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.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, JULY 6, 1999

Volume 16, Number 17

[ Page 14151 ]

The House met at 10:05 a.m.

Prayers.

Petitions

The reason that I present these separately is because the second petition is signed by 250 individuals, but these are individuals who are actually in receipt of home care in the capital regional district and who, again, express concern about the manner in which it's been proceeded with.

The Speaker: The hon. member presents petitions.

Orders of the Day

The House in Committee of Supply B; W. Hartley in the chair.

ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS
(continued)

Hon. P. Priddy: With the agreement, I think, of the opposition critic and our desire not to leave outstanding questions, we have answers for some questions that were asked earlier. We said we would try and get back to people before estimates were over. I think we have agreement that I would just read those answers into the record, and I'll identify what the question was. I think ten minutes should do it.

There was a question taken on notice from the member for Surrey-White Rock about diet, training and nutritional information for parents and children with celiac disease. There are about 1,400 children with diabetes in B.C. If 7 percent have celiac disease, it would be about 240 children in the province.

[1010]

I'm sorry -- may have misquoted myself or the note. B.C. Children's Hospital has recently confirmed celiac disease in 20 diabetic children, not 20 percent.

The member for Cariboo North asked a question about the ICU at G.R. Baker Memorial Hospital being threatened with shift closure because of a lack of qualified staff to operate. According to the CEO of the Quesnel and District CHC, over the last three months there were two occasions when a shortage of skilled ICU nursing staff almost forced the closure. Fortunately, at the last moment administration was able to find skilled nurses to fill the vacant shifts.

In response to the shortage -- and that's provincewide -- of skilled critical-care nurses, G.R. Baker launched its own four-month in-house training program at the end of last year, and in the last six weeks three nurses have completed that critical-care training. But they do expect that in the summertime, with holidays, they may still have a challenge filling some of those shifts.

Another question from that member was around Quesnel ultrasound services -- about why the hospital had its remote ultrasound removed. The hospital there provides about 3,000 ultrasound exams per year and receives radiologist service four days a week from a Prince George radiologist. The diagnostic accreditation program and the Medical Services Commission feel it's important that a radiologist be on-site when all ultrasounds in B.C. are performed, to ensure quality. For very small sites, it is possible, based on geographic remoteness and low volumes, to be granted remote status by the diagnostic accreditation program, allowing an ultrasound technologist to do ultrasounds on-site when there's not a radiologist there.

In 1999, G.R. Baker was no longer considered eligible for remote status, as it performs 150 scans per months more than the agreed-upon or acceptable limit. In May they were informed that they were no longer eligible to bill as a remote site and were allowed two to three months to readjust their staffing levels. They've rearranged their ultrasound bookings so that all scans are now performed during extended hours during the four-day week that the radiologist is on-site. According to the CEO, this has worked well for patients. They're receiving the service they need, and the radiologist is always there to be able to read the films, which we know is often. . . . We've talked before about the issue between when you have the test and when you might get the information. . . .

We had a question around Dawson Creek from the member in that area, about someone ambulanced to Edmonton because he couldn't get a CAT scan. A review of the patient record has taken place. The patient had been booked electively to be seen by a specialist in Edmonton in January. The condition worsened, and he was referred earlier, as it is a condition that we could not look after here. Patients -- at least in that area -- are given the option of Edmonton or Vancouver. Most patients prefer to go to Edmonton, as it's half the distance.

I think we may have answered this; maybe not. There was a question about legal fees in the CRD tobacco bylaw court challenge. As of May 31, 1999, the Ministry of Health

[ Page 14152 ]

From the same member, on the 800 Vancouver Island cancer patients that we cannot service at this time and where would they be serviced. . . . From December '98 to May '99, there were 1,030 radiotherapy treatment courses provided for Vancouver Island patients. Of these, 831 were treated in Victoria and 199 received their treatment off-Island. That's 19 percent: 191 in Vancouver, five in Surrey, three in Kelowna.

There was a question about the parkade from that same member, on why there's been such a delay around the issue of the parkade. The answer is -- and I think the member knows this -- that I understand the site has been selected and the project's in the preliminary design stage. It is 100 percent financed by the capital regional district -- the parkade part, I mean. The capital region is interested in self-financing the project and has made this proposal to the ministry. We haven't yet received a formal request from them. I think it was around: "Were there extra costs?" If there's agreement for the CHR to self-finance, then they would be expected to be reimbursed for all expenses related to the project to date.

[1015]

Around the critical-care unit at Kelowna General, which I think the member from Kelowna asked about, the earliest that construction will finish is February-March of 2000. It was actually approved on the basis of no operating cost increase; that was actually one of the questions the member asked, about operating dollars. Apparently the project was approved on the basis of no operating cost additions. Since approval of the project, there has been a suggestion that the number of beds should be expanded even beyond what is approved, but the current project is proceeding at the approved level.

Just to add to it -- this is the last one, and I thank you for letting me read these in -- this critical-care unit at Kelowna General will centralize 17 critical-care beds that are currently fragmented around smaller units of the hospital. It will add one ICU bed without increasing operating costs -- at least, that was the agreement. It also includes a six-bed shelled-in unit for the proposed expansion of cardiac surgery. I think those were all the ones we'd get back to you on.

C. Hansen: Some of the members that raised these particular issues may want to follow up. I know there was one issue in particular that I am a little bit familiar with, but not as familiar as the member for Okanagan West is. That is the issue of the critical-care unit in Kelowna General Hospital. Does the minister have at her disposal the amount of. . . ? She said just now that there would be no increase in critical-care dollars for that unit, that it was meant to operate on the existing budget that was there. I'm wondering if the minister would be able to tell us how much is allocated today for critical care in the Kelowna area.

Hon. P. Priddy: I can get that to you before estimates are over. I don't happen to have that staff person right here.

