Orders of the Day

Hon. M. Farnworth: I call second reading, Bill 36, Health Professions and Occupations Act.

[S. Chandra Herbert in the chair.]

Deputy Speaker: Members. Members, we would like to get this business underway, so if you have conversations, please take them somewhere else. Thank you.

Second Reading of Bills

BILL 36 — HEALTH PROFESSIONS AND
OCCUPATIONS ACT

Hon. A. Dix: I’m moving second reading of Bill 36, the Health Professions and Occupations Act, 2022.

[2:25 p.m.]

As noted, this is different from most of the bills that we will be debating this session — indeed, in most sessions — in that it’s a new act, and it’s a very significant one that reflects significant consultation and input from the public; from members of this House, including members of all parties in this House; from outstanding international experts as well; and, of course, from our health professions in our health colleges.

This legislation will enhance patient safety and improve oversight of regulated health professions. But the new legislation this legislation sets to do is to set a path forward to modernize the way health professions are regulated in B.C. by replacing — and that’s what we’re intending to do here — the former Health Professions Act with the new Health Professions and Occupations Act.

These comprehensive changes will help ensure that health professions are regulated more consistently and transparently in the public interest, moving away from a system that is decades old. It’s a task that we’ve done together.

The current framework, as you will know, hon. Speaker, for the regulation of health professions was developed nearly 30 years ago. Health care practices, professional oversight and public expectations have changed significantly since then. Our health care system is changing, and we need to ensure that regulated health professionals are keeping up by improving public patient safety and public protection, which are important; efficiency and effectiveness of B.C.’s regulatory framework; and building public confidence through transparency and accountability.

I want to talk a little bit about how we got here today and the work that we’ve done together. What’s the recent history behind this legislation? I’ll say, to the member opposite, that I will probably take about 35 minutes overall for this — just because I know, having been in opposition, that it’s good to know that as one prepares one’s own remarks in this case.

In March of 2018, I decided, and the Ministry of Health decided, to launch an inquiry into issues at the time at the then College of Dental Surgeons of B.C. We appointed Harry Cayton, an expert in health professional regulation, who conducted the inquiry. We also asked him, as part of that inquiry, to review the Health Professions Act, which sets out how health professionals are regulated in B.C. In response to this request, Mr. Cayton wrote the report. It’s called An Inquiry into the Performance of the College of Dental Surgeons of B.C. and the Health Professions Act and was made public on April 11, 2019.

The Cayton report recommended approaches to modernize B.C.’s health regulatory framework through legislative reform in the interests of the safety of patients and the public. In response to the recommendations outlined in the Cayton report, we did something that I think is quite unusual and quite positive.

We established what was called the Steering Committee on the Modernization of Health Professional Regulations. It was myself, as the Minister of Health and representing the government side at the time; the member for Kelowna–Lake Country, who was then the Health critic for the official opposition; and the member for Cowichan, who was then the Health critic and the House Leader for the B.C. Green Party, for the Third Party, in the Legislature.

We, in principle, decided that we would review the report and do our own report that would be based on a unanimous approach to our recommendations. We worked for a very significant period together, along with the public service and the public, on responding to the Cayton report and the practical recommendations that were needed to form the basis of regulatory reform. In that period, we consulted a lot of people in the two sets of processes.

We received about 6,000 submissions in one form or another from the public and heard from the public on those issues. The steering committee joined to make, in fact, a unanimous recommendation — we finalized them — for improving the model of health professional regulation. Those recommendations of that report, made by the unanimous members of the committee, who were representing their caucuses at the time, form the basis of this legislation today.

The key recommendations dealt with six areas, and I want to talk about that a little bit. Enabling cultural safety and humility — that’s important in everything we do. Improving governance. Reducing the number of regulatory colleges. Creating a new oversight body. Improving the complaints and discipline process and improving information-sharing across the board. After putting our initial recommendations forward, we received a second phase, and then we established our final recommendations on the same issues after those two phases of public consultation.

[2:30 p.m.]

In addition to these two phases of public consultation, a very significant amount of consultation was conducted with Indigenous leaders, health regulatory colleges, regional health authority leadership and several other stakeholder groups that are affected by these changes. In short, we, if anything….

Ordinarily, a minister comes up and introduces the legislation on behalf of the government. In this case, I think, because of the exceptional work….

I want to acknowledge the exceptional work of the member for Kelowna–Lake Country, the member from Cowichan and their successors, including the member for West Kelowna, who is participating in this process, and, indeed, the current Health critic for the official opposition, the member for Prince George–Valemount. All have been, in some ways, involved, although the primary work was done in the first phase, together, by the three original members. I want to acknowledge their role.

Again, when I became Minister of Health, this wasn’t my first priority — to do a massive reform of the health regulatory colleges. But circumstances required that we make changes — circumstances that came from the public — and we responded to that.

I think people on all sides of the House, when invited, responded to that in a spirit of generosity and good sense. We worked together on that basis. I think we have to try to do that as much as possible. I think when that happens and when that occurs. we should acknowledge it. This is their legislation as much as mine.

In summary, the new legislation does the following things. I want to go through some of the details of that, to lay it out for people who might not have heard of this debate.

I think when you consider the number of people regulated by health professions — well over 100,000 — and the number of people who go to health professionals, which is, one might say, five million to five million plus…. Really, everybody in the province, at one time or another in their lives….

It’s very significant legislation. It’s new legislation and, therefore, will make some changes in the way we’ve historically done business. This is very important legislation. These things are not always reflected in media attention, which is sometimes guided by other things. But this is some of the most important work that I think the government and the opposition will do in these four years of legislation that we’ll deal with in the Legislature.

In summary, the new legislation addresses discrimination in health care and requires cultural safety and humility to be embedded in the way professionals provide health care. It improves governance to ensure the regulatory colleges are governing the professions in the public interest. It creates a path to reduce the number of regulatory colleges for improved efficiency and effectiveness, establishes the creation of an oversight body to ensure the regulatory framework is functioning in the public interest, creates a new discipline process which is safer and accessibility for patients who’ve experienced harm while getting health care. It improves information-sharing. This includes with the media but, most principally, with the public for better transparency and accountability.

I want to break down each element of that to show how the legislation achieves each of these goals.

With respect to the proactive approach to eliminating discrimination, the new act will now be clear that discrimination is a form of professional misconduct and that a regulated health professional who engages in discrimination could be subject to an investigation and discipline. There will also be more clarity to ensure health care is practised in a way that is consistent, with objectives for anti-discrimination and improved cultural safety for patients, something that was at the centre of the In Plain Sight report, which has been published subsequent to our reports on health colleges.

Secondly, with respect to improved governance, the new legislation clarifies that the role of a regulatory college board is to function exclusively in the public interest. It shifts away from the election of health professional board members, creating a system where all board members are appointed by a competency-based process. It also establishes smaller boards of regulatory colleges, with equal numbers of public and health profession board members.

The third thing, a streamlined path to reducing the number of regulatory colleges through amalgamation…. We’re reducing the number of regulatory colleges to improve efficiency and effectiveness. It’s been something we’ve been taking action on since 2017 and before. In that period, we’ve reduced the number of colleges from 22 to 15.

[2:35 p.m.]

Members of the House will remember…. Early on in my tenure as Minister of Health, we amalgamated the four nursing colleges, who now have between 60,000 and 70,000 members, making them, by far, the largest…. In fact, basically half of the regulated health professions…. It’s now, of course, the College of Nurses and Midwives.

This process was started under the previous Minister of Health, Terry Lake, and concluded in this Legislature with legislation I’ve introduced. Since then, other colleges have amalgamated as well. The College of Podiatric Surgeons, for example, which had 87 members and had to fund, through the fees of those 87 members, an entire college, has joined the College of Physicians and Surgeons. That makes sense. We’re seeing the coming together of the four dental colleges now, in advance of the legislation, which I think will serve the interests of the professions.

One of the interesting things in the Cayton report was the lack of communication between those professions and, indeed, between those colleges. Obviously, they’ll be working with each other closely now. Team-based care in any area requires us to act as teams, and that’s what’s happening.

We’re seeing a reduction in the number of colleges. It’s from 22 to 15 now. It will be six at the end of this process. That, I think, is a valuable process, meaning that we have colleges that are strong enough…. Some of the smaller colleges, in terms of numbers, also had the members who earned the least amount of money and were required to pay the most to sustain the college. It allows us to ensure we have organizations capable of doing the investigations and doing the work required without putting an undue burden on an individual profession for that.

Coming together as six, as opposed to 24, and then adding to that 24, 26 or 28, is, I think, the right approach, meaning that we’ll have six core colleges, several of which will have multiple, of course, professional disciplines within them. We’re going to have that process go through, in a streamlined process, and a reduction in the number of regulatory colleges to six. This will also, I think, make it less confusing for some patients as to which regulatory colleges they can direct complaints to.

Fourthly, we create an oversight body to promote accountability, transparency and consistency across regulatory colleges.” The oversight body will conduct routine audits of regulatory colleges, set standards for regulatory colleges on policy and practice, investigate regulatory colleges when necessary and make recommendations to the minister on…health professions or occupations to be regulated under the act.”

Members of the public will also be able to engage directly with the office to submit complaints about the governance activities of a regulatory college or a complaint about this act or its regulations. The office cannot pursue complaints that relate to matters involving health professionals, as this remains a role of the regulatory college. By having a dedicated place for members of the public to go, the new system adds a layer of accountability on regulatory colleges to ensure they are functioning at a high standard and continue to be laser focused on their public protection mandate.

Next, a new discipline process with improved transparency. This is an area of some concern and has been for members of the public, as members of the Legislature will know from their experience through casework. The complaints and adjudication system will have a new complaints process that separates the investigation stage, which will remain with the regulatory college, and the discipline stage, which will be handled by an independent discipline body. Information about all discipline imposed during a discipline hearing and about all agreements made between regulatory colleges and health professionals will be public in order to increase transparency.

Regulatory colleges will provide support workers for those who’ve experienced sexual misconduct, sexual abuse or discrimination from regulated health professionals to help navigate through the complaints process in a safe and trauma-informed way. Regulatory colleges will also fund counselling for people who have experienced sexual abuse, sexual misconduct or discrimination from regulated health practitioners. The regulatory college will be able to then recover the associated costs from regulated health practitioners found to have committed….

Finally, greater information-sharing. Regulatory colleges will now have new abilities to share information between each other and with other agencies where necessary for public safety and protection. Enhanced information-sharing will remove barriers to improving patient safety, enable more transparency and improve public trust in the system.

I think what is always important…. Sometimes these debates sound a bit arcane. It’s about colleges and how they operate. At its core, what we want are changes that will help people. I just want to go through, in some detail, the connection between people who might be listening to us today and the changes, and significant changes, we’re making today.

[2:40 p.m.]

I think the new legislation helps people in four ways. It builds stronger public protection supports, it creates a safer complaints process, it enhances public safety measures, and it ensures greater transparency and accountability.

Here’s some…. If you want some examples of how that does that, when you think of stronger public protections, I think it protects the public from the harms of discrimination in health care and promotes anti-discrimination practices by doing the following.

The legislation addresses all forms of discrimination by strengthening the response to discrimination when it occurs and promoting anti-discrimination objectives. We noted that.

Health regulatory colleges will now be required to take action against professionals who are found to have engaged in any form of discrimination made against protected grounds under the B.C. human rights code. Discrimination based on race, colour or ancestry is an example of that.

Additionally, we are establishing a legal duty for health professionals to report other health professionals who engage in acts of discrimination and for employers to report to a regulatory college if a discrimination incident occurred that may have resulted in a termination.

Often, and occasionally — it’s not all the time, but when it happens, we see it — there will be a case of someone who moves within jurisdiction or within positions. It’s important that there be transparency about that.

The safer complaints process helps the public in the following ways. It opens the doors to complainants who are in a vulnerable position. The new legislation enables such people to request that their identity be protected during the investigation process of a regulated health practitioner.

In the past, people may have avoided submitting a complaint or providing information during an investigation process as it can be traumatizing to do so and could lead to retaliation or the perception of such retaliation. Offering identity protection will encourage more people to come forward to hold regulated health practitioners accountable for their action when required.

The new legislation reduces the potential risk of re-traumatizing someone testifying during discipline hearings by allowing reasonable steps to be taken to support them and to shield them from the health professional they’re complaining about. For example, this requires sensitive documents to be only be disclosed when relevant and necessary.

Requiring patients to face the person who perpetrated harm in an adversarial discipline hearing setting or having their sensitive documents disclosed only to damage their credibility can be traumatizing and prevent people who’ve experienced harm from coming forward. Allowing the independent discipline body to take steps to prevent this is intended to help people who experience harm feel more comfortable in making complaints.

The Health Professions and Occupations Act is offering funding for support. A new provision of the act creates a pathway to support people through counselling services who have experienced sexual abuse, sexual misconduct or discrimination by a regulated health professional. To ensure people have prompt access to support services, support can be provided before an investigation reaches a conclusion.

The Health Professions and Occupations Act creates a new role of support workers and, in this way, creates a safer complaints process as well. A new provision in the legislation creates a funded support worker position for those who have experienced a traumatic experience of sexual misconduct, sexual abuse or discrimination by a regulated health professional. These support workers play a dual role. Firstly, they are there to support the complainant through the complaint process. Secondly, they’re there to make recommendations and monitor the complaint process to help make it safer and trauma-informed.

The Health Professions and Occupations Act establishes clear definitions for sexual misconduct and sexual abuse. The new legislation defines sexual misconduct to include acts such as sexual manipulation, harassment and communication. It also defines sexual abuse, which is an attempted or realized sexual act or physical contact of a sexual nature.

Defining these terms provides a clear understanding of what they are, which will better hold everyone who commits these harms accountable for their actions and help ensure that the discipline matches the severity of the incident. Clear definitions also enhance public understanding of what is prohibited and the basis for which complaints can be made.

Enhance public safety. There are a number of provisions of this act, and I understand that we’ll be dealing with some of these at committee stage, but I just wanted to lay out, in general, what we would expect those to be.

The superintendent’s office, whose role is to monitor and assess the performance of regulatory colleges, is a new body created by the Health Professions and Occupations Act. Members of the public will be able to engage directly with the office to submit complaints about a regulatory college’s actions or policy, providing appropriate oversight.

[2:45 p.m.]

The office can then choose to investigate the regulatory college, complete a report on the findings and bring issues to the Minister of Health’s attention when regulatory colleges don’t change or improve.

By having a dedicated place for members of the public to go, the new system holds regulatory colleges accountable to the public and streamlines the complaint process, which enhances public protection.

The Health Professions and Occupations Act creates a new mechanism to regulate lower-risk health service occupations. The purpose of regulating health service providers is to enhance public protection from health services that may present a risk or harm. However, the current Health Professions Act is binary, with only two options: become a fully regulated health professional with their own regulatory college or don’t get regulated.

The new legislation creates another pathway for regulation by government. It enables health occupations to become regulated who may not meet the threshold of a health professional where there is some risk which requires a level of regulation commensurate with that risk.

When health occupations are not held to the same regulatory standards — well, they aren’t the same regulatory standards — as health professionals, they must uphold anti-discrimination objectives and can lose their authority to practise for committing emotional, financial, physical and sexual abuse or neglect of a patient.

The Health Professions and Occupations Act enhances public safety through regulatory college boards. Regulatory colleges get their direction from a board. Under the current Health Professions Act, a proportion of board members are elected by health professionals through an election process. This system has created a misconception that health professionals are members of a regulatory college and beholden to those who elect them. However, a regulatory college’s goal is to protect the public, not those that they govern.

The new legislation removes the election process and replaces it with a merit-based appointment system. This is an issue of which we had long discussions with people, of course. The new system will ensure regulatory board members have the right skills and competencies to effectively regulate health professionals with the goal of enhancing patient safety.

Finally, greater transparency. The Health Professions and Occupations Act enhances communications between employers and regulatory colleges. The Health Professions and Occupations Act requires that employers of regulatory health practitioners are notified when an employee has been disciplined or has had their practice restricted for any reason by the regulatory college. When an employer makes a decision to let a health professional go due to sexual misconduct, sexual abuse or discrimination, the employer will be required to inform the regulatory college that regulates that health professional.

The Health Professions and Occupations Act streamlines the amalgamation process, of course, in order to create fewer and stronger regulatory colleges.

We are also, I think, in this process, acknowledging some of the very significant challenges in new professions who are not currently regulated health professionals but would wish to become regulated. In the past, such processes have taken years and years and years. And often the public demand for this, and even the professional demand for this, wishes that to be significantly more.

The diagnostic and therapeutic professions, for example, are one example of health professionals who wanted to be regulated in their own college for some years. The process takes much, much too long, involved their process and the government’s process and legislation. This process will allow — and this is an important question for all members, I think, of the committee and members of the public and members of groups such as counsellors, such as the therapeutic professions, such as perhaps potentially ambulance paramedics and others to get regulated….

If it takes too long, then it’s almost impossible to move forward in that way for many of them — or to deal with rapidly changing circumstances. Just as if the only tool for overseeing health regulatory bodies is for the minister to put them under administration, that’s a strong tool, but it’s not a very subtle tool as well.

So we have changes here, and we are proceeding, in particular, in those cases, with the diagnostic and therapeutic professions, who are well along the road to be regulated by the allied health care professionals college, and to equally move forward with counsellors. That process is underway, and we are hoping that process will coincide with the bringing into force of the legislation. In short, this is a more flexible system as well.

So I wanted to, again, express my appreciation to the member from Cowichan, to the member for Kelowna–​Lake Country, to members of the House and to all of those involved in this process.

[2:50 p.m.]

We know that our health professionals and our health colleges are committed to the public interest and do extraordinary work. We know that when issues, such as some of the ones I’ve discussed here, come forward, they are exceptions but important ones. We know that the standard of health professional regulation is critically important in a society that so depends on health professionals. It’s the public health care system, and then there are a number of health professionals that are primarily not in a public system but are in a separate system.

