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BILL NO. 15





Private Member's Bill




5th Session, 56th General Assembly
Nova Scotia
46 Elizabeth II, 1997




An Act to Establish

Regional and Community Health Boards





Robert L. Chisholm
Halifax Atlantic




Halifax
Printed by Queen s Printer for Nova Scotia







An Act to Establish

Regional and Community Health Boards





WHEREAS Nova Scotians have long supported health system reform in order to improve the quality of health care in the Province as expressed through numerous commissions, inquiries and public consultations since 1983;

AND WHEREAS the Government of Nova Scotia committed itself to proceeding with such reform following the release of the final report of the Nova Scotia Royal Commission on Health Care in December 1989, and subsequent release of Nova Scotia's Blueprint for Health System Reform in April 1994;

AND WHEREAS enabling legislation is widely viewed as being essential to support and facilitate the implementation of health system reform;

THEREFORE be it enacted by the Governor and Assembly as follows:

1 This Act may be cited as the Regional and Community Health Boards Act.

2 The purpose of this Act is to

(a) provide Nova Scotians with a framework for a comprehensive and integrated range of health services and programs at the community, regional and Provincial levels through a universally accessible, portable, publicly-funded, comprehensive health system;

(b) provide the legislative framework for the devolution of certain authority from the Minister to a network of community health boards and regional health boards;

(c) create the first stage in the establishment of regional health boards and community health boards across the Province; and

(d) ensure that health planning at all levels proceeds in partnership with the community.

3 In this Act,

(a) "community" means the area within which a community health board has jurisdiction;

(b) "community health board" means a community health board established pursuant to this Act;

(c) "consumer" means a person who uses the health system, but is not a provider;

(d) "core programs" means those essential categories of health programs and services that shall be accessible to Nova Scotians at a consistent standard as determined by the Minister;

(e) "designated hospital" means a hospital designated by the regulations;

(f) "health region" means a health region established pursuant to this Act;

(g) "hospital" means a hospital as defined in the Hospitals Act;

(h) "Minister" means the Minister of Health;

(i) "primary health care" means health education, health promotion, disease prevention, rehabilitation and support, and treatment for illness and injury;

(j) "provider" means a person who is an employee of a regional health board, a community health board or the Department of Health, an employee or owner of any organization receiving operational funds from a regional health board or a physician with privileges in the region;

(k) "provincial program" means programs that serve the entire Province, including tertiary care, and provincial programs that may be delivered by one or more regions but which are organized for the whole Province;

(l) "regional health board" means a regional health board established for a health region pursuant to this Act;

(m) "resident" means a person of the age of majority who has had his or her ordinary place of residence in a community for at least one year;

(n) "tertiary" means services usually only accessible through referral from a primary or specialized medical practitioner, involving the application of highly specialized knowledge or equipment, usually provided on a regional or provincial basis for unusually complicated or seriously ill patients who cannot be cared for at the primary or secondary levels of care.

4 The Minister has the general supervision and management of this Act.

5 (1) The Province is divided into four health regions as described in the regulations.

(2) Each health region has such name as the regulations determine.

6 (1) A regional health board shall be established for each health region.

(2) Each regional health board is a body corporate under such name as the regulations determine. 7 (1) Each health region shall have two or more community health boards.

(2) Each community health board is a body corporate.

(3) Each community health board has such name as is approved by the regional health board.

8 (1) A community health board shall be composed of residents of the relevant community, but in no case shall a community health board be composed of more than fifteen persons.

(2) Community health boards shall be composed of a majority of persons who are consumers.

(3) The members of community health boards shall be elected by the residents of the community to be served, by such means as the regional health board, in consultation with the community, deems appropriate.

(4) Subject to subsection (5), the members of a community health board shall serve for a term of three years.

(5) A member of a community health board may be elected for one further three-year term, but in no case shall a member serve for a time exceeding two consecutive terms.

(6) For the purpose of establishing community health boards, the initial terms served by members may be varied by the regional health board to preserve continuity on the community health board.

(7) In the event of a vacancy on a community health board, such vacancy shall be filled by the community health board for the unexpired term of the vacancy.

9 Unless provided for otherwise in the regulations, sixty per cent of the members of a community health board constitute a quorum.

10 (1) Each member of a community health board shall comply with the conflict of interest requirements prescribed in the regulations.

(2) Where a member of a community health board fails to comply with the requirements relating to conflict of interest, the member ceases to be a member of the community health board in accordance with the regulations.

(3) A member of a community health board ceases to be a member of the community health board upon

(a) being absent, without reasonable excuse, from three meetings of the community health board in any one year; or

(b) such other circumstances as are prescribed in the regulations.

11 (1) A community health board may make by-laws for its proper administration that are not inconsistent with this Act or the regulations, subject to the approval of the regional health board.

(2) With the approval of the Governor in Council and in consultation with the regional health board, a community health board in a particular region may make regulations or by-laws with respect to the selection of regional health board members in accordance with Section 13.

