1998/99 Legislative Session: 3rd Session, 36th Parliament
HANSARD
The following electronic version is for informational purposes only.
The printed version remains the official version.
(Hansard)
MONDAY, JULY 5, 1999
Afternoon
Volume 16, Number 16
[ Page 14109 ]
The House met at 2:07 p.m.
Prayers.
Hon. D. Lovick: I see in the precincts today an old friend and somebody who will be well known, I'm sure, to all of us who have served in this chamber for any length of time. I'm referring to Paul Nicholson, lobbyist extraordinaire. I'm going to blow his cover a little bit and tell something about him that is not well known. Paul -- forgive me for saying this -- is an avid reader of Hansard. Nevertheless, I want to ask all members to please join me in welcoming Paul.
G. Campbell: It's a pleasure today for me to introduce Brian Aston, who is a North Vancouver resident. He's joined in the House by his two sons, Craig and Grandt, who are visiting us from Ireland. They are in grade 11 and grade 9. I hope that the House will make them welcome.
Hon. M. Sihota: I notice in the gallery today a friend of many members of our caucus: Diane Wood from the British Columbia Government and Service Employees Union. I have no idea why she's here, but I'm sure that she'll enjoy the proceedings.
B. Penner: It's my privilege today to introduce a councillor from the district of Chilliwack, Mr. Clint Hames. He'll be meeting with members of the B.C. Liberal caucus later this afternoon to talk about children and families. I wish the House would please make him welcome.
Hon. J. MacPhail: Accompanying Diane Wood in the gallery is a veteran caretaker of pension plans, a super superannuation commissioner. I heard a rumour that he had retired; I don't believe it for a second. We're joined by John Cook, the superannuation commissioner.
[1410]
PENSION STATUTES AMENDMENT ACT, 1999
Hon. J. MacPhail presented a message from His Honour the Lieutenant-Governor: a bill intituled Pension Statutes Amendment Act, 1999.
Hon. J. MacPhail: I move that the bill be introduced and read a first time now.
Motion approved.
Hon. J. MacPhail: I am pleased to introduce the Pension Statutes Amendment Act, 1999, which will amend the Hydro and Power Authority Act, the Insurance Corporation Act, the Pension (College) Act, the Pension (Municipal) Act, the Pension (Public Service) Act and the Pension (Teachers) Act. This bill implements the pension components of the various public sector accords between the government, employers and major public sector unions, including changes recommended by the various public sector pension boards.
The first purpose of the bill is to provide a framework for considering the possibility of moving the British Columbia Hydro and Power Authority pension plan and the Insurance Corporation of British Columbia pension plan to joint trusteeship. Under this structure, management of the pension plan would be shared between the plan members and the plan employers. The second purpose of the bill is to implement specific changes to four statutory public sector pension plans that have been agreed upon in various accords. This information has been made available in the past. However, I will again detail the specific changes at the next reading of the bill.
I move that the bill be placed on orders of the day for second reading at the next sitting after today.
Bill 89 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
PUBLIC SECTOR PENSION PLANS ACT
Hon. J. MacPhail presented a message from His Honour the Lieutenant-Governor: a bill intituled Public Sector Pension Plans Act.
Hon. J. MacPhail: I move that the bill be introduced and read a first time now.
Motion approved.
Hon. J. MacPhail: I am pleased to introduce the Public Sector Pension Plans Act, which replaces the Pension (College) Act, the Pension (Municipal) Act, the Pension (Public Service) Act and the Pension (Teachers) Act. This bill has two primary purposes. First, the bill modernizes pension statutes; this fulfils a commitment made to plan members and their representatives in 1994. Second, the bill provides an option to move the public sector pension plans to joint trusteeship. Under this model, management of the pension plan would be shared between plan members and plan employers. This option is included as a future possibility for the municipal pension plan, the public service pension plan and the teachers pension plan. The terms of joint trusteeship for the college pension plan are included in the bill. These terms have been agreed upon among the College Pension Advisory Board, the College-Institute Educators Association, the B.C. Government and Service Employees Union and the government.
This bill also provides the necessary infrastructure to enable pension plans to move to a joint management structure, including the establishment of the British Columbia pension corporation and the British Columbia investment management corporation, as the successor organizations to the Superannuation Commission and the office of the chief investment officer respectively.
This bill is the culmination of a lengthy dialogue and consensus reached among the boards of the four statutory pension plans, the provincial and municipal governments and the major public sector unions. The changes contained in the bill are progressive advances in the way the pension plans and their funds are managed on behalf of plan members and bring this legislation into line with legislation that exists all across the country already.
I move that the bill be placed on orders of the day for second reading at the next sitting after today.
[ Page 14110 ]
Bill 95 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
[1415]
EDUCATION STATUTES AMENDMENT ACT (No. 2), 1999
Hon. P. Ramsey presented a message from His Honour the Lieutenant-Governor: a bill intituled Education Statutes Amendment Act (No. 2), 1999.
Hon. P. Ramsey: I move that the bill be introduced and read a first time now.
Motion approved.
Hon. P. Ramsey: This bill amends the School Act to provide the authority for the creation, collection and use of personal identification numbers, known as PENs, consistent with the principles of the Freedom of Information and Protection of Privacy Act. PENs are unique identification numbers assigned to each K-to-12 student.
The amendments to the School Act enable the Ministry of Education to accurately collect and track information gathered through provincial assessments and student performance. The bill also amends post-secondary legislation to enable implementation of the PEN project by the Ministry of Advanced Education, Training and Technology. It will extend the use of PENs to the post-secondary level.
The principal objective is to ensure and enhance the relevance and the accountability of public post-secondary education in B.C. Through the PEN project, the Ministry of Advanced Education will have the ability to track groups of students over time and across institutions through the post-secondary system. The use of PENs will enable the ministry to gather accurate and complete information about post-secondary students that will contribute to more informed program decisions and enable more effective program planning at both institution and system levels.
The amendments also provide for the exchange of student information between the Ministry of Education and the Ministry of Advanced Education, Training and Technology. This exchange is primarily for purposes of research and statistical analysis, to enable both ministries to enhance the effectiveness of educational programs and initiatives. The PEN permits the exchange of information without unintentional disclosure of the identity of individuals, thus protecting their privacy.
Hon. Speaker, I move the bill be placed on orders of the day for second reading at the next sitting of the House after today.
Bill 87 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
VANCOUVER TRADE AND CONVENTION CENTRE PROJECT
G. Campbell: Hon. Speaker, we now see that the government has incorporated the Vancouver Trade and Convention Centre Authority in Ottawa rather than in B.C. According to the government's own officials, this has been done to shift the taxpayers' liability off the books and to hide the facts from the people of British Columbia. After all the problems that this government has run into -- from the fast ferry debacle to the Hydrogate affair -- why on earth is the Minister of Employment and Investment now planning to hide even more information from British Columbians on the convention centre project?
Interjections.
The Speaker: Order, members.
Hon. M. Farnworth: Once again the opposition has shown us why you should never rely on the sloppy scribblings that you sometimes see in a Friday edition of the Vancouver Sun.
The Speaker: First supplementary, Leader of the Official Opposition.
G. Campbell: Unfortunately, what we in the opposition have to do is count on government officials to tell us the truth. What government officials have said quite clearly is that this government has already spent $54 million on the new trade and convention centre expansion -- $54 million, at the rate of almost $4 million a month -- and still there is no business plan. Still we don't know how much the convention centre is going to cost. Still we don't know how the convention centre's going to be paid for.
My question to the Minister of Employment and Investment is: has he got a business plan? Has he not learned anything from the past? Why on earth should any British Columbian trust him and believe that we are not going to run into hundreds of millions of dollars more in overruns with regard to the convention centre?
Hon. M. Farnworth: Hon. Speaker, I find it really interesting that this
opposition finds that the only way they can attack a project that's supported by the city
of Vancouver, that's supported by the federal government, that's supported by the
Vancouver Board of Trade, that is going to bring untold hundreds of millions of dollars
Interjections.
The Speaker: Order, members. Order, members.
Hon. M. Farnworth:
Interjections.
The Speaker: Order, members.
Hon. M. Farnworth:
[1420]
Interjections.
The Speaker: Members
[ Page 14111 ]
Hon. M. Farnworth:
Interjections.
The Speaker: Minister, take your seat.
Interjections.
The Speaker: The question was listened to in some silence and some order. The answer must also be listened to similarly.
Minister, finish your comments, please.
Interjections.
The Speaker: Members, come to order.
Hon. M. Farnworth: The authority is set up because there is a provincial asset
and a federal asset, and the two have to mesh together. They do it that way to work for
efficiency -- to save over a hundred million dollars on the cost of the project. Hon.
Speaker, this is required in the same way that authorities right across this country
operate facilities such as this. Whether it's an airport authority, whether it's E-Comm,
whether it's NavCan -- all those things where there is interjurisdictional involvement
have authorities like this to do that. They are subject
The Speaker: Minister, thank you.
Hon. M. Farnworth: The province's involvement is subject to
freedom-of-information
Interjections.
The Speaker: Thank you, minister. Take your seat, please.
Hon. M. Farnworth:
The Speaker: Minister
Hon. M. Farnworth:
The Speaker: Second supplementary, Leader of the Official Opposition.
G. Campbell: Hon. Speaker, there is no business plan. The Premier announced that this was going to cost $200 million. Then he announced it was going to cost $300 million. Now we hear from the minister that it's going to cost $440 million at least. My question to the Minister of Employment and Investment is quite straightforward. This government has not managed one project properly. If you are going to have a convention centre expansion, it's got to be done on a sound business basis. Why should any British Columbians trust this minister or this government to bring this project to fruition in a cost-effective and sensible manner?
The Speaker: Minister of Employment and Investment.
Interjections.
The Speaker: Order, order.
Hon. M. Farnworth: Thank you
Interjections.
The Speaker: Members will come to order. The minister will answer the question when there is order in the House.
Hon. M. Farnworth: We have one of the best teams in place to bring this project along, hon. Speaker.
An Hon. Member: Prove it.
Hon. M. Farnworth: We have the auditor general of British Columbia as the auditor for the project, hon. member. Go question his qualifications.
Interjections.
The Speaker: Members, come to order.
Interjections.
The Speaker: It is impossible to hear either the questioner or the person giving an answer when there is so much noise in the chamber. Minister, will you continue, please -- briefly.
Hon. M. Farnworth: We have Henry Wakabayashi, the individual who oversaw the construction of the Vancouver International Airport expansion -- brought in on time and on budget. He is representing the province's interests on this. He has an excellent track record of over 30 years in the private sector. We have one of the most respected former deputy ministers in any province in the country -- Doug Allen -- involved in the project, overseeing the province's interests, doing the negotiations. We have a first-class team in place, and this project will be brought in on time and on budget.
G. Farrell-Collins: We heard exactly the same song and dance about the Hydro Pakistan project, exactly the same song and dance about the fast ferries, and both of those were woefully out of control and unaccountable. You'd think that after Hydrogate, you'd think that after the fast ferry fiasco that was engineered by the Premier of this province, you'd think that after all of that this government would try to be more open and more accountable with their megaprojects. But instead we have Chris Nelson, from the ministry, saying: "If it was a Crown corp, it would impact on the debt of the province. That's why the province decided to use this structure."
We now know there's no business plan. We now know that they're trying to hide it off the books. We now know that the government isn't going to subject it to the freedom-of-information laws. Instead of being more open, they're being more closed. What does the minister have to hide from the taxpayers in British Columbia on yet another megaproject that looks like its going to run amok?
[1425]
Hon. M. Farnworth: That member is straight wrong. The province's involvement, until the authority is up and running
[ Page 14112 ]
after the project is complete, is subject to FOI. After that, Pavco, which holds the
lease, is subject to FOI. The fact of the matter
The Speaker: Minister, minister.
Hon. M. Farnworth: This is not just the province's own project.
The Speaker: Minister
Hon. M. Farnworth: In order to make the existing Trade and Convention Centre
work together and mesh with the new provincial one, there has to be a way of making that
happen. That's why you have an authority. That's what you're able to do with
representation from the federal government
The Speaker: Minister, thank you very much.
Hon. M. Farnworth:
The Speaker: Minister, minister. Take your seat, minister.
First supplementary, member for Vancouver-Little Mountain.
G. Farrell-Collins: The minister got one thing right. Until this thing gets incorporated in Ottawa, it is subject to FOI -- if you're a millionaire. That's because we sent in a freedom-of- information request to find out on behalf of the taxpayer where their $54 million has gone. You know what? We got a bill for $22,275. I would think that this government, given its track record on boondoggles, given its incredibly incompetent management of just about every Crown corporation in the province, would want more openness. What is the minister trying to hide that it cost $22,000 just to find out what his minister and his government are doing with their tax dollars?
The Speaker: Minister of Employment and Investment.
Interjections.
The Speaker: Members, come to order.
Hon. M. Farnworth: FOI requests are handled by the freedom-of-information officer, who's independent of this Legislature. So deal with them.
But here's the issue: why doesn't this opposition get on board and start to lobby the
federal government on the benefits of this project here in British Columbia? Why don't
they for once stand up for British Columbia? Why don't they work with British Columbians
to ensure that this federal government's
Interjections.
The Speaker: Members
Hon. M. Farnworth:
Interjections.
The Speaker: Members, come to
Hon. M. Farnworth: Why do they have to be selective in their quotations?
The Speaker: Time, minister.
Hon. M. Farnworth: Why don't they recognize the article on Saturday, for
example, that laid everything out for them: why we have an authority, why it's subject to
freedom of information
The Speaker: Minister, it's time to finish your answer now.
Hon. M. Farnworth:
The Speaker: Second supplementary, member for Vancouver-Little Mountain.
G. Farrell-Collins: The answer to the minister's question is: it's because you're the most incompetent government in the history of British Columbia.
The Speaker: Member
G. Farrell-Collins: After the election, he'll have the opportunity -- if he wins his seat -- to ask many more questions of this side of the House.
I have a question for the janitor of the NDP cabinet: can he save the people of British Columbia $22,000? Will he stand up in the House today and hand over the business plan? Or isn't there one?
Interjection.
The Speaker: The members for Kamloops-North Thompson and Okanagan West will come to order. I recognize the minister of the Crown -- Employment and Investment.
Hon. M. Farnworth: I guess on the question of competence, this opposition is so
competent
Interjections.
Hon. M. Farnworth: Shake your head; you're one. So are you. You're another. So are you.
Interjections.
The Speaker: Order, members. The House will come to order.
[1430]
C. Clark: Well, I can give the member this assurance: on this side of the House, all these members will be here long, long after the voters have said goodbye to that minister and the rest of that crew over there.
[ Page 14113 ]
Interjections.
The Speaker: Members, come to order.
C. Clark: Last March this minister and this government reneged on its commitment to bring in the convention centre at zero cost to taxpayers. Now we're finding out that taxpayers are going to be on the hook for up to half a billion dollars. But only if you're a crony of the government will you be allowed to work on the worksite, because they're limiting it to union workers only.
Will the minister stand up and tell the 80 percent of the construction industry in British Columbia that's non-union why they're good enough to bankroll this thing for half a billion bucks, but they're not good enough to make a dollar on the worksite?
Interjections.
The Speaker: Members
Hon. M. Farnworth: Well, I guess the first part of your question
On the second point, this project was put out to bid and was won by
Interjections.
The Speaker: Members, it's very difficult to hear the minister. Members, come to order.
Hon. M. Farnworth: This project was bid on by Greystone in an open tendering process. They were the successful bidders. All the proponents that bid on the project were union companies. They're the ones that bid on it. It was put out in terms of it being bid by the private sector or under financing arrangements with the province. So this project has been bid by a union company, and they will be building it.
The real issue is: why won't this opposition get up and lobby Ottawa to ensure that we get our fair share of federal tax dollars on this project?
The Speaker: The member was on her feet. I'll let her ask a question -- a brief one, please, with a brief answer.
C. Clark: Well, maybe the answer to the question is in the business plan that
the minister won't give us. Maybe the answer to the question of whether we could have
saved $30 million on the cost of this project if we'd been able to open it up to both
union and non-union labour
When will the minister realize that British Columbians are fed up with a government that wants to take care of its union pals and that wants to grease the palms of its friends and insiders instead of taking care of the taxpayers of British Columbia?
Hon. M. Farnworth: You know, hon. Speaker, the only thing that's happening is watching the opposition get up and criticize a project that is being built by a company that bid it in a fair, open process. They're criticizing a project that has the support of the city of Vancouver.
Interjections.
The Speaker: Members, members.
Hon. M. Farnworth: They're criticizing a project that has the support of the board of trade.
Interjections.
The Speaker: Order, order.
Interjections.
The Speaker: Minister, the microphones have been turned off. Take your seat, please, minister.
Interjections.
The Speaker: That's no help either. Some members keep persisting -- no help at all.
Hon. H. Lali: I'm pleased to submit the 1997-98 and 1998-99 annual reports of the Motor Carrier Commission.
[1435]
Hon. J. MacPhail: In this chamber, I call Committee of Supply. For the information of the members, we'll be debating the estimates of the Ministry of Health.
The House in Committee of Supply B; W. Hartley in the chair.
ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 36: ministry operations, $7,569,524,000 (continued).
C. Hansen: When we were last on Health estimates, which was last Tuesday evening, we were discussing Pharmacare issues. There was a survey that I referred to that the minister was interested in getting a reference on. So I'll just start by passing this on. But I'll also put on the record that it was from the second annual Hoechst Marion Roussel report, titled "The Canadian Consumer Survey on Health Care." I'll send that over to the minister so at least she has that reference.
[1440]
I want to continue with some of the regional issues that we had been discussing
previously. Specifically I want to start with the issue of
[ Page 14114 ]
CAT scan operations. The understanding I have is that the ministry guidelines call for one scanner per 125,000 residents in a region. I'm wondering if the minister could confirm whether or not that's still the guideline that's used.
Hon. P. Priddy: I'm told by staff that that is correct.
C. Hansen: I want to move to the Cowichan Valley and the Cowichan District Hospital, where a businessman by the name of Pat Carson donated -- a couple of years ago, actually, going back to 1991 -- $861,000 for the purchase of a CAT scan. He did this in memory of his wife, who was suffering from cancer and was put through trips back and forth between Duncan and Victoria many, many times because of the lack of a CAT scan in the Cowichan Valley.
The reason the ministry gave at the time as to why they couldn't install a CAT scan was that it was because of the operating costs. Now we find that that particular donation that Mr. Carson put in has grown to, I believe, approximately $1.3 million. The company that would provide the CAT scan -- I believe it's Packard Bell -- made an offer that they would provide the CAT scan to the hospital and fund the operations of this CAT scan for a period of four years. Given that the ministry's guideline, as the minister just explained, is for a CAT scan for every 125,000 people, we are now at a point where the Central Vancouver Island health region has a population of 250,000 people being served by the one CAT scan in that region. I'm wondering if it is time for us to revisit that issue, now that the population has increased so dramatically and now that there is a commitment for the four-year operating funds for that particular CAT scan.
Hon. P. Priddy: I don't think I'm ever in a position to say that nobody would ever review a decision. That's foolish. What I'm told at this stage is that when one went into Campbell River, the one in Nanaimo was upgraded to be able to do more work. As a result of that, the wait-lists have come down to about three or four weeks. Victoria, of course, has expanded its hours as well.
The region has not indicated it to be a top priority for them. While I am prepared to have another look at it, it would seem to me that if the Nanaimo one has been upgraded, and Victoria is doing expanded hours and the region doesn't list it as a priority, then I'm not sure that it would change the decision. But I'm always willing to look.
C. Hansen: The minister was quoted in the Cowichan News Leader in Duncan as saying that she would consider a CT scan to be located there when there are "enough numbers to substantiate one." The argument that is being made is that, given the ministry's guidelines, those numbers have now been reached. I appreciate the minister's willingness to review it. I only hope that she reviews it with a bit more optimism than the tone of her voice implied, because I think that's a service that certainly those residents of Vancouver Island would be very anxious to receive.
[1445]
I want to move on to Houston, British Columbia. When I was in Houston earlier this year, in March, a woman told me a story that really struck me as one that sort of emphasizes the difference between urban and rural health care in British Columbia. This was a single mother. Her daughter fell out of bed in the evening. She was concerned about whether or not her daughter should be seen by a doctor. As a result of some of the Dobbin issues not being resolved at this point -- which is an issue we'll get into later in the estimates -- the doctors were not providing on-call services in that community, so she phoned the health clinic in Houston. She got an operator who said that if she was concerned about her daughter, she should phone the ambulance and have her daughter transported by ambulance to Smithers, which, in the best of weather, is about a 40-minute drive.
This was a mother who was basically placed in the dilemma of not being able to obtain some of the most basic medical advice without a very expensive ambulance ride and the prospect of leaving her other children or finding somebody to take care of them. I'm wondering if the ministry has looked at all at providing that kind of advice to a parent or to anybody in this province via telephone. What this mother lacked was the ability to phone a doctor and get a doctor's advice as to whether or not she should be concerned enough to call an ambulance to transport her daughter to another community. I'm wondering if the ministry has looked at any provision of that kind of advisory service that could be available by telephone in remote communities that are not served by acute-care hospitals.
Hon. P. Priddy: I would agree that not being able to get advice, particularly when it's your own child, is very frightening.
A couple of things have happened. Those were extraordinary circumstances, where doctors were not providing or were refusing to provide after-hours service. But the Bulkley Valley health council, with the Houston diagnostic and treatment centre, is actually hiring additional nurses and working with doctors to provide 24-hour-a-day, seven-day-a-week care. I know your question is broader, but you raised the issue in the context of Houston.
