[ Page 2035 ]

The House resumed at 6:42 p.m.

[The Speaker in the chair.]

Hon. M. Sihota: I call Committee of Supply. For members' information, in this chamber we'll be dealing with the estimates of the office of the Premier and in Committee A, the estimates of the Ministry of Health and Ministry Responsible for Seniors.

The House in Committee of Supply B; G. Brewin in the chair.

J. van Dongen: I just have a few questions for the Premier, mainly to do with the comprehensive review of government programs that was talked about in the budget speech, I think, and possibly in the throne speech. I'm wondering what types of programs are being reviewed. Could the Premier comment on that?

[6:45]

Hon. G. Clark: I guess that is a more appropriate question for the Minister of Finance, but essentially the correct answer is that all programs are being reviewed. I don't want to alarm people, because many worthwhile programs will, of course, continue in their current form. But I think it's appropriate in any exercise like this that all programs be subject to a kind of zero-based budgeting, where they are forced to justify their existence, to look to see if they can find some savings and to question, in fact, whether that program should exist at all. I think from time to time it's important to do that, and we're doing that with every program.

J. van Dongen: The reason I was asking the Premier is that if I recall correctly, this review is being coordinated through the cabinet policy and communications secretariat. Is that program being coordinated through that unit?

Hon. G. Clark: No, that's not correct. The program review is being done by the Ministry of Finance and Treasury Board of the Ministry of Finance. The CPCS, which reports to me, is of course going to be involved at a high level. It will be involved in sort of reviewing any major program reviews which come through the ranks to make sure they fit with governmentwide programs and to ensure that when cabinet makes its deliberations, it is armed with all the facts regarding the various programs we are trying to review.

J. van Dongen: If I understand correctly, then, Treasury Board and the Ministry of Finance will coordinate with the deputy ministers, the ministers and the deputy ministers' council to get it through every ministry.

Hon. G. Clark: Actually, that's correct, yes.

J. van Dongen: Are there any specific targets established in terms of this initiative, in terms of savings or other objectives?

Hon. G. Clark: There will be, and that's the Minister of Finance's job. Just to put it in context, every year the Minister of Finance -- at least that's the way it's been done, and this minister may or may not choose to do this the same way -- gives every ministry a target budget and a range of target budgets, which would be maybe 90 percent of last year's budget, up to possibly 110 percent, or some range. That happens every fall. In that context, there will be targets set over the course of the next few months. There will be some target savings to be achieved through the program evaluation, but I don't believe that is there yet.

J. van Dongen: The Premier talks about the budget process, which takes place, as I gather, every fall. I want to know if there is any specific target with respect to this program being established that is separate and apart from the normal budgetary process for the ministries.

Hon. G. Clark: I don't think they are separate and distinct from the normal process. In the normal process, you're really looking at the margin.

Let's say -- excuse my analogy, which is not entirely correct, but for the sake of illustration -- the Minister of Finance puts out targets for next year's budget, say to the Ministry of Employment and Investment. It was probably the same when the member for Peace River South was a cabinet minister. The targets would be 90 percent, 95 percent, 100 percent, 105 percent. Let's assume the Minister of Finance, then, decides in the budget process that that minister is going to get 90 percent. That may be the case. That's an easy way to save 10 percent -- not necessarily easy, but you could do that.

Here is the difference in the program review. That 90 percent ends up not being reviewed in the normal budgetary process because you end up looking at the margin, if you will -- the programs up for vulnerability. So it is appropriate from time to time -- not every year, frankly, as it would be expensive and cumbersome to do so -- to go back in and look at all of the programs, all that make up even that 90 percent, for a full and independent re-evaluation to see whether these programs meet their original objectives, whether the objectives are valid today, whether the program is the most cost-effective, whether there are alternatives to it, whether we need that program at all -- those kinds of questions.

There is the ongoing budgetary process, which is tough: there's a lot of due diligence and Treasury Board examines it. The program review is related to that, but it is to review all programs from a zero-based-budgeting perspective to see if we can, frankly, find a larger savings or bigger changes that might take place.

J. van Dongen: I guess I'm asking these questions because I had the sense from reading the budget speech or throne speech that this was a distinct and separate program. I think the way the Premier has explained it, to some degree it is. It sounds like it's something incremental to the normal budget process. Are there any incentives or bonuses to ministries or ministers to encourage them to find actual savings or candidates for savings? Is there any sort of incentive plan built in with this for the civil servants and the ministers in the various ministries?

[7:00]

Hon. G. Clark: No, there isn't, but maybe there should be. Actually, Ralph Klein in Canada is pioneering the notion that there might be a structure of bonuses, rewards and penal-

[ Page 2036 ]

ties in the public service to try to do precisely that. In principle, I think it's worth exploring, but we haven't done it. I guess the glib answer would be that if they find savings, they'll be promoted, but there isn't any structure of bonuses or private sector-like incentives for civil servants. We expect them to act professionally and to deliver the savings that we demand and to try to find them in a way which meets with our values and our goals.

J. van Dongen: I wasn't necessarily suggesting that bonuses are the be-all and the end-all because.... I heard recently with respect to B.C. Hydro that executives there have pretty significant bonuses coming to them if they maintain spending in certain areas, etc. The comment was put to me that sometimes that kind of a plan can have negative impacts. I think bonus schemes and incentives are good to look at, but they need to be looked at very carefully, and I don't know enough about the Hydro comment to question the Premier further, so he's okay on that.

I want to ask one final question in this area. In terms of this comprehensive review that's being done -- again, I viewed it as some kind of a special program as opposed to an ongoing thing -- will there by any time frame on this effort? Is it part of the annual budget process? Will there be any kind of specific report to the Legislature on that initiative?

Hon. G. Clark: To answer the last question first, there won't. We don't anticipate any report coming to the Legislature on the program review -- any omnibus report -- but believe me, the results of the program review will be a matter of a lot of public debate and debate in this chamber. Actions flowing out of that could perhaps be significant.

I think it's fair to say that it is incremental to the current budget process. Perhaps it shouldn't be, but in terms of effectiveness and cost-effectiveness, there isn't a review every year right from zero-based in every program. That's really what we're doing.

Is it time-limited? Yes and no. Yes, in the sense that we expect it to be complete so that we can have an informed decision into the budget for next year. Those would be the major items, if we're reviewing it, for input into the budget-making process this year. The "no" part of that is that increasingly we have to be constantly looking at major program reviews in the foreseeable future, given that we are in an era of declining government revenue at the provincial level and given the federal cuts -- if for no other reason.

We expect the major review of all programs to be completed this fiscal year, so it can inform our decisions on the budget. There will be announcements about that. Then I hope and expect that there will be an ongoing program review and evaluation of major programs and base budgets -- probably at a reduced level, but over a long period of time. In a sense, it's not a public exercise to report to the Legislature, other than through the normal course of debate in the Legislature, but rather a good government initiative to inform cabinet and government on how we might effect savings or deliver programs in a more cost-effective fashion.

J. van Dongen: In his response, the Premier suggested that some of the results of this review may be debated in the Legislature. I wonder, then, does he expect that there could be some significant policy or legislative changes. Is the review that comprehensive that it could result in those sorts of impacts? I don't have any problem if it does. I'm just curious if that's how comprehensive it is.

Hon. G. Clark: Yes.

J. van Dongen: Yesterday, I noted the Premier's response to the member for Surrey-White Rock in the discussion of the possibility of raiding Forest Renewal funds to help meet budgetary targets. The Premier talked about a commitment to structural change in the way government is delivered to the B.C. public. Does the Premier see this comprehensive review as a significant element in that structural change in the way government is delivered?

Hon. G. Clark: Pardon? Sorry.

J. van Dongen: The question is.... Yesterday, in response to the member for Surrey-White Rock, in a discussion about forest renewal funds and the possibility of having to tap that fund to meet budgetary targets, the Premier, as I recall, made a commitment to a structural change in government as a way to meet budget targets. I'm just wondering if he views this comprehensive review that we've talked about as a significant element in that change.

Hon. G. Clark: Yes, I do. If you want a bit of elaboration, the challenge for government is that revenue is, in general, growing slower than costs. There are a variety of reasons for that. Part of it is that the elasticity or the amount of revenue growth is not as cyclical as it used to be. In other words, when there was a recovery in the economy, government revenues went up dramatically. People went to work -- by and large at good jobs. When there was a recession, they were laid off and the revenue went down. Increasingly, through a combination of fixed fees and fixed taxes and trying to ensure a steady flow of revenue, and because of the growing service sector, which is less taxed, and for a whole bunch of other reasons, government revenue does not flow up and down as much as it used to. It is, in fact, kind of flat. It does go up with a recovery and down with a recession, but not nearly as much as it used to.

On the other hand, costs are rising inexorably in government. There are a couple of reasons for that in Canada. The most important is that the three major demand-driven programs are health care, education, and welfare -- social services. You have a right in this country to free education for your child when they turn five years old. You have a right in this country to get service for free if you're sick. You have a right in this country to welfare if you're poor. Those are statutory obligations passed by this Legislature. They're actual rights that citizens have by virtue of being Canadian. Now, those are all a matter of debate in the next decade, it seems to me, as we deal with these issues, but that's what we find ourselves with. By the way, they're not a matter of debate for me; I support those initiatives, and as long as I'm the Premier, I hope to try to protect them.

Having said that, if you have 2 percent more people in B.C. and a 2 percent inflation rate, for example, then you generally have an increase in costs of 4 percent. If you have an aging population, then you have a further cost pressure on the health care system. So many people in the health care field, or the education field or in welfare -- particularly those in education and health care -- would say that to maintain our current system, we need, say, 4 percent -- or whatever the number is for population and inflation. Revenue is not growing by the same kind of mechanical increase, so we have a kind of structural imbalance in the country which governments across the country are struggling with.

If you're going to effect long-run change, you have to look at structural changes to costs of government which take 

[ Page 2037 ]

some of those costs out of the system permanently. It's not easy to do. They are big challenges for government, and in many cases, we haven't done them. I'm simply saying that what we are looking at are structural changes we can change to find some permanent cost-savings that will impact on the structural imbalance between costs and revenue. The program review is a major part of looking at the structure of government and the way government operates, to see if we can effect structural change and save money but stay true to the values and the rights I just enunciated.

J. van Dongen: I was interested in the Premier's comments on the cycles in revenue flattening out, and I want to pose a question to him. Isn't part of the problem also that the taxpayers have reached their limit in terms of taxation, either increases in existing taxes or new taxes? Isn't that also part of the problem we face in maintenance of government in the next ten years?

Hon. G. Clark: I apologize. I'm not sure whether the member said.... What we're finding is that because tax revenue doesn't rise the way it used to with a rebounding economy because of the changing nature and structure of the economy and all the factors I've barely touched on here today, governments then raise taxes to get the increase. What has happened across the country and in British Columbia is that governments like mine have said: "We're sorry. We're not going to do that any more." We can't raise taxes every year to make up for that structural imbalance, and so my government has taken out of the equation in British Columbia the option of simply raising taxes to rectify the imbalance. Whether we like it or not, that means we have to look at the expenditures of government to effect the savings we need to bring about structural balance, and that's what we're doing.

J. van Dongen: I'm pleased that the Premier is looking at the cost side in his government. We were talking about the willingness of citizens to cough up more taxes, and it reminds me of a tax that was put in place, or increased, with respect to the sale of automobiles a few years ago by the previous government, when this Premier was the Minister of Finance. It certainly didn't produce the kinds of revenues that it might have because of the reaction of the public. I'm pleased that the government is looking at the cost side in an effort to try to maintain services.

I want to ask a few questions about the Crown Corporations Committee, which was announced in the throne speech. Maybe I will start out by asking the Premier to tell us what the government had in mind when it made the announcement in the throne speech in terms of the Crown Corporations Committee.

Hon. G. Clark: The Crown Corporations Committee is, in a sense, an innovation of parliamentary reform that I want to give a shot at and see if we can't bring some more accountability and openness to some of the issues around Crown corporations. One of the challenges, and this may be the member's question, is that, having made the commitment and struck the committee, what, then, does the committee do to effect that?

A related issue is how much committee work we can do in what I hope is a new era of MLAs of all parties working on issues. It quickly became apparent to me that three or maybe four committees is the maximum. By the way, I think one is the maximum we've ever had in the history of the province, so three, maybe four, committees might be the maximum that we could utilize off-session, at least right now. You can take this up with your leader, but I presented some options about what we might do in the spirit of cooperation to see where we could move with this.

One was the Aboriginal Affairs Committee, which everybody agrees with and I think has great promise. Second was the committee to deal with conflict of interest, which is to look not just at replacement but at the whole act and how it's working and revisions of that. Now, thanks for the member for Peace River South, it is also to look at a replacement. It doesn't appear that he's happy yet, but that was the intent. The third, and I think all members agree, is the Gove committee review -- looking at that issue. So we're up to three, which consumes virtually all of the backbenchers of the government.

Then, having said that, I still said: "Look, we have some other committees which maybe we can try to fit in." One of them is the Public Accounts Committee, which, for the first time in history, sat off-session last year at my request, and I didn't want to back away from that. Not to betray any confidences or negotiate on the floor, but I really said: "Which one can we have sit? We have Crown Corporations, and we have Public Accounts." I think where we're at -- and the House leaders are discussing this -- is that we're probably going to have Public Accounts sit a few time, we're going to have the Gove committee sit, the Aboriginal Affairs Committee, conflict of interest, and I think there might actually be some other brief one.

So I think for this session the Crown Corporations Committee is not going to have the work which I envisaged it to do. Now let me try to give the member some comfort. What I think we have to do is look at reducing the size of the committees so more can meet. Because this is a recent commitment on my part, it now gives us a chance to work on a bit more task-orientation for the Crown Corporations Committee. I want to be clear: it will be a functioning committee; it will work. There are a couple of options which are still live for me, and I'd welcome the member's input.

One is to send all the annual reports of all the Crowns to the Crown Corporations Committee and have it sit during the session -- maybe after the session as well, but certainly during the session. The other would be more task-oriented: to take issues which members on all sides want or which the government wants and send it to the committee with respect to Crowns.

Let me give you the example of Victoria Line, which we're interested in privatizing. Perhaps an all-party committee might want to scrutinize the terms of reference, how that would work, etc. -- maybe even adjudicate or pass judgment on the decisions made as a result of those bids. A bigger, more controversial option would be no-fault insurance, which has been the subject of some discussions -- big debate, big controversial issue. Perhaps the Crown Corporations Committee of the Legislature may want to deal with that.

In any event, it seems to me that we have to work our way through this because if that committee was to look at, say, no-fault insurance, clearly that would dominate the agenda and would be the only thing you could do. That's a big, big task. I think that it doesn't appear the committee is going to sit, then, when the House is not sitting, given what I just said in terms of the committee schedule that we've negotiated a little bit.

Then what I want to do this off-session, if you will, is work on more clearly defining what I intend to have the committee look at for next year. I give you seriously the 

[ Page 2038 ]

undertaking that in the next session of the House, we will, for sure, refer work to the committee on Crown corporations. It will sit and it will be significant. That's my commitment. We haven't quite got there this year, but I hope the members appreciate that it's simply because we have a fairly ambitious parliamentary reform agenda. I hope that there's some understanding of that when you realize the significance of some of the committee work that we have agreed to.

J. van Dongen: I'm pleased that the Premier responded on both fronts in terms of my rather open-ended question. I guess I'm surprised that it got the prominence it did in the throne speech, and then he gives in so easily in his negotiations with the Leader of the Opposition. I look forward to the commitment that something will be assigned to the committee in the next session.

By way of suggestion, in his report today the auditor general says that he is currently doing a study together with the Crown corporations secretariat on the governance issues for Crown corporations. He expects that report will be finished in September. As I understand it, it will deal with the sort of standard generic issues of accountability: how it should work, the role of the board of directors, the role of the minister and the role of, say, the Crown corporations secretariat. I'm wondering if the Premier could comment on whether that might be a candidate to be referred to this committee.

Hon. G. Clark: That's a very good suggestion, and yes, it is a candidate. As I said, I have no intention of making a commitment in the throne speech of creating a committee and then not have it do meaningful work. So I think that may well be a legitimate candidate for some early work.

I think it's also true that as these committees function, as they never have before -- including the Aboriginal Affairs committee, which has the biggest mandate -- we want to learn from it, adapt it, change it, whatever. I think the Public Accounts Committee, under the member for Delta South, has really changed the nature of that committee. It has really learned from the past and continues to evolve in a really constructive way. I don't agree with all of the recommendations coming out of the committee, but that's fair enough.

Similarly, I'm hoping that these kinds of experiments in MLA democracy and work in a non-partisan way, like the Aboriginal Affairs committee.... Maybe it won't work that well. Maybe we should change the format. We just want to be upfront about the notion that to some extent, given the history of this House, there is a certain experimental nature to this initiative, and we shouldn't be afraid of that. We should recognize that different committees are going to function differently, and we should try to learn from that and adapt from it. As the chair of the committee -- and I think the member is the chair of the Crown Corporations Committee -- I will try to pay particular attention to recommendations that the chair makes so that we can work cooperatively on some of these issues, which I think really are essentially non-partisan issues.

J. van Dongen: The second question I have is: I'm wondering if the Premier has looked at the Saskatchewan model for Crown corporations committees. They have an approach whereby on an annual basis, they have every Crown corporation reporting to the committee. They talk about their business plans and mission statements, as well as looking at performance in terms of the past year. Has the Premier looked at the Saskatchewan approach to this committee?

