Hansard -- Volume 20, Number 3 -- Monday, June 5, 2000

2000 Legislative Session: 4th Session, 36th 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)

MONDAY, JUNE 5, 2000

Afternoon Sitting

Volume 20, Number 3

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The House met at 2:07 p.m.

Prayers.

Hon. H. Lali: Joining us in the gallery today are some respected photojournalists and journalists, some from India and also some from here in Canada. They are Jarnail Singh from India, who's also an artist; Kanwaljit Singh from India; Sukhminder Singh Cheema; Nirinder Sidhu; Jaiteg Singh Anant; Kuldeep Malhi; Lakhbir Singh, a businessman from the United Kingdom; Dr. Darshan Singh; and Mahesh Inder Singh. Will the House please make my guests welcome.

Hon. J. Doyle: I have three very special guests in the gallery today. My wife Judy, the love of my life, is up there along with our son William, who is 131/2 or thereabouts, and also our other son Adam, who is 16 today. Actually, Adam got up this morning and wrote his driving test, and he passed. I'm sure we could find a nice Jaguar or something like that out in the parking lot that he could repark for someone. Welcome the Doyle family to Victoria.

B. McKinnon: I'd like to introduce to the House my sister-in-law Jean Chizeck, who lives in Victoria and is once again visiting us to watch question period. Would the House please make her welcome.

V. Roddick: I would like to introduce Caroline Durston-Smith from Bristol, England. She is a schoolteacher for specific learning difficulties and is here visiting the Cridge Centre for the Family in Victoria and friends in North Saanich. Will the House please make her welcome.

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Oral Questions

DRAAYERS FOSTER CARE CASE

L. Reid: On December 15, 1999, British Columbians saw two little girls taken from the home of Bert and Anna Draayers, the only parents these girls had known their entire lives. In fact, they arrived at that home when they were babies. A Children's Commission tribunal has now concluded that the girls' rights had been breached, that the ministry was wrong to remove them from the Draayers' home and that they should be returned to the home immediately. Will the Minister for Children and Families tell us today when these two little girls are going home?

Hon. G. Mann Brewin: I thank the hon. member for her question. At this stage there is a due process in place that is part of what the act says must happen.

Interjections.

Hon. G. Mann Brewin: Hon. members, it's not appropriate. What is appropriate is that the political side of things stay right out of this process, that the director of child protection has the legal authority to respond to the tribunal's recommendations. He has said he will do so by June 12, which is next Monday, and we will find out at that time how that works.

If, at the end of the day, it is indeed in the best interests of the children to be returned to the family, then so be it. It will happen. But until that time, we need to finish up this process.

The Speaker: The hon. member for Richmond East has a supplemental question.

L. Reid: This minister and her ministry have caused these two little girls six months of anguish -- absolutely six months of anguish. They were taken from their home. Cast your memories back, members. They were taken from their home ten days before Christmas -- ten days before Christmas. The Children and Families minister of the day said: "This is the right decision. Staying with the Draayers is not in the best interest of the children."

The Children's Commission tribunal now says unequivocally that the best interests of the children were not met -- they were not met -- when the girls were taken from the Draayers' home. Now that the Children's Commission tribunal has concluded that the government was wrong to take these girls from their home, will the minister admit that her ministry has failed these girls and tell us today who has been dispatched to bring those girls home?

Hon. G. Mann Brewin: Mr. Speaker, again, I thank the hon. member for the question. The concern for the girls will always be uppermost in all our minds, I know. There is a process in place. The act was passed not very long ago. Hon. members opposite were part of that debate. They know that that's part of what the act says. The act in fact says that the director of child protection could have a whole month to deal with this. In fact, he has said that in the interests of the situation, he will do it in a week. So he will do it in a week. Then we will find out, and we'll work from there, from that point.

B. McKinnon: To add insult to injury, instead of doing the right thing and returning these children to their home months ago, the government filed a complaint against the Draayers' physician, because he said that the ministry did not properly consider this matter. Instead of doing the right thing, the government filed a complaint against BCTV for having the nerve to show the public what was happening. Now the Children's Commission tribunal says that the ministry failed these children. Will the minister tell us why her ministry spent more time trying to silence the critics than it did looking after the needs of these children?

Hon. G. Mann Brewin: At this time, I'm not going to get into the details of any of the history of all of this. At this time, the process is in place, and we will proceed with the process, which is that the director of child protection will review those recommendations, and he will report out on June 12.

The Speaker: The hon. member for Surrey-Cloverdale has a supplemental question.

B. McKinnon: When these two girls were taken, the government assured us that the girls were consulted. However, the Children's Commission tribunal says that there was no meaningful consultation with the children, nor was the decision made in the best interests of the children. Does the minister accept the findings of the tribunal when it says that the children weren't consulted, even though the government has been telling us the exact opposite?

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Hon. G. Mann Brewin: Mr. Speaker, one of the things that concerns me about all of this -- and I know it concerns many others -- is that this is about two little girls. At this stage, it's now become a terrible political football, and that is not appropriate. These two little girls are the subject of a lot of controversy and a lot of public attention, which I'm sure has not been welcomed by them or their families. At this point in time, the director of child protection is reviewing the recommendations made by the tribunal and will report on June 12.

C. Clark: This is about two little girls, and this minister has the authority to stand up today and fix the mistake that her ministry made and fix the problem that she caused in their lives. She has been ordered by the Children's Commission tribunal to reverse this decision, and instead she wants to take a week to scramble around and try to justify the decision that she made. Why, when she's been ordered to do this by the Children's Commission, is she still digging in her heels, going to take another week, instead of doing the right thing and telling those girls that they can go home?

Hon. G. Mann Brewin: I'm sure the member has read the legislation. She was no doubt part of the discussions and the debate that took place around that and would know full well what the role of the minister is in all of this and what the role of the director of child protection is in all of this. Child protection has the authority, in this case, to respond to those recommendations, and that is what he will do. And the time will come. It is not -- it is not, I repeat, and the member knows this -- the minister's role to intervene, and this minister will not intervene until the process is complete.

Interjections.

The Speaker: Order, members. The member for Port Moody-Burnaby Mountain has a supplemental question.

C. Clark: This minister has a responsibility. She has a responsibility to all the children that she was duty bound to protect when she was appointed to become Minister for Children and Families by this government. She is abdicating that responsibility by refusing to intervene and by refusing to tell those children that they can go home to the Draayers.

If she will not stand up in this House and say that she was wrong, or if she will not stand up in this House and even apologize to those children and to that family for taking them away ten days before Christmas, will she at least find the courage -- dig down deep and find the backbone -- to stand up in this House and tell those children today that they are going to get to go home to the only family that they've ever known?

Hon. G. Mann Brewin: There's no question that this is a distressing situation; there's no question about that. And what is part of the distress of it all is what is happening here on the floor today. We have some very serious questions that need to be answered and will be in due course. We put the legislation in place; it's there to protect children. And that's what we are doing. We just continue this piece of the process, and I say: patience. Patience. In a week, June 12, the director of child protection will produce his responses to that report of the tribunal.

PHYSICIAN AND NURSE SHORTAGE

IN NORTHERN AND RURAL AREAS

P. Nettleton: This government seems to be bouncing from crisis to crisis. On Friday, Prince George Regional Hospital declared a state of emergency as the number of nurses dropped below safe minimum levels. This is not the first time this has happened at Prince George hospital. In fact, just over a week earlier the hospital declared a state of emergency for one shift. Why does this problem continue to get worse? And Minister of Health, don't tell me you're going to have another meeting to address this problem.

[1420]

Hon. M. Farnworth: Well, I won't tell you, then.

What I can tell the hon. member is that we're very aware of the issue and the situation in Prince George and that we are working with the health authority to address it. We have been working with them over the past several weeks to try to identify some solutions. In terms of the nursing shortage in northern British Columbia and rural parts of the province, it is something that occurs right across the country.

What we are trying to do is deal with it on a three-pronged approach. One is to look at specific recruitment measures, which we are currently undertaking; two, to try to address some of the issues around practising in northern and rural communities in terms of making it a more attractive place to work; three, to try and ensure that we have the training spaces in place to deal with and to attract nurses here in British Columbia -- 400 new spaces, for example, that are coming on stream this September.

The Speaker: The hon. member for Prince George-Omineca has a supplemental question.

P. Nettleton: This minister is the latest in a string of ministers, most of whom are from the lower mainland, who have paid lip service to health care delivery in northern and rural British Columbia while it's continued to deteriorate.

For months we have known that Prince George is short 25 specialists -- listen to this -- ten family physicians and 75 nurses. About two weeks ago we heard that Prince George is going to lose another three general practitioners, and that means thousands of families will be without a family doctor.

This crisis wouldn't last ten seconds in the lower mainland. In Prince George and the Prince George region, this Health minister and his NDP colleagues have allowed this crisis to build for over ten years. When are you going to do something about it, minister?

Hon. M. Farnworth: I'd like to point out to the hon. member that his party's position across the way is to have a Health critic who's also from the lower mainland. So what's your point on that?

Interjections.

Hon. M. Farnworth: The issue, hon. Speaker, is attracting and retaining physicians in rural and northern areas of British Columbia. It's a problem that we face right across this country. We have undertaken a number of initiatives to try and deal with the problem. The first is to recognize, through the nego-

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tiations with the BCMA in terms of around a master agreement . . . dealing with specific measures to look at alternatives to the traditional methods of paying physicians in the province of British Columbia.

The second has been to come up with a rural and northern agreement to recognize some of the unique conditions that exist in the rural and northern parts of British Columbia and find specific ways of dealing with the issue through that approach. That is something that's been done in partnership, with the physicians and the government both working together.

Third, we're trying to recognize that there needs to be a coordinated approach by provinces right across the country in terms of seeing how we can train more physicians here in British Columbia specifically with a northern approach, so that when people go into the schools, they come in with the idea of practising in northern areas. We want to work with the federal government to ensure that we can get more physicians into the country so that we can meet some of the challenges we're facing at the current time.

Finally, hon. Speaker, what we're trying to do is recognize that there are unique conditions in northern British Columbia, and we're working to do that in a cooperative manner.

HIRING OF CONSULTANT

TO SELL FAST FERRIES

G. Plant: On Friday the government announced that it had retained a consultant to attempt to sell the fast ferries but that they won't tell the taxpayers of British Columbia how much the consultant will be paid. The fee terms will be kept secret, and the amount of money eventually paid will be kept secret. All this secrecy apparently even got the Premier temporarily concerned.

So my question for the Minister responsible for B.C. Ferries is this: after nine years of failing the people of British Columbia with endless secrecy, why don't you try something new for a change and agree today that the terms of the deal with the consultant for the sale of the fast cats will in fact be made public immediately?

