than comparable private sector hangars. Could the minister justify such a ridiculous amount of money being committed by the air services branch when it was common knowledge that this Treasury Board review was underway?
Hon. E. Cull: The member is incorrect, because the Treasury Board review was not underway when the decision was made with respect to the hangar. Nonetheless, the Treasury Board analysis shows that the overall costs of the air services branch are excessive compared to private sector services, and moving in this direction is a sound financial decision. We are doing so while looking at all of the options with respect to the hangar and other costs. The Treasury Board analysis shows that even with the hangar, it still makes s
[ Page 12413 ]
ense to move in the direction that the government has decided on.
The Speaker: Supplemental, hon. member.
K. Jones: The present occupants of the old hangar did their modifications for about $200,000 instead of going to this kind of expenditure. Further, the government is dithering in this matter due to the increased pressure not to end the air services, and the BCGEU has attempted to undercut the findings of the Treasury Board review. Could the minister explain whether or not the Treasury Board review is, indeed, accurate? And could the minister explain what sources of information this government bases its decisions upon -- government documents or the heavy-handed labour movement?
Hon. E. Cull: Well, again, I'm very happy to clarify the matter for this member. When our government makes a decision like this, we don't just do a report in-house and then refuse to share it with our employees. One of the first things we did as we began to implement the decision was to sit down with the employees of government air services and share the information with them. We worked through that, and there is a difference of opinion between us and the government air services employees with respect to all of the information in there. The government stands behind the report. It is more cost-effective to move to a private sector solution in this regard, and that is what we will do. We are doing it in a thoughtful way. This is not a fire sale or an immediate shutdown. This is a very serious service, particularly with respect to the air ambulance service, which has to be managed in a way that is in the best interest of everybody in the province.
FEDERAL-PROVINCIAL MUNICIPAL INFRASTRUCTURE PROGRAM
H. De Jong: My question is to the Minister of Municipal Affairs. Earlier this year, the Premier offered his moral and financial support and full cooperation to the federal public works program designed to stimulate new job-creating projects. Can the Minister of Municipal Affairs assure us that these moneys are not channelled through the revenue-sharing programs normally carried out by the ministry?
Hon. D. Marzari: Yes, I can state unequivocally that $675 million will be shared across British Columbia between municipal, provincial and federal governments. There is not one municipality that won't have some share of this infrastructure program, a program that has been a long time coming.
I can also assure the member that municipalities across this province will not only have the benefits of the infrastructure program invested in their communities, but the benefits of a stable unconditional grant system, which has been renamed, reallocated and properly indexed in perpetuity. They will also have conditional grants for sewers that will be maintained this year and for years to come in this province. So actually, municipalities in this province have received the benefits of all three programs this year, in a way that this government intends to provide stability and security for financing local infrastructure.
The Speaker: Hon. members, due to the intervention in the regular question period, I will provide an extra two minutes for members to proceed.
WCB FIRST AID CERTIFICATION OF HOSPITAL WORKERS
L. Reid: My question is to the Minister of Health. The policy and procedures manual of the WCB looks at registering physicians and nurses in this province to be certified as having a first aid certificate. How can this Minister of Health, in times of stress on those budgets, justify asking hospitals to spend money to comply with a regulation that does not make sense for a hospital? First aid is what you get before you get to the hospital. Justify that expense.
Hon. P. Ramsey: Hospitals are worksites like any other, and WCB has the responsibility for ensuring the safety of those who work at those sites.
L. Reid: This is the government that promised no duplication. You are in fact asking those hospitals to duplicate that service. They are highly skilled technicians and professionals. Why will you not confer with the Minister of Labour and somehow suggest that tax dollars -- health dollars -- should be spent on patients, not on some ridiculous regulation?
Hon. P. Ramsey: I regret that the member opposite sees no need to ensure that health workers are working in a safe environment, as other workers in this province have the right to. It is the responsibility of the WCB to ensure that that happens, whether it's a hospital, ship or forestry camp. I'm glad the WCB is doing that for workers in B.C.
MINISTER OF ENERGY'S CORRESPONDENCE ABOUT POACHER
A. Warnke: My question is for the Minister of Energy. In a radio-collaring elk program in the minister's riding, of which she is regional minister, the minister replied to a letter that she believed a poacher was not convicted; in fact, the poacher was convicted in a Seattle courtroom. I'm wondering whether the Minister of Energy had been in touch with the Minister of Environment about the convicted poacher. Why did the minister respond the way she did?
Hon. A. Edwards: Indeed, you're correct. There was a mistake in that letter. As soon as we determined that there was a mistake, we contacted the correspondent and made clear what had happened and that the information we initially had was incorrect. We've made very clear that it was a mistake. So we've done everything that we can to correct a mistake that sometimes happens in correspondence.
The Speaker: The bell terminates question period, hon. members.
Before I recognize the hon. member for Fort Langley-Aldergrove, I'd just like to clarify that the Chair was in error in recognizing the member for Yale-Lillooet as a parliamentary secretary. He is not as yet, to my knowledge; nonetheless, the rule would apply generally to backbenchers on the government side as well -- just for the edification of the members.
The hon. member for Fort Langley-Aldergrove rises on a point of order?
G. Farrell-Collins: Earlier during question period, when the Speaker made a ruling with regard to parliamentary secretaries, he talked about past practice, the precedent set in this House and how that applied. I would ask that in
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determining the order and the length of questions and the number of supplementals, the Speaker also consider the practices of his predecessor in this House over the last two and a half years, and not make changes to that pattern without consulting all members of this House, to the benefit of all members.
The Speaker: Order, hon. member.
G. Farrell-Collins: Hon. Speaker, I do realize that it's much more comfortable for the government to receive questions from their own backbenchers...
The Speaker: Order, please.
G. Farrell-Collins: ...but that's not the intent of question period.
The Speaker: The hon. member is not making a valid point of order, and I'm sure the hon. member realizes this, as do all members of the House. The Chair was elected by the members to serve the members, using the members' rules, standing orders and practices. The responsibility of recognizing members, in any event, remains with the Chair. The Chair has always been available for comment, however.
Hon. J. MacPhail: First of all, I'd like to advise all members of the House that we will be sitting tomorrow.
Some Hon. Members: What time?
Hon. J. MacPhail: Upon adjournment we will advise the House of when we will sit tomorrow morning, as is the custom. But I certainly don't mind saying ahead of time to hon. members that the notice upon adjournment will probably be that we will sit tomorrow at 10 a.m.
Interjection.
Hon. J. MacPhail: Time and a half! I guess that will be according to the value that they contribute during those hours, hon. Speaker.
I now call the summary of estimates for the Ministry of Municipal Affairs.
[2:30]
REPORT ON COMMITTEE A ESTIMATES: MINISTRY OF MUNICIPAL AFFAIRS
L. Fox: As has been evident in most estimates in Committee A, it is usually a good, forthright exchange of concerns and ministry issues, one that generally reflects mutual concern over mutual interests. That was no exception in terms of the Municipal Affairs estimates.
Over the course of the many hours of debate, we dealt with many issues about planning in terms of municipalities having a need to plan for school and infrastructure sites, and so on. There was general consensus that a mechanism has to be in place to allow municipalities to do that, but in that process we have to respect and honour the private rights of owning property and the rights of property owners. We had a very good discussion in that area, and the minister understands that prior to addressing that issue in a planning way, there is a need for some protocol arrangement between the Ministry of Transportation and the Ministry of Municipal Affairs in order to allow municipalities that right.
We had a very lengthy discussion on taxation issues. From my perspective, there is a need to overhaul the taxation on residential properties. We have to find a taxation model that better reflects the ability to pay, in that there is a need to adjust it not only from a municipal perspective but also from a school district perspective. We had a considerable discussion about those issues, and I think there is some general consensus with this minister that the system isn't perfect. But I think there was a difference in philosophy as to how it might be fixed.
We also discussed Islands Trust issues at some length and the difficulties that surround the Trust in terms of various values on the different islands. We discussed what we might do in the future to respect those values and update the Islands Trust's policy so that individuals have an opportunity to put their values forward. Many options were talked about, including the option that some islands may wish to pursue forming a municipality to give them more direct planning and direct governance over their island.
The Speaker: Hon. member, your time has expired.
C. Tanner: This is the first time we've had an opportunity to talk to this minister in her new portfolio, and we had a very interesting philosophical discussion on a number of subjects. I should warn the minister that we let her off lightly this year, because we felt she was new and she should become more familiar with it. Next year things are going to be a lot rougher. And as long as she doesn't bark up this member, I won't bark up her.
There really is not an awful lot to report. As I say, we had a nice discussion, and next year we'll look forward to getting at the facts of the matter.
The Speaker: The hon. minister concludes the report.
Hon. D. Marzari: I'm very pleased to report that debate on the estimates for the Ministry of Municipal Affairs has been successfully completed within 1994. I spoke to the committee in the Douglas Fir Room about the ministry's commitment to community stability, because that's what this ministry is about. It's about giving proper and appropriate service to the Islands Trust and to municipalities and regional districts throughout this province. Our role is to provide legislative tools and policy direction and to provide financial support and appropriate advice about the Municipal Act that will help the people of British Columbia create and maintain prosperous and livable communities.
Our two most significant achievements this year were the introduction of a reformed revenue-sharing program, which will give greater predictability and stability in terms of local government grants, and the three-way infrastructure program that we referred to in question period which brings provincial, municipal and federal dollars together. I'm not alone in calling these achievements significant. The Union of British Columbia Municipalities has referred to them as major successes, and I'm proud of the win-win solutions that we've developed. If the member thought that we got off lightly in estimates, I can only suggest it's because Municipal Affairs has done its homework and provided the service, and that in fact there is very little to complain about this year.
I'm also continuing our legislative modernization program to ensure greater local control at the community level. The amendments in this year's package in Bill 25 will respond directly to concerns expressed by local government. The sections in that act will respond exactly to what they have asked for over the last number of years. Of course, this
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year we brought in the new Library Act to create a solid foundation well into the twenty-first century for our libraries throughout the province.
Part of our mandate is to ensure safe communities. I was happy to announce funding for the B.C. Safety Training Centre for firefighters throughout the province, which will increase access to safe hands-on training at the Maple Ridge site. This funding from B.C. 21 is going to protect other investments in the province by reducing property loss due to fire, and it's going to save lives of our firefighters in training.
During the estimates, I talked about the future and the ways in which this ministry is working to create lasting stability for our communities. We're reviewing the province's building regulatory system to address issues such as training and local government liability and better access for persons with disabilities. We are now pulling together a committee that is looking for ways to encourage communities through-out this province to properly implement section 3.7 of the Building Code. That section has basically been around since 1979, but many of our municipalities, design professionals and building inspectors have not yet found ways to implement it. This is basically an attempt to ensure that people with disabilities can get around their communities as easily as the rest of us do.
We are using existing programs to encourage communities and regional districts to think and plan regionally, to identify common growth-related problems and to work with their neighbours on solutions. Urban sprawl is our enemy in this province. We are undergoing mammoth redevelopment, and there are massive development demands down the east coast of Vancouver Island, throughout the GVRD, all the way up to Hope and in the Okanagan. Our communities will not be the same; they will simply not be livable if we do not act quickly to reduce the impacts that urban sprawl has brought. My colleagues in this House are experiencing the impacts and deleterious effects of urban sprawl, and are witnessing the degradation of our environment and the disappearance of our agricultural lands.
One of the issues that we addressed -- and all parties came together in this discussion in the estimates debate -- was about how we manage growth for the future. We do not want to do away with growth but must accept it and understand that it's a natural part of what this province is: a rich, dynamic and prosperous province. We must ensure that we can afford it and that our communities remain livable. That has to be our mutual goal.
I found our estimates debate to be useful and educational. We exchanged a lot of good ideas across the floor. We certainly let each other know what was going on in our local communities, and we talked about some very constructive programs that we could engage in. I certainly had an open ear and listened to members of this House very carefully as they talked about their communities, whether they were in the far northeast, on the Island or in the lower regional mainland.
The purpose of this ministry is to maintain stability, promote safety, generate employment and make community life better throughout this province. I thank all members of this House who participated in the estimates debate for Municipal Affairs. If I may take this opportunity, I especially thank members of the UBCM; that is, representatives of the mayors and councils across this province who have been so helpful in generating topics for discussion, ideas for change -- legislatively and otherwise -- and new program ideas that this government can work with them on. So my thanks to the UBCM. And my thanks to the members of this House.
Hon. J. MacPhail: I now call Committee of Supply.
The House in Committee of Supply B; D. Lovick in the chair.
ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 42: minister's office, $436,943 (continued).
L. Reid: Moments earlier we were chatting about hospital efficiency, cost savings to the system and, certainly, the question I just had the opportunity to pose to you in terms of the WCB regulation. To be absolutely clear -- because I'm not convinced that this issue doesn't bear some debate this afternoon -- we are talking about certifying, with a first aid certificate, a qualified emergency room nurse and a qualified emergency room physician. We're talking about $150 for a medical examination and upwards of $75 for a certificate. I personally take some issue with that in terms of regard for a profession -- both professions, if you will. These people are the most highly skilled medical practitioners we have, and again, I see this as a hoop that your ministry is going to be pushing people through. It's going to cost hospitals. If we take the example of Kimberley, one hospital in this province, it will cost approximately $3,500 just to certify their staff -- emergency room physicians and emergency room nurses. That $3,500 multiplied by a hundred-odd health care facilities in this province is a great deal of money.
As the Minister of Health, how do you justify that it's a reasonable expenditure, to give somebody a health certificate? We're not talking about a course or any increased certification in terms of training; we're simply giving them a piece of paper when they send in their money. To me, that lacks judgment. Would you kindly comment?
Hon. P. Ramsey: Question period continues, hon. Chair.
L. Reid: As long as we get the answer.
Hon. P. Ramsey: Hon. member, I'm quite willing to look into this to make sure that inappropriate fees are not being levied by the WCB, but I want to reassert the principle that I stated during question period. Workers, regardless of the facility in which they are employed, have a right to be assured that they are operating in a safe worksite. Part of that safety is to ensure that prompt and certified first aid is available. The member raises a good point with regard to some personnel who work in hospitals. There are many other areas of hospital operations where I think it is entirely appropriate to ensure that somebody on staff in those areas is available with appropriate training when employees are present.
[2:45]
L. Reid: We're not talking about employees in other sites, hon. minister. We are talking about regulation 15(1), which pertains specifically to emergency room physicians and emergency room nurses. I can't think of anyone more qualified, and I think the issue that we have to understand is that first aid is typically not something that you receive in an emergency room. Hopefully it is received on-site, where the injury occurred.
Interjection.
[ Page 12416 ]
L. Reid: Thank you, hon. member. If indeed there is some overlap, fine. But the extreme cost that will come to bear on every single hospital in this province seems to me to lack justification. Surely you've had some discussions with the Minister of Labour about why this is valid. I can certainly look at certifying all kinds of WCB worksites around this province, but an emergency room would not be one of them.
I certainly want to continue my discussion this afternoon from where we left off before lunch in terms of wait-lists in this province. We covered joint-replacement wait-lists and cardiac wait-lists. I would simply ask the minister to confirm whether or not the wait-list today for a CAT scan in this province is approximately five to six weeks, and whether there are indeed 2,800 patients in this province currently waiting for that service.
Hon. P. Ramsey: I don't have that precise information available to me now, hon. member. I will ask staff to provide it. Since we are going to be here for some time today, I hope to have it for you later today.
L. Reid: In terms of providing information, am I to receive the checklist of regional health boards this afternoon? If so, that would be most helpful.
Returning to the CAT scan question, if your staff needs some time to prepare, perhaps I can ask another question and they could respond at the same time. Since we began this afternoon on the WCB, it seems to me that with respect to the wait-list for patients for WCB and ICBC, if we are not going to provide them with an immediate and accurate diagnosis -- and certainly the research suggests that a CAT scan and MRI lends credibility to those kinds of diagnoses -- and ensure that those services are in place, the downside is that it simply costs us more. People are off work longer and are not being put into the stream to receive services, because they are awaiting a diagnosis. That has been my experience with a number of WCB claims in this province. The number of people who are waiting is certainly statistical information that's available from ICBC. At the end of the day those all become health issues, because people are waiting for some kind of diagnosis.
When the minister has an opportunity to provide that information, I would ask if we could perhaps break down how many folks are waiting for ICBC and WCB. The cost to the health system is significant, because it also plays on the social services and judicial systems in this province. None of those other services can work if they are waiting for diagnoses which tend to flow from the Ministry of Health.
Hon. P. Ramsey: I share the member's concern for anybody who has to wait for diagnostic imaging, particularly those who are injured in the workplace or in an automobile accident. I will ask the staff to gather more detailed information. I do have some information. The WCB has estimated for the ministry that they have something like 120 cases a year requiring an MRI scan. That is a very small number, since one MRI unit operating one shift a day is capable of doing some 2,000 scans a year. So it's a very small requirement of the overall volume for MRI scans in the province. I share the member's concern that this be dealt with promptly, since people are looking to get well and return to work. I'll leave that there and see if we can get some further details of CAT and MRI scans later.
To return to the member's first question about a checklist of the status of interim regional health boards, a document summarizing the status of every RHB in the province was delivered to the member's office at 2:15 this afternoon.
L. Reid: For the record, the list will no doubt appear at.... Thank you most sincerely. I will see if we can receive it in a timely fashion.
I would like to ask the minister to respond to questions as they pertain to the treatment of eating-disordered individuals in British Columbia. To continue with the wait-list theme, at St. Paul's there is a wait-list for initial assessment of up to a year and a half. I understand that is still a valid wait-list, supported by your ministry, because I believe that is where the statistics came from. There are 280 individuals on the wait-list at present. We have some concerns about that wait-list, because as the minister is more than aware, those kinds of services are urgent; they are immediately required. To put somebody who is wasting away on a wait-list of upwards of a year and a half is not helpful.
I was present when the minister announced his new strategy for eating disorders on June 7 regarding the creation of a residential care unit. I would be interested in some definition and criteria about that, because my discussions with the minister certainly suggested that those criteria were months down the road. Is that still the case? Are we still looking to some time in October, November or December before we will have some sense of the patients who will be admitted to that program?
Hon. P. Ramsey: The member refers to the strategy for dealing with eating disorders, which I was very pleased to announce earlier this month. As the member noted in some of her comments, there are a variety of components to this. Yes, residential care is part of it. Yes, assessment is part of it. And moving assessment and prevention programs out into the regions, away from the tertiary facilities, is part of that strategy.
I want to focus on those very important tertiary facilities. The residential component is indeed part of that. As you know, we've established ten new beds to be associated with St. Paul's and a further ten beds that will be associated with Children's Hospital. Those are going to become operational in the next little while. Those who require that sort of residential facility at St. Paul's will have it available to them in the very near future.
The member asked specifically where we are in the development of standards for certifying private providers of residential care for eating disorders. Currently, we are finalizing the membership of the advisory committee on eating disorders. The first task that that committee will have will be to examine standards for residential care of people suffering from severe eating disorders. Without knowing exactly the tasks before it, I'm loath to speculate on an exact date when they will have their report in front of me. As I said earlier, I would expect it would be sometime this fall.
L. Reid: I want to spend a few moments this afternoon talking about the costs of this residential care. When asked during your press conference, if you will, the discussion centred around $250 a day per patient. I would be interested in how that figure was arrived at and where you're headed with it in terms of funding patients who may choose to be served by a private clinic -- whether you will fund them to that level as well.
Hon. P. Ramsey: The $250-per-day charge for residential care for somebody suffering from a severe eating disorder was one arrived at after discussion with St. Paul's Hospital, which was doing the on-the-ground work of establishing such a treatment facility. This is not a theoretical number, nor is
[ Page 12417 ]
it a charge from the hospital to us. This is the actual cost of delivering that sort of care in that sort of setting.
As time goes on and as St. Paul's Hospital and Children's Hospital gain some experience in operating such facilities, we may have further refinements of the cost per day. As I said earlier, I have not closed the door on funding private agencies who wish to offer residential care, nor have I established any level of funding for that care at this time.
L. Reid: I appreciate the minister's comment that $250 a day is the actual cost. The second part of my question was: is that the amount of money that individuals seeking care in a private facility can expect to be reimbursed?
Hon. P. Ramsey: Perhaps the member missed the last part of my response, which was that I've made no such decision. When the advisory committee completes its work and reports to me on standards and on appropriate means for funding private clinics, then I will make that decision.
L. Fox: I request leave to make an introduction.
Leave granted.
L. Fox: I note in the gallery some Prince George residents who are down enjoying this beautiful weather we're having in Victoria. Mr. Eisbrenner is a pharmacist from Prince George, who no doubt has great interest in the debates that are currently going on within the Legislature. With him is his wife, their two children and his mother, Mrs. Eisbrenner, who is very involved in the delivery of health care services to the elderly in Prince George. Would the House please make them welcome.
L. Reid: To come back to the minister's comment, I did hear your answer that you haven't made a decision yet. My concern is the number of individuals who do need that service. If a number of months elapse and they are uncertain about the funding of that service, there will be some fatalities in this province. There's no question about that. A number of people have died up to this point because of wait-lists and because they were not being served. This is not to suggest that this is something the minister is not acutely concerned about, because I know he is. The issue is whether or not, today or in the next few days, this minister can give any assurances to the parents of those patients who are currently receiving service in private clinics.
Hon. P. Ramsey: I think it would be totally inappropriate of me to indicate whether or not this ministry would be funding private clinics to deliver residential services for eating disorders prior to receiving the report of the advisory committee, which is examining the standards and circumstances for such funding and making recommendations to me.
L. Reid: Hon. minister, I am not asking you to fund the facility. I'm asking if the parents in this province can expect individual reimbursement for the services they are currently purchasing for their children. That is a very different question. I'm not asking you to give dollars to any private clinic.
[3:00]
I can assure this minister, as he well knows, that out-of-province services are often paid for by this ministry. Money goes to families that have put out dollars to purchase the service. If the service is not currently available -- and it is my contention today that waiting a year and a half renders a service unavailable -- will this minister, until his guidelines and evaluations are in place, come forward with an interim response to this question? I hope that will allow the less than 50 patients in this province who are currently in that scenario to have some reassurance that they can continue to avail themselves of that service. I think that's a vastly different question.
Hon. P. Ramsey: I'll try once more. We do not fund services that are delivered through private clinics unless those clinics have met the standards established by this ministry for that care. That pattern is true for home support and for long-term care, and that is the pattern that is going to be true for residential facilities dealing with eating disorders. This member is saying it is one thing to fund the facility and another thing to fund the person, and I think she is misleading this House with that sort of assertion. If the funding is going to an institution, it is the responsibility of this ministry to make sure that the care provided by that institution meets the standards expected of it.
The Chair: Before I recognize the member for Richmond East, I caution both the minister and the member that the convention that we seem to be forgetting is to address one's remarks through the Chair. What that translates into, in the most blunt and basic terms, is: get rid of the second-person personal pronoun -- i.e., the word "you." I am the only "you" in the chamber. In other words, it's okay to point the finger at me and say "you," but not at each other.
L. Reid: This ministry is circulating materials from the Ministry of Health. Miss Tanya Haverstock requested payment for her eating disorder treatment in Texas. It is noted that $45,000 has been committed and allocated. I need some information on that. If you are suggesting that you cannot fund parents in this province who are in dire financial straits, yet $45,000 will secure that treatment for someone out of province, I find an incredible dilemma with that, hon. minister.
Hon. P. Ramsey: Hon. Chair, I always thought you were a ram, not a ewe, but we'll let that pass.
The answer to the member's question regarding funding for a treatment in Texas is as follows: yes, this ministry did pay $45,000 to a clinic in Texas to treat a B.C. patient suffering from a severe eating disorder. This was done largely to gain information about the treatment provided through that facility. It was the concern of the ministry that we did not have information in this province about a full range of treatments that might be made available to those suffering from severe eating disorders.
The clinic in Texas claimed that they had different sorts of treatment above and beyond what was currently being offered here. The deal was: we'll fund this patient to receive your services, in exchange for which you will provide us not only with the services for that patient but with full clinical records and full documentation of treatment received. That was the agreement. It was some time ago, and I believe it is a unique situation.
L. Reid: It may indeed be unique, but I can assure you it's incredibly distressing to patients and their parents in this province who are looking for $250 a day from this minister. So to spend $45,000 and then suggest somehow that this minister cannot move on a decision to ensure that patients whose wish is to receive service in this province are at least funded to the ministry maximum.... If the
[ Page 12418 ]
ministry maximum is $250 today, I have tremendous difficulty with what I see as a huge contradiction: that this minister can spend $45,000 out of province but cannot spend $250 per day per patient for British Columbia eating-disorder patients.
I would be interested in some background on this program and in what this province received for $45,000. I can assure this minister that the parents listening to this debate have serious concerns about the decision that allowed $45,000 to leave the province but which somehow hasn't allowed $250 a day to remain in this province for those individuals who are currently receiving service.
It's not because this ministry cannot offer the service today. With a year-and-a-half wait-list, that service is not available. So to deny them the funding to purchase a service that their youngsters desperately need leaves a great deal to be desired. I would ask the minister to comment.
Hon. P. Ramsey: The concern about eating disorders and about appropriate services being available to deal with those who suffer from eating disorders, as the member says, is not new. What is new is a comprehensive strategy for dealing with the issue and for making a range of treatment available to those who suffer from disorders, and that was announced earlier this month.
I'm sorry that we can't seem to distinguish here between funding of a private care provider on an ongoing basis.... I assure this chamber and everybody who is watching that this ministry does indeed fund a variety of private care providers when they meet the standards established for care. That is all we are doing in this situation as well. We're saying: "Let us make sure we have appropriate standards established; let us make sure that the clinics providing treatment meet those standards."
I am not prepared to shortcut that process. I think it is incumbent upon those who use tax money for health purposes to make sure that the care provided is of good quality. The spending of money for the clinic in Texas was done as a pilot project, as I said, to gain information about treatment provided there. The ministry has done similar pilots for a number of other conditions with other clinics, both across this country and in other jurisdictions.
This is not an uncommon way of gathering further information, but it is not, by any means, to leap from that to the assertion that somehow a set amount per day should be available for the use of any clinic to anyone who requests it. To bypass the establishment of standards and the certifying of care providers strikes at the heart of what this ministry attempts to do in ensuring the best-quality medical care for British Columbians.
L. Reid: I want the minister to clearly understand what I'm asking. I am not asking this ministry to fund a private care provider on an ongoing basis. This minister has heard me say that three times now: this is about funding individual British Columbians today and asking the minister to do that on an interim basis until the guidelines that this minister spoke of earlier are in place.
I respect what the minister said in terms of the pilot project -- and I have asked for that, as have many British Columbians -- and this ministry believing that it needs more information about private eating-disorder clinics in this province. Our discussion has always centred around funding two or three individuals and then collecting that documentation, doing some kind of evaluation and actually funding a pilot project. I'm asking for that today, as an interim measure for British Columbia parents and their children. Let me be perfectly clear that I'm not asking for some commitment regarding a facility; this is about whether or not the ministry will stand in today, on an interim basis. Today some British Columbia families are in jeopardy of losing their homes and families because there is some time lag built into what this ministry intends to do. I support the direction in which this ministry wants to go and where it wants to get to, but I think there needs to be a solution now. The next three or four months is critical in the lives of these British Columbians, who are typically young women. I would ask the minister to respond as to whether or not his ministry can provide an interim solution to an immediate and urgent problem.
Hon. P. Ramsey: I think we've canvassed this issue fairly thoroughly. Let me give an example outside the field of eating disorders that I think is exactly parallel to what this member is asking about. It strikes me that something that would be exactly equivalent is if I were asked to provide funds to somebody who wished to purchase home support services from an unlicensed provider. My answer would be exactly the same: "No, we only provide funds when they are going to providers who have met the standards set by the ministry." We are asking no more and no less of clinics that wish to specialize in the treatment of eating disorders. I believe that is an appropriate response and that it will ensure that the care provided in this province is of the highest standard.
L. Reid: I have a number of questions relating to the evaluation done on the Montreux Clinic. There certainly seems to be substantial evidence to suggest that the first draft of the report was dramatically different from the second. I would ask the minister to make available to this House, and certainly to the Health critics, the draft report and the final report, and perhaps give some comments as to why those variations exist.
Hon. P. Ramsey: What the member refers to as a first draft of the report was an initial impression, which I believe was largely based on a little field examination of the Montreux clinic. It comprised only part of the work that was done to evaluate the Montreux clinic. Much more work was done. The final report took into account the initial -- I don't know what to call them -- notes, as well as other evaluations. The final report was obviously boiled down and condensed to make sure that the overall impression of those authoring it fit the facts they had found.
L. Reid: Hon. minister, is it your practice to have an evaluation report written after a single site visit?
Hon. P. Ramsey: A number of elements go into such a report, and obviously a site visit is one. A variety of other objective evidence should be gathered and assessed on a clinic's operations, or on any treatment centre's operations. A site visit is surely only one component of what needs to go into a report on the provision of care provided by a particular clinic.
As the member knows, a variety of documents were asked for to make sure that we had the best possible information. I'll just mention one. The Montreux clinic was asked to give us follow-up data so the ministry could very carefully examine the claims of success and efficacy of treatment provided by the clinic. To date, Montreux has not been able to give us the objective follow-up evidence that would help to establish the efficacy of the care provided. That's but one example. I hope that sort of data could be
[ Page 12419 ]
forthcoming. Other data, of course, has to do with the certification and qualifications of care providers and links between the clinic and other care providers in the area, such as acute care facilities. As evidence was gathered on a variety of things, those assessing Montreux found, regrettably, that at present they could not determine whether it met appropriate standards for the residential care of those with eating disorders.
L. Reid: I will certainly concur that accreditation is a complex task, as is evaluation. My question to the minister: is it this ministry's practice to write a report after a single visit?
[3:15]
Hon. P. Ramsey: It is this ministry's practice to write reports after adequate data is gathered; whether that's one site visit or ten depends on what information is sought. Much other evidence can be gathered, either without or in addition to site visits, that bear equal or greater weight.
L. Reid: Hon. Chair, allow me to say that this is one issue where the minister and I will disagree. Any accreditation or evaluation team worth their salt goes back more than once. That's simply the state of the art; that's public administration at its finest. I have some serious concerns, and I trust we can resolve this in the next number of days.
My next questions look to the issue of continuing care. A week ago this minister promised a special briefing a week from now -- the first week of July. With the briefing not being provided in a timely fashion, I have questions today, and this is the opportunity afforded to me. I would simply bring the questions to the minister's attention and trust that if all the information is not available today, perhaps this can be covered on, I believe, July 5 or 6.
I speak specifically of community services for the handicapped in our communities, or services for community living. I'm talking specifically about individuals with multiple handicaps who require a range of services. We have some issues, and a number of issues have been brought to me. I have taken the opportunity to share these issues directly with the Minister of Health. Individuals have suggested that there has been no true consultative process regarding the transfer of service between the Ministries of Health and Social Services. If the minister has some information on how that process came to pass and whether or not there were consultations, I would be very interested in his opening remarks. He may indeed be able to answer some of the questions I have.
Hon. P. Ramsey: I thank the member for sharing and bringing to my attention some of the concerns that have been brought to her office by the families of people with severe disabilities. I think she and I shared some common concerns about taking steps to ensure that these people and their families feel comfortable that the high quality of care that they've come to expect will continue.
I would say only this at this time. After a very long, and sometimes heated public consultation in '91, a recommendation was made by senior staff in the Ministries of Health and Social Services to realign some services to adults with multiple disabilities from the handicap branch -- it's called Services for Community Living -- to the Ministry of Social Services. Both ministries are now examining options to relocate some or all of the people supported through that program to the Ministry of Social Services. No decision has been made; no services have yet been transferred. I continue, as does the Minister of Social Services, to consult with families and agencies so that we understand thoroughly the concerns of those families. We are basing decisions on transfer in a way that will reflect and address any concerns that we're hearing.
L. Reid: Can the minister perhaps comment on why the decision was taken to move the program from the Ministry of Health to the Ministry of Social Services? There seems to be some confusion around that. The clients who have brought this issue to me suggest that they are being compromised for some kind of administrative ease. Would the minister please comment.
Hon. P. Ramsey: Nobody's health and no services are going to be compromised if a transfer occurs. That's the clear pledge that both the Minister of Social Services and I have made to the families whose family members may be involved in this transfer. The recommendation that transfer be made was on the grounds that many of these individuals are dealing with conditions that are non-medical in nature. Indeed, the supports required are non-medical in nature. Those services are very similar to what those who are not adults are currently receiving through the Ministry of Social Services. The two ministries recommended that we look at combining our programs and expertise in the delivery of services for those individuals, whether they be adult or youth.
L. Reid: I have also been made aware that the associate family program may be transferred from the Ministry of Health to the Ministry of Social Services. The program provides training for families to work in partnership to provide home care for severely disabled children. Is that a decision that's in progress? Could the minister kindly comment on the intention when the proposal to move the programs was considered? What was it that the minister hoped to achieve by that change?
Hon. P. Ramsey: This ministry and other ministries of government are, I think you could say, constantly in discussion on how best to rationalize services and make sure that government services are delivered in both the highest-quality and most cost-effective manner. There has been no decision made on transferring the associate family program to the Ministry of Social Services. That is one set of services that I know was looked at, but no decision has been made.
L. Reid: From the letters I have, these families believe the decision has been made. I will happily indicate your previous comment that no decision has been reached. I'd be happy to share with the minister this correspondence, which outlines in tremendous detail their concerns, because obviously they arrived at these concerns for some particular reason. If indeed their concerns are unfounded, I know they will be pleased to receive that information.
The head injury program, I understand, has recently been questioned in the press in terms of what kinds of resources are available. The ombudsman's office has clearly indicated that resources and programs are sadly lacking in this province. What kinds of supports can this province's head-injury clientele, if you will, expect from this ministry? Their concerns revolve around the Closer to Home initiative. Will those services be diluted as a result? Will they be emphasized as a result? Will there be any change in the delivery of that program at the present time?
[ Page 12420 ]
Hon. P. Ramsey: There is no change contemplated in the nature of care received by those suffering from severe head injuries. The issues around that care are very similar to the issue of associate families and services to those with severe handicaps. In this, as in other areas, there are opportunities for looking at rationalization of services. But no, the short answer that I can provide at this time is that we do not contemplate any change in the services that those people are receiving.
L. Reid: The minister is suggesting that no changes are contemplated, however the ombudsman's office has said that the current services available are lacking. That is in your ministry documentation. I would hope some changes are being contemplated. If the offices and agencies cannot provide services today, surely there will be some infusion of support and resources to look at what is indeed a very critical issue. Frankly, it's a very urgent issue for families in this province who are often trying to provide that care in-house.
Hon. P. Ramsey: The ombudsman's report, to which the member refers, did indeed result in this and other ministries engaging in a pretty thorough examination of what services were available to those suffering from head injuries and a close look at what recommendations they would like to bring forward about improving that service. Most of the detailed work on this report has been completed. I expect that myself, the Minister of Social Services and others will be receiving this report in the near future. After we receive it, we will then look at acting on the recommendations brought forward. In conclusion, just very briefly, as with some of the other issues the member has raised this afternoon, it is a matter we take seriously. I'll be looking very seriously at the recommendations of this report.
L. Reid: We can spend a few minutes this afternoon on services to very young children in the areas of speech and language service. There are a number of questions regarding the similarity of, for example, Delta as compared to Maple Ridge. Maple Ridge has approximately 60,000 people, and they have a minimum of three occupational therapists and three physiotherapists. Delta, with a population of 90,000, has only one OT/PT in the district. These questions come directly from the Delta Child Health Society, and I know they have been shared directly with your ministry. The answers have not been received. It's worthwhile to discuss putting resources into children when they are very young. Indeed, if you're going to make a difference in terms of providing some kind of specialized support service, you want to do it when children are in the zero-to-five range, particularly as it relates to speech therapy, growth and fine motor function. Those issues are best addressed when children are in that age range.
I know families in Delta have brought those issues to you, and they've certainly brought them to my office. They have some serious questions as to why these youngsters would have to wait based on where they live in the province. This plays very keenly into the discussion we've had on bringing some of those services closer to home.
I can assure this minister that in 1993, 129 children needed that service. More than half of them had to leave Delta while they were under five years of age, which causes great strain on their families, typically financial hardship. There's no transportation available. These are tremendous issues not just for the lower mainland but for other regions of the province. It has been this minister's and this government's contention that similar levels of service are available in all parts of the province. This particular group suggests that is not the case, and I would ask the minister to comment.
Hon. P. Ramsey: This is an area where the member and I share a common objective. We may not share a common perspective on the funds available to actually carry out the goal that we share.
We are attempting to move forward in providing better speech-language pathologists to preschoolers in the province of British Columbia. In some areas of the province, wait-lists are excessive and staffing is less than ideal. That's a reality. I think we've made some progress in the last little while. We are working hard to increase coordination of existing services within communities. As the member knows, other agencies that provide speech-language therapy are employed through school districts and other agencies. We're also working to expand the educational programs for parents and child care workers who deal with children -- those requiring a language therapy to assist them in dealing with the condition of their children or the children they care for -- and to enhance an early speech and language environment for those children. We're also working with providers of speech-language therapy services to monitor and assist with recruitment and retention. In this area, as in other areas, very often that is an issue. Particularly for some of the more remote areas of the province, attracting and retaining therapists has not always been easy.
We share a similar perception that this need must be addressed. My question is: how fast can we move to address it with the funds we have available? We are taking the steps we can. I wish we could do more and faster, hon. member. We are doing as much as we can with the resources we have.
L. Reid: I do appreciate the minister's comment. My concern -- and what I would like to be in a position to relay to parents in this province -- is whether the decision formula or framework will change once regionalized health and the Closer to Home initiative are in place. Is there any value, hon. minister, for these parents to expect a change in the near future? Will they have any ability to influence this process? This government has continually raised the issue of local decision-making and bringing those decisions closer to home. Is it something that consistently will be on the back burner for Delta? Or are there indeed opportunities for them to bring the service level in their municipality -- in Delta -- in line with what they know to be the fact in Maple Ridge and other lower mainland communities?
[3:30]
Is there a formula today that drives the number of physiotherapists, occupational therapists, speech and language therapists? That certainly seems to be where the grey area exists in this discussion. I'm not asking the minister to spend more money today. I'm simply asking what the formula is that has driven the current service delivery model.
Hon. P. Ramsey: The current pattern of services has been driven by a large number of variables: the decisions of individual boards of health, the establishment or non-establishment of child development centres and other care providers in communities and whether school districts in a region are coordinating their activities with those of health units. Finally, I suggest that the pattern of services also has been driven by the ability to recruit and retain therapists. So a large number of factors have gone into it.
[ Page 12421 ]
The first question the member asked, though, was whether regional health boards and community health councils would have the ability to receive funding based on a formula that recognizes the health needs of their community and to make allocations within that region to address those needs, if they consider them higher priorities in funding than they are presently given by health units or union boards of health. The answer is emphatically yes.
L. Reid: My thanks to the minister. If we can spend a few moments this afternoon on child and youth mental health services, I have a number of specific questions. The ministry's annual report stated that additional funding has been allocated to the sexual abuse intervention program. The program is described as targeted for the development of services to children under 12 whose behaviour is sexually precocious or intrusive.
I've had a number of calls to my office regarding whether that language is appropriate to describe someone who's under 12. In some cases we are talking about very young children -- two or three years old -- who somehow have been described as sexually precocious or intrusive. I ask the minister to comment, because it probably has potential to be a very valuable service. It just seems somewhat contrary to use language that is somewhat inflammatory, which probably takes away from the intent of the program.