We have not looked at a physician referral service. I'm told that there's not another one in the country -- except a private one back east, which was not successful. But we do have a very large project here in the capital health region, which has been going for two years. It is a line that runs from 6 o'clock at night till 8 o'clock in the morning. It is answered by a nurse, and it's called self-care: the TeleCare project. As a result of that, emergency room visits are down significantly since the project began. Are we looking at a way to do TeleCare around the province? Yes, we are.
C. Hansen: I want to move over to Prince Rupert, which has recently been faced with the departure of six doctors from that community. Certainly there are doctors who have left many communities in this province recently, and I know the minister has talked about the number of new doctors who are being recruited. But when you start adding up all these numbers, it's more than cause for concern, particularly when you start looking at a community like Prince Rupert, where six doctors have departed in recent months.
I'm wondering if the minister could give us some assurance that the recruitment of new doctors to northern communities is actually going to be able to keep pace with the number of doctors who are departing.
[1450]
[ Page 14115 ]
Hon. P. Priddy: Can I assure you that nobody will leave and that they will all be replaced in a way that we'd like? No, I can't provide that assurance. I think the member would know that I'm not able to do that.
But I am able to assure the member that the ministry and the recruiting agency, through HEABC, are doing everything they can to recruit new physicians. As I think I talked about earlier, we have recruited new physicians into some remote and rural parts of British Columbia, where six months or ten months ago people were extremely concerned because they believed, quite correctly, that their physicians were leaving and they would not have someone there. We have been able to replace a number of them.
I know that over the last four years, say, the ratio overall of physician to
population, if you will -- the number of residents per physician in rural and remote
communities, which are the ones that would be assessed for the NIA allowance
That doesn't mean -- and I'm not trying to suggest -- that we still won't see situations, like Prince George or Prince Rupert, where a number of people have left at once. The places where we have been most successful either in ensuring that it doesn't happen or in being able to provide support when it does are those communities where there's a really strong partnership between the Ministry of Health, the recruiting agency at HEABC, the local community -- which often provides additional supports or incentives, if you will, as they might to anybody else they needed to come to their community -- and the local health authorities. So those four partners -- I think that's where we've been the most successful.
C. Hansen: Certainly, when you start looking at the challenge of ensuring that there is an adequate number of doctors for rural communities, retention is an awful lot easier than replacing or recruiting physicians. When you start looking at communities like Prince Rupert and Prince George, which have lost a significant number of doctors -- or, in the case of Prince George, are about to -- the ministry has been very quick to put troubleshooters into different areas where there have been particular problems. But I don't see any effort by the ministry to start looking at those particular communities and asking the question: what is it about the way we are working our doctors that results in so many leaving those communities at the same time?
I'll quote one doctor out of Prince Rupert. He says that the departure is a result of physicians being run ragged by overwork. I'm wondering if the minister is looking at the particular working conditions that we are subjecting doctors to in some of these specific communities where they are seeing a very large number of doctors departing.
[1455]
Hon. P. Priddy: Well, it's a yes and an ongoing answer. When we've looked at
communities that have lost
If you look at the kinds of things that physicians talk about or at the reasons that
are talked about by, for instance, the BCMA when physicians leave communities, there's no
question that on-call hours, etc., are a factor. Some people leave because they had gone
to a smaller remote community in order to start a practice, and then they decide they'd
rather be somewhere else. Some people leave when their children get to high school. There
are a variety of reasons, but I'm not in any way underestimating what the workload is.
When we've looked at that with the BCMA or with the College of Physicians and Surgeons
As a result of the Dobbin report, doctors -- general practitioners, anyway -- who are
providing year-round emergency medical coverage in, again, the NIA communities with
hospitals are eligible to receive compensation for that service. That's another sort of
remuneration incentive. The northern and rural locum program is an incentive, because it
means that
There are just a couple of other things that I would mention. The UBC family practice
rural and remote program -- which we support -- at least enhances the preparation of
physicians for rural practice so that you don't get somebody
There is more. I could go on -- the Prince George teaching unit, etc. Some of that is about remuneration; some of it is about being able to upgrade skills. I think there are some pieces over which we probably won't ever have control, because they're about people's preferences for personal lifestyle.
[J. Doyle in the chair.]
[ Page 14116 ]
C. Hansen: Certainly when we get down to the issues of the Medical Services Plan, we'll be talking about the Dobbin report and where we're at now, 13 months later. I raise this specifically in the context of Prince Rupert and also, to a certain extent, Prince George. In the case of Prince George, there is some attention being paid to the reasons behind doctors leaving. I don't see that kind of attention being paid to Prince Rupert today. I think it comes down to the kind of formulas that we're using in order to determine how the northern isolation allowance is quantified, how locum support is allocated in certain regions and how on-call payments are made, based on the number of doctors. It's that one-size-fits-all around the province that doesn't necessarily apply when you get into a specific community.
I would urge the minister to take a look at Prince Rupert to try to determine the reasons why these doctors are leaving in such numbers and to see if there are issues specific to Prince Rupert that we need to address in order to ensure that there is adequate health care for the residents of that community. The minister may wish to respond to that. Otherwise, I'll move on. I'll give her a chance to respond.
[1500]
Hon. P. Priddy: I think that Prince George
C. Hansen: I want to move to Terrace, which has been one of the areas where the minister has seen fit to send in an individual to try to deal with specific problems. Certainly that has led to some concerns about what this individual's mandate is. The ministry has dispatched Tom Novak to go in and look at their budget issues. I guess that one of the things that has come out, as a result of the work that Tom Novak has been doing, is questioning whether or not his mandate is to ensure that there is better health care in the Terrace area -- at Mills Memorial Hospital -- or whether his sole mandate is just to make sure that the budget gets balanced at all costs. Specifically, there was talk about longer wait-lists. One of the quotes that was made is that his measures to balance the budget may in fact create longer wait-lists for patients at the Mills Memorial Hospital. I'm wondering if the minister could enlighten us on exactly what Mr. Novak's mandate is when it comes to health care in the Terrace area.
Hon. P. Priddy: The person who is in Terrace -- although, I mean, we certainly recommended a name -- is actually hired by and is working for the health authority, not for us, so his mandate comes from them. But I'm still pleased to speak briefly about the mandate. If there's a need for someone to go in, you try and have someone go in on the basis of at least initially being a mentor, not somebody who goes in with some kind of heavy hammer or whatever. They go in to be a mentor to the people who are there. His mandate is to look not only at the budget but at the way that health care is being delivered and if it's being delivered in a way that meets the needs of people in Terrace, and to work with the board and to work with the CEOs up there to be able to do that.
While cost is very often a consideration in terms of people who may need more resources in one place or another, we have often found that it is also about how people are managing the resources they have. Sometimes people just need some assistance to actually manage the resources in a bit of a different way. He's doing both: he's looking at how they manage their budget as well as at the most effective way of delivering services to patients there, to meet their needs.
C. Hansen: Again continuing on the area, on Terrace issues, the chair of the regional health district recently expressed concerns about the number of times that northerners who are transported to Vancouver for emergency surgery are left stranded in Vancouver. There have been two incidents recently where individuals have had to come to Vancouver for surgery, and they were basically left to their own devices to get back to Terrace. I'm aware of the specific cases in terms of Terrace, but certainly it's an issue that affects all communities throughout northern British Columbia. In one situation a patient with a broken leg had to endure an 18-hour bus ride in order to return home to Terrace, because that was the only means he could afford, and even that was at some hardship.
[1505]
I'm wondering if the ministry has looked at programs to allow individuals to get transportation back to their communities again. Will the health care system in British Columbia take responsibility for these individuals not just from the time they pick them up in an ambulance until they're finished surgery, but actually responsibility to ensure that they have the means and ability to return to their communities without a great deal of suffering?
Hon. P. Priddy: I'll try and answer the question. I'm not absolutely certain of
the circumstances. This someone who came to Vancouver was not treated and was sent back
Interjection.
Hon. P. Priddy: Okay, thank you. I know of one, and I don't know if that's one
of the two. There may be others. What happens under normal circumstances is that the
hospital has a responsibility to notify the patient that their surgery has been cancelled.
If they do not do that
Interjection.
Hon. P. Priddy: Oh, so they didn't cancel the surgery. They completed the surgery. Okay.
Then the resource that that person is able to access, at least to some degree, is the travel assistance program. It is true that if you are sent by ambulance or air ambulance or whatever to a hospital and your treatment is completed, the health care system doesn't then take someone who's ambulatory and pay the cost of their returning home. I'm not sure we would be able to do that in every circumstance. This sounds like it may be a bit different, and I'm prepared to look into that case -- whether someone was sent home in very uncomfortable circumstances. We're not typically able to do that if we have
[ Page 14117 ]
somebody who is ambulatory and who has completed their treatment. But they can access the travel assistance program, and hospitals and social workers should let them know that it's available.
C. Hansen: Let's be clear as to what the travel assistance program is all about. That's basically by the good graces of a few of the airlines which offer a discounted rate. So instead of paying $1,000 for an airfare that can't be booked on a charter-class basis, because there's never time, they might get an airfare that's perhaps 30 percent less, or something along that line.
But still, in urban centres we often talk about seamless care, and we often talk about the continuum of care in health care in British Columbia. Well, when you talk about a patient who is picked up by an ambulance and then sent down by air ambulance to Vancouver for surgery and who then is basically dumped out on the street and left to their own devices to get back to their own communities, that is a tremendous hardship on many, many families. I certainly think it's something that warrants a review by the ministry. While I have the example specifically from Terrace, I know there are cases exactly like this from communities all over rural and remote British Columbia.
I will move on. I will give the minister an opportunity to respond; otherwise, I will move on.
Hon. P. Priddy: I would not attempt to minimize at all the fact that if you are not from an urban area, it's harder. The tertiary care centres are in urban areas, and you're not, if you live in a rural or remote community. There are far greater challenges; there's no question about that.
We do note that with the travel assistance program, about 90 percent of the people who ask for assistance actually ask for ferry assistance, for which, of course, there is no cost to them. We administer the program, so we have some administrative costs that we provide for, and -- you're right -- the rest is as a result of discounts provided by the airlines.
It is a challenge; it continues to be one. I would not for a moment suggest that it's as easy or as seamless for people who live in very northern communities as it is for somebody who lives in an urban centre. There are really big challenges to that. I don't know if we'll ever have a system where it's absolutely as easy if you live in Valemount as it is if you live in Victoria. But we'll continue to work with the airlines and with people, to try and make it as accessible as possible.
[1510]
C. Hansen: I want to move on to Kitimat. On June 2 we raised some of the issues around Kitimat health care in question period. The minister's response was basically to say that they're getting a new $35 million hospital and that they should be happy. That certainly doesn't address some of the real, fundamental problems that the community has in the confidence they have in their health care system and the community health council.
Several issues arise out of that, but if I can just pick up on question period itself.
The minister made a comment
The other issue, though, that I flagged out of that Hansard discussion was the minister's comment. She said: "This government delivered on not moving orthopedic care out of Kitimat, which we promised." I'm wondering if the minister could explain how the ministry has actually delivered on that promise.
Hon. P. Priddy: With the greatest of respect, I don't think I said they got $35 million for a health centre and that they should be happy. I think my answer was around a question of: "People in Kitimat have been neglected, so why should people believe that you would do something?" Well, there was an increase in the Health budget, and they have had their health centre approved. So I don't think I said they would be happy. I was trying to indicate -- and I think I did -- a couple of promises that were kept.
Let me move on to the orthopedic one. By the way, I am aware that they don't currently have an orthopedic surgeon in Kitimat. But there had been some discussion about moving the orthopedic service from Kitimat to Terrace. There are people who would make the argument or take the position that it should be in Terrace. It's currently certified or agreed to be in Kitimat. They are recruiting a new orthopedic surgeon with HEABC and the health authority, and our commitment is that that person will go to Kitimat. That's what I meant by saying that I've not said: "Oh, you're right. You should worry. We're going to put this person into Terrace." They're being recruited for Kitimat.
C. Hansen: I think that until such time as there is a new orthopedic surgeon serving Kitimat -- working in the Kitimat hospital -- there is an enormous amount of suspicion. The words ring a little bit hollow until that person is actually hired. I wonder if the minister can give us a time line as to when the residents of Kitimat are going to be able to see an orthopedic surgeon engaged and working out of that hospital.
Hon. P. Priddy: No, I'm not able to do that. We are using our best efforts; so is HEABC; so is the local health authority. I can't promise you when there will be an orthopedic surgeon who is prepared to work in Kitimat.
C. Hansen: Generally speaking, I'm sure I don't have to tell the minister that there is a huge amount of anxiety about health care in Kitimat. She's been getting the letters, and I've been getting copies of them. There are some that I just want to reference.
This is a letter that I actually referenced on May 2, when I raised it during question period. It's signed by the mayor; the CAW representative; an HEU representative; a B.C. Nurses Union representative; a physician representative; Health Watch; the Home Support Service; first nations; the KAHC, which is the Kitimat and Area health council, I believe -- I may have that wrong; a retired spokesperson; the Health Sciences Association representative; and an industrial community representative, which this signature is.
[1515]
It's a letter that is very strongly worded, and it was addressed to the Premier on May 28. It says: "The citizens of
[ Page 14118 ]
this community have, over the past eight years, witnessed a progressive deterioration
in the level of health care available within this community." It goes on to say, a
little later on: "The citizens of Kitimat have been denied care within the community
Another letter which I received a month ago today, actually, is from an operating nurse at the Kitimat General Hospital. She says that she has worked in the community for 25 years, and this is a quote from her letter: "For over six years, medical services have been unstable and declining for our townspeople." These are strong words.
I understand that the minister has asked a few individuals to go into that community on behalf of the ministry. Again, I'm assuming that they're engaged by the ministry, but the minister could correct me on that. These are issues that I think go back to some of the fundamental structuring of who represents the community when it comes to the delivery of health care.
I would like to ask the minister about the appointment process for representatives on the Kitimat and Area health council. Specifically, there were three new appointments made very recently, effective May 31. There is an appointment process that the ministry puts out, a document entitled "Appointment Process for British Columbia Health Authorities: Implementation Guide for 1998-99." It says quite clearly that community health councils will lead an open, publicly inclusive nomination process. It says that there will be a nomination review panel composed of ministry staff, the minister's delegate, the manager of agencies, boards and commissions and a representative from the Health Association of British Columbia.
There's also a process in there for nominees to be put forward from the community. My understanding is that, as happens in most communities, they put an ad in the Kitimat paper calling for nominees to come forward. Several names came forward. Yet it appears that the names that ultimately got appointed on May 31, which is only a small portion of the board -- I think there are only eight active board members on that community health council today, out of the 15 that will be the full quota -- did not come out of that nomination process that has been set forward. I'm wondering if the minister could explain to us where these names came from and how they came to be appointed to this community health council.
Hon. P. Priddy: The member is correct when he talks about the typical process, which is the process that this board went through in January. When the board was left with only four people and no chair, I think the options became somewhat more limited. To do a full public process -- ads in the paper, etc. -- and have a board that is not large enough to function and does not have a chair almost says that you have to take some other kinds of steps. As I've said in the Legislature before, I am always very loath to put in a trustee if there are any other options available.
These are minister's appointments. I have chosen as minister to do these in the way
that we did them in January, which is the way that the member has described. But I think
that in this particular circumstance, there was not time to
[1520]
The members' names that went forward
Without trying to totally dance on the head of a pin -- but a little bit -- the letter that the member refers to, signed by representatives of the unions, was signed primarily by people who -- it certainly doesn't discount their concerns, by the way -- are members of those unions. But it was not initiated by the union; it was initiated by those people who happen to be members in those unions. It doesn't take away from their concerns, but it does mean that their provincial union didn't take that perspective.
I can only speak for the next five minutes, but I think that currently things are quieter there. People are pleased with the physician who's come on to the board, and I think that at the moment it's quieter and people are trying to find ways to move forward together.
C. Hansen: The appointment process had started, though. It wasn't a case that
when there were mass resignations from the community health council, suddenly everyone had
to scramble. The ads had already gone into the paper. There were individuals that had
already been appointed or had put forward their nomination papers. And yet it appears that
the people who put their names forward from the community were ignored and that instead,
through some other process or some other route, they went out and found three other people
to appoint to this board. I'd like to know, since we have a document that talks about the
appointment process
You get a community where there is enough anxiety about their health care system, and
then there are individuals being appointed
Hon. P. Priddy: My understanding -- at least with the names that I can recall -- is that those did come through the agencies, boards and commissions branch. They didn't come out of nowhere. We do canvass the community, and the community submits the names. For the most part, those are the folks who are appointed. But we also canvass the agencies, boards and commissions branch to make sure that we have some kind of blend on the board in terms of -- and we've had this conversation before -- ethnic representation, gender
[ Page 14119 ]
representation, youth, etc. We don't always meet all those criteria, but we work hard to at least meet some of those. That's my understanding. The name of the physician, I understand, came from the community or from Health Watch.
C. Hansen: Actually, I'm going to deal with the physician appointment in a moment, because that's another whole story unto itself.
Maybe I'll ask the minister this: what role did the member for Skeena have in coming up with the three names or in screening the three names that were finally approved?
Hon. P. Priddy: The role that the member for Skeena played is not much different from what another MLA would have played. They are asked -- as I hope any MLA would -- to pay attention to their health board appointments and to submit names. That's not much different. But would he have had a role in submitting names? Of course he would have.
[1525]
C. Hansen: I think what's important here is that you have a community that was
lacking confidence in its community health council and that you wound up with appointments
coming forward, which are not the names that the community put forward through the regular
nomination process that was in place. Then you wind up with individuals who are being
appointed -- two of the three, I understand
That's what's key, because I think it's a question of: who in the community do you have confidence in to serve on community health councils and regional health boards? There has to be a perception that those individuals who are appointed are there to serve the community, to serve health care and to advocate on behalf of residents of those communities. Quite frankly, I don't believe that that kind of partisanship should have any role in the appointment of members of the health authorities. That's why we have this appointment process that has been put forward. I believe that some accountability is needed in terms of why this particular appointment process was abandoned so dramatically.
To say that they were left without an adequate number just doesn't cut it, because the voluntary nominations were already in. People had already submitted their names, and there was not an opportunity to have the community put in place the people they wanted to see represent them.
I want to move on to the medical representative, and I'm pleased that there is finally a medical representative appointed to this community health council. I'm wondering if the minister could explain: why is it that it has taken two years to get a medical representative on this board? It appears to me that there have been lots of excuses, in terms of correspondence that went astray. There was one name put forward, and that name was finally withdrawn in frustration. A new name was put forward, but it has truly taken two years in order to get a medical representative on this board. I wonder if the minister could give us some assurance that medical representatives will in fact be appointed with much more haste than we have seen in this case, so that this doesn't become a practice in other community health councils around the province.
Hon. P. Priddy: I can't respond to the length of time. I mean, I guess I could if I got someone to check. I think the member has raised a point that is a challenge for all of us as it relates to Kitimat. There have been more issues around the dynamics of the community than there might be in some other places; that happens. But normally I can't think of any appointments this year where the medical representative was not appointed at the same time as the rest of the board. So yes, I can assure you that it happens with haste or at least at the same time around the rest of the province. There may be an exception, but I can't think of one offhand.
I appreciate the comment from the member about partisanship, although I guess if there are four new members and two are seen as being pro-NDP, then the other two are seen as not. So I'm not sure that's a really big problem. But I have not met anybody, whether they are Liberals or New Democrats, who doesn't hold a partisan position for a party that is currently elected in British Columbia and who aren't doing their work on the health authority, because their first concern is about health care.
You know, the last time I met with a group of health care chairs -- just because I happen to know them -- out of the people there, two-thirds would not be seen as pro-New Democratic Party in any way, shape or form and are active, actually, with other parties. That's fair enough. They're the health chairs, and they're concerned. Around the partisanship, I think that you will find chairs of health boards who are Liberals, chairs who have no political affiliation and chairs that are New Democrats. But I don't think that you will find a partisan imbalance.
[1530]
C. Hansen: I think what's important is the perception in the communities. The communities have to perceive that these individuals are there to serve the communities. That's where it comes back to the importance of protecting the integrity of the appointment process; that's the point I want to leave the minister with on that.
Going back to June 2, in question period the minister referred to the new facility in Kitimat as a health care centre. There are also other references that talk about the health centre in Kitimat, as opposed to the hospital. I'm wondering: why the distinction? Why is this new facility being called a health centre rather than being referred to as the Kitimat General Hospital?
Hon. P. Priddy: I must admit that we have a lot of terminology in the health care profession, and sometime we use them interchangeably. But the intention here in using "health centre" is to have all of the services, including acute-care, under one umbrella, if you will.
C. Hansen: Actually, I understand that to a certain extent the opposite is happening -- that the current facility actually has doctors' offices in it that they can lease from the hospital, from the health council. The new facility doesn't have that opportunity for fee-for-service doctors. So in fact the new plan -- the new blueprints that are there for this so-called health centre -- where it has doctors' office in it actually has the words "salaried doctors," which is quite a departure from the way that particular hospital is operating today.
I'm wondering if the minister could, first, give assurance to Kitimat that their acute-care designation is not and will not be jeopardized. Secondly, why is it that we're looking at blueprints that show positions for salaried doctors in that community as opposed to the current situation that's there?
[ Page 14120 ]
Hon. P. Priddy: I can absolutely guarantee that their acute-care status, if you
will, or definition is not in any way at risk. The comment about the blueprints, I'm
afraid, is too technical for
C. Hansen: There are several other communities in British Columbia where there is growing anxiety about whether or not their acute-care status will continue, and two others come to mind right off the top of my head. One is Quesnel; the other is Princeton. There are other communities as well. I'm wondering if the minister could define for us what a minimum standard would be for the number of beds at an acute-care hospital in British Columbia.