Hon. J. MacPhail: Let me begin in reverse order. First of all, I would be happy to provide a full briefing for the members of the opposition with PricewaterhouseCoopers, where they can ask all of the questions of the contractor. We can make that available as soon as you're ready to come and listen.

[1425]

Secondly, the process by which PricewaterhouseCoopers was chosen was a fair, open tendering process. The Ministry of Finance was involved. It's a performance-based contract, so the cost of the contract is dependent upon the sale. The corporation is more than willing to comply with all of the rules around freedom of information and protection of privacy right now with the members of the opposition. But it is a commercial contract, and it's performance-based.

The Speaker: The bell ends question period.

Orders of the Day

Hon. D. Lovick: I call Committee of Supply. In Committee A, we will be debating the estimates of the Ministry of Social Development and Economic Security. In this chamber, Committee B, we will continue debate on the estimates of the Ministry of Health.

The House in Committee of Supply B; T. Stevenson in the chair.

[1430]

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 36: ministry operations, $8,125,203,000 (continued).

C. Hansen: It's been some time since we left off on these debates, I guess two and a half weeks ago, it would be, since we last dealt with these issues. To refresh the minister's memory, we left off in the middle of regional programs, about to deal with areas of public and preventive health.

If I can start out by giving a table of contents of the issues that I hope that we can address this afternoon, then I see us moving through some of these things fairly quickly. The first issue, which is something I had advised the minister of earlier, is that I did want to go back to one issue involving Pharmacare, to get an update on what had happened in terms of the process for approvals of olanzapine, in particular, and its progress through the therapeutics initiative. From there I want to move on to public and preventive health. I want to deal with a few issues on B.C. Ambulance Service continuing care.

There are some capital issues that are outstanding, including equipment issues. We will go on to the Medical Services Plan legislation and Health Professions Council. There are compensation issues, a few minor things under information systems and then communications. We will see how quickly we can move through those today.

Hon. M. Farnworth: As I told the member the last time we talked about this particular issue, I'm taking this very seriously. I'm looking at it with a way to seeing how the medications that are used within the system can be made more accessible. At this point I can't give a definitive answer on when a decision will be made, other than to say that it's one I'm attaching a very high priority to.

C. Hansen: Specifically, it's my understanding that there is some data, some information, some very specific outcomes-based research that is before the therapeutics initiative. It's been there for a long, long time. The concern is that this process has been stalled. I gather from the minister's response that there really has not been progress in the last two and a half weeks that he can report on.

Hon. M. Farnworth: That's correct; I don't have any substantive progress to report, other than to say that I am attaching importance to this. I would like to see it dealt with

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expeditiously. The fact that there's new information is something that I want the committee to deal with as quickly as possible.

C. Hansen: I think the concern is . . . . It's not new information, but it's solid information that is taking a long time getting through the process.

But let me just say that certainly the minister will have the full support and cooperation of the opposition in moving forward on some of those issues. As my colleague the member for Okanagan-Vernon has very ably set out earlier in these estimates, these are issues that on the one hand can dramatically change people's lives. On the other hand, which is the more secondary issue, there are some real cost savings to the health care system in ensuring that people have access to proper medications as early as possible after they are diagnosed as facing those mental health challenges. So he will certainly have our cooperation, and I urge the minister to make it a priority.

I would like to move on to public and preventive health. Specifically, in a more general sense, I want to get into some of the specific issues involving tobacco strategy and immunization.

Generally, there is a model that has proven to be quite successful with regard to preventive medicine or preventive care, patient information and education. That is the model that we see in terms of the HIV centre, which is a direct referral from a physician to a body that can actually give good information and education to individuals who are diagnosed as being HIV-positive, in terms of how to care for themselves, how to prevent their illness from becoming more serious and what to see as the signs of that.

[1435]

I'm wondering if the minister could give us some sense of whether or not he sees that model as one that would be replicated with other diseases and illnesses -- chronic conditions such as asthma, diabetes, arthritis, and the list goes on, of other chronic conditions -- where individuals could benefit by a direct referral at the primary care level to the self-help organizations that exist in British Columbia.

Hon. M. Farnworth: I would say the answer to that is yes. I can give the member a couple of examples. In fact, he was with me at one of them recently, at the Arthritis Centre, where there is an area now devoted to information that's available to the people both in physical book literature form within the particular site at the Arthritis Centre and also available on the Web. I also was at St. Paul's Hospital about six weeks ago, opening up a wellness centre there that focused on issues around cardiac health, what to do after you've had your operation and how you can get the latest information there.

It's very much that principle of self-help, of being able to find out what the latest information is and being able to access it through different modes, whether it's paper-based literature or technology-based through the Internet.

So the answer is yes. What I would want to see is to see them start to link up so that they're not just sitting isolated from each other, but that there's an opportunity to share the information.

C. Hansen: As I have met with individuals around British Columbia who have linked up with some of these various not-for-profit organizations, I have made it a habit to ask them how they first got connected to one of these organizations. In the case of somebody with rheumatoid arthritis, how was it that they linked up the Arthritis Society? In terms of individuals with Parkinson's disease, when did they hook up with the B.C. Parkinson's Disease Association? You can basically go through the list of chronic conditions that are being diagnosed.

What I have found in the kind of survey of individuals I have done is that the response typically is that they wound up reading something about it, or they heard about it from a friend. It was usually months after they had been diagnosed with the condition, and it was almost by accident that they realized there was a resource out there.

I think the thing that is significant about the HIV centre is that the doctors, the physicians, are actually making a direct referral. Once a person is diagnosed as being HIV-positive, the physicians at the primary care level are taking a leadership role in actually recommending to their patients that they seek the advice and support that can come from a centre such as the HIV centre. I don't see that happening in other areas. And yet I think from the point of view of our health care system in British Columbia, we could benefit enormously from that kind of a direct connection.

My understanding is that the reason it works in terms of HIV diagnoses is that there is a limited number of primary care physicians who are really seeing HIV patients and assisting them through that process. The connection between those physicians and the centre is much more easy to get rolling.

But if you look at the case of diabetes, for example, there are . . . . Literally every family physician in British Columbia, I would assume, has had to inform a patient that he has diabetes, yet we don't see the same kind of direct referral to those kind of self-help organizations. I'm wondering if any consideration has been given to that by the ministry.

Hon. M. Farnworth: The member's point is very well taken; it's one that I am quite interested in. I would agree with him that there are, I think, some tremendous opportunities. He's right: the issue around HIV and AIDS is that you do have a limited number of physicians who treat and see AIDS patients on a regular basis, and so it becomes a matter of course. I don't see any reason why we couldn't extend a similar practice to physicians around the province in dealing with other diseases and illnesses, particularly as we're seeing the development now of a number of centres where patients can go and get information.

[1440]

I think what we need to do is look at how we might do that. I think one of the ways certainly is possible; it's to work in conjunction with the BCMA or the College of Physicians in terms of trying to encourage, when someone is diagnosed -- let's say whether it's with diabetes or arthritis -- that part of that is to refer them to, in the case of arthritis, the Arthritis Centre and the resources that they have. But also I think what we need to do is to encourage that model in terms of other illnesses around the province, and I'm quite interested in trying to make something like that happen.

C. Hansen: In the case of diabetes, we've actually seen things going in the opposite direction. I've had stories relayed to me from smaller communities in British Columbia that are

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losing access to their diabetic clinics as an education vehicle. I'm wondering if the minister could comment on whether or not that is a trend that is expected to continue. Is there a consolidation of those types of services? Can these communities expect to see diabetic education brought back up to the standard that it's been in years gone by?

Hon. M. Farnworth: It's certainly not my intent to see resources available in terms of self-help and education diminish. One of the issues that we're raising at the discussions with the federal government is: how do we expand primary care, and how do we look at primary care reform?

Clearly in a host of areas, this being one of them, education is crucial. While I recognize that in the case of some illnesses there is quite often a critical mass that's required to support a particular centre, in the case of illnesses and conditions such as diabetes it's widespread throughout the province. So what we want to see is that there are community resources available. That's something I can tell the member I am trying to deal with, to ensure that those continue to stay in place and in fact are enhanced as opposed to being reduced.

C. Hansen: I am told that in some areas of the province, the wait-list to access an initial diabetes education program can be as long as five months, with additional wait-lists of several weeks to months for further education that is necessary for effective self-care. I'm wondering if the minister can tell us, based on his previous answer, if I can just take it one step farther: does he see these wait-lists being addressed in a meaningful way? Are there specific actions that are being taken to try to bring these wait-lists down and to make sure that those kinds of education programs are available?

Hon. M. Farnworth: One of the things that's happening is that we have a meeting this coming Thursday on most of the major chronic diseases to look at issues such as this, as to how we deal with education and how we make sure that patients are getting information. So that is in fact taking place.

One of the other initiatives we also have to do, looking at it in terms of education and the information that's available, is to make better use of technology. Particularly in rural and northern areas, as we're seeing the dramatic increase in the use of home computers, for example, people are able to access the information that's available at these centres through the Web. This is a method which is going to increase in popularity and allow us to deal with some of the pressures in a practical sense. So we are aware of it in the ministry, and we are taking steps to try and deal with it.

[1445]

C. Hansen: I certainly agree with the minister that Internet information is going to be incredibly valuable, but what's going to be important is the ability to identify good information. And that's where a primary care physician is going to be able to play such an important role and where these not-for-profit organizations will be able to play such a vital role.

I have one more question regarding diabetes. It's not directly relevant to public and preventive care in the context of education that we've been discussing, but I will ask the minister at this time because we're on that subject. There are new clinical practice guidelines that have been developed by the Canadian Diabetes Association. I'm wondering if the minister could advise in terms of what steps have been taken to implement those guidelines in British Columbia.

Hon. M. Farnworth: We in fact have a diabetes working group within the ministry that is dealing with that particular issue as we speak.

C. Hansen: Is there a time line in terms of when we might expect those guidelines to be either rolled out and adopted or amended, or at least some direct feedback?

Hon. M. Farnworth: I don't have a specific time line for the hon. member, but I can tell him that the provincial group is working to deal with the issues on the provincial perspective. Plus, I am meeting with the Diabetes Association in the very near future, and I expect that this will be one of the key issues that we will be discussing.

C. Hansen: I want to move on to tobacco strategy. In the performance plan that was circulated, a key program objective is to reduce tobacco use and in particular to protect young people from tobacco. It then lists five points under performance measures. One of my questions in this area is . . . . The five things that have been issued are actions as opposed to outcomes. I am wondering if the minister could tell us: what are the measures of success from the tobacco strategy? Are there specific goals that the ministry has set in terms of the reduction of tobacco use among teenagers, for example?

Hon. M. Farnworth: About four years ago there was a baseline study undertaken in the province on the usage of tobacco in British Columbia, in particular with a lot of focus on young people and children and tobacco use. It was a very comprehensive study that gives us data right across the province from health authorities throughout the province. So we have a very good base of data from which to work.