Hon. P. Ramsey: I regret if the member finds the language inflammatory in some way. It was surely not intended to be. My understanding is that it is technical language used within the field when dealing with sexual abuse and intervention. It is a term used by psychiatrists and others to describe a particular set of behaviours. I understand further, although I don't know the Latin, that this is a direct translation from Latin to describe a particular set of activities or behaviours.
L. Reid: The parents who raised this issue have some concern about the language. If your contention is that the language is appropriate, I'm happy to relay that.
I understand pilot programs are underway in Vancouver, Port Coquitlam and Campbell River. I would be interested to know what types of programs those three pilot projects are delivering around sexual abuse interventions and perhaps what the client base is for those programs.
Hon. P. Ramsey: I'm not sure how much detail I can get into at this time. We are looking at working to develop a coordinated service delivery model. An office providing those sorts of services was established recently in Prince George. It should be an interministry effort. We're providing training for workers who deal with sexual abuse victims and looking at establishing intervention materials and program standards for those who are intervening in such cases. Counselling services form a core of what's going on, and we're also developing services for sexually abused children and youth with disabilities.
The funding provided has been enhanced recently. Actually, I think a couple of years ago it nearly doubled. We take the issue seriously. In '92-93, around 3,500 victims were counselled and treated. That compared just two years prior to some 1,300. We have nearly tripled the number of victims we're able to deal with through enhancement to the program.
As for the particular pilot projects in particular locations, quite frankly that is a level of detail I don't have at my fingertips. If it would be useful for the member to have the information for each pilot project, I can make sure she gets it. I don't have it with me today.
L. Reid: I thank the minister for his comments.
I have a number of questions regarding the availability of services in communities. We talked earlier today about issues that are emotionally complex. The next questions are in that range in terms of individuals in need of psychiatric intervention who are presenting themselves at an emergency room of a hospital but are not admitted for a myriad of different reasons -- as outlined both in the correspondence and in the coverage -- and are then involved in murders and stabbings. The three that I have before me are incredible tragedies for all concerned. There's no question about that. What is the solution, and what are some of the useful steps along the way? Just to give you some examples, each of these individuals was turned away from emergency rooms for a different set of reasons -- i.e., there wasn't a secure site; there wasn't a protective room where they could be secured. There was a whole range of reasons, but the bottom line is that all three cases have been documented as presenting at an emergency room for some kind of evaluation or medication, and were turned away and then committed some horrific crimes.
The parents who brought these issues to me believed that two crimes happened: their children did not receive medical care when it could have assisted them, and the people who were abused in this process -- the public -- were also compromised. I would be interested in whether there have been any studies and whether this ministry has some direction in how best to receive the adult psychiatric patients when they voluntarily present at emergency rooms in this province and emergency rooms do not have the resources available to receive them. What is the next step for patients and for parents in this province?
Hon. P. Ramsey: I sought a fair bit of advice from staff, because I find this a very complex issue, one I didn't want to respond to without having some advice.
I share the member's concern. Indeed, I could give her similar examples from my own correspondence or my own experience of people with psychiatric disorders who have used one of those two classic self-referrals of last resort, almost, which results in people suffering from severe psychiatric disorders ending up in emergency rooms or in police cells, neither of which is probably the appropriate venue for them to be dealt with. As government, this ministry has done what we can to ensure that the traditional neglect of funding for mental health services has been reversed. Over the three budgets that we presented, funding for mental health services has gone up at a greater rate than any other period in funding for mental health services in this province's history. I think the total goes up to an increase of about 60 percent.
What is lacking is the coordination of those services at a local level. If I look at some of the recent reports that have been done on the Riverview replacement, coordination at the local level is very often seen to be what we as a ministry and as individual care providers need to be concerned about. In a way, it is almost classic of the fragmented nature of the health system that we have now. There are close to 100 agencies in the Vancouver area that provide one service or another to mental health consumers. Sometimes I can't find my way through the chart of which services are provided where. How can we expect those who are suffering from a psychiatric disorder to find their way? Quite frankly, I don't think that can ever be done operating out of this building or this city. We need to make sure that the coordination is occurring within the communities where those suffering from psychiatric disorders needing mental health care live.
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Not to dwell on it, that's another reason I am so committed to the idea of making sure that we establish those coordinating bodies and administrations for health care delivery for mental health consumers and for other British Columbians needing health care.
L. Reid: As the minister heard, I did not refer to specific hospitals or specific patients; I am happy to share that information. The dilemma still is: what happens to a patient who presents at an emergency room and is turned away? I appreciate all the coordination and how valuable that will be.
[3:45]
The families that have written -- and I know that they have written to both of us -- talk about the suicides because of inappropriate jail placement, and about the assaults that have occurred. Is there any answer today? Is there any consistent protocol in place across this province for adult individuals who present with immediate psychiatric needs and who can't be turned away. In two of these instances, the individuals were asked to come back the next day, and horrific things occurred in the intervening time period. Is there a protocol that parents in this province can rely on if they have a psychiatric patient who is now finding their way into the community and who will place some stress and strain on the system unless there is a protocol in place?
Hon. P. Ramsey: I do not want to leave the impression that the ministry has been standing still or simply saying that we have to wait until the establishment of the community health councils before we can start to address that problem. That's simply not the case. In the last fiscal year, for example, we established 116 new support groups for mental health consumers and drew up over 7,000 contracts through the partnership education program, which is designed to provide information and education on mental illness. So we are doing the work, as we can, to ensure that there is the coordination of mental health services at community and local levels for mental health consumers. This has been part of the overall and very substantial increase in funding for mental health services over the last few years. And those initiatives go on. For example, Vancouver General Hospital is currently partnering with St. Paul's and the Greater Vancouver Mental Health Service Society in developing a proposal for the Closer to Home fund in that city for a bridging team -- a short-stay, transitional facility -- in the community. So a lot of work is going on in communities around the province to address this serious issue.
There are standard procedures for addressing the needs of mental health consumers who present at emergency rooms. Do they always work? I won't pretend that they do. You've seen the letters, as have I, about some of the tragedies that occur when things go wrong. Is this being addressed as best it can right now through the fragmented system we have? I see many care providers doing their best to coordinate with each other. I continue to stress, though, that I think the ultimate way of dealing with this is to make sure that we have the coordination and the responsibility for the delivery of mental health services in place at community and regional levels, not at the variety of levels to which they now report.
L. Reid: My thanks to the minister. If I may spend a moment this afternoon on alcohol and drug programs, I also have a number of pieces of correspondence that, frankly, suggest extreme hardship, based on the increased daily costs for those programs. Apparently -- and the minister will know far better than I -- there are agencies, such as fire departments and police departments, that have resources in place to pay for those kinds of programs, but their ceiling is no longer commensurate with what the ministry is now charging for those services, so it leaves a tremendous shortfall for the patient. It seems to me that it would be the goal of the ministry to have anyone who's interested in a drug and alcohol rehabilitative program benefit from it, because the costs to society are significant if those issues are left unchecked, particularly when the patient has expressed some desire to participate in a program such as that.
I also understand that the program-analysis system is now in place to monitor patients in this province. I'm not familiar with that monitoring system, and I would appreciate the minister's comment on the program-analysis system regarding the delivery of drug and alcohol programs. I'm asking the second question to emphasize the need for some kind of cost-benefit analysis. Will the monitoring program suggest any other avenues of funding for individuals who are currently being asked to contribute a tremendous personal outlay for participating in those programs? I think this government would very much want them to take advantage of those kinds of programs in order to reduce the other social costs, which the tax base would continue to pick up.
Hon. P. Ramsey: I thank the member for raising some important issues regarding alcohol and drug programs provided through this ministry. Just for the record, I want to indicate the scope of the alcohol and drug programs being delivered in the clinical service area. That's what we're focusing on here.
We have over 200 service providers who provide clinical programs throughout the province. They do policy development, program innovation, improvement in strategies and implementation of changes. Last year some 14,300 adults were admitted to detoxification services, another 18,000 were admitted to out-patient services and 3,200 benefited from treatment in residential settings. That's a large number, and I think it reflects the seriousness of the problem of alcohol and drug abuse in our society.
One of the things happening in alcohol and drug treatment is that the emphasis on residential programs as the answer is fading. Studies seem to show fairly consistently that there is no real difference in outcomes of people who've gone through a residential program compared to those who have gone through a day program or short-term program. That's the reality of treatment outcomes right now in the alcohol and drug field. Given that that is so, the choice for residential is almost an individual choice of where the patient wishes to receive care. Therefore we took that into account when we addressed the issue of fees for residential settings and increased them this year.
The rate that has been established reflects the actual cost of room and board, not of the treatment program. We recognize that some individuals will need financial assistance; therefore those fees are based on a sliding scale in order to provide assistance from the limited support funds we have available through alcohol and drug programs.
L. Reid: I appreciate the minister's comments. That's one of those very complex issues that hopefully will be resolved very soon.
I have some questions this afternoon on funding for AIDS issues in the province. There are some pressing contradictions in what has gone forward from this government and what is considered to be fact by the AIDS
[ Page 12423 ]
organizations. I would simply put forward both these items into the debate and ask the minister to comment.
Today the government is claiming that community groups received a 10 percent increase in AIDS Secretariat funding for AIDS projects -- more than any other area of health care this year. However, the AIDS organizations in this province suggest that the overall funding for community-based AIDS organizations decreased by 3.5 percent in 1994-95, which represents an actual decrease of $98,000. It's not just the AIDS Vancouver issue I want the minister to address, because I have a number of pieces of correspondence that look at AIDS funding for the needle exchange program throughout this province. Could the minister perhaps comment on the first contradiction?
Hon. P. Ramsey: I'm pleased that the member has seen fit to raise the issue of the treatment this ministry provides to those living with HIV/AIDS. There are approximately 5,000 to 8,000 British Columbians currently infected with the AIDS virus. As of December of last year, close to 1,700 cases of AIDS had been reported since the first case was reported back in 1983. In the last decade, our experience and ability to assist those living with HIV/AIDS have grown considerably. Over that period, we have increasingly dealt with measures to educate the broad community about the dangers of this disease and the prevention measures that should be taken.
In '92-93, the last year for which end-of-year figures are available, the Ministry of Health spent approximately $22 million on targeted AIDS and HIV programs: about $12.5 million that went into hospital programs; another $1.5 million for continuing care services; close to $2 million for medical and diagnostic services; $4 million for prevention and education; and $2 million for drugs through Pharmacare. I suspect that there are other health programs that were used by people living with HIV/AIDS.
In 1993, the previous Minister of Health established the AIDS Secretariat and charged it with allocating funding for community-based groups who provide prevention and education projects. This is one segment of funding that this ministry provides for HIV. I also want to note for members in the House that this portion, this $2.75 million that was provided for community-based AIDS prevention and education projects this year, is part of what this ministry and government does on HIV prevention and education initiatives. The total cost of those initiatives for government this year will be closer to $4.5 million.
Considering that when we took office, the amount spent on all AIDS prevention education programs was less than $1.5 million, I think our commitment to prevention and education projects dealing with the AIDS epidemic is clear. Last year, for '93-94, the secretariat allocated some $2.5 million; this year the budget provided to the secretariat amounted to $2.75 million, a 10 percent increase. I think I'll end there. I'm sure the member has further questions.
L. Reid: The minister has confirmed that the government's claim of a 10 percent increase.... That's the story, and that's where he's going with it. The AIDS organizations suggest that there has been a 3.5 percent decrease. I am left wondering which indeed is the correct figure, hon. minister.
The government's second claim is that the secretariat decided to provide most major Vancouver AIDS groups with the same money as last year or more, and devoted new money from the 10 percent increase to ensuring equitable distribution throughout B.C. The AIDS groups are suggesting that the major AIDS groups in B.C. received over a quarter of a million dollars less than last year, representing a 12.7 percent decrease. That is their contention. Would the minister please comment.
Hon. P. Ramsey: I would say that I have had some interesting times myself in the last couple of months trying to ascertain what the accurate figures are on this issue. One thing I do know with all certainty is that the cheques we're writing and the funds we're providing to the AIDS Secretariat for distribution to community groups working on prevention and education projects have indeed increased 10 percent. What is also clear from those figures I read earlier is that this ministry and other areas of government provide additional funding for these groups, for other AIDS education and prevention projects and for the treatment of those living with HIV/AIDS.
As the member is aware, I have asked my deputy minister to review the funding received by all those community groups involved in AIDS prevention and education with a view to ascertaining the facts of this matter. I can tell the member that I expect to be making an announcement later this week on the results of that review. I'm not prepared to share them at this time, because there is some work being done to contact individual groups.
I will say one other thing as long as we're dealing with the AIDS Secretariat. One thing that I have announced already is that I share the secretariat's view -- indeed, I share the Coalition of AIDS Groups' view -- that what we need is a comprehensive provincial strategy to deal with AIDS. We've had a strategy to date that has been a bit of this and a bit of that. It's been largely the responsibility of the Ministry of Health. It has not acknowledged the contribution that other ministries of government need to make both in preventing the spread of HIV/AIDS and in assisting those who are living with the disease.
[4:00]
That is why I announced, earlier this month, the expansion of community membership on the AIDS Secretariat. The number of community representatives now represent over half of the members of the secretariat. The ministries of government that are represented on the secretariat have also been expanded to include not just the Ministry of Health but also the Ministries of Social Services, Housing and Attorney General. This will ensure that we're getting a cross-ministry view of both the issues affecting those living with HIV/AIDS and the measures that should be taken through prevention and education projects to prevent the spread of the disease.
L. Reid: I certainly won't comment on the minister's upcoming announcement. I can only trust that it will make these groups happier than your previous announcement. I will simply make my comments known today, and if the answers to these questions can be contained within the announcement that is yet to come, I would certainly appreciate that. The contention today, which seems to be documented appropriately, is that no additional dollars were received by AIDS Vancouver, AIDS Vancouver Island or British Columbia Persons With AIDS. In fact, membership has increased by 35 percent, to over 2,000 members. That's their contention. I am not in receipt of information that allows me to believe that they are in error.
[A. Warnke in the chair.]
I would ask the minister to comment, if he might, on the fact that the AIDS Secretariat believes they are being asked to divide the AIDS-funding pie, if you will, into smaller and smaller slices. They received 65 applications for funding in
[ Page 12424 ]
1994-95, and they ended up allocating dollars to 47 of those agencies. That is the government claim. The fact of the matter is that this represents a total increase of 142 percent in the actual number of groups receiving money, but they are having to divide a diminishing resource. I hope that claim can be addressed in your pending announcement. Their other contention is that only two dozen groups receive secretariat support, many of which are based in the lower mainland. Their contention is that the 19 groups that received support this year were cut back 22 percent.
I appreciate the minister's comments that he too is having difficulty coming to grips with what the facts are surrounding what appears to be very contradictory information. I can only trust that the announcement that is expected this week will respond to a number of these concerns. The issue is one of prevention in a number of respects, particularly around the delivery of services in the needle exchange program. It's not just the Vancouver-based agencies that have difficulty -- certainly the Surrey Interagency Network.... "This letter is written on behalf of the Surrey Interagency Network to express our concerns regarding the recent funding cuts to needle exchange programs throughout the province and particularly to the Surrey Family Services Society needle exchange program." So it's not just the Vancouver program.
I will not read the entire document into the record, but it seems to me that there is tremendous confusion around the issue. I for one look forward to your upcoming announcement, which will hopefully shed some light on where all these inconsistencies appear to lie. If the minister wishes to shed some light on them today, I would welcome that.
Hon. P. Ramsey: Let's deal with a couple of the general realities that I think are affecting this whole case. The first is that there are any number of worthwhile projects out there. The AIDS Secretariat received requests for funding of prevention and promotion projects. It was a total request for in excess of $7 million, and I do not doubt that many of those projects are very worthwhile. What we are faced with, as the member and the Chair know, in these difficult financial times is limited resources to meet that range of growth. I authorized the provision of a 10 percent increase in funding to the secretariat. The member has alluded to some concerns about how that funding was distributed.
Let's make it very clear. Funding for the AIDS Secretariat did not diminish this year. Funding for AIDS prevention and education projects did not diminish this year; it increased. The AIDS Secretariat took it upon itself to look at the applications it received and allocate the funding that was made available to it. In the cases that the member referred to, the AIDS Secretariat made a decision that less funding or the same amount as the previous year would be provided. In some cases they said very explicitly that they felt that the services being provided by a specific agency did not justify the extent of funding that had been received in the previous year or had been requested for this year. I suggest that that is an appropriate decision for the secretariat to make. This is a group of highly involved individuals who are very committed to AIDS prevention and to caring for people living with AIDS in their communities. When they tell me that they think a particular agency has not made good use of funding provided and that they are therefore recommending a decrease in funding, I think it's incumbent upon me to take their advice, and in many cases I have.
As I indicated earlier, I have asked my ministry to review the funding for all agencies that have received funds through the secretariat and to advise me of any decrease in services that has occurred in the broad AIDS prevention initiative through the community agencies. As I said, later this week I hope to announce the results of that review and any action on recommendations in it.
L. Reid: Rather than ask the minister to pre-empt his announcement, I hope, just for the record, that the announcement contains some assurance about long-term funding. It seems that a number of these agencies spend a great deal of time and energy on the bureaucratic process in terms of trying to assure their funding and to commit to some kind of long-range plan for the delivery of services. I don't know if that will figure prominently in the announcement that is to come. But if there is any way to allow these agencies to focus on the direct delivery of the service as opposed to constantly grappling with the funding issues, that would go a long way to providing some kind of ease or sense of purpose for these agencies.
I concur with the minister that they do some very fine work. The secretariat has done some very fine work, but if we allow all its energies to focus on where the funding is coming from and what the amount might be, that detracts from the direct services it was created to provide and, I think, would very much like to provide. I would hope that some sense of that is contained in the announcement on Friday, because it's an issue for every British Columbian, in terms of health care costs. We have talked many times about the cost of prevention, and the needle exchange program is about the cost of prevention. When we talk about one-time grants and one-time funding for something that is a continuum of service, it lacks justification. It lacks what it is to be rational about whether or not you fund a needle exchange program or some of the other resources that are designed to provide direct service on the street. I hope that will figure prominently in the minister's announcement, and I thank him most sincerely for his comments.
Hon. P. Ramsey: I thank the member for raising these important issues in the chamber today.
I don't want to pre-empt some of the work that's going on by people in the ministry in dealing with community groups concerned with HIV/AIDS. Let me just say that I think the member has identified one of the root problems here, and that is that this network of community groups providing services -- sometimes for prevention and health promotion, sometimes for service delivery -- has really grown like Topsy. What is occurring in one part of the province is not necessarily the same as what is happening in another part. The funding for needle exchange programs, for example, is not consistent in the source of that funding around the province.
In developing a provincial AIDS strategy and focusing on prevention initiatives, we have asked the secretariat to help us address how those programs should be funded. I share the member's concern that we don't want groups spending half their time and two-thirds of their resources preparing their next grant rather than delivering the services that they wish to get on with delivering; that is a serious concern. The question of ongoing funding and how those services are actually delivered through community groups or through other agencies is something that the AIDS Secretariat is going to be looking at, as well as the issue of what ministries and what sources of funding should be available for AIDS prevention and education projects.
L. Reid: I will ask just two more questions. I want to refer to a February press release from the Vancouver Hospital and
[ Page 12425 ]
Health Sciences Centre entitled "Vancouver Hospital Planning To Restrict Access." My office has received a number of calls about whether it is the intention of this hospital or this government to dictate from which physician and at which hospital a British Columbian can receive services. For the record, it seems to suggest that the Vancouver Hospital and Health Sciences Centre has initiated planning to redirect patients from outside the city of Vancouver who require secondary-level services. These patients will be encouraged to seek medical care from a local community hospital instead of coming to Vancouver Hospital for treatment. Examples of secondary services include gall bladder surgery, hernia repair, general gastrointestinal medicine, hysterectomies, and general ear, nose and throat surgery.
A number of questions that I would pose to the minister regard British Columbians whose doctors have admitting privileges at hospitals in Vancouver but the patients do not happen to reside in Vancouver. They read this announcement as somehow directing them to select another physician, because if they needed any of these surgeries or interventions I indicated, they would have to seek another surgeon, if you will. Was that the ministry's intention? Was the ministry aware of this directive from Vancouver Hospital?
Hon. P. Ramsey: I surely was aware of it after I received it in my office. Let me just say this very briefly, since the member indicates she has more questions to ask on this issue. As a result of the Shaughnessy closure, a substantial number of resources and beds were distributed to other hospitals in the greater Vancouver area. In some cases, while the funding for services went to those hospitals, the physicians and specialists who delivered those services chose not to. This has created some sort of an imbalance. I read the announcement of Vancouver Hospital -- and I should emphasize that it's their announcement -- as their method of dealing with what they perceive as being put upon to deliver services for the funding that has gone out to some of the suburban areas around Vancouver.
This letter, and the responses to it, is one of the reasons why, in the funding letters sent to hospitals this spring, we required that they consult with one another before any of them took measures to reduce services provided within their facilities. We did not want the situation where one hospital said, "We're not going to do that," and another hospital said: "We're not going to do it, either." If the services are going to shift -- and in some cases they should shift, because it rationalizes health care delivery and helps avoid unnecessary wait-lists, which is something that the member was talking about a great deal earlier today -- then it needs to be done in a coordinated fashion between hospitals.
In conclusion, hon. member, I have no difficulty saying that those services should in some cases be shifted out of central Vancouver, out of VH, to community hospitals. The responsibility of those hospitals and this ministry is to make sure that the services are, indeed, shifting and are still available to residents of the greater Vancouver area.
L. Reid: I would like to spend just a moment on the doctor-patient relationship, which I perceive as very significant. Even though the service may indeed be available, what this notice is suggesting -- and from your comments, I suggest that you're concurring with this announcement -- is that the direction for patients in this province is that they will need to select a different physician if the services are not available to them. There would be little value in having a physician who could see you for a common cold and a surgeon who could see you for minor things, if when you really needed them, you were forced to find another physician. I'm not sure we've done anything in terms of improving service delivery. What patients in this province have said to me is that they value that relationship. What this has done is to open the door in terms of directing people to select another physician. Is that a discussion you have had with your ministry?
Hon. P. Ramsey: On the contrary, I would say that this sort of rationalization of health care delivery asks physicians to move to where their patients are. There is nothing that prevents a physician from having privileges in a variety of hospitals and going where his or her patients are. As we make regionalization of resources more of a reality and move some services "closer to home," I think we will have better distribution of physicians and resources around the province.
[4:15]
I might point out to the chamber that yesterday in Prince George I had the pleasure of announcing a task force to look at a rural and remote health care delivery strategy for this province. One of the prime components of that is looking at the whole issue of whether we should be asking people from rural and remote regions to come to major urban centres to receive specialized services, or whether it is more appropriate and cost-efficient to look at moving those services closer to those patients. Also, we need to quantify exactly where people receive specialized services now, and do a good analysis of whether or not those services could be moved closer to where people actually live.
I want to make it very clear that as we move forward in regionalization, the boundaries between regions are not made of barbed wire. It is not the intent of regionalization to say: "You must receive services within this region." The intent is to make a wider range of services available within regions that have been traditionally underserviced, so patients have the choice of receiving services closer to home.
L. Reid: I disagree with the minister. There is something today that prevents physicians from having admitting privileges at a number of hospitals: the physician resource plan. Most hospitals do not wantonly open their doors to a myriad of physicians. The minister probably would concur in hindsight, because this minister has often said there needs to be a plan around physician supply. So I perhaps we're looking at some interim discussion on how we don't move immediately to a plan that in fact will dictate to patients in this province where they can receive the service.
My question to the minister is about this directive from Vancouver Hospital. Is it the ministry's contention that this is binding? Or will we be in some kind of evolutionary phase that allows this to be brought in through a measured, controlled approach to changing a fundamental service option, which is the ability to select your physician?
To add to the discussion, we currently have a lot of British Columbians who work in Vancouver but reside in all parts of the lower mainland, and a lot of medical services are received during the day. They take time off from work during lunch or whatever to receive that service. Are we oftentimes in fact simply shifting the cost somewhere else? We're going to say: "Come in to work if you need X service. Take the day off; go back to Surrey, Langley or Abbotsford; get that medical care and then come back again." Are we in fact looking to save some dollars in health care, simply to shift them over to spend them in some other place? I'm not
[ Page 12426 ]
clear what this ministry does with this announcement. To condense my question: is this binding today?
Hon. P. Ramsey: I'm not sure what I'm being asked is binding today. Nothing is binding today, nor have I said something is binding tomorrow. "Thou must receive thy health services at the hospital that's closest to thee" -- I have made no such pronouncement.
Let me say this very clearly, though. Those services that are received on a day basis traditionally have been funded in some of the major urban hospitals. That funding base is there, and I don't think we plan to change that. But a number of specialty services requiring hospitalization are more appropriately delivered closer to where people live. To simply say we're going to restrict choice, when the only choice for people in Kamloops has been to come down to St. Paul's, or the only other choice for somebody in Terrace has been to come down to a Vancouver hospital, is to ignore the reality of people's lives, I submit. That was not a choice. That was forced, because the services were not available closer to where they wished to receive them. Our goal through regionalization and physician supply measures is to match the need for delivery of services with funding and the physician resources required to deliver them.
L. Reid: I was asking if indeed this directive was binding. I heard the minister say no, British Columbians will still have a choice. They will be very pleased to hear that.
In the broader issue of physician resource supply, certainly there are a number of medical students today who have some questions regarding where they would take their medical training, postgraduate training, fellowships and advanced educational opportunities, and whether the choices they make today will hinder their ability to return to British Columbia to practise. I know that's certainly been an ongoing discussion with the profession and ministry officials. I'm wondering if there is some further discussion or update on where that sits, and perhaps some advice for new physicians in this province, folks who have recently graduated or will graduate next year, as to where they can head under that physician resource plan.
Hon. P. Ramsey: When we announced the interim physician supply measures back in February, we made it very clear that we did not want to impact on those studying and currently preparing to practise medicine in this province. Those measures were designed not to curtail their options, and that remains a very serious issue for us.
I now have received the report of the task force on physician supply. As the member knows, the representatives of residents, interns and UBC medical students were involved in consultation and preparation of that review. I plan to be announcing some next steps in physician supply measures -- this is going to be a busy week -- in a couple of days. I assure the member that the issues raised by medical students, residents and interns are being taken very seriously as we design some next steps in developing a comprehensive physician supply model and measures to ensure the right number of physicians, the right mix of physicians and the right distribution of physicians for the health care system in British Columbia.
L. Reid: I look forward to the announcement in the next number of days. I would simply question whether or not some discussion has gone on between other ministers of health in the other provinces in terms of a national strategy for physician resource supply. Could the minister kindly comment?
Hon. P. Ramsey: There's both a yes and a no to the questions here. The Barer-Stoddart report, which was agreed to by all ministers of health, said that one of our difficulties is that we were simply training too many physicians in the country and that measures had to be taken to reduce the number of medical school placements by some 10 percent. That initiative was taken on a countrywide basis.
The other task that provincial ministers of health are undertaking is to coordinate the physician resource plans that are being developed by various provinces. Ideally, those will be worked out across the country in such a way that one province isn't doing something that impacts on another. That's the theory; the reality, unfortunately, has been somewhat different. Some provinces, particularly Ontario early last year, took measures to restrict the practices of new entrants to the medical profession, and other provinces responded to prevent an influx of physicians from Ontario who were seeking but unable to obtain practices in that province. I would hope, when I meet with my colleagues from across the country in the fall, that we'll take steps to coordinate our activities in physician supply management a little better than we have done in the last 12 months.
L. Reid: I would hope that the discussions around physician supply that occur in the fall are indeed fruitful, because I tend to think it's somewhat simplistic to suggest that a 10 percent cut is going to solve the problem. I'm hoping that the discussion will focus on encouraging students to enter specialty and subspecialty fields that are in demand in British Columbia. The reports I have before me suggest that we need psychiatrists, obstetricians and general surgeons in this province. A 10 percent reduction in who enters medical school does nothing in terms of measuring whether we graduate people with the skills we need in the province. I'm not convinced that our needs are dramatically different. If they are, I welcome that, because I'm hoping it is a unique plan for British Columbia. What I consider to be a gross measure -- to restrict by 10 percent -- will not answer the needs.
We started this debate by talking about Williams Lake needing a surgeon and another area in this province needing an obstetrician and the fact that psychiatric services are difficult to find in various parts of the province. Perhaps the minister can comment on whether the plan will recognize those three specific needs -- obstetrics, psychiatry and general surgery -- and whether the discussion he will be having in the autumn with other health ministers will recognize that for different parts of this province it cannot be just the crass measurement of decreasing entrance by 10 percent. There has to be some ability to measure who actually finishes medical school and what kinds of skills they bring to bear on a very pressing problem. I would ask the minister to comment.
Hon. P. Ramsey: First, I hope I didn't create the impression that we were reducing enrolment in UBC medical school by 10 percent; we have not. The recommendation of Barer-Stoddart was that nationally we need to look at that sort of reduction. Other provinces were indeed overtraining for the population they had available.
There are a number of very serious issues here. The member is absolutely right that you can't do physician supply planning simply by looking at the gross number of physicians. It is far more complex than that. The member
[ Page 12427 ]
identifies three specialties that are obviously of great concern. I might mention in passing that psychiatry is an example. I think the member and I both read the recent auditor general's report on psychiatrist supply in the province and saw the great disparity of supply which was all out of proportion to the need for those services in different parts of the province.
We have a system that depends almost entirely on an individual practitioner's choice about where to practise or on how many practise. That's the sort of disparity we're going to get. That is precisely why we need a physician supply plan that addresses those inequities both in broad terms -- number of physicians -- and in the number of individual practitioners.
More than that, though, there are other aspects of this issue, and I will talk about a couple of them. One is to make sure that the training that physicians receive fits the needs of the health system they are going to practise in. I'll give one example. Particularly in some rural and more remote areas of the province, there is a need for surgeons with a broad range of expertise that may not be inculcated by current medical school training, which tends to focus more narrowly on one particular specialty. We need to make sure that we are training and planning for the future population of physicians in a way that fits the needs of the health system we're devising and building in this province. Those discussions are ongoing with the medical school in this province and, I suspect, between ministers of health and medical schools in other provinces as well.
[4:30]
The other issue is the more difficult one of how to get better distribution of physicians around the province. The interim measures that I announced back in February attempted to do that by offering 100 percent fees in areas of the province that are underserviced and 50 percent of normal fees in areas that are overserviced. That seems to have had some effect. I won't pretend that it's been perfect, but it has had some of the desired effect. Measures like that, worked out through negotiation and cooperation with the BCMA and the College of Physicians and Surgeons, will lead us to a physician supply plan that can meet the needs of the province for the number, for the training and specialties of physicians, and for their geographical distribution.
L. Reid: When the minister talks of areas of the province that are perhaps overdoctored, or underdoctored, is that formula available? Indeed, is it always appropriate to look at that breakdown in terms of the number of GPs, specialists and subspecialists? I can appreciate that there may be regions of this province that are overdoctored in terms of general practitioners, and that relates to my comment in terms of just a 10 percent reduction. When it appears that we need specialists and subspecialists in greater numbers, I'm not convinced that a 10 percent reduction across the board is the answer. So I ask the minister to perhaps clarify whether the 10 percent reduction that is not in place -- but that is anticipated and being discussed -- refers to general practitioners or to medical admissions across the board.
Hon. P. Ramsey: The 10 percent reduction I referred to is in medical school admissions across Canada. There have been no reductions in medical school admissions in this province. Traditionally, this province has actually admitted more physicians from other provinces to practise; it has met some of its need from that, rather than from training within the province. That has been a traditional part of medical training at UBC. So we're not reducing the numbers.
The issue of how you make sure that the needs meet the training -- or that the training meets the needs -- is as complex for medicine as it is for any other profession. Those discussions are ongoing both at the provincial level, to which I referred, and at the national level to make sure that we have the right mixture of specialists, subspecialists and GPs practising in this country and in this province.
I thought there was one other item I wished to comment on, but it slips my mind now. I'm sure the member will remind me of it.
L. Reid: I was hoping that the minister would respond in terms of whether or not there will be a breakdown.
Hon. P. Ramsey: I knew there was another part to that question. The Medical Services Commission has drawn on a variety of models for ratios of specialists to general population, and it has developed a table of what those ratios should be, broadly, for a particular population. These are seen as guidelines that can be used to assist in the development of regional or provincial physician supply plans. They are not cast in stone for particular regions or for the province as a whole. They indicate a general consensus framework, rather than any rigid requirements.
L. Reid: I have just one other question pertaining to physician supply, and it's regarding the J-7 visa scenario. I have been in touch with this ministry on a number of occasions on behalf of medical students who are British Columbia graduates but wish to take additional training outside the province. It now seems that stumbling blocks, other obstacles, have been placed in their path in terms of them getting that training, which is very much in demand in this province. Unless these students can provide to the ministry -- to the body -- some verification or authorization from a British Columbia hospital that they are guaranteed of being a physician at that hospital when they return, they are indeed not able to go. It seems to me that that was an add-on bylaw -- an add-on regulation, if you will -- in terms of restricting physicians trained in British Columbia from receiving what I think should be available to them and to the patient base in the province.
It would certainly seem that we would wish to have the finest trained physicians in this province, and to bring to bear the finest level of expertise, the finest calibre of medicine. If we suggest that a British Columbia physician who wishes to receive some of the fellowships or residencies that are available....
The issues that I brought to your ministry were around oncology training. There were two individuals. Both had been offered fellowships at centres in Texas, but were not able to satisfy the J-7 visa requirement, which seemed to be somewhat of an arbitrary item. Could the minister kindly comment?
Hon. P. Ramsey: I don't think the issues for out-of-country training are greatly different than those for in-country training. We need to make sure that the physicians being trained fit the needs of the population of the province or the country in which they are going to practise. Therefore, when Canadian residents apply for postgraduate medical training in the U.S.A. they are asked to acquire a letter of support. The letter must state that there is a need for the candidate's services in Canada on completion of training.
When they wish to train in disciplines recognized as having pending or present shortages in this province, we
[ Page 12428 ]
provide those letters -- no question at all. If a shortage is recognized, those letters are there, whether it's for somebody simply doing initial training and completing the two-year prelicensure training abroad or for a practitioner going on to further training. Those letters are provided to physicians who wish to go to the States or elsewhere to obtain further training.
This is a requirement, I must say, of the admitting country as well as the country sending the physicians abroad for training. They wish to know they are training people who are going to be returning to the country or province they're coming from and practising the skills they are acquiring in the States or elsewhere.
I don't think the member would suggest that we should be providing letters saying that that opportunity to practise is available when our analysis says it is not.
L. Reid: Perhaps where the confusion lies is that it did not seem to be a simple requirement -- i.e., is the service needed in this province today? It was asking hospitals and future employers in this province to guarantee that person a position four or six years down the road. A lot of these residencies and fellowships were of many years' duration. That was where the confusion existed.
The minister indicated in his earlier remarks that trying to indicate specifically what the need will be four or five years from now is not a pure, predictive science. We agree on that point.
It was explained to me and these practitioners at the time that they must have a guaranteed job to return to, whether they were out of the country for five years or ten years. That made that educational opportunity non-existent for them: no one could provide that kind of guarantee. It was a greater expectation than a simple suggestion that their services may be needed. I ask the minister to comment.
Hon. P. Ramsey: Let me just say I can provide the assurance that I think the member is seeking. I am not aware of the ministry requiring a specific position to be identified before writing a letter of support for a physician seeking U.S. training. If the member has an example, then I'd be interested in knowing about it. I'm sure the ministry indeed does canvass hospitals, as they should, to ascertain the need for physicians with a particular specialty or subspecialty training. Just to restate it, I'm not aware of the ministry requiring a specific position at a specific hospital be identified and guaranteed before a letter of support is issued. We want to ensure that training is obtained. We have a high-quality physician resource for use in the health system and for the use of the people of the province. Whether that training is obtained in-province, in Canada or in other countries, I think all are valuable.
L. Reid: There were two physicians whose names I shared directly with your office; the name of one individual was Dr. Ralph Wong, and I can certainly provide the other name to you. But in ministry correspondence, both were asked to provide a job guarantee, and it seems to me that that is incredibly restrictive. If it was not the intention, I trust this situation can be rectified. But in dealing with your ministry officials, it was abundantly clear that that was the requirement and the expectation. That seems very contrary to what you're suggesting today, and I would simply ask for clarification.
Hon. P. Ramsey: Without knowing the details of the cases here, I guess we're dealing in the realm of theory. I can conceive, I suppose, of a case where a physician might be required to produce an indication that a job would be forthcoming at a particular hospital. I can conceive of some subspecialties which would only be applicable in one or two hospitals in the province, and if those hospitals have no need for that training after a year or a year and a half of time abroad then, indeed, there's no demand for that training in the province. So I can conceive of a theoretical situation where that might exist. I'll be quite pleased to look into the specific circumstances that have been brought to the attention of the member.
L. Reid: I thank the minister most sincerely for that, because the question was truly whether or not any institution could be asked to predict needs five to ten years down the road. So I would certainly thank the minister for seeking clarification on both of those cases.
W. Hurd: I have a brief series of questions for the minister with respect to the Boundary health unit in Surrey. The minister will be aware, of course, that Surrey is one of the fastest-growing regions in the country. I have received a specific set of concerns from the Boundary health unit with respect to programs which cannot be funded or met out of the existing FTE allocation. The concern being expressed is that these deficiencies in funding -- these somewhat unfair allocations based on the inability to recognize growth in that region -- may in fact become institutionalized or entrenched in the conversion to the regional health model.
[4:45]
I wonder if I could ask the minister specifically what protection is being built into this transitionary period to account for the fact that some regions of the province, by virtue of the growth, are already struggling to deal with the existing funding allocation. Are we now in danger of seeing that level of funding transferred into a regional health model and the inequities that are built in merely being transferred on? Is an effort being made with this conversion to recognize that the high-growth areas face critical funding issues? They seem to fall through the gaps of the existing funding formula. I wonder if the minister could comment on that briefly, to start.
Hon. P. Ramsey: For fast-growing areas such as the Boundary health unit, I sometimes think it's almost impossible to keep resources up to the demands being generated. I recognize that the Boundary health unit is having difficulty making sure that sufficient resources are available to the people who live there. Let me just point out a couple of things here. This year public health in the Boundary health unit was provided with $8.5 million. Three years ago, in the last budget of the previous administration, they received a budget for public health of $5.8 million. That's a 46 percent increase for public health spending in the Boundary health unit in three years.
I would say two things to the hon. member. First, this government and this ministry recognize that there are unmet needs for public health services in the Boundary area. We have been increasing funding for services in that area more rapidly than in other areas of the province where population growth is not as rapid. Second, I want to acknowledge that what the member says is accurate. Even with this infusion of funds, substantially above funding increases elsewhere in the province, there are unmet needs in the Boundary health area.
There was one other issue that the member raised that I should briefly comment on, and that was whether current inequities in funding for health services -- and there are all
[ Page 12429 ]
sorts of them -- are going to be locked in by funding to regional health boards when they take responsibility for funding services provided to citizens in their regions. The answer is no. We are working to devise a funding formula for regional health boards that is based on the population served by those regions. What is the number of people who live there? What is their health status? What are the difficulties of delivering health care services in that region? Therefore, what sort of money should be allocated to that region?
The member is quite right in saying that the current funding pattern has grown over time. It is not well tied to the population of specific regions; that's a reality. I believe that through regionalization and through a formula allocation of funding we have a chance, over time, of rectifying some of those inequities.