C. Hansen: My understanding from my colleague -- the reason that she raised the issue in the first place -- is that last year there were zero dollars allocated for critical care in the Kelowna area and that all of the critical-care dollars were in fact allocated in the lower mainland. So with the opening of the new unit, there didn't show any increase in critical care. But if there are zero dollars allocated in this past year, then it's obviously not going to serve them well if there are zero dollars for the new facility once it is opened. I certainly look forward to a response from the minister in due course on that particular issue, unless she wishes to respond now.

Interjection.

C. Hansen: In due course? Okay, thank you.

I want to move on to. . . . Actually, what I'll do is first of all just sort of outline a program as to where I anticipate our discussions going today. I provided this list to the minister's office first thing yesterday morning, but for those that are perhaps trying to follow these discussions either as a result of the televised broadcast or as a result of reading through Hansard, it may be useful for them to know how we see these issues coming forward.

[1020]

The issues subsequent to our resuming the sitting today after 2 o'clock, in the order that I see us dealing with issues, are capital projects -- and a lot of that has already been dealt with as a result of the input from my colleagues -- public health, health research, mental health, communications and issues management, Medical Services Plan issues, professional regulations and then information management. That's the sequence that I foresee us dealing with these remaining subject areas.

On the issue of wait-lists, the minister earlier this year had directed the ministry to put forward a web site that gave the wait-lists for various hospitals around British Columbia and that also posted the wait-lists for individual surgeons in B.C. based on their specialties. It has become very clear, I think, to those of us who have followed that web site since it was launched, that it may have been launched in haste. Clearly the information that was posted on that site was not accurate -- at least, not accurate to the extent that it would be useful to a patient in British Columbia trying to determine how to plan their health care. I'm wondering if the minister could explain to the House the rationale for launching the web site when they did, when clearly the data was not accurate enough to be useful to anybody trying to go into that particular web site.

Hon. P. Priddy: I understand the question. The data that is on the web site is provided to us by the hospitals on information that they get from the physicians. The member is correct. People called and said that some of that data was not

[ Page 14153 ]

Even that being the case, I don't believe that we shouldn't have launched it in the first place. We said when it went up that we were sure there would be all kinds of challenges as it moved along, and we have corrected them as we've moved along. I've heard from patients that they actually do find it helpful. If people call us and say it's not the correct data, then we correct it. As I say, we post what the hospitals give us, so that's the data that the hospital is using to work on.

C. Hansen: Maybe the minister could outline for us what she sees as the purpose of this web site. What is it meant to accomplish? One of the things that's clear to us now is that it's not going to contain current data. I think the minister's most recent press release talks about the data gathered being several months old in its most current form. Certainly if you start looking at wait-lists around the province, particularly the wait-lists for individual surgeons, they can be quite volatile. To have wait-list data that's several months old. . . . It may have been accurate back in December, but even if it accurately portrayed what the December data was, how is that relevant today? How is that a useful tool for patients in the province?

[1025]

C. Hansen: One of the issues that's been brought to my attention by some of the surgeons in the province is that their particular individual wait-lists are a product of the amount of operating time that they can get access to. If you have a surgeon who, as it may appear, may have a short wait-list compared to another surgeon in a neighbouring community or health district -- or even a colleague -- that may be a product of the fact that that's all the operating time that particular surgeon has access to. As patients make choices -- which is a word that the minister has used a lot in this particular context of giving patients choices -- a choice is to consider, at least, going to a surgeon with a shorter wait-list. Is the minister prepared to back that up with providing additional OR time for those surgeons so that they can deal with patients who happen to move to them as a result of an apparently shorter wait-list?

Hon. P. Priddy: In spite of the fact that we've been getting information back since 1992, it wasn't until the information was public that a number of these concerns came forward. So even that, I think, is a useful outcome or output. It's not the reason you would do it, but it's been a useful side effect to having the web site up. As we work with the BCMA and surgeons across the province -- because they've raised that with us as well -- then we will look at whether that is information we need to add to the web site so that a patient understands that, or whether we need to be reallocating or looking at different kinds of times. Each hospital allocates its OR time as it sees appropriate to the different services and different surgical services that it provides. But we will continue to get that information back, and we're working with the BCMA to analyze it.

C. Hansen: The minister raised the issue of the BCMA involvement in this. Why were the BCMA, or at least the specialists in British Columbia, not involved in the design and launching of this web site in the first place?

Hon. P. Priddy: The BCMA certainly had a briefing on the web site. Did they have input into its design? No, they didn't; it's a ministry web site. But the method of information collection is no different, whether it's on a web site or on a piece of paper, and the BCMA is aware of what that is. Their physicians have been collecting information in exactly that way with exactly the information you see on the web site for the last seven years. So no, they weren't consulted on the design of the web site, but they've always been part of the data collection information.

[1030]

But the one thing that does confuse me is the connection between the RAD days and the wait-lists. Perhaps the minister is playing some games when she tries to point that finger. The reason I say that is because the wait-lists become a product of the amount of OR time that is available, and the amount of OR time that is available to a surgeon in British Columbia is a product of budgets that are allocated in the hospitals. The hospitals are going to allocate budget for a certain number of hours of OR time. If you shut down an OR for a week, and it's totally predictable. . . . You know it's going to happen. It's not something that is sprung by surprise because of some unexpected labour action or some other thing that might occur, which will result in an OR being closed and all elective surgeries being cancelled.

The one thing about the RAD days, whether you support or don't support them, is that they were totally predictable, in that hospital administrators around this province were able to basically close down their ORs because they knew the surgeons weren't going to be there. But the money that was saved on that could easily be allocated to make sure that OR time was open during other weeks. So in that context, I would like the minister to explain why she persists in pointing fingers at the RAD days as one of the primary causes of longer wait-lists in British Columbia.

[ Page 14154 ]

In fairness -- and I know the member has said that they did not support that as well -- people are booked a fair bit ahead, and many people were booked far further ahead than the amount of time given for RAD days, particularly in the beginning. It is true that many people's surgeries were cancelled. People are using the money to do catch-up. But that still means that for every RAD day, that's how many surgeries were cancelled, and somebody has to try and catch up someplace else and probably with additional money.

