2011 Legislative Session: Third Session, 39th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

official report of

Debates of the Legislative Assembly

(hansard)

Tuesday, May 24, 2011

Afternoon Sitting

Volume 22, Number 9

CONTENTS

Page

Routine Business

Introductions by Members

Tabling Documents

Office of the Merit Commissioner, interim report

Introduction and First Reading of Bills

Bill 14 — Coastal Ferry Amendment Act, 2011

Statements (Standing Order 25B)

Child and Youth in Care Week

C. Trevena

Potlatch celebration on Haida Gwaii

C. Hansen

Service fair for low-income families in Victoria

C. James

Vic Green and ActNow B.C. program

D. Barnett

Environmental protection of Fraser River estuary

V. Huntington

Nechako Lakes school district

J. Rustad

Oral Questions

Business plan for B.C. CareCard initiative

A. Dix

Hon. M. de Jong

M. Farnworth

Funding for programs at Capilano University

M. Mungall

Hon. N. Yamamoto

R. Fleming

Vancouver floatplane terminal contract

S. Chandra Herbert

Hon. P. Bell

J. Horgan

Government action on homelessness and affordable housing

S. Simpson

Hon. R. Coleman

Grant's law and protection for workers

R. Chouhan

Hon. R. Coleman

Orders of the Day

Committee of Supply

Estimates: Ministry of Health

M. Farnworth

Hon. M. de Jong

D. Donaldson

D. Thorne

C. Trevena

D. Black

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Transportation and Infrastructure (continued)

H. Bains

Hon. B. Lekstrom

M. Sather

B. Ralston

R. Fleming

D. Thorne

B. Simpson

G. Gentner

V. Huntington

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TUESDAY, MAY 24, 2011

The House met at 1:34 p.m.

[Mr. Speaker in the chair.]

Routine Business

Introductions by Members

Hon. P. Bell: [Mandarin was spoken.]

Thank you for your tolerance, Mr. Speaker. I think of that as my revenge to the member for Burnaby North.

[1335]

Hon. I. Chong: I'm delighted to introduce in the precinct 45 students from a school not in my riding but that I have a close connection with. They're from Reynolds Secondary School in Victoria — the member for Saanich South's riding. They're French immersion sciences humaines — their French immersion class 11. They are here with their teacher Selena Jensen.

I know that later today they will be meeting with the Minister of Education but are here today to see what we do and also to learn about how the Legislature works in general. I would ask the House to give them a very warm welcome as they visit us here today.

M. Elmore: I'm very pleased to welcome to Victoria and to their tour in the Legislature a number of students from John Oliver School in Vancouver-Kensington as well as their teachers or staff members: Klaus Klein and Liane Langton, who are staff with the Take a Hike program; as well as students Puneet Aujla, Isaiah Cartier, Otis Graydon, Rueben Lobe, Dylan McTavish, John Phun, Jordan Reid, Jean-Luc St. Jacques and Ben Carter.

The Take a Hike program was founded ten years ago. Students combine adventure-based activities with academic and leadership training. These students have volunteered at community centres; senior centres; the food bank; elementary schools, where they help run sports programs; and the children's festival, as well as a number of outdoor activities: camping, hiking, kayaking and rock climbing.

They recently completed the West Coast Trail, and I'm very pleased that they've invited me on their next hiking adventure, probably on the North Shore. I'm looking forward to that. I ask everyone to please give them a warm welcome.

P. Pimm: It's with great pleasure that I rise today to introduce two guests. First, I would like to introduce the hon. Jay Hill, who served as my MP for 17 years and was House Leader in Ottawa. He was a great asset to our province and to Canada. Would the House please make him welcome.

Secondly, I would like to introduce Hanif Ladha with CCS Midstream Services. This company is involved with soil remediation in our area and does a great job of looking after our environment. Please help me welcome him to our House and his first question period, so everybody be nice today.

L. Krog: Joining us in the gallery today is an old friend of mine from Richmond, a real political junkie and one of those bright techie guys who works in a world that I don't understand — Dale Jackman.

Hon. H. Bloy: I'm proud to join some of the other members in the House. My wife and I became grandparents again late last week, for the second time. I can tell you that my son Jeremy and his wife, Jen, and their first child, our first grandchild, James, are all fine, and they welcome Jackson Robert to the world.

Tabling Documents

Mr. Speaker: Hon. Members, I have the honour to present an interim report of the Office of the Merit Commissioner.

Introduction and

First Reading of Bills

Bill 14 — Coastal Ferry

Amendment Act, 2011

Hon. B. Lekstrom presented a message from His Honour the Administrator: a bill intituled Coastal Ferry Amendment Act, 2011.

Hon. B. Lekstrom: I would move that the bill be introduced and read a first time now.

Motion approved.

[1340]

Hon. B. Lekstrom: I'm pleased to introduce Bill 14, the Coastal Ferry Amendment Act, 2011. Amendments to the Coastal Ferry Act are needed to provide the B.C. ferries commissioner, as he requested, with the mandate to undertake a review of the act to recommend changes to better balance the interests of ferry users with the financial sustainability of the ferry operator. It's also to provide the B.C. ferries commissioner with the time necessary to conduct the review before issuing the final price-cap

[ Page 7322 ]

decision for the next four-year performance term commencing April 1, 2012.

It will establish an interim price cap of 4.15 percent for all routes for 2012-2013. As well, it will provide the B.C. ferries commissioner with the financial resources necessary to undertake the review, and it will constrain the ferry operator from discontinuing services or asking for extraordinary fare increases until the commissioner releases a final price-cap decision. I will provide more information as these amendments go to second reading.

Mr. Speaker, I would move that the bill be placed on the orders of the day for second reading at the next sitting of the House after today.

Bill 14, Coastal Ferry Amendment Act, 2011, introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Statements

(Standing Order 25B)

CHILD AND YOUTH IN CARE WEEK

C. Trevena: This week marks B.C.'s first Child and Youth in Care Week. This is a significant statement which should not be treated lightly. There are more than 8,300 children and youth in B.C. who are in the care of the government. A disproportionate number of them are aboriginal.

We have a huge responsibility to ensure that those children and youth are given the best start they can have. More often than not, children and youth who are in care have faced traumatic situations in their lives, situations that many of us as adults simply cannot envisage. Sadly, looking at statistics, those children who have been in government care face more health risks, have a greater likelihood of substance abuse, are much less likely to graduate from high school and are more likely to attempt suicide.

We have a duty to both protect and to nurture those children and young people. That means providing stability. It means guaranteeing education. It means treating children and youth with dignity and respect, not just ensuring that their basic needs are met. It also means ensuring that their rights are respected and that they know what they are. We should adhere to the UN rights of the child, and young people should be made aware of them.

We are lucky in this province to have, after many battles, an excellent Representative for Children and Youth — an independent, articulate person who acts as a watchdog for children and young people in care, a voice for those least heard.

Everyone wants to have as normal a life as possible — family care rather than institutional, keeping families together rather than breaking up the natural relationships. But it's incumbent on us during this week and all weeks to make sure this is never done simply as a way to reduce costs.

In the long run, everyone knows if there's no investment in young people, the later costs — whether through the criminal justice system, the health care system, social services — are immense. Children and youth in care are often among our most vulnerable citizens, but they deserve the same start in life that every child and young person wants and deserves.

Let's hope that this first Child and Youth in Care Week makes a difference for the many thousands who need more than a proclamation.

POTLATCH CELEBRATION ON

HAIDA GWAII

C. Hansen: This past weekend I had the pleasure of attending an event that for more than half of the past 120 years would have been illegal in British Columbia. It was a potlatch that was held on Haida Gwaii. It was very special occasion for me, as in 2006 at a ceremony in Skidegate, I was given the Haida name of Nang K'ang.gudang.as, and in October of 2008 I was adopted into the clan of the Gidins of Skidegate, one of the eagle clans.

At that potlatch the Gidins of Skidegate were celebrating as Sid Crosby became their new chief, Chief Wigaanad. This past weekend Chief Wigaanad became the first chief in many decades to raise a new totem pole. Saturday morning the ropes and pulleys were all in place as hundreds of people showed up to pull on the ropes to raise the pole. The pole has two distinct rings at the top to indicate that Chief Wigaanad was hosting his second potlatch.

The potlatch that afternoon and evening lasted nine hours. The clan prepared food to feed a thousand guests. There was an abundance of salmon, halibut, octopus, crab, prawns and many other Haida delicacies, including herring roe on kelp, or k'aaw , as the Haida call it. There was singing and dancing that showcased the richness of the Haida culture. The masks and button blankets were beyond what anyone could find in any museum today. At the end of the evening every guest left with gifts of art prints, carvings and blankets.

And to think that from 1889 to 1951, the potlatch was illegal in Canada. This Legislature, along with the Parliament of Canada, took many unfortunate actions to stamp out the languages and the rich cultures of our First Nations communities.

This past weekend I witnessed a Haida culture that is moving confidently into the future, as young Haida are embracing the traditions and learning the language. I left tremendously proud of my chief, Chief Wigaanad, who demonstrated that he is one of the strong Haida leaders who will lead the Haida Nation into the future.

[1345]

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SERVICE FAIR FOR LOW-INCOME

FAMILIES IN VICTORIA

C. James: I'm pleased to talk about an important initiative in my community called Project Connect. Project Connect has been held for the last three years and is a popular service fair for people living homeless and in extreme poverty. It's organized by the Greater Victoria Coalition to End Homelessness and offers a long list of much-needed services for hundreds of individuals each time it's held.

In 2010 the coalition noted there was a need for a similar event outside the downtown core for families living in poverty. So in April of this year Coalition Connect for Families was held at the Victoria Native Friendship Centre in partnership with the Burnside Gorge Community Association.

Over 250 families representing over 700 individuals attended this very successful event. Over 30 service providers volunteered their time — everything from haircuts to acupuncture treatments and foot care; CareCards and birth certificate replacements, a service my office is pleased to assist with; resumes; family portraits; money management; and, of course, entertainment and food for the families.

The generosity of several community sponsors led to the success of Coalition Connect, a true community partnership. Donations meant the families received a reusable grocery bag containing much-needed items, including shampoo, toothpaste, toothbrushes, children's books, school supplies and baby wipes.

Both Burnside Gorge and the Victoria Native Friendship Centre offered staff to help organize the event, and event coordinators Mary Gidney and Nicole Jackson worked above and beyond to ensure the day went well. Special recognition must also be paid to key volunteers Deb Nelson and Joy Spencer Barry, along with 75 other volunteers.

I ask the House to join me in thanking all those involved in this extraordinary initiative and to join with me to work towards the day when Project Connect and Coalition to End Homelessness are a thing of the past because adequate services and supports are in place for everyone in our community.

VIC GREEN AND ACTNOW B.C. PROGRAM

D. Barnett: Today it gives me great pleasure to speak about a constituent of mine, Mr. Vic Green. A bit of background. In June 2006 the provincial government, under the Ministry of Health, initiated a program called ActNow, which went on to be recognized by the World Health Organization as a best-practices model for health promotion.

An opportunity was given to local governments to receive pedometers free, to either give them or sell them to promote active lifestyles. At that time I was mayor of a small community, and I am proud to say that we obtained 2,000 pedometers and sold them for $5 each.

