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British Columbia — Debates (Hansard)

4th Session, 37th Parliament OFFICIAL REPORT OF DEBATES OF THE LEGISLATIVE ASSEMBLY (HANSARD) Thursday, May 15, 2003 Morning Sitting Volume 15, Number 13 THE HONOURABLE CLAUDE RICHMOND, SPEAKER ISSN 0709-1281

PROVINCE OF BRITISH COLUMBIA (Entered Confederation July 20, 1871) LIEUTENANT-GOVERNOR Honourable Iona Campagnolo 4TH SESSION, 37TH PARLIAMENT SPEAKER OF THE LEGISLATIVE ASSEMBLY Honourable Claude Richmond EXECUTIVE COUNCIL Premier and President of the Executive Council................................................................................. .........................Hon. Gordon Campbell Minister of State for Intergovernmental Relations.............................................................................. ..................... Hon.

Greg Halsey-Brandt Deputy Premier and Minister of Education ....................................................................................... ..................................Hon. Christy Clark Minister of Advanced Education................................................................................................. ...........................................Hon. Shirley Bond Minister of Agriculture, Food and Fisheries.................................................................................... ..............................Hon.

John van Dongen Attorney General and Minister Responsible for Treaty Negotiations.............................................................. .................... Hon. Geoff Plant Minister of Children and Family Development.................................................................................... ..............................Hon. Gordon Hogg Minister of State for Early Childhood Development.............................................................................. .................................Hon.

Linda Reid Minister of Community, Aboriginal and Women's Services......................................................................... .................. Hon. George Abbott Minister of State for Community Charter........................................................................................ .................................. Hon. Ted Nebbeling Minister of State for Women's Equality ......................................................................................... .................................... Hon.

Lynn Stephens Minister of Competition, Science and Enterprise ................................................................................ ..................................Hon. Rick Thorpe Minister of State for Deregulation ............................................................................................. ............................................ Hon. Kevin Falcon Minister of Energy and Mines................................................................................................... ....................................... Hon.

Richard Neufeld Minister of Finance ............................................................................................................ ....................................................... Hon. Gary Collins Minister of Forests ............................................................................................................ .................................................. Hon. Michael de Jong Minister of Health Planning .................................................................................................... ............................................ Hon.

Sindi Hawkins Minister of Health Services.................................................................................................... ................................................ Hon. Colin Hansen Minister of State for Mental Health ............................................................................................ ...................................Hon. Gulzar S. Cheema Minister of State for Intermediate, Long Term and Home Care ............................................................................. Hon.

Katherine Whittred Minister of Human Resources.................................................................................................... ............................................Hon. Murray Coell Minister of Management Services................................................................................................ .........................................Hon. Sandy Santori Minister of Provincial Revenue................................................................................................. ................................................Hon.

Bill Barisoff Minister of Public Safety and Solicitor General ................................................................................ ..................................Hon. Rich Coleman Minister of Skills Development and Labour...................................................................................... .............................Hon. Graham P. Bruce Minister of Sustainable Resource Management.................................................................................... ..................................Hon.

Stan Hagen Minister of Transportation..................................................................................................... .................................................... Hon. Judith Reid Minister of Water, Land and Air Protection..................................................................................... ....................................Hon. Joyce Murray LEGISLATIVE ASSEMBLY Deputy Speaker................................................................................................................. ..............................................................

John Weisbeck Leader of the Opposition ....................................................................................................... ...........................................................Joy MacPhail Deputy Chair, Committee of the Whole ........................................................................................... .............................................. Harold Long Clerk of the Legislative Assembly .............................................................................................. .........................................E.

George MacMinn Clerk Assistant ................................................................................................................ ................................................................... Robert Vaive Clerk Assistant and Law Clerk .................................................................................................. ........................................................ Ian D. Izard Clerk Assistant and Clerk of Committees........................................................................................ ............................................Craig H.

James Clerk Assistant/Committee Clerk................................................................................................ ............................................ Kate Ryan-Lloyd Sergeant-at-Arms ............................................................................................................... .........................................................A.A. Humphreys Director, Hansard Services ..................................................................................................... ........................................

Anthony Dambrauskas Legislative Librarian.......................................................................................................... ............................................................. Joan A. Barton Legislative Comptroller ........................................................................................................ .................................................................Peter Bray Published by British Columbia Hansard Services, and printed under the authority of the Speaker by the Queen's Printer, Victoria.

Rates: single issue, $2.85; per calendar year, mailed daily, $298. GST extra. Agent: Crown Publications Inc., 521 Fort St., Victoria, B.C. V8W 1E7. Telephone: (250) 386-4636. Fax: 386-0221. www.leg.bc.ca/hansard In addition to printed transcripts, Hansard Services publishes transcripts on the Internet and broadcasts Chamber debates on television.

Party Standings: Liberal 75; New Democratic 2; Independent Liberal 2. ALPHABETICAL LIST OF MEMBERS Abbott, Hon. George (L) ....................................................................... Shuswap Anderson, Val J. (L) .............................................................Vancouver-Langara Barisoff, Hon. Bill (L)............................................. Penticton–Okanagan Valley Bell, Pat (L).........................................................................Prince George North Belsey, Bill (L).................................................................................

North Coast Bennett, Bill (L) ........................................................................... East Kootenay Bhullar, Tony (Ind. L) ................................................................. Surrey-Newton Bloy, Harry (L).................................................................................. Burquitlam Bond, Hon. Shirley (L).........................................Prince George–Mount Robson Bray, Jeff (L)......................................................................Victoria–Beacon H ill Brenzinger, Elayne (L) ...............................................................

Surrey-Whalley Brice, Susan (L) ............................................................................Saanich South Bruce, Hon. Graham P. (L)................................................ Cowichan-Ladysmith Campbell, Hon. Gordon (L)............................................. Vancouver–Point Grey Cheema, Hon. Gulzar S. (L) ..........................................Surrey–Panorama Ridge Chong, Ida (L)................................................................ Oak Bay–Gordon Head Christensen, Tom (L) .............................................................