Hon. G. Clark: Yes, actually more than looked at it. In some ways, I think that is the sort of model that is probably the most likely that we can pursue -- not because my deputy is from Saskatchewan and used to sit on that committee, but because it's the right thing to do. Perhaps, and I say this seriously, the committee chair, or even the committee, may wish an all-expense-paid trip to Regina.

An Hon. Member: One way.

[7:15]

Hon. G. Clark: Yes, one way for the chair.

They may want to visit Regina or members of the committee and see firsthand how it functions. In some ways that might actually be quite helpful. We shouldn't be afraid of that kind of thing either. Maybe not the whole committee, but some people could be sent out to see how it's functioning and see if we like what they're doing and whether we can learn from it or not. I think the member for Delta South is the most-travelled MLA not in cabinet. I have never criticized that, and I won't, because the work he's doing, generally, is to improve upon and to learn about ways in which we can improve public accounts in B.C. I think I would say that to the chair of the Crown Corporations Committee, as well.

J. van Dongen: I appreciate the Premier's offer of a trip to Regina. I just want to be sure that all the members of the committee go with me. The question is: when can we go?

Hon. G. Clark: You can go when the House is sitting.

J. van Dongen: Just a few questions about how accountability of the Crown corporations is actually working right now -- in particular, the chain of accountability. I am mainly interested in the role of the Crown corporations secretariat. How does it fit in? Do all the Crown corporations currently report in through the Crown corporations secretariat, or what is its role?

The Chair: I recognize the hon. member for Powell River-Sunshine Coast, on what matter?

G. Wilson: I seek leave to make an introduction.

Leave granted.

G. Wilson: I would like to introduce to the House and members in the gallery a former MLA -- an outstanding MLA -- Judy Tyabji, and with her are my family: Tanita, who waves, Kiri and Kas, and Mathew. Would the House please make them welcome. They are anxious for this debate to terminate so we don't lose the entire summer.

Hon. G. Clark: Hear, hear -- and welcome. Well, it may be shorter now that the former member for Kelowna is not in the chamber.

To the question from the member for Abbotsford. Yes, the Crown corporations secretariat was and is really an innovation for having a bit of a control mechanism -- an accountability mechanism -- internal to government, as opposed to the committee of the Legislature, which would be sort of external.

How it works, essentially -- I think we've discussed this in this chamber before -- is that the board chairs and the 

[ Page 2039 ]

CEOs are expected to fully cooperate and provide full information and be accessible to the Crown corporations secretariat to really do several things: to do the kind of business plan review and rigour, to establish policies and guidelines with respect to activities of Crowns, to provide an independent evaluation of Crown activities for the cabinet and for Treasury Board, and to pursue cross-government initiatives or corporate initiatives for government within the Crowns. Rather than them being totally autonomous agencies owned by the government, they should in fact be expected to respond to government's initiatives as well. That's a very thumbnail sketch.

I encourage the member to meet with the Crown corporations secretariat staff. They are superb. Currently, Lawrie McFarlane, former Deputy Minister of Health, is the deputy minister responsible. He has a long history. I think he was in Saskatchewan for a while, but we won't hold that against him.

Just to follow up on our earlier discussions, we have to figure out or work on the Crown corporations secretariat and the role it might play in assisting the committee in its deliberations. Again, I would encourage that. I think that's a logical possibility at least, or one which should be in the hands of the committee, but we should look at it.

Saskatchewan has gone further than that -- just to use the Saskatchewan model. Rather than the Crown corporations secretariat, they actually set up a corporate entity -- a Crown holding company -- and they use that company like we do the secretariat, although it has actually more formal power. Because it's a holding company, it can direct more than the Crown corporations secretariat, which is more of a service agency than the Crown corporation holding company model.

Again, not to be too long-winded or philosophical, the Crown Corporations Committee of this House might, for example, want to analyze the Saskatchewan model of the holding company model of accountability and compare it to the Crown corporations secretariat model and make recommendations to government as to whether they prefer the Saskatchewan model or whether they think some changes could be made to the Crown corporations secretariat model. Those are public policy initiatives that I believe should not or do not have to be partisan ones. Members of the House can come together and make recommendations for more effective governance.

J. van Dongen: What is the size of the staffing component in the Crown corporations secretariat? How many staff are in the Crown corporations secretariat -- just to get some sense of the size of it?

Hon. G. Clark: I'm not the minister responsible -- so I'm not trying to evade the question. The last time I checked I think it was six or seven permanent staff members and then quite a large consulting budget. We don't want to set up a big bureaucracy to police bureaucracies. Rather, it's a smaller agency with the ability to contract services, say, for program evaluation, for business plan critiques, for human resources issues, and that kind of thing. The budget is comprised of a tax on the Crowns themselves, a self-funding thing. But I believe there are only six or seven -- or maybe a dozen staff at maximum -- associated with the secretariat.

If the member will forgive me, I'd really rather not answer a question on it because it's not an area I'm responsible for. It's totally out of order and I'm giving you information based on my past life as a minister -- as opposed to the Premier -- and that's always very dangerous.

J. van Dongen: I certainly didn't intend to stray into areas that the Premier wasn't fully versed in, but it seems to me that he's pretty well fully versed in everything.

I was asking the question because of the concern about what level of responsibility the Premier expects from his ministers in terms of whatever Crown corporations they may be responsible for. It seems to me that with the Crown corporations secretariat in place -- and I'm not saying it's a bad process -- you end up with more of a dotted-line relationship to the minister.

For example, if you look at the Workers Compensation Board, as I understand it, it's the responsibility of the Minister of Education and Labour. If the Workers Compensation Board is actively reporting in and working with the Crown corporations secretariat, which has the equivalent of a deputy leading it, and that deputy is part of the deputy ministers' council and, I assume, reporting ultimately to the deputy to the Premier, it seems to me that you end up with more of a dotted-line relationship to the minister. Could the Premier comment on how he views that accountability process, in terms of the ministers themselves?

Hon. G. Clark: Actually, the member is completely incorrect, and it's important for this House, if there is any confusion, that we try to clear it up.

The minister responsible is the minister responsible in this House -- not the minister responsible for Crown corporations secretariat and not the Crown corporations secretariat. The minister responsible for B.C. Ferries is the Minister of Employment and Investment, and he's held accountable in this chamber for that ministry. The Crown corporations secretariat as a central agency function reports through that minister as well. Maybe that's not a good example, but it does not supplant the ministerial accountability in the statute and it does not supplant the ministerial accountability in this House. It is not intended to do so.

It is a central agency. It can provide critiques, it can provide advice to cabinet, etc., and to the minister responsible, but in the end it's the minister responsible and the board of directors that carry the can for decision-making around those Crowns and are held accountable in this chamber. I don't think it's complicated. Treasury Board deals with every ministry budget, etc., but you don't hold the Treasury Board chair accountable for the minister's budget. Similarly in the case of CCS.

If you move to the Saskatchewan model of the holding company, then I'm not sure how they do it there, but you may have a better argument that the minister responsible for that holding company would have more than just advice, more than just a critique, more than just influence. He may in fact have formal control over those line Crowns. I don't know actually how they do it there, but that would maybe stray into that area. We haven't done that; it's not intended to do that. And I think it's important for members to direct questions to the minister responsible not for the Crown corporations secretariat but for their particular Crown.

J. van Dongen: I really appreciate that clarification by the minister. I just want to sum up by saying that I'm looking forward to the Premier's commitment to enact the necessary initiatives to get the Crown Corporations Committee active. It's certainly been my observation in the last year and a half that Crown corporations within government are probably the least accountable to the Legislature in an overall sense, if I compare that to the accountability of the line ministries. So I 

[ Page 2040 ]

think it's a very good initiative, but it doesn't count for anything unless the committee is actually activated. I look forward to that happening and thank the Premier for his responses.

J. Weisgerber: I'll start with a comment with respect to the select standing committee -- and not a critical one at all. First of all, I want to commend the Premier for moving as quickly as he did to get a motion into the Legislature. My purpose earlier today was only to suggest that perhaps in the haste of drafting it there hadn't been consideration given to the existing act, which I believe obliges the Premier -- and only the Premier -- to appoint an acting conflict-of-interest commissioner. I thought it would have been far more appropriate for the committee to make a recommendation to the Premier, as opposed to, as the motion stated, making a recommendation to the Legislature. So it was only with that point in mind that I raised those concerns. Perhaps I could just get clarification from the Premier that it is in fact his intent to have the committee recommend to him, at some time before the House sits, the possible appointment of an acting commissioner or commissioners.

Hon. G. Clark: Yes, absolutely, as soon as possible. I'm not absolutely certain of the member's point. The member's point the other day was that this committee didn't actually have the power to make a selection or recommendation to the Premier; it could only recommend changes and review. So I took that up, and you can see we changed that so it had the power to select. Now I think the member's criticism -- correct me if I'm wrong -- is that it should have the power to make an interim appointment or a recommendation to me to make an interim appointment. I infer it to have that power. I would hope that they might consider doing that, and I would certainly.... Let me say that I don't think they need that power, because it's my prerogative to appoint an acting commissioner, and if they recommend someone to me unanimously, I'll appoint them.

If they don't do that, we have an acting commissioner, and his name is Ted Hughes. Everybody knows Mr. Hughes. He's doing a superb job for British Columbia. The committee, I would hope, may find a permanent replacement before the House sits again, in which case I would choose to appoint that person, either on an acting basis or a permanent basis. But I assume the committee will recommend legislative change -- they may not, but I'm assuming that they will -- which takes away the Premier's prerogative to make this appointment. In that case, it's a small transition thing, but it might be that I would make the appointment in the interim, and then we change the act and then have the House ratify that appointment with the new procedure, however defined by the committee. I hope that's a satisfactory explanation.

[7:30]

J. Weisgerber: An entirely satisfactory explanation. I think the clarification will be useful for the committee, for the Legislature. I guess it again reflects how complex sometimes simple tasks can become when we use this forum.

I take this opportunity to raise an issue that I don't believe clearly falls into any particular ministerial responsibility; I'm not sure, in fairness, that it falls under the purview of the Premier either. It is the issue of encouragement of the use of ethanol in motor fuels. I know the Premier probably got some information. I've been dealing with this in one forum or another since 1987.

I think that the current initiative, the current movement in the area of ethanol crosses a number of ministries: obviously the Ministry of Environment; obviously in the concern about air quality in the Fraser Valley; obviously some economic opportunities in terms of the employment created through the production of ethanol; and perhaps, if the current initiative is followed up, it falls under the Minister of Forests by the opportunity to use wood wastes and material not currently brought in from the forests as a fuel for ethanol production.

The minister might know of the early initiatives. Most of the activity in the United States is on grains, whether they be barley, wheat or corn, for the production of ethanol. The movement appears to be to wood wastes: limbs, branches, hog fuel, etc. There are three or four ministries involved, at the very least, that would have a very direct interest in seeing ethanol encouraged as an automobile fuel or a motor fuel. Self-sufficiency is another, so I suppose you could add the Minister of Employment and Investment in his role as the minister responsible for petroleum resources. I am curious to know whether the Premier has looked at some coordination within ministries, some activity at the cabinet level, that would drive the idea of encouraging ethanol for both economic and environmental reasons in British Columbia as an automobile motor fuel.

Hon. G. Clark: I haven't actually done that. The member seems to be alluding to work underway in the government with which I am not familiar. I am familiar with the ethanol debate somewhat, and was familiar with it when I was in opposition about eight years ago. I don't think the member was in cabinet then. Were you Minister of Energy later on?

If we can, I wouldn't mind having a short debate on the general question, because instinctively, I, like probably many members in this chamber and certainly the member who spoke and who has spoken in this House before on this subject, am very supportive of the notion of ethanol substitution for gasoline. Environmentally it makes sense and it can potentially be much better for us in British Columbia economically.

The problem is really quite simple. The price of wheat is very high, the price of gas is, relatively speaking, very low and you simply can't economically drive the substitution. The member is then suggesting that maybe this huge surplus of wood chips which we have in British Columbia, or this surplus of wood residue which is not economic for other things, could then be turned into ethanol. I am familiar, and understand that that is actually possible. Again, the market seems to me to be telling us that it doesn't make any economic sense.

Here is my question for the member, hon. Chair, which is highly irregular and totally improper: is the member suggesting that we engage some kind of tax-induced activity to promote this enterprise? He can answer this question in a second, but I would say that I'd be reluctant to cut taxes significantly, as the previous government did at one point to try to induce some major investment. I wouldn't rule it out entirely, because there are strong environmental benefits and potentially strong economic consequences. I know that there are some reasonably successful initiatives with corn in the United States, and there is the one plant in Canada which the member for Delta South was involved in. It was Mohawk Oil in Saskatchewan, and it was induced to happen as a result of the oil crisis and other things. In a way, one can be thankful for that decision now, because I think it does provide cleaner fuel for us. But I'd be surprised if any kind of socioeconomic analysis had suggested that it was probably the right decision to make.

Let me conclude by saying that if the member wants me, as Premier, to ask staff and/or ministers to take another look 

[ Page 2041 ]

at this question and work with the member, who comes from upcountry where there are some possible benefits, then I'd be prepared to do that. But I want to say at the outset that I would be instinctively opposed to any kind of tax break to artificially induce this kind of behaviour, although I wouldn't try to fetter any work that was being done with that in advance. I guess I'm just saying that I'm really open to the idea. Instinctively, I think we all like it, and it would be kind of nice to do in British Columbia. But it just doesn't seem to make any economic sense from any of the information that I have seen. Obviously, with technological change and other things....

I see the Minister of Agriculture here. People in the Peace River country have struggled with the wheat question, which gives them an incredible opportunity, but they really haven't been able to make it work. I note that the member who was, in fact, the Minister of Energy for a while couldn't make it work seven or eight years ago from his own constituency with his passionate belief in ethanol. But if something's changed and we can help now, it's worth another look at it. Or if the member has any information or wants to work with the staff.... If he asks me to do that, I'd be happy to do that. I'm sure the Minister of Agriculture would be interested in it or in having staff take a look at it with the member.

J. Weisgerber: The fact of the matter is that ethanol currently, I think, is produced in at least two plants in Canada, probably three. There's one in Manitoba and one in Saskatchewan and I believe there have been a number of initiatives in Alberta. I'm quite honestly not certain whether any of those have actually gotten off the ground. In the United States, the production of ethanol has become quite substantial. It has almost always been encouraged and supported by some relief with respect to road tax. That's a fact of life.

The other fact is -- and I'm sure the member for Delta South would confirm -- that Mohawk have enjoyed an enormous increase in the sale of their ethanol-blended gasolines, even here in British Columbia. As people become more environmentally conscious, they have been able to capitalize on advertising the fact that it is cleaner-burning fuel. In northern climates, there are, incidentally, some benefits with respect to gas-line freezing that they use as a marketing tool as well. When I first came to this Legislature, I came supporting an ethanol project. We did, in fact, put in a tax measure that would have given some tax relief to gasoline containing ethanol that was produced in British Columbia. A plant never came in, so the tax relief measure expired and was never renewed.

I'll be up front: I think that today the movement is away from grain. As grain prices across the continent are high, the prospects look good and so does this move now toward using wood residue. Other jurisdictions, most notably South America, have used wood products for a long period of time. They burn ethanol almost exclusively, and somehow they have worked out a regime. There may well need to be some encouragement, whether it be by way of tax relief, but I think it would be foolish to try to immediately jump into that debate.

However, having had that issue raised, it kind of leads naturally into another fuel tax issue, and that is the expiry of the tax-free status with respect to propane and natural gas. In 1992 the Premier -- then as Minister of Finance -- brought in his first budget and announced that there would be a five-year period, after which taxes would be introduced. I don't think it was quite worded that way; it was a promise not to start introducing taxes on alternative fuels, namely propane and natural gas, for a five-year period. Time flies. That five years will be up on March 31, 1997.

An Hon. Member: When you're having fun.

J. Weisgerber: When you're having fun. From a non-partisan position, I think that before we come back here again, it might be well -- and I'm encouraging the Premier in a very genuine way -- to put in place a mechanism to look at this question of ethanol and the opportunities that exist there and to also look at the impacts of any move towards starting to tax propane and natural gas.

I believed in 1992, as I believe today, that it's a step in the wrong direction to start discouraging the broader use of propane and natural gas by the imposition of a tax; it is contrary to everybody's interests. It doesn't meet the tests of cleaner air. It would seem to me to drive people back to fossil fuel, and I would argue that it has already started to do that. People making a decision to convert their vehicles from regular gasoline to natural gas or propane have to see a period of time of payback. With this looming expiry of the tax-free status for those things, I believe that significant numbers of people are now not making the decision to convert in anticipation of taxes being introduced before there's a payback on the conversion.

The Premier might well look at the whole question of alternative fuels, including propane, natural gas, ethanol and methanol, with the idea of making an announcement to introduce or extend for some period of time -- perhaps indefinitely -- the tax-free road tax status with respect to alternative fuels.

Hon. G. Clark: That's a good suggestion from the member, and I'll follow up on it. It is pretty clear that this was always intended to have a sunset clause and that there would be an equalization of taxes over time. That sunset clause does expire, but I think the member has made a legitimate point that perhaps before we rush in we should review that question. I make no prior commitments that we won't eliminate or equalize the differential, but I think it's worth reviewing, perhaps in the context of the member's ethanol questions. We'll try to do that, and if I can, I'll try to have the member be apprised of any work that comes out of that.