For example, naturopathic physicians and others are not principally providing services within the public health care system but are recognized as health professionals. They wanted to be recognized as health professionals, were recognized as health professionals by previous governments — either the previous Liberal government, the previous NDP government or governments before that — and are regulated and expected to hold, and to be held to, high standards. Regardless, when you’re a health professional, we expect you to have high standards in B.C.

These are, of course, challenging times, and there’s often criticism of health colleges, I think, and I think the committee felt this, an increase in transparency would and will allow, people to understand more and will actually benefit those colleges by ensuring that people see, when they act, what happens. They’ll see, when action is taken based on a complaint, what happens — and understand that there’s accountability and oversight for those colleges as well.

That balance of ensuring more oversight but fewer colleges, for not seeing us go forward from 22 to 24 to 26 colleges, as is necessary — I think we regulate, for example, counsellors as a diagnostic profession, potentially other professions — that we not keep simply adding regulatory colleges but that we bring and make our system more efficient and make these colleges stronger and working together…. In a time of team-based care, ensuring that health professional colleges act in teams, as well, I think is a positive approach.

I wanted to conclude by again thanking all of the people involved in this process — I’ve noted the exceptional role of members of the opposition, whom I’m very grateful to — officials of the Ministry of Health, who have done some exceptional work and proceeded and pursued this task with dedication.

I want to thank the health professional colleges and all of our health professionals for being open to a necessary change — change is always difficult — and being so open and so willing to participate in a serious way in this process.

I want to thank everyone in B.C. for making this legislation possible. I have to say, of course, that once the legislation is passed, even a greater effort will be required in implementing that legislation.

We’re putting legislation in place for the 21st century that ensures accountability — I think the legislation is going to be followed in other jurisdictions in the country — legislation that ensures greater cultural safety and greater transparency; legislation that makes the system more efficient and, I would argue, less expensive for many health professionals; and legislation that allows us to expand the number of regulatory health professionals in a more efficient way and integrate those professionals when they come into colleges — not in their own colleges, separate from all the others, but as part of broader colleges, working with other health professionals, to put in place a high level of professional regulation and responsibility.

Like I say, people are going to hear this debate over the next few days — or however long it takes; it’s a long bill — and they’re going to….

Sorry, the member for Skeena may not be listening to it as carefully as other people in the last few days. He was just giving me a hard time over there, which is fair enough.

I think we’re going to see…. Some of these issues may be seen as narrow, but overall, there will not be British Columbians who are not, in the course of their lives, affected by this discussion.

I expect that we’ll have a thorough discussion of this massive effort to put the recommendations of the committee and of Mr. Cayton into law. How they did that, and the clarifying questions, will be very important for members of the opposition. I want to say, finally, that I’m proud of this work. I’ll say that when I became Minister of Health, I didn’t plan to bring forward a health professions act, but circumstances required that.

[2:55 p.m.]

Instead of standing in the way of that, we shared respon­sibility and accountability with other members of the House, and they participated in good faith. We have today legislation that reflects that effort. It reflects the 6,000 people who participated in the process, reflects the views of members on all sides of the House and, I think, will serve us well in this 21st century as we move forward to regulating our existing health professionals, others who want to become health professionals and, most importantly, protecting the public.

S. Bond: Thank you to the minister for those comments. Certainly, one of the words that I will agree with right off the top is…. He used the word “massive.” I can honestly say that in my time in the Legislature, I can’t remember seeing a bill that has 645 sections in it, so there is going to be some substantive discussion about the bill that the minister has tabled.

I think we actually need to, first of all…. I also want to say to the minister that in many ways, it’s a sad commentary on the work we do when the minister describes the process that was undertaken as unusual and positive. Positive is the good part. Unusual is the fact that rarely do we see the kind of effort that was made to actually be inclusive in terms of the work that was done leading up to the creation of this piece of legislation, and I think that’s something that will warrant further discussion as we look at the processes in place here in the Legislature.

I want to back up for just a minute, because today, as we speak, British Columbians have, probably, no idea that this work has been undertaken — or certainly are probably not aware that it’s on the floor of the Legislature. One of the things that’s pretty important about this bill and what regulatory colleges actually do in British Columbia is make sure that when you have a relationship with a health care professional in British Columbia, there are expectations about what that relationship looks like.

I think most British Columbians assume what that looks like and how that happens. I don’t think they particularly pay a lot of attention intentionally to the regulatory colleges, but it’s a pretty essential piece of what happens.

When you think about the mandate of regulatory colleges, their mandate is to serve and protect the public at all times. So when you think about the process that the minister has undertaken, that really is the underpinning of the work that’s been done.

The work is twofold. One is about protecting British Columbians, and the way that colleges do that is by ensuring that their registrants, the people that are members of their colleges, are qualified, that they’re competent, and that they’re following standards of practice and ethics. Colleges are also in the position of responding to complaints, both from patients and the public. So one of the things that’s going to be critical in our discussion with the minister as we engage over these 645 sections is talking about an increase in transparency and what that looks like.

The colleges today, if they must take…. They must take action. There isn’t a question of whether they do or not. They must take action if one of their registrants is incompetent, unethical, illegal or impaired in some manner. I think those are pretty fundamental things when we’re looking at the provision of health care in British Columbia. What we want to know is that the health care professions that are in the system in British Columbia meet all of those particular characteristics: qualified, competent, following standards of practice.

We also know — and I’ve heard this, in fact, from one of my colleagues, who has been in a regulated college — that members themselves want to ensure that people who are their colleagues in that profession are actually all of those things as well: competent, that they are following standards of practice. So I think there’s a mutual interest from the people who are regulated. As the minister pointed out, there are about 100,000 people who are impacted by this particular bill, but it impacts all British Columbians, so it is incredibly important work.

[3:00 p.m.]

I want to let the minister know that when we engage in some discussion through committee, obviously later today, he will Hear from the our member who was engaged in the work along with the Leader of the Third Party. The MLA for Kelowna–Lake Country will be participating. We’re also going to have the MLA for Vancouver-Langara. He is the critic for Aboriginal relations, and it’s an important element of this work that was not the focus of the work done by the steering committee.

Again, looking at the issue of humility and cultural safety, looking at the aftermath of the report In Plain Sight…. My colleague from Vancouver-Langara is taking a look at that. I have a colleague that will look at, in particular, the issue of clinical counsellors. We know that there is some intent to potentially look at clinical counsellors. So the MLA for West Vancouver–Capilano will take a look and have some conversation with the minister about that.

Then my colleague — actually from where I represent, Prince George–Mackenzie — who was a member of the Health Professions Review Board wants to have a better understanding of how that independent structure is actually impacted by this piece of legislation.

Let’s talk a little bit about what, actually, the minister…. First of all, we should begin by saying that bills of any size, but this one in particular, don’t simply appear on the Legislature floor. It takes the work of an incredible team of dedicated professionals in the Health Ministry, drafting, looking at the content. I want the minister to know that when he outlines the principles that are important in this piece of legislation, those are things that we, certainly, as an opposition — the Leader of the Third Party, I’m sure, will speak as well — have a good sense of understanding about.

But we also need to recognize that when you take those policies and turn them into law, we need to make sure that what we’re talking about is the same thing. One of the concerns that I have, certainly, is that this is an enabling piece of legislation. We have continuously raised in this House, with the government, the fact that much of the very specific detail about how this bill comes to life, how it actually works in practice, is done in regulation. What happens — those details and that work — is done behind closed doors. It isn’t done on the floor of the Legislature, particularly in the case of a new bill.

We are not talking about minor amendments here. We are talking about a brand new bill, and you make that decision based on how much of it you have to amend. So there is a very significant shift in this bill. I want the minister to know that, certainly, I think it is our intent as opposition to allow this bill to pass through second reading, and then we’ll have the opportunity to look in much, much more detail at the sections that have been presented in the bill.

Our ultimate support, either for the bill or not, will be based on the discussion that we have in committee stage as we ask those very hard questions. That, of course, is despite the fact that there was a collaborative process to get us to this place. We want to make sure that if we’re making these changes, first of all, they are understood and that there are as few unintended consequences as possible. We will pursue that during committee stage.

The minister has walked us through some of the steps that were taken. One of the things that struck me when I was looking back at the history of this…. Of course, my colleague will speak to the work that he did as part of the steering committee. But the steering committee was actually guided by a number of objectives, and the number one objective, of course, was to improve patient safety. We want to make sure that that is captured in all of the changes that the minister is recommending today. Of course, public protection, and improving efficiency and effectiveness of the regulatory framework….

Probably most important is improving public confidence. One of the ways we do that in legislation is by increasing transparency. There is a very substantive change here when it comes to the disciplinary process. We will look at what that looks like and how that will be accomplished. I can imagine that there’s probably some concern on members of the colleges about that shift in how discipline will not only be processed, but what the end result is.

[3:05 p.m.]

The end result will be that if a person, after a fair process, separate from the investigative process, that person…. Both the issue that has been brought for discipline, and the discipline, as I understand it, will be made public. Those are things that we’ll walk through in terms of how we are making sure that that person is protected until that point in time and we know that that is the ultimate outcome. Those are the kinds of questions that we’ll be asking.

We should remember the history of what happened here. I think there’s also an example to be made of the way the process worked. It was an iterative process. The minister actually had a number of steps involved in the process. When you look at the work that the Cayton inquiry did, the report actually looks at two parts. The first part is that it makes recommendations specifically to the College of Dental Surgeons of British Columbia, and secondly is possible suggestions to look at modernization of the overall health regulatory framework.

That was in the spring of 2019. The minister, then, in response to that — especially part 2, which was the public interest side and the modernization overall — established and chaired the steering committee on modernization and ultimately had a phase of public consultation, where members of the public and health sector stakeholders were invited to provide written feedback. The steering committee went through a number of other steps, which leads us to earlier this month. Eventually, the bill appears here in the Legislature.

We should point out that this bill, while core to making sure that health care services and the provision of services, the people who provide those services, are paramount, certainly — and I will wait for the minister in committee — does little to deal with the current situation in health care, in terms of many of the other challenges that we’re facing.

That doesn’t mean it won’t have an impact, necessarily, on the system as a whole, but it is not about fixing the specific challenges that we’re facing in health care. We have to make sure that while this is important work, we don’t want to see there be any unintended consequences that further exacerbate the challenges we’re facing in the health care system.

This has been a work in progress for literally years. Again, I’m grateful to the people who participated in the process. You’ll hear from the Leader of the Third Party and, obviously, our MLA for Kelowna–Lake Country. The main purpose was to look at a series of recommendations, in terms of how we modernize the health profession regulatory framework.

There was a lot of discussion and consultation. Very significant recommendations have been made, as I’ve mentioned, including cultural safety and humility. I know that there’s going to be a need for us to have a conversation about that, because the steering committee’s work, actually, I think, concluded before that work was considered as part of the legislation. That’s going to be an important discussion.

The bill that is written, certainly, as much as we’ve had the chance to look at all of the sections, does include many of these changes. Its main intent, of course, is to protect the public and streamline the way we regulate health professions. Both of those goals are things that I think most people, including us, would be supportive of.

Again, it’s in the details. When you create law, it is very difficult to change it, so what we want to do is make sure that we’re getting it right, as much as possible, in the first iteration of this law. Again, I do have concerns about the fact that it is enabling. There will be a great deal of work that is done by regulation, and that concerns all legislators. We raise that frequently in this House.

We do want to recognize that it’s taken a lot of work to make sure that the bill appeared here — dedicated staff and committee members who literally took part in years-long processes to get us where we are.

I want to just talk about a couple of things as we think about this. The Health Professions Act deals with, currently, the number of regulated health professions. Twenty-five regulated health professions are currently governed by 15 regulatory colleges.

[3:10 p.m.]

Colleges have a legal obligation to protect the public through the regulation of their registrants. What they do is that they determine registration requirements. They set standards of practice. They recognize education programs. They maintain, literally, a register that everyone can search. Critically, they address complaints about their registrants. Currently, at the moment, colleges review all of the complaints about the professionals they regulate, including both current and former registrants.

Bill 36 significantly expands on the previous duties of a college and establishes a series of guiding principles that will be applied to all those that are governed under the act: colleges, the office of the superintendent, and the director of discipline, which, by the way, are new — the office of the superintendent and the director of discipline — so that the guiding principles will be applied to everyone who is governed by the act. It’s important to note that the principles act in accordance with the United Nations declaration on the rights of Indigenous peoples, or UNDRIP. That’s a very important piece of this legislation.

I know that my colleague will be raising some of those issues and discussion in greater detail later in the debate. Other principles include procedural fairness, respect for privacy, promotion of a holistic health care system and identifying and removing barriers for extrajurisdictional practitioners. The latter part of that speaks to those who are internationally trained and educated. As the minister pointed out, the bill also creates a much clearer path for an unregulated health profession to apply for and receive designation.

One of the very significant pieces of this bill is the creation of a new office — a new oversight body. That will be the office of the superintendent. The superintendent would be appointed by cabinet and would have a number of duties, which include providing advice and recommendations to the minister on the administration and amendments of the act and the regulations; the performance improvement by regulators; and other matters that are requested by the minister. It’ll be interesting to know how the minister expects to set up that relationship with the superintendent’s office — brand-new to the act.

Also, the superintendent will be expected “to promote awareness and adherence to the guiding principles” and to promote regulatory consistency. In the work that was done by the steering committee, that’s certainly one of the key things that was heard: that there were concerns about inconsistency. The superintendent will also report on regulatory performance, make recommendations for improvement, and publish information and records that are deemed to be of public interest. Of course, there are always the other duties as set by the minister.

The superintendent will also have the ability to conduct an assessment of an unregulated health profession. The minister spoke to groups of health professionals that, previously to this, have found it very difficult to find a pathway to regulation. The new act will give the superintendent the ability to look at that assessment of an unregulated health profession or occupation if regulation is needed, if different regulation is needed, if required by the minister or if the superintendent determines that assessment would be in the public interest — again, always looking at what’s in the best public interest.

The bill clearly sets out a process for how an assessment would be conducted. However, again, parameters will be decided and left to the minister to decide. For example, scope, conduct, timeline — all of those things are not captured in this bill. The minister will have the opportunity to make those decisions.

In Section 440, the superintendent may require colleges to pay a general administration fee, to be set by the superintendent — again, subject to regulation. What that means is that the cost of the superintendent’s office is going to be covered by the regulators. I think it’s going to be critical, for the colleges and for us, to understand exactly what the implications are of that decision to have the superintendent’s office funded by the regulators — what that means.

[3:15 p.m.]

While the office of the superintendent is an independent body, there is a provision in this bill that requires the superintendent to comply with any orders that the minister makes. That’s a relationship that we will want to explore: what does the minister anticipate, or at what point would he anticipate, that there would be specific orders he might make — or she might make — to the superintendent.

The office of the superintendent is a significant creation in this bill, but the bill also creates an independent discipline tribunal. The tribunal brings discipline. It removes discipline from the jurisdiction of the colleges, which the minister mentioned, to the independent body, but the investigation piece remains with colleges, and the new tribunal will deal with the disciplinary piece.

When we look at this concept, initially, it seems to make sense that there would be a more independent and transparent process in the final decision around discipline. Again, we’re going to have questions in terms of what that looks like in practice and, of course, what it means for individuals who might be part of that process.

Another very significant change in the act is the way that regulatory colleges’ boards are created. Under the new system, one of the office of the superintendent’s purposes is “to develop and implement a merit-based selection process for the appointment of members to boards of regulatory colleges.” Despite that, it is the minister who will ultimately make the board appointments, based on the recommendations of the superintendent. That is a very substantive shift.

I’m certain there must have been a great deal of discussion about that with the colleges, because currently, colleges have the ability to elect members to their board. It’ll be interesting to hear not only the rationale but how the minister feels that will work in the practical application of that.

The other area that we’re very interested is internationally trained professionals. We will certainly be clear about the fact that we think it needs to be easier, particularly when we look at the number of Canadians who have gone and trained in other parts of the world with very highly accredited institutions. We want to make sure that at a time when we need them most, they’re able to actually work in British Columbia. We’ll want to take a look at the piece that talks about it: are their impacts on internationally trained and educated health care professionals?

In addition to the guiding principles piece under part 3, division 3, section 50, regulatory colleges would be required to create bylaws specific to the processes and requirements for licensing extrajurisdictional applicants, including the issuance of provisional licences. That, from my perspective, doesn’t sound like it is an expeditious way to make sure that we’re moving people who are credentialed into the system.

This would, though, appear to respond to the minister’s mandate letter, which required the minister to improve the province’s credential recognition process and licensing. We’re going to want to make sure that that isn’t adding another layer that’s going to take time and extra regulation.

The expediting of approvals for internationally trained health care professionals is something that the official opposition has been calling for, for months. If the bill addresses that and actually speeds that up — obviously, in an appropriate way — we would consider that quite beneficial. Among the duties established in the bill, there is a requirement for a designated health profession licensee to practice ethically, which includes the requirement for a licensee to practice a designated health profession in ethical manner in accordance with ethical standards, as well as for the board to make bylaws respecting ethics standards.

The latter includes a requirement for the board to make bylaws respecting providing false or misleading information to patients or the public. There’s also a new duty to practise in accordance with the principles of protecting the public, as the minister mentioned, from harassment and discrimination and to take anti-discrimination measures, and so forth. That is a constant and interwoven theme in the bill.

[3:20 p.m.]

There are also additional elements in this bill that respond to issues that have arisen during the COVID-19 pandemic. For example, provisions in part 7 relate to public health emergencies and emergency orders, specifically the duration of emergency orders, end dates and consultations required for emergency orders.

As we go through this bill, we also need to keep in mind that it is largely enabling legislation. Much of what the bill seeks to accomplish is not done in the text of the legislation but through regulation at a later date, at the discretion of the minister. While it allows the government to potentially be more nimble where flexibility is necessary, it also raises significant questions about how those regulations will be determined.