Mr. Vic Green, who is a very active senior, a member of B.C. Power Hydro Pioneers purchased pedometers for himself and his wife, Irene. He has kept track of his total daily kilometres for a year. His total for twelve months was 1,559.63 kilometres or an average of 4.3 kilometres per day.

Today Vic celebrates his 79th birthday. He was also a volunteer firefighter for 50 years, and both he and his wife are active square dancers and involved in many other community activities. Vic says at that the ActNow program has helped him, his wife and others become active on a daily basis. Today he says he is virtually pain-free and mobile.

ENVIRONMENTAL PROTECTION OF

FRASER RIVER ESTUARY

V. Huntington: Some 30 years ago continuous habitat losses in the Fraser River Estuary resulted in the creation of the Fraser River estuary management plan or FREMP. That plan has, until recently, permitted development to take place more or less in parallel with the need to protect the environmental values of the estuary.

But FREMP doesn't work the way it used to, and developments in the Lower Fraser River now threaten our beloved river. We are failing to provide the protection this world-class river so desperately needs and, in particular, failing to protect that

section of the river from Hope to Steveston.

Our Fraser River still supports the world's largest single-river salmon runs. It is one of two of Canada's largest estuaries of global significance. It is Canada's largest waterfowl overwintering area, and it is a vital recreational and economic driving force in B.C.'s economy.

[1350]

Despite the brilliance of the Fraser ecosystem, we are seeing one of the largest threats to the estuary in the last 30 years — the proposal to ship toxic jet fuel in barges and tankers from international sources into the estuary. This development is unprecedented in its risk to the fish, wildlife and public safety of the estuary, yet has been expedited with inadequate public input. The applicant even obtained construction permits before the environmental assessment is complete.

We are also witnessing the mining of gravel bars in the Chilliwack

section of the river. In spite of the studies to the contrary, we are told this reduces flood risk. Those same studies caution that many of the gravel bars are key habitats for salmon, sturgeon and eulachon.

We desperately need a Lower Fraser River environmental management plan stretching from Steveston to Hope. We have taken our river for granted for too long, and without conservation leadership, our children will wonder what happened to this world-class legacy.

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NECHAKO LAKES SCHOOL DISTRICT

J. Rustad: You can find innovation in school districts around the province, but I would like to take a moment to boast about school district 91 in Nechako Lakes. They have been front-runners in many activities, often setting a template for other districts to follow.

Last week I had the pleasure of joining 35 students from across the district in one such endeavour. Project Heavy Duty celebrated their 25th year in operation, exposing students to a world of heavy equipment operation and the many careers available. Students experience skidders, loaders, feller bunchers, gravel trucks, excavators, backhoes, graders, earth-moving machinery and Bobcats. Among other things, they travelled to Endako Mines to learn about mining and spent some time at L&M Lumber to see what's involved in the sawmilling business.

Project Heavy Duty would not be possible without the terrific support from local businesses and individuals, such as: YRB Vanderhoof; Henry Klassen Sawmills; Bid Construction; the B.C. Ambulance Service; Vanderhoof Co-op; Endako Mines; K & D Contracting; Harry O Contracting; Vanderhoof fire department; Ambroy Construction; Gordie Peters Logging; Gulbranson Logging; Fraser Lake Sawmills; Pitka Logging; and of course, the maintenance department at school district 91. I would like to thank all the volunteers who've made Project Heavy Duty possible, especially Darren Carpenter.

There is a significant need for students to choose careers that are fulfilling but also that meet our economic needs. School district 91 is working with industry and communities to meet those challenges. Their leadership in PHD, E-bus and project agriculture, which is celebrating its 20th year this year, is phenomenal. Now school district 91 is taking on a new role, engaging in China to build an international school and to attract foreign students to attend schools here in B.C.

Please join me in congratulating school district 91 in all of their endeavours and in thanking the staff, volunteers and businesses that are making such a difference for our students.

Oral Questions

BUSINESS PLAN FOR

B.C. CARECARD INITIATIVE

A. Dix: As much as I'd like to ask questions about the formerly revenue-neutral HST, today it appears I'm going to be asking questions of the Minister of Health. Just a really simple one to start with for the minister. Can he table with the House his business plan for the introduction of the new CareCard plan?

Hon. M. de Jong: To the hon. opposition leader, I presume his interest in the matter is tied in part to the fact that he, as I do, finds it unsatisfactory that there are over nine million CareCards floating around British Columbia for a population in excess of four million people. The government has decided to take steps to try and address that. During the course of this discussion, the estimates that will follow and the bill that is before the House, which gives rise to that transition, will give us ample opportunity to discuss the matter in detail.

Mr. Speaker: Leader of the Opposition has a supplemental.

A. Dix: I guess the better question would be: is there a business plan? Because the minister said earlier today, based on anecdotal evidence, he thought the amount of fraud in question was between $50 million and $100 million. He got the margin of error down to 100 percent. He got it down to 100 percent. The ministry has identified last year $936,000 worth of CareCard fraud.

[1355]

The ministry suggested…

Interjections.

Mr. Speaker: Members.

A. Dix: …to the public yesterday that they thought they could save $10 million a year on $150 million worth of expenditure.

So I guess the question to the minister is very simple. Is there a business plan, given the completely contradictory information his ministry has put out about this plan over the last three days?

Hon. M. de Jong: Well, I can begin by assuring the member that any document I table will have an accurate date on it.

Interjections.

Mr. Speaker: Members.

Continue, Minister.

Hon. M. de Jong: The Canadian Health Care Anti-fraud Association is an agency that is dedicated to examining matters such as this. It estimates that British Columbians lose upwards of $300 million plus to health care fraud every year. Now, maybe they're wrong. Maybe it's $200 million. Maybe it's $100 million.

Fraud, by its very nature, is a difficult matter to quantify, but we believe that by taking steps to update and upgrade the CareCard in a manner in which many other provinces already have and add an enhanced security feature that is actually good for patients' safety, that that is the right thing to do.

[ Page 7325 ]

We've indicated what the cost of that is. We think it is a good investment on behalf of the taxpayers to support publicly funded health care.

Mr. Speaker: The Leader of the Opposition has a further supplemental.

A. Dix: The minister is saying that the ministry has found $936,000 worth of fraud and that he believes, according to the report, that there's close to $300 million worth of fraud. So that is, shall we say, a giant gap.

What we would like to know is — since this apparently has been going on year after year after year — where is the business plan, and where is the evidence? Isn't it reasonable that the Minister of Health today table in this House and table with the people of British Columbia, in advance of spending $150 million, what the business plan is for this initiative?

Hon. M. de Jong: Part of the reason we are confronted by the situation that presently exists relates to a decision that was made, I will assume in good faith, in the mid-1990s.

Interjections.

Mr. Speaker: Members.

Continue, Minister.

Hon. M. de Jong: I would have thought that some of the members, at least, would like to reminisce about those halcyon days.

The decision was made at that time to eliminate the expiry date on CareCards. Now, as I say, I presume and accept that the decision was made in good faith. In fact, what we are now confronted with is a proliferation of CareCards in British Columbia, which we believe enhances the possibility of fraudulent access to our publicly funded health care system.

Just as the Health critic, who I expect we're going to hear from in just a moment, said a few days ago: "I think a system that's much more focused on ensuring that people have a card, and that it's the right card…. We do it with drivers' licences. We do it with credit cards." That is the underlying principle behind precisely what the government is doing, and I would hope the members would accept that.

[1400]

M. Farnworth: Forgive us on this side for being a little skeptical, but when it comes to numbers, this government's record is not quite up to par, not quite up to scratch. Thursday the minister announced the program. He said $10 million. Two hours later it was changed to: "Well, there's an additional $28 million for the next five years." That's $150 million.

Yet by the ministry's own figures, $936,000 in fraud last year. The minister has stood up here in the House today and said that it could be upwards of $300 million. Yet the number that they used over the weekend was $240 million. The numbers around this initiative keep changing faster than the Premier has got positions on the HST.

The public has a right to know, on an initiative like this — everyone supports cracking down on fraud — that the government has done its homework; that they've put together a business case; that they've looked over the last five years, for example, at what type of fraud is taking place and how much fraud is taking place so that when they make an investment of $150 million, we know exactly what it's for and where it's going.

The question is really simple. Did the government do a business plan? Did the government do any reports on the amount of fraud taking place? And if so, will the minister table them here in the House?

Hon. M. de Jong: Presumably the member agrees with the proposition that having twice as many CareCards floating around the province as there are citizens is an unsatisfactory situation. Presumably he also agrees with the proposition that fraud, by its very nature, is difficult to definitively quantify. In fact, the analysis, as best we can, has been conducted.

The analysis around costs. There is a cost. It is a significant cost to move from an antiquated CareCard to one that contains a picture, to one that contains a smart chip that will allow for better procedures in emergency rooms, that will provide for more ready access to patients' health care records. All of that does come at a cost.

It is in the neighbourhood of $20 to $30 per card, and that cost will be borne over the next five years as drivers' licences come up for renewal and people have the option of combining two cards into one.

Mr. Speaker: The member has a supplemental.

M. Farnworth: The minister may have trouble quantifying fraud, but I can tell him this. The public have no trouble quantifying the fraud around the HST that was perpetrated on them before the last election. What it comes down to is that the minister made an announcement on Thursday about $10 million and CareCards, and since that announcement we have seen number after number, figure after figure. It has changed more than bids and figures around the B.C. Place roof.

So the question the public has is: on what basis did you make the decision? Was it on the basis of studies done by the ministry on the nature of fraud, on the types of fraud? Was it just pulled out of a hat? The public deserves the right to know. Again, was there a business plan done? If not, just say so. If there was, table it in the House. Finally, finally, table any studies that you've got on fraud. Were they done?

[ Page 7326 ]

Hon. M. de Jong: I think the last time the member and I were discussing fraud, it was originating out of Nanaimo. But that was another time, another place.

[1405]

Interjections.

Mr. Speaker: Minister, just take your seat.

Interjections.

Mr. Speaker: Members.

Continue, Minister.

Hon. M. de Jong: I can assure the member, this House and British Columbians that I, the government and the ministry, having examined all of the available evidence, are firmly of the belief that by taking this step and by making this investment on behalf of British Columbians, the savings in eliminated fraudulent activity will more than offset the investment that we are making on behalf of British Columbians — period. That's why we've made the decision to proceed.

FUNDING FOR PROGRAMS

AT CAPILANO UNIVERSITY

M. Mungall: This evening Capilano University is contemplating a major cut to programs, and 1,100 seats are at risk. Four hundred of them are in adult basic education, a program that provides learners with the basic skills to go on to university, trades and job training. Capilano University president Kris Bulcroft said that the program cuts are necessary because provincial funding hasn't kept pace with rising costs of providing an education to adults.

Can the minister commit today to increasing the current levels of funding in order to ensure that each one of these students has access to fundamental education programs like adult basic education?

Hon. N. Yamamoto: As the former board chair of Capilano, I'm actually delighted to have the opportunity to speak about Cap and what this government has done to post-secondary education in the last decade.

Since 2001 this government has invested almost $21.8 billion in post-secondary education. We've also invested almost $2 billion in student financial aid. Despite the global economic uncertainty, this government has protected core funding for post-secondary education.

Capilano has been and continues to be a provincial leader in innovative student-centred programming. This government and Capilano University will continue to partner in providing high-quality post-secondary education at Capilano University.