[7:45]

D. Symons: I was interested in the conversation earlier regarding the Crown Corporations Committee and was very disappointed, as the member for Abbotsford was, that the committee hadn't been called into session and isn't going to be in session at all when the Legislature isn't sitting. There are two or three very important issues that I think have come up during this sitting of the Legislature that could have been referred to that committee and haven't been. I don't know if I totally buy the Premier's reasons for that, because the committee exists and it's very easy to simply refer something to it. It could have been done. It doesn't take a great deal of extra legislative wrangling or staff or anything to get that committee up and running. But it didn't happen.

I wonder if I might move onto something else, and that's one of the Crown corporations, B.C. Transit. The particular aspect that I would like to explore with the Premier is the issue relating to Mr. Frank Dixon, the former CEO of B.C. Transit. He was hired in early 1993, and it turned out that 7-1/2 months later he was fired. I'm wondering if the Premier might give me a little bit of an explanation of the hiring process that was done. Did you use a headhunting firm, or was it done in-house? Could you give me a small idea of how the hiring process worked, because obviously something is very wrong in the whole process there.

[ Page 2042 ]

Hon. G. Clark: I've been trying to answer all questions on everything that's been out of order, but I'm simply, with great respect, going to draw the line at something that happened several years ago for which I was canvassed on extensively in the House and for which I have absolutely no.... I mean, it's totally out of order. Some time we'll have a coffee or something, member, and I'll tell you what we did. I'm just not going to take the committee time to answer something which is so out of order. Almost half of what we've talked about is out of order, but this is way beyond it.

The Chair: Member continues, on another topic.

D. Symons: I don't know that it all could have happened long ago. The Premier was then the minister responsible for that and certainly would have intimate knowledge. In fact, he was involved, I believed, in one of the interviews with the gentleman involved. So the Premier does know something about this issue. I believe, it's only since last September that the actual final settlement in that fiasco came through, and I believe the figure was over $500,000. It was a settlement on that particular case, so I'm surprised that the minister wouldn't....

The Chair: Hon. member, I think the discussion should move on to a new topic.

M. de Jong: I wonder if I can ask the Premier if we can turn our attention -- and we're fortunate we've got the Minister of Aboriginal Affairs here as well -- to an area that we canvassed, or an issue that arose in the course of our debates during the Aboriginal Affairs ministry estimates. It was a theme that arose in many areas when the minister and I discussed provisions relevant to the agreement in principle. I asked the questions of the Premier, recognizing that, as far as contact with the federal government is concerned and with other first ministers across the province, he really is the provincial representative at the top of the heap. So when the Minister of Aboriginal Affairs. . .

Hon. G. Clark: That's the technical term, I think.

M. de Jong: Yes. That, of course, is the term taken from the flow chart that the minister's. . .

Interjection.

M. de Jong: I was going to call it a McArthurism -- and not of the scurrilous sort.

One of the issues that arose out of our debate -- that is, with the Minister of Aboriginal Affairs -- was that there are a number of areas where the suggestion has been made by the Minister of Aboriginal Affairs that the federal government is dragging its heels. We discussed the difficulty that the minister has experienced in something as basic as obtaining an indication of the federal government's position on a definition or language for the notion of certainty that the government and most of us want to see incorporated into agreements with aboriginal peoples.

To what extent does the Premier believe that it is appropriate.... To what extent does he involve himself in exerting the pressure that apparently is required to impress upon the federal government that these are matters of immediate concern to British Columbians? To what extent are these issues he intends to raise, if not at this Premiers' conference, at first ministers' conferences that will be held in the future?

Hon. G. Clark: I've been the Premier for about four or five months, and there has been an intervening election. During the period I have been the Premier, I have not raised these questions with the Prime Minister or the federal government. I've raised lots of issues, but not the aboriginal one.

It's also true that during that brief period we signed a historic agreement-in-principle and made some significant breakthroughs. Then we had an intervening election, and now we're moving forward with the agenda through a parliamentary committee and some other means as we negotiate. As a member of cabinet, I can tell that you I'm aware of the frustration and of the inability to get the federal government to really bring to bear some resolution of some of these difficult questions on this file.

One has to hesitate, I think, to question the motivation behind that. These are tactical negotiations questions, and sometimes being stuck on what would appear to be minor questions are really delaying tactics in order to seek advice or counsel on a range of other questions. I hesitate to ascribe particular motives, except to say that we have had a great deal of difficulty over the last few years on some issues which really should have been easily resolved, given the apparent willingness of the federal government to entertain these issues. In the last little while we've made some breakthroughs. We've really moved forward, and I have not been subject to my colleague the Minister of Aboriginal Affairs raising specific concerns.

The next question is sort of hypothetical. It appears likely that over the course of the next four years, maybe even over the course of the next few months, as we move to the detailed treaty negotiations, as we are given advice by the people through the committee and others, and as we inform our deliberations, there no doubt will be very sticky issues to be resolved. If we feel the federal government is being intransigent on a particular issue, then I won't hesitate, frankly, to advocate on behalf of British Columbia and the government of B.C. with the federal government -- not to tell them to take British Columbia's position, but to really try to expedite negotiations.

My hope is that we can achieve the first modern treaty with the Nisga'a people within a reasonable time frame. Obviously that's months, not days -- I hope it's not years -- away. I think we've made great progress, and we want to expedite that as fast as we can, albeit recognizing and being fully informed by what people are saying. It's a balance of moving quickly but also moving carefully.

I anticipate, given our past practice, that there will be some sticky issues of debate. I anticipate, at least on behalf of the government, intervening with the federal government, if I can, to try to expedite things from time to time. I don't think I'd make it a practice -- I hope it's not a practice. My guess is that before we get even the first treaty, let alone other AIPs or further progress, there will be some very tough negotiations.

In some cases it's us versus the other two parties; in other cases there are different alliances, but the federal government bureaucracy.... If anybody thinks that ours is hard to navigate or not responsive, the federal government is sometimes very challenging indeed.

M. de Jong: I just want to address two issues that arise partly out of what the Premier has said. First of all, if I can say this, one of the frustrations the Minister of Aboriginal Affairs expressed was not necessarily simply the fact that there are disagreements with respect to the position taken by the federal government -- his federal counterpart -- vis-�-vis 

[ Page 2043 ]

himself, the provincial government or the Nisga'a, but that in some cases he can't get a position. The feds simply aren't responding to the extent of something as basic as a definition of finality or certainty. The minister says, "Well, that's the federal government's responsibility. The federal government will take the lead." I baited the minister a little bit by suggesting that if I were in Ottawa asking his federal counterpart, he might be telling me exactly the same thing: "We're waiting for our provincial counterpart to take the lead." Where that sort of logjam seems to exist, there is, perhaps, a role for the province's leader to play in reminding the top leadership in Ottawa that there's a lot at stake out here.

The second thing on this issue that I want to elicit some sort of response from the Premier on is that there is a sense among those of us who watch these negotiations from outside of one of the three parties involved that the federal government, at least, views things like land and resources that are vested in provincial jurisdiction as a form of currency they're prepared to play fairly fast and loose with, that albeit a cost-sharing formula is in place, they can buy peace on the backs of the provincial treasury, be it land or resources. There is perhaps a need to impress upon those officials in Ottawa that that sort of approach has a real impact on the lives of working families here in B.C. Again, I guess the question is the same.

I appreciate what the Premier had to say about his not being directly involved to this point, but I suppose it's my way of flagging to him the sense of frustration that many British Columbians seem to feel about the approach taken by the federal government.

Hon. G. Clark: I can almost feel a speech coming on with respect to the federal government, but I restrain myself.

I agree entirely with what the member said. These are challenges for British Columbia,, and for politicians of British Columbia they are more acute because we're here. It's a lot easier for a bureaucracy thousands of miles away or even politicians thousands of miles away to trade off certain issues without dealing with the sentiment of people in British Columbia.

If I could just go back to the earlier question. Forget just negotiations for a minute. Let's take road blockades -- Gustafson Lake or Apex. The federal government has the primary responsibility for this issue, yet they manage to maintain an incredible silence through some issues which we're struggling with, which is really unacceptable. It's not unacceptable because we're afraid of taking the issue or dealing with it through court action or otherwise; it's unacceptable because they have constitutional responsibility. These are serious problems, and they should be engaged in the solution.

I think their attitude on those is really appalling, more so than even in negotiations, where you can get frustrated but where they're party to the table. They take a position that it's none of their business, when in fact it is their business, and in fact is primarily their business. We end up dealing with these difficult issues with, in some cases, police action and in others without really dealing with the core problem. The federal government needs to be engaged.

I hope not, but I suspect there is a chance that some of those issues come up from time to time. In that case, I will be very aggressive to press the federal government to be part of the solution, to take some ownership of this issue, which they jealously regard in other areas in terms of their constitutional protection but conveniently forget when it comes to some of these issues.

[8:00]

M. de Jong: Having heard the expression of frustration from the leader of the provincial government that I also heard from the Minister of Aboriginal Affairs, my last question on this particular issue would be: what mechanisms does the Premier believe exist for him to exert some pressure, some leverage, to elicit the kind of response he seems to be calling for from the federal government, be it fiscal or otherwise? Surely there are things we can do as a province to bring home to the federal government that where we believe there has been an abdication of their responsibility, that cannot continue, and if it does, there will be implications for them.

Hon. G. Clark: I think that's the $64 question. We have some discussions and negotiations with the federal government on a range of fronts, if you will, and we have been exploring ways in which we can provide some linkages between issues, so that we can help get resolution. Having said that, I think you have to be very careful in terms of exercising linkage -- as they say in the diplomatic business -- because one has to deal with these issues at face value and not always engage in bartering between issues which we deal with with the federal government. Sometimes it gets down to that. We can't trade off, in other words, B.C.'s rights in some area to get more attention in another area. You have to be very careful in doing that.

There has been a bit of progress with respect to some of these questions. I'm just advised that the federal government is finally taking some note of the Adams Lake situation, which is really another unacceptable situation which we've been trying to deal with in an interim way. I think the federal government is showing some faint signs of interest in the subject, so we're hopeful there.

I say this very genuinely: if the member has any suggestions that he wishes to place before me at any time -- not just in the chamber or publicly -- in terms of ways in which we can work with the federal government, to put in politely, or lever the federal government, or pressure the federal government to take action, I'd be very interested in pursuing them.

M. de Jong: On a different matter altogether, pertaining to parliamentary reform, which I think we heard signalled in the throne speech, was a matter that the government took seriously.... My questions relate to the reporting mechanisms that are available and to the opportunities for questioning that are available to members of the Legislature with respect to legislative officers. I was here earlier when the Premier described those officers as, I think the words he used were "watchdogs" on government, and said that he certainly takes it seriously when criticisms are levied at government by those watchdogs.

The difficulty that we have under our present format is that there is a very limited opportunity for members of this chamber to engage those officers in any sort of meaningful and open question and answer session or to engage in debate respecting their operations or the findings they present for consideration in their reports. Has the Premier given any thought to how the reporting mechanism might be improved, or the opportunity for exchange between members and those officers might be improved?

Hon. G. Clark: Yes, I have, is the brief answer. I thought we canvassed this yesterday -- or was it the day before? I am giving serious consideration to having the legislative officers of the House report through a parliamentary committee to the 

[ Page 2044 ]

House, so that there is an opportunity for them to come and take questions, particularly with respect to their reports that they've tabled. We've had some brief discussion of this virtually every year with respect to.... At the very end of the session -- as will happen, I guess, tomorrow -- there's a series of votes which govern some of these and, from time to time, people wish to ask questions of the minister -- say with respect to the auditor general. In fact, the auditor general's not a good example, because it has the Public Accounts Committee, but the ombudsman or something. It's unsatisfactory, because you're asking a minister who's not really responsible. Really what you want to do is have some dialogue and discussion in an organized forum with the legislative officer. I'm not going to give any absolute commitment, but I certainly am giving it some thought. I'm going to give some consideration to some mechanism we can look at for next year or the year after.

M. de Jong: I'm going to attempt to engage in that practice of linkages the Premier referred to earlier. Part of the frustration, and I'll try to present it in terms of an example that might have some present relevance, is that if, for instance, an officer of the Legislature -- the chief electoral officer, for example -- were to make known his dissatisfaction with the filings of a particular political party, perhaps even specifically the question of the issuance of tax receipts, the opportunities to question and debate that are very limited. Is that an issue that troubles the Premier?

I should be specific. I am sure that the issue troubles the Premier. Is the fact that there are suggestions and allegations being considered by the chief electoral officer regarding as fundamental a matter as the issuance of tax receipts and the suggestion by the chief electoral officer that he is not satisfied that the particular function was carried out entirely properly for the year 1995 by the governing party an issue that troubles the Premier and one he deems worthy of a response in these debates?

Hon. G. Clark: We sort of segued into that, actually quite nicely, for the member. It's a bit off topic, but let me deal first with the substance of it, if the members really are interested, even though it is not a subject of this deliberation.

To put it in context, perhaps the member sort of sees more in this issue, in some ways, than I do. The chief electoral officer made some remarks about certain aspects with respect to the NDP filings and asked for the NDP to respond by October with changes and details around filing. That will be done, and we will comply, of course, with any concerns the electoral officer has. I have no worry about that, and I think that even the member opposite would know that there is nothing untoward here. There are some changes which are required.

The member also may be aware that other political parties might be under investigation from time to time with respect to their filings, and I certainly wouldn't suggest that there is anything nefarious there either. This is the first time we have had this legislation, and there will be some technical compliance questions. The member opposite can speak for the Liberal Party, but certainly for me, obviously, they will be complied with. I am sure that is true of the Leader of the Opposition as well.

Now, back to the estimates discussion, unless the member wants to engage in a debate. Should the chief electoral officer report in some way through, say, a parliamentary committee, so that there could be some questions around this or any other matter with respect to the operations of that office, which is a legislative office? My view is that this is certainly something we should consider. I think there is some merit to it for all the legislative officers, so I am giving it consideration.

My only little caveat to that would be this. Sometimes I sound like I've been here a long time, so I always catch myself when I say that....

An Hon. Member: How long. . .?

Hon. G. Clark: Ten years in the chamber, but I have been in opposition for a long time -- five years. That's more than the Leader of the Opposition, at least for the moment anyway.

Having a parliamentary committee really doesn't do that much on some of these issues. I'm sorry to break it to you, but the ombudsman, for example, is very high profile and presents public reports which are often a matter of some controversy and debate. They are reported in the Legislature. Special reports are issued, and they have no problem getting public scrutiny or debate. Neither does the privacy commissioner, who is constantly under scrutiny. Neither does the child advocate, who has released a report which is the subject of some discussion.

I just want to make sure that members don't overstate the case. We have independent legislative officers, and they do a good job, and I know all members agree with that. They're appointed by unanimous consent by members from all parties. They report publicly, often in very high-profile ways, and get lots of scrutiny.

Should we add to that scrutiny the ability for members to question once a year their annual report so they can respond? I say that is worthy of consideration, and I'm going to review that. I think that adds to accountability, and we can always do a better job of that. But I simply must say that I don't think one should overstate the significance of that. We don't really have a problem with our independent officers. They are accountable, they are public, they are doing a good job, and we don't need this committee to fix a problem. Can a committee system add more accountability and legitimacy and a more formal way of involving members of the House in that? The answer to that is probably yes. And so therefore it's worth considering.

M. de Jong: Well there are two aspects of this, of course. One is the procedural aspect, which the Premier is indicating some willingness to consider changes to. I'm trying to look ahead as well, and one could argue that if the government intends to fill this chamber with six additional members, we want to have something for them to occupy their time with, and an expansion of the committee system is one means by which that could be accomplished.

With respect to the other issue, let me leave it on this basis. I think the Premier knows that I, more than anyone, want to share his optimism that there is ultimately no difficulty with the filings of any of the political parties involved, including his own. But I am persuaded or affected to this extent. On the day the inquiries were made prior to the election, there was a blanket denial by the Premier's official within his party, who sent a very detailed letter to the chief electoral officer. The fact that the chief electoral officer has sent correspondence to Mr. Gardiner requesting, in all cases, additional information, suggests to me that he's not satisfied with those explanations. I have to presume that Mr. Gardiner at the time provided all the information that was available to him.

I suppose in the fullness of time we'll discover whether there's additional information to be made available to Mr. 

[ Page 2045 ]

Patterson. But in the case -- and I only focus on this one because it's the easiest to deal with -- of the issuance of tax receipts, the explanation offered by Mr. Gardiner is simply that the Liberals haven't taken account of the fact that we reported receipts for six months and it was a 12-month reporting period.

I can tell the Premier that my immediate response to that is that at the convention that elected him leader of the NDP -- a great convention that I was happy to attend as an observer; I was shamelessly denied voting credentials by the Premier's party.... At that convention, documentation and financial statements were tabled which are not consistent with what Mr. Gardiner is now saying.

So I say to the Premier that the documentation that's available to us now, that's available to Mr. Patterson, obviously isn't satisfactory to Mr. Patterson. In that instance and in others, that is very troubling. For those of us on this side of the House who engage in this exercise of politics in the hopes that at least the rules, if they're not perfect, will be applied and followed by all participants.... I don't want to overcomplicate the thing. If the rules are going to be followed, let them be followed equitably by all.