Hon. P. Priddy: Although many of these decisions are made at a health authority level, I can tell the member that I'm told that there is no place in British Columbia that is in danger, if you will -- that's your phrase -- or is considered to be not having their acute-care status in the future. There isn't a bed count, if you will. We have hospitals with three beds occupied that have an acute-care status. They may have ten beds, but they have three occupied the majority of the time and are not full. They still have an acute-care status. The health authority might choose to add beds or subtract beds or use them differently, but they still act as an acute-care centre.
C. Hansen: I was asked to raise an issue specifically. This is coming from the Kaslo and District Health Planning Society. They are extremely anxious about the site plan evaluation for the Kootenay Lake District Hospital and the Mount St. Francis Hospital in Nelson. I'm wondering if the minister could give us an update on the status of that particular project.
[1535]
Hon. P. Priddy: To the member: is your question about the status of St. Francis? Is that it? I want to be clear.
C. Hansen: It's specifically regarding the Kootenay Lake District Hospital and the Mount St. Francis Hospital or facility. My understanding is that there's a site evaluation that has been approved. I'm just wondering if the minister can give us a time line as to when that project is going to move forward.
Hon. P. Priddy: I do know that the Ministry of Health supports this particular project and is working out the logistics of completing the project. I have staff just checking the time frames. It will take a couple of minutes, if you want to move on to your next question, hon. member -- through the Chair.
C. Hansen: We'll move over to the Kootenays, specifically to the Elk Valley, which is another area where there has been some concern and anxiety regarding whether or not the community health council was truly able to represent some of those concerns.
There was a letter sent to me a few months ago by an individual resigning from the community health council. I'll read just a portion from that letter, because it's certainly much more powerful than what I could put in my own words. It says: "I hereby resign from your community health council, a council that, in the matter of physician on-call services, is so tied by your ministry's terms that it is creating divisions in the Elk Valley far deeper than any that existed previously. I am very tired -- tired of constantly having to put out fires, trying to stop the erosion of basic services."
This letter goes on to talk about Closer To Home and about how emergency health care for 3,000 people is in fact being moved farther away from the community than what they had previously. The mayor of Elkford, Bill Wilcox, was quoted -- referring to the Dobbin report -- as saying that the on-call formula for physicians in Elkford was inappropriate. I think that, again, it's an area where one size doesn't necessarily fit all. The programs that are in place today aren't meeting the needs of that particular community. I'm wondering if the minister could tell us how those particular concerns are being addressed.
[1540]
Hon. P. Priddy: I am aware of this particular circumstance, although I have not
The member's right: there is no such thing as one-size-fits-all in the province of British Columbia. That's just not what we look like here. I don't think that Dobbin has answered every single concern out there that people have, although I have letters written to me by mayors that were incredibly outspoken at the time this was happening, saying how well it's working for their communities. I know the member is not suggesting that it's not working well in other places as well.
In Elkford, I think the mayor's concern is that there is a difference, for an acute-care hospital, in the on-call paid if the community has a diagnostic and treatment centre, not an acute-care hospital. That was the Dobbin issue that in the end Lucy Dobbin did not resolve and that we still have not been able to resolve satisfactorily. I don't have an answer for how we're going to resolve that. We've still talking about this issue in our advisory committee on rural and remote health care, which has representation from rural communities and from mayors, but I don't have a resolution at this stage. I do know that the CHC up there is recruiting another physician -- and I think they've been able to do that -- in order to at least provide better coverage so that people aren't doing the same amount of on call as they have been doing.
I expect you'll canvass this, so you probably don't need to do it now. I'll just note -- I expect you'll canvass it under Dobbin anyway -- that some of this is about what a general practitioner is and what a specialist is. That's one of the issues that we hear is still not satisfactory for people.
C. Hansen: I'm going to move on to "Strategic Directions," a document that has been circulated in draft form. But before I do that, I don't know if the minister has an answer now in terms of Kaslo. Now would be a good time to deal with that.
Hon. P. Priddy: I think that I have as much as I'm going to be able to provide to the member. I think he referenced earlier -- no, maybe not -- that there has been a planning study done to accommodate 20 multilevel-care beds in the Victorian Hospital of Kaslo -- so in Kaslo, as well, looking at additional multilevel-care beds. I didn't know if there was
[ Page 14121 ]
more beyond this. I knew this piece. The West Kootenays have just completed -- this is our undertaking, but I think it's actually completed -- a comprehensive review of service requirements in their whole area. I think the timing of the next steps is contingent on what the West Kootenay plan and recommendations are -- which, I will tell you, we haven't seen as yet. I think the plan was just completed. We have not seen it at all, but part of that future direction will be dependent on what the West Kootenays recommend in their review of service requirements.
C. Hansen: I'd like to move on to "Strategic Directions for British
Columbia's Health Services System," which is in draft form. The minister has
circulated it, I believe, to health authorities around the province for input. If we go
back to the Hansard debate of last year -- in fact, last July 16 -- when we were in
the middle of Health estimates
[1545]
Hon. P. Priddy: I have learned the hard way over this last year not to use time lines in quite the same way -- or not to accept them at face value. The strategic document, when it was completed last year, was still not a satisfactory document for many people. Albeit it was very close to completion, it turned out to be not satisfactory in a number of ways. People went back out to communities, and you have the result of that further consultation.
C. Hansen: That actually leads nicely into the next point that I want to raise, and that is to get an understanding from the minister as to whose document this is. Is this a document that was developed by the policy planning section of the ministry, for example? When the minister talks about people going out for further consultations, who are the people? Who has put these words together?
Hon. P. Priddy: Much of the initial work was done by policy people in the
Ministry of Health -- that's correct. However, our understanding with health authorities
and others has been that this is not intended to be a strategic plan or a work plan only
for the Ministry of Health. It's intended to be something where there is investment by all
partners -- or as many partners as we can -- who are part of the health care constituency
group, if you will. It's not a phrase I like, nevertheless
C. Hansen: I want to read a couple of the lines just from the introduction in this document. It says:
"This document is intended to provide a context for planning and as such will help support the planning activities of health authorities, practitioners, professional colleges and others involved in the delivery of health services."
It goes on to say:
"This strategic document will be complemented by the health service plans of the health authorities and by the Ministry of Health workplan. The Ministry of Health workplan will describe specific actions the ministry will take within the broad directions laid out in this document."
When we started, we talked about the various accountability documents that were being produced by the ministry. This strikes me as though you've got the cart before the horse on this whole process. Strategic vision is not something that you do after you do workplans; strategic vision is something that leads the process. In fact, later in here we talk about the accountability cycle. I'm not sure if I can find it, but I'll certainly come to it as I go through this document.
[1550]
The vision coming from the minister, which should be the vision that basically sets out the direction that health care is going to go, should be the starting document. From there the workplans of the health authorities flow and the workplans of the various divisions with branches within the ministry flow. I'm wondering if the minister could explain to us: why is it that we have this document coming at the end of that process rather than at the start of that process?
[W. Hartley in the chair.]
Hon. P. Priddy: I suppose in the best of all worlds you'd have a start point for everything, where everything would start on Monday. But that's probably not the way that any kind of planning happens. This is not to suggest that there have not been other kinds of planning documents. Of course there have been -- from health authorities, workplans as part of the ministry, individual parts like the mental health plan, etc. All of them have been, if you will, planning documents. What this looks at is: where do we go from here, given that -- while people had seen a draft of this as they were developing their community health plans -- this was not finalized?
So this is what we intend it to look like in the future. As I say, in the best of all worlds everybody starts on Monday. But it is a much more dynamic kind of process than that. The workplans that we see this year are partly based on this, because this was far enough along for people in the ministry to at least have a sense of that vision. But next year, with this absolutely complete, then the workplans and the health authority plans can link very directly into this. Certainly the feedback I've had from the health authorities about this -- because this is sort of a rolling three-year plan, if you will -- is that they consider it to be very helpful.
C. Hansen: I guess the issue is that it's a rolling three-year plan, but three years have already rolled before we've even got into this. Certainly a whole year has rolled since the minister told us a year ago that it was ready for printing.
I want to get into some of the specific goals and strategies that are set out in this document. If the minister is following it,
[ Page 14122 ]
I'm on page 3 under the title of "Health of British Columbians." There is objective 2, which is: "To assist individuals, practitioners and health authorities in planning for and responding to emergency diseases and changes in disease patterns." Under "Strategies" it says that the ministry will maintain robust and comprehensive surveillance and research systems so that diseases, disease patterns and adverse health effects can be quickly identified.
I wonder if the minister could explain to us the capacity that health authorities, practitioners and individuals have in order to deliver on that particular strategy? Certainly if you look at the ability that regional health authorities have to put in computer equipment, the common protocols for data management, there is still a lot of work to be done. I'm wondering if the minister could tell us whether or not we even have the capability within our health system to deliver on that particular strategy.
Hon. P. Priddy: As I reply to any of these, both goals and objectives, this will be work, in part, that is still underway. One of the examples I would use is the British Columbia Centre for Disease Control. We're now putting in a provincial system to manage information, particularly to manage immunization -- or non-immunization, because that's a concern I have as well. That means that there will be a provincial system for managing the data around communicable diseases that we see are affected by immunization -- which is primarily children but certainly some adults as well. We certainly have legislation on reportable diseases, and it works well. That is reported not only to local health people but to the B.C. Centre for Disease Control, and is entered into a database as well.
Every health authority doesn't have to have its own database to track disease control. There is a funded B.C. Centre for Disease Control which marks those trends; so does the provincial medical health officer. It's not that each health authority is intended to do all that work on its own.
[1555]
C. Hansen: Thank you. I want to move along to objective No. 3. I'll just read it out, because it's a very big issue in this province: "To reduce the inequalities in health status among people in British Columbia. In particular, the health of the aboriginal population and of those regions with lower health status should be moving toward the level enjoyed by the general population."
That is a huge issue, and it is one where we certainly see some huge inequities between the health outcomes within aboriginal communities and the health outcomes in other centres -- particularly urban centres but even compared to other rural centres -- in British Columbia. Yet the strategy that comes out of that objective is one sentence, and that is: "Develop and implement a provincial aboriginal health services strategy." That's it.
First of all, for something that is such a huge issue in British Columbia, I would expect that there would be a lot more concrete action that would be planned to address that issue. Secondly, perhaps the minister could inform us as to where we are in the development of that strategy and when we can expect it to be made public.
Hon. P. Priddy: There are many things that already go on, so it's not that nothing goes on in the area of aboriginal health. But the member is quite correct, as was the provincial health officer in his report about the health of aboriginal people. Their health outcomes are not anywhere near what we would want to see, compared to the non-aboriginal population. So a number of those things will be reflected in the provincial aboriginal health services strategy.
But there are a couple of other things -- and then I'll come back to that in a moment -- that I want to state out loud. In large part, we have to go back to the social determinants of health and look at the other ministries that have a role to play in the health of aboriginal people. When you look at the health determinants and outcomes, it's not only about health services; it's about self-determination. We know, for instance, that the Nisga'a population, who've had control of their own health care system for a long time, have better health outcomes than most other aboriginal people in the province. So it's not only about what the Health ministry is doing; it's bringing together other ministries that have a responsibility for the social determinants of health.
By the way, it's also a federal government responsibility, as I know the member knows -- at least on reserve. That is a really unresolved question in terms of how the federal government makes its contribution to that, whether it's enough and what they fund off and on reserve. I mean, that's one of the other pieces to be worked out as it relates to this.
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The aboriginal strategy people have been meeting for about a year now, at least. I think the member would understand that in the aboriginal community, it's not just one group that you have to get to the table. There are lots of groups that you have to get to the table. There's a meeting with staff this week, which is the first time that all of the aboriginal organizations will be in the same room together talking about this. So it is a much slower process than I would like, but I also know that it's the only way to do it -- because you can't impose it.
If I could give you an answer about when it would be ready, I would. I can't, and I'm not sure that I can estimate. So much of that depends on what happens in the dynamics in that room and what kind of agreement you're able to get. But in the meantime, there are certainly things that we in the Ministry of Health are doing directly to make a difference in health for aboriginal people. But you'll probably canvass that somewhere else.
C. Hansen: If I can move on to objective 4, I'm going to read out this objective. I'll give the minister the opportunity to respond to it if she wants; otherwise I'll move on. I just want to make the point on this particular objective that it's a very big objective: "Use the provincial health goals to stimulate social, environmental and economic actions to improve health in the broadest sense."
That is a huge objective. Yet if you go down to the strategies, the strategies don't
match the objective at all. You talk about implementing community- and neighbourhood-level
strategies that support the health and well-being of residents. The second one is:
"Encourage the population to understand the impact of social, economic and
environmental factors on health." The third one is: "The provincial health
officer will continue to report
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I make that point only because it sort of ties into an overall approach that I have on this document. But if the minister wishes to respond specifically, I'll give her the opportunity before I move on.
Hon. P. Priddy: I'll try to be brief in my response. In the earlier documents that you have, I think it says strategies; and in whatever the third edited version is, it says subobjectives. This is not intended to be the workplan; this is intended to inform the health care system. So what the health authorities or others will do is use these to develop their own plans. A lot of the specificity will come because the health authorities have used this to inform their plans or the CHCs or the physicians or another organization's. This isn't intended to have in it every single piece that somebody will do; it's intended to be something that informs the work of people within the health profession.
C. Hansen: If we move on to page 6
I understand that out of the meeting of western Premiers, there was an agreement that the western provinces were going to work cooperatively on coming up with standards for waiting times and defining waiting times. Although it's not directly relevant to the document, it's referenced in here. So I thought I would use that as an excuse to ask the minister to give us an update on where we're at in terms of the development of those standards.
[1605]
Hon. P. Priddy: This was referenced at the Western Premiers' Conference. This is a
project that has been underway for six or seven months now, using health transition
funding in partnership with the federal government. It's a two-year project, so it's due
to finish in
C. Hansen: If we move on to page 8, there is
We're talking about developing standards for access. There's a requirement here to provide regular reports to the public on services provided and to develop and implement coordinated systems." Again, if you come down to the bottom on the page, it says: "Define which services British Columbians can expect to receive in communities of various sizes; develop and implement supports and programs to improve access in remote and rural areas; develop strategies to ensure the recruitment and retention of service providers in remote and rural areas of British Columbia." I know the minister is reluctant to give dates, but these are obviously some pretty important documents that the public is going to be looking for. Certainly there would be great anxiety if these were years off as opposed to weeks or a couple of months off. I wonder if the minister can give us some perspective.
Hon. P. Priddy: You're right. I don't have a particular date beside each of
those, though I think we can at least get closer to that once this has been finalized with
the health authorities. It is important to remember that this is all identified work. It
is a three-year dynamic or rolling plan, if you will. I'm not sure I can point to these
and say that in two weeks this will be done. I'm not sure there is anything in there --
and there probably shouldn't be anything in there -- that's a goal, objective or
subobjective that could be done in two weeks. And in that case, I would have hoped we
would have done it earlier, if it were only a two-week plan to be able to identify
One of the questions you asked -- you said you pencilled it in the notes -- was: who gets to have input, and so on? As far as this is concerned, the intention is to continue with the current people who have had input and also to expand that input. For instance, some people from UBCM have been consulted, because they're on other committees with us. But I'd want to take this to UBCM, maybe even this fall. UBCM needs to be an important part of that, and so do health authorities. We're beginning this process, but what we would also do is take it to the public. That doesn't mean the work won't start until it's been to the public. Again, this is about it being too bad we can't all start on Monday. But that is the intention also: that the public will have input into this.
[1610]
C. Hansen: If we wind up going through Health estimates next year without an intervening election, I will certainly be raising these particular reports, documents and strategies that are outlined here. I think the public are anxious that we get on with the job of delivering a secure health care system. I can see that the minister wishes to respond to that, so I will allow her to do that before I go on to the next point.
Hon. P. Priddy: I just want to assure the member that I'm sure that regardless of who is the minister -- certainly if it's me, but whoever it is -- the Health ministry will have the information available to answer most of those questions in the estimates next year that we will certainly have together.
C. Hansen: We could go down a lot of roads with that comment, but let me say that I appreciate the commitment that the minister just made on behalf of the ministry: that whoever is minister at the time will be able to deliver some of these documents one year from now -- or, I would say, most or all of these documents and strategies that are discussed in this particular report.
I want to move on to page 11, where we talk about accountability. Specifically, I want to point out to the minister that under strategy 2.2 -- which is: "Ensure that ministry annual reports include interregional performance comparisons and information on what the system includes, how the system works, how the public can access services and
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activity levels within the system
Again, I raised this when we started the estimates process on June 28 -- that one of my big disappointments is that we don't have an annual report that is more current than the 1996-97 fiscal year. If we're going to start using the annual report as a primary vehicle for accountability -- which it should be -- it certainly has to be more timely. I point that out. When we get into discussing communications issues, the one thing that I am going to be looking for from the minister is an ironclad commitment as to when we are going to see the next three annual reports that are due. But we'll save that until we get into communications.
I also note that they talk in here about measuring public satisfaction with the system. It says: "From time to time the provincial government conducts polls of public satisfaction with the health care system." I'm wondering if the minister could explain to us what kinds of polls the ministry has done over the past year to measure British Columbians' satisfaction with the system.
Hon. P. Priddy: In terms of the specific ones done over the last while, I'd prefer to refer that question to when we do communications, because I don't have that particular staff here. I can talk to you a bit about the kinds of things we would ask but not about the specific ones.
C. Hansen: I certainly appreciate that. We will probably be getting to communications tomorrow, with any luck, and I will raise that issue at that time.
I want to move on to the issue of the various self-regulating professional colleges that we have in British Columbia. In here it talks about ensuring that colleges conduct their businesses fairly and transparently. This is an issue that certainly comes up from time to time -- public concern about transparency at the various colleges. I'm wondering if the minister could explain to us what she envisages seeing changed in order to ensure that there is adequate transparency on the part of all of the colleges.
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Hon. P. Priddy: Some of this may be about change, but some of it may be about being able to assure people that in any of the colleges there are processes, if you will, that abide by administrative justice -- that people know how they make a complaint. How is it handled? What's the transparency of the outcome of the complaint? You can read the newspaper to know that people may have more concern in some areas than they do in others, but if people have complained, they want to know what the outcome is. There may be some information that people should not be privy to, but they need to know how their complaint has been handled, that there's been an outcome to it, and so on. Those are the kinds of transparency things that I would want to ensure not only are there in all colleges but are seen to be there by the public.
C. Hansen: As we move forward through this document and come to page 15, there's another reference to the accountability being through the ministry's annual report. I want to flag that again, to highlight how that document is going to become important.
Moving onto the next page, there is a reference under objective 4 to the principles of health reform. So I don't take it out of context, I'll read the whole sentence. "Ministry of Health will require health authorities to develop health service plans proposing changes to their health care systems to better align them with the principles of health reform, including integration." I'm wondering if the minister could explain to us what the principles of health reform are in this particular context. It sounds like something very profound, but perhaps I'm reading too much into it.
Hon. P. Priddy: I guess the answers are profound in their impact on people, but I don't think that they're anything the member doesn't know. Integration of services, very particularly. I think that's something that the health system has not been particularly effective at -- not for any reason; it's just the way it was designed initially. We don't integrate services very well in communities between acute care and community care and continuing care and so on. That integration of services is critical.
Closer to home. We know that not everybody can have all services in all communities; that's not possible with lots of the tertiary services. But we can find ways, as we've done with some of the renal dialysis treatments, to at least make sure that it's closer to home for many people.
Looking at the cost-effectiveness of the system, I think that probably the member has
made this point before, but on the other hand, so have I. We talk a lot about the amount
of money we spend in this health care system, but we have to find ways to know whether we
spend it well. It's one thing to say we spend "more than," and it's another
thing that we must be able to say: "As a result of that, here is the outcome and here
is the proof that this has been spent effectively and efficiently." Integration,
closer to home, affordability for people and -- I probably should have said this first --
patient-centred, access -- which is a bit about being closer to home
C. Hansen: I want to move along to governance. There are some notes that I've made regarding the appointment process being transparent. I think we canvassed that well in our discussion under Kitimat, but certainly there's some room for improvement in the transparency of our appointment process to health authorities.
It moves down under there to strategy 2.2 on page 18. It says: "In 2000, following three years of experience with the health authority structure established in 1997, the ministry will undertake a comprehensive third-party evaluation of the structure, governance, management, operations and results of regionalization." Can the minister tell us: is this budgeted for in this budget we have before us, and who will undertake this third-party review?
[1620]
Hon. P. Priddy: When we are in estimates next year, I think we'll be closer to
having an answer for you on that. I'm sorry; I'm not trying to avoid the answer. The
answer is no, there's not money budgeted in this year's budget for this. This is something
that would be undertaken in 2000-2001. In terms of who would do it, I don't have any
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we've said it's third-party is the key here. It's not an internal review to say how good are we, or not; it's a third party coming in to look at that objectively.
C. Hansen: If you move on to objective 3, it talks about the establishment of effective partnerships between health authorities and physicians. To make a comment, in terms of the various health authorities that I've visited with around the province, some health authorities are very good at this, and others are very bad at this. I think there's a real discrepancy in terms of the relationship and the sense of partnership that exists from community to community around the province.
Under "Strategies" in that area, there's something that I wanted to get some clarification on, because I didn't know what it meant. It says: "Work with individual physicians and the BCMA to align incentives faced by health authorities and physicians." I'm wondering if the minister could explain what is meant by aligning incentives.
