ADMINISTRATIVE REPORT
Date: May 24, 1995
TO: Vancouver City Council
FROM: General Manager of Community Services
SUBJECT: Transfer of the Vancouver Health Department to the
Vancouver Health Board
RECOMMENDATION
A. THAT the General Manager of Community Services be
authorized to negotiate terms for the transfer of the
Vancouver Health Department from the City of Vancouver
to the Vancouver Health Board; and THAT these terms be
reported back to Council for its approval before
entering into a transfer agreement;
B. THAT the Mayor, on behalf of Council, write the
Minister of Health and request that the Ministry
provide 100 percent funding for municipal health
services effective with the establishment of Regional
Health Boards, as the Minister had apparently
committed; or, if this is not possible, that the
Minister at least clarify the schedule and criteria for
implementing 100 percent Provincial funding;
C. THAT the Metropolitan Board of Health be provided with
a copy of this report and Council's actions.
COUNCIL POLICY
On September 13, 1994, Council resolved:
THAT Council advise the Minister of Health that the health
regionalization model prescribed by the Ministry does not
fit the City of Vancouver or the Greater Vancouver
Metropolitan Area; and THAT Council request the Minister to
commission an open planning process to develop a results-
oriented health plan which will work for Greater Vancouver.
On November 1, 1994, Council took no action on an invitation to
submit names of potential Council representatives to the
Vancouver Health Board.
BACKGROUND
In spite of the objections of Council and others to health
regionalization as it is being implemented in Greater Vancouver,
the Ministry of Health has moved rapidly to put a Vancouver
Health Board in place and to give it significant powers.
On May 3, 1995, the Chair of the Vancouver Health Board, Mr. Ron
Yuen, wrote Mayor Owen and announced the Board s intention to
"assume direct operating responsibility for the Vancouver Health
Department by November 1, 1995". A copy of Mr. Yuen s letter is
attached to this report as Appendix A.
The Ministry of Health currently funds 70 percent of the Health
2
Department s general preventive health budget and 100 percent of
Continuing Care. When it transferred authority to the Vancouver
Health Board, the Ministry was apparently committed to funding
100 percent of all Health Department costs. On February 28,
1994, when speaking at the Minister's Health Forum: Implementing
New Directions, the Minister of Health said the following:
Unlike most health unit programs which are funded fully by
the Ministry of Health, there are six metro-area
municipalities that raise funds for public health programs.
I am pleased to announce that, with the formation of local
governance structures, the Ministry will assume 100 percent
responsibility for these municipal costs.
However, even though the Vancouver Health Board and other
regional health boards have been formed since late 1994, 100
percent Provincial funding has yet to arrive. It now seems
contingent, in Vancouver at least, on the Health Board assuming
direct operating authority over the Health Department. Other
municipalities seem to be experiencing similar problems,
prompting the Chair of Metropolitan Board of Health to write the
Minister requesting that he stand by his 1994 commitment and
implement 100 percent Provincial funding now (Appendix B). The
Metropolitan Board of Health is a consortium of municipal public
health providers which predates the present regionalization
scheme.
DISCUSSION
While separation of the Vancouver Health Department from the City
of Vancouver works against many of the integrated service
concepts the City is pursuing, it does have some fiscal
advantages. Principal among these is the assured implementation
of 100 percent Provincial funding, as in most of the remainder of
the Province. We estimate that full provincial funding and
separation of the Health Department is worth a net $2 to $2.5
million annually to the City. As well, the City could receive
additional revenue by putting properties currently used by the
Health Department back on the tax rolls, and there could be some
one-time revenue from the sale of capital assets assigned to
Health. In addition, the City might benefit from not having to
administer a B.C. Nurses' Union contract, which may be better
managed exclusively in the health sector rather than in the
municipal sector.
However, there are a number of major issues which need to be
worked out for the transfer to be successful. At minimum, these
include the following:
1. Role and placement of Environmental Health
The Environmental Health Division of the Health Department, in
addition to its Provincial health role, plays an important City
function. It enforces many City by-laws (e.g., noise) and is
heavily involved in the City s development regulation and
licensing operations. It chairs the City's Special Office for
the Environment and leads many City initiatives (e.g., anti-
smoking by-law). In its efforts, it works closely with many
other City departments and is a major player in many inter-
departmental efforts (e.g., the FEST Committee).