Mr. Speaker: The member has a supplemental.

M. Mungall: It seems that the minister is still stuck on page 1 of the briefing note. Last week in estimates the minister said she knew of no adult basic education program being cut. Two days later she's defending those exact cuts in the news. She even went on to say about the funding: "We actually haven't seen the cuts."

Well, the minister might as well be running with scissors, because shortfalls and failure to keep up are certainly effective ways that the B.C. Liberals are making cuts and costing schools, students and families more.

How can the minister be so off the mark when it comes to the situation at Capilano University? She even noted that she was on the board there. Will she commit today to protect the 400 adult basic education seats at Capilano University?

Hon. N. Yamamoto: I'm pleased to say that B.C.'s post-secondary institutions continue to benefit from the largest investment in post-secondary education in this decade. Since 2001 this government has overseen the creation of over 33,000 seats in post-secondary education in B.C.

[1410]

To the member opposite: I'd be happy any day to compare this government's record on post-secondary education against yours.

R. Fleming: Everybody knows that the number one barrier to getting into the job market in British Columbia is getting a high school diploma, and without one, 85 percent of any job openings are already closed. So how can this minister…? How can she oversee the elimination of 400 adult education seats in her own back yard in North Vancouver and deny that there are cuts going on in the ministry?

The question for the minister is: what does this cut do for raising adult literacy? What does it do for tackling chronic poverty in British Columbia? How is it good for families wanting an opportunity for a better life in her riding and in the province of British Columbia?

Hon. N. Yamamoto: The member opposite is simply wrong. As I've said, this government has continued to protect core funding for post-secondary education in B.C.

Capilano University, like other post-secondary institutions, makes its own decisions. They're autonomous. They make their own decisions regarding staffing, programming and administration. I'm confident that the budget decisions that Capilano University administration has made will ensure that Capilano University students will get a high-quality post-secondary education in B.C.

Mr. Speaker: The member has a supplemental.

[ Page 7327 ]

R. Fleming: The minister is quite wrong. The province of British Columbia is the principal funder of Capilano University and other institutions in British Columbia.

Here's what the Capilano board of governors is discussing tonight. They are discussing a seat reduction of 1,100 seats at the institution — for students with disabilities, for students seeking to get a high school diploma so they can go on to earn a trade or to pursue advanced education at another stage at that institution or another one. That's what the president of Capilano University says.

So who's right? Who's wrong? Is it the minister, or the president of Capilano University, who says that it's funding cuts that are causing an 1,100-seat reduction in the institution in her riding? Will she stand up today in the House and stand up for adult literacy and students in British Columbia and in North Vancouver?

Hon. N. Yamamoto: The member opposite is wrong. Capilano University will still be offering the ABE, the adult basic education, programs at all their campuses, and they will be fulfilling a hundred percent of their commitment to the government to provide adult basic education on their campuses.

VANCOUVER FLOATPLANE

TERMINAL CONTRACT

S. Chandra Herbert: My question is a simple one. It's reported that the B.C. Liberals are giving nearly $4 million of British Columbians' money to the private for-profit Vancouver Harbour Flight Centre to subsidize an airport which will start gouging the public with the highest fees in all of B.C. when it opens tomorrow. This shakedown will hurt tourism businesses on the Gulf Islands, Nanaimo, Victoria, Comox, Sunshine Coast, to name just a few.

Will the minister tell this House how many millions of dollars the B.C. Liberals are giving away?

Hon. P. Bell: This issue was canvassed thoroughly in estimates and again in question period two weeks ago. I assure the member opposite that I'm not going to reveal any of the details on this until the negotiation is complete. In fact, there are meetings going on today between all of the parties, and we're still optimistic that we'll find a positive outcome.

Mr. Speaker: The member has a supplemental.

S. Chandra Herbert: So I get this. The B.C. Liberals are negotiating how many millions of our dollars they're giving away for a botched P3 project which is gouging the public — the worst rates in all of B.C. This is astounding.

[1415]

Now, we understand that B.C. Liberals often say there's no money for education, no money for health care, but a private floatplane operator service company calls up and says, "We need subsidies here for your botched project," and they get them. This is outrageous.

When will the B.C. Liberals call a halt to this ridiculous giveaway that they're trying to do to fix their botched project? Will the minister do this today?

Hon. P. Bell: The floatplane industry is an important industry in British Columbia for the tourism sector. There is in the order of 350,000 passengers per year that are carried between Vancouver and Victoria and other centres around the province. Certainly, in speaking to the tourism industry, I know how important it is. We are looking to find a collaborative solution to this, and I'm not going to discuss the terms of that until we complete that in this House.

J. Horgan: You'll forgive me if when I hear that the B.C. Liberals are working for a positive outcome that I'm not convinced the taxpayers are the end result of that.

I want to ask the minister a simple question, following on my colleague from Vancouver–West End. If Harbour Air, which carries 85 percent of the traffic in and out of the harbour, is not participating in this negotiation, then how can we possibly get an outcome that's positive for everyone?

Hon. P. Bell: The member opposite is obviously not reading his media clips. If he was, he'd know that Harbour Air is part of the negotiation.

Mr. Speaker: The member has a supplemental.

J. Horgan: I was just there the other day signing the petition to see if I could do something to get some sense into this minister's head. When he talks about a positive outcome, perhaps they could have used some of that massive cost overrun at the convention centre to subsidize this profitable organization that's at the front of the line.

I want to know if the minister can quantify just how much PavCo is authorized to give away of taxpayers' money to get a deal with a positive outcome for everyone?

Hon. P. Bell: This issue, as I said previously, has been canvassed extensively in the estimates process, in question period two weeks ago, and again today. I've been very clear with my answer. Until we complete the negotiation between the various parties, I'm not going to disclose the level of those negotiations. That would not be appropriate to do.

We do care about the tourism industry. We know it's a key contributor to the overall provincial economy, and

[ Page 7328 ]

I would think that the member opposite would respect that and make sure that we get a positive outcome for everyone in British Columbia.

GOVERNMENT ACTION ON HOMELESSNESS

AND AFFORDABLE HOUSING

S. Simpson: We saw the homelessness count that came out in Metro Vancouver today, and we saw some progress around sheltered homelessness in the province. What we know is that that has largely been due to the Vancouver heat shelter strategy, and it has been a good strategy.

However, the other thing that's been dismaying in this report is that it shows that there really has been no progress on the larger question of homelessness since 2008. The numbers are essentially the same. Hon. Speaker, the problem here, though, and it's laid out in the report to some degree, is what may be right over the horizon.

My question is to the Housing Minister. Mr. Wayne Wright, who is the chair of the Metro Vancouver housing committee and the mayor of New Westminster, is quoted as saying in the report: "The lack of affordable rental housing in the region is putting low-to-moderate-income young people, families and seniors at risk of homelessness. Addressing this needs to be a priority for all levels of government as well."

This government has done little when it comes to families, seniors and youth. Can the minister tell us when he's going to introduce programs for families and seniors and youth?

Hon. R. Coleman: Well, this is the same member opposite who three years ago, along with his former colleague from Vancouver-Kensington, I think was the riding…. They were claiming there were 15,000 homeless people in the city of Vancouver.

[1420]

Today we have done a homeless count, and the housing…. It shows us that homelessness is down in British Columbia, a trend that has not been achieved anywhere else in North America, hon. Member.

You know, I thought for once the member opposite would actually stand up and say that the fact that street homelessness in the city of Vancouver has dropped by 82 percent is a good thing, and actually compliment the government. I thought he might want to reflect on the 6,000 people who were previously homeless in 2008 but who have been connected to housing and support in the last three years in British Columbia and changed their lives. I thought he might want to reflect on that.

And he doesn't have to ask me, hon. Member.

Mr. Speaker: Thank you, Minister.

Hon. R. Coleman: Oh. That's okay. I've got more.

Interjections.

Mr. Speaker: Members. Members.

GRANT'S LAW AND

PROTECTION FOR WORKERS

R. Chouhan: I want to ask a question to the Minister of Labour. I can't find her or see her there. I hope she'll be back soon.

Mr. Speaker: Member.

Interjections.

Mr. Speaker: Members.

Member, just take your seat for a second. By the rules of the House you do not indicate whether a minister or a member is in or out of the House, please.

Continue, Member.

R. Chouhan: Sorry about that, Mr. Speaker.

Since its proclamation in 2005 Grant's law has provided necessary protection for gas station workers requiring two workers on site on night shifts. Despite strong opposition from workers and the labour community, the Minister of Labour is choosing to review the current regulation and considering exemptions that would water down the existing regulations.

My question is to the Minister of Labour. Will the minister commit today to protecting vulnerable workers by scrapping the review and ensuring enforcement of the law in order to save lives?

Hon. R. Coleman: Hon. Speaker, I will take the question on notice for the minister, but I would be happy to expound on the great achievements of Housing in the province of British Columbia, if you'd asked me a question.

Mr. Speaker: The member has a supplemental.

R. Chouhan: My question is to the Solicitor General now. Despite the government's so-called families-first agenda, the B.C. Liberals refuse to listen to public opinion. The workers' safety should be paramount for any government. We need to take real, concrete steps to ensure that these workers are protected and that the current regulations are enforced.

To the Solicitor General: will there be any action taken by the government to protect the workers' lives? We have seen in the past that Grant's law has worked to protect those workers. Will there be any action taken in the near future to scrap the review of these regulations?

[ Page 7329 ]

Hon. R. Coleman: I've already taken it on notice for the minister responsible, and I'll do it again.

[End of question period.]

Orders of the Day

Hon. R. Coleman: This afternoon, we'll be discussing or actually telling people the rest of the stats on housing in the province…. No, I'm kidding, Mr. Speaker, but we would be happy to.

[1425]

In this House this afternoon we'll begin the estimates of the Ministry of Health, and in Committee A we'll be doing the estimates of the Ministry of Transportation and Infrastructure, continued.

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

The House in Committee of Supply (Section B); L. Reid in the chair.

The committee met at 2:30 p.m.

On Vote 32: ministry operations, $15,566,169,000 .

M. Farnworth: I'd like to start off by…. We can't seem to get away from each other in this place. For the last few years it was as Solicitor General, and now it's for the Ministry of Health. I know that the minister is basically still new in the portfolio, as am I in the critic area that I'm in. I can commit to him that I will not be raising questions as to how we both ended up in these respective positions.

Suffice it to say that for the next few days we will be discussing Ministry of Health estimates. My office has, I think, communicated with him about some of how it should unfold. Tomorrow we'll be dealing with seniors issues, by and large, most of the day, and then Thursday morning, public health issues.

Today, just to give an outline of some of the topics that I would like to try and get through — and I know that we're not going to be able to get to everything because we are somewhat constrained for time — I want to talk a bit about the minister's office; the business plan; the health accord; long-term funding; patient-focused funding; CareCard; skills and shortages — doctors, nurses, the health professions. Also, probably we'll finish on facilities — Surrey Memorial, Royal Columbian, the major hospitals.

If we can cover that today, I think that will be great. This afternoon I think there'll also be an opportunity, on a lot of those sort of regional facility questions, for my colleagues to get into asking some questions.

So if that's fine with the minister, if other staff are required…? We can begin.

Hon. M. de Jong: To the hon. member, the critic: I, too, anticipated the possibility of facing off with him in this chamber, perhaps under different circumstances. But here we are in these circumstances.