Okanagan-Vernon Chutter, Dave (L) ........................................................................... Yale-L illooet Clark, Hon. Christy (L) ..................................................Port Moody–Westwood Cobb, Walt (L) ............................................................................. Cariboo South Coell, Hon. Murray (L) ........................................ Saanich North and the Islands Coleman, Hon. Rich (L) .............................................. Fort Langley–Aldergrove Collins, Hon.

Gary (L).........................................................Vancouver-Fairview de Jong, Hon. Michael (L)....................................... Abbotsford–Mount Lehman Falcon, Hon. Kevin (L) .......................................................... Surrey-Cloverdale Hagen, Hon. Stan (L) ................................................................... Comox Valley Halsey-Brandt, Hon. Greg (L) ..................................................Richmond Centre Hamilton, Arnie (L)............................................................Esquimalt-Metchosin Hansen, Hon.

Colin (L) .....................................................Vancouver-Quilchena Harris, Roger (L)......................................................................................Skeena Hawes, Randy (L) ............................................................ Maple Ridge–Mission Hawkins, Hon. Sindi (L).......................................................... Kelowna-Mission Hayer, Dave S. (L) ................................................................... Surrey-Tynehead Hogg, Hon. Gordon (L) ........................................................

Surrey–White Rock Hunter, Mike (L) ...................................................................................Nanaimo Jarvis, Daniel (L)...................................................... North Vancouver–Seymour Johnston, Ken (L)............................................................ Vancouver-Fraserview Kerr, Brian J. (L).............................................................. Malahat–Juan de Fuca Krueger, Kevin (L).................................................

Kamloops–North Thompson Kwan, Jenny Wai Ching (NDP) ...............................Vancouver–Mount Pleasant Lee, Richard T. (L).......................................................................Burnaby North Lekstrom, Blair (L)................................................................. Peace River South Les, John (L) .......................................................................... Ch illiwack-Sumas Locke, Brenda (L) ...........................................................

Surrey–Green Timbers Long, Harold (L) ...................................................Powell River–Sunshine Coast MacKay, Dennis (L)....................................................... Bulkley Valley–Stikine McMahon, Wendy (L).............................................Columbia River–Revelstoke MacPhail, Joy (NDP) ..........................................................

Vancouver-Hastings Manhas, Karn (L) .............................................Port Coquitlam–Burke Mountain Masi, Reni (L) ...................................................................................Delta North Mayencourt, Lorne (L) ..........................................................Vancouver-Burrard Murray, Hon. Joyce (L) ........................................................... New Westminster Nebbeling, Hon. Ted (L) .......................................... West Vancouver–Garibaldi Nettleton, Paul (Ind. L)..................................................Prince George–Omineca Neufeld, Hon.

Richard (L)...................................................... Peace River North Nijjar, Rob (L)...................................................................Vancouver-Kingsway Nuraney, John (L) ...............................................................Burnaby-W illingdon Orr, Sheila (L) ...........................................................................Victoria-Hillside Penner, Barry (L)....................................................................... Ch illiwack-Kent Plant, Hon. Geoff (L) ......................................................... Richmond-Steveston Reid, Hon.

Judith (L)............................................................Nanaimo-Parksv ille Reid, Hon. Linda (L) ................................................................... Richmond East Richmond, Hon. Claude (L) ................................................................ Kamloops Roddick, Valerie (L)..........................................................................Delta South Sahota, Patty (L).....................................................................Burnaby-Edmonds Santori, Hon. Sandy (L)..............................................West Kootenay–Boundary Stephens, Hon.

Lynn (L) ........................................................................ Langley Stewart, Ken (L)...................................................... Maple Ridge–Pitt Meadows Stewart, Richard (L) ...................................................... Coquitlam-Maillardville Suffredine, Blair F. (L) ................................................................Nelson-Creston Sultan, Ralph (L)....................................................... West Vancouver–Capilano Thorpe, Hon.

Rick (L) ..........................................................Okanagan-Westside Trumper, Gillian (L)................................................................Alberni-Qualicum van Dongen, Hon. John (L) ................................................Abbotsford-Clayburn Visser, Rod (L).................................................................................North Island Weisbeck, John (L).........................................................Kelowna–Lake Country Whittred, Hon.

Katherine (L) ...................................North Vancouver–Lonsdale Wilson, John (L)........................................................................... Cariboo North Wong, Patrick (L)............................................................Vancouver-Kensington LIST OF MEMBERS BY RIDING Abbotsford-Clayburn....................................................... Hon. John van Dongen Abbotsford–Mount Lehman ..............................................Hon.

Michael de Jong Alberni-Qualicum.......................................................................G illian Trumper Bulkley Valley–Stikine ..............................................................Dennis MacKay Burnaby North..............................................................................Richard T. Lee Burnaby-Edmonds............................................................................Patty Sahota Burnaby-Willingdon......................................................................

John Nuraney Burquitlam ........................................................................................ Harry Bloy Cariboo North ..................................................................................John Wilson Cariboo South .................................................................................... Walt Cobb Chilliwack-Kent ............................................................................. Barry Penner Chilliwack-Sumas .................................................................................

John Les Columbia River–Revelstoke....................................................Wendy McMahon Comox Valley .......................................................................... Hon. Stan Hagen Coquitlam-Maillardville .............................................................Richard Stewart Cowichan-Ladysmith .......................................................Hon. Graham P. Bruce Delta North.......................................................................................... Reni Masi Delta South................................................................................