C. Hansen: Well, maybe the minister can explain how that differs from the corporate days that hospitals have scheduled over the last year, where the hospitals themselves have actually shut down their ORs for periods of time. I am just wondering how she would differentiate between the two, in terms of the impact it would ultimately have on waiting lists.

[1035]

C. Hansen: In fact, the RAD days resulted because of the lack of agreement specifically and, I think, because of the lack of constructive dialogue. I know the minister has made some comments earlier this year that she hopes that some of the spirit of cooperation and dialogue can be rekindled between the ministry and the doctors in British Columbia. That's something that I certainly hope we will see.

As we go forward this year, I think all of us are hoping that we can have that kind of an agreement that we're not going to be seeing RAD days on the part of doctors come back this year as a tool, because ultimately they don't help us solve the problems that are before us. So I hope there is meaningful dialogue, meaningful discussion, and that the BCMA and other physician representative groups are truly part of a meaningful dialogue in terms of how we can deliver health care in this province.

I want to move on to a press release that was issued by the Health Association of B.C. last week. They expressed concern over the underlying causes of wait times. Just to quote the opening sentence:

" 'B.C.'s health care system needs a coordinated strategy before the issue of long waiting times for elective procedures can be resolved,' says Robyn Woodward, chair of the Health Association of B.C."

"We appreciate the Ministry of Health's recent effort to deal with wait-lists-waiting times through such measures as targeted funding and increasing patients' access to information."

"We need to reach agreement and understanding across the province on these and other issues: how waiting-lists should be measured and monitored" -- I appreciate the fact that discussions are underway in cooperation with the western provinces -- "the different reasons for long waiting times, which can vary in each community; and the need for health authorities to have full responsibility for the continuum of care in their areas."

[1040]

As it moves on to HABC, since they certainly have the right to disagree with us, we have the right to disagree with them sometimes. I don't believe that there isn't a strategy.

Let me talk about three pieces. The issues of agreement and understanding on measuring, monitoring and managing wait-lists or wait times are being addressed by the Provincial Advisory Committee on Access to Care, which has representation from a variety of well-respected people who work in the field. This has been part of their ongoing work over the last 12 months.

Secondly, there was a recent study -- well, not that recent -- on acute medical beds and how they are used in British Columbia, which identified the use of acute care-beds and their association with the availability of long-term beds, ambulatory services and other community services. These issues are being acted upon by the various regions. The regions received $10 million late last year to act on this particular issue -- at least in the short term -- and on long-term strategies to come. The Ministry of Health -- you've referenced that already, member -- is working with the other three western Canadian provinces as a partner on the health transition funding. We've talked about that before, and we've talked about the five areas and so on. I won't necessarily read those into the record again, but the strategies around those five areas of surgery. . . . The $58 million that was allocated

[ Page 14155 ]

C. Hansen: I want to focus in on two specific areas of wait-lists that have been brought to my attention. One was brought to my attention by the B.C. Lung Association. They have a grave concern about the huge wait-lists that are growing for allergy testing for children. I know it's not something that typically attracts attention when we talk about wait-lists, but I'm wondering if the minister would have any comments in terms of the availability of allergy testing for children in British Columbia. It actually affects adults as well, but I think we primarily hear about it in regard to children.

Hon. P. Priddy: None of the staff here have had this issue raised with them, so we will check and get back to you during the estimates.

C. Hansen: The other issue is around Parkinson's disease and the provision of deep brain stimulation -- or DBS, as it's commonly referred to -- to help control tremors and stiffness that individuals with Parkinson's disease suffer from. There was a statement by a Ministry of Health official that serious consideration was given to funding DBS in this year's budget. I'm just wondering if in fact it is in this year's budget

Hon. P. Priddy: The answer is yes.

C. Hansen: Could the minister tell us what the extent of the funding will be and how it's going to be directed?

Hon. P. Priddy: We will be making an announcement about this next Monday, so I can provide the member with more detail around it at that time. There are dollars this year.

C. Hansen: I want to move onto the issue of the labs. I would like the minister to give us an update as to where we are at with the lab accord that was circulated last fall. It caused a lot of consternation. Certainly there are individuals all over British Columbia who have come to appreciate the lab services that have been offered in their communities and in their neighbourhoods. They saw the accord that was signed last fall as something that would certainly threaten that service in communities throughout British Columbia. My understanding is that the minister has indicated to some of the private labs that the process, at least, is on hold. Yet we see the committee that was provided for under the accord is proceeding -- has been structured under the chair of the HSA. My understanding is that it seems to be that on one hand, there are signals coming out that it is on hold; on the other hand, there are signals coming out that it's moving ahead behind the scenes. I'm wondering if the minister could clarify for us the status of that.

[1045]

The member is correct: it was identified in the "Public Sector Accord on Strengthening B.C.'s Public Health Care Services." The member is aware of that accord and has referenced it. What it is intended to do -- and I'll speak to the specifics in a moment -- is provide a framework within which unions, employers, the government and providers can cooperate in planning the provision of health care services in the future. The overall objective of looking at how we do our work with laboratories in B.C. is to improve both quality and cost of services and ensure to that British Columbians have access. The laboratories agreed to that as well. I've had fairly extensive discussions with them. They would not challenge that particular point at all.

We did hire or retain Mr. Bert Boyd to manage a process to solicit views of all key stakeholders. When the information went out, I know there was a great deal of anxiety on the part of the public that somehow they wouldn't be able to go to the lab that's three blocks away or whatever, which is very handy for many people and, I'm sure, used by many people even here. I stood back and asked Mr. Boyd to talk with all of the stakeholders in that. The laboratory people as well as the unions would say there are places to make savings in the system. So while the unions would say that, the laboratories as well -- the lab people at MDS and B.C. Bio -- agreed that there are ways to make savings within the lab system.