W. Hurd: In my capacity as an elected member for one of the Surrey ridings, I've received a submission from a Surrey councillor who is a member of the board of the Boundary health unit. He makes a number of submissions with respect to services that cannot be provided in that particular health unit. One of the observations he makes is that this particular unit has been at the bottom of the funding list for the last seven years. For seven consecutive years it has bottomed out on the list.
I wonder if the minister can explain exactly how the health units in the province are graded in those terms. What kind of criteria are we using to make that observation that one health unit is funded at the lowest rate in the province? It would be helpful to me in responding to the directors of the board to know exactly what we mean. Are we talking about full-time-equivalent funding for programs? Are we talking about the level of funding per population? The minister has indicated that doesn't enter into it. Perhaps he could explain, for my benefit, the rating system as it currently applies to health units in the province and how Surrey or Boundary ends up at the bottom of the list seven consecutive years running.
Hon. P. Ramsey: I shouldn't say that we don't attempt to look at per capita funding. We do. The ranking that the member may have received from a member of the public health unit in Boundary is based on per capita funding figures that have been produced by this ministry. They indicate that Boundary is tied with Central Fraser Valley for bottom spot in the funding per capita.
This is a result of two things. One is the legacy of failure to recognize the rapidly expanding areas of the lower mainland, which we inherited. And even with the best will in the world and a 46 percent increase in funding over the three budgets of this government, we have not yet caught up to place Boundary higher in that ranking. Those are the two things that have driven this, and the figures are based on per capita funding. I hope that in a few years the spread between high and low on per capita funding for public health and other health services will be narrow enough that the ranking won't make a lot of difference. But currently, it surely does.
W. Hurd: Given that the minister has acknowledged the existing funding inequity, one would conclude that there would also be inequities in the level of service provided. I wonder whether the ministry attempts to mandate certain levels of service in the public health field when dealing with these varying budgets. I have been provided with a list of services that are apparently not being provided in the Boundary health unit. Item 9 is the inspection of community care facilities for compliance, which is essential for the assurance of health and safety of individuals in those care facilities. This document indicates that there's a backlog of 161 facilities out of 425 in the Boundary health unit that are not in compliance in terms of inspections. If that figure is accurate, if in fact the level of inspections may not be sufficient in that health unit because of a difference in funding levels, surely the minister can see that it would act as a disincentive for relatives to place one of their elderly relatives in a continuing care facility.
Again I return to my general question: given the fact that there are disparities in funding, does the ministry at least try to maintain a semblance of commitment to service levels across the system, or does the Boundary health unit or any other health unit meet its funding crisis by whatever means is available to it, including sacrificing regular inspections? I would think that is a critically important issue for not only this particular health unit but health units across the province.
Hon. P. Ramsey: The member refers to a document which was made available to my ministry, I think, earlier today. My staff has informed me that they are looking right now at the issue of inspection of community care facilities for compliance so that we can assure people who are relying on those facilities that standards are being met. There are other issues in this two-page submission that I suspect the member may refer to.
Let me just say this in general. I have said very clearly that I recognize the needs of the Boundary health unit. We continue to increase funding to it at a rate more rapid than other areas of the province, and we recognize that there may be some unmet needs. I would also say that in some cases it might be possible to meet some of these needs out of the $4.5 million of Closer to Home funding that is provided for the Boundary health unit area. Currently, some of these needs may be inadequately addressed by acute facilities but could well be addressed by programs funded through the Closer to Home initiative.
W. Hurd: I don't know whether the minister is referring to the same document as I have. I know that our councillor is an industrious sort of individual who undoubtedly would have copied the information to the ministry. The minister will know that item 4 talks about the recommendation for one public health nurse per 5,000 people, which the document refers to as a national standard for public health -- which is not being met in the Boundary health region either.
What troubles me is that I'm not detecting from the minister any indication that there are levels of service which have to be maintained despite the funding disparities. It should not be unreasonable to expect that every health region in the province would be meeting the national recommended standard of one public health nurse per 5,000 people. Surely it's not unrealistic to expect that the inspections of continuing care facilities would not be allowed to fall into arrears.
Does the ministry not have some way of mandating certain levels of service that have to be carried out as part of a responsible and functioning public health unit? I am hearing the minister say that no such designations exist and that the funding formula sort of falls where it will, and if some of what I would consider to be essential levels of service fall into arrears, then so be it. Is there any commitment from the ministry to at least ensure a level playing field in terms of some of these basic services: inspections, public health nurses per unit of population --
[ Page 12430 ]
those kinds of figures that I think are an accurate barometer of the success of public health in the province?
[D. Lovick in the chair.]
Hon. P. Ramsey: Yes, indeed we do have the same document before us. You have alluded to two. There are 19 items here, and I suspect we could go through another 17 of these. Let me try once more on the general topic of funding, and the member can advise me whether he wishes to pursue the other 17.
The case is clearly that the area served by the Boundary health unit has been growing extremely rapidly. Over the last three years our funding for public health services in the Boundary health unit has increased over 46 percent. I think that demonstrates a substantial commitment by this government to increase the amount of public health services that are being delivered to people in the Boundary area. I would also comment that we are operating, as the member well knows, within a very tight fiscal framework. We are doing our best to make sure that those funds go where they are needed the most. Boundary is a clear example of that, and the funding increases that they have received are a clear example of that as well.
W. Hurd: I have no desire to go through the 19 items, either, even though I have been lobbied to do so by the councillors and the public in my region. But the minister has not answered the original question, which relates to all 19 deficiencies. Does the ministry have any sort of ceiling or minimum level of performance or minimum level of provision of service? I think that's an important issue as we move to the community-based model. If it's possible for some regionalized health service bodies to be able to not carry out adequate inspections, for example, because of budgetary constraints, not be able to provide the national standard for public health nurses per capita.... Those are service levels which one would expect any health unit to supply, and clearly the fact that Boundary is not able to supply that level of service indicates a crisis. The concern being raised in my riding is that these deficiencies are now going to be shifted and entrenched in the community-based health model. The fact that the health unit still trails the field -- is still dead last -- despite the funding increase alluded to by the minister, indicates that we are going to have a problem when we move to regionalized health care.
[5:00]
I don't see any indication from the minister that the situation is going to improve, by virtue of the fact that there is apparently no built-in recognition of the increased population of that particular health unit. I guess what the people of the region are concerned about is that when they move from eliminating this board into the regional health model, they're not going to see the minimum levels of public health adhered to. I guess my question really is the same. Despite the funding increase that he's alluded to and the fact that we don't have the time or willingness in this set of estimates to struggle through 19 deficiencies, can the minister at least assure the committee that when it comes to public health in British Columbia, there are standards of performance and of care that the ministry demands?
Hon. P. Ramsey: Of course this ministry requires that high-quality services be delivered. Let's be very clear about what we're facing. First, I want to refer to some specifics, and then I want to refer to some general themes that I touched upon when opening these estimates. There's no doubt that the areas served by the Boundary health unit and the acute care facilities in it have seen rapid increases in population, exceeding most other areas of the province. The funding has recognized those increases. For example, I mentioned the increase in funding to public health units. Funding for mental health in the area has increased, depending on the local health area, by between 55 and 70 percent over the last three years. Funding for continuing care has increased by between 27 and 44 percent. These rates are vastly in excess of those in most other areas of the province. I regret that the member continues to say that somehow the needs of Boundary are not being met or that nothing is being done to address them. They clearly are.
Let's go back to some of the basic principles that we started these estimates with. We are faced with a health care system that has to shift the way it delivers health care to the citizens of British Columbia. That's what the Royal Commission on Health Care and Costs said very clearly to those of us who sit in this Legislature and those of us who receive health care in British Columbia. Simply doing the same thing and delivering more dollars to the same set of care providers is not going to work. We must ask those care providers to work more closely with one another through regional and local authorities for governing and delivering health care. We must shift resources from care delivered on an in-patient basis in hospitals to care delivered on an out-patient, clinic or home basis. That is the reality of what we must do to ensure the preservation of medicare.
If the member opposite says that we should increase funding at 10 percent a year to the overall system, then my question to him would be: which taxes does he wish to see increased by an additional 10 percent? If he wishes to see a cost curtailment, as apparently other members of his caucus do, does he wish us to follow the lead of Alberta and start slashing health care spending across the board and let people deal with the results of it? Or does he wish us to go on with what we are doing in this province, which is a concentrated, coherent plan to shift to local authorities? It's a conscious shift from a system based almost solely on acute care facilities to one that has a balance between acute care facilities, community facilities and home-based services.
I will refer one more time to the other sets of services that have been provided in the Surrey area through the Closer to Home fund. This year they have been allocated some $4.6 million to provide new community and home-based services, and I believe that on a per capita basis that's probably the highest amount of funding in any area of the province.
W. Hurd: I appreciate the minister covering the gamut of the estimates debate to date. I want to focus the discussion a little more narrowly on the Boundary health unit again. I have to summarize what I've deduced from the minister's comments so far with respect to this health unit. He has acknowledged that this is one of the fastest-growing regions of the province. He has acknowledged that it currently occupies the last-place standing in terms of per capita funding among the health unit districts in the province. He has acknowledged that while there are minimum levels of standards for public health care.... I'm not too sure what they are. They are not related to the number of nurses per capita, for example. They don't appear to be related to inspections of facilities in that particular health unit. Surely the minister can understand the alarm. As we move to community-based health care, these kinds of inequities are going to result in a tremendous burden for the regional health council. They are going to have to address these endemic funding deficiencies that have resulted in this
[ Page 12431 ]
health unit facing considerable problems in reaching a minimal level of care.
The purpose of my question is pretty logical. If the ministry has a minimum level of care for public health, that is at least a starting point for assistance to this health unit as it moves to regional care. Clearly, if they have to spend dollars to meet the national requirement of one public health nurse per 5,000 people, that could consume a disproportionate amount of the budget allocated to the regional health council. Unless the ministry and this minister are prepared to say that we are going to mandate certain standards in public health across the province and that those standards are going to be recognized in the funding formula before it's transferred to regional care, he's merely transferring the inequities. That's all we're talking about. I think it's a legitimate concern of councillors in Surrey and of members of the board.
I'm delighted that he has a copy of the deficiencies that have been listed concerning the Boundary health unit. I don't know how many of those deficiencies are in contravention of ministry standards. I don't know whether these occur regularly in other public health units. Some of them may; some of them may not.
I'd certainly feel a lot more comfortable if I could hear the minister say that this ministry has certain expectations for public health in the province, and if some units in the province are not able to meet them, we will deal with that before we force the regional health council to expend a disproportionate amount of its resources to pull these units up to acceptable levels. I hope the minister understands the concern and the reason I'm raising it. This particular health unit appears, by virtue of a seven-year funding inequity, to be in a very vulnerable state when it comes to the transition to community-based care.
Hon. P. Ramsey: As I said earlier, the transition to community and regional government structures should enhance the opportunity for those governing bodies to apportion dollars where care is needed. The allocation of funding across the province will be based on a formula that respects the number of people in a region as well as health status and the difficulties of delivery. This should be moving toward more equitable funding of regions, not away from it, hon. member.
As for the rest of it, I think I've responded to many of the questions you've raised. I've asked my ministry to look at the document you have in front of you and ascertain the accuracy of some of the assertions that are made in it. I'll be asking them to get back to you with the information on the accuracy of those assertions.
Boundary health unit, like most health units, does provide a full range of services to the residents of the Boundary region. As I acknowledged earlier, the population of the region has been growing more rapidly than even the very substantial increases in funding have been able to match.
R. Neufeld: I have a few questions for the minister that relate specifically to my constituency. First of all, I'd like to reiterate the viewpoint brought by my colleague the member for Prince George-Omineca regarding the Closer to Home issue. It is a great concern in the north, and I know my area -- Fort Nelson and Fort St. John -- has much the same feeling. They would like to see the process slowed down a little maybe, and a few pilot projects. I would just like to get that into the record. I know it's been well canvassed. I've listened to most of the estimates, so I'm not interested in going into that. I see the minister is happy about that.
One thing I would like to touch on with the minister deals with air ambulance services to the north. I represent Fort Nelson, which has the furthest-north hospital in British Columbia. Fort Nelson supplies services to a tremendously large area -- a large industrial area -- that encompasses most of northeastern British Columbia to the Yukon and Northwest Territories border. There's a nurse's station in Watson Lake, which is 300 miles away. The next hospital going north is 600 miles away in Whitehorse. Fort Nelson has always depended heavily on air ambulance to get people to the lower mainland. We are and have been lucky for quite a number of years in having Dr. Kenyon in Fort Nelson, a valued and competent doctor and surgeon; but Dr. Kenyon will not always be there.
A lot of people try to say we don't have a two-tier health system. I say that anyone who lives more than 100 miles outside of the lower mainland survives on a two-tier health system; that's just a fact. But we still have an excellent health care system. And we have -- we still do have, but it looks like it's going by the wayside -- an excellent air ambulance service. An air ambulance could be ordered out of Victoria or Vancouver and arrive specifically in Fort Nelson in about the same time it takes to prepare a patient and take them to the airport to meet that aircraft.
I'm a little concerned, and so are the people in Fort Nelson -- and Fort St. John, because Fort. St. John utilizes the air ambulance an awful lot, too -- about what will happen if we go to private industry and what kinds of services are going to be available for aircraft. We know that one of the Citation jets we use presently will leave the lower mainland and probably arrive in Fort Nelson in less than two hours, and it will be back in Vancouver -- a round trip -- in less than four hours. I don't think any jets are based in either Fort St. John or Fort Nelson. If we were to rely on services from those areas, the aircraft that would be available are prop, which would make a tremendous difference in the time it takes to go from, say, Fort Nelson to Vancouver.
I just wonder how in depth the minister has gone in working with his cabinet colleagues. I know the member for Prince George-Omineca dealt quite a bit with Government Services regarding the air ambulance service. I would just like to know what steps the minister has taken to try and keep that excellent service that we presently have. It may not be cherished in the southern part of the province, but let me tell you that air ambulance is cherished in the northern part of the province by a lot of people. I would like to see it stay somehow.
[5:15]
If the minister can assure me that jets will still be used, so that we have that speed to get people in our two-tier health system to those specialists in the lower mainland, then I will be reassured. But just saying we can go to the private sector and get that kind of service.... I don't know whether we can or not.
Hon. P. Ramsey: Without wishing to revisit everything in estimates that has been done today, let me just say a couple of things of a more general nature before we deal with air ambulances.
First, I think the member is quite right in saying that there is maybe another "tier" of health care for those of us who live outside a certain radius of major urban centres. Indeed, that was one of the conclusions of the Royal Commission on Health Care and Costs. If you happen to be poor, a woman, an aboriginal person or live in a remote or rural area, chances are you may have poorer health status. That's an issue that
[ Page 12432 ]
needed to be addressed as we reworked and devised a health system for the twenty-first century in British Columbia. As the member quite rightly points out, part of that is access to specialized services that may not be available in a person's community and that may require this sort of rapid air evacuation to which he refers.
Let's just review, though, the situation with air evacuation. Currently, air evacuation is provided through a mixture of private contractors and government air services. Some 40 percent of fixed-wing evacuations are now done by private contractors, 60 percent are done by government air services, and 100 percent of helicopter evacuations are provided by private contractors. So a substantial portion of air evacuation is now provided by private contractors, and it's done with high quality. Quality assurance is an integral part of qualifying contractors and making sure that air evacuation is done in a timely way.
As we move towards winding up government air services -- for the reasons that the Minister of Finance alluded to in the House earlier today -- we have a responsibility to ensure that the care of patients who are evacuated by air remains high. That is fairly easy to do, because it's going to be the same set of paramedics. The B.C. Ambulance Service will be involved in patient care during air evacuation in the future, as it has been in the past. We're looking, then, at making sure that the aircraft are of the highest quality, the contractors are adhering to the highest possible safety standards, and that the time of air evacuation is within limits that are acceptable.
Contract air companies that I expect will be bidding on the requests for proposals, which are going to be put out soon, have both turboprops and jets available in the province. There are obviously differences in performance between turboprops and jets. There are times when a turboprop may be better suited for a specific trip; surely there are times when speed is all, and we must ensure that that takes precedence.
I assure the member that as we move forward and look at the shape of the requests for proposals, the siting of contractors and air evacuation -- the issues that he raises -- are going to be in the front of my mind as those proposals come forward.
R. Neufeld: I appreciate what the minister has said. I gather from his statement that the private contractors are going to have to supply a jet air ambulance, such as we have now, when they put out for a contract. It doesn't have to be a specific aircraft, but rather, a jet for speed, with the array of machines that they will charter out to the government. I appreciate that turboprops make more sense in some areas; there's no doubt about it. But when you're flying the length of British Columbia, from the southern part to almost the northern tip, jets and speed are of the essence. If the minister can concur that part of the proposal package that goes out to private enterprise will be that they must supply jet service, then I will be happy.
Hon. P. Ramsey: I will say a couple of things. As the hon. member knows, one of the great deficiencies with the current model of air evacuation being based in Victoria for dispatch is that sometimes speed may not be of the essence. It's a long way from Victoria to Fort Nelson, as the member points out quite accurately. I hope to be looking at a model of basing evacuation aircraft in different areas of the province, rather than having them all centred in one city. We'll be asking for proposals to site aircraft in different areas in order to increase the speed of response to air evacuation. While I can assure the member that speed -- jet versus turboprop -- is one factor, it is just one factor. When we get into the formal tendering stage, I'll be glad to review with him what demands we will be asking contractors to meet. I don't have them before me today, as some of that work is still ongoing.
R. Neufeld: I thank the minister for that, and I look forward to going over that when the time is appropriate. I'm sure he will let me know.
If there is some way that you can get someone from Fort Nelson to Vancouver with a turboprop as quickly as with a jet, I don't have any problem at all. I'm concerned about being able to supply the service we have had in the past for transporting people who need extra special care from northern communities to the lower mainland as quickly as possible. That's what I'm looking for. I'm sure the private sector can supply that, and the Ambulance Service will certainly be involved. I don't have any problem with that. I have a problem with making sure that we can still provide the same service that we have today. That is my greatest concern. However it is done is fine with me. So I look forward to doing that.
I am sure the minister is aware that I have been waiting for estimates to come forward. The other question I have is with regard to child development centres, specifically the child development centre in Fort St. John. I will bring the minister up to date and allow him to respond. Maybe he has already dealt with the issue, and we can all go away happy. Last December I contacted the minister in regard to funding for child development centres, specifically the child development centre in Fort St. John. The child development centre in Fort St. John is a non-union child development centre, but pays its employees, as I understand, rates comparable to those which union members receive. The people who work in the child development centre in Fort St. John have elected not to unionize, and that's their prerogative. If they wish not to, they shouldn't be forced to.
Simply by cutting funding to non-unionized centres, the Minister of Health is trying to force those centres that are not unionized to unionize. All centres have signed a three-year contract -- and I don't think anybody has any problem with the three-year contract. What the Fort St. John centre has a problem with is that in the three-year contract the amount they receive per FTE for a therapy worker is $8,000 less than a unionized centre, and for a family support worker it's $10,500 less than a unionized centre, keeping in mind that a unionized centre in Fort St. John pays comparable wages and benefits. What has happened in Fort St. John -- and I would assume other non-unionized centres -- is that you have arbitrarily reduced the service to those areas by paying less. You have to remember, Mr. Minister, that those centres will have to pay the union rates over a period of three years -- whatever they happen to be -- the same as the unionized centres, and receive no increase in funding for it. Using Fort St. John as an example, I think they lose about $45,000 or $50,000 a year in funding. They have one therapy worker and, I believe, four family support workers who are affected.
The minister responded to my request in January, which related some of the things that I have just said, by saying that because of union agreements they have to respect those centres and give them more money. One part of the letter that came out very distinctly was the fact that the minister says: "...assist agencies in recruiting scarce therapy staff by providing fiscal stability to each agency for a span of years, and hence a lengthy employment opportunity could be offered to potential staff." I guess if you're equating that to unionized centres, that's fine, under what the minister said in his letter. But by reducing the amount of funding to
[ Page 12433 ]
non-unionized centres, this statement by the minister is exactly opposite. What you're doing is reducing services to people who need and require them -- and they are the children of our province, and the children of Fort St. John.
Fort St. John has an excellent child development centre. It's not fully funded by the province -- none of them are. A tremendous amount of work has gone into the centre in providing an excellent service. I believe the minister has been there and seen the centre; it is a class A centre, with help from government, but also with an awful lot of contributions and work from within the community.
At the end of January, records were supplied to the ministry -- employment records, payroll and everything involved with what the centre pays in wages to its employees. To date, to my knowledge, there has been no decision made on whether you're going to start treating union and non-union child development centres equally. I want to remind the minister that his initial response was that all they have to do is unionize and the money is there. Those are the minister's words, not mine. So if the money is there, it's amazing that we can't have equal funding for those centres; I think it would only be fair. If the people don't want to become unionized, why should they have to just because the minister believes that they should? Maybe the minister has an update on some agreements that have been reached since I last talked to him about it.
Hon. P. Ramsey: I thank the member opposite for his very good advocacy for the Fort St. John child development centre. I was very much impressed by the centre when I visited it, and I greatly respect those who have worked to establish it and those who are providing care through it to the citizens of Fort St. John and the surrounding areas.
[5:30]
One of the things I was most impressed by was their outreach program. I was amazed at the diversity of services they deliver -- at a distance -- to communities surrounding Fort St. John. I think the member opposite and I should help educate some other members of the House, perhaps, about what delivery of services in people's homes means when it's done by the child development centre in Fort St. John. At times, therapists drive three and four hours to deliver services to a distant community.
Let me say that after the member brought his concerns to my attention earlier this year -- and other child development centres did as well -- I asked my ministry to undertake a review of the situation and to look at funding concerns raised by child development centres across the province. Three things came very clearly out of that review. First -- and I know this is the one that is a source of contention between the member and myself -- it was quite clear that a single rate-payment mechanism simply did not take into account the widening gap between service providers at the unionized and non-unionized sites in terms of wages, benefits and complexities of contract. But that was only one part. The review also revealed a really inequitable rate for administration and program costs, separate from wages and benefits, in child development centres across the province. We weren't doing very well at funding those equitably, either. Perhaps more important than either of those was what in some cases could only be described, I believe, as a funding crisis and a concern that current levels of services would not be able to be maintained.
So we have a complex set of issues that are affecting the operations of child development centres around the province. I recognize very clearly that child development centres are facing severe financial pressures. I do not think it comes entirely from wage differentials; I think there are other causes for it as well. I'm going to be discussing this matter with my colleague the Minister of Finance. But in the interim, I'm asking ministry staff to monitor the situation in the centres closely and to keep me apprised. We want to ensure that the services they deliver are kept up, because in many cases centres already have what I would describe as lengthy waiting lists. Here again, I think we have a situation, hon. member, where we need to find ways of making sure that centres are working with other care providers in their communities or other communities. Clearly they are faced with severe financial pressures, one part of which is funding for wage costs.
R. Neufeld: To my knowledge, the child development centre in Fort St. John, which I said is an excellent child development centre covering a huge part of the province, works well within the community and the other communities that it services, and it works well within the health care community. That's not the issue. The minister stood up and talked about all those things -- and I appreciate it -- but he totally skirted around the question of equal funding for the child development centres in the province, and specifically for the one in Fort St. John. The minister has stated very clearly to the press that all they have to do is unionize and they would receive the same funding as other unionized centres. The minister says that he would have to talk to the Minister of Finance. But if the child development centre in Fort St. John and all the rest in the province unionized today, would the minister live up to that public promise he made that all those centres would be funded equally?
Hon. P. Ramsey: I think funding for child development centres must be based equitably on the services they deliver, taking all factors into account, and wages and benefits are two of those factors. The ministry is continuing to work to make sure that this current crisis is temporary. But recognize here that there are other inequities in funding. My goal is to provide equitable funding once all factors are taken into account.
R. Neufeld: I know the minister received the information from Fort St. John in regard to what they pay, so there's obviously no discrepancy with what the child development centre said in Fort St. John: they pay wages and benefits that are comparable to what unionized centres pay. I'm sure he would have brought it up otherwise. They provide an excellent service. The minister is on record as saying they do; he said that it's one of the better child development centres. All factors being equal, all we're talking about here is funding per FTE, whether it's union or non-union. Is your ideology going to drive you so far that you're going to take away services from children in Fort St. John because it's not a unionized centre?
Would the minister...? I'll ask him again: if the Fort St. John centre unionized tomorrow, would he live up to his promise and change and increase the contract to what other unionized centres have graciously received from the minister? I don't even think they had to lobby for it; the minister just came across with a number. I didn't hear a lot of lobbying from those other centres. The minister looks a little surprised. Maybe the non-unionized centres didn't lobby enough, or maybe they weren't in the right union. That's the problem; that's the crux of the whole issue. If they unionized tomorrow, would the minister pay them the same as unionized centres? Would he live up to his promise?
[ Page 12434 ]
Hon. P. Ramsey: I assure the member opposite that funding decisions are not based on ideology but on the realities of the costs of centres around the province, and I hold to that. I want to make sure that the centres are equitably funded. I would ask the member opposite: if there are real gaps or differences in the costs of wages and benefits between care providers, whether it's those in child development centres or other care providers in the health care system, should those differences be taken into account in funding or not? My sense is that as we attempt to stretch health dollars, we ought to make sure that we are basing our funding on the services that are actually delivered, and we should fund those services equitably. That's the goal I have, whether it's with regard to the Fort St. John child development centre or the home support agency in Nakusp.
R. Neufeld: I'm not going to belabour this for long. I'm going to read verbatim a few paragraphs from the minister's letter, which will prove exactly what he is saying: if you are unionized, you are going to receive $8,000 more per year for an FTE therapist, and you are going to receive $10,500 more per year for a family support worker. That's grossly unfair. In fact, if that isn't ideology, I don't know what is.
We went through the whole system. The minister agrees with me that the child development centre in Fort St. John provides a comparable service and an excellent service. In fact, he said that we should maybe teach some of the other members in the House about how well it is done in Fort St. John. Obviously the minister is very happy with the services they provide. What he's not happy with is the fact that they are not unionized. It's not because of the organization that runs the child development centre; it's because the employees don't want to be unionized. That's the ridiculous part of it. You say that you're here for the people. The people are telling you that they don't want to be unionized, but you are saying: "You unionize, and we'll give more money to Fort St. John." In time, Mr. Minister, you'll deprive the children of services, not only in the Fort St. John area but also in Hudson's Hope, Dawson Creek, Chetwynd, Fort Nelson and Mile 101. They provide services to so many areas that it's hard to mention all of them. Maybe I should get all the areas that they provide services to. It's a tremendously large area.
The minister says that they provide that service in an excellent fashion, but he says: "Because you're not unionized, we're going to short-fund you." That's unfair, and that's ideological. That's all it is. The minister is quoted as saying, that all they have to do is become unionized and the funds are there. If the funds are there, why in the world don't we pay them? It's obvious in this letter from the minister, and I am going to read verbatim from it:
"In the 1993-94 fiscal year an analysis of union wage increases and benefits already agreed to by the Health Labour Relations Association led to the establishment of a new rate of $68,000 per therapy FTE and $45,000 per family support worker. Funding was provided to cover unionized FTEs only...."
There we are -- "unionized" again. We're making a very clear distinction that we're only going to fund unionized FTEs. I'll go on:
"...with no funds provided to maintain the parity between unionized and non-unionized centres."
You have decided to arbitrarily say that non-unionized centres are not going to get the same funding that unionized centres get. I say that's straight ideology, and that's taking services away from those people in the north. Further on in the letter the minister states:
"Hence government is a part of the process and is obliged to provide commitment funding for the unionized HLRA member agencies, as necessary, to cover the financial aspects of the collective agreements. This has been, over time, a standard government practice."
That might be a standard government process to you, but I can tell you.... You can point at me, and if you are talking about the past administration, I can tell you that the past Social Credit government funded all CDCs equally, whether unionized or non-unionized. At least you can give them that. You, sir, have decided to change that philosophy and fund unionized centres more than non-union.
Can you imagine what would have happened if the past administration had said that a unionized centre was going to receive $8,000 and $10,500 respectively less per FTE than a non-unionized centre? Would that have made sense? No, it wouldn't have made sense at all -- they're providing the same services. But that's how ridiculous what you are doing to those non-unionized child development centres is.
[5:45]
I want to take you back, hon. Chair, and read a couple of quotes from a speech the minister made in February 1994 at the Minister's Health Forum: "...perhaps, most importantly, we must have more local participation in decision-making." I agree -- if someone listens. "In addition, one of my priorities for the coming year will be to see some results from a new rural and northern health strategy." Is that your northern health strategy, Mr. Minister -- to reduce services to people in Fort St. John, to the children of Fort St. John and area, by arbitrarily saying that if you're non-unionized you get less money and if you're unionized you're going to get more? Is that your health strategy? It's a lousy strategy, and it won't work.
Further on in his speech he talks about "increased community-based funding." I would assume from "increased community-based funding" that he's going to look at those northern areas, specifically Fort St. John, and fund them equally. I can't imagine, for the life of me, why the minister would continually beat around the bush and not answer the question of whether he is going to start funding non-unionized northern areas the same as unionized areas in the southern part of the province that provide the same, comparable services. You've promised it. You promised that if they unionized you would, so I can't imagine why you wouldn't do it even if they're non-unionized. Obviously, the money's there. Those are your words. You said the money is there and all they have to do is unionize. Would the minister commit to treating those areas where people have voted not to unionize on their own the same as unionized centres, because they do provide the same, comparable service? Or are you not going to back up your word?
Hon. P. Ramsey: I'm really glad the member opposite decided not to belabour the point. I'm not sure I could have taken the speech he delivered, had he chosen to belabour the point rather than deliver that calm, dispassionate analysis of the situation. Let me respond to a couple of points in there amidst the general union-bashing that the member opposite engaged in. Let's say this very clearly: a number of cost pressures on child development centres are affecting their ability to deliver services at the present time. One of those is the wage rates that have been negotiated. I fail to understand why this member believes that if we have two centres, union and non-union, and one pays X and the other pays Y, we should pretend that somehow they are identical. We don't do that in other areas of government services.
If that is the principle, should we then go on to pay equivalent amounts of money for operation and admini-
[ Page 12435 ]
stration regardless of where centres operate? Should we provide, for example, the same amount for travel to the child development centre in Fort St. John as the one in Burnaby? Should we provide exactly the same amount for heating to one that's located up where he and I come from and the snow gets a little deep as opposed to one in Victoria?
There are a variety of administration and program costs that are separate from wages and benefits, where there are great inequities and stresses on child development centres, and I've acknowledged those differences and those stresses. The difference in wage rates is one stress, and I recognize that. There are real differences in wage and benefit rates, and their impact on centres and on their provision of service is real. Slice it as you will, those are real differences that I believe funding should recognize.
Finally, let me deal with some of the more general areas the member opposite strayed into. The rural and remote strategy is designed, I believe, to address the three major issues that affect the delivery of health care in the part of the province where he and I come from. Those are, first, making sure that a wider range of health services is available in regions and in communities rather than at the end of a long plane ride. Second, it's designed to look at how we attract and retain health professionals to deliver services in rural and remote areas of the province. He mentioned the concern about what happens when the surgeon in Fort Nelson chooses to retire or leave. That's an issue many communities across the province face.
The member talks in a fairly disparaging way about whether more money is actually going into increased community care. Here are some facts that he can check with his local hospital and other care providers. In Fort St. John, in health region 17, Peace River, there has been an increase in funding for the delivery of community-based programs from 1991 to the current budget year of '94-95 of 59 percent. He and I share the perception that mental health services have been greatly neglected, particularly outside the lower mainland. Funding for mental health in the Peace River health region increased by 90 percent in the last three years. So when this member stands and talks about the great inequities in funding, I would ask him to consider that we are carrying through on what we committed to in terms of better funding to community health care services; developing a strategy to make sure that rural and remote residents receive their fair share of health funding; and dealing with what I recognize as the serious funding situations faced by child development centres in this province.
R. Neufeld: I just want to say that I didn't union-bash at all. What I said was exactly what's happening in the north. Those people have the right to vote whether they want to be union or non-union. I totally agree. That's not union-bashing. That's the farthest thing from union-bashing that I can imagine. They have voted not to; that's not union-bashing. Where are you coming from, Mr. Minister? I'm not union-bashing at all.
When you talk about X and Y, it's you and your ministry that is making that distinction. What your ministry is saying is that if you're union, you're going to receive more money than if you're non-union, regardless of whether you provide comparable services and pay comparable wages and benefits. It's you and your ministry that have decided that you're going to make a difference between X and Y, not me. I'm asking for them to be the same.
The minister has still not answered the question about whether funding would be available if they unionized. I guess in the heat of the moment he made some remark that he would, and on second thought, he's not going to. I don't know. Maybe that's the case and maybe not.
If the minister refuses to answer that question, could he tell me when...? I know his ministry has requested some more information and meetings. We can have meetings and information forever and put off the decision for a long time. Can the minister tell me when a decision will finally be made, or has the decision finally been made on funding non-unionized child development centres, specifically the one in Fort St. John? Are they spinning their wheels, shall I say, if they think they're going to get more funding? Is there some alternative solution to be able to provide services to the people in the north? The minister is removing that by underfunding an agency that provides a comparable service.
Hon. P. Ramsey: I have asked my ministry to continue to work with all child development centres to identify inequities in the way funding is provided. As I said, my goal is to develop a more equitable way of delivering funding. Having said that, I want to make this clear so I'm not heard as saying that different situations should be treated as if they were the same. If there are real differences in the costs of program delivery, I think they should be recognized; if there are real differences in the costs of wages and benefits, I think they should be recognized. What needs to be the same is equitable funding for the delivery of services.
The member is right: additional information has been requested from agencies delivering these services. We've gone through a rather extensive process in the last couple of years in developing a new and, I think, more equitable funding arrangement for home support agencies in the province, and we're in the process of doing a similar thing with funding for child development centres. This is an ongoing effort to make sure that we are funding them equitably.
Let me just close this portion of the debate by saying very clearly that I recognize that the child development centre in Fort St. John, like other child development centres, is facing severe cost pressures this year, and I'm asking my ministry to monitor very carefully the services they are providing and the level of funding required.
With that, I would move that this committee rise, report progress and ask leave to sit again.
The Chair: To guide members on how they might vote on that particular motion, I am pleased to advise them that the committee on Health estimates has now been sitting 11.5 hours.
Motion approved.
The House resumed; the Speaker in the chair.
Committee of Supply B, having reported progress, was granted leave to sit again.
Hon. P. Ramsey: I move that the House, at its rising, recess until 6:35 p.m.
Motion approved.
The House recessed at 5:59 p.m.
The House resumed at 6:38 p.m.
[The Speaker in the chair.]
[ Page 12436 ]
Hon. J. MacPhail: I call summary of the estimates of the Ministry of Forests.
REPORT ON COMMITTEE A ESTIMATES: MINISTRY OF FORESTS
R. Neufeld: I rise to respond to the Ministry of Forests estimates. Unfortunately, I was not able to take part in all the Ministry of Forests estimates this year, because we were simultaneously dealing with environment legislation in the House, for which I am also the critic. My colleague from Prince George-Omineca probably followed the Forests estimates more closely.
Just briefly, it became very evident from the outset of his opening remarks that the minister was doing his favourite thing: bashing the industry and the previous administration for their poor stewardship of the forests. I reminded the minister that we should be trying to improve how our forest practices are viewed by the rest of the world. We can't do that by continually getting up in public at every opportunity, as government members have, and bashing the industry and the previous administration -- rightly or wrongly; I couldn't care less. What I am saying is that it's time the minister took his ministry seriously and dealt with it fairly and equitably. Start saying to the world: "Yes, we do look after our forests, and yes, we have good forest practices."
In fact, that's not just my viewpoint. When they announced the forest renewal plan, an ally of the government, Mr. Peter Bentley, had the same viewpoint. Mr. Bentley said the same thing in an article I just read today about him: it's time the Premier and the ministers started talking about forestry practices that are always going to improve, for the betterment of British Columbia. That's what we should be looking to.
The other part of the debate will be interesting when we get into the Forest Practices Code later on. That is probably going to affect the Forests ministry more than anything this year -- along with the forest renewal plan, which has already been completed in committee. I look forward to committee stage on the Forest Practices Code and to going through the code section by section and bringing out areas that we have some concerns with. Hopefully we can come together collectively, and with some good amendments change the code in a few places so it will be more acceptable to industry, workers and everyone in British Columbia.
D. Mitchell: I'd simply like to reinforce some of the statements made by the member for Peace River North. This minister, a brand-new Minister of Forests, actually did a commendable job defending the Forests estimates for the first time.
This is one of the most challenging areas of public administration in British Columbia and perhaps in Canada. The minister is presiding over what I have termed a revolution in forestry in our province. The minister might not agree with that word; he refers to it as a "half revolution." It's very significant to contemplate the changes that are going on in our province, which were canvassed very thoroughly during the review of the Forests estimates. We talked about the timber supply reviews; the Forest Practices Code, even though there is legislation before the House; the forest renewal plan; the protected areas strategy; and the CORE process. Since that time, the Vancouver Island land use plan has been announced and we have yet more legislation before the House dealing with the forest land reserve. A lot of the detailed discussion is going to take place during the review of legislation that coincides with this session, although the minister was relatively forthcoming during the estimates process.
[6:45]
I'd like to congratulate this brand-new minister for taking these initiatives forward. They're certainly very significant. I don't think any Minister of Forests in memory has brought forward so many significant initiatives affecting our province. But I'd like to also urge the minister to be very cautious as he brings forward these initiatives, because this revolution in forestry that's taking place in British Columbia is, like most revolutions, likely to have some casualties. There will be winners in the process, but the casualties also need to be looked after very carefully. In the timber supply reviews that are ongoing, he needs to be particularly sensitive to those working in the forest industry, their families and their communities so that they don't become casualties in this revolution in forestry.
W. Hurd: I'm pleased to rise today to speak to the discussion of the estimates of the Ministry of Forests.
This is the third set of estimates that I've participated in as the official opposition critic for Forests. I have to say that this, in many respects, was one of the most disturbing and troubling sets of estimates that I've participated in in any ministry, but particularly of the last three Forests estimates.
We started our discussion by reinforcing the importance of the forest industry to the lives of British Columbians and the fact that in the province today a harvest of between 72 million and 75 million cubic metres of timber sustains the jobs of 94,000 British Columbians directly, and the jobs of probably 200,000 to 300,000 people directly and indirectly, and that the welfare of between 150 and 200 communities in our province is directly impacted by the activities of this ministry.
I was deeply troubled by some of the statistics and information the minister conveyed to us. He acknowledged, for example, that on the basis of the Forest Practices Code alone, the government will be investing in 60,000 hours of training for ministry staff in the coming fiscal year. There seems to be no reciprocal increase in the number of full-time-equivalents that would lead me to believe that the ministry is going to be able to undertake that kind of training to implement this code and still be able to meet its ongoing obligations. We talked about the difficulties that ministry staff face in the field. The challenges of dealing with this code will be formidable. I was also disturbed to learn that when it comes to the training for the code generally, the ministry is apparently determined to go on its own. A minimal effort appears to be being made to correspond the ongoing training within the ministry with those of the licensees and others in the private sector.
The minister acknowledged that the ministry is undergoing a transformation -- a "reorganization" is the way he termed it. The ministry is grappling with the Forest Practices Code: 365 individual clauses of a new bill which will eventually have the force of law. The minister talked about the timber supply review which is analyzing the amount of inventory in the province, yet we were able to discern during this set of estimates that the Commission on Resources and Environment and the Forest Practices Code had not been taken into consideration when it cames to establishing an annual allowable harvest in the province.