Valerie Roddick East Kootenay .................................................................................. Bill Bennett Esquimalt-Metchosin...................................................................Arnie Hamilton Fort Langley–Aldergrove ..................................................... Hon. Rich Coleman Kamloops ....................................................................... Hon. Claude Richmond Kamloops–North Thompson ........................................................Kevin Krueger Kelowna–Lake Country...............................................................

John Weisbeck Kelowna-Mission ................................................................ Hon. Sindi Hawkins Langley ............................................................................... Hon. Lynn Stephens Malahat–Juan de Fuca .....................................................................Brian J. Kerr Maple Ridge–Mission ................................................................... Randy Hawes Maple Ridge–Pitt Meadows .............................................................Ken Stewart Nanaimo..........................................................................................

Mike Hunter Nanaimo-Parksville ...................................................................Hon. Judith Reid Nelson-Creston.......................................................................Blair F. Suffredine New Westminster ..................................................................Hon. Joyce Murray North Coast ........................................................................................Bill Belsey North Island........................................................................................Rod Visser North Vancouver–Lonsdale.......................................... Hon.

Katherine Wh ittred North Vancouver–Seymour .............................................................Daniel Jarvis Oak Bay–Gordon Head .......................................................................Ida Chong Okanagan-Vernon .................................................................... Tom Christensen Okanagan-Westside.................................................................Hon. Rick Thorpe Peace River North .............................................................Hon. Richard Neufeld Peace River South .......................................................................

Blair Lekstrom Penticton–Okanagan Valley ....................................................Hon. Bill Barisoff Port Coquitlam–Burke Mountain.................................................... Karn Manhas Port Moody–Westwood......................................................... Hon. Christy Clark Powell River–Sunshine Coast.......................................................... Harold Long Prince George North................................................................................Pat Bell Prince George–Mount Robson................................................Hon.

Shirley Bond Prince George–Omineca................................................................Paul Nettleton Richmond Centre......................................................... Hon. Greg Halsey-Brandt Richmond East .......................................................................... Hon. Linda Reid Richmond-Steveston ................................................................ Hon. Geoff Plant Saanich North and the Islands ............................................... Hon. Murray Coell Saanich South...................................................................................

Susan Brice Shuswap .............................................................................. Hon. George Abbott Skeena.............................................................................................Roger Harris Surrey-Cloverdale ................................................................. Hon. Kevin Falcon Surrey–Green Timbers .................................................................. Brenda Locke Surrey-Newton ............................................................................... Tony Bhullar Surrey–Panorama Ridge................................................. Hon.

Gulzar S. Cheema Surrey-Tynehead .......................................................................... Dave S. Hayer Surrey-Whalley ...................................................................... Elayne Brenzinger Surrey–White Rock ...............................................................Hon. Gordon Hogg Vancouver-Burrard................................................................. Lorne Mayencourt Vancouver-Fairview............................................................... Hon.

Gary Co llins Vancouver-Fraserview ...................................................................Ken Johnston Vancouver-Hastings .......................................................................Joy MacPhail Vancouver-Kensington...................................................................Patrick Wong Vancouver-Kingsway..........................................................................Rob Nijjar Vancouver-Langara....................................................................Val J.

Anderson Vancouver–Mount Pleasant............................................Jenny Wai Ching Kwan Vancouver–Point Grey ................................................... Hon. Gordon Campbell Vancouver-Quilchena............................................................ Hon. Colin Hansen Victoria–Beacon Hill.............................................................................Jeff Bray Victoria-Hillside.................................................................................. Sheila Orr West Kootenay–Boundary.................................................... Hon.

Sandy Santori West Vancouver–Capilano ..............................................................Ralph Sultan West Vancouver–Garibaldi ................................................. Hon. Ted Nebbeling Yale-Lillooet .................................................................................. Dave Chutter

CONTENTS Thursday, May 15, 2003 Morning Sitting Routine Proceedings Page Committee of Supply ............................................................................................................ ................................................... 6819 Estimates: Ministry of Health Services (continued) J. MacPhail Hon. C. Hansen J.

Kwan Proceedings in the Douglas Fir Room Committee of Supply ............................................................................................................ ................................................... 6831 Estimates: Ministry of Health Services — Mental Health; and Intermediate, Long Term and Home Care (continued) Hon. G. Cheema B. Locke K. Krueger J. Kwan L. Mayencourt R. Stewart

6819 THURSDAY, MAY 15, 2003 The House met at 10:04 a.m. Prayers. [1005] Hon. M. Coell: I seek unanimous leave of the House to permit

Section A of the Committee of Supply to sit and consider a portion of vote 29 relating to the estimates of the Minister of State for Mental Health and the estimates of the Minister of State for Intermediate, Long Term and Home Care at the same time that the estimates of the Ministry of Health Services are being considered in

Section B, and that an official record be kept of the debates in

Section A. Leave granted. Orders of the Day Hon. M. Coell: I would call in

Section B of the chamber of the assembly the estimates for the Minis- try of Health Services and in

Section A, the Douglas Fir Committee Room, the estimates for the Minister of State for Mental Health followed by the Minister of State for Intermediate, Long Term and Home Care. Committee of Supply The House in Committee of Supply B; J. Weisbeck in the chair. The committee met at 10:10 a.m. ESTIMATES: MINISTRY OF HEALTH SERVICES (continued) On vote 29: ministry operations, $10,038,097,000 (continued). J. MacPhail: If I could, for the minister and his staff, outline pretty much the order…. There may be a bit of variance, but I'll do it again. Wait-lists, executive sala- ries….

Under that subhead would be compensation for non-executives as well, provincial comparisons of wages, then health authorities — just individual health authority by health authority. One, in the old days, might have called it local issues. The new federal money. We discussed Romanow a little bit and the accord that arose out of that. Under the federal money, last night, in reorganizing my work…. I will, as we're discussing the new federal money, talk about accountability throughout that as well. A few more issues around physicians: on call, ER and then primary care.

