1995 Legislative Session: 4th Session, 35th Parliament
HANSARD
The following electronic version is for informational purposes only.
The printed version remains the official version.
(Hansard)
MONDAY, MAY 29, 1995
Afternoon Sitting
Volume 20, Number 11
[ Page 14597 ]
The House met at 2:09 p.m.
Clerk of the House: Pursuant to standing orders, the House is advised of the unavoidable absence of the Speaker.
[D. Lovick in the chair.]
Prayers.
Hon. A. Petter: It's my pleasure today to introduce to the House a group of about 30 members of the families of Slesse, including Andy and Karin Kleven, who are our guests for an announcement that we'll be making shortly on the future of Mount Slesse. Also present for this event from the Chilliwack forest district are Murray and Judy Sluys, Jim McMillan Murphy of the Canadian Peacekeeping Veterans' Association, and Morley Eldridge and D'Ann Owens-Baird of Millennia Research. I'd ask the House to please bid these very special guests a warm welcome.
Hon. U. Dosanjh: Today we have some very special guests in the members' gallery. His Excellency Alfonso Lopez Caballero, Ambassador of Colombia to Canada, and His Excellency Alfredo Crespo, Ambassador of Ecuador to Canada, are visiting British Columbia from Ottawa. Accompanying the ambassadors are Josefina de Lopez, Cecilia Gonzalez de Crespo and Beatriz Hernandez de Horry, honorary consul of Colombia at Vancouver. Would the House please welcome them.
R. Neufeld: On behalf of the member for Peace River South, I would like to introduce Mr. Jim Rose from Dawson Creek. He is also here to take part this afternoon in what the Minister of Forests talked about -- the Mount Slesse announcement. Please make him welcome.
Hon. U. Dosanjh: Present in the gallery are 60 grade 11 students from Sir Charles Tupper Secondary School, one of the two grade schools in my constituency. Present with them are Mr. Ron Boulding and Ms. Eleanor Whyte. Would the House please welcome them.
Hon. J. Cashore: We have two constituents from Coquitlam in the gallery today: Joe and Ria Smeets. Accompanying them is Joe's mother, Juria Smeets, who lives in The Hague in the Netherlands. Please join me in making them welcome.
F. Randall: In the precincts today are 85 grade 6 students from Clinton Elementary School in Burnaby-Edmonds. They're accompanied by Mr. Jacobsen, their teacher, and some other adults. Would the House please make them welcome.
MOUNT SLESSE COMMEMORATIVE SITE
Hon. A. Petter: I rise today on a matter of significance to British Columbia, to make a ministerial statement, one that concerns the final resting place of 62 people who perished in a plane crash on Mount Slesse on December 9, 1956. This tragic event devastated families and friends of the victims and touched sensibilities in every part of Canada. When the scene of the crash was finally discovered, the wreckage was found covering a vast expanse of rock and ice in a high mountain reach. The site was deemed so remote and inaccessible, and the devastation so complete, that no further attempt should be made to bring down the remains and that Mount Slesse should remain their resting place.
The course of time has belied the hope that Mount Slesse would remain a remote and inaccessible wilderness. It has also revealed that an important promise made at the time -- namely, that this place would be dedicated to the memory of the lives it had claimed -- was never actually carried out. This disturbing fact has renewed the distress of families who believed a special status had been conferred in recognition of their loss. All members of this House feel compassion for the anguish this has caused the families of Slesse. Today it is our privilege to fulfil a commitment that will give them comfort. On behalf of the province of British Columbia, I would like to acknowledge the oversight and say to the families of Slesse -- many of whom are with us in the gallery today -- that we share your wish that this place be dedicated to the memory of your loved ones.
I am pleased today to announce the creation of a Mount Slesse commemorative site covering approximately 582 hectares on the mountain's east face. The crash site and debris field are now formally recorded as a heritage wreck in the B.C. archeological site inventory and are thereby protected by statute from damage or desecration. Consistent with the families' wish that the site be managed for quiet contemplation of its grandeur, a protective zone is now placed around the debris field. Within this area, by means of orders-in-council passed under the Land Act and the Forest Act and by ministerial order under the Mineral Tenure Act, intrusive uses have been prohibited. At a future date modest signage will be placed to identify the nature of this special scene for the hikers and mountaineers who happen upon it.
[2:15]
It is our sincere hope that by these actions we can finally lay to rest a troubling memory and thereby initiate a process of reconciliation that is long overdue. There will be an opportunity for members of the House to join with the families of Mount Slesse at a reception following question period in the Ned DeBeck lounge, and I invite members to do so.
W. Hurd: The opposition is pleased today to join with the government in endorsing this caring and compassionate decision to dedicate this as a memorial site for those 62 people who tragically lost their lives back in the 1950s.
We know that in most cases every effort is made to recover the remains of victims of air disasters, but with the type of terrain we see in British Columbia and the inaccessible areas, that sometimes proves to be impossible. I know that the families will be comforted by the government's decision to make this special effort to dedicate the site as a reminder of the perils of air travel in British Columbia, but it is also a beautiful site at which to recognize the families and the people who lost their lives. We hope and know that the memory will live on. It's indeed a caring and compassionate move by the government.
R. Neufeld: On behalf of the Reform Party of British Columbia, we would like to join with the government and the
[ Page 14598 ]
families who are represented in the gallery today, in setting aside some 582 hectares as a heritage site for the crash that took place in the mid-fifties and took 62 lives. We agree with the government that there had to have been some kind of oversight, and we apologize along with them and hope that what is done today will finally meet the needs and desires of those people who are here today watching.
DOUGLAS LAKE RANCH BLOCKADE
G. Campbell: Since last Thursday, members of the Upper Nicola band have been blockading the road to Douglas Lake Ranch. I understand a court injunction was issued last week, and an enforcement order was granted on Saturday. Since then, telephone lines have been cut, ditches have been cut across the road, and today school children did not get to school. Tour groups have been forced to be cancelled, people have not been able to get to work, and activities of the community have not been able to be carried on. Can the Minister of Aboriginal Affairs inform the House today when the Douglas Lake roadblock will be dismantled so that kids can go school, people can get to work and the normal activities of the community can be restored?
Hon. J. Cashore: As we meet, there is a meeting taking place involving the chief representatives of five ministries of government and others who are involved in this issue. As a provincial government, we have been playing an effective role in seeking to mediate this dispute between parties. We are very disappointed over the failure of the federal government to recognize its responsibility with regard to this issue. Since I'm sure that all parties in this House would want to see this issue managed with cooler heads prevailing, I would encourage the Leader of the Opposition to talk to his cousins in Ottawa and encourage them to take their full role in participating in bringing this to an appropriate dispute resolution, especially since it's the federal government that holds lands in trust.
Deputy Speaker: Supplemental, Leader of the Opposition.
G. Campbell: In spite of what the minister may feel about my party's lineage, we have no cousins in Ottawa. We do have, however, a provincial government that has some responsibility here. What I would....
Interjections.
Deputy Speaker: Order, hon. members. I'm sure we would all like to hear the question.
G. Campbell: British Columbians are concerned that a double standard seems to be being set by this provincial government. Today children did not get to go to school and people did not get to go to work, because an enforcement order has not been carried out. Can the Minister of Aboriginal Affairs explain why the government was willing to enforce an appropriate injunction in the Clayoquot Sound but is not willing to enforce an order which requires public access to be restored to Douglas Lake? There should be a single standard for all British Columbians so that they can understand and all work together for resolution of these issues.
Hon. J. Cashore: I, for one, appreciate the fact that the RCMP exercise wisdom and caution when it comes to enforcing such an action.
WRONGFUL DISMISSAL SUIT AGAINST B.C. TRANSIT
D. Symons: The wrongful dismissal suit of Frank Dixon v. B.C. Transit comes up for trial next month. I understand that there are discussions about an out-of-court settlement that could be as high as $1 million. Will the minister commit today to assuring the people of British Columbia that the terms of any out-of-court settlement will be made public and that there will not be a gag agreement on a settlement that could cost B.C. Transit and, subsequently, transit users and taxpayers a great deal of money?
Hon. G. Clark: We're working very hard to achieve a settlement. There is a court date set, so I have no further comment at this time.
Deputy Speaker: The member for Richmond Centre on a supplemental or a new question.
D. Symons: In Mr. Dixon's statement filed with the court, he says that during job interviews the minister indicated his desire to bring the transit union into closer support of the NDP. Would the minister agree that reference to generating support for a political party is totally inappropriate during interviews for executive positions of government agencies?
Hon. G. Clark: Yes, Mr. Speaker.
DOUGLAS LAKE RANCH BLOCKADE
R. Neufeld: My question is for the Premier. For nearly a week now, the government has sat back and done nothing to remove an illegal blockade at the Douglas Lake Ranch. Local residents are so furious at the Attorney General's gutless response to this illegal blockade that they are now threatening to take matters into their own hands. Why has the government sat idly by and allowed the blockade to continue instead of enforcing the Supreme Court injunction?
Hon. M. Harcourt: The provincial government is involved. Senior officials from the Attorney General's ministry, from Forests and from two other ministries are actively involved with the parties in trying to seek a peaceful resolution. We are of course guided by the advice we get from the policing authorities, the RCMP, who have much experience all over this country in these matters. Their advice at the time was that it would have been imprudent to have attempted to enforce the order yesterday when there were over 250 people on the blockades, and it was their advice that we should go back and negotiate a settlement to this particular issue. If the member has other advice, I await it with interest.
R. Neufeld: The government should be sending out a clear message that native militants will hamper, not help,
[ Page 14599 ]
native demands at the bargaining table. The Apex fiasco sent precisely the opposite message, and that's why other bands are looking to militants as a bargaining strategy. Why doesn't the government crack down hard on illegal native blockades instead of rewarding the militants responsible, and why doesn't the government prosecute the Douglas Lake blockaders with the same vigour it did the Clayoquot protesters?
Hon. M. Harcourt: I will just simply say again that we are working very closely to try to bring a resolution to this, so that those who are being disrupted can have their transportation corridors restored. Second, you should go and talk to the leader of the Reform Party about the two months of dithering and then walking away with his tail between his legs at Duffey Lake that he had when he was the Minister of Native Affairs. That's certainly not an example.
ALLOCATION OF HEALTH CARE FUNDS
L. Reid: British Columbians learned this weekend that Alzheimer's patients are forced to occupy acute care beds, often under inhumane circumstances. These acute care beds cost $900 to $1,000, yet top-quality care is available at Delta View for less than half that cost per day. Why is this government allowing this two-tier system to exist when a proper allocation of health dollars could save taxpayers money, eliminate the two-tier system and give patients the best care available? To the Minister of Health.
Hon. P. Ramsey: It's good to see a warmup for estimates debate taking place during question period. We are indeed, I think, funding appropriately and making sure that priorities are there. As the member opposite may know, the budget for long term care facilities for this province has risen from slightly over $345 million, when this government took office, to $409 million last year, with a further increase expected this year. We are concerned about the seniors in our society; we are very concerned that they get appropriate care.
Deputy Speaker: Supplemental, Richmond East.
L. Reid: I would ask this minister to talk to the families in British Columbia. Indeed, 55 beds awaiting public funding at Delta View could accommodate British Columbia families today, but because this minister would choose to spend three times that, rather than put those dollars into community beds.... Indeed, this is the same government that said that moving resources from the acute sector to the community sector was their goal. Why has this minister not moved on that?
Hon. P. Ramsey: The member opposite should be leery of letting the media do her research for her. We currently fund 57 beds at the Delta View facility.
EMERGENCY PREPAREDNESS AND CANADIAN FORCES MOVE OUT OF B.C.
R. Chisholm: My question is to the Premier. It is in reference to CFB Chilliwack. I'm tabling today another summary of 21 more communities and regional districts that I have received letters from, raising concerns about the safety of British Columbians in times of natural disasters and what sort of federal assistance we will get from the Canadian army based in Alberta after the closing of CFB Chilliwack. Some officials say we will just fly forces into Vancouver or Abbotsford, but they may not be there to land. The Premier has indicated that he is willing to work with municipalities and myself on this issue. I am wondering if this matter and other matters involving cuts by Ottawa to Victoria shouldn't be before a special committee of this Legislature for consideration. What is the Premier's comment on this suggestion?
Hon. M. Harcourt: I have talked with the member for Chilliwack about this particular matter. It is of grave importance to British Columbians that we have the Armed Forces here in British Columbia, able to play their role in an earthquake or a disaster of some sort. I'm very sympathetic to what the member is saying. I have informed him that it is before cabinet right now; it is a matter that has been considered by cabinet. I will keep him fully informed. He speaks for his community well on this matter -- and for all British Columbians, who want to see the capability to deal with a disaster here in British Columbia. Most likely the best facility is already there in Chilliwack, rather than having to fly in from Calgary.
HOSPITAL BUDGET OVERRUNS
W. Hurd: I have a question for the Minister of Health. We learned this weekend that the Peace Arch District Hospital and Langley Memorial Hospital budgets are $2.7 million over their allotment, caused by the lack of a firm commitment by the government. The proof is in a regional health memo, dated May 24, that criticizes the government for these delays, which have increased construction costs. In an era of limits on dollars for health care, what possible justification can the minister offer for a one-year delay, causing a $2.7 million budget overrun at these two hospitals?
Hon. P. Ramsey: This is a fascinating performance on Health by the Liberal opposition. On the one hand, we have this member saying that we're not spending enough, and on the other hand, this member says that we should spend those capital funds faster. This must be a first for this session: we have a Liberal member saying here that the capital allocation for Health is too small. It's good to see you stand up there, hon. member. I hope your colleagues will do a similar thing.
Deputy Speaker: The member for Surrey-White Rock on a supplemental.
W. Hurd: The health committee memo says that the government spent $2.7 million to sit on its hands for a year. That $2.7 million would buy 5,000 days of patient care at Peace Arch District Hospital and Langley Memorial Hospital. What possible justification can the minister offer for the delay of one year, at a cost of $2.7 million -- for no useful purpose? Not one patient was treated in British Columbia for that money.
[2:30]
Hon. P. Ramsey: All members of this government are doing debt management within the plan that the Minister of Finance announced. Therefore we are asking a variety of facilities to work with us to make sure that the facilities are
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constructed and come on line in a manner that the taxpayers of this province can support. It is again fascinating, hon. Speaker, for the first time in this Legislature, to see a Liberal member stand up and urge more capital spending.
PLACEMENT OF USED GOVERNMENT COMPUTERS IN SCHOOLS
L. Fox: My question this afternoon is for the Minister of Government Services. Given that the Education minister recently made an announcement that his government was going to make a $100 million commitment to put computers in classrooms, can the minister tell us how many used computers the province sells each year through public sales and auctions, and how much is raised through this process?
Hon. U. Dosanjh: I'll take that question on notice.
Deputy Speaker: The question was taken on notice, member. Do you have a sup?
L. Fox: The fact of the matter is that nobody knows the answer to the question, because the government...
Deputy Speaker: I hope there is a question, member.
L. Fox: ...doesn't keep track of that information. Thousands of used government computers are sold each year for a fraction of their worth. Why aren't those computers being used in the classrooms today where they would be most highly valued? Why don't we first utilize these surplus computers before we commit $100 million in the buying of new ones?
Hon. U. Dosanjh: Hon. member, the suggestion is extremely good, on the face of it. I'll certainly look into it.
BAIL FOR ACCUSED IN VIOLENT CRIME
J. Dalton: For the Premier. Last Wednesday a man accused of the first-degree murder of Tiffany McKinney of Quesnel was released on $150,000 bail. The accused was in custody until that time. We know the Crown opposed the application to release, but as the Premier well knows, it is most unusual for someone accused of first-degree murder to be released under any conditions. Will the Premier ensure that the Crown appeals that decision?
Hon. M. Harcourt: That is certainly a question that I will take up with the Attorney General. It is a very important issue, and I will take it on notice for the Attorney General to get back in touch with the hon. member.
Deputy Speaker: The bell terminates question period.
The member for Chilliwack on what point?
R. Chisholm: Leave to table documents, hon. Speaker.
Leave granted.
R. Chisholm: I table documents of support from the ity of Langley, the region of Vanderhoof and various other communities throughout the province, which brings it to a total of 38 communities and regional districts that are in support of CFB Chilliwack.
F. Gingell: Mr. Speaker, I seek leave to table a petition.
Leave granted.
F. Gingell: On Saturday night I had the privilege of listening to Dr. David Bellamy, the internationally renowned expert on bogs. It was an opportunity for the Burns Bog Conservation Society to give to me a petition:
"To the Legislative Assembly of the province of British Columbia in Legislature assembled, this petition of British Columbia voters and other concerned citizens humbly showeth: whereas Burns Bog, the last major domed peat bog on the west coast of North America, contains a tremendous richness of animal, plant and insect species, and is an island of valuable wilderness in a rapidly developing lower mainland, therefore be it resolved that we, the undersigned British Columbia residents and others, request that Burns Bog become an ecological reserve. We humbly pray that your Honourable House may be pleased to pass the necessary legislation to preserve Burns Bog, and, in duty bound, your petitioners will ever pray."
This, Mr. Speaker, is the third series -- 10,000 signatures were tabled by the Hon. John Savage, 5,000 by my friend the member for Delta North, and there are a further 5,000 signatures here.
Hon. G. Clark: I call Committee of Supply. In Section A, I call the Ministry of Health estimates, and in Section B, the Ministry of Social Services estimates.
The House in Committee of Supply B; S. Hammell in the chair.
ESTIMATES: MINISTRY OF SOCIAL SERVICES
(continued)
On vote 53: minister's office, $402,165 (continued).
V. Anderson: I wanted to thank the minister for her responses to one of our members last Friday in Social Services estimates. I've had an opportunity to review those and found them extremely interesting. Perhaps I will refer to them at a later time.
Just to indicate the process, first of all I would like to go through the transfers of programs into and out of the ministry so that we might discuss those, and then, having done that, work through the various functioning areas of the ministry and the programs within them. I would like to thank the minister and her staff for the opportunity of meeting with them and having the opportunity to get an initial introduction to some of these areas and concerns.
There were nine areas of transfer either in or out of the Social Services ministry to other ministries within government, which I think is probably more than usual. So I would gather there's a larger reorientation, integration -- or what-
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ever the proper word might be -- between Social Services and other ministries. I'm wondering if the minister might comment generally on the reason for this fairly wide scope of transfer, and then we might deal with each of them in turn.
Hon. J. MacPhail: The Ministry of Skills, Training and Labour received $40 million from our income assistance budget for a training initiative for young people between the ages of 19 and 24. We received from the Ministry of Health $35.31 million, including 50 staff -- 50 FTEs -- for the Services for Community Living. This is for families and children with mental handicaps. As the member is probably aware, we have a substantial division ourselves for community services, so we are integrating the two programs. We received $2.46 million from the Ministry of Education for staffing and operating the Jericho Hill School for the Deaf. It was previously run by the Ministry of Education. We received $2.06 million from the Ministry of Finance for wage annualization, the pay equity settlement for direct government employees. We received $0.31 million -- $310,000 -- from the Ministry of Government Services for the social program renewal secretariat that was dealing with the renewal of the social safety net and the Premier's Forum on New Opportunities for Working and Living. We received $0.47 million and eight FTEs from the Ministry of Government Services for freedom-of-information services to British Columbians. We received $0.34 million from the Ministry of Women's Equality for rape relief contracts. And we turned over to the Ministry of Attorney General $0.4 million for legal services related to family and child services.
V. Anderson: With regard first of all, then, to the one of Ministry of Skills, Training and Labour, could the minister explain why there were no FTEs involved in this transfer? Were those FTEs doing that program just absorbed within the ministry, and so it added to her number? And were they transferred into other areas of the ministry? How many FTEs would have been involved in that undertaking?
Hon. J. MacPhail: The staffing responsible for the youth strategy is carried out by what used to be called rehabilitation officers under our ministry, and are now called training consultants with the Ministry of Skills, Training and Labour. That transfer of staff took place under last year's budget.
V. Anderson: You're saying that the transfer of staff took place under last year's budget, but the transfer of money took place under this year's budget. Just to clarify that confusion, how did the staff get paid last year if these were done in separate years?
Hon. J. MacPhail: The staffing of government employees who are responsible for training initiatives for people who are unemployed and relying on income assistance was carried out formerly by rehab officers, now by training consultants. So they have had their duties increased with the transfer of responsibility from my ministry to the Ministry of Skills, Training and Labour. Thirty million dollars of that transfer is for training and living allowances to support youth under the age of 25 -- those between the ages of 19 and 24 who are currently in classroom training programs. The remaining $10 million is for full-time students who may be eligible for student loans but are currently on income assistance. This is only a first step, and the intent is to remove youth from dependence on the welfare system and place them in a much more supportive environment that will lead not only to training but to employment. This is a first step of a much larger initiative that our government is contemplating.
[2:45]
V. Anderson: Could you explain the nature of that training initiative, why you think it's better done under Skills, Training and Labour, and why it is a better program and more effective by having been transferred over? What is the rationale and what means is there to verify that it will be more effective? I have heard a great deal of concern in the community that people are caught in between -- that neither Skills, Training and Labour nor Social Services is now meeting their needs.
Hon. J. MacPhail: There's no question that the public of British Columbia wants the income assistance system to move to a much more active system where people are able to be employed and not rely on income assistance. This initiative begins that process toward an active system in assisting employable people back to the workforce. The logic in transferring young people who are currently on training programs into the ministry of Skills, Training and Labour is one of integrating them into the ministry responsible not only for the delivery of training programs but for the community skills centres, which is the basis for finding jobs and working in partnership with the business community to employ the unemployed in British Columbia. This begins the integration of government support through training allowances into a much closer connection with the real world of work.
V. Anderson: Is the minister indicating that under the previous program under Social Services there were many shortcomings -- that people were taking programs that didn't really lead them anyplace, and that now you have transferred them over...? What is the exact nature of the training programs available to them that would lead you to transfer the authority and the responsibility outside the ministry? What is the new type of program and what is the advantage? What is the addition to the program over what they had previously?
Hon. J. MacPhail: There is no question that as the economy of British Columbia changes and grows -- and as we know, it's in a substantial period of growth right now -- programs of training and employment need to keep up with the changing economy. Programs that in the past may have been appropriate have been evaluated. Some have been carried on; others have not. That in no way indicates past success or failure, but it has behooved us to have reviewed those programs for their current usefulness.
What does make sense is to have a seamless web for people who are now unemployed -- a seamless web of services -- so that there is no chance for them to slip through the cracks or to fail because of bureaucratic red tape. That's particularly appropriate for our young people, who may not have the skills, which you and I have had through experience, of manoeuvring our way through government bureaucracies. There are many programs of support for young people through the Ministry of Skills, Training and Labour. There are many -- as you know, tens of thousands of -- young people on income assistance who may be unaware of those programs.
So this is a transition period to assist in matching up the appropriate unemployed person with the appropriate con-
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tracted service. We have co-located many of our Social Services offices with the Ministry of Skills, Training and Labour, where spacing and staffing permit that. We've made significant computer changes to provide the Ministry of Skills, Training and Labour with consultants -- the former rehab officers with my ministry -- and the access and information they require to deliver the employment and training services with the least disruption to clients. Of course, our office has continued to make referrals to the employment and training services.
V. Anderson: I have a two-part question. The minister has indicated that there's roughly $40 million here, $10 million of which goes to student aid and $30 million to other program training. Could the minister, on one hand, indicate approximately how many young people are in that area that would be served by this program with those kinds of funds? And does she also...? When these persons, who presumably are under Social Services, enter into this program under Skills, Training and Labour, are they still receiving social services benefits as well as training benefits in the skills program?
Hon. J. MacPhail: Over the course of a year, approximately 20,000 young people between the ages of 19 and 24 would access training initiatives in the Ministry of Social Services. I have to give you the number of bodies; that's not the equivalent of 20,000 full-time, because some may access it for two weeks and get back into the workforce, and others may require six months. They receive one support allowance -- one food and shelter allowance. It would be called a training allowance.
As the member opposite is aware, I'm sure, there are other supports for which people in a training program are eligible. Single moms may need child care services -- payment for child care -- and in some cases, books, clothing support for the minute they get a job, etc. So there are other supports. But they don't receive two food and shelter payments.
V. Anderson: I think I understand how a young person who is under Social Services and has come forward would then be referred to this kind of program. Would the referral come in the opposite direction as well? Would someone who has gone to Skills, Training and Labour to get onto a program that they might offer but who does not have the funds for daily living be referred to Social Services? They might go to Social Services in order to have a living allowance in order to take the course. Is the referral now going both ways?
Hon. J. MacPhail: Yes, there are some examples of that; however, eligibility is always a criterion.
V. Anderson: In this particular program, could you comment on what the rules of eligibility would be for young people? Are there residency requirements, for being in the province for a certain period of time? Are there requirements that one has to be unemployed for a certain period of time? What kinds of finances, backgrounds...? What kinds of requirements are necessary for this new program?
Hon. J. MacPhail: The rules of eligibility are that they have to meet the eligibility tests that they would meet for regular income assistance: asset levels, employability, looking for work, etc. However, this program is the beginning of what we hope will be larger initiatives. It's much more proactive. Once they've reached that threshold of being eligible for our assistance, there is a much more engaged test of eligibility: remaining in the course, ensuring that they work with us for active job searches, and participating in partnership programs. It has even been suggested by many community members with expertise that where life skills are necessary in order to become eligible to work -- for instance, getting off substance abuse -- that should be a mandatory requirement.
V. Anderson: What kind of method of evaluation will be in place for this transfer? I commend the two ministries for working together on doing this. What kind of evaluation will be in place in order to see what effectiveness this is really having, and to know whether this should be continued or if changes should be made to it?