One of the recommendations from Mr. Boyd's report, I understand, is for a process for discussing and implementing those changes, in which all of the people would be at the table. I've accepted this recommendation; I've directed the ministry to set up that committee. That report will be released to the public once people have had an opportunity to review it. I think Mr. Boyd did a good job of talking to all of the stakeholders and identifying what the issues were. It was well articulated. I think that if all appropriate parties are involved, we will be able to do two things. We'll be able to make savings in the lab system, and we'll still make sure that patients are not denied access that they're currently accustomed to.

C. Hansen: The minister talked about the Boyd report; certainly that was going to be my next question. My understanding is that that report was finished in April. The minister made reference to that being released to the public once it has been reviewed by all the parties. Do all of the parties that are involved now have a copy of that report? When can we expect it to be released? This is something that I think is important that we get a specific time frame on, so that it is in the public domain.

Hon. P. Priddy: No, they do not have a copy of the report. But the ministry has been contacting people to set up a meeting for Mr. Boyd to actually walk people through the report. Then they will have it, and it will be public.

C. Hansen: But once that meeting takes place, will the report be made public? The minister says once parties have had a chance to review it. Are we talking a couple of weeks, or are we talking many months?

[1050]

C. Hansen: One of the numbers that has been tossed around in the discussion over who should be providing lab services is $25 million. It's a number that got thrown out early in the discussion -- that this was how much could be saved

[ Page 14156 ]

Certainly at the NDP convention, which I know the minister attended only a few weeks ago, there were three policy resolutions put forward on the issue of private labs, encouraging the government to go to a process of public labs only. Two of those resolutions referenced this $25 million number. Nobody seems to know where it came from. I'm wondering if the minister could tell us if she knows where it came from or, secondly, if the ministry has any estimation or has done any empirical work in terms of how much the private labs save the health care system, or vice versa.

Hon. P. Priddy: I don't know where the $25 million figure comes from. I suppose somebody would have to ask the movers of the motion, but I don't know where the $25 million figure comes from. What we have done is a comparison between British Columbia and other provinces -- particularly western provinces, but we've looked at all of the provinces. Our lab costs are significantly higher in British Columbia than they are in other provinces -- certainly in western provinces but, I think, actually compared to most provinces. I think the issue here -- and I'm on record, by the way, as saying this -- is cost-effectiveness, not ownership. I have publicly stated since the beginning of this discussion that I as the minister believe that there's room in the system for both, but that if there are savings to be made -- and I believe there are -- then we ought to look with all of the partners at doing that. But I've always said that there's room for both in the system.

C. Hansen: I want to move on to one very quick question about the B.C. Cancer Agency. I'm not sure that this is the right place to insert it, but I'll throw it out anyway at this time. The minister has indicated that there is going to be a review done with regard to the recent court case involving Stephanie Nicolls. I'm just wondering if the minister could advise us as to what type of review would be undertaken and whether or not she anticipates that there will be a public report made as a result of that review.

Hon. P. Priddy: I believe what I said is that I've asked staff in the ministry to work with the Cancer Agency to make sure that all the protocols are reviewed. I don't think I suggested an external review. If I did, that was not my intention at all. I mean, the Cancer Agency has its own protocols. It has an external review by way of their accreditation program, and I don't think that another external review is necessarily what we need to look at.

Since 1994, the cervical screening program has been reviewed on a regular basis and subject to improvements in its management and quality assurance. As well as that, the BCCA is subjected to periodic accreditation surveys in which full accreditation has always been the outcome. One of the things they would look at, of course, is the issue of how slides are dealt with or how pap smears are dealt with, how they're read and what the quality of that is.

So the BCCA will certainly be addressing those issues raised in the judgment. I've asked my senior ministry staff to work with the Cancer Agency to make sure that's done. That's what I meant by "review."

[1055]

I want to move on to, specifically, trauma care and, briefly, the emergency services. There was a very good article -- I guess it's a year ago now -- in the Georgia Straight on the whole issue of trauma care in British Columbia. It was written by Paul Grescoe. I want to read just a few quotes from this article and ask the minister to comment on it. It's almost ten years ago now, when a report was done for the Ministry of Health on trauma care in British Columbia. The report was titled "A Vision of Trauma Care in the Province of British Columbia." As I understand it, very few of those recommendations have been implemented. Eight years after the release of the report, only a handful of the recommendations have been implemented. One of them is a trauma registry and a central 1-800 hotline. But apparently there are relatively few hospitals that report to the registry.

This article says:

"B.C. may have 780 full-time and 2,300 part-time ambulance attendants, but only one-third of them are qualified at the emergency medical assistant 2 level. . . . The province doesn't have an action plan to ensure that sophisticated ambulance-equipped aircraft with well-qualified transport teams which are as easily accessible to rural hospitals. . . ."

"Most important of all, we don't have the regional network, proposed in the report, 'linking rural trauma units and the community trauma centres with regional trauma hospitals where more advanced skills and capabilities are located. . . .' In other words, small primary-care hospitals should be able to communicate with trauma hospitals in various regions. . . ."

One individual involved in trauma care says:

"I'd like to see a telemedicine system where you can transmit X-rays and CAT scans and talk to the trauma surgeon by computer. The ability to transmit the image can make the difference about the destination hospital and whether the patient needs to be transferred at all."

"He says the revival of the Emergency Health Services Commission might be the first step in a long steeplechase, but 'the government has to give that body the authority and the resources to do their job.' "

Hon. P. Priddy: To talk about emergency services in the context of the report. . . . I'm not able to do that at this time,

[ Page 14157 ]

C. Hansen: The only reference I have is that it was released eight years ago.

Hon. P. Priddy: Thank you. I don't have staff here that are current on the report -- at least on that one. We can answer other questions on emergency services, and we will either find it or get it from you and be able to then put our answers in the context of the questions you've asked directly related to the report.

[1100]

I will move on to the Vestrup report, which was done and released in January of 1997. A letter that I received from somebody who works very actively in health care. . . . I'll just read part of this letter:

"It has been two years since four-year-old Amanda Fletcher died in Maple Ridge. An ambulance was two minutes away, waiting to discharge a patient to the emergency ward at Maple Ridge Hospital.