There are very broad regulation-making powers affecting designation assessments of health professions and occupations, including the criteria to be used when deciding whether a health profession or occupation should be regulated — what regulatory model should be used? — and the powers and duties of a health occupation director when governing a designated health occupation.

There are other reg-making powers regarding hearings as conducted by a discipline panel or by the director of discipline; regulatory complaints and restorative processes; monetary penalties, as well as setting rates, tariffs and others to recover costs or expenses; support programs administered by regulators; broadly defined general matters; restructuring of regulators and the appointment of discipline panels; and the superintendent’s office matters that relate to fees and applications to court.

So as you can see, while some of these make sense as regulation-making powers, it means that there is so much that we will not know about what the bill will do and how there are potential impacts on individuals governed by colleges, also how it will impact our already burdened health care system.

We certainly will be examining the bill closely and thoroughly in committee. As I said, a number of my colleagues will be participating in that process. I think that it is very difficult to be critical of a bill that is going to protect the public interest and make sure that health care professionals are actually competent and following standards-based practice. Those are important principles that I think any British Columbian would think are essential. It is when you take those policies and create law that the questions need to be asked and answered.

I do want to thank the minister’s staff, in particular, for being available to speak to us about the bill. We certainly…. It would have taken days to walk through it line by line. As you can imagine, that did not occur, but we do appreciate the efforts that have been made by the minister, the minister’s staff and others, who have been engaged in helping us prepare for the follow-up committee work, and by the steering committee that worked hard.

I thank the minister for his comments. We will certainly be supporting the passage of the bill through second reading. Again, we will make our final determination about our support for the bill after we have worked our way through committee stage.

With that, I’ll conclude my remarks.

S. Furstenau: I rise to speak to Bill 36 and thank the minister for his comments and the member for Prince George–Valemount for hers.

It’s always interesting to listen to how the lens is, really, through which we’re looking at a piece of legislation like this. I think one thing, a starting place we can all agree on, is the importance of public safety, public trust and public confidence when it comes to the regulation of health care professionals in our health care system.

[3:25 p.m.]

I just want to start from the perspective of a regular person, a citizen accessing the health care system. I think all of us have this sense of an expectation that there are rules in place. There are regulations happening.

As a patient or a person accessing the system, there is a level of protection that comes with that. There are bodies that are overseeing and ensuring that my safety is considered to be paramount in the system, and that is, absolutely, a situation and a scenario that we want to ensure we have in British Columbia when it comes to the health care system.

As has been noted, the member for Kelowna–Lake Country and I participated as part of a steering committee with the Minister for Health back in, what feels like a very long time ago, 2019, I believe, and we were participating in reviewing the report from Mr. Cayton and in working with the minister and his staff to produce a report that was delivered.

I will add a clarification, however. We participated — and I won’t speak for the member for Kelowna–Lake Country — in the production of that report, but that’s where the participation really ended. I was in no way involved in in the legislative process here. I saw the legislation at the same time as my colleagues in the official opposition, which was just a few days ago.

The minister talks about six key areas: cultural safety, improving governance, reducing the number of colleges, a new oversight body, improving the complaints process and transparency when it comes to the public. I think these are all laudable aspirations and goals to have, and I think the lens through which we would always want to be looking at this is the lens of the person accessing the health care system. Do these steps achieve these outcomes and how are we measuring that success?

These are really significant changes, and I expect there will be aspects and elements that different colleges, different professionals, different stakeholders will have concerns about. As was raised by the member for Prince George–Valemount, this will have to be an iterative process. There will have to be a recognition that things won’t be, necessarily, all perfect the first time around.

As we saw with professional governance, there were amendments to that bill that have already come in, just a few years after that bill was introduced, for a similar restructuring of governance and regulation in the resource sector and the professionals that are involved in that.

I want to talk a little bit about what has come up quite a bit in both comments from the minister and the opposition member around increased transparency and accountability. Absolutely, this is critical for building that public trust, that sense of public confidence and ensuring that what we are achieving is a sense, for the people of British Columbia, that they can be assured when they’re accessing the health care system that their safety and protection is paramount.

There is some irony in this in that we have currently, in our health care system, some pretty significant deficits when it comes to transparency and accountability.

[J. Tegart in the chair.]

We have some ongoing concerns that are being raised with all of us in here around accessing information, seeing data and understanding the workings of the health care system and whether or not it is actually meeting the needs of people in a really transparent and accountable way.

So I would say that as we look at this legislation and consider the outcomes that we’re trying to achieve with it, that lens should be applied to the health care system writ large and not just to the regulatory colleges and the health professionals. Are our health authorities being transparent and accountable? Is the data being made available to people? Is government being transparent and accountable?

[3:30 p.m.]

We have to recognize that what we are expecting from health professionals and health colleges — that same expectation should absolutely be on government and the health authorities that are delivering health care in this province. I don’t think it’s really hard to dismiss the fact that this government and this province and this health care system have had some pretty serious concerns raised around that lack of data availability, lack of transparency and lack of accountability.

I just want to speak — I have a few more notes here — to the points raised by the member for Prince George–Valemount. The piece around enabling legislation also speaks to this. Again, I’m going to quote my friend Laura Colpitts, and I’m going to tell her to check Hansard, that her name is there.

Laura Colpitts used to say…. In the days of Shawnigan, which was really, in our efforts to protect our watershed there, very much what we saw — a failure of regulation, a failure of government to protect public interest and public safety, putting a permit for a five million–tonne contaminated landfill site at the headwaters of our watershed…. But Laura Colpitts, who was very involved in our efforts in Shawnigan, used to say: “How you do one thing is how you do everything.”

We have seen a growing trend. I will acknowledge openly that it’s not just in British Columbia, but we’ve seen a growing trend in Canadian parliaments and legislatures across the country, the federal parliament in other parliamentary systems, this growing tendency towards enabling legislation. We had a piece of legislation in the spring session that was essentially blank. We couldn’t debate it. We didn’t know what we were debating. I recognize that this is a rather significant and complex piece of legislation. There is a lot that is being done here.

There’s also that orientation that we want governments to have, particularly in a democracy, towards shining a light as much as possible, making that part of the process so that the public is not left wondering what is happening behind closed doors, what kind of decisions are being made. And when we see this increase in more and more details being left to be brought in by regulation and we see this growing trend of enabling legislation, there is an irony that goes along with a piece of legislation like this that has embedded in it the goal of more transparency and more data available to the public that…. As Laura would say, how we do one thing is how we do everything.

I think that we, too, will be watching and participating in the committee stage of this. And this is a…. I think the member for Prince George–Valemount said maybe it’s the biggest bill she’s ever seen in terms of number of clauses. It’s a huge bill. So there’s a lot in there to get clarification on, to get details on so that it’s well understood as it goes through the processes, which is one of the benefits of a parliamentary democracy — that teasing out of what the intention is here. How do we understand this legislation? What are the consequences? What are the implications? What are the expectations? And, ideally. that helps to inform how we’re measuring the success of this.

We will be, of course, supporting this at second reading and watching very closely as it goes through. The goals are very laudable, and we should be embracing all of these kinds of goals. The job of all of us in here is to make sure that we are, ideally, going to be achieving these goals with the legislative work that’s being done.

[3:35 p.m.]

I appreciate the opportunity that I had to be part of that steering committee in 2019, and I think that it was an example of the kind of participation that we can see across party lines in here that contributes to, really, a deepening of the legislative work and a weakening of the partisanship that can often, so many times, be so overwhelming in here, that partisanship.

We don’t have to be in a minority government to do that. We can always look for ways to deepen that collaboration and that work across party lines. There are perspectives to be brought that are so important. The member for Kelowna–Lake Country was certainly one of the most diligent and hard-working members of a steering committee that I’ve ever worked on with, and I really appreciated what he brought.

From my perspective, it was really critical to raise issues and concerns that had been coming into my constituency and notice trends, particularly around the lack of regulation when it comes to counsellors in this province, and also the lack of regulation of social workers who work within the Ministry of Children and Families. They’re not regulated by their own college in this province. I think that that remains an outstanding issue that needs to be addressed.

I hope to see, again, that level of expectation of transparency, accountability and public trust being put at the forefront of what we’re doing.

A. Singh: I rise to put my support behind Bill 36. Members have spoken about the luminous nature of this bill. I do not envy the minister’s time that he’s going to have in committee stage, so I wish him luck there. And if he needs any of our help, we are here for him.

You’ll often — and I’ll probably repeat it for the next few years, as long as I’m here. — hear me say that government is all about choice, and this bill reflects that as well. Really, a bill that has — I don’t know — several hundred sections…. What’s really illuminating is that after the interpretation sections in the beginning, the first two sections that you see are the sections on sexual misconduct and sexual abuse and discrimination. So it really sort of shines light on the perspective of caring for public safety and caring for the public. That’s really a part of this bill.

The explanatory note that comes…. I’m not going to go through the bill, thank god.

Interjection.

A. Singh: You will? At committee stage, yeah. That’s going to take a few days.

What the bill does is it replaces the Health Professions Act. I like the explanatory note because it really encapsulates what’s here.

The primary objectives of the bill are “to prioritize protection of the public and to facilitate good governance by regulators.” Again, you see that reflected right in those first initial sections and in direct response to the report In Plain Sight and other things and what we’ve seen in our system.

What the bill does is it expands…. I’m going to just read out this: “The Bill expands the regulation of health service providers. While the practice of health professions continues under this Bill to be fully regulated through self-regulating bodies, more flexible models of regulation are available under this Bill for the practice of health occupations that present a lower risk of harm to the public.”

Again, for many regulations out there that want to be part of a regulatory structure, this allows them to be recognized as health professions. It “streamlines the process for designating new health professions and occupations. It also clarifies processes for creating and combining regulatory bodies and transferring the governance of health professions and occupations between regulators.”

It also establishes the office of the superintendent of health professions, and my friends have spoken about it earlier. And it establishes, within the superintendent’s office, an independent discipline tribunal.

[3:40 p.m.]

That’s really important for regulators, because oftentimes the colleges and regulators are set up as self-regulating bodies. What happens is important, but public perception of what happens is far more important. To have an independent discipline tribunal lends credence to that. That’s Bill 36, the Health Professions and Occupations Act.

What exactly, as I said, is being announced today? What is being introduced today? This new legislation will enhance patient safety, and it’ll improve oversight of regulated health professionals. It sets a path forward to modernize the way that health professions are regulated in British Columbia by replacing the former act with the new Health Professions and Occupations Act. These are comprehensive changes, and they’ll ensure that health professionals are regulated more consistently and transparently and more in the public interest.

It moves away from a system that is decades old. The reasoning for this being done: the current regulation is old, it’s outdated, and it hasn’t moved with society. The current health regulation that exists right now, before this bill, was developed over three decades ago. Health care practices, professional oversight and public expectations have changed significantly since then. What constitutes health care has changed significantly since then. We’ve seen an expansion of the types of providers out there.

Our health care system is changing. We have to adapt to that, and we need to ensure that the regulated health professionals change with the times. We need to be able to keep up to improve patient safety and public protection, to make sure that B.C.’s regulatory framework is effective and efficient. Again, public confidence, public perception, is really key, so increasing public confidence through transparency and accountability. Bill 36 does all of that.

Like in many pieces of legislation, there is a history. Not only is it decades old and needs to be overhauled, but in March of 2018, the Ministry of Health launched an inquiry into the College of Dental Surgeons of B.C. Harry Cayton, an expert in health professional regulation, conducted the inquiry, and what we see now is part of that.

In response to the inquiry, Mr. Cayton wrote a report. That report was made public in 2019. As my friends have spoken of earlier, Mr. Cayton recommended that B.C.’s health regulatory framework be modernized, through legislative reform, to improve governance and regulatory performance in the interests of the safety of patients and of the public in general.

In response to those recommendations, the Minister of Health established and chaired the steering committee. My friend the Leader of the Third Party was on it, as were others. I believe we’re going to be hearing from our friend later on today. A public consultation on the Cayton report, on its suggestions to modernize health regulation, was held from May to June of 2019.

After reviewing this public consultation feedback and their suggestions, the steering committee then developed a further consultation paper to seek public feedback on the proposed changes to the health professions regulation. That consultation was open for public feedback from November of 2019 to January of 2020. The feedback from the consultation assisted the steering committee to finalize recommendations, which were finally finalized in August of 2020, to improve the model of health professional regulations.

The six recommendations that there are — which is really, essentially, what this bill breaks down to — are to enable cultural safety and humility; improve governance of the health professions; reduce the number of regulatory colleges — I think there are many, many at this point; create a new oversight body that oversees all of the regulatory colleges, including a disciplinary body; improve the complaints and discipline process; and improve information-sharing in the public interest.

[3:45 p.m.]

What does this new legislation do? It addresses discrimination in the health care system and requires cultural safety and humility to be embedded in the ways that professionals provide health care and take care of the public. It improves governance to ensure that regulatory colleges are governing their own professions in the public interest. They’re still self-governing, but there is that overarching interest that they have to accede to.

It creates a path to reduce the number of regulatory colleges for improved efficiency and effectiveness. As I said earlier, there are other health care professions out there that want to be recognized, and instead of creating multiple, numerous colleges with their own separate rules, this is a much more efficient and transparent system.

It establishes the creation of an oversight body to ensure that the regulatory framework is functioning in the public interest. It creates a new discipline process that is safer and accessible for patients who have experienced harm while getting health care.

Again, for patients who have suffered harm, sometimes there is that stigma of going back to the regulating body of that health care profession, which is made up of the same people that would have possibly caused that harm. Having an independent discipline process improves public safety, improves public perception. Process also improves the information-sharing for better transparency and accountability.

The Health Professions and Occupations Act will now be clear that discrimination — again, it is right in the first few pages of the legislation — will be a form of professional misconduct, and a regulated health professional who engages in discrimination will be subject to investigation and could be disciplined. There will also now be more clarity to ensure that health care is practised in a manner that is consistent with the objectives for anti-discrimination and improved cultural safety for patients.

The new legislation also clarifies the role of the regulatory college board as functioning exclusively in the public interest. It really breaks down the sort of mishmash that we had before of a regulatory college and professional association. They were both sort of the same thing. What this really does is that it creates that wall. This is a regulatory college. It’s there exclusively to rule and govern in the public interest. Health care professionals can have separate associations that advocate for them and advocate for their interests, but that’s not what a regulatory college board will be designed to do.

It shifts away from the election of health profession board members, creating a system where all board members are appointed by a competency-based process, and it establishes smaller boards and regulatory colleges with equal numbers of public and health profession board members.

What we’ve done here is that we’ve streamlined the path to reducing the number of regulatory colleges through amalgamating some of them. Reducing the number of regulatory colleges to improve efficiency and effectiveness has been something our government has taken action on since 2017, when we passed the legislation to allow college amalgamations.

Since then, we’ve reduced the number of colleges from 22 to 15. Under this act, those amalgamations will continue but with a more streamlined process. This will ultimately reduce the total number of regulatory colleges to six. That’s down from 22 that there were in 2017 to, ultimately, six.

It will enhance our ability to regulate and make it less confusing for patients as to which regulatory college they direct their complaints to. It will allow for those health care professionals who are sort of outside of the system to fit in, in one of those six regulatory colleges, if they choose to do so. Most health professionals that are not in the traditional health care stream will want to do so. It lends credibility to their profession.

The oversight body that the legislation will create will conduct routine audits of regulatory colleges. It will set standards across the board for regulatory colleges on policy and practice. It also will have the power to investigate those colleges, when necessary, and make recommendations to the minister on health professions or occupations to be regulated under the act.

Members of the public will also be able to engage directly with the office to submit complaints about the governance activities of the regulatory college or to make a complaint about the act or regulations. The office cannot pursue complaints that relate to matters involving individual health professionals, as that will still remain the sole jurisdiction of the regulatory college itself.

By having a dedicated place for members of the public to go, the new system adds another layer of accountability on regulatory colleges to ensure that they’re functioning at the very high standard that we require them to and to continue to be laser-focused on public protection as their main mandate.

[3:50 p.m.]

There will be a new discipline process, with improved transparency. The complaints and adjudication system will have a new complaints process that separates the investigative stage, which will remain with the regulatory college, and the discipline stage, which will be handled, again, by an independent discipline body. Again, it’s not just what actually happens. It’s also the public perception of what actually happens. Having an independent discipline body gives credibility to the actions and the results that come from that discipline body.

Information about all discipline imposed during a discipline hearing and about all agreements made between regulatory colleges and health professionals will be made public in order to increase transparency. Again, the crux of this legislation is for public safety. Regulatory colleges will provide support workers for those who have experienced sexual misconduct, sexual abuse or discrimination from regulated health professionals and practitioners to help navigate through the complaints process in a safe and trauma-informed way.

What you often see is victims don’t have a process that aids them. They don’t have an association or a professional body that will help them through this. They’re sort of left out in the cold. What this does is it provides support workers. It actually does that. It provides support workers.

In the criminal realm, we talk a lot about victims. What are we doing for the victims? This is, again, part of that sort of move forward to provide a more caring environment, so that when someone does come forward with a complaint, they’re not left alone. They have support. They have the support that they need. They have the support in a really, really a substantial way — in a trauma-informed way.

Regulatory colleges will also fund counseling for people who have experienced abuse, sexual abuse, sexual misconduct or discrimination from regulated health practitioners. The regulatory colleges will be able to then recover the associated costs from the regulated health practitioner found to have committed the harm.

There will be greater information-sharing. Regulatory colleges will now have new abilities to share information between each other and with other agencies where necessary for public safety and protection. Enhanced information-sharing will remove barriers for improving patient safety. They’ll enable more transparency and improve public trust in the system.

Really, a system is only as useful…. You can create a system that’s effective — that looks, on the outside, effective, looks efficient. But if the public has no trust in that, it is of no use. This will help the general public by building stronger public protection supports, by creating a safer complaint process, enhancing public safety measures, establishing greater transparency and accountability of health care practitioners.

