(Hansard)
THURSDAY, AUGUST 15, 1996
Morning
Volume 2, Number 23
[ Page 2063 ]
The House met at 10:06 a.m.
Prayers.
F. Randall: In the gallery I see an old friend, Bruce Ferguson, who is the business manager of the Tunnel and Rock Workers Union in British Columbia. Would the House please make him welcome.
E. Gillespie: In the gallery today we have two very good friends of mine, Liz and Brad Robinson, accompanied by their friends from Ontario, Alan and Mary Suddon. Liz Robinson has served the party and the government for many years. She served as the constituency assistant to Margaret Lord, my predecessor. Brad Robinson has served the NDP ably as the chair of our constituency association. I'd like the House to please make them welcome.
Hon. J. MacPhail: I call Committee of Supply. For the information of the House, we will be debating the estimates of the Ministry of Health and the Ministry Responsible for Seniors.
The House in Committee of Supply B; G. Brewin in the chair.
On vote 39: minister's office, $462,000 (continued).
W. Hurd: I'm pleased to rise late in the debate on estimates for the Ministry of Health. I want to start this morning by asking the minister a series of questions that flow from issues that arise in my own constituency related to the availability of acute care beds in the hospital. Surrey-White Rock is a riding where a large percentage of the population are seniors who require access to the health care system and would be, on a per capita basis, probably in need of surgery a greater number of times than the younger portion of the population.
Just recently, an incident came before my office involving Robert Melynchuk and his elderly mother. She was admitted to Peace Arch District Hospital and there wasn't a bed available for her at the time, so she was discharged. He was greatly concerned about that incident and has written to the Minister of Health. It is a problem that is occurring in a number of Surrey hospitals. The trend seems to be that the hospitals are making more difficult judgments in terms of admitting patients. The recovery time, the post-operative time, has been shortened dramatically, and elderly patients are being sent home.
I just wonder if the minister can advise the House whether the ministry is apprising itself of the bed availability on the acute care side, and of the concern that is being expressed about the post-operative period now being dramatically reduced. I wonder if she can also advise us of whether, in ridings where you do have a large population of seniors, the ministry is reviewing the difficulties that those hospitals are facing in making some difficult decisions sometimes about the availability of beds -- both when the patient is admitted to the emergency ward and after surgery, when they are required to be sent home, where there may or may not be the support mechanisms to help these seniors cope with their condition.
Hon. J. MacPhail: I appreciate the comments from the member for Surrey-White Rock. I'm pleased to have him enter the debate. He raises some good points. Let me just tell you the action that's being taken now, and then we can discuss it in that context. I have a couple of comments about utilization.
There's no question that acute care bed utilization is important. It's an issue that determines whether we're being fiscally responsible, as well, in the delivery of health care. It is a matter that we have put to the hospitals, saying that the hospitals cannot close beds without consulting the ministry, and they can't close beds unless they ensure, and assure us, that it will not affect patient care. So it's from that point of view that we discussed these matters with hospitals.
In the particular area of the member's concern, two hospitals I think I'll talk about are Peace Arch, of course, and then Surrey Memorial. The ministry is working with the region to develop a geriatric-psychiatric proposal, which is one of the issues that the hon. member brought up. We're reviewing that proposal now.
Secondly, we are aware that Surrey Memorial is suggesting that there are service shortfalls and that if there were a proper redistribution of provincial funds, it would result in an increase of resources to Surrey Memorial. So we're taking their points seriously, and we've organized a financial review of Surrey Memorial Hospital. Included in that, we'll be looking at issues such as an adjustment based on population pressure, and then also there are requests in for things like increased in-patient psychiatry, a sleep lab, a cardiac catheterization lab, and other such services.
W. Hurd: I wonder if the minister could, then, clarify for me the role the ministry might play in reviewing bed closures in acute care hospitals. I understand that is now becoming a routine part of the hospital strategy over the summer months, where there is a history of lower utilization of acute care beds. The hospitals have been sort of temporarily closing beds over the period of the summertime and then, perhaps, restarting them in the fall. That's almost based on predictions that may or may not come true.
I wonder if the minister can clarify whether a decision by the hospital to close beds over a season, perhaps, or over a period of a couple of months, would come to the attention of the ministry. It's my understanding that some of the bed shortages are the result of temporary closures, not permanent closures, by the ministry, and that this may be creating some of the difficulty.
[10:15]
Hon. J. MacPhail: I would just
To answer you, it is a hospital administration decision to do seasonal closures of beds, for lack of a better term; but they must consult with the Ministry of Health.
W. Hurd: With respect to the post-operative period, where it has been the practice in years past for there to be a
[ Page 2064 ]
longer period of stay in the hospital, now, as the minister knows, efforts are being made to discharge patients more quickly. I suppose with a younger population that might be an objective that could be achieved.
The concern that I hear from my own constituents who are seniors is that they sometimes don't have the support mechanisms at home. This may inevitably lead us into a discussion about the whole regionalization and community-based health care concept later in this set of estimates. The concern is that they are being discharged after heart surgery and hip-replacement surgery and that type of rather serious operation. The hospital is not necessarily in a position to know whether the support mechanisms are there in the home -- or in the community, for that matter -- to provide the assistance. It just seems to me that we have this current split underway between the community-based services that might be there and the hospital's ability to discharge patients and monitor their progress after they do go home.
I just wonder, in connection with this review that the minister has indicated will be happening in Surrey, whether the review might include the policies toward the post-operative period, which for seniors, I think you could argue, needs to be perhaps longer in some cases than hospitals can currently allow for.
Hon. J. MacPhail: Yes. It is important when health care practice reduces the post-operative time in the hospital that we then shift the resources into home care. The hon. member is quite right. We have increased home care nursing funding by 40 percent over three years, so that budget now stands at $53.25 million. In April of this year, in recognition of the points the hon. member makes, we actually increased the home care services budget by $10.75 million, and that will mean that an additional 8,000 British Columbians will be able to receive health care services at home. It actually is working as we gradually get more health care givers working in the community. This will provide the funding for an additional 200 home care nurses, rehab staff or home support workers being hired.
W. Hurd: I appreciate that response from the minister.
I'm asking about the responsibility of the hospital and the ministry. I'm trying to clarify that in terms of who is responsible for monitoring the patients once they leave the hospital and are in a home care setting.
I am only relating it to people who come into my office and express concerns about the fact that they were sent home and the hospital and/or the community support mechanisms weren't there. The hospital wasn't necessarily in a position to determine whether the support was there. All it was able to do was provide the patient and the family with a phone number to call. I wonder if the minister can clarify whether the ministry expects the acute care hospital, out of its own budget, to be able to provide more assistance for patients beyond the door of the hospital.
As I say, it's particularly a concern in a riding like my own where I have such a large proportion of seniors who, during the course of the last ten or 15 years of their life, might spend many days in a hospital and be continually moving from the emergency ward or from the hospital back into their homes and are in that continual sort of flow. It's my impression that the hospital has less of an ability to monitor the progress of the patients once they are discharged.
Hon. J. MacPhail: My apologies for not addressing that point the hon. member made.
