2005 Legislative Session: First Session, 38th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, NOVEMBER 15, 2005

Afternoon Sitting

Volume 4, Number 9

CONTENTS

Routine Proceedings

Page

Introductions by Members

Statements (Standing Order

25 B )

Guru Nanak

D. Hayer

Medical services in 100 Mile

House and Williams Lake

C. Wyse

Toastmasters accomplishments by

Angela Louie

R. Lee

Tigers and Dragons exhibit

J. Kwan

Zajac Ranch

R. Hawes

Universal Athletics Club

J. Brar

Oral Questions

Call for independent review of

children's deaths

C. James

Hon. J.

Les

Hon. G.

Campbell

A. Dix

Austin

Farnworth

J. Kwan

Manufacturing jobs in coastal

forest industry

Simpson

Hon. R.

Coleman

Fleming

C. Evans

Government action on shortage of

skilled workers

Robertson

Hon. C.

Hansen

Supply of skilled workers to

rural communities

Simons

Hon. C.

Hansen

CN Rail commitments on safety,

maintenance and environmental protection

Chudnovsky

Hon. K.

Falcon

Reports from Committees

Select Standing Committee on

Finance and Government Services

Lekstrom

Karagianis

Committee of Supply

Estimates: Ministry of Health

(continued)

Cubberley

Hon. G.

Abbott

H. Lali

J. Brar

Trevena

C. Wyse

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Education

and Minister Responsible for Early Learning and Literacy

(continued)

Hon. S.

Bond

C. Evans

Austin

Trevena

Macdonald

J. Kwan

Horgan

Routley

H. Lali

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TUESDAY, NOVEMBER 15, 2005

The House met at 2:02 p.m.

Introductions by Members

D. Hayer: Visiting here today in the parliament building, we have Kim Bolan, a reporter with the Vancouver Sun and a great writer, who also wrote a book on loss of faith and who knows a lot about the Sikh community and Indo-Canadian community. Could the House please welcome her.

N. Simons: Today in the House I would like to welcome Chief Stan Dixon of the Sechelt Nation along with councillors and former Chief Gary Feschuk, former Chief Tom Paul and Marita Paul, along with three people who helped the band do the work they're doing: Brian Woodward, Cam Forrester and Allan Donovan. I'd like the House to please make them welcome.

J. Nuraney: We have in the gallery today what I consider to be three very important people who keep our film industry very competitive in our province. It is such a very important part of our economy. We have Dusty Kelly, who is a business representative of IATSE Local 891. She's accompanied by Howard Storey and Rob Morton, the president and treasurer, respectively, of the Union of B.C. Performers. May I ask the members to please make them welcome.

M. Karagianis: Today in the precinct we have a number of guests here on behalf of the Special Olympics. It is my great pleasure to also have my son Nigel Gamracy here, who works with Special Olympians. He has 15 individuals right now that are going to be competing, and I see some of the members here in the House today. I hope you will all join me in making them welcome and wishing them the very best of luck.

[1405]

R. Sultan: We have in the galleries today two grade six classes from Ridgeview School in West Vancouver along with ten parents and two other Ridgeview staff members. These children have come today with a special assignment. They are to focus on various systems of government. They've been learning about various forms of democracy, but they've also been learning about dictatorships, coups and anarchy. I'm looking forward to meeting with them after this session to find out their

interpretation of what they've seen here in Victoria. Would you please make them welcome.

G. Gentner: It is with great pleasure that I, too, introduce students from Delview Secondary School. Not all of them are here now. They were here earlier seeing the stimulating debate during estimates in health. There are still a few that have trickled in. Would the House please make the Delview Secondary School students welcome.

R. Lee: In the House today I have the pleasure to receive a group of distinguished Toastmasters and their families as my guests. Angela Louie from Burnaby Mental Health and Addictions Services recently won a second-place trophy in the Toastmasters International world championship of public speaking. Accompanying Angela are members of her family: Allan de la Plante, Mary Louie, and her children Bajan Oates, India Oates and Keane Oates.

Together with them is Diana Cheng, president of Toastmasters of Today, who has won three Toastmasters of the Year awards in the club level. I'm also pleased to see her husband Peter Lau and Toastmaster Gladys Chiu.

Last but not least, it is my pleasure to meet Anne Krammer, immediate past governor of District 21 Toastmasters. Would the House please make them welcome.

C. Puchmayr: I'd like to make a friend welcome — Tim Bailey, who is a member of the International Association of Firefighters and who has been in the gallery for the last couple of days. I think he has drawn triple duty. Please rise and make him welcome.

Hon. G. Campbell: I know the House has already been made aware of the fact that British Columbia's Special Olympians are here with us today. This is the 25th anniversary of the British Columbia Special Olympics. I want to take a moment to say thanks to all the Special Olympians on behalf of all the members of the House and the people of British Columbia for the exceptional example that they set for all of us.

We have proclaimed the week of November 20 to 26 as Special Olympics 25th Anniversary Week in the province of British Columbia. On behalf of all the House, I would like to say thanks to all of them for their commitment, their dedication, their leadership and, most importantly, the example they set for all of us of individuals striving to be the best they can possibly be.

G. Robertson: In the House today I would like to welcome a friend and colleague from the business world in Vancouver, Mr. Joel Solomon, who joins us — a great proponent of sustainable business and community activism in Vancouver and the lower mainland in general. Would the House please make Joel welcome.

Hon. G. Campbell: The students of Ridgeview Elementary School from West Vancouver are here with us today in the precincts. There are two very special students here, Jamie and Michael Heale, who are occupants of the same beach where I am in the summer. I want to say thanks to Jamie and Michael for leaving me alone and getting on with their life in the summertime. I hope the House will make them both welcome.

Hon. J. van Dongen: Today in the gallery we have a very special delegation from the Netherlands. This delegation is on a fact-finding mission to discuss and

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learn more about electoral reform. The delegation is led by Jan van Schagen, project leader, civil forum electorate system. Accompanying him are Cora van der Meer, PR advisory for the delegation; Rachel Broekmeulen, project secretary; and Marleen van Fessem, the deputy project secretary. They are accompanied by Joop Corijn, consul general of the Netherlands. I ask the House to please give them a warm welcome to British Columbia.

[1410]

Statements

(Standing Order 25

b) GURU NANAK

D. Hayer: Today we are celebrating the birth of the founder of the Sikh religion, Guru Nanak Dev Ji, born in 1469. Guru Nanak represented much of what the Sikh religion stands for. He was a positive leader, embracing other cultures and studying other religions. His devotion clearly showed his deep conviction that people needed a new prophetic message.

The most fundamental shift in thought was Guru Nanak's declaration of the brotherhood of man. This principle formed the foundation of Sikhism. He spent 25 years of his life travelling to Asia and the Middle East, preaching his new religion.

Guru Nanak believed in the casteless society. There would be no distinction based on birthright, religion or sex. He began that common kitchen called "langar" where all can sit together and share a common meal, whether you are a king or a beggar. He showed the true path to humanity with his teachings.

Guru Nanak persuaded the people to lead a moral life. He asked them to follow these principles: always speak the truth; don't take possession of things which don't belong to you; earn your living by honest means; and don't injure the feelings of others. Guru Nanak used to say that goodness and evil both run parallel, but we should adopt goodness and struggle against the evil. Having spread the message of change throughout the world, Guru Nanak was successful in challenging and changing and questioning existing philosophies and laid the foundation of Sikhism which we are celebrating today in this House.

MEDICAL SERVICES IN

100 MILE HOUSE AND WILLIAMS LAKE

C. Wyse: I rise in the House today to recognize the improvement of medical services provided in the Cariboo communities of 100 Mile House and Williams Lake. It is important to recognize both Interior Health and the Cariboo regional hospital district for their financial contributions to these projects. Equally importantly, the members of this House also must be advised of the contribution made by volunteers to both of these projects.

In 100 Mile House the former health council began the planning and instituted the renovations to develop a community health centre, involving hospital services, public health and seniors care on one site. The newly renovated emergency room and laboratory are part of that vision, developed and started in the 1990s.

Locally the South Cariboo Health Foundation raised about $750,000, with a significant portion of that sum coming from the Elgrin Lockridge Estate. In Williams Lake a CT scanner as well as a new renal unit and tele-thoracic services are added to Cariboo Memorial Hospital.

Likewise, in the 1990s the local health council incorporated in its redevelopment plans a room to house a CT scanner, made for the day a scanner would be purchased. In addition, the Cariboo Foundation Hospital Trust will raise more than $700,000 towards its purchase.

In closing, I ask the House to recognize not only the local foundations and their volunteers under the leadership of Sandy Foster in 100 Mile House and Carol Taphorn in Williams Lake but all individuals and organizations that contributed to both these projects being completed to serve the health needs of Cariboo residents.

TOASTMASTERS ACCOMPLISHMENTS

BY ANGELA LOUIE

R. Lee: Toastmasters is an organization whose mission is to make effective oral communication a worldwide reality. Toastmasters started in October 1924, when Ralph Smedley assembled a group of men together in the basement of a California YMCA to practise the art of public speaking. A club was formed, and now 81 years later over three million men and women worldwide have benefited from the communication and leadership programs that Toastmasters provides.

Toastmasters arrived in Canada during the early 1930s — to New Westminster and Victoria. In fact, the first club chartered outside of the United States was right here in Victoria, B.C. in 1935. Today there are about 200,000 Toastmasters worldwide in over 70 countries. In B.C. alone, there are now 261 clubs serving over 2,000 members.

[1415]

The most prestigious and recognized competition in public speaking is the Toastmaster International speech contest. Toastmaster Angela Louie has accomplished what no one else before her has done in B.C. — win three of the last four district contests. From there, the district winner competes in the regional level but has to compose a brand-new speech. Ms. Louie competed and won her regional contest in June 2005, defeating competitors from Alaska, the Yukon and the western United States.

Last August the ten regional winners met to compete for the title of world champion of public speaking, an event that can be likened to the Olympics of public speaking. Ms. Louie had the honour of representing her region, but more importantly, she represented all British Columbia when she stood on the world stage and held aloft the silver trophy. I would like the House

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to join me in recognizing the achievement of Toastmaster Angela Louie.

TIGERS AND DRAGONS EXHIBIT

J. Kwan: I rise in this House to let the citizens of British Columbia know about an exciting exhibit that will tour Vancouver for eight months next year, premiering at the Vancouver International Children's Festival.

Tigers and Dragons: China and India for Kids is a hands-on exhibit that will teach children and families about two of the most important countries in the world and two of the most prominent cultures in British Columbia. This is the first exhibit produced by Kids Around the World Children's Museum Society, whose mission is to promote intercultural understanding, global citizenship, and environmental, economic, social and cultural sustainability.

Children's museums are magical places where children and their caregivers can explore and learn together in a hands-on environment that incorporates the very best in early childhood education. There are more than 200 children's museums in the United States but only six in Canada and none west of Winnipeg. Tigers and Dragons offers a high-quality proof of concept of what is to come in the permanent museum, which will celebrate all the countries and cultures around the world.