I would like, however, to simply do this: introduce the officials that are here at the moment with us. Graham Whitmarsh is the deputy minister; Michael MacDougall, chief operating officer; Manjit Sidhu, ADM, financial and corporate services division; and John Bethel is the chief administrative officer.

The program that the hon. member has laid out for discussions is one that makes sense for me. If we come to an area where we feel it is helpful for the discussion to draw on the expertise of another official, I am reliably advised that there is a veritable armada waiting in another room, and we can draw on that expertise as it is required. I'm looking forward to the discussion today and tomorrow.

M. Farnworth: I'd like to begin my opening question with, I mean, the obvious, which is that health care is the largest component of government spending in the province of British Columbia. Indeed, it is in any province. The rate of growth in the health care budget has been significant every year for the last 30 years, and it's projected to continue that way.

I was interested that during the leadership campaign there were some questions, comments, from the current Premier, about tying the health care budget to the rate of economic growth. So my question to the minister is: is that a practical and doable suggestion by the Premier — to tie health care spending to the rate of economic growth?

[1435]

Hon. M. de Jong: The member fairly, I think, points out the challenge that we face. I say "we" as a society. He has first-person experience with this as a former Health Minister: the, some would say, exponential growth in health care spending which tracks the demographic evolution of our society.

However, the need to try and constrain the rate of that growth is very real. To acknowledge that addressing the health care needs of British Columbians isn't merely a function of moving on the wishes that we all have as caring members of this Legislature and society generally…. There must be a matching ability to pay.

The notion that our ability to spend is tied to government revenue — which, in and of itself, is tied to growth in the economy — is perhaps an imperfect concept but not one without merit. So our ability to pay is tied ultimately to the revenues that government collects, and that is tied to growth in the economy.

[ Page 7330 ]

The member will, I'm sure, agree that the pressure that is being placed on government operations generally because of the growth in health care spending is very real and something that has presented challenges, obviously, to this government over the last decade and to governments before this one over the last 30 or 40 years.

M. Farnworth: The minister's point, I think, is well taken. Government is responsible for paying. There is an ability-to-pay aspect to the delivery of health care in the province, but it is also the service that most British Columbians rely on most and expect to be there when they need it.

When the Premier of the province says, "Let's tie health care spending to the rate of growth," that has some significant implications on the delivery of health care in B.C. I think, if you look at the latest figures, that would have resulted in about a $518 million cut to the delivery of programs in British Columbia if the government were to adopt a position of tying health care to the rate of growth in the province.

Can the minister tell us: has the Premier been briefed on the impact of that type of approach to health care spending in the province?

The Chair: Hon. Members, if I might take this opportunity to welcome 35 students visiting us today. Femida Jagani is the teacher. It's the Az-Zahraa Islamic Academy in the riding of Richmond East. I'd ask the House to please make them very welcome.

Hon. M. de Jong: There are a couple of ways, I think, to try to fairly address the point that the hon. member has made. First of all, I'm reminded that there is a difference if you benchmark against real GDP versus nominal GDP. It will take keener economic minds than mine to lay out accurately and in detail all of the differences, but I am advised that when you talk about nominal GDP, it actually tracks fairly closely.

I think a couple of things have happened, though. The experience of September 2008-2009 and what it did fiscally and economically — not just to the province; the country, North America and the world — was clearly abnormal.

[1440]

So part of the role one could argue for government when confronted by that sort of calamitous change in economies, in economic performance, is to smooth out some of those radical changes, and that is a valid argument. But it is equally valid — and my point — for governments to strive, through three-year economic planning and forecasts, to try and draw some parameters around the growth that is taking place.

One of the things that I have learned over the last number of years — generally, as someone sitting at a cabinet table in a department of government that has been adversely impacted by the growth in health care spending — is if you go on the street and stop ten people, probably eight or nine of them would very fairly, very honestly, tell you that in their view, health care spending has been cut in B.C. — and say that at a time where over the last ten years it has almost doubled from $9 billion to closing in on $18 billion.

There's a reason for that. People don't make that up to be purposely dishonest. It's a perception they have, but it's also a reflection on the fact that those costs continue to grow at an alarming rate.

It is, in my view, legitimate for government — governments across the country, for that matter — to speak about the need to constrain in some reasonable manner the rate of that growth and to draw some parameters around it, or the impact that growth in spending and health care is having on other public services is going to continue and to amplify.

M. Farnworth: I appreciate the minister's answer, and I understand exactly what he's saying. Health care spending is growing exponentially, faster than the rate of growth that's taking place, but overall, as a percentage of our GDP, it's remained fairly constant.

I think one of the questions, though, if you ask the public is: are we getting the best bang for the dollar? Are we being innovative in terms of how we spend our health care dollars? I think some of those questions we'll be dealing with later.

The issue that I think people want to have some confidence in is that the head of government truly understands the role and nature of health care spending in the province today, how people value it. The fact that there are…. You know, a simplistic idea of saying, "Let's just tie it to the rate of growth," has some very important consequences.

I think one of the things that we will certainly look for and I think the public is certainly looking for is that the Minister of Health, in his role as Minister of Health, is making the Premier acutely aware of the impact of statements such as that and of decisions that may go down that path will have on the delivery of health care services in the province.

To that end, I'd like to ask the minister…. Again, during the campaign the Premier indicated that she wanted to create a subcommittee on health care spending to look at spending. Has that taken place? Is the minister aware if there are plans to put in place that subcommittee that the Premier talked about during her leadership campaign?

Hon. M. de Jong: The hon. member correctly points out that several months ago the now Premier spoke, as part of this discussion, about her interest in looking at the possibility of establishing a committee to examine overall health spending, trends in health spending. The

[ Page 7331 ]

member or his colleague will be able to put this question to her directly next week, but again, I think, it's a reflection of the ongoing concern around accelerating growth in health care spending.

[1445]

The specific question is whether such a committee presently exists. It does not. There are discussions taking place about the possible composition and mandate, but I think the member's specific question was whether that committee presently exists and is meeting. It does not.

I hasten to add the obvious. The Premier is set to take her seat in this chamber on Monday of next week, I believe, and has obviously had a full plate these past six or seven weeks.

M. Farnworth: I, too, look forward to the Premier taking her place in this chamber and being able to answer, or not answer, questions both in question period and in other parts of our legislative program.

In the service plan…. I mean, when we're talking about health care, we're not just talking about delivery of service; we are talking about the dollars and cents that go to it and the fact that there are considerable cost pressures on our health care system that aren't going away anytime soon. The government has made a great deal about the challenges posed by cost increases in our health care system. So can the minister provide an overview of what areas are seeing the highest rates of cost inflation?

The 2011-2012 service plan says that we must use innovation to make strategic changes to keep costs under control. Can the minister tell us what specific initiatives are being undertaken to control costs?

Hon. M. de Jong: Member, apologies for the delay.

I'm going to do this in two parts. I think the member asked, first: what are the cost drivers, essentially; and then: what is government doing in response? If I can, let's deal in general terms with cost drivers and perhaps explore that a little bit and then get to some of the initiatives that are being pursued in response to that.

First, the obvious is our demographic changes, and the member will be alive to this, I suppose, as we all are. We are an older population. We are living to be older. The member knows all about the data that relates to our usage of the health care system as we get older — today's 60 was yesterday's 50, and all of those terminologies. So demographically those changes are driving costs.

[1450]

Utilization, I'm reminded, doesn't just relate to the fact that people are older and, therefore going to the doctor more. We are using medical services more as 30- and 40-year-olds than was previously the case. So we are more apt to access health care providers and health care services than was previously the case.

Drug costs, of course, continue to escalate. We have seen some examples of that recently and some examples relating to rare disease and rare drug treatments that cost $300,000, $400,000 or even half a million dollars a year. Those are exceptions, but it doesn't take many exceptions along those lines to represent significant cost drivers.

The fourth thing that I'll mention is inflation. One can argue that generally speaking, general rates of inflation have been trending to the lower side. But as again I'm reminded, on a budget the size of health care, even 2 percent represents a significant cost.

Within health care delivery itself — whether we're talking about technology, equipment or professionals — in some cases those inflationary costs have increased by far more than 2 percent per annum. So there is a built-in inflationary component that is, I'm advised, unique to health care services and, in some cases, health-related equipment and technology that is also a factor.

There are four areas. I know that the member may want to ask about any one of those or may want me to move on to some of the things that government is doing in response.

M. Farnworth: There are a couple of areas where I will ask some particular questions around those general areas the minister has outlined. But I think it's probably best that I let him go through the specific initiatives that they're undertaking with regard to them, and I'll see whether they cover off the questions I have or whether I have additional questions related to them.

Hon. M. de Jong: In response to the four areas of pressure that I mentioned, the Health Ministry, I think, has done a reasonably good job over the last year or couple of years trying to establish the basis upon which to respond to that. This is, by definition, fairly general, and we'll drill down from there.

Four pillars against which we try to measure our response and our actions. Firstly, and I would say arguably most important, health promotion and effective health promotion. Prevention and self-management. This may be unnecessarily apocalyptic on my part, but I would say this based on what I have seen at least as a participant in this chamber over close to 18 years and a member of cabinet for a decade. If we continue to simply try to fund disease management, we are not going to be able to do it.

We're going to eviscerate other departments of government and then run out of money. It just won't be possible, given the aging demographic. So prevention, health promotion…. It is challenging, because it is obviously a longer-term solution, and the challenge is diverting scarce resources today from other areas.

[1455]

When we talk about spending $20 million plus on funding a program to help people quit smoking…. Now, I think you can make an argument. We have the lowest

[ Page 7332 ]

incidence of smoking in the country, at 15 percent. If you could take that number down to 12, I think you'd, arguably, save billions of dollars in terms of health care costs down the road. The challenge is finding the $20 million or $25 million today, which needs to come from somewhere.

That's a prevention strategy today, a prescription for health — aligning patients and families with their doctors so that they can help. There's an incentive to build a health care prevention plan. So that's one — effective health promotion and prevention.

Quality primary and community-based care is the second of the four pillars. The highest-quality hospital care is the third, and improved innovation and efficiency, generally, within the delivery of health care in B.C. Those would be the four general pillars, principles, against which actions are measured and considered before proceeding.

M. Farnworth: The member raises a couple of interesting topics. I just want to touch on the one in terms of spending the money on the smoking cessation. I agree. The costs you save over the long term are significant.

One of the challenges that we face, of course, is…. It's like anything. There is also an incremental cost. Often it's very easy to spend an initial sum of money to get people to change their habit, and you'll make significant progress on a broad base of people who will change in response to efforts by government to get them to change.

But then you also come to trying to get from 20 percent down to 10. That 10 percent is much harder and requires incrementally a greater amount of money being spent in order to achieve that. It may well be worthwhile, and spending that money is no doubt a good thing to do, but it's a lot more effort than it was to get the original 30 or 40 percent to change their habit.

So when the ministry does programs like that, do they take into account any analysis of the incremental difficulty in reaching that goal when they make the decision to spend the money in those particular areas? I'll use the smoking one as an example. Were there studies done saying: "Okay, if we took that $20 million, we can get it down, and we've got some empirical evidence to back that up"?