Hon. P. Priddy: I wanted to respond, if I could, not to get into the debate. I don't think there is a debate actually. As I have travelled around the province as well, I have found communities where there are superb relationships. I think that is as a result of physician groups that have an enormous capacity to work well with their health authorities and health authorities that have a great capacity to work with their physician groups. You're right: in some places, it works. I think it works well in more places than it does not. Nevertheless, there is, I guess, room for improvement.
In terms of aligning incentives, obviously the goal of that is to provide the very best care and to ensure -- well, not to ensure, to agree -- that health authorities and physicians have a goal of wanting to provide the very best service to people. Sometimes those incentives faced by health authorities and physicians do have to have, if you will, a level playing field. That doesn't mean that everybody's are the same, but it does mean a level playing field. That might, for instance, be around how people do recruitment. It might be around continuing medical education. It might be around whether, if a community needs a physician and doesn't have enough work for a fee-for-service physician to be able to make a living to support herself and her family, you maybe put a paid physician in, because that's the only way you'll have a physician who goes in there. I think it's those kinds of things -- to make sure not that everybody has the same thing but that we're able to align it enough that there's a level playing field for people.
C. Hansen: Before I leave the actual specifics of the document, I just want to point out to the minister the last reference to the ministry's annual report on page 19. In three locations in here we've got the annual report being used as the principal document for accountability. We'll come back to that when we get onto communications, which may well be tomorrow.
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This document is certainly presented as a document that is really to map out strategic change over the next three years. As I read it, it's the document that in some ways will become the blueprint or the bible in terms of strategic directions. It will be used by all health care players in British Columbia. I certainly read it, in the way it's been set up and presented, as being a very important document. I want to put it in a context. If you put it in a context of where we're at in British Columbia today, there is a growing anxiety about health care and a growing sense on the part of the public that perhaps the health care system isn't delivering what they expect of it.
Just to reference a Marktrend survey that has asked the public about satisfaction with medicare over the last number of years, if you go back to May 1992, some 77 percent of British Columbians polled felt that medicare was either very good or quite good. In terms of the negative side, there were only 5 percent that felt it was either quite poor or very poor. If you fast-forward to December '98, which are the most recent numbers that I have here, the satisfaction with medicare has actually declined to 43 percent in terms of very good or quite good. Those who think it is just satisfactory number 33 percent, and 23 percent say it's quite poor or very poor. I think those numbers sort of point to what I think we all hear from people we talk to and the letters we get: that the public is growing increasingly anxious about the health care system that is there to serve them.
I just want to reference a couple of quotes that the minister has made. There's a headline in the Vancouver Sun from last November 16, which says: "Health Care System Needs Major Reforms" -- to quote the minister. "B.C.'s health care system will not survive without major reforms, the Health minister believes." Again, on "Voice of the Province" in December of last year, the minister said: "If we do not do things differently, if we continue doing things the way we are for the next 20 or 25 years, medicare will not survive. We cannot survive that kind of economic burden." I don't believe the minister is understating the magnitude of the problem, combined with the public anxiety that is there. My question for the minister is: is this the strategic document -- the strategic directions -- that she sees as fundamentally addressing that need for major reform in terms of health care in British Columbia?
Hon. P. Priddy: Well, I think that it is -- certainly for the ministry and for the system -- a particularly key piece. I don't think anything is the bible, with words or interpretation never to be changed, but I think this provides an extremely important and solid foundation on which to move forward. I have been honest enough to say that it won't survive unless we do things differently. I think the concern that you reflect and the polling I've seen suggest that this is not a British Columbia phenomenon, by any means. This is something that we're seeing across North America in terms of people's concerns about health care. I don't see that as happening only in British Columbia. Some of the polls I've seen -- and we can all find a different poll -- actually have said that the concern is somewhat less here in British Columbia but nevertheless very present.
So yes, I see that as a particularly important solid foundation on which to begin our
work forward. But you can put anything in words on paper. It is going to take creative
thinking and innovation on the part of people for us to be able to do this kind of work,
and it's going to take some real challenges for us to find the ways to
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terms of people's thinking to be able to move this document forward as well. But I see it as a particularly good start. I don't quite see it as a bible.
[1630]
C. Hansen: I want to move more specifically to the issue of regionalization and where we're at. When we embarked on these estimates debates a week ago, I raised the issue of the three accountability documents that I didn't feel were in place. One of them was the report card on Better Teamwork, Better Care. I'm just wondering if we will in fact see that document come forward in the months to come.
From there I want to go on to talk about the accountability framework and some specific questions I have about that document and also to get on to some of the broad issues of health authority funding. But we could start with the issue of the report card on Better Teamwork, Better Care.
Hon. P. Priddy: Will you see the report card in the next few weeks? I'm not sure of the time frame you used. Probably not. But let me tell you a little bit about how that is developing.
I'm not sure whether, when a report card was first talked about, people understood how complex developing one is. You can't just go around to a region and say: "This is an A, and this is a C." You have to base it on something. So in terms of the steps, I think they are more complex than people may have originally anticipated.
In terms of where we are now, the ministry and health authorities are currently working to both identify and agree on what are reasonable measurable goals and objectives for the health system. Is it patient satisfaction? Is it how many surgeries you do? Is it how many people have a post-op infection? Is it how many people are readmitted? I expect it would build, but you have to decide where you're going to start in terms of what you're going to measure and what you're actually able to measure in a finite period of time. I don't think you want a report card that only measures over five years; you want something that can be measured, probably, on an annual basis.
We are working with health authorities that have given me a fair bit of feedback at the last meeting I had with them about that. It's much like the goals and objectives, but we still have to reach agreement with health authorities -- and we're working on that -- on exactly what the key performance indicators would be in their community. You also have to think about: what does the community want to hear? In the end, undoubtedly we are accountable to the people we serve in our own communities in health care, if you use that particular example. So what are the key indicators that would indicate to a community whether their health authority is doing well, not doing well, is in the middle, needs to improve or whatever? We're working with health authorities on what those key performance indicators would be in their communities.
If those are the key indicators, is that data readily available -- that we can access? Or do you have to put a structure in place to be able to retrieve that data? I hope that what we would find, and I expect what we would find, is that we'll have to select some key indicators -- at least originally, in the beginning -- that have data available, because I don't think we can afford the time before we do any of that to set up yet another data collection process. But we do have to decide and find out if that data is available to be collected or whether somebody has to put something in place.
Currently -- and the member probably knows this -- health authorities collect a variety of data in a variety of ways about their own health services and how it's used. Once we've developed those key indicators, it will be necessary, I think, to revise some of those requirements, so health authorities can make sure that they incorporate that function into their current planning and into their current reporting cycle if that's not one that they currently are collecting. Then that would be information that, once collected, would be disseminated to the public.
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The other organization we've been working with is called CIHI, which I'm sure you're familiar with -- the Canadian Institute for Health Information -- because they've begun to identify a number of performance indicators, as well, that you can compare nationally, provincially and regionally. Even if you collect it here in B.C., people still want to know and may need to know: how does that compare to western Canada? How does that compare to central Canada? How does that compare to a Canadian average? We're working with them in terms of indicators you can collect that you can actually compare currently. The Canadian health information work probably will be finished early next year -- at least, that's the target date they currently have.
I don't know if you want more. I mean, I can go on or not.
C. Hansen: I want to move on to the accountability framework for B.C. health authorities, specifically. Let's see if we can take these in the order that they basically arise here, which isn't necessarily in order of importance. There is reference to a performance contract that is an agreement between the Ministry of Health and a health authority with respect to specific tertiary care, which sets out the Ministry of Health's performance expectations with respect to that service. I'm wondering if the minister can give us a bit more information about the nature of performance contracts. I guess that's about it; it was rather thin in terms of descriptive material.
Hon. P. Priddy: The performance contracts which are currently being developed
with the health authority
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C. Hansen: If we move forward a couple of pages in this document, we have a section
titled "The Accountability Cycle." I think it probably reiterates what I was
saying earlier about having the cart before the horse on this whole process. It says that
the accountability cycle "
Again, I just want to make the point that I think the ministry has that backwards. The accountability cycle is one that should start with the government's policies and priorities, start with the government's strategic directions and then go into setting performance expectations of the health authorities in the province.
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One of the messages I get from health authorities around the province is that they feel like they're flying blind on a lot of this. They're asked to come up with three-year strategic workplans -- yet in what framework, to accomplish what? What are the provincial standards? What are the provincial goals? And I don't mean the health goals but where the ministry, the provincial government, is taking health care over the coming years. Once that is properly articulated, then all of the players in health care will be able to identify where they fit in and what they have to do in terms of delivering on that broader vision of health care.
I would just like to make the point that I think the way it's articulated in this particular document puts it backwards. I think it goes back to the discussion that we had on the strategic direction: that has to come first and be even broader and more forward-looking than what currently exists. Then the health authorities and the doctors and the nurses -- all of the health care professionals, all of those in British Columbia who have an interest in health care -- can see where they fit in. Then it's going to be much easier for them to deliver on their own regional perspectives and their own regional strategies that they have to do to deliver on that broader framework. If the minister wants to respond to that, I'll give her the opportunity. Otherwise I'll carry on.
Hon. P. Priddy: I'll try not to do that each time the member offers the opportunity. The goal is to get through, as I regularly tell my colleagues who are in estimates, and not to make speeches.
But I do just want to comment for a moment, if I might. Certainly I wouldn't take issue with the points that the member is making. Again, this is a bit like anything else: you're trying to drive the bus and change the tire at the same time. If we were starting fresh -- my Monday morning scenario -- you'd be able to do that, and that is what it will be like. Nevertheless, we've had to have some accountability for people, even though this document, with contributions done by health professionals, was not completed. You still have to have some accountability going on. So in the ideal world and when this is complete, that's exactly what should be expected. And you're quite right: it should come from the strategic vision.
The one point I would mention, though, is that I'm not sure it's about where the provincial government is going to take health care, although I guess we could say that. I'd like to think it's where the whole health profession is going to take health care. I think the provincial government has a very clear leadership role to play. But so do physicians, so do nurses, so do lab technicians and so do a whole lot of other people out there. I'm not sure it's for the government to say: "We'll decide where you're going, and you fit it." But it's to say to all of us: "Where is it that we're going together, as a province?"
C. Hansen: I'll resist getting into a long philosophical discussion on that. But I do want to make the point that I think it is the role of a Health minister to set the strategic direction for health care: to listen to the health providers -- the doctors, the nurses, the physiotherapists -- and listen to the health authorities in the province and, most importantly, listen to the public, and then to articulate that vision as to where health care is going. The leadership has to come from the provincial Minister of Health and then everybody else. One of the problems we have today is that there is a vacuum of leadership in health care in terms of the direction that it is going. You have all of these various groups within health care that are trying to provide the leadership that is in a vacuum today. I think it's incumbent upon the Minister of Health to provide that direction so that everybody knows exactly where they fit into that picture.
If you go out and talk to doctors in British Columbia today, you'll get multiple ideas as to where health care should go in the future. Certainly their organizations -- whether it's the BCMA or other organizations of physicians -- have their ideas as to where they think health care should go. They obviously have very important input into that direction. But ultimately, it falls on the shoulders of the Minister of Health to articulate that vision and leadership and then explain to the health providers in this province where they fit into delivering on that objective, which should be the objective that reflects the public's will and wishes as to where health care should evolve in the years to come.
I won't go on to the next subject without giving the minister an opportunity to respond to this one.
Hon. P. Priddy: I absolutely agree with you. Both the government and the minister have a responsibility for leadership. As an only adopted child, I welcome it; I love it. If people give it to me or I have those opportunities, I'm delighted to have them.
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My only point about leadership or a vision is that I think it fails if you say:
"This is the vision, and you fit here." If you don't have buy-in from all the
people in the system, it won't work. You can't go and say to people: "This is where
you fit." Maybe that's your point about
C. Hansen: I agree 100 percent.
Moving on, last year during estimates there was a lot of discussion around population-based funding for the various health authorities in the province. I know this came up last Monday or Tuesday, when we were talking about some of the very specific regional issues around the province. At the time,
[ Page 14128 ]
a year ago, the minister said that there would be a review of population-based funding.
I'm wondering if the minister could tell us: was that a formal process. Or was it
basically: "Yeah, we thought about it"? Other than just giving lifts to certain
areas with high population growth, could the minister tell us exactly
Hon. P. Priddy: It wasn't a formal review in terms of a report being issued, but there is a committee of assistant deputy ministers in Health and health authority chairs and CEOs that have addressed this particular issue in the work they do. They've addressed it for two reasons -- and they're going to need to continue to, by the way. There isn't a solution. When the formula that we're using now was developed, there were 20 health care regions. We didn't have community health councils, and we didn't have CHSSs. We know that the formula we have isn't a good fit with the number of individual authorities that we currently have, so it will be up to those folks to look at that.
Last year, when they looked at
We think we had this discussion last week, hon. member -- that every region that comes to see me thinks that if we only had population demographic funding, everybody would have more money. Well, unless you add more money to the system, that would not be correct. Some would have less; some would have more. Some would have to cancel programs that they run; some would have money for additional programs.
The other thing to mention, I think, is that primarily -- and we have to look at this as well -- the formula used applies to acute care, which is, of course, where most of the dollars are. But that doesn't totally meet the needs of the shift we're trying to make towards community either, so that's another issue that needs to be considered.
So no, there's no kind of final definition or report or whatever. We'll continue to use population demographics for new dollars until we reach some resolution, but I don't see us as particularly close.
[1650]
C. Hansen: Do I take those comments to mean that the review which the minister talked about last year is in fact ongoing and that next year this will still be an active discussion as to whether we move to population-based funding in the province or whether or not we continue with the process of giving lifts to the high-growth areas? Is there a resolution in sight? I guess that is my question.
Hon. P. Priddy: What I'd like to think is that it would not be ongoing. But I must admit that I don't see a conclusion either. I think the issue of equity in funding and access, by the way, will continue to be an issue. You know, you can change the formula. I expect that in the following year there would be somebody or some group or some region that felt it wasn't working for them. So I expect it is an ongoing issue.
But, you know, the really hard question for a province that spends as much of our budget as we do on health care is: do you put in another $200 million or $400 million to bring everybody up to the highest level? Or do you actually take from other regions that, by some formula, are thought to have more and make them shut down programs they run? Those are really tough decisions for people, and I think that's a very hard way to go at it. So I don't see an immediate resolution, no.
C. Hansen: There is one issue regarding budgeting that I think the ministry
should be in a position to deal with in the short term; that's the issue of multi-year
budgeting and projections. You've asked the health authorities to come up with three-year
strategic plans. Yet not only do they not get three-year, at least, notional budgets --
that's a very interesting term, and we'll come back to that one -- but they don't even
Hon. P. Priddy: No, not at this stage. We're not any closer. I think there are lots of us in and out of government -- or wherever we've been -- who've had the discussion about multi-year funding, whether it's in this ministry or the Ministry of Education. I certainly have. I don't know whether your critic canvassed that with the Minister of Finance, because that's really a Finance decision, not a Ministry of Health decision. But those discussions continue. You have people who take one position or a different position about whether multi-year funding should go ahead. I'm sure you've heard all of the arguments, both in favour and not in favour of doing that. But no, there's no resolution to that.
C. Hansen: Actually, most of the health authorities around the province would be glad to even have one-year budgets, because what they're dealing with in this current year is that they didn't even get their budgets until May 21 -- well into the fiscal year. They were already seven weeks into the fiscal year before they got their budget allocations. In fact, last year those budget allocations did not come forward to the health authorities until July, so I guess that in one respect at least it's getting a little bit better this year. I'm wondering if the minister can give us some assurance that by next year the health authorities will at least be able to establish their budgets before they have to start implementing them on April 1.
Hon. P. Priddy: It's certainly the ministry's intention to have that process move forward to as close to the beginning of the fiscal year as possible. This is year 2 of doing this, so it's not in any way perfect. It's not in any way as quick as we would like it to be, but the goal is certainly to move it as close to the beginning of the fiscal year as we can.
[ Page 14129 ]
[1655]
C. Hansen: I understand that all of the regional health boards have now submitted their finalized budgets. On May 21 they got their allocations. They then had to report the specifics in terms of their spending plan for this fiscal year by the end of June. I understand that some of the community health councils were still to come in. Could the minister tell us where we're at in terms of getting the specific spending details from all of the various health authorities in the province?
Hon. P. Priddy: The member is correct: all the regional health board ones are in. I don't have a list, but we can get it for you for after dinner, if you like. Not all of the CHC ones are in yet. With the ones that are in, if there are pieces of their plan that we don't understand, then we're in discussion with them about that.
C. Hansen: It's not so much a list of those that are in or not in that I would be interested in. What I would be interested in is getting the two-page summaries of each of those budgets. My understanding is that there is a two-page summary for each health board that is put together, as well as the community health councils and, I believe, the community health services societies. It's been very difficult to try to get one set of compiled numbers for the various health authorities in the province. I'm wondering if the minister could undertake to supply that to us -- for the health boards that are now in and for the community health councils that are in -- and then follow up with the numbers from the other community health councils as soon as they're available.
Hon. P. Priddy: I will do a bit of checking, but the two-pager we're aware of is the one that we send out to them. They have not all come back with two-pagers -- at least not to the knowledge of the staff that are currently beside me. If you would allow me to check over the dinner hour, I will do that. Certainly with the ones we sent out to them, there's no reason that you can't have them. I'm not aware, at this stage, that each health authority or CHC submits a two-page summary -- at least not according to the staff I've got with me -- but we'll check.
C. Hansen: I think we're talking about the same thing: the two-pagers that are sent out to each health authority. I would appreciate receiving those. I'm wondering why these wouldn't be routinely released on a provincewide basis. My understanding is that they get sent out to the health authorities. The only way you can get your hands on them now, outside of the Ministry of Health, is to phone each and every health authority and hopefully talk them into supplying a copy, which doesn't allow for any kind of broad, provincewide analysis. Certainly I would look forward to getting those for the health authorities from the minister -- those would now be available -- and for the balance of the community health councils as soon as they become available.
I want to move on to the issue of the allocations that have been made. There was a press release put out by the Health Association of B.C., expressing areas of concern with regard to the funding allocations for this current year. I'll just read from their report, and I'd like to get the minister's explanation as to how this came about. It says: "In its March 30 provincial budget the government announced increased funding for public and preventive health of $12.16 million and adult mental health of $7.94 million." However, funding increases announced in the health authorities budget letters for public and preventive health only total up to $8.09 million and adult mental health to $5.04 million. If I can just skip down: "The ministry has not explained items listed under 'Other Grants' totalling over $95 million in funding, including $88.5 million toward other grants, acute and continuing care." I'm just wondering if the minister could explain the discrepancy between the numbers announced in the budget and the numbers that the health authorities are seeing.
[1700]
Hon. P. Priddy: To the best of my understanding, when HABC put out the press release, the numbers they used were blue book figures that don't actually match the health authority funding letters. What HABC failed to consider when they did that analysis -- or didn't consider, or failed to consider -- was that the Ministry of Health funds agencies other than health authorities. They didn't factor in those dollars. For instance, they didn't factor in Riverview Hospital. They didn't factor in the Canadian Blood Agency; they didn't factor in the B.C. Transplant Society, etc. There are a number of others like that. That's why their figures wouldn't necessarily match the health authority's, because that's not the only place our funding goes.
C. Hansen: In terms of other areas of concern that they've raised, another one is the Y2K issue, which I'm not going to deal with right now. I want to deal with that when we get to information management and the whole area of Y2K -- but just to flag that for now.
The other area that they raised is funding for equipment being decreased. Certainly this is an issue that comes up time and time again with various acute-care facilities and other facilities around the province with real concern about aging equipment. This is totally outside of the Y2K issue, although I recognize that some facilities have been able to upgrade equipment as a result of Y2K funding, which we'll deal with at that time. They talk about the global equipment grant remaining static at $15 million, while the total funding for group purchases and equipment over $100,000 has been reduced from $16.11 million to $12.16 million. Again, I'm wondering if the minister could explain to us why we see that kind of decrease.
Hon. P. Priddy: Two things. One of them is that I think that there's always, particularly in this profession, a need to upgrade equipment. That's the part that in lots of places sometimes gets pushed down a bit when you look at other priorities. When I look at the dollars that have been spent this year, they reference a figure of $12.16 million. But what they haven't factored into that is the $15 million that's already gone out to health authorities this year for new equipment. I know we will have the discussion about Y2K later, but out of the $100 million for Y2K, $58 million is for new equipment.
C. Hansen: There are two more points, but I guess they're in the same general area, and that's the restriction on the movement of funds. One of the comments that I often hear from health authorities around the province -- members of health boards and community health councils -- is that they are called a health authority, but they're not given any authority, and that in terms of their actions, they are very much dictated to in terms of precisely where they can spend dollars.
[ Page 14130 ]
They feel that in order to meet the needs of communities
[1705]
I'm wondering if the minister can give the health authorities any assurance that they are going to be given more authority, as they evolve, to make determinations on how funds should be allocated. What they see happening is the exact opposite. Instead of evolving and the apron strings being cut from Victoria, they see that in fact there are more and more apron strings being tied between Victoria and those various health authorities.
Hon. P. Priddy: The situation as I understand it is that certainly before
regionalization, the movement of funds was completely restricted. Currently the health
authorities can move funds around and don't have -- I don't know; I guess we'd need to get
both perspectives -- a lot of restrictions on them. I think they have some that we're not
likely to move on, but let me tell you a little bit about what that looks like. The one
thing they cannot do is move funds to the acute-care sector from any other sector. That's
the natural tendency. As we're trying to provide more support in the community, and people
feel
It may be that because we're new in the process, we need to do a better job of explaining that to people. I think there are a number of factors. I take your point as you've stated it -- that there are people concerned that they don't have any authority -- but only 23 percent is actually fixed with restriction.