[8:15]

Interjections.

M. de Jong: The only thing worse than provoking the Premier to get up and commence a speech of the sort he's probably thinking about right now would be to provoke the Minister of Agriculture to engage in a rant and run, which is what it would amount to.

Let me say this to the Premier: the concern, of course, is that if political parties are going to ignore the rules and make use of moneys that they're not entitled to make use of because of those rules, you've got a contest that is not being contested fairly. That is the essence of the complaints, of the allegations that have been made, and that's why I think they deserve to be dealt with very seriously.

Hon. G. Clark: I promised myself I wouldn't get angry, so I won't get angry. I don't disagree with what the member said with respect to the rules of the game, and I assure him that that will be the case. I only ask the member -- I know it's not his style, and I know that he's in the opposition -- to please not jump to conclusions with respect to that. There was a complaint levied; there was an explanation given. The chief electoral officer has asked for further information to be provided by October, and it will be provided. I have every confidence in the party apparatus, and in the fullness of time, I'm sure the member will see that. I simply take exception to any innuendo that the member might have in advance of any inquiries or any investigation that there's anything untoward, because there isn't.

I share the member's concern about elections and how political parties operate, I share his thoughts on that subject and I assure him that I intend to act with the best standards, the highest standards, the kind of standards that I think British Columbians expect, which the member has elucidated.

G. Campbell: I have just two items that I'd like to talk to the Premier about briefly. The first is the debt management plan, which I think is fundamental to his government's strategy. I think it's appropriate to deal with the Premier with regard to this for a number of reasons, but one of them is that he said quite clearly that he's committed to the debt management plan. I believe the debt management plan that was brought forward in 1995 -- it was initiated in 1995, the inaugural plan, if you want -- would suggest that the government is at this point about $2.2 billion behind. In other words, we have to find $2.2 billion worth of savings between now and the year 2000 -- not for one year, but over the next four years. I'm not trying to be cute about this. When we raised that issue, we were told that that wasn't correct, that indeed it was much less than that. So I would just like to start by getting some facts and information on the record from the Premier because I'm sure he has these numbers at his fingertips, or quite close to them.

An Hon. Member: Oh, I wouldn't assume that.

G. Campbell: Well, I do.

Can the Premier tell us if there has been a new debt management plan initiated, brought forward, since the one in 1995, or are we still basing our...? When we use the words "debt management plan," are we still looking at the 1995 debt management plan?

Hon. G. Clark: No, it's the same debt management plan, and we're working hard to live up to it. As was made much of, the first payment, if you will, was missed for a variety of reasons that have been a matter of public debate, and we're going to work hard to recover that, to, in other words, simply add that payment onto future payments so that we can meet the spirit and intent of the debt management plan. There has been no revision to it, and we intend to live up to it as best we can.

G. Campbell: Just so I can understand the Premier's answer, will we expect that the debt situation in the province by the year 2000, by the end of the term, or three years out -- depending on when you decide the end of the term is -- will be pretty close to what was projected when the debt management plan was brought out?

Hon. G. Clark: This is a third-party source, the Canadian Bond Rating Service analysis, which recently confirmed B.C.'s credit rating: it indicates that by the year '99-2000, $1.3 billion worth of debt will be retired. This is the same debt management plan that we published and which we share with the rating agencies. That's the goal, and that's what we intend to pursue.

G. Campbell: Then we will expect over the next few years to hear some announcements about how we reduce the base. I think all of this is about reducing the base and the cost of government, instead of just saying: "Well, we'll watch as it escalates and hopefully we'll deal with something later on." We're talking about reducing the bases, and the government will be making announcements with regard to that so that we can look at the debt management plan, and say: "Yes, the government has met its targets" -- the targets that I know about. I haven't seen what you shared with the bond-rating agencies, and I haven't seen that particular report.

Hon. G. Clark: It's an excellent report. I'd be happy to share it with the member. Debt retirement translates to an approximate 2 percent reduction in the province's debt-to-GDP ratio over four fiscal years, so that's the target. The member is correct that in order to meet those targets the government obviously has to take a series of actions. One action is to run consecutive surpluses. One action, as the 

[ Page 2046 ]

Liberal Party talked about, is to sell assets to reduce debt. The other is to cut spending to generate requisite services. We've had discussions.... The Leader of the Opposition has been out from time to time and I'll try not to repeat some of the long, semi-academic discussions I've entertained, but the challenge -- and I know the member agrees with me -- is to make structural change to the cost of government; not to reduce the base -- to use the words of the member -- to reduce the cost of government, and not to engage in either quick-fix or one-time revenue solutions, for example, which don't fundamentally alter the basic structure.

The basic structure -- and I won't make that speech again, although I'm tempted to -- is that in this country, generally, we have a structural imbalance between revenue and expenditures of all provinces, because costs are rising faster than revenue. Costs are based on demand-driven programs which are largely based on a combination of population and inflation and other factors like demographics, and tax revenue is not rising the way it used to; it's not as elastic as it used to be. There are a whole bunch of reasons. Some of it is underground economy; most of it is the changing nature of service-sector economy, which is a different tax base; and some of it is high unemployment and other demographic changes. But for all provinces, costs are rising faster, in general, than revenue. That is particularly true in provinces where you have a further complication of reduction in federal transfers.

While you can have cyclical swings which can temporarily balance the budget, particularly when you have a resource economy that is doing well from time to time, the real challenge is to structurally make the changes to reduce the costs of government over time. That's one which is a much more challenging problem and one which the program review we've engaged in is an attempt to look at ways in which we can do that.

G. Campbell: I appreciate the short version. I will just say that I concur that we do have to make structural changes to the way government works. We have to do that on the basis of the services that people value, and we have to look at how those services are provided in the most cost-effective way. I think the Premier can expect that we will all watch as the government goes through its exercise, and we will hopefully be able to protect our health care and public education systems and protect the supports we give to people in need while we provide new solutions to problems which have been there for some time. I hold the Premier to account for many things, but I don't hold him to account for all of the problems that we all face in British Columbia today.

Hon. G. Clark: I look forward to your support.

G. Campbell: Thank you. Well, I'm glad to help in any way I can.

I would like to move on to one other situation. I will take the Premier's answer with regard to this to be: "Yes, Leader of the Opposition, you can look at the debt management plan. That is the schedule we're looking at. Those are the standards we have set for ourselves, and those are what we attempt to meet." So unless that's the case, I'd like to move on.

The last quick item is an item that's a big issue. It's one that we all face; it's one that British Columbia faces. We face it as British Columbians; we don't face it as New Democrats, B.C. Liberals, Reformers or whatever. That's the health of the country and the structural integrity, I think, of a lot of the government services we provide in the country.

I know the Premier was a member of the government when we went through the Charlottetown initiative. I know that he has moved away from some of the initiatives that were taken there and the positions that were taken there. I would just like it if the Premier would outline for us some of the initiatives that he would see taking over the next few months. I believe it's time for British Columbia to take a leadership role with regard to this, rather than wait for either the federal government or another provincial government to take the lead. I think it is time for British Columbia to take the lead.

I think all of us have shown that there are times when we can work together for British Columbia. I'm interested in what process the Premier perceives going through. I'm sure that people on that side of the House as well as this side of the House are interested in that and would like to be able to contribute to try and strengthen the bonds that hold us together as a nation and that remind everybody that British Columbia does have a leadership role to play.

Hon. G. Clark: I can't lay out a definitive plan for the member this early in my term, and I hope he appreciates that. In general, there are several things which I'm sort of considering and looking at. One is the idea of having at least an advisory committee to me, looking at questions around national unity issues, overlap and duplication, and ways in which we can help contribute or at least give advice. That advice, I want to say up front, wouldn't be private advice to me, but public advice which can be part of the public debate. That's one option that I think is worth exploring.

[J. Pullinger in the chair.]

Another option is the parliamentary committee option. I mean that seriously, but I think we have to give more thought to how that might be a more focused discussion and where it might go. So evolving a parliamentary committee in the future in ways that we can work together on some issues at least, if we can break it down a bit....

Another process which I want to explore with other premiers is whether we can work with other provinces, even in a formal way, in examining the nature of the federation and options which we might pursue in tandem. This is probably no surprise to the Leader of the Opposition, although it tends to be a surprise to lots of other people. But for me, if you go to first ministers' meetings, Alberta and B.C. tend to often be on the same side, and to a great extent Manitoba, Saskatchewan, Alberta and B.C. tend to often be on the same side, notwithstanding, in fact, our quite unique circumstances.

So I think it's important for British Columbia to look at ways, not in a destructive or selfish way, in which we can build alliances with other provinces, at least to explore ways in which we can restructure the federation. I think it's fair to say, at least from my limited experience, that Ralph Klein has exercised some leadership in this area. I haven't agreed with everything he has said, but he has been at least pursuing different ideas, particularly on the redefining of the federation or re-engineering the federation to look at ways in which we can redefine the respective roles of our government. I find myself very attracted to that, to looking at ways in which we can, in British Columbia, contribute to that process and build from there. I suspect there's probably much we might have in common. I don't know that.

[8:30]

If I could just put it in context for the member in a substantive way rather than in a process way, really the cur-

[ Page 2047 ]

rent status quo is untenable. The federal government has been engaged in using its superior spending power to induce provinces to engage in programs and areas of exclusive provincial jurisdiction. The federal government is systematically withdrawing funding in all areas while continuing to try to maintain that there are federal standards in all areas. It's simply not going to hold. The centre cannot hold; it won't function. Even in a rich and relatively affluent province like B.C., we're struggling with some of these challenges. In other provinces, it's simply not tenable. The status quo, where the federal government tries to dictate federal standards to the provinces while they systematically withdraw funding, is not even a short-term solution.

My position would be that we need some fundamental rebalancing of the federation, where the federal government does maybe not fund as much as they currently do in every area, but what they do fund, they fund adequately and in such a way that they could in fact have the moral authority, and indeed the ability, to enforce national standards and mobility rights across the country. Those may be some tough decisions, including for the federal government, but currently I think we have a very, very unsatisfactory situation.

I think there's a lot of hope for nonconstitutional rebalancing, and British Columbia can play a lead role in that. Some of that might not be particularly popular. Again, I probably shouldn't muse like this, but I would go so far as to say that we should look at it both ways. For example, maybe the federal government shouldn't fund universities at all; they should just not fund them at all. But they should say that health care as a national institution is important. It's a symbol of the country, it's important, and we need to make sure there are national standards. We can't allow the balkanization of that system, and therefore they're going to fund 50 cents on every dollar of significant programs across the country.

That kind of decision I am very attracted to, notwithstanding the fact that that poses challenges even for British Columbia fiscally, among other things. But the federal government -- and this is my general inclination and what, as we develop further, I won't hesitate to say to the federal government -- has to decide fundamentally its role in the federation and then provide the requisite funding to pursue that role. Right now, we have a sixties-seventies kind of view, where the federal government has a role in every area. They used to fund every area and therefore had the ability to influence, control and dictate standards. And now it's withdrawing from funding in every area while they're still attempting to impose standards.

Quite frankly, it's dysfunctional, and it's not sustainable. It has sort of been allowed to be sustained for a while. But looking ahead, it simply isn't. It's somewhere where I think that some provinces like B.C. and Alberta and other provinces can provide some leadership by engaging in the debate about what their respective roles should be.

G. Campbell: I want to start by saying that I was very interested to hear the Premier's comments on Premier Klein. I've always said that former mayors of big cities would make excellent Premiers, and I hope the Premier will keep that in mind as he moves forward.

An Hon. Member: The last Premier said that.

G. Campbell: Did he? I guess that's true: that's the exception that proves the rule.

I just want to say, first of all, that I concur with many of the comments that the Premier has made. First of all, I do agree that the country, with the way the structure's set up, has similar problems to those we face in British Columbia in terms of delivering services, only on a much larger scale. We're going to have to change some fundamental delivery mechanisms, some fundamental tasks, that we set on the national level vis-�-vis the provincial level.

I should also say that I think one of the things we have to guard ourselves against, whether it's in this House or whether it's across the nation, is politicians thinking that they've got all the answers to these issues. I think that people, in fact, do have a commitment to the country, as they have a commitment to the province. So I would encourage the Premier -- as he looks forward to how we will deal with these things -- to try to break some of the logjam, I believe, that's being created, where Premiers talk to Premiers and ministers responsible talk to ministers responsible, and everyone else we are supposedly serving gets left out.

I would hope that we can look at a way that we can include citizens. I think an idea of a citizens' assembly is one that we should look at and we should consider pursuing. Again, I think that they remember that their goals are -- forget what our political goals are, or what our provincial government goals are -- for the services they want to have and how to do that. I believe they would all agree to protect health care; I believe they would all agree with universal education; they would all agree with sensible public safety requirements, whether it's provincial or national or even local.

I would like the Premier to consider the opportunity for some form of citizen's assembly. Obviously you have to do that in a way that does not lock it in. I think the Premier was talking earlier about a youth assembly, and you don't want to institutionalize youth. I don't want to institutionalize the citizen's assembly either, but I think there is a way we can create some new ideas in the discussion so that we'll have a better result, which is, I believe, what we're looking for.

There is another thing that I would like to suggest, and I do agree 100 percent with the Premier with regard to this. A part of what we talk about nationally when we talk about national standards is, frankly, a myth. It doesn't exist. I think that one of the challenges we have in British Columbia is to show how we can provide for standards to be applied provincially in a way that's worthwhile, universal and understandable. If we take this model in British Columbia, I think we can use it as a tool to generate a better understanding nationally of how me might be able to respond.

I'll give you a quick example. When we talk about health care in B.C., everyone in this Assembly, everyone I know in public life is committed to a strong, universal, publicly accessible health care system that doesn't have anything to do with how much money people have in their pockets but has everything to do with how we provide care when they need it. There is absolutely no question that we do not have a standard of health care across this province. Where I live in Vancouver, I have four major emergency wards within 15 minutes of where I live. If you live in Fort St. John, you don't have one within 15 minutes; you might have one within four hours. I think we have to look at how we do that. I think we actually have the opportunity to decide how to do that in B.C. and show how to do that in B.C. so that we can take that and use it as a national model. That's part of what I mean by showing some leadership and doing those things.

I think it also requires us as a province to be willing to say provincially that there are things we're not going to do anymore -- not just things we're not going to do so we'll let the national government do them and let them take care of things 

[ Page 2048 ]

but also things we're not going to do here provincially so we'll let the local governments do them and let them take care of things. Let's leave the dollars at home; they'll be accountable for them. That's something we will look to.

I can tell the Premier that I think this is an important issue. I know there are a number of people on this side of the House who are committed to this, who would like to be participants in this, who are committed to bringing people in the communities across British Columbia into this discussion. Anything we can do to help move that forward in a constructive and, frankly, new way, perhaps a provocative way, is something that we would like to try to help the Premier with.

I want to close with one comment with regard to standards. As I've gone through these estimates with the Premier -- and I thank the Premier for his patience, in spite of his display of humanness at times -- I think it's important that we all try to recognize that there are many things we in this House where we do have mutual objectives, mutual goals. We may not agree how to get them. In fact, there are probably more times that we don't in terms of public policy. But I think to establish those standards and to establish ways we're going to measure how well we're doing is going to be critical.

What I would say, what I'd like to get from the Premier tonight -- and I'm going to something he talked about a little bit earlier, because it caused me some concerns as a public person when I read about it, although I'm not talking here about what happened or anything -- is the whole issue with regard to B.C. Transit, the dismissal of Mr. Dixon and how the government and the board participated in that.

I think there are standards of behaviour that we all have to have. As well, I think we all have to be willing to be held accountable to those standards. It's not just the Premier and myself and other people who are elected; it's not just the people who are paid public officials; it's people who are appointed to do public tasks as well that have to meet those standards, I believe, of ethical conduct. I think it's critical for us that we understand. I know the Premier believes that he's held up to a different level of standards -- and he should be, he's the Premier of the province -- or I might be, as the Leader of the Opposition. We have to set an example. It involves the whole issue of perceptions and how people feel.

I believe there are a number of people who were very upset by that whole series of events which took place between sessions. I believe we also have a number of the public who don't trust any of us regardless of party, regardless of label, regardless of who appoints whom. It seems to me to be one of our goals and objectives. I would hope that over the next months we can go forward in establishing those goals and objectives together and say that there are some standards of conduct that we demand. We demand them from the Premier, we demand them from the cabinet, we demand them from the Leader of the Opposition and MLAs. We also demand them from people in the public service and from people who are appointed to serve the public interest, because at the end of the day -- I'll go back to some of the comments that both the Premier and I made yesterday -- I believe the government should reflect the values of the people who live in this province. I believe the people who live in this province believe in fair play. I believe that people who live in this province believe the government shouldn't be onerous, overwhelming or punitive. It should be helping people achieve their goals and objectives. They can't do that if they believe there's an elite group or a special group or a group that's outside of the goals, the objectives, the standards and the values that we all share.

I would hope as we move through the next term, before we get to the next set of Premier's estimates, that we will have a better understanding on this side of the House of the goals that this government has set, of the standards and values that this government has laid out, and of the way that this government will measure whether or not it is achieving those goals and objectives beyond, to be blunt about it, politics -- so that people who are outside of this House and outside of the political life that we lead in this province can look at what's taken place and say, "that has worked" or "that hasn't worked" or "we should change this" or "We should improve that." I believe that's going to require all of us in public life -- in terms of our behaviour and the behaviour of those who work with us and for us -- to make sure that we establish those standards and move them forward.