The responsibility of monitoring the patient's well-being after discharge generally rests with the doctor and the home care nurse, and there is a system of monitoring set up by the health care professions. But let me offer this: with the process of regionalization, the goal, of course, is to bring together acute care services and community services, including home care services, in a continuous, aligned, interrelated model so that the person who's receiving health care services is not treated in isolation by each of those services but is treated as a human being with the need for continual service. As regionalization is implemented, continuous care, regardless of where the care is given, will be better; that's my hope.
W. Hurd: There are just a couple of other issues related to my own riding and its health care needs that I am interested in addressing today. As the minister may well know, there has been a series of what I would term disastrous strikes in the home care industry in Surrey that have seriously impacted the quality of the home care the minister describes. I just wonder, since we are involved in this shift from acute care beds to community-based health care, whether this particular minister has given any thought to extending the current provisions of essential service legislation in acute care hospitals to some of these community-based health care initiatives which, as the minister has indicated, are becoming more and more critical to the well-being of patients. The problem is, of course, that when there is a strike that drags on for many months in the home care field, there is tremendous stress and disadvantage to patients who are left without the critical part of their health care needs. Home care can be interrupted for many months. I wonder if the minister can tell us whether the shift to home care is also going to result in some review with respect to essential service legislation in the province.
Hon. J. MacPhail: That's future policy. I wouldn't advise the member to take hope that his question would be answered positively, but I would also say that the delivery of health care services -- and the continuous delivery of health care services -- to meet the needs of patients in this province is our highest priority, even in the context of labour relations.
W. Hurd: I appreciate that it might be future policy, but perhaps I can, in the course of the estimates, issue a plea on behalf of those home care workers who are covered by a collective agreement and are members of a union. It's a tremendous concern for them when they have a health care responsibility. They know the people who are in the homes that need the care, and they are required to participate in a legal work stoppage. I've had health care professionals in my office who are gravely concerned not about their own contract as much as about the well-being of the patients they are required to visit every week.
It is an issue that puts health care workers in a very difficult situation, because they see their role as home care nurses and skilled professionals being every bit as critical as the role of people involved in an acute care hospital. When there is a work stoppage, they are required to suspend their professional qualifications and suspend the natural concern they have about the welfare of their community and the patients to participate in a full work stoppage. It's an issue that really needs to be critically addressed by the ministry as it tries to move people out of acute care beds and into community-based settings where, I think we all agree, it's cheaper, more cost-effective, more humane, perhaps, and where families can get more involved.
If there is going to be a threat of disruption, I think that families are going to be exceedingly reluctant to allow their
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relatives to be discharged from hospital. They are going to resist that kind of initiative, because there have been a number of serious disruptions in Surrey. The White Rock and Surrey home support was out, for example. There have been at least three major strikes that have gone on for many months, and they have had a major negative impact on seniors who rely on home care.
The Chair: Hon. member, I think you have made your plea, so you might move on to another topic -- or another speaker. I recognize the hon. member for Okanagan West.
S. Hawkins: If we can move on to the issue of regionalization -- better known as New Directions and often referred to in the past as "No Directions." I believe that the New Directions social experiment can be summed up in the wisdom of an old prairie saying. As the minister knows, there are quite a few of us who hail from Saskatchewan. The old prairie saying is that if you start your trip without a destination, you probably won't get there.
For the record, this side of the House has never been opposed to the concept of providing services closer to home. We believe that the Seaton report is an important vision for health care, something we should strive toward, and that the regionalization program was based on reasonable and logical recommendations for reform of our health care system arising from the Seaton commission report.
The New Directions program, we believe, was a well-intentioned effort by numerous community-minded individuals to implement the recommendations reported by the Seaton commission. The royal commission noted there has never been an overall plan for health care delivery and that the current structure that has evolved lacks coherence and sometimes logic. The report further noted that our health care system lacks the ability to assess itself and to objectively judge just how efficient and effective it is in providing health care. From the 1991 commission, nine recommendations emerged on which health care reform was to have been based, and I'd like to outline these.
The first was the provision of medical and health services close to home. The second was putting the public -- meaning the patient -- first. Next, there was a recommendation for focusing on providing services that improve health care outcomes which can be measured, giving greater decision-making for health care delivery to the local community, and reforming and improving our health care system within current levels of spending while ensuring less variance -- meaning, recognizing that although provincial revenues may vary, illness does not. Next was breaking down administrative walls in favour of an integrated health care system with provision for proper training and educational requirements for those working in the health care systems. There was a recommendation that volunteers should not necessarily replace health care workers, and I believe that's one of the most important principles. Lastly, except where privacy and confidentiality demand otherwise, all the information on health and health care gathered by public servants should be made available to the public and to researchers.
These principles, forming the Seaton report, outlined a vision, but unfortunately not a plan. We're no further ahead today than we were three years ago when the decision for major health care reform was undertaken. I've said before in this House that without leadership and guidance, and certainly without a provincewide strategic plan, this New Directions program will not be able to succeed.
[10:30]
The whole program, from terms of reference to committee structure to governance issues, is fuzzy. It's nebulous. It's been a trip without a destination. New Directions has gone through four Health ministers and five deputy ministers. To say there is a lack of continuity and leadership, I believe, would be an understatement. We've gone through one deputy minister whose vision was for a strong regional health board with advisory health councils to another deputy minister whose vision was for stronger community health councils with less prominent regional health boards. Now this whole project is on hold while yet another committee of partisan MLAs in Victoria decides what the role of community involvement should be.
Some regions have amalgamated hospital boards with regional health boards. Other regions have yet to determine what the governance arrangement for the RHBs and CHCs should be. The hidden costs in terms of wages alone for hospital administration personnel planning for the transfer of governance is staggering. How naïve to think there is no cost to hospitals to plan for the transfer of governance. The Ministry of Health publications themselves have boasted that knowledgeable local people will be able to manage the delivery of local health services and ensure decisions and services better reflect the needs and realities of their communities.
Unfortunately, the terms of reference for the boards and communities excluded the participation of anyone working in the system, effectively disenfranchising the ones who make the system work. This was in terms of anyone who worked for, or is paid by, the Ministry of Health and anyone whose spouse was paid by the Ministry of Health. These people were excluded from the initial planning and committee implementation phase. Many of the meetings that were advertised -- with small notices in the local newspapers -- were neither timely nor eye-catching. The terms of reference for the steering committees effectively excluded the knowledgeable local people, so that the success of New Directions could not really be relied upon -- without knowledgeable people who actually had work experience in the health care industry.
Regional boards are, as a result, generously populated with well-meaning but perhaps not particularly well-informed members with respect to health care administration and governance issues. This has culminated in regional health boards and community health councils developing an antagonistic relationship with the hospital boards that they're meant to amalgamate with. I've said before that this has resulted in pitting regional health boards against community health councils against hospital boards, as well as pitting communities against communities as they fight for control of health care facilities and services within their regional boundaries.
There were very serious concerns expressed from the very beginning of the implementation of this program. For some reason these concerns weren't heard, because despite the calls in the past three years for reassessment, for pilot projects and for more well-thought-out planning, and despite the concerns that closures and downsizing of facilities and services were occurring with no substantial, coordinated plan or real efforts to move these services to the community, the so-called health reform of New Directions was driven on.