Hon. J. MacPhail: We and the Ministry of Skills, Training and Labour are working out that evaluation process. We are working toward a very rigorous evaluation process for the very reason that I think you were hinting at in the beginning: there's no sense in putting a program in place that doesn't meet the needs of our young people, or that leaves them vulnerable or on a treadmill of training programs that lead to nowhere. As that evaluation mechanism unfolds, I'll make sure to keep you informed.
R. Neufeld: The minister commented on the changing economy. I certainly agree that the economy is changing. There were some programs eliminated, and some were substituted to take their place. Just to bring me up to date, maybe the minister could tell me what programs were eliminated because they were redundant in today's economy, and what programs have been put in place to match today's economy.
Hon. J. MacPhail: I won't shirk my responsibility; I'll give you an answer. But I'll also advise you that a program-by-program evaluation is available under the estimates of the Minister of Skills, Training and Labour, because those programs were transferred in last year's budget. That information will be available under his estimates. This is the second year running that we have not had direct responsibility.
My understanding is that in the range of training programs -- all of which were evaluated -- approximately 5 percent proved to be immediately in need of conclusion, and others were re-evaluated to change the focus. But that information.... I'll make sure that the minister is prepared for you on that question.
[M. Farnworth in the chair.]
V. Anderson: That raises the question I was going to ask -- and I'm glad the member raised it -- about how long the programs.... This is the second year, yet the minister says that the program evaluation is just now being planned. It's my understanding that for evaluation to be effective, it would have had to be in place from the very start of the program, because you would have to know very clearly what had been happening, and the results or failures of the programs it was replacing, and then you could evaluate the new programs against the criteria that previously existed. I hear the minister saying that the evaluation process, even though we're into the
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second year, is still being developed. I'm wondering if I understood her properly, and if there really was no evaluation before to compare against the new system, and if that base still has to be built.
Hon. J. MacPhail: Sorry, I didn't make myself clear. The evaluation process we are establishing now is the active approach for people between the ages of 19 and 24, where they are required to participate in a training program. The evaluation I spoke of before was an evaluation of the standard, in-place programs in the Ministry of Social Services for all employable people. At the time of transfer of those employment programs to the Ministry of Skills, Training and Labour -- 18 months ago -- we went through a full evaluation of the current programs. Actually, I do have the statistics available, and I don't mind sharing them with you, but I might be stealing the thunder of the Minster of Skills, Training and Labour on that.
V. Anderson: I have two questions. I understood the minister to say that she had the evaluations of the previous programs, and that she'd be willing to share those with us. We'd be happy to see the evaluations of the previous programs, because that would enable us to then compare them with the evaluations of the new programs through the Ministry of Skills, Training and Labour. I would be happy with that.
Also, she said that people aged 19 to 24 would be required to take these programs. I'm wondering if the minister might explain what she meant by being required to take these programs.
Hon. J. MacPhail: I'm not clear if you're asking for the evaluation of the programs prior to them being transferred to the Ministry of Skills, Training and Labour. That would be back before 1993-94. We can make note of it. But that would be for your use in the estimates of the Ministry of Skills, Training and Labour?
Interjection.
Hon. J. MacPhail: Yes.
There is a report called "Routes to Independence," which is the evaluation of the programs prior to their transfer.
The requirement for participation in the new training program is that if you're able to work, you participate.
[3:00]
V. Anderson: I still am not quite sure if the minister is saying that if you're able to work, you must participate in the training program. Is there a compulsory requirement that you must participate in the training program, with the implication that you would not be able to receive the living allowance -- which would be the normal Social Services allowance -- unless you were in a training program? Am I hearing that there's a requirement here for a training program?
Hon. J. MacPhail: When a person comes into an income assistance office and they are able to work, they have to fill out an individual opportunity plan, which requires them to make a commitment to participate in a training program as one becomes available -- and that's what the $40 million is all about. But in the meantime, if they're not eligible for a training program immediately, they have to be out looking for work. When that doesn't occur, they are no longer eligible for benefits if they are declared able to work.
V. Anderson: Two question arise that follow up. As they are available, what percentage of young people between 19 and 24 are there presently programs for: 10 percent, 25 percent...? How did the number of programs match with the number of persons who would have needed them?
Hon. J. MacPhail: I'll give you an example of one month so that you can get a snapshot picture of this. This isn't broken down by employability, but we can work back from there. In the month of March of this year, for instance, there were 20,000 single men between the ages of 19 and 24, 10,000 single women and 1,200 couples that fell in that age group. I will have to break those down further. That's the overall, but it could fall under unemployable or a person with a handicap as well. It does not include single parents, though.
V. Anderson: Just in passing, how does the situation differ for those who are 19 to 24 than for those who over 24? Is there a factor of opportunity here for those 19 to 24 that is not available for those 25 and older? What is the difference between the opportunities for those different age groups?
Hon. J. MacPhail: The criteria are the same no matter what your age if you're declared employable. But the whole thrust of our government's initiative is to emphasize and make it much more active for those who are just entering the workforce and not to have them in a cycle, very early on, of writing them off, so to speak. That is what the youth initiative and the expansion of the youth initiative will be all about. It will be much more proactive, so that we are not writing off a generation.
R. Neufeld: For instance, in March 1995 -- the stats that you just gave us -- 20,000 employable men were....
Hon. J. MacPhail: Single men.
R. Neufeld: Just single men seeking support. To get that support they had to attend a training program or actively be looking for work or both? Is the training program designated by the Ministry of Skills, Training and Labour or does the Ministry of Social Services have any input -- and if so, into what training that person would take?
Hon. J. MacPhail: Let me just walk you through; we're just trying to clarify that. I want to reiterate that that 20,000 includes all the categories. Of those single employable men in that amount in March 1995, the person would come through the door and first of all have their eligibility determined -- and some may not even be eligible to get any assistance. If there is eligibility for assistance and they are determined to be able to work, then they have to start working immediately. They are then referred to the Skills, Training and Labour centres for the individual opportunity plan that I referred to earlier. It is there that the assessment is made -- while they continue to look for work -- of appropriate, if any, training. In some cases -- I know that the member is familiar -- it's merely a temporary situation. Many, many people on income assistance find their own work. It's not a matter of training; it's a matter of a job search.
[ Page 14604 ]
R. Neufeld: As I understand it, then, the Ministry of Social Services does not direct, in any way, what training this person would be looking for, if that was the ultimate goal; that is strictly up to the Ministry of Skills, Training and Labour. There's just a referral, and then obviously, I guess, there must be some tracking between the two ministries as to what's taking place. Can I ask the minister what would happen in a community like Fort Nelson, where there is no Skills, Training and Labour outlet? The nearest one, I believe, would be Dawson Creek or even Fort St. John -- that's 50 miles away. What happens in those cases when that single, employable person -- whether they're male or female -- is referred, let's say, to the skills training office? How do they get from Dawson Creek or from Fort Nelson to the skills training office to be placed or to follow up?
Hon. J. MacPhail: That's a very good point. As one leaves the larger centres, and certainly as one leaves the lower mainland and lower Vancouver Island, the issues facing us become very different -- sometimes much more difficult to resolve, but not always -- and many communities take up the challenge quite well. The Ministry of Skills, Training and Labour is in the process.... Again, I hope that you'll ask the minister this question of having travelling consultants. Certainly we are working very closely together, as I said earlier -- a shared computer system, etc. -- to try our best, and we are doing an admiral job, I think, of not letting people fall through the cracks merely because of geography, etc. Certainly these are appropriate questions to ask the Minister of Skills, Training and Labour.
R. Neufeld: Specifically, I think the question is fit for this minister -- Social Services. I understand that once they go to Skills and Labour, it's Skills and Labour that will determine where they go to train and what they're supposed to train in so that they can, hopefully, get permanent work. But the Minister of Social Services must be responsible for referring that person from a community, let's say like Fort Nelson, to a skills training centre, which is Dawson Creek -- that's 300 miles one way. How do you do that through a computer? Or is that done by someone actually in the office in Fort Nelson -- because there is an office in Fort Nelson? Would Social Services actively try to place that person in work -- try to find work for them -- or work via a computer with Skills? If that's the case, obviously the minister has some responsibility with her ministry for what kinds of programs these people are going to go into -- not just referring them to Skills and Labour.
Hon. J. MacPhail: It is our responsibility to refer; there's no question. I think what the member is getting at is to refer in the most cost-effective and efficient way possible. I know that there are programs developing in small communities -- partnership arrangements with small businesses for on-the-job training. There are certainly new programs for distance education that don't necessarily require a person to travel. We have to do an individual assessment of each particular case and support them in the most cost-effective way possible with tax dollars.
V. Anderson: Following up on that same discussion and picking up from the smaller community -- following that same line of reasoning for the kind of training that would be available in the city -- I presume there would be many options through Skills, Training and Labour for those opportunities to be there. But, as has been mentioned, there presumably wouldn't be the opportunity for those programs in many of the small communities. Does Social Services then pick up travelling and relocation costs for that person to be able to access the skills training opportunities that are available in another community?
Hon. J. MacPhail: Each case is individually assessed, but there are allowances available in order for a person to exceed in the area of transportation and education.
The Chair: Shall vote 53...? The member for Vancouver-Langara.
V. Anderson: Optimist -- it's early in the day so far.
I appreciate the minister indicating that it would naturally be an individual assessment. I would hope that it would be, and I think that's what the other member was trying to get at: who does the assessment in a community where Skills and Training offices are not available, and what is the nature of that assessment? How is that assessment undertaken? How is that assessment transferred to Skills and Training and the opportunities made available? What is the process?
I presume that if you're in the city, and particularly where you have integrated offices, you send them next door to the Skills and Training office and then they move back and forth between them. If you're in a rural area, it's not as easy to do that. So what is the process by which a person actually works through the opportunity to discover what the assessment is, how the assessment was made, what the opportunities are and how they get into that process? Do you do that with the local social worker, or is it with a finance worker? Who is actually doing this where there is not a Skills and Training office person available?
[3:15]
Hon. J. MacPhail: I'll try to make it clear about what it meant when the program was transferred, so that the members can ask the questions at the appropriate estimates. I didn't say this earlier, so it's not your fault, but in addition to continuing many of the training and employability services transferred from my ministry to the skills development division of the Ministry of Skills, Training and Labour, that division is refining existing programs and developing new training and employability program models that hopefully will, and that I expect will, increase the opportunities for income assistance recipients to access training that's actually relevant to today's market. Those models include assessment and referral, community-employment-based training, workplace-based training and institution-based training, as well as partnerships with business, labour, community agencies and post-secondary institutions in communities across the province. During the process of assessment and referral to the right program, the training consultant would determine what supports are needed to achieve success.
V. Anderson: I understand that, and I appreciate that the program is in development, so it doesn't have all the final answers either on its strengths or its weaknesses at this point. But in the small community where there isn't a Skills and Training office, I'm still not clear how that process.... John comes in. John is 20 years of age and unemployed, and John
[ Page 14605 ]
would like to have the opportunity of getting into this kind of program. Who does the assessment for John in Fort St. John or even in some of the smaller communities where there is no Skills office, and how is that process implemented for the small community?
Hon. J. MacPhail: The member is quite right that there has to be range of supports available, depending on the community need, and these are actually being worked out community by community, and in many communities have already been worked out. By June, next week, there will be 61 Skills, Training and Labour offices -- skills division offices -- opened across the province. Many of those offices will co-locate with our ministry, but where those offices are not open, there may already be in place community-based agencies that can take a direct referral as a contracted agency for the Ministry of Skills, Training and Labour. Right now the assessment of how that unfolds across the province, and to fill all of the gaps, is part of the responsibility of the Ministry of Skills so that people are not falling through the geographic gaps, literally. But it sounds to me like they're well on their way to blanketing the province.
V. Anderson: Part of the reason why we pressed this a little is that we are aware of many people who have fallen through the cracks over the last number of months -- ever since this switch has been taking place. They have been falling through the cracks. If that process is not in place in a given community, who in Social Services -- because that's the person they have come to in that community -- takes the responsibility? Is it the financial assistance worker who meets them who takes that responsibility? Is it a social worker? In a local community where the other facilities are not available, who takes the responsibility for filling the gap until those facilities become available?
Hon. J. MacPhail: Again, it depends on an individual case, but certainly it is.... We're in an awkward situation always in our estimates in that so many of the individual cases that we may talk about are wrapped in confidentiality rules. So I can't lodge a complaint that you are being hypothetical, because you have to be hypothetical. But in the few cases where the community may not meet the needs of a person who seeks temporary assistance, it is the requirement in order to maintain eligibility.... It is the relationship between the financial assistance worker and the income assistance recipient to determine continuing eligibility.
R. Neufeld: The statistics that the minister gave earlier for March, I believe -- just so I have my numbers right -- were somewhere in the area of 20,000, 10,000 and 1,200 couples between the ages of 19 and 24 who had come to the office and requested monetary help. I know the minister also said that a number of those are for help usually only for three months. Can the minister tell me what percentage -- just a ballpark percentage -- of those people who applied in March would be those who fall in the category of just needing help for three months?
Hon. J. MacPhail: We keep annual statistics; we graph them annually. Some 75 percent of people who apply for income assistance need assistance for between three to six months only.
R. Neufeld: I would assume, then, that those 75 percent are trained in some form of work and are employed, or maybe they're just off because of seasonal work. Would that be a correct assumption?
Hon. J. MacPhail: Again, there is a litany of reasons why people need income assistance. Of course, it does vary from community to community, because many of our economic factors are affected on a community basis. Certainly we have lately been greatly affected by unemployment insurance regulations, where people have worked but are not eligible for unemployment insurance.
R. Neufeld: So the 25 percent, on average, that are left would go over to Skills, Training and Labour for some kind of training. They would have to either actively look for work or take training. I find it difficult that we can't ask the minister what kind of training. That's the difficulty I have with some of these programs. Some of the training is not always for what's happening in the real world in today's time. It's training to just take up time for.... Let's say that they need social assistance for three months. They go to school for three months and take some courses that may not help them in the future, and that's some of the difficulty I have.
Maybe the minister could explain a little bit more to me about the couples -- men and women between the ages of 19 and 24. We all know of cases -- I know a number of them in my community -- where we have young mothers, 16 or 17 years old, with one or two children, living with a male of the same age, and both are collecting social assistance. How does the ministry go about dealing with those people? They're both employable, presumably. Do you send them both out to training, or do you just pick one to go to training? How is that determination made? Because obviously that must be made within the Ministry of Social Services.
Hon. J. MacPhail: I sense the frustration of the members opposite in not being able to ask me questions about training, but the fact is that that responsibility was transferred. I'm sure your frustration will disappear the minute that the minister arrives here, and I know you'll engage him in some pretty good discussion.
Interjection.
Hon. J. MacPhail: No, he won't refer them back to me.
Let me just clarify the stats again. I gave you the statistics for all people again. However, the 1,200 couples that I referred to are couples without children. There are no children in that; they are employable, childless couples. Their eligibility to stay on income assistance is treated individually. They both have to search for work and/or be trained, and the income earned, if any, while on social assistance is treated as a family unit.
V. Anderson: One question arises. I believe that the minister indicated that it was the financial assistance worker who would be working for those people when they come and reviewing either that they were looking for work or that they were eligible for training, and then would refer them for training. Because of this new process -- I should have asked this question before -- what kind of training was given to financial assistance workers to enable them to make those kinds of decisions? And what kind of additional or new
[ Page 14606 ]
training has been given to financial assistance workers to help them to tie into this new process?
Hon. J. MacPhail: The financial assistance workers are obligated to participate in core training. That core training changes, and has changed, in order to cope with the new system of referral; it's part of the ongoing update of their training. But I'll also say that I visited many offices where they engage in in-service training in the office to make themselves familiar with the services available in the community, because the referrals may change, depending on the client. It may have to be a referral to a mental health agency, or whatever. So the financial assistance workers receive continuing training in this area.
N. Lortie: I seek leave to make an introduction.
Leave granted.
N. Lortie: In the gallery up here we have another large group of students, from North Delta Senior Secondary in -- guess where -- North Delta. They're led by their teacher Mr. King. Would the House please make them welcome.
V. Anderson: What is the nature of the core training that they receive? What's the nature and length of the core training, and what's the automatic nature of the upgrade of these on a regular basis? This question will come up more often now, because, as we discovered on the Gove inquiry, the core training for social workers was very limited, and the upgrading of in-service training for them was non-existent almost. So for the financial workers, who are the front line and therefore the key people in this process, what is the core training, and what is the automatic nature of upgrading?
Hon. J. MacPhail: I'm glad you asked. First of all, we're very committed to providing the training for our financial assistance workers, and I hope to be able to convince the member opposite that that's true of social workers as well. The mandatory core training for all new financial assistance workers has been in place since 1986. It consists of an on-the-job training package and two one-week modules of classroom training. The on-the-job training package has been expanded from 20 to 27 workdays over the years. The topics covered include roles, functions and responsibilities of an FAW, programs, policies, procedures, ministry principles, values, philosophy, assessing and determining eligibility, referral procedures, knowledge and understanding of community resources, and caseload management skills.
[3:30]
After four to six months of job experience, the first week of module training is taken. It covers the GAIN act and regulations, appeals, audits, other ministry program areas, caseload management and the ministry's computer information system. After ten to 12 months the second module is taken, and it covers communication and interviewing skills, effective service delivery and working within the community. It covers the economic environment of the day and managing change and stress. A third week of centralized core training for FAWs with more than four years' experience was started last year, the 1994-95 fiscal year. As of the end of last fiscal year, March 31, 1995, 205 experienced financial assistance workers had been trained. The topics covered under that new module include values and objectivity, prevention, compliance and enforcement, advanced communication and interviewing techniques, and occupational health and safety.
Training for financial assistance workers is revised on an ongoing basis to ensure that it's consistent with current trends and research. Trainers are senior financial assistance workers themselves who have been selected by their area managers. They undergo one week of specialized training before assuming the role of instructor. All financial assistance workers have access to the ministry's central library, and that contains an extensive collection of current materials and the capacity, via computer, to research most issues that could arise in the field. The ministry is involved in ongoing discussions currently with community colleges with regard to their curricula in the social service worker programs, one of which is financial assistance workers. Just so you know, because workload is an issue with financial assistance workers -- and I know you've spoken eloquently on that issue -- we do backfill during training.
V. Anderson: She takes my question before I ask it. My next question was about the backfill, because I know that was the problem raised with social workers in child abuse cases: the opportunity to have backfill.
How many financial assistance aid workers do we have in total in the ministry at this point? I noticed that you mentioned 205 who are in the fourth year. How many of those have continued? Is there an approximate number in each...? How many years have they been working in financial assistance? In other words, how great is the turnover, and how consistent are the people in those positions?
Hon. J. MacPhail: We have 911 FTEs in financial assistance work. We have a relatively small turnover rate for all employee groupings; it's under 6 percent. For financial assistance workers, the turnover from the previous year to the last fiscal year was 3.1 percent.
V. Anderson: This is the last one on financial assistance, following that stream. I presume that there is a process of ongoing evaluation. How much opportunity do clients have to be part of that evaluation? Is there a process whereby clients...? If you go to McDonald's Restaurants or some other places, there are opportunities for you to say that you've had good service or bad service. Is there the opportunity to compliment a particular worker, and say that this worker has really done an excellent job? What is the opportunity? Is there a regular base for client feedback in the evaluation of the FTEs?
Hon. J. MacPhail: Surprisingly -- you wouldn't know this from the public's mind, although it's not their fault -- I get many letters of commendation to staff from clients, etc. I also get a share of complaints as well. It's kind of scary, but we now have a complaint coordinator. We have a new complaint procedure available, which is handed to each and every client for their input: complaints and/or suggestions on the basis of service. I also try to make myself readily available on a continuing basis to community groups that advocate on behalf of income assistance recipients in order to hear their concerns and act upon them.
V. Anderson: I would hope that the supervisor is not called a complaint supervisor, but that we have a more posi-
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tive name, so that compliments and complaints and suggestions.... A lot of the good suggestions that we all hear can come from the person who's receiving the service. I would hope that there's a more positive terminology than that, that there's an opportunity for people to know that their feedback and suggestions are welcomed, and that it's not: if you don't have a complaint, you can't say anything. I think that would be unfortunate and would bias.... I would say the same thing if it were only a process for compliments, and there were no opportunity for complaints. The process of people knowing that it's open and fair and balanced, and that you really want their suggestions for improvement as well as their complaints for bad service -- as they see it -- is important.
I wanted to come back.... When the ministry took out that service to those aged 19 to 24 and transferred it to Skills, Training and Labour, that left those persons who are aged 25 to 95 still in that area. Have there been any like changes...? I don't want to go into this in detail at this point, because we will come back to it. Just in passing, have there been changes that would affect that group, or is that group -- and we'll come to it later, if so -- simply business as usual? That's not negative or positive; that's just saying that it's business as usual. I'm just saying that since we've moved one category out, has it made more time, more energy and more resources available for the other sections of the population?
Hon. J. MacPhail: The member is quite right about the name of that person. I was in error -- sorry. The person is called the client services coordinator, which probably makes him or her much more popular than I suggested. He's quite right about how we identify people.
It's a bit.... I won't say that it's business as usual for 25-to-65-year-old people who are employable. They haven't had the same substantial change as the people who participate in the $40 million program right now. I've had some very interesting recommendations made to me by.... I've got a Minister's Advisory Council on Income Assistance. They've made some excellent recommendations in that area, as has the Premier's Forum on New Opportunities for Working and Living. All of them are being considered now in terms of a much more proactive system for all unemployed people. Those are under consideration by cabinet now.
I would also say that we are more greatly affected by the off-loading of the unemployment insurance system onto the income assistance caseload. We can no longer sit passively by and assume that some other system will take care of unemployed people. Eventually, those who are unemployed come to us. The unemployment insurance system has really been made much more ineffective. Of course, all of these training programs are being reviewed as we review the demise of the Canada Assistance Plan.
I will take this opportunity to say that we made a change on Friday concerning people who are part of our system. We made a substantial change in the area of people who receive benefits for the handicapped. On Friday our government announced that we're coming into the nineties as opposed to keeping people with disabilities in the thirties and forties. We're changing the definition. They no longer have to declare themselves unemployed in order to be eligible for benefits. I'm extremely pleased with that, and the community itself is very pleased with it. We're also looking actively at.... The government has made a decision to remove people with disabilities from the state welfare system and provide a separate system that is much more inclusive, much more coordinated, and that actually meets the needs of the vast majority who want to be in the workforce.
V. Anderson: I won't pursue that. I appreciate the information from the minister. If you could provide us with that information in some detail, it would be most helpful. It may have come across my desk, but so far I haven't seen it. I would be happy to receive it, and I'm sure others would be happy to receive it, too. Then we could discuss it. It may help us with some of the questions that will come up later on. So I appreciate that very much, and I hope we can receive that before too long.
I would move on to the next category, and as I understand it, that is transfers from the Ministry of Health into this ministry of the Services for Community Living branch, and of families with children with mental handicaps. Could the minister comment specifically on the focus of that? Why was the transfer made from the Ministry of Health to the Ministry of Social Services? Why is there that difference between people with mental handicaps and people with mental illnesses? Why the transfer over, and why one rather than the other?
Hon. J. MacPhail: The community of people with mental handicaps would probably reply by saying that they require continuing and ongoing support not only of a physical nature but of a staff nature as well, in terms of the level of immediate care required for people with mental handicaps. While there are grades of support required by people with mental handicaps, some of whom become quite independent, it is in no way similar to people with mental illnesses, who are subject to episodic illnesses and many times, as you and I know, are not incapacitated at all.
The other thing, of course, is that there is recognition by the community of people with mental handicaps and their families that the medical model isn't necessarily the answer. They often need extra medical support for their physical limitations; the solutions available for improvement are not medical solutions but very much support solutions. That isn't necessarily so of the community of people with mental illness. Often, medical support is the answer.
V. Anderson: The minister has indicated that there was $35 million transferred, plus 50 FTEs. Could she indicate briefly the kind of programming or services that are now being undertaken by the Ministry of Social Services? Are they different from what they were when they were under the Ministry of Health? Or has there simply been a transfer with the same thing happening, or because of the things the minister has mentioned, are these different programs with new things happening as a result of this switch?
Hon. J. MacPhail: We are realigning the services for people with mental handicaps because the services provided by both ministries were the same, with the exception of the head injury program that remains with the Ministry of Health. Indeed, the similarity is a direct overlapping between the services that our ministry provided and the program in the Ministry of Health, so we are rationalizing for efficiency and cost-effectiveness. There will therefore be more services within the tax dollar amount available to support the families. The benefits of realignment are immense. They allow for the maximum integration of people with a mental handicap into the community.
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[3:45]
I must say that everywhere I go, self-advocates speak to me about how I have to find a new term for "people with a mental handicap." I fully agree, and I've got lots of them working on it right now. The self-advocates are going to bring forward their suggestions to me.
The realignment will also ensure that the changing needs of the individuals can be met. It's limiting the jurisdictional overlap, and there is also easier public access to the services, in that families and self-advocates don't have to search through the bureaucracy to find the service they need. We are also maximizing the use of the physical and economic resources, as I said, and I think the services will be much more operationally viable and able to secure adequate resources.
Again, I say that the community living branch of the Ministry of Health provided exactly the same services as we do in our community services division, save and except for the head injury program. The process for realignment began in October last year, but it will continue over the full course of a year from October 1994. The realignment steering committee is very effective in overseeing the work of the realignment.
V. Anderson: No doubt we'll come back to it under the community program for mentally handicapped adults, but just in passing, am I to understand that this program has been added to that particular branch? Or does it include adults, children and families, like...? To whom is this transfer limited, this $35 million? Does it cover families, adults and children, or is it an inclusive program?