In terms of stronger public protection supports, the legislation addresses all forms of discrimination by strengthening the response to discrimination when it occurs and promoting anti-discrimination objectives for safer health care.

The colleges will now be required to take action against professionals who are found to have engaged in any form of discrimination made against protected grounds under the B.C. human rights code. This includes discrimination based on race, colour or ancestry, for example.

Additionally, we’ll be establishing a legal duty for health professionals to report other health professionals who engage in acts of discrimination and for employers to report to the regulatory college if a discrimination incident has occurred that may have resulted in a termination. That, again, forms part of that whole transparency portion of this piece of legislation.

The process of complaining will be safer. The act enhances public protection by opening the door to complainants who are in a vulnerable position. You generally go to a health care practitioner when you’re in pain or you’re suffering, and to be victimized at that point further denigrates and puts you in an incredibly vulnerable position.

What the new legislation does is it enables people to request that their identity be protected during the investigation process. It allows for support workers. People have avoided, in the past, submitting a complaint or providing information during an investigation process, as it can be quite traumatizing to do so. Whether it’s true or not or is perceived, it could lead to retaliation.

[3:55 p.m.]

Offering identity protection will encourage more people to come forward to hold regulated health practitioners accountable for their actions. Again, there will be protections for the health care professionals built in so that this is adjudicated in a fair manner.

The legislation will also reduce the potential risk of re-traumatizing someone testifying during discipline hearings by allowing reasonable steps to be taken to support them and shield them from the health professional they’re complaining about. This includes requiring sensitive documents to only be disclosed when relevant and necessary. Requiring patients to face a person who perpetrated harm in an adversarial discipline hearing setting or having their sensitive documents disclosed only to damage their credibility can be traumatizing and help prevent people that are already experiencing harm from that victimization from coming forward.

Allowing the independent discipline body to take steps to give greater protection to complainants and to prevent this is intended to help people who have already experienced harm and to make them feel more comfortable in making the complaints.

The act also offers funding for support. It creates a pathway to support people, through counselling services, who have experienced sexual abuse, sexual misconduct or discrimination by a regulated health practitioner. It will ensure that people have prompt access to support services and that support can be provided to them before an investigation reaches a conclusion.

I’ve spoken about this before. It creates a new role of support workers. It will create a funded support worker position for those who have experienced a traumatic experience of sexual misconduct, sexual abuse or discrimination. These support workers play a dual role in the system. First, they’re there primarily to support the complainant through the complaint process. Secondly, they’re also there to provide recommendations and monitor the complaint process to help make it safer, trauma-informed and more efficient.

The act establishes clear definitions for sexual misconduct and sexual abuse. It defines sexual misconduct to include acts like sexual manipulation, harassment, communication. It also defines sexual abuse, which is an attempted or realized sexual act or physical contact of a sexual nature. Defining these terms outright provides a clear understanding of what they are, which will better hold regulated health practitioners who commit these harms accountable for their actions and will help ensure that the severity of the discipline matches the severity of the incident.

Clear definitions also enhance public understanding of what is prohibited and the basis of which complaints can be made. The more information the public has, the better prepared they are.

The act also creates a streamlined system for submitting complaints against a registry or college. The superintendent’s office, which will be created…. Its role is to monitor and assess the performance of regulatory colleges. It’s a new body that will be created by the Health Professions and Occupations Act. Members of the public will be able to engage directly with the Office of the Superintendent to submit complaints not only about a particular practitioner but about a regulatory college’s actions or policies.

The office can then choose to investigate that college, complete a report on their findings and bring issues to the Minister of Health’s attention when regulatory colleges don’t change and improve. By having a dedicated place for members of the public to go, the new system holds regulatory colleges accountable to the public and streamlines the complaint process, which enhances public protection much in the same way that it does for the health care practitioners.

It also creates a new mechanism to regulate lower-risk health service occupations. Again, the purpose of regulating these lower-risk health service providers is to enhance public protection from health services that may present a risk of harm. Again, there are many health-related occupations out there that would want the credibility of being regulated.

It creates another pathway for regulation by government and enables health occupations to become regulated who may not meet the threshold of a health professional but that operate in the health arena and where there is some risk, which requires a level of regulation commensurate with the risk.

While health occupations are not held to the same regulatory standards and obligations as health professionals, they must uphold the anti-discrimination objectives and can lose their authority to practice for committing emotional, financial, physical and sexual abuse or neglect of a patient.

[4:00 p.m.]

The act also enhances public safety through the regulatory college boards. The colleges are set up. They get their direction from a board. Under the current act, a portion of board members are elected by the health professionals through an election process — so internally. This system has created a misconception. Again, much of what seems fair is about perception. The system, currently, has created a misconception that health professionals are members of regulatory colleges and beholden to those who elect them — an insiders’ club, essentially.

However, a regulatory college’s primary goal is not to protect the practitioners but to protect the public, and that’s what this…. The new legislation removes that election process and replaces it with a merit-based appointment system. This new system will ensure regulatory college board members have the right skills and the competencies to effectively regulate the professionals, with the goal of enhancing public safety. That is the one and only goal: greater transparency.

The act allows for enhancement of communications between the employers and regulatory colleges. It requires that employers of regulated health practitioners are notified when an employee has been disciplined or had their practice restricted for any reason by their college. When an employer makes a decision to let a health professional go due to sexual misconduct, sexual abuse or discrimination, the employer will be required to inform the regulatory college which regulates that health profession. So it closes those loopholes, where that communication between the employer and their regulatory college did not exist before. It also streamlines the amalgamation process in order to create fewer regulatory colleges and make things more efficient.

How do these changes address cultural safety and humility, including what was the subject of the In Plain Sight report, anti-Indigenous racism in B.C. health care? That really was sort of the catalyst for a lot of things as well.

In addition to changes mentioned that address discrimination, promote anti-discrimination and create a legal duty to report discrimination, there will be new provisions to address anti-Indigenous racism and enable a culturally safer health care system for Indigenous people. Health regulators will now be required to support and promote awareness of reconciliation with Indigenous peoples, the United Nations declaration on the rights of Indigenous peoples and the need to address racism and anti-racism issues that are specific to Indigenous peoples, based on the distinctions-based rights of First Nations, Métis and Inuit peoples.

The complaint process will include a restorative process, a process that’s intended to align with Indigenous practices, where necessary and where it’s needed. Changes to make the complaints process safer include new supports, such as support workers selected in partnership with Indigenous governing bodies and access to funds for counselling, including traditional Indigenous healing.

Indigenous health practices will be protected under this act. They cannot be used as grounds for investigating or disciplining a regulated health practitioner, unless a patient has been misled or the health service that the regulated practitioner is performing is demonstratively riskier than the prevailing practice.

Colleges and others will be required to work with Indigenous governing bodies and other entities representing Indigenous peoples on numerous issues that pertain to Indigenous rights, such as the development of regulatory college bylaws on cultural safety and practices.

These changes are a significant response to the In Plain Sight report, the Declaration on the Rights of Indigenous Peoples Act action plan and significant consultations throughout the development of legislation that have happened with Indigenous people.

Once the act goes through — what I expect — a pretty lengthy committee stage and it passes…. I think it has substantial support, and we will go through the machinations of looking at the various sections themselves. But once it goes through that, the legislation will be brought into force, and the regulatory colleges will begin operating under the new modernized system immediately. That also helps protect patient safety and enhances oversight of the regulated health professionals and occupations. As I know the minister has spoken before, this is a key priority for the Ministry of Health.

Now, what do the colleges think about this? B.C. Health Regulators, which includes all 15 of the existing regulatory colleges that will be governed under this act, were consulted throughout this process.

[4:05 p.m.]

Prior to this, self-regulation…. You would have heard of self-regulation a lot. Terms like self-regulation don’t actually capture the true purpose of regulatory colleges, which really…. A regulatory body should be there primarily for the protection of the public. A term like regulatory self-interest doesn’t really reflect that properly.

Profession-specific expertise and professional knowledge are required in order to keep patients safe and ensure high-quality care, which is why health professionals will continue to make up half of all regulatory college boards and professional standard advisers, because they have the relevant professional background, so they can make the relevant decisions. They will be involved in advising on professional practice standards.

The continued reliance on profession-specific knowledge and expertise for effective regulation is an important element of any future system, because you want people who are actually doing that work and know what the standard of care is in that work to help inform decisions that are being made.

The role of regulatory colleges has always been to protect the public and enhance public safety through regulations. Professional associations and, in some cases, unions will continue to provide professions a voice and representation. They always have.

Unfortunately, over time, regulators and the voices of those associations have sort of amalgamated. This really separates it out and makes a clear distinction between what a regulatory college is and what an association is. A regulatory college has, as its primary function, the protection of the public. An association is an association of health care professionals or other professionals. It has, as its primary function, its own self-interest and the interests of its members.

How will these colleges be governed? Each regulatory college will have a board, as I said earlier, which will be made up of health professionals who hold a licence with a regulatory college and the public board members who are comprised of representatives of the public, who are not regulated by the regulatory college.

I see my time is coming to an end. Extensive legislation. It has my full support.

N. Letnick: As the previous speaker has demonstrated, it’s very difficult to talk about this legislation within the 30 minutes that’s usually allotted to speakers. I’d like to thank him for his 30 minutes and announce that I’ll be the designated speaker for the opposition, so I can go up to two hours.

The last time I stood up in this House and declared I was going to be the designated speaker actually was the only other time. That was when I was the Minister of Agriculture, and the now Minister of Poverty Reduction was on this side. We had a little heated debate about me taking over the designated speaker role, if he remembers. He doesn’t remember at all. Okay, we’ll talk about that later. But it was quite interesting. Anyway, I will speak for more than 30 minutes. I thought I’d tell you right now that that will happen.

First of all, I want to thank all the respondents, all those that, over the years — and it’s been years since this was started — have worked with the steering committee, worked with the minister and his staff to come to where we are today. Where we are today is a piece of legislation that is quite thick, as you’ve heard already from other speakers. The opposition critic for Health, the member for Prince George–Valemount, did a wonderful job of highlighting the key points, as well as, of course, the Minister of Health and the Leader of the Third Party.

That process that we undertook was only possible with the cooperation and input from all the key stakeholders, those that were members of colleges and those that were on the boards and other members of the public. What I’d like to do today is actually go through, from the Clayton report all the way through the process that the steering committee embarked on that led to this particular piece of legislation. Obviously, the minister and the Leader of the Third Party and I have a little bit more knowledge, since we were involved in that committee. I thought it would be a value-added to do that here.

Some of it will be new. It hasn’t been discussed yet in the House. Some of it will be repetition of other points. That’s hard to avoid. Even though we all like to always hear new things, I’m sure some of the words that I bring up and some of the readings from the different reports will be familiar to the members.

[4:10 p.m.]

If I may also articulate my appreciation for the Leader of the Third Party and, in particular, the Minister of Health for the work that they did as part of the steering committee. When I was the Minister of Agriculture, I invited my critics to come to my office on an annual basis and discuss what their priorities were so that we could work together wherever possible in addressing their priorities for the benefit of all citizens of the province. on some occasions, I even invited them to stakeholder meetings with me.

This was not something that was common, I understand, but that’s just the way I run, and that’s the way it worked. At one point, I even toured the province and invited all MLAs on both sides of the House to organize round-table meetings with their constituents.

It was kind of funny. A previous member of this Legislature who was in the opposition at the time, after the meeting, asked me how I got away with that. How did my handlers, so to speak, let me meet with opposition MLAs and their constituents? I said: “Well, isn’t that what we’re supposed to do — meet with all British Columbians?” So it was quite an interesting revelation, on my part, that that was actually something that was new. I didn’t think it was. I don’t think it should be.

We see that in the House all the time. We see members of this House on all sides get together in committees and try to work things out, try to find the best path forward for the people of British Columbia and do consultations with the public. We’ve seen that in the children and family committee, we see that in the Finance Committee, and the list goes on and on.

Of course, the public doesn’t get to see that. What they get to see most of the time is the back-and-forth of question period. That’s just the way TV ratings go. A lot more exciting to see someone yell and scream and pound their desks than to see them in a corner room working together, almost singing “Kumbayah” sometimes and trying to come up with common solutions. But that’s the way it goes.

This particular one, this particular piece of legislation, I think, is a little different, and I’ve only been here 13 years. I don’t recall seeing any government inviting members of the opposition to come and almost craft the guiding principles for legislation. I’m sure I’ll be corrected if I’m wrong by more senior members at some point. But in my tenure, in my experience, I haven’t seen that. So kudos go to the Minister of Health for inviting the two of us, the Leader of the Third Party and myself, to join him in this quest.

What are we trying to do here? Well, I think the best solution to that, for me, as I said earlier on, was to go through why this was created in the first place. I think the best place to start would be the Clayton report, so I’m going to read and paraphrase parts of the Clayton report, because that’s the report that really got things going. There were issues with the college of dentistry and other challenges in all the other colleges that needed to be addressed. So when the minister engaged Harry Clayton back in March, I believe, of 2018, to come up and look at the issues, he came out and presented to the public the report on April 11, 2019.

The Clayton report basically starts out with the framework that says the regulation for health professionals in British Columbia was developed 30 years ago and brought into law through the Health Professions Act in ’79. He goes on to talk about health care systems around the world facing similar challenges to those that are faced here in British Columbia: aging populations, an increase in multiple long-term health conditions, the increasing costs of health technologies, rising public expectations and consumer demands, and global shortage of health care workers.

Now, in those years and still today, health care workers are very mobile. We have a lot of people in British Columbia, and I know that you’re familiar with some of them, that come here from other countries and are serving in some of our more rural areas to start with. That’s a challenge, not only for them but also for where they leave, because I’m sure they would like to keep their own health care workers resident in their own countries instead of seeing them come up to Canada. So I think this part of it is really important, that we recognize there’s a shortage and we have to do a better job of training and keeping our own young people right here in this country.

[4:15 p.m.]

Mr. Clayton goes on to say that Canada is a little different from other developed countries. Infant mortality is low, and life expectancy is increasing, with over 18 percent of the population in B.C. being over 60 years of age. There are regulatory implications of all this, and the framework that has lasted for the last 20 years, from the time the report was done, needed to change to be effective going forward to protect patients and be flexible so that we can get value for money for registrants, as well as be reliable, to make sure we promote public confidence.

There were, at the time, 21 separate colleges that had their own strengths and weaknesses, and there must be a significant variation given that the very sizes themselves were different. The resources were different. That was part of the problem with the Health Professions Act, which is the overarching legislation applied to very different professions and colleges.

The 21 regulatory colleges in B.C. needed to have something that would keep them together — something that common sense would work in setting up separate regulatories for every occupation regardless of its numerical strength. That was a challenge, because the colleges covered everywhere from, in those days, 118,000 registrants to the smallest of just 78. It would be impossible to have common standards, common goals and common abilities to attack the challenges that they faced when they have such diversity in numbers.

Again, at the time, the B.C. College of Nursing Professionals had 55,000 members. The highest annual fees paid by registrants of the smaller regulatories…. The optometrists, 805 of them, paid $1,390 a year. The midwives, 228 of them, paid almost double that: $2,340 a year. The nursing professionals paid between $450 and $650. Again, trying to get the same outcomes with much fewer dollars, depending on which college you belonged to.

In line with the findings that Mr. Clayton came up with in the U.K. and Australia, he showed that the larger the register, certainly up to 100,000 registrants, the greater the economies of scale. That was a key aspect of our work on committee. The whole idea of coming back to economies of scale was part of the driving force. The lower-paid occupations actually paid a higher proportion of their income to be registered than the higher-paid occupations. Well-paid physicians and surgeons paid $1,685 to their college, while low-paid denturists paid $1,249 a year to their college.

He goes on to say that self-regulation also hands control of supply to the occupation. Then he quotes Adam Smith, the 18th-century social economist, when he says, 250 years ago: “People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public or in some contrivance to raise prices.” Professional regulation has, at its public intention, the maintenance of quality. In practice, it may create a cartel or a monopoly. So here he was, Mr. Clayton, quoting Adam Smith and saying that this is not in the public best interest.

An example of the weakness in the public protection of a fragmented self-regulated system may be seen in the case of the B.C. naturopathic physician who breached their college standards on vaccination and reportedly treated an autistic child with a homeopathic remedy containing saliva from a rabid dog. After a collegial discussion, the registrant was allowed to resign from the college with no action taken. He cites that as an example of how the system just wasn’t working to protect patients. Patients, he goes on to articulate, do not have a great confidence in the colleges or in the health regulation generally.

Mr. Clayton says that the overall objectives of reform of health professional regulations should be (1) to protect the safety of patients, to prevent harm and to promote the health and well-being of the public; (2) to provide a framework for safe, competent and ethical professional practice; (3) to have the trust of the public and the confidence of regulated occupations; (4) to be able to adapt to change and respond to new risks and opportunities; and (5) to be efficient and cost-effective in the interest of all citizens.

[4:20 p.m.]

He says that colleges need a clear mandate prioritizing patient safety and the clinical competence and ethical conduct of registrants. He says that to do that, you need to protect the safety of patients, to prevent harm and to promote the health and well-being of the public.

As you’ve heard from other speakers already, and you’ll hear from me several times this afternoon, the focus of the steering committee, led by the Minister of Health, was to make sure that we protected the safety of patients and had their trust.

He says: “A mandate of this nature would ensure the regulatory colleges were focused primarily on safety, on standards of clinical care and on the health needs of patients.” So one of his first sections, of Mr. Cayton, was to talk about governance.

The Health Professions Act, or HPA, “is ambiguous in its use of ‘members’ and ‘registrants.’ The concept of membership has led to many misunderstandings about the nature of professional regulation. The idea of membership should be discarded and replaced throughout with ‘registrant.’ If colleges do not have members, then there is no need for an annual general meeting — not, indeed, any of the other trappings of a club, such as award ceremonies and gifts to volunteers.”