Hon. M. de Jong: I'll begin by acknowledging and agreeing with what I think was the underlying proposition, which is, as I understand it, that as you move from the 30 percent to the 20 percent to the 10 percent, it gets tougher. There's probably a hard-core group of smokers out there that you're not going to change. For whatever reason, they have come to the conclusion that they either don't have to or don't want to, or they are immune, or they don't care.

[1500]

I guess the philosophical question that flows from that, if you get to that point, is to what extent the rest of society should contribute to the cost associated with that choice. But that's probably another conversation that we can have. It's an interesting one, because as you work your way down…. We're still at the point, though, where we believe that by removing, dare I say, some of the impediments — or I could say even excuses — that people might utilize to explain their refusal or inability to quit….

The funding announcement of several weeks ago was designed to address some of those impediments. There are some people who may have trouble fiscally, may not have the money to purchase some of the services that are available to help quit. We think this is a good investment. I have to say this: we have not set a target. We have not said: "As a result of this, by 2014 we expect the rate of smoking to be 14 percent or 13 percent."

We had actually just this morning in Vancouver a family who accessed QuitNow at the time when the mother was pregnant, before the funding announcement. It's a very compelling story. They decided that they were going to avail themselves of the program and have had their last cigarette together, the mother and the father, and are now raising, I think, three children. So we think the investment is worth it.

I understand the member's point. There is a temptation to say: "Well, surely set a target." I think this might be one of those examples where we believe the investment is sound, and if we can reduce by it 1, 2 or 3 percent, the investment is worthwhile.

M. Farnworth: I accept the minister's comments on this. I guess the point I'm trying to make is that….

Given the statements that have been made about limited health care resources and making sure we get the maximum benefit for our dollar, one of the things I want to make sure the ministry is doing is some really good, solid analysis on programs before they're unveiled. That’s so people know — is it new money, is it money that's been reallocated from somewhere else, or is there a sense of goals that are achievable? — that given competing choices, we're actually going with the best choices that will make the longest difference to our health care system and to the health of the population over a long time.

Talking about smoking…. I think that has to continue to be a priority in terms of reducing the incidence of the rate of smoking in the province of British Columbia.

But when you look at that and you compare it to, for example, childhood obesity and unhealthy eating habits…. If you've got a pot of money that can go to changing the habits of a population, what I'm wondering is, does the ministry do studies that say: "You know what? We actually can get a bigger bang for our dollar in this area that's going to have a significant impact on our

[ Page 7333 ]

health care system down the road, dealing with a problem that we all know is far more prevalent today than it was 20, 25 years ago"?

So when these types of decisions are made, is the analysis taking place in a comparative look at how that money could be spent in terms of trying to achieve long-term health care goals?

[1505]

Hon. M. de Jong: Well, a couple of things come to mind. The member, and I think quite properly, raised the issue of obesity. I'll say this as a general statement. Here's what my sense is. The single most important thing we can do to improve health outcomes rests in education. The better educated someone is, the better educated a family is, the better equipped they are to make sound decisions. So the linkage between education and health outcomes is, I think, a very strong one and one that has been established empirically.

Obesity. You look at the fact that…. I think the latest study I saw showed that somewhere between 45 percent and 50 percent of British Columbians qualify as being overweight or obese. Look, I teeter on the brink, so I'm hesitant about preaching. Our lifestyle has changed. I live in Abbotsford. The closest thing we have to a rush hour within town is at three o'clock when school is out. No one walks home anymore. That's got to have an impact.

The modes of entertainment that young kids are drawn to now are as likely to involve the computer screen as they are a baseball diamond or a soccer field. So the role for parents, for caregivers to ensure that children have access to that physical activity is more important now than ever.

I'm told, through some of the analyses and studies that I have been given, that the ministry has been undertaking that, along with obesity, sodium intake is a huge problem. It's not the stuff you shake on your steak — although I suppose that amplifies the problem. It's the built-in sodium content in manufactured foods. We talk about sugar and how it contributes to obesity, bad teeth and dental hygiene. Salt has…. In terms of hypertension, heart disease, the linkage is as direct.

So one of the things the member will see in the weeks and months ahead is a concerted effort on the part of the ministry — and I think it's valid to talk a little bit about this because we will be utilizing some resources — to provide information to people about the impact of sodium and salt in their diets and smart decisions that they can make in choosing the correct kind of foods and manufactured foods. Check the sodium content on the back of the box.

These are all things driven by studies and driven by the data that has been collected. Changing the behaviour is what represents the biggest challenge — the combination of encouraging people, providing them with the information they need to make wise choices — and not always resorting to the heavy hand of the state to compel behaviour but assisting people in making smart decisions on their own. Those are all part and parcel of the health promotion and prevention agenda that the ministry is endeavouring to set for itself.

M. Farnworth: The issue of health promotion is an important one, and making changes in lifestyle, I think, is one of the keys, too, in dealing with long-term health care costs and also the long-term health of the public at large.

We have some ability to do that, and I think that government does need to take an active role in that regard. That's why, when we do, we need to make sure that we're spending our dollars where we're going to get the most bang for the buck. That's why I'm asking: are studies being done?

The minister makes a good point about kids getting driven to school, as opposed to how when we were kids, we walked to school. In fact, the idea of suggesting to my parents a ride to school would have, no doubt, been met with stunned disbelief and probably a smack across the ear and then being pushed out the door and told: "You will walk, and I don't care if it's raining. When we were kids, it was ten miles to school uphill and ten miles back from school uphill."

[1510]

It's a different world today. There's an expectation that kids get driven to school, and that has consequences in terms of physical activity. There's a whole range of issues, which we don't have time for, that we could get into discussing around education, physical fitness and the like.

I would note, when the minister said that he was teetering on the brink, that during my leadership campaign I put on about 12 pounds, I think, much to my annoyance. A habit of wanting to eat Nanaimo bars at three o'clock in the morning certainly doesn't help. I think what it does, though, is that it illustrates the challenges that we as a modern society have. There are roles that government can play, whether it's dealing with tobacco, dealing with alcohol or childhood obesity, consumption of sodium and issues like that. That's one aspect.

Another aspect that we don't have control over is around demographics and the fact that we are aging as a society, particularly in British Columbia. I'm wondering: has the ministry done work in terms of how this province is changing demographically, particularly in the population aged over 55, and the trends that we're seeing in British Columbia in relation to the rest of the country and the impact that that has on health care funding in British Columbia?

Hon. M. de Jong: Well, there are a couple of things that I can alert the member and other members of the House to. I've got copies of this stuff, so I'm happy to

[ Page 7334 ]

provide the member with it. One of the questions was: are we tracking demographic change within the province? The short answer is yes, in a variety of different ways.

We can see…. I have this very colourful chart that tells me and tells us that in the Okanagan Valley, for example, population is trending a certain way. I'm happy to share that information with the member.

On that front, I ask the question generally, and I'm advised that, despite what we may think, we're not particularly out of sync with the rest of the country. It's not a question of British Columbia having this abnormally high seniors population vis-à-vis other parts of Canada, although I suppose individual communities may vary a little bit.

[1515]

I wonder if I might use the member's question, though, as an opportunity to at least put on the record this bit of interesting utilization data. Again, I'll make sure that the member gets this if he doesn't already have it.

It speaks to the average cost of utilization for particular age groups. I am between the ages of 45 and 50 now. People under the age of 45 generally spend, on average, $2,000 accessing health care services; people between the ages of 45 and 64, just over $3,000; people between the ages of 65 and 74, just about $6,000; people between the ages of 75 and 84, $10,500; and people over the age of 85, in excess of $18,000. So it's a dramatic increase through that, particularly 75 to 85-plus.

When you consider that we have just over 1.2 million people between the ages of 45 and 65, that wave is going to move through, and I have seen nothing to indicate, at this point, that those costs are going to come down. But it's interesting. Again, I will shamelessly use the opportunity afforded by the member to make this point, and it's based on studies from the experts. If each of us exercised for 30 minutes a day, controlled our weight, ate reasonably well and stopped smoking, we could reduce our risk of chronic disease by up to 80 percent.

That $18,000 speaks to chronic disease. Everything I've read indicates that that's where that cost comes from. If all British Columbians had a normal, healthy weight for their height and were physically active and didn't smoke, the studies that the ministry has conducted and accessed say that the province could avoid over $3.8 billion in economic and health care costs every year — almost $4 billion.

Now, the member has been involved in discussions with other ministers and other…. Imagine. I have heard debates with ministries where the difference between anxiety and nirvana is $10 million. We're talking about the potential, if we performed better as a society, for $4 billion in savings and improved health outcomes. The stakes are high. It's why I say that, at the end of the day, the sustainability of health care as we know it is tied to this notion of prevention and well-being.

M. Farnworth: I think the point is well taken that prevention is a key to long-term sustainability not only from a financial setting but also from a healthier population and better quality of life for people. One of the key issues I think we need to address in terms of demographic changes is how we are changing in this province and the wave that is coming through.

I know that one of the questions that is often raised and is of concern, and I guess it will be addressed probably in greater detail tomorrow when we discuss seniors' health issues in much deeper context, is how that impacts people retiring to British Columbia and the impact that it has on communities and government's response to that. From what I'm hearing the minister saying, is that as a province, as a whole, that retiring wave is not seen to be making itself apparent yet in British Columbia.

One thing I know — the minister is in the 45-to-50 demographic, and I'm now slightly moved past that, to the 50-to-55 demographic — is that people do start looking to retire.

[1520]

They start going: "You know what? I don't like minus 30 in Edmonton or minus 40 in Regina. Let's go somewhere where it's not quite so cold and I don't have quite so much snow to shovel." There's only one place in the country that has those wonderful qualities, and that's British Columbia.

Is there an expectation, as this wave moves through, that it will impact British Columbia to a greater extent than other provinces? Has the ministry been looking at that?

Hon. M. de Jong: I'm going to see if I can get the member some definitive demographic data, because quite frankly, it seems to me that as a destination spot for retirees in the country, that should reveal itself in the data. It may be offset by the fact that we're also attracting more than our fair share of young families and other immigrants, so that as a percentage of the population, it doesn't change that much. I think what I want to do is, between today and tomorrow, get some actual demographic

summary material that I can give to the member.

I think we can say this, and I agree with the member. British Columbia is going to remain a spot that folks on the Prairies will be thinking about coming to, whether it's the Okanagan, the Lower Mainland, Comox Valley. People love coming here, and when they get to a point where they don't want to shovel snow anymore, if they've had any experience in British Columbia, particularly on the west coast, they are drawn and inclined to come here.

M. Farnworth: The minister actually just raised the second point where I wanted to go with this. What I'm trying to get an understanding of is the pressures on

[ Page 7335 ]

our health care system right now in terms of population and demographics. There are funding constraints. There's inflation. There's technology. There are all those things. And then there's the response from government in terms of: "Okay, how do we deal with this?"

One of the issues the minister just raised is an influx of young families and new immigrants. That itself brings advantages, but it also brings challenges, in the sense of cultural issues in terms of how health care is delivered but, more importantly, the supply of doctors who are able to work with a particular community, understand the nature of the community, understand the language.

[1525]

That invariably means physicians or health care professionals coming from those countries where we're receiving our new citizens from and the issues around qualifications and getting recognized in terms of their ability to practise their profession, in this case health care professions, here in British Columbia.