12 (1) A community health board shall

(a) develop and co-ordinate community health plans that encompass all primary health care at the local level;

(b) develop the budget and authorize the funding for primary health care programs and services consistent with the community health plan and within the funds made available by the regional health board;

(c) assist the regional health board with the development of a regional human resource plan;

(d) foster community development to ensure health care consumers and providers actively participate in planning and delivering services;

(e) work with other community health boards in the region, to assist in developing the regional health plan;

(f) support the implementation of the community health plan;

(g) support the evaluation of primary health care programs and services at the local level as a basis for future planning and funding;

(h) in collaboration with other community health boards, government departments and non-government organizations, monitor and advocate for healthy public policy guided by the Nova Scotia Health Goals;

(i) report at least annually to the community it serves;

(j) assist in the development of a health information system; and

(k) determine such other matters as a community health board and regional health board considers necessary or advisable to ensure the quality of primary health care in the community.

(2) Community health boards shall not deliver health services.

13 (1) The members of a regional health board shall be selected

(a) on an interim basis by the Minister where there are no regulations providing for the selection of the members; or

(b) in accordance with the regulations.

(2) Communities in the region shall elect two thirds of the members of the regional health board at a public forum.

(3) A regional health board shall be composed of not more than fifteen persons.

(4) No person who is a provider shall be a member of a regional health board.

(5) Subject to subsection (7), a member of a regional health board shall serve a term of three years.

(6) A member of a regional health board may be selected to serve one additional three-year term, but in no case shall a member of a regional health board serve for more than two consecutive terms.

(7) For the purpose of establishing regional health boards, the terms of the initial members of a regional health board may be varied by the Minister, on the recommendation of the regional health board, to preserve continuity of expertise and knowledge.

(8) In the event of a vacancy on a regional health board, such vacancy shall be filled by the regional health board for the unexpired term of the vacancy with a resident of the region in accordance with regulations made pursuant to subsection 11(2), except that a vacancy with respect to a Government appointment shall be filled by the Governor in Council.

14 Sixty per cent of the members of a regional health board constitute a quorum.

15 (1) Each member of a regional health board shall comply with the conflict-of-interest requirements prescribed in the regulations.

(2) Where a member of a regional health board fails to comply with the requirements relating to conflict of interest, the member ceases to be a member of the regional health board as provided by the regulations.

(3) A member of a regional health board ceases to be a member of a regional health board upon

(a) being absent, without reasonable excuse, from three consecutive meetings of the regional health board in any one year; or

(b) such other circumstances as are prescribed by the regulations.

16 (1) A regional health board may make by-laws to govern its conduct, operations and administration and such other matters as are provided for by the regulations.

(2) Without limiting subsection (1), subject to the approval of the Minister, a regional health board may make by-laws regulating the granting, suspension and revocation of medical staff privileges and appointment to the medical staff of designated hospitals within the region.

17 The members of a regional health board and a community health board shall, subject to the regulations, be reimbursed for reasonable expenses necessarily incurred in the performance of their duties.

18 A regional health board shall, after such consultation with the residents of the community or proposed community as the regional health board considers appropriate,

(a) determine the number of community health boards in the region;

(b) determine the community within which a community health board is to exercise jurisdiction;

(c) determine the number of members of the regional health board to be elected by each community; and

(d) determine such other matters where requested by a community health board for the proper operation and administration of a community health board.

19 (1) Subject to this Act, a regional health board may, in its discretion,

(a) establish one or more delegated structures for governance or management; or

(b) contract for such services as it deems appropriate.

(2) In this Act, "delegated structure" means a governance or management structure established pursuant to subsection (1) to which a regional health board delegates such functions and responsibilities as the board deems appropriate to carry out the intent of this Act.

(3) Where a regional health board establishes a delegated structure, the board shall prescribe the terms of reference and approve the by-laws of any such delegated structure.

(4) A delegated structure shall

(a) report to and be responsible to the regional health board;

(b) follow the policy, planning and direction of the regional health board with respect to programs and health services; and

(c) fulfil such duties and functions as may be prescribed by regulation.

20 (1) Subject to this Act, and in particular clause 19(1)(a) and subsections 19(3) and (4), a regional health board shall operate and manage the designated hospitals within the health region.

(2) A regional health board shall determine the number and type of designated hospitals in the health region, consistent with health care planning for the region.

21 Notwithstanding any special or general Act of the Legislature, upon the designation of a hospital by the regulations, the regional health board is empowered to create delegated structures and to delegate such powers and functions to these structures as the board deems appropriate to carry out the intent of this Act and

(a) all assets and liabilities of the hospital become assets and liabilities of the regional health board or its delegated structure including all employee benefits and entitlements;

(b) all employees of the hospital become employees of the regional health board or its delegated structure;

(c) the continuity of employment of the employees of the hospital is not broken by the designation of the hospital;

(d) notwithstanding clauses (a), (b) and (c), Section 71 of the Labour Standards Code does not apply with respect to employment before the designation; and

(e) subject to the Trade Union Act, the regional health board or its delegated structures and the employees of the hospital, who are covered by collective agreements under the Trade Union Act or the Civil Service Collective Bargaining Act, are bound by the collective agreements as if the delegated structures were a party to them.