What program is it added to? Is it added to one particular program in the ministry, or is it dispersed among other programs in the ministry?
Hon. J. MacPhail: The funding is added to one of the three divisions of my ministry called community support services. That division in my ministry, community support services, provides services to adults, children and families.
V. Anderson: We'll deal with that in more detail when we come back to that program.
The transfer from the Jericho residence, from the Ministry of Education to the Ministry of Social Services.... I know somewhat about the Jericho program and the Jericho residence. In transferring it over to Social Services, has there been a change -- or is there a change in process -- in the nature of the operation of the residence because of this transfer? Was there a reason, particularly, for doing it from Education to Social Services?
How does this coordinate and tie in with the educational program? As I understand it, all the students in this residence will still be involved in the educational programs. They're all students who are involved in educational programs. So why is it taken out to be separate? If so, what's the coordination? And what improvement results from this?
Hon. J. MacPhail: Actually, the transfer from the Ministry of Education to my ministry is in keeping with the ombudsman's 1992 public report No. 32. The report was on the Jericho Hill school. The ombudsman's report recommended that the residence be operated by an authority with expertise in residential services for children. That's the Ministry of Social Services; we have that expertise in the province.
Our ministry is working closely with the parents, the staff and the deaf community to provide a very safe and high-quality residence for the children. We have a parent's advisory committee and established training for staff on child care and reporting of abuse, and written communication is provided. There's greater openness and involvement between parents, children and the community -- encouraged, of course.... Report No. 32 went on at some length about how the parents of these deaf children were basically not involved at all in their care from Monday to Friday.
The Ministry of Education remains responsible for the education of the children. We take responsibility for the current residence as it exists at the old site, but we're also responsible for the development of new, group-home style, residential facilities.
Anyway, we're also going to make sure -- besides the openness -- that there are firm policies and procedures in place for the residence of deaf children and that we have quality assurance in place both from a short-term and a long-term point of view, all based on the best interests of the child.
V. Anderson: Two things come into that. One you've already mentioned. We're all very aware that there are going to be some changes with the Jericho lands in that area. An assumption would be that it will affect the residence. What is the planning and the process of a new facility for residents that the minister referred to, with the presumption that the Jericho lands are going to disappear? In transferring over, did the lands, the building and the assets, as well as the operation of the school, come over to the Minister of Social Services?
Hon. J. MacPhail: We accumulated land in Burnaby very near the school to build the residences. It's going to be a residential-type situation -- homes, as opposed to a dormitory barracks kind of concept. The land was accumulated, and we are working with architects and the community itself to design the best residences possible to meet the needs of the children from a point of view of what makes sense for deaf children who have to be in residence for a large portion of their lives. Of course, the advisory committee is working with us. The process will probably be complete in 12 to 18 months.
V. Anderson: Perhaps the minister might just clarify. When you say 12 to 18 months, is that the planning process, or the planning and the building process to completion?
Hon. J. MacPhail: The planning is well underway. The children will be in the new residences 12 to 18 months from now.
V. Anderson: Many of these children come from around the province, and I'm wondering if there is consideration of providing better facilities and transportation and assurances for them in the amount of travel. Is there also built in the new system a better opportunity for families to keep in touch with children during the week as well as when they go home or when the parents come down? That gap of being away all week could certainly facilitate.... Perhaps it could be taken into account in the planning to have modern communication methods built into the new building to make that kind of continuous interaction between parents and children more effective than what we've been able to do in the past.
Hon. J. MacPhail: Those are good points, and that's exactly what the parent advisory committee is established for
[ Page 14609 ]
-- to work out those important communication links, Monday to Friday. I am pleased to say that the Ministry of Education is providing funding for children to return home each and every weekend, which, of course, didn't take place before. I think that's good news for the kids. But your point about communication between their parents and themselves while they're there is important. We will have a full-time social worker at the residences who will be able to communicate with deaf children.
V. Anderson: The other part of that -- and I would stress the family side of it as well as the children's side.... Like all families who have children with one difficulty or another, the children may cope better than the parents do. To serve the best interests of the child may be to give the parents the opportunity to have more interaction and support, particularly parents who live in isolated situations and don't have the opportunity to interact with other parents. I'm wondering if some of that planning is in the process as well. I trust that there has been some interactive video or TV planning, maybe with guidance from Knowledge Network people, so that families can visually communicate by television from their home to the school. Within a very recent time, particularly for deaf children, that visual communication is so fundamentally important and would be helpful to everybody. In looking at this, not to research that area I think would be an oversight. So I'm stressing the opportunity of the growth and support of the family, which is a very important support to the children as well.
If we focus just on the children, we may miss the new opportunity, whereas if we focus on the family and what we can do to help the parents interact on a regular basis -- through TV, visible communication, as well as others -- it would be very important.
Hon. J. MacPhail: The member opposite makes some excellent points. I'll make sure they're investigated.
V. Anderson: I'll move on to the next one: the Minister of Finance and the wage annualization payment of $2 million. Just in passing, could the minister explain what the effect of that was? Who benefited most from it? What was the result of that? Within her ministry, what was the particular need, that equalization required, of that $2 million transfer into the ministry?
Hon. J. MacPhail: I'm sure the member opposite is aware that the pay equity process was implemented to address situations where job categories which were occupied predominantly by women were deemed to be undercompensated. The Ministry of Finance and Corporate Relations put forward this initiative and is represented in this equalization process by the Public Service Employee Relations Commission. We participated fully in the pay equity process, which was concluded October '94.
How it affects my ministry is thus: an interim adjustment was made in January '92 to pay-grades 1 through 7; a second adjustment was made in April '92 to pay-grades 2 through 11; final adjustments totalling approximately $25 million were negotiated in October '94; the '95-96 annualization adjustment value to my ministry, including institutions, is $4.3 million. This money is to assist in payment of that obligation.
V. Anderson: I appreciate that explanation. In reviewing the pay equity, was there also a review of categories themselves and an updating of description of categories and of actual workloads, and bringing it up to date? Many of our categories are outdated and would no longer apply, whether it was men or women or whatever else. Just the categories themselves are unequal. Has there been a review of the categories, and have those been rationalized?
[4:00]
Hon. J. MacPhail: Yes. In order to facilitate the pay equity, ministry employees were involved in the design and development of a gender-neutral job evaluation plan, both as representatives of the employer and as union nominees in a joint union-management process. That plan ensures that compensation is based on skill, effort, responsibility and working conditions. Those principles will be applied to all job classification in the future, to ensure ongoing equity. That means a general classification system will be in place that ensures equitable compensation, regardless of gender composition. The new plan will commence in the fall of 1995.
V. Anderson: I appreciate that. I'm sure there are many out there who would be happy to hear the categories that are involved in that and to realize that this is taking place. If I understand the minister, this process is complete -- at least to its new stage -- as of the fall of '95. Thank you very much.
From the Ministry of Government Services, the social program renewal section was $31,000. I'm wondering if you might comment on the nature of that transfer and its significance. Again -- while I'm asking the question -- there were no FTEs listed in that section, and I wonder why that might be.
Hon. J. MacPhail: This will be a very important issue over the coming months, about federal-provincial relations in the area of the social safety net. This money is to provide for particular targeted research and evaluation and -- I don't want to use.... Well, I will, because I can't think of another, less touchy-feely word. It's also for outreach in the area of working with the federal government in ensuring that British Columbians aren't affected too adversely by the change in the federal-provincial share of social programs. So the government has allocated this money to us under the income assistance division to work.... We have a federal-provincial relations division, small though it is, and this money will be specifically targeted to the new initiatives that will be required as CAP changes and as change in federal funding occurs.
V. Anderson: I think the federal-provincial discussions are extremely important. They always have been and will continue to be important as we readjust within Canada between provincial responsibilities in every area of life and federal, with provinces wanting, in some areas, to take on more responsibility and in other areas to take on less. We talk about forest and land and water and fish. There's a reallocation in every facet of our federal-provincial relations.
When you mention the federal-provincial task force, I wasn't sure if that was an interministerial task force of which Social Services is a part, or whether the minister was referring to a Social Services task force primarily to deal with the social services issue. If so, it would be helpful if she might elaborate a little bit on what the nature of that task force is.
[ Page 14610 ]
Hon. J. MacPhail: It's federal-provincial relations. It's a department in the income assistance division. There are three staff. They are responsible for any federal-provincial initiative between the government of British Columbia and the federal government of Canada.
V. Anderson: That's primarily within the area of income assistance, the CAP program. But does it cover at the same time the Health and the Education facets of that, or is it listed only to the Social Services portion of that?
Hon. J. MacPhail: Our staff, the staff I mentioned, while liaising closely with those other ministries, are solely responsible for income security issues. Those other ministries do have similar departments.
R. Neufeld: I missed out here. I want to go back to pay equity, if it's all right with the minister, and just have her explain to me again: do I understand that this fall you're going to pay the staff by merit? You talked about experience, effort and ability. Are people going to be paid, then, on a sliding scale rather than so much for each position? Could the minister maybe just explain that a little bit more for me, please?
Hon. J. MacPhail: There will be classifications according to your responsibility and, actually, the job that you perform. But this governmentwide initiative is not just particular to my ministry; this is across all ministries and direct government service employees. The way one evaluates the work one does.... No one is changing the work that is being done, but the evaluation for determining the money you receive for doing that work is based upon evaluation criteria of skill, effort, responsibility and working conditions. Those four criteria are actually quite standard in any job classification process, and well received both in the business community and the public service community.
V. Anderson: Continuing with the social program renewal section, which is the federal-provincial discussion, perhaps the minister could help us to understand what she sees as the main issues or themes that are up for discussion within that area. What are the issues, primarily, that she feels British Columbia has to offer within that discussion? And what are the main requests or concerns for action that are being discussed within that section?
Hon. J. MacPhail: A very important question. The immediate concern over the course of the next two years is how we as a government will manage our budget in the context of massive off-loading of transfer payments from the federal government to the provincial government. The cumulative cost to British Columbians in terms of less money coming from the federal government to British Columbia will be $1.71 billion by the end of this fiscal year. In 1995-96 alone, the cost of.... I mean, this truly is a cost: last year we would have received this money, and this year the cheque by the federal government will be $433 million less -- and that's just in CAP, Canada Assistance Plan, off-loading. Of course, the total impact of federal off-loading in the area of social transfer payments will reach $12.8 billion by the end of 1997-98 -- the cumulative total in each budget year. The annual cost, though, in terms of the off-loading by the year 1997-98, which is the final year of federal off-loading announced in the recent federal budget, will be $2.835 billion.
So we have an immediate concern about how to maintain the social safety net in the context of much less money coming from Ottawa. Are we concerned? Yes. Did we wait till we actually received this information? No. That's why the Premier's Forum on New Opportunities for Working and Living was set up over a year ago, which has made an excellent report. It's a broad-based forum -- business leaders, community representatives, academics, economists, consumers, aboriginal groups and labour people -- and they have written an excellent report not only on how the social safety net can change to make it much more responsive to the needs of people in the 1990s but also on how to do that in the context of knowing that there will be fewer dollars available in British Columbia.
I do have a concern that I have raised and will continue to raise on behalf of British Columbians: it is the death of CAP, the Canada Assistance Plan. No question, it needed to be changed. It was not meeting the needs -- as we talked earlier, a very passive system.... But it did have some fundamental guarantees below which provincial governments could not fall. Now the federal government is saying the only floor -- the only plank in the floor for people who find themselves temporarily poor -- in the whole social safety net is that no government can ask you for a residency requirement. But all the rest of the guarantees are eliminated, and they're not replaced, as yet, with national standards. You and I know that as one tries to raise children and as our children reach the age of work, often they leave home and travel elsewhere to find employment. My generation did that; your generation did that. And we were guaranteed a safety net while we did that, and I'm not sure that that is necessarily there anymore. So labour mobility is going to be greatly affected by the elimination of CAP. However, our government is taking the lead in putting the establishment of national standards on the national agenda.
V. Anderson: I appreciate that. We would commend to you that those national standards should be there, and we would affirm from our side that we agree that national standards are fundamental right across the Canadian nation. As long as we're a Canadian nation, there should be national standards wherever you go in education, health and social services, and in many of the qualities of life that are part of the reality that is Canada.
I might ask the minister in this regard about what discussion is taking place between the provinces in order to coordinate with the federal government on these national standards. It seems to me that the provinces collectively bring together a pressure that individual provinces aren't able to. What process is in place for the provincial discussion, apart from the national discussions?
Hon. A. Petter: I seek leave to make an introduction.
Leave granted.
Hon. A. Petter: With us in the gallery this afternoon are some students -- I think they are about ten in number -- from Spectrum Community School in my constituency. They're a grade 11 social studies class that decided to come down and see some democracy in action. They're accompanied by their teacher, Ms. Kathy Armstrong, and I'd like the House to make them welcome.
[ Page 14611 ]
Hon. J. MacPhail: In the third week in June I will be attending a provincial and territorial ministers' conference. Our government has taken the lead in putting this very item on the agenda to discuss among all my colleagues. The deputy ministers had their preparatory meeting last week, and the item is on the agenda at the behest of our government -- and it will consume, I imagine, a substantial amount of discussion on how we handle this collectively.
[4:15]
V. Anderson: I don't know whether the minister is able or willing -- either way -- in these discussions to share any of the themes or concerns we might have in common, in order to get combined support in the interprovincial discussion as well as in the federal-provincial dialogue, and whether there are particular concerns she has that the concerns of B.C. are not being heard or understood, or are different from what she might be hearing from other provinces. Is it her experience that there is a common concern at this point? If so, that would be helpful for us to hear, because, unfortunately, it's only through the minister that we are able to be part of or to keep in touch with that dialogue.
Hon. J. MacPhail: I am concerned about reaching consensus with my colleagues in other provinces. I am concerned that we don't get into a situation where there's a race to the bottom in terms of providing a strong safety net, but also understanding that there is only one taxpayer in this country.... To be frank with you, my colleagues in other provinces are all over the map in terms of their needs and priorities in this area. I think it's important that British Columbia shows the lead in ensuring that the federal government maintains its responsibility in weaving the social safety net.
We have a strong economy now; it's my belief that we are in the best position to not be bullied or bribed by the federal government in terms of transfer payments. I don't intend in any way to get into a confrontational manner with the federal government, but the fact of the matter is that British Columbians should not be penalized, but given recognition for the strong economy. We should not be unfairly treated by the federal government merely because we have a strong economy and are not involved in the race to the bottom. I am working with my other colleagues to try to shore up their concerns about their immediate needs in the way of, perhaps, getting guarantees of extra transfer payments, depending on how they cooperate with the federal government. I think it's safe to say that the fact that Quebec is approaching a referendum on its relationship with Canada certainly has an influence on these discussions. It has an influence amongst us provinces, but Quebec's position in terms of the universality of the social safety net is also very carefully watched by the federal government.
V. Anderson: I think it's important -- and I think the minister has always recognized it -- that even as the services we provide in an integrated way within the province have changed and need to change with changing circumstances, so the Canada Assistance Plan, which has many strengths, also has many weaknesses. There needs to be a new style of Canada Assistance Plan, whatever the terminology or name, and it needs to have new principles for the future that were not needed when the plan came into effect some 30 years ago. I'm wondering if the minister has a vision that comes out of the revamping of the B.C. experience that can be presented to the federal experience for a new vision of what a Canada plan might be and -- if that new vision can be shared at all -- the principles that it shared, that others might interact and support it as well.
What I'm trying to get at is this. To say that the Canada Assistance Plan should be maintained as it was isn't realistic. But to say that there are new principles and perhaps other principles, besides the four that were in the original plan, that now should be added to it or made more comprehensive, or to come at it in a different way.... Is there a plan and a vision that's being developed in B.C.? Is it one that she can share with us, so that we might be a part of that new vision for Canada which B.C. is presenting? It isn't mainly a question of dollars and cents; it is, first of all, a vision -- dollars and cents will be added to it afterwards. Without a vision, the dollars and cents don't make any sense anyway. I'm wondering if there is a new plan and a new vision that you will be presenting on behalf of B.C. which the residents of B.C. might be able to share.
Hon. J. MacPhail: I almost want to break into the jingle of our ads about how there is a plan for B.C. in terms of jobs and investment. But maybe I'll bring in the video of those ads. Yes, we do have a plan around the area of jobs and investment and maintaining the social safety net as people move from welfare to work and unemployment to work. It's a very exciting vision. The member opposite is quite right: it's not just based on plowing more tax dollars into a passive system; it's very much a private-public partnership in moving people from welfare to work and also ensuring that our tax dollars are spent in the most effective way possible to strengthen and enhance the economy. Yes, I agree that the Canada Assistance Plan is not a plan for the nineties and isn't a plan for the next century; however, I am gravely concerned about moving from a very rigid, structured accounting-based Canada Assistance Plan to nothing, and that's what we're on the verge of doing. It's worrisome to me and should be avoided.
I must tell you that our government has a great deal of difficulty getting the attention of the federal government, getting them to understand how this lack of plan in moving from a plan for the forties, fifties and sixties to modernizing it has to be done carefully, in cooperation, on a basis of fairness -- no matter where you live in Canada -- and understanding that there are real constraints on the pockets of taxpayers. I say this with the greatest of concern: they are more interested in discussing gun control than the Canada Assistance Plan. However, we as a government have decided not to let the discussion just slip aside. That is why we have a plan for B.C., and our jobs and investment strategy is well in the making.
Also, we are not remaining still on bringing forward our own suggestion to revamp the social safety net. I refer you again to the report from the members of the Premier's Forum on New Opportunities for Working and Living -- there are some extremely creative ideas there. Cabinet will take those, along with many other suggestions that have come from the business community and from members in this House, in putting together a plan that makes sense for well into the next century.
R. Neufeld: These are interesting discussions around CAP and what is going to happen in the future and the plans. I don't think it is any secret -- and the minister did say that
[ Page 14612 ]
there is only one taxpayer -- that we do have a problem in Canada. We may be enjoying a relatively good upswing in our economy in British Columbia, but when we look at the Canadian situation, it definitely has a lot of problems. That is going to involve British Columbia as much as any other province.
It was interesting to listen to the minister talk about Quebec momentarily. As I understand it, Quebec's taxing arrangements, because they collect their own taxes -- they have a lot of arrangements with Canada that are different than the other provinces -- they don't participate in the Canada Assistance Plan at all when it comes to social services. I know this transgresses a few ministries, but I wonder if the minister is saying that when we are looking at new initiatives and ideas we're talking about the next century, and about maybe getting away from an archaic type of Canada Assistance Plan altogether and starting to work on some new initiatives -- something like Quebec has been doing for long time -- and maybe starting to become a little more self-sufficient in British Columbia.
Hon. J. MacPhail: Actually, Quebec does participate in the Canada Assistance Plan. They do have a different mix of fiscal transfer payments and tax points than we do, and they also collect their taxes separate and apart from the federal system. There is that issue of the fiscal arrangement; we should be examining the most cost-effective way of managing that. There certainly are discussions at the Ministry of Finance level about the proper mix of tax points and transfer payments. The last federal budget, of course, affected only the transfer payments, and it didn't examine a change in the tax points turned over to the province in any way whatsoever.
The other aspect of social policy in Canada and the relationship between the federal government and the provincial governments is the area of program delivery. It's my view that we are way ahead of Quebec in terms of innovative approaches to program delivery -- and almost every other province as well, I'd say -- and we continue to go down the road of constantly re-examining the way we deliver those programs.
D. Symons: I have a question to the minister regarding a letter, which the minister probably has, dated May 8. It deals with a family where the son is, as they describe here, severely mentally handicapped and, apparently, rapidly approaching the age of 19, which seems to be an age which is important in this instance. The reason I'm raising it here is that they first started to try to find the answer to their situation on June 27, 1994, and were advised to go to their district supervisor, which they did. It wasn't until May 3 of this year that they found out that there would not be money in the budget for their son. What they were basically asking for was if he could be extended into the day care program at SCAMPS, which he's been attending since its inception. Both these parents are employed and cannot be home during the daytime in order to supply care for their son. Their concern is that, apparently, if he were under the age of 19 he would be eligible, but having reached the age of 19 he's not eligible for the program. I guess I have a concern -- in my mind, when I was reading this case -- that for an able-bodied child we sort of pick the age of 19 as a time when maybe they're on their own and able to look after themselves. But I suppose for somebody with a severe disability age almost becomes irrelevant; they're still as dependent on their parents at 19, 20 or 25 as they were at age five to ten.
So I'm curious about what is available to these people. Apparently they feel that maybe they have missed the boat, that if they had put him, prior to the age of 19, into government care, where the government would look after him totally, they would have been in a better position than seeking to do that after the age of 19. I'm wondering if maybe it might not be cost-effective if the government could supply this little bit of respite care for their child so they would have some time off, some time free, or at least some time when they're able to work, knowing the son would be in adequate care. It would be much more cost-effective to put out that small amount to have it done that way rather than them, out of frustration, having to put him into total care at the cost of the province, which would be much greater than giving this small amount of care for a summer camp.
I wonder if the minister might be able to respond. They were told recently that they weren't going to get the money. She's written to you outlining the concerns I've expressed to you now, and it might be quicker to get an answer back to her this way than waiting for the response to the letter.
Hon. J. MacPhail: While the parents may have shared with you the correspondence, I'm precluded from discussing individual cases in a public way. But certainly my staff is more than willing to work with you and your constituent on the details of this situation. The letter writer -- I'm not sure whether it's a man or a woman, but I think I'll say "she"....
Interjection.
Hon. J. MacPhail: A couple, okay. Yes, there is no question that there is literally a demographic bulge of aging parents who have always -- admirably so -- maintained their adult children with mental handicaps in their own home, and now those parents are aging beyond the ability to do that. It has created a situation of a waiting list. There's no question about that. While we are a government that devotes one of the largest percentages of its budget to community services programs for people with mental handicaps, and continually is lauded for that investment, a waiting list still continues.
[4:30]
These are the tough decisions that we face about budget expenditures. On the one hand, the public demands -- and you yourself demand -- that we should cut spending. I believe it's fair to say that the issues that have created the waiting list in the community services division are not due to waste and duplication and extravagance. We have a finely honed system, but the taxpayer examines our budget in a way that looks at a bottom-line number and doesn't see the human face behind that low-budget number. You're putting a human face on it. I hope that you continue to put that human face on it as we discuss these matters in public.
Let me give you an example of the human face of the waiting list. There are over 250 individuals -- adults -- wait-listed for residential services, though some are receiving one type of service and require another; there are over 90 children with autism on the waiting list; there are 300 children and families on waiting lists for special services for homemakers; there are over 100 children and their families on the waiting list for at-home respite care.
[ Page 14613 ]
We increased this budget substantially. In 1996, I think, the figure is a double-digit figure in terms of adding 14 percent. So one year over the other there is 14 percent more in this area. But at the end of the day, hon. member, we have to decide what our priorities are, and in managing not only the human priorities but the public taxpayer priority, wait-lists have to develop.
D. Symons: I'm just wondering, then, if you might for my edification give me a bit of an outline of the significance of this age of 19. Is the impression I get from here that at the age of 19, these services that they had been getting for this child are terminated? Then, after 19, is there something else to take its place from the ministry?
The impression I also get is that they feel that if they put their son into care and turn him over to the ministry, that's their out. To me, it seems like it's not cost-effective for the ministry to have another ward of the state, so to speak, where they will be taking much more care of him. It would be much more cost-effective if the parents do it at home with some help. Am I wrong in how I'm interpreting this? Or is help available in some other fashion for them after he reaches this age of 19?
Hon. J. MacPhail: The age at which people with mental handicaps move from the child program to the adult program is the age of majority -- yes, 19. Your interpretation of what that means is quite correct. Chronological age isn't necessarily the change point for people with mental handicaps; there's no question about that.
I just want to explore this a little, because I know how some parents view this situation -- that if they hadn't been loving, responsible parents...somehow the state treats parents who are less so better. I know you're not suggesting that it's what this woman, at the end of the day, is suggesting. But most parents take full responsibility for their children. The vast majority of parents I have talked to over the years are eternally grateful that they had the opportunity to raise their children.
Institutional care is not done just because one wishes institutional care to take place for a child. The profound nature of the illness is taken into account, as are what supports are needed, whether the parent in combination with the state can provide those supports at home, and whether there is a greater rate -- I don't want to use the word "success," because that puts a negative connotation on the child in the first place -- of moving the child more into the mainstream community if the person is put in residential care. There are issues of child protection as well, in terms of taking children with mental handicaps into care. So it's not black and white.
I believe, at the end of the day, that parents should be lauded and continue to be encouraged to look after their children with mental handicaps at home, but we are in a situation of a demographic bulge. We'll work very hard to manage those wait-lists. Perhaps we can by consensus agree to manage that issue next year.
V. Anderson: I'd like to stay with the present discussion for just a moment, because it's not only the particular case that my colleague mentions, but I know other cases as well. There are many other cases and many other families in a similar situation.
The issue I feel the minister hasn't responded to -- and perhaps it was just the way she heard it -- is that up until 19 there is a process by which the government and the families cooperate with each other. What seems to be missing is that beyond 19 there does not seem to be a process to work out an agreeable solution. It just seems to be cut off. The minister indicated in her comments that there are a variety of options that the ministry is involved in, in home care and institutional care. But for some of these people it seems that there is no place to go now. There's no one to sit down with and ask: "What can we arrange together, between government resources in a limited way and our own resources, to come up with a solution?"