The compensation issues will be under executive and non-executive compensation. I think that's it. As I understand it, in Committee A my colleague the member for Vancouver–Mount Pleasant is discussing issues as well. I don't think there'll be any overflow, unless some of those will come back here. On the wait-lists, we had quite a toing and froing on wait-list calculations here in the Legislature already, through question period. Let's move the discussion on.

Checking on the government website from the Ministry of Health Services, there has been no update or change recorded since we had this discussion in this chamber around April 10, 2003. No matter what statistics you use, no matter how you calculate it, for the wait-lists the total increase is 19.8 percent. The reason why I say no matter how you calculate it is that if you redo the calculation based on the government's current report and you use that same way of calculating it before this government took over, the increase is still 19.8 percent.

Let me ask the minister, in terms of wait-lists and wait times, what resources are being directed toward this issue. The reason why I distinguish between wait- lists and wait times is because I accept the premise that increasing wait-lists is not necessarily an indicator of bad delivery of services. If the wait-lists are increased but the wait times are shortened, then that's fine. That means that the population is growing or aging, and therefore the wait-lists are also getting longer. One also has to look at wait times for surgery. [1015] Hon. C.

Hansen: Clearly, wait-lists are an issue that I know provincial governments have wrestled with for many years. It's not unique to British Columbia, and all provinces are trying to meet those challenges. One of the things we have is really the inability to assess need. Not everyone on a wait-list is in need of equal priority. It's certainly not a chronological need — that the faster you get on a wait-list, the sooner you get access to sur- gery. It's that people really differ in their individual needs. There is considerable work being done by all the health authorities.

It's being led by the provincial health services authority. It is a major initiative to look at how we prioritize wait-lists to ensure that those who need quicker access get quicker access. The work that is being done is set out in

schedule A of our service plan. That gives a bit of the background around this collabo- ration around surgical and procedural services. It's

schedule A of the performance agreement with the health authorities. I should correct myself — not the service plan. We have certainly been working throughout the province to try to increase surgical capacity and find the most appropriate location for surgery. We have opened, for example, the ninth operating room in Kelowna at a cost of $6 million. There are other facilities around where we are focusing the kind of surgical procedures that can be offered. Summerland hospital is a perfect example of that — where they are doing day surgeries, primarily elective surgery.

It becomes far more predictable for both the patients and the physicians. They can count on having more predictable access. The net result of some of the changes we've made is that the number of surgeries that are performed in Brit-

6820 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 ish Columbia has increased by 9 percent over the last y e ar. S o w e a re m ak i n g s o m e p ro g re s s i n t e rm s o f i n- creasing surgical capacity. The work that's being done by the PHSA around the protocols is going to feed into the western Canada wait-list project. Out of that, we anticipate that very soon we will start the rollout of some of the protocols that will assist physicians in get- ting access to surgical care in a timely fashion for their patients, depending on their relative need compared to other patients.

It is an area where there's a lot of work being done, but clearly a lot of work continues to have to be done. The last thing I would point out is that the wait-list registry we have on our website is the only one of its kind in Canada. That was implemented by the previ- ous government. The member may have been the min- ister at the time. I can't recall. It is a useful tool for pa- tients to be able to identify which physicians have longer wait-lists than other physicians. But the meth- odology in terms of having a measure that is sound in its methodology….

We really can't say the methodol- ogy that drives that wait-list registry is a sound indica- tor, although I know it's certainly useful to compare from one year to the next. The bottom line is that the number of surgeries are up, and we are working on a more systematic approach to wait-list prioritization. J. MacPhail: I'm wondering whether the minister could read

schedule A from the performance agree- ment into the record or at least give me the highlights of it. We don't have that performance agreement. [1020] Hon. C. Hansen: The performance agreement is on the website for the various health authorities. This is the same wording that's consistent with all of the health authorities. Its expected performance is to col- laborate with the PHSA and other regional health au- thorities and ministries to develop measures of per- formance for surgical and procedural services in the province's hospitals.

The process will include the estab- lishment of measures of the performance of the system in response to emergency treatments and procedures and the development of principles for establishing pri- ority of care for non-emergency conditions and cases.

The product during this last fiscal year wil l be the development of measures of the response of the health care system to emergency surgical and procedural needs to agreement on the principles to be used by the health authorities in classifying cases as emergent or urgent/elective, a plan to measure the appropriateness and outcomes of selected procedures and adoption by the health authorities of these outputs and standards. Five, to consult with…. Sorry; that's the balance of it there. J.

MacPhail: Perhaps the minister could describe for us, then, whether there is a health authority that has the best practices in this area. Are there areas of the province that are moving quickly in this area and from which others could gain a best practice model? Hon. C. Hansen: I have to apologize to the mem- ber. As I was reading from the performance agreement, I got to the fourth bullet, flipped the page and realized that I had the wrong page. There is a continuation, which I will finish just so it's on the record.

It probably showed when I sort of stopped mid-sentence and real- ized I wasn't reading the right thing there. What I read out earlier was the performance…. It was the products, the initiatives that had to be taken in the '02-03 fiscal year.

It continues with the '03-04 fiscal year — that is, the continuation and completion of de- liverables identified in '02-03, assessment of population need and utilization rates of surgical services that will assist in the formulation of guidelines for surgical con- centration and location of core specialty services, de- velopment of provincial access standards and defini- tions for wait-time measurement that will assist in the formulation of guiding principles for the prioritization and wait-listing of surgical cases, and the introduction of surgical and procedural measures and standards.

In the '04-05 fiscal year it will be demonstrated improve- ment in the performance of the surgical services. So that is in the performance agreements for the health authorities. To answer the member's specific question about what health areas are having better progress when it comes to wait-list management, the Vancouver coastal health authority has done a lot of work in the last number of years around the appropriateness of surgi- cal procedures. The interior health authority is proba- bly the furthest along when it comes to its surgical re- view, but all of the health authorities are engaged in that.

