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Bill 42 - Health Governance Transition Act

November 4, 2008 - Second Reading

Ms Blakeman: Thanks very much, Mr. Speaker. I’m also reading my way through Bill 42, so I’m glad of the opportunity to raise some of the concerns and issues that I see arising out of my reading of Bill 42, the Health Governance Transition Act. I’m sure the minister can clear this up for me fairly quickly, but I’ll put the question on the record so that he can answer it. The act includes the Alberta Mental Health Board in the sections on severance and termination pay for employees, but it does not mention it at any other time.

We have a situation where the mental health boards came under the service delivery model of the regional health authorities in 2003, and now that regional health model is gone. Those entities are gone. I haven’t seen any official transfer from those regional health authorities, which are now dissolved, to the superboard, so I’m wondering where the authority is, if he can direct me towards where that actual transfer of power and authority and funding exists and if he can describe for me what he’s anticipating for the future of the Alberta Mental Health Board because this act is silent. It’s very clear what’s being planned for the Cancer Board and for AADAC, but it’s not clear at all what’s being planned for Alberta mental health, so help us here.

I know that the minister likes to play his cards close to his chest, but for a lot of my constituents who are dealing on a daily or a monthly basis with mental health problems or who have family members or loved ones or friends who are struggling with this, they’d like some certainty. One of the things that’s very difficult to deal with when you have a mental illness is a lack of certainty. The uncertainty that’s created through Bill 42 for authority, funding, service delivery of mental health programs is very troubling to me as someone who represents a number of people with mental health problems.

I’m looking at – and I know my colleague from Gold Bar had referred to this in his comments – the Auditor General’s report, October 2008, on pages 151 to 206. There’s quite an extensive report here, including appendices. I’m not sure how some of the things that were being suggested are supposed to be implemented because I don’t know who is responsible for doing this. Where does the buck stop? We got no clarity from Bill 42. So what we’ve had is, as the AG said, a very splintered, sometimes ineffective care being offered. Now we’re looking at demographic changes, workforce shortages, and other innovative programs, which should affect how the system is transformed, but none of those things are clear as I look at what we’ve got in Bill 42.

Let me just take a step back. In second reading we’re talking about the principle of a bill, so what I’m being asked to concur with, the principle of the bill, if I’m understanding this correctly, that’s being brought forward in Bill 42, is to essentially dissolve the Cancer Board and anything to do with it. All of the acts that refer to it or the designated authorities or service delivery expectations, et cetera, and with AADAC have now been, to use the language in the bill, wound up. As I said, it doesn’t wind up the Alberta Mental Health Board, so I’m wondering what the heck is supposed to happen to it.

We have transitional regulations. For example, we have the actual repealing of the Alberta Alcohol and Drug Abuse Act and the Cancer Programs Act. We have the amending of the Alberta Cancer Prevention Legacy Act, which is the endowment fund that had, I think, $500 million put into it, but at the time we were told that it was going to be a billion put into it, and we’re still waiting for the rest of that money. So that particular section of it has been repealed and is substituted that someone designated by the minister will develop a plan and a budget to carry out the purposes of the Cancer Prevention Legacy Act.

The Regional Health Authorities Act is amended to strike out the Alberta Cancer Board. The registry that’s under the Cancer Programs Act, which, as we know, has been repealed, is continued in accordance with the act, but the Hospitals Act does not apply to the information in the cancer registry. If there is a conflict or an inconsistency between the regulations and the Health Information Act, the regulations prevail. There are no proceedings or damages against a physician or a lab person for providing information around the cancer registry. The Lieutenant Governor in Council can make regulations on the cancer registry. Then it goes into the revised statutes around health authorities and delivery of services and additional information around cancer, adds in that drugs that the regional health authorities may provide for cancer are now changed.

The act is clearly trying to deal with all the different pieces of cancer treatment delivery, research, and funding in the province and reassign it. Then it goes into AADAC and starts to deal with some of the same things there. But the third piece, the outstanding entity here, is the Mental Health Board, and as I say, the only reference I can find is the severance and termination clause right at the beginning of the act. We have a situation where certainty and stability are not being created for a very vulnerable population. I’m sure that this is not what the minister intended to create, that kind of instability, so I’m looking for some answers so I can go back to my constituents and explain to them what’s actually going to happen here. How is this going to work for them?

We had a number of things that were suggested by a very thorough report from the Auditor General, and even then he was noting that the RHAs deal with the continuum of care. Well, we don’t have RHAs dealing with the continuum of care for mental health anymore. He noted that the RHAs were implementing the principles of the Alberta Mental Health Board but unevenly and inconsistently. So we had inconsistent application under nine regional health authorities. Now we don’t know where that is. I’m assuming it’s supposed to be with the superboard, but that’s not clear.