C. Hansen: I guess that leads to the broader question, though, and that's the
evolution of health authorities. Certainly it was the expectation that once the health
authorities were up and structured, we'd start to see greater authority being exercised by
those health authorities around the province. I think somebody wrote in an article that I
read
[1710]
Hon. P. Priddy: I think it's Dennis Cocke that you may have quoted a minute ago. That will be one of the pieces that I think a number of people will raise in the external third-party evaluation that will be done. As I understand it from staff, a region can do anything they want -- I mean, within principles and so on -- with 75 percent of their budget. That's a reasonable amount of flexibility.
[H. Giesbrecht in the chair.]
I think that there are always questions from health authorities about: when are you going to put the MSP budget out to regions? There are some regions that have said: "Can we please have the MSP budget out to our region?" That would probably bring more authority, if that was a step we were to take. There's no decision about that at this time. But they could spend 75 percent of their budget now in any way they want. Logistically that's probably not possible, because they might have to close beds or do whatever. But there's no restrictions on 75 percent of their budget.
I would expect them, as we move on, to have more and more authority, as long it meets some provincial standards and so on, so that we don't have totally disparate systems around the province -- that there's a quality of care, a standard of care and services that you can expect in certain rural or remote or urban kinds of communities. But I would expect them to have as much authority as is able to be provided, while still meeting, as I say, the quality-of-care issues and access issues for people. I know that in some health authorities I've seen, they're already delivering services very differently than they were two years ago, because they've had the flexibility to do that. I think we'll see a lot more of that as well. People get the service, but they may get it in a very different way than they did before.
C. Hansen: I take it from the minister's comments that there's no deliberate strategy, then, to devolve greater authority to the health authorities -- that this is something that is progressing. It seems a bit haphazard, if you don't mind me saying. It would strike me, now that we're two years into this experience, that we'd be on a much more specific time line in terms of the devolution of responsibility.
Hon. P. Priddy: I think it would be hard to have a time line whereby everybody did the same thing, because regions aren't in the same position everywhere. CHCs aren't in the same position everywhere. Some are more advanced or sophisticated in certain areas; some still need support in certain areas. So I don't think you can say that on December 31, 2000, everybody will have this particular responsibility. While there certainly is thinking that goes on about that, I don't think everybody will be ready at the same time. I think part of this will be based on when regions have indicated that they're ready to take on some of those additional things -- like an MSP budget, for instance -- and we would move accordingly.
C. Hansen: There's actually a note that I had to myself to raise when we got
into acute care, but I've reached forward in that file and brought it up now, because I
think it is relevant. That's the issue of dollars following patients in acute care. I know
that we do that in cardiac care and that some areas, I'm sure, it's not based
My colleague from Penticton was raising the issue of hip and knee replacement, as have other members of the official
[ Page 14131 ]
opposition. One of the questions was whether or not we should move to a greater system of dollars following patients so that it's not a case of rationing health care within regions. I know that rationing is a word that a lot of people take exception to, but that's in fact what we have today. When the minister talks about having specific numbers of procedures funded in a particular health region, we're talking about the rationing of health care in that region. I wonder if there's been any consideration given to moving towards to a greater degree whereby the dollars will follow the patients, regardless of which health authority actually delivers a particular procedure for them.
[1715]
Hon. P. Priddy: I just need to be clear in answering this that dollars that follow the patient means something different, I think, to me. I'm not sure if the member's talking about targeted funding. If you're going to target funding -- as your colleague from the Okanagan would ask about, and fair enough, by the way -- to hips and knees, then you fund a region to do a certain number of procedures.
If you move to the principle of the dollars following the patient, then what that means to me -- not only from the health care system but from other areas I've worked in -- is that patient A would have X number of dollars attached to them. If they moved from the south Fraser to the Okanagan, those dollars would actually follow the patient to the Okanagan. South Fraser would actually have to transfer those dollars attached to that patient to the Okanagan. For me, that's what dollars that follow the patient means. We talk about that in school systems when we talk about dollars that follow the student.
But I think what the member's talking about is targeted funding. What we do is fund prospectively, based on the number of procedures that we think may be needed or the amount of catch-up we need to do or the amount we're able to budget. But we don't actually have the dollar follow the patient across the system.
C. Hansen: Do I take it from the minister's comments that this is not something that the ministry is considering or discussing? To give you an example, if you have a patient who lives in the south Fraser region -- say he lives in the minister's constituency -- and Royal Columbian Hospital is a hospital that they've heard good things about for a particular procedure, they will go there rather than going to the hospital that happens to be closest to them. But they're actually going across boundaries to a totally different hospital. Yet what we have today is a system whereby a totally different health authority has to bear the cost of treating that particular patient. I'm wondering if there is any discussion that could be or has been done in the ministry to look at changing that process so that we're not in fact giving an incentive to ration access.
You know, I heard of cases in hospitals where, because of budget constraints, they were beyond the number of procedures they were allowed to do within a certain year and were funded. So they came up with all kinds of roadblocks -- in fact, suggestions from the Ministry of Health officials -- in terms of how they could restrict the number of patients coming through their doors looking for that particular procedure, because they had exhausted that budget. So those patients, if they were looking for that procedure to be done, had to go and, in a sense, shop in other health districts in order to find one that didn't have the same kind of restrictions on it. The question is: if dollars follow the patients, then in fact it would change the whole perspective of a hospital as to whether they actually welcome a patient in because they can do the procedure or whether these artificial roadblocks get built because of the rationing system that we have today.
[1720]
Hon. P. Priddy: A couple of things. There isn't a policy change contemplated that
would actually attach money to the patient. Let me just talk a bit about whether you have
somebody who actually moves or whether you have somebody who actually goes from the South
Fraser
There's a fence around only certain kinds of procedures. It's to the advantage of the hospital to do as many procedures as possible in their own hospital. That will benefit them in a future year, because we look at what referral patterns have been for a particular hospital. There are restrictions around certain kinds of procedures for which a hospital can't do any more than X, because that's what they've been funded for. But that's not most of what they do.
I don't think that attaching the dollars to the patient serves a particular purpose. The advantage to the hospital is to keep them, not send them away, other than in those circumstances -- and they're not many -- where there is actually a fence around the money that says: "You are only funded for X number of cardiac procedures." Now, bear in mind there are not very many hospitals that that affects -- four in the province, I think.
The other thing is that if you actually had to administratively complete something
where every time a patient went somewhere else, you had to follow the dollars with that
patient
C. Hansen: This issue was brought to my attention several months ago, certainly
before the web site with the wait-list of individual surgeons was put up. But now that
that web site is in place
[W. Hartley in the chair.]
[ Page 14132 ]
Hon. P. Priddy: I'd like to be able to respond when we actually canvass the whole wait-list site.
C. Hansen: I've got a couple of other rather miscellaneous issues involving regionalization. I'll just take them in no particular order here. I believe it's in the strategic directions document that we were talking about earlier; it may be in the accountability framework document -- I'm not sure which. It talks about the need for the training of health authority representatives. I wonder if the minister could tell us who she expects to deliver training to newly appointed members of regional health boards and community health councils.
[1725]
Hon. P. Priddy: Most of that work is done by the health authorities of B.C.
C. Hansen: My understanding is that the Health Association used to be funded for that, to the tune of, $100,000 to $120,000 a year; That was provided to the health authorities. Now they are still expected to provide that kind of training, yet there is no funding available for it. I guess the logical conclusion is that the only way you can fund the training of health authorities is in fact to charge the individuals being appointed to those boards, which ultimately has to come out of patient dollars in those individual communities. I'm wondering if the minister could explain why we have this change, if in fact it is a change. I'm looking for some explanation from the minister.
Hon. P. Priddy: In 1997 -- right -- it was actually a quarter of a million
dollars that we gave to HABC to do training either that year, prospectively, as new board
members came on
We in the ministry have been able to provide
C. Hansen: I guess that takes me to the next issue that I want to raise, and that is the decision by at least one health authority in British Columbia to opt out of the HABC. I wonder if the minister has addressed that issue. Certainly having all of the health authorities involved in the HABC must be important from the government's perspective in order to deliver programs such as training for newly appointed reps on those various boards.
Hon. P. Priddy: I am aware of the one health authority. I don't know if it has actually followed through with that, but I think we're probably talking about the same one. I'm also aware of the concerns they have and their reasons for withdrawing. I don't think it's about not supporting HABC as a concept or the purposes of the organization. I think there are some pieces to it other than that.
But yes, much like BCSTA -- that you'd like all school boards to belong -- I'd like all health authorities to belong to HABC. HABC is only there for the benefit of its membership, which are health authorities.
Now, if we saw this expanding or we saw a greater degree of dissatisfaction, then maybe we'd have to look at this differently. But I don't think the issue identified by the board that has withdrawn or is about to withdraw -- as I understand it -- is something that's resolvable by the Ministry of Health. I think there are different dynamics involved in that. But all the other health authorities do belong. You're quite right: if everybody belongs, it's stronger. If that spread, we'd have to look at it differently. But at this stage it's the health authority's choice. That is a service to them. If they choose not to purchase that service, then that's their choice.
C. Hansen: I have one last issue before we move on to acute care. Actually, I'm
not sure why I put this one in this particular file. I think it was because it was
actually somebody who serves on a community health board or regional health board who
brought this to my attention. But I gather that the national conference on health care
leadership that was recently held in Quebec City
[1730]
I'm just wondering if there is a policy preventing ministry staff from attending conferences outside of the province, because certainly it strikes me as one that would have been very beneficial for B.C. to have had a Ministry of Health participant.
Hon. P. Priddy: There is no policy that prevents staff from travelling outside of the province to conferences, although each request to do so is carefully reviewed. I'm sorry; I can't comment on this particular one. There's not a restriction. But as I say, each request is reviewed carefully.
C. Hansen: I want to move on to acute care. In the report of the Seaton commission on health care in 1991-92 there was a target set for the number of beds per thousand population: of 2.75 beds per thousand population. I'm wondering if that's still the ministry's target today, in terms of an appropriate level of acute-care beds.
Hon. P. Priddy: Yes, that was a recommendation of the Seaton commission. It is not currently a goal of the ministry, I think, for a couple of reasons. One of them is that -- I mean, that was done eight or nine years ago or whatever -- we're trying very hard not to have the same kind of concentration on beds that we've had in the past. But what is the appropriate health care for that individual? How can they be best supported? Health authorities have learned to think a bit differently about that, as we all have, and don't base it totally on the number of beds per person. Even in the last eight years, the technology available to us has increased so much that often we don't have the same needs -- for instance, things that can be done as day surgery and that can be done now, which couldn't be done then. So no, the goal is not the same.
C. Hansen: Do I gather from the minister's comments that there is not a specific goal? My understanding today is
[ Page 14133 ]
that we're running a ratio of about 2.25 beds per thousand population in British Columbia. I appreciate that it was nine years ago. But I think that when you start looking around at some of the real issues that are causing so much anxiety on the part of the public, one of them is access to acute-care beds in British Columbia. I'm wondering if it's the minister's point of view that the current ratio of 2.25 is adequate to serve the needs of British Columbia today.
Hon. P. Priddy: I think there are probably parts of the province that may require more beds than they currently have, and there are probably parts of the province that do not. It's not to say that 2.25 is satisfactory everywhere, because I don't know if we've reached that everywhere. But I would go back to my point about that this is not an unlimited budget. It is the largest in Canada. If you have extra money, do you put that all into more hospital beds, or do you acknowledge the things that can be done without a hospital bed these days: more out-patient surgery -- and more out-patient care, by the way; more renal dialysis that can be done at home, which used to have to be done in a bed; more day surgeries -- all of those things, which aren't about more beds per capita?
[1735]
I understand the anxiety that British Columbians have about health care. We've been
raised to measure -- at least if you're my age and perhaps even yours, hon. member; you're
much younger than me -- our health care system by the number of beds our hospital has.
That's all part of trying to move that focus. Yes, we need acute-care beds; there's all
kinds of things we need them for. Are there places where there may not be enough when we
need them? That's true. But we really do have to shift that focus to the community. What
can we do with better home support, what can we do with outreach, and what can we do as a
day patient, etc.? So while there may be more beds needed in parts of the province, I
think there are other parts that do not
C. Hansen: One of things I was told is that in British Columbia over the Christmas holidays last year -- in December of '98 -- there were patients in need of ICU care who were sent to Washington for care. I'm wondering if the minister could confirm whether or not that is true -- that we were sending ICU patients to Washington State during the Christmas holidays.
Hon. P. Priddy: Not that my staff here is aware of -- which isn't to say that you won't find a story where that's the case. But what we did do is make contingency plans, particularly around the potential for nurses not being in place over that period of time. We had made potential back-up plans with Alberta, if we needed to do that -- it would have been with Alberta. My staff is not aware that anybody who required intensive care went to Washington. But if you have some information that that was the case, by all means bring it forward. But we're not aware of it, which doesn't mean it didn't happen.
C. Hansen: I want to turn specifically to the issue of the provincial advisory
panel on cardiac care. When that body was set up
Hon. P. Priddy: Here I go -- my neck's out. I'm told that the cardiac panel will have -- I'm so reluctant to do this -- their final report to Dr. Fatin in about three weeks' time. He has been assured by the chair that that will then be available. When they did their first report, they did make some very initial projections around five years. There was one particular procedure where they said that over the next five years, we'll probably need 90 procedures a year. I'm sorry, I don't remember which one it was. So there's a bit of a reference already in the one that they gave me the last time. But this will be a more extensive one, and I understand that it will be out in about three weeks -- first time I've given you a time line.
C. Hansen: I gather this is the report that, during estimates a year ago, the minister promised us for October. Now it's three weeks off. Thank you.
I understand that some of the challenges that came up during their review really pointed to some of the lack of data that would be available and the lack of tracking that was available to them regarding cardiac patients. I'm wondering if some of those underlying problems have been addressed in order to allow us to better follow this in the years to come.
[1740]
Hon. P. Priddy: My understanding is that what they grappled with was not that there wasn't a registry or a data base; what they grappled with was how priorities were set. My understanding is that they will making recommendations in this report around how the priorities are set. So it's less about the data base available, but more about how priorities were set -- and that was a struggle.
S. Hawkins: I want to know how the minister is disbursing critical-care funding this year.
Hon. P. Priddy: The base funding for critical care was disbursed
S. Hawkins: I didn't hear anything for outside the lower mainland. The minister is aware that Kelowna General Hospital is now building its critical-care unit. I understand that we need a commitment for operating dollars of $500,000. Can the minister tell us where the ministry is with preparing for operating funds for that unit once it's up and running?
Hon. P. Priddy: I am aware of the need that Kelowna will have. But the unit is not due to open for 18 months, so there wouldn't be operating dollars reflected in this fiscal year.
[ Page 14134 ]
S. Hawkins: Is the minister saying that the unit won't be open until the next budget year? I understood that the unit would be functional before this budget year was ending. So if that's news, then I would be prepared to take the minister's word for that.
[1745]
Hon. P. Priddy: We have a variety of opinions back here, but let me answer what is probably the most critical part for the member. Then I will bring you the other answer after dinner. Our understanding here is that it will be in construction this year but won't be open until next year. However, if the beds were to open this year, we would ensure that the operating dollars were there for it.
C. Hansen: I'm hoping we can deal with some of the wait-list issues before we
adjourn. Just to give a sense of where I see this going from here
Hon. P. Priddy: We will, and I'll try and go back to my yes-no answers. I'm just trying to provide as much information as I can.
There is another piece of work to be done, apparently, so I would move that the committee 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. U. Dosanjh: Hon. Speaker, I call second reading of Bill Pr403.
POULOS INVESTMENTS LTD. (CORPORATE RESTORATION) ACT, 1999
(second reading)
S. Orcherton: I move that the bill be now read a second time. Just for the members' interest, hon. Speaker, Poulos Investments Ltd. was struck off the register of companies more than ten years ago, when it neglected to file all of its annual reports. Ordinarily, the Company Act would provide a summary process for restoration to the register, but that process is not available after ten years. Accordingly, this bill is required in order to restore the company. The company has apparently been operating since being struck off, as the owner was not aware that it had indeed been struck off.
The Speaker: Seeing no further speakers, I will put the question on second reading of Bill Pr403.
Motion approved.
Bill Pr403, Poulos Investments Ltd. (Corporate Restoration) Act, 1999, read a second time and referred to a Committee of the Whole House for consideration forthwith.
POULOS INVESTMENTS LTD. (CORPORATE RESTORATION) ACT, 1999
The House in committee on Bill Pr403; W. Hartley in the chair.
Sections 1 to 4 inclusive approved.
Preamble approved.
Title approved.
S. Orcherton: I move that the committee rise and report the bill complete without amendment.
Motion approved.
The House resumed; the Speaker in the chair.
Bill Pr403, Poulos Investments Ltd. (Corporate Restoration) Act, 1999, reported complete without amendment, read a third time and passed.
Hon. U. Dosanjh: I move that the House at its rising stand recessed until 6:35 p.m. and thereafter sit until adjournment.
Motion approved.
The House recessed from 5:51 p.m. to 6:36 p.m.
[The Speaker in the chair.]
Hon. P. Priddy: In this House, I call the estimates of the Ministry of Health.
The House in Committee of Supply B; W. Hartley in the chair.
ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 36: ministry operations, $7,569,524,000 (continued).
L. Stephens: I have a number of questions for the minister this evening around issues of women's health. First of all, I'd like to thank the minister for responding to questions that I asked the Minister of Women's Equality during her estimates
[ Page 14135 ]
debates. I received quite extensive answers on obstetrics and gynecology; home care as it relates to caregivers primarily, who are women; mental health issues; FAS and FAE issues; aboriginal health; breast surgery; and new reproductive technologies. These were the issues that I raised, and I thank the minister for her response.
There are a couple that I'd like to talk about. The first one is mental health. The minister has indicated that there's a research project on the response of service providers -- in-patient, out-patient, women-serving agencies and emergency shelter settings -- to issues related to the trauma of women with serious mental illnesses. Has this research project been completed, or is it ongoing?
Hon. P. Priddy: Yes, it is complete. I met the researchers. They presented sort of a synopsis of their findings to a conference recently, and I was actually very, very pleased by the work they'd done. The final report should be available publicly in about a month. But it is finished.
L. Stephens: I would be grateful if the opposition could receive a copy of the research report when it is available.
[1840]
One of the things I found out last week, for instance, was
It's a combination of a drop-in centre
What I'd like to ask the minister is whether or not she has actually toured this particular facility. Apparently the Premier had been there and had the grand tour about a month previous and so was very aware of what the issues were. Could the minister comment on that particular facility and whether or not she has actually visited there?
Hon. P. Priddy: Yes, I have visited on a number of occasions, and I know the folks who operate the services there.
In terms of women's health, it's hard for me to comment. They offer such an array of
services for people who are particularly vulnerable that I'm not sure about the kinds of
comments the member is looking for. If they are around the mental health service
Yes, I know the service quite well. I have visited on a number of occasions. It's actually in my neighbourhood.
L. Stephens: It is helpful that the minister has been there, so she knows what the issues are and the people who are coming to the centre. Many of them do have mental health issues compounded by addiction issues.
This particular ongoing research project that the minister has deals with the issues that those people raised with me, particularly the response of service providers. What they have told me is that the Surrey Memorial emergency department treats them very, very badly, to put it mildly. If people coming in there are known to be homeless, they are lucky if they get served. If people coming there are known to be drug users, they are treated very badly and ejected from the premises as soon as possible.
This was the point of view of a lot of different people, not just those there but others that I spoke to subsequent to having visited. Is the minister aware of that? Has that shown up in this research project that looked at the response of service providers?
Hon. P. Priddy: Yes -- although they looked at a whole variety of services, including hospitals. Quite honestly, while I don't have documented trends, I've certainly heard the same kinds of stories, whether it be Surrey or anywhere else. I think the researchers found it, and certainly consumers have stated to me, both as individuals and at the conference I was at, that that has been the circumstance that they've encountered, particularly if they're multiply diagnosed with whatever vulnerabilities there are for people, whether it's mental health, drug addiction or being homeless.
I think the next question is what they would then do with that. Once the report is public, it will be distributed to health authorities throughout the province. We would ask health authorities to work with the facilities in the region that they have a health responsibility for to set up responses to that. The Minister's Advisory Council on Women's Health has done a workshop for health authority members about the sort of double barriers faced by women as well.
So it's partly the health authorities personnel, but it will also be the people on the board who have to make sure that those vulnerable people aren't meeting those barriers.
[1845]
L. Stephens: Does the action plan that I presume would flow from this particular research information involve anything other than what the minister just said -- making sure that the regional health providers are aware of what these barriers are and holding workshops around the province? I understand that about three workshops have been held. What else is the ministry going to be doing to try to overcome these barriers for the homeless people and the mental health people with addictions, or for people who have just addiction problems or mental health problems? At the moment, from what I'm hearing, these people are not being served in the health care system; they're just not.
Hon. P. Priddy: I don't have the final report yet, so it's hard for me to say what all the specific recommendations are. But I can't believe that there would not be a recommendation about that. I do know that one of the things we will be doing -- and are doing already -- is to have best-practices teams around the province in the area of women's health and mental health. See, there are some hospitals where that doesn't happen, and they do have some best-practices models in terms of
[ Page 14136 ]
how they -- not only women, by the way; in this case women and men -- are responded to
when they come to hospitals either singly with a mental health challenge or with a mental
health challenge and something else. There are some best-practices models, so we would
L. Stephens: Could the minister perhaps tell us where those best practices are in fact being implemented -- where those particular parts of the province are that are receiving those kinds of initiatives?