Also, the Vancouver coastal health authority is well along on its surgical review. I guess the one facil- ity in the province that is leading when it comes to de- veloping a needs-based approach to wait lists is B.C. Children's Hospital. Because so much of the surgery they are faced with is critical at certain ages in the growth of a child, they have really developed some of those protocols to try to make sure that access to surgi- cal care is needs-based and not just chronologically driven. [1025] J. MacPhail: Let me put some stats on the record here, then. These are the stats from the minister him- self.

In May 2001 there were 66,126 patients waiting for surgery. That amount as of February 28 this year was 73,669, so the wait-lists have grown but also the times for some of the surgeries. The wait times for surgeries are up substantially, as well, in almost every category — except cancer, which is great news. That's 1.3 weeks, and 1.3 weeks is greater than eight days, so the cancer wait time is less by a day or so — and also neurosur- gery. In every other category, the wait times are up.

The combination of an aging population, a popula- tion that could have access to greater surgical tech- niques and technology and therefore be healthier, and

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6821 also the funding for access to those services are the inputs around what happens to the direction of wait times and wait-lists. Yesterday we heard that the budget for physician services is increasing at about the same rate as the population growth, maybe just a little bit less — no, about the same. So what about utilization rates? What about utilization rate increases in terms of physician services, and what about operating time it- self? What's happening around the province in terms of overall operating time available? Hon. C.

Hansen: To address the member's first question regarding utilization rates, what we have budgeted for is a 0.9 percent increase in utilization in terms of the Medical Services Plan. In terms of surgical capacity in the province, I think the outcome — the output, which is the important part — is the fact that the number of surgeries performed in the province is up by 9 percent year over year. I think we can look at specific cases — cardiac sur- gery, for example. In March 2001 we had performed 1,334 cases in the 2000-01 fiscal year. By the '02-03 fiscal year, that had increased to 1,480 cases.

In terms of hip replacements, the same story. There is an increase from the number of procedures that were done in 2000-01 to the '02-03 fiscal year, and the same is true of knee re- placements. [1030] The member is right. Median wait times do go up, and the number of people on those lists does go up. We are increasing surgical capacity throughout the prov- ince, but the fact of the matter is that the demand for some of these services is rising even faster if you look at the number of people on the wait-list.

Again, that's one of the reasons why we need better methodology to determine what is a true measure of the number of people in need of a surgical procedure, because right now that methodology is really driven by the self- reporting of doctors. We don't have an indication as to what kind of duplication there may be on those lists. We don't have an indication as to the number of pa- tients that may have been on a particular surgeon's list that, in fact, have already got their procedures done. The methodology that's there now, which drives the wait-list, is really not very sound.

That's part of the reason why we're developing new measures and new tools, so we can actually get something that really withstands the test of scrutiny with regard to how the wait-lists come together. J. MacPhail: If the population is growing by about 1.4 percent — that's the Finance ministry's — and then a 0.9 percent increase in the utilization rate, what other factors have gone into the physicians' budget that would make the lift less than 1½ percent? I think it's a 1.3 percent lift. Hon. C. Hansen: What we have in terms of an in- crease for the medical fee-for-service portion of the Medical Services Plan….

When we talked last night, I indicated that budget was up by about…. I think we had a population increase of 1 percent. We discussed that last night. We also had the utilization increase of 0.9 percent. We have a reduction that then comes in, which is moneys that were in the base budget for last year, so therefore they were annualized into this year. We wound up with the base budget being about $12.5 million higher than utilization actually worked out to be in the end for last year, but that was already in our base budget. That then brings it down by about 0.5 percent. There are some other minor adjustments.

The rural locum program, for example, is seeing an increase of almost $1 million. Physician benefits…. It's basically to sort out some of the potential unresolved issues that are still being worked out in terms of implementation of agreements, which we talked about last night, and there are some funds, as well, that allow for that. If you add all those things together, it's the increase of 1.9 percent in demand pressures, both population growth and utilization, and we wind up with some of those.

The biggest one is the offsetting saving from what was underutilized in last year's budget, and the net result is an increase of 1.44 percent. [1035] J. MacPhail: What protocols is the government working on, then, with physicians around surgical pro- cedure management? The minister raises matters such as that perhaps there are duplicate wait-lists, postings or whatever. What's the government doing with physi- cians to manage and put a proper face on surgical wait- lists? Hon. C.

Hansen: The provincial surgical and pro- cedural services project is one where there is an inter- disciplinary group that has come together to look at how we best approach the management of wait-lists. The other initiative that's underway is the western Canada wait-list project. I remember I was talking to one of the doctors from B.C. who is very much a part of that, and I asked him: "Why is it taking so many years for that to roll out?" He explained that one of the rea- sons is that they are testing it. They're doing pilots with some of the protocols that have been developed.

They want the protocols to be looked at as sound and based on good evidence. This is not some policy that's being sort of imposed out of 1515 Blanshard Street on the physicians of the province. A really important process is to get physician buy-in. There's been a lot of work done to make sure that's communicated around the province so when it does roll out, the physicians will see the merit of it from the time that it's first launched. That's the western Canada wait-list project. If we look at the provincial surgical and procedural services project, which is running parallel to that….

Obviously, they are learning from each other, and these efforts will become very much integrated. The steering committee will oversee a variety of expert panels and task groups that are working. Their task is to develop provincial

definitions for elective, urgent and emergent

6822 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 surgical cases; provincial access standards and defini- tions for wait-time measurement and benchmarking; provincewide measures and key indicators on the per- formance of surgical and procedural services; assess- ment of population needs and/or utilization rates of surgical services; guiding principles for the prioritiza- tion and wait-lists of surgical cases; establishment of guidelines for surgical concentration and location of core specialties; reporting requirements and informa- tion resources for continuous improvement of surgical and procedural services; feasibility plans and processes for practice guideline development; and surgical and procedural services and related outcome analysis and the evaluation framework to measure the effectiveness of improvements to the system.