Tigers and Dragons allows children to practise a range of important developmental skills and gain a sense of intercultural understanding. The 1,000-square-foot exhibit includes, among other things, an Indian kitchen, a Chinese market and a climbable version of the Himalayas. I'm pleased to advise that Tigers and Dragons is under the distinguished patronage of the Hon. Iona Campagnolo, the Lieutenant-Governor of British Columbia.

Kids Around the World also has the support of four well-respected honorary patrons — Thomas Berger, Leon Bibb, Ian Hanomansing and Judith Marcuse — and has received many letters of support from key individuals and organizations. Won't you please join me and join those who have been working hard on this special project in helping bring a children's museum to Vancouver. They accept funding from all sorts of people.

ZAJAC RANCH

R. Hawes: All kids should experience the joy of going to a summer camp, but unfortunately, there are many who suffer from debilitating or life-threatening conditions that preclude them from this adventure. Now one of B.C.'s best-known philanthropic organizations, the Zajac Foundation, is doing something about this. In 2003 the foundation, headed by Mel Zajac and his daughter Carmen, purchased Stave Lake Correctional Facility when it closed. Their vision was to transform it into a camp for these special kids designed to improve self-esteem, confidence and quality of life. Raising the spirits of children with life-threatening illness is the simple objective of this camp.

Set on the shores of Stave Lake in Mission, the camp and its distinctive western theme offer kids experiences including swimming, horseback riding, canoeing, campfires, storytelling and specific therapy programs. There's a fully equipped medical centre under construction, offering everything from first aid to full dialysis. Cost to the camper to attend — nothing. The camp is run as a benevolent, philanthropic venture with no cost to the kids who go there.

[1420]

I've been there many times, and I can say that every visitor becomes an enthusiastic supporter. Even the hardest heart will be touched by this wonderful project after seeing the joy of young campers — many for the first time — experiencing what normal, healthy kids take for granted. The Zajac Ranch website says it all as it speaks to kids who might want to come.

At Zajac Ranch, you will have tons in common with the other campers. All the campers who come know what it is like to be sick or have a disability. That's why you'll feel totally comfortable here. No one will ask you about your medication or scars, and you can talk about the different experiences you've had with other campers, and they will really understand. You can make special friendships that you can keep in touch with long after the camp is over.

I urge all members to visit http://www.zajacranch.com and do what you can to help kids with debilitating illnesses by assisting with the fulfilment of this wonderful Zajac vision.

UNIVERSAL ATHLETICS CLUB

J. Brar: I rise to inform the House about the wonderful youth sports event held on November 6 in Surrey, organized by Universal Health Athletics Club under the leadership of Jessie Dosanjh, a close friend of mine.

I would also like to mention the names of two young constituents of my riding of Surrey–Panorama Ridge that were among the sports people recognized for their achievements at this event. Their names are Gurjot Bal, who won this year's Vancouver Sun Run in his age category, and Monica Kang, who was recognized as a high-performing athlete.

As a past sports person myself, I recognize the importance of sports to ensure that the energy of our younger generation remains channelled in the right direction and that they learn the importance of teamwork and team building. My own experience as a national basketball player has given me an added appreciation for anyone that endeavours to engage our youth through sports activity. That's why I would like to say thanks to Jessie Dosanjh and all members of the Universal Athletics Club for all their work and activities and to congratulate them for promoting sports and physical activity among Surrey youth.

The club provides a safe and fun environment for young players, promotes cooperation and better social

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skills, and improves the level of physical fitness in my community. However, it is disheartening that

whereas our community leaders are making more than their fair share, we continue to remain in serious need of adequate sports facilities and coaching staff. I would urge all members of this House to make every effort to support the work done by organizations such as Universal Athletics Club and make the well-being of our younger generation their top priority.

Oral Questions

CALL FOR INDEPENDENT

REVIEW OF CHILDREN'S DEATHS

C. James: My question is to the Premier. Three years ago this government sent letters to 80 families — we now learn today it may be more than 80 families — informing them that the investigations into the deaths of their children were suspended.

My question to the Premier: who made the decision to suspend these child death investigations, and who made the decision to send those letters?

Hon. J. Les: I have been very clear, particularly over the last several days, that our interest is to make sure that these outstanding files are properly concluded. I have given instructions to my staff to, in fact, make sure that happens and to provide the coroner's office with the resources they need to conclude those files in an appropriate way.

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

C. James: Now, after the fact, we hear that the government is looking at all of these issues. But there is a great deal of concern about how this case has occurred.

In 1996 we heard the Premier stand in this House and demand to know why 49 cases were left behind in the transition period after the Gove report. We heard the Premier call these children "invisible children."

"When a child dies, investigate. When a child dies, pay attention." Those were the Premier's words. Now we hear that there are 80-plus forgotten children. Again to the Premier: you said you cared then. Now it appears you don't. What has changed?

[1425]

Hon. J. Les: I want to make it very clear that we have set a very high standard, which we expect to be achieved through the child-death review process in British Columbia as administered by the coroner's office. Where there are outstanding files, we will ensure that those files are completed to everyone's satisfaction — appropriately completed. I've already made commitments to do that and to ensure that the resources are available to ensure that happens.

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

C. James: In fact, there was a high standard set nine years ago when the Premier was the opposition leader. I'd like to quote his words. He demanded that the government of the day "act immediately to appoint an independent children's commissioner and immediately refer all 49 deaths for an independent review."

It's nine years later. He is now the Premier, and this government has lost all control over this issue. It's time for the Premier to step in. My question again to the Premier: why won't he take his own advice from nine years ago and immediately appoint an independent review of all of these deaths?

Hon. G. Campbell: Let me start by saying that when a child dies, I think we should pay attention. When a child dies, we should investigate. When a child dies, that investigation should be carried out by someone who is independent of political interference. That is exactly what took place when we changed the legislation.

My expectation today remains exactly what it was nine, eight, seven, six, five and four years ago. I expect children's deaths to be investigated. If there is a question of resources, we have been very clear as a government that we will provide those resources. If there's a question of review power, we will make sure that we have the proper review power in place.

The issue for us is pretty clear. We watched as the coroner carried on his obligations. In fact, every year — four out of five years — his budget was below what was allocated for child death reviews. Last year in the spring, we were informed that there may be a requirement for additional resources. Additional resources were put in place. The Solicitor General has said that if additional resources are required, they will be put in place. We have a blue-ribbon panel headed by Mr. Hughes that will come forward, and if there are legislative changes that need to be made, those legislative changes will be made.

Everyone in this House is concerned and should be concerned if a child dies in British Columbia. We have established through legislation that those deaths will be investigated. There clearly has been a problem. The problem is going to be fixed, and children's deaths will be investigated in this province so that we learn and improve on the quality of support we provide to children across British Columbia.

A. Dix: The Premier's words say: "When a child dies, investigate." His actions say: "When a child dies, don't investigate." Eighty cases, I say to the Premier, shelved, stopped; investigations stopped — 80 cases. Today we learn from the Solicitor General that that number may be a great deal more. How many? He doesn't know.

Yesterday outside this House the Solicitor General was asked why his predecessor did nothing on this issue, and he said: "You'll have to ask him." Well, I

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want to ask the Solicitor General today: has he asked the Minister of Forests and Range why he did nothing on this issue, and did the Minister of Forests and Range provide any explanation for three years of negligence?

Hon. J. Les: I want to make it very clear to all members of the House that today I am the minister responsible for resolving these issues and ensuring that we have a child-death review process in the province of British Columbia that meets all of the high standards that we have set as a government for these processes.

[1430]

I also want to advise the House that it has come to my attention as recently as noon today that there is possibly a significant number of additional outstanding files. I am having that information developed as we speak, and I will be releasing that information as soon as that is available.

Mr. Speaker: The member has a supplemental.

A. Dix: My supplementary is to the Premier, who has appointed three Ministers of Children and Families, two Solicitors General and two Attorneys General who have not acted to be in charge of this issue. The Premier said in this House in 1996, in asking for an emergency debate about 49 cases: "It is now time that this House speak with one voice and give clear direction to the Ministry of Social Services and to the Minister of Social Services. He must act immediately to appoint an independent children's commissioner and immediately refer all 49 deaths for independent review."

I say to the Premier: isn't it time he took personal responsibility for his government's failures and he personally referred all cases to a new independent children's commissioner?

Hon. J. Les: As the member opposite is aware, these matters are being reviewed as we speak by the Hughes committee in terms of any matters we might learn as to how we can improve the process. I want to underline again that we have set very high standards in terms of how these child death reviews should occur in British Columbia. We have the chief coroner of the province, who independently can enter into any appropriate investigations relating to child deaths in British Columbia. I think we have taken all of the measures to ensure that, certainly going forward, we have a process beyond reproach in the province.

And where there have been outstanding files from the past, I commit to the House today that all of those files are going to be brought up to date in an appropriate way.

R. Austin: The Solicitor General's version of the story just doesn't seem to add up. He said he found out about the forgotten children a month ago, but in March the chief coroner said his office would look into deaths that took place around the time the Children's Commission was closed. So the chief coroner knew that some cases had been abandoned. The Solicitor General at the time would have known too.

Can the current Solicitor General explain why this information never made it to his desk or why his predecessor didn't take action last March?

Hon. J. Les: While it is clear that a number of files remain outstanding, it is absolutely false for the member to suggest that files were abandoned. These files have not been abandoned. They will be appropriately concluded.

Mr. Speaker: The member has a supplemental.

R. Austin: Maybe not abandoned, just temporarily lost.

After all the questioning and all the revelations, one thing is clear. Multiple members of cabinet have failed. The Attorney General didn't know his role. The Minister of Children and Family Development acted only after massive political pressure. The current Solicitor General can't answer basic questions, and his predecessor, who is still sitting at the cabinet table, led a ministry that forgot 80 child death reviews. Still, not one of these ministers seems to know what's going on here.

It's time for the Premier to take control of this spiralling situation so the public can move past the incompetence of his ministers. Will he ensure that all 80-plus deaths are referred to a children's commissioner for review and live up to his own standards?

Hon. J. Les: Mr. Speaker, I have already indicated to the House that I am going to take the responsibility to ensure that all of these outstanding files are dealt with appropriately, professionally and to the satisfaction of everyone. Again I say that we have set a very high standard in British Columbia. We want to be leaders in terms of child death review, and to the extent that there are outstanding files, I want to make it my personal responsibility to ensure that those are dealt with appropriately.

M. Farnworth: Today and over the last few weeks we've heard that there was no transition plan. We've learned how the government, the Premier, made cuts that impacted on the ministry — the elimination of the children's commissioner, more than 80 missing files. In fact, they don't even know how many missing files there are. The minister talks about high standards. My question to the minister is: does he believe that those are high standards?