I hope that the discussion we've had over the last few hours -- it seems like a very short period of time to me -- will help inform the government. I hope that we can move forward in establishing not just the standards that we'll meet but the measures we'll use to decide whether we're achieving those goals. We look forward to holding this government to account, and I know that this Premier will hold his cabinet and his colleagues to account to make sure that we can make British Columbia a better place for all of us.

Hon. G. Clark: I won't respond with a long response either, but let me say that, of course, one of the problems with the kind of philosophical or high-level discussion that the Leader of the Opposition just undertook was that I find myself in virtual total agreement with the comments he has made. Obviously the challenge is in the details and the way we implement them. Just to conclude my estimates, I have said that I want to work with members of the Legislature from all parties in pursuing a variety of ways. We've made a few baby steps this session in doing that, whether it's in small things like the Lieutenant-Governor's reception or the half-dozen committees that are going to be meeting or meeting off-session on some significant tasks. But I want to assure members that I'm not satisfied with that progress.

I think some of the issues the Leader of the Opposition raised around accountability, goal-setting, values and how, in fact, we can make this place work better and treat people in a standard we accept -- and to segue a little into issues around child protection -- are not issues for ideology. In general, I don't believe they're issues for differences in political party views. They're issues which members of the Legislature, who are all here attempting to serve the public interest, should be able to work together to resolve. This forum doesn't really provide that opportunity very well. This forum is an adversarial forum, and it's a forum where government and the executive council has all of the power and members opposite only have power to critique. I say to members opposite that I am genuine about trying -- in some of these areas that the Leader of the Opposition has mentioned, and which I've tried to mention -- to come up with new ways in which we can, in fact, work together to pursue some of these interests, recognizing fully that we are from different parties, that we are the government, that the opposition not only has a right to oppose but a duty to oppose many of the things and shouldn't compromise that ability.

[8:45]

It's that kind of reform that we should strive to seek because it's not just good government but it's something that is about time we move to in British Columbia -- a level of civilized debate, discussion and ways in which we can try to work together. It's easy to say. Obviously, there are lots of 

[ Page 2049 ]

reasons why things never work that way. I'm hopeful that with advice from members of the opposition and with some progress in these areas, we can, at the end of this term of government, whenever that is, regardless of election results, have made some permanent changes in the way the place operates in a manner which British Columbians increasingly expect.

Let me conclude by saying that I actually think that in the 1990s, aside from all this talk of values and nice discussions, increasingly and desperately taxpayers expect their politicians to try to work together. They know their differences, they voted for different parties. They understand that. They don't want you to park your differences at the door -- that's what democracy is all about -- but they're almost desperate for people to put aside some of the theatrics that come with this business and work collectively to solve some problems. They're desperate about different levels of government doing that and showing some leadership.

I'm very encouraged by the Leader of the Opposition in his remarks -- not just today but privately and over the last few months. I hope he's similarly encouraged by some of the small steps we've made this session, and I hope that we can make some much larger steps in the months and years to come, so that we can make some changes which I think people really are demanding and which I think will lead to permanent structural change in the way we do business in British Columbia.

So with that, hon. Chair, I conclude my remarks.

Vote 8 approved.

Vote 1: legislation, $24,294,000 -- approved.

Vote 2: auditor general, $7,392,000 -- approved.

Vote 3: office of child, youth and family advocate, $1,040,000 -- approved.

Vote 4: conflict of interest commissioner, $178,000 -- approved.

Vote 5: Elections B.C., $23,967,000 -- approved.

Vote 6: information and privacy commissioner, $2,630,000 -- approved.

Vote 7: ombudsman, $4,819,000 -- approved.

Vote 64: office of the police complaints commissioner, $500,000 -- approved.

Hon. M. Sihota: I move the committee rise, report resolutions and ask leave to sit again.

Motion approved.

The House resumed; the Speaker in the chair.

Committee of Supply B, having reported resolutions, was granted leave to sit again.

Committee of Supply A, having reported progress, was granted leave to sit again.

Hon. M. Sihota moved adjournment of the House.

Motion approved.

The House adjourned at 9:00 p.m.

PROCEEDINGS IN
THE DOUGLAS FIR ROOM

The House in Committee of Supply A; H. Giesbrecht in the chair.

The committee met at 6:45 p.m.

S. Hawkins: I'd like to start on Pharmacare, if I may. Is someone available?

I must have taken this off the line breakdown. The budget for MSP and Pharmacare together appears to have gone up by 1.78 percent, from $2.086 billion to $2.090 billion, and the actual budget for Pharmacare appears to have gone down by 2.5 percent. I'm wondering if the minister can tell us what accounts for the reduction in the budget for Pharmacare.

Hon. J. MacPhail: Reference-based pricing.

S. Hawkins: Can the minister explain the reference-based pricing program and give us some idea of the savings to Pharmacare that have resulted from the introduction of this program?

Hon. J. MacPhail: Reference-based pricing is the selection of the drug that's chemically similar to treat similar conditions on the basis of the least-cost drug being used; that's what reference-based pricing is. This year the savings -- just from October '95 through till the end of July '96, so it's not a full year -- will be $21.1 million.

S. Hawkins: Patients who can afford to pay for prescriptions that aren't covered by Pharmacare are able to have a much wider choice of pharmaceuticals than patients who rely solely on the Pharmacare system. I'm wondering if the minister can explain for me how this system is different from the two-tier system that she's on record as opposing.

Hon. J. MacPhail: Actually, the Pharmacare program isn't covered by the Canada Health Act.

S. Hawkins: That's a good way out, I guess -- some are covered, some are not. This is the government that says they believe in comprehensiveness in covering patients. Where it appears there's two-tiering or shifting down of the system, I guess it's an easy way, to say it's just not covered by the act, so we're not going to do it. Reference-based pricing has been applied to ulcer medications, arthritis medications and certain heart medications used to treat angina pain -- the nitrates and the nitroglycerin preparations. I wonder if the minister can confirm that Pharmacare now has plans to apply reference-based pricing to high-blood-pressure medications.

[ Page 2050 ]

Hon. J. MacPhail: Hon. Chair, it's future policy.

I'd just like to take a minute, though. Pharmacare is not covered by the Canada Health Act. It's not demanded that the government in any way provide drugs in the system as we know it. That is about protecting medicare. I do want to say that while drug costs in this province have increased beyond even the population increase, we are committed to ensuring that there is government funding for the delivery of drugs in the province of B.C., unlike many other provinces. We are also committed to ensuring the integrity of that system within the context of the most cost-effective, efficient use of drugs.

I don't want to spend the evening engaging in a discussion about one pharmaceutical company's position over another's. I'm not a physician either, but I do know that reference-based pricing is working. Doctors have been given the opportunity to make appeals if there is a drug that they wish to use beyond what is provided for in reference-based pricing. Our position has been made to the court system in British Columbia, and our position has actually been upheld.

It's in the context of that that I look forward to discussion around what's useful for people in British Columbia. I must tell you that I'm taken aback, moving from my previous portfolio to the portfolio of the Ministry of Health, around the issues of drug use in the health care system. I don't in any way see it as my role to engage in defending one pharmaceutical company over another.

S. Hawkins: I'm not talking about defending or not defending drug companies; I'm talking about patients and therapeutic benefits to patients. I'm also talking about access to certain medications for patients. The system in place allows for a very basic, generic level of medication to be prescribed, and patients that can afford a registered drug, as opposed to a generic drug, get the benefit of that drug. That is the argument I'm making. Is that not two-tiering? Patients who can't afford the registered drug don't get it. Sometimes I think the argument out in the field right now is that a physician will prescribe a drug for a patient; they go to fill their prescription, and they don't get the drug that is on the prescription; they get the generic drug. Can the minister comment on that?

Hon. J. MacPhail: If a drug is medically necessary, the patient gets it. The exceptions to the policy are based on a special authority process. In instances where the physician has determined that the patient must have a specific drug due to a specific clinical indication, the authority can be granted by Pharmacare for the full benefit coverage for the patient. Certain physician groups are exempt from the policy, on the basis of their speciality and expertise, and I can go through those exemptions if the hon. member wishes. But, again, I put on the record that I'm not a physician, and I don't in any way wish to undermine her authority or expertise, or any colleague on the other side of the House, in terms of being a health care provider. This is about spending health care dollars in the most cost-effective way possible. And I say unequivocally that reference-based pricing is working in the best interests of the patient.

S. Hawkins: I guess I didn't get the answer to the question. The question was.... Some patients go to the doctor. They get a prescription. They go to fill it. They don't get that medication; they get the generic. Obviously, if they want the medication that's written, they pay more. To me, there's an inequity in the system there. Obviously, the minister doesn't think that's two-tiering; we do on this side of the House.

The other concern we have is that yes, there is an option for doctors to fill out a form and get the right medication for patients. So maybe we'll just canvass that area a little bit. Does the ministry keep a record of how many forms they get from doctors asking the patient to get the medicine that they prescribe?

Hon. J. MacPhail: If a patient goes to have a prescription filled and makes a decision to pay for a drug that is medically no more effective, yes, that patient pays more. In terms of us making sure that we best use health care dollars, we are ensuring that public tax dollars go toward providing medically necessary drugs. We can have this dispute about the best health care system across Canada, but our Pharmacare programs stands up to any across Canada.

In the case of the number of prescriptions that doctors say need to be different than those provided by reference-based pricing, which of course is different than the generic drugs -- I know the hon. member is probably just trying to provoke me by using the term generic drugs, because of course it isn't generic drugs at all that we are talking about here -- about 5 percent of the prescriptions filled have to be different than the reference-based priced drug.

S. Hawkins: Can you break down that 5 percent into hard numbers for me?

Hon. J. MacPhail: Out of almost 449,000 prescriptions, almost 23,000 were outside of the reference-based pricing policy.

S. Hawkins: What is the process that a physician has to go through to get a prescription upgraded to the medication that he actually wants to prescribe for his patient, but doesn't get because of this system?

Hon. J. MacPhail: Sorry, I missed the last part of the question.

S. Hawkins: I just want to know what the process is that the physician has to go through to get the medication for the patient that he prescribed but that the patient can't get because of the Pharmacare system.

Hon. J. MacPhail: There's a form that the doctor then faxes in and gets approval. I have it here. I'll make the copy available to the member.

S. Hawkins: What's the turnabout time for that form? There seem to be concerns that the form is filled out, it's sent down there, and then there is quite a lag time before the doctor gets it back and the patient gets approval for the medication.

Hon. J. MacPhail: Actually, it's interesting, because the doctors are certainly getting used to this. There's been a substantial drop in the number of forms submitted; it's approximately one-third of the number that were originally submitted. There's a 48-hour turnaround on paper and a 20-minute turnaround on a telephone call.

S. Hawkins: I think you might find that the substantial drop is due to frustration with the administration, not to the fact that people are getting used to the system. I think people just get so frustrated with the process that they say: "Well, it's not going to work anymore, and why fight the system?" I think you see that with burnout and everything else in the 

[ Page 2051 ]

field because of these kinds of programs. I wonder how much consultation there was with physicians, what consultation the ministry had and what ongoing consultation the ministry has to make the decisions about what drugs are added to this group of reference-based drugs.

Hon. J. MacPhail: There was consultation with people in the medical field, and we will continue to do that. I'll just read from the court decision from the Supreme Court of B.C. on the previous point the hon. member made: "The reference-based pricing policy has changed the pattern of prescription of drugs within each category without any evidence of widespread, significant, adverse health impact on patients. The reference-based pricing policy has not restricted the availability of drugs to which it applies."

S. Hawkins: Is there a committee set up that advises the ministry when drugs are added? Can the minister advise how these decisions are actually made and what the terms of reference of this committee are, if there is one?

[7:00]

Hon. J. MacPhail: There is a physicians' consultative group on the reference-based pricing program, with physicians represented from across B.C. -- nephrologists, general practitioners, family practice, the B.C. chapter of the College of Family Physicians of Canada, cardiologists, internists.

S. Hawkins: With respect to the drugs that are going to be added on, I understand that high-blood-pressure medications will be added this fall. I'm asking for confirmation of that.

Hon. J. MacPhail: It's future policy, hon. Chair.

S. Hawkins: If these are the estimates for the next year, and we are looking at ways of cost-cutting or looking at cost containment, I think it's a fair question to ask if there's policy in place right now. Apparently, out in the field, that is the message they're getting. They are advising patients that these medications are on the group that's going to be included in reference-based pricing. I think it's a fair question to ask.

Hon. J. MacPhail: No, is isn't. So....

The Chair: Shall vote 39 pass?

S. Hawkins: That's a good way of avoiding the issue, I guess. I wonder if the minister is aware of a survey of 100 British Columbia practitioners, conducted in April of this year, regarding opinions on reference-based pricing. The survey was conducted by PSL Access Co. The survey found that doctors equally felt that antibiotics in certain medications were the most ineffective categories of drugs for reference-based pricing. In view of the opposition to this program from a panel of experts and the opposition to reference-based pricing voiced by general practitioners across the province, I wonder how the minister can defend a decision to go ahead with some of these categories without some kind of wider consultation with people practising in the areas.

These medications are usually prescribed by general practitioners. These are groups of medications that have wide-ranging use. I wonder again what committee is set up that advises the Pharmacare program, and what studies are done to show that there is support for new drugs being added for which perhaps consultation hasn't been done in the field.

Hon. J. MacPhail: It would be interesting if the member would actually put her position forward on reference-based pricing, which saves $30 million to the health care system. I think it's working admirably well in terms of the most cost-effective use of taxpayer dollars. I'd appreciate knowing her view on reference-based pricing.

There's a reference-based pricing expert committee. It was established in the fall of 1995. There are seven people on the committee. Mr. Corbeil is the director of Pharmacare here. He sits on the committee with Dr. Ken Bassett, Dr. David Blair from the Royal Columbian Hospital, Dr. Bruce Carlton from UBC, Derek E. Daws from the Drug and Poison Information Centre, Dr. Janet Martini -- I think her name has appeared here before -- from St. Paul's Hospital and Bob Nakagawa from Lions Gate Hospital pharmacy. This committee met as recently as this week, I believe. Oh, I'm sorry, that's not true. Mr. Corbeil met with the BCMA, which is also being consulted on reference-based pricing, as recently as this week.

S. Hawkins: The minister asked for my position on reference-based pricing. My position is that if people aren't consulted, then the program will definitely not work and will not be successful. The problem with reference-based pricing is, again, that some people were left out of the consultation.

Reference-based pricing isn't a new concept in this world. I believe Mr. Corbeil knows, and he's pointed to the experience in Tennessee that was reported in the New England Journal of Medicine in June of 1995. It reported that: "Prior authorization requirements may be highly cost-effective with regard to expenditure on NSAID drugs" -- those are the non-steroidal anti-inflammatory drugs -- "that have very similar efficacy and safety but substantial variation in cost."

What Mr. Corbeil may not be aware of is that in Tennessee the Tennessee Medical Association has filed legal action to delay the implementation of TennCare -- it's a more widely applied version of this prior-authorization scheme -- partly on the grounds that: "The state has violated federal Medicaid laws that require the state to ensure that Medicaid patients have access to care which is equal to that of other citizens." Put simply, these restrictive drug formulas do not put the patient first. I wonder if the minister can explain how limiting patient access to the full compendium of pharmaceuticals protects the health care of those patients.

Hon. J. MacPhail: I'll refer to Canadian experience, although we're well aware of the Tennessee experience. Again, I would appreciate knowing the Liberal opposition's position on reference-based pricing. The questioning is provocative, but I always know that provocative questioning doesn't necessarily mean a lack of support. So I'd be interested to know if the Liberal opposition supports reference-based pricing.

I'll just quote from the decision of the courts. The date of that is this year, actually, as opposed to a 1988 study from Tennessee -- March '96. This is the decision: "Reference-based pricing policy has changed the pattern of prescription of drugs within each category without any evidence of widespread significant adverse health impacts on patients. The reference-based pricing policy has not restricted the availability of drugs to which it applies."

S. Hawkins: It may not restrict the availability of the drug for those who can afford it. I guess that is one of the points I'm trying to make. If a patient goes to a doctor again 

[ Page 2052 ]

and gets a prescription, Pharmacare doesn't cover it. They can purchase it only if they can pay the higher price, unless a doctor can justify that the patient needs that drug.

Hon. J. MacPhail: Yes. Is it medically beneficial? You're right; that's exactly what it is.

S. Hawkins: But some of the drugs that are on reference-based pricing do not have the same makeup as the drugs that don't. Until they are trial-tested on the patient, and they show some kind of adverse reaction.... You know, the patient could be on this drug for a month, two months. Some of the different compounds in drugs cause reactions. They take a while to find out. There could be serious implications for the patient. So why does a patient not get the drug that a doctor prescribes? It's a very simple question.

Hon. J. MacPhail: I say this with the greatest respect, but this is not the place for us to show our stripes in terms of technical expertise in a life before politics. So I'm not going to engage in this. I do know that we have a court case before us that's been decided; it shows that there is no impact on health care delivery from reference-based pricing. I do know that of the 20 new drugs introduced in 1995 in this country, only two offered a benefit over existing therapy. I do know that there is evidence presented in the courts that shows specifically, drug by drug, that the only significant difference between a reference-based pricing policy of a lower-cost drug and a higher-cost drug is the higher cost of the other drug. That's the only difference.