"Little has changed. Ambulances still wait at emergency wards, trying to get patients into hospitals. At the larger hospitals in the GVRD, waits of one to two hours are not uncommon. Waits of three hours or longer are not unheard-of. All of this time waiting is time in which the paramedics are not able to respond to people in need. I find it ironic that the minister has just announced 30 additional extended-care beds to be added to Surrey Hospital. It has been very rare for ambulances to wait more than a few minutes at Surrey Hospital."

Hon. P. Priddy: In relation to the -- I don't know -- ten or 12 recommendations coming out of the Vestrup report, let me respond to what has been done directly related to those recommendations. The patient transfer fleet, which is one of the most important recommendations, went into operation in January. The B.C. Ambulance Service. . . .

Interjection.

Hon. P. Priddy: Pardon? Not this past year?

Interjection.

Hon. P. Priddy: I'm sorry -- the transfer fleet went into effect in January of '98. There was a recommendation about acquiring a CAD system in the lower mainland. The Ambulance Service is in the process of doing that, and it may already be completed through partnership with E-Comm. Response time benchmarks have now been defined in policy. All dispatch time clocks have been synchronized, and I think that was one of the issues and one of the recommendations as well. A target of 95 percent compliance with response time recording has been achieved to date. A reporting mechanism has been initiated through publication of a quarterly improvement report, which is also one of the recommendations about public accountability. The Ambulance Service is continuing to work with representatives of regional health boards and working groups to formulate and refine operational policies.

C. Hansen: I'm going to move on to long-term care, but I would be very interested in follow-up on the other report that I mentioned, from eight years ago. Perhaps that's something we could facilitate through a briefing with somebody in the ministry outside of the estimates process as well, if that's more appropriate.

I want to move on to long term care. One of the things I've heard the minister say -- and I've certainly heard individuals involved in health care around B.C. say many, many times -- is that so many of our acute-care problems at many of our hospitals in British Columbia -- certainly not all -- are issues regarding beds that are being tied up by individuals who should be in places other than an acute-care hospital.

A report was recently released by the Vancouver-Richmond health board on the subject of wait-lists and wait times, and that was certainly the conclusion they came to -- that the most critical issue resulting in beds being tied up in an acute-care hospital was the lack of alternate level-of-care beds in the Vancouver-Richmond area. The numbers they came up with were that in 1996-97 there were 46,400 patient-days in that region alone that were either tied up in what they call ALC -- alternate level of care -- or DPU, the discharge planning unit. But these are 46,400 patient-days spent in acute-care beds where that patient should have been in some other type of facility, which would have been a much less expensive facility. A year later, '97-98, that number had risen to 57,000 days. The most recent figure was as of February of this year, and they anticipated that for this year that has just ended, the number it would actually reach is 79,000 patient-days. So in the space of two years alone, we have gone from 46,000 patient-days up to 79,000 patient-days being spent in acute-care facilities, which should have been in other facilities.

[1105]

Recently the minister put out a press release indicating that she was interested in ideas as to how to expand the provision of not-for-profit facilities in British Columbia with regard to multilevel care. Yet what I don't see is any kind of grand strategy -- any kind of campaign -- that is truly going to meet the very severe need that is there. A lot of people have

[ Page 14158 ]

The continuing-care review is now completed. My understanding is that it has been on the minister's desk since April, and it hasn't seen the light of day since it was completed. That is cause for a lot of concern. There was a lot of concern that the review wasn't completed last year. The original deadline was November, and it was extended to March for all the right reasons -- to ensure that there was adequate consultation. Now that the review is completed, could the minister tell us why it has not been released and when we will see it being released?

Hon. P. Priddy: In terms of the report, it hasn't been on my desk since April, by the way. Just for the record, it has not. The ministry has it. It's in; there's no question that the ministry has the report. It has not been on my desk since April. I had a recent briefing about what is in the report. I think the ministry and I still have some questions we're asking about the contents of that report, but I would expect us to be able to make that public. . . . I want to make it public when we actually have some response to it as well. I would expect that it probably won't be much before September.

It is a challenge, and I don't have an easy answer for this one. We are not in any way caught up in terms of the kinds of long term care beds that we're going to need in this province. If the provincial government is the only partner in this, or the only player in this, then there's no question that it will be a huge challenge. I guess we can say, as the member has said, that we have tried to find dollars and ways of supporting the system as it exists. I don't even have an estimate of what it would cost to immediately initiate the number of beds that people have indicated may be needed. But the government is not, particularly from a capital perspective, able to do that.

[1110]

Part of the provincial strategy is working with groups like Abbeyfield House, and there are other organizations. I referenced one the other day -- the Elim project in Surrey -- that people have written about. There are other projects that people have seen recently in the paper, which are about ways to provide either long-term care or alternate care to people in communities. So my job is to do what the ministry can do but also to work with partners in the community, because the provincial government simply cannot do it all.

C. Hansen: I think that's exactly the point that I was trying to make: there is a huge need. There is absolutely no way that the provincial government, out of its existing tax base, can possibly meet the challenge that is there. There is a need to find other ways of solving the problem, and I think those ways are there.

To answer the minister's question about how much it would cost. . . . There are some people who estimate that what we currently need are about 5,000 additional beds in this province, and within the next six years we will probably need in excess of 10,000 beds. But if we deal first of all with just the existing need of 5,000 beds, I'm told that it costs about $113,000 per bed to build a facility in this province. You're talking about half a billion dollars in excess of that just to meet the current level of need that's there. The problem is that you cannot do that out of the Ministry of Health budget, so there's got to be an effort to find other ways.

What we have seen in recent years are actions taken by the provincial government either deliberately or accidentally, which have had the effect of actually discouraging the construction of community beds by organizations other than the provincial government. I wonder if the press release that came out the other day, on June 18, about the Ministry of Health broadening its guidelines for the development and operation of multilevel beds. . . . Specifically, the ministry is looking at ways to expand the not-for-profit facilities in British Columbia. I wonder if that is a signal from the ministry that there is a significant change of policy or a change of attitude in terms of who is able to construct the number of beds that we need in this province over the next few years.