Hon. P. Priddy: Again, because it's mental health
L. Stephens: Yes, that will be fine. We can get that list of people and locations.
What a number of people have said to me is that a lot of the difficulty seems to lie around dual diagnosis and whether or not people actually have a dual diagnosis. It seems that people are treating mental health issues or they're treating drug addiction issues or alcohol issues, but they're not treating all of those different components that may be at play in this particular individual. Does the ministry have pilot projects around dual diagnosis? Is the ministry aware of the whole issue around dual diagnosis, or is the ministry moving in any way to address a dual-diagnosis initiative?
Hon. P. Priddy: Yes, we're more than aware of dual diagnosis. It's interesting. In the field I come from, dual diagnosis means somebody with a mental handicap and a mental illness, but I realize that the context in which it's most commonly used these days is somebody with a mental health challenge and perhaps an addiction. Yes, there is work going on. It's very clearly acknowledged that those people who are most vulnerable are very often those people who carry two challenges, in terms of dual diagnosis or whatever phrase that we use.
Yes, there is work going on. I'm not sure if there's a pilot project or not. Again,
it's a mental health question, and I don't have mental health staff here, because I didn't
think we'd be dealing with the women. Anyway, we didn't anticipate these questions this
evening. But there is work going on in dual diagnosis. Yes, it's considered extremely
[1850]
L. Stephens: The group of women that seems to be falling through the cracks -- at the moment, with this government -- are those who have mental health problems and very often also have drug and alcohol problems. They have prostitution issues; they're homeless. All of these issues revolve around a large number of these women. There needs to be a more holistic way, if you like, of dealing with the multiple issues that many of these women face.
Of those particular women that I'm talking about, very few of them are receiving service, for a variety of reasons: because they don't fall into this niche, or they don't meet those criteria, or they're rejected by the acute-care hospital emergency wards, or the beds aren't there, or the counselling isn't there. It's very, very difficult for these particular individuals to get the kind of help that they require -- not even from Human Resources.
One of the big problems, I'm told, is that many of the Human Resources social services workers all have answering machines. It is virtually impossible to get a live person -- a live financial assistance worker -- on the phone. With people who either are homeless or have mental health problems or drug addiction problems, if they phone and can't get a live person, they may leave a message, and they may get a call back on a pay phone. The fact is that they just don't connect. So those services just simply aren't accessible. When you have people with these kinds of disabilities, they don't understand 1 o'clock on Friday or 6 o'clock or 2 o'clock or whatever it is.
So there needs to be some way to allow them to access the services. Whether or not it's done through the kind of community resources that people like the South Fraser Community Services group provides or others, the fact is that people are not receiving what they require. So has the minister done anything about these people? Is there anything being done at all to try to make it easier for them to access the services of the Ministry of Health either in mental health or in drug and alcohol addictions or even to address the homeless issue through the government in some way?
Hon. P. Priddy: The questions that the member raises, I assume, she canvassed
with other ministries when their estimates were up. I don't know what their responses were
to that, because you've clearly raised a concern which I don't think is
So let me try and speak from the Ministry of Health perspective. We do work as much as
we can both with Human Resources in terms of people -- women, just because that's the
subject that we're engaged in -- being able to access the financial resources that they
need
[1855]
But again, we work closely with the Ministry for Children and Families, particularly around the issue of women and addiction treatment beds. There has been some expansion of that. I shouldn't speak to other people's portfolios, should I? But I don't think anybody would suggest that one of the challenges is not just beds for women but beds for women where they have a safe place for their children. So that's one of the issues that we've been working with the Ministry for Children and Families with, because often -- not always, but often -- women do not have a safe environment in which to leave their child behind if they seek residential treatment.
The homelessness
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announcement, but there may be more to come -- some significant initiatives around supported housing. We are doing some of that in the Ministry of Health as well. I guess one of the other things we -- all of us; not just the Ministry of Health, but others -- have to work at is having municipalities understand that they may have a responsibility as well. If you visited that service, they would have shared with you that it has been a significant challenge in the municipality in which they are located. So, you know, the municipalities have a partnership role to play as well. I know that we've worked with the Minister of Municipal Affairs around that one as well.
I just want to add a couple of comments, although we will
We're also about to do, with additional funding from us, from Women's Equality and form the Ministry of Health -- I don't know if that was in the letter or not, but if it wasn't, I'll say it -- a training symposium for sexual assault centre and transition house staff to work more effectively with women with serious mental illnesses. That will be, as I say, with dollars provided by all three ministries. I know that's often a place, particularly for women with children, where they will go, and many will state that it's very difficult for them there.
The other issue that I will raise, and sometimes it doesn't get named
L. Stephens: Around that issue of women and children seeking some health care, there was a report presented to the ministry by the advisory council in November of '97, looking at women with addictions. Apparently the 1998-99 budget had some enhancements in support of women-centred detox and withdrawal services. Could the minister talk a little bit about what is happening at this point -- whether or not there is money in her budget for improved services for women with addiction problems?
Hon. P. Priddy: That is not a mandated responsibility that the ministry carries, so those dollars are in the MCF budget.
L. Stephens: What responsibility does the Ministry of Health have around the detox centres and around the health services for these addictions?
[1900]
Hon. P. Priddy: We don't have an operating responsibility role, except for
methadone. Because we do that with the College of Physicians and Surgeons, we do have a
role with methadone. But we don't have any kind of operating responsibility as it relates
to any drug and alcohol programs, including detox centres, other than
L. Stephens: B.C. Women's Hospital has a number of residential beds for women with addictions. I think 25 was the number that I heard at the last count. Does the ministry have responsibility for those 25 residential beds? Is there any consideration for expanding the number of beds at B.C. Women's Hospital?
Hon. P. Priddy: I may need to get back with one part of this answer; I need to check with someone else about the funding part. But I do know that the Women's Hospital has had discussions about expanding the number of beds there by a few. I haven't seen a proposal come forward, and what we're checking on at the moment is which ministry it would come forward to.
L. Stephens: Could the minister update the committee on breast cancer surgery wait-lists and how the ministry has been able to, hopefully, shorten those wait-lists?
Hon. P. Priddy: You asked about breast surgery wait times -- right? Not diagnostic services but breast surgery? There are, then, two pieces to the answer.
In my recent conversations with the head of the B.C. Cancer Agency and in other conversations I've had with him over the last year, I have not had the wait time for breast cancer surgery identified as a particular problem. I mean, it's not one that's been brought to me by the B.C. Cancer Agency. That's not to say that there are not individual anecdotes of people who may have had to wait too long. I know that, and I know that this isn't the information you received.
[1905]
For the record, wait times for surgeons in White Rock are being reduced by having breast cancer specialist surgeons set aside a block of time every week for women who require urgent breast surgery as the result of a cancer diagnosis. In Victoria and Nanaimo, they've reduced wait times by reducing the number of visits a woman makes to her general practitioner. An example of that is specialist referral upon an abnormal mammogram. So these are pilot projects. They are in the process of being evaluated; I don't think we'll have results for a little while. But it's about looking at whether people can organize the work differently, as in the White Rock situation which I mentioned.
I have had raised with me the issue of the difference in time between an original mammogram and diagnostic testing.
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I think that many of us may have heard those stories and that some of us could tell those stories. We recognize that women who undergo diagnostic testing after an initial screening mammogram need information about their health status as fast as possible. I think that anybody who has ever stood beside anyone -- whether it's breast cancer or something else -- who gets some initial information and then waits for the next piece knows how awful that is and how every hour feels like a day in those circumstances.
We are doing some things to reduce the amount of time that women wait for that kind of information. We're doing it in five communities. In Vancouver, the Children and Women's Health Centre offers what people tend to call -- I wish there were a better phrase for this -- a "one-stop shop." Diagnostic services are offered at the same location as the screening mammography, and women wait a maximum of one week from the time of the initial screening mammography for their results. Vancouver Island will soon have a similar service.
If I could go back for a moment to the beds at the Women's Hospital, they're funded by MCF.
L. Stephens: It looks like MCF is taking over all of the services around drug and alcohol addictions. Perhaps that's unfortunate. Perhaps they would be better left with the Ministry of Health, which provides the services -- or should provide the services, perhaps.
One other issue I would like the minister to comment on: you have commissioned a review of triple-marker screening. Perhaps the minister could talk about that and whether or not the review has been completed. If so, is it public, and if it is, would the opposition be able to get a copy of it? What is going to come of that particular process?
Hon. P. Priddy: The Minister's Advisory Council on Women's Health -- what people call MAC -- did do a review. They did a review of the literature and what was happening in the province. Apparently it is close to being finished, and we should have it -- soon?
Interjection.
Hon. P. Priddy: I got one time commitment tonight. We should have it soon. The estimate is a month, but I don't sign my name to that at this stage.
But what they did look at, I think
[1910]
So they didn't just look at how this could be bigger and better. They looked at whether women had enough information to understand the actual implications of the test and what that could show when it was done. Then they looked at the number of women who were screened and who received a positive test and what they did after that diagnosis and so on -- what the final outcome was. Did they choose to terminate the pregnancy? Obviously that's where the ethical debate about not just termination but termination of, for instance, a baby with Down's syndrome -- or neural tube defects, actually -- comes in.
So I don't know what the recommendations will be. I just know that they didn't look at it with a particular goal in mind, other than the review. They didn't look at it as, "Should we expand?" or "Does it need more money?" etc. They really looked at that on a broad basis. And I'm told that it will be about a month.
C. Hansen: I want to move on to some issues around the future workforce in terms of the recruitment and training of nurses, the recruitment of doctors -- the training of not only nurses and doctors but of all health care professionals. But I want to start with nurses in particular, because I think it's the one that there's probably been the most attention paid to.
It's interesting. Out of the Canadian Institute for Health Information, if you look at the number of nurses that we employ per 100,000 of population in Canada, B.C. actually is No. 9 out of ten provinces when it comes to the number of nurses on a per-capita basis. I think the only province that has fewer nurses on a per-capita basis, as of 1998, is Ontario. As the minister is aware, there have been some commitments made to recruit a significant number of new nurses in Ontario, as there have been in other provinces. So we're starting into a competition among provinces, I think, for the available nurses that we need to serve us. I'm aware that the minister made a commitment in the contract negotiations last November or December, I guess it would have been, to hire 1,000 new nurses over the coming three years. I'm wondering if we could start with the minister telling us where she thinks we're going to find 1,000 nurses in today's climate in Canada, where all the provinces are setting out on the same objective.
Hon. P. Priddy: There's no question that we are doing it in an environment of
competition, which isn't sort of how one usually does it. But I would think that there are
indeed a couple of things in our favour in terms of doing that. When this was agreed upon
with the B.C. Nurses Union, their estimate at that stage, and that's all I can quote, is
that out of that 1,000 -- I don't think the number is here, but I think I can recall it --
a number of the new positions
Therefore the next thing we would look at is bridging programs, where you have LPNs
who, with a bridging program, could become RNs. I actually just met a couple of days ago
with the B.C. Nurses Union, and they're doing some preliminary work along with HEABC on
this issue. So bridging programs, because that would bring us people more quickly
Interjection.
Hon. P. Priddy: That's what I said -- right. Yes, bridging programs to provide upgrading for licensed practical nurses:
[ Page 14139 ]
refresher training programs, fast-track training programs and so on. We know that we will also have to expand nursing seats. Other than bridging programs or fast-tracking people, that's not going to bring us people in the next two or two and a half years. But we know we also do that.
One of the things that we find interesting -- and I don't think there's much analysis for it -- is that there is more interest in nursing in B.C. than there seems to be in other provinces. If you gauge the number of people who want to go into nursing, as compared to Ontario, for instance, where there are very few people interested in doing that, I think that there is an interest in nursing in British Columbia. We think our salaries are more than competitive with the rest of the country, so if we have to recruit out of province, the salaries are competitive. There is, at least in this province currently, some stability -- as it relates to negotiations and so on within the health care system, as opposed to some of the things we see happening in other provinces. So those are some of the things that I think will help. Just a couple of things I might add to that -- never mind; I'm sure you'll ask.
[1915]
C. Hansen: The minister was talking about training new nurses, and that's an issue we'll come to shortly. But I want to deal with some of these other things first, and one is recruitment. My understanding is that in the current year's objective of 400 new nurses for this current fiscal year, only 50 of them are in fact going to be new nurses. The other 350 will be either part-time or casuals whose designations will be changed to a full-time designation. I'm wondering if the minister could comment on that.
Hon. P. Priddy: I don't know if those are the exact numbers, but I think that's quite possible. As I say, BCNU identified at the time that about 40 percent of those people would be people working in the system who want full-time work. But the point is that there are still 400 new full-time-equivalent positions in the system. Now, whether those people are hired from out of the system -- from Saskatchewan or Alberta -- or from within the system, it's still 400 new FTE positions for people who are currently sort of trying to provide for their families and working in four different hospitals trying to put together a full-time salary.
C. Hansen: I think the minister is using a couple of different terms that I want to address. When we talk today about a nurse who is working casual and that she or he may be working a full 36 or 37 hours -- whatever a full workweek is considered to be -- that may be made up of several casual positions. If you have a person who might have three different casual positions at three different hospitals but who puts in a full FTE, and if we change that individual to a "full-time" nurse, is that one of the 400 new nurses we're going to see in this current fiscal year?
Hon. P. Priddy: Member, I think the answer to your question is no. What we are providing is money to the system for 400 new full-time-equivalent positions. That person who's working as casual in four different places would end up with a full-time job in one place. So to use my own community, just because it's easier than trying to use someone else's, Surrey Memorial Hospital might have someone who's currently tried to work casual in Richmond and New Westminster and somewhere else and who's now a full-time position in Surrey Memorial. You could have a number of people impacted by this.
But the end result is still
C. Hansen: Actually, some of the latest stats that I've got, which are 1997 stats -- these, again, come out of the Canadian Institute for Health Information -- show that in British Columbia, of the total 28,974 nurses, 14,339 were full-time, 14,219 were part-time, and 416 were not stated, so I guess they couldn't classify them. But certainly half of all nurses employed in British Columbia today are not working full-time.
I still want to be sure that we're talking about the same thing here -- that when you
talk about 400 new full-time nurses, it's not 400 new full-time nurses. It's 400 new FTEs,
so that in fact there are going to be that many additional hours of nursing added to the
system in British Columbia. If you take two part-time people that are each working
half-time and you create, if both of them
I see heads nodding, so I will take that and move along. I appreciate that.
[1920]
The minister mentioned the bridging program earlier. I'm wondering how we can take the existing LPNs out of the system long enough to train them, because certainly that's going to result in a net decrease in the number of nurses that are available on the front line. I recognize the fact that the education programs are essential and important. But has the ministry factored in the actual decrease in the number of nurses that are going to be working on the front line during that process?
Hon. P. Priddy: Yes, we have considered the fact that if you take somebody off a unit or a floor for a year -- which is what a bridging program is -- then there's a vacancy. It's a bit like a domino effect. The other thing we know is that there's a number of women and men out there who are LPNs who are working in non-LPN positions, because there haven't been enough LPN positions for them to move into. So I think they would want that opportunity to move into the LPN positions that were vacated by people doing the bridging program. Now, you always have a domino effect. You say, "Okay, if they were in the non-LPN position, then you have to fill that one," etc. I realize that. But we do know that we have LPNs in this system who would like to work as LPNs and have not been able to because there have not been spaces available.
C. Hansen: The minister talked earlier about B.C. being a desirable place for nurses, so that recruitment may not be as difficult as in other provinces. But certainly the message that I
[ Page 14140 ]
get from nurses around B.C. is that morale is a huge issue and that they are seeing the
quality of their
Just as an example, I've got a quote from a nurse in Quesnel who says that government has to do something about making nursing a desirable profession. She says: "Why would anyone want to go into nursing when all they hear is that it isn't satisfying anymore?" A nurse that I was visiting with made the comment that no one is caring for the caregivers in British Columbia today. I think that's probably an expression that the minister has heard from time to time. I'm wondering if the minister could tell us what strategies may be in place or are being worked on to encourage nurses to stay in the profession rather than being driven out because of workload and other factors.
Hon. P. Priddy: The member is right: it is not only about remuneration, although that's always a factor, but that's certainly not the only thing. I don't think what you would hear from nurses in British Columbia is any different than what you would hear from nurses anywhere in the country. I don't know if it's to a greater or lesser degree or not. But low morale is something that we're facing in health care across Canada, if not across North America. That doesn't make it okay; I'm just saying it's not unique.
In British Columbia several things are beginning to happen. One of them is -- you'll
note it in the "Strategic Directions" document -- that addressing the working
environment for people is important. And it's important in a variety of ways. Safety in a
working environment
The other thing it does, of course, is reduce the incidence of accidents and occupational diseases, which are two kinds of stresses. It's a stress for the people who are off, but it's also a stress for the nurses remaining on the floor who are trying to pick up some of that additional work, which makes it more difficult. So that's one thing that's addressed in the "Strategic Directions" as an important piece.
[1925]
Secondly, as part of the accord -- it's part of the agreement with the B.C. Nurses
Union -- we have a committee that has met twice already, I guess, around recruitment and
retention. We recognize that retention
Another strategy is
C. Hansen: One of the issues that's come up, of concern in terms of the future number of nurses we may need, is the move towards requiring a baccalaureate degree for registered nurses. I don't want to get into the debate of whether or not that's right or wrong today, but I want to raise it in the context of the number of nurses we will need in the future.
Has the minister taken any decision with regard to whether or not existing nurses who are diplomaed nurses would be grandfathered in? I'm not sure if it's right to use the word grandfathered -- grandmothered, grandparented -- in this context. There is a real concern that the experience that diplomaed nurses have today is as valuable -- if not more valuable -- as the training that would come as a result of a baccalaureate program. I'm wondering if the minister is prepared to commit that all of the registered nurses with diplomas who are serving today will in fact be given the same or equal status to those who in the future may be required to have baccalaureate degrees.
Hon. P. Priddy: I think a number of the questions that the member asks are hypothetical -- which are always risky questions, perhaps not to ask but to answer. Let me just have a little bit of a run at this one.
There's certainly nothing in the province at this stage that says that a baccalaureate degree is a mandatory entrance for nursing, although we certainly have baccalaureate nurses in the province. We have baccalaureate training seats in the province. But there is nobody who has said: "You must have a baccalaureate as an entrance into nursing." So some of those questions are hypothetical questions.
For nurses who've done diploma programs -- and I probably just need to check with somebody beside me or behind me -- they're getting close to three years now. I think they're five semesters, if I'm correct. If they go into a baccalaureate program, they don't automatically get a bachelor of nursing science, but that experience is acknowledged. I'm told that they get three years' credit in the baccalaureate program for their diploma education and experience. So it is recognized. They still would have to do more. By the way, a lot of nurses do that. My local college has a program where people move from a diploma program to a baccalaureate program by doing the extra amount of time. But their time is recognized.
[1930]
C. Hansen: I do want to get into the number of training spaces very quickly here. Last year there were 1,229 new registered nurses in British Columbia. Those that actually graduated from schools in British Columbia were only half that -- 670 nurses that actually graduated from institutions last year. If we start looking at some of the future projections in terms of nurses leaving the profession, David Baxter has done some work in terms of looking at the future. He has a number of 30,940 nurse supervisors and registered nurses in British Columbia as of 1996. He points out -- and that's three years ago -- that 42 percent were 45 years of age or older. His
[ Page 14141 ]
projection
Yet when you look at the training spots that are available, we don't come anywhere near that. The ministry recently put out an advertising campaign and put $200,000 into television commercials enticing young British Columbians to consider nursing as a career, and yet we don't have those training spaces today. I'm told that at the UBC school of nursing, for example, is only able to accept one out of five applicants. So we do have British Columbians who are prepared to go into nursing, and we don't have the training spaces for them.
In fact, if you start looking at the numbers over the last couple of years, we've
actually been going in the wrong direction. If you look back to
The other thing that's of great concern, given this trend at least -- that is, towards
a baccalaureate-trained nurse as opposed to a diploma nurse
Hon. P. Priddy: I won't quarrel with the statistics. But I do know that a large number of people in the nursing profession entered nursing when I did -- which was a long time ago -- and are 55 or 50 or older and -- you're right -- are ready to retire if they can do that. But there is a need for training spaces; there's no question. Now, whether those are bridging or whether those are diploma programs or baccalaureate programs, there is a need for additional training spaces. There's no question about that.
You know, I think we're seeing in nursing a little bit of what education is seeing: suddenly you have either too many or not enough. I was at an alumni luncheon the other day, and somebody said that when they came here, they couldn't get a job because there were nurses to spare. So I think that is one of the cycles we've seen, but it's still a really emergent problem for us.
Now, we're working quite closely
[1935]
One of the challenges in this -- and we'll find a way around it; I promise you that --
is that colleges and universities really don't like targeted money. They don't like it
when you give them a budget and say: "You have to spend it on this." My guess is
that's it's the only way that we're going to be able to get nursing spaces, because what
happens
What happens this year -- I'm not sure about last year -- is that the Ministry of Advanced Education and Training gives X number of spaces to each college that has a priority list of where they'll allocate those seats. No college in the province allocated them to nursing -- nobody. I shouldn't say that, sorry -- Kwantlen College did with 13-1/2 for the baccalaureate program. But otherwise, nobody did. The individual faculties may see it as a priority. But when the university or college gets its lump allocation of seats, they don't see nursing as high enough priority to allocate those seats to that. They'll allocate it to -- I don't know, whatever -- high technology or something else.