The question seems to be: to whom do these parents go to work out a solution which is beneficial to the person particularly, using all our collective resources together? Is it volunteer agencies in cooperation with the government? Is it home care with visitation? To whom do you go to work out a solution, instead of just saying: "I'm sorry, but this person is 19; there's no one to talk to anymore." The question is: who do you go to that can work out a solution in cooperation...? They're not asking for something more; they're saying that they simply can't do it on their own. Whether it's a couple or an individual, the same issue is there once you hit 19: where do you go? There's help until then; after 19, it seems to be a stalemate. There must be a way to find a way through this.
[H. Giesbrecht in the chair.]
Hon. J. MacPhail: Let me correct a misconception: there are services specifically for adults in special programs for people with mental handicaps. The overall program has 212 social workers, a large percentage of whom work with adults. We also have a very good working relationship with the advocacy groups in the community who represent adults with mental handicaps. Believe you me, they are on me all the time. It was as a result of their advocacy that the announced moving of people with mental handicaps out of the GAIN system actually occurred, and I laud them for that.
Yes, there is a great support system in place for adults. Again, that budget increased by $53 million last year to this year -- that's an extra $53 million. Some $9 million of that was to serve additional adults with mental handicaps. Through prediction, we assumed that if we offered them services in 1994- 95, we could budget for them in 1995-96. There is half a year of funding to provide residential and day-program services to children who are in care and will reach age 19 during the year. We have a substantial population-growth budget increase, too. That will be used to serve priority cases on wait-lists. That means that the increase adds.... Oh, there's more: there's $11.9 million for the continuation of the downsizing of Glendale Lodge and Woodlands; there's $5.7 million for the transfer of Services for Community Living from Health to the Ministry of Social Services; and there's $13.8 million to the agencies that continue to work with us, as you quite rightly pointed out, to provide services and expansion in that sector. The total budget for programs for adults with mental handicaps is $314.8 million. I would suggest that that's the largest percentage of any provincial budget in Canada.
Again I say, however, that there's no question that there are waiting lists. Many people with handicaps are advocating for themselves. They do that with me daily -- vigorously -- and they're pretty hard to set aside when suggesting that they
[ Page 14614 ]
want to be integrated at the age of 19 into the work community, as well. That's one of the reasons that the handicap benefits announcement was made. Again, we must do it in the context that the taxpayer and those unfamiliar with the wonderful services offered may suggest that we cut, cut, cut, without understanding the consequences of that.
V. Anderson: I appreciate that. Perhaps there's a simple question, though. Recognizing that the minister can't deal directly with all of these individuals and sit down and have an appointment with them, to whom would the minister recommend that a person like this could go to and sit down with to see if something can be arrived at? Where does a person like this start? You write a letter to the minister because you haven't found a place to go or somebody to talk with. Where do you recommend that a person like this go, and to whom do they talk concerning these varieties of programs, of which they may not be aware?
Hon. J. MacPhail: We are truly a community-based ministry. We would prefer that families have the ability to go into their own community and seek the services or the advice available. In each smallish but urban area, and in many non-urban areas, there is an office for special programs for the mentally handicapped. I would suggest that they start there, but any Social Services office will have the right office to which they should speak.
I am also proud to say that we have an advocate within the ministry for people with mental handicaps. Pat Vickers has a very effective office, and she does exactly what you talk about. She advocates on behalf of people who need assistance through the system. She has an increasingly growing caseload and meets with much success from the point of view of cooperative advocacy.
V. Anderson: Going back to where we were talking about interprovincial relations in new programs -- and it's relevant to the topic we've just had -- with the increase in our population and the changing world in which we live, it seems that we are getting more and not fewer persons with handicaps to be concerned with and to share in the society in which we live. We are getting more not fewer persons with mental handicaps, and we no longer want to shut them out, but to include them in. But as we were talking about earlier, in spite of our job creation programs, we are also getting a realization that.... And people have coined the phrase "jobless recovery." We've talked about the educational change in the Premier's forum, that there are not going to be jobs as we knew them in the past. There has to be a whole new format opening up, and the increase in our welfare rolls should be a sign to us that this jobless recovery is not something in the future, it is something which is now present.
Simply trying to train people for jobs which are not going to be there is not the answer for the future. I'm wondering if the minister has some plans to talk about the kind of society in which jobs, as we have them right now, are not available, because I think that's a fundamental principle that has to be raised. They're not available for people with mental handicaps, they are not available for people with mental illness and they're not available for many with the physical skills that five years ago would have made them employable. Those kinds of jobs are not there anymore, and we cannot pass this without at least a comment about the interprovincial discussion of how we are working for "the jobless community," because the results of not dealing with that question are coming back on Social Services. If you could comment on that, then we could move on to other areas.
[4:45]
Hon. J. MacPhail: One of the factors that we work with as a government, and an economic factor to be considered, is that we don't believe that British Columbia demonstrates a jobless recovery. Sixty-six thousand jobs in the last year.... I'll get those stats and make sure they are accurate. Two-thirds of the new jobs in Canada are created here in British Columbia. So what we have to do is seize the opportunity of a strong job creation economy, work in partnership with the private sector -- a public-private partnership where that makes sense, or merely support a private initiative where that makes sense -- to ensure that we don't fall into a jobless recovery trap.
After we make sure that the economy is stimulated in terms of job creation that a government can assist in as much as possible, that the people who are eligible and get those jobs are distributed in an equitable way that makes the most sense from the standpoint of economic efficiencies.... That is why we have our Skills Now initiative, which is proving to have great success, why we are also looking at the barriers that perhaps single parents face, and expanding our child care initiatives so that people do not face the barrier of child rearing in order to get into the workforce.
Last, we don't say that maybe 20 years ago because of your disabilities you couldn't have worked in the workforce; we say that may have been true then, but now there is all sorts of technology available for people with a multitude of disabilities to actually contribute in the employed workforce. I must say that on the Premier's forum on working and living, the business community has been very receptive towards all of these changes. They themselves have come to the conclusion that a passive support system makes no sense for them at all. These are the three initiatives that we are concentrating on in the investing-in-people side of our plan, but we also know that we have to invest in our infrastructure, to support and stimulate the economy in partnership so that there are no roadblocks to an expanding economy, and that we have to.... It makes sense in British Columbia to invest in natural resources, which still remain the engine of our economy.
V. Anderson: When the minister is getting those figures -- which I appreciate -- could she provide us with job creation figures that are net or gross? How many jobs have we created? How many jobs have we lost? And what is the balance between those? I've never been able to find somebody who will give me both the net and the gross figures to see what the outcome is. Also, we may need to look at the kind of jobs that we've lost or created. Are they related to the 300,000 who are unemployed on welfare? What is the direct relationship between the kinds of jobs that are created, or are no longer available, and the increase in welfare? Is there a direct relationship or even an indirect relationship? Is that a pattern that has been shown to us for the future that's ahead of us? I think that's an important item.
When you get the figures, I'd appreciate it if you could clarify the relationship between the job recovery or non-recovery and the unemployment, plus the net and the gross number of jobs that we've received. I'll look forward to getting that, and will move on to the next section, hon. minister, which is the freedom-of-information section. Or do you want to reply before I move on?
[ Page 14615 ]
Hon. J. MacPhail: I appreciate the opportunity to reply. Well, there is a direct correlation between a booming economy and the caseload in income assistance; however, it's not absolutely overlapping downward, which is unfortunate, and that misleads a lot of people. They assume that if you've got a booming economy with the highest job creation record in Canada that your caseload should fall directly proportionate to that. The good news is that it does fall in proportion, but not in the full amount and not absolutely, for these three reasons.
Really, the biggest caseload drivers in British Columbia today are the changes to the unemployment insurance system. A couple of years ago, just at the end of the 1980s, fully 85 percent of unemployed people collected UI. That is now down to 55 percent of unemployed people. It gives me cause for concern. It really is the Americanization of our unemployment insurance system. In America, you know, in many areas of the country, less than one-quarter are eligible for unemployment insurance. So that is a cost driver. One-third of our starts coming onto the caseload are because they are laid off and are not eligible for unemployment insurance, either ever or yet.
The other effective driver, which is good news in one way and is one we have to prepare for, is in-migration -- not immigration, in-migration -- from other provinces. We talked about labour mobility earlier on and that it should be the Canadian right to travel across Canada to get a job. There were long treks of people doing exactly that in the course of economic history. Now there are 3,000 people per month who come from other provinces in Canada. They come here and, in the course of one month, need income assistance while in transition to finding a job -- that's 36,000 new starts per year in the income assistance caseload. As we heard earlier, the Canada Assistance Plan supports the right of a person, as long as she meets the eligibility requirements, to collect income assistance in any province, regardless of whether she has lived there one day or one year.
The last area that's a population driver that gives me cause for concern -- and I know you have spoken eloquently to this issue -- is the change in demographics, with more and more single parents coming onto the caseload. I am increasingly becoming harsh in my language to describe non-custodial parents who abandon their children to poverty through lack of income support -- parental support. We have all sorts of programs to change that. We're lobbying very vociferously at the federal level to get changes to that. That is a substantial caseload driver too, but one that I'm very hopeful we'll be able to change in the near future.
V. Anderson: Thank you, hon. minister, for your comments; I appreciate those. I think those are the kinds of drivers that we need to look at and be aware of. In the vision we were talking about earlier for a new plan for Canada, those are the principles that we have to take into account and find some way of responding to.
I wanted to move on to freedom of information, which is, again, a transfer of $470,000. Interestingly enough, the federal-provincial discussion on social program renewal -- which we've talked about being so important and really setting out the kind of future that we have in our Canadian relationships -- costs less than the actual freedom of information; freedom of information is more expensive. And where there were no FTEs listed in the previous program, there are eight FTEs here. Perhaps the minister could explain what the effect has been of freedom of information on the Social Services program and their ability to respond and to provide services -- or whether it hinders them in providing services. Is freedom of information overtaxing the ministry? Do they see that the ministry will be overwhelmed by people requesting information? Even though we may agree with it, has trying to respond to that in the workload become a ministerial nightmare? It indicates that with eight new FTEs coming in, there has been an increased demand. But will that even meet the demand that's out there? My experience is that very few people are yet aware of how to make use of freedom-of-information sources.
Hon. J. MacPhail: I don't know whether the hon. member was in the House last week when the Minister of Small Business, Tourism and Culture replied to the Leader of the Third Party about the cost of FOI. It was about the incident of the 1-900 numbers and how the search cost $2,000 and found $150 worth of abuse over five years, or something. That is a factor; it's a fact of life that that kind of use -- and I use that term advisedly -- will occur. In any democratic government where we open ourselves up to those who pay our wages, pay our taxes and use our services, there is a cost; there's no question. I personally am surprised at the cost of freedom-of-information and protection-of-privacy legislation. However, I think it's a good investment, particularly in the area of my ministry -- separate and apart from those who play politics with it. I don't mind.
I also think it should be there for partisan use; but all of us in this House have to use FOIPP in a responsible way, so that we're actually assisting in the development of good public policy or advocating on behalf of British Columbians. Having said that, my ministry has three times more FOIPP requests than the next-highest-requested ministry. That is good, because this legislation is connecting all of those people who were the responsibility of or the legal guardians of people.... We're connecting them to their past, and that is excellent news. Sixty-five percent of our requests under FOIPP legislation from its inception in October 1993 to the end of the last fiscal year, March 31, 1995, were for family and child services-related records; 24 percent were for income assistance-related records.
It is costly. We now have 19 permanent staff in our ministry devoted to fulfilling requests. Of course, the transfer of the eight FTEs from Government Services to my ministry involved FTEs that were held centrally during the course of the implementation and the gearing up of the legislation, but they always did work for our ministry. The budget for the 1994-95 information and privacy division was $0.82 million. That excluded the half a million dollars that was funded through the Ministry of Government Services, so the net cost to us was $0.3 million.
V. Anderson: I appreciate the information and the percentages that the minister has presented. I'm sure that that will increase, because my experience is that the vast majority of people in the community are not yet aware (1) that they can apply for this information, and (2) how they would go about inquiring. I'm wondering if the Ministry of Social Services is involved in a process of assisting persons within the community to apply in the most cost-effective way, for both them and for the ministry. I'm sure there are educational processes which would help these people in the manner in which they apply, which would help the ministry immeasurably in the way they are able to respond to it. I'm wondering if there is a process in place -- a proactive process rather than a passive
[ Page 14616 ]
process -- in the ministry. Probably in the beginning, the ministry waited to see what would come. As we look into the future, is there a proactive way in which the ministry can help clients -- members -- to receive the information they are looking for in a way that is more efficient, effective and cost-effective to both them and to the ministry?
[5:00]
Hon. J. MacPhail: We did an education process amongst all of our own staff about how to advise clients to access the information and privacy branch of our ministry, and we did have our community groups, with whom we have a relationship as well.
Basically, the process is very centralized. There is one central agency which consistently and constantly evaluates itself for efficiency and productivity. What happens is that the client, or past client, asks one of our local offices how they get this information, the staff would provide the direct, free number to the central body, and our information officers take over from there. So there is cost-effectiveness in terms of its centralization, and we have made very sure to keep our practices and policies very flexible to meet the ever-burgeoning requests.
V. Anderson: One of the comments we very often hear from people in the community -- from both professionals and non-professionals -- who are discovering that what they write, what they say and what they put on E-mail is now open to be reviewed somewhere down the road. There is a comment out there that people no longer do the kind of recordkeeping or notekeeping that they used to. They no longer make those notes; they no longer make those E-mail comments; they no longer put them down on the record. This can be a disadvantage in being able to do the kind of casework, follow-through and support work that's necessary. I'm wondering what kind of guidance and directive is going on in the Ministry of Social Services, where records and the ability to follow cases are so crucial, to protect the workers, to make it effective for them to be able to do the casework that's required and to ensure that people aren't getting the impression that everything is hidden now and won't be recorded anymore in case it might come up at a later time. I'm hearing a great deal of comment about these concerns.
Hon. J. MacPhail: Actually, I think it's appropriate for all divisions of my ministry to continue excellent recordkeeping. We've seen examples of what happens to human beings who fall through the cracks because of poor recordkeeping. But it does make sense to learn from the past and change the way we keep records; you're quite right about that. What our staff has been doing increasingly, and with the full direction of the executive branch, is giving out the information up front and being very open with the client, including giving the client the opportunity to see the file and engage in discussion around it as it's being recorded so that there are fewer and fewer surprises later on. We've all been in offices where the worker actually turns the screen around and says, "Take a moment and look at this; review it," and: "Here's what I am doing." Our staff has been very innovative in doing that in a responsible way while still protecting people's privacy as well. Excellent recordkeeping is a goal of ours; we will continue to work toward that. But we also know that the days of secrecy are over.
V. Anderson: I thank the minister for that. I think that's very important, and I hope that there's some way that this kind of information can be made more available, to get away from the myths and uncertainties that people.... It may be useful to have a simple document, a pamphlet, available to people in offices that says, "Here's what freedom of information is. Here is how you can access it," and also, simply: "Ask your worker, and they'll let you look at the screen." There needs to be some understanding between the workers and the clients -- and I use "clients" guardedly at the moment, just because it's the easiest way to refer to it -- that things are open and upfront. Freedom of information at the moment has highlighted that there have been a lot of secrets; there was a lot happening that nobody was aware of, and even when they asked, they couldn't get the information. If there is some way of highlighting that at this point, it would save a lot of difficulty and uncertainty in the future.
I would move on, then, from that to talk about the hostels and the $500,000 here which was transferred into the ministry from the Ministry of Women's Equality. I think it's been the understanding in the past that there were many things -- safe houses and other things -- going out to Women's Equality, in the opposite direction, so it's probably a surprise to discover that something has been coming in. Perhaps the minister could explain what is referred to in these hostels. Why have they come in, and what has been the effect? Again, it's without FTEs attached to it, so she might explain what that is about.
Hon. J. MacPhail: Actually, this transfer is to correct two errors that occurred in the previous budget. They are contract dollars; they're not direct-service, public service expenditure dollars. We'll contract these out. The contracting will allow for eight FTEs as well.
Contract funding of $500,000 for a new hostel had been transferred to the Ministry of Women's Equality in 1994-95 in the belief that the funding was intended for a transition house, which was incorrect; the funding was for a hostel. The second error was that funding of $160,000 was retained by my ministry in 1994-95 for counselling, but it should have been transferred to the Ministry of Women's Equality, as the costs in question were for rape relief counselling. The cumulation of the correction of those two errors adds up to that amount.
V. Anderson: Okay, so it deals with the two. One was hostels and the other was special day care. The hostel was money coming back in that had been falsely transferred out, and the other was special needs day care. Could you just comment on what that $500,000 for the hostel was supposed to be for in the first place? Could the minister just comment about the nature of the hostel that the $500,000 has come back in for?
Hon. J. MacPhail: I'll get you the fuller details, but it was for a planned hostel in the Vancouver area. I'll flesh out those details for you.
V. Anderson: It's for a hostel that's planned in the Vancouver area and is yet to come?
Hon. J. MacPhail: Yes.
V. Anderson: Thank you.
[ Page 14617 ]
The Ministry of Attorney General, then, is the final one on this section. This has to do with legal services and was transferred out, as I understand, from Social Services to the Attorney General ministry. Perhaps the minister could explain the nature of that transfer.
Hon. J. MacPhail: This is for funding additional legal services that will be incurred this year by the Ministry of Attorney General on behalf of the Ministry of Social Services in the area of family and child services. There is increasing legal activity, and therefore we have to give them more money to represent us.
V. Anderson: What kind of representation does this cover on behalf of the Ministry of Social Services? Are there other moneys that we are paying them as well to represent you that are in the budget? If so, where do they appear within the budget?
Hon. J. MacPhail: It's primarily child protection cases proceeding to court and being judged in the courts, but there is some family maintenance courtwork as well -- us proceeding on behalf of a single parent, usually a mom.
V. Anderson: Just to follow that up, since we're on the topic, does the minister indicate that there's a fair bit of work being done on behalf of the Social Services ministry by the Attorney General, both in maintenance and in family and child services? Is it fairly extensive? Is the budget for that extensive work that's done on behalf of Social Services mainly in the Attorney General's budget, or is it also in the Social Services budget for both of those items? If so, where does it turn up in the Social Services budget?
The Chair: I recognize the member for Mission-Kent.
D. Streifel: I request leave to make an introduction.
The Chair: Shall leave be granted?
D. Streifel: Someone say aye. Come on.
Aye.
The Chair: Please continue, hon. member.
D. Streifel: That may be unprecedented -- to vote on my own request.
Hon. Chair and those in the House who are here and watching the paint dry, I would like to introduce, on behalf of my colleague from Ridge Meadows, a class of elementary students from Alouette Elementary. I've just spent half an hour in glorious conversation and sunshine with them out on the front steps. I prepared them well for their entrance into the House; I can tell you that. I bid the House make them welcome on behalf of the member from Ridge Meadows.
Hon. J. MacPhail: The payments to legal counsel for contracted services for child protection are a budget line item of the Attorney General. They needed more from us this year to put into their budget, and that's what this is.
V. Anderson: That completes the area of ministry transfers. What I would like to do now is turn to the area of the general budget as we're dealing with it in the coming year. In the first area, I would comment only on the minister's vote, which is the one that we're on at the moment -- technically. In that particular vote, I think there was an extra $10,000 in this current year, which I just assume is a natural, logical increase in the process. I commend her for staying within her budget. The only way she might have done better was to have had a $10,000 decrease. I would assume that the staffing component within that area of the minister's budget has remained basically the same. I don't know if she wants to comment on that for a moment.
Hon. J. MacPhail: Yes it has, and you touch on a good point. While my staff has remained the same, they did get a wage increase, as per a collective agreement.
V. Anderson: I think one of my colleagues has some questions that he'll raise with you for a few minutes. I would simply indicate that when we come back, I would like to look at the administration and support services line and try to sort it out using the BC Guide. That's where the public usually goes to look for the services of the ministry. I would try and relate the BC Guide to the budget that we're discussing today -- if they're relatable. So what I would try and do, as I look at this, is ask what areas in the BC Guide come under administration and support services. What are the areas that relate to it, rather than to the other three areas that we'll be dealing with? So I'll be looking at that when we come back. I'll turn it over to my colleague for a few moments.
[5:15]
W. Hurd: I just wanted to briefly explore with the minister the situation of damage deposits, in particular the changes to the Residential Tenancy Act and how that might have impacted on the ministry's operations. The minister will be aware of concerns expressed by some in the community that a very low percentage of damage deposits are recovered by the ministry. It would seem that since the deposits may or may not be automatically returned to the recipient, I wonder if the minister could just take a minute to explain what measures are in place within the ministry to deal with the changes that have now become law with the Residential Tenancy Act.
Hon. J. MacPhail: Actually, I'm not sure what the reference is to the Residential Tenancy Act and the change. The change that affects my ministry and security deposits is a GAIN Act regulation change from March 1994, which makes the security deposit what is called an assignable benefit and therefore recoverable as a deposit, and we can recover accrued interest directly from landlords. In the past, that would have been returned to the tenant. The member is quite right to say that when the deposit was returned to the tenant the recovery rate was almost nil. When we made this regulation change and implemented that change partway through last fiscal year, we actually recovered and had in hand $1.16 million in security deposits by the end of last fiscal year. The deterring effect of the assignment of security deposits has actually resulted in savings of $2.85 million, through a decrease in the number of security deposits issued. We did keep track of it previously, and with the new regulation we can easily determine that fewer people are eligible for repeat security deposits. So that's good news for the taxpayer.
[ Page 14618 ]
The new accounts receivable system is being developed to allow the ministry to monitor and track landlords who routinely fail to return security deposits, as well as clients who may abuse the system. While there have been isolated cases of clients who leave rented accommodation in a damaged condition, there is no documented evidence that tenants on income assistance are any less responsible than any other tenants. In addition, the ministry advises landlords to treat tenants on income assistance as they would any other tenants. Maybe what you were referring to is that the changes to the Residential Tenancy Act places the burden of responsibility on the landlord to prove damage in cases where security deposits are retained. Do you want me to give you more information on that?
W. Hurd: I appreciate that detailed response. Rather than looking for numbers, I was interested in the scenario that would unfold with respect to the front-line ministry employees in dealing with this issue. Where a recipient does change address, what steps does the ministry take to immediately track the damage deposit before another one is issued? In many cases the recipient is not able to gain alternative accommodation until the damage deposit issue is resolved, if there is a new landlord. Does the ministry routinely issue another damage deposit directly to the new landlord? Or is an effort made to collect the previous damage deposit or to make contact with the landlord with respect to where it would be? Clearly, the concern being raised is that there is no incentive for the recipient to necessarily pursue the damage deposit, but there would be some initiative -- or some pressure -- on the part of the Crown to recover that as an asset.
So I wonder if the minister could take a moment to explain what might happen where the person receiving assistance leaves a domicile suddenly, is required to immediately take over new accommodation and requires a damage deposit. Is that automatically issued? What steps are taken by the ministry to look at the previous situation or to verify the financial arrangements and take steps to collect any deposit that might be due the Crown?
Hon. J. MacPhail: On occasion, when a client has left a previous place of residence and moved to a new place before we've had a chance to recoup the security deposit, we will issue a second one. But it doesn't go to the client -- that's what I'm saying. We have changed the relationship of security deposits. The security deposit is now exchanged between our ministry and the landlord. So we will still recoup the first security deposit, and we will recoup the second security deposit from the landlord as well. As well, to prevent abuse, we are keeping track of tenants. We now have this computer tracking system that I described earlier that allows the file of a client to indicate the number and frequency of security deposits.
There are tools available to financial assistance workers to prevent future abuse in the area of issuing multiple security deposits, including not issuing one and/or putting the client on what is called the administration of benefits, where the payment of rent, etc., is done directly from the Ministry of Social Services office to the business person who should receive payment for services.
W. Hurd: I wonder if the minister could take a minute to explain, then, how the ministry is dealt with under the Residential Tenancy Act. The minister has described correctly the change in the act, which now requires the landlord to prove that the damage deposit is needed in order to offset damage to the premises.
Since the ministry is now responsible for verification of the damage, if any, with the landlord and for collecting the damage deposit back, obviously that would imply to me a significant new workload for the ministry in trying to make contact with landlords and if necessary to go before the residential tenancy branch to determine whether there's justification for the landlord keeping the deposit. Is there any concern on the part of the ministry here that the burden may in fact induce the ministry not to pursue damage deposit collection, where it might be difficult to haul the landlord into a rent review situation to determine whether the claim is genuine or not? Is this a new burden on the ministry? Or is it merely just the same policy that we've always seen with respect to the recovery of damage deposits?
Hon. J. MacPhail: Well, far from it being a burden so far, we've saved taxpayer dollars around this -- $2.85 million, plus $1.16 million in the last fiscal year. So that's great news.
But if you're asking about the changes in the Residential Tenancy Act placing a burden upon our staff or our ability to recoup, so far the answer is no. That will be the next phase of evaluation. Right now we're very much in the stage of tracking to prevent abuse at the front end rather than waiting and having to go to residential tenancy branch at the back end.
Of course, I'm sure the member opposite is well aware that the Residential Tenancy Act allows landlords to collect a security deposit of one-half of a month's rent. They may hold that security deposit for 15 days after the tenancy terminates and at that time assess damage done. But also, as I'm sure you're well aware, there are increased fines under the Residential Tenancy Act for deliberate damage. I'd also like to reassure the member opposite that there is no statistical evidence to show that tenants who are on income assistance are different as a class from anyone else.
W. Hurd: Really, that wasn't the implication of the questions I'm asking. I think it's just the fact that there seems to be a great deal more difficulty on the part of the Crown to reacquire what could be legitimately called the assets of the Crown -- namely, a damage deposit which in fact the landlord is holding. There has been, I agree, no damage to the premises, and yet the damage deposit continues to be held by the landlord.