Five years later, which is next year, the province and Health Canada will be going back and doing another baseline study to see what impact our programs have had since that time. The goal set at that time was to see a reduction in the number of children and young people who were using tobacco. That work will take place next year in a partnership between the province and the federal government. Though no specific target was set -- let's say 10 or 20 percent -- certainly the focus of the program was geared to reducing the use of tobacco in young people.

C. Hansen: One of the concerns is that some of the studies that have been done in recent years show that in the four years this tobacco strategy has been underway we have in fact seen an increase in the prevalence of smoking among teenagers, and in particular teenage girls. I'm wondering if the ministry has taken that into consideration and whether or not that is leading to any kind of revamping of the tobacco strategy.

[1450]

Hon. M. Farnworth: I also am concerned about the indications we've heard from reports that are saying there is an increased prevalence particularly amongst teenage women in terms of taking up tobacco. That's why next year's baseline study is crucial in determining what is taking place.

There has been a focus on women, in terms of the program, over the last couple of years. I can tell the member that last year the federal government did a review as a precursor to next year's baseline study; that showed that of all the

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provinces right across the country, British Columbia has the lowest participation rate of women, young women and teenage women accessing or using tobacco products. That, however, does not give me cause for complete satisfaction, because what I want to -- the goal that I think we all want -- is to see that this trend line is going down, not up.

[P. Nettleton in the chair.]

C. Hansen: I think the minister is right in looking at the . . . . It is the trend that is of great concern, not so much where we rank compared to other provinces. But the trend is certainly unsettling if those studies are in fact accurate.

I would like to ask the minister if consideration has been given within the ministry to the issue of smoking pits on school grounds, and I'm wondering how that plays in terms of the tobacco strategy.

Hon. M. Farnworth: Hon. Chair, it's nice to see you in the chair.

What I can tell the member is that we have a K-to-12 tobacco strategy, "tobaccofacts," that's in the schools right across the province. The issue is decided on a school district by school district basis, and it's in particular schools. I think we've seen some terrific examples of what happens when the strategy has been put in place with schools that adopt a strict non-smoking policy.

Stelly's School here in Victoria, for example, has seen the use of tobacco reduced, from 28 percent of the students using tobacco products down to 7 percent. There are some very good examples. It is certainly the ministry's hope and encouragement that we want to see schools right across province not encourage the use of smoking pits on school property.

C. Hansen: I guess my concern is that the presence of smoking pits in a lot of schools is seen as one of the great hypocrisies of government generally. There is certainly the sense that it encourages tobacco use. I'm wondering if the minister could tell us, in view of what he just informed the House, what specific action is being taken by the ministry to provide some leadership in this area.

[1455]

Hon. M. Farnworth: I think there's a number of things the ministry can do and in fact should be doing and will be doing. One of them is to sit down with the Ministry of Education to review our strategy and to ensure that we're being as comprehensive as we can.

One of the areas where I think we're certainly willing to review -- because, quite frankly, I do agree with the hon. member that it is hypocritical if some school districts are doing it and some aren't, and we have regulations, for example, that prohibit smoking in bars and restaurants -- is dealing with the issue of smoking pits in schools or school districts in the province. I know that in my own school district of Coquitlam, they're outlawed throughout the district. If we need to expand that right across the province, I am certainly happy to sit down with the Minister of Education and discuss doing just that.

C. Hansen: One of the success stories about the tobacco strategy in the last few years is the amount of money that some lawyers are making in terms of various legal cases that are before the courts. I am wondering if the minister could tell us the value of the legal fees that have gone towards the various tobacco-related court cases.

Hon. M. Farnworth: I don't mean to duck the question, but it probably would be better directed to the Attorney General.

C. Hansen: Well, just let me get some clarification on that, because the question is: who is the actual client in this case? Is the client the Ministry of Health through the Attorney General, or is the client actually the Attorney General?

Hon. M. Farnworth: Why I make the comment about the Attorney General is that I'm not a lawyer; he is. They handle the legal cases for the province.

In terms of which ministry is pursuing cases, it would be the Ministry of Health. Having said that, it would also be incumbent upon me to also add that in terms of when we are involved in a case, it would not be the policy of the ministry to disclose what the legal fees are, in part because you're giving away an unnecessary advantage to your opponent -- in this case, the tobacco companies. However, that having been said, once cases are finished, then that's a different question.

C. Hansen: Will the minister representing the Ministry of Health as the client in this case undertake to ensure that information is made public once those cases are resolved?

Hon. M. Farnworth: At the end of the cases, when they are resolved, I have no trouble in releasing the figures that are involved in the protection of the public's health.

C. Hansen: If I can move on to immunization, there was reference made in the throne speech this year that immunization was a big issue for the ministry. Certainly we saw the success of Alberta the last flu season, when, because of the immunization program they put in place, they managed to significantly reduce the number of individuals who were coming to emergency wards in their hospitals.

[1500]

Just to refer to the annual report that the minister tabled two weeks ago, there is a reference in here to immunization of seniors. It says: "An estimated 58 percent of British Columbians age 65 and older had an influenza shot during the 1998-99 flu season -- far below the proposed target of 90 percent." It goes on to then refer to health care workers: "To protect health care workers -- and to safeguard the vulnerable people they care for -- it is vitally important that health staff be immunized. In 1998-99 the immunization rate for staff of care facilities was only 32 percent, up from 28 percent the previous year, but still far below the 90 percent target."

I'm wondering if the minister could tell us what actions are being taken to get those immunization rates up and how he sees the immunization program this year differing from last year's program.

Hon. M. Farnworth: The provincial health officer is putting together a strategy to deal with the issue of how we increase the rate of immunization. Part of that is to look at it in

[ Page 16159 ]

terms of long-term care and continuing care and also to work with the staff so that we get the rate raised from 32 percent -- which is, I agree, far too low -- to something significantly higher.

C. Hansen: I guess I have some concerns that the minister can't give more specifics in that regard, given that we are at June and that, really, to roll out an effective immunization program as they have done in years gone by in Alberta and in Saskatchewan . . . . It would be necessary to roll a program like that out early in the fall. My understanding is that one of the problems is that the immunization program we developed didn't start early enough in the fall. Here we are at June, and I'm wondering if the minister can give us some reassurance that in fact we are far enough down that road to ensure that there is an effective immunization program put in place for this coming winter.

Hon. M. Farnworth: I can tell the member that in terms of time lines our program is scheduled to be up and running at the beginning of September and that it will be an advance on previous programs. There's another area of significant difference this year. We're not just targeting the traditional groups associated with influenza -- you know, the elderly, those over 65, and people with a chronic illness or disabilities -- and dealing with issues around staff, but are also recognizing that we are taking the warnings around an influenza pandemic seriously. That is also part of the strategy. So it will be up and running at the beginning of September.

C. Hansen: I think one of the other things that was a big surprise out of those statistics is the very low percentage of health care workers that availed themselves of the opportunity for free flu shots. I believe this was also the case in Alberta -- that they set targets of, I believe, 90 percent in Alberta as well. While they did come very close to that target for residents of long term care facilities, they fell remarkably short, as we did in British Columbia, of encouraging health care workers to get those flu shots.

I'm wondering if the minister could tell us what specific actions are being taken to encourage those health care workers to get flu shots. I think it's an area that if anybody must appreciate the importance of it, it would be somebody working in health care facilities. I'm wondering if the minister could tell us what kind of a program will be put in place in that regard.

[1505]

Hon. M. Farnworth: The member raises a good point. You know, if someone offered me a free flu shot, I'd take it, because quite frankly, having the flu for two weeks isn't much fun. If you can prevent it, I'd take the prevention every time.

That having been said, we are working and looking at ways in terms of what other provinces have done. We recognize the issue around, for example, Alberta and the challenge that they had. There's a number of ways that we're approaching it. One is through the provincial health officer, looking at the different models that are used across the country. Some are more successful than others. The model in Ontario has been quite successful and may in fact be an option for British Columbia. But we are taking it very seriously, and trying to significantly increase the goal from 32 percent is one of the targets that we've set for ourselves.

C. Hansen: Again, I guess my concern is that here we are at June, and if we're still studying the way it's done in other models, we're not going to be in a very effective position to roll the program out for this particular year.

I want to move on to the issue of substance abuse, which I know doesn't fall directly under this ministry. I was trying to think of exactly the right place to insert it in these discussions, and I felt that this was probably the appropriate spot. I'm wondering if the minister has had a chance to familiarize himself with the recent report of the Kaiser Youth Foundation with regard to substance abuse prevention and addictions, where they were calling for an integrated commission that would really cut across ministry lines.

One of the issues that we have today in terms of addictions is the fact that there are so many different ministries that impact on it. Certainly part of the solution to that is to make sure that the Ministry of Health is front and centre in whatever programs may be developed. I'm wondering if the minister has had an opportunity to review the proposal for an independent substance abuse prevention and addictions commission as put forward by the Kaiser Youth Foundation and whether or not he sees the Ministry of Health playing a significant role in moving that proposal forward.

Hon. M. Farnworth: Yes, I am familiar with the report and the recommendations. I can tell the member that my ministry is working with Children and Families, the Attorney General's ministry and Education in dealing with it. In fact, I can tell the member that I met, I think it was, on Thursday of last week on that very issue.

C. Hansen: Thank you. I'm sure it's welcome news to a lot of people that in fact it is moving forward and not collecting dust somewhere.

There is one other area under public and preventive health that I was planning to raise when we got into continuing care. That's the issue of the community care facilities. I'm surprised to see that it's actually on the ministry's organization chart located under this particular branch. I can deal with this either here or when we get into continuing care.

I specifically wanted to ask about the Community Care Facility Act. There are many people who believe that it is a piece of legislation that has been long in need of overhaul, redrafting and rewriting. I know there has been some work done on that. I also appreciate that in estimates we're not supposed to be asking about legislation or pending legislation, but I did want to take the opportunity to ask the minister to comment on that. As I say, I could either raise it now or raise it when we get under continuing care.

[1510]

Hon. M. Farnworth: I think it's fair to say -- and I agree with the member in recognizing the rules that govern this place -- that anything that is governed by either legislation or policy that is 30 years old certainly needs to be reviewed. It's my expectation, or it's certainly my hope, that we can do that in a timely fashion. I recognize his concerns, and I would just say that we are dealing with them.

J. van Dongen: I seek leave to make an introduction.

Leave granted.

[ Page 16160 ]

J. van Dongen: I'd like to introduce to the Legislature a large number of grades 4, 5 and 6 students from Margaret Stenersen Elementary School. With them are a number of parents and teachers Ms. Debbie Roberts and Ms. Pam Byers. I'd like to ask the House to please make them welcome today.