I have to say I'm willing to be convinced, and I'm going to do as much as I can to ensure that our government is right on target with this. But drug therapies in this province, for me as a layperson, are a significantly increasing cost to the health care system without any significant or even -- I would go as far as to say -- any additional contribution to the well-being of people in B.C. Once again, let me make it very clear: our government totally supports the success of the reference-based pricing policy in British Columbia. If the Liberal opposition doesn't support reference-based pricing, I would be pleased to know where indeed we should make up the savings of $30 million per year.

An Hon. Member: Health labour accord.

Hon. J. MacPhail: Exactly -- health labour accord. We'll fight any election on that.

S. Hawkins: The minister says that it will save $30 million annually. I only see a $10 million reduction here, so I wonder where the other $20 million went.

Hon. J. MacPhail: I just gave that to the.... I'm sorry. Listen, I'll make a generic apology here for being tired and having to deal with.... For being tired.

The savings from October 1, 1995, to July 31, 1996, for three-quarters of the year, are $21.1 million.

S. Hawkins: I'm wondering if there have been any cost overruns associated with the implementation of the PharmaNet system. We're hearing that there have been.

Hon. J. MacPhail: If the hon. member wishes to present evidence of cost overruns.... There is no evidence. We have evidence of savings.

S. Hawkins: I will look into that.

I wonder if the minister can give us a little overview of something that's called the therapeutics initiative.

Hon. J. MacPhail: The therapeutics initiative is a cooperative effort of the Ministry of Health, UBC and the Ministry of Education, Skills and Training. It operates at arm's length from our government. The therapeutics initiative is guided by an advisory committee composed primarily of health professionals and the public. I'll just name those: UBC faculty of medicine -- medicine and pharmacology and therapeutics departments; UBC faculty of pharmaceutical sciences; College of Physicians and Surgeons; College of Pharmacists of B.C.; College of Family Physicians of Canada; BCMA; B.C. Pharmacy Association; the RNABC; the general public, including seniors' and women's health organizations; and the Ministry of Health staff. It functions as an advisory body to the Pharmacare division, and their recommendations are considered by the economic evaluation committee in the process of approving pharmaceuticals under the Pharmacare benefits program.

[7:15]

S. Hawkins: Do they get funding for the work they do?

Hon. J. MacPhail: Annually, it is $500,000.

S. Hawkins: Do you have any idea how that money is broken down, and what it goes towards?

Hon. J. MacPhail: No, I'm sorry. We'll get those details for the hon. member.

S. Hawkins: I understand that this committee does make recommendations to Pharmacare. Do they do it in the form of a report, and could we get those reports?

Hon. J. MacPhail: I'll go through the approval process, which is the actual work of the committee. Pharmaceutical companies would submit product information to the director of pharmacy services, Pharmacare, for listing as a benefit. That information is reviewed by the director of pharmacy services. Then there's a recommendation review by the therapeutics initiative and other bodies, such as the Drug and Poison Information Centre, if it's appropriate. The therapeutics initiative's scientific committee reviews the new drug. It assesses its therapeutic benefit, and then the committee makes a recommendation to the economic evaluation committee. The decision of that committee is conveyed immediately to the company, accompanied by a rationale for the decision. Then there is an appeal available to the company.

S. Hawkins: Does this therapeutics initiative committee make formal reports? Are those reports available for review so that we can see what kinds of discussions are going on and what kind of policy is coming out of a committee that's being funded by the ministry?

Hon. J. MacPhail: The committee does a letter of information, a therapeutic letter. It's made available to health care practitioners when they use the drug. The information around the decision is proprietary information, which is a specific legal term under the Freedom of Information and Protection of Privacy Act, but it is subject to the rules of FOIPP.

[ Page 2053 ]

[W. Hartley in the chair.]

S. Hawkins: Since we are looking at cost-saving measures, I'm wondering what else Pharmacare is doing to help cut costs. Can the minister outline some of those programs?

Hon. J. MacPhail: PharmaNet is another initiative which is a cost-savings exercise, and not only.... I hope we can agree that experience is showing that's it's good health care for the patient on an individual basis. It will also be effective, and is proving to be effective, around the issue of fraud and abuse. The year before last 8,000 patients were admitted to hospital for improper drug-use reaction, and that cost the system $42 million. It's that area of abuse of the health care system that PharmaNet will assist in terms of cost savings.

There's also the expansion of the trial prescription program. That was implemented in 1993 for a group of eight medications. They were chosen -- and I can make more information available about this -- because they were very expensive, not well tolerated and tended to be used chronically and therefore typically dispensed in large quantities. Under the trial prescription program, when consumers presented new prescriptions for these drugs, only an initial supply of seven to ten days was dispensed. It turns out that the TPP, trial prescription program, has strong support from pharmacists. We actually did expand the program, effective April of this year. Also, the trial period for all affected drugs was extended from ten to 14 days in order to accommodate the period of potential reaction associated with the new drug. Those adjustments were made to the trial prescription program. Reference-based pricing, low-cost alternatives, the TPP and PharmaNet are areas that are garnering savings.

S. Hawkins: Are there other preventive measures being taken in patient education?

Hon. J. MacPhail: There's the prescription review program. It's a drug-utilization review. Its mandate is to develop and implement a centralized system for health care professionals, for providing the optimal level of drug therapy and poison management. It's a drug-use review education program. It identifies and then changes exceptional drug-prescribing patterns. It was named the drug-utilization review, and then it became the prescription review program. The responsibility for that initiative shifted to the College of Physicians and Surgeons this fiscal year. The prescription review program works in partnership with the therapeutics initiative. The college will review patterns of prescribing and utilizing medications with respect to the therapeutic guidelines and education programs developed by the therapeutic initiatives.

There's the excellence in health community pilot project. It is a means by which as many recommendations as possible in the Pharmacare review panel's report and the seniors medication framework are implemented. We select a community where there's a large population of seniors. In the summer of 1995, for instance, White Rock was chosen as the site for the pilot project. The hon. member for Surrey-White Rock should in no way take this as an indication that we think he's a senior citizen. The project team consisted of representatives ranging from local geriatricians to seniors in the community. We've committed $100,000 to this project over the next two years.

There's just one other program that I'll describe for you -- maybe two. It's called B.C. SMILE, the B.C. seniors medication information line, and it's located in the faculty of pharmacy at UBC. It's a joint effort between the B.C. Drug and Poison Information Centre, our ministry, the pharmaceutical industry and SPARK, the health sector of the Science Council of British Columbia. It's line funded primarily by the pharmaceutical industry. All calls are fielded by a pharmacist. It responds to queries or makes appropriate referrals for seniors.

Lastly, there's the North Shore community drug utilization program and the Nanaimo pilot project. The North Shore project is a pilot program aimed at assisting physicians in selecting the most appropriate and cost-effective drug therapy for their patients. That was expanded to include a pilot project at the Nanaimo Regional General Hospital.

S. Hawkins: I wish I'd interrupted the minister before, but perhaps afterwards she can provide the cost of those different programs and what savings we can expect from each of them. Some of them are obviously on trial. Are there plans to expand some of these to other communities? Are there plans to do any advertising or patient education on a provincewide scale as far as drug use is concerned?

Hon. J. MacPhail: We have patient education programs in the field now. I'll actually be working with my colleagues across the country, because, of course, the education issues around this really go countrywide. So my colleagues from across Canada and I will be looking at this issue of how we expand the education programs next year. But in the meantime, the success of the pilot projects will necessarily lead to expansion. If they're not successful, they won't.

L. Reid: When I was last in this set of estimates, almost a year ago now, there was lots of discussion around the cost of the hardware and software for the PharmaNet program. There was lots of debate as to what the actual numbers were. That information was promised pending that last set of estimates and was not forthcoming. If the minister is able to provide that information today, I would be most appreciative.

[7:30]

Hon. J. MacPhail: It's $19.9 million in total.

L. Reid: Could the minister break that down in terms of hardware costs and software costs?

Hon. J. MacPhail: Hardware cost is $13 million, and then the balance is software cost.

L. Reid: Could this minister give some indication as to the amount of cost shared or borne by individual pharmacists in the province? Is that the government outlay? What indeed were each of those pharmacists asked to bear, in terms of having that program operational in their pharmacy?

Hon. J. MacPhail: We negotiated a flat-fee cost of approximately $3,000 per pharmacist.

L. Reid: You obviously did well. The original cost was supposed to be $6,000 per pharmacist -- so, government in action. In terms of the 700-plus pharmacies in the province, are we to understand that each pharmacy today has that program up and running?

Hon. J. MacPhail: Yes, all pharmacies have been connected since September 1, '95. There are 672 community pharmacies in B.C. They process all prescriptions dispensed to anyone in these pharmacies.

[ Page 2054 ]

Hon. Chair, with the indulgence of the members, could we have a five-minute break? Can we recess to do that?

The Chair: Good. On agreement, we'll just take a five-minute recess.

The committee recessed from 7:35 p.m. to 7:40 p.m.

[W. Hartley in the chair.]

L. Reid: My recollection is that we were debating issues around the PharmaNet program. One of the issues that I don't believe was resolved satisfactorily last time out was the call for confidentiality around people's medical information. There was some discussion around a password system, but there was also greater discussion, I believe, around the actual setup of pharmacies, where there is no place to engage in a private conversation. You simply arrive at the counter, meander along with everyone else, and you don't feel.... Lots of individuals who wrote to me as Health critic said they did not feel comfortable sharing that kind of private information. I know the discussion between the Pharmacy Association and the ministry was to provide either some incentives or some funding dollars to allow pharmacies to create a private consultation area. Could the minister provide a status report on that?

Hon. J. MacPhail: Yes, there has actually been a bylaw developed. It's the privacy bylaw: the Pharmacists, Pharmacy Operations and Drug Scheduling Act. It actually deals with the issue exactly as the member outlines. It's an important issue, and I can make that bylaw available and would be happy to do so. It's newly developed. I think it's the first in Canada, isn't it? Then, of course, we do have the issue of the opportunity for people to use a keyword in the system to protect the privacy of their profiles. There are 1,300 people so far in British Columbia that have made use of the keyword to protect their privacy.

L. Reid: I appreciate learning that the number is 1,300. I think that's still a relatively small number, so the confidence in the system must be building. My question would relate to whether or not there have been any errors in information transfer to this point. Certainly I've had correspondence to suggest this, and I would simply like some verification.

Hon. J. MacPhail: There has been one error by a professional organization. Advice has been given to that professional organization, and the practice has.... Well, I'm not alleging that there even was a practice, but it won't happen again.

L. Reid: I thank the minister for that. I am certainly prepared to pass that information along. The minister referenced earlier the child prescription program, and I would concur with the minister that it is an excellent program. What I would wish the minister to provide is a cost-benefit analysis around that program. The only dollars that are discussed openly are the alleged savings around the reference-based pricing program. I think the same courtesy should be extended around all the other programs the minister outlined -- i.e., the child prescription program and particularly the low-cost alternative program. Both of those programs probably do have significant savings, and it seems to me that if this is a comprehensive program, all of that information should be available.

In the discussion of the reference-based pricing program, one of the issues that has continued to arise is around physicians requesting an exception, asking for a product that is not reference-based priced, and the process has taken quite some time -- phone calls, letters and all the things that physicians typically don't have time to do, because they simply don't get through to the program the first time. There was discussion in the last set of estimates that the process would somehow be streamlined and that if the patient was not able to tolerate the product as presented, the exception would be made and the process of getting them that product would be streamlined. Is the minister aware of any steps that have been taken to resolve that issue?

Hon. J. MacPhail: Yes, and I appreciate that the hon. member wasn't present when we discussed this just a few minutes ago. But there's a 48-hour turnaround on the form guaranteed now and a 20-minute turnaround on a phone call if the physician wishes to make an appeal on the basis of the use of a reference-based-priced drug. That is in effect now. On the basis of that, the process is that we're having the.... The complaints have virtually disappeared around getting approval for an exception.

And yes, I will make available the cost-benefit analysis of the other cost-saving programs. Just to give an indication, over the last three years we saved $120 million in Pharmacare costs. The low-cost alternative in itself has saved almost $20 million. I will make available to the members opposite the cost-benefit analysis of each of the savings initiatives.

L. Reid: The minister referenced in her comments earlier that there are approximately 672 community pharmacies. In the estimates just over a year ago, there were 700-plus pharmacies. One of the issues that came to light at that point was the payment structure around pharmacies which also served residential care homes, long term care facilities. Either the payment process was not effectively in place or there was some disagreement with government around that. Are these 672 pharmacies a prudent downsizing? Or indeed, are these other pharmacies now out of business as a result of that issue not being resolved?

Hon. J. MacPhail: I was going to accuse the previous minister of cavalierly rounding off the numbers -- and therefore slagging him -- but I won't do that because that's not true. Actually, there is virtually the same number of pharmacies this year as there was last year. We have clarified how we identified pharmacies, including dispensing physicians. We are more accurately counting the pharmacists now. I can tell you the change in how we're counting them, so that you're not confused by that. But basically, there was the same number last year as this year.

L. Reid: In my previous question, we talked about streamlining the process around exceptions. I appreciate the information the minister gave. Can the minister tell me how many exceptions were sought in the last calendar year?

Hon. J. MacPhail: Five percent. There were 448,000 prescriptions dispensed, and approximately 22,000 of those were by exception.

L. Reid: If this question is not in order, I trust the Chair will so advise. One of the issues that has always come before me as Health critic is around the dispensing of cancer drugs while in treatment -- anti-nauseant drugs and all those attendant prescriptions, if you will. Those are not given to the patient when they leave chemotherapy. I know that's perhaps 

[ Page 2055 ]

not a significant issue for all British Columbians, but it is for people on limited income when it comes to purchasing a product that sometimes costs $20 or $30 a tablet.

I know that the minister, in the last set of estimates, offered to evaluate that process and see if there is any way that this medication can be considered part of the treatment package, as opposed to sending someone to an outside pharmacy. Has any movement been made on that issue?

Hon. J. MacPhail: It's a good issue. It actually expands even beyond cancer patients -- the issue of drugs that are dispensed in the hospital, and then the patient is responsible for them according to her Pharmacare coverage, post-discharge. It is an issue that we have to grapple with. It's simply a cost issue.

Just for the information of the member, cancer drugs themselves even continue to be supplied by the Cancer Agency upon discharge. It's the anti-nauseant drugs that are subject to the changed rules. I'm sympathetic to the point that the member makes, but it's a cost item that we have to deal with.

L. Reid: Not to belabour this point, but certainly I want to leave with the minister the sense that the larger investment is the cancer drug. To not allow that to work to its optimum, by ensuring that the person feels wretched for days after, denies some of the benefit. I certainly think the minister concurs. If we're going to expend that amount of Pharmacare dollars on the actual cancer drug, at least allow it to work to its full benefit and provide something that's not a significant cost when you compare it to the actual initial outlay. That's my only point, and I would leave that for the minister.

In terms of other areas of Pharmacare.... If my hon. colleague has covered this, I will certainly take my seat. But I still receive a number of pieces of correspondence around seniors' medication. They anticipate -- and maybe it's just the paranoia in the system -- changes coming into effect that will impact how they receive prescription medicine in the province. Is there any discussion or any plan in place to make any changes?

[7:45]

Hon. J. MacPhail: It's future policy.

S. Hawkins: I'd like to move on to funding for acute care. I'd like to talk a little bit about capital equipment for hospitals. The BCHA has made some fairly significant comments with regard to this. I quote from their report:

"Over the past few years, the funding allocation for capital equipment has been eroded to the point that reports from health care facilities now indicate potential closures of such critical care services as neuro-angiography suites and critical care units due to the inadequacy of old and outdated equipment. The standards of safe patient care demand the hospitals offer services supported by equipment which meets current standards."

"A recent inventory of the state of diagnostic equipment in all the province's hospitals estimated that more than $40 million will be needed in each year until the year 2001 to replace aging and obsolete diagnostic equipment alone, not including medical and surgical equipment requirements."

"The health industry has employed a variety of strategies to acquire needed capital, such as group purchasing, sharing equipment, buying second-hand equipment and soliciting increased private donations. However, these strategies are insufficient to address the current capital crisis....

I understand that hospitals were to receive a 2.5 percent increase or $100 million in additional funding. I'm wondering: where exactly did that $100 million go?

Hon. J. MacPhail: I know the member is asking this question in a different way, but I think the answer is the same. Maybe I'm not answering her question. We dealt with the funding methodology committee yesterday. They were responsible for allocating the $100 million, but I can give you a general breakout. For instance, $13 million went to capital equipment, and $20 million went to operating costs generally. But the funding methodology committee allocated those funds.

S. Hawkins: With respect to the hospitals' concern about dated equipment, is there money in the budget for equipment that the hospitals have been asking to upgrade?

Hon. J. MacPhail: I'm sure a case will always be made that it's not enough, but the $13 million this year.... The previous year there was $1.5 million, and then in 1996-97 we made $13 million available -- $5.1 million of that will go to CT scanners, $7.2 million will go to equipment that has a cost of $100,000 or more per piece -- and then there's $750,000 for special projects. This year we have also allowed the hospitals to use up to 3 percent of their operating funds for capital equipment expenditures.