My question would be: how has the ministry been responding to those challenges? Are we keeping statistics and looking at analyzing the impact that the significant immigration flow into the province is having on our health care system and the challenges in some of those key areas in terms of how we're able to handle it taking place? Has work been done in that area?

The Chair: Hon. Members, I believe we've been joined in the gallery by students from Daniel Woodward Elementary School in Richmond. I'd ask the House to please make them welcome.

Hon. M. de Jong: I'll begin by saying that to my view — and my guess is the member agrees with this — the benefits that accrue from young families immigrating to this province from elsewhere in the world far outweigh some of what might be short-term challenges. At a time when the ratio between those who are working and those past the age of retirement is far different than what it was 20 or 30 years ago, we are in a position where we not only benefit greatly from people selecting our country and our province as a place they want to come to, but it's actually an essential part of the overall equation for economic success.

We have to be competitive. I think that is, going forward, one of the things. We can say it falls outside of the specific realm of health care, but if we're going to get to where we want to be as a province and enhance our standard of living, we are going to need to recognize that it is competitive in terms of attracting people. They have choices, whether they're in health care or any other economic field. We are, I think, proving that this economic question is one that is not separate and apart from the health care formula.

We are, as the member knows, training more physicians domestically, upwards of twice as many as we were a decade ago, and that is significant. I have met a number of individuals who are either enrolled or in the process of graduating from those expanded medical programs for physicians or for nurses, for that matter, who are first-generation — I guess we still use that term — Canadians.

Their families, their parents immigrated here, so they have a cultural awareness that perhaps others don't, and they are in a position to address some of the unique needs that members of particular communities might face.

In addition to that, I am advised that some additional steps have been taken on the recruiting front. The number of entry-level residency positions for foreign-trained doctors has tripled from six to 18 — still modest numbers but a significant improvement from where it was back in the early part of the decade — and 12 of those positions are in family medicine. So that is significant.

[1530]

We've endeavoured to expedite the immigration process for internationally trained doctors under the provincial nominee program through the Ministry of Advanced Education and Labour Market Development.

My experience has been that there are two components to making this work. One is government — provincial, federal — expediting the entry of someone who wants to come here and practise their profession. The other is professional, and that is ensuring that there is a regime in place, as administered by the medical college or the self-governing body, that responsibly recognizes those credentials.

It is about a balance, because whilst I am one of those persons who historically have been very critical of the phenomenon of the neurosurgeon driving the cab, the grossest example of people's skills going to waste, I know this also. British Columbians want and expect and deserve to know that the people administering to their needs in medical facilities are properly credentialed. So finding that balance in a way that meets both of those objectives is important.

The short answer: some progress has been made. We are training far more people domestically. Some of those people are uniquely positioned to address some of the unique challenges within particular communities. We are also doing a better job recruiting from afar, though I would say, particularly with respect to the latter, there is still more that can be done.

M. Farnworth: I thank the minister for his answer. We're going to get deeper into that when we talk levels of staffing and doctors and nurses and health care professionals and the training that's taking place.

The point he makes is a good one, in response to my question. That is, we are seeing significant demographic changes in this province that bring with them, I think, significant advantages, both economic and social, but

[ Page 7336 ]

also, at the same time, challenges in terms of our health care system.

We're seeing it in terms of seniors. We're seeing it in terms of new arrivals. Those are things that the government needs to be aware of in determining its health policy because, as the minister stated, there are a number of drivers. That's one of the key ones in terms of health care costs in the province today. The minister has mentioned some others.

Inflation. It affects everything, and I think — the minister doesn't have to respond — that it does allow government to give an answer to questions from opposition that we are spending more money today than ever before. While that is true, I think inflation is often a key component of that.

One of the areas that I would be interested in hearing the minister's comments on is: what is happening in terms of inflation within health care delivery? Where are the major drivers? Is it wages and benefits? Is it technology and the fact that 20 years ago a heart monitor was a heart monitor or a bed was a bed, and quite often it had a life expectancy of ten years?

Now, you bring out, say, a heart monitor, and technology changes it. Two years later there's a new, improved, better one. I'd like to have a sense of where inflation is, the role of inflation and how it's playing out within our health care system. It does, I think, appear to most people, or to people who look at it and ask questions, significantly higher than other areas of government service delivery or within the private sector.

[1535]

Hon. M. de Jong: Well, again, the proposition that I think the hon. member lays before the House is not one with which I will quarrel. The inflationary trends cut across the various components.

I will say, to preface my remarks, that I don't want to leave the impression that the government holds the valuable, incredible people that do the work responsible for the costs. Yes, when wages go up, there are costs. I am told that across the fold a 1 percent increase in wages equates to roughly $150 million. So that's $150 million, but the budget has gone up by a lot more than $150 million. That's one part of it.

I was in Kamloops at Royal Inland and was shown the new CT scanner. The new CT scanner is state of the art; it's fantastic. It replaces the old CT scanner. I can't say this for certain, but it wouldn't surprise me if the new CT scanner was at least 50 percent, and maybe more, more expensive than the old CT scanner.

Now, the technicians and the physicians there pointed out that it represents, as a diagnostic tool, an incredibly more valuable instrument than its predecessor. But the price of this diagnostic equipment is measured in the millions of dollars.

Drug costs have gone up. I am reminded by officials that we have managed to keep those increases in the range of 4 percent. They were, for a period of time some years ago, rising much more rapidly.

[1540]

Even that involves asking clinicians to make some very difficult choices about what is going to be covered, what is not going to be covered and which drugs are going to be made available. And when it comes to rare diseases, and we've seen some examples of that in the media of late as well, those are very, very difficult decisions that have to be made.

So technology, drugs, personnel — but I don't want to overstate that as part of the equation — these are all drivers of the increases that we see.

I think somewhere in the member's question was perhaps the underlying notion that with the technology, the equipment, the drugs, there is an element of specialization which means, on many occasions, that the supplier sets the price and that those of us who are consumers of the service or who purchase on behalf of the public are in a position where there is not a lot of room for negotiation. We try to negotiate as aggressively and effectively as we can to get the best value possible for the taxpayers that are paying for it.

M. Farnworth: No, I appreciate the minister's answer, because I think one of the things that's often out there is: "Oh, it's just a case of wages driving health care costs." The reality is that an increase in the health care sector…. Increases occur in every other sector of government and in the private sector, as well, and other areas of the public sector, yet health care costs are rising faster than all those other sectors. There are other factors at play here that I want to get it on the record a bit — issues around drug costs, which we'll explore a bit further this afternoon, and also equipment.

In my mind what it speaks to in health care is that we can approach things as a province from a B.C. perspective, or we can recognize that in many cases these are issues and problems that face not just British Columbia but other provinces as well, other jurisdictions, in terms of the delivery of health care.

That also relates in terms of how we fund health care in B.C. I mean, we've been talking about the cost pressures and some of the drivers of costs in health care. One of the things I want to get to in a few minutes is the issue of how we fund it, both at the local and provincial but also at the national level.

Just to ask this question in terms of equipment — I think this is the appropriate time to ask it — do we engage…? When we purchase major equipment — CT scans and MRIs, for example — do we do it in isolation as British Columbia? Or do we sit down and work with other provinces — let's say Ontario, Quebec, Alberta and Saskatchewan — who are also buying these types of equipment, and say: "Well, let's hang on a sec"? Rather than all of us going to these companies individually as

[ Page 7337 ]

provinces, do we get together and go: "You know what? We have more leverage if we work together"? Is there any sort of strategy to do purchasing in that regard?

[1545]

Hon. M. de Jong: It seems to me, first of all, that the short answer is yes, there is collaborative purchasing, but I want to give the member as accurate an answer as possible. I am advised that most of that to date relates to — and I'm not sure I'm using the right term — what I would call consumables and drugs.

We were speaking a moment ago about large-equipment purchases. It has not evolved to that point, and one wonders whether the volume is such that it could. There are procurement practices and policies in place that are designed to elicit the best possible price on that large equipment. But thus far the interprovincial collaboration on drug pricing and purchasing, a specific agreement with the province of Alberta around the purchasing of consumables, is also in place.

I'm told, just so the member has some appreciation of the order of magnitude here, that according to the Canadian Institute for Health Information, western government drug plans — B.C., Alberta, Saskatchewan, Manitoba and the Territories — spent a combined total of $2.2 billion on drug plans in 2007. I guess that has gone up since then, but there are savings that are being realized. The equivalent figure for all of Canada in '07 was $8.7 billion.

There is a joint agreement in place for the purchasing of drugs. That seems to have gone reasonably well between Alberta and British Columbia on consumables, and it remains to be seen whether or not the next step can be taken, as part of that collaboration, around some of the other larger-ticket items, although they are purchased far less frequently.

M. Farnworth: I look back to my time as Health Minister. It's 12 years ago now, which is a long time. One of the things that struck me during that time was how many of the challenges that we face as a province are shared by other provinces and the need, I think, in many cases for not just provincial and collaborative strategies with one province but a sense of the opportunity that exists, with collaboration on a national scale and national strategies, for dealing with a number of the issues and the challenges that we face in health care. Events over the last 12 years, I think, have reinforced that idea with me.

While the minister has stated issues on drugs, and we'll come to that in more detail later on, and he's touched on the issue around Alberta with consumables, I actually think that there is a considerable scope. The minister says these purchases are made more infrequently, and I think that yes, that's correct. They are made more infrequently, but judging from the number….

I think he mentioned $8.7 billion on equipment. That's a significant amount of money that the provinces spend on equipment, and much of that equipment is very high-tech. It will be order-specific, and its manufacturing process requires a commitment. That is one of the reasons why it's expensive.

I think there is an opportunity there not just for British Columbia but the provinces in general, if they work and coordinate their purchases around some of those — particularly expensive high-tech equipment such as MRIs, CAT scans, what have you — to be in a position to leverage savings for the taxpayer in the health care system with regards to that aspect of health care expenditure.

[1550]

My question to the minister would be: if that has not taken place, would the minister commit to looking at the potential or possibility of those kinds of initiatives or an initiative like that with other provinces?

Hon. M. de Jong: Just to follow up on a bit of the chronology, which may be relevant to the question that the hon. member has asked, back in July of '09 the governments of B.C. and Alberta announced an agreement to consolidate the procurement of drugs, supplies and equipment used in hospitals through HealthPRO, a group-purchasing organization owned by participating health agencies. I am advised that Saskatchewan and the Winnipeg Regional Health Authority have since joined that collaboration with B.C. and Alberta.

B.C. Health Shared Services is now in the process of aligning health authority purchasing with HealthPRO contracts. I'm further advised, and this perhaps goes directly to the point that the member was making, that back in August of last year, at a meeting of the Council of the Federation, the Premiers for the provinces agreed to establish a pan-Canadian purchasing alliance to consolidate public sector procurement of common drugs, medical supplies and equipment where appropriate.

It seems the foundation has been laid for an expansion of this pan-Canadian purchasing strategy. It is firmly established in some areas — like drugs, like consumables — and perhaps less established in some of the other areas.

The member will get no argument from me. Where we can, it makes sense for us to consolidate on a national basis. We are an incredibly large geographic nation with a comparably small population, and where we can maximize the benefits by working together, it makes sense to me to do so.

M. Farnworth: Thank you for the answer. I hope that British Columbia is active in terms of driving the initiatives out of that. I do think, particularly around major equipment, that there is opportunity there for the provinces, not just British Columbia, to improve what we do have but also to use it as leverage.