Now, as a result, after three years and countless community volunteer hours and millions of dollars spent on this experiment -- we still don't know how many millions because we can't get a straight answer from the ministry -- we've ended up with what many have predicted and feared. Instead of streamlining the system and demonstrating greater
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efficiency, equity and cost containment, we've ended up with a parallel bureaucratic system alongside the boards that were meant to have been eliminated, amalgamated and streamlined.
The implications of the imposed new structure have had a very negative effect, and I've witnessed that in my own community. There are very important questions that need to be answered. The issue of health care doesn't belong solely to one party. It's an issue of concern to all members of this House as we serve the people that we represent. The Premier and the Minister of Health have both made reference to an era of cooperation and to working on issues together. But instead of using a non-partisan approach for reviewing the health care mess we're in, and instead of involving members from all sides of this House, we find that we've been given lip service again, as a partisan, NDP backbench committee has been chosen to get us out of the mess that they got us into in the first place.
I guess my first question to the minister is: why did the government deliberately choose to ignore the concerns brought forward for years by those in the health care system that New Directions was actually bringing about a deterioration of health care? Why were these ignored in the last three years and miraculously heard just in the recent past?
Hon. J. MacPhail: I guess we'll take a moment here and sort of loosen up on estimates and just have a bit of a discussion, because this is an appropriate point to discuss the issue of regionalization in non-financial terms. Let me just make a couple of opening comments, and the question certainly permits me to do that.
We're taking a pause before we move on in regionalization. We are not in any way taking a step backward, and we're not in any way going to move forward without ensuring that we're moving forward in the best possible direction. In the context of that, I actually appreciate the several discussions I've had with the hon. members from across the way and their advice on how to do that. We probably would differ slightly on the nature of the problem, although I'm holding my judgment on that until the final assessment is in. At the end of the day, we may actually end up fully agreeing on the problems.
There are about three things that I would take issue with in the hon. member's comments. One is that while there are lots of stories and rumours out there -- because it's a very labour-intensive and widely spread field -- we have to make sure that we are dealing with the facts. When the hon. member says that we haven't indicated what the cost has been of regionalization, I did indicate that as recently as day one of our estimates. If we exclude the Seaton commission, the total costs have been around $27 million over the three years. If we include the Seaton commission, the cost is about $34 million for starting to move the concept of health care closer to home, and that's from '89-90 right through to today. I hope that gives the hon. member some comfort.
I also have heard from others in the health care field about the unfairness around excluding certain members of the health care field from participation. That is an issue we're dealing with right now as part of the assessment. But I would also bring to the attention of the House that the transition teams have been teams of health care providers in the industry, and their work has been invaluable.
I also don't want to leave on the record that the government admits that there has been no work done, because there has been a lot of work done. A lot of very valuable time has been put into planning for regionalization, and there are plans in place to make the final step of moving health care closer to home. I don't know. It just makes sense, from the point of view of fiscal responsibility in a system that's got a price tag on it of billions of dollars, for us to take a pause, regardless of politics, and make sure that we do the right thing as we put in place the plan to move health care closer to home.
I have actually really appreciated the individual comments of members in the Legislature about situations they face in their own ridings around health care delivery. The comments haven't been made in the context of regionalization, but they have been made in the context of health care delivery. I very much appreciated how there has been recognition that there have been some moves and that we've got to make more moves. We are facing hugely different demographics here in British Columbia than existed even ten years ago.
I also understand that the government and the opposition will not agree on the structure of the regional assessment team. Having said that, I am going to make sure that every opportunity is given to the members opposite to have input into that. I'm going to make sure that every opportunity is given to members of the opposition to comment and have input on the report -- after it's done and before decisions are made, as well. So I hope that we can have a discussion around regionalization on that basis, and I also know that the discussion won't end with the conclusion of estimates.
S. Hawkins: It's not very comforting to know that we are going to just have some input. I think, again, that I made it very clear that health care is not an issue that solely belongs to one party; it belongs to everybody in British Columbia. To have an opportunity to just make a submission I don't think is enough. We have an all-party Select Standing Committee on Health in this parliament. I think it would have been very appropriate to have all members reviewing health care -- not just having input but having the opportunity to hear submissions, to review what was given to the committee and to help develop the plan for the future. I don't think it's enough to just say that the people that we represent get left out because the NDP have decided that they can do it better.
Now, coming back to this committee, it's interesting that the minister says that there has been movement towards regionalization in the last three years, and yet the committee put out a questionnaire that deals with 13 questions. These are issues that probably should have been decided a long time ago. I am wondering why you are questioning now how many regional health boards and community health councils there should be and how to determine membership on these boards and whether the current approach will reduce waste and duplication. Aren't these questions that should have been answered before New Directions was ever implemented?
Hon. J. MacPhail: I would just caution that the opposition can't have it both ways: to say that they want recognition for their point of view that regionalization has been a failure so far, and then to say: "But you've got to live with it, even though it's a failure." So I just caution members opposite against taking that point of view.
The questionnaire is to take a pause, to either get confirmation that it is moving in the right direction or that change should occur. And if somehow the members opposite want me to stand up here and say there will be no change, I won't. I'm not going to predict. We will do everything possible to get valuable advice and direction from those who know or who have very strong opinions on the future direction of moving health care closer to home.
S. Hawkins: I don't think that we said regionalization is a failure and that we don't want it to work. We said that we
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think -- we've always said; the Health critic before me is on the record as saying -- that regionalization is a good concept. Everything that came out of the Seaton report has a laudable vision. The way it was implemented was not, and that is what we take issue with. The way it was implemented is a failure. For three years the money and time that's been wasted and the negative impact it has had on communities is the failure. That is what we're taking issue with. What we want to get involved in is trying to build a plan for this province that's positive, that includes everybody. This is a very exclusive type of process that the government has taken on, and I don't think they can be proud of that. They have left out people on this side of the House who feel that we also have the ability to assess and help plan for the future of health care in this province.
I truly believe that regionalization is a good concept, but planning for it has not occurred. We look at the questions on this questionnaire that the committee has sent out. The first one is: "Should the responsibilities of the health care system be the same in all regions of the province?" The second one is: "Based on your experience and knowledge, what could constitute the responsibilities of the regional health boards?" We were going to have elections this fall. These people were going to be in place to manage health care regions, and we don't even know what their responsibilities are. In three weeks a partisan, backbench committee is going to have all the answers to these questions. Unbelievable! That is outrageous!
Now, some cynics -- and I'm not saying that I'm one of them -- have said that the report is already written, that this is just a rubber-stamp committee, that this is a sham, a cover-up. By the way things have been going the last three years and by what we've been witnessing of the top-down kind of management that this government has demonstrated, it's not hard to see that maybe some of the cynics are right. For the last three years, the people who had concerns about the system were not heard, so why should they be heard now? In three weeks we're going to have all the answers. The minister herself talks about implementation. We haven't even heard from the committee to see if implementation is a reasonable plan. There were elections that were cancelled. I guess I should ask the minister when these elections are going to go ahead.
[10:45]
Hon. J. MacPhail: Let me just say one thing: if the opposition says that the implementation of regionalization is a failure, it seems unusual that the opposition would now stand up and say that these questions should not be asked. Taking aside the point of view you're suggesting, that the last three years have been a failure around implementation -- which are your words -- these are questions that we're asking broadly.