[1435]

Hon. J. Les: We have already been very clear, I believe, that these outstanding files are unacceptable. I have taken steps and put measures in place to ensure that those files are properly dealt with. We want a child-death review process in British Columbia that is second to none. I'm going to, along with the help of my colleagues, ensure that that happens.

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J. Kwan: What's clear is this. Yesterday the Solicitor General called those 80 forgotten children's files drive-by allegations. Today he told the media that there are more cases from 2002 that are lost, but he doesn't know exactly how many children were forgotten in the shuffle through the transition period when the children's commissioner's office was closed.

That completely flies in the face of his comment that he discovered the problem a month ago and that he was doing everything he could to fix it. He doesn't even know how many children's files have been lost through that transition period. Clearly, this minister doesn't know what he is talking about, and he cannot get his story straight.

Let me go to the Premier, who is the head of the executive council — to take some responsibility for the actions of this government to date and to do the right thing. Do the right thing by reinstating an independent children's commissioner and having those 80 files reviewed immediately and ensuring that this never, ever happens again.

Hon. J. Les: We are in fact taking all of the steps necessary, I believe, to ensure that we have a child-death review process that is beyond reproach. We are dealing with the outstanding files in a responsible way. I've already indicated to the House that hopefully as early as later on this afternoon, I will be able to update the public as to the exact state of those files and how many of them there are.

I want to be open and transparent about this process. I would ask the member opposite not to presuppose what the recommendations of the Hughes committee might be with respect to the children's commissioner. I think that together, we should await those recommendations.

MANUFACTURING JOBS

IN COASTAL FOREST INDUSTRY

B. Simpson: The Minister of Forests and Range has indicated a number of times in this House that he's working with the Coast Forest Products Association on a strategy for the coast forest sector. To the minister: does the strategy he's working on involve a substantial increase in the export of raw logs to China?

Hon. R. Coleman: No.

Mr. Speaker: The member has a supplemental.

B. Simpson: I think that's a record for the shortest answer.

The minister has talked about a marketplace adjustment that is necessary for the coast forest industry. As we found out today in an

article in the Vancouver Sun , it appears that this adjustment is simply to shift our manufacturing capacity over to China and then to help China compete in our own markets.

My question to the minister is this. How can we have a strategy that the Coast Forest Products Association is working on, which the minister says does not involve an increased shipment of raw logs? Does the minister support the Coast Forest Products Association strategy and the export of British Columbia jobs to China?

Hon. R. Coleman: The member is referring to a PowerPoint presentation that was done by the Coast Forest Products Association on May 6, 2005, to a bunch of international people. It was actually some wood products forum they were at. It has nothing to do with government. It was not a policy of government.

[1440]

The only thing the member has got wrong is that I'm working with the Coast Forest Products Association on a fix for the coast. That's not what I've said. I've said I'm sitting down with all the industry on the coast, all the participants on the coast, to look for a fix and a long-term strategy for the coast. One of the organizations I've met with is, no doubt, the Coast Forest Products Association. I've made it very clear to this organization that I do not support the points that were contained in that PowerPoint on May 6, 2005 — and will not, and neither will this government.

R. Fleming: That presentation was funded by this government. In fact, the taxpayers of British Columbia have given the coast forest industry association almost $3 million to develop markets for B.C. products. But today we find out that some of this money has gone to a China strategy that would have us abandon manufacturing jobs in British Columbia.

Will the Minister of Economic Development tell us: what other strategies are British Columbians paying for that will send jobs overseas?

Hon. R. Coleman: This was a PowerPoint presentation. This was not a policy of government. What we have done with organizations — and, actually, every government has done it — was work with trade organizations to try and find new markets for B.C. wood products. I think that's important. We are not going to send raw product over to China to be subsidized with Chinese labour to sell product back to British Columbia. It is not a policy of this government and will not be a policy of this government to do that.

Mr. Speaker: The member has a supplemental.

R. Fleming: A million dollars to come up with a plan to ship jobs overseas — now, that is what I call value for money. Does the minister support the Coast Forest Products Association's strategy? If not, what will he be doing to counter this strategy and grow our own value-added industry?

Hon. R. Coleman: In actual fact, we do have a value-added strategy that is coming forward very shortly, which has actually come across my desk, for British Columbia. The most important part of a value-added strategy is, frankly, for us to get to a deal with the U.S. and make sure it's a first-mill pricing so that

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our value-added sector isn't going to be disproportionately charged a duty or a tax when they ship their product to the United States, which is their largest and most major market. We are actually going to include in that strategy the ability to do that.

As we go forward, frankly, none of this strategy has anything to do with how the member couches it. The money that went to look for markets didn't go to try and find a way to ship a raw product and have it brought back to Canada cheap to buy it here. That is not the position of this government, and it was never the position of yours either. We in British Columbia have been pretty consistent on how we will deal with those aspects of the industry.

C. Evans: Yeah, well, I think those are great answers. So it kind of begs the question: if they were developing a new strategy and not the old strategy, when did the minister communicate that he didn't accept the old strategy? When did he communicate that he was going to develop a new strategy, and who's doing it for the minister?

Hon. R. Coleman: As soon as I saw that PowerPoint, I communicated that it wasn't on and that it was of no interest to this minister or this government to have any further discussion on that topic.

GOVERNMENT ACTION ON

SHORTAGE OF SKILLED WORKERS

G. Robertson: Speaking of government mismanagement, the skills shortage is no longer looming. It's here. Congratulations.

Interjections.

Mr. Speaker: Members. Members.

G. Robertson: Construction sites across this province are running behind

schedule and over budget. Businesses can't fill key positions. My question is to the Minister of Economic Development.

Interjection.

Mr. Speaker: Member, can we have some quiet, please.

Continue.

G. Robertson: My question is to the Minister of Economic Development. When will this government take action and implement a comprehensive plan for the estimated 40,000 new skilled workers that British Columbia will need by 2010?

[1445]

Hon. C. Hansen: The good news is that the Industry Training Authority is actually exceeding its targets, exceeding all expectations of the number of new registered apprentices that we have in British Columbia today. If you go back just 20 months ago when the ITA was first established, there were 14,676 registered apprentices in British Columbia. Today I am pleased to report to the House that there are over 23,000. They have set as a target that we're going to have 30,000 registered apprentices in B.C. by the year 2007, and they're well on track to exceeding that.

Mr. Speaker: The member has a supplemental.

G. Robertson: My farming background brings me to that age-old saying: don't count your chickens before they hatch. The Minister of Economic Development is talking about registrations and not completions of apprenticeship programs, and there's a very, very clear distinction between them.

The reality is that fewer and fewer people each year are getting credentials. Completion rates for apprenticeships are down by a shocking 44 percent since 2001. We need 40,000 new skilled workers by 2010 to replace retiring workers. According to the Industry Training Authority's own service plan, by 2008 the government will come up short by 32,650 workers.

To the minister again: when is the government going to initiate an action plan to accelerate training and completion of apprenticeships for our young people so British Columbians can benefit from our economy?

Hon. C. Hansen: The reason that completion rates are taking a little bit longer is because of the strong economy. You know, when the labour force survey came out just a week ago last Friday, it showed that British Columbia actually has a record low unemployment rate of 5.1 percent, the lowest ever recorded in the province. What we are finding is that for the first time in many, many years — certainly we never saw it during the 1990 decade of decline….

What we're seeing is that young British Columbians who want to get into the trades have opportunities not only for more education, more training opportunities, but they've also got opportunities for jobs. Mr. Speaker, that's great news for British Columbia.

Interjections.

Mr. Speaker: Members.

SUPPLY OF SKILLED WORKERS

TO RURAL COMMUNITIES

N. Simons: Yesterday we learned about the government's Industry Training Authority plan that will force rural colleges to cut programs. My question is to the Minister of Advanced Education. How does this program-cutting approach benefit B.C.'s rural communities?

Hon. C. Hansen: In fact, it's interesting because there is talk about…

Interjections.

[ Page 1806 ]

Mr. Speaker: Members.

Minister, just so we can have a little quiet so we can hear what your answer is.

Hon. C. Hansen: …a so-called leaked document that's out there. This so-called leaked document was in fact published in December of 2002 on the website of the Ministry of Advanced Education, which at that time was responsible for industry training. It has since been moved to the Ministry of Economic Development. What that document talks about is the need for some consistency in entry-level trades training throughout the province. What we have engaged in is a discussion with colleges and universities to actually get some standard approach so that a student in one part of the province is going to be facing the same kind of course requirements as a student in another part of the province.

Just to give an example, carpentry. In the College of the Rockies it's a one-year program. In Northwest Community College it's a 16-week program. We are actually endeavouring to bring some consistency throughout the province. It's an open and transparent discussion, and we invite all input, including that from the member.

Mr. Speaker: The member has a supplemental.

N. Simons: Mr. Speaker, I thank the minister for the credit for finding the leaked document. I'm going to tell my colleagues about that. My supplemental question is to the same minister. I'm not sure which one, but the same one.

[1450]

The chamber of commerce is warning that young people from smaller communities are being drawn to job prospects in our bigger cities. Over half of the businesses surveyed said that they are currently unable to fill positions in their communities. This government is failing to address the huge shortfall of qualified workers in small towns across this province. At the same time, the ministry is restructuring the funding for our colleges that will eliminate diverse training programs in those very same communities.

Interjection.

N. Simons: I'm glad to see the member across was awake.

I'd like to know what the minister is doing to ensure that rural communities will be able to attract enough skilled workers to keep their economies viable.

Hon. C. Hansen: We know that what happened during the 1990s is that many of those young workers from British Columbia…

Interjections.

Mr. Speaker: Members.

Hon. C. Hansen: …left to go to Alberta to seek employment opportunities.

Mr. Speaker: Members, we listened to the question. We'll listen to the answer.

Minister, continue.

Hon. C. Hansen: I had the pleasure last week of travelling through the northwest of British Columbia through Houston, Smithers, Kitimat, Terrace and Prince Rupert. Up there in the year 2001, when the NDP was still in power, they had an unemployment rate in the North Coast–Nechako region of 12.5 percent. Mr. Speaker, do you know what it was as of just a week and a half ago, when the labour force survey came out? It's down to 6 percent.

Unlike during the 1990s, when the unemployment rate used to go down because people left the workforce or left the province, what we've seen in the North Coast–Nechako region is a significant growth in the number of people employed in that region over the last four years under this government's administration.

CN RAIL COMMITMENTS ON

SAFETY, MAINTENANCE AND

ENVIRONMENTAL PROTECTION

D. Chudnovsky: On August 11, I wrote the Minister of Transportation and asked him whether the government had discussed safety, maintenance and environmental protection with CN during the privatization of B.C. Rail. So far, no answer. Will the minister tell the House today whether the government brought these issues to the table with CN, what commitments the government sought from CN, and what commitments were made by CN as regards safety, maintenance and environmental protection?

Hon. K. Falcon: Actually, I responded to the member, as I recall, and I made it clear to the member that I would forward his letter to the federal Minister of Transport, which I did. We've addressed those issues.

Mr. Speaker: The member has a supplemental.