C. Hansen: I want to move on to the Ambulance Service, if I can. I know a lot of these issues have been canvassed in the input from my colleagues when we were dealing with various constituency issues. There are a few remaining issues. I wanted to pick up on an issue that was raised by the member for Peace River South with regard to the ambulance invoice from Alkan Air for a British Columbian who was travelling in the Yukon.

On the last day that we were dealing with Health estimates, which was two weeks or so ago now, the minister advised that member that that particular ambulance charge was going to be covered by the ministry -- the portion that wasn't being directly covered by the Yukon Territory.

But I wanted to go back to a letter of May 8 that was sent to that member. It was sent by the acting executive director of the B.C. Ambulance Service. In that letter it says: "Unfortunately the B.C. Ministry of Health has no legislated authority to pay the ambulance invoice from Alkan Air or negotiate with the carrier as to the billing practice or specific amount involved."

I wasn't in the House at the time when that member raised that with the minister, but I did go back and read the Hansard , and there was no reference to this seeming change in policy. On one hand, it is indicated that there is no legislative authority, and then the minister comes back a couple of weeks later and says: "We've changed it; we're going to cover it."

I'm wondering under what legislative authority the minister is in fact able to cover that. I'm glad he did; I'm not disputing the fact that he covered those expenses. I think that was entirely appropriate and entirely necessary. But my question is on the apparent discrepancy between the minister's actions and what was contained in this letter.

Hon. M. Farnworth: In this particular instance, I think what's key to remember is that it was not the Ambulance Service that paid the bill. It was the Ministry of Health that paid the bill. So in that sense the policy is still in place. But in this case it was reviewed around a particular circumstance -- the bill. And it was the Ministry of Health that paid the bill. That's where the authority comes from.

Having said that, I think this is also indicative of what the discussion was during the last part of estimates. The member for Peace River South was identifying, I think, one of the weaknesses in the current Canada Health Act, in that it doesn't recognize the challenges faced around transportation and ambulance services. And this is one of those areas that I would like to see changed.

[1515]

C. Hansen: I have an ambulance invoice that was sent out to a family in Harrison Hot Springs; their infant child had to be transported to Children's Hospital on an emergency basis. They actually received an invoice for $2,796, and it was only when they raised it and they questioned it that that particular invoice was reversed. The charges were waived under the circumstances. But I'm wondering if the minister could explain. Why is it that British Columbians receive invoices for ambulance charges, whether it's air ambulance or ground ambulance, and then after they raise it or become the squeaky wheel, they can in fact get those charges reduced or eliminated?

Hon. M. Farnworth: What happens is that the Ambulance Service does the transportation. And from the crew log, that's forwarded to the Ministry of Health. We send out the bill based on the information that's in those logs. It doesn't take into account, though, the extenuating circumstances that may surround a particular visit. Therefore we have the ability to review the situation, which we do, and if necessary, make adjustments, which we also do as well.

C. Hansen: My question is: how is that review done? How does the minister or the ministry review an ambulance bill, and who is entitled to have those ambulance charges waived?

Hon. M. Farnworth: There is a remissions committee within the Ministry of Health that's operating under guidelines, and they review invoices on that basis. They're the ones who make the decision.

C. Hansen: First of all, is the review by that remissions committee only started or commenced when there in fact is a complaint that comes forward from the individual? And secondly, what are the guidelines? What are the circumstances under which they are permitted to waive an invoice?

Hon. M. Farnworth: The committee kicks in when people raise a concern, and then it's looked at.

C. Hansen: But on what basis is it looked at? Is it, basically, as some people have said, the squeaky wheel gets the grease, and if you raise enough fuss, then you get your ambulance fee waived? Or is there some kind of a means test that is done?

Quite frankly, I find that one of the greatest areas of two-tiered medicine we have in British Columbia is the access that individuals from outside the lower mainland have to necessary medical care. Often so much of that necessary medical care is ambulance transportation, and we wind up sending up some very large bills for ambulance charges to people outside of the lower mainland who perhaps have to access the air ambulance system.

My concern is that the ability to have this waived, first of all, is dependent on some kind of a complaint process. Those who tend to not complain to government are the ones that are paying the bills, and those who complain are the ones that get their bills waived. In addition, it's something that doesn't seem to have any particular guidelines attached to it. I'm wondering if the minister could elaborate.

[1520]

Hon. M. Farnworth: It's because we're discussing individual cases, and sometimes that can be a . . . . It depends on the circumstances around the case as to why that invoice is the way it is. For example, are they residents of the province, or have they been in the province the required amount of time to be covered by MSP? But if, for example, you're covered by MSP, as most people are in the province of British Columbia,

[ Page 16161 ]

your ambulance charge, whether it's air or road ambulance, is $54 for the first 40 kilometres plus 50 cents per kilometre after that to a maximum total charge of $274. That's regardless of where you are in the province, and that's regardless of whether it's by air or by road. That would be a standard ambulance bill in British Columbia -- the maximum.

Having said that, in terms of if you're not covered by MSP -- in which case the ones that we talked about, in the case of Peace River South, are for people outside of the province -- there's the opportunity to review them through the circumstances surrounding the particular case. It happens very few times -- you know, occasionally. I said before that I'm trying to find ways of dealing with that.

Within British Columbia, the remissions committee can look at fees in terms of a number of criteria. They involve income assistance, they involve whether you're on premium assistance, they involve the type of work -- for example, fire or police personnel, in terms of things that happen while they're on their job -- and whether the service rendered to a person is incommensurate with the fee as prescribed. Those are some of the criteria which the committee operates under. I've also outlined for the member what the actual fees are within the province of British Columbia for people who are covered by MSP.

[1525]

C. Hansen: Many of the cases that I hear about are people who have been charged the full amount and, in some cases, are charged it several times for different trips that they've had to face. And even though it is up to the maximum and it is not the real cost, there are still some true hardships there, which I understand would come before this committee.

I would like to get some data on this, and if the minister doesn't have this information with him today, I would certainly appreciate receiving it at a later date. In terms of the total charge-out by the B.C. Ambulance Service, how much of that would be waived by this remissions committee that he's talking about, and how much of those ambulance charges would be covered by other providers, such as WCB or employers? If the minister has that information or has access to it, I would appreciate receiving it in due course.

Hon. M. Farnworth: We'll get that information for the hon. member.

C. Hansen: I want to move on to a specific case. I received a phone call from an individual in Vancouver whose wife had been involved in a motor vehicle accident. The bottom line, in terms of what they were . . . . The ambulance was called by a passer-by; it arrived. There may have been a language difficulty, but the ambulance left without caring for this individual, who, in the opinion of her husband, should have been transported to a hospital.

The concern that came up was that there were several different stories, depending on whose report was being filed -- whether it was the witnesses to the accident, whether it was the police officer that attended or whether it was the ambulance driver that attended.

The concern is the opportunity that there is for a citizen to file a formal complaint and have a particular circumstance such as this reviewed. I'm wondering if the minister could tell us what kind of opportunity there is for an individual to file that kind of a complaint or a request for an investigation with regard to the care that is given to somebody who is attended by ambulance personnel.

In saying this, I don't want to denigrate the reputation of the Ambulance Service at all. Certainly I think the ambulance attendants in British Columbia have a very high reputation, and we are well served in this province. But when there are problems that come up, I think it is only appropriate to protect the reputation of the B.C. Ambulance Service -- that there be some kind of a formal process so that the individual can see that a proper review is done.

Hon. M. Farnworth: In fact there are a couple of ways that an individual who may have a complaint can access a complaint process. One is through the licensing branch that licenses the ambulance paramedics. The second is through the regional authority or the provincial authority. If a complaint is received by either of those two authorities, it is investigated and looked into.

C. Hansen: From what the minister just said, I gather that those bodies have an obligation to proceed with an investigation. Could the minister tell us if they also have an obligation to report back? Is it an internal investigation? What nature does that kind of process take? What obligation is there to give reassurance back to the individual involved that an adequate review was done?

Hon. M. Farnworth: Yes, in fact it is the policy to get back to the complainant and explain what happened in the review and what the findings were.

[1530]

C. Hansen: I've got one more question with regard to Ambulance Service, and then I want to move on to continuing care. In the performance plan -- I always have to check the title of this; I always question whether I remember the title properly -- there is "Enhance quality of patient care by expanding local access to paramedic training programs." This is an area that I have had brought to my attention by a few individuals in different parts of British Columbia.

The concern is that the access to training within the B.C. Ambulance Service is something that is very regimented. The perception, at least, is that it is based more on seniority than it is on the willingness and opportunity to get on with training and to build a career path. This often comes from young individuals who are starting out their careers with the B.C. Ambulance Service. They are feeling that there is a long process and a delay before they can get access to some of the higher levels of training. I'm wondering if the minister could tell us how he sees this expansion of paramedic training programs unfolding and whether or not the access is as open as one might hope it would be.

Hon. M. Farnworth: I don't want to duck the question, but we are in negotiations right now around the new contract. As in a lot of organizations, issues around training as well as salary and other working conditions are often up for discussion. At this point I would rather reserve comments on some of those issues until a later date. I am happy to sit down and discuss with the member some of the issues around training. But at this particular time, I'd rather wait until negotiations have been resolved before I address some of the specific natures of the member's question.

[ Page 16162 ]

C. Hansen: I found it interesting, hon. Chair, that he starts out by saying, "I don't want to duck the question," and that's exactly what he did. But I appreciate the sensitivities there, and I will accept that response.

I want to move on to continuing care. The continuing-care review, which came out last fall, was made public last fall. In fact, the original expectation for this report was 12 months prior to that. It was originally slated for completion in the fall of 1998. There were some real concerns raised within the continuing-care community with regard to the direction and the degree to which that community had been consulted in developing the report. As a result, the deadline for completing the report was extended by six months to March 1999.

My understanding is that the report was put in the hands of the then Minister of Health in either late March or early April 1999 and then did not get released to the public until the fall of 1999. I'm wondering if the minister could tell us why this particular report sat on the corner of the minister's desk for so many months before it was made public.

Hon. M. Farnworth: In fact, the report was being finalized during the period the member is referring to.

[1535]

C. Hansen: From that, I gather, the report was amended, from between April 1999 and the time it was finally released.

Hon. M. Farnworth: No, it wasn't amended. There was some fine-tuning that took place, but basically it was being put into a format for publication.

C. Hansen: I think the delay in terms of releasing that report was very unfortunate, because there are some very good points that are made in here in setting out the problem and challenges that we have in continuing care in British Columbia. A lot of these are issues that we have to get on with addressing. If the delay of six months while it was fine-tuned . . . . Were those the minister's words? I find that a little difficult to take.

I just want to go through and review some of the issues that were raised in this report, just to set the stage for the concerns we have. They talk about the challenges in terms of continuing care as being things such as the inflexible philosophy and inflexible approach. Rather than accommodating individual needs, it has a focus on illness instead of wellness. The barriers to empowering clients . . . . I've just highlighted a couple of sections from here, where it says that often clients and caregivers aren't aware of what services are available and that caregivers fear some form of retribution if they question decisions that are made. I found that comment particularly disturbing.