Can the minister tell the committee whether she or ministry staff are aware of how much money is legitimately coming back to the Crown for damage deposits that under ordinary circumstances would be no problem and would automatically return? What kind of dollar figure are we looking at here?
Hon. J. MacPhail: Actually, let me make myself clear. The figure I quoted -- the amount recovered from security deposits for the first time ever -- is $1.16 million in the last fiscal year, in partial implementation of the policy. It is the first-ever recovery. It used to be a grant. There used to be no recovery whatsoever of security deposits. We issued about $24 million per annum in security deposits and recovered zip, so this recovery is new -- and that was for a partial year. Also, we can absolutely confirm the deterrent effect of the assign-
[ Page 14619 ]
ment of security deposits to a decrease in application for security deposits to the tune of $2.85 million in non-expenditure in the area of security deposits. So if you add those two numbers together, you're actually looking at, in the first year of implementation, almost a 20 percent recovery or 20 percent savings on the budget item. We anticipate that to increase this year.
W. Hurd: Can the minister then advise the committee what the target would be for this year? Is there any idea where the ministry wants to be at the end of the year in terms of recovering this money?
I must confess that I'm somewhat amazed and surprised that the ministry has paid out damage deposits and treated them as a grant. I'd heard that this was the case but wasn't aware it was actually ministry policy. Clearly, I guess you could say the ministry was being, you know.... Maybe "ripped off" is too strong a word, but they certainly were paying money out for not having value received.
In light of the fact that every dime paid out in legitimate damage deposit, when the premises are left in good order, should come back to the Crown, is any effort being made to at least identify those damage deposits which in the opinion of the ministry should come back, even if they're not collected? There must be a way of tracking the amount paid out, and -- there having been no claim on file or no damage reported -- it theoretically should be recovered by the Crown. Is there a figure that the minister could offer? Could she maybe advise us what percentage of that legitimate revenue coming back -- what level -- is going to be achieved during the coming fiscal year, within a ballpark?
Hon. J. MacPhail: The hon. member makes a good point in terms of being surprised about the fact that the system treated security deposits as a grant. I too was surprised. That's why, within three months of assuming responsibility of the ministry, I changed it. That's the policy we're talking about right now. Every dollar should be recovered from a security deposit assignment when a person moves.
Now, we do have people on income assistance who are in stable accommodation. So whatever the turnover rate is -- our turnover moving rate -- with a bit of a time lag, those dollars are to be recovered. We do keep an accounting of all security deposits issued. The assignment of benefits is issued to each and every landlord who rents to an income assistance recipient and who is required by law to return that. There's a complete tracking system of security deposits that need to be returned.
I suggest that with our instituting of the tracking system, plus an excellent new centralized accounts receivable system, we'll be able to give you the full year's fiscal effect at next year's estimates. Or I may take the opportunity to announce the good news partway through the year.
[5:30]
W. Hurd: I look forward to that good news. I'm confident -- or I hope -- that there are some targets in the ministry to recover money that legitimately belongs to the Crown and taxpayers of the province.
I wonder if I could just ask a brief series of questions about the rules for eligibility with respect to households that may have one or more people on income assistance. Can the minister tell us what steps are routinely taken to verify the living arrangements of income assistance recipients? Maybe just briefly to start, the minister could describe for the committee the rules that are in place governing households where there may be one or more people receiving income assistance. It is my understanding that, for example, people living in a common-law arrangement or relationship are not eligible to both be collecting income assistance in the same domicile. Is that a correct assumption?
If it is, I wonder if the minister could tell us what steps are taken to monitor that type of situation -- to verify the living arrangements to ensure that we don't have situations where there are multiple recipients in one household who may or may not be eligible to receive benefits. Is that the role of the front-line worker? Or is there a separate department or a caseworker who deals specifically with living arrangements? I wonder if the minister could just describe for the committee her knowledge, or the ministry's knowledge, of how this matter is dealt with.
Hon. J. MacPhail: In order to determine eligibility, the person is required to declare address and household income. If there is an improper declaration of that, based on household income -- family income -- that has to be investigated and treated as an abusive or fraudulent situation. We do keep track of payments by residence; that is tracked by computer. There are occasional visits to residences to check accuracy of information. We have eligibility officers now who determine up front in particular areas where there may be fraudulent situations -- the existence of abuse -- in the area of inaccurate reporting of dependents, income and residency. There are a number of checks that can be done and followed up on. But one is required to declare household income in order to determine eligibility for income assistance.
W. Hurd: I can only relate this issue to my local office. I know that there have been concerns expressed in the past that front-line workers have not had time to verify the living arrangements of income assistance recipients. In light of the concern that has been expressed directly from front-line workers, I just wondered whether there are target levels in each office to increase the number of inspections into living arrangements. Are we dealing with an effort to increase the number of inspections? If so, I wonder if the minister could tell the committee whether we're looking at a percentage increase or whether there is a reporting schedule for visits to the domicile. What types of measures of increased monitoring and auditing are being done by the ministry to verify that living arrangements don't violate eligibility rules?
Hon. J. MacPhail: This is a good opportunity to review some of the past announcements of our government. Let me start by saying that caseload is an issue with our financial assistance workers, in terms of making sure that they're determining eligibility most effectively. We've put a lot of extra staff on the front lines, and the caseload increase has decreased dramatically from past years, so there has been a substantial effect on the financial assistance workers' caseloads.
We have a range of pilot projects to try to deter the kinds of situations you're talking about. One of them was the eligibility officer appointments, which I just told you about, in order to try to deter abusive and fraudulent situations of
[ Page 14620 ]
applying for income assistance. That's proving to be very effective, so much so that last year alone we had a 52 percent increase in the number of investigations into false addresses and a 113.9 percent increase in investigations into common-law status abuse on the basis of household arrangements. We have increased the FTEs in income support by 105 since last year. Much of that has gone into prevention, compliance and enforcement, which is our department that deals with fraud and abuse. In just that department alone, there is an increase of 23 financial assistance workers for this year. And there's a substantial increase in prevention, compliance and enforcement as well to detect some of these situations.
Let me just review for you the announcements that we made a year and a half ago now -- three months after I took over the portfolio -- to increase accountability and combat fraud and abuse in the system. These announcements, which were made in January 1994 by the Premier and me, resulted in savings last year alone of $46 million. There was computer identification of individuals claiming assistance in more than one province. There were new policies for lost and stolen cheques; recovery of security deposits directly from landlords, which we've already described; federal-provincial actions to eliminate duplicate payments with unemployment insurance claimants -- previously, we would advance money to UI claimants and they would never have to pay it back, although they were getting double payments. We've changed that. Mandatory job search report cards for single employables and childless couples; required cheque pickups; there will be new measures to increase accountability in terms of data sharing with Revenue Canada; a system to follow up on outstanding debts of former recipients who are now in the workforce -- all of this is good news for the taxpayer.
W. Hurd: I just had a brief series of questions on this issue. I wonder, again: when the front-line official in the office suspects that there might be living arrangements that violate the rules of eligibility, is there a requirement that a report be filled out? Is there a trail of paper within the office on this? Are the front-line workers -- where they have reasonable and probable grounds to believe that there is a violation of the rules -- required in any way to file a report? And if so, I wonder if the minister could tell us whether that is the procedure in the office; and if it is, whether there's an attempt going to be made to identify a number of these reports and an attempt to audit or monitor or verify how many are acted upon. Where that suspicion exists, is there a requirement of the front-line worker to report it verbally, to simply take it under advisement, or to actually fill out a report which can be placed on file at the ministry and then potentially followed up on?
Hon. J. MacPhail: Yes, front-line workers are required to report suspicion of fraud or abuse. They report it directly to our newly established prevention, compliance and enforcement division, which we discussed at length on Friday, and all of the complaints are tracked and followed up on. Just so you know, the number of complaints investigated between fiscal '93-94 and the last fiscal year increased by 104 percent, and the convictions achieved in enforcement increased by 48 percent.
W. Hurd: I have one final question that relates to the statistics the ministry often uses about the number of people who receive income assistance and then leave the rolls -- I think it's a fairly high percentage. Does the ministry then determine how many of those on short-term assistance get back on again? Is there a means of monitoring whether the ones that are on for a brief period in fact come back on again? Or is anyone who leaves the system considered to be that percent that leave the system? Is there an effort to track the number of people who may make multiple claims on and off over a period of months? My question is: would it not be more appropriate to deal with that kind of measurement as a true measure of how the system is providing assistance, rather than simply categorize a person who leaves the system for two or three months as having gotten off income assistance? Do we have a way within the ministry of cross-referencing the people who come back on after a few months? If so, would the minister agree that that's perhaps a more realistic assessment of how many British Columbians actually rely on the system over a longer period of time?
Hon. J. MacPhail: Yes, we do keep track of.... I will use the term, but only from a statistical and research point of view; it's not an appropriate term to use when talking about human beings. People who leave income assistance and then come back on within a defined period -- they are called cyclers. That's for research purposes only.
The average time that we talked about earlier.... Some 75 percent of the people requiring income assistance only require it for three to six months, but nearly 60 percent of those return within two years. We have just published a report on this, because we are very concerned about people who need to recycle in and out of income assistance. We have found in our research that 80 percent of people who cycle in and out of income assistance within a two-year period do so because of job loss or UI pending or benefits ending -- they have been back into the workforce working and have lost their job again through no fault of their own.
So we as a government are concerned. Many of these people are young. Hence, we are putting forward our initiatives around moving all people -- but concentrating on young people -- from welfare to work with the series of initiatives that has been discussed at length here. But I'm happy to go over it again.
W. Hurd: In terms of the people who do return and cycle back into the system, does the ministry make an effort to determine how many are legitimately laid off or terminated from employment and how many voluntarily leave their employment? In terms of this auditing and monitoring function, is there an effort made by the ministry to determine whether recipients who do come back into the system quit their jobs or were actually terminated because of a layoff or a downsizing of the organization they worked with?
Hon. J. MacPhail: People who quit their jobs are not eligible for income assistance. And yes, it is part of the eligibility process for each and every person to determine the nature of why they're not working. It is the requirement, as we discussed at length earlier, that those who are able to work look for work in order to maintain eligibility for income assistance. When they fail to maintain that eligibility through not participating in an approved training program or partnership program for employment, or not actually searching for work, they are cut off.
[5:45]
W. Hurd: Can the minister then tell the committee how many people might have been denied assistance last year
[ Page 14621 ]
because of having quit their job as opposed to being laid off? Does the ministry maintain those statistics? It was my impression that even if someone had quit their job but had no support, there was some sort of assistance available. Is there an effort made on the part of the ministry to group the people who cycle through the system in terms of whether they quit the job or lost the job; and if so, how many were denied benefits -- the percentage?
Hon. J. MacPhail: No, we don't. In a system the size of ours, we don't keep track of refusal of benefits; we only keep track of those who are eligible for benefits.
W. Hurd: The minister has indicated that people are denied benefits because of a decision they might make to quit their job. Surely if the decision is made on that basis, there must be a record of how many individuals that might apply to. That doesn't seem to be a complicated question.
Hon. J. MacPhail: Well, it is a complicated question. I would be happy to demonstrate that complexity; if the hon. member thinks that's a good investment of taxpayer dollars, I'm absolutely willing to work with him on it.
V. Anderson: I would like to say thank you to the minister and her staff today. I think they would appreciate it if we were to ask that the House rise, report progress and ask leave to sit again.
Motion approved.
The House resumed; D. Lovick in the chair.
Committee of Supply B, having reported progress, was granted leave to sit again.
Committee of Supply A, having reported progress, was granted leave to sit again.
Hon. J. MacPhail moved adjournment of the House.
Motion approved.
The House adjourned at 5:49 p.m.
The House in Committee of Supply A; G. Brewin in the chair.
The committee met at 2:44 p.m.
ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 42: minister's office, $461,000 (continued).
[2:45]
J. Tyabji: My thanks to the Health critic, who allowed me to budge my way in here.
As the minister is aware, I represent one of the ridings in which Kelowna General Hospital is the main institution. There have been quite a few cuts in services; there have been bed closures. I would like to read into the record that we had a problem this spring where KGH closed 30 surgical beds to save $1.5 million a year, that nursing department changes will save another $237,000 and that extensive bed closures last Christmas saved $600,000. That's from the Kelowna Daily Courier.
There's a lot of talk that the health accord has led directly to higher staffing costs, and because of that, services are being rolled back. There's a lot of uncertainty about budgets as they come, because we're on an annual budgeting system right now.
Could the minister please send a message to the people of Kelowna that there will be a commitment to allow a consistent level of service and how that would translate and how the new approach to health is going to be reflected in service delivery? For example, if these beds are being closed because those services won't be at the hospital, will there be a closer-to-home service available in that community?
Hon. P. Ramsey: I thank the member for Okanagan East for joining us and participating in our discussion today.
First, I think the member knows that hospitals in her part of the province and others have traditionally closed some beds around holidays and around summer vacation. That has been a tradition in this province that has gone on for some time.
The closure of beds at Kelowna General -- there have been similar bed closures at other facilities -- must not be read as a change in services provided to the people of the Okanagan. Frankly, every study of how we restructure our health care system to make sure that it is sustainable for ourselves and for our children says that we have to look at different ways of delivering service -- not changing the services we deliver but changing the way in which we provide those services. One of the best examples of that, as the member knows, is looking at which services now provided in an acute setting should more appropriately be delivered through a combination of community services and possibly home-based services.
That is as true for the Okanagan as it is for others. Okanagan general hospital has received funding increases for the past three years above the provincial average in recognition of the rapidly growing population of the Okanagan region. The Okanagan region is also scheduled for construction of the fourth full-service cancer centre in the province in conjunction with Kelowna General.
Finally, the member spoke of funds provided by Closer to Home. As I believe she knows, in the South Okanagan-Similkameen region, the allocation for Closer to Home funds was $3.4 million. The majority of those new services are now up and running, whether it's the outreach rehabilitation project for intermediate care facilities run in Kelowna, the home IV services run in conjunction with Kelowna General Hospital -- which is an excellent example of providing people with
[ Page 14622 ]
service in their homes that in the past they have had to receive as an in-patient in a hospital -- the planned maternity-care program in Penticton or the Kelowna information exchange system. We simply make sure we are getting out as much information as possible.
I'll mention one other. One of the projects put forward by Kelowna General Hospital, which they told the steering committee looking at allocating Closer to Home funds would help take pressure off their facility and help reduce the number of in-patient days, was the assisted self-care renal unit. Through the Closer to Home fund, that program was funded to a value of $107,000 last year. Much work has been done to say that we need to provide services in a community or home setting rather than an acute setting.
There is one other piece to this which I think the member and I have to acknowledge. We have asked all hospitals in the province to look at more effective ways of delivering service. Kelowna General, I submit, has been a leader among regional hospitals in reducing the length of stay, in providing more services on a day surgery rather than an in-patient basis and in liaising with community agencies to make sure that where a person can be provided service that will keep them out of hospital, that service is provided.
J. Tyabji: It's interesting to note that the doctors' staff representative has said that there would be a $3 million to $4 million shortfall in the budget, as it was presented to the hospital this year, and there's about $3.4 million being spent on Closer To Home initiatives. The number seems to be roughly the same in transferring the services. The minister is saying no, so he might want to respond to that.
Is there any long-term projection for budgets for that area? Is there a growth projection that's been built in and some sort of formula to guarantee a certain base of funding, and if so, what is it?
Hon. P. Ramsey: First, there is no connection between this alleged $3.4 million shortfall in the budget of Kelowna General Hospital and the $3.4 million of new Closer To Home services that are now operational in the area. Budgets for hospitals, which will be announced in the next little while, are based on an overall increase in the budget that we're debating of a bit more than 3 percent. Compared to other budgets for hospitals across this country, I think that's probably the best of any province right now in terms of providing funds for hospitals, which we acknowledge are always going to be the cornerstone of our health system.
Areas of the province that are experiencing rapid population growth or which have been traditionally underserviced receive more funds. Those that are relatively stable areas are asked to achieve greater efficiencies. I must say, though, that in all cases we are working with hospitals to look at how they get effective and efficient. Kelowna General has done a good job in the past. I know from talking to their board and to their administration that they feel they can make further progress and efficiencies to operate within the means of the taxpayers of B.C. and to provide a regional referral centre in the Okanagan.
J. Tyabji: There is a facility -- there was a ribbon-cutting for it in Westbank, and I don't have the name in front of me, but the minister will know which one I'm talking about, I'm sure -- which was to be opened by now, in the spring of this year, and it's sitting there. As I understand it, it's costing the government roughly $5,000 a month, and it hasn't been opened for operation. I think it's called the Westbank health centre. The minister will.... I can go on to a different subject. There are a lot of questions coming out. You have to recognize that Westbank is not in my riding, so that's one reason why I don't have it in front of me.
I get a lot of questions in my riding about the fact that there's a cancer clinic coming on stream, with added cost. We have the MRI facility -- which is an outstanding facility, and certainly the people of that area are very happy to have that -- and there has been this large construction cost in Westbank without the additional operational funding that it needs to operate. There are a lot of questions about how priorities for health care spending are being set. Some people are arguing that instead of putting the money into the capital costs for the facility in Westbank, which is not being used, they could have taken that money and put it into operational funding for the hospital or the cancer clinic. Perhaps it could have gone into general revenue. Could the minister respond?
Hon. P. Ramsey: I must confess that the member opposite has more information than I do on the Westbank health centre. I will get information for her on the specifics of the planning, construction and operations.
Interjection.
Hon. P. Ramsey: A long term facility, hon. member?
J. Tyabji: It's primarily for seniors.
Hon. P. Ramsey: Okay. I will check on that and get back to you.
In general, one of the difficulties of doing appropriate capital and operational planning is, of course, that it takes four or five years to go from the concept to opening the doors of a health facility. Assessment of need may change during that period due to population growth or changes in how need is evaluated. I recently engaged in a rather protracted debate with the member for Matsqui over a re-evaluation of the need for acute beds at the MSA hospital, based on population growth, but on current trends of fewer acute beds per thousand in population.... Plans for that facility have been downsized. They surely haven't been downsized out of existence, but they have been downsized. Occasionally there is a mismatch between operational budgets and capital facilities coming on line. That doesn't happen too often. We try to plan well and know what facilities are coming on line in the fiscal year, and we budget for them. I will check on the Westbank facility to see whether funds are coming fairly soon or whether there has been a mismatch in planning.
J. Tyabji: As the minister may know, there's an outstanding need for a detox centre in the central Okanagan. That's something that has been talked about for a long time. There are a number of non-profit associations in Kelowna that are prepared to work together on this. There is certainly a high amount of community support for a detox centre. Last year there was finally some serious discussion of a Kelowna detox centre being planned for the fall.
First, I'd like to make sure that the minister is aware of the need for detox, that there have been longstanding problems
[ Page 14623 ]
with people being released when they shouldn't have been -- when they're still intoxicated -- and that it's led to some safety issues. Second, I'd like to know if there are any plans in the works or if there's a plan of action to get the community activated to support a detox centre. If so, what they are?
Hon. P. Ramsey: First, let me say that I don't think there's a need to get the community involved in supporting the need for a detox centre. I think there has been an expression of need from the community, from many of those involved with treating people with substance abuse problems. I just want to confirm for the member that I'm well aware of the difficulties of doing detoxification in the Okanagan Valley by shipping people to Kamloops. It's not exactly "closer to home."
Some recent planning on how to relocate these facilities on a regional basis is, as the member says, underway. I think one of the results of that will be a dispersion of those detoxification facilities from one location to serve the Thompson-Okanagan region in a number of different sites. The other thing I would say to the member is that in this area, as in many other areas of health care, there is ongoing rethinking of what sorts of facilities should be available for detoxification. In the past, this has been conceived largely as maybe not just an acute facility but almost a jail-like facility to hold the people while they're going through detoxification.
More recently, a number of people and professionals -- experts in the field -- are saying we should look at something that's a lot more residential-like than institution-like in providing for detoxification services. I think the nature of the facility, as well as location and size, should be carefully considered as we plan for the needs of the Okanagan.
The final piece I would call to the member's attention is the need for this planning to take place at least in consultation with the regional health boards in the Okanagan. In the very near future, of course, they will be responsible for delivery of those services and will be doing decision-making, not just being consulted. In this interim period we will be working closely with them, as plans for detox facilities in the Okanagan are pushed ahead.
J. Tyabji: The detoxification committee, which began roughly four years ago to lobby for a detoxification centre in Kelowna, was actually originally asking for a 21-bed facility, based on the demand they had already gauged. As I said, it was four years ago that the coroner asked for that.
[3:00]
The minister is probably already aware -- but in case he isn't, he should be aware -- that many of the people who need this facility are urban aboriginal people. Perhaps there could be a proposal with the urban native nations or one of the Indian friendship centres to assist with the detox facility in the interim until the regional health councils are in a position to direct funding. The committee that came together four years ago scaled down their proposal to a ten-bed proposal. Three years after they started, they scaled down to less than 50 percent of their original request. The estimate is that it would take between $200,000 and $400,000 to operate this as a good facility with ten beds. They would be able to rent or lease the facility from a private owner.
I'm just wondering if there's any action underway at all to look into this as a proposal for this fiscal year, where there would be some sort of detoxification facilities in that area. Certainly that's a question that has been asked every year. Considering that they're prepared to go for ten beds instead of 21, and in consideration of the fact that the Indian friendship centre could be approached as well or that there could be some funding from other ministries, would this minister undertake to look into that within this fiscal year?
Hon. P. Ramsey: The member raises some excellent points about the need to work with groups representing first nations. As the provincial health officers and others have flagged for a long time, there is a need for services that deal with substance abuse and addiction for aboriginal people and many others in our community. I am aware that the original proposal was scaled down. Part of that was in response to some changes in thinking about detoxification, which I was discussing earlier. Finally, as far as the actual time when a facility is planned, I regret to say that I do not believe there are any planning moneys in this year's capital budget. I would hope that we can find some for next year's capital budget.
J. Tyabji: Putting aside the capital budget, I think it's the operational budget that's key to this. With roughly $200,000 in operational funds, the local group feels that they could put together a ten-bed facility prior to approaching some of the local agencies for funding. So if we ignore the capital budget and look at the operational budget, is there any way that they could ask specifically for some money to be directed -- even if we look at it coming onstream in September for six months of the fiscal year? A one-year estimate would then be $200,000. You could even do half of that, starting a few months from now.
Hon. P. Ramsey: I will undertake to look at the alcohol and drug budget to see if there are some funds for day treatment in the Okanagan region that might be topped up a bit this year. Let's not, though, get ourselves in the position of having capital without the facility. We just discussed a case where we may have a facility without the....
Interjection.
J. Tyabji: I guess I should get that on record. I happen to know a building that's empty right now that we could put some....
Hon. P. Ramsey: But not appropriate.
J. Tyabji: But not appropriate. With respect to the Kelowna and Area AIDS Resources, Education and Support Society, I should acknowledge that this government has been supportive of their work in the past and that there has been some funding. However, the funding has been minimal and this group is struggling. They're having a very hard time keeping their doors open. When they wrote at the end of April for assistance, they said that they have struggled very hard.
This group has been extremely good. They have braved some of the reactionary responses of the community of Kelowna. KARES put in place programs in the school system; they tried to make people understand that AIDS is a community-based problem and that they were looking for solutions everybody could live with. There are those in Kelowna who don't believe that some of those programs should be in place.
[ Page 14624 ]
I want to read into the record that in their letter of last year they said they had struggled to meet the needs of constituents. Certainly this is the case right now. These needs include education, support and advocacy. They heartily wish to continue. The reality of their funding is such that they now have to seriously consider restricting not only their geographic range but also the hours and services that they can realistically provide. There is nothing else in this area for people with AIDS. It is very difficult, especially for youngsters. They are not close to a lower mainland centre where there could be some sort of support. There is a growing problem with street children in the central Okanagan, and many of them have found that KARES is a good facility. The downtown storefront office is fairly high profile, and people converge on it for information. They are non-judgmental, and that's very important.
There are many other associated problems that we as a constituency office have found this group helpful with, whether those problems are teenagers who have run away from home and are having difficulties with substance abuse, who can then find information from KARES that will lead them away from that; or whether they are people who are sick or have been diagnosed with HIV, who need to know where to turn for information about what to expect as the disease progresses.
I would make a request that the government consider KARES as a regional centre, that they consider how much work they have done and their track record in the community and that there be a solid commitment for funding from the government so that they can continue to work with students and with members of the public.
Hon. P. Ramsey: First let me express my appreciation to the member opposite for her advocacy on behalf of this group. I share her concerns that in too many communities AIDS is still an issue that people want to ignore. They believe it cannot affect them, let alone that it can affect them as close to their home as it clearly is. AIDS is no longer exclusively an urban issue or an issue of identified populations. It is an issue that is going to affect every one of our communities wherever we may live in this province. Organizations like KARES are essential if we are to do the work of preventing the spread of AIDS so that we do not have an epidemic of this disease in our province.
Last year, funding for AIDS prevention to KARES and close to 50 groups across the province rose by nearly one-third. At the same time that we put that additional money in, we said to AIDS groups across the province: "Work with us in designing a provincial AIDS strategy for the first time, one that takes account of the various ministries that may be involved in doing prevention work."
The member spoke of the necessity for school-based prevention programs and the involvement of the Ministry of Education. I would submit that the Ministry of Social Services, the Attorney General and Women's Equality -- a variety of ministries -- can be and should be involved in doing the necessary work to prevent the spread of HIV-AIDS. I have recently received a draft document from the group that is doing the work on an AIDS strategy for what they're calling their "bridging year" -- the 1995-96 fiscal year. They expect this is a time of transition, and they have put a proposal together for the consideration of this ministry and this government. By the fall of this year we expect to have in front of us an AIDS strategy that looks at the long term -- 1996 and beyond to the turn of the century -- so that we are able to continue our excellent record over the last several years of doing the necessary work to prevent the spread of AIDS.