There is already lots of input on the answers to these questions. Many regions have actually moved quite far along in terms of the implementation of regionalization of health care. On the one hand, the hon. member stands up and says, "My God, we were about to have elections, and nobody knew what they were doing," which is a point of view that is shared widely amongst the opposition benches and in some parts of the community. Then the opposition stands up and criticizes the government for not proceeding with the elections.
Let's just take aside the rhetoric for a second. I promise not to indulge in the rhetoric, either, because I can't afford to. These questions are being asked so that when we take the final step toward regionalization, toward moving toward Closer to Home -- that takes billions of taxpayer dollars -- it should be the right step. It makes sense to ask those questions. It makes sense to not proceed on governance structures that there is not widespread consensus on. It makes sense to take a pause.
I appreciate the hon. member putting the doubts of others on the record and not her own about the fact that there are foregone conclusions in this report. There are not. There is an excellent consultation process going on here. The government will examine the report of the regional assessment team, which is receiving wide input, and we will move forward to making decisions after receiving that report.
S. Hawkins: I guess the minister will be interested to know that yes, I am concerned about the failure. I'm not saying that we don't want to get involved because we think we don't have something to offer; we're saying that we do have something to offer. We think we have good ideas to offer. Obviously, what came from that side of the House has not resulted in anything that's workable in the last three years. I'm concerned that these questions weren't answered in the last three years, and I'm concerned about the $32 million that you say has been spent. What has been done? What was happening? What was being developed? What kind of leadership was being shown that these questions weren't answered in the last three years? My concern is whether in three weeks this is all going to get done without the input of other members of the House. That is my concern.
My next question is on the committee. We understand that the Premier has sent Doug McArthur and Tom Gunton to oversee this NDP caucus, and I'm wondering exactly what kind of information Mr. McArthur and Mr. Gunton will be providing the Premier with.
Hon. J. MacPhail: I think that was an appropriate question for the Premier.
S. Hawkins: I understand that the minister has appointed Jack Gerow as a public consultation adviser. I'm wondering why he was chosen to do this.
Hon. J. MacPhail: Mr. Gerow has been active in the health care field for almost two decades, and several of those were spent as the chief administrator of the Hospital Employees Union. I think he ended that in 1988. He then worked as a consultant within the health care field, and he has had two years' experience on our regional health board.
S. Hawkins: I understand that Mr. Gerow will be receiving almost $25,000 for his participation in this review -- I believe it was $400 a day. Can the minister define for us, first of all, what a day is for Mr. Gerow? How many hours is a day defined as?
Hon. J. MacPhail: Mr. Gerow will be working with the politicians, and those days vary. I would say a short day is eight hours and a long day is 16 hours.
S. Hawkins: We understood from a leaked document, obviously from the ministry, that Mr. Gerow would be getting $400 for a day. Does that mean $400 for eight hours, and then if he works 16 hours, he'll get another $400 to make it $800 for a 16-hour day? Could the minister please define that for us?
Hon. J. MacPhail: The hon. member has been advised that that was an early draft of a document, and that she shouldn't rely on it. I don't mind her asking questions from it,
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but it's an early document, an early draft, that's been substantially changed. The hon. member has been advised of that several times.
A day is a day. It's 24 hours.
S. Hawkins: The minister also advised us that we would be getting a later document, which we haven't received. I understood from the minister when she spoke to me that she would be providing that for us. Is that still going to happen?
Hon. J. MacPhail: I said to you that the information had changed. I don't recall advising you that we would give you a document. I don't even know if a document exists. But you're free to get any information that you want, and I know that the chair of the committee has offered that to the hon. member as well.
S. Hawkins: Thank you. We would appreciate a copy of what comprises the team and their schedule. If the minister can get that to us, we'd appreciate that. Will that happen?
Hon. J. MacPhail: That's a public document.
S. Hawkins: Will the minister confirm, then, that the total amount Mr. Gerow will receive does not exceed $25,000?
Hon. J. MacPhail: That is correct.
S. Hawkins: Does that include his expenses and everything within that $25,000?
Hon. J. MacPhail: Yes.
S. Hawkins: With respect to the consultants the minister has called on from other provinces to help with this so-called review of New Directions, the former Health minister took a taxpayer-funded junket to Alberta to illustrate how bad the health care system was in Alberta. There was some fearmongering around this, I would say. Now, apparently, the Health minister is using taxpayers' dollars to fly officials in from Alberta for their advice on how to proceed with regionalization. I'm wondering if the minister can explain what she's actually hoping to learn from Alberta.
Hon. J. MacPhail: We're bringing in three people from Saskatchewan and three from Alberta to seek their advice and input on the success or failure of regionalization in those two provinces. That makes eminent sense to me. Health care in this country is not a closed system. We've had lots of discussions where
L. Reid: I'm pleased to enter into the Health estimates again today. The minister continues to provide very mixed messages when it comes to the Alberta scenario. Just last evening in the small House, if you will, the discussion was about the fact that any kind of staffing issues in Alberta are being absolutely jeopardized, and that patient care is being jeopardized. But the fact remains that there are indeed fewer people per 1,000 waiting for any kind of medical treatment in Alberta than in British Columbia.
So I would suggest to this minister that she can't have it both ways. Her predecessor certainly said some very confusing things, and that does not add any consistency to the message this minister is attempting to provide to us today. In terms of the dollars that have been spent, what alarmed me when Elizabeth Cull introduced New Directions, a move to regionalization in health care, was that there was no accountability framework in place. There was no measurement of how this government was going to measure success. To this day, that framework does not exist. The minister's only comment was: "Valuable work has been done. Committed individuals have been part of the process."
We've never taken any issue with that, hon. minister. What we've always said is: "Pilot the program, know what you are doing and have in place a determination of when you have achieved some measure of success." The fact that that's not in place three years later is still alarming. As for your comments that good people have been involved, we've never taken any issue with that, and we have never attempted to malign any of the individuals who have been part of the process. We see it as elitist and exclusionary in many respects. We see it as an absolutely selective process on the part of this government as to who would be invited to participate and who would not. The people who have been there have probably done good work. What alarms me, and what I'm going to question this minister on, is accountability measures. How are you today measuring the success of New Directions?
Hon. J. MacPhail: I'll just comment on Alberta. By bringing in people from Alberta, we're in no way commenting on anything other than that we need to evaluate their experience,
Interjection.
Hon. J. MacPhail: That's all we're doing.
Interjection.
The Chair: Order, hon. member.
Hon. J. MacPhail: Certainly there may be nothing to learn -- absolutely. But the point of the matter is that before we move on to invest in a system that costs billions of dollars, we're going to make sure that the final steps are done the right way. The regionalization assessment team itself is an evaluation process, and somehow
But lastly, there are protocols in place with every single region, and the protocols require that an evaluation be in place. There are individual evaluations built into individual programs, as well.
L. Reid: I appreciate the minister's comments that they're going to ensure that the final steps are done correctly -- too little, too late. This government didn't ensure that the initial steps were done correctly.
My question, specifically, was: how are you measuring? I need some guidance, some comment, from this minister on even one example of a particular evaluation tool. Even one would give some confidence to this side of the House that there is an evaluation framework in place.
[ Page 2069 ]
Hon. J. MacPhail: I'll make the protocols available that exist in the regional
L. Reid: The regional assessment team cannot be an evaluation tool unless there are some measures in place, unless we know how they are going to determine success. Their very existence does not make them an evaluation tool. Again, I would ask the minister: what will she be looking for when this group makes its report?