That wait-list project…. The steering committee is made up. It includes doctors. It includes nurses. It in- cludes health administrators. There's a director, for example, in transition planning, and there's been a lot of work that's gone into that process. I think we'll start to see the benefits of that unfold over this coming year. J. MacPhail: When's the next provincial-territorial ministers' meeting and/or federal-provincial-territorial ministers' meeting? Hon. C. Hansen: The next formal meeting of fed- eral-provincial Health ministers is going to be in Sep- t e m b e r .

I t i s n o r m a l l y h e l d i n S e p t e m b e r . T h a t ' s c e r - tainly my experience in these years. I think this year it will be held in Halifax. There are from time to time other teleconferences involving all of the Health minis- ters. When issues come up, we certainly do meet via telephone as well. J. MacPhail: I wanted to ask the minister whether he would consider raising this topic. As I recall, there is a view, and it may be supported by studies — I'm sorry, I'm doing this from memory — where a certain portion of people on wait-lists for surgery end up get- ting better without the surgery.

They don't die. They end up actually not needing the surgery and still liv- ing. There's also a portion that die. [1040] What I'm wondering is this. One of the silver lin- ings that we could take from the situation that occurred in Ontario as a result of the SARS epidemic and the quarantining of whole hospitals there is an examina- tion of what actually has happened to surgical wait- lists in that province. Here's what I mean, and I'm just asking the minister whether he would consider raising this matter.

There has been a massive amount of time in Ontario when surgeries weren't performed as a re- sult of the SARS epidemic. That is my understanding. Therefore, is Ontario doing any study of the special effects that that had on surgical wait-lists? It's a terribly unique challenge for which I feel the pain of people in Ontario, including the doctors and nurses who are there, but maybe there is something to be learned from this particular period of time as well. I'm wondering if I'm making myself clear to the minister. Hon. C. Hansen: The short answer is yes. I would be pleased to ask that of my colleague in O ntario.

I'm quite sure they would be und ertaking that kind of re- view, because obviously it is a major challenge for the Ontario health care system. One of the things we have in British Columbia is probably the best wait-list data compared to other prov- inces. I know we talked about the challenges that we have in B.C., but we're actually further ahead than other prov- inces. One of the things we have learned in this province from the challenges around the SARS outbreak is that the way we have structured our health care system in British Columbia is a real advantage — the fact that we have the six health authorities.

There is the ability for instant and effective communication among those health authorities and the ability to identify who exactly in this structure needs to know and needs to take action so that decisions can be made very quickly. We certainly saw that in British Columbia. I think it's a credit to those individuals that we were able to contain the SARS outbreak as effectively as we did in British Columbia. In Ontario they have a very different structure. It is really quite fractured. They don't have the integration of facilities that we have in British Columbia.

They may have a bit bigger challenge of doing the analysis of an impact on wait-lists just because of the way their health system is structured. They do have a very good cardiac registry and car- diac wait-list management — p ro b ab l y t he b e s t i n t he country. I know that other provinces are certainly learning from that Ontario example. That may be one area in particular where the review of the impact on wait-lists might be very instructive and something we can learn from in all provinces. J. MacPhail: I think this will be the last area of wait- lists and wait times that I want to discuss.

It's the issue of private surgery versus public surgery. I've had many, many letters on this topic, but I've taken one that's current and is highlighted in the media and also pretty much covers the range. It's a letter to the minis- ter dated March 27, 2003, and it was copied to me as well and to the Premier. There have been news articles on it as well. I'll just read it into the record. [1045] "Dear Minister of Health Services: "I'm hoping you can assist me with regard to a five- year surgery wait-list that is absolutely unacceptable.

I have been diagnosed with chronic sinusitis requiring surgery, which would be performed at St. Paul's Hospital by Dr. Amin Haver, MD, endoscopic sinus and skull base surgeon. It would be done at St. Paul's sinus centre. "According to Dr. Haver, he is the only fellowship- trained surgeon west of Ontario that is qualified to do image-guided surgery. I have attached e-mail correspondence from Dr. Haver with his explanation for the long wait-list. What appears to be the major cause of the delay is the unavailability of operating time three to four days per month." That's what the doctor told the patient.

"Alternatively, I could have the surgery performed at Dr. Haver's private clinic. However, I don't have the money to pay for it.

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6823 "Enclosed is an

article from yesterday's Vancouver Sun" — which is dated Wednesday, March 26 of this year — "which highlights this terrible situation. When I asked Dr. Haver if he could recommend where else I could get the surgery done in less time, he indicated Ontario or Seattle. "If this is the case, then I would like to know how this can be funded by our medical plan during the interim, since Dr. Haver is the only qualified surgeon to perform this surgery west of Ontario. I believe these necessary surgeries should be funded by our health care unit until such time as Dr. Haver has more operating time available at St.

Paul's Hospital and the wait-list can be reduced to an acceptable level." Hon. C. Hansen: I think a bunch of issues flow out of that letter the member has read. One of them is the whole issue of the Canada Health Act. We have made a commitment to support the Canada Health Act and its principles. When we hear of cases that could be poten- tially in violation of the Canada Health Act — when patients report those to us — we do investigate and do follow up on those.

I'm not saying that this particular case is or is not, because obviously we would want to do a proper investigation before there's any determina- tion along that line. But the crux of the issue here is really the allocation of operating room time. The system we have had in British Columbia up till now has really been very ad hoc. The amount of operating room time a physician can get access to is often based on just their historical patterns of practice.

When you wind up with a new procedure that comes in or perhaps a new specialist who comes to the province who has unique skills, his ability to get adequate operating time is often frus- trated by some of those who are driving the status quo that had been there previously. [1050] It is our intention that out of the provincial surgical and procedural services project, we will be better able to determine how to prioritize procedures to ensure that people do get access to medically necessary proce- dures in a timely fashion. We're not there yet obvi- ously.