What is noticeably lacking is a vision for this ministry. So much of what other members have referred to is occurring outside the boundaries of this ministry: a new Crown corporation, a Forest Practices Board and an independent process outside of the bounds of the ministry. We are seeing the ministry having to chase after the same kind of
[ Page 12437 ]
regulatory hurdles that the government is setting up. We talked about the small forest business enterprise program, which is allotted the bulk of the additional funds in this year's budget.
It's important to note, as we did during the estimates debate, that the largest single cutblock planner in this province is not MacMillan Bloedel, Fletcher Challenge or Canadian Forest Products; it's the Ministry of Forests. It's the ministry itself which will have to meet the guidelines under the Forest Practices Code, and certainly we'll get into that debate in due course. But I asked the minister during our estimates how he felt his ministry was coping in the field. What specifically were we looking at in terms of addressing the issue that I've heard from the field -- that the ministry is currently being run by the latest fax from Victoria? It's a concern, because we're seeing a dizzying number of changes which are going to put stress on this ministry. It's my understanding that licensees in the field will have to resubmit all their working and management plans in totality. They will have to be cross-referenced by ministry staff to ensure adherence to the code. How is the ministry going to accomplish all of this and do the job that it was intended to do?
These are some of the issues that we talked about in this set of estimates. I really think that the keys to this ministry are the timber supply, the amount of annual allowable harvest -- which we were unable to discern -- and the area of working forest in the province.
Hon. A. Petter: It's a pleasure to wind up here and respond to some of the comments made by the opposition flowing from the estimates, which I found a very interesting and useful exercise for me as minister. I very much appreciated the exchanges that we had.
I must say that it's becoming increasingly clear to me that what the official opposition finds most troubling is anything that amounts to change. Indeed, I would say that the opposition generally, regardless of whether they call themselves Reform or not Reform, Liberal or not Liberal, seems to be decidedly illiberal and unreformist on issues of forest practices. I'll exempt from that the member for West Vancouver-Garibaldi, who seems to be racing ahead in some respects. What I think these estimates disclosed, and what I think the opposition is having trouble coming to terms with, is that this government is committed to change in the way we manage our forests. I think it's clear to most British Columbians -- unfortunately, not to members of the official opposition or of the Reform Party -- that we can no longer continue to manage our forests and natural resources in the way that was done in the past. I know there's a hankering to believe that it would be nice if we could just continue the way things used to be. But most British Columbians -- indeed, most in industry -- know that that is not sustainable and that we must make the necessary changes to ensure that our forest industry is conducted on a sustainable basis, consistent with good forest stewardship principles in light of information we now have and maybe didn't have more than 20 years ago.
What I hear from industry as much as from communities is that we must work together to make the necessary changes. What I hear from the opposition is that we shouldn't make changes at all. I think that's profoundly disturbing, and it should be disturbing to the people of British Columbia who want us to work together with industry, with communities, with those in the environmental movement and with workers to bring about an orderly system of change that speaks to the concerns we have.
During the course of the estimates we discussed the timber supply situation and the need for a timber supply review that can give us a much more accurate picture of our timber supply situation. Regrettably, under the previous government, inventories were not kept up to date, and we didn't have that information. We desperately need that information not only to determine rates of cut but to decide how we can map out a strategy to increase our timber supply in the years ahead.
We discussed the need for good forest stewardship and the commitment this government has made to a Forest Practices Code. We discussed the changes that industry is prepared to make in partnership with government, workers, communities and the many talented people in the Forest Service and other ministries of government to ensure that we have standards that are sustainable and that will ensure that we have a healthy forest resource in the years ahead.
There's a high measure of anticipation and willingness to cooperate on the part of most British Columbians, including those in industry who understand that change is essential both in tackling these real problems and in regaining public confidence at home and abroad. Regrettably, throughout this set of estimates, the opposition continually questioned from a posture that change was to be resisted and fought, and that we should continue in the same old model and resist any attempts to change. Most regrettable is the position taken by the official opposition, who stood in this House against the forest renewal plan -- a plan aimed at both increasing employment and timber supply -- and who, in the report from the official opposition member and in other statements, now claim that somehow this government is unconcerned about both those issues. That clearly isn't the case, and the position of the official opposition against the forest renewal plan, in my view, clearly demonstrates that it is the opposition, not the government, who needs to defend its record in respect of employment and in respect of a commitment to ensure that we have adequate timber supplies in the future.
What we need to do -- and I think this set of estimates demonstrated it -- is to invest in our future. That means that we have to come together and set aside the conflicts of the past, not do what the official opposition tries to do and continue to foment division and conflict. I found it highly ironic that the official opposition spokesperson on this issue talked about vision, because the only vision the opposition has on these issues is division. They constantly wish to divide people rather than bring people together in the way this government has demonstrated is possible through the forest renewal plan and now through some of the land use decisions that are being made.
Yes, we do need a vision. We need a vision that speaks to the future and is inclusive. Through the timber supply review we are demonstrating that that vision will include a concern for sustainability; through the Forest Practices Code we are demonstrating that vision as one that must speak to good forest stewardship; through CORE it's a vision that must account for the need to have a stable land base for the future of our forest industries and forest communities; and through the forest renewal plan we are demonstrating that it's a vision in which industry, communities, workers and environmentalists must work together to ensure that we have a healthy economic future. We really have to look to the future. That's what this is all about. Can we grapple with the future instead of doing what, regrettably, the official opposition seems to have as its only preoccupation -- longing for the past?
[ Page 12438 ]
I found this a very illuminating set of estimates debates in which the line was clearly drawn between those on the government side who wish to move ahead with a new vision that includes all of the players in society working cooperatively, and those on the opposition benches who hanker for the past, who believe that their best political strategy is to divide British Columbians and who are not prepared to grapple with changes and problems. That, perhaps for all British Columbians, is a foreshadowing of the debate to come -- not only in this House but beyond this House -- on the future of this resource that matters to all of us, because certainly there is nothing more important to British Columbians than the forest resource and the value it represents for our future. With that, I conclude my report on the estimates debate.
Hon. J. MacPhail: I call second reading of Bill 53.
PENSION STATUTES AMENDMENT ACT, 1994
Hon. J. MacPhail: Today I'm pleased to describe in detail the contents of Bill 53, which will amend the four public sector pension statutes. Bill 53 contains important changes to the Pension (College) Act, the Pension (Municipal) Act, the Pension (Public Service) Act and the Pension (Teachers) Act. These pension plans cover over 175,000 public sector employees working for approximately 700 public sector employers. The invested assets of these plans currently exceed $19 billion. The sectors covered include the provincial government, Crown corporations, municipal governments, and most health and education sector employers.
The amendments proposed in this bill are another important step in the continuing evolution of pension plans provided for public sector employees. This bill lays a solid foundation for a new, cooperative approach to plan management. It contains measures to put the plans on a sound financial footing. Lastly, it contains benefit changes that will improve equity within the plans by addressing the needs of plan members who traditionally have had the least opportunity to access benefits.
[7:00]
This bill represents the culmination of a lengthy process of in-depth discussions between representatives of the plan, of plan members and of government. The process focused on the resolution of complex pension plan management issues that had been left unattended for many years. The last major changes to the plans were made 14 years ago, in 1982. We are pleased with the goodwill and cooperation that the parties brought to this process and with the work that has been done to help resolve these very difficult issues.
I look forward to joining the minister responsible, the Minister of Finance, who will address the issues in greater detail in committee stage.
F. Gingell: This is an important piece of legislation. It's a pity that it was brought into this House so late in the session. It is not a bill that should be dealt with quickly. If this had been brought in by the previous government, the present government, which was then the official opposition, would certainly have used terms like "smoke and mirrors" when referring what is involved here.
I'm going to restrict my remarks at this time to the teachers' pension fund. As the minister so rightly stated, there are four funds involved. But the teachers' pension fund has the greatest unfunded liability, which is substantially greater than the other three funds. Because I wish to primarily focus my remarks on that issue, I will do it in that fashion.
The role of the actuary in determining the value of this fund and the value of the pension benefits that have been earned by people who are participants in this fund involves a very complex and difficult science. It's a particularly complex and difficult science for me, because as an accountant I look to the facts rather than the conjecture about what is going to happen in the future. That's really what is involved in this bill -- conjecture. The premise is that the funds of the teachers' pension fund have been invested in the money market or fixed-rate-of-return securities -- primarily government and very high-grade corporate bonds. We dealt earlier in this session with a bill that in the future will allow these funds to invest their funds not only in those guaranteed government securities but also in the equity market.
You will remember, Mr. Speaker, that we spoke about investments that would be made by a prudent person. The actuaries have said: "If you invest a portion of these funds in equities or common shares of corporations rather than in government guaranteed bonds, the fund will earn a higher rate of return in the future than it does now." At this point, the first 6.5 percent of investment return each year goes into the basic pension account, and any earnings over and above 6.5 percent go into a special fund that is for the purpose of paying what are probably best understood as cost-of-living adjustments to teachers' pensions in the future.
So before anything has been done -- before any funds have been invested in this hopefully higher rate of return -- the actuaries have said that, on the assumption that we will make higher rates of return in the future, we will push eight-tenths of a percentage point of that additional return into the basic account and the rest of the additional earnings will flow into the cost-of-living fund. Based on the conjecture that the fund will earn greater returns in the future, we are now going to agree to increase all of the benefits, make certain forms of non-worked service eligible service for the purpose of the fund, allow better pension arrangements on early retirement and allow additional health benefits to be paid to retired teachers. All these things that we are going to approve now are going to be paid out of these additional future earnings. That's not the way we run our own households. We don't assume that our incomes are going to go up or that our investments are going to give us a greater rate of return in the future, and then increase the monthly costs of running our homes. But that is what is being done here.
I don't have any problem agreeing with the government that it is appropriate for them to have a more flexible investment program. To me that is common sense. But if the unfunded liability in the teachers' pension fund is 120 percent of payroll, which it presently is, a cautious and sensible person -- I won't use the word "conservative" -- would first of all allow those additional earnings to be used to bring down the unfunded liability, which, in the teachers' fund, is huge.
It seems to me that we're using the money that is going in from teachers who are working at this time to fund additional benefits for retired teachers who are not currently making contributions. I accept that the moneys that are in the funds now have been put there not only by the teachers who are presently working but by the teachers who have retired. But these retired teachers made payments into this fund based on the benefit package in existence that was defined and regulated by the fund at the time they were teaching. Through this bill, we are now going to increase those
[ Page 12439 ]
benefits and reduce the amount of money that would otherwise be in the fund on the uncertain promise that the fund will be able to earn larger rates of return in the future than it has in the past by investing in the stock market.
June 28 is not a good day to talk about rates of return being earned in the stock market. We are all aware of what happened in September 1989 when there was a so-called stock market crash. There have been dramatic drops in the value of the Canadian and U.S. stock markets in the last three weeks. Before we have tested this and before the earnings have been made, we are saying that we are going to increase the benefits payable to retired annuitants. We are going to make improvements to the manner in which service is calculated and to the health benefit plans -- all from these proposed future earnings.
For the additional amount of money that is required to make up the shortfall in the teachers' pension fund and reduce the unfunded liability from its present position of 120 percent of the annual payroll to only 50 percent, which this government has set as a maximum -- and with that I agree -- they have restricted the additional payments to the fund at this time to one-quarter of 1 percent of payroll. This is going to have to be paid in for 35 years. So what happens? The government says: "Okay, we're going to pay in an additional amount over the next 35 years, and we're going to limit that at this time to only a quarter of 1 percent per year for the purpose of reducing this unfunded liability." I don't have the faith that the actuaries do -- and this government obviously does -- that the unfunded liability isn't going to grow in the future.
The way contributions are calculated in this fund is on the basis of level contributions as a percentage of earnings over the life of each employee's anticipated work career. If inflation hits us, we are going to rapidly get into a new unfunded liability position. Why? Teachers' salaries will move up with inflation; one would not expect it to be otherwise. Their contributions will go up in the future, but no payment will be made for the consequences that has on the contributions that have been made in the past. These pensions are paid on the best four years' earnings, multiplied by a percentage and by the number of years of service. No one ever goes back and says: "Inflation has caused us to increase teachers' salaries by 7 percent across the board, and we now have to pay the contributions for all their service years prior to this point, because their pensions, by the increase they've now received, have been automatically increased."
These additional contributions are going to be made by the employers. Who are the employers? As far as teachers are concerned, they're the school boards. The school boards have faced additional costs, as we all know, in the past year from additional assessments on all kinds of things, such as additional unemployment insurance contributions and Canada Pension Plan contributions put in by the federal government. School boards around the province have complained, understandably, that no specific additional amounts were included in their grants to cover those additional costs. Through this bill, they are going to be committed to an additional one-quarter of 1 percent of the annual payroll to start work right now on the unfunded liability that exists at this point.
[7:15]
I haven't heard this government say that in addition to the other increases that must be put into their grants to look after all the issues in our education system, including servicing the debt that school boards incur in building new schools and looking after the salary increases that teachers get throughout the first ten or 15 years of their careers, where they automatically step up, and the other increases that happen because they improve their qualifications.... The school board is the employer and is always liable, but I don't hear this government saying that they're going to make these contributions on their behalf.
What applies to the teachers also applies to municipal workers. The municipal workers' pension contributions are made by their employers, who are the local taxpayers. There isn't any need at this time for an additional amount to deal with the unfunded liability, because municipal workers are right on the 50 percent of payroll as the amount calculated for their unfunded liability. But there are provisions for changes in service and other benefits. Who makes those changes? The employer -- the aldermen and councillors we elect that tax us? Oh no, Mr. Speaker. Those changes, as I understand it, can be made by the Lieutenant-Governor-in-Council. They don't even have to be debated in this House. The municipalities will have no choice but to make the payments into the pension fund; the municipal councils will have no choice but to turn around and include those amounts in their annual budgets and on the annual property tax notices.
There is also the issue, particularly in the teachers' pension fund, of who is liable. The teachers understandably believe that the government is liable for the unfunded liability. Who is the government? Of course, that's all British Columbia taxpayers. The teachers' pension act does not in any way, to my knowledge, require the province to be a guarantor of these pension funds. But it is the government of British Columbia that has set contribution rates every year and that has invested all of the funds. It is quite reasonable for the teachers -- although they may not be legally right, one certainly has sympathy with their position -- to think that it is the people of British Columbia, all the rest of the taxpayers, that are liable.
As the minister said in her opening remarks, these pension funds cover 175,000 employees. What percentage is that 175,000 of the total workforce in British Columbia? I don't have that number at my fingertips, but we do have roughly 3.5 million people in the province, and I would imagine that about 1.5 million of those work, so this would be somewhat over 10 percent, I would think. So it's a very real liability that the 85 percent, or whatever the number is, take on for the other 15.
I have real concerns that this bill does two things. One thing that I strongly approve of is, for the first time in many years, a defined and clear plan to deal with the unfunded liability. We would be irresponsible not to ensure that that unfunded liability is dealt with in a sensible and responsible manner. But at the same time, it changes the benefit plans, it allows for early retirement and it allows for increased service to be counted where teachers may be off doing other things that qualify. I believe we would be better placed and more responsible if we were to get our own house in order first.
It is, as I said earlier and as the minister said too, I think, a very complex piece of legislation. For us who are social workers or teachers or farmers or automobile dealers, it is very difficult to understand all the true consequences of this bill. It's a complex matter. I talked with Mr. Cook, the superannuation commissioner, who is always most helpful explaining these matters to us. But at the end of the two-and-a-half-hour briefing that I had from Mr. Cook on this particular bill, I was all tired out. It really is a complex subject.
They don't even value the investments by adding up their value at a certain day. They make assumptions about what
[ Page 12440 ]
the investment rates of return have been in past years and what they will be over a number of years. They suggest that the values of our investments are greater than they really are because low returns in past years will be compensated by high returns in future years, or, as happened in this particular case, high returns in past years will cause lower returns in future years, so the extrapolated value of our investments for the purpose of calculating the unfunded liability is shown at a lower sum.
The real meat of this, of course, is going to be dealt with in committee stage, where I'm sure all of us will have the opportunity to get a much better grasp of the intricacies of what is involved. I look forward to that opportunity.
J. Weisgerber: It's a pleasure to rise and speak to the philosophy underlying Bill 53. The current unfunded liabilities of public service pension plans are: for college employees, 22 percent of the annual payroll; for municipal workers, 50 percent; for public service workers, 10 percent; and for teachers, 120 percent. The response from the government to this rather alarming situation is to bring in this bill.
To quote the minister in a press release of June 6: "This package will improve benefits to workers with no additional cost to taxpayers." Increased benefits with no cost to taxpayers? One wonders what kind of magic that is. Indeed, as the former speaker said, there's going to be some diversification of investments. With better returns come bigger risks. We're talking about pension plan funds invested over long periods of time. I'm not at all convinced that tinkering with the investment plan is going to change those kinds of fundamental problems, such as the 120 percent unfunded liability for the teachers' pensions.
The bill is a huge disappointment for anyone looking for real change in pension plan funding. This legislation fails to deal with the real problems underlying public service pension plans in this province. It puts off to another day the tough decisions that some government is going to have to take to bring pension plan funding in line with the liabilities that exist there. But this government says: "No, we're going to diversify and tinker with our investment plan. We think that might solve the problem."
If it doesn't, a couple of years from now -- perhaps after the next election -- governments will have to take another look at this issue. It's safe to say it won't be this government. After the next election another government is going to have to look at this problem and deal with it in some serious manner. I believe that the next government is going to have to make some hard decisions. I don't think there's any doubt that a Reform government would be prepared to take those steps.
But this government is going to continue to try and pretend that some minor changes to this plan are going to solve some serious problems. They're going to hope that maybe inflation will be low. Perhaps future wage increases won't be as high as they have been over the last couple of years -- and why they would believe that, one wonders. Perhaps future costs for the plan will go down, although with increasing life expectancy the opposite is far more likely to happen, I believe. But this government is determined to put this problem off. This government doesn't want to deal with the problem today or take steps that I believe are necessary to deal with the serious problems faced here today.
This bill doesn't bring in any solutions. It's interesting that the Minister of Finance wasn't here today to bring this bill in. The Minister of Finance, like many government members in this House, is a beneficiary, a member who will indeed benefit from the pension plan we're debating today. Perhaps that's the reason the minister chose not to come and speak to second reading of the bill. We will see, as we move through this process.
[7:30]
This bill ignores completely the question of the MLA pension plan, which is the most seriously underfunded of all pension plans. This bill ignores that challenge for government. I believe that's where the government should start -- by changing the benefits for the MLA pension plan. The government should require that MLAs be sixty years old and have served at least seven years before they're eligible for pensions. Then the government should calculate what's necessary to make that plan self-sustaining and should increase contributions from both MLAs and the employer -- read: the taxpayer -- equally, so that the pension plan is funded. That same principle should be applied to the teachers' plan, municipal plan, college plan and public service plan. Both employers -- taxpayers -- and employees should contribute enough to make these plans self-sustaining. But there is a more fundamental problem than that, because for some reason governments in this country have decided that if you work for the public service, you will get a benefits-defined plan -- a plan that represents a percentage of your best four years of employment. But those British Columbians and Canadians who are not public service employees know that they get a plan based on contribution. They know that their plans depend on the contributions that they and their employers make in order for the plan to be self-sustaining.
But government doesn't want to deal with these kinds of questions. Indeed, this government doesn't want to deal with coming to grips with what's necessary to bring the MLA pension plan in line and making it sustainable. It doesn't particularly want to deal with other public service plans, the teachers' plan or other benefit packages. What has to happen here is that not only should the employer contribute more in order to reduce this unfunded liability, but workers and employers -- as is the case in other plans -- should contribute and bring these plans onto a sound financial basis. That's the difficulty we see, and that's what this government has failed to address completely. Indeed, in many ways it has gone in the other direction. At a time when benefits and contributions should be reconsidered, this government says no. I quote the minister again: "We will provide greater benefits with no additional cost to the taxpayer." It doesn't say in there that these new benefits are somehow going to be provided with no extra contribution from the employee.
It's not believable. It simply won't wash. Anyone who looks at this and analyzes it wouldn't accept this plan or the rationale for it. But the government has chosen on the basis of one actuarial opinion. It has gone out and simply got an opinion -- one that happened to suit its needs and the direction the government wanted to go. On that rather flimsy basis, the government has brought forward a plan that, rather than dealing with the unfunded liabilities in pension plans, will be seen and ultimately recognized over time, I expect, as contributing to an even greater unfunded liability in these plans.
Having said that, I would advise that I certainly intend to vote against this legislation. I think it's bad legislation. I think it's poorly-thought-out legislation. Further to that, the motivations for this legislation are not at all what the government would have us believe. One only has to look at comments made by representatives of the B.C. Teachers' Federation and of the BCGEU to understand the true rationale, the true motive, for this legislation, which is
[ Page 12441 ]
indeed to bring in broader benefits without making any greater contribution, except for one-quarter of 1 percent of payroll from the taxpayer and none from the beneficiaries. I believe that's unacceptable, and I believe that this legislation should fail.
D. Mitchell: I'd like to say a few words about Bill 53, the Pension Statutes Amendment Act, 1994. Perhaps members on the government side might wish to follow me with some of their comments as well, because I think we need to know where they stand and what contributions they've made to bringing forward this legislation.
The Minister of Finance introduced this bill in the House a few weeks ago. Now the Minister of Social Services has made some very brief and modest remarks in second reading. She hasn't really said very much about it. We don't know who's going to defend the bill in committee stage, but we hope it is going to be someone who can answer some of the questions that need to be answered before the House can possibly pass this bill into law. I have an interest in seeing the House deal with this matter and in seeing the bill passed into law, because expectations have been raised with the announcement that this legislation would be forthcoming, so much so that there's a lot of uncertainty in the public sector right now as to whether this bill is going to be dealt with and passed by the House this session.
For instance, I can tell you that schoolteachers in the constituency I represent are concerned, and many of them have put their future plans on hold pending the possible passage of this legislation. Many who are deciding whether or not they should retire this year have put that decision on hold to see whether or not this legislation is going to pass. If they can't, or don't, retire now, then they might have to wait until the fall. If they wait until the fall, that will cause chaos in terms of personnel and hiring decisions by school boards.
Expectations have clearly been raised by the government bringing in this legislation, so much so that the B.C. Teachers' Federation put out an issue alert on June 10, a few days after the bill was introduced in the House on June 6 by the Minister of Finance, and sent it to all their membership around the province. They said in the alert: "Bill 53, which includes significant changes to the pension plans announced to members earlier this year...." I don't know who announced that to them earlier this year. Before it even came to the House, it was announced to the membership of this union. This alert says: "It may take one or two weeks to clear the House." I'm not sure who told them that it would only take one or two weeks. It has already been longer than that, and that's only because the government's legislative program is in such disarray that it's impossible to predict when anything will clear this House. The reason I raise this is that I want to point out that expectations have been increased and fanned by this government in terms of their relationship with trade unions such as the B.C. Teacher's Federation and the BCGEU.
I'd like to point out another publication known as The Provincial. Many members on the government side will be familiar with this. It is put out by the BCGEU and distributed to all members of the B.C. Government Employees' Union in the province. While this publication represents a provincial public service union representing government employees, the front cover of this particular edition -- volume 42, No. 5, June 1994 -- preaches about the relationship of the trade union movement with the NDP, both provincially and federally, and how they're going to participate in the renewal of the federal NDP. It's interesting that they would be bothering to....
Hon. J. MacPhail: Make it relevant to this discussion.
D. Mitchell: I will make it relevant to this discussion.
A key part of this discussion relates to this government's relationship with the trade union movement and why this government is not fit to govern. It cannot be both employer and employee at the same time.
Interjections.
The Speaker: Order, please. Hon. member, please take your seat.
The hon. member for New Westminster rises on a point of order?
A. Hagen: On a point of order. While I very much want to hear the comments of the hon. member with respect to this bill, I think it would be well to remind members that they are not permitted to display papers and artifacts -- or whatever one might call them -- in the course of the debate. I hope the member will continue with his debate acknowledging that rule.
The Speaker: Thank you, hon. member. I'm sure the hon. member recognizes the prohibitions under the standing orders and will comply. Would the hon. member please proceed.
D. Mitchell: Hon. Speaker, I thank you for that. I can only tell you that I look forward to the day when publications like the one I'm referring to are historical artifacts and are no longer current in our province. I'm talking about a publication that preaches the joy of having trade unions constitutionally aligned with a governing party that not only seeks to represent those employees but also tries to pretend to be an employer that will bargain with them in good faith at the same time. It's a sham. Bill 53 really speaks to this issue.
Interjection.
D. Mitchell: Let me give you an example....
Interjection.
The Speaker: Order, hon. members. I'm sure that hon. members realize that intervening from their seats is quite unparliamentary and disruptive. I would request that hon. members respect the person who is in his place in debate. They will have the opportunity at a later time.
D. Mitchell: I look forward to the contribution of some of the government members in this debate as we proceed in second reading on Bill 53. It is going to be interesting to hear how they defend coming forward with this legislation when they are members of a party that is constitutionally aligned with organized labour. Where does the legislation come from? I want to point out an article in the issue of the publication called The Provincial, which is the newsletter of the BCGEU, of the date that I referred to earlier. Page 11 says: "Bill 53, Pension Changes You Should Know," and in the article it says:
"The proposed changes follow months of discussion by pension advisory committees. Although the public service pensions are established by law and cannot be negotiated through the collective bargaining process, the BCGEU played a significant role in achieving these improvements."
[ Page 12442 ]
We can't ask that question now in second reading, but when we get to committee stage we are going to want to know what role the BCGEU played in bringing forward these amendments. What role did the other trade unions that are involved play in bringing forward these amendments? Is the government simply the messenger of the employees? Is the government fulfilling its fiduciary and other responsibilities as the employer in this case, and making sure that the taxpayers' dollars are well protected, or are they simply the agents of the employees? That's the paradox of power. This party is not fit to govern in this province, in my opinion, because they cannot fulfil that role.
This bill is going to increase costs; there's no question about that. There are a number of areas where that's very obvious. There's a cost associated with lowering the reduction for early retirement. Anyone who has made even a cursory study of pension finance knows there is a cost associated with that. There is a cost to indexing. The indexation of reduced pensions is going to provide a cost to those pension plans. The indexation of the Canada Pension Plan offset is also going to provide a cost. The vesting and locking-in provisions, and many other provisions of Bill 53, present costs.
As the member for Delta South indicated earlier -- and it was reiterated by the member for Peace River South -- we are not even dealing with the unfunded liabilities of these public service pension plans. That is a crucial issue, but this bill ignores that completely. In addition to not dealing with the unfunded liabilities, how are we going to deal with the increased costs of these enriched pension benefits and other benefits that are dealt with in Bill 53? The article that I referred to in The Provincial explains it, and it became very clear to me what the trade union expectations are with respect to this bill and how it's going to be paid for. I would like to quote from the conclusion of the article that I referred to.
Interjections.
The Speaker: Please proceed with the debate, hon. member.
D. Mitchell: This is what the publication says. This is the explanation for how these benefits are going to be funded. It says that a new investment strategy will see funds disbursed into a broader range of assets that could include stocks, real estate, mortgages and equity positions in new companies. This is the vision of the future. We have trusteed pension plans with massive unfunded liabilities that we, the taxpayers, are ultimately responsible for. We are going to enrich the benefits of these plans in a significant way, but not to worry. There is no cost to the taxpayer -- we're told, or at least the trade unions are telling their members -- because we are now going to have a broader investment strategy pursuant to this act with these amendments, and we are going to be investing in companies, real estate, mortgages and joint ventures, and we're going to be taking equity positions in companies. This is the vision of the future, and we can only fear that what the government has in mind is to invest in casinos and gambling projects. A number of trade union members have been in touch with my office telling me that they are very concerned that their trusteed pension plans are being invested in investments that may not be secure. If those investments turn out to be insolvent or if the casino project on the waterfront of Vancouver, which this government is supporting and which has trusteed pension funds invested in it, goes belly up, what happens to the pension plans?
Those questions have been asked of me many times by several union members. But this government is telling us not to worry. We're going to diversify our investment strategy and invest in all kinds of projects, possibly including casino megaprojects. That's how we're going to pay for these benefits. We're going to earn so much money from investing in casinos and other real estate investments that we are going to be able to pay for enriched pension benefits for teachers, municipal employees, public servants and others. This is a bogus vision. I'm obviously using some hyperbole here to make the point. We don't know if all of these funds are going to be invested in the casino, but that's clearly one possibility under the expanded investment strategy with this bill.
[7:45]
This highlights the paradox of power. Once again, this is demonstrating to this government -- and I've said it before -- that you cannot be the employer and represent the employee at the same time without being caught in a massive conflict of interest. This government still hasn't caught on to that. By bringing forward Bill 53 they have demonstrated once again that they cannot and will not take into account the paradox of a government like the New Democratic Party trying both to represent employees and pretending to be the employer at the same time. I encourage the Minister of Social Services, when she closes debate on this bill, to tell us what safeguards she and the government have taken to prevent that conflict of interest being expressed in ill-thought-out legislation like Bill 53.
The Speaker: There being no further speakers, the hon. minister concludes debate.
Hon. J. MacPhail: I'll make a few remarks in response to the hon. members opposite just to clarify a few issues so that we don't go into committee stage with them again misleading the debate.
First of all, let me say on the issue of conflict of interest that I look forward to the next book of the hon. member for West Vancouver-Garibaldi where he describes a new model for the parliamentary system, the public service and what relationship an employer would have to that. I wait for the day of his new book where he defines, for the very first time ever, a relationship that is different from the one that exists right now between the employer as government and the employees who are the public service.
The issue we have before us is one where we are saying to public employees, who contribute $17 billion, that they should have some interests in the future of their pension plans in the same way that private pension plans do. I'm sure some of the members opposite have in past lives had pensions plans with companies, perhaps with the real estate board -- no, I guess they wouldn't have pension plans. The Forests critic is from an industry where there are private pension plans that have many of the same aspects as this.
In terms of our government dealing with the issue of conflict of interest, we are well aware. We have a conflict-of-interest commissioner, with clear guidelines set up by our government, who has addressed this issue both publicly and privately. I'm sure the hon. member will be interested in receiving that opinion.
The Minister of Finance is away today on important business and was regretfully unable to attend the debate. She is meeting with other ministers of finance from across the country to discuss issues of federal Liberal government off-loading on to the provinces.
[ Page 12443 ]
It was interesting that I didn't hear anything about how these improvements will help women. I guess that didn't occur to the members opposite. The key point of this bill is how it will help those who have consistently had to contribute but have been unavailable for the benefits of pension plans. This bill will now assist women and those who work part-time as well.
In closing, let me address the issue of the unfunded liability. In my opening remarks, I stated that these acts have remained unchanged for 12 years, since 1982.
Interjection.
Hon. J. MacPhail: Thank you, hon. member, for that information. I appreciate that.
It wasn't as if this unfunded liability occurred in October or November 1991. In fact, the auditor general made many comments on it before that as well. Certainly our government has taken initiatives to deal with the unfunded liability. This bill proposes that, when required, additional contributions will be phased in to help public sector employers manage the financial impact of the higher contribution rates. Unlike previous governments that did nothing to manage the unfunded liability, this bill actually deals with that. None of the members opposite actually picked up that point, so I'm sure that we will be able to have that good debate in committee stage.
It allows the plans to continue to benefit from the current period of positive financial results under the management of....
Interjections.
The Speaker: I call the hon. member for Peace River North to order. It is difficult for the Chair to hear what the minister is saying with the chatter going on. Would members please stay in order.
Hon. J. MacPhail: As I've said, this bill will ensure that the unfunded liability is not increased due to extended benefits -- a point that the members opposite missed completely in their reading of this, as well as many other important factors. I would also note that the funded position of the plans has been steadily improving, and we expect their financial health will continue to improve greatly over the coming years.
Having said that, I know that the member for Delta South, who is the Chair of the Public Accounts Committee, knows that our government is the first to address these issues, both through public accounting and through the pension fund contributions for the unfunded liabilities of the plans. One is verging on receiving surpluses, which will be good news for members opposite.
[8:00]
I very much look forward to committee debate when we can actually get the facts onto the table and hear from members opposite their creative solutions to employer-employee relationships in the public service in the parliamentary system and get down to the real issues of how public employees will benefit from these changes. With that, I move second reading.
Motion approved on the following division:
|
YEAS -- 31 |
||
|
Sihota |
Pement |
Priddy |
|
Edwards |
Zirnhelt |
Charbonneau |
|
O'Neill |
Garden |
Hagen |
|
Hammell |
Lortie |
Giesbrecht |
|
MacPhail |
Barlee |
Lovick |
|
Pullinger |
Janssen |
Evans |
|
Randall |
Beattie |
Farnworth |
|
Doyle |
Lord |
Streifel |
|
Sawicki |
Jackson |
Kasper |
|
Krog |
Lali |
Hartley |
| Boone | ||
|
NAYS -- 11 |
||
|
Chisholm |
Farrell-Collins |
Hurd |
|
Gingell |
Stephens |
Weisgerber |
|
Mitchell |
Neufeld |
Fox |
|
Jarvis |
Tanner |
|
Bill 53, Pension Statutes Amendment Act, 1994, read a second time and referred to a Committee of the Whole House for consideration at the next sitting of the House after today.
Hon. J. MacPhail: I move that we have a recess of about 15 minutes. Both people who have to participate in the next item are not here, but they will be in 15 minutes.
Motion approved.
The House recessed at 8:02 p.m.
The House resumed at 8:14 p.m.
Hon. J. MacPhail: I call Committee of Supply to hear the estimates of the Ministry of Health and Ministry Responsible for Seniors.
The House in Committee of Supply B; D. Lovick in the chair.
[8:15]
ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 42: minister's office, $436,943 (continued).
L. Reid: I would pose two or three questions to the minister to continue with the discussion raised earlier by the MLA for Surrey-White Rock. He was posing questions about the Boundary health unit and made a comment which he believes was left unanswered.
Inspection of community care facilities for compliance is essential for assurance of health and safety of individuals in care. There is a critical need to reduce our backlog of 161 facilities out of 425 that may have had their last inspection several years ago. This would require one person five months to complete and could reduce our current heavy demand for extensive investigations due to noncompliance. Apparently, that was not touched on earlier, or the answer was not forthcoming. Could the minister kindly comment? To refresh his memory, it's the Boundary Union Board of Health, and the issue was raised in debate by the member for Surrey-White Rock.
[ Page 12444 ]
Hon. P. Ramsey: I replied to the member for Surrey-White Rock that I would have ministry staff check out the figures presented in that document and report to me on how we make sure that we are up to date with having inspections done and ensuring that quality care is being provided in facilities in the Boundary health area.
G. Wilson: In our introductory comments, we asked some questions on the larger provincial issues. This evening I have questions that are more specific to the riding of Powell River-Sunshine Coast, but I think people around the province will listen carefully to the answers to these questions. If the minister will answer tonight, I think many of the health care facilities in the province might learn from the minister's approach.
The minister will be aware that there is growing concern on the southern end of the Powell River-Sunshine Coast riding, particularly in the community of Sechelt. Sechelt is one of the fastest-growing communities in British Columbia -- and, indeed, some could argue in western Canada at the moment -- according to readily available statistics. As a result of that, it tends to be a community that is attracting a lot of retirees. Therefore it has an aging population, a population that is requiring of community services a good deal more than the hospital is currently funded to provide.
The concern is around the fact that the second floor has had to be closed down. Four palliative care rooms that were to be available -- that is the service most frequently referred to as needed and desired by the community -- have been removed or reduced; in fact, we're down to one room. We have problems associated with ambulatory care in that area. With respect to the psychiatric services that are there -- which last year the minister, at my urging, took steps to correct -- we have difficulty understanding how we're back in the same situation this year.
I'm not speaking just about the health care providers, but the community as a whole is not quite understanding why, when in his home riding of Prince George on the weekend, the minister made a comment that due to the fact that Prince George is a reasonably fast-growing community.... I'm paraphrasing from the media, and I have hesitancy in doing that because they often don't get the story right, as I well know. But I hear from the media that the minister suggested on the weekend that, because of the problems with the budget of the hospital, he was prepared to review and perhaps take a second look at it.
Given the problems I've just outlined in Sechelt, that it's in an area of extremely high population growth -- it has a very fast-growing demographic development -- and that St. Mary's Hospital was ranked one of the finest hospitals in Canada by an independent review just a couple of years ago, and recognizing that now the entire second floor sits empty as a result of lack of funding, I wonder if the minister might tell us whether he might entertain a review for Sechelt similar to the one he's prepared to entertain for the hospital in his own riding of Prince George.
Hon. P. Ramsey: As the member said he wanted to address some general issues, let me respond by addressing those general issues as well, applying them to the Sechelt area and the funding that health care facilities in that area have received over the last few years. I said in my opening remarks in estimates that in order to preserve the Canadian medicare system we all value so highly, the royal commission clearly said changes needed to be made. We needed to look at funding services increasingly in clinic and home situations rather than in institutional settings, and we needed to assist communities in doing that. In the Sechelt area, as in other areas of the province, that indeed is what has been happening.
The member mentioned the concern about psychiatric services. That's one very important part of mental health services in his riding and in other areas of the province. I don't know if the member is aware, though, that in the Sechelt local health area 46, funding for mental health services has increased by 95 percent in the three budgets that have come in this House.
G. Wilson: What does that mean in terms of growth?
Hon. P. Ramsey: It means nearly a doubling. That's good news, I think, for mental health in the Sechelt area. So what we have here is a clear commitment to improving mental health services and making sure that we have a wide range of services available throughout the province.
Similarly, funding for community programs has risen nearly 40 per cent over that same period. In addition to that, this year we're providing approximately $360,000 in Closer to Home funding to that health area to build up and provide additional services to the community. As I said earlier, those are to be proposed and provided by hospitals, working in conjunction with community groups and others, and they are to be approved in the region served by the facilities. That is the challenge that all health areas face. We are working with them to make sure we can preserve the high quality of health services that people have a right to expect. Changing the way those services are delivered is important.
The member alleges a number of things about services provided through St. Mary's Hospital. Like other hospitals, St. Mary's has been given a preliminary budget, and it has been asked to work with other care providers in the community to see what provision can be made to address what I recognize as a challenging budget. They are to look at options for providing services outside the walls of the institution through Closer to Home projects. At the end of the day, they are to come back to this ministry and tell us how they're doing.
We've said very clearly: "Do not reduce or cut services until you have done that consultative work, shown us what you've done and talked to us about it." That's what I look forward to doing with those responsible for providing services at St. Mary's Hospital -- as with other hospitals around the province. I expect that in the not too distant future St. Mary's will be doing that and will be telling us very clearly what the implications of the budget are, and I'll look very carefully at those for the Sechelt area, as I will for other areas of the province.
G. Wilson: Let me be the ambassador for St. Mary's and tell you right now that the situation there is, I'm sure, not unlike many other communities, but I think it is particularly problematic in Sechelt. The problem is severe, and I don't think we need to wait for any further analyses to be done.
It's interesting that we throw around the fact that you've got a 95 per cent increase in funding for mental health care and you've got preliminary budgets; you again throw out this notion of percentages of increase. On a per capita basis -- and I think that's what we have to look at and that's what the minister has said will be one of the key issues with respect to reviewing the processes of community hospitals -- with respect to the service provided by the facilities, St. Mary's does better than most hospitals in the province. It does better with fewer dollars now.