Hon. J. MacPhail: The protocols deal with evaluation by the regional health boards. I will make those protocols available to the hon. member. I also would like to say that in terms of
L. Reid: The question, specifically, is: has the expenditure of upwards of $27 million impacted on the health of British Columbians? The minister has not responded to that question. Perhaps the minister doesn't know the answer to that question. I appreciate that regionalization has now been in place in some ill-thought-out form for more than three years. The fact that the medical health officer continues to report out is not a creature of regionalization; that happened before and will continue long after this experiment is done. Is there some particular measure that this minister can comment on today around the creation of New Directions, around the infrastructure of New Directions? The other reporting process has not changed as a result of New Directions. The question, again, is: has the expenditure of $27 million around this program been evaluated in any way, shape or form?
[11:00]
Hon. J. MacPhail: I don't know how many times I can repeat this. I have already answered that question. It's $27 million over three fiscal budgets, which will total over $20 billion. If the hon. member is indicating that at this point, with a percentage that is 0.000-something in terms of three fiscal budgets, that we should have an evaluation process other than what I have outlined, one that directly says that the investment of $27 million in structural changes has an outcome in health, I would suggest that the hon. member is asking to look for a needle in a haystack.
I will tell you that we have evaluation processes in place, protocols in place, for the regional health boards, and -- I assume, now, that there will be support from the opposition side -- the assessment tool that before we move on to spend a further $7 billion, we are pausing and assessing the overall change.
L. Reid: The minister may choose to denigrate $27 million; I don't. That is more money than this government has put into reducing the wait-lists in this province, or put into direct patient care. This minister, in debate last evening, talked about $25 million. Minister, $27 million could receive a reasonable evaluation on your part. This is not a needle in a haystack; this is a demonstration that once again this ministry has not looked carefully at how best to spend those dollars. Ask any average British Columbian how important $27 million is to their health care, and they would place far more credence on it than you just have.
The Chair: Through the Chair.
L. Reid: Through the Chair, hon. Chair. Certainly, there seems to be a lack of evaluation. This discussion is not new, coming from this member in this chamber. I have asked in year one, year two and year three for some discussion about measurement. What is the target? What is the goal? I appreciate that there are protocols. I can assure this minister that they have been promised every single year. They have never come. None of it has been tied to health outcomes. There is nothing tangible about the existence of yet another assessment team or yet another report.
The minister is obviously not taking my point. The point is valid. People are looking for evaluation on how government chooses to spend their tax dollars. The question is valid. The question deserves a response other than, once again: "I'll promise you a piece of paper." That's not it.
Hon. J. MacPhail: I don't appreciate having my words twisted around -- that somehow I don't think $27 million is important. The whole health care system is important. What we were talking about is $27 million out of $20 billion of expenditure. It's very important. My point is that for the hon. member to suggest that on the basis of that investment, $20 billion of health money, there can somehow be an isolation out of the expenditure of that money to health outcomes
The health outcomes continue to be done by the provincial health officer. Health outcomes are done regardless of the health care system that's in place, and that's exactly how it should be. If health outcomes deteriorate in this province, then it's the provincial health officer's responsibility and mandate to tie that to weaknesses in the system. That's the way it should be, and that's the way it will continue to be.
I will also take exception, only this once, to the idea that somehow $27 million over three years has been frittered away. There has been extremely valuable work done in the area of regionalization of health care. There have been achievements made. In my own city there have been achievements made, and one might want to ask about
An Hon. Member: Tell us what they are.
Hon. J. MacPhail: Well, one might want to ask about the city of Vancouver, about how it makes more sense to have health delivery done by the regional health board in that city as opposed to being divided between the city of Vancouver and the Ministry of Health. One might want to go to communities where there are the Closer to Home projects, where there has been a great deal of success. We have discussed some of those Closer to Home projects, and we can do more of that.
It is politically expedient to somehow take a
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health care dollars, and there is value attached to every single one of those health care dollars. What we are doing, though, is saying: before we spend the final amounts of money on regionalization of health care, we are going to take a pause and make sure that the investment of those health care dollars is the right one.
L. Reid: This minister has taken a few moments to suggest that it would be impossible to put in place evaluation. I can assure this
It seems to me that yet another New Democrat program has been oversold. This is not first-year commerce, where the minister can suggest to me that she can account for every single dollar. I am looking for whether or not those expenditures were value-added, were decent, were useful, were helpful. Beyond the rhetoric, hon. minister, that conversation has not taken place this morning.
The protocols were promised. The evaluation tools were promised. The accountability framework was promised. What is the status of any one of those three items today -- any one of those evaluation tools, whether we are talking the protocols, whether we are talking the accountability frameworks for year one, year two, year three? Those things were promised. They have not been delivered. I don't understand why the minister is suggesting they are not available. Your predecessors promised that information. Surely there is some communication on that side of the House.
Hon. J. MacPhail: I don't want to spend all of the time remaining on this point, so I'll concede to the member that I have to go back and look at the records of the previous ministers in this area to see exactly what was promised. I will do that as soon as the opportunity permits.
Interjection.
Hon. J. MacPhail: The hon. member for Peace River is saying that it's fall now where he lives.
The evaluation protocols are in place for the regional health boards, and I will make that available, if the hon. member hasn't already got that.
I greatly appreciate the experience that this hon. member has in being an excellent critic in health care, so I don't want to engage in some sort of rhetorical debate here. But it's time for the opposition to put their money where their mouth is, in terms of an evaluation tool that they have. Perhaps they're going to whisk it out of their pockets and say: "Aha! You should have known this!" The evaluation tools that we're
But the tools that we use here are health outcomes. Each year the provincial health officer publishes health outcomes. Right now the provincial health officer is working to ensure that when the Closer to Home model is in place and up and running, his assessment of health outcomes carries on. That work is being done right now. I would need to be advised of other ways of determining the value of our health care system.
What we're talking about here is the evaluation of our health care system, and the model that we're using to deliver that health care system will be regionalization. You don't evaluate the structure; you evaluate the outcomes. In the provincial health officer's annual report of 1995, the whole report is about health outcomes in this province. The provincial health officer will do an annual report for 1996 as well, he will do one -- or maybe she, at the time -- for 1997, and on and on.
But if I'm missing something here, if there is an evaluation tool based on structure that can be separated out and identified and tied to health outcomes, I look forward to being advised of that. I'll take the advice. I'll stand up in the House and I'll say thank you, and give full credit to the source of that advice.
L. Reid: If the minister has indeed read that report, she will know that there are two communities in this province that are considered the healthiest communities in which to live: one is Richmond and the other is North Vancouver; and my colleague and I from North Vancouver believe it's the level of leadership. In terms of evaluation, I look forward to having a discussion with the minister, and I know that I will have the discussions in the next number of weeks.
In terms of remuneration for those who sit on community health councils and regional health boards, what is the current level of remuneration, and are any changes anticipated?
Hon. J. MacPhail: The remuneration is expenses only, wage replacement up to $175 a day, and reimbursement for dependent care.
L. Reid: I appreciate the clarification. There was legislation before this House that gave the minister the option of putting a salary in place for those individuals. Has that happened for any of the boards or councils in this province?