So I hope that out of this review, our approach to allocating operating room time to physicians will be based more on need rather than just on historical precedents. J. MacPhail: Flowing from that, could the minister, for the record, put his government's

interpretation of what the law is around private versus public access to surgery? I'll do that first. Hon. C. Hansen: The Canada Health Act dictates that a medically necessary procedure that is provided to a Canadian citizen must be funded publicly. Regard- less of whether that surgery is performed in a privately owned clinic, whether it's performed in a privately owned doctor's office or whether it's performed in a publicly owned hospital, that surgical procedure must be covered and paid for by the public purse, and there can be no additional charges directly to the patient.

The other thing to point out is that the Canada Health Act covers hospitals and doctors' fees only. I think there are a lot of Canadians who tend to think that somehow the Canadian medicare system, or the Canada Health Act, covers the full scope of health care services. In fact, it covers medically necessary services provided by doc- tors or in hospitals in Canada. J. MacPhail: Does the minister have statistics about the growth in private clinics in British Columbia in the last year or 18 months? Hon. C.

Hansen: The provincial government does not directly license private clinics; nor is there sort of an official registry of something that is defined as a private clinic or private surgical centre. The licensing requirement is that the physicians that provide services in any facility in the province…. That service has to be authorized by the College of Physicians and Surgeons. We don't keep a registry per se, but I think that during the 1990s there was an increase in private clinics from 26 — I think the number was — to about 50.

My under- standing is that in the period over the last 18 months or two years that the member indicated, there may have b e e n a n i n c r e a s e o f a b o u t f o u r o r f i v e , b u t w e d o n ' t have an exact number. J. MacPhail: The review the minister is doing — will it incorporate the aspect of privately funded surgi- cal increase, surgical operating time as well? [1055] Hon. C. Hansen: It will look at all of the publicly funded surgical procedures, regardless of where they get performed.

One of the things we did was develop a protocol for the health authorities to guide them in the issues they have to address before they can contract out any surgical procedure to a private surgical centre. What we have said to the health authorities is that they may use private surgical centres, provided they can demonstrate it is more cost-effective and will not have a negative impact on the services provided in our publicly owned facilities, and that they have to be con- sistent with the Canada Health Act. Therefore, there can be no additional charges assessed.

The short answer to her question is yes, the surgical review that's undertaken will look at all surgeries that are funded out of the Ministry of Health Services budget. As the member will know, there are organiza- tions in Canada that are exempt from the Canada Health Act. Workers Compensation Board is probably the most significant case in British Columbia where they can go directly to private clinics. In fact, I believe that in British Columbia, they're probably the largest client of the private clinics. [K. Stewart in the chair.] J.

MacPhail: T he l as t a re a I h av e o n s u rg i c a l w ai t - lists — and just for the information of the minister, we'll be going to salaries next, executive and non-

6824 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 executive — is organ and tissue transplants. The record is improving here in British Columbia, which is won- derful news. There are more people waiting, but that can't be the responsibility of anything other than avail- ability. The median wait time is down, which is great. I'm wondering if the minister could tell me about the government's organ and tissue donors. What changes have occurred in the last year in terms of encouraging donors, and what's the trend? Hon. C. Hansen: The B.C.

Transplant Society certainly has an ongoing public relations campaign to encourage more people to sign up as organ donors. It is an area where we still have a long way to go. We are making progress in terms of a greater percentage of the population that have registered. I apologize, but I don't have the exact number as to where we're at right now in terms of what percentage other than the fact that it is increasing as a result of the very good efforts of the B.C. Transplant Society.

One of the big challenges we have is actually a good-news story, and that's that the number of people being killed in car accidents in British Columbia con- tinues to drop. As a direct result of that, which is good news, there are fewer and fewer organs available for transplant. The B.C.

Transplant Society is doing a lot of work around policy development and evolution around living donors, for example, and they have re- cently added more flexibility to enable non-related living donors to be part of that program. [1100] In terms of tissue banks in the province, there is n o w m u c h b e t t e r c o o r d i n a t i o n a s a r e s u l t o f t h e i n c i - dents that we had at the ear bank in British Columbia, which I think was a real….

It was an opportunity for us to double-check that other tissue banks in the province have proper information and are keeping appropriate records, and that is the case. We have put the coordina- tion of that under the B.C. Transplant Society as well, so there is better oversight and better coordination. I guess the bottom line is, as the member said, that it is a good-news story in that we are getting more British Columbians signed up as organ donors and that people are getting access to donors with shorter wait times. J.

MacPhail: Moving to compensation now, I want to start in reverse order of compensation — for the minister to outline in his budget what the severance costs are allocated for this year and for whom the budget for severance is targeted. Hon. C. Hansen: Each health authority has estimated severance and restructuring costs over a three-year period for this. The budget we are estimating for that three-year period for severance and restructuring is $81 million.

Most of that was actually booked in '01-02, and some of it was booked last year, because accounting rules allow for that to be booked providing there is a specific plan for that to be drawn down over the ensuing years. J. MacPhail: There was an

article in the newspaper that said that…. It's dated March 3, 2003, and I didn't see any correction by the government. This govern- ment's great at issuing letters to the editor, and credit to them for correcting the record. There was none in this particular case. The

article said: "B.C.'s six health authorities will pay laid-off staff up to $225 million over three years." Hon. C. Hansen: The ministry staff sitting beside me have big smiles on their faces, because what they had handed me was the briefing note which the mem- ber will recall from her experience in cabinet.