S. Hawkins: I did understand that the hospitals could use up to 3 percent, but the minister can probably appreciate that hospitals don't really have much room to move within the funds they are given. One thing that we have requested -- I hope the minister can provide it, and I won't ask for it here if she can give an undertaking to give it -- is a budget for capital equipment, a breakdown hospital by hospital. I wonder if the ministry has that and if we could be provided with that.

Hon. J. MacPhail: Yes, I can give the hon. member that, and I want to give some comfort to the member that I do agree that there is a problem here that we need to address, and we will be paying some attention to it.

S. Hawkins: I appreciate the comments of the minister.

In recent years, it's not unknown for communities and hospitals to set up foundations for private fundraising. I know a lot of this is going on in my community alone. I think it's commendable that communities do this to provide for their hospitals and cancer centres, and to provide equipment and comfort measures for patients. There are a lot of service clubs, as well, that are providing for this kind of equipment. I think there is a problem there, because I really believe that our system has the money to provide for it. We just have to set priorities and decide what's important.

I know there is a lot of cost now being attributed to the health labour accord. There is criticism that perhaps money is going there rather than to patient care; I know you have heard that from us on this side of the House. I would like to canvass that with the minister a bit. I understand that there was a report -- I will call it the Dorsey report -- which recommended amalgamating several health care unions. 

[ Page 2056 ]

I understand that this is going to be implemented with regionalization. I wonder if the minister can tell me how much that is going to cost and if the health care budget includes that this year.

Hon. J. MacPhail: I'd be pleased to discuss the Dorsey report with the member. It actually doesn't have any cost bearing. It's a union representation matter, but there are no extra costs associated with the Dorsey report.

S. Hawkins: I'm sorry, I misread it; it's the Vince Ready report. The Vince Ready report speaks to something called levelling-up, and I wonder if the minister can describe that for me.

Hon. J. MacPhail: Yes, actually the health accord, which.... I mean, the '96 accord is also referred to as the Ready report, but it's the same. It's a tool to help both government and the industry work together to allow for the necessary shift of nurses and supporting health care workers from urban areas, which some would argue are overserved, to underserved non-urban areas and then also the shift from larger hospitals to smaller hospitals. Government determined -- and industry agreed, because industry renewed the accord -- that this was the fairest and most reasonable way for this shift to take place.

The accord did result in us being, really, the leader in Canada in achieving the necessary shifts in delivery of care from the urban to the non-urban areas in a way in which we still maintain the skill level and experience level of nurses and health care workers. Part of the accord is to retrain workers and then to reassign them without disruption of service.

There are two areas that we need to look at to see where there's been substantial detriment to the retention of health care workers. One is Ontario, and the other is Alberta. Right now they have severe retention problems and anticipated retention problems. The accord, certainly in British Columbia, has augured well in terms of our having experienced worker retention problems. That's the reason for the accord.

The cost of the accord is $30 million this year. Again, I put that in the perspective of an acute care hospital system that costs $2.7 billion, of which 80 percent is labour costs. There will be a $30 million cost this year and $50 million next year. We have been able to fund that in the health care budget by virtue of our saving $210 million through eliminating public sector positions elsewhere in government.

S. Hawkins: Is the Vince Ready report inclusive or exclusive of the 2.5 percent increase that the hospitals got? I wonder if the Ready report was anticipated in the health care budget this year.

Hon. J. MacPhail: Let me say this, in a very political way.... No, I'm just kidding. Let me just tell you that we gave the hospitals 2.5 percent. In funding the hospitals at 2.5 percent, we were aware that the Ready recommendations had to be accommodated, but we are also working with the hospitals on how to accommodate that.

S. Hawkins: From the information I get from the hospitals, they estimate that it's going to cost between 4 and 5 percent to implement this levelling-up concept. I wonder if the minister can assure us that this will not be at the cost of patient care in the hospital budgets.

Hon. J. MacPhail: Okay, there are two issues. One is the health labour accord. We have costed the calculation of that, and it's $30 million this year and $50 million next year. Perhaps what the member is referring to is the Ready recommendation that deals with what is outside of the labour accord, which is the transfer of employees from the acute care sector into the community health care sector. There may be what some people loosely call levelling-up in that, but that has not been agreed upon yet. So really, neither the industry nor the government can estimate those costs, because there is no agreement in that area.

L. Reid: The minister referenced the original accord. The understanding around the original accord, when it was introduced by Elizabeth Cull, was to move 4,800 people from the acute care sector to the community. When that was deemed to have come to an end, it was somewhere between 1,300 and 1,600 people that had actually moved -- not a significant measure of success, in my view. Was the program oversold to start with? What was the problem? Why did it not meet your own objectives for success?

[8:00]

Hon. J. MacPhail: You're right about the original number of 4,800, but the figure of what the hospital sector has been reduced by is 2,200.

L. Reid: That is as of what date?

Hon. J. MacPhail: March 31, 1996.

We had anticipated a higher rate of attrition. I agree with the hon. member that the figures are not what we had originally estimated. Basically, the miscalculation is due to the fact that we had anticipated a higher rate of attrition than actually occurred.

There are several factors besides the voluntary attrition rate. There was actually a substantial increase in acute care demand during that period of time that we hadn't calculated in. Then also, to put it on the record now but not in any defensive way, there were structural problems, both in the accord and in the health care sector, that did cause delays in placing employees. The renewed accord actually has been -- and I don't think it's too strong a word -- welcomed by both the industry and the unions and is working very effectively now, after what one could call substantial growing pains.

L. Reid: I would concur with this minister around substantial growing pains. Frankly, I think implementation around the original accord was lacking. What saddened me was that you were basically tearing down the acute care house when there were no houses in the community for those workers to move to in terms of offering their services in a different way. That was the intent of the original accord. That was certainly the discussion around the Seaton royal commission -- offering services differently, delivering health care differently. When it came to putting those structures in place in the communities, that was noticeably absent.

I'm not convinced today that that scenario has changed dramatically. It seems to me that again the cart is before the horse. The example of Riverview comes up many times. I mean, dismantling that program.... There are not sufficient or adequate or decent places for a number of those individuals to be in the communities.

So again, I'm submitting to the minister that I have extreme caution around the level of implementation. If the minister believes that this accord will somehow be different, I would welcome that thought, but I have nothing to go on yet. 

[ Page 2057 ]

I would ask the minister, in terms of evaluation, when can we expect an interim report? When can we expect a final report?

Hon. J. MacPhail: Fair comment. I think it's important that we discuss that during the regional assessment process. That's fair comment, and I look forward to the hon. member's input on that.

L. Reid: I accept the minister's wishes that we participate in the process, because we certainly have some very grave concerns on behalf of patients in the province. I look forward to that opportunity.

The minister in an earlier remark referenced $210 million savings by eliminating public sector jobs elsewhere in government. Where? The best example that the Premier touted repeatedly was B.C. Systems. Again we learned that those were lateral transfers; no one actually moved out of the system. Would the minister be so kind as to highlight where those positions were removed?

Hon. J. MacPhail: Hon. Chair, I would never deem having an expertise beyond the Minister of Finance or the Premier in this area.

L. Reid: I appreciate that stand-back from the issue, if you will. But the bottom line is that moments ago you said it. You said there were savings realized. If you can enter that into the record, to me it demands an explanation, and I would ask the minister to provide one.

Hon. J. MacPhail: Well, I will provide it. I'll garner that information from the other ministry estimates.

L. Reid: One of the other issues that my hon. colleague has raised has been around the costs of the accord on patient care. One of the most alarming trends has been around hospitals in this province instituting what they call corporate days. Most hospitals have incorporated ten corporate days into their programming. A corporate day, for the information of the general public, is simply that the services aren't offered. It's like ten days where they shut down operating rooms or special care units around the province.

Every person I spoke to said it was absolutely essential to meet the demands of the accord. Those dollars were not in the system. That was the only way they could accommodate the accord. What alarms us on the opposition benches is that every time that happens, the patient suffers and the wait-lists grow in this province. This is not new. This minister will know that this is ongoing. I can give the minister many examples, and I probably will over the course of this evening's debate.

One of them that is of grave concern to me is the adolescent psychiatric unit at Children's Hospital. It closes this Friday for two weeks. It has patients in that program today; those patients will be discharged in two days' time. There is not sufficient planning in place to ensure that those young people have a place to be for two weeks. There are myriad examples like that across the system, where operating rooms close for ten days -- where the summer closures are standard practice now.

This minister will stand in the House and say this government has done more to tackle wait-lists. My contention is that this government has done more to create wait-lists. That's a dramatic, profound impact on wait-lists when you stop delivering the service. Would the minister comment?

Hon. J. MacPhail: I will actually rely on the record of Hansard, because we have gone into quite an amount of detail around the wait-lists. I just hope the hon. member would be able to read that. We have canvassed that area.

Two responses. Corporate days are actually administrative initiatives. Corporate days apply only to administration services, not health care delivery services.

But the hon. member is quite right in saying there are closures or reduction of services in the summer. I challenge anyone to say those closures have increased because of a change in government. It's common practice for such reductions to occur. It's agreed upon by those who make the decisions about medically necessary services. It's the doctors themselves who make those decisions. That practice has not been exacerbated in any way by a change in government.

L. Reid: I profoundly disagree with the minister on that statement. There are a number of hospital documents in this province that define corporate days as relating specifically to patient care delivery and make no mention of any kind of administrative exercise -- none whatsoever. Operating rooms in the lower mainland and around the province.... It's a separate and distinct issue from summer closure, which is something we may discuss later this evening. I have been apprised of some of the issues around wait-lists, and there are some issues I intend to canvass in more detail. The summer closure issue is a concern, but the corporate days....

Certainly everyone in the industry has suggested to me and has provided me with materials in writing that suggest that this is a result of the health labour relations accord. It seems to me that the minister should provide more information around what happens next. Do we continue to see this level of corporate day bed-closure service disruption and somehow marginalize it by saying it's part of a summer closure program? I don't accept that notion. I know that there are thousands of people in British Columbia today, approximately 27,000, awaiting some kind of medical treatment. This situation is only exacerbated by closures.

I'm not even clear why the minister believes there's any justification for summer closures. People are not healthier in the summer. There are demands placed upon the system that need to be in place year-round. Would the minister kindly comment?

Hon. J. MacPhail: Actually, the evidence does show that the demand does greatly lessen during the summertime. I'd be more than happy to provide that information to the hon. member. There is a reduction of demand for services in the summertime; there are statistics to prove that.

Secondly, we're just going to have to agree to disagree. I'll get to the bottom of it, though we probably won't be able to do it tonight. Corporate days are applicable to administration only. I don't in any way suggest that the hon. member is misleading anyone; it's just that we have to get to the bottom of it. But my information is that it applies to administration.

We have thoroughly canvassed the issue of wait-lists, including the numbers and the reduction, etc. I'm sure that we will be going into our estimates tomorrow. Perhaps the hon. member would agree to read the Blues overnight and not get a life -- just spend her time doing that. Then we could talk further about it tomorrow if that's....

L. Reid: I appreciate the minister's concern for my social life or lack thereof. The point is extremely well taken.

In terms of the issue before us this evening, I will be pleased to share with the minister documentation that talks 

[ Page 2058 ]

about corporate days relating to service. Certain Vancouver hospitals -- I'm sure the minister has access to the same information that I do.... In terms of the costs of those closures, I would appreciate the minister.... If she wishes to refer to it as summer closure, I can live with it for the sake of this evening. What are the cost savings to the system by those summer closures? I'm not convinced that any cost savings outweigh the fact that wait-lists continue to grow.

Hon. J. MacPhail: Actually, summer closures aren't about cost savings; they are an exercise to manage within the funds allocated. Just looking at the utilization numbers, there has been no reduction in terms of patient days, for instance, in acute care hospitals or extended care. In fact, it remained constant; maybe there is even a slight increase. Certainly the surgery visits are static, and outpatient services are static, as well, over the course of the last few years. So there hasn't been a reduction in services. Summer closures, in my understanding, are a way of dealing with the fact that there is a reduction in demand during the summer and that there is a long-established practice of allowing people vacations. That combination is used, in a way, as a management tool within the individual hospital administrations.

L. Reid: I appreciate the minister's information. What concerns me is that I know in my constituency office I have correspondence from people who are continually bumped from the list. Certainly it may not begin July 1, but when they're not having their needs met by the first day of July, they get the letter that says: "Talk to us in September." I appreciate the minister's comments about holiday time and all of that. I would submit that this is a vital service and that that's probably not a reasonable response. I mean, if there were anybody in our family, anyone we knew.... We wouldn't tolerate it. So it seems to me we're asking the general public to say, "Fine, fine, fine, see you in September," when we know full well that a eight-, ten- or 12-week wait is not appropriate. Frankly, it is not appropriate medically, let alone in terms of having any kind of humanity around these issues. I mean, the anxiety people must feel when they are put on a wait-list and then told, while they're needing some kind of cardiac treatment, for example, that the unit is closed because people are on summer vacation.... I don't accept that notion, and I would hope the minister can reassure us that reasonable service levels are maintained year-round.

The Chair: The member continues.

L. Reid: The lack of response disturbs me. It seems to me that the 75 MLA offices around this province should be more than mini-ombudsman's offices trying to assure people that the government actually is there for them, when indeed we know it is not, particularly on this issue. I'm certainly more than pleased to engage in any kind of discussion in terms of what has transpired earlier in this chamber around wait-lists. There are more people waiting this year than last. That evidence is clear in a number of specialist areas. British Columbia is not the leader across Canada. And the minister remains in her seat. It seems to me that if this minister is going to continue to say that British Columbia has done more to shorten wait- lists to provide services.... Part of that is about what kinds of services are offered in June, July and August in the province. Again I would invite the minister to comment.

[8:15]

Hon. J. MacPhail: It's not a sign of disrespect that I remain in my seat. There is an acknowledgment of a point well made that doesn't need to be challenged.

Let me just say this: if what we're going to conclude here today is that the system does not take into account a North American practice of people going on vacation and that in spite of that, we're going to pursue a health care system.... There are incredible costs attached to that. If we're going to say that doctors must deliver the same level of service, regardless of whether the patients want it during those months, then there are incredible costs attached to that. We'll probably have to do wage replacement for patients who aren't able to take their vacation at that time. Wait-lists are affected by holiday seasons. Christmas is affected in the same way. Separate and apart from allowing for that, if we can agree that the issue isn't....

We had a good discussion around wait-lists. Points were made about how the ministry and the government must keep very careful track and make effective use of an infusion of money in a way that doesn't exacerbate the ups and downs of wait-lists. I just don't accept that doing away with summer closures will in any way contribute to the health care system in a cost-effective way. That's all. I accept the other points that the hon. member made. Actually, they're issues that I can work on over the course of the next year.

R. Neufeld: I have a number of questions relating to my constituency. I know that some of the issues have been canvassed, but with the indulgence of the minister, I'd like to maybe explore some of them a little further, if that's acceptable. When I look at the agenda.... I'm obviously not going to follow it, and I beg forgiveness for that.

I would like to start with the diagnostic centre replacement in Hudson's Hope. The minister is aware that it burned down a while ago and that services are now being provided, as best they can be, out of the basement of the municipal hall, I believe. The replacement of the facility comes under review -- the freeze. I just wonder if the minister could put on the record when she anticipates lifting that, or whether she has already, and when they can get on with building this facility.

Hon. J. MacPhail: If this question is being asked because the member who asks it can claim credit for the success of getting the decision reversed, I'll answer it.

Actually, this is a very important issue. We've agreed that the Hudson's Hope hospital construction will go ahead -- we've announced that -- for health and safety reasons. The hon. colleague from Peace River North is already claiming credit for reaching that decision, so I'm sorry.

R. Neufeld: You're so perceptive; you read my mind. We do what we have to to carry on. So I appreciate that, and so do the people in Hudson's Hope.

There are two other issues in Fort Nelson that I want to deal with briefly. One is to do with the Closer to Home initiative and the lumping in of the Fort Nelson hospital district with that in the South and North Peace, in that whole northeastern part of British Columbia. I am sure the minister has been made aware of the fact that Fort Nelson has been under a restructure study for some time -- in fact, quite a long time -- to amalgamate hospital and community services such as regional and town council and those kinds of things under one board, along with the school district. Those studies have been going on now for well over a year. In fact, I remember much the same studies going on a number of years ago when I was involved in it, when we amalgamated the regional district and the town into one board.

Although the people in Fort Nelson didn't agree with it, the Ministry of Health wanted to continue their study, finish it 

[ Page 2059 ]

and get some kind of input from government as to what they should do. The Ministry of Health went ahead and lumped them in with the whole Peace district. It upset part of the process. I just wonder if the minister could maybe explain to me some of the rationale behind that.

I know she wasn't the minister at the time, and at the time I spoke to the minister responsible, asking that those things be left alone in the Fort Nelson district. The Ministry of Health went ahead with it, anyhow. Maybe the minister could explain to me why we would do that, when the government of the day had already sanctioned a process of trying to amalgamate all those services.

Hon. J. MacPhail: It's a good question. I do confess to a lack of knowledge in this area, and I will look into it. I will make sure that if, indeed, the answer is that that has become part of the regionalization process and therefore the assessment, I will make sure it is dealt with by that committee. I also will investigate the particular situation that the member outlines, and make sure I get an answer for him.