Hon. J. MacPhail: No.
L. Reid: In terms of hospital boards -- and I believe many are in transition today, if not all -- is there any other remuneration in place for any of those individuals?
Hon. J. MacPhail: No.
G. Abbott: I'll be very brief here. I know our time is relatively limited, and I want to see others, who have a more profound understanding of this area of government than I do, have the time.
I do briefly want to ask a question or two about local government and its role in regionalization. As a former local government representative, I was peripherally involved in health care regionalization. Listening to some of the concerns and criticisms that were being put forward, there was a lot of frustration on the part of government over the past three years with respect not to the current minister but to the former Minister of Health. For example, back in 1994 the president of the UBCM wrote a very impassioned letter to the then Minister of Health asking that what the current minister has done be done -- that is, suspend the process of regionalization so some of these very important questions could be considered.
While I guess some take some comfort in the recent suspension by this minister, still there's a good deal of frustration here. I don't want to go on at length, but I do want to emphasize that this current minister should not do what her predecessor did, and that is make some mistakes in this regard in terms of consultation and discussion with local government in this area. It's important that history not repeat
[ Page 2071 ]
itself with respect to some of these issues. So I'll ask, first of all: has the RAT team, if I can use that acronym, advised the UBCM regional districts and municipalities of the process that's pending? And have they invited their input?
[11:15]
Hon. J. MacPhail: On behalf of my colleagues, I'll take exception to the referral to them as rats. Of course, that was the name we gave them, yes. But I know exactly what the hon. member means.
We consider it very important to meet with the UBCM. The regional assessment team is meeting with the UBCM. We have had correspondence with the UBCM. As minister, I am going to the UBCM convention next month, as well, to discuss regionalization.
G. Abbott: As much as anything, I want to alert those in the acronym factory in the basement that possibly they may have slipped up on this RAT one: it doesn't necessarily smell like a rat but it certainly sounds strikingly like one.
Have the municipalities and regional districts in this province -- given that they appoint or submit members to the various boards that are part of the new governance -- been advised as well? Has their input been welcomed?
Hon. J. MacPhail: We've actually left it up to the UBCM to decide how they wish to have the consultation take place. The UBCM will decide whether it should be done on the basis of clusters or individuals or overall.
A. Sanders: It's nice to rise this morning and talk about regionalization. I'd like to start by again reviewing the RAT team, as my colleague from Shuswap has mentioned.
An Hon. Member: Rats are smart; they can get out of mazes.
A. Sanders: Getting out of things is not necessarily something to brag about.
I would like to just point out, when the minister pointed out that Mr. Gerow had experience in the health care system, that even by choosing a less partisan team including both sides of the House in a standing committee on health, this side of the House could have offered you 20 years of training experience in the health care professions cumulatively, with just two members. We could have offered you 30 years of working experience in the health care professions, representing several of those professions. We could have offered you an entire year on a community health council steering committee. We could have offered you four years of hospital board experience from the members on this side of the House, in a non-partisan situation, for evaluating the regionalization process without an extra dollar being spent by this House in terms of gathering people.
No matter whether the minister feels that this partisan group can do the job properly. What's really important for all of us is that when it's all said and done, the public feels that it's been done properly. I don't really think it matters whether we feel it can be done fairly or not; it's a matter of what British Columbians feel. Has this House done the job? Health care is a non-partisan issue. Have we dealt with it in a non-partisan way? Have we moved forward to make decisions that will be for the best health of all British Columbians?
There's one thing I'd like to offer the minister, because there has been a survey going around to look at regionalization to see where it's at. I would be very pleased to offer the minister this survey, done as part of a doctoral thesis at UBC. This survey, already done on hospital governance in British Columbia, surveyed 947 separate institutions -- 511 acute care hospitals, 338 long term care facilities and 98 specialized care facilities.
Not only that, they surveyed the CEOs of those places -- 106, 73, 26 and seven -- around 200 people who were in charge of the hospital administration. They surveyed chairmen of the board -- 106, 73, 26, seven -- again, around 200 boards were surveyed in this doctoral thesis. They surveyed board members: 735 plus 365, plus 286, plus 84. This is a huge document in terms of the number of people in the communities who have been surveyed. Not only that, they surveyed 14 officials from the Ministry of Health -- deputy ministers, assistant deputy ministers and executive directors.
All this information has been compiled, and it is a snapshot-finding of New Directions. The things they have found with respect to the regionalization process are very much of interest, and in the next three
In this study, 57 percent of the hospital participants felt that the plan was not working in theory, and only 46 percent supported the plan in practice. That was compared to the Ministry of Health people, who voiced their support 100 percent for the theory and practice of regionalization. Eighty-five percent of hospital respondents felt that the government had not thoroughly thought through New Directions and regionalization prior to implementation, and they suggested pilot studies.
A statistically significant number of hospital respondents, 30 percent, referred to the government's health reform plan as a multimillion-dollar social experiment. Ninety-five percent of all of the CEOs said that they understood the roles and responsibilities, but 68 percent of the board members and chairs were confused over what they were supposed to be doing.
In terms of looking at direction in communication of regionalization, 100 percent of the ministry officials said that the educational information was good, but the hospital -- 69 percent -- said the government's performance was poor. Sadly, 42 percent of all of those surveyed referred to New Directions as No Directions.
When questioned if New Directions was economically sound, 100 percent of the ministry respondents said it was; however, less than 50 percent of the hospital population agreed. They stated that efficiencies may be occurring but that they would have to be in the long run because they certainly weren't in the short term.
Sixty-four percent of all the participants stated that the major impetus of New Directions was to make the present health care system more cost-efficient. Seventy percent felt negative toward New Directions and felt it did not decentralize decision-making at all. Ninety percent of hospital participants expressed concern and frustration over selection of the regional health board and community health council members. They also felt that the lateral shifting caused additional layering of administration and additional funding responsibility without any true authority being reached by the communities.
These kinds of things are available, and I think that if we are going to truly consider this as a non-partisan issue, and if we are going to look at health care and make it the best it can
[ Page 2072 ]
be, then I don't think it's reasonable to set up a committee that could potentially decide in three weeks in any way, shape or form what someone has taken a year and a half or two years to do. I would be very concerned about the quality of the information that would come out. It's such a short time, but it's such an important step. I do not think that analyzing it is a problem; in fact, that's so important that it should have been done all the way along. What we need to do is take the information that we have and extract from it what people are saying in the communities -- we do have that information available and could look at even the raw data -- and try and make some sense out of that, so that we don't fall on our face again with our $6.7 billion social experiment.
We need to have health care work. No matter what side of the House you come from, I really, truly believe that side of the House and this side of the House want that to happen. I'd like to see us working together to do that, but not in the context of saying that this RAT pack will decide what New Directions and regionalization will do. I don't think it's realistic, and I'd like the minister to reconsider that.
Hon. J. MacPhail: I was with the hon. member all the way to her last comments, and then she really bugged me. Apart from the final statement, I agree with the hon. member.
K. Whittred: I would like to begin my questioning by simply asking the minister a hypothetical question: if I were to take you out to dinner, hon. minister, and promise to pay 100 percent of the bill, what is your interpretation of 100 percent?
Hon. J. MacPhail: I take it as a trap, so I'm not going to answer it in case I'm held to it by a future person I have to take to dinner.