D. Chudnovsky: There seems to be a theme developing here from the other side of the House which is: if there is a problem in B.C., we should go to Ottawa to get it solved.

Is the minister — the same minister who never asked CN to shorten its trains from the time of the first derailment to the time that the federal minister finally acted — telling the House that the government didn't once in the entire process of privatizing B.C. Rail mention safety, maintenance or environmental protection — didn't have a discussion, didn't ask a question, didn't seek one commitment from CN? Is that what the minister is telling this House and the people of British Columbia today?

Hon. K. Falcon: Well, here we go again. It's time to give the Transportation critic a lesson in the fact that it's actually the federal government under the Canada Transportation Act that regulates the railways. What I

[ Page 1807 ]

would say to that member is that if he would actually pay attention to the discussions we've had in this House, we canvassed this very, very thoroughly. We spoke to the president of CN, senior executives at CN, and I spoke to the federal Minister of Transport. They made it very clear that the Transportation Safety Board has an investigation underway.

The member opposite apparently has all the answers. He already knows, apparently, what these derailments are a result of. But actually the public doesn't know that. The public won't know that until we get the results from the Canada Transportation Safety Board. I will wait for those scientific results until we know what the real problem is.

[1455]

[End of question period.]

Reports from Committees

B. Lekstrom: I have the honour to present the report of the Select Standing Committee on Finance and Government Services for the first session of the 38th parliament respecting the 2006 budget consultation process.

Hon. Speaker, I would move that the report be taken and read as received.

Motion approved.

B. Lekstrom: I would ask leave of the House to suspend the rules to permit the moving of a motion to adopt the report.

Leave granted.

B. Lekstrom: Hon. Speaker, I would now move that the report be adopted, and in doing so, I would like to make some brief comments. This year the Select Standing Committee on Finance and Government Services heard from 4,436 British Columbians in our consultation process. This was regarding the upcoming provincial budget, and this level of participation sets an all-time record for public input to any parliamentary committee in the history of our Legislative Assembly.

The report, which was unanimously adopted by all committee members, contains 21 recommendations addressing the fiscal and budgetary priorities of our province. Overall, the committee heard and found that British Columbians were calling on the government to pursue a balanced approach when allocating the surplus funds. This balanced approach includes measures to enhance our economic competitiveness, to invest in infrastructure projects, and to support access to social programs for individuals and communities.

The committee report makes specific recommendations in key priority areas, including a long-term debt management plan, investments in transportation infrastructure, fair and reasonable wage guidelines for public sector workers, and a gradual reduction of the provincial sales tax.

In closing, I appreciate this opportunity to move the adoption of the committee's report, and I would like to thank all British Columbians who took time to provide us with their thoughts. As well, prior to closing, I would like to extend my sincerest appreciation to all of the committee members as well as the staff that worked so hard to bring this report together in such a short time frame. I'm proud to be Chair of a committee that had such great workers and great help and support, and I thank the members here today.

M. Karagianis: As the Deputy Chair of the Select Standing Committee on Finance, I, along with my other colleagues on this side of the House, would also like to extend my thanks for the committee's work to everyone who participated, including the individuals and groups from across the province who submitted presentations to us. I would also like to thank the Chair for the way in which the committee ran and the way that issues were handled from both sides of the House. I appreciate very much his cooperative nature.

The opposition caucus, in accepting this report, would like to acknowledge that certainly we heard from many people and many individuals across the province who were not included in this report. This, we believe, was a function of time and the structure of the process only. Legislative committees are not a creature of government. In fact, they are the responsibility of the Members of the Legislative Assembly and belong to the province of British Columbia.

Therefore, we would join the other members of the committee in saying that we have some suggestions to put forward for how the system can be improved next time around, and we look forward, in fact, to working with the other committee members in finding ways to improve the process so that we can all serve the community better.

I think it is imperative that the committee go to communities with questions that are timely and that reflect the public's desire to have a real role in shaping policy and priorities. We need to work together to develop questions that give individuals and groups the opportunity to contribute to the process, and we must work together to ensure that more is done to facilitate consultation.

[1500]

There needs to be a strong commitment from both sides of the House to increasing public awareness. There are many examples of important issues in this province that did not make it into the report or get the attention they deserved in the process — groups like the aboriginal community, the ethnic communities. Members who are marginalized, in fact, often do not have a voice with which to present to government.

I think all of us recognize that the process this time around was an anomaly and that we will see a different process in the future. I think we all want to strive to do a better job of representing the people of our province and to allow them to participate in this process.

We do know that the time frame this year was a problem. It did not allow us the kind of consultation across the province that we would have liked. It was

[ Page 1808 ]

foreshortened. We would actually like to work with all members of the committee to improve the process next time around so that it is a much more productive report.

Saying that, you do have our unanimous support in this.

Motion approved.

Orders of the Day

Hon. M. de Jong: Mr. Speaker, I call Committee of Supply. For the information of members, in this chamber it's the Ministry of Health. In the little House it's the continued estimates of the Ministry of Education.

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section B); S. Hawkins in the chair.

The committee met at 3:05 p.m.

On Vote 34: ministry operations, $11,323,248,000 (continued).

D. Cubberley: So we left off, I think, with a couple of tagged-on questions around long-term care beds, acute care and some other things. Unless the minister is passionate at this point about making further comment on it, I'm going to suggest we go into another area.

Hon. G. Abbott: There were a couple of points I wanted to make around the wait-times information that had been advanced by the member. Perhaps their appreciation of the Fraser Institute is stronger than ours is on this side of the House. I have no brief for or against the Fraser Institute. The members opposite may have a stronger attraction towards the work that's produced by the Fraser Institute. I know they based a news release around the Fraser Institute report, and that's fair enough.

The only problem…. Well, among the problems with the Fraser Institute analysis around wait times is that they drew their conclusions only from the polling of a relatively small number of physicians. In contrast, the data that the ministry has in relation to wait times is based on not only physician consultation but also admissions and discharge data from hospitals, information from health authorities and other sources. It's a much broader-based analysis than one would find in the Fraser Institute report.

Again, people form conclusions based on a variety of things. I do think that what we're able to offer in terms of rigorous analysis leading to conclusions about wait times is stronger from the ministry perspective than the results that are indicated by the Fraser Institute's reports.

D. Cubberley: Well, just on that, I wasn't championing the Fraser Institute per se or the report in particular. Like the minister, I've read it. He's clearly conversant with it, and there were a couple of interesting things in it which I didn't hear the minister actually counter. So I would just come back to them.

One of them is that British Columbia has a longer median wait time for access to orthopedic surgery — substantially longer than the national average of access. We know that orthopedic waits are the most troubling category of waits that we deal with. So I was using it in the sense of providing a reference which was available and not trying to say that those numbers are absolutely accurate. It's more a question of an indicator.

The other thing that we think was interesting in the information provided by the Fraser Institute report indicates that as limited as the sample is — something like 35 percent or 40 percent responding — the access to GP and initial analysis appears to be contemporary with the amount of time it takes people to get through that part of the process in other parts of Canada. But the actual time taken from seeing the surgeon, completing diagnosis and getting approval for surgery, that part of the process is substantially longer in British Columbia than the Canadian average.

[1510]

I'm not arguing in favour of those numbers. I'm trying to analyze and, through questioning, probe the ministry's understanding of where the bottlenecks in our system are and where the emphasis needs to be placed in order to remedy that.

I do come back to the fact that the context we're in today is one that…. Whether we are directly affected by it or not, public health policy is directly affected by the Chaoulli case at the Supreme Court, which determined that an individual waited too long for access specifically to orthopedic surgery. That decision is hung on a wait for what we deem is an elective surgery, which, I believe, is a class of surgery that tends to get put off more by its nature and to have longer waits because it's deemed to be less medically urgent.

The whole focus is on trying to find where the correction needs to be applied, and I'm simply probing and not championing the numbers of the Fraser Institute. I'll leave it to the minister if he wants to answer that further; if not, I would like to move on.

Hon. G. Abbott: Again, the conclusion that one might draw from a body of data is going to be…. The accuracy of what is predicted by that analysis is going to be dependent on the accuracy of the data that is put into the model. As I've indicated, the challenge with the Fraser Institute data is that it's drawn from a very narrow base. Just some physicians are polled in respect of, you know: "How are we doing?"

[ Page 1809 ]

The challenge with that is that it does yield what is supposedly, in their view, the longest median wait time for orthopedic surgery at almost 50 weeks. That is strongly at odds with the discharge and admission data from all the hospitals in the province which forms, along with a number of other factors, our conclusions about what median wait times for hip and knee replacements are.

In terms of hips and knees, we have 29.3 weeks for knees and 23.3 weeks for hips. Again, that's based on discharge and admission data primarily but others as well. Recall, as well, that those numbers reflect a 65-percent increase over four years in the number of procedures that are being done in terms of knees and a 35-percent increase in the number of procedures that are being done for hips. So there's lots more work being done and a lot more procedures being done, and that's good.

As our discussion of yesterday pointed out, there are lots of initiatives underway to extract as much efficiency as possible from the system to ensure that for every taxpayer dollar that is expended in this area, we get the maximum public benefit. But, again, a wait time is going to be a product of two things: not only the availability of the procedures and the availability of the human resources that are required — nurses, doctors, anaesthetists and so on — to do the procedures, it is also going to be a product of the demand.

[1515]

Again, while the number of hip and knee surgeries is up 35 percent and 65 percent respectively, the demand curve is as strong or stronger than that growth in the number of procedures. So, you know, there is a continuing challenge here. It is rooted largely in the demographic character of our society as an aging society, but all of these factors are at work. I think it's unfortunate that people work really hard to try to reform a system and then they're confronted by studies that are based on partial data that are not reflective of what's actually happening in the system.

People are free to do that. We live in a great democracy, and it is always possible for anyone who has a pencil to tell the world what they think about something, and that's fine. We hope that when they do that, they base it on some empirical relationship to what's actually happening in the world, but it is not always so. Again, I think the Fraser Institute is headed in a certain direction, often ideologically, and I think we'd appreciate them working with more comprehensive data so that the conclusions they formed were based on more compelling evidence than what we have today.

D. Cubberley: I would certainly agree with the minister that paper puts up with anything that's printed on it, and that is a problem in one sense, because anything can go into circulation. I don't defend the methods of the Fraser Institute by any means. I think that last time I looked…. Perhaps I was reading a

summary study that Statistics Canada, which releases wait times data, puts a very large caution around the accuracy of the data that it releases on wait times. It is not sure that it is comparing like with like, quite clearly, and I would suspect in a general sense that the problem we face is coming to a uniform set of standards for how we actually generate data on wait times.

So when the clock begins ticking is probably an important factor. Does it happen when the surgeon books the surgery at the hospital, and we calculate the wait time after the surgery is booked, or is it from the time that the doctor does preliminary diagnosis and says: "You need to visit a surgeon, because I believe there's a problem"? That's obviously going to affect how we look at wait times and how long those wait times appear. I think probably over time, as we spell out our assumptions about how we plot wait times, we will come to a better public understanding of what it is we're talking about. But that's an ongoing work, and I don't think we'll wrestle that to the ground this afternoon.