I’m just wondering if mental health – I guess I know the answer to this. Mental health is going to get bounced once again. It’s always been the poor cousin. I mean, let’s face it. Most people with mental health issues don’t turn up on the voter rolls. They have no way of coming back at the government when they have to deal with the consequences of the actions that the government has taken. They could vote, but many of them are not able to on a particular voting day. So the government really doesn’t have to fear any consequences from that particular sector. I worry about that because I think the government should pay attention to what happens to that particular sector. They say that 1 in 5 people will deal with a mental health problem at some point in their life. In fact, we think that it’s much closer than that; it’s more likely to be 1 in 3.

Some of the other things that go along with mental health that we understand now to be successful at supporting people with mental health to really contribute and thrive in our society, which is possible, are things like security of food, to know where your meal is coming from and to know that you’re going to be okay in getting it; housing, which is a huge issue for people with mental health issues; a social network, friends, a place, a community to belong to, activities to do; an opportunity to contribute to society through some sort of meaningful interaction, whether that’s working or volunteering, contributing in some way so that they feel they have a right to be in that society. All of those that I’ve been talking about are social determinants of health, and I was hoping to see some improvement around the delivery of mental health services in the province. I’m quite concerned by the lack of any clarity in Bill 42 around mental health services.

A second agency that’s being dealt with in Bill 42 is the Alberta Alcohol and Drug Abuse Commission. This is another agency that’s been bounced around quite a bit. Well, in my time as critic for different departments I think it’s come and gone from under me a couple of times. It was under Health for a while, and then it was taken out. It was under Justice for a while. It was under Gaming for a while. I mean, without trying very hard, I can think of three different structural places that AADAC has held over a fairly short period of time.

Again, we’ve learned a lot about how to work with people with addiction issues, which is what the Alberta Alcohol and Drug Abuse Commission is trying to work with, both treatment but also the transition back as a fully participating member of society. Prevention was also part of what they were doing. Now, back in the late ’90s the number of their prevention programs was cut, and funding for them was cut. There used to be a group that came here to the Legislature and did the tour, and I used to go down and meet with them. It was part of what they were doing to reintegrate people into society and help them to understand that, you know, there were roles for them to play and various institutions that they could both participate in and draw upon. That program was cut in the late ’90s.

Now we have a situation where the Alberta Alcohol and Drug Abuse Commission itself is being cut. I have to presume that the government is going to put its programming somewhere, and what I’ve heard is that the programming is going to be split up into three different places. Some programs will go to Justice; some programs will go to Health, and some programs will go somewhere else, a third piece. I think they’ve already changed their letterhead to sort of wipe out AADAC.

There’s a great deal of uncertainty with the employees there about where they’re supposed to go and what’s going to happen to their pension contributions. What we’ve got here in this legislation essentially says in the severance and termination section, which is right at the beginning of the bill – for anyone that’s tracking it, it’s section 2; it appears on pages 1 and 2 of the bill – that “this section applies only in respect of employees who are not represented by a bargaining agent.” So those that are AUPE members would not be included in this. [Ms Blakeman’s speaking time expired] Oh, it’s 15. Right.

Thanks very much, Mr. Speaker.

The Deputy Speaker: Standing Order 29(2)(a) allows for five minutes of questions and comments. The hon. leader of the third party.

Mr. Mason: Yes. Thank you, Mr. Speaker. I’d like to ask the hon. Member for Edmonton-Centre to conclude the comments that she was making at the time that the bell rang.

Ms Blakeman: Well, in answer to your question of what I was talking about…

The Deputy Speaker: May I just give a warning that the five minutes are for questions and comments, not to allow to finish the speech.

Ms Blakeman: Thank you. I’m answering the question that he placed.

The Deputy Speaker: All right. Go ahead.

Ms Blakeman: I’m happy to continue doing that. Thank you.

The question was around what’s happening to the AADAC employees. According to this, my reading of it is that it does not include the AADAC employees who are represented by a bargaining agent, which would be AUPE: no employee “is entitled to severance pay or termination pay or other compensation if the employee’s position is substantially the same after the change in governance or restructuring.” What it’s saying is that if they get essentially the same job under Justice or under Health or whatever the third agency is that this department is being broken up and sent to, nothing should change. That’s, of course, what everybody’s worried about, that somehow they’d end up doing substantially the same job for less money and less benefits. That’s what the employees that are my constituents that have come to meet with me and talk with me have expressed concern about.

I would like to think that this government would really uphold that vigorously, but the proof of the pudding is in the eating, and if we look back to what happened to employees of government agencies and departments that were dissolved or reorganized in the mid and late ’90s, that does not reflect what happened to them. Some of the lucky ones or the ones with great connections took a buyout package or severance package and then got hired immediately again to deliver the same services but as a contractor. They just got paid less this time because it was a lump sum funding for it.

On behalf of my constituents I’m expressing real concern about the job security and transition there as it moves from the AADAC agency as we knew it to some other version of it which is broken into pieces. People are really stressed and concerned about this, and I frankly would hate to see that level of expertise lost.

Thank you.