K. Whittred: I'm reading from a news release of March 22, 1995, where the then minister promised to provide municipalities with 100 percent funding to regional health boards. This was in payment for health services that many of the urban districts previously paid. These include: Richmond, Vancouver, Burnaby, New Westminster, the North Shore, and the capital regional district. Now, in the case of my region, which is North Vancouver, 100 percent apparently doesn't mean 100 percent, because there will be almost $1 million less in funding than previously. I wonder if the minister could explain how that can happen.
Hon. J. MacPhail: I'm aware of the differences of opinion between the municipalities and regions where we've taken over the delivery of health care. Let me say that I want the ministry to work toward a resolution on this matter, but I don't think it would be helpful for me to offer an opinion that in any way could exacerbate the disagreement. Let me just say that I want to resolve it.
K. Whittred: I hope that I am understanding the minister properly -- that she does intend to look at these. A number of urban ridings -- and, in particular, my riding -- are affected. Further to that, the programs that are affected are basically community programs. One of the points that I tried to make during estimates on seniors was that this whole program of Closer to Home is to have an infrastructure in place so that we reduce the ultimate acute care costs. Yet the urgency of acute care always takes precedence over the support-type programs. I give you an example: in North Vancouver, one program that would be seriously affected is the adolescent mental health program. Therefore we're removing the infrastructure that supports the whole concept and the whole delivery of health care service.
One other point is the increase in salaries. In these urban municipalities that previously had their own health services, health care workers, including nurses, who worked for these municipalities earned less than nurses and other workers who worked with the accord. It is estimated in the North Shore that the additional salary will cost anywhere from $0.5 million to almost $2 million, depending on how all of this breaks down. If this is the case, how much of the additional
Hon. J. MacPhail: I just want to make a comment, once again, about how one can distinguish from the delivery of the service and the person who delivers the service and somehow say that the person who delivers the service isn't part of the delivery of health care. I sense a difference on the point of view around that. Eighty percent of health care delivery is labour-intensive and so we have to value the labour input in that area.
The issue that the hon. member refers to is the levelling -- some people say up, some people say across -- of when services are transferred out of the acute care health system and into the community. There have been no conclusions reached and therefore there are no estimates. There has been no expenditure made in terms of that transfer of services and the effect that that transfer of services has on salaries, but discussions are going on between the Health Employers Association of B.C. and the representatives of the workers. To date, there have been no costs.
[11:30]
K. Whittred: Minister, I understand very well that the services in health care are labour-intensive. I understand that if you take a health care worker who was earning $10 per hour in this job and move her and put her to work for the regional health board, where she is doing precisely the same job but because of the contractual agreements is now earning $12, a portion of that money -- as much as I would love everyone to earn lots of money -- is going for an increased salary for the performance of the same service. I won't dwell on that point. I think I understand the minister's position on that.
I would like to conclude my remarks on this -- I believe I got the answer I desired from the minister in terms of looking into this financing -- simply by commenting that in your assessment of the New Directions program, I understand that of all of the regional programs, the North Shore is in fact one that is working quite well. I hope that the committee will perhaps look at it and try to discover why this model is actually progressing and perhaps even doing what it should. That concludes my remarks, hon. Chair.
A. Sanders: I've asked the minister to perhaps consider having other members from the
[ Page 2073 ]
necessary steps. I'd like those to be part of the public record, and I'd like the members who will be doing this to be able to read them, because they are important.
The first thing I think the government needs to do is provide a clear, objective plan for regionalizing health care, and it should be open to professional and public scrutiny.
I think we need to look at the definition of health adopted by New Directions because it is too broad, and given the breadth of that definition, we would never be able to sustain it. We need to refocus on a slightly different, sustainable definition of health and to publicly fund it equally, according to the rules of the Canada Health Act.
I think the current government needs to define "core," "health" and "medical services," and their standards need to be redefined. This should include direct input from the medical profession, because this has definitely been lacking in New Directions. I do speak on behalf of the medical profession, because they are the one profession that has especially been cut out of the loop.
I think the government must develop a comprehensive regional funding formula, and that needs to be open to public and professional scrutiny. The Ministry of Health needs to establish one level of regional governance and abandon the community health council model. I don't think that model is going to work, and I think the regional boards are enough. The government must also resolve all boundary issues in the 21 health units.
I think conflict-of-interest guidelines need to be revisited. This is the one area of most concern to me. The conflict-of-interest guidelines must be delineated to ensure that all British Columbia residents are equally eligible to be elected or appointed to regional governing bodies. An example of that is I was on the steering committee for my community health council. I picked, as part of the nominating team, the applicants that were to sit on the council. I can tell you from firsthand experience that the people with the most to offer the community health council were the first we rejected because they had a conflict of interest, meaning that they actually knew something about health, whether they were married to a health provider, whether they were a nurse, whether they were working in the lab in the hospital or whether they were a physician. These people who came forward and offered to volunteer their time to sit on our community health council and represent us were not allowed to have their names stand because of a conflict of interest. That to me, hon. minister, makes no sense.
I think we have to have direct accountability of regional governing bodies. This can be improved by reducing the percentage of appointments to the regional health boards. I think government must ensure that this shift to regional governance does not result in an increase in the size of the health bureaucracy. I think that there are enough people in British Columbia who think that we're overgoverned and we need to make sure we don't enlarge the bureaucracy.
I think there should be a legislative requirement for medical advisory committees to be able to sit on regional health boards and they should be able to vote on regional health boards the same as the other members.
I think government should commit to regional pilot projects. I think that with the magnitude of money that we're describing here, and the importance of changes we make, small
I think those things, along with some of the information that is available within our own universities that have evaluated regional health boards and New Directions, are absolutely valuable to any team that's going to be participating in an analysis of our situation.
Hon. J. MacPhail: I appreciate the input from the Liberal opposition on this.
V. Anderson: To follow up on my colleague from just a moment ago, most of my experience has been in community activities and community work with community groups. I am wondering if the minister would say what the relationship is between the New Directions and the Healthy Communities programs that have been operating in the province for some years.
Hon. J. MacPhail: We're preparing to transfer the Healthy Communities projects to the authority of the regional health boards.
V. Anderson: I was afraid of that, and I think that's exactly the wrong thing to do, for just the reasons that the member has brought forward.
The Healthy Communities concept is an entirely different thing from New Directions in health. The Healthy Communities concept, as the minister may be aware, came out of the United Nations working in aspects around the world and was adopted in Canada through the federal and provincial governments in order for a community to look at its total health, at how all of its health, its transportation, its housing, its social services, its education and all of these things build a healthy community to support healthy persons. That's a different concept, and that program was developing very well and very effectively in British Columbia until the New Directions program came along and stole its thunder and superseded it and stole its power and stole its money and stole its authority.
I think we would get far more if New Directions in health dealt with the health of persons, and Healthy Communities was left to deal with the health of communities. I know: I've been attending our local health council, and our local health council is talking about a healthy community. They're not talking about the technicalities of health delivery and health service. They are doing a little bit of that, but the persons who are coming are not able to continue with that kind of focus.
I'd like to get the minister's reaction on whether she will reconsider and let New Directions in health deal with health, and let Healthy Communities be left on their own to deal with healthy communities, because Healthy Communities is an interactive program which calls on social services, health and education -- the whole community. I think the very idea that they are the same is largely responsible for the problem you are having.