So I would propose that we move into another area of equally interesting discussion, and I believe that we had suggested we'd look at enhancing primary care — primary care reform as another area.

I just wanted to begin with a brief comment. Looking over the service plan update gives you an opportunity to look at the goals for the system, and obviously one of the goals — goal number two — is high-quality patient care. Under "Ministry objectives," which are on page 16, in relation to high-quality patient care, it gives "timely access to appropriate health services by the appropriate provider in the appropriate setting," which is a good objective. Under the "Key strategies," one of them is enhancing primary care. So one of the vehicles for improving the quality of patient care is to enhance primary care and presumably improve access to it.

As a comment, though, in looking at the "Performance measures" section, given the overall importance of access to a physician, the fact that in British Columbia and in other provinces in Canada it is increasingly a struggle for many people to have the kind of access they would like or develop a relationship on an ongoing basis with a GP….

In looking at the performance measures there are three given, and none of the performance measures relate to what the layperson like myself understands as access to primary care, which is getting to see a physician or other health care practitioner around general problems or around a testing or screening process for problems that might be occurring but have not given any particular sign. The three performance measures have to do with access to residential care, access to chemotherapy and radiotherapy and hospital admission from emergency departments.

Those are all important elements, but I don't immediately or intuitively connect those to primary care.

[1520]

In thinking about renewal and reform of primary care, I'm wondering if you would like to comment on the fact that there isn't a performance measure that appears to relate to it.

Introductions by Members

The Chair: Members, with the indulgence of the committee, the chair would like to make an introduc-

[ Page 1810 ]

tion. I see we're joined in this House by members of the Red Hatters club. I had the privilege of being inducted into a local club in Kelowna, the Red Hot Divas. In my experience with the Red Hatters, it's more about fun and laughter and enjoyment, so I can only imagine what they're doing here with us today. Would the House make them welcome.

Debate Continued

Hon. G. Abbott: I thank the member for his question. I'm glad the opposition is canvassing this area, because primary care is really a growing area of importance in the health care delivery system. There are a number of real and expected benefits that can flow from having good primary care resources strategically located across the province. I'll go into a few of those.

First, to address the member's question about why there isn't a specific performance measure around primary care. The challenge is that, relatively speaking, the Ministry of Health has been an overperformer in terms of identifying lots and lots of performance indicators. The Auditor General has indicated, in fact, that if you can ratchet it down a little bit and kind of focus in on some of the key ones from, I guess, a broad perspective…. That's part of the challenge here.

Health is a big world, and there are a lot of important areas in that world. It's tough to have all of the performance measures we might like because they would get very extensive if we tried to do them all. But notwithstanding that, primary care is something that we want to excel in, because we believe that it is fundamental to excellence in the future in the health care system.

[1525]

It was identified as an important element in the first ministers' accord of September 2004, and 24-7 access to primary care is something that provinces report on regularly and something that we believe is very important from an access perspective, physician supply perspective and so on.

Good primary care is something that we want to do, because we do believe that it can be the foundation of a strong and increasingly excellent health care system. If we are doing an excellent job of primary care, it can divert people who might otherwise find themselves inappropriately, for example, in an emergency room, because some of those issues, unless they're resolved outside of that forum, might find their way into emergency rooms. Also it eases, generally, on the acute care side. We're finding increasing interest from physicians in finding a new model of primary care that will work for them.

I think the one thing that is sometimes lost in the fee-for-service model, with the need to roll over patients or clients on a regular basis in a fee-for-service system, is the opportunity for longer consultations on issues like chronic disease management or even counselling on cessation of smoking — those kinds of things. We need to build more opportunity to be able to help people manage their own lives better.

D. Cubberley: The minister has embarked a little bit into where I wanted to go, which is the direction for renewal and reform of primary care. Primary care teams are obviously one approach to reforming the system; an association of practitioners of various kinds which could simply be more than one doctor but could also include many skill sets that are not under the fee-for-service structure — everything from nurse practitioners and therapists to nutritionists. Obviously, that kind of model would afford much greater opportunity for the incorporation of aspects of preventive medicine into primary care.

I guess the questions are: does the minister see an expanding role for primary care teams in the delivery of primary care? Does the minister see problems with the existing fee-for-service structure in terms of enabling multidisciplinary care teams to get established and to be able to pay for the other services that don't fall under fee-for-service?

Hon. G. Abbott: I again thank the member for the question. I really believe this is a very exciting area in terms of public health policy, and I'm passionate in my belief in the future of a strong and growing primary care model.

[1530]

I've had some firsthand experience with this in the city of Enderby. Enderby Hospital was announced for closure, I think, about 1998. It was a very small acute care facility — I think four beds in its last phase — and the health authority concluded that it should close in '98. It actually was closed, I think, in 2001 or 2002 and was replaced by a primary care centre.

Initially, there was some skepticism in the community about it: "Well, you know, this isn't really a hospital. This seems like, you know, a second-rate substitute for a hospital." I think as time has gone on that people are embracing the new model in many ways. They're delighted, for example, that they can go into the primary care centre in Enderby and they can see a doctor, a nurse or a speech pathologist. They can get advice about lifestyle issues or perhaps some support from the drug and alcohol worker that is there on a regular basis.

[S. Hammell in the chair.]

It really is kind of a much more holistic centre than what would have been possible in the latter stages of the life of Enderby Hospital going into the emergency room. It's a different atmosphere than one finds in a hospital. Obviously, if you have a substantial medical emergency, a primary care centre is not the place to go. That's a given, but for a lot of the things that confront people — and chronic disease management might be one of them, some lifestyle crises might be another…. The best advice, for example, about FASD and how to make healthy choices during pregnancy is a very important issue at that centre.

To me, the centre embodies a lot of what is great in our system, and I think that the potential of this is going to grow over time.

[ Page 1811 ]

I was to a conference probably about two or three weeks ago now. I have trouble tracking all of these things in my busy schedule, but it was probably about three weeks ago. I went to a conference, which we were co-sponsors of, which was looking at opportunities for primary care and for collaborative models, not only in rural settings, where they probably would be more common, but in urban centres as well, where we are increasingly finding physicians kind of frustrated with becoming more business-oriented in a fee-for-service model, rather than dealing one-on-one with people, which I think is what originally drew a lot of physicians into it.

The one collaborative that was spotlighted in the primary care conference that I was at was a collaborative in the northern part of Vancouver Island where the doctor, the nurses, the midwives, the physio, the nutritionist and others were involved in a collaborative aimed at doing many of the things that, for example, the Enderby primary care centre would do, which is to try again to work as a team to deal with the health challenges that will be evident in communities on the north end of Vancouver Island.

Again, the folks that were there and spoke to it were, clearly, very pumped about the opportunity they have to build better health care up in that very beautiful part of Vancouver Island, and it's a model that works for them.

It's not a model that's going to work in every part of the province. My staff advises me that, in fact, across the province — and I don't know if I'd use the term models — there are 91 different approaches that are being adopted to primary care in different locations. Some of them, for example, are in places like White Rock, where the physicians there, at least some of them, have concluded that they want to move to a different model of care. We want to support them in that.

There is a challenge around that. When these issues come up, of course, ultimately it all kind of drifts back down to fee schedules and how we're going to remunerate people for different functions, whether they're in the fee-for-service model or whether they're in a primary care model. I don't think they all want to go on salary, but they want to have a different way of recognizing the kind of work that they are undertaking, because it is a variant from the fee-for-service model. That's part of the challenge that we will have as we move forward in our discussions with the B.C. Medical Association.

[1535]

As the member undoubtedly knows, there was the so-called GPSC agreement, which came to the consideration of the membership, or at least a portion of the membership, of the BCMA — I think it was in August — rejected by an approximate 58-42 margin. That was an attempt, largely developed by the BCMA itself, to try to put together a physician agreement that would capture the support they'd hoped, I think, of a very strong majority of their members. Regrettably — or not regrettably, I guess, as the case may be — it failed.

We still really need to try to work with the BCMA to see if there's a way that we can develop an agreement that will enjoy stronger support among the family physicians and the primary care physicians and so on across the province. We really do believe, powerfully so and passionately so, that this is a model that can provide better health care for the province.

D. Cubberley: Given that GPs historically have had lower incomes than specialists — and that, in and of itself, has been a problem in helping to keep people interested in being GPs — there's obviously going to have to be some method of incentivizing the kind of changes that we might want to see that would help people to engage in associated practice.

Without a great deal of knowledge of how the existing system works, if we have a fee-for-service model and the only way that doctors can be paid is by doing specific things with specific fees associated, then in order for them to put together a stable of other skill sets that would supplement or complete the range of services they offer and get people coming in at appropriate levels, they'd essentially have to do something like pool their billings and then find a way to retain staff within their total income, as I understand it — if they were doing that simply of their own accord.

A couple of questions. One is: are the ministry and the minister thinking about something along the lines of the BCMA recommendation that would put some additional funding in place that would enable the creation of multidisciplinary care teams, which would not simply be teams that are sponsored in some fashion by a health authority through some special device such as the creation of a clinic, but would allow doctors themselves to draw together into associated practices and form their own entities?

Perhaps I should just leave it there, but the question is: are we looking at reforms to the fee-for-service structure that go beyond adding a certain amount of money for a general consultation to try and make it a little bit richer for a doctor who may or may not be interested in serving in a primary care team setting? Are we looking at going beyond that and setting aside some other moneys that would enable doctors to come together and to pay for some of the additional skill sets that might be required in order to give a more complete practice, in order to create a team?

[1540]

Hon. G. Abbott: These questions can get complex in a hurry, so I'll try to get the important issues out here. In terms of looking for better models, we need to work with the B.C. Medical Association to identify models that will work for their organization or some components of their organization. I think the first thing that we have to recognize is that the B.C. Medical Association is not a large and monolithic organization. It is a large and diverse and complex organization that contains not only family physicians but specialists and surgeons and a range of skill sets, a range of economic interests.

There are often regional or geographic factors that enter into the consideration of portions of the B.C.

[ Page 1812 ]

Medical Association. We do work with them as the professional organization representing doctors in this province, so we are always keen to work with them to find ways in which we can make their job satisfaction higher and their happiness to be working in British Columbia higher as well. If there are workable alternatives to the fee-for-service model, we want to discuss it with them, recognizing that there's going to be a diversity of what will work and where. We need to work those things through with the BCMA.

To set the context, though, it's important to note that British Columbia ranks second among provinces at 111 per 100,000 population in terms of physician supply, second only to Newfoundland, for whatever reasons. It's also important to note that in terms of expenditures per capita on physicians, British Columbia is number one in the nation. That doesn't always yield the most procedures, however; one would want to measure the productivity of each physician. That's not always represented in the dollars that are going forward.