[ Page 7338 ]

I was going to go to the health accord, but what I think I might do at this particular point is segue into — because it crops up in the minister's answers, and it does so because it makes sense — the issue of the other cost driver, which is pharmaceuticals and drugs and the costs that are taking place with drugs.

Do we need to get additional staff at all?

Interjection.

M. Farnworth: Okay, in that case, it's probably good to take a little break for five minutes.

The Chair: A five-minute recess, hon. Members.

The committee recessed from 3:54 p.m. to 4:04 p.m.

[D. Black in the chair.]

M. Farnworth: Before the break we were just starting a discussion on pharmaceuticals, drugs and cost pressures on our health care system. Can the minister just outline what's been happening with pharmaceuticals in terms of the rate of increase, the issues around new drugs coming onto the market and the role that pharmaceuticals are now playing within our health care system? I guess a brief outline of where we are in terms of….

[1605]

I remember when I was…. Well, 12 years ago the issue at that point was that pharmaceutical use was coming very close to being the same or would be passing invasive procedures. So just a sense of where we are right now in British Columbia with the pharmaceuticals within our health care system.

Hon. M. de Jong: The member is correct about the increasing order of magnitude. In terms of the raw numbers we can go back to '91-92. Twenty years ago the cost would have been $228 million. For budget year 2011 it is $1.1 billion. So in addition to inflationary pressures, there are some other significantly growing costs obviously built in.

But I'm reminded…. I should introduce the member in the House to Bob Nakagawa, who is ADM from the pharmaceutical services division of the ministry. From what I've just said, the member will appreciate that he oversees a significant portion of the expenditure of public moneys.

I am advised by him that those costs relate to a variety of things: increased costs for specific drugs, but also significant advances and a broader range of pharmaceutical products — clot busters for heart conditions, statins for cholesterol. We go through HIV treatment. The development and the advances relate to drugs that are commonly used and especially drugs for very rare conditions, some of which are very, very expensive. So we're looking at about $1.1 billion worth of expenditure for 2010-2011.

M. Farnworth: What it shows is that for a variety of reasons the rate of use of pharmaceuticals and the cost to our health care system have increased dramatically. There are, as the minister rightly stated, drugs that do things that couldn't be dreamed of 20 years ago, that are now able to treat conditions, extend people's lives, quality of health and quality of life and all those things. It's important that we're able to supply and be able to provide that medication to British Columbians.

At the same time, we've seen the development of new drugs that are often either slightly better or…. The efficacy rate is very similar, yet those are more expensive than traditional drugs that have been in place. The demand for them can have an impact on our health care budget as well.

[1610]

So governments have had to not only respond to the advances in terms of providing new pharmaceutical treatments but also to deal with the challenges of drugs whose efficacy may be an incremental increase or very similar but yet are heavily marketed compared to drugs that have been around for a long time.

A number of remedies or initiatives have been undertaken in this jurisdiction and different jurisdictions to be able to deal with that and deal with the advances and to ensure that we're able to provide as much as possible.

I'd be interested to hear the minister's thoughts on, for example, how reference-based pricing is working, any changes around the issue of reference-based pricing, the impact that it's had and studies the ministry has done in terms of the effect of reference-based pricing on the cost of pharmaceuticals in the province of British Columbia.

Hon. M. de Jong: I'll start here, and there may be questions that flow from this. I think the point can be made that on balance, reference-based pricing does serve us — serve the public, serve the funder — well. But I'm advised that the way it has evolved, new drugs within a particular class of drugs are priced at the same price point,

whereas there used to be a range.

To that extent, referencing the price doesn't result in additional savings. So there's a class of drugs, a new drug comes along, it's fit within that class, and the price point is set. To that extent, the kinds of savings that you might have seen when there was a range don't exist in the same way.

M. Farnworth: What was the reason for that change, and when did it take place?

[1615]

Hon. M. de Jong: A complex area. I want to make sure I provide the member and the House with accurate

[ Page 7339 ]

information, and if I don't, I can assure the member that I will immediately correct it based on the advice.

I am told that within a class of drugs, the federal agency involved will set the first price point, and that up until the early part of this century, you would, depending on the class of drugs, see a pretty wide discrepancy — could be upwards of a hundred dollars. But starting in the early part of this century, 2001, '02, '03 — in there — the manufacturers quickly realized that there was very little to be achieved by varying from that federally set price point, so the range that used to characterize or used to exist within some of these classes of drugs has eventually disappeared.

That is largely the result of pricing policy set by the manufacturers, who take their mark from the price set by the federal agency and move to it so that there's very little variation.

I'm going to check with Mr. Nakagawa to make sure that is an accurate description of what has taken place over the last ten or 12 years.

M. Farnworth: Let me see if I've got this right. The way it used to be…. I'll do pain relief because that's easy to understand. You have aspirin — been around forever and has a standard price of, I don't know, let's say ten cents a tablet. Then you have your new, improved Voltaren, and it was like two bucks. The doctor would prescribe: "Take two aspirin." It would bill PharmaCare ten cents — okay? But if you really needed Voltaren, the doctor, the physician would write an explanation and we, PharmaCare, would pay for Voltaren. So you had a significant price difference between the ten cents and the two bucks.

Now what you're saying is that the feds' drug pricing sets a price point for pain relievers — okay? The way I understand what you're saying, that point — is it set at the cheapest or the most expensive? Do we know what that price point is, what's determining that price point? And did I have my explanation correct?

[1620]

Hon. M. de Jong: Hopefully, this'll help the member; it helped me a little bit. No new categories have been added to the reference-based pricing scheme since 1997, I'm told. What has developed since then is the federal agency that I talked about, the Patented Medicine Prices Review Board, which is now involved in some of those other newly evolved categories.

The member's example, I think, also touched on a second component to this, and that is the phenomenon that we as legislators and MLAs frequently see, which is the opportunity for a patient to be diagnosed by a doctor and for that doctor to say: "In my view, your situation is unique, and you need a particular type of anti-inflammatory that may be more expensive than the generic or the one set in the reference-based pricing."

That continues to occur. It does involve filling out the form and the doctor indicating why that higher-priced pharmaceutical is required, but that part of this still remains. It is still possible for a patient, through their physician, to gain access to a different product, even a higher-priced product, on a case-by-case basis. I hope that was part of what the member was exploring in that question.

M. Farnworth: I thank the minister for his answer. Yeah, that was one of the issues that I wanted to try and explore a little bit. I appreciate it because I learn through this estimates process, like he does, some of the inner workings of this ministry with which we are both newly getting acquainted.

The minister said that there have not been any categories added since 1997. Can he explain why that is, why no new categories have been added since 1997? Is there a rationale for it? Are there any plans to add new categories?

[1625]

Hon. M. de Jong: I think the explanation that I've been offered is that historically the impetus for governments initially — surprise, surprise — was the opportunity to realize some significant cost savings because the spread within these original categories was so large and bringing a reference point resulted in some real savings.

The advice I've received today is that in what might otherwise be considered as new categories, the spread simply isn't there. The manufacturers draw close to the price point that is set by the Patented Medicine Prices Review Board. The prospect of realizing significant savings by expanding into new categories simply isn't there in the way that it was in the early part of the 1990s when the original shift was made.

M. Farnworth: I appreciate that answer. When the minister says that price disparity is no longer there, does that apply to…? Are the categories we're talking about, then, new categories of drugs that didn't exist when reference-based pricing was put in place? If a new anti-inflammatory came along today, would it be captured by the reference-based regime that is still in place, or is it just like, I don't know, some new drug that has been developed in the last five years?

Hon. M. de Jong: I think the short answer is yes. The all-new, improved Aspirin, not to be trite, would, I am advised, likely be captured by the existing classification scheme and then find its place. There would need to be decisions around whether it was going to be covered at all, but in terms of whether it is captured by the existing classification system, the best advice I have is that it would be.

[ Page 7340 ]

M. Farnworth: That leads me to my next question. Who makes that decision?

[1630]

Hon. M. de Jong: I think the question related to the drug review process. It would begin nationally through the common drug review agency, which is national. It involves the provinces, the Territories. They provide a recommendation, which then comes to the province, to the provincial Drug Benefit Council comprised of clinicians, economists, a range of individuals who ultimately make the decision. So it starts national with a recommendation and then flows to the provincial Drug Benefit Council.

M. Farnworth: So the Drug Benefit Council of the province makes a decision, and then the ministry acts on that decision. When that drug council makes a decision…. The determination — is that something the ministry generally accepts, or is there another decision point before something's adopted?

Hon. M. de Jong: To follow this through, we talk about the national body making the recommendation, which goes to the provincial Drug Benefit Council. They in turn make a recommendation following their work to the ministry, to the branch, and it is ultimately the ministry that makes a decision.

I asked, anticipating perhaps what the next question might be, what the mechanism was for that ministerial-level decision. It is not an OIC. It is done as a matter of policy, so it's at the policy level that the decision around a particular drug is made.

M. Farnworth: How would the Therapeutics Initiative have fitted into this process?

[1635]

Hon. M. de Jong: I can advise the member, based on what I've been advised, that the drugs that fall into the category we are now discussing would be those that, for one reason or another — and I have not explored this in detail in the conversations — have not been reviewed or considered at the national level by the common drug review agency.

I am told that would be in the neighbourhood of 15 — some years, ten; some years, maybe 20 — drugs in a year. Those drugs would formerly all have been considered at UBC by the TI. Now, of course, in the aftermath of some changes, it would not exclusively be UBC and the TI but perhaps any number of a few other agencies.

I think the point for the first part of the question is that there are very few drugs that require an analysis that don't come via the national review process, and those are the drugs that I think we are talking about now.

M. Farnworth: The drugs we've been talking about, captured by reference-based pricing or coming into a new class, have been cleared at the national level. That would come through the common drug review council. That comes to the ministry with a recommendation. The decision made is a policy-based one. It's not an OIC-based decision. So I'm correct in that. I see heads nodding. That's with those drugs that have come through that route.

Now, other drugs come through the Therapeutics Initiative. Am I correct in that? If I am seeing heads nodding, then I will go on to the next question. I'm not seeing heads nodding. So if the minister could explain how the TI was supposed to work in terms of the drugs that it deals with.

[1640]

Hon. M. de Jong: I'm going to go through the note, which may be the best way to convey the information.

M. Farnworth: Do we need to have additional people here if we're going to talk about Riverview when we're getting to facilities?

Hon. M. de Jong: Thanks to the member for the heads-up.

I am advised and can convey to the member and the committee something I said earlier: that the majority of clinical evidence reviews in Canada are completed by the national common drug review agency, which was introduced in 2003. Since the CDR, common drug review, was introduced, the amount of work and number of reviews done by the Therapeutics Initiative has declined substantially. I am told that in 2010 the TI only completed six reviews for the ministry, compared to up to 20 in past years.

In August 2010 a request for qualifications was issued to expand the available list of reviewers to complete academic drug reviews. The Therapeutics Initiative chose to apply to the RFQ as three separate groups, I am told, all of which were successful. These reviews represented one of the three services that the TI previously provided as part of a million-dollar contract with the government.