KARES, like other prevention and advocacy groups, received an interim grant through the end of June to make sure that while these proposals were being put forward, the delivery of services would not suffer. I expect to be looking at their proposal in detail and considering action on it in the very near future.
J. Tyabji: Could the minister let us know whether or not there are plans to table the final strategy in the House? Certainly that would be something I'd be interested in reading. I think I can put this on record. The issue of AIDS is very much an underground issue and should receive a higher profile. It is affecting a lot more people every year, but because it's not in the media, people think it's gone away. Perhaps if there is this initiative being taken, we should all know about it. Maybe the minister would like to do that.
Hon. P. Ramsey: The strategy document will be a public one. I don't know whether it will be tabled in the House or released to the broad public at a news conference, but this is nothing that the AIDS community or this government wishes to hide.
J. Tyabji: I look forward to speaking with the minister further on specific funding for KARES when that strategy is in place, in the event of it not meeting the needs of my constituents.
I would also like to put on record that I'd like to follow up on the detox centre operational funding. I'll touch base with the committee at the conclusion of this debate to see whether or not they would like me to bring back any more concerns.
L. Reid: In terms of the debate this afternoon, I'd like to begin with a consideration of some issues around Pharmacare. I'm sure the minister received countless hundreds of cards from seniors across this province. Some months back there was some discussion -- obviously at the ministry level -- that considered making some changes to perhaps the categories around funding. That was certainly the content of the cards received from seniors across the province. Could the minister perhaps touch on the thinking around that? Was that a trial balloon? Was the intention to make changes? Surely it wasn't just to agitate the seniors in the province.
I would hope that some useful data was derived from that card- and letter-writing campaign. I'm happy to share with the minister the 2,000 responses I have. If he has a response that he would wish to make to those people, I'd be pleased if he could do so now. Then I will include that in the correspondence. If I could have the minister's comments....
Interjection.
L. Reid: This is about eight months back. Stick to the topic.
Hon. P. Ramsey: First, I want to introduce to the committee Mr. Mike Corbeil, executive director of the Pharmacare program. He has been leading the work on many of the initiatives within Pharmacare.
[ Page 14625 ]
Yes, hon. member, I too have a nice stack of mail regarding the issue of ability to pay for the seniors plan, plan A in the Pharmacare program. No, I assure the member that there was not a "trial balloon." What was undertaken was a consultation, which grew out of some work that we did with the B.C. Pharmacists' Society. We undertook to examine not just the theory of moving the seniors program to an ability-to-pay model but the practicality of what it meant if the funding for Pharmacare plan A was redistributed based on income and to share those models of what it might look with seniors and other groups.
This was done at the insistence of those who believed that the Petch report and Pharmacare had got it right on ability to pay for the seniors plan, even though this government chose not to act on that recommendation last year. We did revisit it and said: "Okay, we'll undertake that consultation if it means that much, but we're not going to do it on theory. We're going to do it on the practicality of how many dollars are allocated within Pharmacare, on what that looks like." The results of that were that seniors with an income as low as $18,000 a year could be faced with up to $2,000 worth of drug costs. That was seen as unacceptable by the seniors organizations. I think it was seen as undesirable by most of us who looked at the reality of what an ability-to-pay model would look like. As a result, after looking at the consultation and some of the preliminary feedback, I announced that we as a government would not be proceeding on ability to pay, in spite of some associated with the pharmacies of the province who wished us to move in that direction.
L. Reid: So having gleaned from the Petch report that a closer examination should be undertaken, the ministry had the examination done and decided not to proceed. The conversation between seniors and the province can simply be that at this time the ministry is not proceeding, or they are.... I'm certainly not wishing to intimately know future policy. At the present time there is no decision, and it's something that this ministry is comfortable with.
The second part of my question concerns no changes to the plan A portion of the package. Will the status quo remain for the other funding categories, if you will, under the plan? There seems to be some sense that changes are anticipated. Could the minister kindly comment.
[3:15]
D. Schreck: Hon. Chair, while the minister is contemplating his answer to the question on future policy, perhaps I could ask him to also consider an answer to events that unfolded that the hon. Health critic was asking about.
When the ministry made the decision not to proceed with changes based on consultation -- the changes being the elimination of benefits uniquely targeted for seniors and replacing them with a co-insurance and deductible feature, as is currently the case for those under 65 -- did the B.C. Pharmacists' Society, through its executive director, as illustrated in its publication, The Tablet, criticize the ministry for doing that and advocate that the reduction of benefits for seniors should be something that remains on the agenda?
Hon. P. Ramsey: I thank the members for their questions around the consideration of an ability-to-pay model for Pharmacare benefits for seniors. When the government of British Columbia announced that we were not interested in pursuing this model of new drug benefits for seniors, not only did the B.C. pharmacists' association question that decision in correspondence, I believe they also issued media releases and publicized in their own publications that they were vehemently opposed to preserving unique benefits under Pharmacare for seniors. It will be interesting to see what success the executive director of that organization has in pursuing a nomination for the opposition party here in the next provincial election and what influence he might have on Liberal health policy.
As far as the other question the Liberal critic asked as to whether there are any other changes in benefits -- I guess that's the best way to put it -- or the economic structure of the Pharmacare plans, there are none contemplated for the 1995-96 fiscal year.
L. Reid: Perhaps the confusion has arisen regarding possible changes and certainly regarding the trial balloon around ability to pay. The individuals in the seniors' groups that made representations to me in my constituency office and here in Victoria did not believe that consultation had transpired. Perhaps the minister is referencing transportation under the Petch report. They don't believe that that consultation was brought forward. Two of the three significant seniors' groups in this province did not believe they were consulted and did not participate in any discussions regarding any change to the funding base for Pharmacare. The minister suggests that indeed that consultation did transpire. Perhaps the minister could comment.
Hon. P. Ramsey: No, the consultation on the actualities of what ability to pay would look like was not carried out by the Petch report, though I understand that that committee did consider, within its own deliberations, what some models might look like.
What we undertook to do was take those models out to groups representing seniors and others in the province and hear their views on the actuality of what ability to pay would look like for drug benefits for seniors. There were at least three consultation sessions held with seniors' groups. The only group I'm aware of -- a significant seniors' group -- that was not part of that meeting was COSCO, because it deliberately chose not to participate in the consultation. I believe its position was: "We disagree with the theory of an ability-to-pay model. We do not even wish to examine the actualities of such a scheme."
L. Reid: The minister referenced three meetings. Could he tell us how many people were in attendance at those three meetings?
Hon. P. Ramsey: I have just a little more information on the consultations: there was an initial meeting with seniors' organizations on October 28, and approximately 20 to 25 people represented eight seniors' organizations and a variety of other groups; on November 18, a consultation with health support groups included, obviously, support groups for seniors; on November 25, Federated Anti-Poverty Groups; and on December 5, health professionals. Each forum formed the basis of the report; all four reports were pulled together with an invitation to reconvene at a summary forum. That forum was held on December 16 and looked at bringing all the various perspectives together.
[ Page 14626 ]
We were not involved -- as the member may be alluding -- with taking this issue out broadly to the 300,000 or 400,000 seniors in the province. We were looking at having some of their representatives on seniors' organizations look very hard at what the details of such an ability-to-pay proposal might look like, and to indicate their groups comfort or lack of comfort with such proposals.
L. Reid: It seems to me that the issue is significant enough to agitate a great number of seniors in the province of British Columbia. Frankly, if the 75 MLA offices had been aware that that consultation was ongoing, they might have been able to direct those constituents, if not to attendance at the meeting, then certainly to contact some of the heads of those organizations. It was not well communicated; it certainly was not something that seniors understood was underway. I appreciate that perhaps the folks in charge of their organizations may have been aware of that. That communication was not forthcoming, and I can share with the minister that the MLA offices in this province often tend to become mini-ombudsman offices. If we can in any way facilitate some kind of ongoing communication....
Those individuals are agitated for six, seven or eight weeks for no good purpose, simply because your ministry did not share any of that information around ongoing consultation. The individual seniors who came to our constituency offices had no way of knowing this was underway because as MLAs we had no way of knowing it was underway. That certainly seems to be an oversight, perhaps easily corrected for next time. I can only anticipate that these will be regular events and that people coming together to discuss the future of Pharmacare will be an ongoing issue for seniors around the province.
They can be more aware of how this consultation originates and what kind of life span it has. I think that would be very, very helpful. That is simply a request on my part to be more forthcoming with that kind of information. There doesn't seem to be anything confidential around that; it was simply done in isolation. I appreciate that you know you had eight groups and you had 15 groups, but I had 2,000 seniors who contacted my office. I had no way of knowing how best to direct those folks. That information doesn't need to be housed in a dark corner; it seems more than appropriate to share with the public at large. I would appeal to the minister to have those kinds of discussions in the public domain to keep people apprised of meetings going on behind the scenes. That would be my comment.
In terms of what Pharmacare has tended to fund in the past, I'm sure the minister also receives correspondence on individuals who require some type of medical device or orthopedic support, as an example, and sometimes where you fit in the queue, where you happen to be in terms of age or attachment to a particular organization determines whether or not you have that funded for you. My contention today is that a number of individuals fall through the cracks. Either they are the wrong age -- they pass from being a child, in terms of receiving funding, and are not quite an adolescent. They may have an orthopedic device that was previously funded by some private agency -- Kinsmen or Rotary or something -- and then they're no longer able to move ahead as they grow and need a different size, etc.
There are a significant number of inquiries as to that. I would ask the minister if he could kindly give us some information on the status of those ongoing discussions because the ministry correspondence I have copied back to me says that we're looking at this issue and investigating it. What is the status of those discussions and how best might I advise my constituents?
Hon. P. Ramsey: Just so we can finish up with this consultation over ability to pay, there was no intent to keep this a hidden consultation. In fact, letters announcing what the consultation was going to be, who was involved in it and what was being undertaken were sent broadly to seniors' groups around the province urging them to participate in it.
Interjection.
Hon. P. Ramsey: We could indeed publish in a newsletter, but I must also say that members of Pharmacare and other health services consult regularly with affected groups around the province. Quite frankly, we don't do news releases on all of them.
Let me say, though, that I surely recognize that this is an issue that agitated seniors in the province, and I respect their concern about having a comprehensive and universal program diminished in some way. That was not the decision this government took; that is not the decision we have in place.
I would suggest, though, that if seniors have concerns about this, they might have cause to be agitated. We do have people seeking to enter the political arena -- for your party, hon. member -- who have a very clear view of what policy on that ought to be. And that is a policy that will indeed agitate many, many seniors as they look at a Liberal candidate who feels that ability to pay is an appropriate measure for plan A Pharmacare benefits for seniors.
As far as orthotics and medical devices go, the work indeed has been ongoing. I've just asked the staff here where we were. There is, I hope, a penultimate or ultimate meeting scheduled for next week. I'm looking very hard at whether we can reallocate some of the savings we have made in some areas of the Pharmacare program to enhance the orthotics program and, as the member says, make sure we are identifying those cracks that people are falling through and can plaster over as many of them as we can.
L. Reid: I'll make two points. The minister's comment about consultation is not well taken. The fallout of that is simply that you have to be a member of a group to have your issues recognized. I can assure you that when people walk through the door of my constituency office, I don't ask: "Which group are you a member of?" I simply take each individual's concern and question and try to have those addressed.
The fact that you sent out letters to the groups is irrelevant. If you indeed are looking at active communication, I would encourage you to put out something that reaches individual British Columbians as opposed to just the groups that do or do not have some basis from which to represent others.
In terms of the comment on devices, I appreciate that the work is still ongoing, but that is the same response I've had for upwards of four years. These individuals need to know when a decision may be reached. Is there a time line in place? When can they ask for an answer?
[ Page 14627 ]
Hon. P. Ramsey: I recognize the member's frustration as she tries to figure out how to ask questions about future action in terms of dealing with the current budget estimates. All I can say at this point is that we are looking very hard at the orthotics budget for children under 19 years of age. I believe that is where the gaps are most apparent. I think staff is appropriately targeting those, and I hope to have a budget proposal in front of me in the near future.
[3:30]
L. Reid: I thank the minister for his comments. I hope "near future" means this year, because these same individuals have been waiting for an answer for upwards of three years, and I certainly think that is blatantly unfair.
In terms of management of the overall Pharmacare system, certainly the minister takes every opportunity to cite the increases in funding for this area, but I have serious concerns about overall cost-benefit analysis. I would submit to the minister that it's absolutely lacking around the use of Pharmacare products in the province of British Columbia.
I hope that some commitment will be taken by the ministry and this minister in terms of the management of the system -- moving towards some evidence-based research and some outcome measurement around Pharmacare. Both this minister and this minister's predecessor have taken great delight in grandstanding around the increase in costs: "Isn't it shocking how many individuals are admitted inappropriately to hospitals?" All of those issues have some validity. The dilemma British Columbia has is that there isn't measurement around what percentage of hospital admissions are inappropriate as a result of inappropriate prescribing. There's a lot of speculation; there's limited data. There's limited hard data of the system management as a package. This is an ongoing theme through these estimates debates: that I have a burning desire to know how best this ministry manages the public resources, which are, in this case, the tax dollars which fund this program.
There is, I think, limited attention paid to a research model of where we're headed with the funding of this program. If I had to speculate, this minister will be on his feet in the next number of weeks saying: "Isn't it shocking that it's costing us more money?" It's happened many times in the past. There needs to be something concrete. There needs to be some baseline measurement, and there needs to be some validity -- some clear, intense scrutiny of particular products and how they move through the system. We have some bits and pieces, which I know we will touch on in some detail this afternoon, in terms of the therapeutics initiative and even the risk institute in British Columbia. I would submit, again, that those are fragmenting the package. We need some kind of clear direction. If the minister could perhaps start with his management of the Pharmacare system and some kind of cost-benefit analysis -- if one exists today -- we can perhaps begin there.
Hon. P. Ramsey: I think the member opposite and I may find ourselves in agreement on much of the work that needs to be done. Where we might find ourselves in disagreement is the allegation that nothing has been done to date. That is simply contrary to the facts of what has been carried out over the last three years in seeking to get effective use of therapeutic medications, in increased measurement of effective outcomes and in appropriate prescriptions for all people in British Columbia.
I'll talk only about one to start. The therapeutics initiative out of UBC, which this government established, brings together the medical and scientific community to look at both new and existing therapeutic drugs and do exactly what the member says: evaluate their effectiveness and communicate that information widely to prescribers of therapeutic drugs throughout the province. To quote from their newsletter which they send to all physicians in the province: "The therapeutics initiative is committed to evaluating the effectiveness of all its educational activities using the Pharmacare database. Data will be in a form such that individual physicians, pharmacies or patients will not be identified."
We're going to get you the information. I had in my hand here just one of their examples, some work they did on H2 blockers. I don't know if the member has seen this sort of work. This is the sort of initiative that provides to prescribers some non-drug-company-produced analysis of what's actually beneficial and what the costs of those benefits are. For this one, you've got a variety of medications ranging in costs from 14 cents a dose to $2.30 a dose. The therapeutics initiative concludes that there's little difference in the effectiveness of those various H2 blockers. This is the sort of information that can be widely used by physicians to help educate their patients about what is effective and appropriate and to help patients understand why sometimes a low-priced spread works just as well as the high-priced variety. It may preserve one of the most valuable drug programs that we have. That's but one example.
Let's talk about a couple of others here. The drug utilization review, which has carried on, looks at economic evaluation. We do in-house research, and TI does a lot of work in pulling all of these together.
I'll just mention two other initiatives that have been taken. On the surface, one is nothing but an economic initiative: the low-cost alternative policy that simply said that Pharmacare was prepared to pay the lowest cost of the identical therapeutic drug -- generic or patent. The effectiveness, therefore, will be paid for. We're not going to be paying for packaging, advertising and marketing of drugs. That, I submit, is also a way of educating, I hope, both prescribers and the general public about what drugs are -- base chemicals. We are paying for and looking for effective chemicals. We want to purchase the right chemicals at the least cost to the taxpayer and purchase the ones that will have the greatest possible health benefit.
Finally, I would talk about some of the work we're doing right now with the PharmaNet program, which I know we'll be debating further as these estimates go on. It will have a database of the last 14 months of prescribing history for you and me and every individual in the province, therefore enabling trained health professionals -- in this case, pharmacists -- to look at that data, identify overmedication, inappropriate interactions and ineffective medications, and advise the patient to return to the physician and look very hard at what's being done. I think it will address some of the concerns that I know the member and I share around multiple prescribers for a single patient and failure to identify interactions that may lead to somebody in hospital.
Finally, the impetus for this work is twofold. First, there is a clear economic imperative here. If we are to preserve Pharmacare as a cost-effective program for the citizens of British Columbia, we need to look at spending every tax dollar as
[ Page 14628 ]
wisely as we can. Second, there are clear health benefits to it. I have seen some studies that suggest that one out of four hospital admissions for seniors is a result of either overuse of particular therapeutic drugs, or drug-drug interactions that have led to hospitalization. The coroner's report of a number of years ago suggested that 80 to 90 British Columbians die every year from the inappropriate prescribing of therapeutic drugs -- legal medical drugs that either were inappropriately prescribed or resulted in adverse interactions that led not just to illness, but to death.
The initiatives that we're undertaking through PharmaNet, through the therapeutics initiative and through a variety of other means are looking at precisely the sorts of issues that the member opposite speaks of. I think that in the last three years we've advanced considerably. These are measures that need to be taken to make sure that we're getting the right drugs to the right people at the right time.
L. Reid: Perhaps one or two very straightforward questions will allow this debate to continue with some factual information. The minister made the comment that when comparing product A and product B, the therapeutics initiative committee arrived at a determination. I want to know how they arrived at that determination. On what did they base that decision? I think it's the decision-making around those decisions that is of interest not just to taxpayers but to patients.
It seems to me there will again be grandstanding around the simple issue of the cost of the pill. There are lots of cases where the course of treatment with a $2 pill is far shorter than with a 45 cent pill. In terms of some kind of quality of life issue, I would like to know how those decisions are reached. I fully appreciate the economics of it, but I want to have some understanding of the reasonableness of the decision.
Hon. P. Ramsey: The therapeutics initiative setup is not a government agency, but we fund it. The people that are appointed to it are from the medical and scientific community. Do not read its decisions or its findings as being influenced by government decisions around economics; they are not. The work that they do and the material they produce is based on peer-reviewed research done in universities in this country and other countries. It is the best scientific data they can find to evaluate the effectiveness of therapeutic drugs. They do look at some of the items that the member speaks of, as far as the required length of dosage, etc. They are not interested in, and their mandate is not one of, simply looking at the bottom line. We'll leave that to Treasury Board staff. They are very interested in making sure that we evaluate the therapeutic effectiveness of drugs. If, when new drugs come on the market, they are an advance in effectiveness, they are identified as such. If, as in many cases, they are not an advance, that too is identified.
L. Reid: I know the minister is aware of these concerns. Copies have been sent to my office and his, and they look at the composition of that committee. In the past, I've given the minister the example of individuals discussing cardiology drugs, but no cardiologists. It seems to me that it has degenerated into a reading exercise, where they come together and look at peer reviews and perhaps take a look at some clinical studies. People who work in the field, and not just in British Columbia.... We will spend a great deal of time this afternoon on the scenario underway in Alberta, because I think they have moved to the next level, which I hope is our goal. I would submit to the minister that we're not there today. It seems to me that it should be about inviting the finest minds to come to the table; it seems to me that there are some omissions. Does the minister have any intention of ensuring that not just an expert academic but also an expert practitioner is at the table when particular product lines are being discussed?
If this is about getting to best practice, it seems to me that it makes sense to look at the experience of people who actually prescribe and treat patients in that area. I don't believe this needs to be, can be or should be an academic exercise alone. I don't believe that for one moment. I ask the minister to comment.
Hon. P. Ramsey: I assure the member opposite that I share her concern. As the therapeutics initiative carries out its work, specialized practitioners in the various areas are consulted. Yes, I have seen the occasional letter from a specialist whose nose is out of joint because he or she has not been included in the consideration of a specific drug. Quite frankly, I'm not prepared to mediate over who the therapeutics initiative selects to consult, as long as they assure me, as they have, that they do indeed consult. They should consult not only with those who are doing the reading -- though I would ask why the member wants to denigrate that -- but also with practitioners who are actually carrying out the work of delivering health care to British Columbians.
L. Reid: In terms of where we are today, I simply believe we're missing some opportunities around the possible scope of that committee. In terms of where we will go next with it, I support the contention that the minister doesn't have a lot of input into who that committee chooses to consult with. But I do believe that those individuals.... I'm willing to stand corrected, but it's my understanding that the regional committee is appointed by the Ministry of Health, so there's tremendous opportunity to put in place a reasonable cross-section of practitioners. For the record, I'm simply suggesting that that opportunity hasn't been taken. I would again ask the minister to comment on the composition of the original therapeutics initiative committee.
[3:45]
Hon. P. Ramsey: One of the difficulties in establishing an organization such as the therapeutics initiative is to make sure that it is not seen as the captive of a government policy or economic interest, either of a particular pharmaceutical manufacturing group, a particular professional organization or others interested in the use of therapeutic drugs. Therefore the appointment of the scientific information education committee, which is the main body that deals with practitioner advice, is not by the ministry nor by this minister. I do appoint a general advisory committee that represents broadly the health sector in British Columbia, including members from the RNABC, the Seniors' Advisory Council, the BCMA, the faculty of medicine and others. But I do not choose which scientific experts and medical advisers the therapeutics initiative appoints to its committee. I would ask the member to contemplate what the perception might be, should the ministry undertake to do that. I think it would be detrimental to the work of the therapeutics initiative and to its hard-won reputation of being an objective and independent body.
[ Page 14629 ]
L. Reid: I appreciate the minister telling me he doesn't appoint them. Perhaps he could enlighten me as to who does appoint those individuals.
Hon. P. Ramsey: The managing directors of the therapeutics initiative.
L. Reid: Who are?
Hon. P. Ramsey: Dr. James Wright and Dr. Casey van Breemen.
L. Reid: I appreciate the minister's response. I am happy to direct the majority of writers of correspondence to my office directly to those two individuals, because hopefully they will be able to arrive at some answers to some of these questions.
In terms of the minister's comments about the drug utilization review, what was the budget for that? And what are the cost savings from having participated in that?
Hon. P. Ramsey: The drug utilization review is budgeted at around $180,000. It works through the drug and poison information centre at St. Paul's Hospital. Its primary function is to look at prescribing practices for drugs that have clearly been identified as potentially inappropriate by Pharmacare and to work with those physicians in changing prescribing patterns by providing them with information.
L. Reid: If indeed the cost is $180,000, how do you measure the benefit? What is the benefit to the taxpayers in this province?
Hon. P. Ramsey: It's too early in the day to get a longitudinal study for ten years on the effectiveness of it. If we want anecdotal information, we can look at prescribing patterns that have changed and at Pharmacare data that evidences that. I would expect increased health status to reduce hospitalization costs for the people of British Columbia.
L. Reid: I appreciate that ten years has not elapsed in terms of a longitudinal study of that magnitude. Since this is the Health estimates debate, I'm very interested in cost savings around new programs. When the decision was taken to expend $180,000, there must have been some discussion that the possible return to the Ministry of Health was X. I'm interested to know what the amount was; I truly hope that it's more than speculation. Perhaps the minister could comment.
Hon. P. Ramsey: I wish I could give you a firm figure and say: "This is exactly how much it saved in the first year." That work is going on right now. When they have reported back to us, the information will be available. The evaluation of the first year of work will be undertaken, and we will have the results of it as soon as the period is completed.
In launching things like the drug utilization peer review and the therapeutics initiative, we are embarking on proposals whose advocates say that it would quantify the results in orders of magnitude of ten or 20 times and that the cost will be evidenced in savings. I can surely point to examples of that, but I'm cautious about throwing those examples out. We are embarking on things that I think are on the leading edge in looking at the utilization reviews of practitioners and what we can do to educate prescribing physicians about the cost-effectiveness and the health-effectiveness of the drugs that they prescribe daily.
These are not short-term ventures. While I could indeed quote from the advocates for these practices, who say that we will achieve ten or 20 times the savings, I'm not going to do so. I'm not going to hold those up as a benchmark, because I want to see some results. When I see them, they will be shared.
L. Reid: I appreciate the sentiment that the minister is expressing. But it's incredibly frustrating to be at point A, which is zero, and then have the minister suggest that there isn't a ten-year longitudinal study, so the question is not valid -- which is basically the song and dance the minister has just suggested that I listen to. It's not warming my heart. Give some guidance around the question.
I truly believe that at the end of one year, you should be able to say something about a program, whether it's a health program, an educational program or a program within the Transportation and Highways ministry. I think you should be able to say something at the end of each fiscal year, because that is indeed the only opportunity we have as opposition members to discuss the spending.
I'm trying to get at the level of decision-making that allows this ministry to budget $180,000 for the drug utilization review and then to suggest: "We anticipate it's going to do some really good things, but because it may be future policy, I'm not going to tell you when I'm going to report out on that." Frankly, that's not fair to the taxpayer. If it's a two-year or five-year reporting out, I would accept that, but I think I deserve to hear what the answer might be.
D. Schreck: I would like the minister to comment on who has been lobbying him not to bring about these cost-saving changes in Pharmacare.
It's important for all of us to keep in mind that everybody's cost is someone else's income. When we talk about trying to save $50 million in the Pharmacare program, as a hypothetical example, and that $50 million were saved, that would be $50 million less going into the pockets of the pharmaceutical industry.