Hon. P. Priddy: I think that in a way it's a bit like the laboratory issue, only inasmuch as it's a mix. We know we can't do all that. What we want to see is a mix. I want to make sure that there's room -- and good room -- for non-profit organizations to be able to provide housing for seniors. I don't know if they would be able to provide all of the housing that is necessary. We certainly have private, if you will, or independent businesses or private organizations that are also building in the province. The recent article, I think in the Sun -- I guess it was a couple of days ago -- talked about one of those, the one in Langley. So there's room for both in the system.

[1115]

C. Hansen: I'd like to ask the minister about the continuing care review that is being reviewed. There are a couple of points. First of all, I'm certainly disappointed that that report will not be made public until, as the minister said, probably September. I think the issue is too big to have sitting there until then. I also don't accept the notion that the ministry has to review the report and come up with its action plan before it releases it. I think this is an issue that isn't going to result in solutions coming specifically from the Ministry of Health.

I appreciate the fact that a big portion of the solutions will come from the ministry. But we have to involve the not-for-profit sector; we have to involve the private sector to ensure that they too are part of the solutions.

[ Page 14159 ]

But I would like to ask the minister what we can expect of that particular continuing-care review report. Will it in fact include an analysis of the number of beds that we're going to need in this province? Will it include some very specific solutions to how we're going to meet the projected demand that is there?

Hon. P. Priddy: The report, as I've been briefed on it, does not include nearly the kind of information I expected in relation to numbers of beds, etc. I've asked for some more work to be done on that, because the kind of information I expected to be in there wasn't there. So we have asked for some more analysis around the specifics. I mean, I think good work has been done around the principles and values and a number of other things that have to be in place. But in terms of the specific analysis around numbers of beds in regions, that work has not been done in a way that's satisfactory to me.

But I do want to go back to a point I made earlier in estimates -- that when we're talking about this, we have to remember that it's not only about beds. It's about all of the supports that people need to live either in their community with support in their home, or in long term care beds. But that's connected. So we want to make sure that. . . . While we certainly need new beds -- there's no question about that -- you have to look at the other supports around that.

C. Hansen: I would urge the minister to look at it from the perspective of, "How do we meet the challenge that's there?" rather than in the fashion of: "What have we done up to now, and what can we do slightly differently tomorrow?" I think it's more a case of looking at the need that's there and working backwards. If you start looking at the need for the number of beds that could be provided in this province by the not-for-profit sector and then asking, "What are the impediments to those beds being built in this province and provided for?" I think the minister will come up with a variety of answers to that question -- legislative action that she needs to take.

One of them that I pointed out to her recently was the Health Authorities Act, where sitting on the books is the provision that the government can expropriate the assets of community care facilities. You know, who in their right mind wants to go out and put the energy into a not-for-profit organization that's going to build new long term care beds in a community, when that threat of expropriation is hanging over their head?

I think if the minister started looking at some of the impediments that are out there. . . . Let's get rid of those impediments. Let's make sure that the private sector and the not-for-profit sector can go full steam ahead in providing for the needs of British Columbians in the future. I think we'll be farther ahead -- rather than government taking the attitude that it has all the answers or has an obligation to come up with all of the answers and that we have to deal with this thing within the confines of the existing availability of tax dollars, because that clearly is not going to meet the needs in this province.

I want to address one of those concerns that I think would come up if the minister went out and said: "How do we create 9,000 or 10,000 new beds over the course of the next ten or 12 years in this province?" One of the things that's going to come forward is the uncertainty of funding. If an organization, whether it's profit or not-for-profit, is going to provide for beds in a community, they can't do that based on the one-year commitments that are able to be made today by health authorities in this province. If you're going to be able to finance a project like that, you're going to need to make longer-term commitments.

This is something that we raised yesterday. The minister asked whether we had raised it with the Minister of Finance. But I think it's incumbent upon the Minister of Health, given some of the problems that we face in health care, to make sure that the Ministry of Finance is starting to look at the availability of long-term funding commitments so that some of these challenges can be met.

[1120]

I'm wondering if the minister can tell us the rationale for that variation in funding formulas and whether or not there is any particular review of those funding formulas in the offing.

Hon. P. Priddy: Two responses to this: one is that in the continuing-care review, people have tried to identify what would make it easier for people. I think that's a question the member asked a few minutes ago. So what would make it easier for people? What would make it easier for people has been raised with us in terms of the difference in per-bed funding.

What's happening now is that every new bed is being funded in a consistent manner across the province, much like health budgets. The historical base was funded in a different way. It was funded at so much, depending on the kind of bed that people had, and what they ended up with was sort of a blended budget. But all new beds are now being funded at a consistent rate across the province; you don't see that discrepancy.

[1125]

[ Page 14160 ]

In home support, which is the example that was given to me, the total expenditure has gone up quite consistently over the last number of years, but the actual number of clients receiving services has decreased. The numbers that have been given to me are that since 1993-94, home support expenditures have gone up by 38 percent. The number of hours of service remain the same, but the number of clients has actually decreased during that period of time. I appreciate the fact that one of the reasons for that is the increasing acuity of clients that are being cared for with home support. But the biggest chunk of that has to reflect increased labour costs.

I'm wondering if the minister has done any analysis or review of how much these increased expenditures have actually resulted in better patient care, as opposed to simply reflecting the increased cost of the various collective agreements.

Hon. P. Priddy: I don't have home support specifically. We could probably get that for you. But I would say two things to that. One of them is that if you look at acute and continuing care in general, under which home support falls, the labour costs in this budget have been about $85 million. The overall increase is $282 million. By no means does the labour cost eat up, if you will, the overall. . . . I mean, it's part of the overall increase, but with $85 million in labour costs and a $282 million increase, that still leaves significant dollars for actual increase.