He goes on to discuss that people were thinking, by being on the college and elected to the college, that they were there to protect and serve the people that elected them, which is understandable. They got elected by the people, and therefore, they should be serving the people. But really, their goal or their mandate should have been serving the broader public, not just the people that elected them.

Mr. Cayton goes on to say: “It would be beneficial to move to fully appointed boards, combining health professionals and members of the public in equal parts.” When I read the legislation — and I admit I did read all the legislation — I did find that in here. The one thing that was different than the recommendation was that the legislation does call for one person on the professional side to be the tiebreaker, so one more person than equal. But someone has to break the tie, so why not?

He says: “The government should consider the process for the appointment of public members so that it is more transparent, with public criteria and competencies for appointment and attention paid to the skill mix on individual boards.”

He also recommended that board sizes be reduced, going from the large boards down to eight to 12 people. He says that they have a much better opportunity to be effective than very large boards.

Mr. Cayton also recommended that “terms of office should be extended to three years, renewable for further three years, to provide continuity and the expertise which comes from experience.” The current structure at the time, he says, encouraged “amateurism and short-term planning.” He didn’t hold his words. He says: “Regulation is a long-term business.”

He also went on to say: “Colleges should be given greater freedom to change their own rules and bylaws. Current arrangements are too cumbersome to allow them to respond to change.” Again, that’s in here as well. So I’m glad to see that made its way through.

“Colleges should separate themselves entirely from professional associations. They should not collect fees for professional associations or give them grants.” So basically, if professionals want to form their own associations, they should feel free to do so, be even encouraged to do so, but not confuse that with the work of a college, which is there to regulate.

If a higher performance is to be expected of board and committee members, they should actually be rewarded for their work. “Board and committee members, both professional and public should be paid for the time they give and the expertise they provide.”

“The board should be removed from any involvement in complaints and discipline. Inquiry committees and disciplinary panels should be independent, separately appointed and should have regular training and appraisal.”

On the issue of the number of colleges — at the time, 21 or 22, depending on what counts you want to use — Mr. Cayton says: “The Ministry of Health should actively encourage and facilitate mergers, especially of the smaller, less well-resourced colleges. The joining together of the three nursing colleges is an example to others.” Again, we’ve had other colleges that have joined together since the report has come out.

“Fewer, larger colleges with resources adequate to do their job should be the objective. This should also reduce fees to registrants.” Nothing gets someone talking like their pocketbook. So fees, even to very rich doctors, are something they talk about. So we have to make sure that the fees are reasonable from the college. I’ll talk about that in a few minutes.

[4:25 p.m.]

“The HPA defines ‘professional misconduct’ as including sexual misconduct, unethical conduct, infamous conduct and conduct unbecoming a member of the health profession. Separately, it defines ‘unprofessional conduct’ as including professional misconduct. The word ‘including’ suggests there are other behaviours which might constitute unprofessional conduct but which are not professional misconduct.”

As you can tell from my articulation of the words, this is very unclear and open to interpretation, especially the definition of what is a serious matter, which is even more problematic. So the HPA needed to make sure that it addressed that, and I’m glad to see that it has.

“The test is problematic, as the decision as to whether a matter is ‘serious’ or not can determine whether or not publication of the outcome is required.” When do you have to inform the public that someone has had a disciplinary action taken against them? That’s a big part of the discussion that we had at the steering committee and, of course, is a big part of the legislation.

“Consent or undertakings in relation to ‘serious matters’ may be published. If matters are not serious, they can be kept secret. Publication is a difficult part of the process for registrants and is often contested. The controversy and perverse incentives created by the link between serious matters and publication of consent orders or undertakings creates unnecessary cost, delay and uncertainty. Overall, it is difficult to discern any benefit to the public.”

On the complaints and discipline topic, Mr. Clayton proposed that the “purpose of the investigation of complaints and the disciplinary process is to protect patients and reduce harms, to secure public trust in professions and to promote professional standards.” These need to guide the objectives at all times on complaints.

“There needs to be a common entry route for all types of complaints or referrals so that all are prepared in the same way and sufficient information gathered before consideration by the registrar or inquiry committee.”

The HPA complaints process needed significant revision where, after a while, working with Mr. Clayton, it was pretty obvious that the current legislation could not survive a few tweaks and that really, it had to be rewritten, and that was a big job.

Having served on the legislative review committee in the past, I can tell you that I’m very happy I wasn’t serving when this came forward, because this probably took weeks of analysis to make sure that all the i’s were dotted and all the t’s were crossed. So my hat goes off to all the members of the legislative review committee and, in particular, all the legal counsel that was there to advise them on this legislation.

Mr. Clayton also did a flow chart. I know I’m not supposed to use props, so I’m just going to move my page down, along with the other pages. But if you do stop the video at that point, you will see a flow chart, which is very, very ugly, as to what is connected to what and how you do things and how you make a complaint. I don’t know how anybody in the public followed that kind of process. Mr. Clayton basically said: “We need to clean this up.” In the legislation is the proposal as to how we do that. I’m happy to see that as well.

“The ability of the registrar to dispose of complaints as set out in section 33 of the HPA is unsatisfactory.” He goes on to articulate again the difficulty created by using the term “serious matter.” Colleges need defined thresholds at every stage of the process. That way, the registrar would know whether or not something is a serious matter and what outcomes are appropriate and considered by the inquiry committee.

“Another concern is the lack of clarity about the consideration of the registrant’s past history. A history of upheld complaints is clearly relevant to sanction, particularly if remediation has previously been prescribed but has failed to improve performance.”

Again, as the HPRB points out, consideration of past conduct history appears to be discretionary, and that’s the way it is right now. We had major discussions, I would say, at the steering committee about making sure that the public knew the past history of any registrant so that they can make informed decisions as to whether or not they wanted to avail themselves of that person’s professional trade.

[4:30 p.m.]

Past history is very, very important. So I’m glad to see that that was also followed through with.

“Defined and consistently applied thresholds at every stage will be fairer to registrants and clear to complainants. They will make it harder for registrars to use the ‘summary dismissal’ in cases where there has been a serious, harmful outcome — even if they are legally entitled to do so. Such decisions undermine public confidence in the regulation of the professions.

[S. Chandra Herbert in the chair.]

“Colleges need the power, when appropriate, to mandate remediation…. There needs to be clarification that, once a citation has been issued, the outcome of the case will be published, even if a consent order is agreed, because it has passed a threshold of seriousness or risk to the public….

“The option for a registrant to make a proposal to the inquiry committee after the discipline committee has ‘assumed jurisdiction’ should be removed. There should be no settlement once a matter is referred to a hearing by citation, unless that settlement is considered and agreed by the disciplinary committee at a hearing and public protection and the public interest taken into account.”

He also went on to say that “the role of fines should be reconsidered” and that “they have no contribution to make to public safety.” We’ll make sure that when we go through the legislation through committee stage, we see if that has followed through in the legislation.

On increased transparency, I believe the Leader of the Third Party did articulate her viewpoints on transparency and this legislation’s demand for more transparency versus the government record, so I don’t need to go there. But for this particular piece of legislation, “colleges need to increase the openness and transparency of their work.” There is considerable variation in practice between colleges. “Board meeting should be open to the public, and time should be reserved for visitors to ask questions or to comment. The assumption should always be that business will be done in daylight. Boards, if voting, should not have secret ballots; board members are accountable for their decisions.”

Now, having said that, some regulators are very good, and of course, some aren’t. Some are very good in their websites, and some aren’t. Some make good decisions, and he was saying that some might not. Hopefully, with this new legislation, we’ll have more consistency throughout all the colleges and throughout all the professionals.

“The HPA builds secrecy into the complaints process. In doing so, it protects registrants and not the public.” For “concerning conduct that, if proven or admitted, would normally result in the imposition of practice restrictions, a suspension or cancellation of registration, or a fine; where discipline is applied after a citation is issued for hearing before the discipline committee; or that involve the imposition of practice restrictions, or the suspension or cancellation of registration,” the HPA right now limits publication to these decisions.

We need to move away from that.

“It is not possible for patients to give informed consent to care if they do not know that their health practitioner has had a complaint upheld against them. It should be considered a fundamental right of a patient to know about their health care provider’s competence and conduct.”

I’m just about done on Mr. Clayton’s initial report.

“The colleges should work together to agree a consistent way of reporting data so that they can assess their own performance and benchmark themselves against each other.” That way they can hopefully improve their performance.

“Two additional roles for the Health Professionals Review Board, HPRB. First, it should be able to publish guidance for all the colleges on improving their complaints performance and learning from good practice. The HPRB has a wealth of data that could be analyzed qualitatively as well as quantitatively to generate learning.

“Second, the HPRB should be empowered to review decisions of the colleges in relation to complaints on its own account and without receiving a referral…. It might exercise this power rarely, but…it would be beneficial to public protection if a college has made a perverse or transparently lenient determination and the patient complainant is not in a position, for whatever reason, to take the matter further. The HPRB could act on behalf of the public interest by initiating its own review.”

That’s where we started from. We started with Mr. Clayton being hired by the Minister of Health to go out and review the….

Interjection.

[4:35 p.m.]

N. Letnick: Clayton, Cayton. I’m glad to be informed by the Minister of Health that it should be Cayton, not Clayton. Thank you very much. If the Minister of Health has any other corrections to make, I welcome them as well, because I still have an hour and a half to go. I’m open to anything that would help us get to that time.

Interjection.

N. Letnick: One mistake every half hour. No problem. I’m happy to accommodate the Minister of Health with that.

So Mr. Cayton was hired by the Minister of Health and government to come up with a report.

This is the analysis, by Mr. Cayton, of where we’re going wrong and what we can do, if followed, to improve health and safety of the public through this process. Some of the objectives of a new regulatory framework should be: "To deliver safe and good-quality care provided to patients and the public, to restore public trust and professional confidence in regulation, to be risk-based and proportionate, to be fair and consistent, to be effective and efficient, to be open and accountable, to be agile and adaptable, to promote collaboration between occupations.”

Therefore, he recommended, and I’m going to go through quickly the specific recommendations that went to the public for comment, that one, we should “reconstitute the colleges as bodies responsible for setting standards and licensing health professionals who are within their jurisdiction. This might cover two or more occupations within a single college.”

Two: “The colleges should agree to a single code of ethics and conduct for all health professions. There is no reason why the ethics of doctors, say, should be different than those of dentists or of chiropractors.”

Three, the colleges should remain responsible “for setting standards for clinical competence and practice and for issuing guidance to their registrants.”

Four: “The colleges would issue a licence to practise for individuals who met the good character and clinical competence requirements for registration.”

Five: “The colleges would remain responsible for assuring continuing competence and assessing registrants prior to annual renewal of their licence.”

Six, the colleges would investigate complaints but not adjudicate them.

Seven, the names of all registrants should be held in one register.

Eight: “A new body should be created to do this, a professional registration and adjudication agency.”

Nine, a single register should make it easier for members of the public, patients and employers and registrants to identify individual professionals. “It should mitigate concerns by registrants that decisions by inquiry committees are unduly influenced by college investigators.”

Ten: “The shared code of ethics and conduct jointly agreed by the colleges would be required of all registrants and would be the standard against which unethical behaviours or unprofessional conduct was judged by an inquiry committee or a disciplinary panel.”

Eleven, the oversight body for regulatory framework: “If such a different regulatory framework were to be established, with greater transparency and accountability, the question arises as to whether further oversight or supervision might be necessary. Full disclosure of all licensing bodies and the register and tribunal of the HPRB of performance data to the public to registrants and to government would be sufficient to hold the components accountable.”

Twelve, the following functions for an oversight body for a professional regulation would be to approve the shared standards and ethics conduct; approve the range of standards for professional practice; approve of a revised and more flexible arrangement for colleges to change their rules and bylaws; establish performance standards of good regulation to be applied to both colleges and registrants and adjudication bodies; establishment of the dataset to be reported on by all colleges for compilation, analysis and publication; encouragement and support for voluntary amalgamation of colleges; the absorption of the functions of the HPRB.

Also, conducting reviews and investigations of the performance of colleges at the request of the minister; advising, but not directing, colleges and the minister on improvements in regulatory practice; assessing the risk of harm to patients and the public of health care occupations and to make recommendations to the minister as to whether or not statutory regulation is necessary and which college would be responsible; and lastly, create and oversee an independent appointment process for both professional and public members of the college boards, based on open competition, published competencies and relevant experience and to make recommendations to the minister.

[4:40 p.m.]

Another recommendation, and there’s three more that Mr. Cayton made to the minister, is that in order to make the process on reform of the professional regulatory framework, there should be a policy commitment that no new colleges be created. In fact, even the prior government followed that — where it was very, very difficult, near the end, to see new colleges created. It had to go through a process of ministry approval, cabinet approval.

So the prior government, as well as the current government, did not advance any new colleges. Part of the benefit of this process is that those people that now want to be regulated will have a much easier time to do so.

An evidence-based occupational risk assessment process should be developed and implemented to identify the potential risk of harm from occupations within the health sector to consider appropriate mitigations. Lastly, the occupational risk assessment should be the responsibility of a new oversight office.

The decision as to which occupations should be regulated will remain with the minister.

In summary, on this part of the Cayton report, he does break it down into a number of areas of who’s responsible for the process. The Minister of Health is still responsible for the controlling legislation, appointing of boards and decisions on regulation.

Under the Minister of Health would be an oversight body. This oversight body would review determinations, publish performance data, oversee the appointment process, approve bylaw changes by the colleges, do risk assessments, investigate and review.

Next to that, you have the registration and adjudication body. They hold the single register for all the registrants. They will adjudicate complaints, and they will remove individuals from the registrar when necessary.

Then you have the colleges. The colleges will set standards and guidance and do registration and licensing. They will do continued professional development, investigate complaints and publish data sets.

The professionals, of course, will be under the colleges, and the public — overarching everything, the ones that we’re doing this for — will be able to see a single register of all the professionals through the registration and adjudication body, and they will also be able to make complaints about the professionals.

What happened after Mr. Cayton submitted his report to the minister? Well, the minister thought it would be a good move to bring together the opposition, along with the minister, to form a steering committee to guide the process. As I said before, I congratulate the minister on doing that. It also helped take what could potentially have been a very politically divisive topic and make it more collaborative, more collegial, amongst all members of the House.

In my role as a member of the steering committee from the official opposition, as the then Health critic, I would brief my caucus as to where we were on the work, listen to their particular perspectives, and bring that back to the steering committee. I assume that the Leader of the Third Party did the same with her caucus when she was on the committee.

We then set out a plan to basically ask the public…. When I say “the public,” it wasn’t open to all the public, but most of the respondents were people that had an interest in the colleges — the professionals themselves, as well as those that were regulating them. We set out a plan where it would be an iterative process. We would go to the public and say: “Look, here are the recommendations by Mr. Cayton on how we should change the HPA. What do you think of those recommendations?”

Then we heard from the public and came up with our own set of recommendations, on which we then went back to the public again and said: “Okay, we heard from you. Here is what we heard from you and how we tweaked our recommendations. What do you think now?” Of course, the public again came back to us and said: “Well, based on what you revised, here’s what we think currently of what you said.”

[4:45 p.m.]

That was the end of the process. We provided our final recommendations to the government, and the government went off. Unfortunately, COVID hit. Through that time, staff — along with the minister, I’m sure — created this piece of legislation, which I did not see until this week. Sorry, that would be last week. For some reason, I think it’s Friday. So until last week. Maybe that’s wishful thinking.

In large part, that’s the process. What I’m going to do now is actually go through the specifics of the process, because I think it’s important to get on the record what the committee actually recommended to the public and what the public told back to the committee, and then, what the committee revised, based on that public input and the input from our caucuses — the three caucuses that were informed of the process and progress.

The steering committee first issued their report in November of 2019, called Modernizing the Provincial Health Profession Regulatory Framework: A Paper for Consultation. At the beginning of the report, it has the usual preambles of how this happened, Mr. Cayton’s report, who the committee were and what the process was. Then it goes into scope. It says the scope of the committee is guided by three objectives: (1) to improve patient safety and public protection, (2) improve efficiency and effectiveness of the regulatory framework and (3) increase public confidence through transparency and accountability.

In addition to consultation, the steering committee supported the implementation of the Declaration on the Rights of Indigenous Peoples Act and committed to honoring the United Nations declaration on the rights of Indigenous peoples. Prior to the committee being formed, the act had been passed by all members of the House. We articulated that right up front in our report to the public.

We offered to the public different ways to participate. I’m not saying this is totally exhaustive, but it did garner a lot of feedback from the public.

We went, from November 27 of 2019 to January 10 of 2020, through an online survey and through written submissions, which were submitted directly to government. The members of the committee did have an opportunity to read all the submissions. The staff — again, thank you to the staff who did this work — did put together a summary of those submissions. I think this is where part of the comment from the Leader of the Third Party made regarding my work. I, for one, did read every single submission.

There were some submissions that were duplicates. It was kind of a chain letter kind of thing. You know what I mean? I did read one, but I did not read the other thousand that were copies of the original one sent by email. But all the unique ones I read. When the staff came forward with their summary of the submissions, I was totally confident that staff had done a great job in summarizing the submissions that I had read. So again, hats off to staff for summarizing quite a variety of different submissions and different directions.

The steering committee reviewed and considered all submissions and published an overview of themes on the Ministry of Health’s profession regulation website. We received over 300 written submissions. A broad section of respondents submitted, including 190 members of the public, 50 health practitioners, 25 professional associations, 18 regulators and 30 other health sector stakeholders, including unions.

The submissions were broadly supportive of modernizing health profession regulation in B.C., improving transparency and accountability throughout the system of health profession regulation. These were common themes. They also wanted greater oversight into all of this. That was frequently expressed.

Members of the public who made complaints to the regulatory colleges shared concerns about the current process for complaints and discipline. The importance of profession-specific clinical knowledge and health profession regulation was expressed. Other feedback themes included the need for consistent approaches to regulation across the continuum, cultural safety within the complaints and discipline process, and the performance monitoring of regulators as well. Members of the public and health care sector stakeholders expressed support for continued engagement and consultation as the work progressed, and that’s exactly what they got.