Hon. J. MacPhail: The point the hon. member makes is a legitimate one, where he actually is distinguishing, I think, between healthy people and health care. That makes sense. Healthy people require greater input than just the health care system. There is
[ Page 2074 ]
Let me just try to give the hon. member reassurance, though, that the contemplated transfer of spending authority from Healthy Communities to the regional health boards will in no way affect Healthy Communities programs. The future of Healthy Communities, the community basis of those programs and the broader community input beyond just the health care professions will in no way be affected by the potential transfer of authority. But let me also reassure the member that the importance of community programs that go beyond health care delivery is also being assessed by the regional assessment team. Your comments will be added for their consideration.
V. Anderson: Maybe I could use the B.C. Council for the Family as an illustration. It has done excellent work with families across the province. One of the things they learned very early on is that a program which would work in small communities -- where everybody knows everybody, basically, and you share the same coffee shop, almost -- is quite a different thing in the city, where people do not know each other, and they live in one place and have their recreation some other place. Even people on the same block don't know each other. Communication is totally different there. In the local communities, even for elections, MLAs can go to their local media. In the smaller communities in the city, which are larger in population, there aren't local media. There is just a citywide media. The Healthy Communities concept, though, was able to adapt to the community because it came out of the community.
What's happening now is that the New Directions program is laying a structure and a format on the community that will work well in some places; I realize that in the Victoria region -- and probably on the North Shore, where they already had an interactive model -- they have been able to meld that community participation with the top-down kind of program in some way. But in the places like the lower mainland, it's a totally different undertaking because those communities interact across cultures. There's not the same kind of process.
[11:45]
In our community, I dare say that 95 percent of our citizens are not aware of or have not participated in any way in the community councils in the local community areas. There are eight, ten or 12 people in the meetings, and half of those people are the people who are otherwise involved in the process in other places. They're not local community people. The local community people who are going to those meetings are trying faithfully to do what they're told, do the surveys they've been asked to do and get the information out, but they're spinning their wheels, and they're going to burn out. Some have already burned out and dropped out of the process in anger.
So I'm really saying to the minister that it doesn't work in our community, even though I'm in a community which has far more people with a higher educational background who are able and used to dealing with meetings, going to meetings and those undertakings. I have worked on the east side of the city; in the congregation I had, there was not a single professional person. There were many people with backgrounds from all around the world who are not used to meetings, functions and structures. Taking away the validity of Healthy Communities and replacing it with New Directions does a disservice to both, and neither are going to function as a result.
If Healthy Communities was left and encouraged as an independent body to develop and interact with New Directions, and if New Directions didn't have this total mandate that my colleague was talking about, then New Directions could get on with its job and Healthy Communities could get on with its job. Will the minister reconsider separating Healthy Communities and letting it have a life of its own, as it did have, to do its effective work around the process like the round tables, instead of you usurping it into the New Directions model?
Hon. J. MacPhail: Yes, I will consider that. I'll make sure that the regional assessment team takes your comments into consideration and explores that further.
V. Anderson: In your reconsideration, I would expect, hope and trust that you would talk with a group like SPARC -- the Social Planning and Research Council -- which has looked at the interactive models around British Columbia and is aware of the distinctions that take place. They have looked at the needs of communities in a whole variety of ways -- the needs of the disabled and those on low income, and the needs of what makes a good working community. Get some advice from them in looking at the distinction between the Healthy Communities model and the New Directions model. I wonder if the minister would be willing to talk to them. I haven't talked to SPARC about that, but I know their history, I know their ability, I know their resources and I know the research they've done. I think it would be an important model for the minister.
Hon. J. MacPhail: All I can offer is that I will advise the regional assessment team of the member's input and ask them to consider his comments.
V. Anderson: One of the things I want to ask the minister is a moment away from regionalization but it still has a bearing on it. It has been a topic of our conversation in the House lately. It's the transition team which will be looking at youth services and the Gove report and integrated services, health being a part of that. The minister knows all the background very well in that area. Could the minister tell me what participation and resources Health is putting into that transition team and model? That's a very fundamental aspect of it.
Hon. J. MacPhail: The office of the transition commissioner has a senior bureaucratic team that she works with. We're participating fully on that, and our cooperation at every level is full and unfettered. We consider it a high priority to move forward on the Gove recommendations as they pertain to Health as well.
S. Hawkins: I've been asked to raise another issue in the House with respect to programs that are provincially funded for the use of all patients across B.C. The way the structure has been set up with these RHBs, only certain centres will get the funding for these programs. That is of great concern to physicians in my constituency. We had raised the issue of cardiac emergency wait-lists, and I think this is where we start becoming aware of some of the problems. If we have a regional health board in Vancouver that's going to get funding for cardiac surgery or transplants -- all these kinds of things -- these programs affect patients across B.C. I wonder if the ministry has thought of this problem and how they're going to address this issue and make sure that people across the province get the same kind of say for how these programs run, because the whole plan of regionalization was to allow communities greater involvement in the say of programs and funding. Has the ministry thought of this, and how are they
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going to address it and make sure that everyone in the province has some say in the way funding for these provincially run programs is going to be provided?
Hon. J. MacPhail: I concur with the hon. member's point of view, especially in my hometown of Vancouver. Even within Vancouver the lines become blurred, even though the hospitals are there and theoretically within the Vancouver regional health board. The lines get very blurred in the lower mainland. The hon. member makes an excellent point about provincial programs for residents throughout the province. This is a very important issue that the regional assessment team is looking at. We are also seeking input on exactly that issue, not only from the health care providers but also from the communities and through the UBCM, who receive those services as well.
S. Hawkins: As we have progressed this morning, it seems the RAT team -- and I use that in humour only -- has a lot on their plate. When can we expect this report?
Hon. J. MacPhail: I accept all of the cautions that the government has received about not doing this by some arbitrary time lines, but we anticipate that there will be some public comment. Again, I don't want these words to come back and haunt me by saying: "Well, what does some public comment mean?" By the end of September or at the latest, early October, some public
S. Hawkins: When did the review team -- the RAT team -- start meeting?
Hon. J. MacPhail: They are actually meeting now with various organizations who have come to Victoria, so those meetings have been ongoing. Much work has been done throughout the month of July, but when the session concludes -- whenever we anticipate that -- the regional assessment team will continue to work full time throughout August and September. Because of that, it's considered a great honour to be on the regional assessment team; they will not get a summer vacation.
S. Hawkins: The minister had indicated before that we had old documents. Can the minister tell us what the new budget for the RAT team is?
Hon. J. MacPhail: I'll get that information for the hon. member.
S. Hawkins: I'm wondering if the minister could also get us the information broken down so we know who is coming from outside, what the consultants are being paid and what the communications budget is. If the minister can provide all that detail broken down, then we won't pursue this line of questioning.
Hon. J. MacPhail: I'll do my best.
S. Hawkins: In noting the hour and the presence of the Speaker here, I move that we rise, report progress and ask leave to sit again.
Motion approved.
The House resumed; the Speaker in the chair.
Committee of Supply B, having reported progress, was granted leave to sit again.
Hon. J. MacPhail moved adjournment of the House.
Motion approved.
The House adjourned at 11:56 a.m.