Secondly -- and maybe it's because I've worked in this field -- when you ask about the difference to patient care, I think what you can say is that if you cannot pay trained home support workers a wage that recognizes their training, then they're going to leave, and there will be unskilled, or less skilled, people there. So by being able to retain skilled people, you do make a difference, particularly given the increased acuity.

C. Hansen: While we're touching on the area of labour relations, I want to ask the minister about the discrepancy in fees that are paid to not-for-profit and private facilities, particularly the not-for-profits, which are the ones I hear it about -- between union and non-unionized facilities. Certainly the non-unionized facilities see the discrepancy in fees -- or the per diem rates that are paid -- as one that really mitigates against them giving pay equity, unless their workers go into the union. Certainly I'm the first one to stand up and recognize the right of workers to be unionized if they so choose through secret ballot and good information in terms of the decision they have to make to unionize or not unionize. But if a group of workers choose not to unionize, why should they be penalized in terms of the wages that their employer is able to pay them, given the current disparity in fees?

[1130]

C. Hansen: I do have information from a specific not-for-profit facility. I will talk to them and make sure that they're comfortable in my passing along a copy of their correspondence.

In one not-for-profit long term care facility that I visited in a small community, the administrator was telling me that one of the issues that has profoundly affected them in terms of their annual budget is the way that assessments of acuity are done. Previously the home care nurses would come in to do assessments every six months. What they're facing, which I think all community care facilities in the province are facing, is increasing acuity. Originally, what was happening was that the assessments being done every six months allowed them to reflect the increasing acuity of their residents on a semi-annual basis. Now those assessments are only being done annually. The result of that is that they have the increasing acuity but not the change in funding to reflect the staff demands that they have to fund. I wonder what the rationale is for going to the annual assessment -- I'm assuming it's for cost reasons -- and, if that is to continue, whether or not the assessing process can be revised to anticipate the growing acuity rather than to reflect the acuity that has transpired in the previous 12 months.

Hon. P. Priddy: The member is correct. We have moved to a 12-month assessment. At the same time, we've also moved to global funding for facilities so that they have more ability to be able to manage within the global funding. The 12-month assessment was based partly on the fact that when the research was done -- and we have done work here in British Columbia. . . . At least according to the research we have, the acuity rate is not changing at the speed at which people seemed to indicate it was. Therefore a 12-month assessment was felt to be satisfactory.

C. Hansen: I guess I would just leave that with a request to the minister that she give consideration to a review that anticipates growing acuity, rather than one that simply reflects the previous 12 months -- basically that the ministry look at the impact it's having on some of these facilities and their ability to properly fund care for their residents.

On the issue of public-private partnerships, when we were discussing this on June 28, the minister. . . . Actually it was my colleague from Okanagan-Penticton that raised the issue of the role of public-private partnerships with regard to long-term care. She made a comment. I wrote it down quickly, so I hope I'm quoting her correctly. She said that she would continue to look for P3 partnerships. I wonder if the minister could define for us what she sees as P3 projects, when it comes to long-term care. There are a lot of different definitions. There are a lot of different types of projects that have been lumped under the term "public-private partnerships." It has become somewhat of a term du jour that I think tries to capture a whole bunch of things. In the context of encouraging and, as the minister says, continuing to look for P3 partners, I wonder if she could explain for us the role that she sees P3s specifically playing in the provision of long term care facilities in the province.

[1135]

[ Page 14161 ]

Hon. P. Priddy: I think the member is right: P3 has become a very broadly interpreted phrase these days. But basically what it means to us as a ministry is that somebody from the community comes to us with the capital dollars to be able to construct a facility. Those may be privately owned or from the non-profit sector, but somebody comes with the capital to be able to do the construction.

C. Hansen: Will the continuing care review include anything with regard to P3s -- defining them and determining what the parameters for P3s may be in the years to come?

Hon. P. Priddy: The report will deal with P3s. The actual definition of P3s is the Ministry of Finance's, not ours. I'm not trying to pass that along, I'm just saying that that's where the definition actually comes from, and that's where the responsibility for that definition lies. But in terms of the report, yes, we will be dealing with the issue of P3s and their future role in B.C.

C. Hansen: I want to ask the minister about the report on the frail elderly in care facilities. My understanding is that this was a document that was completed some time ago, but it has not been released. I'm wondering if the minister could tell us if and when it will be released, and what may result in terms of implementation of the recommendations of the task force.

Hon. P. Priddy: This is a report that's being done by the Seniors Advisory Council. That's the advisory council to the Minister Responsible for Seniors. It is a project that they took on, and it's in draft form now. We expect it to be available by fall.

C. Hansen: Maybe I'm reading things into the minister's words, but will that document be made public at that time?

Hon. P. Priddy: Yes.

C. Hansen: One of the issues that's come up in terms of home care is the fact that discharge planning at acute-care facilities is something that goes on. . . . The need for it is there seven days a week, 24 hours a day. But much of the discharge planning and the coordination with home care is something that is largely restricted to weekdays when staff who are assigned to that function are available.

In fact, in one particular region, I'm told that the only time they can schedule home care for someone who is being discharged from a hospital is between 9 o'clock and 3 o'clock, Monday to Friday. This has resulted in a lot of individuals being forced to stay in acute-care facilities over a weekend or even overnight. They've got a desperate need for beds, yet they can't discharge them, because there's no ability to coordinate the home care support outside of those particular hours. I'm wondering if that's an issue that the ministry is addressing.

Hon. P. Priddy: That is actually a responsibility of the regions. It's actually one of the reasons that. . . . I mean, it's one of the things that was included in the thinking behind regionalization -- that is, the regions have the ability. . . . People don't have to work nine to three. The regions have the ability to deploy their staff in any way they want. While there may be circumstances as you've described, I don't think we normally discharge people at night. In the circumstances I'm aware of, if people are likely to be discharged on the weekend, people will know that and some of that work will have been done.