[1545]

This is all a way of setting the context, though our challenge as a ministry is not only to get the best value for the investment of the taxpayers' dollars that we are stewarding in this ministry. We need to do that. We always need to ensure that the maximum public benefit is derived from every taxpayer dollar that we expend, but just as importantly or perhaps more importantly, we need to align, as closely as we can, physician resources with patient need.

That's really sort of the crux of the matter: identifying the range of patient need that's out there. It's going to be different in Fort St. James than it is in Cranbrook and different in Cranbrook than it is in Kelowna, different than it will be in Powell River, Victoria or Sicamous. It's going to vary across the province, so we need to have a model that is adaptive enough that it will take account of different patient needs in different corners of the province. Just like the BCMA, the province is a large, diverse and complex entity, with different patient needs in different corners of the province, though the challenge is clear enough.

We need to find a way. You know, the GPSC that was rejected in August may constitute a kind of base that we can work from. We're happy to talk about how we can build on the GPSC agreement with the BCMA, so that discussion is underway. It's not a simple discussion. It won't be an easy discussion. The province has finite resources as well, and that needs to be recognized.

Given all that, I think there are some opportunities that we can explore with the BCMA. In the process of working through these things I do hope that we identify not only where, from the perspective of the province or the BCMA, there needs to be some adjustment in terms of a fee schedule, but more importantly, that we explore some ways in which we can better meet patient needs and at the same time ensure that physicians in this province are enjoying the maximum job satisfaction that they can so that they'll want to continue to work and enjoy life in British Columbia.

D. Cubberley: I understand from reading the service plan that there's a national and provincial fund that's dedicated to primary care transition, of which B.C.'s share is something in the order of $74 million. I believe that the update suggests that the decision has been to turn this money over to health authorities to invest in accelerating and expanding sustainable primary health care initiatives.

My question would be: if there's this lump sum of money that can facilitate reform of primary care, is it best spent through health authorities? Is that the way you will induce the maximum amount of reform of primary care? And within the expenditure of that money, are there any targets set? For example, would there be targets for health authorities to make funding available either for the creation of community health centres or to initiate the creation of community clinics of the kind that the minister was describing as a replacement for the hospital in Enderby?

I guess the point of the question there is: are any of these resources actually going to go into triggering the creation of collaborative practice in the delivery of primary care?

[1550]

Hon. G. Abbott: I know the member opposite asks innocent questions and suddenly a barrage of information comes back to him, not because I know it, but because the people around me are so full of information, and they're delighted to share it with me. I'm honoured and gratified by that and honoured and gratified to share it with the member opposite.

One of the things that is astonishing about being in this ministry is that we were just talking about the $74 million. To us, it's a relatively small sum of money, but some ministries operate on that on an annual basis, so it's actually a lot of money, but let me put it in context. It's $74 million over five years, so that becomes somewhere between $18 million and $19 million per year for five years. In terms of the allocation, the health authorities will receive 65 percent of that. The province will retain 28 percent of it and the ministry 6 percent of it for different initiatives in the different areas.

In terms of the allocation by type of project — just to give the member a sense of the kinds of things that will be done with this — close to 40 percent will be around practice models and networks. That's the collaboratives, among other things, that we've been talking about — shared care, information management and site software, infrastructure, evaluation and evidence. All of these are in descending order of what we're doing with it.

Among the projects, I'm glad to share with the member these 91 different approaches, models or projects that have been underway. They're termed here "new practice models for improved quality of patient care." There are lots of them occurring across the province: the White Rock Medical Associates, for example; Morgan Creek Family Practice Group in Fraser;

[ Page 1813 ]

in Vancouver Island Health Authority, the Cool Aid Community Health Centre is probably one that the member is very familiar with; the Port McNeill project, which I mentioned and I thought was very compelling; the Gathering Place, which replaces the Aboriginal Friendship Centre — that's one.

In the Interior Health Authority: the Chase and District Health Centre is one I'm very familiar with, along with the Enderby one; and there's the Kamloops Downtown Health Centre, which I think is doing great work; Sparwood Health Centre; Kimberley Health Centre, and so on across the province. The Northern Health Authority has community collaboratives in six different centres: Chetwynd, Massett, Mackenzie, Fraser Lake, Quesnel and Kitimat, so that's great work being done there.

There are a lot of exciting projects underway that are being supported by the $74 million. We're going to learn an enormous amount from this. That's one of the exciting things about this ministry: things are not always perfect, but there's continuous improvement going on, and it's continuous improvement that's based on ongoing work to determine things that work better. When they work better, we learn best practices. We put those best practices into action, and every day we can see better patient care as a consequence of that.

D. Cubberley: A couple more questions. I thank the minister for the response. I know that his staff has brought to his attention the BCMA study on multidisciplinary care teams which was recently published, one which I had a chance to read recently and found interesting. I note that they polled doctors regarding barriers from their perspective on engagement and primary care teams. The number one barrier by a long shot was financial.

[1555]

The report doesn't identify, as far I can remember, whether that was perceived financial or real financial, but the unknown dimension of finances was the number one inhibition.

The second inhibition, which came up quite high on the list, was liability. This has to do with conferring elements of decisional authority on to associated practitioners and not understanding entirely where the responsibility might lie — whether it comes back to the doctor.

The third and fourth barriers, which were also substantial, were concerns about professional autonomy which I've heard quite frequently from doctors who have not had an experience of working with other health professionals who are not doctors. The fourth one was care-coordination concerns — the whole idea about managing care in moving from a setting of being a doc in a box somewhere with entire responsibility for it to moving into a situation where you may be managing care provided by an array of providers.

To me, reading those over, those concerns suggest the need and the potential for interventions that would address each of them. In the case of liability, it may be the development of a template for how liability might be handled — not just on the insurance side, although that probably is a question in moving into collective practice, as to how liability is shared amongst practitioners with different scopes of practice.

But to get back to interventions, some kind of process that would allow doctors some exposure to people who have successfully made a transition into collaborative practice and understand how it works, and some opportunity to actually develop some elements of the skill sets that are required to manage in a more complex environment…. It's a big step, as anybody who has been employed as an independent consultant of some kind will know. It's a big step to move into team practice with people, and it requires different levels of skill.

To me, it's not difficult to understand that that might be a challenge, that there might be barriers within the way medicine is currently practised to taking the step into another form of practice.

I'm not looking for a long answer, but just…. No, that wasn't a shot, minister. But is the ministry going to be looking at the potential to generate field supports that would help enable the kind of behaviour change that's required in order to gain a higher level of primary team care in the province of British Columbia?

Hon. G. Abbott: I'm tempted to simply say yes and sit down. Really, that would fill the bill in terms of an answer, but of course I won't. The member's question is a very good one. As the member indicated, when the members of the BCMA were asked what they believed to be the barriers, they identified a number of barriers.

[1600]

Indeed, there is a strategy in place which hopefully will be supported in whatever successor agreements we have with the BCMA that will make it possible. But there is going to be training needed, I think, for those portions of the medical profession that want to embrace a more collaborative approach. I think it's important that some training be undertaken. Conferences like the one we held, which had quite a number of physicians attending them, would be good examples of how information is disseminated around how collaboratives can be built successfully.

The liability issue is also an important one — not one that is within the ministry's purview. I understand from staff that there is an organization called the Canadian Medical Protective Association that deals with liability issues on behalf of the physicians of Canada. So that would be something, likely, that they would be seized of in terms of liability, along with, to some extent, the College of Physicians and Surgeons as well.

The care coordination, either through physician management or nurse management — these are possibilities. There will be, among the 91 approaches that are being undertaken in the province, different examples of nurse, doctor or other professional management of these collaboratives. Again, we wouldn't seek to be proscriptive, because British Columbia is a large and diverse province, and it's not going to be a one-size-

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fits-all model that's going to work. It's going to be a range of models that will work in different cases.

In terms of how we can backstop the movement towards collaborative models and primary care models across the province, obviously we'll need to backstop it with agreements like the one we had tentatively secured with the BCMA through the GPSC, a proposed agreement where there was recognition of maternity care enhancements and networks, where there were fees for patient conferencing and things like chronic disease management.

I mean, there is an infinite number of variables that may come into play in terms of building an agreement with the BCMA that's going to work. We recognize that this is large and complex, but obviously, it's worth doing. We do hope that we're building on what I think is a good, positive and sound relationship between ministry and government and the BCMA. I'm hoping that we can move ahead and build an agreement that ultimately will benefit many more patients across British Columbia.

D. Cubberley: I'd just like to bring this close to what I think is a relevant example of how primary care teams can be created in embryo through an association, because not everything is going to be formed on the basis of being a full-scale clinic with a whole range of different skills in one location. One would like to think that there is room in the system for doctors to begin associating themselves at relatively small levels of aggregation.

The reason that I'm interested in it is because I've had a longstanding experience with a community health centre, which I found a very satisfying experience, and I've also had a long experience with an individual doctor. I can say without reservation that the quality of care and the immediacy of care provided through the health centre is far superior to that which can be provided through an individual doctor, if only in part because it's ever so much easier to get in to see someone initially in a practice where there are associated professionals.

[1605]

If you go to a doctor — especially these days, the way things are operating — and you needed to talk about something that you hadn't booked the appointment for, you would be in the position of booking another appointment — unless, paradoxically, you had gone to a walk-in clinic, in which case you could walk out through the door and walk back in again and have it immediately. But if you're dealing with the standard doctor operating alone, it's one appointment for one topic.

If you try to add another topic, it's three weeks or two weeks or however long to get back in to see that doctor again, which is a very, very rigid model. It's not the doctor's fault. It's where we've come to with a model that I think we're outgrowing.

On the other hand, from my point of view, the experience of the health centre…. Although there was a whole array of skills within that centre, there were really only two skill sets that I was in contact with on an ongoing basis. One was the doctor, and the other was a nurse practitioner.

I think you have the beginnings of associated practice when you can put a doctor together with a nurse practitioner, because a nurse practitioner can handle a whole range of things that doctors currently have to find a way to fit into practice that are not especially remunerative and that often take them away from dealing with chronic disease management or other things — acute care of some kind — that they might be more engaged in dealing with and that might be more suitable for their skill set.

I guess my question is: given that we are expanding the creation…. We've created nurse practitioners. We're now generating a substantial number of them. Would the ministry be looking at the role they might play in primary care and some way of creating a connection between those graduating nurse practitioners and practising fee-for-service doctors so that you could begin to insert that level of care, where a doctor was interested, into a matrix and begin to create collaborative practice in that regard?

Hon. G. Abbott: I appreciate the member's question. First, just to ensure that we're clear on this point, any practice that involves not raising more than one issue at one visit is not something that's mandated by the province. It may be something that appropriately or inappropriately a physician might adopt as a practice within their office, but it's not something that we as a ministry encourage them to do. In fact, we would encourage them to do otherwise, but that would be, in some cases, at odds with the practice.