[ Page 12445 ]
Hon. Chair, when you look at an acceptance ratio of about 60 percent, with 40 percent being serviced by hospitals in the large urban centres, primarily Lions Gate Hospital, and when you have a population of 23,500 expanding quickly -- I believe it's the second-fastest-growing community in the province -- we are isolated by virtue of the fact that we have no way of getting people off the coast other than by ferry or by air. Air ambulance is not an option after-hours, because there's no opportunity for IFR flying in that area. As a result -- and I'm going to make exactly the same argument for Powell River in just a minute -- these two communities are in urgent need of a review of the budgets that they've been provided, because they are simply inadequate for the provision of those services. While I'm sure that those arguments can be made for other communities, the Closer to Home concept is generally not one that people are rejecting per se. What they are rejecting.... I believe I've heard this comment from the member for Richmond East in a rather eloquent way, and I think I've heard the same thing from the member for Prince George-Omineca. I urge the minister to listen to what is being said here, because we're not here to fight a partisan battle on this question. There will be time to do that later on when we ultimately stand to have our mandates renewed -- or not. But right now we're speaking out on behalf of people who are urgently trying to communicate to the minister that this whole notion of regional reform of health care isn't working. It isn't functioning properly; something is wrong.
When the entire second floor of a hospital is closed down and there is a net reduction in service of six beds, that is a clear reduction in service. The minister is saying: "Don't reduce service until we review." There is no option if you're going to provide the quality of health care that I think all of us have come to expect. We recognize that in looking at the formula used as a derivative to the number of beds per capita that should be there. Right now, the number of beds that should be there is 39, rather than looking at the formula that we end up with, which is around 32 or 33. So there is a really urgent need here, and I think that it isn't going to be enough for people to simply hear platitudes from the minister on the palliative care side of things. It is the one service that people in the community of Sechelt have said is an outstanding service. It's a service that has provided for many, many people in the last hours of their life, and it is now being cut -- not eliminated, it's true, but drastically reduced.
I would say that no amount of talking about budgetary increases is going to solve the problem. As the member for Prince George-Omineca points out, they are figures that are relevant only if you know what the baseline data is in the first place and if you apply that to some kind of standard application on a per capita basis. The problem is twofold, and I would first ask: what do we have to do to convince the minister that the budgets that have been set down are inadequate? Second, what do we have to do to convince the minister that you cannot create a hiatus in the delivery of health care services while we're still sorting out how this Closer to Home is going to work?
[8:30]
You can't just all of a sudden create a hiatus in service delivery until such time as we know that what is being proposed is in fact going to be functionally available, will serve the community in a way that's cost-effective and, far more importantly, is going to be providing the quality of health care we've come to expect.
I'd like the minister to respond to that. The figures here make it pretty clear, just using the formula that the minister or his staff will use, that that facility requires additional funds.
Hon. P. Ramsey: I'm very glad that we're not engaged in a partisan debate on these issues tonight -- forbid that we should get into such things in this chamber.
But let me make it very clear that we are indeed engaged in serious debate about health care in British Columbia, and I recognize the seriousness of it. I feel the seriousness of the issues that this ministry deals with daily. And let me say this very clearly, hon. member: we need to recognize that changes have to occur in the way we deliver health services. It is not enough anymore to simply call for funding increase on top of funding increase. That was the attempt made in the late eighties and early nineties by the previous administration -- if somehow enough funds could be devoted to it, no change would be necessary. That did not prove to be the case. The Royal Commission on Health Care and Costs said very clearly that we needed to take swift steps if we were to preserve the health system that we have. Part of those swift steps had to be a downsizing of the resources devoted to the acute care sector through the hospital-based sector and provision of hospital services.
I know that that is contrary to what some believe about health care; I know there are those who simply say we have to keep funding and raising the funding to all institutions. I reject that. I think that is a road to disaster. It would neglect the change that needs to come about. I would urge this member, as I will urge others, to recognize that the change is needed, and to also recognize that far from having a hiatus here, we are going about this transition in as planned, cautious, pragmatic and non-partisan a way as we possibly can.
The Closer to Home fund established this year for the Sechelt area and other areas is an excellent example of that. We are asking hospitals to work with community groups to design services that can be delivered outside the walls of institutions while preserving services. The member says -- and I think the record will show this -- that hospital services is the issue. I submit that the member has got it wrong. The issue is health services and designing those services so they can be delivered -- whether through hospitals on an in-patient basis or on an out-patient community or home basis. That is the issue, hon. member.
G. Wilson: I don't take issue with the minister when he says that we have to have reform and that we have to somehow change the health system; we do -- and I'm speaking about small-r reform, don't mistake my comment on that. There is no question that the health care system has to be reformed; nobody's arguing that point, especially not in these estimates, when we're trying to get down to some real answers to some rather important funding questions.
The fact is that while the minister might say that the real issue is health care, try and tell that to a patient in a hospital who's trying to get in, or to somebody who's on a wait-list who can't get in. The minister has to recognize that while we enter into long philosophical debates and protracted discussions in community groups about how we're going to create regions and health councils and put them into regional hospital boards, and about how the administration and distribution of money is important in the long term, there are people out there who need health services but can't get them. There are dozens of them; I have files full of them. We need to try to get off the philosophical question of the Closer to Home concept and get down to some specifics.
The minister talks about the question of the provision of health care: should it be within the hospitals, should it be a treatment and release program, and so on. Statistics are now being kept in the Sechelt area, and we find that a number of
[ Page 12446 ]
people are being readmitted. People are coming in, being released and coming back in again because they need additional service and care.
I don't know how much time this minister has spent on the Sunshine Coast or in Powell River looking at what other kinds of facilities there are outside the clinics and health care providers. I would urge the minister to tell us what he believes is equitable about this. When you have a population that is growing at the rate this population is growing; when you look at the per capita service that is provided, which is among the highest in the province; when you take a look at its isolation by virtue of its geography; when you take a look at the immediate service costs that have been forced on this hospital because of a lack of service, why wouldn't this minister turn around and say: "Look, we've got a problem here."
In a speech that this minister made to the BCHA in the spring, he talked about bridge financing and loans, so let's talk a bit about that. Given that we recognize that we are in an urgent and difficult situation, what is the availability of bridge financing for a facility such as St. Mary's to ensure the provision of services? What exactly does the minister have in mind with respect to these loans?
Hon. P. Ramsey: I surely do not mean to imply, and I hope my response is not taken to imply, that St. Mary's Hospital and the services it provides are not important to the people who live on the Sunshine Coast -- an area of the province that I have a great affection for, having purchased some property there that I plan sometime to retire to.
Let me point out two facts about funding for the area, and then address the specific question the member asked about bridge funding. Fact: population in that local health area has increased by some 13 percent over the last three years; I don't know if that is your figure as well -- from just under 21,000 to about 23,500 people. Fact: health funding for that local health area for community grants, continuing care, mental health, Closer to Home and hospital care increased a total of 19 percent over that period. I believe that we have recognized the growth there, and that is a rate of increase in health funding that demonstrates this government's commitment to ensuring that health funding is one of our highest priorities.
To address the specific question of the member as far as bridge funding is concerned, I will be asking St. Mary's Hospital -- as I am asking all hospitals, after they have received their budget and done that consultation -- to work with my ministry and to report on how they are dealing with it -- whether they need two years to balance, whether bridge funding is something they wish to pursue, or whether loans are something they wish to pursue. We will be considering those requests from St. Mary's and from other hospitals.
G. Wilson: It's just a little misleading when you look at the 13 percent increase, which I think the minister himself would agree is a very high increase over three years. I think we are all encouraged that the minister has purchased property on the Sunshine Coast which he plans to retire on. Now he has a vested interest in making sure there will be some health services there when he retires, which is probably when he is going to need them. So we will take at least a little bit of comfort in that.
Let's come back to this question of bridge funding. There is no question that the situation is serious. The minister might think we are playing partisan politics here, but I'm not. We need to find a way to assist St. Mary's in the provision of care. Quite clearly, talking about a 19 percent increase to that community and about the Closer to Home question, community grants and various other sundry kinds of expenditures doesn't look at the hospital administrative problem with the budget that is in place. We're talking now about looking at additional expenditures with respect to renovations to provide some additional facilities. That is going to give us an opportunity to provide some space to assist with ambulatory care. Sixty thousand dollars is being put into a renovation. Herein lies a real problem. Ambulatory care is something that this minister and the Health ministry is generally trying to encourage. They suggest that we need to move to the question of patient care wherever possible. Yet, interestingly enough, we find an entire floor of a hospital closing down, where there could clearly have been services provided with respect to that care. It doesn't make sense.
Rather than looking at ambulatory care being set up with a renovation of what used to be an old ambulance station to find some service provisions there, surely the minister would agree that an early and expeditious move toward some form of bridge financing would be in order. Could the minister tell us specifically what steps should be taken? What kind of pool of money is he looking at with respect to bridge financing? Could the minister tell us if there are guidelines already in place with respect to the amounts that might be available? If the minister could tell us exactly which programs that bridge financing might be applied to, we might have a better idea of the kinds of expenditures that this ministry is looking at with respect to financing for hospitals that find themselves in rather urgent need.
Hon. P. Ramsey: I'm not sure whether I should reply to the member's warm welcome to the Sunshine Coast by saying that obviously I can't do anything for him because I'd be in a conflict of interest. I assure the member that I will treat St. Mary's and its budget challenges with the same seriousness I treat others.
Bridge financing is one option that I've asked hospitals to consider as they put their budgets together. I've also asked them very clearly to demonstrate to this ministry that they are taking the steps that are needed to coordinate their services with community care providers, to take a hard look at efficiencies of administration and support, and to do the other things that must be done to develop a more efficient hospital sector, and a hospital sector that works with the community sector on a more integrated basis.
I would suggest that the member go home to Sechelt over the weekend and make sure that St. Mary's Hospital is providing this ministry with information on how they're dealing with their budget difficulties, determine what steps they have made to coordinate service with other agencies and find out what plans and proposals they have for use of Closer to Home funds to assist in the transition towards a more integrated and balanced system. It should ensure that my ministry has that information so it can consider bridge financing and other options.
G. Wilson: I certainly want the minister to know that the people on the Sunshine Coast are an enormously receptive and wonderful group, and that he will indeed be made welcome. I look forward to the day that I can serve the minister as an MLA, because I'm sure that when he's retired there I'll still be representing that region.
Interjections.
[ Page 12447 ]
The Chair: Don't provoke him.
G. Wilson: All right, hon. Chair, I'll take your advice and not provoke this minister. We take courage in the fact that the minister has said we should get some figures together and present them. I can assure the minister that I have been in communication with the hospital administration and other health care providers, and I'll make sure that the message gets through. We will put together the kind of package that's discussed -- either over the weekend or as soon as we can -- and hopefully we can come up with some additional money.
Having said that, let's move on to several other issues. One is psychiatric day care. I notice the minister has said that this issue has increased substantively. The minister will know that he and I have had many discussions.... I should say once again on the record that I have found this minister to be very forthright; he certainly has had an open-door policy -- with respect to this member, at least -- on health care issues, and I appreciate that. I also appreciate the fact that his staff has always been most helpful on these questions.
[8:45]
But there is still a rather urgent need. The matter of psychiatric day care is still a rather critical issue in the community. Many other community organizations have applied for it, for sure, and some are being funded. I don't mean to diminish in any way the role that the various established and organized groups play. The difficulty that we have -- and the minister will agree -- is that in many instances, these patients require specialized care that requires people who have unique and particular training. It is often something not provided by support groups, even though the support groups are extremely important, particularly to families with members who have a mental illness and have moved back into the community and require ongoing service and care. The problem we have with this is that we still do not have the facilities we require. I wonder if the minister might tell us what provisions are being made within the ministry to look at this particular question.
The minister will be well aware that through a program of deinstitutionalization, the movement back into the community of many people who suffer mental illness, there are growing issues in the communities that require some urgent attention. Mine is one that I'm most familiar with, obviously. It isn't just a matter of saying: "You've got a 95 percent increase." As the member for Prince George-Omineca asked: "Ninety-five percent of what base figure?" By looking at the per capita expenditure, you can clearly recognize that this area really does need some attention. Perhaps we could hear from the minister on that.
Hon. P. Ramsey: The member mentioned that St. Mary's Hospital had received some recognition as being a high-quality institution. From those who are devoted to the treatment of mental illness, Sechelt has received public recognition for the quality of its mental health services, and I must recognize that too. The community mental health services seem fairly well integrated with those provided through the hospital psychiatric day clinic, and that's really a step forward compared to the situation in many other areas of the province.
The constituency the member represents is expected to benefit from increased funding made available from the Riverview replacement project, and I expect that there will be enhancements in the community service structure as we develop residential living spaces in the region. I think the member can expect some firm announcements on that in the not-too-distant future. I know that residential facilities are being planned for the Sechelt area. Also, I know the member has had a concern -- as I think the mental health community in general has -- with a "secure room" at St. Mary's. I think the member is aware that the mental health division of this ministry is providing $60,000 to renovate a secure room at St. Mary's to contain people who are experiencing a psychological crisis and need that sort of secure facility. So there are several initiatives underway. I believe Sechelt has a good range of mental health services available, and I think that those services will be increased in the next couple of years.
G. Wilson: Is the minister able to tell us what range -- if not, what dollar figures -- is likely to be available through the Riverview replacement project? Also, what dollar figures are allocated this year for residential projects? I'm well aware of one project that I believe is almost completed -- or it may be completed and is now open. But I'm not aware of more than one project that's underway. Perhaps the minister might enlighten us as to which projects he's referring to.
Hon. P. Ramsey: My understanding is that the Riverview replacement team has identified a need for six living spaces in the Sechelt area and another six in Squamish, at the other end of the riding. I'm unsure about the status of the completion of either of those. I would expect that those are on the drawing board for completion either this year or next. I hope those are the figures the member needed.
G. Wilson: Is there a dollar figure attached to those six spaces? I believe that the six spaces in Sechelt are what I'm referring to. The site has been identified, and I believe that even the home has been identified. Is there a dollar figure, and can the minister tell us how that money is to be administered? Certainly the mental health services on the Sunshine Coast are excellent. The services we have are outstanding. The difficulty we have is that they are strained. Because a growing number of people in that community require those services, we need to look at the best use of the money to alleviate the strain that's already there.
Hon. P. Ramsey: With a rough figure, a six-space living unit should probably run in the range of $160,000 to $180,000. That's the estimate for providing that sort of facility in the Sechelt area. I don't know what the final figure will be, hon. member. As I said earlier -- and I'm glad to hear the member confirm it -- there is a good range of mental health services available in Sechelt, as elsewhere. As planning goes forward with increased facilities, we need to assess the need for additional services.
G. Wilson: I wonder if I could move into the question of palliative care. As I mentioned in my opening remarks, we have a situation where we only have one room where we had four, and I would remind the minister that these were largely put together by the community. The community generated the support for those rooms, so it's a community initiative. Now we're reduced to one room. I think the minister would recognize that it causes concern when a community has a necessary service such as that being reduced and therefore severely compromised. It's an issue that is high on the minds of many people in the community, particularly as there is only one private room where four existed before, and they see the entire second floor of a hospital being closed. Could the minister tell us what specifically is being done with respect to funding palliative care and whether or not there are areas where we might seek the necessary resources to keep those four rooms open?
[ Page 12448 ]
Hon. P. Ramsey: I've already made many of the comments I wish to make regarding hospital funding. I expect that St. Mary's will be presenting its accounting of budget difficulties and challenges -- those it has successfully overcome and those it's having difficulty dealing with.
The only other thing I would add, hon. member, is that in many areas of the province, people are increasingly considering palliative care as something that they might wish to see delivered in a home setting rather than in an institutional setting. I have heard of proposals coming forward for use of Closer to Home funding for establishing palliative care in a different setting. I don't know whether that's an option that those who live on the Sunshine Coast wish to pursue; it is an opportunity that could be available through joint work of the hospital and community agencies.
G. Wilson: Indeed, what kind of palliative care can be provided in-home and what can -- or should -- be provided in the hospital has been discussed at length. I think the minister would recognize that it is not even appropriate that care be provided at home in all cases. Where we are dealing with that service, it's important that the community have the services it needs. I'll take the minister at his word when he suggests that that should be put into the review of the budget, which I am sure is going to be expeditiously put together and put before the minister in the clearest of ways.
I wonder if the minister might just go forward to another issue that has to do with a grouping of hospitals. With respect to the peer grouping, there seems to be a hierarchy of hospitals with respect to application into various diagnostic and treatment centres. It would seem that you have the largest hospitals ranked one to four. There seems to be demographic information used fairly extensively with respect to allocation of primary budget allocations, and then it cuts off. A whole series of those hospitals -- and there are many, such as St. Mary's, Terrace, Prince Rupert and Smithers -- fall into a subsequent grouping in which there doesn't seem to be a formula applied, at least not consistently. This has been brought to my attention by a number of administrators. I wonder if the minister might tell us why that hierarchy was established, why there isn't an even application with respect to demographics and application of demographics to funding, and why there seems to be this kind of two-tiered system of allocation. It doesn't seem to make a lot of sense to people, particularly those in the rural areas that are experiencing rapid demographic growth.
Hon. P. Ramsey: I don't wish to be seen as facetious, but there are actually eight tiers of hospitals. Over the years there has been an attempt by the ministry to group hospitals together that deliver comparable sets of services, both to ensure that appropriate funds are being accessed by the hospitals and to assess the possibilities for efficiencies in delivery of care. The ministry is currently reviewing the placement in the groups. I must say -- at least in the last couple of budgets -- that one of the efforts of the ministry in allocating funding to hospitals has been to shield the smaller facilities, recognizing that in many cases they lack the flexibility in adjusting services that some larger institutions may have. Far from it being a penalty to being farther down the list, in some cases it may have been an advantage. I wouldn't place a disproportionate amount of weight on this, hon. member. This is a device for comparing services that are delivered for seeking efficiencies in delivery of service and for allowing hospitals to talk among themselves to their "peers" in their group -- to discuss what they are having success in doing and where they are having difficulties.
G. Wilson: It's interesting that you say it's an eight-tier system and don't put too much weight on it. But in fact a lot of weight is put on it with respect to the way that funds are allocated -- at least, if I read the ministry's budgets properly. I have looked at the amount of money that has been provided to a variety of institutions, and it seems to me that the ministry does in fact put a significant amount of weight on it with respect to the provision of services on a per capita basis within a prescribed community. I don't take issue with how that formula is established, but it is interesting, because the minister has said to us many times that members should have an option. If we don't travel along the route that this government is travelling along with respect to health care reform, the other option is to do what Mr. Klein is doing in Alberta. I heard the minister say that, and I thought I might just do a little bit of work on that.
[A. Hagen in the chair.]
Subsequent to a comment made to me by a learned person -- somebody who is knowledgable of the health care system -- I actually did some looking up myself. It's interesting that even with a 10 percent cut in the drastic manner of Klein, on a per capita basis Alberta is still ahead of B.C. So on a per capita basis, I'm not sure that we -- and clearly the minister -- want to argue that, because figures are often manipulated. That's our concern here. Even if you were to look at the 10 percent cut on a per capita basis, British Columbia may be seen to be worse off in straight figures. If we start to look at the use of per capita information, we then have to know the criteria by which the ministry modifies, changes or somehow alters the kinds of budgets provided in these particular communities.
I'm about to move into discussions more specific to the Powell River area. In that particular area, there's a brand-new facility, which the minister will know, because we were both there to cut the ribbon, although ironically enough it wasn't this government that created that new hospital. Before we hear applause from the previous government, it wasn't even that government that created it. In fact, I think it was initiated back in.... I don't know.
An Hon. Member: It was 1952, under a Liberal government.
G. Wilson: I don't think it was '52 under a Liberal government. Actually, I think it was back in the '72-75 days, when.... Nevertheless, the fact is that it took a long time to get that hospital built.
[9:00]
Now, of course, they're looking to have adequate funding in that region. Again, it's an isolated community in which population growth is occurring. We are concerned that this notion of per capita funding is going to take hold. We'd like to be sure that what's necessary here is to examine the provision of a wide latitude of service to meet the community service needs rather than simply to look at the demographic size of the centre and the next highest centre and say: "You are able to transfer patients into these various other facilities now, because we're going to restrict your funding on the basis of your population and make some distinctions as to what kind of health care services you might need because of that." The minister might want to comment on that, because that clearly is a common concern -- even in the regionalization process, when we get into looking specifically at the division of boundaries. If the minister can answer this question, then we can move into that issue.
[ Page 12449 ]
Hon. P. Ramsey: That was a brief tour of issues in health care in Canada, that's for sure. Let me just say this about 10 percent cuts versus whatever. Actually, I believe the figure that Mr. Klein is proposing in Alberta is a 17 percent to 18 percent cut in the acute sector, not 10 percent -- as opposed to what we in this province have been able to do over the last three budgets, which is to provide approximately $320 million of additional funding into the hospital sector, which amounts to an approximate 12 percent increase over that period. I'd say that's a significant difference in what we've been able to do with funding health facilities in this province. I much prefer the route we have been able to take -- continuing to fund both the hospital sector and build up the community sector.
If I heard him right, I believe the member's question was whether per capita funding was part of regionalization. I've said before that population is one component of a formula to distribute funds equitably to regions around the province. We'll be asking those regions to do the best job they can in designing how those health services are delivered.
In regions such as the Sechelt area and the Sunshine Coast, given the size of the population, I suspect there will always be a need for people to travel elsewhere to receive some services. A population that size, as the member knows, will not attract a full range of specialties and tertiary services. So we have to make sure that the residents of that area also have a say in the sort of macroplanning that's involved, to make sure they have access to higher levels of acute services.
G. Wilson: It's interesting that the member for Richmond East referred back to 1952, to the last Liberal government. It's interesting that in Sechelt in 1966 -- which is not quite back to 1952, but almost -- they had as many beds as they've got now. You talk about per capita increases in costs. They had 32 beds then, and they've just had to reduce their beds by six. So in 1966, basically, they had the same number of beds as they do now. The minister might be able to put out all kinds of figures as to how much has gone forward in increases, but the point is that in terms of the services available.... Clearly, when you have the third-fastest-growing population....
Interjection.
G. Wilson: Well, I'm telling you, that's what the figures are. The minister may or may not want to take issue with that, but those are the facts.
With respect to the services for which you have to go to larger centres, I don't take issue with the fact that not every hospital can have every service available to it. We recognize that specialists will need to be called upon for certain matters. One of our concerns in this regionalization process on the Sunshine Coast is that it seems we're being linked with the Vancouver Island region, although the primary services that we go to when we require services not available locally are in Vancouver, not Vancouver Island. So we wonder what the ministry's thinking is that might link us to Vancouver Island; and secondly, whether or not the Coast-Garibaldi health unit, at least in the mind of the minister or the ministry, has been defined yet.
This process has been ongoing for some time now. Sechelt, as the minister will know, is not on an island; it's on the mainland. Even though it's linked by ferry, it's a functional part of the mainland, and this is causing some concern. Physicians as well as patients are concerned as to whether or not there's going to be a limitation with respect to the specialists they'll be able to access, dependent upon the region that is eventually determined for them.
Hon. P. Ramsey: Let me just say this about the planning for an interim regional health board in the Coast-Garibaldi health unit. My understanding is that a planning group has had its first meeting, and they're working on getting the call for nominations together. Most of the boundaries for community health councils within the region seem fairly well-defined. They are starting the work that the member refers to, which is to confirm regional boundaries. I would suggest that one option that they should consider is whether they wish to stick within the boundaries that we started with, which are these health unit boundaries, or whether they wish to look at some part of the health unit amalgamating with the unit representative of the North Shore.
I think the member makes a good point that might lead them to advocate that change in regional boundaries -- that is that people from the Sunshine Coast, if I understand referral patterns accurately, do indeed access many of their specialty services and higher-level acute care services on the North Shore. That might be one reason for that shift in boundaries. Those working with the planning groups that are forming regional health boards are quite prepared to identify an issue like that and work with regions to see if they can redress boundaries to make them fit the way people actually travel to receive health services.
G. Wilson: I'd be remiss if I didn't point out that one of the difficulties with Coast-Garibaldi is that it involves Squamish, which is very much an isolated.... Well, it's a better-connected community than Sechelt, by virtue of the fact there's a road, at least, by which you can drive to it. It also involves Powell River, which is yet another ferry ride away and has no road connection yet -- although certainly a road and rail connection to Powell River would be a good thing for this minister to advocate in caucus. However, that's another matter.
The point is that when you have these three very significantly isolated communities.... As the minister well knows, Powell River generally does look to Vancouver Island for a lot of health services -- as we get into this mammography question, which I'm going to raise in just a few minutes. But there is no question about the need to look at what is an appropriate division of services. The real question that I'm getting here, and it's coming from a number of people in the community, is that the services provided that are outside those of the local hospital are ones that, quite clearly, are different for Powell River, Sechelt, Gibsons, Pender Harbour and that whole peninsula area, and different for Squamish -- which are all within the Coast-Garibaldi system.
I don't know how we accommodate that, but one thing that I think the people want to hear from this minister during this set of estimates is with respect to the allocation of dollars in those areas -- that whatever the region is, we are not going to be competing internally for dollars. The transferability of service which might be facilitated in some regions, where you might have three facilities or more, just isn't the case on the Sunshine Coast. So it's important that we don't end up with a region where the local distribution process, however that's going to work in the final analysis, with these regional hospital boards or councils.... It's important that we don't end up with three competing interests within one region, which would make things chaotic.
[ Page 12450 ]
I'd like the minister's comment on that, because it's important that that be on the record now. It's a very serious concern.
Hon. P. Ramsey: I would say that the member has made a very comprehensive presentation to this chamber of some of the criteria for health planning that needs to go on in the Coast-Garibaldi area. I expect -- indeed, assume -- that those who are working to form community health councils and regional health boards see things in a very similar way.
There's a difference, of course, between seeing the planning for funds as competing for them and figuring out how you make the most effective use of those funds. I think the member makes a good point about the isolation of those three separate areas within his riding, and I would suggest that one of the things analysis might lead to is a desire to form different regional boundaries to take account of where referral patterns go and which locations people from those three areas go to to receive higher-level services.
Funding for regions should be based, as I have said repeatedly, on the number of people in a region and their health status, and it should also take account of the difficulties of delivering service. Having been in all three parts of the member's riding, I'm aware of the difficulty of getting from one part of it to another, and you really do have in some cases three distinct "health systems." There are some services that are provided over all three, but relatively few. Most of them, as I understand it, do work just within those three distinct areas within his riding.
G. Wilson: I must say that the members have been most generous with their time in letting me deal with specific riding issues. I actually have only three other questions.
I would like to say that Squamish is not in my riding. My riding goes almost to Bella Coola. It's a large coastal riding, and I wouldn't want there to be confusion. Squamish lies within the riding of my colleague from West Vancouver-Garibaldi.
Having said that, then, I would like to talk about the whole question of the relationship between the cancer society and this ministry with respect to mammography screening. The minister is well aware that this is a very serious issue in Powell River. It's an issue on which ongoing questions are being raised as to what portion of funds are available from the ministry and what the role of the cancer society is with respect to the designation of screening services versus diagnostic services which might be available in a community.
[9:15]
Would the minister clear that up? Right now there is confusion among those who believe that if there is a machine available, both screening and diagnostic services should be available. Clearly they are not. There are moneys available at the moment for diagnostic services but not screening. It appears that there needs to be some involvement by the cancer society with respect to that.
Hon. P. Ramsey: Actually, I see a couple of options for acquiring mammography services for the Powell River area, which the member and I have discussed. We have already spoken about one of them, and that is to see whether Powell River General Hospital could become a screening centre. If so, it would need to meet the guidelines established by the screening mammography program of British Columbia, which is run by the B.C. Cancer Agency. I should say that approximately two-thirds of the centres run by the screening mammography program are administered by hospitals, so this would be one more site that would be administered by a hospital.
Powell River General Hospital should be applying to the screening mammography program to become that sort of centre. That could result in some shifts of revenue to the hospital. Very often the procedure, as I understand it, is that the interpretation of the mammograms is done by the screening mammography program, although the actual mammograms are done in the local facility. Obviously it involves technician training, making sure that stringent controls are in place using the machine and other factors. Potential funding could be available through the screening mammography program.
The other option is for Powell River to avail itself of the mobile screening mammography program that has been developed by the screening mammography program of British Columbia. It's being developed for upper Vancouver Island, and they hope to have that service in place this fiscal year. So far the agency has not made a final decision on whether or not to have this service visit Powell River on a clinical basis. But that is another option for making sure that the service is available to women in Powell River.
Both of those options would have the necessary controls in place to ensure that a quality screening service is available to women in Powell River. I would suggest, hon. member, that we have a couple of options available for people in Powell River to work with the screening mammography program of British Columbia and take the next steps to make sure that a program is developed for women in Powell River.
G. Wilson: I thank the minister for his detailed response. There will be follow-up on that, I'm sure.
My last set of questions deals primarily with people living in an isolated or relatively isolated rural community, with respect to community health nursing. I don't wish to get into a debate or discussion on matters relating to labour disputes. We're going to have an opportunity to talk about labour and health workers under a miscellaneous statutes bill, and we'll do that in some detail. I would welcome this minister defending it; I hope the Attorney General doesn't defend it.
Nevertheless, I'm thinking of island communities in particular -- Texada Island and Savary Island -- and other areas further north in my riding, such as Knight Inlet, Kingcome Inlet, Bute Inlet, Simoom Sound and Stuart Island. There is a whole series of small communities where people are now residing year-round. In some instances, there is a provision for services on a fairly regular basis, and in others, it's not on such a regular basis. As we start to see those communities become more stable and more long-term.... A lot of them that developed mainly as summer communities are now becoming permanent communities, and people are staying on.
Can the minister tell us what program is available now, or is being planned, with respect to the provision of community health nursing in those communities? I know I specifically brought Texada Island to this minister's attention. However, as I mentioned, there are other communities where those services are becoming increasingly required, yet they are going to be expensive to provide, quite frankly. It's going to be expensive to keep them there on a residential basis; they're not going to be able to reside there. What's the best approach to that question?
Hon. P. Ramsey: I think the member identified an excellent issue -- and a thorny one, perhaps -- that demonstrates as well as anything the necessity for the local
[ Page 12451 ]
design of services to be delivered. Far be it from me to stand here in this chamber and design home nursing for the people of Texada Island. Let me say only that the information I have indicates that if you look at the care provision for people on Texada Island -- and I asked the ministry to look at this after the member inquired -- you're probably looking at a quarter of one full-time home nursing position. Whether that is provided by a resident on the island or by somebody travelling to Texada is dependent, I suspect, on whether people with the appropriate qualifications can be identified.
Last year the home-care nursing budget for the Coast-Garibaldi health unit was fully committed. This year I would suggest that one source of planning money for developing home nursing could indeed be the Closer to Home money, which has been made available for that area and others. The figure for the Powell River area is a couple of hundred thousand dollars, but this would be a small component of that.
So I'd suggest that that's a possible way to look at providing home nursing. It can provide the care people need in their home, rather than requiring them to stay in Powell River in the hospital to receive the care. It would be an efficiency to the hospital, as well as delivering care to people where they wish to have it received.
G. Wilson: That completes the series of questions I had. Once again, I would like to thank my colleagues in the House for the latitude they provided on those questions that were rather specific to my riding.
I guess by way of a closing comment and question to the minister, one of the concerns with the whole regional process is the fact that the differences that occur in areas such as the one I've just outlined -- and it's not really that unique, other than the fact that there are big divisions of bodies of water as opposed to the large tracts of land in the north and central regions of the province.... When you get into this regional concept and this idea that somehow it's all going to be locally planned, the difficulty is that we have to make sure that people who are best able to make those decisions make them with the view to the complexities that they're going to face, the degree of scarcity of the resource that may be there and also the very different demands that are going to be placed upon those scarce resources by virtue of the communities they have to serve, the isolation of those communities, specific needs -- if there's an aging population in one area as opposed to another, for example -- and so on.
One of our concerns is that if there is no overall blueprint for the distribution of those funds, a group in one centre may take hold of an RHB or a community council and dominate it to the detriment of other areas. That's a huge concern, because demographics dictate who gets onto what boards. I know this minister is going to appoint -- or his successor might appoint, if he's not there at the time of appointment.... But whatever future role this member may play as Minister of Health, I would suggest that if he plans to retire on the Sunshine Coast he might try to become the minister responsible for ferries before the term of office is over so that he can get a decent ferry service up there, because he'll need it. Having said that, whoever is in charge of distributing those funds is going to have to recognize that those needs are tremendously diversified. It is very important that issues such as community health nursing, which is critical in some communities, be brought up. They are likely to be forgotten if the process is dominated in any way by people who look toward one centre over another. That's a big concern. Parochiality is something that we do find among communities where the population is concentrated and also divided by water, land or whatever. There's often not the kind of equitable distribution that this minister might find desirable.
So with those questions I yield to other members, reserving the right, of course, to come back in if necessary.
Hon. P. Ramsey: I'll just try to respond very briefly.
The member raises some interesting concerns about regionalization. Let me respond to a couple of them. First, I surely recognize that there are "parochial interests" among communities, particularly those that are widely dispersed in more remote areas of the province, or, in the case of the member's riding, divided by patches of water and scenic coastline.
Interjection.
Hon. P. Ramsey: Well, it's the chamber of commerce speech I'll do next time I visit Powell River.
Let me just say that one of the things that has happened in many areas of the province is that the view of parochial interests has been exacerbated by the fact that there has been no local responsibility for planning in many, many areas. I give the member the example of the first community health council that was designated in this province, the Mount Waddington area on the north end of Vancouver Island. There are five small communities in that area. Each of them has a small health facility.
Interjection.
Hon. P. Ramsey: Mount Waddington? I don't believe so.
Interjection.
Hon. P. Ramsey: Well, the Mount Waddington health area is in the north end of Vancouver Island. It encompasses the communities of Alert Bay, Port Alice, Port Hardy, Port McNeill and Sointula. It has these five small communities there.
When I went up to designate the council, one of the things I was told very clearly by the people who stepped forward to serve on it was that for years their way of working toward health funding was to compete bitterly and parochially with the community down the road or across the strait. They saw the formation of this council -- or the planning that had gone into the formation of it that they're now moving forward with it -- as an opportunity to put that behind them. They recognized that they had both the authority and responsibility to do good health planning for all five of their communities and the people who depended on the health facilities in all of them. I do believe that the formation of community health councils has the potential for enabling communities to have both the responsibility and the authority for doing that work for their own communities. I think that it is positive.
The other thing that I must point out is that there continues to be a perception that somewhere there's a group of people who have all the answers and can do it better. I haven't found them. As much as I respect the dedication and professionalism of the Ministry of Health employees, I do not think there is a fount of unending knowledge and wisdom at 1515 Blanshard that can design health care services well and perfectly for Richmond, Fort Nelson or Powell River. I simply don't believe that's there, and the fragmented structure of health delivery that we have
[ Page 12452 ]
prevents us from doing the proper health planning for regions and for communities around British Columbia.
The Chair: Shall vote 42 pass?
L. Fox: Nice try, hon. Chair.
I've been listening to the member for Powell River-Sunshine Coast. The concerns in his constituency are not unlike the concerns in my constituency, and certainly not unlike the concerns of any rural constituency. For members who have communities that are spread out, whether they are separated by water or by long distances and roads, the effect is the same.
[9:30]
While I wanted to ask a question a little later about this, I think it's timely to ask it now. It's already apparent to me -- and it's certainly apparent to the people who deliver our ambulance services -- that this Closer to Home initiative for community care is putting an expanded need on ambulance services. In fact, they're seeing a substantial increase in the number of calls in the Prince George region. It came to mind that while they can respond with vehicles in our region of the province, on Texada Island and some of the other islands that the previous member talked about, ambulance services are obviously going to be somewhat more expensive, because they're going to have to be helicopter ambulances.
Can the minister tell me if, in this regionalization initiative, there have been any studies on what impact this new delivery of home care is going to have on the ambulance service, given that we're now going to be trying to treat people in their homes? We could effectively keep them there until it is no longer a minor problem. In fact, it may become an emergency problem, and they would therefore require ambulance services at an increased cost. Have any studies been done by the ministry that explore what impact this new process will have on ambulance services in British Columbia?
Hon. P. Ramsey: The British Columbia Ambulance Service provides very high-quality services to people in Prince George and elsewhere. My understanding is that they have done a study of projected needs in the future. They do see a rising need for ambulance services, but the main driver of that rising need is the aging population rather than the regionalization of health governance and health care delivery.
L. Fox: I take the minister at his word, but I've already seen evidence of expanded use of the ambulance service in my constituency, primarily because we see patients -- and I can name patients, but I prefer not to -- who have been almost forced out of the Prince George hospital to make room for others, only to be ambulanced back to the Vanderhoof hospital or the Fort St. James hospital or the Fraser Lake diagnostic centre because, in at least three cases, they prematurely released the patient. The pressure that's on those facilities is obviously going to increase the cost of ambulance services. Those statistics are readily documented and accessible, and I'm sure the ministry will monitor that.
I want to very briefly get back to a subject that we talked about. I don't plan to get into it in any great detail. This morning we spent a lot of time talking about the status of the Prince George hospital and whether or not it was a regional hospital or a community hospital. I think it's useful to put on the record a letter from Ailve McNestry, the medical director of the Prince George hospital, to a Dr. Peter de Vos, who is a physician at St. John Hospital. This adds further proof that that regional hospital is no longer a regional facility. I'd like to quote:
"It is indeed true that 7 percent of the patient days at the Prince George Regional Hospital in the 1992-93 fiscal year were spent by residents of local health area 56, which includes Vanderhoof, Fraser Lake and Fort St. James. This is up from 6 percent in each of the two previous fiscal years. We do recognize our role as a regional referral hospital in north central British Columbia, and in identifying medical manpower needs and service requirements we try to give a strong focus to the need to provide regional services. However, the recent resignations of a number of our surgical staff will indeed make it difficult for us to provide continuous coverage in both obstetrics and orthopedics over the coming months."
I assume that we can add neurosurgery to that in the coming months as well, because, as the minister alluded to this morning, we are losing our neurosurgeon.
"In a recent letter from our CEO, Mr. Dennis Cleaver, he commented on our recruitment efforts and recent meetings with representatives of some of the lower mainland hospitals. We are trying to arrange a process, or game plan, if you will, to enable us to arrange the transfer of patients as smoothly as possible.
"Given that we have not yet identified any specific hospital which will be willing to receive patients from our region in the event of our lack of specialist coverage, I would offer the following suggestions. Although I will provide you with a call schedule for obstetrics and orthopedics for the month of July as soon as one is available, I think as a basic precaution your physicians should be advised to contact PGRH switchboard prior to referring any patient to this hospital. If there is no specialist on call in a speciality area, then quite simply the patient must be transferred in the same way that you currently arrange transfer for a patient for whom services are not usually provided here."
Obviously, this medical director is telling the doctor in St. John Hospital that they may not be able to do either one of two things: (a) offer the service in PGRH and; (b) refer him to another hospital, because other hospitals are reluctant to take patients when their constraints are such that they can't deliver care in their respective areas. Maybe the minister wants to respond to that.
Hon. P. Ramsey: Hon. member, I think we share a common goal of making sure that Prince George Regional Hospital remains a high-quality regional referral centre for people of the central interior. That's what I've said repeatedly in this House, that's what I've said in the community and that's what I believe. I regret that some physicians have chosen to move their practice elsewhere. Quite frankly, I can work with them to try to ensure as wide a range of specialist services in Prince George as possible. I'm not sure what mechanisms the member would have me use to compel them to stay. I will be using all the offices of this ministry to assist Prince George Regional Hospital in recruiting a specialist so they can continue to provide a full range of specialist services, and I provided money in this year's budget to assist them in that process. I think that the goal of this minister and this ministry is clear.