I, for one, was extremely disappointed when I saw former federal Liberal cabinet minister Judy Erola become the spokesperson for the Pharmaceutical Manufacturers' Association of Canada. I had the opportunity to be present at the hearings of the Seaton commission, the Royal Commission on Health Care and Costs, when Ms. Erola engaged in debate with Prof. Bob Evans on inappropriate prescribing habits and the need to stop some of the profit-taking through bad practice and bad prescribing habits. I urge all members to go back and read the transcripts of the royal commission and see how that former federal Liberal cabinet minister was fronting for the pharmaceutical industry in what I would say outright is bad medical practice. As an MLA with a longstanding interest in this matter, and having been hired out of graduate school to put the original Pharmacare program together some 20 years ago, I can say that I have had industry representatives from the brand-name pharmaceutical industry sitting in my office, lobbying me so that I would use my influence with the minister to stop cost-saving changes from going forward. I expect that if those representatives of the pharmaceutical industry are lobbying me, they may also be making representations to the minister and the official opposition.
[ Page 14630 ]
We are all interested in the answers which the critic has put forward. I expected to see those answers, however, not on the order of a $190,000 return for a $180,000 investment. I expect to see those savings on a magnitude of tenfold to a hundredfold for every dollar invested. When we have returns on the scale of tens of millions of dollars, somebody is losing big-time by having those resources reallocated. I'd like the minister to speak now about who is trying to stop those changes.
Hon. P. Ramsey: First, let me speak to why I'm not tabling an evaluation of the drug utilization review today for the member's perusal. We are just now doing the final work on compiling all plan E -- general plan -- prescription patterns for last year. Any evaluation must be based on that. You have to get some baseline data before you can proceed, and it's going to take awhile.
I think what we need to do, hon. member, is look at the potential savings there. I'll give you a very finite example of something that was done by the therapeutics initiative that they were able to quantify because it was such a little microcosm. They did a series of teleconferences with physicians around the province to educate them on a number of therapeutic drugs that they were using. They were able to monitor the prescribing practices of those individuals before and after this example of continuing education by teleconference -- a nice, tidy little project. They found that for every dollar it cost to put on this teleconference and get this information out, they saved $5 in the cost of drugs that were prescribed: better health, lower cost. That's a very small example. We were able to measure it because we were looking at a very small impact and a relatively small project. Looking at these larger issues, through the drug utilization review or the overall work of the therapeutics initiative, will take some time.
One of the great struggles in getting the therapeutics initiative established and some of these mechanisms in place was in resisting inappropriate involvement by manufacturers of therapeutic drugs. I say inappropriate, because there is appropriate involvement. Obviously the therapeutics initiative needs to look at research and scientific data from the manufacturers of drugs themselves. That's part of the data they need to do their work. But when drug companies wish to go one step further and be involved in analyzing data or deciding what drugs are on the Pharmacare approved list, I submit that a line is being crossed. Along with other health ministers across this country, I work very hard at maintaining that line. Some of the initiatives of the risk institute at UBC that the member talked about earlier strike me as crossing the line inappropriately. I believe, therefore, that a more appropriate approach is the one I've described, with a therapeutics initiative having its independence with the work it does in advising both the physicians of the province and the Pharmacare program.
[4:00]
L. Fox: I'm pleased to enter into this part of the debate. I've been listening here for approximately an hour, and during that time the member for North Vancouver-Lonsdale has roused himself to his feet twice. In all fairness, I think he should be embarrassed that he is attempting, by his suggestions to the minister to put answers in the minister's mouth, to suggest that the minister may not be capable of answering his own questions. That is something the member should feel rather concerned about.
The other issue is that I think we're all going to be fighting an election before too long. I recognize that the member for North Vancouver-Lonsdale, as a candidate, may have some affiliation with Pharmacare initiatives, but that's something that should be fought outside this room, and we should pay attention to the many problems and concerns we have. I have met with the Pharmaceutical Manufacturers' Association of Canada, the B.C. Pharmacists' Society and a number of medical professionals from the BCMA. Without exception, all of them have agreed that we have a problem in medicare.
My perception is that each one of them attempts to point the finger, and it keeps going around and around. When the pharmaceutical association comes to me and meets, and it says that just holding down the costs of drugs is not the answer, my suggestion is that as long as everybody keeps pointing the finger at one another, the only thing the minister can do is put a cap on costs until such time as they can all agree to get together unilaterally to resolve the concerns and to help design initiatives that would provide some stability in that program. That's the rationale I have come to, and the minister may perhaps want to agree or disagree.
Hon. P. Ramsey: Far be it from me to inhibit any member of this committee who wishes to rise to his or her feet and participate in the debate on the estimates of the Ministry of Health. I welcome that; that's what this venue should be about. If the member had been present other days, I think he would have seen other members of the government side of this committee also rising to engage in debate and questions. I find it actually passing strange, because I've repeatedly heard members of the opposition criticize the members of the government bench for not rising to engage in debate. Now, hearing this member criticize a member who does rise strikes me as totally inconsistent. I surely would not seek to inhibit any member of this House who wishes to engage in debate on the estimates of this ministry.
I find the member's suggestion that all we need to do is get all the players together and we will have the ideal Pharmacare program to be attractive but, I must say, naive. The question is: are we going to have the barnyard designed by the chickens or by the foxes? To ask the chickens and the foxes to get together and design the ideal food chain could be a little hard.
Having said that, let me make it very clear that I as minister and the Pharmacare program and the ministry seek to work closely with the pharmaceutical industry. We have established a formal liaison committee with manufacturers of both patented therapeutics and the generic drug industry to hear their concerns, to receive information and to share perspectives. They sit on the low-cost alternative committee to make sure that when Pharmacare is designating the least-priced alternative that we are prepared to pay for, we have the best information from the industry. Indeed, in the seniors' information line, it is a joint initiative, and the pharmaceutical industry is involved in it.
So we welcome their involvement. Let me go back to my original statement, hon. member. What we do not welcome is their inappropriate involvement, where economic interest may overwhelm program design and the cost-efficiency of Pharmacare for the people of British Columbia.
L. Fox: I'm surprised at the response of the minister -- that a government that supposedly prides itself on consulta-
[ Page 14631 ]
tion wouldn't see the advantages of somehow working collectively with all agencies toward meeting the objectives of having an efficient Pharmacare system. To put the analysis forward that the minister has put forward just goes to show that this government's attitude is: "We know best. Those others better follow in line." It seems to me that that attitude got this government into a lot of problems with the BCMA and the medical profession, and it created a lot of problems that we're still facing in medical services around the province, including opted-out doctors. We'll get into that a little later on in the estimates. But what I was proposing was very simply that we work together.
There is an admittance that the rising cost of Pharmacare is a concern to the medical profession, to the pharmaceutical companies and to the pharmacists. There's a real concern, particularly in the pharmacies, because of the different levels on which pharmacies operate in the province of British Columbia. When we take action unilaterally without a good amount of input from all of these small independent pharmacists in Fraser Lake, in my constituency and in the smaller communities throughout.... These independent pharmacies are feeling the pinch to deliver the service and meet the demands of this government. I was trying to point out some positive ways that we might resolve it. The minister calls it naive; I don't believe that consultation and working together is ever naive. I think it shows that there is a willingness to listen, to heed and to come up with a plan that is in the best interests of British Columbia overall. I would hope that the minister would look at this more optimistically than he does, rather than just suggest that the only way we can do it is by the heavy hand of government.
Hon. P. Ramsey: I'm not so sure what I should prescribe for the member opposite so he can hear what I'm saying clearly. We seek to work very closely with both pharmaceutical manufacturers and others involved in the pharmaceutical industry. That is why they sit on the low-cost alternative committee; that is why we have a formal liaison committee to discuss issues around Pharmacare with them; that is why we work with them doing the information line for seniors on drugs. That is, I think, very appropriate, and we do indeed consult regularly. Further, hon. member, we definitely do value the economic contributions that pharmaceutical manufacturers make to this province. That is why the Premier of this province and I have announced and are in the process of getting construction underway on an $8 million building that will house a research initiative in conjunction with Merck Frosst, one of the largest -- if not the largest -- therapeutic drug researchers and manufacturers in the world, at the Oak Street site. To allege that somehow we treat these folks as undesirables is simply not accurate. I will say again that we need independent advice that is free from economic bias as we look at decisions around effective use of tax dollars to provide the people of the province with therapeutic drugs.
Far from saying we know best, the therapeutics initiative is a deliberate attempt to say we don't know best. That is why we have funded this independent body, that's headed by those who do know best and are the leading medical, pharmaceutical and scientific personnel in their fields. That is why we've charged them with selecting the scientific panel that advises them, not appointed by government, to avoid the impression of the heavy hand of government imposing a decision on what drugs are effective and what the economic costs and benefits of using certain drugs are.
When the therapeutics initiative comes up with a circular it sends to physicians around the province, saying, "Here's a list of medications you can use for an acid stomach -- H2 blockers -- and they range in cost from 14 cents a dose to $2.30 a dose; we've reviewed the scientific literature and talked to the experts, and we can't find any difference in effectiveness between these two kinds of drugs," that is why the physicians and the pharmacists of the province can rely on the fact that this information is based on science. It's not dictated by the drug companies, it's not an advertisement for any particular manufacturer nor is it an imposition by a wing or an arm of government. It is independent therapeutic advice.
L. Fox: The generic drug issue -- the utilization of generics over patent drugs -- is certainly an important one. I think there's a recognition out there that there's a need, where possible, to prescribe generic drugs. The costs of Pharmacare go beyond the use of patent drugs versus generic drugs. The problems go into such things as quantity as well as quality of the prescriptions, doctors spending time counselling their patients on how they might utilize methods other than going on prescriptions and a whole host of issues.
While the generic drug issue is something I personally support, as the minister well knows, I've run into a couple of issues where individual patients have not reacted in the same way to a specific generic that they have to a patented drug. I have sought permission to have those recognized by Pharmacare and have received that recognition for the patient.
In many cases, generic drugs do the job and do it well. For reasons beyond my understanding there seems to be the odd case where the generic drug -- perhaps because it may dissolve over a two-hour period rather than a 24-hour period or whatever the case may be -- may cause some reaction in the patient. In any case, my suggestion here is that just dealing with the generic drug issue is only a very small part of the overall cost of our Pharmacare problems. I would hope that we continue good, open dialogue to encourage getting all the effective players onside.
I think the biggest problem will be getting doctors to take the time to do the proper educational process on the patient; that's going to be the largest single challenge, in my view. Druggists seem to be reacting very positively towards trying to educate the person who brings in the prescription. Oftentimes they're caught between what the doctor has said and.... Immediately, they are in a fight with the patient, because they are trying to exercise economies that haven't been explained well enough to the patient by the doctor. I guess that's where I come from on the issue, and I'll let the minister comment.
[4:15]
Hon. P. Ramsey: The member raises a number of issues around the low-cost alternative program. Let me say first of all that the program has built into it a recognition that a special authority or an exemption to the rules is required at times. Where it can be demonstrated that there is a need, authorization to bill for and get reimbursement for a higher-priced alternative is granted. That's built into the program, and it has been from the start.
As the member knows, though, when we are talking about generic therapeutic drugs, the manufacturers are
[ Page 14632 ]
required to produce them to the specifications of the patent manufacturer. They can't skimp. That is the whole point of it. It has saved us millions and millions of dollars -- $17 million over the last year. I think that is good value, because we can then spend that money on more effective therapeutic drugs.
The member raises an issue around how long a prescription should run for. One of the things we announced at the same time as the low-cost alternative was the extension of the trial prescription program. We are not asking everybody to buy a 100- day supply immediately. They get a freely dispensed supply without paying another dispensing fee, so they can see whether the drug agrees with them.
With some of the extensions we are making in the PharmaNet program, we are actually going to be providing pharmacists with a dispensing fee when they do not dispense a drug, because they have been able to identify it as an inappropriate prescription, inappropriate for health and inappropriate for the outcome it will have on the patient. In all those areas, we are working with the wide range of folks who are involved in prescribing and using therapeutic drugs.
Finally, I want to say that I agree with the member that one of the major challenges we have here is working with the 7,000 or so physicians of the province, each of whom practises and prescribes independently, and helping them to understand what advances have been made in therapeutic drugs and what the scientific and medical community knows -- what best practice knows -- about the use of those drugs. We are working with the BCMA on a day's-supply committee to look at what the appropriate length of an initial or a continuing prescription could be, because we have heard this concern from pharmacists and from doctors.
One of the largest challenges of the therapeutics initiative, though, is to work with those individual practitioners and help educate them. I have heard repeatedly from doctors around this province that they value this sort of initiative. First, they feel they didn't get a lot of training in the use of pharmaceuticals during medical school -- it was an underresourced part of their training as physicians. Second, once out in practice, they found themselves too often relying for information on drugs from the manufacturers themselves, from those who are flogging or selling the drugs. They found it very hard to distinguish between a new drug on the market, which was actually a therapeutic advance over what had been there before, and one which is simply a different coloured tablet which would do essentially the same thing. That's where the therapeutics initiative comes in, and that's why it is so important to the long-term health of the Pharmacare program.
L. Fox: Just a few more questions around Pharmacare. I didn't realize we were going to be discussing this, so I left the file on it downstairs. As I recall, in a meeting through the agreement just signed by Pharmacare with the pharmacists not too long ago, there was a 6 percent increment allowed from the manufacturer to the wholesale level, and there was an 8 or 9 percent increment -- I'm not sure which -- from wholesale to delivery.
One of the concerns expressed to me by small independent drug stores not contained within a chain is that there seems to be a movement where eventually they are going to have to look at such things as.... Government was attempting to remove the middle person and get more direct pricing between the manufacturer and the pharmacy. Can the minister suggest to me that whatever pricing policy is put in place by Pharmacare, it would not give larger corporations an advantage over smaller independent drug stores in terms of the overall cost and selling price?
Hon. P. Ramsey: The whole issue of markups is one that, as you know, we have dealt with this year. The member may have seen a earlier version of our agreement with the B.C. Pharmacists' Society over this issue. The conclusion of those negotiations was to allow a flat 9 percent markup between wholesale and retail and that was it. We found that in many, many cases Pharmacare was getting billed for a price really in excess of that level of markup. We felt we didn't need to pay for that, nor should we.
I recognize what the member says as far as the small independents. That is why, at the same time we negotiated this markup plan, we have also enhanced what the member may know as the rural incentive program. It provides an economic lift for some of those very small pharmacies, including the one the member mentioned in Fraser Lake, who have real difficulties maintaining sufficient stock of enough different drugs to meet people's needs. We were cognizant of that and felt we could not continue to blink at what I think could best be called a kickback scheme that had arisen between wholesalers and retailers. We needed to establish some firm guidelines and principles for markup which would not disadvantage any aspect of the industry, at the same time recognizing that in the very low volume of pharmacies there was a very inherent disadvantage that we should enhance the RIP program to alleviate.
L. Fox: It may have helped if I had asked this question prior to asking the last one. Can the minister define for me what he perceives is a legitimate wholesale price?
Hon. P. Ramsey: I should share with the member opposite that as we try to poke into how distribution systems actually work for pharmacies, it has been a fascinating experience in some of the trickier convolutions of the market there.
What we've said is that from the time the price leaves the door of the guy who's manufacturing it to the time it hits the retailer, 9 percent has to do it. We're finding huge variations -- in some cases, charges of as much as 400 percent. Those charges were being borne by the Pharmacare program, and we felt that we should establish an essentially level playing field.
After negotiations with the pharmacy association and others, we have reached an agreement that that is an acceptable way to control this sort of market. There were indeed, as the member may know, wholesalers that were really owned by retailers, and you ended up with two or three levels of markup going on. This was not equitable to the final distributor of them, nor was it fair to the people of the province who were bearing the costs of these markups through their tax dollars.
L. Fox: Earlier the minister suggested that it was 9 percent over wholesale. In his statement now, he's saying it's as it leaves the manufacturers, so that is the manufacturer's price produced. He's suggesting then that it's 9 percent over what the manufacturer sells it for that the pharmacist gets paid for it.
[ Page 14633 ]
That would suggest to me that the distributor -- oftentimes there are distributors in the middle -- is essentially cut out. Or the smaller drugstore, which cannot buy enough volume to buy directly from manufacturers -- because oftentimes you have to buy a set volume to get shipped direct -- would pay a premium to buy it through a distributor. So they would get something less than 9 percent.
This is where I'm trying to iron out exactly how this is going to work. It appears to me, at least in our discussions here, that the smaller drugstore is going to be hurt substantially through this. Many of the bigger drugstores belong to a buying group or an association which buys their product for them, or their franchise stores buy the product for them, but the independents still have to buy their small quantities from distributors.
The minister is suggesting that the.... I forget what he called the program that was designed for smaller stores. He used Fraser Lake as an example. What kind of percentage does that give them to offset the extra costs that they might have to fit?
Hon. P. Ramsey: First, let me clarify. The markup is based on first the best available price from the manufacturer, plus 9 percent. That means that no distributor can charge more than 9 percent as he or she passes it on to the retailer. I would also note that the cost of that marked-up drug is paid for by Pharmacare.
I understand the member's concern that small pharmacies not be disadvantaged; I do not see this as a disadvantage to them. The only way in which it disadvantages them, hon. member, is that some of them may have lost some of the special financial arrangements around the edges which they may have had with particular distributors. Those special financial arrangements increased the cost of those drugs to the purchaser and to the Pharmacare program by, in some cases, as much as 400 percent of the manufacturer's price. While that may have been wonderful business for a small pharmacy, it was not acceptable to the Pharmacare program or to the taxpayers of the province.
[4:30]
L. Fox: Just one further question around that topic. I don't think a 400 percent profit is a reasonable profit. I'm a small business man, and I believe that small business should make a profit, but it should be reasonable, because ultimately, if it isn't Pharmacare, it's the consumer or the taxpayer who is paying. But in these buying groups or in these franchise stores, they often have a corporation which operates as a distributor only among its own franchise stores, and they're all shareholders in that particular distribution. Is the minister telling me that the member pharmacists or pharmacies -- whichever it is -- are not allowed now to share in the profits of that buying group?
Hon. P. Ramsey: No, we are not attempting to change any private business arrangements that might be made by a distribution service owned by pharmacies. We are saying very clearly that the maximum markup that we're prepared to pay is 9 percent over the manufacturer's best available price. I must say that the principle of the Pharmacare program has always been that the pharmacist makes his profit margin out of the fee being charged -- not of markup of product over cost. That has been the way the Pharmacare program has run, I believe, since its inception -- although the member for North Vancouver-Lonsdale is not here to confirm that, which I'm sure he would do in some detail. So that is the way it has worked.
What had happened -- and the member needs to know this -- was that excessive markups were being charged for some drugs. The pharmacists that then received those drugs would also receive a rebate from the distributor, and Pharmacare was paying both for the markup and for this inflated part. Call it a special arrangement; call it a kickback; call it what you will. What we said very clearly was: "Nine percent over manufacturer's best available price is it." We've struck a deal with the pharmacy association and the distributors that says this is acceptable. We believe that it will provide therapeutic drugs to the people of British Columbia through Pharmacare at an appropriate markup. We also believe that the profit and the incentive to pharmacists to participate in Pharmacare lies with the dispensing fee. That, too -- as the member probably knows -- was adjusted upward recently as a result of our agreement with the pharmacy association of B.C.
L. Fox: Can the minister tell me how you're going to determine the manufacturer's best available price?
Hon. P. Ramsey: The manufacturer's published list.
L. Fox: So then it would be possible -- and I'm going to put out a scenario here -- for a particular manufacturer to put on a special in an area and a buying group, because of its volume, can take advantage of that special. The minister earlier said "rebates and kickbacks," but if he recently bought a car or a TV or even a bar of soap, you send in the tag today, and you get a rebate. That's a marketing tool. No matter what package you pick up in the grocery store, there's something in it that gives you some form of rebate. We're presently in a rebate mentality, I guess, in terms of selling our product or using it as a sales tool.
My question is whether that kind of initiative is still available so a particular company may want -- for whatever reason, maybe an overstocking problem, who knows? -- to dispose of a substantial amount of product all of a sudden by way of special pricing or whatever. I'm not about to guess what their marketing tool might be. Is that still available to them, or is that going to be perceived by the ministry as some form of kickback or rebate, and unacceptable?
Hon. P. Ramsey: The member opposite and I could devise all sorts of marketing schemes here. What I need to refocus the debate on is what our concern was in reaching this agreement with the manufacturers and pharmacists of the province, and that was to make sure that the taxpayers of the province were not being charged excessively for markup on therapeutic drugs available through Pharmacare.
The program we have does that. I believe it captures well the intent to allow markup and the cost of distribution, but not to allow excessive markups or some markups that had been allowed only because part of the markup was coming back to the individual purchaser. I'm sure there are lots of things that may still happen within that 9 percent, but I believe we have captured the essence of it here to make sure it's a cost-effective program for the people of the province.
L. Fox: I have just a couple more questions, and I'll gladly turn it back to the Health critic for the official opposition.
[ Page 14634 ]
I believe then, as I heard the minister reading between the lines, that there would be some opportunity as long as they stayed under the 9 percent from their product list in terms of cost. If they decided all of a sudden, for whatever reason, that they needed to market a product into the pharmacies at a lower cost than that, they could use some inventive ways of trying to market their particular product. I think that's what the minister said, but maybe I'll let him confirm that.
Hon. P. Ramsey: I would suggest to the member opposite that we are understanding each other about what is allowed. What we are concerned with is paying actual acquisition costs. We're saying that if you're going through a distributor, it doesn't go up above 9 percent, and it also doesn't go above 9 percent over best available price from the manufacturer. If it's 7 percent, fine, we'll pay the 7 percent over the best available price. If it's 2 percent, fine, we'll pay 2 percent over the best available price. We're not interested in allowing some of the schemes that have gone on, as I say, and have resulted in excessive charges to the Pharmacare program.
L. Fox: I'm really trying to understand this. The minister told me earlier that he's going to take the best available price list produced by the manufacturer, add up to 9 percent, and that's going to be what Pharmacare will pay. As I understand it, it's going to be from a published price list; it's not going to be made on an invoice-by-invoice basis.
What I'm trying to get clear is that if I'm a pharmaceutical company, and for whatever reason -- maybe I have a cash flow problem, maybe an abundance of product, maybe it's becoming dated.... I'm not a scientist or a pharmacist, so I'm not sure what would be there. But I am a businessman, and I know that occasionally we have to have tools to market our product, particularly in those kinds of circumstances, in order to keep the rotation going, if for no other reason.... What I'm trying to determine is whether a pharmaceutical company will have that opportunity under this new pricing policy. I haven't been able to get that answer from the minister with any kind of certainty.
Hon. P. Ramsey: I'll be glad to make staff available so that you can discuss some of the ins and outs of this, but the short answer is no. What you are offering as a manufacturer and what you're marking up are what Pharmacare pays. If it's 2 percent, fine. If it's 9 percent, great. If it's more than 9, it's not allowed.
The other thing that is going on here, of course, is that Pharmacare pays a portion of drug costs in the province, but not all. We check on what is actually going on through invoice checks, so if there are special deals, we want to know about them.
Let's go back to basic principles. We found ourselves in a situation where there were markups of from 14 to 400 percent. We said very clearly that we would limit those markups. We will pay your actual acquisition cost if you're doing it direct; if you're going through a manufacturer or a distribution scheme, it's 9 percent. That's all there is, and let's not fool around too much with special benefits. If you want some more details on how it's monitored and so on, I would be glad to give you an opportunity to talk with staff.
L. Fox: Perhaps I will meet with staff, because I don't think the minister understands what I am trying to put forward. I'll try one more time; if I fail, I'll drop it and go on to another topic.
The minister agreed that they're going to pay up to 9 percent on the posted, best available price, period. That would be from the manufacturer's price list. They would develop a pricing index for the ministry and say: "There it is." I'm not suggesting at any point that the ministry should pay more than that. What I'm looking for is whether or not, if all of a sudden my purchasers or my.... If, for whatever reason, I bank a bunch of product and want to go to the pharmacies and say, "I'm overstocked and I'll give you a $750 rebate if you buy 15 cases of whatever," is that kind of marketing allowed? At the end of the day, is the ministry still going to pay according to the price that was originally identified?
[4:45]
Hon. P. Ramsey: If you are a pharmacist and you're purchasing product from a manufacturer through a distributor, the maximum we will pay you for the product is the best available price from the manufacturer plus 9 percent. If the manufacturer is offering a special deal -- say a 10 percent markdown -- we want that 10 percent markdown. Therefore we will charge 9 percent above whatever that base price is, and we will check the invoices to make sure we're getting it.
L. Fox: In other words, there's no longer an incentive for the business to bulk-buy or to explore any kinds of special arrangements to increase their profitability. As I understand the minister, they are going to have to produce invoices or proof of costs on all their requests. Or are you going to do it on a regular basis? How are you going to monitor that? That is a lot different than what was said earlier, when you said it was price list. Now we are talking about each invoice.
Hon. P. Ramsey: As we get into enforcement, I'm reluctant to get into too much detail here. I would be glad to have you consult with pharmacy staff on some of the measures we intend to take.
Let me say this, though. The pharmacist who's doing a bulk buy at a lower price clearly has an incentive, because he or she is able to pass on that lower price to his or her customers. Again, it's an incentive in the marketplace. What we are not interested in is paying for that incentive to the pharmacist and to the seller of drugs to the general public.
L. Fox: So now we get back, way back, to where we started, in that the larger organization that can bulk buy, and perhaps get a reduced price through bulk buying, then has the advantage over the smaller, independent drugstore in the respective community. That's something you said wasn't the case when we first started this, but it in fact will be the case if your answer to the last question was indeed correct.