[4:50 p.m.]

Input from the initial public consultation assisted us to identify and prioritize the following elements of regulatory modernization that were important to British Columbians: ensuring regulatory colleges are putting the public interest and patient safety ahead of professional interest — again, that recurring theme, and you’ll hear it again; improving the effectiveness of regulatory college boards; ensuring boards are comprised of members appointed based on merit and competence and not elected; reducing the number of regulatory colleges to improve efficiency and effectiveness; creating a body to oversee regulatory colleges to improve public confidence and patient safety; and simplifying and increasing transparency in the complaints and disciplinary process.

Mr. Cayton’s report wasn’t actually the first time that the issue had come up. In 2003, the Ombudsperson’s office reported on self-governance and health care professionals in B.C., citing concerns that the professions do not appear to have fully accepted or understood what it means to act in the public interest. Concerns persisted. The Cayton report highlighted that many regulatory colleges…. Their governance was insufficiently independent, lacked a competency framework and had difficulty managing skill mix or clear accountability to the public they serve.

The regulatory college boards must provide effective leadership to ensure that regulatory colleges fulfil their legally defined mandate. To achieve this, the boards need to be composed of individuals, with the right balance of skills and experience, who are focused on public safety. Ensuring that boards are comprised of individuals whose motivation is consistent with legislative requirements is critical to ensuring the protection of public safety.

The majority of regulatory college board members, however, at the time and still today, are elected by health professionals who are registered with the regulatory college overseen by the board. The Ombudsperson’s 2003 report highlighted concerns that these elections have led to a strong sense of accountability among colleges to the profession and, ultimately, have led to a diminished “sense of direct accountably to the public.”

The election of registered board members has continued to promote the misconception that these board members are accountable to those who have elected them. Again, I don’t blame them for that. That’s just the way it works. You always try to serve those that elect you.

Striving for balanced numbers of public and registered board members will ensure that the perspective of the public is well represented. Again, I see that in the legislation, and I’m happy to see that.

A competency-based board appointment process to appoint the members will give the boards a mix of skills and experience to govern effectively. Therefore, we recommended to the public that it be proposed that regulatory college boards have an equal number of registered and public members. We recommended that the appointment, through a competency-based board process which considered diversity, was independently overseen and was based clearly on specified criterion competencies, be established and that the Minister, of Health would appoint all board members based on recommendations from this competency-based process. Again, that’s in the legislation, and we’ll canvass that more clearly in the committee stage.

On the size of boards, our committee made the recommendation…. To improve functioning and effectiveness, it was proposed that the regulatory colleges move to a more consistent and smaller size. We asked the public if they supported that reduction in the size of boards. We also asked them if there were possible challenges to reducing board size and, if so, how they could be addressed.

On the issue of compensation, we asked the public how members should be fairly and consistently compensated. If this would be a move from being volunteers, would they support fair and consistent compensation for board and committee members, which would be paid, effectively, by the members eventually, if not initially? What are the benefits of this approach? How would challenges occur, and how would they be addressed?

We also asked the public to comment on improved efficiency and effectiveness through a reduction in the number of regulatory colleges. The larger the regulatory colleges, the more economies of scale they had. We wanted to make sure that all regulatory colleges were efficient and effective. So we suggested to the public that we supported Mr. Cayton’s report and recommendation that we reduce the number of regulatory colleges. Specifically, we recommended that we reduce it from 20, at the time, down to five.

[4:55 p.m.]

Now, I understand that what’s in the legislation is not exact as far as how many, I believe. We’ll canvass that in committee stage, as far as the regulations go. The minister has made it pretty clear that the number is now six. We’ll talk about that again in a few minutes, as to how we got from five to six. Initially, we had recommended five.

Maintaining the College of Physicians and Surgeons of B.C., the College of Pharmacists of B.C. and the B.C. College of Nursing Professionals. The College of Physicians and Surgeons and the College of Pharmacists and the College of Nursing Professionals were of sufficient size and had sufficient registrant base to continue as stand-alone regulatory colleges. As a result of previous amalgamations, the College of Nursing Professionals had over, at that time, 59,000 registrants and was the largest regulatory college in the province.

There was a proposal to create an oral health regulatory college, with the four oral health regulatory colleges amalgamating to form a single oral health regulatory college. As we all know, that is no longer the case.

There was a proposal to look at the remaining regulatory colleges. Given the commitment to a reduction in the number of regulatory colleges, we asked the public if any new health professionals be regulated by an existing regulatory college or a new college of health care professionals.

We asked them if they were supportive of the proposal to have those five: the College of Nursing Professionals, the College of Physicians and Surgeons, the College of Pharmacists, the College of Oral Health Professionals and the omnibus college of health care professionals for the rest. Should anybody else want to be a college, put them into this college of health care professionals as well. We got a lot of feedback on that one. Actually, that attracted, probably, the most feedback of any of our questions.

We wanted to, of course, strengthen the oversight of regulatory colleges. It’s becoming common for governments to establish independent bodies to regulate regulators as part of the transparent regulatory system. This is to restore public trust in natural resource decision-making. That did happen. Also, Mr. Cayton said we should do something similar but learn from the experience that we had on the Professional Governance Act and not repeat some of the similar issues.

The creation of a new oversight body had the following responsibilities proposed for them. Number one, routine audits of regulatory colleges based on clear performance standards. Public reporting on common performance standards was important. Conducting systemic reviews and investigations. Reviewing of registration and complaint investigation decisions. Publishing guidance on regulatory policy and practice. Identifying core elements of shared standards of ethics and conduct across professions.

We also wanted to establish a range of standards of professional practice. Development of model bylaws and oversight of the process for bylaw amendments. Oversee board member appointment process. And recommending health occupations that should be regulated under the Health Professions Act, new professions as well as existing professions not currently regulated under the act. Holding a single register of all regulated health professions. Oversight of systemic progress on timelines of the complaint process. And finally, the collection of fees.

We asked the public if they supported the creation of an oversight body. Did they agree with all these 13 different functions, as listed above? If they had concerns, what were their concerns, and how could we address them?

We also asked the public if they agreed with increasing accountability to the Legislative Assembly. We propose that annual reports of the regulatory colleges and oversight body be provided to the Legislative Assembly by the Minister of Health. We got some feedback on that as well, mostly unanimous and saying yes.

The complaints and adjudication process. Simplifying the complaints and discipline process was proposed in order to provide a clear focus on patient safety, public protection and strengthening public trust in legislation. These proposed changes would include establishing a new disciplinary process that would create a clear separation between the investigation and the disciplinary stages of complaints. Regulatory colleges would continue to investigate complaints; however, disciplinary decisions would be made by a separate and independent process.

We also would include increasing transparency by requiring that actions resulting from accepted complaints be made public and, lastly, removing the ability of professionals to negotiate agreements late in the process.

[5:00 p.m.]

A new disciplinary process is proposed in which independent discipline panels would make decisions regarding regular health professionals. We asked the public if they supported this and if they could tell us some of the benefits of the approach and, if they did not, why not.

As you heard from other speakers, transparency was very important. It was proposed that the actions taken to resolve accepted complaints about health professionals be made public. Now, we knew that this might be contentious in some quarters, so we wanted to make sure that those responding to the survey had an opportunity to tell us how they thought about this and, if not, why not and what options they would come up with other than that.

We also proposed that regulatory colleges be able to make limited public comments if a complaint under investigation became known to the public. Right now, if someone in the media says, “I heard of somebody violating some part of the act or some conduct,” it’s very difficult for the people in the college to comment.

We wanted to make it very clear as to what could be said and when it could be said, to make sure that not only was the public protected, but also the people who are speaking and the person who was involved with the complaint would be protected. It was proposed that regulatory colleges be able to make limited public comments if a complaint under investigation became known to the public. We asked again if this was something people would support.

One thing that I personally thought was very important, and I’m glad to see that it made it to our recommendations, was that the act appears to give regulatory colleges discretion as to whether or not past conduct will be considered when current complaints are reviewed. I personally believe, and I’m glad to see others do as well, that it is very pertinent to making a decision on someone’s conduct if that conduct has been part of their history, so we really pushed hard to make sure that that history would be known if it was appropriate to be known.

In order to better protect patients from harm, it was proposed that complaint and disciplinary decisions must take into consideration a professionals’ past history. We asked if people actually supported that particular perspective.

Responses to sexual abuse and sexual misconduct. The steering committee sought feedback to help establish consistency across all the colleges in relation to how they address sexual abuse and sexual misconduct. What measures should be considered in relation to establishing consistency across regulatory colleges regarding how they address sexual abuse and sexual misconduct was important, so we asked the public about that.

I think, yes, the last one we discussed with the public was about information-sharing to improve patient safety and public trust. During our public engagement, regulatory colleges noted that legislative barriers to information-sharing made it difficult to work with other health system stakeholders. Information-sharing between regulatory colleges, health authorities and other agencies is affected by multiple pieces of legislation. It was suggested, therefore, that statutory changes be required to allow effective communication among the colleges and other agencies.

It was also suggested that regulatory colleges should be responsible for coordinating team-based care complaints so that complaints only have to connect with one regulator. We proposed exactly that and asked people for their comments.

That was the work of the committee, basically — to go through the Cayton report, identify the key recommendations that we thought should go to the public and then, once they went to the public, to review the public’s input.

Your next question, I’m sure, Mr. Speaker, is: what was the public’s input? Well, it just so happens I have a report right here that discusses the public input. I’d be happy to share that with you now, since you most graciously asked me what the public input was, in hand gestures and other things.

[5:05 p.m.]

If anybody wants to read the input in full, they can go online to What We Heard: Engagement Summary Report, August 2020. I will highlight some of the highlights from the report for all the people that are watching.

My wife, my constituency assistant. “Maybe not her,” Mr. Speaker is saying. Okay. Well, my mother is watching from up there. That’s for sure.

Some of the responses we got. Well, first of all, just to remind everybody, we went to the public between November 27, 2019, and January 10, 2020, before COVID. We went in two ways: online surveys and, also, written responses. We also had meetings with different partners. I think it’s important to articulate who they were.

Online survey responses. We received over 4,000 surveys, and 71 percent of the survey respondents identified themselves as health professionals. Members of the public were the second-largest group, at 22 percent. The remaining 7 percent included health professional regulators, staff and board members, professional association or union representatives, health profession students and researchers.

The survey was not a general population survey and should not be interpreted to represent the views of the general population of B.C. but, rather, individuals who had an interest in or some relationship with health professions and their regulations. That’s what we get elected for, 87 MLAs. We’re here to represent our constituents. We’re here to represent the public. We’ll see, through this process of second reading and of committee stage, how effectively we do that.

Sixty-three percent of respondents identified themselves as women; 25 percent identified themselves as men. About 11 percent preferred not to say, and 1 percent of respondents identified themselves as gender diverse. Three percent of respondents identified themselves as Indigenous persons. Regional distribution of the survey more or less aligned with B.C.’s population distribution, with the proportion of people from the Lower Mainland, Vancouver Island, Thompson-Okanagan, etc.

There were 255 unique written submissions received from health professionals — 94 from professional associations, 53 from members of the public, 38 from B.C. health profession regulators, 21 from regional health authority representatives, 11 from Indigenous partners, two and others from provincial bodies, and 36 from out-of-province regulators, non-profit groups, unions and educational institutions.

In addition, 1,225 writing campaign form letters were received regarding professional scope of practice, amalgamation of regulatory colleges and regulation of additional professionals. Then, finally, 24 meetings were held, with a total of nearly 50 health care sector partners and organizations, with the staff of the minister.

What were some of the themes and results? There were five principle areas of focus for modernization. Ensuring regulatory college boards are comprised of members appointed and not elected — members appointed based on merit and competence. Ninety-two percent of the respondents said they supported the appointment of members based on merit and competence and moving away from electing — 92 percent. Five percent were neutral, and only 3 percent were not supportive or thought it was somewhat unimportant. If you’re looking for a strong mandate, 92 percent said we should move away from electing members.

On the concern about regulatory colleges putting the public interest first and patient safety ahead of professional interest, it might sound like motherhood, but 90 percent supported that as well. Seven percent were neutral, and 3 percent thought it was not at all important or somewhat unimportant. On the area of simplifying and increasing transparency in the complaints and disciplinary process, 80 percent of the respondents thought it was important or very important, 14 percent were neutral, and 6 percent thought it was not at all important or somewhat unimportant.

On the issue of creating a body to oversee regulatory colleges to improve public confidence and patient safety, 64 percent of the respondents thought it was important or very important, 17 percent were neutral, and 19 percent didn’t think it was important or was somewhat unimportant.

[5:10 p.m.]

The most ununanimous, if there’s such a word, or divergent in opinion, which is probably better grammar, was on the whole issue of reducing the number of colleges. On reducing the number of regulatory colleges to improve efficiency and effectiveness, 42 percent of respondents thought it was important or very important, 23 percent were neutral and 35 percent didn’t think it was important or somewhat important. Again, 92 percent thought they should be appointed.

I’m just going to go quickly through those. On the complaints and adjudication process, the majority of survey respondents indicated support for the proposal to increase transparency of publishing actions taken to resolve accepted complaints. A number of written submissions raised concerns about the proposed change and commented that requiring regulatory colleges to publish all actions taken to resolve accepted complaints may limit colleges’ ability to negotiate consensual agreements with registrants.

Survey respondents expressed support for requiring past history to be considered as part of the complaints review. Written submissions had varied levels of support for this change, with some noting this would help colleges recognize patterns of ongoing behaviour and others suggesting that past history would only be considered under specific conditions. Again, it’s something we’ll need to canvass in committee stage. Most of the written submissions supported enabling regulatory colleges to more easily share information of public safety, while some noted concerns about privacy and confidentiality.

Consultation respondents recommended Indigenous approaches to justice be integrated with complaints and adjudication and that regulatory callers, investigators and inquiry committee members are trained in cultural safety and humility. You will find, throughout this legislation, attention paid to that.

On the matter of supporting for publishing actions taken to resolve accepted complaints, 65 percent of those who responded did support the government publishing actions taken to resolve accepted complaints. I was very heartened by that. Only 20 percent did not support it, and 15 percent were neutral. And then on the matter I discussed before about the importance of past history being considered in making current complaint reviews, 77 percent of those responding thought it was important that past history be taken into consideration. Only 9 percent thought it was not important or somewhat important.

The steering committee sought feedback to help establish consistency across regulatory colleges when they address sexual abuse and sexual misconduct by health professionals, and the majority of survey respondents were supportive of mandatory cancellation of registration in cases of sexual abuse. So 85 percent supported mandatory cancellation. Mixed levels of support were expressed in the written submissions. A proportional approach was preferred in some written submissions, which recommended that decisions reflect the severity of the misconduct.

Both survey respondents and written submissions expressed support for requiring regulatory colleges to provide funding for counselling. Respondents suggested regulatory colleges should be able to recover costs from registrants who have caused harm.

I’d just like the Minister of Health to note that I passed my second 30 minutes without a second mistake. So that’s one for 60. Not bad. Or at least he hasn’t pointed one out. Let’s put it that way.

Written submissions suggested a range of measures for regulatory colleges to address sexual abuse and sexual misconduct, such as common standards; policies amongst regulators for prevention, investigation and discipline; and a unique or independent complaints investigation process with specialized investigations and supports and training in trauma-informed care for investigators and decision-makers.

This is something we’ll canvass through committee stage. It’s probably going to be something that will be under regulation, but we’ll make sure we hone in on that because of the importance of it.

[5:15 p.m.]

So that is a summary of what we heard from the public: a lot of support for many of the initiatives that Mr. Cayton had recommended and that we articulated to the public would be our recommendations to government. The only one really coming back with soft support was the amalgamation of colleges.

After we heard from the public, we then published another report. If anybody wants to see and read the report in its entirety — because obviously, in the time I have left, 52 minutes, I can’t go through the entire report; nor, I’m sure, do my colleagues want me to read the entire report into the record — they can go to the report. It’s called Recommendations to Modernize the Provincial Health Profession Regulatory Framework, Steering Committee on Modernization of Health Professional Regulation, August, 2020.

We took all the input that we got and put together our recommendations — as they turned out, our final recommendations — to government, and here they are.

“The steering committee recommends work be undertaken to determine how cultural safety and humility should be supported by the regulatory framework.” That was No. 1.

Number 2, “Both written and survey feedback received during the second consultation expressed support for regulatory college boards with an equal number of professional and public members,” as well as support for a competency-based board appointment system.

Now, I understand that there are still some members out there, especially some members of some associations, that are not supportive of this, but the vast majority of the feedback we received was supportive of it. The committee itself was also supportive of it. We went on to recommend that regulatory college boards have equal numbers of registrant and public members, that the board members be recommended for appointment through a competency-based process which considered diversity, was independently overseen and based on clear, specified criteria and competencies. The Minister of Health should appoint the board members based on the recommendations of this process.

It was recommended that prior to or immediately following appointment, all board members receive appropriate training and education to govern effectively.

We also recommended, to improve functioning and effectiveness, that the regulatory college boards move to a more consistent and smaller size. We also recommended that they be compensated, that this would not be volunteer work, that these people that would be picked would be highly sought after by many organizations because of their competencies and experiences, and therefore, we would have to compensate them for their time. We recommended that the board and committee members be fairly and consistently compensated.

We also looked at the number of regulatory colleges. Some submissions from regulatory colleges indicated that smaller regulatory colleges were struggling to meet their mandate due to resource challenges. In some cases, these resource constraints significantly hampered the college’s ability to protect the public from harm. The COVID-19 pandemic has placed new demands on regulatory colleges, further straining their resources.

When you look through the legislation and read through this legislation, you’ll see all the other things that the government’s going to be asking the colleges and their associations to undertake. They’re going to need money. They’re going to need economies of scale.