"Insufficient support for caregivers." It says: "The system doesn't sufficiently recognize the contribution of families and friends who are caregivers. Respite services, support programs and education activities are inadequate to protect caregivers from exhaustion and burnout." That whole area of family members and friends as caregivers is one area that I think is not given the attention it deserves in our society.

They talk about the lack of transitional beds, where we have too many patients who are in acute care hospital beds while they're waiting for some form of long-term or community care. And currently in British Columbia this transitional level of care, falling between extended care and in-patient hospital care, is simply not available.

They talk about insufficient education and training for service providers, no standardized training program or set of skill requirements for home support workers. The result is that performance levels cannot be guaranteed.

"Difficulty in determining and responding to client needs." It refers to the cumbersome process to change care levels once clients have been assigned. They get slotted into a particular niche in terms of continuing care, and the family have great difficulty in getting reassessment done or re-evaluations of what their needs are.

One of the other issues is that the perception is there of growing wait-lists for community care residential programs and that they are administered on a first-come, first-served basis, which often forces clients to go into a residential care facility earlier than they might actually need to, for fear of losing their place on the wait-list that exists. That is something I have had many letters on, as I'm sure many MLAs in this House have had, of family members or individuals who have been torn with that decision to take a residential facility when it comes available, even though they may not feel they are ready for it or in need of it at that point.

In terms of acts and regulations, it's talking about three different acts and sets of regulations to govern continuing care, extended care and private hospitals -- that there is an inconsistency of rules and regulations that slows down efforts of health authorities to build a coordinated system.

There is a lot of concern about the role of the health authorities. It talks about the confusion among health authorities and the roles between the community health councils and the communities' health service societies -- that neither has a clear responsibility for planning or delivery of health services. The duplication and gaps in service, particularly in home support, are the result.

In terms of issues regarding the funding formulas for facilities, it points out, for example, that extended care facilities provide for the cost of medication and equipment, but these costs are not covered by intermediate care facilities. Significant financial hardship can result for intermediate care clients. Again, it comes back to . . . . How people are categorized in the system can have very different results in terms of the impact it will have on those particular families.

I found the report very enlightening in setting out some of these challenges. One of the big concerns is: what are we going to do about it? When will we see an implementation plan? When will we see some direction from the minister as to how these challenges are going to be dealt with?

[1540]

The Chair: I'd like to ask leave of the committee to make an introduction, please.

Leave granted.

The Chair: It's my privilege to welcome a group of bright students from the village of Tachie, all the way here from some distance away, roughly two hours northwest of Fort St. James. I asked them today what the big news was in the village of Tachie, and they said they have a new health centre.

[ Page 16163 ]

I guess it's appropriate that you're here today during the Health estimates. Please join me in welcoming this group of students.

Hon. M. Farnworth: It sure didn't take you long to take advantage of the mike when you got the chance; that's pretty good.

I'd like to respond to the points the member raises. I think he raises a number of the key findings in the report. That's why the report was done. The system's been in place for 20 years. We know there is going to be a huge demand and increase in the need around community care and continuing-care services in British Columbia over the coming decades. The question is: what do we have to do? What can we expect in terms of where are some of the key issues that need to be addressed? Those are identified in the report.

The member asks about a framework; that will be in place. And a plan of how we move forward -- that will be in place by the fall of this year. From the provincial perspective, we are starting to take action, and you'll see that outlined this fall.

Second, this is one of the key areas of discussion with the federal government in terms of the funding formula with the provinces, because this is an issue not just faced here in B.C. The question is: how do we deal with it?

One of my particular concerns, for example, that I'd like to put out at this particular time is that if we're looking at a federal funding contribution, for example, to deal with issues around continuing care, long-term care, then there is recognition for provinces such as B.C., which will probably see a net increase in seniors coming from other parts of Canada to retire here in B.C. and then also take advantage of the services that we have here. I would like to see something like that addressed in any funding formula.

I think what this report does is outline as a foundation the key areas, the key challenges that we're facing in our continuing-care system. The challenge for the province is to move forward in a framework. That we're doing; that'll be ready by the fall. The second is to recognize that this issue is a major one and that we also take it, in terms of discussions, as part of the national debate that's also taking place on these particular concerns.

C. Hansen: One of the officials in the Ministry of Health noted that we need at least 6,000 long term care beds over the next five years to meet the needs of the elderly. It noted -- and this is a quote from the associate deputy minister of regional programs -- that we have a shortage of 3,700 beds right now. It also goes on to say that the Health ministry has warned the government that it needs to begin a massive building program, starting with 1,200 beds next year -- and I assume that to mean this current fiscal year -- at a cost of $140 million. I'm wondering if the minister could tell us where we're at in terms of meeting that need for residential beds in British Columbia.

Hon. M. Farnworth: The member's absolutely correct. If we do nothing, that will be the shortfall, and that will be the requirement in the next five years. However, what we also need to do is recognize that yes, we need more continuing-care beds. And if we innovate, if we use new ideas, if we look at what's happening in different parts of the country, we can have an impact on that number. We can manage that number a lot better than we have been doing.

[1545]

There are a number of programs, for example, in different parts of the province that are dealing with the issue through innovative ways. The Simon Fraser CareLinks program, for example, has seen the demand or the need for their beds cut in half by instituting a number of different ways of approaching the problem, and it's been very successful. The challenge for us is to expand these initiatives provincewide. That was part of the recent innovation forum, but it also goes further than that. Home care figures very strongly into the numbers that you need, as does home support.

So there's a range of options in dealing with the challenge facing us, but clearly the option that presents the greatest challenge for the government is the one of doing nothing. If we do nothing other than stand still, then yes, those figures would in fact be correct. But we recognize that that's not an option, so we're working to innovate and to find better ways of doing it. Health authorities are in fact doing just that.

C. Hansen: I appreciate that it's not a case of this government doing nothing in this area, but I think we have to question how much above that level we're at. In the budget that came down, in the budget reports, it notes that this year's budget provides for the opening of 194 new continuing-care beds in this current fiscal year. I'm wondering if the minister feels that that is adequate in dealing with a situation where the ministry itself has warned the government that it needs a massive building program starting with 1,200 beds this year.

In fact, we're only at a fraction of that; we're at about 15 percent in terms of what has been provided for in this year's budget. I'm wondering if the minister is satisfied that the 192 new beds provided for in this budget are a significant improvement over doing nothing.

Hon. M. Farnworth: I guess I'll make a number of points. First off, in terms of the strategy for implementation, that's part of the framework. That will be released in the fall and shows how we're going to get to where we need to be over the next three to four years. Is it enough? Well, it's never enough. I would always say that, yes, I want more in terms of being able to meet some of the needs. Clearly that's the challenge this ministry would face.

That having been said, I don't think it's as simple as just saying that there are 191 beds, because in reality what is happening . . . . There are beds that have been budgeted for in previous years, which are coming on stream. So the number is in fact actually higher. But what the member does illustrate, I think, is the relevant point, which is that we need to be doing a key amount each year if we are to meet the demand.

At the same time we also have to be more innovative than we have been in the past. We have to look at better ways of delivering the services required. In that sense, I am pleased with the initiative being taken by many of the health authorities in that area and, in particular, with the success that they are having. In fact, my sense that this is the right direction is also confirmed by what's happening in other provinces, where they're taking similar measures to meet similar pressures that we face here in B.C.

C. Hansen: In fact, in some parts of the province the number of beds available is decreasing. I've got stats from the capital health region when they note that the number of long term beds in the capital health region has actually dropped to 3,050 from 3,470 in 1990. There are currently 1,200 people

[ Page 16164 ]

waiting for beds in the capital health region, compared to 350 that were on the wait-list in 1991. I'm wondering if the minister can tell us: since 1995, how many new beds have been added to continuing care provincewide?

[1550]

Hon. M. Farnworth: I'll get the number for the member.

C. Hansen: Thank you. One estimate, in terms of the number of beds that have been added since 1995, is 500 additional beds over the course of five years. That's a pretty sad comment when you realize the terrific need that is there for these beds in British Columbia and the shortage, as I noted earlier, of 3,700 beds. That's the number used by the ministry, and we haven't even come close. I guess I have some very real concerns, given the magnitude of the problem and the magnitude of the shortage that is there and the impact that that is having on our acute care facilities.

You talk to every single hospital CEO in British Columbia, and they will tell that one of their major problems is the number of patients tying up acute care beds who should be in some alternate level of care. That goes from health region to health region to health region around this province.

Yet if you look back over the last five years and the series of Health ministers that we've had, there really has not been the leadership to address that issue. I have a real concern when the minister stands up here today and tells us that we have to wait until this fall before we're going to see an action plan in terms of dealing with this in any kind of a meaningful way. I'm wondering if the minister can tell us, or at least tell those people who are on wait-lists in British Columbia, why we should have to wait until this fall before we can see some meaningful direction and leadership taken to address this shortage.

Hon. M. Farnworth: I understand the member's concern, and I think there are some key points that need to be made. One, the system has been built outside the Canada Health Act over the last 20 years. We recognize as a government that in fact it's going to be an area of health care delivery that's expanding in this province significantly over the coming years. We recognize the challenges that are facing hospitals in terms of acute care beds being used by people who should be in other, more appropriate forms of care. In fact, that's been one of the key areas of focus over the last couple of years.

I've said in the estimates debate so far that that tends to be one of the key areas that I want to focus on during the coming year within the ministry. That's why the continuing-care report was done. It has been reviewed; there is an implementation plan being put in place. I think it is important that the plan be thorough so that when it's released, we're ready to move on it.

There has been considerable work done in terms of bringing new beds on, perhaps not as many as people would like or as quickly as some people would like. But the fact is that it is happening. You also have to couple this initiative with other areas of government policy, which have an impact on the ability of people to stay in their homes. One is around social housing, for example, and the fact that there have been social housing units that help people in more appropriate forms of accommodation.

Two, there has been the recognition that there are other areas that need to be developed as well, not just long term care and continuing care, but home care and home support. There is a key issue in terms of federal government participation. That's why the provinces have recognized that this is one of the main areas of focus. We want to see the federal government restore funding to the provinces in terms of providing the types of services that are required so that, whether it's home care or home support, people who can stay at home do stay at home. Then when they're required to go to continuing care and long term care, which is available, and then finally acute care.

There is action being taken; there is a concerted effort by government to address this particular issue. We know that it's going to be part of the health care reforms that are taking place right now and that are going to take place over the next few years. It's also important to recognize that it's not just a question of expending money and building new beds, but it's also recognizing that the system itself has to change and that we have to be more innovative.