As for the issue of increased use of the ambulance service and "improper discharge," I find that a very serious allegation. It's clear to me that people are occasionally discharged and need to return to hospital for some reason. The member is adducing that there is an increased incidence of this and, indeed, improper discharges. I have asked the administration of Prince George Regional Hospital exactly that question, because I was as concerned as this member is. The administration of Prince George Regional Hospital, at least as recently as about six weeks ago, was unable to
[ Page 12453 ]
document any rise of readmissions. Their figures were not showing an increased incidence of readmissions. The hon. member shakes his head and says that there may be some. I looked forward to seeing that. Clearly, we should not be discharging people before it is medically advisable.
Finally, as we talk about the needs of Prince George Regional Hospital, I would urge this member to recognize that this institution was built and supported over the years by previous administrations and is supported by this administration. It's an institution that we fund to the tune of some $50 million a year. It is a substantial regional centre in the central interior and provides a substantial set of services for the people living in that region. I would urge him not to continue to talk about it as a community hospital. It is far more than that, and people in the community recognize it as far more than that.
L. Fox: The minister is correct in that it was built by previous administrations, but it appears it is being torn apart by this administration. The fact of the matter is that we have a dramatic reduction in services in the Prince George area, while at the same time.... I had a chance to look over the state-of-readiness report of the regional hospital councils that the minister made available to the opposition critic, and it's pretty obvious that that's still very much in its infancy in terms of developing. Yet we have a timetable before us. We have ongoing reports that are being taken up. We saw an announcement yesterday, June 22: "Northern and Rural Health Needs To Be Addressed." Another study -- another group is going to be put together.
We have the politically appointed group that's going to study the Prince George hospital. All these things are happening and nobody knows who's responsible for what. All these regions are trying to get a mechanism together so that they can have some constructive discussion in terms of issues, such as the one regarding boundaries the member for Powell River-Sunshine Coast talked about. There's a huge concern in virtually all areas of the province with respect to the boundaries that are going to be in place.
I counted very quickly, but I believe there are 21 regional health boards. What is this new review going to do? Is it going to talk about the level of service in the rural and northern area? Is it going to look at the whole process of regionalization and whether or not it can provide equitable health care in those regions of the province? Just what is this group going to do? What length of time are they going to have in which to make the report? I see that members are going to be appointed within two weeks, but I don't see any time frame for it to report back to the minister.
Hon. P. Ramsey: I am going to resist the impulse to revisit the entire debate we covered this afternoon when the hon. member raised the matter of Prince George Regional Hospital and the study team that's going to be advising me on its immediate financial needs, and also studying the role that it plays as a regional referral centre. I am pleased that he arranged to have some constituents watch this evening and felt the need to repeat his debate. I don't feel the need to repeat my response.
The northern rural strategy is an integral part of what we are doing in the New Directions initiative. The news release that the member has in front of him says that this team should look at three basic issues. First, looking at more equitable access for all British Columbians to specialized health services means, in my mind, how we make sure that where services should be delivered in a region rather than in an urban centre, the provision is for those services to be delivered in regions rather than in urban centres. It also means, as I've said in this chamber and elsewhere, that we need to start recognizing that for individuals the cost of health care starts from the time they leave their home, not from the time they enter an institution. We're looking at the travel assistance program that was announced earlier in the mandate of this government and at perhaps taking other steps to ensure more equitable access to health services.
Second is the question that both this member and the member for Powell River-Sunshine Coast have raised, and that's how we ensure, as we ask regions to assume the responsibility for design and delivery of health services, that the funding they receive is equitable. I've said repeatedly, and I'll say it again, that we need to hear from the people in the region as to what factors should be taken into account as we look at equitable allocation of resources. What are the costs of the delivery of health services in rural and remote regions? I submit that they differ substantially from the costs of doing so in urban centres, and that should be recognized in allocations.
[9:45]
Finally, an issue that we've touched on in previous debate is how we recruit and retain health professionals in rural and remote areas. That's a large challenge -- not just attracting specialists to acute care facilities but also, as we've mentioned elsewhere, psychiatrists, speech therapists and other health professionals. At times it's difficult to attract and retain them in more remote areas of the province.
That is what this rural and remote strategy is charged with doing. I've asked for nominations throughout the regions that are considered rural and remote, from the north end of Vancouver Island through the central interior and off into the Kootenays. We'll be asking that team to look at some of the work that's already been done by the ministry, consult with others in the province and report to the ministry by early fall so that the results of their work can be taken into account by those who are establishing interim regional health boards.
I have one final note on that, just to wrap this up. Let's be very clear about October deadlines. I've said it before in this House, and I'll say it again: October is the deadline for getting interim regional health boards up and running -- you know, formally established. It is not a date for transferring formal program responsibility to them for all health facilities in their region. I've said that repeatedly, and I'll continue to make that clear to anybody who is concerned about turning over the operation of health resources prematurely. I have no intention of doing that or of creating discontinuities in the delivery of health services. I am quite intent on getting regionalization going and asking these regional boards to be operational as soon as possible.
L. Fox: I'm actually quite pleased that in many respects the minister has finally seen that there's such a mess out there and that there's the need for some guidance. We on the opposition side have been standing up and saying in the Legislature for some time: "Let's give these regional health boards and the community health councils some guidance in terms of what a core program should be." I know this goes nowhere near that, but at least we are talking about more equitable access for all British Columbians to specialized health services.
My concern is that this minister and the previous minister have been saying, over the last two years of this initiative, that they wish to see the regions develop their health services and the health councils develop their respective health services; yet now we see some removal of that autonomy. Not that that bothers me. Obviously, there is
[ Page 12454 ]
going to be some direction given in those kinds of specific concerns and service deliveries.
Earlier, the minister made a reference to the fact that the hospital allotments had gone out to the hospitals. I have a number of clippings projecting deficits in virtually every part of the province, anywhere from small amounts to very significant amounts. The minister has made the statement that he would offer either bridge financing or allow deficit budgets for this year, with that deficit to be made up in subsequent years. If in fact we have lean, mean operations -- which I suggest many of these hospitals are -- how does the minister suggest that those deficits...? Let's use Prince George, because it's close to both of us. The deficit projected so far is in the vicinity of $3 million. How does the minister suggest that in subsequent years they are going to make that up, given the operation that is presently there?
Hon. P. Ramsey: I'm going to resist the temptation to use Prince George. Through the Cranston report, lots of evidence has already been presented to Prince George Regional Hospital about areas where it can operate more efficiently. The hospital has already adopted many of those goals through its own strategic plan. I anticipate that when we hear clearly what the financial needs of the hospital are, that will be tied into achievement of many of those goals. The same thing is going to be true elsewhere in the province.
The member speaks of deficits; indeed, there are some hospitals that are having some budget difficulties. I intend to review the reports that are being made to my ministry by hospitals as they present their plans for use of their '94-95 budgets, including the difficulties they have with them.
But let's be very clear what we have said to them. We have said:
"Look at your cooperation with other hospitals in your area. If you are going to reduce a service, make sure that there is provision for that service in another facility. Don't do things unilaterally, please, anymore. Look at cooperation on services delivered in your hospital and those delivered by community-based services in the same area. Use Closer To Home funds to assist in designing services that might be delivered on an out-patient or home basis rather than an in-patient basis. At the end of all that, let us look at your budget difficulties with you."
The member needs to recognize that every study I have seen so far that looks at the role of hospitals within a health system suggests that we must look at eliminating care delivered inappropriately in hospital settings. On any given day, 20 to 30 percent of patients in a hospital probably should be receiving those services elsewhere. Studies reveal that again and again. We need to find ways of delivering those services more effectively and more efficiently outside the walls of institutions. That's what the royal commission said, and that's what this government has been doing in building up the community side of health care over the last two and a half years.
There is a large challenge here, but I do not see the alternative to doing it this way. We've talked much in this chamber about the options facing the Canadian medicare system. I believe this is the correct approach. It is not dissimilar to what is taking place in many other provinces. Indeed, it's not dissimilar to what is taking place in many other jurisdictions in the Western world. Increasingly, publicly funded health systems are being designed to deliver managed care, integrated care and community-controlled care to their citizens in the twenty-first century.
L. Fox: I'm not going to belabour the point of regionalization. But let me put on the record that I believe this initiative by this government is going to go down in history as the largest single failure of any government in the history of Canada in terms of any kind of transition and delivery of any service. There's no question in my mind, and I'll go on record as saying that. It's primarily because the government, for whatever reason, has its sights set. It only listens to whom it chooses; it doesn't listen to the public at large -- and in many instances doesn't listen to the health care givers in this transition. So let me leave it at that.
My colleague from Peace River North talked about ambulance service and the privatization of it. I guess I was a little concerned with one of the answers that the minister gave, in which there didn't appear to be a real commitment to set up regional depots in terms of contracts to the private sector. My understanding now is that we have some regional depots. We have a company in Prince George and another company in Kelowna, I believe. I'm not sure where the others are or if there are any others. There are probably some in the Vancouver and Victoria regions.
One of the reasons I requested from the previous Health minister -- going back two estimates ago, I believe -- a review into that whole delivery of service is that I thought there were some efficiencies to be gained, and so did the ambulance workers in the rural parts of the province. If we privatized the service and moved it out into the regions, obviously there would be a need for paramedics to be located in those regions where the aircraft are housed. If you look at the Prince George situation versus the Kelowna situation, there are very similar calls but a lot fewer qualified paramedics. We could use those people when they're not on call, rather than have them sitting in Vancouver or Victoria waiting for a call from a community or a facility. We actually could utilize those paramedics in the delivery of services within the respective communities. So I'm hoping that the minister is committed to looking at a regional delivery of that service and at where we might utilize the expertise of those individuals in the delivery of a local service when they're not needed in the air ambulance.
Hon. P. Ramsey: I share much of the member's analysis of what is efficient in air ambulance service. I think I said in earlier discussion with the member for Peace River North that it makes little sense to have air evacuation services for the northern half of the province based out of Victoria, so that you're automatically starting with a plane trip upcountry to pick somebody up, with all the cost and time that that involves. I think that a different configuration of siting for air evacuation services will be a component of the requests for proposals that will be going out; and obviously, part of the structure that's going to be proposed will require some redistribution of paramedic services around the province. We need to make sure that they're available where the planes are actually sited.
F. Gingell: Late last fall two members of an organization called the British Columbia Association of People Who Stutter met with one of your officials, Deloris Hutcheson, and left with her a report that was addressed to you that was really a follow-up from earlier discussions that representatives of the Association of People Who Stutter had had with your predecessor, Ms. Cull. I was wondering if you've seen this report.
[D. Lovick in the chair.]
Hon. P. Ramsey: Hon. member, I don't remember receiving it. Given the volume of paper I deal with in an
[ Page 12455 ]
average month, I wouldn't swear that it hasn't crossed my desk, but I do not remember seeing it, hon. member.
F. Gingell: You can appreciate that the reason this organization has been created and that representatives of stutterers are coming to see you and talk to you -- or, preferably, to write to you; it's usually easier for us stutterers to communicate in writing -- is that there has been a terrible cutback in services in out-patient speech therapy in this province. One of the best examples, perhaps, is here in Victoria. The treatment program for speech therapy at the Gorge Road Hospital has been cancelled. The only available programs are at Lions Gate Hospital in North Vancouver and at the UBC hospital site, and they are only available to people who live in the lower mainland. Can the minister advise me if some funding arrangements have been made to bring back some of these programs around the province?
[10:00]
Hon. P. Ramsey: As I said earlier in discussion with the member for Surrey-White Rock, there is a shortage of speech language programs in British Columbia right now. That's exacerbated in some areas, partly as a result in difficulties in attracting and retaining professionals; partly it's just a difficulty in level of resources.
As for the specifics of the services at Lions Gate Hospital that you're talking about, I think my best response to you at this point would be to say that we should talk about it outside the chambers, as we did briefly earlier this session, and make sure that you're in touch with people in my ministry who deal with this area and are aware of ongoing efforts to provide those services. I don't have the detail at my fingertips this evening to respond in a comprehensive way.
F. Gingell: I don't think there is a complete shortage of therapists, because therapy is available at $60 to $80 an hour. It's true, I think, that very often people who stammer are not quite as well off financially as others. It's an impediment that hurts the whole family. But recognizing that you understand the need, that the therapy is available at a cost and that this government in no way includes any private speech therapy under the Medical Services Plan, isn't the first solution to deal with a serious impediment that can really be helped? Speech therapists can change the lives of people who stutter. Isn't the first move to at least bring the cost of stutterers going to private therapists within the Medical Plan? Have you given that any thought as a starting point?
Hon. P. Ramsey: There are a number of questions wrapped up in what the member raises. One is the issue of whether it should indeed be delivered through the Medical Services Plan and funded on a fee-for-service basis. I understand from brief conversation here that to the knowledge of senior staff, that issue has not been brought to the Medical Services Commission. It might be worthwhile to bring it to the commission as to whether it's best to do those speech language services, as we provide many others to the general population, through public health units on a salary basis. That raises its own set of issues, such as whether we have sufficient funds and personnel in place now. What are the options for increasing the amount of funding or personnel?
There are several options for dealing with this, in addition to the specialized sort of care that you and I discussed earlier. At this point I really don't have much more information to provide the member as far as what the options are. It's not an issue that has been addressed comprehensively by the ministry, that I'm aware of. Speech therapy is an issue that has been dealt with through public health units both for school-age children and for adults. Of course, there are private therapists available, which the member referred to. I do think there is perhaps a shortage of speech therapists in the province. In some areas more than others, recruitment and retention of therapists has been a major issue -- perhaps not in major urban centres, but surely in other areas of the province.
F. Gingell: One of the problems that stutterers face in looking for therapy is that the funding for speech therapy seems to have been happening, to my knowledge, through two areas. The first is through the Ministry of Education for children in the school setting. People who are looking for these services for their children have concerns about whether that money has always been used in that fashion, because of the problems of school boards trying to balance their budgets and using funds proposed for certain uses for other things. Seeing that the issue of stuttering is unquestionably a health issue and not an education issue, has your ministry done anything to ensure that the health funds for stuttering therapy that are going into the education system are in fact being used for that purpose?
Hon. P. Ramsey: The member raises yet another question that I think bears some work by staff. To my knowledge, no work has been done to track those funds through the public school system. That's all I can really say at this time.
F. Gingell: I'm sure the minister will remember from our earlier discussion, and the discussion I've had with officials from his ministry, that everybody seems to hold the ISTAR program in Edmonton in high regard. Their success ratio is very good. People attend that clinic on a residential basis, and their success ratio is encouraging. The discussions I've had with the minister indicated to me that he felt that a program of that type would show payback or reward and would be a good use of resources. Seeing that we can't organize it that quickly -- although maybe a residential facility is a thought for Royal Roads -- will the minister consider funding a number of British Columbians to go to the residential school in Edmonton for their program?
Hon. P. Ramsey: At this point in these estimates and at this point in the evening, I simply don't have enough information before me to respond in an intelligent and comprehensive manner to the member. I'll take these issues on notice and make sure that we respond to him.
F. Gingell: Perhaps I've dealt with the issue in the way that I wanted to. What I hear the minister saying is that you will deal with the issue of stuttering seriously, recognize the tremendous burden that stutterers carry and appreciate the good that can be done at relatively little cost. The results really can be worthwhile.
In looking at the issue and coming up with a plan, please deal with the British Columbia Association of People Who Stutter. As a child I stuttered much worse than I do now. I remember that it is only stutterers who really understand all of the issues. In that organization there are some individuals who are very knowledgeable. They know what's happening in the rest of the world and are well aware of the speech therapy services that are available in the rest of the province. I know they will be able to make a very worthwhile contribution towards the work which I now hear you committing your ministry to.
[ Page 12456 ]
Hon. P. Ramsey: I can assure the member that the ministry will be consulting with those who are involved in providing services and therapies to address the issue of stuttering and stammering. And I must say that the hon. member is an eloquent spokesperson for this health need in the province.
L. Reid: If I might, I'd ask the minister questions pertaining to two regions before we move into consideration of corporate programs.
I have two pieces of correspondence. One is from the Bulkley-Nechako Regional Hospital District. They indicate that they've been trying to obtain a decision from the Minister of Health regarding the government's position on financing of hospital capital projects. Their question relates to the transition period between now and when the regional health boards will be in place. Apparently, their issue relates directly to the capital financing of Smithers hospital. For the record, I would simply ask if the minister has reached a decision, or if a decision will be forthcoming in the near future.
Hon. P. Ramsey: The answer is yes. I've been in regular contact -- perhaps too frequent contact -- with the Bulkley-Nechako Regional Hospital District seeking to answer their questions about capital funding and transitional arrangements. I have asked members of my ministry to meet with them to provide all assurance that they can so we can move forward with projects such as the Smithers hospital.
L. Reid: I draw the minister's attention to Prince Rupert Regional Hospital correspondence that is, again, directed to the hon. Minister of Health. The individual here was compelled to write about four outstanding issues: pathology, as it was outlined in the "Northwest Health Services Review," echocardiography, orthopedics and, I believe, a master development plan. Apparently this hospital -- Prince Rupert Regional -- has asked for a decision on each of those four areas. I don't believe I need to read each of the detailed submissions into the record. I certainly appreciate that the minister has the same correspondence I have. I simply ask the minister if he could comment on the status of the decision around Prince Rupert Regional, on whether any progress has been made on each of these four areas.
Hon. P. Ramsey: Yes, I think I do have the same correspondence that the member opposite has. I recognize that the hospital in Prince Rupert is acquiring a number of new services for the people of the region. Discussions between the hospital and my ministry on objects and amounts of funding are ongoing. I hope we have a conclusion to those discussions before we all go off on vacation this summer.
[10:15]
L. Reid: I heard the minister suggest the answer will be forthcoming to Prince Rupert Regional within the next two weeks. I will certainly accept that comment this evening.
Interjection.
L. Reid: If you promise, I will promise, hon. minister. If you can answer the questions that this fine board chair has outlined to you this evening in terms of Prince Rupert Regional, that's fabulous.
I have just one question -- depending on the answer -- regarding midwifery in this province: what is its status, how is it intended for that service to be evaluated and what kind of outcome measurements or cost-effective measures have been taken in terms of the cost of providing midwifery service in British Columbia?
Hon. P. Ramsey: I'll try to respond briefly. I look forward to the establishment of an independent college of midwifery to regulate the provision of midwifery services in British Columbia. The work that's been done is ongoing. I expect that college to be operational by 1995. In the very near future I expect to be taking forward for consideration by my cabinet colleagues a decision paper on both establishment of that college and options for funding midwifery services in British Columbia.
L. Reid: If I can just confirm this, did I understand the minister to say services will be available in 1995?
Hon. P. Ramsey: To repeat myself at not too great length, my expectation is that.... First of all, we continue to support the establishment of a college of midwives to regulate that autonomous profession. I hope decisions can be made and that that college is in place before the end of the year. My goal is to make it happen by then. The committee that's been working on implementation of midwifery as a regulated health profession in the province has done excellent work to date.
The second part of my answer was that clearly a variety of decisions are to be made about how midwifery services are made available and funded. I plan to be taking a paper forward for cabinet consideration on regulation and funding of midwifery in the very near future. Preparation of that paper is underway right now.
L. Reid: For my clarification, the minister discussed the establishment of the college by late '94 or early '95. What is the time line in terms of having those services up and running and available to be regulated by the college? Will it be the same time line? Are we speaking of the same amount of time before those services are available in the province?
Hon. P. Ramsey: The member opposite recognizes, as do I, that midwifery services are currently being provided to women in British Columbia. The question is: how do we go about regulating those services under an autonomous college to make sure that the services provided are of the highest quality? Then the second question is: in what venues are those services provided and with what assistance in funding from provincial coffers?
I expect that if the college is up and running by the end of this year, it will still have some work to do in establishing criteria for certifying midwives. I had hoped that they would get that done, and the submissions I'm making to my cabinet colleagues anticipate that midwifery services regulated by the college will be in place in 1995.
L. Reid: I thank the minister for his answer.
Last April, the previous Minister of Health announced: "B.C. Community to Benefit from Innovative New Nursing Centre." That's up and running in the Comox Valley. Could the minister provide a status report on the services and some kind of cost-benefit analysis of that new service delivery model?
Hon. P. Ramsey: It's a little early to provide a cost-benefit analysis, since the centre opened its doors, I think, less than a month ago.
[ Page 12457 ]
Interjections.
Hon. P. Ramsey: I hear cries from the benches opposite of "shame" and "resign." It must be the rigours of this office; it's some of my friends that are imploring me to consider that course of action.
Let me say that I consider the nursing centre that we've established in Comox to be a very valuable pilot project providing a different mode or venue for accessing health services. When I toured the centre on its opening, those that had been involved in establishing it said very clearly that they wanted to be seen not as duplicating other services in the community but providing a holistic way of accessing those services and allowing nurses to practise more fully the range of their profession. That's my goal for that centre. The evaluation team is in place to make sure that we have as thorough and prompt an evaluation of the effectiveness of the centre as possible, so that it can be replicated in other communities in British Columbia.
L. Reid: It stated in the press release: "This centre will present a unique opportunity for nurses to provide nursing care in an independent facility." I would ask the minister to address two points: first, how that differs from the current public health offices in this province, which are also independent facilities; and second, whether this innovative nursing centre has a different scope of practice. My understanding is that the same kind of public health services are available: support to maternity patients and new moms and those kinds of public service initiatives that are currently offered in the province. Please indicate, for my benefit, how this new nursing centre presents itself in a different fashion.
Hon. P. Ramsey: I think the biggest difference between the nursing centre and nursing provided through a public health unit is that people are being encouraged in Comox to come to the centre with virtually any health issue they have. It's a primary care centre; it's a point of access to other health services. I would suggest that the range of services provided and funded by public health nurses through public health units are considerably more defined. This is saying to the community at large: "If you have a health issue, try using the centre." If the personnel at the centre can't deal with it themselves, they will assist in making sure that the correct liaison with other health services is provided. I guess what I could say is that too often, at least in my experience, public health nurses are seen as one side of the health system. This centre says that the one place for nurses is at the very heart of it.
L. Reid: For a sum of $385,000, I would hope that we could perhaps have a more detailed discussion in terms of the credentials. Are we saying that this facility is staffed by community and public health nurses? My understanding is that it's a similar delivery system. Could the minister perhaps comment on the credentials of the staff who are employed at this facility?
Hon. P. Ramsey: I think we're getting down to a level of detail where my memory is not serving me well. I met the staff of the centre when I participated in its opening in Comox. My recollection is that they had a great diversity of nursing backgrounds -- some had worked in public health, some in acute care and some in independent practice. They had a real range of expertise and service. Some came from the mental health field. They were bringing quite diverse backgrounds to the operations at the centre in Comox. I would be glad to provide the member with probably more detail on the operations of the centre than she might care to read. I know that the community group that planned it did a considerable amount of work, both in terms of how the centre liaised with other health providers in Comox and how evaluation of the services that are provided could be carried out.
L. Reid: I would contend that you would find similar backgrounds among the staff of any public health unit you wandered into in this province. You would find folks from the private sector, acute care nurses, public service nurses and municipal nurses. I was trying to arrive at how this facility is different -- how it differs in scope of practice and in credentials -- and I certainly haven't heard that. I appreciate that the minister may need some time. Indeed, this facility may need some time to present itself as a unique, innovative centre. I'm not convinced that it's dramatically different as it stands, and if I simply don't possess all the information, I would welcome it at some future point.
Another issue I'd like to bring to the minister's attention today -- and certainly we talked earlier this afternoon about the age of patients in this province -- is security in extended-care homes. It certainly seems to be an issue that's always covered in the press when someone is not monitored closely enough, for whatever reason, and ends up being in a less than secure situation -- for example, they've left the facility or they haven't been supervised adequately. Certainly one of the comments that was brought home today -- and it was raised by a constituent -- was whether or not the ministry has ever looked at monitoring bracelets or devices so that when patients enter and leave facilities -- for example, if they've left with another group of patrons, a group of visitors or a singing groups that visits institutions.... Typically, the cases in the press are when someone has wandered out with individuals leaving the facility and was simply not monitored at that point. Has any discussion occurred around the security of our seniors in extended-care situations?
Hon. P. Ramsey: My understanding is that various long-term care and extended-care institutions deal with security issues for their clients in a variety of ways. There are an increasing number of units designed for clients suffering from dementia, and most of those units have security measures in place so that people don't wander off.
We're getting into an area where, for people who suffer from mild forms of dementia, you get into that lovely interface about how much you infringe on a person's liberty. If you go to the one extreme and lock somebody up, are you perhaps in some way even hastening their loss of ability to deal with the everyday world and their surroundings? I can say, hon. member, that I know long-term care facilities are dealing with this, and the ministry is looking very hard at this issue. As you know, in some cases it has provided funding for renovations to provide a secure environment for patients suffering from dementia to move around without the danger of them wandering away. As the age of people who are cared for in long-term care facilities and extended-care units continues to go up, this will become an increasing issue.
L. Reid: I thank the minister for his comments.
I would like to draw the minister's attention to the tobacco sales act regulations. Tighter controls on tobacco sales to youth were promised by the Minister of Health. In a
[ Page 12458 ]
joint news release the minister announced new regulations by July 1 that would implement five recommendations of the March 1993 report of the Legislature's Select Standing Committee on Health and Social Services. It's my understanding that to date the new regulations have not been approved. In our inquiries we were told that they're being worked on. We understand there's a cabinet meeting still to go before July 1. When is the likely date for those regulations to be approved and put in place?
Hon. P. Ramsey: The likely date for those regulations to be in place is July 1, 1994. In a speech to the B.C. Lung Association earlier this month, I confirmed this government's intention to have those regulations in place by July of this year. I also outlined some of the steps that we planned to take to assist tobacco retailers with the implementation of those regulations.
[10:30]
L. Reid: I look forward to seeing those regulations on Friday.
I would like the minister to consider some questions around the delivery of corporate services in the ministry. I understand there have been some new implementations and upgrading to information systems around the anticipated New Directions. What changes have been made to date in that technology, and how have the system changes addressed the fast-tracking of the implementation of New Directions?
Hon. P. Ramsey: The status of advanced information systems for the health system could currently be described as an examination and assessment of systems that are available. The ministry is working with several vendors of high-tech systems for health data to assess the range of data that might be available, and what configuration of those systems might be most appropriate for use by facilities and governance bodies delivering health services. In the next couple of months, we hope to be in a position to start making some decisions on configuration and extent of data systems.
L. Reid: I appreciate the minister's comments, because I was intrigued by some recent coverage that talks about software aiding hospitals in understanding true patient costs. I don't know if this particular ministry is having those discussions. It certainly suggests that Ontario and Alberta are the leaders in the science of measuring true medical costs for patients. Indeed, those kinds of measurements can look at how best to deliver the service and at which ones have the best cost return. The article makes some very fine points. One example is in the treatment of cerebral palsy, and the discovery, based on this kind of computer documentation, that there is a difference in terms of treatment and outcome. Is British Columbia looking at a program similar to what is currently underway in Alberta and Ontario?
Hon. P. Ramsey: I've had the pleasure of examining a couple of systems currently being used in British Columbia hospitals. If the member is interested -- and this is an area of particular interest to me -- she might consider a visit to Royal Columbian in New Westminster. I think they've done some excellent work in this field, as have St. Paul's Hospital and University Hospital. Some good data management systems have been placed in the hospital sector by some of the major hospitals in the province, and I know that other hospitals are looking at that.
More broadly, though, what we need to develop in this province is what I might characterize as the "infobahn" for health data that would link doctors' offices, the drug pharmacists of the province and hospital care. There's a whole range of health data that could be, and I believe should be, available through one system, with proper measures, of course, to ensure security of private and privileged information.
I think there are huge opportunities in such a system for individuals to assess their own records, for health professionals to compare models of care and for institutions to look at models of care being provided and assess what is effective and efficient.
L. Reid: Again my thanks to the minister. I think we share some passion, if you will, around whether or not we're using the most appropriate data to arrive at the most appropriate conclusions in health care. I think that this health economist and the hospital cost program discussed in the article -- Hildo Boiley, and his HosCos program -- can bring some good information to bear on future decisions in health care. I hope the minister has had the opportunity to visit B.C. Research and look at the hospital data programs they are currently doing some R and D on. There are some fabulous opportunities in British Columbia, and what I will take from the minister's comments is that the ministry is interested in and taking a look at those issues. I can only say that it's all to the good.
In terms of allocation of funding dollars and moving to the 21 regional boards by October 1, who will have responsibility for that $6.4 billion, and will it involve some discussion around asking those 21 regions to, hopefully, use some computer technology, some of this new data management, to reach some of the most appropriate allocations?
Hon. P. Ramsey: In terms of planning and implementing the health system for the next century, I would characterize that as a midrange objective. As I said earlier, I think we're at the early stages of assessing what a regional or provincewide data system for the delivery of health services might look like. That's surely something that needs to be explored with regional boards.
You mentioned B.C. Research. That's one of the organizations that the ministry has been in contact with in exploring what configurations of software and hardware are available and appropriate. There's a variety of work that is ongoing, and I expect that there are going to be immense applications for it.
One of the difficulties we have in the present system is one I've referred to before. Right now, it strikes me that we have 123 hospitals, each with its own data system. It's not that they've been standing still, but very often they've been taking decisions on data collection and how that's being done, and they have gone their own way. The task here is to devise a system that will work well for the health system broadly -- in hospitals, out of hospitals, physicians' offices, pharmacists and others.
L. Reid: I thank the minister for his comments. On page 19 of the ministry's annual report there is mention of a cardiac surgical registry system. Could the minister give an update on that, and whether or not something such as that would figure into this data collection and new computer system overlay that we have been discussing in the last few moments.
Hon. P. Ramsey: As we discussed earlier, the cardiac list the member refers to is one way of keeping track of wait-lists for elective surgery in this area. We need to expand the collection of that sort of information for many procedures so
[ Page 12459 ]
that we have a much more accurate sense of what the demand for certain services is, where they are obtained, and what treatment of various health conditions is most effective.
L. Reid: I have one or two questions on facilities construction. It is my understanding that planning was underway in terms of community health centres for Kitimat and Dease Lake. Could the minister give us a status report on where that planning sits, and are we looking at other constructions regarding community health centres in other parts of the province?
While the minister is checking that information, I will ask another question on which I can perhaps receive an answer at the same time. It appears that $47 million has been allocated to capital construction under B.C. 21. I would ask for confirmation of that number. If that is the accurate number, which division has responsibility for deciding where those dollars are spent?
Hon. P. Ramsey: I believe there is a group working in Kitimat now to do some of the preliminary work on what the facility ought to look like. I am not sure about the Dease Lake one. I am aware that a centre has been opened in Stewart, and I wonder if that is what the member is referring to. A variety of other centres are either looking at or have started local planning for health centres.
As for the overall capital budget for this ministry, the capital budget is some $235 million to be spent on construction of health facilities in '94-95. That's probably the largest budget for health facilities in the province's history. It will substantially increase our ability to have facilities for long-term care, hospital renovations and replacements, community health centres, and a variety of other initiatives.
L. Reid: It is my understanding that there was a press release which related to planning dollars being awarded to Dease Lake. If the minister can come back to me at a future time in terms of the status of that, I would be pleased to receive the information.
I was making the case for $47 million that had been allocated to the construction of these centres, separate and distinct from overall health facility planning. Could the minister confirm whether or not that is an accurate sum?
Hon. P. Ramsey: You've asked an interesting poser for staff here, and we'll see if we can get you a breakout. I don't know what the exact figure is for planning and construction money for community health centres in '94-95. I haven't really bothered to break out those figures and add them up in a column. I'm sure we can get that data for you, but I think more important is this government's ongoing commitment to making sure that we have high-quality facilities for the delivery of health care in British Columbia.
L. Reid: I don't want to belabour the point. However, I think the point needs to be made that there are certainly facilities in this province that have an empty wing or empty floor, and perhaps we could look to utilizing those resources more effectively and efficiently. I believe the taxpayers have already paid for them once and wouldn't volunteer to pay yet again. The capital construction of a community centre of that nature is, for the most part, an administrative delivery system. There aren't necessarily huge considerations given to direct care. Perhaps some of that office space can already be accommodated in some of our existing centres. That would certainly be a discussion I would be interested in having with the minister.
Hon. P. Ramsey: Not only am I glad that the member opposite is interested in having that discussion with me, I've already had that discussion with many community groups that are planning for community health councils and looking at facilities to deliver more integrated service. Indeed, that is one option that many communities are looking at: a conversion of space that's now used for acute care services but may well be downsized to house some of the community-and home-based services. I know many communities are looking at that option.
[10:45]
L. Reid: Certainly there have been a number of press releases on other capital construction that is either planned or underway. Are there other items yet to come forward, or have the majority of the announcements been made amounting to the $247 million that you have just spoken of?
Hon. P. Ramsey: The total capital budget for this year is some $235 million. I was trying to calculate in my own head what percentage of that had already been announced. My impression is probably only about a quarter of it. So there are many more announcements to come this year as planning goes forward and work with planning groups from hospitals, community health councils and others gets finalized, signed off, and either planning funds or construction moneys are made available.
L. Reid: I thank the minister for his comments. If there is other information that needs to come forward, I would be pleased to receive it.
I would ask the minister to take a look at the submission to the Royal Commission on Health Care and Costs by the Prosthetics and Orthotics Association of British Columbia. They have some serious concerns regarding individuals up to 18 years of age who receive some coverage today and individuals over 65 who basically need those kinds of devices for quality-of-life issues. There seems to be discussion around the fact that British Columbia is the only western province not offering a comprehensive program of health benefits. Again, I know this will come up. It says: "Pharmacare has a selective program of benefits for orthotics services to specific groups of children." Certainly I don't take any issue with that.
The individual constituents who have come to me are over 19 and require spinal braces, orthotics and prosthetics. Has the ministry been in discussion with this group? Are there any changes anticipated for funding these kinds of devices? When we talk about quality of life, the Ministry of Health tends to fund a lot of devices under Pharmacare and the like. But I believe they have some very serious questions, and it seems to me that the submission they made has not been adequately answered. I would ask the minister to comment. What has been proposed.... I'll give you the entire question in one go, then perhaps you can respond. They are looking at all children resident in British Columbia, up to and including 18 years of age, who hold a valid medical card for whom a medically requested orthotic device has been indicated. Has the ministry looked at changing the benefit coverage that currently exists? Apparently there is a dramatic difference for the zero-to-18 and the over-65 groups. Typically, the group in the middle is always the one that is disenfranchised in some way. Have discussions occurred surrounding this particular group of individuals?
[ Page 12460 ]
Hon. P. Ramsey: The information I have from my staff is that while work with this association on these issues has been ongoing, a resolution has yet to be reached. They have had consultations around exactly what classes of orthotics and prosthetics should be provided and some costing of programs to provide those. Discussions are underway, but no conclusion has been reached.
L. Reid: I bring this issue forward because it's this group's contention that if these devices are not provided, there will be more costly hospitalization and services at a greater cost to the taxpayer. I think that's fairly evident, so again it's a question of when this ministry wants to pay. If I understand their material correctly, it seems to be the case that other provinces have put programs in place that provide what turns out to be very expensive devices. Even children 19 years of age, as their conditions change, sometimes require two or three changes in a year, and each device is upwards of $800 or $900. That's a significant cost to a family. I trust this is an issue that the ministry will come back to and address in some detail.
This submission went in prior to 1991; three years have elapsed. I appreciate the minister's comment that the discussions are ongoing, but that's of little value after a discussion has been ongoing for three years. I think a decision could be reached in some reasonable time. Could I ask the minister what he believes would be a suitable time line for an answer to some of these very pressing questions?
Hon. P. Ramsey: I will inquire of those in the ministry who have been engaged in dealing with this issue as to the status of it and get back to the member as soon as I can with at least a time line for considering changes to this policy.
L. Reid: I've had a number of questions raised, as I'm sure the minister has, regarding the Pharmanet program. Perhaps we can start with the status of this program. I understand that it was to be in place by March 31, 1994. Certainly the information forums are ongoing in the province -- to borrow the minister's favourite word for this estimates process: "The discussions are ongoing." When will there be a decision regarding implementation? Has it been put on hold indefinitely? Perhaps the minister could comment.
Hon. P. Ramsey: Implementation of the Pharmanet program is going forward. We expect to have the initial stations up and running this fall. A delay has been caused by a couple of concerns, as I'm sure the member is aware. Basically, we want to make sure that we are comprehensively addressing concerns around protection of privacy as we move forward with the establishment of the Pharmanet program. Consideration of those concerns has resulted in some significant changes to the hardware and software that may be used in the program. We think that this is still a very valuable program that can eliminate drug interactions that cause severe distress and that can reduce fraud when acquiring drugs. And it has a number of other virtues both for good health practices and for the efficient use of the Pharmacare system.
L. Reid: My thanks to the minister. I have a number of questions around this program. If we can spend a few minutes on this at the present time, I trust that we will not have to return to it in the wee hours of dawn. Could the minister be more specific in terms of when the program will be implemented? I understand that the forums have gone ahead -- the June 22 forum was in Prince George, I believe, and the June 23 forum was in Terrace. Could he give some synopsis around the discussion that occurred at those forums? The time line seems fairly open-ended. Will it be the end of '94 or the end of '95? Could the status of the acquisition of the bits and pieces the minister alluded to form part of his response?
If I can, I will continue to lay two or three questions on the table for the minister to respond to. I would be interested in learning the original projected costs of the Pharmanet program. I understand that some $17 million was spent on hardware acquisition, and I would be interested in a confirmation of that amount. I would also be interested in learning how much of the original budget has been spent and what the projected total cost is for completing the implementation of this program.
Hon. P. Ramsey: As I said in my previous answer, we expect the initial stations of the Pharmanet system to be up and running by September of this year. We expect that those stations will meet all the requirements of the protection-of-privacy and freedom-of-information legislation in this province. We will be providing a provincewide profile of complete individual prescription histories, a comprehensive information base for drug use review programs, program profile monitoring and program monitoring cost control, as the member knows. The total development cost for establishing this program is estimated to be approximately $12.8 million. We anticipate that the operating costs will generate a net saving of approximately $5 million a year, based on reduced staffing for the Pharmacare program, reduced drug consumption, reduced errors, and other savings.
L. Reid: I have a number of questions regarding the safety and security of the system, which I would ask the minister to comment on. A number of constituents have written about safeguards in the system and about how the minister intends to ensure that browsing by unauthorized personnel does not occur. If the minister wishes to hear about two or three of them, then perhaps he could respond. There is a commonality among the writers. I'm sure the minister also has similar correspondence.
There are questions regarding security breaches during the transmission of this data and whether the province will be beholden to any business interests as a result of this. I have a number of constituents who have wondered about drug companies and pharmacy companies having access to this program for research purposes. I know that David Flaherty has addressed those kinds of questions in the past, but he had questions as well when I attended his information session in Vancouver some months ago. A number of folks are interested in whether or not academic researchers will have access to this database. If the minister could start with that kind of discussion, then perhaps we could continue the questions.
Hon. P. Ramsey: Indeed, the member raises a wide range of issues. Let me deal with them as expeditiously as I can. The security of data transmission is a very important issue, and I have been informed that those designing the Pharmanet program have been taking precautions that I would characterize as extraordinary. They recognize this as one of the main privacy concerns they must deal with.
Is the Pharmanet program beholden to any private interests? No. This is a government-funded network -- it's funded by the taxpayers of this province. No drug
[ Page 12461 ]
companies will have access to the data that's contained in the system.