22 (1) The Public Sector Compensation (1994-97) Act applies to a regional health board and the employees of a regional health board except that, notwithstanding subsection 3(4) of that Act,

(a) Section 23 of that Act does not apply;

(b) the Labour Relations Board has jurisdiction to and may exercise all of its powers under the Trade Union Act but the total effect of any changes to collective agreements shall not increase the total cost of all compensation in respect of all employees of a regional health board to whom the collective agreements changed apply and the pay rates, as defined by the Public Sector Compensation (1994-97) Act, are not more than permitted by that Act; and

(c) no change shall be made in a collective agreement without the approval of the Labour Relations Board in accordance with clause (b).

(2) In applying subsection (1), the Labour Relations Board shall treat employment of an employee as defined by clause 2(1)(k) and subsection 2(2) of the Trade Union Act as employment under a collective agreement, whether or not the employee was employed pursuant to a collective agreement.

23 A regional health board shall

(a) develop regional health service plans, including plans respecting the level and mix of health services needed in the health region and how and where these services are to be provided;

(b) rationalize institutional health services to ensure the most beneficial allocation of health resources to avoid duplication of health services and meet the needs of the health region;

(c) develop a regional health human resources plan to ensure that the proper mix of human resources is available to support health services;

(d) fund regional health programs and services;

(e) oversee the co-ordination, integration and delivery of health programs and services and related community development activities in the region;

(f) recommend to the Minister the core programs that should be basic to the health system and be accessible to all Nova Scotians;

(g) participate in the development of a provincial health plan;

(h) participate in the development of provincial human resource plans, tertiary and provincial health programs;

(i) participate in the development of a provincial health information system;

(j) conduct a regular and systematic evaluation of the regional health system; and

(k) carry out such other functions as the regulations prescribe.

24 (1) A regional health board shall review plans developed by community health boards to assess whether such plans

(a) are consistent with core programs;

(b) are consistent with available resources; and

(c) can be linked with the health plans of other community health boards in the region where appropriate.

(2) A regional health board shall allocate funds for primary health care and community development in accordance with the plans that meet the criteria in subsection (1).

25 (1) A Provincial Programs and Services Board shall be established by the regional health boards in consultation with the Department of Health.

(2) Subject to subsection (3), the role and responsibilities of the Provincial Programs and Services Board shall be developed by the regional health boards through regulation.

(3) The Provincial Programs and Services Board shall make recommendations to the regional health boards on the delivery and funding of provincial programs and services.

26 Notwithstanding any enactment, trust or agreement by which a hospital foundation is established with respect to a designated hospital, whether established before or after the designation, the foundation shall, as the foundation considers appropriate,

(a) continue to use its funds to benefit the hospital or for any other charitable purpose for which the foundation is established; or

(b) where a designated hospital is no longer operated as a hospital or no longer exists, use its funds to benefit the health care programs of the regional health board in the area formerly served by the hospital.

27 No action for damages lies against a regional health board or a community health board or the Provincial Programs and Services Board, or a member of a board for any act or omission, or any proceeding initiated or taken, in good faith in carrying out their duties or obligations as a Board or member under this Act.

28 Any person charged with a duty under this Act or the regulations is required to maintain the confidentiality of personal health information unless the person to whom the information relates consents to the release of the information or unless the person is required to divulge the information by

(a) the Minister; or

(b) any law or order of a court.

29 (1) The Governor in Council may make regulations

(a) describing a health region and determining its name;

(b) establishing a regional health board and determining its name;

(c) respecting reimbursement for expenses of members of regional health boards, community health boards and designated structures;

(d) designating hospitals for the purpose of this Act;

(e) prescribing the quorum required for community health boards and regional health boards; (f) prescribing duties and functions of regional health boards and community health boards that are not inconsistent with this Act;

(g) prescribing the conflict of interest requirements and the procedures and method by which members of the regional health boards and community health boards may be removed for a breach of the requirements;

(h) prescribing core programs;

(i) requiring the reporting by regional health boards to the Minister and to the community health boards in the region;

(j) requiring the reporting by community health boards to the regional health boards and to the community they serve;

(k) prescribing such circumstances under which persons shall cease to be members of community health boards and regional health boards;

(l) defining any word or expression used but not defined in this Act;

(m) respecting any matter that the Governor in Council considers necessary or advisable to carry out effectively the intent and purpose of this Act.

(2) The exercise by the Governor in Council of the authority contained in subsection (1) is regulations within the meaning of the Regulations Act.

30 Chapter 12 of the Acts of 1994, the Regional Health Boards Act, is repealed.



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