[1555]

I've given the member some examples of areas in the province that are doing just that and have seen the requirement or the demand for beds in some cases cut in half. I think that's crucial. That work needs to take place, and in fact it is taking place and is having good success. The challenge for the province and for health authorities is to take that work that's being done through health authorities such as Simon Fraser and to take the initiatives and the methods that they're doing provincewide. That's what we're trying to do.

C. Hansen: When the ministry -- I was going to use the words "sat on the report for six months," and I won't use that -- did not release the continuing-care review for the period of that six months, there were a lot of individuals who expected that the reason was that they would be releasing it with an implementation plan. This government probably would have been forgiven for that delay in releasing the report if in fact it had come out with an action plan as to what to do about some of the challenges that were raised in that report.

But we didn't see that. The perception is certainly there that the ministry, this government, released that report and only now has started to work on what to do about some of the real problems that are outlined. It's a real disappointment to people that they're going to have to wait until the fall of this year before they see that kind of leadership being provided from the government.

I want to move on specifically to the area of the multilevel-care standards. It's now been about ten years since those standards have been in place. I think most people recognize that building new construction to a multilevel-care standard is indeed desirable. But what we also see is a significant stock of available units in British Columbia at a level of intermediate care that do not meet a multilevel-care standard. They are beds in this province that are not open today because of the fact that they do not meet multilevel-care standards.

I wonder if there is any consideration being given by the ministry to some flexibility in the application of those multilevel-care standards to allow some of this stock of residential units to be opened and made available, even though they don't meet the multilevel-care standards that have been set out.

Hon. M. Farnworth: Yes, I am open to it, and I think it's a good idea. That's why I would say it will be part of the implementation strategy in the fall.

[ Page 16165 ]

C. Hansen: Again, this heightens my concern if so many of these decisions are put off. Obviously there is a need for a comprehensive strategy and a comprehensive approach. I don't take that away from the minister. But I also believe that there are some things that can be done and done quite quickly.

In the riding of Vancouver-Quilchena there is a fabulous facility called Blenheim Lodge, and Blenheim Lodge has an entire wing that is sitting empty. I believe, if my memory serves me right, it's 62 beds or 62 units that are built to an intermediate care standard, which could be open in a very short period of time to serve people who need that kind of care. It's not at a multilevel-care standard.

It strikes me that with just a little bit of flexibility in how we implement this, we can actually meet a real need that exists today in terms of the wait-lists that are out there if we show some flexibility in the short term and not have to wait until this overall comprehensive review is released in the fall. I'm wondering if the minister is prepared to consider some kind of flexibility in the interim.

[1600]

Hon. M. Farnworth: We have an industry advisory committee that works with the ministry in looking at issues such as this. As I said, we do have an overall strategy, and the key dates around that are in the fall of this year. Certainly if there's an opportunity for flexibility, I'm more than happy to take a look at it and to consider proposals that cross my desk.

C. Hansen: I want to move on to the issue of the disconnect that seems to exist between operating budgets for continuing-care facilities and the capital and construction side of them. I was debating whether to raise this under continuing care or under the discussion on capital projects, but I think this is probably the appropriate time.

There was certainly the case that came to light earlier with regard to Fischer Place in 100 Mile House, where what appeared obvious to me was that the construction was completed and, as I understand it, ready for occupancy in February -- although I know that the minister has said on several occasions that there were still some construction issues outstanding. But my understanding is that it was actually ready for occupancy and that the only reason they couldn't was because the operating budget wasn't put in place in a timely fashion to allow for that facility to be utilized, when the construction was at a stage where it could be occupied.

We have another instance that has come to my attention. That involves Bulkley Lodge in Smithers. There was funding approved for the construction and expansion of Bulkley Lodge in 1997. Construction was completed in the fall of 1999, increasing the number of beds from 50 to 75. There were no operating funds available for that facility when the construction was completed, and the operating funds were received at the beginning of April. There was a public announcement made to that effect on April 12. But in spite of receiving the new operating funds, the community was informed that no new beds would be opened, nor would any date be given for that to occur.

There are now apparently fewer people in the lodge than there were before. Before the construction started, there were 50 beds, and now there are only 45 residents in there -- as of a month ago. I'm wondering if the minister could explain how we can wind up with this lack of planning and the lack of connection between the construction side and the operating side. It strikes me as being a real shame if we have facilities that are available that are in great demand with wait-lists that are there, and once those facilities are in fact completed or expanded, we can't arrange for the operating dollars to be in place in a timely fashion to ensure that those facilities could be utilized.

Hon. M. Farnworth: I can tell the member that he raises some valid points. As much as possible, we like to see the integration of operating and capital. What has happened in the past, though, is that sometimes there has been delay in terms of construction, which has impacted on operating. There have been other projects that have also been under construction. Sometimes they have come on earlier, and so operating is used to get them opening. That creates some challenges in the system as projects can be out of sync, if you like, with regards to operating capital.

One of the recommendations in the Deloitte report was to address that. For the first time this year, I think you are going to see a much greater integration between operating and capital than you have seen in the past. We have identified that as a key area of concern, one which we wish to address and are in fact doing so.

[1605]

C. Hansen: I wanted to raise a couple of issues that have been raised by operators of long term care facilities in the province, three in particular. It's the differences in funding between multilevel care, public extended care and intermediate care, where they all have their own funding structures. What those operators would certainly like to see is more standardized global funding made available.

Secondly, the funding of capital cost is an area of great concern, where they do not feel that funding reflects the need to keep facilities upgraded on a regular basis.

Thirdly, wage and benefit costs are not funded in terms of the funding formulas that are available. Those are costs that, because those facilities are forced to be part of the HEABC negotiations, are imposed upon them and really are totally beyond their control. Yet the funding that flows from the ministry through the health authorities does not reflect some of those costs. I am wondering if the minister could comment on some of those concerns.

Hon. M. Farnworth: In terms of the continuing care and the collective agreement, that is fully funded. In terms of Pricare people, we are meeting with them to look at some of the issues that they have raised with us around funding. So those concerns are being recognized, and we're meeting to discuss them.

C. Hansen: But do I take it from the minister's comments that it is a policy of the ministry to fund 100 percent of the compensation issues that flow from the collective agreements that are negotiated by the HEABC?

Hon. M. Farnworth: That is correct.

C. Hansen: Actually, with the minister's indulgence, it may be an appropriate time now to deal with some of the compensation issues that flow from that. We'll come back to home support.

[ Page 16166 ]

There are certainly a lot of concerns under the area of compensation, but I think a lot of them have been dealt with in other contexts. So I'll deal with the few remaining issues, which we should be able to dispense with quite quickly.

First of all, I'm wondering if the minister could give us the status and the titles, if that's appropriate, of the various accords that have been negotiated involving compensation issues. We've heard of the big health accords that flowed in 1992 or '93 and then again in '96. But since then, we've seen several different approaches to different types of agreements in health care that have all been called accords. I'm wondering if the minister can tell us: what defines an accord in terms of compensation on health-related issues?

Is there a policy to expand the number of accords, or whether or not we're going to continue to pursue big-picture ones, or whether or not we will see more of some of the isolated accords dealing with specific sectors?

[1610]

Hon. M. Farnworth: I'll try and get the specific particular accords for the hon. member. It may in fact be a question of directing it to Finance, which does the negotiating, as opposed to Health. What I can tell you is that as they relate to Health in general, they cover non-wage items associated with collective bargaining as an opportunity of dealing with some of the issues outside the non-wage sector. So they may in fact be useful in terms of dealing with issues in the future. But that is something that would be part of the collective bargaining process.

C. Hansen: I would like to ask the minister what the relationship is between the ministry and the chief . . . . I believe the title of Mr. Penikett is the chief accord negotiator. I'm wondering what role the ministry has in impacting on the negotiations that Mr. Penikett may be engaged in from time to time.

Hon. M. Farnworth: I guess the best way to describe him is that he was the government's chief negotiator. We as a ministry would provide him with advice on issues as they related to the Ministry of Health.

C. Hansen: I guess my concern flows from what became obvious to me a year ago and in the year preceding -- that some of these accords were in fact being negotiated, which had a very major impact on the Ministry of Health and the delivery of health care in British Columbia. Yet it was obvious to me at the time that the ministry really was not in the loop when it came to some of those particular accords. I'm wondering if the minister can reassure me that that is not the case anymore -- that the ministry is involved in an integral way in any accord negotiations that take place and involve the delivery of health care in British Columbia.

Hon. M. Farnworth: Well, I can tell the member that the deputy minister is always involved in accord negotiations and will continue to be involved if any are in fact taking place.

C. Hansen: I wanted to move on to the issue of severance payments. There is a provision in some of the collective agreements that has caused a few people concern. The example that I have before me is actually the nurses' agreement -- the agreement with the B.C. Nurses Union -- although it's my understanding that a similar clause exists in other areas.

As we discussed earlier in the Health estimates, we in British Columbia are facing a shortage of various trained health care professionals. Yet we have in these agreements the provision of severance payments that are paid out when somebody voluntarily leaves their profession, leaves their job. At a time when we are trying to do everything we can to encourage nurses, for example, to stay in the profession, it seems to me that these severance provisions run directly contrary to that interest.

We're actually rewarding health care professionals who quit their jobs and perhaps move to the United States or seek some other form of employment. I'm wondering if the minister shares my view that this may be counterproductive when it comes to ensuring that as many health care professionals -- in particular, nurses -- are encouraged to stay in their profession in British Columbia.

[1615]

Hon. M. Farnworth: In fact, I think it's probably fair to characterize it as a retirement allowance as opposed to a severance package. I understand where the member's coming from. I would also say that there's a flip side to it, in that it's equally valid to say that it is of benefit to people and attracts them into the system as being something that, if you're working in British Columbia, is a benefit that you can accrue and is in fact something that attracts people to come into the system.

C. Hansen: I think that's a bit of a stretch for the minister. Certainly working conditions and salary . . . . I'm not sure too many people go into a profession with designs as to how they're going to quit it and how much they're going to get paid for quitting the job that they're applying for.

Certainly I have heard comments made that severance allowances upon voluntary retirement are something that are common. It's not common in society generally; it may be increasingly common in the public sector. It is actually referred to in the collective agreement as a severance allowance. And it says: "A regular employee leaving the employ of the employer shall be entitled to receive severance allowance." And then it goes on to say that one of the categories to be eligible is "employees with ten years of service who voluntarily leave the employer's . . . . " This is one of the criteria.

I should complete that: " . . . leave the employers' workforce after their fifty-fifth birthday," and that they "shall be paid severance allowance of one week's pay for every two years of service to a maximum of 20 weeks' pay."

The point I'm making is that I believe we should be doing everything possible to ensure that nurses and other health professionals are properly remunerated and that their working conditions are such that they will be encouraged to stay in the profession. It strikes me that retirement allowances such as that may run counterproductive to what's in the interest of good health care in British Columbia.