R. Neufeld: I appreciate that.

The second question, dealing with Fort Nelson and the hospital, has to do with a gentleman who is one of our resident doctors and has been in Fort Nelson for many years, Dr. Kenyon. He is an excellent surgeon. In fact, he is just an excellent doctor, and Fort Nelson has been fortunate to have had this person in Fort Nelson for many years. He actually wants to stay there. I believe he is from South Africa, one of the doctors that came from South Africa many years ago and decided to stay in the north. But, of course, he is going to continue to practise probably not much longer. He has been successful in obtaining and getting doctors into Fort Nelson on a regular basis. I am afraid that when we lose that doctor's services -- I don't know when it will be, but I don't think it's that far in the future -- we are going to experience some real problems in Fort Nelson with being able to get doctors and retain them.

I guess it leads to some of the issues that surrounded Fort St. John. We had one doctor for, I think, every three or four thousand people. It just was not acceptable. Can the minister explain to me a little bit about how we intend to, as a government, try to encourage doctors to the north from the lower mainland, and try to improve the way that we have doctors immigrate to the province of British Columbia?

Through my experience and that of many others that live in the north, doctors from the lower mainland have no interest in moving north. I shouldn't say all of them, but very few of them. For some reason, it's just not something that happens. But we have many doctors that come from overseas.

I know that a couple of years ago, there were some fairly significant roadblocks put in the way of those doctors immigrating to British Columbia, especially to the north, by the Ministry of Health and the government. Some of that has been rectified, but it takes a while to get everything back working again so that we can continue to get doctors there, unless there's some magic way that the ministry and the minister herself have to encourage doctors to actually move from Vancouver to rural B.C., and specifically to the north, to practise.

Hon. J. MacPhail: I appreciate the question. We do acknowledge that there is an issue of physician supply in rural and non-urban areas. Part of the doctors' agreement that the BCMA and the government signed in April has an agreement around physician supply, and particular elements of that physician supply agreement deal with doctors in rural and remote areas, and that will come into effect later this fall. We think it's an agreement that will withstand the test of any court challenge, which makes it different than what occurred ten years ago. Most of the elements are to encourage in very substantive ways doctors to locate and remain in rural and remote areas, and I'll be happy to supply the details of that agreement to the hon. member.

We're not just leaving it at that, because of course this issue of physician supply is not a new problem, and the hon. member makes note of the fact that this has been going on for some time. Unless there's the personal will of a particular community member, more needs to be done in the area of getting doctors to come and then stay. We recognize that it goes beyond just paying doctors more to practise in rural and remote areas, and that's what the physician supply agreement is all about. So we've put in place more initiatives. For instance, there's a special allowance given to doctors who locate in northern and interior areas. We're also working with the Health Employers Association of B.C. to make sure that during the regionalization process, there are community supports for doctors, such as family supports and also relief for on-call, etc., which are the issues that rural doctors face.

Then there's also the travel assistance program, and I know that the hon. member has done a great deal of work around travel assistance costs. I'm sure he would reach the conclusion that it ain't that good. He's made recommendations about how we could improve that, and I am following up on those recommendations. But we, too, are restructuring the travel assistance program, not to answer the question of doctors locating but because northern citizens deserve accessible health care.

We're also instituting what is called medical TeleCare, which will give support to physicians by phone. I know that someone would say that perhaps this isn't the best way, but certainly physicians are encouraged by this, because they can immediately consult with colleagues around the province by telephone. Also, there's the anticipated program of teleradiology, where there actually will be the practice of medical care through telecommunications. Then we also have the northern and rural locum program that encourages locums to give relief to northern physicians. There's lots more to be done, but I'll begin by giving the details of the new physician supply agreement to the hon. member.

Lastly, I would just comment, because we had a good discussion around the provincial government assisting in immigration matters, that it's my view it would be much more productive for us to invest our time around recruiting doctors who don't require immigration approval, our investment in ensuring that Canadian doctors, B.C. doctors, locate where the services are necessary. However, I did make a commitment that if the last resort is around ensuring that federal immigration practices don't prevent doctors from going to the north and being the only doctors there, I would raise that with my federal counterpart.

[8:30]

R. Neufeld: I am aware of many of the issues that the minister talked about in recruiting and retaining doctors in the north. I know, or at least I have been informed, that in the past we paid a premium to doctors. I don't think this is anything new, to try and encourage doctors to practise and stay in the north. I don't think it has been a total failure, but it hasn't been the answer, to be frank. As late as last year, when we were paying a premium, we were down to one doctor for every 

[ Page 2060 ]

three thousand or four thousand residents. It's totally unacceptable when, at the same time, you have one doctor for every four or five hundred people in the lower mainland. In fact it is absolutely critical. This is in the middle of the summer, and they couldn't get anyone to come up on locum. You could imagine the hours that some of those doctors are putting in. I would think that just like any human being, after a certain amount of time -- even in this place -- we tend to not function as we should when we work too many hours.

It is an issue, and just working on the fact that we are going to try and encourage more doctors from the south to move north.... I'll be frank and honest with the minister: I commend her for trying, but I don't think it has worked in the past, and I can't see where it is going to work in the future. For some reason, people would rather remain in the lower mainland, be it whatever, amongst the millions. I guess that is true in many professions. . .

An Hon. Member: The water is better, I understand.

R. Neufeld: Yes, the water is better up north. You should come try it sometime.

I'll just give the minister another example, and it has nothing to do with doctors. There are miners that are unemployed in the lower mainland, and a mine out of Chetwynd needed about 100 workers -- good-paying jobs, year-round, union wages. Not one turned up. In advertisements, in inducements.... I tell you, they were filled with miners from New Brunswick, quite willing to come to British Columbia and work for that kind of money. It is not just in doctor professions; it is in many other professions that people just don't want to. That is why I believe we have had such good luck in the north -- and I can only speak about Fort Nelson and Fort St. John, because I am not sure of the rest of rural B.C. -- with getting doctors out of South Africa and Europe. I think they wish to come out of countries that are heavily populated, that have maybe some unstable situations, and they enjoy the wilderness. To be frank, they enjoy that kind of lifestyle. That is where we have had our best luck in getting doctors. Many of the ones I speak about, in Fort St. John or Fort Nelson specifically, are people from South Africa.

So, I would hope that we wouldn't leave that part about immigration. It wasn't just the federal government's immigration policy, it was some changes -- and I just can't remember, they are not right on the tip of my tongue -- made by the Ministry of Health to bringing doctors. I believe it had to do with only allowing them here for six months instead of a year. If I remember, that was part of it. What doctor is going to uproot themselves from South Africa, come to Canada and only be able to practise for six months? If they know at that time a Canadian doctor can fill the position, they're gone.

I would hope that the minister would, along with the other initiatives of trying to get doctors from the south -- and I hope that happens -- work hard also on the issue of trying to make the immigration process as easy as possible for those kind of professionals to come to British Columbia -- and specifically to northern British Columbia -- to practise.

Hon. J. MacPhail: Yes, and I appreciate the member's general comments about issues that the north faces that are far different from those of the lower mainland and high-population areas. One of the things that I have learned in the course of my time in government is that if we recruit people to train in the professions, who come from the north, it works much better in getting people to return to their home communities. The UBC medical school now has a rural physician training program that not only recruits from the north but trains people specifically for rural practice, and that is meeting with some success.

While I appreciate the concerns raised by the hon. member about assisting people from out of the country to come and practise here, I would just make note of the fact that ministers from across Canada have agreed that our efforts would be -- this would be prior to my time, but our government is committed to it -- collectively spent not on immigration but on ensuring that there's a proper physician supply of Canadian-trained doctors. Our government is committed to that. But rest assured that in the context of ensuring that that process works, I will raise the fact that we have to do a good job in order to prevent this other issue from gaining momentum.

R. Neufeld: I'm not going to belabour it much further, and I appreciate the minister for her words. The health ministers from across Canada have tentatively agreed to that process, and that's fine -- remembering that probably most of those health ministers come from areas that are well serviced with doctors, and don't experience the same problem that many rural communities or northern communities do with health care professionals. So I appreciate that, and I hope it does work. If it does work, that's fine.

The end result is the fact that we have to provide the service, and however we can best provide the service, that's what we should be doing. I take the minister at her word that she will work very diligently at that, and that she won't forget the fact that foreign doctors are an essential part of northern life, and have tended to be for many years -- and I can't imagine it's going to change.

Just a little bit on that note. When we talk about training people from the north, I appreciate that, and I think that's one way that we can get people to go back to the north. Maybe I could encourage the minister.... It just comes to mind that physiotherapists don't come from the southern part of British Columbia to the north, either. Again, we have had to recruit from out of Canada for physiotherapists -- much the same as with doctors -- to get them to come to the north. For instance, two students have contacted me in the last two years who wanted to get into physiotherapy training.

I know this is not in the minister's purview, but as I understand it, in British Columbia there are only 30 taken every year -- or less than 30, maybe it's 28 -- and that's all we train; that's all we put through. So here we have students from the north that want to take physiotherapy programs and can't get in them. In fact, they have gone, I think -- one to Ontario and the other to the U.S. -- to do it. I don't think that helps us, and maybe the minister could work with her counterparts on trying to increase that kind of enrolment within British Columbia too.

[S. Orcherton in the chair.]

The other issue about Fort Nelson is residential care. In fact, in your former life as Minister of Social Services, I had written you a letter in regard to a 1,100 square foot home that was purchased in Fort Nelson that was renovated for residential care for children in care, ages 12 through 18. The house is, like I say, 1,100 or 1,200 square feet, was purchased for a sum of $167,000 and was then renovated at a cost of $137,000. This is a house of 1,200 square feet that cost over $300,000. I'm not trying to diminish it; I know that they needed the facility in 

[ Page 2061 ]

Fort Nelson; I'm not disputing that. But some of the reasoning was that the cost was so high to renovate it because of Ministry of Health care standards.

If I look around the province of British Columbia and think of all the small communities that may have one, two or maybe three of these -- I don't know -- in each community, it seems to me to be an awful lot of money. It's not that we should attach the safety or health of younger children always to money, but I think we should be looking carefully at how we can look after maybe three or four children in a $300,000 or $400,000 facility. Maybe the minister could just brief me a bit on if that's common through the province, and whether she thinks there is a cheaper way of providing the same service to those children in some other fashion.

Hon. J. MacPhail: I must admit that it was one area that I was quite surprised at in terms of the cost -- that and school construction. I was quite surprised at the cost for residential care. I appreciate that the hon. member is probably making a generic comment here and not asking me to comment on a specific facility.

R. Neufeld: Yes, that's right.

Hon. J. MacPhail: Right.

The previous minister responsible for the B.C. housing commission -- maybe it's two ministers ago -- recognized that either purchasing and renovating or constructing residential care facilities from the ground up was an issue that we should be dealing with across government, so the B.C. housing commission is actually establishing a working committee across government to deal exactly with this issue.

One of the things, though, that I did learn is that in terms of licensing for community care facilities, there are rigorous regulations -- for good reason. So that does add cost. But nevertheless, we are taking an across-government approach to this issue to try to deal with some of the concerns that the hon. member raises, and that's being done through the B.C. housing commission.

R. Neufeld: Yes, I did just want a response in a generic term. I mean, $300 a square foot, if that's common around the province.... I realize that health care facilities cost lots of money, but it would seem to be an awful lot of money that's being spent around the province, and maybe we could build some other facilities or do something else that would be much more cost-effective and still provide the service.

The minister talked earlier about the movement of qualified staff around the province, and the health care accord. I realize you've already discussed it, but I want to go back a little bit -- with the minister's indulgence -- to kidney dialysis, specifically in the community of Fort St. John, where we had the machines in place in the hospital but no one that was qualified to run them. I shouldn't say no one; I think we had one.

[8:45]

We were transporting people from Fort St. John to Prince George on a regular basis for kidney dialysis. This went on for quite a while; in fact, we had to get fairly strong with the ministry to try and get people to the north. We talk about moving the qualified staff around, and I must admit that the ministry did respond, We acquired some more staff in Fort St. John to be able to start looking after more people with the dialysis machines, but it's still not up to par.

I wonder if the minister could respond a bit about how we deal with those issues. We talked earlier about trying to get doctors into Fort St. John and Fort Nelson. We also have trouble getting qualified people to run the kidney dialysis machines. How are we going to be able to provide that service to people in Fort St. John?

Hon. J. MacPhail: This is another example of the issue that the hon. member talks about in terms of attracting people to rural and remote areas. I am advised that it's a highly specialized area of nursing. The training takes place in the lower mainland, and we're well aware of the problem that this community faces. We've only been able to attract a nurse on the basis of not-permanent employment. The whole issue of recruitment and then retaining people within the community is one that we're working on, not only in the physician profession but in other health care professions as well. I'll keep the hon. member advised of the actions that we're taking in this area.

R. Neufeld: I appreciate the response. To be honest, it doesn't give me or the people who have to leave their jobs much comfort. In fact, some have had to quit, to be able to access care in Prince George, for instance. It's 400 miles from Fort St. John to Prince George by road. It is an area that demonstrates to all of us the difficulty of trying to get professional, well-trained or highly trained people for these kinds of services to come to the north of British Columbia. It's just another example of why we do have to look seriously at continuing and pushing for the immigration of people who really want to come to British Columbia and to the north to provide those services to residents in the north.

D. Symons: I have a few questions, more or less from Richmond. This one deals with a group in Richmond referred to as RADAT, the Richmond Alcohol and Drug Action Team. They're a very important group in our riding, and they are funded partially by the Ministry of Health.

This group works a lot with people who have histories of drug abuse and substance abuse and who are getting a lot of help to keep them on a level path and stop them from falling backward and becoming addicts again. The problem is that there are funding shortfalls. It's as simple as that. They have applied to the ministry for approximately $40,000. They currently get funding through the alcohol and drug services branch, but they are short some. They do some fundraising through the society, where they have casino nights, and they raise a fair amount of money to help supplement what the ministry supplies them for the services they supply.

Over the years the population of Richmond has blossomed, to put it mildly, and the requirement for the services that RADAT provides to the community has also grown considerably. At the same time, because of the large growth of Richmond, rents have gone up. So the pressures put upon that particular organization have put them in a very bad position, where they are not going to be able to maintain the current staff they have, let alone expand to meet the current needs. I'm wondering what the ministry has in mind in the future for organizations like RADAT, but also for other ones around the province that face those same pressures.

Hon. J. MacPhail: I accept the member's premise that when we invest in alcohol and drug treatment programs, it's a worthwhile investment. We work carefully with the community programs and fund them, based on their successes and their advice to us on how to fund them, but we are unable 

[ Page 2062 ]

to fund all of the requests. We are ensuring that an adequate number of resources go into education and prevention, but at the end of the day the demand around addiction and abuse programs exceeds what we're able to fund. But we have increased our support in this area, and we will continue to attempt to do so.

D. Symons: I thank the minister for that answer. I'm sure that if you take a close look at the situation regarding the Richmond team, at least, you will see that the work they have done has been valuable to the community and, in the long run, is money saved. If these people end up dropping back into their habits of substance abuse, the cost to society is much greater than the few thousand dollars it might take to take care of them at this time and help them over that hump to make the break from past habits.

There is another question that I bring up each year, and the answer I get, basically, is that you're looking into it. I'm wondering if maybe this time we can get a little further on that. It deals, really, with the problem of involuntary treatment versus people's civil rights.

This question first came to me from a person who had a son who was schizophrenic. The son went off his medication, and in the process of going off his medication, he lost the ability to be a good judge of how he was looking after his health and himself. The child lost the ability to make value judgments. What happened was that the parents watched this young lad of theirs basically go down the tube. They were looking for help. They went to Health and other areas -- the police and all the rest -- because he went on to abuse substances, and he was living in flophouses. They knew that if he kept on that same path, he'd be dead within a few years, yet they couldn't find help for him anywhere. Basically, he said: "It's my life; I can do what I want." They knew that if they could get him back on his medication and get his mind going properly again, he would realize what had happened and be able to live as normal a life as a schizophrenic can.

I'm wondering if the government has come to any resolution on how to deal with this problem of someone's best interests in maintaining health by taking them into involuntary treatment centres, compared to the civil rights of that person to be able to do what they want with their lives.

Hon. J. MacPhail: Let me take it from this approach. We have determined that our Mental Health Act is constitutional and that perhaps we can work within the Mental Health Act to achieve some of the results the hon. member advocates. I have to confess that I am very cognizant of protecting the civil rights of the individual, as well. But within the context of that, we have an aggressive program to work with police and other professionals in the communities -- social workers -- so that under the Mental Health Act, they have the right to convey to a physician the necessity of getting the physician to declare the person in need of treatment. That is working with some success. I would hope that we as a community would be able to proceed.

I know that there are many people with schizophrenia who live in my community, and we often face the same issue. It's from a point of compassion that we wish to ensure the well-being of people who may at the time not be able to make those decisions for themselves -- knowing full well the cyclical nature of the illness, though, and that at another point the patient would be able to be quite competent in maintaining their own well-being.

I would just advise -- and this is in no way to preclude discussion; if the hon. member has a couple of other questions, I don't want to cut him off -- that the other chamber is awaiting our adjournment. Is that all right? Or we could go for a couple of hours.

An Hon. Member: Hey, let's do that.

Hon. J. MacPhail: I move, hon. Chair, that the committee rise, report progress and ask leave to sit again.

Motion approved.

The committee rose at 9:00 p.m.

Copyright © 1996: Queen's Printer, Victoria, British Columbia, Canada