The Therapeutics Initiative will continue to provide the other two services — health professional education and PharmaCare program evaluations, which evaluates whether drugs currently in use are safe and effective — at a fixed rate of $550,000. The new clinical evidence review contracts awarded to the TI have a value of up to $50,000 per year representing up to $150,000. Combined with the fixed rate for the other services, the TI will be receiving $700,000 a year from government.

The other clinical evidence review experts are the B.C. Drug and Poison Information Centre and Providence and Vancouver Coastal Health Research Institute. They too receive contracts for up to $50,000 for the clinical

[ Page 7341 ]

review. So that's a bit of the history of the evolution of the TI and the clinical review process for what is now a much smaller number of drugs since the advent of the common drug review agency.

[1645]

M. Farnworth: I thank the minister for his answer. But it still leaves some questions because in essence, when it was created, it received international acclaim in the work that it was doing. It put B.C. definitely on the leading edge of prescriptive drug policy. Harvard, the New England Journal of Medicine all looked at what was taking place and were very favourable to the work that it was doing and to the impact. The model that it represented was something that other jurisdictions could learn from in their ability to deal with rising drug costs.

My question is, then: how did the changes come about that changed it to where those same journals — they're not the opposition; they're not British Columbians — are saying, in essence:

"Replacing the Therapeutics Initiative with a process that's allowing drug companies to further their interests at the public expense will have predictable results. First, more drugs will be listed on B.C.'s formulary, and they will be expensive brand-name drugs with long patent lives ahead of them. As a consequence, B.C. drug costs will surely rise more rapidly than they otherwise would.

"Second, scientific judgment will yield to commercial pressures, with less reason to assume listed drugs are the most effective. In addition, the requirement to review drugs quickly makes it more likely that dangerous drugs like Vioxx come into widespread use. Prescription drug policies in the U.S. are heavily influenced and distorted by the pharmaceutical industry. It is a pity that B.C. wants to replace its exemplary system with something similar."

How would the minister respond to that criticism from outside of what, at the time when the Therapeutics Initiative was announced, was viewed as cutting edge and leading the way in terms of controlling the costs of pharmaceuticals in our health care system?

[1650]

Hon. M. de Jong: The member will hear no argument from me about the positive attention that the TI received and, more particularly, I think, the model for review that the TI received. The point I would make — based on all of the advice I am being provided with, previously and today — is that that model has not been changed.

The advent of the national reviewing agency has obviously shifted some of the work away from the provincial reviewing agency, but the approach that the TI initially introduced has not changed. What has changed is that it's no longer the exclusive domain of UBC and the Therapeutics Initiative. The other agencies that I have referred to, which we and the ministry believe are qualified to apply similar approaches and methodologies, are now doing that precise same work.

So the manner in which those reviews, albeit a smaller number of reviews, are undertaken has not changed. It is true that the work is no longer the exclusive domain of one single agency, but we believe that the same high standards are being applied by the other agencies, like the B.C. Drug and Poison Information Centre, Providence and the B.C. health research institute.

M. Farnworth: I understand the minister's answer, and I thank him for that. I'm still somewhat puzzled. If that work is not there, then…. When the decision was made to reduce funding for the Therapeutics Initiative, the minister at the time, the current Finance Minister, said that the reason this was done was because of the TI's resistance to meaningful stakeholder input.

I'm sort of interested as to…. I know that the minister is new in his position, as I am to the critic area. But perhaps the ministry may have a better sense of what resistance to meaningful stakeholder input means and why that would matter if the decision is that the work is now being done by this other agency at the national level.

Hon. M. de Jong: It won't surprise the member to know that I won't try to surmise what may have been in the mind of a predecessor or a colleague. I will say this, speaking for myself. I've been an MLA long enough to know that this is an area of public policy that attracts its share of controversy. It is a complex area, but oftentimes fraught with emotion when someone is seeking access to a drug that has been listed and covered and all the things that flow from that.

The Therapeutics Initiative has played, and continues to play, a major role in providing a key recommendation to government. Over the course of the years that they have been undertaking their work, at times some of those decisions have attracted criticism from a variety of quarters, depending on the nature of the recommendation that they made or the length of time it has taken to make the recommendation.

[1655]

The other agencies now involved will, I'm sure, experience some of the same commentary and at times criticism. It is true that there has been an element of, I suppose, competition introduced between those agencies to ensure that they remain at the top of their game in applying the very highest standards necessary for making recommendations to the government around the particular drugs that they are analyzing.

It has in the past been controversial. I am sure, given the stakes for people and citizens, for any one of these agencies involved in this work, there will be times when it is controversial again.

M. Farnworth: I think that's one of the points that we need to make. When reference-based pricing was brought in it was controversial. There was considerable resistance from the brand-name pharmaceutical industry. When a Therapeutics Initiative was brought in, again,

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there was considerable resistance from the brand-name pharmaceutical industry, in part because what they see is that what works in one jurisdiction gets adopted by other jurisdictions.

When you have something that is successful, that is being peer-reviewed by bodies such as the New England Journal of Medicine or the Harvard Medical School saying that they work, and they're not happy with that, then clearly there are efforts and a lot of resources brought to bear to make changes.

My concern is that change is brought about not in the best interests of, I think, long-term public policy but in terms of short-term. That's my concern around some of the changes that have taken place with the Therapeutics Initiative. It comes back to what I said earlier in terms of government making decisions on the best information they have and making decisions that are based on fact.

I would again ask a question here. There have been changes made to the Therapeutics Initiative. There's a baseline that has been established in terms of before the changes and after the changes. Has there been any kind of study done to measure the impact of the changes that have taken place with the Therapeutics Initiative from when the initiative was announced to when the changes were made and subsequent to the changes being made? Have there been any studies in that area?

[1700]

Hon. M. de Jong: I think it's actually an important line of questioning and discussion, because it at least affords an opportunity to describe what has taken place. The shift has admittedly provided the ministry with some flexibility because, instead of granting a single agency blanket funding, the funding now follows the individual drug reviews. I am reminded that that may provide some additional capacity to actually conduct additional reviews.

The expectation, however, is that there would be no change in terms of the quality of the product that emerges. The member may have heard me. I was asking: "Well, what does that mean? Does that mean timing, length of time for the completion of the reviews?" The standards remain in place, and there is an expectation that they will be met. The expectation is on the accuracy of the review, the extent to which the reviewing agency drills down and makes a recommendation that is supportable, defensible and tested over time.

We would not expect to see a product that has received a positive recommendation from any one of the agencies now doing this work to be withdrawn from the market because problems emerge. That would reflect badly on the quality of the review being undertaken.

Yes, there is an altered funding model that has funding follow the individual reviews — with which TI is still involved, but not exclusively any longer. But we wouldn't expect to see any negative change in the quality of the work that has been undertaken by any of the qualified agencies now involved.

M. Farnworth: My final comment on this before we move on would be that I do think it's important that we look at the impacts while the TI was working until the changes were made and the changes after. I think that would be a very productive exercise for the ministry. It would be keeping in line with what I think should be a priority for government — looking at the impact the changes have and comparing to before so that you can actually see whether you're achieving the goals you've set out and whether it is having the desired effect that was anticipated.

I know that a number of colleagues have questions to ask around facilities, so I'd like them to have this opportunity to be able to do that. I do know one of our colleagues wants to ask a question about air ambulance. So I just wondered: do you need additional staff for that? We can deal with it tomorrow or Thursday. That's not a problem. If we're capable of dealing with it now, that will be great.

Interjection.

M. Farnworth: Okay, so with that, I will cede to my colleagues probably for about another hour or so on these facilities questions.

D. Donaldson: Thanks to the minister and staff for being here today. I do have two questions, actually, that relate to air ambulance service in a general sense. It's more around discharge after air ambulance service and experiences with medical transportation.

I have two constituents who've had experiences with air ambulance. I would suspect their experiences aren't unique, being that air ambulance is very important for remote rural areas and the service to get to specialists, especially in the Lower Mainland.

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Regina Lockwood was medevacked from the Bulkley Valley District Hospital to St. Paul's on March 17. She had a heart condition and was treated on March 22. Because she was medevacked, she had no clothes, no money, no relatives in Vancouver. When she was released, she was released just on her own. When she asked about getting back home, it was suggested she take the Northern Health bus home, which takes approximately two days from Vancouver back to Smithers.

Understandably, she was a bit nervous about this long travel, and when she refused to leave until she was flown back, she finally got a response and did receive a voucher and a plane ticket back. She had the expectation that she would be returned to her home community — when she had no clothes, no money and no relatives — in the same manner that she was medevacked on the air ambulance.

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Another constituent has the same story. Again, he had no money and no clothes for winter travel, but he was unable to convince staff, on discharge, that he wanted to return by plane after being air-ambulanced out. He ended up on the bus in this situation.

My question is around discharge policy after a patient is air-ambulanced from a remote rural location to a central location for accessing specialist care, such as in these cases. Many times, as I said, these people don't have any money or clothes or relatives because it's been an emergency situation. Is the policy to then return them by the same transportation mode that they were transported out of their community?

[1710]

Hon. M. de Jong: I apologize for the delay. I just wanted to try and anticipate what all of the nuances and different circumstances might be. I am, as the member might expect, not entirely familiar with the specific case, but I have no doubt that this occurs with regularity. Someone comes from a great distance elsewhere in British Columbia to a medical facility in the Lower Mainland and is treated and then deemed well enough to be discharged from the hospital but confronted by having to travel a great distance to get home.

I was thinking back to an elderly family member of mine who, in the last few months, was in that circumstance, the difference being that we only had to drive 15 minutes to get home, which was okay for her. There was no way she was going to be on a bus for 16 hours.

Having tried to convey some appreciation and understanding of the challenge, I will be as blunt as I think I need to be. The policy is generally this: that people are responsible, once they have been discharged, for financing their own way home. There is a default option with the bus, but that's not always suitable for people. In rare circumstances where someone is deemed well enough to leave the hospital but not be on a bus for 12, 14 or 16 hours, alternative arrangements are made, but those are rare circumstances.

The challenge, of course, is to balance everyone's desire to be as humane and realistic about an individual's condition as possible with the ability to pay. Look, I know that the cost of flying from Smithers or Terrace or even Prince George is prohibitive, but I don't want to mislead anyone. The ministry is not in a position fiscally — nor, I expect, are the health authorities — to offer blanket assurance to people that if they are flown by air ambulance to a treatment facility in B.C., there is a return ticket waiting for them. There is just not the means available to do that.

For some people, for some families, I recognize the cost is prohibitive — probably for most families. For others, they are able to weather it more readily. There are, however, circumstances in which a decision can be made that whilst a patient is well enough to leave the hospital for medical reasons, it is inadvisable for them to be on a bus for 16 hours, and alternate arrangements need to be made.

D. Donaldson: Thank you for your answer, Minister. I will convey that policy information to my constituents. I appreciate you coming forth with it, because it's an important policy consideration for people that I represent.

The idea that specialists are…. People in the north don't expect that every community will have every specialist that they need to see. They do expect the specialists to be available, and this government has promised air ambulance service to get to those specialists and beds that are available.

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"Our experience to date has been a system that's broken down" — the words one of the constituents used with me around this policy. But thank you very much for the policy. I'll convey that, and I'll also tell the minister that I'll be providing a letter from constituents who have worked out, perhaps, other policy initiatives around costs of travel that he might be interested in.

My final question does concern, again, the Air Ambulance Service and, in par