If I can just continue on that area. I'm wondering if the minister could tell us whether or not the health authorities and other employers that would be employing individuals who may be eligible for these severance allowances are in fact funded for their liabilities that they may have to pay out.

Hon. M. Farnworth: We cover the costs associated with these allowances at the current time.

C. Hansen: I guess the concern is that there is an unfunded liability that exists. Is the minister saying that when

[ Page 16167 ]

there is an actual pay-out to an individual who is leaving their employment, the ministry will cover those off on a one-on-one basis? The employer, whether it be a health authority or perhaps a not-for-profit organization or another employer, has to apply to the ministry to cover that liability that would result from a severance allowance being paid.

[1620]

Hon. M. Farnworth: It's not done on a one-on-one basis, because it's hard to predict in any one year how many people would take advantage of the particular provision. However, the cost is budgeted for within the global grant and is covered in the funding that the health authority receives.

C. Hansen: One last issue under the area of compensation, and that's the issue around wage parity. We have just had the settlement with the HEU on wage parity issues, and that certainly had a very huge price tag attached to it as a result of the Kelleher recommendations. I'm wondering.

One of the concerns that has come up subsequent to that is that there is another whole round of wage parity issues that could be triggered because of benchmarking, where you have one profession that is benchmarked against another profession. As soon as one gets adjusted, it then has a ripple effect through all the other professions that have benchmarked against that. I'm wondering if the ministry has had an opportunity since the settlement with the HEU to look at what the future ramifications may be in terms of wage parity and what the costs may be to the health system in British Columbia.

Hon. M. Farnworth: I guess my answer in the short context would be that it is part of future bargaining which hasn't taken place yet and which would be done through PSEC. But certainly we as a ministry would be working with PSEC to look at the implications of what it is that they are negotiating or potentially bargaining -- what the impact would be upon us as a ministry.

C. Hansen: That's all I have on compensation issues, so we can move back to home support, just to continue our discussion on continuing care.

In January the Victoria Times Colonist asked each of the candidates for the leadership of the minister's party to set out their policy as pertained to health care in British Columbia. The member that was successful in becoming the leader of the party and is now our Premier made an interesting commitment in that article, and I will just quote it. It says: "We can start by providing more home support services, more long term care facilities and training more nurses here in British Columbia, and I'm committed to do that."

We have discussed the training of more nurses, and I know there are some initiatives that will start to unfold this fall. Earlier today we have discussed the issue of long term care facilities. As I indicated earlier, I have my concerns that we will have to wait till the fall to see the nature of that particular plan.

But to come back to the third one -- that is, the provision of more home support services in British Columbia -- what we have seen community by community around the province is in fact a reduction in the number of individuals who benefit from home support programs, particularly at the lower levels of need. I know the acuity has been rising. But those who are dependent on minimal levels of home support have certainly seen those withdrawn around the province. I'm wondering if the minister can explain what action he's taking to fulfil a commitment that was made by his leader to provide for more home support services.

[1625]

Hon. M. Farnworth: I'll make a couple of the following points. First, in terms of the money that was annualized this year and that came in late last year -- the $26 million that was available to health authorities -- that is available for either continuing-care beds, long term care beds or home support. It's up to the health authority to make that decision.

The second point is in terms of the more long-term strategy that we're working on. I've said a number of times in the estimates debate, in terms of where this fits with continuing care and long-term care and the provision of services required in the coming year, that I see this as very much in that priority. It's been very much a focus of our discussions with the federal government in terms of their commitment to putting more money in. This is one of those areas that I see resources being devoted to.

In fact, my preference probably would be to see some of the targeted funds going into this particular area so that we can start to develop the home support and home care programs to a greater extent than they have been, right now. This has one of the best potentials in terms of ensuring that people can stay in their own homes longer than otherwise might be expected. It will allow them a measure of independence and allow a greater degree of freedom, either by not having to go into an acute care bed or by going into the appropriate level of care at the appropriate time.

So it is an area that we attach a great deal of importance to. There are some steps that have been taken. It is part of the overall strategy and the direction that we need to go in, in terms of the discussion around health in the province.

C. Hansen: In the continuing-care review there was a reference made that I quoted from briefly, regarding the lack of clarity with regard to the role of the CHCs and the CHSSs in terms of delivering home support. I'm wondering if the minister is going to address that issue before the fall. Or is this an issue where we will have to wait until the strategy is unveiled in the fall with regard to clarifying the responsibility for the delivery of home support in the communities that are served by CHCs and CHSSs?

[T. Stevenson in the chair.]

Hon. M. Farnworth: Certainly it is tied in with the overall strategy, but I am also looking at ways in which I can advance particular ways of addressing home support before then. But I think the bulk of the work on the initiative around that is tied in with the continuing care. You'll see a lot more work made public this fall.

C. Hansen: I had the opportunity to meet with an organization in Victoria here known as the Family Caregivers Network. I was very impressed with the dedication and the work that they do in terms of supporting family caregivers. As I mentioned earlier and was referenced in the committee, in the continuing-care review it is estimated that 90 percent of the care that is given for seniors in our communities comes from

[ Page 16168 ]

family caregivers -- family and friends. The Family Caregivers Network, it strikes me, provides a very useful role in providing assistance and information, education, training and advocacy on behalf of family caregivers.

I'm wondering if the minister sees that particular organization as a model that could be replicated around the province to really help support family caregivers around the province to have the assistance, the backup and the education they need to meet some of these challenges that they're facing.

[1630]

Hon. M. Farnworth: You're absolutely right. The one here in the CRD is an excellent model, and it is one that I wouldn't have any problem in seeing adopted around the province. Certainly that approach, that sort of model, is one that I attach a high degree of importance to. Trying to see something like that in different parts of the province is very much a priority for the ministry.

C. Hansen: I wanted to ask the minister about the CSIL program that is in place. It's a program that works quite well for some people in the province who are facing home care challenges. For those individuals that it works for, it's a tremendous program.

I often hear complaints from individuals who have looked at the program and feel that it doesn't work for them, not because of what the program provides, but more because of the work that has to be undertaken in order to qualify for it. It's the structuring of a committee basically to help administer the program on behalf of each individual that's in that program. It strikes me that this is a program that could be of benefit to a lot more people in the province. It could be very cost-effective for government, provided that it is streamlined in terms of how it is administered.

I'm wondering if the ministry has given any consideration to looking at the CSIL program and whether or not it might be made easier to manage by those who would like to qualify for it.

Hon. M. Farnworth: I think the member raises one of the key points around whatever program you have or that is designed. It's always designed for a specific group of people or a specific target, and it is often very successful at delivering the results that we expect. But at the same time, quite often it can't reach everybody, or there are people who find that it doesn't work for them, for one reason or another.

We have had recommendations from people who've been in it on how we can change the program or how we can improve it. Those recommendations are currently under review. It's my expectation that at some point in the next while we'll be able to act on some of those recommendations. So we are aware of some of the issues, and we are trying to deal with them.

C. Hansen: Could the minister give us some expectation as to what time line we're looking at? When does he expect this review to be completed and recommendations to be made?

Hon. M. Farnworth: There isn't a definitive time line that says it must be done by, let's say, September 1, in part because what's taking place is that it's not a ministry-imposed series of changes. What we're trying to do is review the recommendations that we've received, see how they can be changed and modified, what the effect of the implementation would be and also, equally importantly, to ensure that before those changes are put in place, we go back and talk to the community and ensure that they're being done in a way that is consistent with how they see the recommendations being implemented and consistent with how they see the changes being made.

[1635]

C. Hansen: I want to move on to issues of capital. I want to start specifically with equipment-related issues first and then move on to some of the capital projects. I don't have a lot in this area, because, again, they are areas that have been well canvassed by my colleagues when we were talking about constituency issues.

I am told that the replacement cost of all hospital equipment in British Columbia is about $1 billion -- the total value if we had to replace it all at one time. It is expected that equipment depreciates and becomes obsolete in about a ten-year cycle, so that in any one year we would need about $100 million in order to maintain the integrity of the equipment on a regular basis. This is a particular concern, because over the past five years the total provincial equipment funding has averaged only $15 million a year. I think somebody estimated that at that rate it would take us something like 75 or 80 years in order to cover our equipment needs in British Columbia.

What we're seeing from facility to facility around British Columbia is that equipment is deteriorating. It's wearing out; it is breaking. It is taking an enormous amount of staff time in some cases to keep obsolete equipment going. We have patients in British Columbia who are clearly not getting a standard of care they deserve, if there was equipment being put in place that was really at a standard that is expected in industrialized countries today.

The implication of not funding equipment replacement in British Columbia is quite serious, when you think about it. The first and probably the most important one is the issue of patient safety and whether or not equipment is going to be there when it's needed in order to ensure that patients are being cared for in the manner they should expect.

The second is an inability to deliver care as per existing standards in Canada. I have a document that I'm going to refer to shortly from the diagnostic accreditation program, where there are some very real issues raised.

The third is the inability to retract and retain qualified staff. I hear anecdotal stories of facilities that have tried to attract specialists from other parts of the world to come to British Columbia. They show an interest, only to realize that we have some real obsolete equipment that they would have to be using, equipment that they haven't had to use in their practices in other parts of the world in recent years.

The fourth area of impact is the adverse impact that it has on our teaching programs. If we're going to train health care professionals in British Columbia, we should be training them on the state-of-the-art equipment that they should be expected to use in the years to come, rather than equipment that was really designed for the 1970s or the 1980s.

I'm wondering if the minister could explain to the House how he plans to meet some of these equipment challenges. I'm a little bit concerned at the answer that I might hear. I expect the minister to stand up and say: "We're talking to the feds." With so many of these issues, we have to find ways of solving

[ Page 16169 ]

some of these challenges in British Columbia with the resources we have available, rather than hoping that somehow there's going to be some manna from heaven that's going to fall from Ottawa and bail the minister and this government out of some of these problems that they're facing.

[1640]

Hon. M. Farnworth: My answer will contain a number of components. I'll start with some of the basic ones. The fact is that new facilities in the province are funded with new equipment, the latest equipment. There's been a considerable amount of that taking place over the last number of years. So if you are opening a new facility, the equipment will be in there.

The second point I'd like to make is that, yes, in terms of equipment replacement you do need to make a significant investment. The member's correct in the amount that he has said. But there are some areas where equipment is provided for through foundations, in particular with individual hospitals; it's one area in which equipment is addressed. It is nowhere near enough but is in fact taking place and does meet a small portion of the need.

Second, in the last couple of years there has been a significant investment in hospital equipment through the infusion, even though it's one time, of over $100 million to deal with Y2K, which helped to deal with maintenance and the computer components around much of the equipment in B.C. hospitals. It did have a significant effect upon the state of the equipment in the province. That has taken place, and that has had an impact as well.