I don't want to speak for the Minister of Advanced Education, and you may have asked him that during his estimates; I don't know. But I'm not sure. He would know better than I if there's a way to do it other than targeted dollars, and I'm not averse to that. I don't know if the minister is or not. But colleges really are. That doesn't mean you don't do it; it just means that there is a resistance on the part of colleges and universities when you tell them on what kind of spaces they have to spend their dollars.
C. Hansen: We did raise it with the Minister of Advanced Education. Specifically, the question was regarding the training of nurses, and the question was why this province wasn't being more proactive. I must say I was quite disappointed with the minister's response, because he basically passed the buck to the Minister of Health. I'll just read you a couple of quotes. He says: "I know that the Ministry of Health is certainly working closely with the college of nurses" -- I assume he means RNABC -- "and with the institutions, along with my ministry, to try to identify training needs in order to ensure that those needs are met."
I gather from what the minister just said that maybe the two of them should talk a
little bit more, because these needs obviously are not being met. It's actually
interesting that the Minister of Advanced Education went on to talk about
You know, the universities and colleges, I appreciate, don't like being told where to allocate dollars. But I think that it comes back to this question of leadership. The provincial government -- the Ministry of Health -- has to provide the leadership to ensure that future needs for nurses in this province are met, because right now if you look at the training spaces that are available in this province, we are woefully lacking. If we start now, it's not going to start to address that need until three or four years from now. But at least three or four years from now we're going to have a leg up, because we're going to be training some of our own students in this province to fill those positions.
We're still going to have that shortage in the interim, where we're going to have to carry on essentially stealing nurses from other jurisdictions that have paid to have them
[ Page 14142 ]
trained, because we haven't put the training spaces into this province. I would certainly like to see the minister being a little bit more proactive in terms of ensuring that those training spaces are there, because I think it is vital to the needs of health care in this province in the very near future.
I would like to ask the minister a specific question. Given that these training spaces are not available, given that our colleges and universities are oversubscribed for the spaces that they have available, why did the ministry embark on this $200,000 ad campaign to encourage British Columbians to go into nursing in the first place?
[1940]
Hon. P. Priddy: I want to go back to an earlier point, and then I'll work to answer his question. In the time that I've been the minister, we have set up regular work with the Ministry of Advanced Education, Training and Technology. At all of our meetings now we have at least an assistant deputy minister from the Ministry of Advanced Education who sits at the table, so we know we are working together to try and advance the training spaces. In point of fact, I believe I just said that I actually think it's fine to target money. I just said that the colleges don't recognize this as a priority, whereas they recognize high technology as a priority.
There's no question that we need more training spaces, and there's no question that I'm a strong lobbyist with the Ministry of Advanced Education. I would expect to see more training spaces in the allocation next year as a result of that. I think we are providing leadership -- or, at least, I have in the time I've been here -- to try to do that planning for additional training seats in the province. But we don't pay for them in this ministry, so my job is to ensure that it's seen as a priority by the Ministry of Advanced Education to put those forward as a priority or to target money -- one or the other -- for those seats. I recognize that as my responsibility. I take it seriously, and I do it.
In terms of the advertisement, I think a couple of things happened. One of them began with an intent to actually make people more aware of nursing as a career opportunity and to make a broader array of people aware of nursing as a career opportunity. It's interesting that every speaking note I get talks about getting more young people to go into nursing. But in point of fact, it's not just young people. We see far more people now who are older, have done something else and have made a decision to go into nursing. I think we have to change that awareness. In part, we were trying to do that.
My instinct has always been that there are wait times at colleges for nursing. Before we did this, however, we called all the colleges. We were told -- I mean, we can argue about whose data is correct and where people get it from -- by only two colleges that they had qualified applicants on their wait-lists. Not that there wasn't a wait-list, but in terms of those applicants who were qualified to get into a nursing program, there were only two colleges that said they had assessed the people on their wait-lists and had people who met all the criteria. So we based it on that. Clearly the data isn't good enough, in terms of how the colleges collect the data and how either Health or Advanced Education collects the data from those colleges and universities. That needs to be much better, and it will be.
C. Hansen: In the time that we have, I wish I could canvass all the health professions. If you start looking at the changing demographics of all health professions in British Columbia, it's a similar story. Nursing is the one that has attracted the most attention recently. I've heard comments from the minister that we are overdoctored in British Columbia: that we have too many doctors per capita. Certainly many people would take issue with that. But if you start looking at the future trends for five, ten or 15 years from now, we're going to go through the same process in B.C. in terms of doctors that are going to be retiring and specialists that are going to be retiring. We're going to be facing the same kinds of shortages in British Columbia.
In this province we train fewer than 50 percent of our doctors. We actually import from other jurisdictions that have trained them, whether it's other provinces or other countries in the world. Currently in British Columbia we accept only 120 new med students a year into the UBC school of medicine, and that is the lowest of any province in Canada when you compare that on a per-capita basis. In fact, not only is it the lowest, it's the lowest by far. Even Alberta, which has a smaller population than British Columbia, takes in 180 new med students a year. It's only if we start to address some of these issues that we're going to start to be able to deal with them in the future.
I understand that there is an initiative underway to start looking at the ages, the practices and the specialties of doctors in British Columbia. I'm wondering if the minister could fill us in as to where that's at. I understand it's an initiative between the Ministry of Health, the College of Physicians and Surgeons and the faculty of medicine. The Centre for Health Sciences and Policy Research at UBC may be involved in it or may be driving it, and I'm wondering if the minister could give us some background on where we're at with that particular study.
[1945]
Hon. P. Priddy: As it relates to the question you asked about the report or the
work that was going on and an update on that to look at, as the member has described, our
future supply needs
The committee is looking at ways of matching training programs with future needs,
including adjusting the mix and type of specialists. That may be based on demographics.
Sometimes you'll see a specialty area that was, I guess, more salient or interesting -- or
whatever -- at a particular time; you'll see a group of specialists who may be a
particular age. So you may happen to look at not only the types, the mix, the age
Currently that postgraduate committee is working with the Centre for Health Services and Policy Research at UBC -- which I think the member referenced -- to analyze the current physician supply in terms of age distribution, retirement, etc., and to provide a solid foundation for future planning.
C. Hansen: There are a bunch of issues under this area that I'd like to canvass, but in the interests of time I'm going to
[ Page 14143 ]
move on to the Pharmacare issues that we left outstanding from the other night. Specifically, I want to deal with the exemption levels -- the $800 deductible for the plan E programs. This is basically anybody in the general public who has to pay the first $800 worth of their Pharmacare benefits before they can be eligible for any benefits under Pharmacare.
In Pharmacare, we cover those who are on B.C. Benefits; we cover those who are seniors; we cover those who are status Indians in British Columbia. There are various programs that we have for full coverage, yet under the universal plan we have this $800 deductible. In the Ministry of Human Resources, I know that last year the minister last year announced programs to extend dental care coverage, for example, to the working poor -- people that had not previously been able to qualify for dental coverage. Yet what we see in the Pharmacare program is that it's either all or nothing. Either you're on B.C. Benefits, where you get everything covered, or you're on the universal plan, where you get nothing up to $800 covered.
[1950]
I think some of the real hardships that we've seen in British Columbia are in working families that are on very low and marginal incomes. There's no flexibility in there. They can't afford the $800, and they get hit with some of these huge fees. I think that a couple of years ago, when the deductible was at $200 -- in fact, it was lower than that in years prior to that -- that was not as much of a hardship. But now that it's up to $800 deductible, we see more and more cases of families who are really not able to cope with that. I wonder if the ministry has looked at any flexibility, as has happened in the Ministry of Human Resources, with regard to providing programs and program assistance to those we might call the working poor in British Columbia.
Hon. P. Priddy: I think the majority of what the member has described is correct. But not everybody actually pays nothing -- or $800. When the premiums went up to $800, everybody on premium assistance -- and I'm sure we would have those numbers here -- was frozen at that level, and they pay $600. Is that total coverage? No, but it is different from the $800; $200 makes quite a difference to many people.
C. Hansen: I've got several real examples I want to give the minister. It's not with regard to pharmaceutical prescriptions, but rather it's with regard to orthotics and braces. I understand that British Columbia is one of the few provinces that does not provide some form of coverage under extended health for braces and orthotics and prostheses. I've got several cases, and I'm just going to use this one as an example.
This is a woman who is now in her eighties. She has developed a massive knee hyperextension. The knee is so hyperextended that it is at the point of rupturing, so it is very difficult bracing the problem at this point. A knee hyperextension should never be allowed to progress to this degree. This woman is on a very limited pension. She has no extended health benefits, and we have tried in vain to find funding for this client. She is a good example of clients that we see who often do without bracing because of funding issues. This is a woman who basically has difficulty even getting out of bed without the kind of brace that would be required for her.
I wonder if the minister could comment on the way that we are denying
Hon. P. Priddy: I know it's hard to get into specifics, and I don't really want to do that. But I'll just assume, from your description, that the woman you describe is not someone who is on premium assistance.
By the way, I just want to go back to the number, because I did find it
As a result of the member's comment, I will go back and look at whether we are indeed the only province not to cover adult orthotics. I'm not disagreeing with you; I simply don't have that information in front of me.
[1955]
There are a couple of things we do cover. You're correct: orthotic devices for adults are not benefits under Pharmacare. I will check and see if that is the case in other provinces, as you stated, and maybe ask people to take another look at it. But Pharmacare does cover prosthetic devices: limbs, artificial eyes, mastectomy forms, the mastectomy supplies. It also talks about the replacement. Depending on the kind of prosthesis it is, you'll replace it every two years, every 36 months or every year, depending on what the prosthetic device might be. We clearly provide orthotic devices for all children 19 and under. I guess that's all.
C. Hansen: I appreciate the minister's willingness to take a look at that particular issue. I think it is causing not only hardship but some real cases in B.C. where common sense doesn't get a chance to prevail. I'll give you a specific example of that. In Royal Columbian Hospital two weeks ago, there was a patient who had a spinal fracture. This patient requires a $400 brace and cannot be released or discharged from the hospital without the $400 brace. They can't get the $400 brace. So here we have a patient in a hospital tying up an acute-care bed at $700 a day or $1,400 a day, depending on whose numbers you believe, and there's no ability for common sense to prevail.
I think it's something that's common throughout health care generally. We talk about getting rid of the stovepipes in health care, and yet you can't move funds from one particular source of funding to another. You can't move funding from acute care, for example, to provide for the $400 brace so that this particular individual can be discharged and that bed can be freed up. In the end, it's the health care system that winds up with a much higher cost as a result of the inability to deal with this kind of a situation with some flexibility. I'm wondering if the minister could comment on that lack of flexibility and the inability for common sense to prevail sometimes.
Hon. P. Priddy: There are some things, I suppose, that need to be inflexible. I don't know. But there are times that we do need to be flexible. If the member would pass me that information, I will have my staff investigate it. It's difficult for me to understand why the hospital -- because they do in
[ Page 14144 ]
many other circumstances -- has not been able to arrange for that through a variety of places that provide some assistance in that area. But if you pass that over to me, I will have staff look at it. While there are always difficulties with being flexible -- because people say, "Oh, but you've set a precedent here or here or here" -- I don't want to think that the system is so inflexible that we do things that, not only on the surface but underneath, look like they make no sense whatsoever.
C. Hansen: Just before I turn it over to my colleague from Okanagan-Vernon, I
have one last issue that I want to raise at this time. It's with regard to a husband and
wife who wound up on two separate plans. This is an example of an individual that
[2000]
Hon. P. Priddy: The member is correct. It is, I guess, one of the ways that
A. Sanders: I'd like to continue the discussion on Pharmacare, and I'd like to start with an issue that we left off with last Wednesday or Thursday. That was the covering of two medications, olanzapine and Seroquel, both used for schizophrenia or specifically for psychosis. We had quite a prolonged discussion on these medications, and I don't intend at this time to relive that entire experience, but I want to follow up from last week. Over the last five or six days, has the minister had any further opportunity to review these medications with her staff -- as to whether there is any second look at whether these medications should be covered, based on a thorough canvassing of the area and based on, I would say, the minister's ability to look at that rationally and perhaps make some other decisions?
Hon. P. Priddy: No. Since the member raised it in debate last Tuesday, I have not had that opportunity. My intention would be to do that when estimates adjourn.
A. Sanders: I would very much encourage the minister to look at those issues. I believe it's one of the most valid issues and one of the largest shortcomings that we presently have in the B.C. medical system at this time.
I want to look at the "Special Authority Request," a new form that's put out
by the Ministry of Health through Pharmacare. I had some concerns about the form, and I'd
like the minister to address those. The form has three areas that concern me to a certain
extent. The top box on that form, if the minister has one available
"Collection, use and disclosure of this information is permitted under the Freedom of Information and Protection of Privacy Act. Should approval be granted for this special authority request, Pharmacare's authorization is solely for the purpose of providing a prescription benefit for the cost of the requested medication. Pharmacare makes no representation about the suitability of the requested medication for the patient's, or any other, medical condition or problem."
Is the collection, use and disclosure of this information used for any purposes other than the filling in of the special authority request?
Hon. P. Priddy: The answer is no.
A. Sanders: I'm sure that will make a lot of people quite happy.
The second part, by "patient's signature," that needs clarification is:
"When patient available, please complete" -- assuming that sometimes the patients are not available. "I authorize the prescriber to release information to Pharmacare to obtain special authority for prescription benefit, including access to my health records in the custody of the prescriber, as appropriate, to verify the information on this special authority request."
Could the minister please define "appropriate" and how wide that definition can be?
[2005]
Hon. P. Priddy: I want to answer part, and then I need to clarify part of the question. Just as a matter of information, we're currently working with the BCMA about the wording actually on that form and how some of those words are defined. I'm sorry to ask, but could you please repeat the question, hon. member?
A. Sanders: I want to be instructed as to the scope and magnitude of what a patient is actually signing away here. Basically this reads to me, if I am a consumer, that I am signing away for the benefit of a medication on special authority "access to my health records in the custody of" my family physician or specialist, "to verify the information on this special authority request." That could be quite a broad definition. Having signed there, what protection does the patient have that this information will be used appropriately? What protection does the patient have that only relevant information will be asked for?
Hon. P. Priddy: My understanding is that the information asked for is only information that would apply to the criteria for using that medication -- not everything in their health records that's ever happened to somebody or every health challenge they've ever gone to their physician about, but what would be related to a criterion for the use of the drug.
A. Sanders: Is there any collateral access to that information? The patient is, carte blanche, signing away -- potentially -- their medical records. What are the protections in place to assure that this information cannot be used by another source in the Ministry of Health or otherwise?
Hon. P. Priddy: Okay, then, sort of following
[ Page 14145 ]
relating to the criteria around how the drug will be used. Once that information has been released, there is no ability to access that from some other part of the ministry for some other kind of reason. Obviously the people who grant special authority, as others who work in the ministry or as the physician, have taken oaths of confidentiality and would not release that information for other purposes -- or certainly should not. I've not been aware of circumstances where they have.
Then in terms of the access through PharmaNet, where we've had, I think, very little of
people trying to access that information
[2010]
A. Sanders: Let's just follow that line of logic. Based on PharmaNet, how many infractions of PharmaNet have we had in the last year where information was used inappropriately?
Hon. P. Priddy: Since it began in 1995, there has been one infraction. I'm sorry; I don't know if you asked what it was. If you did, somebody is checking; if you didn't, we won't bother to tell you -- whichever.
A. Sanders: The third area on this new form for special authority requests that causes me some concern is the prescriber's signature. It says: "I hereby certify that the information given on this form is correct and complete to the best of my knowledge, and agree that Pharmacare may request, and I will provide, additional documentation to support this special authority request, as appropriate." This is basically asking the prescriber to guarantee additional appropriate documentation, and there may be an aspect of liability associated with that. I think the ministry should look into that, if this is the form that is to be adopted. Those are just some things that I noticed on that form and that I think need a bit more work.
The third issue that I'd like to go over is the addition of medications to Pharmacare. Could the minister give me the list of the medications that have been added to the Pharmacare system in the last calendar year and the ones that we anticipate will be added in this budgetary year?
Hon. P. Priddy: Beginning in January 1998, because I think you asked for the
calendar year, hon. member
A. Sanders: Both.
Hon. P. Priddy: Okay. I'm sure we'll all have patience with my pronunciation of some of them. In January 1998, Xalatan was put on. In June 1998, four different doses of Requip -- 0.25 milligrams, 1 milligrams, 2 milligrams and 5 milligrams; Tasmar 100 milligrams and Tasmar 200 milligrams; Famvir 500 milligrams. That was all June 1998. In August 1998, Diovan 80 milligrams and Diovan 160 milligrams. In October 1998, Alesse -- for a 21-pack and a 28-pack. In December 1998, I guess it's a short form, but it looks like Ocuflox Ophth solution. Also in December 1998, Humalog; Avapro -- 75 milligrams, 150 milligrams and 300 milligrams; Alphagan -- 0.2 percent and 0.5 percent; hP-PAC -- it's an hpylori eradication drug.
[2015]
In January 1999 -- we're into this calendar year, so far, anyway -- Baycol 0.2 milligrams and Baycol 0.3 milligrams; Mirapex 0.25 milligrams, 1 milligrams and 1.5 milligrams -- that was into February; Wellbrutin SR 100 milligrams and Wellbrutin SR 150 milligrams. In March, a COPD asthma drug, Combivent inhaler; still in March, Ocostim. In April '99 -- so two months ago, I guess, Biaxin -- 125 milligrams in suspension, Biaxin 250-milligram tabs and Biaxin 500-milligram tabs; Imitrex; and Avonex. Still April '99: Rebif, 11 micrograms; Rebif, 44 micrograms; Rebif, 88 micrograms. Still in April: Copaxone; Atacand, 8-milligram tabs; Atacand, 16-milligram tabs. Up until this past calendar month of June '99, it looks like Aredia IV, 30 milligrams and 60 milligrams; Amerge, 1-milligram tabs and 2.5-milligram tabs; and Zomig, 2.5-milligram tabs. That takes us from January of '98 to June of '99.
A. Sanders: Some of those medications are inexpensive, and some are very expensive. Can the minister outline what process brought those particular drugs on to Pharmacare and rejected others?
Hon. P. Priddy: We do that in a couple of different ways. One of them is that we look to the therapeutics initiative committee for recommendations in terms of the efficacy of the drug and the pharmacoeconomics initiative in terms of the cost benefit of the drug. Sometimes a drug company will give a submission directly to us, and we will send that either to the TI or the pharmacoeconomics committee.
A. Sanders: In the ministry's own handbook on Pharmacare, it says:
"
. . . the pharmacoeconomics initiative provides Pharmacare with independent scientific and economic assessments of the cost-effectiveness of new drug therapies. While the [therapeutics initiative] evaluates safety and medical effectiveness, the [pharmacoeconomics initiative] considers broader cost-effectiveness. . . [including] social costs and benefits and issues such as quality of life, likelihood of hospitalization, and effect of the drug on work days lost."
Can the minister comment on the status of the drug alendronate or Fosamax right now?
Hon. P. Priddy: It's on a second-line authority.
A. Sanders: Can the minister comment on the use of Fosamax in other provinces?
Hon. P. Priddy: To the best of our information, the information I have in front of me is that no province other than Quebec provides coverage -- and I assume that may be first-line coverage -- for alendronate.
[2020]
A. Sanders: Actually, Alberta offers Fosamax open access for a year as well. Big bad Alberta, which has such a terrible health care system, seems to be offering a whole lot more than British Columbia these days.
Let's look at the pharmacoeconomics initiative committee with respect to the evaluation
factors. Is the minister aware that the research on alendronate in the scientific journals
that are reputed by most who follow these kinds of issues is
[ Page 14146 ]
incontrovertible. Based on the drugs that have been added to Pharmacare and on the evidence in the scientific community, can the minister tell us how the therapeutics initiative group arrived at their decision that this would not be one of the medications to cover?
Hon. P. Priddy: We don't have that print information with us. I'd be happy to submit that to the member -- probably tomorrow, if that would be satisfactory.
A. Sanders: I would be most appreciative of that. But for the minister's information, should she have received different messages from the middlemen, this medication, in many reports -- the New England Journal of Medicine and other sources -- is probably one of the medications best linked in terms of use-to-response, in terms of efficacy. Therefore the sensibility of it not being covered or used as a second-line drug is a little bit of a stretch from the therapeutics initiative.
If we're looking at the criteria that the pharmacoeconomics initiative committee says
it's using -- likelihood of hospitalization, effect of drug on lost workdays, social
costs, quality of life
The other thing that I think needs to be on the record, seeing that this drug is second-line and not available for many women in our province, is that the therapeutics initiative committee -- in their wisdom, having come to this decision -- has come to a different decision than 700 physicians, the Osteoporosis Society of B.C., 22 experts from all regions of the province in the B.C. Coalition of Osteoporosis Physicians, the Federation of Medical Women of Canada and many other groups. In fact, the Federation of Medical Women, which does not particularly wish to back a specific drug, has stated in its mission statement: "As osteoporosis is a significant women's health issue, the Federation of Medical Women of Canada recommends that osteoporosis be managed effectively, including government-funded access to appropriate diagnosis, prevention and treatment, and ensuring that provincial formularies provide a choice of available drugs."
That choice does not include, in the province of British Columbia, a drug that has excellent clinical evaluation and research to say that of all the drugs we do cover in Pharmacare, this drug probably has better research to back its covering than others. So it's an interesting conundrum as to why we do not cover this medication in this province.
I would like the minister to commit that she will have an impartial review of the information that the public and prescribing physicians would like to see covered and ensure that the therapeutic initiatives has come to an unbiased and impartial judgment, based on the information that they've used.