The legal and practical implications of separation from the rest
of the City need to be articulated and tested against a number of
3
alternatives. Options include keeping all or part of the
function within the City, contracting all or part of the function
with the Vancouver Health Board, creating cooperative
arrangements, or implementing a new parallel City structure to
deal with City concerns which fall outside the responsibility of
the Health Board.
2. Disposition of City real estate
The Health Department currently occupies three buildings which
are owned by the City. Other Health Department activities are
housed in facilities which the City leases from landlords.
Arrangements will have to be made for the Vancouver Health Board
to purchase or lease the City buildings and to assume the leases
in the other private and public buildings.
3. Disposition of other City assets
Most of the Health Department s non-property capital assets -
from desks, to computers, to stethoscopes and baby scales are the
City's property, and many were purchased at a time when the City
bore an even higher proportion of health costs than now. The
City and Vancouver Health Board will have to agree on a price for
these assets and a mechanism for purchase.
4. Continuation or replacement of City services to the Health
Department
Other City Departments currently provide a number of services to
the Health Department. These include payroll, budgeting and
accounting, purchasing, building maintenance, real estate and
facility management, computer services, legal services, human
resource services, and parking exemptions. These are valued at
nearly a million dollars a year, and the Health Board will either
have to contract with the City for all or a portion of these
services or find replacements.
5. Status of other City health services
The City operates a limited number of health-related services
outside the Health Department (e.g., the Taylor Manor and Cordova
House continuing care facilities). If the City is being asked to
get out of the health business, it likely makes sense to consider
the future of these services and facilities. We believe these
could logically be part of the package taken over by the
Vancouver Health Board. As the two care facilities are fully
integrated into City services, the details of any transfer will
need to be considered together with those of the Vancouver Health
Department. Arrangements to sell or lease Taylor Manor s
building and land would need to be negotiated; and the existing
tripartite operating agreement for the shelter portion of Cordova
House would need to be reviewed with the B.C. Housing Management
Commission, the active partner in the Federal/Provincial
operating agreement.
Similarly, it may be timely to question the City s continuing
role in Mountain View Cemetery, which has been historically
justified on a public-health basis. Another Council report
recommends a request for proposals for the operation of the
cemetery.
4
6. Clarification of Community Health Council roles
We understand that the Vancouver Health Board intends to delegate
responsibility for many public health functions to six Community
Health Councils. The present terms of reference for these Health
Councils are vague. As the Community Health Councils cover
geographic areas within the City of Vancouver and do not have
clearly defined responsibilities, members of the public could
become confused about the respective roles of City Council and
Community Health Councils. This could be counter-productive and
wasteful. It is, therefore, essential to clarify Community
Health Council functions before the Health Board transfers
tangible responsibilities to these entities and before the City
transfers the Health Department to the Health Board. The
division of the Health Department into six mini-departments does
not seem in the best interest of Vancouver taxpayers or health
consumers.
7. Capital funding for hospitals and other health facilities
Although it promised a revised formula, the Province has yet to
modify its proposal to charge Vancouver property taxpayers with
40 percent of the cost of new hospital capital in the city,
regardless of whether the facilities principally serve Vancouver
residents or not. Charging provincial health care costs against
the municipal property tax base continues to defy logic, as does
the separation of responsibility for capital and operating
budgets. Capital and operating expenditures should be integrated
so sensible trade-offs can be made between the two, so that the
operating implications of capital are clear, and so that those
who make capital decisions are responsible for the operating
consequences. Part of the health transfer package should be a
more sensible capital financing scheme which leaves the City
property taxpayer out of the equation and which does not place
additional demands on an already overcrowded City property tax
base.
CONCLUSION
The Province funds most public health services in Vancouver, and
the Province is apparently intent on transferring responsibility
for the Vancouver Health Department from the City of Vancouver to
the Vancouver Health Board. In spite of its historic opposition
to the ill-conceived health regionalization scheme, there is
little that the City can do to prevent this transfer from
happening. And, while the efficient provision of integrated
community services will be impeded, the City will likely derive
some moderate financial benefit from getting out of the health
business. However, sensitive negotiations are required to
protect the City's and the community s interest. While it may be
possible to complete these negotiations before the Health Board's
arbitrary November 1 deadline, the public interest should take
precedence over expediency
In the interim, the City and the Metropolitan Board of Health
should continue to remind the Minister of Health of his earlier
commitment to fund 100 percent of municipal health services upon
the establishment of regional health boards.
5
* * * * * *