The third point that I'd like to make -- and this comes to the member's original comment -- is that, yes, there is the discussion with the federal government, as with all the problems, because the problems around equipment aren't unique just to B.C. The question is: what is the standard of equipment that we should have in the province? In fact, it's something that should be right across the country, and it's very much a part of the discussion.

So one of the initiatives that British Columbia has advanced is the need for an equipment fund; it has met with considerable positive response from the federal government. I don't think it's a question of waiting for manna from heaven, because it's not that. The fact is that the federal government has committed to the provinces. There is significant money available and coming into health care, and this goes some way to restoring the partnership with the provinces. The question is: how is it going to be spent? I think it's appropriate that some of it go to equipment; that's one of the areas that we're pushing. That will also have an impact.

So there are things -- the member's right -- we are doing here within the province that are currently taking place. But it's also important to recognize that there are external factors outside the province that will have an impact on our ability to provide equipment, and they are just as important for discussion as well. It's one of those issues where we need to recognize, as in the maintenance of facilities, that there are long-term costs associated with equipment. They can in fact have a dramatic . . . .

The advances and the changes in technology put one of the key pressures on hospitals that is hard to predict in terms of the equipment that's required. For example, ten years ago MRIs were not standard equipment throughout most hospitals in Canada; a decade later they are. They are an important diagnostic tool. That's the challenge with technology, but it is something that we're working on within B.C. and from outside B.C. as well.

C. Hansen: I mentioned earlier the diagnostic accreditation program, and I just wanted to quote from a letter that was sent to the former minister and was copied to me. It came from Dr. David Zacks, who is chair of the medical imaging division of that program. It's quite alarming when you look at it in terms of the threat that this may have to the delivery of quality health care in British Columbia. If I can just quote some of these things:

"It is becoming increasingly difficult for the diagnostic accreditation program to accept the quality and accuracy of much of this aging equipment, which has outlived its useful or expected life span. Inevitably, with declining budgets and aging, outdated equipment, medical standards will inevitably fall. The diagnostic accreditation program is extremely concerned about the current situation of not replacing decaying equipment.

"Without doubt, we can and already do see the lowering of acceptable standards of practice. Unless there is a rapid reversal to the insufficient equipment funding and replacement process, the diagnostic accreditation program will soon have little alternative than to declare such obsolete equipment as diagnostically unacceptable."

When the minister is outlining some of the various initiatives that he hopes will result in more dollars for equipment, I'm wondering how he can address what appears to me, from this letter, to be a very short-term and very immediate concern about necessary diagnostic equipment being declared unsuitable for use in British Columbia.

[1645]

Hon. M. Farnworth: What I would do is . . . . I think that's why the work that was done with the $100 million in terms of dealing with Y2K and this ability to deal with some of the problems in terms of aging equipment was key. I recognize the concerns around the issues of aging equipment. That's why I've said that this is one of those areas that is a priority in terms of our role with the federal government.

And that's why I want to see, and why we're pushing for, an equipment fund that will allow us to do replacements around aging equipment and to upgrade the standard of equipment in B.C. hospitals and in fact right across the country. So I understand the concerns, and we're working on dealing with them as quickly as we can.

C. Hansen: There's another very specific issue raised in this letter that I wanted to ask the minister's response to. It says:

"The Ministry of Health's plan to bulk-purchase has created considerable unhappiness with individual users, who cannot obtain equipment to meet their needs in a one-size-fits-all model. It has also precipitated the withdrawal of some suppliers from B.C., which unfortunately eliminates competition between vendors and results in a loss of competitive bidding. Individual health authorities are having to bear the additional costs that this poorly-thought-out process has realized."

I'm wondering if the minister could respond to that and indicate whether or not that particular purchasing policy is being reviewed.

Hon. M. Farnworth: I guess the point I'll make is that, yes, I understand that sometimes people have concerns, and

[ Page 16170 ]

they're entitled to their opinion. But our experience in terms of bulk purchasing in this province and in fact right across other provinces is that bulk purchasing has saved a considerable amount of money, that it has not driven suppliers out of the province and that it has in fact given us a better ability to negotiate better deals. My sense of it, just based on instinct, was that bulk purchasing allows you to save a considerable amount of money. I mean, that's one of the key elements of doing business by volume, particularly in supplies and equipment that you're using a great deal of.

So if there are specific concerns, I'm more than happy to look into them. But from the province's experience to date it has been very effective. We have saved a considerable amount of money, and it hasn't resulted in suppliers leaving the province.

[1650]

S. Hawkins: This is not a new issue; I don't know how many times I stand up in this House and say that for each issue that comes up. But this is something, I believe, that has been raised in the House for at least the last four years that I've been here: the issue of us being technology-poor. Equipment for hospitals is especially a concern that's been raised by members on this side of the House for years; it's interesting that the minister stands up and says the government recognizes that. We've had a new minister almost every year. I don't know if this has slipped by other ministers.

I hope this minister does pick up this football and run with it this time, because I don't think patients across the province and especially in rural areas can afford to wait much longer. Perhaps it's an issue that should have been picked up, and leadership from B.C. should have been focusing on this in the past few years. I'm glad it has taken a federal stage now, because I know this is a problem that is unique not only in B.C., but across the country.

What I want the minister to know is . . . . I want to relate some of the concerns of my constituents. This government says they make choices. They said health care was a choice, a priority that they wanted to make. Yet my constituents . . . . I get calls weekly, daily, hourly about the choices the government made. They've written off $70-odd million on the convention centre. They're writing off fast ferry debt; they're writing off the fast ferries -- millions and millions of dollars there. I guess constituents look and say: "Hey, you know, we just need this at our hospital. If health care is a priority, why isn't some of that money being spent there?"

I'm sure the minister has heard that as well. I won't dredge on and on about that. It is about choices, and I guess that in the last few years, on some of the issues we've been raising, the government could have made choices. I don't think they've made the right choices; my constituents don't think they've made the right choices.

I want to ask specifically about the MRI in Kelowna, because the minister did -- and rightly -- state that MRI is not new technology; it's boilerplate now. I trained years ago as a nurse, and we were using that technology years ago. So 15 or 20 years later, it is almost standard in hospitals today, and regional facilities especially should probably have one. Kelowna General Hospital has an MRI that it shares. It's a travelling MRI that travels between Kelowna, Kamloops and Prince George. Kelowna gets it for two weeks; Kamloops gets it for a week, as does Prince George.

I think the case has been made to the minister and to the ministry that circumstances at Kelowna General Hospital have changed. We do complex and more aggressive programs there. It is an extra-regional facility. We do programs like angiography. We have a full-scale ICU there. We do all kinds of complicated orthopedic surgery there. In addition -- and the minister knows this as well -- two years ago we added a cancer centre. So there are the complications of adding a cancer centre that services a huge region, the southern interior.

I want to know from the minister: what is the status of getting a fixed MRI unit at Kelowna General Hospital? I know the case has been made by the regional health board. Is it something that's not being planned for a few years? Is it something that's on hold, or is it something that the ministry is moving ahead with? The constituents want to know, the region wants to know, and I'm putting the question to the minister. I would like his comments on that.

Hon. M. Farnworth: I understand that the member's comments . . . . I will resist the temptation to sort of rant from this side. What I will say is that I appreciate the concern around the MRIs; we've had some debate around this, under "Equipment" in the previous parts of the estimates debate. It's crucial. I see that increasing the standard of MRIs throughout the province is not only something that's desirable, but something that we in fact have to do. We have a program that will see more MRIs in the province over the next two or three years.

I can tell the member that in the case of Kelowna, they are at the top of the list -- I think either number one or number two. So we recognize that the addition of the cancer centre -- what's happening in terms of population growth in Kelowna . . . . Clearly they are the logical choice for a stationery MRI. That is something that I see as a priority.

Having said that, this is an issue that is of importance to different parts of the province and, as the member correctly stated, is something right across the country, because the level of MRI technology in Canada is considerably less than it is in many other jurisdictions. That's why I've said, in terms of capital, that one of the areas I think we need to focus on -- not just in B.C. but in the country -- is technology and equipment.

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B.C., with the federal government, has spearheaded the initiative to get a technology and equipment fund in place. We've taken the lead on that. We are spearheading that; that's a B.C. initiative. I've been very pleased with the response that I've received so far from the federal government. If it means that we cost-share less -- let's just say, for the sake of argument, 50-50 -- then we cannot only do one in Kelowna or one in Surrey, if we are doing two in a particular year, but then we could probably do one on the Island and one in another part of the province. That will allow us to do more and at the same time raise the standard.

So yes, I am committed to increasing the level of equipment and technology in the province. Two, I've got a plan that will allow us to do that, and we're working on it, and I'm encouraged by the response. And three -- most importantly, I guess, from the point of view of the member asking the question -- is that Kelowna is very much at the top of the list.

S. Hawkins: I'm glad the minister recognizes . . . . I've heard those from every other minister who's stood up. So I'm

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really hoping this time it's not empty words. I don't know where we're going to get the money from. I hope there is some movement on the federal stage to work with the province, although I know the province hasn't really had that good of a relationship with the federal government. Let's hope they improve under this minister. Let's really hope they do.

I just want to put on the record as well that for those two weeks when the MRI isn't in Kelowna -- and I know the minister understands that -- patients either wait or are sent to other centres. They're sent down to the lower mainland, or they're airlifted out if it's an emergency. None of those are ideal situations, and it's not just in Kelowna; it's in other parts of the area that we service. So if we did have . . . .

If there was a plan, and I hope there is a plan because I don't think . . . . With the turnstile leadership, unfortunately, in the Ministry of Health, I think every minister has had a plan, and it has changed every six months or year or however often they've been replaced. So let's hope this minister lasts -- you know, there's a "best before" date that's a little longer than some of the other ministers who have sat in that chair. I'm hoping these aren't empty words. I'm hoping there is a plan. You know, I'm not just speaking for my region, I'm speaking for other regions, and I'm hoping that the government makes the right choices.

If health care is a priority, then this is certainly an area that needs attention, and certainly there are other facilities in the province that are asking the same questions -- and rightly so -- on behalf of patients. MRI is just one, and it's not that it's quicker or faster or whatever; it's safer and it's non-invasive. It makes sense to provide that kind of technology for our patients, especially if they're acutely or critically ill. We don't want to complicate their case any further.

So I will leave it at that, and I wait to see what the minister's . . . . Oh, you do want to say something. Okay, I'll let the minister respond to that. But I do wait for the announcement. And hopefully, it passes Treasury Board and has the blessing of cabinet before the announcement's made. We've seen too many times where other announcements are made, and there's no money in place. So I will wait for that.

Hon. M. Farnworth: That's why I said that I've got a plan and that we're working on it. I'm pleased with the progress that's being made. Also, I know the member's concerned about the "best before" date and the number of Health ministers. That's why, when I took the job, I signed it on the condition of a five-year no-cut, no-recall contract. So I'll be around for a w