Hon. P. Ramsey: I acknowledge that there is a potential incentive for the bulk buyer. I have also said that we are enhancing that rural incentive program to deal with the case of the very, very small retailer-pharmacist who may have difficulty acquiring the necessary range of drugs at a competitive price.
[ Page 14635 ]
L. Fox: I'll leave that. I will, at some point in the near future, get together with my old friend from Kitimat, and we'll discuss the ins and outs and the business practices of Pharmacare.
I want to ask a question around what hospitals will now pay for pharmaceutical supplies. That's probably covered under the acute care facilities, not under Pharmacare. It's my understanding that this ministry's get-tough position with the pharmaceutical companies ended up costing the ministry $30 million more last year through the acute care facilities for the same level of drugs. In other words, in the get-tough situation, the ministry was trying to achieve the same cost level that the acute care facilities were getting, because they were getting a special deal. And they were getting a special deal for many reasons. It ended up costing this ministry $30 million more in this year's budget because they said, "No, we can't do that," and they raised their costs by that amount of money.
[D. Schreck in the chair.]
Hon. P. Ramsey: We have no evidence or indication that there was any increase in therapeutic drug costs to hospitals at the magnitude the member suggests.
L. Reid: I want to touch on two other programs that the minister mentioned earlier; one is the trial prescription program. What was the budget to put that in place and how is the minister measuring the success of that program?
Hon. P. Ramsey: The real expansion of the program is going to take place this year. We are going from six drugs that are covered under the trial prescription program to 26. So it's too early to look at the effectiveness of spreading it out over a larger number of drugs.
Since the prescription program has been in place a number of years and so many other factors have come in, it's very difficult to measure its effectiveness. On the surface of it, it's hard to conceive of the trial prescription program being a detriment. I think the member knows the principle of it. You show up with a therapeutic drug prescription for a chronic condition, and you will be offered a trial prescription of up to 30 days so you can see whether the medication agrees with your system and whether you can take it without adverse side effects before going to a maximum day prescription of 100 days. That's the way it works.
My staff just informed me that in some cases we're looking at a shorter prescription period, say of seven to 10 days -- a "let's see." Clearly, any drug that's prescribed and not used is in one sense a waste of resources. The trial prescription program is designed to minimize that scenario. It won't catch them all, obviously, but it is a way of assisting that.
As for the large expansion, the cost of putting it in captures more than.... Let me phrase that again. We've been going two and a half hours now, and my mind's getting a little frayed. The savings were greater than the cost of putting it in, but only minimally. It looked like it was essentially budget-neutral in the last year. But that....
Interjection.
Hon. P. Ramsey: I don't remember the total cost of putting it in. I'll see if I can get that figure for you. Essentially it was cost-neutral. The cost of actually putting the trial prescription program in place and paying the additional dispensing fees was made up for by reduced overall cost of drugs. In that sense, it worked. We got the right drugs in the right place and we had less drug waste. We think that as we expand it from six to 26 drugs, we will achieve greater cost savings.
L. Reid: Again, the same two questions regarding the low-cost alternative program. What was the budget cost for that, and how is the minister measuring the success of that program?
Hon. P. Ramsey: The real costs of putting the program into place were the booklet, of course; working with the B.C. Pharmacists' Society to make sure the information got out there; some, but not a great deal, of additional staff time; and some modification, probably of the billing and software. The estimate is $100,000 for that work, and the cost savings in the first fiscal year of having the initiative in place is $17 million.
L. Reid: I thank the minister for his comments. The hon. member for Prince George-Omineca was in a discussion about the 9 percent cap. When the executive director of Pharmacare was quoted some months back in the fine Vancouver Sun about reference pricing, was that part of the discussion? And if indeed this ministry is putting up a trial balloon around reference pricing, what would the reference point be in reference pricing?
Hon. P. Ramsey: The reference point would be the lowest-cost, therapeutically effective drug for the condition being prescribed for.
L. Reid: To a cap of 9 percent.
Hon. P. Ramsey: I'm sorry, hon. member, and I'm sorry, hon. Chair. We're engaging in an activity which I know you proscribe.
An Hon. Member: He prescribes or....
Hon. P. Ramsey: Proscribes.
When we were speaking of the markup, what we were speaking of is the manufacturer's list price, which is published. If we find invoices submitted that have a lower price on it, then that becomes the reference price, and 9 percent is the markup above that.
L. Reid: I appreciate the minister's clarification on that point.
I want to spend a couple of minutes talking about the Institute of Pharmaco-Economics. I was delighted to receive the proposal out of Alberta, because I'm one of those strong believers that this is about partnership. I believe the partnership should include government, the academic community and, hopefully, legitimate practitioners and experts in the field. I think that makes good sense.
I don't see a lot of value in excluding the industry at this point. I think they do have a contribution to make. Reading through the proposal here, I think perhaps they're approach-
[ Page 14636 ]
ing this in a more sophisticated way than we are currently doing in British Columbia. I hope that we would see our mandate expanding somewhat to look at how best to reach best practice. That is indeed what all these agencies and entities are hoping to achieve.
The mandate statement is not dramatically different across the country -- no matter what province you look at -- in terms of pharmacy budgets and how best to decide where to spend those dollars and how to establish some of those priorities. The fact is that this one comes as a partnership: the University of Alberta, the University of Calgary, Alberta Economic Development and Tourism, Alberta Health, Alberta Heritage Foundation for Medical Research and the Department of Western Economic Diversification. They're seeing it as being an overlapping issue, where all these areas of government have a role to play. They're trying to move, I think, away from this stovepipe discussion that you and I have had many, many times in terms of how it's not appropriate just to move the spending from one column in the ledger to another, and how it's more appropriate to get a handle on the spending, on what the overall package looks like.
They are trying very, very diligently to make some of those kinds of decisions. I think their decision-making -- the calibre of how they reach those decisions -- should be a goal for British Columbia. Again, this is at the proposal stage. They've done some very good things. They report out very differently and in more timely ways. They provide more information to individuals who ask for information than our current therapeutics initiative. That kind of intense, ongoing dialogue warms my heart. I think it's really important that you can get information out of an agency such as this -- frankly, that is not forthcoming today from our therapeutics initiative. I would see our therapeutics initiative as one rung on the ladder. I would ask the minister to comment on this particular creation, because I think this is indeed a useful direction.
Hon. P. Ramsey: I certainly would agree with the member that different provinces can learn from each other as they look at how best to approach this. I must say, though, that my understanding is that under the Alberta model, the industry representative chairs the committee that decides what products are going to be reviewed. I would ask the member whether she finds that an appropriate way of dealing with this very delicate balance of assessing new therapeutic drugs without involving one proponent or another's economic interest.
[5:00]
We may criticize the therapeutics initiative as it is in its infancy. I believe that it's doing good work and will be doing more good work. It's recently contracted with a Dr. Aslam Anis, one of Canada's leading pharmaco-economists, who has been writing the national guidelines on how we go about doing evaluation of economic benefit of therapeutic drugs, working with the department of epidemiology at UBC. He's very much a leader in his field, and he's going to be one of the people involved with the therapeutics initiative to make sure that we have the right structure in place.
I must say again that I think we need the involvement of the industry. Clearly, the therapeutics initiative or any assessment of the economic benefit of particular therapeutics needs their input. I submit it is inappropriate to put them in positions where economic self-interest can conflict with scientific decision-making.
L. Reid: Perhaps I will just define what these individuals have suggested as a pharmaco-economic position. They will tell you that pharmaco-economics evaluates the costs and benefits of drug therapy from the multiple perspectives of the patients, drug insurance budgets, health care providers, provincial or regional health departments and society at large. The analysis involves many disciplines and requires extensive collaboration among investigators in pharmacology, ethics, epidemiology, health, economics, bio-statistics, pharmacy, medicine and a variety of other areas.
I don't see any downside to that, hon. minister. I think that is the larger vision in terms of having a need for measurement. I think that's where we need to be headed in British Columbia. Again, I will submit that I believe where we are in terms of the therapeutics initiative is one rung on the ladder. I think the bigger picture is where we need to focus our energies.
[J. Beattie in the chair.]
I'm not suggesting that every province needs a pharmaco-economics institute. I am suggesting to you that the vision is that such an institute could serve more than one province. To have an institute that serves western Canada, or perhaps looks at packaging differently, would be something that I would be interested in having an ongoing dialogue on. I would ask the minister to comment. Has there been discussion in terms of having an institute serve more than one province? I think the value of this expertise is something we should applaud and, hopefully, bring in-house into British Columbia.
Hon. P. Ramsey: Yes, we are involved in discussions with some other provincial governments and with the federal government about establishment of a national institute of this sort. We explored opportunities for some joint work with the Alberta model that the member refers to and found that some parts of it gave us some discomfort. We decided to seek a more national perspective and consensus on the whole issue of balancing access to therapeutic drugs with the economic benefits or economic costs.
L. Reid: The pharmaceutical program at the UBC risk studies institute is also a document I will touch on this afternoon. I, too, believe that they fill another void in what is currently underway in British Columbia. I think that if we truly want to work towards evidence-based pharmaceutical policy, and that seems to be the goal, we don't have the methodology in place yet, in my opinion. We're not putting the building blocks in place. If that is the goal, and we have not, up to this point, disagreed on the goal, then perhaps we should look at how other folks have decided to proceed and select the best items from each of the three methodologies we've touched on this afternoon. I'm not prepared to compare the therapeutics initiative and suggest it can stand alone. Again, I will suggest that it is one rung on the ladder.
I think some of these other programs can offer some very, very useful information to the taxpayer, which has to be a goal of any government: to return a reasonable product with some kind of reasonable measurement of success. I appreciate, from the minister's comments, that we're not in a position, for a number of reasons, to evaluate a lot of what is ongoing around Pharmacare. I appreciate fully the minister's comments about
[ Page 14637 ]
a ten-year longitudinal study. I believe the taxpayer deserves an answer year one, year two, year three, and if there's any way that any of these agencies can provide that information or at least assist us in how best to acquire that information, I believe it's worth looking at. Again, in the interests of not closing any doors, I would suggest that this has some reasonable benefit. I would certainly encourage the minister to examine it in some detail if he has not already had the opportunity, because I do believe this is about outcomes research. The fact that these folks are structuring some different proposals to take a look at it makes perfect sense to me. What we're talking about is combining drug therapy with outcomes -- including therapeutic gain, a change in quality of life, and an increase or decrease in the risk of adverse effects or adverse events.
That's basically the Sun news coverage of the previous few days. It was in yesterday's paper about dementia; it was about adverse drug utilization. All of those issues tie directly to this mandate statement: how do we ensure that people are taking drugs appropriately, and how do we measure that? These three agencies I mentioned this afternoon talk a great deal about dementia and talk about inappropriate hospital admissions and how best to get at that type of measurement. The therapeutics initiative is not going to provide us with all the information we could use. It simply is not structured to do that; that's well beyond its mandate statement. If there are ways for us to pull in other useful information, I think it's absolutely appropriate that we do that.
Traditionally, pharmaco-epidemiology has focused on post-marketing drug surveillance -- that is, measuring the performance of a drug in everyday medical practice to evaluate risks that cannot be determined from clinical trials alone. That was the point I attempted to make many times earlier about having not just expert academics but expert practitioners at the table. You cannot glean all the necessary information you need simply from reading clinical trial studies. It simply does not work that way. For us to expand our horizons and look at what else might be available -- I would encourage the minister to do so, because this is about what the total cost to the health care system truly is. That's the issue for all of us today.
When the minister rose earlier and said that we have some common ground, I believe we do. But I would like, in conclusion of today's debate, some comment on where this minister might go and whether he sees this as one of the useful vehicles around measurement in cost in Pharmacare.
Hon. P. Ramsey: The risk institute at UBC is, at this stage, a proposal, not an operating organization. We've already indicated to them that we may be interested in contracting with them on some pharmaco-epidemiological studies if we see the need and they demonstrate that they have a sound proposal to carry through on. So we're not closing the door to them. But let me again state the challenge we face: to make sure that those who are deciding which therapeutics are covered by Pharmacare and which are not are looking at the evidence of effectiveness rather than recommendations that may be tainted by self-interest.
Let me finally say -- and let me just say it as clearly as I can -- that I'm not saying at all that clinical practitioners don't need their say in the works of the therapeutics initiative. They have that, and they will continue to have that. The therapeutics initiative will be taking steps to make sure they have an expanded role in that. But I would again say: let's be very careful about evidence that may be at times anecdotal from the work of an individual practitioner -- as opposed to research that has studied, as carefully as it can, either clinical trials or long-term use of therapeutic drugs. While it's very good to involve practitioners, anecdotal evidence of an individual practitioner without the basis of actual long-term epidemiological studies is limited.
L. Reid: The minister has to know, after all these hours of debate, that I am simply not interested in anecdotal reporting. The entire contention of this debate has been about whether this ministry and this minister can provide any useful data -- anything that provides some opportunity for measurement. What I'm suggesting is that it makes perfect sense to have all the players at the table. I'm not going to ever get into a debate with this minister about who should be excluded, because that's not where we're coming from. It's important to invite people who have that kind of expert knowledge -- invite them to the table as opposed to ranking them on what you perceive to be their self-interest. I don't think that's fair or valid or terribly visionary. I think, if they've got something to say, we should invite them to the table and ask them to give that information.
In terms of when I next return to the debate, I'll be coming back on strategic programs, and my colleague is going to touch on emergency health services. I thank the minister for his comments.
K. Jones: I was just giving the minister an opportunity to respond to that very eloquent....
The Chair: Excuse me, hon. member. Would you just wait till you're introduced and I find your name here?
K. Jones: Surrey-Cloverdale.
The Chair: The hon. member for Surrey-Cloverdale.
K. Jones: I just want to give the minister an opportunity to respond to the eloquent summation by my colleague from Richmond East. I must congratulate her for the fine job she has been doing here today. It's been quite interesting to see how she's going through this part of the estimates and doing a very, very fine job. She unfortunately has another appointment right now, so she asked me to take my turn with you.
Hon. minister, I'd like to look at the ambulance services and ask you: what is the philosophy that is going on at the present time in regard to changes being made to the staffing of the ambulance services in the lower mainland?
Hon. P. Ramsey: If the member wishes to elaborate, then maybe I can answer. I just asked staff, and they're unaware of any reconfiguration of staffing for ambulance centres in the lower mainland.
K. Jones: I'm surprised that the minister doesn't seem to be aware of changes that are occurring. There was, I think, a press release put out that indicated the minister was increasing some staff in the north Langley area to establish a full-scale facility at Walnut Grove. There are other changes that I think the minister is fully aware of. Perhaps he'd like to give us an idea as to why and tell us what the rationale behind these changes is.
[ Page 14638 ]
Hon. P. Ramsey: I had assumed that the member opposite was speaking about a general policy for staffing on the lower mainland, not a constituency issue in Cloverdale. As we discussed earlier and as I told him I'd get back to him on, there have been.... The member did express some concerns regarding a change in ambulance staffing levels in Cloverdale.
There have been some minor alterations in the distribution of ambulances in the Surrey and Langley areas due to increasing call volumes in the industrial area of north Surrey. The effect on the Cloverdale area has been a consolidation of part-time callout units into a response vehicle staffed by full-time crews. That's been a change in staffing, I guess. The consolidation of part-time into full-time crews should result in faster response times and an excellent level of emergency care for folks in the Cloverdale area. The other part-time unit which was stationed in Cloverdale has been changed to a full-time unit and is now stationed in north Langley.
K. Jones: Could the minister tell us what he's talking about with regard to the part-time crew becoming a full-time crew in Cloverdale? How is that creating a greater efficiency?
Hon. P. Ramsey: The member opposite may know that there are some 800 full-time ambulance attendants employed by the B.C. Ambulance Service and that 2,400 are employed on a part-time basis. When there's sufficient volume of callout, part-time positions are converted to full-time positions. This provides full-time employment for attendants, rather than callout income, which is based on a minimum of four hours of pay per callout. Having full-time staff means that they are stationed in the centre for shifts. There's no need for attendants to be called from home or by pager. In most parts of the province full-time crews are able to respond faster than part-time crews.
[5:15]
K. Jones: Could the minister tell us how these part-time crew operations are manned? How are their hours allocated in a station?
Hon. P. Ramsey: Part-time attendants who are rostering for a particular station have a way of doing that which is worked out with the union and the ambulance service. It's rather complex, but essentially, they bid on roster positions and are placed in those roster positions, depending on a variety of factors.
K. Jones: Could the minister tell us what a roster is?
Hon. P. Ramsey: A list of paramedics available for duty at a particular time.
K. Jones: I'm just trying to understand the process, hon. minister. You have a list of people, and they are called out from their homes whenever there's a call? Is that how it is working?
Hon. P. Ramsey: The location is at the option of the part-time staffer. Some of them choose to spend time at the ambulance station; others choose to be at home and available by pager within a particular period of time.
K. Jones: If they are not at the station, and I understand most of them are, what is the minimum time that they have to be able to get there?
Hon. P. Ramsey: They have to be available at the station, ready to go, within seven minutes of receiving the call.
K. Jones: With regard to the Cloverdale area, could the minister tell us what the new staffing configuration will be as a result of this change?
Hon. P. Ramsey: I will have staff get the number of full-time and part-time paramedics that operate out of the Cloverdale station for the member. The number of full-time staff is more than two, so it's more than one shift. We'll ascertain whether it's four, six -- or how many are available.
K. Jones: Could the minister give us both the current situation and the staffing situation that would be there after the changes have been made? Could he also give us the same figures for Langley? Could he give us the figures for the Guildford and White Rock stations, and also -- I was just waiting for him to get that all written down -- for his staff. Could he also provide us today with the function of what is called a Kilo car?
Hon. P. Ramsey: I'll be pleased to provide that information to the member opposite. A Kilo car is a car available for callout, staffed by part-time attendants.
K. Jones: Could the minister give us an indication of the types of functions that the Kilo car does in its routine daily activities?
Hon. P. Ramsey: There's no difference in function between a Kilo car and a unit staffed by full-time attendants.
K. Jones: So the minister is saying that transfers from hospital to hospital, transfers from hospital to home or to a special treatment or lab facility are done by all cars equally. There are not some used more than others.
Hon. P. Ramsey: Yes, they can perform all those functions. The actual volume of different kinds of business allocated to full-time versus part-time cars depends on the need of the particular area and the availability of full-time staff.
K. Jones: Could the minister tell us whether the staff on the Kilo cars are equally as qualified as those on the full-time cars?
Hon. P. Ramsey: First, let's make clear that all the attendants are qualified for the duties they are asked to carry out. The staff in the Kilo car is a mix of EMA 1 and EMA 2. Full-time attendants staffing the full-time vehicle are generally EMA 2; some of the part-timers riding with them may be EMA 1.
K. Jones: Would the full-time car also have the EMA 3s? In many cases they would have the EMA 3s rather than the EMA 1s. Would you send an EMA 3 on a transfer -- unless it was a very critical transfer -- or would you send a Kilo car with an EMA 1 or an EMA 2?
Hon. P. Ramsey: Some of the people riding -- full-time attendants -- have achieved ALS -- advanced life-support training. The callout and the staffing of the car depends on the
[ Page 14639 ]
needs of the patient when a transfer is involved. It could involve a paramedic with ALS certification; it could only require somebody with EMA 1.
K. Jones: The minister is saying that it doesn't really matter. You'll be taking whatever car is sitting there, and if there are two -- if there's a Kilo car, a part-time car, and a regular full-time car -- you may end up taking the full-time car rather than calling out and paying a callout for the Kilo car. Is that correct -- for a transfer?
Hon. P. Ramsey: We'll make sure the patient is riding in an ambulance that is staffed by paramedics with the necessary level of training to meet his or her needs.
K. Jones: I don't think the minister heard my question, because he didn't answer the question. The question was: would you send out a Kilo car to do a transfer that was suitable for the Kilo car, if it meant that you were going to have to constitute a callout when you had the main full-time car sitting there waiting?
Hon. P. Ramsey: We would use the full-time car that's available.
K. Jones: That's what I thought would be the case. And if that's the case, then moving the Kilo car from that station means that there is no backup at that station, because you've taken the full-time car out on a transfer. Therefore you have no primary emergency facilities within eight to ten miles of Cloverdale. Is that correct?
Hon. P. Ramsey: I think we've finally figured out where the member opposite is going with his rather abstruse line of questioning.
The main transfer car that serves the Langley-Cloverdale area is stationed in North Langley. That would be the primary vehicle used for transportation. I hope the member is served well by his line of questioning here and he gets a mailer out of it.
Interjection.
The Chair: Hon. member, could we keep our comments to the Chair, please.
K. Jones: That's what I was asking. Did the member want to speak?
The Chair: Excuse me, hon. member. I'll recognize you. The hon. member continues.
K. Jones: Thank you, hon. Chair. Perhaps the member from North Vancouver wanted to speak on the subject. He seems to be having a lot to say. Do you want to...? Help yourself.
There appears to be a plan, for some reason, to downgrade the amount of service in the city of Langley and the town centre of Cloverdale. These are areas that have very high population centres and a lot of young families. They are quite a distance from any adjoining station, and that is particularly critical at rush hour, when heavy traffic prevents the movement of vehicles to provide service. Could the minister explain why his staff are making a decision to downgrade Cloverdale and the city centre of Langley at this time?
Hon. P. Ramsey: There's no plan to downgrade service for the residents of Cloverdale. What we have done is add up the number of part-time callouts there and convert them to full-time staff in order to deliver the services more effectively and efficiently. It's a shame that the member opposite doesn't want to see effective and cost-efficient delivery of service.
D. Schreck: In several provinces across the country, an approach to dealing with the public service has been implemented, which calls for forced holidays, time off without pay, reduction in service hours and, in some cases, pay rollbacks. I think all members are aware that recently the Leader of the Opposition advocated a similar policy in question period and to the news media in this Legislature. Has the minister looked at what it would do...?
K. Jones: Perhaps you should speak about your own leader and not worry about the Leader of the Opposition.
The Chair: Excuse me. Would you please take your seat.
Hon. member for Delta South, I think that gesture was completely uncalled for. I would appreciate it if you would try to control your urges.
K. Jones: So is the statement....
The Chair: Hon. member, please sit down. The member for Delta South rises on a point of order?
[5:30]
F. Gingell: I don't know whether it's a point of order. I think after what you said to me, Mr. Chairman, I should have an opportunity to respond. I think that the member for North Vancouver-Lonsdale came here intentionally to create moments of tension. I think it would be a great disappointment and a great pity if we disappointed him by not responding to his bait. This is not a series of questions about statements made....
The Chair: Excuse me, hon. member. This is not a point of order.
F. Gingell: This is not a series of questions about statements made by the Leader of the Opposition, they're questions to the Minister of Health.
The Chair: Please take your seat, hon. member. A point of order is certainly not to do with whether or not the member creates tension in the House. Tension is created all around on different issues. I think there are borders which some people cross over, and I think throwing paper across the room is definitely a border that should not be stepped over. I'd ask the member for North Vancouver-Lonsdale to make his point, directed to the Minister of Health, please.
D. Schreck: I can understand why the members would be sensitive about the anxiety they have created in the public sector throughout the province. Health care workers in North Vancouver approached me....
[ Page 14640 ]
K. Jones: Only the lies that you've made.
The Chair: Excuse me, hon. member. Would you please sit down. The hon. member for Surrey-Cloverdale made what I think could be taken as quite an unparliamentary remark. I would hope that he has no intention of impugning the motives of the member. If he does, I would ask him to withdraw the statement he just made.
K. Jones: I will withdraw the statement at this time.
The Chair: Thank you very much, hon. member. Please continue, member for North Vancouver-Lonsdale.
D. Schreck: What we are discussing is the problems in staffing, how one goes about staffing. I find it particularly troublesome to on the one hand hear calls for forced pay reductions and forced holidays without pay -- in other words, service reductions by reducing the number of staff -- while at the same time lobbying for increased service for their particular areas.
I spent part of the weekend dealing with health care workers in North Vancouver-Lonsdale who are suffering from major anxiety as a result of statements made by the Leader of the Official Opposition with respect to advocating such policies -- a repetition, quite frankly, of what we saw in this province in 1983.
I recognize that we've gone slightly past the normal adjournment time, but my constituents are concerned about this level of anxiety that's being raised when one talks about replicating what this province saw in 1983 and what's going on in the rest of the province. I know that the Minister of Finance was questioned recently in question period with respect to alternative hypothetical plans for dealing with staffing levels. I'd like to know whether this minister has considered what impact we would have on the ambulance service or any other service were we to implement forced service reductions.
Hon. P. Ramsey: One of the things that has distinguished the work of this ministry with its staff over the last term of this government has been respecting care providers. It's one of the primary principles that has been enshrined in the health reforms that we announced after the Seaton royal commission delivered its report. That's been evidenced in the health accord, on which both opposition parties have cast aspersions, saying we simply ought to dismiss and reduce staff without any regard for careers and the individual wishes of the people involved in them.
It's similar in the Ambulance Service. We recently reached a new collective agreement with the union that represents the paramedics of this province. Part of that agreement was an undertaking by both sides to look collaboratively at how the resources of the Ambulance Services could be used to effectively deliver emergency health services to people of the province, and whether changes in staffing levels in a particular location might be a wise thing to do -- whether to maintain the level of service or do it at a lower cost. That, I submit, is a far different approach from simply saying: " We need fewer of you." That approach assumes that somehow this can be done without regard for the people who have served this province well in delivery of health services.
We have no plans to diminish the amount of service provided by the ambulance attendants in the province, and we will work with them to make adjustments to staffing levels at individual stations where it is necessary.
Having said that, I note the time and move that the committee rise, report progress and ask leave to sit again.
Motion approved.
The committee rose at 5:36 p.m.
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