To increase public protection and improve efficiency and effectiveness of regulation, a reduction in the number of regulatory colleges was recommended, to go from 20, at the time, to six. Basically, we moved from the five, based on the input we received from the public. Again, I want to reinforce the process, because this kind of process is something, whether I was involved with it or not, I believed should be followed as much as possible.

Some independent group or person, like Mr. Cayton, does a report on what’s going on. The minister responsible puts out the report, looks for public feedback, sets an all-party committee to review the public feedback and makes recommendations. The public then reviews those recommendations and again makes feedback based on the recommendations. Then the all-party committee makes the final recommendation to government. Then, of course, government is free to do what government has to do, which is to govern. Sometimes we’ll have to make difficult decisions.

[5:20 p.m.]

When we canvass the legislation in committee stage, I’m sure there’ll be some things in here that the committee did not recommend and that are new, based on the experience through COVID, for example, or consultations with First Nations, amongst other things. That’s the government’s responsibility: to make sure that the legislation is as current as possible and as broad as possible.

With all of the different clauses in here, I would venture to guess that they’ll be back with a Miscellaneous Statutes Amendment Act, including some changes, because it’s clear that you can’t write this much legislation and not make some mistakes. We’ll try to identify those, as much as we can, in committee stage and try to avoid a misc stats act incorporating this.

You know, that’s something that the colleges will also have to help us with, because they also only got this final legislation last week, I assume. They’re all now, I’m sure, out there studying it, to see what questions they would like us to ask, maybe, on their behalf through committee stage.

That would be my invitation to everybody out there, to all the colleges and those people that provided us input through the process: after you read the legislation, if there’s something new that you want us to focus on, by all means, write the critic for Health in the opposition, and we’ll see if we can incorporate that in our committee stage.

A reduction in the number of colleges from 20 down to six. The results of phase 2 of the consultation indicated support for the reduction. We didn’t want to go too far away from the five, but based on the feedback that we got, there seemed to be good consensus to go from a college of health and care professionals to splitting it into two.

One, an umbrella regulatory college, tentatively referred to as a regulatory college of allied health and care professionals, would include dietitians, occupational therapists, optometrists, opticians, physical therapists, psychologists and speech and hearing professionals, as well as diagnostic and therapeutic professionals in the future. Of course, things have changed since then, but that’s what we recommended at that time.

A second umbrella regulatory college, tentatively referred to as a regulatory college of complementary and alternative health and care professionals, would regulate chiropractors, massage therapists, naturopathic physicians, traditional Chinese medicine practitioners and acupuncturists. That’s what the recommendation was to government.

We also recommended the creation of an oral health regulatory college. That brought the total to six. We also recommended that profession-specific councils be created within multiprofessional regulatory colleges to address matters requiring profession-specific expertise. We received feedback indicating concern that access to profession-specific expertise could be lost in the transition to fewer regulators. For example, profession-specific expertise is needed in the development of standards of professional practice.

A continued reliance on profession-specific knowledge and expertise was acknowledged as an important element of any future system. Profession-specific councils should be created within multiprofessional regulatory colleges to ensure that regulators continue to have access to profession-specific expertise and that the understanding of professional context is maintained for effective regulation. We’ll be looking to make sure that that’s envisioned in the legislation as well.

To improve public protection and increase accountability and transparency of the regulatory framework, it was recommended by the committee, to government, that a new oversight body be created. This oversight body would be responsible for monitoring and reporting on regulatory performance, publishing guidance on regulatory policy and practice, recommending a range of standards of professional practice, identifying core elements of shared standards of ethics and conduct across professions, doing periodic and random reviews of the bylaws, and overseeing a board member appointment process.

The pathway to regulation. Under the Health Professions Act, following a review, the oversight body should recommend to the minister which, if any, unregulated occupations should become regulated.

[5:25 p.m.]

Now, there’s a new part to the act that’s being proposed. Those professionals out there — I’m going to paraphrase — that aren’t posing a very serious threat to the public are also looking for some form of designation. We’re going to canvass that during committee stage — as to how the government comes to creating this intermediating body — this group of professionals but not members of colleges. Why are they created? Who do they think will fall under this? What kind of powers will they have? What kinds of responsibilities to the public will they have, and so on. That’s something that we had not envisioned in our recommendations but is in the legislation, so we will want to cover that as well.

Existing professionals not regulated under the Health Professions Act. As I said, not all current regulated health professions fall under the umbrella of the Health Professions Act. For example, emergency medical assistants are regulated by a government-appointed licensing board under the Emergency Health Services Act. Some social workers are overseen by a regulatory college under the Social Workers Act, while other social workers are overseen by their employer, the Ministry of Children and Family Development. We need to talk about how we work with that through the legislation.

The steering committee reviewed all feedback provided during phase 2, public consultation, and noted the opportunity to consider improvements to how social workers, counselling therapists and emergency medical assistants were regulated. Upon establishment of the oversight body, the steering committee suggested that the oversight body prioritize review of social workers, counselling therapists and emergency medical assistants for regulation under the HPA. But as I’ve just said, the government has come up with a different solution, and we’ll need to canvass that.

We want to make sure that we simplify the complaints and disciplinary process. In order to do that, we recommended that we provide a clear focus on patient safety, including cultural safety and public protection, and strengthen public trust in regulation. The changes that we recommended to do that were to establish a new disciplinary process that would create clear separation between the investigation and disciplinary stages of complaints. Regulatory colleges should continue to investigate the complaints. However, discipline decisions should be made by a separate, independent process.

We also recommended increasing transparency within the complaints and discipline process by requiring increased public notification when action is taken in response to a complaint about a health care professional. We wanted to limit the ability of professionals to negotiate agreements late in the process. Additionally, we wanted consideration to be given to how these changes might be reflected and serve cultural safety and humility.

A new discipline process was recommended, in which independent discipline panels would make decisions regarding regulated health professionals. Now, this is very similar to other professionals, where you separate the investigation from the adjudication and decision. So we recommended that regulatory colleges and their inquiry committees continue to be responsible for the investigation of complaints. This would assure clearer separation of the investigation and disciplinary stages of the complaints process in order to more closely align with common legal principles.

[J. Tegart in the chair.]

Welcome back, Madam Speaker. You will note I am still here, with 39 minutes to go.

The following provides an overview of the recommended approach to transparency based on three stages of the complaint process. I chose to put this on the record because I think it’s a difficult process, at best, for people to understand. If they have a complaint with a health professional, what can they do?

I don’t know about others, but when I’m dealing with my doctor or my health professional, I feel like they’re the expert. They know best. And it’s very difficult sometimes to challenge a health professional. We come in from a position of vulnerability, and we count on our health professionals to give us the best advice and help us through our journey in life — our camino, as I like to say it these days, the way.

[5:30 p.m.]

If someone has a problem, has a complaint, then here’s the process that we recommended to government, based on two rounds of public consultation and Mr. Cayton’s report. We’ll be looking to see if this is in the legislation and/or accompanying regulations.

The first stage is triage. Once a complaint is received, an initial assessment or review of the complaint should occur to determine whether the complaint is within the jurisdiction of the regulatory college. At this point, certain complaints may be redirected to employers, patient care quality offices or other avenues, and others could be determined to be frivolous or vexatious. This stage of the process should continue to be private unless there was a serious risk to patient safety identified that required immediate action.

Now, I’ve heard in the consultation that some professionals were concerned that they could be falsely accused of doing something, and that would get out to the public. As you know, if you — I’m going to be dating myself — take a pillow made of feathers, and you take all the feathers out and throw them to the wind, it’s next to impossible to gather all the feathers back and put them back into the pillow.

It’s the same thing here. If you accuse someone of doing some wrongdoing, serious wrongdoing, and there was no basis for it, it’s very hard for that person to get back their reputation. So the triage that we recommended should continue to be private unless there was a serious risk to patient safety identified that required immediate action.

After the triage, there’d be an investigation and inquiry. As noted previously, regulatory colleges continue to be responsible for investigating complaints. So in this para­digm, our recommendation to government, which we’ll check against the legislation in committee stage…. We’re going to see if regulatory colleges will continue to be responsible for investigating complaints. The answer is yes, because that’s what the legislation says.

Regulatory colleges’ investigators would gather information on the matter. The inquiry committee would review this information and take appropriate steps as required. If a consensual agreement between the registrant and the college inquiry committee were made at this stage — for example, an agreement for reprimand or mediation — information about this agreement should, and I re-emphasize should, be made public.

If the inquiry committee determined no action was required, the complaint should not be made public. Any cautions or warnings should remain private but should be considered as part of the registrant’s past history if there were complaints in the future. We’ll have to canvass that very specifically in committee stage as to how that’s going to work, because the public needs a clear understanding that their safety and their concerns are paramount in this legislation.

After triage, and after investigation and inquiry, comes the discipline, if it gets that far. Discipline that we recommended would be independent of the inquiry. Independent discipline panels should make decisions regarding complaints about regulated health professionals. The outcome of all complaints that are referred to the discipline panel by the inquiry committee process should be made public.

At present, most complaints to regulatory colleges are addressed at the first or second stage of the complaint process, however, with the requirement that all agreements between registrants and inquiry committees result in public notification. This could result in more complaints being heard at disciplinary hearings. This has not proven to be the case in other jurisdictions, such as the United Kingdom, as reported to us by Mr. Cayton.

It is expected that regulators exercise their regulatory authority on behalf of the public and in the public interest. The shift to a more transparent complaint process will improve public confidence in the regulatory framework. The public cannot have confidence in regulators if the public is not aware of the actions taken by regulators to protect them.

Finally, we recommended that increased transparency about complaint outcomes be required. In particular, the steering committee recommended that information about all agreements between regulatory colleges and registrants in complaint matters be made public and done so in a consistent manner. We also recommended that regulatory colleges should be able to make limited public comments if a complaint under investigation became known to the public — usually by a reporter, is how that would work — and we’ll canvass that again in committee stage.

[5:35 p.m.]

In order to better protect patients from harm, it was recommended that complaint and discipline decisions take into consideration the professional’s past history.

We also talked about timelines, but I won’t go through that in detail. Just know that we recommended that we monitor systemic timelines for the complaint process, and we recommended that statutory time limits for the length of time that investigations be completed be removed and that timelines or time limits for stages in the complaint process be put in place.

The steering committee also recommended that steps be taken to ensure strengthened responses to sexual abuse and sexual misconduct by registrants, including more stringent discipline outcomes and improved consistency in outcomes between colleges. I’ve already talked about that, so I won’t go into that in detail.

We also recommended that health professional regulatory colleges be able to share information, not only between each other but also with other agencies, where necessary for public safety and protection. That was our last recommendation, and that brings us to today.

Today was a piece of legislation that, as the members of the House have already discussed, is many clauses long. I won’t say many inches thick, but as you can imagine, it’s almost an inch thick — the longest piece of legislation I can remember in my 13 years.

I would just want to finish my comments by thanking again the staff that worked so hard over a year with the steering committee and over many years after that with this legislation and in light of COVID as well. I’d like to thank all those that participated in the two public consultations. They put a lot of good thought into their written submissions and into their meetings, I’m sure with staff, on the one-on-ones. We had some incredible support for some of the recommendations that we made in our first set of recommendations. We also had some incredible recommendation changes that we were able to get from all those submissions.

So again, thank you to all the colleges, all the professionals, all the associations, the unions and the public who provided input into the process. It was very rewarding process. I also want to thank, in particular, my caucus and our then leader Andrew Wilkinson for allowing me to be part of this process. It was not something that was common, to be part of a collaborative process on bringing in legislation. Andrew made it happen and supported me when I said I would like to do this.

I also want to thank my caucus for also agreeing to allow this to happen. So thank you, because you are a member of the caucus, and to all my colleagues who were in caucus at the time; and also to those that had a difference of opinion. Obviously, in any caucus, you’re never going to get unanimity, and that difference of opinion was healthy and helped to come up with better recommendations and, I believe, stronger legislation.

I don’t know whether we’re going to support this legislation when we’re done at third reading. I know we are going to continue with it through second reading, but the devil’s in the details, as they say. The details will be canvassed thoroughly during committee stage. At that point, I’m sure the Health critic will have a recommendation to make to us as to what we do based on what we hear from the minister on the details of the bill.

Lastly, if I may repeat where I started from, I’d like to thank the Leader of the Third Party and the Minister of Health for this opportunity to participate in this process. It was unique in my experience at the legislative level. Not at the committee level, because we see this kind of work done all the time at the committee level.

I’m just appreciative that the minister took up my invitation to invite his critic into the process rather than leaving me on the outside just to criticize the process. It was much better to be on the inside working towards a common solution than being on the outside and just being critical of whatever they came up with. So that was a blessing for me personally.

[5:40 p.m.]

With that…. I didn’t quite go for the full two hours, but I think I’ve gone on long enough. I will sit down and invite somebody else to take the floor.

Deputy Speaker: Recognizing, once I find your name, the Minister of Jobs, Economic Recovery and Innovation.

Hon. R. Kahlon: Thank you so much, Chair.

Deputy Speaker: So sorry.

Hon. R. Kahlon: I know the feeling. I haven’t been getting up.

Interjection.

Hon. R. Kahlon: Yeah. The hon. member who spoke earlier had us in a lull. An hour and a half. He did great. I have to tell him he did a fantastic job. I, too, stand, and you know what? After hearing his comments, I thought: how could he not support this? How could he not support this this bill?

One of the pieces I want to touch on around this bill was that sometimes, obviously, we focus on the outcomes. But in this case, the process is something to be noted. The fact that the Minister of Health, the member from Kelowna and the member from Cowichan, the Leader of the Third Party, worked so well collaborating together to get to this point…. I think I heard the member from Kelowna say that he’s not aware of this type of collaboration on any piece of legislation. I certainly am not, to this level. I just want to recognize them for the work that they did.

It was amazing to go through the process and understand the amount of feedback that was received through this process — over 300 written submissions. I believe it was almost 1,500 letters, I guess, that were written with recommendations. Of course, as was noted by my colleague across the way, I appreciate that not everyone will be supporting this. There may be some stakeholders that, perhaps, liked the system as it was, but I think the ability to get people together to put this important work in place reflects an understanding that changes needed to happen.

Some of the keys that have been highlighted in this…. There are a couple that I want to touch on. When the public sees this, they see the bodies. I don’t think the public fully appreciates or understands how all the bodies work, how they’re structured, why there are so many of them. But what they do understand is the outcomes at the end. I know that there was a lot of work done around addressing racism. Much of the feedback that was brought forward at the time around how we can create cultural safety is reflected in this legislation, I think. I, particularly, appreciate that.

Certainly, early on, when we were working on the Human Rights Commission, there was a lot of conversation from people saying: “Well, you know, we often don’t want to go to a Human Rights Tribunal because the word ‘tribunal’ is scary.” Especially if you’re coming from a community where tribunals have multiple meanings, it’s a scary proposition.

Even that conversation, I see reflected in this. When people have a concern or if they have had a particular issue, instead of them facing, perhaps, the perpetrator, or having to go through a process, creating a mechanism for that issue to be dealt with without making it so confrontational will allow for more people to come forward, which will then allow for us to make the system a better place.

The ability to address those pieces, to reduce the amount of regulatory colleges — I think most people will understand that there were a lot of them — and the ability to come down and work with so many stakeholders to bring them down to a number will be a benefit to not only all the professionals that are served by these organizations. They’re going to be able to find efficiencies. They’re going to be able to run their organizations in a more efficient way there.

It will also, I think, serve the public in a better way, because each of these teams will be led by professionals. Each of these teams will be led by people who have the skills to be able to adjudicate processes, as opposed to going through an elected system, which, we’ve heard from many stakeholders, can create, I guess, protected territories within some of these professional organizations. Not all of them, but we certainly have heard from many stakeholders that it’s seen as something that has been a real challenge and sometimes a barrier from making progress.

[5:45 p.m.]

Even in situations where you think it’s very easy to make a change, it becomes more problematic. I think one of the pieces that I really appreciate about this work is the ability to have a complaint mechanism, an improved complaint and, I guess, resolution process for people that have concerns, a way for people to navigate the system that is easier to navigate, more transparent. Certainly, my hope is that we’re able to get better outcomes for people. That’s what this is about in the end.

Lastly, I think, is the ability for this to improve information-sharing. There are a lot of people that want access to information, and by having this type of system, I do believe the public will be better served by all those pieces.

I don’t want to stand up for too long. I do just want to say that I do appreciate the work that has gone in here. It’s a large, large package that will be canvassed thoroughly in third reading. But I want to thank the Minister of Health. I want to thank the members from Cowichan as well as Kelowna for the amazing work they’ve done in putting this forward.

K. Kirkpatrick: Thank you to the minister for his remarks.

I’m pleased to rise today to speak to Bill 36, the Health Professions and Occupations Act. This has been a long time coming, and I thank all of those involved who have provided their feedback and input. The legislation is based on recommendations of the steering committee, as co-chaired by my colleague the MLA for Kelowna–Lake Country, the Leader of the Third Party and the Minister of Health.

The main purpose of the committee was to make a series of recommendations meant to modernize the health profession regulatory framework. We are supportive of many of the goals and efforts of this bill, but as it’s very long, very complex, it needs to see some serious scrutiny before we can be fully supportive.

After a long period of discussion and consultation, significant recommendations were made by the committee to include cultural safety and humility, improve governance of regulatory college boards and establish an independent discipline process, while also revising the complaints process with the aim to make it more transparent and more focused on patient safety. Patients need to be the focus of health professionals oversight. They are those most impacted by the care received or not received and the quality of that care.

The goal of this new legislation is to enhance patient safety, strengthen oversight of health regulatory colleges and improve governance of health professionals. The Cayton report came out in 2018 and made a number of recommendations to the regulation of health care professions in B.C. It said, “Quite simply, the Health Professions Act is no longer adequate or modern for regulation,” and that it would require significant changes to meet future requirements for protecting the public.