The regions have the ability to have staff on the weekend or to have them work a different set of hours. I don't question the member that there are circumstances where this has occurred. We're certainly prepared as a ministry -- and I'm prepared as a minister -- to address that with the regions at my next meeting with the CEOs and health chairs. But they have the ability to deal with that. Nobody says you can only have people nine to three, Monday to Friday.

[1140]

Does the ministry have an absolute number as to how many community care beds are available for community care throughout British Columbia? Somebody had indicated to me that nobody really has a fix on how many community care beds are available in this province. I'm wondering if that is data that the ministry collects.

Hon. P. Priddy: If the member wants a very specific figure, we'd have to get it for him, but there are approximately 25,000 publicly funded continuing-care beds available. Of course, the capacity is greater because there are many beds that are not publicly funded.

C. Hansen: I also want to ask the minister about whether or not there is a common database of facilities in the province. This is actually an article from "The Guardian," the HEU's newsletter, from July of last year. They raise the issue that when consideration is being given to an application for a licence, there is a review of the facility and the administrators of the facility, but there's no database that really would connect other facilities that may be operated by the same organization. I'm just wondering if there's been any look in the course of the last year at whether or not a common database would be a useful addition to our ability to track community beds in the province.

Hon. P. Priddy: We certainly have a common database as it relates to continuing care, but it's not a common database in the way that the member describes it.

C. Hansen: I want to ask the minister about the Noble-Allen report that was released. I guess it's a little over a year ago now that it came out. In the press release that the minister issued when she released the report, which was on community care licensing, she said: "I have asked the ministry to move quickly to implement the majority of the report's recommendations."

[ Page 14162 ]

[1145]

C. Hansen: I want to move to the issue of the provision of home support throughout the province, particularly the one that I think has caused the most discussion around the province: the changes to home support in the capital region area. But it's broader than just the capital region, because there are other regions in the province that are looking to take similar initiatives to the one that was taken in the capital health region.

I just want to read a letter from Cindy Robinson, who is a client of community support in the capital region area, because her words probably demonstrate the concern and the issue much better than I could if I put it in my own words. She says: "I have great concerns over the CHR's immediate plans to alter the way home support services are provided. Approximately 3,000 of the 5,000 home care clients will have to change all of their home care workers. . . ."

I'm going to skip some of this just so it doesn't take too long for me to go through this. She says:

"Imagine the simple task of making a meal. From experience, I would say a new home support worker gets less than half the work done, but I must expend three to four times the amount of energy directing their every move. Many clients do not have this energy. So much of the true training of home care workers is done by clients in the home. This consists of orientation to the home itself, as well as knowledge of the particular needs around your disability and the care plan. In my case, I have had rheumatoid arthritis since the age of one. One of my most debilitating limitations is the joint damage to my hands. Someone who hasn't worked for me for several months -- or more -- and tightens all the jar lids and taps and perhaps leaves things out of my reach or on the floor is more disabling to me than helpful.

"Continuity of workers also provides safety. Having untrained workers in the home can lead to falls or accidents which could actually be life-threatening to clients. Most people who have had to stay in hospital at some point in their lives can remember the stress of having a series of virtual strangers investigating and touching their body in very personal, invasive ways. Now, I'd like you to imagine the life of a person with a severe disability. They will be getting a series of strangers doing personal care for tasks like lift-assisted bathing, bowel care, catheter bag changes, etc. for the rest of their lives. They don't have the right to choose who touches them in this manner. I hope you agree this is putting them through an unacceptable amount of stress. . . .If they are truly interested in this, I believe they must look to other options of meeting their goals."

"I have trained each and every person who comes into my home as to how my home functions for me, and how I function in my home. With continuity of care and of home support workers specifically, I can achieve this efficiently, safely and with minimum stress."

"I hope you will carefully consider my two options."

[1150]

C. Hansen: One of the other individuals who I think the minister has met with, but who I also met with, is Joanne Neubauer, who is president of the Action Committee of People with Disabilities in the capital health region. She has raised with me, certainly, the issues surrounding the change of home support workers -- and others that came with her. But there is also a concern with regard to the funding levels and flexibility in the CSIL program. The CSIL program is certainly one that I think is a desirable option for some individuals -- and obviously not all. But she raises the concern first of all in terms of funding levels but also in terms of the amount of choice that's available for individuals who don't yet qualify for the CSIL program.

I'm wondering if the ministry has looked at any other models of flexibility somewhere between the existing home support system that is there, where in the future there's going to be diminishing choice on the part of the client in terms of who their home support worker is, and the CSIL program, which gives them a very high level of control but is not the right solution for all people. Is there a solution in between that gives clients a bit more control over their lives as to who their home support workers are in the future? Is that something that the ministry is taking a look at?

The Chair: Minister, noting the time.

[ Page 14163 ]

It's not at this current time.

Will you close?

C. Hansen: There is one additional issue that I want to put on the table with regard to this particular area, and that is the case involving Val O'Connor. Val O'Connor had certainly been in touch with my office on many occasions. An article occurred in the Times Colonist last month regarding her particular experience with the CSIL program, which is Choices for Support for Independent Living.

Where it comes in is the flexibility that she has. She's on the CSIL program, and she has the ability to design her own care. The best care provider she has is her husband, yet there is not the flexibility in the program to allow for that. I'm wondering if the ministry would give any consideration to increasing the kind of flexibility so that, again, clients can design the care that best suits them.

Hon. P. Priddy: This has certainly been raised with me before, actually, not just in this ministry but in my previous portfolio. I feel a lot of empathy for people who want to do that. There are huge policy considerations as to the family member being the paid caregiver. We don't have a solution to this, so there is not an initiative at this stage to change that. It is one that stays on our list of things to be examined, but I don't have a solution at this stage.

Noting the time, 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. D. Streifel moved adjournment of the House.

Motion approved.

The House adjourned at 11:57 a.m.

[ Return to: Legislative Assembly Home Page ]

Copyright © 1999: Queen's Printer, Victoria, British Columbia, Canada