Will there be academic research availability? Only under the very strictest privacy protection. Clearly, it may be possible -- and indeed desirable -- to strip patient identifiers from drug histories and provide data in a raw form to academic researchers who are interested in drug usage reviews and in increasing the efficacy of therapeutic drug use.
L. Reid: Let me say that I appreciate the minister's thoroughness in his responses, because I have to respond to all this correspondence and I would certainly appreciate the answers as we move through this. There are a lot of questions about who will be able to access the actual patient file once it has been created on the system. The discussion tends to roam around whether or not it will be licensed pharmacists or pharmacy staff, and around how access will be restricted to whoever those authorized personnel may be. Can the minister kindly respond as to who will have access, who will be authorized and how that will be ensured?
[11:00]
Hon. P. Ramsey: Those using the system would be licensed pharmacists, basically, or those behind the counter who have access to the password provided to the pharmacist. Let me state very clearly that the system is going to built so that browsing -- I think that's the term that's sometimes used for scanning through records for no good reason -- is going to be tracked and caught. So accessing the system without performing a specific transaction -- issuing a prescription, for example -- is going to be the subject of extremely vigilant monitoring, and those who abuse the system are going to very quickly lose their rights to use it. Note that the use of the Pharmanet system is going to be a cost-saver to pharmacists as well as to the Pharmacare program, so I think that there are good, self-interested reasons for securing the system and for monitoring and adherence to privacy provisions by all users of the Pharmanet system.
L. Reid: I think the minister appreciates that the individual British Columbians who have come forward have a desire to learn who will be practising this incredible vigilance to ensure that unauthorized access to the system does not occur. Are we talking specifically about the staff of the Pharmacare program? Are we talking about general government staff? Who will have the responsibility to bring due diligence to bear on this issue?
Hon. P. Ramsey: Supervision of access will be the responsibility of Pharmacare staff, so they will be charged with ensuring that. I must make it clear that the Pharmanet program must meet the privacy provisions of the Freedom of Information and Protection of Privacy Act. It must withstand the scrutiny of the commissioner. It is clearly going to be a requirement of the system. I recognize the concerns raised about it. I think the member is well aware that there are great health and efficiency benefits through the establishment of the system.
L. Reid: There seems to be some confusion as to how long prescription data will stay on the system. It has been suggested that the magical number is 14 months. I have not heard that myself. Has that ever been part of the discussion, or will all the data remain active on the file for as long as the patient has a file on the system?
Hon. P. Ramsey: The users of the system in pharmacies will have access to the last 14 months of prescription history -- the member is accurate in that. There may well be other Pharmacare program data that will not be accessible by keying into the system from a pharmacy.
L. Reid: For my clarification, if a patient enters the system tomorrow, is that patient's previous 14 months of prescription history then entered onto the system and we go forward from that point? I'm not clear on that point.
Hon. P. Ramsey: No, hon. member. We will start entering data when the patient is registered on the system. We are not going to be entering 14 months of history for everybody who signs up.
L. Reid: If that is indeed the case, will the data stay live on the system for 14 months, and every time it gets dumped from the system you just retain what is active on the system? The minister is nodding. I can confirm that that is the case? Thank you so much.
A number of my constituents have wondered if they will be able to learn if their file has been accessed inappropriately. Will that kind of information be available to them? I understood the minister's comments about bringing due diligence to bear, but what is the answer to the access question?
Hon. P. Ramsey: Individual patients will be able to get a printout of everyone who has access to their records -- yet another check on inappropriate access to patient records on the Pharmanet system.
L. Reid: So the patient receives the record of who has accessed his file. If inappropriate individuals are listed, what is the response? Is there some action that will be taken? Will they simply have restricted access in future? As an example, let's say that your file has been accessed and you take issue with the number of individuals who have accessed your file. Is there any disciplinary action available?
Hon. P. Ramsey: Yes. The College of Pharmacists has made it very clear that they will expect their members -- who are the ones who will have access to the system -- to practise ethically and to access that system ethically. The penalties for abuse of their privileges as pharmacists include penalties up to and including revocation of their ability to practise pharmacy.
L. Reid: That leads to the next point. It appears that the province will own the network and the College of Pharmacists will own the data. Is that an appropriate rendering of this discussion?
Hon. P. Ramsey: The ministry will own the data. The college will be charged with managing some of it, but it's the property of the Pharmacare program.
L. Reid: I appreciated the minister's comment that pharmacists who access this system inappropriately will be responsible to the College of Pharmacists. What is the disciplinary action, if any, if a non-pharmacist makes the inappropriate access?
Hon. P. Ramsey: I can conceive of violations of the privacy provisions by a ministry employee working in the Pharmacare area. Pharmacists' staff, of course, are acting
[ Page 12462 ]
under the privileges granted to the pharmacist, and therefore he or she has a responsibility for controlling that and making sure that this authority is exercised appropriately. A member of ministry staff who violated those provisions would obviously be subject to discipline as an employee of the ministry.
L. Reid: There seem to be some ongoing discussions about the evolution of this program. At some point that data will be available to doctors in their offices and in other health care facilities. Certainly it brings to bear the same concerns -- simply whether the safeguards will be strong and effective enough to ensure that inappropriate access does not occur. Is it the minister's contention that all of those different sites and the available data will in fact be safeguarded under the Pharmanet program?
Hon. P. Ramsey: The security provisions are built into the program and will apply regardless of where the stations are located -- a pharmacy or a physician's office. The same provisions for protection of privacy will be in place.
L. Reid: The minister can appreciate that a number of British Columbians have wondered and continue to wonder as to the mandatory nature of this program. Certainly it's my understanding that every British Columbian who seeks a prescription from a licensed pharmacist will become part of the program as a result of having done that. Is there any option? Has there been any discussion about citizens in this province having the ability or choice to opt out of the program?
Hon. P. Ramsey: I'm sure there have been discussions and will be future discussions. The difficulty is that...
L. Reid: You get involved?
Hon. P. Ramsey: Oh, yes -- formally and informally.
...the more optional the participation becomes, the less effective the system becomes for the purposes that we're designing and implementing it for.
L. Reid: Perhaps we can wrap this up in the next few moments. I've had a number of young people in this province wonder if their parent or guardian will be able to access their files. I'm intrigued by the question, because it's also come to my office from parents and spouses. Will they be able to access their children's or spouse's files? What kinds of safeguards are in place to prevent that?
Hon. P. Ramsey: It's an interesting set of legal questions, really. My understanding of it -- and grant you, this is an area that gets pretty complex pretty fast -- is that these records would be considered medical records. The same provisions that allow or prohibit access to general medical records would be in effect for access to Pharmanet records. There are some cases in which guardians or parents do have access to children's medical records, but they surely don't in all cases. There are much more restricted access provisions for spouses for access to medical records.
L. Reid: Just to seek further clarification, this House has debated the Infants Act in the past and has in fact given more rights to young people in this province in terms of safeguarding their privacy. Applying that discussion, I think we can assure young people today that only they will have access to their own prescription file, and I'm wondering if the minister can confirm that. It's my understanding that each British Columbian will receive their password, and unless they choose to provide it to someone else, that information is secure. Is it the minister's contention, based on that legislation, that parents will not have the ability to access that information?
Hon. P. Ramsey: Young people in the province would have the ability to request their own password. Obviously, unless they chose to share it, the information accessed by that password would be theirs alone.
L. Reid: Is there any age limit on who can request a password to secure their own medical file?
Hon. P. Ramsey: I think I remember reviewing some information on this, but I can't recall it right now. The best I can do is get back to you on that one, hon. member.
L. Reid: I thank the minister for providing the information at some point. That is an issue that has been raised by a number of young people in this province. If we can assure them, I think that would certainly be in everyone's best interest.
[11:15]
Perhaps a last question: is there any consideration being given to who in the B.C. Ministry of Health will have access? Other than the Pharmanet individuals, will anyone else within the ministry be able to use the information for any other purpose?
Hon. P. Ramsey: No, there's no anticipation of access to this data by areas of the ministry other than the Pharmacare program, and the ministry would only have access to those files for which Pharmacare benefits have been claimed.
L. Fox: I have a couple of questions around Pharmacare. Earlier this year, the minister and the ministry directed pharmacists to supply generic drugs in place of the traditional drugs and provided a list of generic drugs that in fact could be substituted. I wonder, firstly, how that transition has taken place, and whether or not the manufacturers of those generics have been able to keep up with the demand. Has there been a need to approve alternatives on a special basis because of a shortage of particular drugs? Would the minister like to comment?
Hon. P. Ramsey: First, let's be very clear about what the low-cost alternative program is. In no way are we "directing" the supply of generic drugs. We're simply saying that the Pharmacare program, for cost-efficiency and making sure we have a Pharmacare program that can survive, will pay for the low-cost alternative medication when more than one therapeutic drug will meet the same need. That's what this low-cost alternative program is about. If any member of the public wishes to receive a drug other than the low-cost alternative, they are quite able to do so. The sole restriction is that Pharmacare will be reimbursing only for the price of the low-cost drug.
The member raised a question about access to supplies of drugs. My understanding is that currently there is no shortage of the low-cost alternative drugs in this program. If there are specific cases -- and I know there were some initially where supply didn't quite meet demand -- the program has made adjustments and provided reimbursement for higher-priced alternatives.
[ Page 12463 ]
L. Fox: I should perhaps make one observation in terms of the smaller pharmacies in smaller communities. Because Pharmacare is only prepared to pay for the generic drug, you limit the ability of pharmacists to stock a host of different products -- they can't afford that kind of inventory to provide the alternatives for people. I have a letter from a pharmacist in Fraser Lake that points out one particular drug. Mind you, this is dated May 13, and I am sure it is now outdated. I recognize that, but that's why I ask the question. In this case, he suggested there was a supply problem. I won't go into the specifics, but his ability to stock the alternatives to this particular drug was somewhat constrained by his inventory costs, because it is a very small community with a small pharmacy. As has been mentioned many times, that shows that there is a different level of health care in different segments of the province because of the number of people in those regions.
The other issue that I wanted to ask about is that it's my understanding that a study -- and the name escapes me; perhaps it has to do with the hour of the evening -- was done on the delivery of pharmaceutical products, and much of the focus of it was on the number of pills that were to be given out in a prescription. It looked at dispensing fees, and there were some recommendations that, given the circumstances that I understand were in place, we should look at dispensing smaller amounts because it was cost-effective to do so. It seems to me, however, that the instructions of the ministry and the Pharmacare program are to continue to dispense the larger amounts. I am wondering why the minister hasn't taken the advice of that study. Perhaps once he answers that, we could go on.
Hon. P. Ramsey: Perhaps I will give a couple of points of clarification, and then we can proceed with discussion. There is no policy for a higher number of pills, or longer length rather than shorter. There is a maximum period of 100 days' supply. There is nothing that prevents a prescription of smaller quantities. Indeed, with the trial prescription program there is an incentive and an encouragement for initial prescriptions of drugs to be for a shorter term. There is actually a benefit to pharmacists for encouraging a smaller prescription initially.
L. Fox: The problem is that it puts pressure on the pharmacist because the patient, particularly a senior, is suggesting that he's only doing that because he wants another dispensing fee. Therefore it puts him in the middle. We regularly read in the newspaper about many seniors.... In fact, I read a story recently about one senior who was on 24 different drugs at the same time. So obviously drug dependency is a real concern.
There is perhaps an analogy here. As I talked about in my statement, there is a shift in the spending priorities of this government. It is my understanding that if the government contributed $34 million, it would literally wipe out all the dispensing fees to seniors. If we look at the Island Highway project increased cost of $73 million, we have to wonder about the government's priorities.
Let me just say that it seems to me there should be a definite policy so that the druggist is not on the firing line and is not the individual who takes the abuse. I've spoken to many of them, and they tell me that if they do want to constrain that individual in terms of the amount of pills they take, then they're at question and are the ones who take verbal abuse rather than the doctor or the minister.
Hon. P. Ramsey: Surely the length of prescription should fit the need for which the drug is being prescribed. Let me clarify the trial prescription program. If I go to a pharmacist with an initial prescription for a drug which I may require for a very long period of time, the pharmacist has the ability to offer me a trial prescription. This gives me a chance to assess how this drug affects me and whether I have adverse reactions to it. When I come back for a longer-term prescription, there is no dispensing fee for that longer-term prescription. The dispensing fee for the second prescription is waived. We are working with pharmacists to encourage an initial shorter-term prescription so that an assessment of drug reaction can be done by the individual patient. That's how the trial prescription works, hon. member.
More generally, for drugs that are for a chronic condition and that are going to be used by a patient over a great length of time, the longer-term prescription is the appropriate one.
I'm not sure that I have a one-size-fits-all answer. It depends on the condition that is being dealt with by the therapeutic drugs being purchased.
L. Fox: I have only one question that I want to ask the minister, and it relates to a specific issue in my riding. The minister will be well aware that there was a longtime initiative for an extended-care facility in the community of Vanderhoof. The earlier minister upheld the promise of the previous government, initially, to deliver that service to the community of Vanderhoof, then subsequently fell back on this promise.
This minister apparently has axed that whole program in favour of a regional service. It seems it's the wish of the ministry to develop more beds in a neighbouring NDP riding, in Smithers, instead of meeting the demands of the community of Vanderhoof. Is there a policy now to provide extended care to seniors on a regional basis rather than on a community basis? Has that focus been changed from what it once was?
If we look at the demographics of the Vanderhoof, Fort St. James and Fraser Lake region, we see that 8 percent of the population in 1996 will be over 65 years of age, and that's projected to 9 percent by the year 2000 -- and these are right out of the 1992 health stats. When we look at Smithers -- I will get the number of beds in a minute -- we see that presently only 6 percent of the population is over the age of 65, with a projected 8 percent by the year 2001. One has to wonder why this ministry took the initiative to put more beds into Smithers, where there is a lower percentage in terms of people over 65, rather than come through with the promise made to the communities of Vanderhoof, Fort St. James and Fraser Lake.
Hon. P. Ramsey: There has been no change in policy as for where beds are planned and surely no decision to make them available regionally rather than locally. We do ask both communities and regions to participate in planning the number and location of beds within their area.
Members of this ministry have dealt with the Omineca Hospital Society on this issue -- repeatedly, I think -- and I have met with them twice to discuss the issue as well. I would hope that we can come to a resolution. I would suggest to the member that we ought to look very hard at using acute care space that may be converted. I think we ought to look very hard at the need for home support in the Vanderhoof area to see if some of the needs for long-term care might be more appropriately met in individuals' homes, and to address a range of planning for health care in the Vanderhoof and Fort St. James area.
[ Page 12464 ]
L. Fox: Let me deal with a couple of the minister's comments. First, the planning process on this project has been going on and on for probably about seven to eight years. They get to a point where they can justify it, and then the ministry asks them to go back and review it; by that time, they have lost a number of the patients that have been identified and they have to go through that process all over again. To be very frank, the community is frustrated with this government and with this ministry on this issue. When the minister suggests that we have to look at home care for some of these people -- and the demographics put out by his ministry show that there has to be a need -- if the percentages are lower in Smithers, there's a need to increase the number of beds that are already available, but there aren't beds available for extended care in Vanderhoof. How does the minister justify that? The ministry took the initiative to go into Smithers and suggest that it had to expand the number of beds in that community, but told Vanderhoof to go out and look at alternatives. How can we balance those two directions?
[11:30]
Hon. P. Ramsey: The hour is indeed getting late. Perhaps we're getting a bit testy on this issue. I recognize that this planning process has been frustrating to some of the people involved with the Omineca Hospital Society, and they expressed that when they met with me. I indicated to them that I want to get this resolved as quickly as possible. Whether it is to be conversion of acute space to this, provision of a different mix of services or whatever, let's get on with it so we can get a resolution to this, because we can't go on planning and replanning forever.
L. Fox: I won't belabour the point, but let me ask the minister this. If the hospital board is prepared to use some unused space that he earlier indicated was there and to commit that to extended-care units, is the minister suggesting that that's the only decision that has to be made and that it would move forward?
Hon. P. Ramsey: My understanding from staff is that that offer was made to the Omineca Hospital Society. I would hope they would take advantage of that offer.
L. Fox: When was that offer made? Was any kind of promise attached to it?
Hon. P. Ramsey: My understanding from staff is that the offer was made to the Omineca Hospital Society sometime last year during a visit of an assistant deputy minister to discuss this with the Omineca Hospital Society. If this is an option they wish to explore, I'll make sure that the offer is renewed and that we can move ahead.
L. Fox: It was my understanding that along with that offer they had to go back once again through the planning process and prove need. If I misunderstand that, then that's fine. I'll check that out in the morning.
I have one further question in response to a question asked by the Liberal Health critic with respect to the concerns in Bulkley-Nechako. The minister suggested that he resolved the financial issues around the concerns that Bulkley-Nechako had with respect to ongoing funding and responsibilities. I want to know how it was resolved, and what kind of information the Bulkley-Nechako Regional Hospital District received from this minister around the issues that they were concerned with.
Hon. P. Ramsey: What I said was that we have attempted to resolve this issue with the Bulkley-Nechako Regional Hospital District and provide them assurances that the formal funding mechanisms for future capital projects would enable them to move forward. I understand that they still have some concerns, and I keep encouraging my ministry to deal with them to attempt to allay those concerns so that we can move ahead with construction of projects in the Bulkley-Nechako district.
The Chair: Richmond East returns.
An Hon. Member: It sounds like a movie.
L. Reid: But a darn fine movie, hon. member.
When we were discussing Pharmanet moments ago, I had one last question about how individuals will present their passwords. There seems to be a lot of confusion as to whether or not they will have a keypad to press it in, or have to share it verbally with the pharmacist. There are questions around confidentiality as to how that password will be shared directly with the pharmacist. Could the minister kindly comment?
Hon. P. Ramsey: Currently the plans are for providing the password to the pharmacist, who would enter it.
L. Reid: I'm sorry, hon. minister. How is that password going to be shared with the pharmacist.
Hon. P. Ramsey: Verbally.
L. Reid: Perhaps the minister could consider individuals who do not wish to share their information verbally and perhaps not even in writing. They're looking for some evolution in the program where, at some point, they'll be able to press it in in a very confidential fashion. If that comes down the road, I think that would be fine.
As a last question, I understand that last March, David Flaherty was asked to review the confidentiality aspects of this program and to report back. Has that work been completed, and has the privacy and information commissioner indeed reported?
Hon. P. Ramsey: First, just to return to the password entry system, the member is right to say that perhaps the direct entry by patients is a down-the-road option that we can look at in the future. Current planning is for one entry system for passwords.
As you know, the privacy commissioner has been involved in the presentation of information about Pharmanet. That continues to go on through forums, print and others means. We continue to work with the privacy commissioner to identify and address specific privacy concerns. As I've said in this House and publicly, it is clear that the Pharmanet system must meet the standards of the Freedom of Information and Protection of Privacy Act. If it does not, then the commissioner has it within his power to take steps to ensure that it does.
L. Reid: Could the minister address the therapeutics initiative that is currently in place? A number of questions have arisen as a result of this initiative. It certainly seems to be the case that if some agency was interested in delisting a product, the drug company would have only ten days to make their case before this team. The contention is that that's an impossible time line for the industry to come and make a
[ Page 12465 ]
case on behalf of a product on which the decision has somehow been taken to delist. Can the minister kindly comment if a ten-day time line is still the direction that this therapeutics decision-making body is headed in?
Hon. P. Ramsey: There may be some confusion about what this ten-day period applies to. Should the therapeutics initiative recommend the delisting of a drug, a company would have ten days to request an administrative review. Obviously, over some period the therapeutics initiative would have done the work of gathering data, assessing effectiveness and deciding to recommend delisting, and that would have been very extensive work, you know. Should the decision be made to delist, then a company has ten days to request an appeal. Those are going to be referred to the Pharmacare administrative review committee, and the review will occur within 30 clear days after the request. So it is not just ten days in and out. Ten days is a period to say: "Do we wish to contest the decision or recommendation of the therapeutics initiative?"
L. Reid: I thank the minister for his comment, because I'm hearing that the ten-day period allows for the request of the review and then there's an additional 30 days for the industry or company to prepare its response. If indeed that is what the minister has said, I will certainly accept that.
The other concern brought to my attention was the mix of professionals which formed the new therapeutics initiative. There seems to be some question around the balance of practising professionals in the field and the academic community. The particular example brought to my attention was that this group seems to lack a cardiologist, when in fact a lot of their decisions will be on drugs for heart patients in this province. Would the minister comment?
Hon. P. Ramsey: I've had representations from a number of groups wishing involvement in the therapeutics initiative. The therapeutics initiative has the ability -- indeed, I think, almost the requirement -- to involve professionals from a particular field when they're reviewing a particular drug. Nothing prevents them from doing that. Indeed, if they wish their decisions to stand and withstand appeal, I think they'd be wise to involve those professionals from the area.
L. Reid: Just to wrap up discussion on this section, I have two questions. How were the individuals selected? What was the process to put them in place on this decision-making body? And what is the budget for the therapeutics initiative?
Hon. P. Ramsey: The budget for the therapeutics initiative for the initial year was half a million dollars. We requested the organizations that were to nominate people to the therapeutics initiative to do just that and give us their nominees for inclusion on the initiative's advisory committee.
L. Reid: In terms of the Pharmacare program generally, certainly there was some correspondence back and forth between the pharmacy association, your office and a number of government MLAs, I understand. It related specifically to the size of prescription available, not just to individuals in the community but to individuals in the long-term care and extended-care facilities in the province. My understanding is that a 35-day prescription should be the optimum prescription. It suggested to me that, in fact, British Columbia's optimum prescription is closer to 77 days. This raises some concerns regarding the appropriateness of medication. We may see seniors asking for and receiving larger prescriptions to avoid additional dispensing fees, which may not be in their best interest. Is that an issue that this ministry will come back and address at a later point?
Hon. P. Ramsey: The initial research that was conducted after co-pay of dispensing fees went in did not indicate an extension of average prescription length of the dramatic nature that the member is talking about. As I said earlier in my comments to the member for Prince George-Omineca, many drugs are prescribed for chronic conditions, and a longer period is appropriate. We've also got the trial prescription program in place to make sure that initial prescriptions are held to as short a duration as possible so drugs are not wasted while patients assess any reaction they may have to a new therapeutic drug.
[L. Krog in the chair.]
L. Reid: I appreciate the minister's comments. I think there are some complexities and misunderstandings around the Pharmacare program. It seems to me that perhaps the therapeutics initiative can be brought to bear on having individuals better understand the use of drug therapies. I hope that is the goal of the program, because I'm thinking that there's not a great deal of value in pitting one cost against another -- a generic drug and a non-generic drug -- without some understanding of the long-range clinical benefit of a product. Oftentimes -- and certainly in this Legislature -- we get into a debate where drug X is 2 cents cheaper than drug Y, yet the course of treatment may be far shorter and the effectiveness of treatment far more significant.
I'm wondering if the therapeutics initiatives group will come back to the table, and not just for the ministry, but for the public at large so they better understand why some drugs are covered and some are not. That seems to be the focus of a number of constituents who come forward: X has been delisted, and they no longer have access to a certain product. How will the ministry create some kind of communication around what this therapeutics initiative intends to achieve?
Hon. P. Ramsey: First, the member referred in part to the low-cost alternative program and asked whether we had substitutions of one drug for another because it's a few pennies less. Those are for identical drugs, not for therapeutic substitutions. There may well be a therapeutic substitution that's a different drug with a different configuration, but that's not what the low-cost alternative program is about.
[11:45]
As for the educational work of the therapeutics initiative, the member has identified that aspect of the initiative that I think gives the best long-term benefits to the people of the province, and not just in assessing whether a drug should be listed or delisted, but in involving the general public, physicians and pharmacists in broad educational initiatives to let people know what drugs are available and what the appropriate drug therapies are.
One of the things that I heard repeatedly in the time that led up to the establishment of the therapeutics initiative was that physicians doing the prescribing needed to be involved in continuing education about what drugs are there, whether new drugs are indeed an improvement on existing drugs, and what the best drug therapy is. Very often physicians practise in an atmosphere where that broad level of research and analysis is not available to them. It's a major function of the therapeutics initiative to provide that continuing
[ Page 12466 ]
education to physicians, to see how effective it has been, and to devise yet further means of continuing education for physicians in the province about drug therapies.
D. Mitchell: I appreciate the opportunity to get into the debate. I certainly don't want to prolong it at this late hour, but I have a few quick questions for the minister.
The minister might facilitate this question. It goes back to an area already raised by the Liberal Health critic. There's a facility in my constituency of West Vancouver-Garibaldi called the Kiwanis Seniors Housing Society of West Vancouver. The minister has corresponded with them. There are 80 patients in this facility; it's an intermediate care facility right now. Funding is going to run out by September 1995. There's some confusion in the communication that has taken place between the minister's office and the directors of the society, which is going to cause a real problem in terms of the level of intermediate care that is available on the North Shore. I'm more than happy to share a copy of the correspondence with the minister's officials if that would help. But rather than going into details of this, I would be happy if the minister would make a commitment to the committee this evening to facilitate a meeting between officials in his ministry, the directors of the society and the municipality of West Vancouver to try to resolve this situation. The lack of communication seems to be at the base of it, in my opinion. I'm more than happy to share details. I'll send over a copy of the correspondence, if the minister wishes. If he could commit to do that, I would be pleased to go on to the next issue.
Hon. P. Ramsey: I'm pleased to make that commitment.
D. Mitchell: I'd be pleased to send over to the minister a copy of the correspondence, just so he can be certain what I'm referring to.
One other question I would like to ask the minister is with respect to public opinion research conducted by the Ministry of Health. I know that the minister's predecessor had a number of public opinion research studies and polls conducted, some by Decima Research. Some were pretty expensive, and they were on issues that were of political importance to the government in power. I'm wondering if the minister can tell us if the ministry has conducted or commissioned any public opinion research since he has assumed the office of Minister of Health. Is it possible for him to indicate to members of the committee today on what subjects, to which firms and at what cost?
Hon. P. Ramsey: In the 1993-94 fiscal year, I believe approximately $99,000 was used for market research and polling by the ministry. I'm trying to remember in the fiscal year that we just started whether there has been any done. There are surely funds set aside to do further market research and testing by the ministry in '94-95.
I think it is important for the ministry to ascertain on a timely basis what the reaction of the people of British Columbia is to initiatives such as the one we have just been discussing -- changes to the Pharmacare program and Pharmanet -- and to assess the level of knowledge and information that the general public has. In debates here, members have repeatedly raised the issue of making sure the public is well-informed. This sort of research and polling is one way of ascertaining what the level of knowledge is.
D. Mitchell: The minister has indicated that in the last completed fiscal year approximately $100,000 was spent on polling by the ministry. Not to belabour the point now, but in order not to require this member to go through freedom-of-information and protection-of-privacy legislation to obtain the results of those surveys, would the minister make a commitment to provide details of the subject matter and a summary of the results of those polls to me? If that would be satisfactory, I would be pleased to move on to the next question.
Hon. P. Ramsey: As the member points out, the information that is FOI-able is public property held by this ministry. Let's make sure that we can make that available to members in a timely fashion.
D. Mitchell: I appreciate the comment by the minister. If that could be facilitated, I would appreciate it. The minister points out that the public research was paid for with tax dollars. It should be available at some point. If there is some reason why it can't be made available quickly, I would hope that he could at least indicate what the subject matter of the poll was, and at some point make a commitment to make it public.
I would like to ask the minister one further question about a program that his ministry is involved in called the residential historical abuse program. I raised some questions with the Attorney General during the review of his estimates; he suggested I might want to pursue this with the Minister of Health. The Attorney General has brought to my attention a brochure put together by the Ministry of Health, the Ministry of Social Services, the Attorney General and Education -- it's a joint project. This is providing counselling for people who were sexually abused as children in provincially funded or provincially operated residential facilities, or people in British Columbia who were abused at the hands of employees of the government of the province over the years -- a tragic situation, as I'm sure the minister will agree.
It has been brought to my attention by a few individuals that this counselling is available to individuals who reside in British Columbia. But if they no longer reside in the province -- perhaps they move out of the province, let's say to the neighbouring province of Alberta -- apparently they are not eligible for these counselling services. I wonder if the minister can provide a rationale for that. If they were abused by government employees -- a horrendous thought to even contemplate -- the government should be commended for putting together a counselling program. Why would someone not be eligible for the program if they move outside the province? Do they have to move back to the province to take advantage of the counselling? That doesn't seem to make sense.
Hon. P. Ramsey: I thank the member for his comments on this program. I must say that it is unfortunate that we have to provide this program. The circumstances that gave rise to it are tragic for the individuals who were victims of abuse, and for the reputation of the facilities in which these victims were housed and served as children. I am having some difficulty with the member's question, I confess. I am trying to figure out a reason for the ministry to distinguish this set of services from other services that it provides. I am unaware of any services the ministry provides out of province -- that it says it will pay out there because you are out there -- other than services that are unavailable to residents of B.C. who have gone outside the province to obtain them. So I am trying to figure out how this would differ from other services, and I am not finding a good way of distinguishing
[ Page 12467 ]
it. The program, which is funded this year in the neighbourhood of $525,000 for counselling provided in British Columbia, is available to people who are resident in British Columbia.
D. Mitchell: I want to pursue this one step further. I appreciate what the minister has said. Presumably we have a universal health care system with portability in Canada, and we subscribe to that notion, that principle and that belief. Is British Columbia the only province in Canada where there has been such a high incidence of abuse in residential homes -- sexual abuse in this case; tragic circumstances -- that British Columbia is alone in having to establish this kind of a program for counselling? Does that mean that if an individual had to suffer tragically in these circumstances and as an adult they move outside the province, they are not eligible for the counselling provisions that the government of British Columbia has taken a special step to establish? That's what I'm asking the minister.
Hon. P. Ramsey: The member is doing a little mix-and-match here. Yes, medicare is a national program, but a basic tenet of that program is that the services available to a citizen are provided by the province in which he or she is resident. Residency is the basic requirement for access to health services within a province. I suspect that the member shares my belief that there has probably not been a great difference in the incidence of sexual abuse in this province and other provinces, given human nature, fallibility and other circumstances of our condition. We are the only province that has set up this counselling program for victims of abuse in residences paid for by the government. We are also the only province that has said that you don't need to prove sexual abuse to access this counselling; you simply have to indicate that you wish to access the counselling services.
D. Mitchell: I won't belabour the point. I commend the government for establishing a program. I deplore the circumstances that gave rise to it, but that is not any one individual's fault. Because it is a program for historical abuse, which may go back some time, and because we live in a society where there is transience and people do move around, some people, inevitably, will not be covered by it, because they no longer reside in the province. I think that's what the minister has confirmed.
I just have one final issue that I'd like to raise with the minister. This is something I'd like to bring to his attention, because it's a communication issue that I think the ministry may have had some difficulty with recently. On May 27 the Ministry of Finance put out a consumer alert that a number of physicians and clinics in British Columbia were offering patients programs for an annual fee paid in advance, to provide certain services or demand additional cost. The consumer alert that went out around the province said that anyone who is uncertain as to whether any of the specific services offered by such programs are covered by the MSP should contact the Medical Services Commission, and it gave out a toll-free 1-800 number.
The minister will not be surprised to hear that MLAs' constituency offices had this consumer alert, and when inquiries came in to constituency offices and government agents' offices as to whether or not a certain service was covered through the Medical Services Plan, we were encouraged to have people call the toll-free number. I bring this to the minister's attention because when this alert was issued, my constituency office referred several constituents to the toll-free number. We called the toll-free number ourselves. People -- I won't mention names; although I have them in the file, I don't want to embarrass anyone -- answering the phone were completely unaware of this consumer alert and were completely unaware of why we, or anyone, would be calling. They had to get back to us. They did so, but not on a timely basis -- not on the same day -- and suggested that they were having meetings to discuss how they were possibly going to deal with our request for information.
[12:00]
I won't go into all the details of the case, but there was a serious communication problem there. No one knew why we were calling, and no one knew why constituents were being referred to this toll-free number, which apparently was set up because of a consumer alert. The Ministry of Finance sent it out, but the Ministry of Health and the Medical Services Commission were involved with this. We received calls from a number of constituents. We were finally given a local number in Vancouver for them to call. It took a couple of days to get through to that number because it was constantly busy. Perhaps that reflects how busy the office is -- that could well be. But clearly there was no way that concerned citizens who really wanted to know whether or not a particular service being offered was covered by MSP could find that out, and there was no way that the information being given out by the government was accurate. There seems to have been some real disorganization on this issue. Even though I know that some of these issues may have been resolved since the consumer alert was initially released, I would ask the minister whether or not he is aware that there were some real communication problems with that and whether or not the bugs have been worked out of the system.
Hon. P. Ramsey: Thank you for bringing the issue to my attention. Obviously, even when one ministry is issuing the alert and another ministry is responding to it, there should be some coordination of activity behind the scenes to make sure that those receiving the calls know what the alert was about. I think there was obviously a breakdown in some parts of the system regarding this incident.
I would just quickly point out two things. First, I think the alert was absolutely justified. We have a small number of practitioners in the province who.... I'm not quite sure what they're doing; they're issuing what I would call a sort of service contract or insurance policy to cover services that are already covered by Medical Services Plan premiums or by general tax revenues, and that's clearly outside the bounds of the legislation in this province. So it is a serious issue.
As far as the communications response, I'm amazed and overwhelmed by the number of inquiries this ministry receives. The toll-free line that the member refers to receives well over 60,000 calls per month, inquiring about MSP premiums, claims and, obviously, consumer alerts.
K. Jones: I'd like to go back to the area of Pharmanet. Could the minister tell us, with regard to the protection of people's files, whether the minister has given any guidance to the people who are preparing the programming along the lines of not allowing personal data to be available on the screens but to have only an indication as to whether there is a problem related to the usage of the particular prescription being put into the system, thereby preventing the knowledge from getting out of the database and protecting the privacy of those people? That system is quite possible with today's technology, and a simple software design would resolve much of the problem that appears to be facing the minister.
[ Page 12468 ]
Hon. P. Ramsey: That's an intriguing suggestion from the member opposite. I would say only this: we're depending on the intelligence of pharmacists to identify inappropriate prescriptions and potentially dangerous drug interactions -- not the intelligence of software.
K. Jones: Might I advise you that the intelligence of the software, if it's properly input, would be far more safe and secure than to rely upon a human decision as to whether there's a problem or not with the interfacing of various drugs? The details of software decisions are far more safe to deal with than the whole variety of differently trained practitioners you are presently depending upon, making judgments independently, without other advice. You have no control over the quality or standard of that judgment other than the original examination in the person's pharmaceutical training program. The people of British Columbia would be much better off having a safe, solid database that would identify improper interfacing of two different types of drugs or the misuse of those drugs -- ordering multiple dosages or larger dosages than what would be appropriate -- than a person, no matter who or how skilled they are, looking at a bunch of information on a screen and trying to make a judgment as to whether they should dispense the particular drug that's being requested.
Hon. P. Ramsey: Potentially hazardous drug interactions will be flagged on the screen for the pharmacist's consideration. For further debate on whether or not pharmacists can be replaced by computer software, I would really advise the member to take it up with the College of Pharmacists of B.C. They may have some interesting perspectives to share with him.
L. Fox: I neglected to ask a question on behalf of the member for Okanagan-Vernon earlier in the evening. I won't go into a lot of detail, because I promised the Chair it would be a very short question. The minister touched on this earlier, but it wasn't a complete answer. With respect to the services for community living, I am under the understanding -- as is the member for Okanagan-Vernon -- that the associate family program is being transferred, or is under consideration to be transferred, to Social Services. I have two very quick questions. Why? Will the program remain essentially the same?
Hon. P. Ramsey: The member is correct in that this is under consideration; it has not occurred. The member may wish to review today's Hansard. The member for Richmond East and I had a fairly extensive discussion of the issues around the associate family program. Essentially, the transfer is being considered for efficiency of program delivery. There are very similar sets of services delivered by my ministry and the Ministry of Social Services. It may well be that we can enhance service delivery by combining the resources of two or more different programs. That is the why. What was the other question?
L. Fox: Will the program remain the same?
Hon. P. Ramsey: We have said very clearly to users of the associate family program that we recognize that they greatly value the high-quality services provided by that program through this ministry, and that we will ensure that the high quality is maintained should the transfer go ahead.
K. Jones: I'd like to go back to the questioning on Pharmanet that was interrupted. The real protection of people's data -- the concept of the Freedom of Information and Protection of Privacy Act, at least that portion which relates to the privacy section -- is when information is not given out to any other party. That includes pharmacists, staff members of the ministry or staff members of the Medical Services Plan -- unless they are specifically required to deal with it. I have suggested implementing the software warning process that keeps personal data away from those people who have no reason to have knowledge of it. It only indicates a flag if there is a problem; if there's no problem, there's no reason why they shouldn't have the data. If there is a problem, the only reason the network is there is to warn that there is a problem. Again, the data is not necessary.
Your system is wrong, hon. minister, because it is old-fashioned. It does not take advantage of what is readily available through simple software to protect the privacy of the individual. I don't think that you're really willing to accept that there is another alternative to what has been presented to you.
Hon. P. Ramsey: It's interesting to hear a program that has yet to be developed and implemented described as old-fashioned. Let me say two things very clearly. First, I believe that it is a requirement of those practitioners who are registered with the College of Pharmacists of B.C. that they seek to review drug history before dispensing therapeutic drugs. That is their professional responsibility. To say that the information that is being provided to them is somehow unnecessary strikes me as contrary to allowing pharmacists to exercise their professional responsibility towards their patients.
Second, the system that's being devised is, I believe, an advance on some other systems. Regarding the system that the member talks about -- or at least some components of it -- where only inappropriate interactions are flagged, as I understand it, something like that is available in at least one other province, and that's Saskatchewan. The people who have been working with that program are quite envious of the features that are being developed for the Pharmanet program.
Finally, I would only repeat the assurance that I gave earlier to the House that obviously the Pharmanet program must meet the requirements for protection of privacy established by the Freedom of Information and Protection of Privacy Act, which the commissioner is charged with administering and enforcing.
K. Jones: If the people of Saskatchewan that you're talking about are so envious of this program, what feature is it that they want to know about in a person's personal file that makes them so nosey? Why would they need that information, hon. minister?
Hon. P. Ramsey: I think that the issues around Pharmanet have been canvassed fairly thoroughly. The member has some interesting perspectives on what information could or should be provided to pharmacists as they dispense drugs. We're trying to devise the best possible system that we can to both ensure protection of privacy and achieve the aims of appropriate use of therapeutic drugs for which the Pharmanet program is being developed.
K. Jones: There's definite concern in the direction that the minister's talking about. I believe that the freedom-of-information commissioner has been documented as
[ Page 12469 ]
expressing concern about the direction the minister is going with the Pharmanet system. Others have expressed concern. The actions that the minister is planning to implement are very detrimental to the general public, yet the minister persists. Is the minister prepared to allow a wife to find out if her husband has AIDS?
[12:15]
Hon. P. Ramsey: I think access of spouses to records is one issue among others that was canvassed earlier. I recognize that the freedom-of-information and privacy commissioner has expressed concerns about the Pharmanet program. Some enhancements to the Pharmanet program have been made as a result of the concerns expressed. Further work with the commissioner is ongoing.
K. Jones: The minister did not answer my question with regard to whether a wife could find out through this process whether her husband had AIDS.
Hon. P. Ramsey: Hon. member, no.
K. Jones: The minister is saying that no, a wife cannot find out whether her husband has AIDS. Is that what you're saying?