The legislation in front of us today can certainly be described as that: “with significant changes.” Over the past two years, I’ve had the opportunity to speak to members of FACTBC, the Federation of Associations for Counselling Therapists in B.C., and many of their individual members. I’ve also spoken to social workers, who welcome the ability to be part of these regulatory oversight changes. However, my comments today will deal primarily with the impact to the public around counselling services and their regulation.

FACTBC has been advocating for over 20 years for the statutory regulation of counselling therapy in the province. It deemed it to be in the public interest, and although it’s been close to being a reality on several occasions, it has failed to move forward. FACTBC wrote to the current Minister of Health, asking him to declare the regulation of counselling therapy to be in the public, under section 10 of the Health Professions Act, and it is now very encouraging that this legislation before us today will simplify and streamline the process for regulating new professions and that government intends to begin regulating counsellors and then diagnostic and therapeutic professionals as they move forward.

[5:50 p.m.]

In 2019, the current Health Minister said that the changes would make it easier for counsellors and therapists to be regulated. At the time, he said that it takes too long for new regulatory colleges to be created and that the counselling therapists were next in line. We are very pleased to hear that.

FACTBC chair Michelle Oucharek-Deo said yesterday: “Regulation under this new legislation will mean that British Columbians will be able to identify qualified and accountable counselling therapists when seeking mental health services.” The B.C. Association of Clinical Counsellors, the largest self-regulating body for clinical counsellors in British Columbia, issued a statement, also yesterday, that they welcome “the news from the B.C. provincial government that the regulation of clinical counsellors is on the immediate horizon.” BCACC says their “registered clinical counsellors are ready to be regulated and welcome the news of a Health Professions and Occupations Act.”

Regulation provides safety, accountability and standards of care and conduct for those providing counselling services as competent and trustworthy mental health professionals. Counselling and other psychological therapies can do more harm than good if they are provided with poor quality or if, indeed, it is the wrong type of therapy provided. Patients can be retraumatized by unqualified or poor-quality services.

Declaring the regulation of counselling therapy is in the best public interest, and it demonstrates commitment to mental health services. Glen Grigg, past chair of FACTBC, told CBC last year that “therapists deal with people when they are at their most vulnerable, including patients struggling with potentially fatal conditions like eating disorders and suicidal thoughts.” Those things can be made substantially worse by incompetent therapy.

Regulating counselling therapy as a health profession — a step which has already been made in five other provinces, including Ontario, Quebec and Alberta — is an essential part of the provision of ethical, safe and competent mental health services to British Columbians.

The primary goal of FACTBC has been to serve the public interest by advocating for the statutory regulation of counselling therapy, where we can guarantee safety, accountability and standards of care and contact for those who provide services.

Right now anyone in B.C. can call themselves a counselling therapist. Unlike almost all other health professions, counselling therapy has no legislated standard to ensure public protection. Perhaps of most concern for the public has been that there is no single protected title, meaning it’s difficult to discern which people offering counselling services are qualified and accountable to any form of oversight body.

Regulation through title protection is the most effective way to ensure public safety and standards of ethical practice and competency. Not having protected titles also makes the cost of accessing counselling services more expensive, as services, whether they are regulated and under the Health Professions Act…. There is a tax consequence to that.

The vast majority of counselling therapists in British Columbia are professionals. They have years of training and expertise. But British Columbians shouldn’t have to count on chance and guess to get the care and protections they deserve. This needs to change.

That’s why thousands of counselling therapists from every part of the province have joined together to ask the government of British Columbia to declare regulation of counselling therapy to be in the public interest as an important step to the road of full regulation.

Members are on the front lines delivering mental health services to British Columbians suffering mental health issues due to the pandemic and the opioid crisis. Declaring that regulation of counselling therapy is in the public interest is a basic step in building the mental health resources that British Columbians need and that they need now more than ever. Counselling therapists have stepped up to take on their share of the pandemic strain and opioid crisis. In these times, regulation is more important than ever to protect British Columbians.

[5:55 p.m.]

FACTBC membership requires that all member associations provide accountability through compliance with a code of ethics and standards of practice. Member associations have established registration criteria and complaint processes, either nationally or provincially, for all members.

However, without a regulatory system that is properly anchored in provincial legislation, voluntary professional associations cannot exercise jurisdiction over non-members or those members who relinquish registration to avoid disciplinary consequences, and those associations face severe limitations in their ability to ensure compliance with standards of practice and ethical requirements through their discipline process.

We have seen this before in other professions, where people put up a sign and they say that they’re a financial planner or a property manager or whatever it is. If those people are not regulated by an oversight body, which in those cases they are, there would be no way to be able to keep the public safe from using the services of unqualified and perhaps low-quality service providers.

It is important, particularly when we’re dealing with mental health. Mental health right now is so prevalent in the media. Every one of us knows somebody who is being impacted by a mental health challenge.

I have heard terrible stories, one most recently at Lions Gate Hospital, where a young person had come in, brought in by a parent. They were having a mental health crisis, with suicidal tendencies and ideations. They had been left there for a period of time. They were then provided the name of a counsellor. Rather than actually admitting that young person into the hospital, they phoned that counsellor. They had a conversation with that counsellor on the phone. They left the hospital because they were led to believe that they were feeling safe. Unfortunately, a tragic event occurred with that young person the next day.

When it was looked at, the person who had been referred was unqualified. They were not a skilled or a master’s-level counsellor. They were somebody who put up a sign saying that they were…. They put themselves forward as being a counsellor, and it just demonstrates the potential for just horrific outcomes if we are not properly providing oversight and regulation to such an important profession.

There are so many different kinds of counsellors as well. We’re talking about mental health, opioids. There’s so much that we do with our children — counsellors that deal with play therapy, counsellors that deal with young children who have been victims of domestic abuse and sexual violence and sexual abuse. These are the kinds of things where if the person providing that support and care and counselling does not have the expertise to do so, those young people can be re-traumatized and will not be set on a proper path to getting to a place where they’re feeling good and they’re feeling safe and secure and can move forward.

There’s also music therapy. Very often that is something that, again, for young people and for elderly people…. Music therapy is a very important part of someone who is having depression — to be able to…. Particularly if they are somebody who music connects with and motivates them, it’s a very important type of therapy.

Art therapy is another group of therapists. All of these therapies that I’m mentioning are all covered under the counselling therapists. So it’s a very, very important occupation to be a part of, and it is something that is very, very critical in terms of that professional oversight — to be able to have that professional oversight.

[6:00 p.m.]

FACTBC. All the counsellors in British Columbia are looking forward to the ability to build up the quality, build up the reputation. You build reputation through having a well-regulated profession. I know counsellors have come to me saying: “I’ve got a master’s degree. I’ve done all of this training and all of this schooling, but I feel that sometimes my value is undermined because there are people working in the sector and working in the practice that simply don’t have that same level of qualification.” So that regulatory body is a very, very important piece of that.

I thank you for the opportunity to speak to Bill 36. I am looking forward to understanding more of the details in the committee stage. I believe it’s more than 600 sections that we’re going to have to go through piece by piece. The minister is excited about the length of that. I’m glad he’s excited about that. We look forward to committee stage and really being able to dig down into the complexities and provide some serious scrutiny before we can be fully supportive.

I do just want to thank, again, all of the people who have been involved in the steering committee, all of those who have provided their input and feedback into what this bill should look like and how this bill can best protect the public, the patients, and be a framework that is going to simplify the ability to regulate and will address many of the challenges that were recognized in the previous Cayton report.

Again, I thank you very much, Madam Speaker. I’ll take my seat.

G. Lore: I’m very pleased to rise this evening to speak to this bill, to speak to legislation that is about enhancing patient safety, that is about improving oversight, public protection, efficiency and effectiveness, public confidence through transparency and accountability. In the health care system, these are essential, and we need regulation of health care professionals that rises to this challenge.

Earlier today I had the chance to rise in the House to speak to what reconciliation in action looks like, what it means to take meaningful steps forward together with Indigenous partners, with rights and title holders on issues that are important across all communities and, fundamentally, across all ministries. I just wanted to take a few minutes this afternoon to outline the ways in which this legislation does some of that important work.

This legislation addresses discrimination in health care and requires that cultural safety and humility be embedded in the ways that professionals provide care. It also creates more clarity to ensure that health care is provided in an anti-discrimination way, with improved cultural safety for patients.

I don’t think any in this House need to be reminded of the In Plain Sight report and the concerning events that were reported out of Saanich Peninsula Hospital that led to that report. But I think it’s important grounding, when we think about this legislation and the introduction of this large piece of legislation, to remember what it’s responding to, what it’s answering to: the ways in which anti-Indigenous racism in our health care system has been widespread and has been dangerous.

Regulatory colleges, through this legislation and others, will be required to work with Indigenous governing bodies and other entities representing Indigenous peoples on issues linked to Indigenous cultural safety practices. The new legislation also creates new and safer opportunities for those made vulnerable by our systems, those made vulnerable by societal inequity. It makes it easier for these individuals to make complaints and to raise concerns about their care. I think that is such an important piece of this bill.

[6:05 p.m.]

The complaints process will also include restorative processes to better align with Indigenous practices. The supports that will be made available here also reflect the need to move together towards reconciliation, to embed it in all of the work we do. As a result, supports made available will include funding for Indigenous ways of healing.

It is also true that this bill will make Indigenous health practices protected. Indigenous health practices cannot be used as grounds for investigating or disciplining a regulated health practitioner, unless, of course, the patient has been misled.

I think it’s really essential in this bill, in this new piece of legislation, that we’re identifying opportunities for those who’ve been made vulnerable by our systems to make complaints but also protecting additional ways of providing services, care and healing. The changes, of course, in this legislation are a significant response to In Plain Sight, and they were made in consultation with Indigenous leaders, who helped shape the act. This is essential.

From my perspective, there are a number of other really important pieces in this act that will, as my colleague across the floor previously mentioned, reduce risks of retraumatization. We have learned so much as a society, as front-line service workers and as communities of what it means to respond to trauma, what it means to support someone who has experienced trauma. The fact that this act is taking what we know about trauma and building it into the regulation of health professionals is, I think, really an incredible step forward.

Some of these changes include offering identity protection. We know it is not trauma-informed to have someone who’s raising a concern or who’s making a complaint be face to face with the person who perpetrated harm. This is especially true when there are power differences and when some of those power differences are also the roots of racism or discrimination that may have been part of the harm caused.

Making changes here to allow folks to have their identities shielded and protect them from those that they are making complaints about is really important. For example, this includes requiring sensitive documents to only be disclosed when relevant and necessary. This is alongside some of the other important changes that I know some of my other colleagues have raised regarding changes around sexual harassment and abuse. This is strong. These are important improvements here.

On the latter point, the new legislation defines “sexual misconduct” to include sexual manipulation, harassment and communication. It also defines “sexual abuse.” This is really important. It’s important that we’re able to name and identify these acts of abuse and misconduct so that we’re better able to hold practitioners accountable and so that the harm committed is not allowed to go unnoticed, unreported, un-public.

It means that future patients, those seeking care, will not be at risk in the future. This is an important step in that direction: to identify, to outline and to provide opportunities for raising complaints and accessing care and support that are trauma-informed.

I am thrilled to stand in support of this legislation, to outline some of the ways in which reconciliation has been embedded and, as well, to identify some of the ways in which a trauma-informed approach is embedded in what is a huge piece of legislation, covering a lot of ground. I’m really proud to stand and speak in support of it.

[6:10 p.m.]

M. Lee: I rise to speak to this Bill 36, recognizing, as the member for Kelowna–Lake Country, the member for Prince George–Valemount and the Minister of Health have all talked about, the significant work that has led to this bill coming to the floor of this chamber.

I noted with interest the length at which my colleague the member for Kelowna–Lake Country, in particular, took the opportunity to talk about the process of the steering committee that he and the Leader of the Third Party and the Minister of Health had put together and all of the consultations that were there with the public. It was very useful, of course, to be reminded of all of that good work.

In terms of my comments at this stage, on this bill, I’d like to speak as the critic for Indigenous Relations and Reconciliation on the particular items of the bill that relate to many of the challenges that Indigenous peoples face with our health care system. That, of course, was a focus of the In Plain Sight report.

Let me just start here. To the minister and others that will be advising him through the committee stage of this bill, I’d like to just highlight some of my considerations and areas where I would be joining our colleague the member for Prince George–Valemount and others at the committee stage of this bill, as we go through the 600-plus sections of Bill 36.

First of all, I would certainly like to hear more about the nature of the consultation and development with First Nations leaders and others in terms of the framework of this bill. Of course, we see in section 14, for example, that the structuring of this bill includes the guiding principles to incorporate, by reference, the United Nations declaration on the rights of Indigenous peoples as well as the reference to reconciliation with Indigenous peoples, the need to address racism and anti-racism issues that are specific to Indigenous peoples.

These are the references in that particular fundamental part of this bill that I can see that will give guidance to the exercise of powers and duties that are performed under this act and the principles for which those persons must act in accordance with these principles as they carry out the requirements of this act. I know that this is an opportunity, of course, for this government to make good on the commitments to First Nations leaders and Indigenous leaders in this province when, as was noted earlier today, the Declaration on the Rights of Indigenous Peoples Act was passed in this House almost three years ago.

We know that with the DRIPA action plan…. There are specific items that I’d like to review with the minister to gain a better understanding as to where this government sees that this bill being presented meets some of the specific action items, including action items 3.7, 4.8 and 4.14, for example, in the DRIPA action plan. These items relate to, squarely, item 3.7, implementing the “recommendations made in the In Plain Sight report, striving to establish a health care system in B.C. that is culturally safe and free of Indigenous-specific racism.”

On a plain reading of that action item and in discussion at committee stage, I would expect the minister to…. Certainly, I give him and his government top marks for dealing with that particular action item out of the 89 actions under this five-year action plan. So I look forward to that discussion.

[6:15 p.m.]

As we look at other items on this action plan, such as 4.8, we talk about the need to evolve the First Nations health governance structure to ensure First Nations are supported to participate as full and equal partners in decision-making and service delivery.

[S. Chandra Herbert in the chair.]

Well, of course, the regulation of health professionals in our province is certainly related to service delivery. I look forward to how this interacts with the commitments on the DRIPA action plan.

Another example which was related in part to the resources available to Indigenous partners in the COVID-19 pandemic health and wellness planning and response was the implementation of the rural, remote, First Nations and Indigenous COVID-19 response framework, again to ensure access for all Indigenous peoples to immediate, culturally safe and relevant care closer to home.

I think that as we unpack what cultural safety means in the context of health care, as was set out in clear detail in the In Plain Sight report, cultural safety involves physical, social, emotional and spiritual safety. It’s a recognition and respect for the cultural identities of others without challenge or denial of an individual’s identity, who they are or what they need. Of course, as pointed out only at the outset of this report, which is deep in nature, culturally unsafe environments diminish, demean or disempower the cultural identity and well-being of an individual.

With those comments, I would expect to get into some discussion at the committee stage about the nature of consultation with First Nations and Indigenous leaders as to the framework of this bill, hopefully in the same level of detail that the member for Kelowna–Lake Country was able to spell out. Because the work of the steering committee…. As was noted a few times by members in this House, that work predated the additional work that was necessary to ensure that this bill, as it comes forward, deals with the important elements of cultural safety and cultural humility, which are fundamental themes and focuses within the In Plain Sight report.

I know that when we talk about UNDRIP, the requirement under section 3 of the DRIPA act, in terms of ensuring that all laws of this province are consistent with the articles of UNDRIP…. There’s a structural item here, in terms of the guiding principles section. I’d like to get additional clarity as to the meaning, the references and the positioning of the united declaration on the rights of Indigenous peoples, as a principle, with the qualifying words “to support and promote awareness of.”

These are qualifiers. I think it’s important to understand the reasons for those qualifications. As we turn to section 14 of this bill, I will be looking to have more detailed discussions with the minister about that.

[6:20 p.m.]

I must say, for example, that article 24 of UNDRIP speaks to the principle that “Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services.”

I would expect here that the reference to supporting and promoting awareness of UNDRIP and, by definition, specific articles within UNDRIP…. I just named one of them. As we look at the relevant articles of UNDRIP…. I’d like to walk through them with the minister.

The understanding of the government is to…. In the context of this bill, what do these articles mean? In the context of this bill, what do the guiding principles suggest to Indigenous peoples and to the regulator, the new superintendent, as well as those health practitioners that are regulated under this act? What are the requirements that they’re trying to meet or are required to meet?

Of course, when we look at discrimination…. There is a full description of discrimination as defined under or prohibited under the human rights code. I will also note that, of course, in the In Plain Sight report, there are definitions of anti-racism or discrimination in the converse. I would like to discuss with the minister, in terms of that definition of discrimination, as well as the anti-racism definition in the In Plain Sight report…. I note that there is no definition in this act. We have anti-discrimination measures, of course, under section 15, that we can refer to.

As we look further into the bill, there are certainly duties that are outlined under sections 70 and 72 in terms of the requirements to practice ethically. I certainly heard that from members on the government side — reference to the fact that there would be requirements to make bylaws that set out anti-discrimination measures. In the context of the recommendations coming out of In Plain Sight, I would expect, of course….

So much of this bill, as the member for Prince George–­Valemount has highlighted a number of times in her second bill speech…. So much to be dealt by regulation, given the breadth of this legislative framework. Much more detail to be provided by regulation. I think it’s important at this juncture, in second reading as well as at the committee stage, that we have a clear understanding of the direction and how these anti-discrimination measures will be spelled out. What guidance and expectations will be placed on the development of these bylaws?

I am probably getting the signal at this juncture.

Noting the hour, I reserve my place and move adjournment of the debate.

M. Lee moved adjournment of debate.

Motion approved.

Hon. R. Kahlon moved adjournment of the House.

Motion approved.

Deputy Speaker: This House is now adjourned. We will, of course, resume tomorrow at 10 a.m.

The House adjourned at 6:24 p.m.