In terms of the member's broader question about nurse practitioners and what role they might play in terms of the evolution of collaboratives in this province, I suppose that while the answer is generally yes, we don't propose to be prescriptive around exactly what each and every nurse practitioner will be doing. There are only, I think, eight practising nurse practitioners in the province at this point. It's a relatively new addition to the field of medical professionals in the province. We are only graduating, I think, about 30 nurse practitioners per year at this point.

Nevertheless, we do believe that they will be playing an important role, particularly in the provision of primary care across the province.

[1610]

In some rural or remote areas where it's unlikely that we would get a physician practising on a sustained basis, they may be the fundamental provider of medical care. That would be one example, but there will be lots of cases where a nurse practitioner becomes a very important part of a primary care centre, perhaps in an urban setting as well. So we don't have strictly defined or prescriptive ideas around what the nurse practitioners will do.

I think it's our hope, rather than seeing nurse practitioners assigned to specific physicians, although one wouldn't discount that possibility, and that could happen…. We're hoping, rather, that we will create incentives to link primary care physicians to the health au-

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thorities and have the nurse practitioners possibly serving as a part of a number of collaborative teams involving a number of physicians rather than being exclusively assigned to a particular physician.

So the question of how we incent that is a very important one. That will be, I guess, part of the great unfolding here in the weeks and months ahead as we discuss these issues with the BCMA but also with the B.C. Nurses Union and others that are moving towards a renewal of their collective agreements or their other agreements with government.

D. Cubberley: I thank the minister for those comments. It's interesting to think about the possibilities for providing a broader array of skills than can be marshalled by a single doctor working in an office somewhere. I do think, in my own personal opinion, that it is the future of primary care and that it will become increasingly imperative that we move in those directions. But I also think that there's a tremendous amount in it for doctors because collaborative practice is inherently more interesting than solo practice in many regards. There are challenges, obviously, to overcome.

Before leaving it, I guess the reason that I raise the question around nurse practitioners in particular is because while doctors being under fee-for-service can set themselves up pretty much anywhere, a nurse practitioner is going to have to be an employee in some form in order to be able to be in business. This likely makes the nurse practitioner under the current circumstance a creature of the health authority or hospital or other funded entity within a health authority.

I think there may be opportunity in that for an array of doctors to come in contact with nurse practitioners, but there may also be some challenges in nurse practitioners finding their way into associated practices. Again, it's the question of how the services can be billed in a way that's consistent with the delivery of doctor-based primary care.

I'm not looking for the minister or ministry to try and answer that. I'm lodging it just because I think if we can think about some of those complexities and find the ways to not be prescriptive and assign anybody to work with a particular doctor but to be enabling in a way that allows the associations to generate themselves in some fashion, then we could perhaps move primary care renewal and reform along a little bit more quickly.

Anyway, I would like to swing into some discussion of health authorities, and I've been joined by some colleagues who are going to want to ask some questions about particular health authorities. I don't know if that means a full shift change. I see movement. Shall we take one moment for that to happen? I could start because, really, it's….

Interjection.

D. Cubberley: I just want to raise a couple of general issues. We may come back to these in some fashion as we close out the section.

[1615]

One of the things that's a big change in the delivery of health care in the province has been the reorganization from a system that was substantially decentralized, and I think many would agree was too decentralized, to a system that is highly centralized, where we have very, very large health authorities as entities. I don't know if it's the case, but I suspect, just based on the numbers that I've seen, that we probably have the most centralized system of health authorities in Canada now. We have the fewest per capita. That's not necessarily a comment.

It's neither good nor bad inherently, but as the scale of any undertaking increases, there are challenges in the way that services are delivered, the way that communication occurs and the way that relationships evolve with stakeholders and partners.

At a very general level, if I were to quote from one of the sections in the service update on accountability, one of the notions that is set out is: "Our capacity to respond to change has been greatly increased through the development of an accountable, efficient and responsive health sector that welcomes the challenge of improving services for the citizens of British Columbia." I wouldn't disagree with the latter part about the system welcoming the challenge of improving services for the citizens of British Columbia, but I pause at the notion that we have achieved a more accountable and responsive health sector.

It may be more efficient. I can't actually evaluate that fully, and I don't want to make that the gist of my comments, but the accountable and responsive side is a place where I have some pause.

That's based to some extent on the fact that I've had a recent experience as a member of the capital hospital region as a subset of the capital regional district board and have dealt with the Vancouver Island Health Authority over a number of years. I'd just like to read a note, a paragraph from a report that was presented to Saanich council on September 27 of this year by Councillor Carol Pickup, who also sits on the CRD board.

She comments from another direction. She says:

For the past four years locally elected officials at the CRD and the local hospital foundation's boards and agencies have experienced a growing frustration with VIHA. The frustration comes as a result of a lack of consultation, poor communication, a lack of transparency and an absence of accountability for decisions made in the expenditure of over $1 billion a year in tax revenue on Vancouver Island. VIHA's provincially appointed board does not represent our community and is virtually invisible and unavailable to meet with those of us who are elected and accountable to the community.

I set this up for contrast. I'm interested in comment as to…. Obviously, it's a new system. Is the minister satisfied with the responsiveness of the existing boards, and is the minister or the ministry looking at potential changes that might improve some of the deficiencies that are being pointed to by this report? Rightly or wrongly, the perception is there on the part of a large number of decision-makers of something that's operating at several removes from where they're operating. It's in that sense that I wanted to open up discussion.

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Hon. G. Abbott: I guess one of the benefits of now having been in elected office for 26 years is that I have seen the evolution of the health care governance system over two-plus decades. I remember well some of the debates around how to perfect the health care governance system back in the 1980s as a member of the Columbia-Shuswap regional district and the regional hospital district board.

[1620]

There's really nothing…. Well, I shouldn't say there's nothing new. There's always something new in terms of debates about governance, and I know as politicians we often hope that we can find ways to perfect the world around us and to find better ways of achieving things like accountability, transparency, responsibility and so on. I guess the view that I would come down to, and I say this not based on the advice of my staff here….

They might recoil in horror at my impromptu views with respect to this, but it's actually my view — based not only on what I've seen over the past four years, but what I've seen over the past almost 30 years now in terms of being an elected member of the public — that what we need more than anything right now is some stability in the health care governance system, because we have been through a lot of changes. Those changes occurred under the Social Credit government, they occurred under the NDP government, they occurred under a B.C. Liberal government.

So I've seen lots of changes, and I think on balance the fairness, the effectiveness, the responsiveness of the current health care governance model has been better than what I have seen in the past. I think it's getting better. I think it will continue to improve, and I think more than anything what the current governance model needs now is time to grow in the sense of being able to reach out and talk to people, the opportunity to mature as governing entities.

I think, if anything, and it may be unfair, and the members opposite — on this side, for that matter — may take me to task for not wanting more change and resolving their particular concerns with changes in governance model, but I personally don't believe that's what's needed right now. I think we need some stability and an opportunity for the system to mature.

The concerns the member raises around accountability, responsiveness and so on. Are those new issues that suddenly popped up in 2001 when we went from 52 to six health regions? I think even the members opposite would agree — no. There has been a lot of discussion about this, endless discussion about this, probably going on 30 years now. For all I know, it may have been going on long before that as well, although I think the local hospital board things were a pretty stable element going back 25 years or thereabouts.

Are the concerns new? No. I remember a lot of intense discussion, actually, when the NDP government was in power in the 1990s. A lot of discussion about: "Can this governance model be excluded? Should the boards be elected? Should they be appointed? Should they be some combination of those two things?" There's all manner of permutations that have been proposed over time about how we might rejig the governance system to perfect it.

Perhaps one of the better analyses was actually done by a group called the regional assessment team back in the 1990s, chaired by the gentleman who now is the Opposition House Leader. I was delighted in coining the acronym "RAT team" from that perhaps unfortunate set of initials, but the regional assessment team actually did some good work and, after numerous meetings with the public and others, came to the informed opinion that it would be better to have appointed boards rather than elected boards. They didn't even recommend a mixed model of some elected, some appointed.

They came to the, I think, well-informed view that appointed boards were the way to go. So, is that perfect? Really, the debate could be endless around that point of what would be the perfect model.

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I think what we need, and I think what we largely have today, are appointed board members who bring different skill sets to the table. Some will have a business background, some will have a clinical background and some will have a community background. The object, I think, is to bring these skill sets to bear on the issues that confront those board members.

The other thing I want to say, and I think it's…. We need to remember that these are young organizations, now perhaps three and a half years old, that have been confronted with some very, very difficult issues in their infancy as organizations. I think they've come through those very well. What we are now seeing is much more intersection with the public than was the case a year ago or two or three years ago. I know that more and more, the board meetings are being held in different communities and opening those meetings up to community discussions. Is it perfect?

Probably not, but I think we've come a long ways, and what I'm seeing in the health authorities is a willingness to try to do more to respond to community interests for dialogue and so on. Sometimes people mistake not immediately agreeing to what they want with being disagreeable.

One of the challenges, as the member will know, is that there's an infinite range of demands on the system, and they can't all be met at one point in time. But I do think that the health authorities are building increasingly sophisticated ways in which they can reach out to the public and try to take account of what people are suggesting.

In the case of VIHA, I don't actually agree with the sentiments expressed by Carol Pickup. I think VIHA has had some challenges — no question about that — as have all the health authorities. But I believe that the VIHA board is working very hard to try to address what some of the issues are on Vancouver Island, and I think the new chief executive officer there is doing a great job. It will perhaps take some time, but I think that will be clear to the public as we move along as well.

D. Cubberley: I think one of the challenges that is going to be an ongoing challenge but can, perhaps, be

[ Page 1817 ]

solved if there's a different approach to how one entity communicates and engages with another…. Regional districts make a not-inconsequential contribution towards the health care system, which shows up as a tax line on regional property tax. If a regional district board comes to have the sense that its contribution is simply an automatic checkoff and has a sense that its awareness of community needs and community priorities to be addressed does not figure large, or figure at all, in the way that another entity is proceeding, then you are bound to develop a sense of disconnect and some sense of being taking for granted.

That's never going to work well with elected decision-makers. They have to justify to their publics what the money is being spent on, what the priorities are. I think that there is a challenge in having one level of government contributing 40 percent on capital projects and not feeling engaged in a meaningful discussion about the use of that money.

I put that out not to raise debate in particular but to say that I think one of the things that the boards of health authorities have to grapple with is how to work with their partners. The problem probably isn't smaller as you go down the chain and deal with individual agencies, non-profit societies. Other entities that see themselves as partners in delivering services can very readily develop a feeling that they're being told what will happen rather than engaged in some kind of collaborative discussion about what might happen.

I understand the minister's point. Obviously, having been involved in government for a while, I know that there are not the resources to meet all of the needs. It's a very difficult challenge, and I think it will always be that way, no matter how rich our society is. The needs grow with the creation of wealth. It's a very difficult challenge.

[1630]

I do want to ask the question whether any consideration has been given to creating some elected representation on health authority boards and whether any consideration has been given to actually providing representation to regional districts that are contributing capital moneys to health boards.