Hon. P. Ramsey: The records of the Pharmanet program will be considered medical records like other medical records. While there's surely access of patients and, in some cases, access of guardians to those records, I do not believe that spousal access is permitted to medical records, nor would they be to Pharmanet records.
K. Jones: If that is the case, hon. minister, could another part of your ministry -- say, the communicable diseases section -- find out through the drugs that are being utilized and gather statistics as to whether the person has AIDS or not?
[D. Lovick in the chair.]
Hon. P. Ramsey: No.
C. Tanner: Mr. Minister, I would like to talk for a couple of minutes about the ambulance service. Specifically, I have some questions about the vehicle modification depot. Could the minister provide the House with details of the number of vehicles produced by the vehicle modification depot in each of the last five years, the annual expenditures of the VMD and the average production cost of each vehicle?
Hon. P. Ramsey: I don't have that data available in the House at this time. I'll be pleased to provide it to the member if that is his wish.
C. Tanner: I have a few other questions along the same line, Mr. Minister. Would you prefer that I give you the questions and you will give me the answers later, or have you now found some information?
Hon. P. Ramsey: I do not have all the information the member requested. I can briefly run over the number of units produced in the last five years. I don't think we have full figures for '93-94, but the numbers go like this prior to that: '88-89, 65; '89-90, 65; '90-91, 44; '91-92, 43; '92-93, 92. I don't have the budget figures and the breakdown per unit that the member requested. But let me cut to the chase on this one. We are continuing a review of the vehicle modification depot to assess the cost-effectiveness of its production of ambulances and to discuss with staff the alternatives to continued operation of the depot. This is a serious issue, and a serious review is going on.
C. Tanner: Could the minister provide the House, then, with the details of the vehicles that were required for '93-94 to meet the critical need of the B.C. Ambulance Service for reliable ambulances? Could he also provide the number of vehicles that have accumulated a mileage of more than 150,000 kilometres?
Hon. P. Ramsey: I will be glad to provide the member with that data. I don't have it available to me in this chamber; and given the hour, I am reluctant to say that I can provide it before we finish for the evening.
C. Tanner: I have another three or four questions along the same line, Mr. Minister. If you can't provide the answers this evening, perhaps you could have them delivered to my office after we finish the debate. I'll give you the rest of the questions now if that is agreeable to the committee Chair.
Given the high cost per vehicle and the inability of the VMD to meet the vehicle needs of the BCAS, has the government explored the possibility of discontinuing the production of ambulances and instead buying vehicles from commercial suppliers? Could the minister provide the committee with copies of any studies that have been done in the last five years on the feasibility of doing so?
Hon. P. Ramsey: First, if the member could provide me with a list of specific bits of data that he wants, I'll be glad to see if we can get them for him in a timely fashion. As far as whether or not the ministry is looking at the operations of the vehicle modification depot and assessing its cost-effectiveness, the answer is yes, we are. And in regards to whether or not there have been studies done that the member can have access to, yes, there has been one that I'm aware of. I believe it's the subject of an FOI request by the Liberal caucus.
C. Tanner: The minister must understand that we're all very keen on this side. Consequently we have lots of people exploring the various problems that you have in your ministry. I happen to be the one that's pertinent today.
At the current rate of 30 vehicles, we suspect the savings could be higher if you went to a commercial operator. Could the minister comment on the fact that the 30 vehicles that you're now working on aren't sufficient to warrant the depot?
Hon. P. Ramsey: The answer to the question the member poses is one that we were seeking to find out through the review that I've just mentioned.
C. Tanner: My last question, Mr. Chairman. Could the minister inform the committee whether there has been any direct communication between the former Minister of Health and representatives of the BCGEU regarding the closure of VMD, and whether such communication had any impact on the decision to proceed with the closure?
Hon. P. Ramsey: I am unaware of any such communication.
C. Tanner: Mr. Chair, my last question was prefaced by saying the former minister. What about the current minister?
[ Page 12470 ]
Hon. P. Ramsey: I am awaiting the results of the studies that I referred to. I have made no such communication.
L. Reid: If we can proceed in the next few moments through a brief discussion of strategic programs followed by the Medical Services Commission, perhaps we can wrap this up.
To return to the estimates book, the funding for strategic programs has been decreased by 6.2 percent. Could the minister indicate why the funding for strategic programs was reduced, considering that this is the branch which is, I believe, responsible for the implementation of New Directions?
Hon. P. Ramsey: Earlier in these estimates debates I referred to the reorganization and restructuring of the ministry. The reduction that the member refers to relates to the efficiencies that we think we have achieved by the restructuring of the ministry.
L. Reid: The estimates suggest that public servant travel under the strategic programs is close to $1 million for this year. Why such an amount of money? Could the minister comment on the number of employees that will be travelling under that allotment?
Hon. P. Ramsey: I'm reluctant to give the member a partial answer on that. I'll ask staff to provide me with some detail. Perhaps we could move on to something else and revisit this later.
L. Reid: Under strategic programs there is $3.6 million allocated in STOB 20 for professional services. Seeing that close to $13 million is allocated for base salaries, what does the additional $3.6 million cover?
Hon. P. Ramsey: One example that's covered under that is the PreventionCare campaign and the development of that initiative. There are other initiatives that strategic services has contracted out rather than retain full-time employment in-house.
L. Reid: A similar sum, another $3.6 million, is allocated under vote 40 for advertising and for publications, and certainly communications and public affairs come under strategic programs. Could the minister kindly indicate how much of this budget is allocated specifically for promoting New Directions?
Hon. P. Ramsey: I've asked the staff to give me a clear breakout. The communications budget has indeed increased by about $1.6 million over the previous year. Approximately $1.2 to $1.3 million is going into the PreventionCare campaign. Approximately $300,000 of that is used to fund communication activities to support New Directions -- such as newsletters, mailings, events -- directed largely at health stakeholders who are actually involved in the process of developing community health councils and regional health boards. I think the communications area spent relatively little on advertising community health councils to the general public.
L. Reid: Perhaps I could ask the minister to answer one or two questions regarding the Health Professions Council. I understand that a number of professions are in differing stages of movement through that process. If the minister could begin with an update of where each of the most current professions sits in that time line, I would appreciate that.
Hon. P. Ramsey: Another detailed question. Let me say this while the staff is getting me a list of professions that have applied for designation as self-regulating health professions. Perhaps I can anticipate something the member may be coming to, as well.
We are in the process right now of expanding the Health Professions Council to enable it to undertake a thorough scope-of-practice review of health professions in the province. This initiative has been long overdue, and for that purpose the number of people serving on the Health Professions Council will be expanded. That's the scope-of-practice or legislative review.
[12:30]
The council has received applications with respect to 17 health professions at the current time. It has completed five investigations and has submitted reports on the designation of opticianry, dental hygiene, midwifery, denturism and acupuncture. Those five, as the member knows, have been put out for public comment on the results of the council's work. Outstanding applications include clinical counselling, marriage and family therapy, dietetics and nutrition, occupational therapy, respiratory therapy, and prosthetics and orthotics. That's the work they have. Cabinet action to date, after public review of the council's work, has been to formally approve the designation of opticians and dental hygienists and to give approval in principle to midwifery. The regulations governing dispensing opticians and dental hygienists are now being circulated for public comment prior to being finalized and signed off as formal regulations leading to the establishment of those colleges.
L. Reid: If my memory is serving me, I understood the minister to say that there will be a professional council looking at prosthetics. Was that the comment the minister made? If that is one of the items on the list, I would hope that perhaps the discussions we had earlier regarding prosthetics and orthotics and all of that.... Perhaps some of those decisions can be folded into the discussion of whether or not that profession becomes self-regulating.
There is another question I would ask. Let's just take one example: marriage and family therapists. In that they are not currently in the process other than having an application on file, what is the likely time line before they could expect an answer? Is it six months, is it a year, or is it more broadly based than that?
Hon. P. Ramsey: Unfortunately, I don't have a clear time line for the member. Much of it depends on the council's own work as it looks at the complexity of gathering information and consulting widely with practising counsellors and other professionals in the field. One of the advantages to tripling the number of members on the council is that we expect that applications for designation can be dealt with more expeditiously.
L. Reid: If we could, I'd like to move to a very speedy consideration of the health promotion branch of the ministry. There has been some discussion around the Healthy Schools in B.C. initiative. Is that going to reappear in another form? If not, what is the status of the dollars that used to be used for that program, and what is its status?
Hon. P. Ramsey: I can advise the member opposite and the House that Healthy Schools is going to be financially supported by the ministry in the current fiscal year. It's part
[ Page 12471 ]
of the health promotion department, and its programs are ongoing.
L. Reid: I have one or two questions regarding the governance structures around non-profit societies that deliver health care. There seems to be a lot of correspondence to support their concerns. Correspondence from your office that has been written to a number of different non-profit agencies states:
"I'm very aware that the government needs to set clear guidelines outlining which local society boards are expected to dissolve and which ones are not. I expect decisions on this issue to be made in the spring of 1994."
The groups that come to me are typically non-profit deliverers of service. What is the anticipated change for them, if any, or will all groups -- for profit and not for profit -- be rolled into the same community health council or regional health board? Have they been included in the steering committee structures to date?
Hon. P. Ramsey: I believe representatives of many of these societies have stepped forward and have been involved in the activities of steering committees to date. Very small societies that have received funding from multiple sources will typically not be asked to amalgamate; they will probably be contracted for services by community health councils or regional health boards. For major health care providers, the expectation is that they will amalgamate, and I've made that very clear as well. For those that are sort of midrange or run by a service club or denominational organization, we've asked the steering committees to work with those organizations and to advise the ministry on whether amalgamation should take place.
L. Reid: If I can ask the minister to kindly comment on the Provincial Health Council, it seems that when Bill 68 was withdrawn there was some discussion about expanding the role of the provincial health officer, and indeed that has happened. Has there been some kind of cost-benefit analysis around that expanded role? What have the benefits been to taxpayers in this province?
Hon. P. Ramsey: The benefit to the province, I think, is clear. The provincial health officer, through the report he issued last year and the one he's going to be issuing this year, is setting out a clear analysis of the health issues for British Columbians. He's doing work on developing a set of comprehensive health goals for the province, which will form the basis for much work being done in regional health planning. Perhaps most importantly, he provides an independent voice on health issues of concern to British Columbians.
L. Reid: If we can just spend a few moments on research and development issues surrounding the Ministry of Health, certainly it seems that there are some opportunities for payback, if you will, to generate new dollars in health care. As one example, let's consider the $15 million that the Merck Frosst company gave to the University of British Columbia for, I believe, a program to understand further issues around genetics. Is there an ongoing directive from your ministry to encourage that kind of industry support and those kinds of partnerships?
I'm thinking that in the estimates process with the Minister of Skills, Training and Labour we certainly discussed research and development partnerships. There seemed to be some support for that particular ministry to bring some of those issues in-house and actually build on something. Is it a definite direction for the Ministry of Health to encourage those kinds of partnerships? My thinking is that the tax base simply will not be able to provide the necessary resources. There have to be other ways to generate some of those dollars. Is that a direction this minister is comfortable with?
Hon. P. Ramsey: We're not only encouraging but committing to it. The initiative that the member refers to involves the construction of a facility, the Oak Street site. That $8 million facility is being paid for through the capital budget of this ministry. That's a pretty clear indication of our support for that sort of initiative.
Earlier this year, I addressed the convention of the Pharmaceutical Manufacturers' Association of Canada and encouraged them to increase greatly the amount of research conducted in this province. We constitute some 13 percent of the population of Canada. In terms of research moneys invested by the PMAC, we receive less than 3 percent. If we can encourage greater investment through cooperative efforts and partnerships, I'm certainly willing to explore them, and indicated that to the PMAC.
L. Reid: It seems that what would be ideal for this province is even 1 percent of our overall health care budget going into something like research and development. A number of other provinces have adopted that initiative and supported it with that kind of direction and commitment. Has the decision been reached on behalf of this Ministry of Health in British Columbia that that this may be a direction this minister would be comfortable in pursuing?
Hon. P. Ramsey: No, we have not taken that sort of policy decision. We continue to support the initiatives of the B.C. Health Research Foundation, but as we look at objects of expenditure, quite frankly, provision of health services has a higher priority than research at this time. There are a variety of opportunities for research funding for academics involved in it. I think that research also needs to be increasingly shifted to evaluation of health outcomes and the social determinants of health as well.
L. Reid: I don't disagree at all with the minister when he talks about the measurement of health outcomes, but I do support the notion that research and development should not be pitted against direct care. Research and development can often provide less expensive and, hopefully, more cost-effective ways to treat patients. I would think that there is some ability to integrate those two thoughts and perhaps come up with the best solution for the taxpayers in this province.
I ask the minister to move to a consideration of the Medical Services Commission. A number of issues have come up with B.C. Pricare. The private sector has a number of issues regarding whether or not this government is committed to ensuring that they continue to have a place in the delivery of health care. Your predecessor and I became involved in an elaborate discussion on whether or not private health care providers would be welcomed into the process. Could the minister confirm or deny whether private health care providers have a role to play under New Directions and in the emerging new health scenario for this province under this government?
Hon. P. Ramsey: I'm pleased to advise the member opposite that I met with B.C. Pricare in late April to discuss their concerns. I told them, as I will tell this House, that there
[ Page 12472 ]
is no intention to alter the current proportion of profit and non-profit continuing-care institutions and that provisions to contract out services could clearly be incorporated into service agreements between the province, regional health boards and community health councils.
L. Reid: I thank the minister for his comments.
The minister, I am sure, has received an equal amount of correspondence about chiropractic fees and all the supplementary practitioners to the Medical Services Commission. Let's start with chiropractic. How does the minister explain a decrease in government payments by $2.50 per office visit with his statement that the government has increased the chiropractic budget? That is the issue that continually comes back to my office, as I'm sure it comes back to his. I invite the minister's comment.
Hon. P. Ramsey: It took us until 12:45 to get to the chiropractors. They'll be glad to know that they're being dealt with thoroughly by this House.
The budget for chiropractic services has indeed risen in 1993-94. The amount allocated for chiropractic services was $44.5 million from government-funded and patient-visit charges. This year the allocated amount is $47.5 million. That's a substantial increase, and any negotiated fee increases would be on top of that amount. So we have been able to provide a substantially greater budget for chiropractic services.
[12:45]
What the member opposite is referring to, which is a very interesting -- what shall I say? -- negotiating campaign by some chiropractors, is the assertion that they should somehow retain all of the increased patient-visit charge either in lieu of or in addition to fee increases. I reject that notion. Fee increases for total chiropractic services should be negotiated with the Medical Services Commission, as fees for particular services are. The total fee for an initial visit to a chiropractor right now is a little over $21. When the level of the patient-visit charge was at $5, some $16 of the total was covered by the MSC. Now that the patient-visit charge is $7.50, obviously $2.50 less comes directly out of provincial revenue. If the chiropractors wish a higher fee, as I know they do, they should be negotiating with the province, as they are.
L. Reid: I appreciate the minister's comments. However, my understanding of this issue is that the Medical Services Commission payment is now approximately $8.95, and the patient is being asked to pay $7.50. So there is no campaign, as the minister is suggesting, being waged by chiropractors; patients in this province are interested in learning from this minister why their share of that cost as risen from $5 to $7.50. The patient is incurring the additional cost. I would ask the minister to address that question.
Hon. P. Ramsey: I regret the necessity that led us to increase the patient-visit charge this year. That was one source of revenue we needed to maintain the extensive variety of supplemental benefits that we make available to the people of British Columbia. We contributed $15 million in additional revenue to supplemental benefits, and we asked patients to assist by paying a larger patient-visit fee as well.
L. Reid: The same discussion, if you will, pertains to massage therapists in this province and probably will pertain to physiotherapists. Patients in this province have a question about whether it is the direction of this ministry to increase the portion that patients pay. Is that the direction that will be taken for all supplementary practitioners? It's a different approach than has been taken for other practitioners in the field. I think this minister has touched on the chiropractic issue. Can he suggest what direction we're heading in with regard to registered massage therapists and physiotherapists? Frankly, this has been a year when all supplementary practitioners have had issues around how this government has reached those kinds of decisions. I would appreciate the minister's comment.
Hon. P. Ramsey: Given the rapidly rising costs of supplemental services, we were faced with some very difficult budget decisions earlier this year. At the end of that debate, we increased the budget for supplemental services by about $15.5 million from general revenues and by about $9.5 million from increased patient-visit charges. Doing this enabled us to maintain the most extensive range of supplemental services of any province in Canada.
L. Reid: Could the minister perhaps spend just a moment discussing the current status of the Health special account? It is still my understanding that a certain portion of lottery funds in this province goes into that. If the minister is able at some point -- perhaps not at this particular moment, in the wee hours of the morn -- to share with my office information on the projects that have been funded, I would certainly appreciate it.
Hon. P. Ramsey: The proceeds from the Health special account are used for the same diversity of health care spending as general revenues.
J. Tyabji: I'd like to cover some riding-specific questions, and I don't intend to belabour them. I've been waiting for a number of hours now to get into this debate. Having said that, I'm sure the minister is aware of a couple of things. There are a number of developments in the Okanagan with respect to the regional health councils. With respect to chiropractors, I know there are a lot of reviews and discussions in this ministry. Out of 24 chiropractors in Kelowna, 19 have now opted out of medicare, and there is a fairly serious problem there with respect to a perception of a lower government commitment to funding.
One of the biggest problems is the two-tiered opportunity for access to chiropractic treatment, in that people who are not on welfare -- who will be paying $14.75 -- still have to pay in addition to medicare; people who are on welfare have to pay a user fee of $7.25. The minister may say that if a chiropractor chooses to opt out, that is not for him to say. However, the chiropractors are facing very serious problems there. They would like to deliver the service. They believe it's a good form of care, yet the perception is that there is a lower government commitment now than there was five years ago. What could the minister say to those 19 out of 24 chiropractors in Kelowna who are looking to him for some reassurance that there will be something to look forward to?
Hon. P. Ramsey: We can say very clearly to the chiropractors that budgets for supplemental services in British Columbia have risen 15 percent this year. That is the largest increase of any area of my budget. If that doesn't indicate this province's commitment to those services and the importance in which we hold them, I am not sure what can.
[ Page 12473 ]
J. Tyabji: I plan to pursue that debate at some later point. I recognize the 15 percent increase, and I know that because of the reviews underway right now it is impossible to pursue any more specific questions about how the fee schedules will break down and what kind of individual commitment the government has to groups like the chiropractors.
With respect to the AIDS Secretariat, the Kelowna and Area AIDS Resources, Education and Support Society has been doing excellent work with the youth in the valley and has been trying very hard to have education distributed. There is a lack of knowledge and awareness in Kelowna about how prevalent the HIV virus is and the ways of preventing it. The problem there is that the demand is increasing exponentially, and in some cases funding is decreasing. There are very simple programs that groups like KARES are dealing with, such as handing out educational pamphlets, public speaking programs, and the distribution of condoms to young people during the summertime, when there are a lot of street youth. The sad reality is that if somebody isn't distributing literature and condoms, the problems do tend to become compounded.
Could the minister tell me if there is going to be any monitoring by the ministry of some of the groups such as KARES in terms of what their needs are as opposed to what kind of funding they will be getting?
Hon. P. Ramsey: I recognize and respect the good work done by KARES and other community organizations involved in health promotion and illness prevention regarding the AIDS issue. As I said earlier, this year we have provided an increase of 10 percent in funding for health prevention and community-based services through the AIDS Secretariat. I have asked the ministry to review funding for all groups that have received funding through the AIDS Secretariat. I expect the results of that review, and to be making an announcement, within the next day or two.
J. Tyabji: I would appreciate knowing any information that might come out with respect to the Okanagan in that review, and if there are any changes being made.
Further to the question about the chiropractors, I have received a number of letters from massage therapists and physiotherapists in the Okanagan. One thing that is a concern is that although there may be a global budget increase, we are not sure how much of that is going to be allocated directly toward fees. Could the minister give an idea about that breakdown, whether or not it will affect physiotherapists and massage therapists, and whether or not they have had an increase as well?
Hon. P. Ramsey: I am attempting to get specific budgets for each of the specific practitioners. The 15 percent increase flowed directly into budget increases for the allowable amounts for various supplemental services; someone was also set aside to fund fee increases. I'm pleased to report to the member that negotiations have now been concluded for massage therapists. Negotiations with physiotherapists are ongoing.
J. Tyabji: When there is resolution I would appreciate having some information on that so that I can distribute it to my constituents. I do have quite a thick a file on this.
I want to put on the record that I'm very strongly opposed to the direction of the federal government, and of some provincial jurisdictions, with respect to smoking and the fact that to combat the problems in smuggling there was a lifting of taxes on smoking. I've received a number of letters from constituents on this. It's a significant health issue, and it's interesting to note that at the same time that it can be argued cigarettes that are becoming more accessible, there are more people concerned with the effects of secondhand smoke.
I have had direct requests from some organizations in my riding that are trying very hard to limit the effects of secondhand smoke. Is the Ministry of Health going to be doing any educational programs in conjunction with the Ministry of Education with respect to secondhand smoke? In addition to that, is the Minister of Health working with the Minister of Environment on the effects of slash burning and secondhand smoke, in terms of air quality that the Minister of Environment might be very concerned with? The reason I ask this is that slash burning is an enormous issue in the Okanagan. As the minister is no doubt aware, and as the Minister of Environment has said a number of times, every time there's a large slash burn, the emergency room will fill up with respiratory patients who have severe reactions to the slash burning. It's a serious health issue, and I'd like to know what the minister is doing to address it. It's particularly an issue in the interior.
Hon. P. Ramsey: I thank the member for her support for this government's policy of not reducing tobacco taxes and of taking the initiative with the other three western provinces to counter smuggling of tobacco products. I too have received a number of letters commending us for that initiative.
As far as smoke is concerned, both the Ministry of Environment and my ministry are concerned with particulate matter. I think the member may be aware of a study released by the provincial health officer some time ago that deals with this issue. Medical health officers and the provincial health officer continue to work to devise means of addressing the issue.
J. Tyabji: Again, when there is resolution to that, I'd appreciate some report or whatever comes out of that study.
A couple of quick riding questions and then I'm finished. There's a detox centre.... As I'm sure the minister is aware, this is the third year I've stood up and talked about detoxification in the central Okanagan. It's a very serious issue there, and it has been for years. There are no adequate facilities. The only thing close by is Kamloops. As well, in my riding there have been deaths of people who didn't have access to detoxification.
[1:00]
There is now the potential for a scaled-down detoxification centre by this fall, and I'm wondering if the Ministry of Health is planning to provide any funding. I know that right now the local committee for detoxification is asking for some funding and has been for a number of years. It's something that probably would reduce the cost to the Ministry of Health, because it would remove the cost from the hospital and the emergency room.
Hon. P. Ramsey: The issue of providing detox services to the Okanagan deserves either no answer or a very, very long one. What I would suggest is that perhaps the member and I could talk about this outside the House. I know it's an issue to people in her riding. I was made aware of it when I visited the Okanagan earlier this year.
J. Tyabji: Actually, if it's going to be a long answer, perhaps I could get something in writing before we have a meeting, and then I will know what kind of research I have to bring. I have a large file; I've attended some of the meetings of the detoxification committee, and certainly the
[ Page 12474 ]
needs are very.... There have been some very serious issues not just for Kelowna but for that area -- the population growth and some of the pressures from that growth, with the lack of affordable housing.
My last question, I guess, is with respect to the cancer clinic. Could the minister bring me up to speed on the record of what's happening with the cancer clinic -- as briefly as possible, hopefully -- and when we can expect to see the minister cutting a ribbon, holding a shovel in his hand or doing something that ministers love to do?
Hon. P. Ramsey: Planning for the construction of the clinic is ongoing. As I told the member informally, site acquisition is in progress. There have been some significant blockages to completing site acquisition, and negotiations are simply at an impasse with one or two property owners. We may be dealing with legislation later this session to make sure that we can go forward with the site acquisition and construction of the cancer clinic.
There is money set aside in this year's budget for some of the planning work that needs to be done on the centre to make sure that it comes on stream. I think we're probably now looking at early 1997.
J. Tyabji: Just to be clear, would early 1997 be when it's open?
Interjection.
J. Tyabji: Okay. The minister is saying that it would be open in early 1997. Could we expect that the planning would be complete at the end of this budget year?
Hon. P. Ramsey: Yes.
J. Tyabji: That's encouraging. So if the planning is completed at the end of this year and we have a new cancer clinic in '97, that's good news for the riding.
Interjection.
J. Tyabji: I'm being advised that the election might precede it.
Could the minister tell me how much the new community health councils initiative of this minister is costing in the central Okanagan in terms of implementation, salaries, administrative costs and/or capital costs?
Hon. P. Ramsey: I don't have the figure broken down by individual region, hon. member. The figure for the implementation activities to develop community health councils for the province is about $6.4 million.
J. Tyabji: So $6.4 million is the 1994-95 implementation costs of all the community health councils. We're assuming that there are 75, so would it be fair to say that if we divide it roughly by 75, that will be the cost by riding?
Interjection.
J. Tyabji: I understand the minister needs to hear that again; there are too many things to do at once. Does that $6.4 million in implementation costs include capital costs or -- if there are any -- expenses of the people on the committee? Is it fair to say that the $6.4 million can be broken down into the regions? I don't know how many regions have been designated by the minister, but however many there are, are they all basically at the same level? Would they be incurring roughly the same costs, or are we ahead of the game? I understood that the central Okanagan was slightly ahead of some of the other regions in terms of being one of the first out of the gate, and therefore maybe it is taking a bit larger portion of the pie than some of the others. Could the minister perhaps enlighten me?
Hon. P. Ramsey: Indeed, the costs vary from region to region. I have firm figures for 1993-94. Last year some $801,000 was spent on the Okanagan-Kootenay health region, a substantial region. Breaking it down to the central Okanagan within that could be a little difficult.
J. Tyabji: So would this year's figures for the same region, Okanagan-Kootenay, be roughly higher or lower than last year's?
Hon. P. Ramsey: Higher.
J. Tyabji: I would like to say that I have a problem with the cost, and I just want to bring this to the minister's attention very briefly. In February, Kelowna General Hospital closed 30 surgical beds to save $1.5 million a year, changed the nursing department to save another $237,000, and during Christmastime they had bed closures to save $600,000. It seems to me that when there's a problem with funding for direct services to people who need them, maybe a change of governance wasn't the highest priority for the people of the central Okanagan. Obviously that's a philosophical difference between me and the minister, so he doesn't have to respond to that. But I want to put it on the record that there are problems at KGH, that they are having problems with staffing and that there are surgical bed closures. That's a fairly serious situation, notwithstanding that I recognize that this year the ministry was fairly generous in terms of the amount of money given.
This is the last question I have on the estimates. I have had a very strong lobby in the Okanagan since I was elected with respect to the issue of fluoride. Some people -- a couple of them -- have very serious allergic reactions to fluoride, and one case has resulted in chronic and lifetime bone problems. I'm wondering if the minister has looked into any of the alleged problems with fluoride or any alternatives to the fluoride water supplements we currently have -- perhaps allowing toothpaste or other supplements to be adequate.
Hon. P. Ramsey: There is a range of issues here. I'm pleased to tell the member that if she considers this year's budget for Kelowna General Hospital generous, then she should have also looked at the last two years. Kelowna General Hospital received an increase of 9.2 percent in '93, 13.4 percent in '92 and an additional 3.5 percent this year. Their budget is currently close to $85 million; in 1991 it was just over $65 million. I would say that Kelowna General Hospital has received substantial funding increases to recognize the rapid growth in the Okanagan area.
As far as fluoride goes, the decision of whether or not to add fluoride to water is made by municipal councils, as the member knows. I believe it has to be approved by referendum of the general population.
Interjection.
Hon. P. Ramsey: Well, I believe that in most cases it was initially brought in through referendum, and there's a procedure for defluoridizing water through referendum as
[ Page 12475 ]
well. The information that I've had presented to me continues to suggest that this is one of the best public health measures that can be taken. I recognize that there are others who question the efficacy of this initiative.
J. Tyabji: My last comment under this vote would be to acknowledge that although in the two years since the NDP government took power -- now I think I'm being a constructive opposition member -- they have played catch-up with respect to the budget, recognizing the growth that has taken place in the central Okanagan, there were serious funding shortages in Kelowna General Hospital. Even though there were funding increases, when we look at the capital costs that were going in -- expansions under the Social Credit government and then finished under the NDP -- there were significant demands being made on the operations of the hospital. The reason I said a 3.5 percent increase was generous was that they were worried there could be a freeze in funding, and when there wasn't a freeze in funding, they ended up being happy about that.
However, having said that, there's still a difference of opinion as to where the priorities for funding should go with respect to the health councils. I have heard that from a number of people in the health care industry in the Okanagan.
With respect to the fluoride debate, considering that the Ministry of Health determines what's in the best interests of the health of the people of this province, is the minister then telling us that he has reviewed the evidence with respect to health and has determined that there's nothing further necessary? To put it more clearly, have any independent health studies been presented to the minister, or have any been done by the ministry since this government took over, that have provided satisfaction to the government that there's nothing further to investigate?
[D. Streifel in the chair.]
Hon. P. Ramsey: On the fluoride issue, I haven't reviewed any brand-new studies since I took over as minister. I believe this issue tends to be the subject of a fair bit of back-and-forth in articles published on both sides. I don't believe there have been any serious challenges to the scientific studies which established this treatment's validity some time ago, but I recognize there are people who differ with that interpretation.
Finally, I'll comment very briefly on funding for the establishment of New Directions. This constitutes something like 0.2 percent of the ministry's budget. I believe this is vital to get the councils going, to get the integrated services and efficiencies of health delivery that they can provide. In even the short term, spending these moneys will be repaid in better and more efficient health delivery.
K. Jones: I'd like to start off with some questions with regard to my constituency. Particularly, I'd like to follow through on the concerns expressed by my colleague from Surrey-White Rock with regard to the underfunding of the Boundary health unit, which covers Surrey, North Delta and White Rock. I won't repeat what he's already said, but I will concur that there's a serious need for the minister to recognize that this is not only a very large population centre, representing almost the largest concentration in any health unit in the province, but also the fastest-growing centre and a key area of development, which brings along with it many of the other costs that relate to the Ministry of Health -- namely, the staffing requirements to approve various land development proposals and handle environmental impact studies to keep these developments moving along.
[1:15]
We have actually had a slowdown in the process of development of homes, and opportunities for people to have homes, as a direct result of the underfunding of the Boundary health area. This not only causes a problem in that people are trying to proceed without proper approvals and therefore endangering further the health of the community, but it is also causing extreme financial difficulties for those people who are working on developments and abiding by the law. There is absolutely a serious need to provide the funding required to meet those needs in the Surrey, White Rock and North Delta area. I'd certainly like to ask the minister what he is prepared to do to recognize this serious problem.
Hon. P. Ramsey: This matter has been canvassed thoroughly by your colleagues from both Surrey-White Rock and Richmond East. I advise you to read Hansard.
K. Jones: I am aware of what was said in Hansard. I have it right here. I bring up those points that are not mentioned in Hansard, hon. minister, and you can't use that as a reason for not coming forward with concrete answers to concrete questions.
The serious problem I would like to ask the minister about is: how much money is collected in fees for services by the Ministry of Health within the Boundary health unit?
Hon. P. Ramsey: No, I couldn't answer that.
K. Jones: Could the minister make a commitment to provide us with that information?
Hon. P. Ramsey: I'd be glad to.
K. Jones: Thank you, hon. minister.
Would the minister also be prepared to make a commitment that the fees collected in the Boundary health unit be made available to the Boundary health unit exclusively, so that they can provide the necessary services that are being charged for in that area?
Hon. P. Ramsey: Fees go into general revenues. Budgets are allocated by this ministry. Budgets vastly exceed fees.
K. Jones: Could the minister repeat the last part of his sentence. I couldn't quite make out what he was saying.
Hon. P. Ramsey: Very briefly, fees are put into general revenues. Budgets are allocated by this ministry out of general revenues. The budgets that are allocated for the Boundary health unit vastly exceed fees collected.
K. Jones: I realize that the funds provided to the Boundary health may exceed that. We're only talking about one service area that's being collected from in that area. I'd like to have a commitment that all of those funds will go back into that unit, in addition to the other funding that is used for other purposes, such as health care and hospital care funding. The services of inspection of restaurants and various facilities where there's a fee charged is what I'm asking to be provided back into that health unit without restriction.
[ Page 12476 ]
Hon. P. Ramsey: I believe I've already answered this question sufficiently. I'm not prepared to accede to the member's specific request.
K. Jones: I presume that means the answer is no, the minister is not prepared to give the people of Surrey the amount that is taken from them.
I realize it's late and you guys are just as tired as I am, but we have a job to do. The fact that we happen to be willing to wait while others have their turn deserves the proper opportunity for a reasonable response to our simple requests. And that goes for the backbenchers -- if they've got nothing else to do, why don't they go back and sleep.
Could the minister answer a question with regard to lottery funding? Could the minister give us a detailing of the distribution of the lottery funding that comes to the Ministry of Health?
Hon. P. Ramsey: Approximately $115 million, through the Health special account, will be spent on health services in this province. Those moneys are derived from lottery revenues. As I indicated to the member for Richmond East earlier, those funds are expended on the full range of health care that's provided in the province.
K. Jones: Could the minister, within a short time after this, give us a written report indicating how those moneys are allocated?
Hon. P. Ramsey: Perhaps the member opposite missed the import of my answer. The funds go into general budgets for the operation of the Ministry of Health; they are not tagged for specific services.
K. Jones: In the act that created those allocations of funds, specific areas were identified for their intended use. I'd like to have a breakdown as to how this money is spent in those areas.
The minister appears unwilling to answer that question. I'd like to go into an area that is of very great concern to us in Surrey, and that's Surrey Memorial Hospital. It's closing beds and laying off staff, and it sits with something like an $8 million or $9 million shortfall in operating funds. The minister appears to be taking no action to correct this problem. What plans does he have to answer the problems that the administration and the workers of Surrey Memorial Hospital are faced with?
Hon. P. Ramsey: As I indicated earlier to several members who raised issues about hospital funding, I've asked all hospitals to report to the ministry on difficulties they may have with this year's budget. Recently I specifically asked somebody to go to Surrey to look at their financial circumstances and the cash flow difficulties they may be experiencing. I assure this member, as I have assured others, that the goal here is to make sure that services continue in Surrey and elsewhere in the province, but we are asking the hospitals to attack necessary efficiencies, to coordinate their services with other hospitals, and to look at the provision of community- and home-based services.
K. Jones: I can assure you, hon. minister, that the Surrey Memorial Hospital budget is cut to the very bone; there is no meat left. They need serious funding, and that's all there is to it. I'm sure you will get that in the report from your investigation team that is going there -- although you should have as much confidence in the people who are there as you will have in the proposed regional health council, which I presume you will have in place shortly. Could the minister tell us when that will be in place, and how effective it will be in getting the problems of serious shortfalls in the Surrey area addressed?
Hon. P. Ramsey: I expect the regional health board for the Surrey area to be established by this fall. Operational responsibility for Surrey Memorial and other facilities will be phased in according to a plan proposed by that board and approved by this ministry.
K. Jones: Could the minister tell us exactly how a shortfall of $8 million or $9 million is going to be addressed by the regional health council?
Hon. P. Ramsey: I look forward to receiving the report by the people I asked to review the finances of Surrey Memorial. We will work with this hospital, as with others, to ensure that high-quality health services are preserved and enhanced for the people of Surrey.
K. Jones: Could the minister tell us how many conceptions have not gone to completion in British Columbia?
An Hon. Member: Conceptions?
Hon. P. Ramsey: If the member wishes to go on to a further question, I'll be glad to get the detailed number. I believe he's asking for the number of therapeutic abortions in the province last year. If that is not the import of his question, please let me know; otherwise, I'll endeavour to get that figure for the member.
K. Jones: Actually, I was trying to find out several factors. That was one of them. The other was just the general picture of the number of conceptions there are and whether they go to birth or are lost by some process.
Hon. P. Ramsey: I don't have that information available to me in the chamber. I'll see if we can get it for you, hon. member.
K. Jones: If you could provide that, and if it would be possible to have it broken down by hospital and other facilities that would be involved -- I believe stand-alone clinics would be included in that -- it would be very much appreciated. I believe the minister is agreeing to that information being provided to us.
I'd like to go into the area of B.C. air ambulance services, and I'd ask the minister if he could give us an idea of the present plans within his ministry to deal with the need to revamp air ambulance services, such that it would be able to deal with a cancelling of the government air services. What methods does he propose in making it meet some of the recommendations that have come forward in both the ambulance service report of 1992 -- that is, the review of Airvac services -- and the recommendations of the report done last fall for Treasury Board?
Hon. P. Ramsey: Again, this matter has been reviewed thoroughly by discussion in the House. I indicated earlier that we plan to enhance the amount of privately contracted air services that are available and to ensure rapid air evacuation of the highest quality to people who require it in British Columbia.
[ Page 12477 ]
K. Jones: Does that mean that the minister plans to move the Airvac operation to Vancouver, as is recommended?
Hon. P. Ramsey: I recognize the member's right to ask whatever questions he wishes. When they have been answered thoroughly in this chamber, I hope he recognizes my right not to revisit them.
[1:30]
K. Jones: I don't recall that the question of the move of air services to Vancouver has been addressed. Could the minister tell us in what part of the debate that occurred?
There have been concerns expressed about both government air services and other air services' operations for the air ambulance. Could the minister tell us what actions he is taking to improve the standards of present operators of air ambulance services, both private contractors and government air services?
Hon. P. Ramsey: Present and future Medivac personnel will be provided by the B.C. Ambulance Service. I believe the quality of service they provide is widely recognized. The quality of the plane transportation provided is assured by the quality assurance program that's in place through government purchasing services.
K. Jones: What provisions are being made for the establishment of permanent fixed-wing bases in the regional areas in order to reduce the amount of overtime being paid to Airvac employees -- that is, the utilization of properly trained air evacuation people in the regional areas of the province?
An Hon. Member: Read Hansard.
K. Jones: I realize that it's difficult to try and ask questions as the last person in the process, but I think it's only fair that I be given the opportunity along with anybody else who received answers to their questions.
An Hon. Member: They've already all been asked.
K. Jones: I would like the minister to deal with the fact that the cost of air services has been a serious question. What is the method of monitoring these costs? There appears to be a lack of auditing control of air ambulance costs. Could the minister tell us what implementation he has got in place to deal with that?
Hon. P. Ramsey: Government air services is the responsibility of the Minister of Government Services, and I believe these issues have been canvassed. The member also referred to two studies, which he obviously has in his possession, that document the difficulties with cost efficiency of government air services.
L. Reid: Hon. Chair, I thank you most sincerely for your patience this evening. I would like to extend my thanks to the minister and the staff. Have a wonderful evening. Thank you all.
Vote 42 approved.
Vote 43: ministry operations, $6,298,561,057 -- approved.
Hon. P. Ramsey: As we wind up the debate on estimates at this time, I want to thank all members for their contribution to it. I think we have canvassed issues very thoroughly. I want to thank my staff for service above and beyond the normal call of duty, particularly at 1:30 in the morning. We have thoroughly canvassed the challenges facing this ministry in providing high-quality health services to the people of British Columbia, and I anticipate further good debate with members from all sides of this House.
I move the committee rise and report resolutions.
Motion approved.
The House resumed; the Speaker in the chair.
Committee of Supply B, having reported resolutions, was granted leave to sit again.
Hon. P. Ramsey moved adjournment of the House.
Motion approved.
The House adjourned at 1:37 a.m.
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