Hon. P. Priddy: I think the member knows this, but whenever there's new clinical
information that becomes available, we do ask either the TI or the PI to review that, and
I would do that in this case. If the member is asking for an external review
A. Sanders: Well, I'm asking the minister in her capacity as minister to review the information she has available. I will remind her that last week, we pointed out that the therapeutics initiative committee did in fact recommend a drug. Then the letter that came from the ministry staff said that no, they didn't. I want to know that this therapeutics initiative group in fact said that it wasn't a drug that should be covered. I'm not convinced that the information that gets to the minister is always the information that's been procured and decided by the therapeutics initiative. I'd like a clear line of rationale from one body to the next.
[2025]
My last question -- and I'll turn it over to my colleague to talk about another drug of concern -- is: what drugs, if any, are going to be added to reference-based pricing in this fiscal year?
Hon. P. Priddy: Pharmacare has no immediate plans to reference-base any other categories.
L. Reid: I am delighted to enter into this debate this evening and to continue to canvass this issue with the Minister of Health regarding the treatment of patients with dementia in the province. I trust that by the conclusion of this evening's debate we'll indeed have a meeting of the minds in terms of how best to put forward the kindnesses which I believe that the vulnerable elderly in our population deserve.
I want to start by framing the argument this evening. This is a press release of June 15, 1999:
"Family Physicians Given Unique Canadian Guidelines for Diagnosis and Treatment of Alzheimer's Disease and Other Dementias. Canadian Consensus Conference on Dementia updates ten-year-old guidelines with 48 new recommendations published in Canadian Medical Association Journal today."
It goes on:
"Family physicians who provide the majority of care to patients with dementia in Canada now have access to a 'blueprint' for the assessment and care of patients with suspected dementia which is unique in the world. This new Canadian approach, based on the best available evidence, provides family practitioners with 48 recommendations developed by a group of 38 Canadian experts and published today in the Canadian Medical Association Journal. The guidelines reflect the evidence-based conclusions of the latest Canadian Consensus Conference on dementia held in Montreal last year."
My point in bringing it forward is that the recommendations they make speak very strongly to the points I intend to raise as we discuss the Aricept medication.
"The 48 recommendations address the full range of caring for patients with dementia, including early recognition, the importance of careful history and examination in making a positive diagnosis, essential laboratory tests, the disclosure of diagnosis, the importance of monitoring and supporting caregivers, managing behavioral disturbances, detecting and reporting [other practices] with particular emphasis on cognitive-enhancing agents.
" 'Canada is the only country to have such evidence-based clinical practice guidelines specifically for family physicians,' said Dr. Gauthier. 'Considering the emotional and economic burden of dementia, as well as the increasing number of patients, these guidelines should contribute to more consistent
[ Page 14147 ]
and improved clinical care of persons with dementia by family physicians. They will also help contain costs through more selective use of lab testing and promote the appropriate use of medications.' "
Now, the key recommendation I wish to put on the record is:
"Among pharmacologic agents available in Canada, Aricept donepezil is the first and only approved drug available for the treatment of mild to moderate Alzheimer's disease. It is recommended that a trial course of the medication be prescribed to informed and willing patients with mild to moderate dementia due to probable Alzheimer's disease."
That is the recommendation from the report.
I want to put on the record, as well, the support that comes:
"The Alzheimer Society of Canada welcomes the publication of the guidelines, which are being distributed to close to 60,000 physicians across the country. 'We applaud this achievement,' said Steve Rudin, executive director of the Alzheimer Society. 'These guidelines are an invaluable resource for family physicians, and they assist them in the care and treatment of people living with Alzheimer's disease and in working with their caregivers and families. We look forward to their implementation across the country.' "
The person representing us was Dr. Howard Feldman, of the department of medicine and neurology at the University of British Columbia. This report is roughly six weeks old, is in place across the country and will make a difference in terms of how the fragile and vulnerable elderly are treated.
[2030]
The case I intend to make this evening will in fact compare the cost of hospitalization to the cost of effective, appropriate drug interventions and will, I believe, illuminate the issue for the minister in terms of this particular strategy, this one that has been put forward by the medical community and by the caregivers -- the families of individuals suffering from Alzheimer's today -- to be the most decent way to proceed in terms of the discussion.
I will reference the estimates of last year -- July 28, 1998 -- between the minister and myself. We canvassed the issue at some length, and one of the concluding remarks made by the minister was: "I don't know if any other province is considering it; they weren't, the last I heard. We will continue to monitor the studies on it." The minister may indeed know that since that comment was made, the province of Ontario has gone to a proposal -- the Ontario Aricept reimbursement program. Before I continue my remarks, I would simply ask the minister what status, what state of discussions there might be underway today in British Columbia.
Interjection.
L. Reid: That was a very complex answer from the minister, so let me repeat the question. I am interested in knowing where British Columbia currently, is in terms of a status report on the discussions of this particular decision.
Hon. P. Priddy: My understanding of Ontario's -- and then I'll move to ours, and I would stand to be corrected -- is that Pfizer provides the first 12 weeks, and then government will put it on as a second-line drug, not as a first-line drug. Here in British Columbia, as a result of a number of people coming forward -- including the member for Richmond East, other people who have accompanied her and people like Matt Wythe from the Alzheimer Society -- I have asked, and currently the therapeutics initiative committee is reviewing Aricept again.
L. Reid: Thank you for that; that warms my heart.
I will put on the record, then, some correspondence that has basically come from the University of Victoria: "Donepezil hydrochloride: A Cost-Effective Approach to Managing Alzheimer's Disease." It's the report written by Wynona Church, a researcher at the University of Victoria. If there's a current review or evaluation ongoing, I would be delighted if these comments could form part of that discussion. I've certainly made the case fairly extensively over the last number of years that it is a situation where not just the patient is affected but all the caregivers -- family members, friends, relatives, neighbours; all of those folks who are drawn into the care and nurturing of this individual.
I simply want to put on the record some of the cost-benefit analyses that have been done at the University of Victoria. The annual net economic cost of dementia in Canada was in excess of $3.9 billion in 1991, which represents 5.8 percent of Canada's total health care costs. They estimate the cost per patient in that year to be more than $13,000, whereas they make the case that the cost in today's dollars of putting an Aricept program in place is certainly well under $900 annually. A difference of more than $12,000 is something that should and could be looked at very, very easily.
Having been the past critic for science, technology and research, one of the other issues from this paper speaks to me very strongly. The percentage breakdown of $3.9 billion spent on dementia reveals that the most significant component of the total cost was long-term institutional care. That was Gauthier's study of 1997. According to the Canadian Study of Health and Aging, long-term institutionalized care accounts for 62 percent of the $3.9 billion budget. Unpaid services by caregivers represents 18.1 percent of the budget, and paid services fell slightly behind, at 17.5. Surprisingly little was put into research: 0.7 percent. Even more shocking was the fact that only 1.7 percent was spent on drugs. That has certainly not been a position that has been put forward very strongly either by this government or other individuals I've spoken with. They've always come back to suggest that the drug cost of treating Alzheimer's has been enormous -- 1.7 percent, according to this study.
[2035]
I'm more than happy to share this information directly with the minister, but there are also some other very fine comments that I wish to put on the record. Donepezil hydrochloride can also delay the need for institutionalized care by up to six to 12 months for patients who suffer from the mild to moderate form as diagnosed by the MMSE, the mini-mental-state exam. This is a significant advance in the management of Alzheimer's disease. If a patient is suffering from moderate Alzheimer's, he or she will cost the health care system in excess of $12,000 for six months -- again, as compared to $900 for this drug. This would save close to $12,000. In a cost-benefit analysis, it would seem that investing $900 for a return of $12,000 per patient would be very worthwhile.
If the mandate of the B.C. Pharmacare system is "to improve the health status of
British Columbians by ensuring reasonable access to and appropriate use of prescription
drugs and related benefit services for eligible residents of the province" -- and
that's the wording that's currently found on the Pharmacare web site -- the author is
saying she thinks it's unfortunate that the B.C. government has failed to observe the goal
that it set forth. In terms of the macro issue, she states: "
[ Page 14148 ]
context in which it exists -- namely, the social world. Covering the drug costs would be considerable more cost-effective in the long run than covering a multitude of other costs related to institutionalized care."
The minister, in the estimates of last year, made repeated references to a lack of research in this area. So again I want to put on the record a study that was done. The references that go with this paper include a number of studies that were done, and I'll absolutely pass it on to the minister as well. The author says:
"
. . . it is imperative to reconsider the scientific evidence surrounding the efficacy of donepezil hydrochloride. In a 24-week, double-blind, placebo-controlled trial. . . of 473 patients with Alzheimer's disease, patients in the donepezil hydrochloride group were found to have a higher cognitive functioning than those in the placebo group."
That was done by Rogers et al in 1998.
"They showed few side effects, had a high level of compliance, and caregivers reported a higher qualify of life experience for the patients" -- which I think is what this discussion should be all about, that we should be out there supporting families and caregivers.
"In a study conducted to assess the behavioral cognitive functioning of 468 Alzheimer's patients, a statistically significant improvement on cognitive scores (based on the ADAS-cog) was found for the group taking donepezil hydrochloride, as compared to the placebo control group."
That's Standish and Molloy of 1998.
"A clinical study that examined Alzheimer's patients by way of several case studies revealed that donepezil hydrochloride enhances cognitive function, is well tolerated and is easily administered." That's the Geldmacher study of 1997. "I think it is important to note that the cognitive enhancement that was found in the study conducted by Geldmacher was reported not only by MMSE scores but also by the family and caregivers."
So I simply put those items on the record, hon. Chair, to put to rest the concerns that the minister raised last year, in terms of there not being sufficient studies to back up a decision.
Finally "in a retrospective study of 473 Alzheimer's patients, Rogers and Friedhoff found that donepezil delayed the loss of activities of daily living by a year." So someone suffering from Alzheimer's disease today may indeed have a hugely enhanced quality of life for an additional year.
I'm not clear, from the minister's comments, if these additional research studies will form part of the review. I will simply ask her to comment. I trust that they will form part of the review.
Hon. P. Priddy: I know that the member mentioned some of this information in conversation a few days ago. If you could give that to us quickly -- you don't have to fly it across the floor, but reasonably quickly -- we would be pleased to get that to the TI.
L. Reid: I will be sending it over momentarily.
The minister referenced the Ontario discussion, and I will indeed put it on the record:
"Effective June 1, 1999, Aricept, indicated for the symptomatic treatment of mild to moderately severe Alzheimer's disease, will be a reimbursed limited-use benefit under the Ontario drug benefit program. To be eligible, all patients must have confirmed diagnosis of mild to moderate Alzheimer's disease. There are two categories of further eligibility for the reimbursement of Aricept.
"(1) For patients who have been on Aricept for the past 60 days or more, those patients will be eligible for reimbursement effective June 1, 1999, provided they have a confirmed diagnosis of Alzheimer's disease and have an MMSE score between ten and 26 from a test conducted within the past six months.
"(2) For patients who have never taken Aricept, have taken Aricept in the past but not within the past 30 days or have been taking Aricept for less than 60 days, these patients will be given a 12-week trial prescription of Aricept, provided they have an initial MMSE score of ten to 26."
[2040]
"Caremark, a health care company and pharmacy, will administer this program, for which the medication will be provided without cost to the patient by Pfizer Canada. At the conclusion of the 12 weeks, those patients whose MMSE score is ten or more and has increased, remained the same or declined by fewer than three points will receive medication as a limited-use benefit from the Ontario drug benefit plan.
"Application to the trial prescription program and for limited-use reimbursement is to be done by the physician using a special Aricept limited-use reimbursement form from the Ontario drug benefit plan."
That is basically where the province of Ontario is. I would simply hope that the minister can give me some guidance, beyond her earlier comment that a review is underway. Will the therapeutics initiative committee specifically make a recommendation in terms of how best to launch this product into the hands of the people where it will do the most good as quickly as possible? Does the minister have a time line?
Hon. P. Priddy: The therapeutics initiative committee makes the recommendation to Pharmacare; Pharmacare actually makes the decision. I hear your comment that Ontario has put it on as a second-line drug. They use a different phrase, but it's the same as our second-line drug category here in British Columbia. I can't guarantee you that Pharmacare will make a decision to advance this, but I have made the commitment -- and it's happening -- that it will be reviewed. I will add the information that you've given me to that review and wait for the recommendation from the therapeutics initiative committee to Pharmacare. I would expect that there will be a decision by the end of the summer.
L. Reid: I believe I heard the minister say the end of the summer, so that would be August or September of this year. It would be a wonderful thing if that were to happen.
In terms of the other issues -- which I know I've conversed many times with this minister on -- it would be to have her convey, in the strongest possible terms, the necessity for this. I mean, the guidelines are now there, put forward by the Canadian Medical Association. Sixty thousand family practitioners across the country will now be using these guidelines. It only makes sense that not just British Columbia but all provinces allow individuals to benefit from this product, which is highly tolerable to their systems and has the fewest side effects of any treatment for Alzheimer's disease on the market today.
My question to the minister would be: is she prepared to take a leadership role in terms of advancing this issue across the country? I know that a year ago, British Columbia wasn't prepared to lead off on this. The minister has indicated that in fact British Columbia may choose to be second now. They may choose to be part of the process to go forward and have Ontario followed by British Columbia. But I would like to know that when the Ministers of Health across this country meet, this Minister of Health will advance this issue on behalf of all Alzheimer's patients. Is that something that will likely come up on a health agenda for Health ministers?
Hon. P. Priddy: I think that if it comes up -- I mean, I'm not the federal Health minister -- it is more likely to come up
[ Page 14149 ]
with the ministers responsible for seniors. I don't actually see it on a health agenda necessarily. We could try and do that, but I actually see it on a ministers responsible for seniors agenda. That meeting had been planned for June and was postponed until the fall. We could try and put it on that agenda if you wish or if you think it would be useful for discussion there. I would think that those would be the ministers who would take the leadership to do that given that it is primarily seniors.
I do have to be clear that -- cost aside for a moment -- if our therapeutics initiative committee says to me, "We still don't see a therapeutic benefit," I would have some difficulty trying to lead the country in supporting it. That's the reason I've asked for the review, and we'll see what comes from that.
L. Reid: I thank the minister for that. In terms of my clarification, it would seem to me that in the majority of provinces, the Minister of Health is also the Minister Responsible for Seniors -- correct?
Hon. P. Priddy: Actually, it's six out of 14 Health ministers.
[2045]
L. Reid: I appreciate that clarification. Again, I would suggest and would hope
that the minister would take every opportunity to put it forward on both agendas, whether
it be the seniors' meetings or the health meetings. And certainly, based on what I've read
into the record tonight -- and I was very detailed and thorough in putting it on the
record -- the research that the therapeutics initiative indicated to the minister last
year did not exist does in fact exist and did exist last year. These report findings came
out in 1997-98, so they have been published for more than a year. I have a great deal of
concern in terms of the flow of information from the therapeutics initiative committee to
the minister. The minister will recall that in two separate instances last year, I did
come back and correct the record where, indeed, the minister was not provided with
accurate information regarding
I appreciate what the minister is saying in terms of not suggesting to the therapeutics initiative how best to proceed, but based on the information I provided and will provide, the research has been done. The double-blind studies have been done. And we canvassed it very extensively, minister, last year in the estimates. I could easily put these comments on the record -- that the staff of the day were suggesting that there were not appropriate double-blind studies and discussions in place.
In that that notion has now been put to rest -- and, frankly, it was not valid -- I'm not clear how the minister could arrive at the conclusion that the therapeutics initiative could somehow make the same decision they made last year, when they were basically saying that there was no information. Faced with the facts and faced with evidence-based research and with a province that has indeed chosen to support seniors and their families around the treatment of Alzheimer's, there is enough precedent on the table, which I hope will give the minister comfort.
In terms of the ongoing discussions for the Ontario reimbursement program for Aricept
"Pfizer Canada and the Ontario Ministry of Health have reached an agreement under the partnership program which will provide payment to eligible Ontario residents for Aricept, the only approved drug treatment for Alzheimer's disease. In addition, the program will provide educational materials to help patients, their caregivers and physicians deal with this devastating, mind-robbing ailment. The agreement is the culmination of discussions between Pfizer and the government to ensure that any Ontario resident with mild to moderate Alzheimer's disease who is eligible for the Ontario drug benefit program, including all those over age 65, will have access to reimbursed treatment with the drug Aricept.
"The reimbursement plan includes a trial prescription program funded by Pfizer Canada. Once all the diagnostic criteria for mild to moderate Alzheimer's disease have been met, the patient will receive as a benefit under the trial prescription program a 12-week supply of the once-a-day Pfizer medication Aricept, the only medication approved in Canada for the symptomatic treatment of mild to moderate Alzheimer's disease.
"The patient and caregiver will also receive a Pfizer-sponsored program of educational material, including a video and a series of newsletters developed by the Alzheimer Society of Canada. The physician will be supplied with diagnostic and other support tools to help him or her evaluate and track the patient's progress."
I put that on the record because I believe it's important to foster the notion of partnership with front-line researchers in this country.
We have a ministry of science, technology and research. We have individuals in this country who are doing very, very fine work. It seems to me that we want to keep the door open. We want to support those individuals. It's never made sense to me that this government has not been more responsive to some of the pharmaceutical companies who have wished to meet with them about some issues. Again, I could reference those remarks from last year's estimates as well. It seems to me that if you do not honour the individuals who do the basic research, you have, frankly, done nothing to support the geese that are laying the golden eggs when it comes to finding solutions.
I think that in this day and age, the public at large are looking for politicians to be solution providers and to come back to the table with performance-based research, evidence-based research, that says that this is the way we should proceed. If there have been decision-making vehicles -- such as the therapeutics initiative committee -- structured to make a decision, the minister has a responsibility to ensure that the right information is in their hands and that they return a decision that makes the most sense for the public and, in this case, the very vulnerable members of the public who happen to be the seniors in our society.
[2050]
I'm trusting that the minister has heard me on these questions and will in fact come back to this Legislature at the earliest opportunity and put forward a position that cares for and that extends some kindnesses towards individuals today suffering from Alzheimer's. If Aricept is the only product that has the least number of side effects and is the most tolerated by patients, it seems to me that a 12-week trial prescription program, which British Columbia has often engaged in for other product lines, would be a fabulous place to start. I would ask the minister to comment.
Hon. P. Priddy: I would make two or three points. The member has for some time, unquestionably, made a very strong representation on behalf of the work that is done by people who are working with the drug Aricept and its effect on people. As I say, we're doing that review, and that was in part at the strong representation of many people.
[ Page 14150 ]
I do want to be sure, though, that we are clear that because we are not currently
funding Aricept as a first- or second-line medication
I'm not saying that they replace that. I'm not saying that if the information turns out differently than last time, then that should not be added to it. But I am saying that there are other commitments to Alzheimer's going on within the Ministry of Health -- continuing care and certainly the office for seniors.
I want to go back, if I might -- just for a moment, member, before we close -- to the comments about our reluctance to meet with the pharmaceutical companies who are actually doing the work out there every day, not just around Aricept but in general on that.
If I was just to look at last year -- or just the last calendar year, even -- the ministry met last June with Astra, Novopharm, PMAC, Berlex, Bayer and Eli Lilly; in July with Abbott Laboratories, Hoffmann-La Roche, Boehringer Ingelheim, Schering, and SmithKline Beecham; in September with CDMA, Rh�ne-Poulenc Rorer, Abbott Laboratories, Bayer, Glaxo Wellcome, Leo Laboratories, Janssen-Ortho, Pfizer, Rx, BMS, Scherring, Fournier, and so on. There are another ten that I won't read to you.
In this calendar year we've met with Abbott, Astra, Byk, Janssen-Ortho, Purdue Frederick, Pfizer, SmithKline Beecham, Dupont, Glaxo Wellcome, Leo Labs, Zeneca, Hoffmann-La Roche, Merck Frosst, Solvay Pharma. And on April 28 we actually hosted an open forum for Pharmacare and the industry, and there were 40 people there from the pharmaceutical industry. So I would suggest that there is a willingness on the part of the ministry to work and meet with pharmaceutical companies.
L. Reid: I appreciate the minister reading that list into the record. I would simply ask: how many of those individuals has she met with personally?
Hon. P. Priddy: I can't actually tell you how many. It's not a large number, but I have met with some.
L. Reid: Noting the hour, I'm just going to conclude with two last points on the Aricept question. I think the minister was suggesting that Ontario would not put this drug in place over the long term.
Towards the end of the 12-week trial, physicians will conduct another MMSE test, and if the patient continues to meet the program criteria, part B of the limited-use form and a prescription will be given to the patient so their pharmacist can initiate coverage under limited use. These forms must be resubmitted annually thereafter. To continue to be eligible for reimbursement, all patients must maintain an MMSE score of ten to 26, as measured on an exam conducted annually at a minimum.
[2055]
So I think there's some framework in place, if you will, that would allow Ontario recipients to continue to receive that product over a number of years. I think that, frankly, is and should be the goal for this province when it comes to being a product that hopefully could increase the functioning level of British Columbians, could improve the quality of their life as they work their way through this very devastating disease.
I will thank the minister most sincerely for her comments this evening. I appreciate it
immensely. I'm delighted that the review is going forward. If there are ways that we can
continue to advance these issues -- in terms of looking at the cost of hospitalization
versus the cost of effective drug therapies -- where people can have some personal
liberties and choices and can, hopefully, remain in their own homes and continue to have
quality of life
Noting the hour, hon. Chair, I would ask that the committee 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. P. Priddy moved adjournment of the House.
Motion approved.
The House adjourned at 8:58 p.m.
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