Sorry to make a list of it, but to compress it a little bit, the other comment that interested me is that the minister is saying that some health authority boards are engaging in public meetings. I would be interested to know if that's a policy of the ministry — if the ministry is encouraging that — and whether there's a sense that people are aware. I am not aware personally. I've become aware in my role as critic that that may have happened with one health authority or another, but I was not aware of that with the local health authority here — that there were open board meetings.

I'm interested in that side of it, and it may be something to reflect on as a way of bringing the board a little bit closer to the community it's in, or communities.

Hon. G. Abbott: As I indicated in the last answer, more and more, the health authority boards are getting out and meeting with councils. They're having public meetings and really intersecting with the public a whole lot more than health authority boards have in the past, whether it's the current boards or it's the boards of the past. I think there is a pronounced effort to try to have that intersection with the public, and I think that's a very positive thing.

In terms of regional hospital districts, I had the opportunity to chair the Columbia-Shuswap regional hospital district for a decade, and I can tell you that the health authorities of the day — whatever it happened to be — would take liberties with the regional hospital district at their peril. Locally elected officials are notoriously cantankerous, as you know, and can occasionally be remarkably independent in terms of the assertion of their interests and their constituents' interests.

I think it's always important, regardless of function and form of the governance model that's in place, that there be ongoing and real and substantive discussions between regional hospital districts, which often pay 40 percent, for example, of new major capital and pay for some of the minor capital as well.

I think in most, if not all instances, there have been memorandums of agreement developed now between health authorities and regional hospital districts, which guide the way in which these things will work out — again, because particularly when we're going into a period where there are very, very substantial capital demands across the province and where those capital demands are going to have an impact on regional hospital districts and their financing of projects, I think it's very important that both parties understand how they are going to work through the issue of major and minor capital projects.

The other point I'll note…. I don't want to be unfair about this, and I don't want to characterize inappropriately, but there has at times been a difficult relationship between the capital regional hospital district and the Vancouver Island Health Authority. I understand that that relationship, in fact, has dramatically improved this year. I understand that there are new CEOs. I know that there's a new CEO at Vancouver Island Health Authority, and I understand that there is at capital regional district as well. Perhaps that's part of it, but also the working relationship, generally speaking, has been markedly improved.

[1635]

Again, in the specific case of VIHA, VIHA shared their strategic plan with their staff on September 26, 2005, and posted the plan on their website in early October 2005. Consultations will occur throughout the fall with VIHA staff and physicians, including the health authority medical advisory committee; regional hospital district members; Members of the Legislative Assembly; and mayors. A draft plan will be shared with affiliates with an invitation for comments and feedback, and open houses will be offered in various communities in November and December 2005.

That doesn't necessarily answer all the member's questions in terms of why there has at times been a troubled relationship and why the board hasn't been more open, and so on. I think what we're seeing now is

[ Page 1818 ]

the strengthening and maturing of these organizations and the opportunity for them to really get out and do more in the way of public consultation than perhaps was possible two or three years ago.

D. Cubberley: Certainly, the public process that the minister laid out is a new departure, and perhaps that will be a new beginning. I would urge them not to undertake consultation in the month of December, though. That's not a starter. If you want to think about engaging communities, you stay out of that month. I know the minister knows that, because he's been in local government a long time. December is not a month for consulting. That's newness, and they'll come to grips with that, I'm sure.

I think for now what I'd like to do is turn over some time to colleagues of mine who are going to be asking some questions. The member for Yale-Lillooet is going to lead off. I turn it over to him.

H. Lali: What role does the minister or the ministry play at the local level when small rural hospitals or communities want a service reinstated in their hospital or funding for beds? What role does the minister or the ministry play, or what role does the minister play in terms of giving direction to the regional health authorities?

Hon. G. Abbott: I thank the member for his question. The member asks a question at a fairly high level. Somehow intuitively, I see a picture of Mayor Chris O'Connor in my head, a friend of the member and myself, but perhaps that's not what he had in mind at all. Notwithstanding that, I'll perhaps use Lytton as an example of where at times I think the ministry can assist in helping a health authority resolve either shortstanding or longstanding issues that they may have around not just small hospitals but perhaps any facilities. In the case of Lytton there were some issues around changes in the health care model.

The mayor and council were unhappy with those changes. There was considerable give-and-take around that — lots of history there that I'm sure the member is well familiar with.

[1640]

What we like to do, where it's possible is…. If the assistance of the ministry is welcomed by the health authority and the community, we're glad to bring the expertise and information base the province has to the table.

In the case of Lytton it's a relatively a complex issue — a small town but a complex issue — in that not only was the community of Lytton and the surrounding regional district electoral area involved, but first nations were also involved in how they might be a part of that reform of delivery of health care in Lytton. So it was interesting and challenging from that perspective.

Generally, we encourage health authorities to resolve these issues themselves if they can, but on occasion, if the issue demands it or encourages it, we certainly aren't reluctant to assist in areas where our assistance is welcome.

H. Lali: Methinks the minister is trying to steal my thunder. Not to disappoint the minister, yes, I will be talking about Lytton, but not yet. I'm going to talk about something else first.

It doesn't matter if you're talking to Liberals, New Democrats or Conservatives or whatever stripe they may be, the one thing that comes across in rural British Columbia, especially in small rural communities, is that health authorities are not working. Since those changes have been brought in by this Liberal government over the last four years with the institution of the health authorities, we have seen that health care is actually deteriorating in those small communities — the delivery of it and the availability of services.

What we actually see is the systematic destruction of health care services in these small communities. As you see, over those four years more and more of those services are being pulled out. Beds are being pulled out of those small communities. If you look at Yale-Lillooet, whether you're talking about Hope, Merritt, Lillooet, Lytton, Princeton or anywhere — one of those communities or elsewhere in the province — that's exactly what's happened.

All these services have been centralized in the regional centres, whether it's in Kamloops or Kelowna, and now people in my constituency have to go to Kelowna, Kamloops, Abbotsford, Chilliwack or Vancouver and sometimes even Penticton in order to get proper health care. All of those communities are outside the constituency of Yale-Lillooet.

I want to ask the minister specifically regarding what was formerly known as the Nicola Valley General Hospital in Merritt, which has been downgraded to the Nicola Valley Health Centre. There were at one time 24 beds. It has gone down to 19. Now there are only eight beds available in the community of Merritt.

It's a tough time trying to get some of those beds actually replaced. Even according to their own definition, which the regional Interior Health Authority has, there should be one bed available for 1,000 people. Now, in the community of Merritt and the Nicola Valley that it serves, there are 16,000 people. According to their own definition, there should be 16 beds. I'm wondering if the minister will make a commitment to reinstate eight beds to make it 16 full beds in the community of Merritt and the Nicola Valley Health Centre.

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Hon. G. Abbott: I thank the member for his question.

First thing I do want to say is that I disagree with the contentions, the arguments, advanced by the member that, first of all, health authorities are not working. That is not something I have seen or heard. There may be some people who are dissatisfied, but I think that health authorities, including in this case the Interior Health Authority, are actually doing an excellent job, and I think that people are more and more embracing the kind of work that's being advanced by the IHA.

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Is health care deteriorating? I think that proposition is not one that is grounded in reality. I think that we are seeing improvements, in fact, in health care across the province, and I would fundamentally disagree.

Now, the member is suggesting that everything is being centralized in larger regional centres. That's not so. I think it has always been the case and perhaps always will be the case that, for example, some kinds of cancer treatments, some kinds of heart procedure, and some of the more advanced surgical procedures particularly, tend to be centred in the larger regional hospitals, and that's perhaps so.

We don't have a lot of detail around the Nicola Valley Health Centre. What we do know is that there's been a shift to a primary care centre model in Nicola Valley. You know, if the member has specific concerns with respect to how that's functioning or how it can function better, I'm very pleased to hear that and very pleased to take those comments on to the Interior Health Authority. But I know that whether it's with Lytton or Lillooet or with Merritt, the Interior Health Authority has been working with all of those communities to try to find an appropriate model of care for the citizens that exist there.

Again, if the member has specific concerns, I'm glad to forward them, but to simply say this is all going to be remediated by adding six or eight beds or whatever, I wouldn't agree. I think we need to look at it in a more sophisticated way than that.

H. Lali: I just want to clarify something on the record. I mistakenly said that Hope was a part of the interior health region. It's not. It belongs in the Fraser Valley there. Having said that, the minister disagrees, and I just happen to disagree with the minister's disagreement.

I would actually like to invite the Minister of Health to come to my communities in Yale-Lillooet and talk to the people who utilize the health care services there. Perhaps he might have a different perception. What happens is that if you happen to live in the bigger communities in rural British Columbia, like Kamloops or Kelowna…. Because the services that have been pulled out of these small rural communities have gone to these centres, yes, those folks would say there's fundamentally no shift in health care, or they may feel it's better. But people in small communities don't.

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Just again on the Nicola Valley Health Centre issue. As I mentioned, the Nicola Valley has about 16,000 people that that hospital services. We have roughly about 12,000 emergency room visits per year. Merritt is also on the hub of all the Coquihalla Highway system, as well as Highway 5, Highway 8, Highway 97. They all intersect right through Merritt. You've got quite a bit of traffic going through there, with thousands of cars passing through Merritt on a daily basis. A lot of accidents that take place on the highway utilize the facility either in Hope, at the hospital there, if it happens to be on one side of the toll booth, or if it's on the other side, it's in the Merritt hospital there.

If you look at the Royal Inland Hospital in Kamloops, they have approximately 34,000 ER visits per year, and it serves a population of about 100,000 in the catchment area. Even when you look at that, with a community the size of Merritt, which is way smaller than Kamloops, it has so many emergency room visits, and yet there are only eight beds available. If there happens to be an emergency of some nature, sometimes those beds are all used up, and people are actually lying on stretchers in the hallways, as happens on many occasions in Merritt. But when you look at Kamloops and the number of beds that are there….

I don't have the exact figure. I suppose the minister would, but I would imagine it's in the hundreds in terms of the number of beds that are available in Royal Inland Hospital in Kamloops.

If there's such a big disparity taking place, again, I would ask the minister if he would lend support to the people of the Nicola Valley in working with the regional health authority out of Kamloops to have Merritt once again have a 16-bed facility so that when we have emergencies in the Nicola Valley that take place, there are beds for people to utilize. That is a big, burning issue in the community, and the folks there want a functioning hospital rather than what most folks would say would be a band-aid station.

Hon. G. Abbott: I thank the member again for his question. We certainly do encourage the interior health authority and, indeed, all health authorities across the province to work with the communities that are within the province. If, for example, the city of Merritt had profound concerns and evidence about how the current model of care and the current provision of beds within the care centre was inadequate, then I think certainly we would want the city to share those with the IHA, and we would expect the IHA to continue their dialogue with Merritt and try to resolve those things.

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The health authority revisits the number of beds on an ongoing basis, and they will respond with increases or decreases in response to the evidence about whether there is a