The sec- ond bullet says that a Province story, March 3, contin- ues to use the $225 million figure, stating: "B.C.'s six health authorities will pay laid-off staff up to $225 mil- lion over three years." It then goes on to say the correct number is $81 million, so the articles that came out in March are not correct. J. MacPhail: I guess you've got to get that public affairs bureau on to writing more letters to the editor, because it's become a congenial truth, as they say in a book about spinning out there. So does the $81 million figure include the recent renegotiations of contracts? Hon. C.

Hansen: First of all, the letters to the editor. I do write a lot more letters to the editor than you ever see. I just wish they all got published, but that's part of the challenge. No, that does not include the most recent, because that is out for ratification. We're still waiting to see what the results of that will be. [1105] J. MacPhail: There have also been stories — and these are very recent stories; they're not New Democrat– generated stories, either — about the increase in com- pensation at the health authority level and also about the numbers of people who are getting increases.

I recall from the days when we were in govern- ment, there was a similar discussion around these mat- ters in the area of education. It may be before even this minister's time. It may have been from the term 1991 to '96. But the then-opposition, now government, made a huge and legitimate stink, in my view, about compen- sation in the education field at the school board level at the same time when funding was not increasing at the same level for kids in the classroom. The result was that the government of the day, the then administra- tion, did a review and put a cap on administration costs.

That resulted in what, for parents and teachers, became — and, actually, school board trustees didn't object either — an effective way of having a balance between administrative costs going to executives and services going into the classroom. Now the bad news is that this government, just in the last session previous to this one, removed that ad- ministration cap. That's why I was exploring earlier on with the minister at great length about the cuts in ad- ministration. Were they cuts to administration — i.e., executive management people — or were they cuts to

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6825 support services such as laundry, housekeeping, die- tary, landscaping? Can the minister please tell me: what is the direc- tion in terms of executive compensation increases in those who are making more than $100,000 now than a year ago — and how many? Hon. C. Hansen: The member's specific question, if I'm right, was the number of people in the health sector earning over $100,000 a year now compared to before. What I have before me is the number of senior employ- ees earning over $125,000. I have that as of….

Well, it would have been within the last couple of months. What I don't have at my fingertips is a comparison to what was there previously, but I've got a couple of things that would be indicators of that. Incidentally, most of the employees earning over that amount are, in fact, doctors who are directly employed by the health authorities. There are other things that I can point to. One of the things in the financial statements that are provided by the health authorities…. There is actually a separate line item for administration, which would include the salaries, for example, of the top executives.

There are separate line items for finance, human resources, sys- tems support, communications, which we talked about as well. [1110] In the line item for administration, which is one of the reportable line items, in every single one of the health authorities, that declines from the year 2000 through to 2003. Just as an example, the interior health authority goes from $29.5 million down to $22.1 mil- lion; northern health authority from $12.8 million down to $7.3 million.

Now, the provincial health ser- vices authority, as we talked about before, starts out at $9.7 million, and it goes up to $15 million and down to $14 million. That's because they were structuring. They were starting out as a brand-new organization, which we discussed last night. Vancouver coastal health authority goes from $38 million down to $21.6 million; Vancouver Island, $22 million. It actually comes down slightly from $22.2 million down to $22 million. If you look at that provincewide, the provincial totals for that administra- tion line go from $133 million down to $102.7 million.

As was just pointed out to me, what we predicted whe n w e d i d t he ro l l o u t o f r e d e s i g n o f t he he al t h au - thorities in December 2001 is that there would be sav- ings of $15 million, and we've obviously already ex- ceeded that. There is also a study that was done for the Health Employers Association of B.C. in March of this year. It was done by Mercer Human Resource Consulting.

What that shows is that in the employer group 1 — that's all of your top CEOs and senior executive mem- bers — using this compensation strategy, the market data illustrates that HEABC's midpoint/job rates are significantly below the market in aggregate as follows: 14 percent below the median for the health sector in Canada, slightly above the median for the B.C. public sector, and 17 percent below the median for the private sector. J. MacPhail: Is that a public study? I'd be interested in seeing it, if it is. Hon. C.

Hansen: At this point the document is still going forward for review by PSEC, and I'm not exactly sure of the time line of that, so we're not sure if it will be publicly released. At this point we don't see any reason why not, but that determination is yet to be made. J. MacPhail: In the area of compensation — before I move to the non-executive compensation — this gov- ernment changed the way health authority board members are compensated. In fact, they weren't com- pensated before, and now they are compensated. W e n o w h a v e a y e a r o f e x p e r i e n c e i n t e r m s o f health authority board members.

Could the minister b r i n g m e u p t o s p e e d o n w h a t l a s t y e a r ' s e x p e r i e n c e has been in now compensating health board members? Hon. C. Hansen: The workload that we are asking of our board members and our chairs of the health au- thorities is really quite considerable. These are not jobs and responsibilities that take a couple of hours a week. I know the chairs and the boards put in hundreds of hours in terms of their responsibilities, and it was a d e c i s i o n w e m a d e a t t h e t i m e t h a t w e w o u l d p r o v i d e them with some compensation for that.

It certainly is not considerable. Certainly, there's none of them that would do it for the money. It is basically, I think, a token recognition of the time that they put into it. On an hourly basis, it certainly wouldn't amount to very much. J. MacPhail: Just because the Liberal government appointed these people doesn't mean that the people who did it in the 1990s are any less dedicated, and they didn't get paid. So I'm asking what the payment is. Hon. C. Hansen: I agree with the member.

I cer- tainly had the pleasure of working with many of the board members and chairs that served on the other 52 health authorities, and I have great respect for the dedication they put into those jobs at that time. [1115] The remuneration. The chair is paid an annual re- tainer of $15,000. Directors are paid an annual retainer of $7,500. The board and committee meeting fees are $500 per meeting. Other meeting fees are $250. The maximum payments that can go out to these individu- als is $45,000, plus travel fees and expense reimburse- ment per fiscal year. For directors that amounts to a maximum of $25,000. J.

MacPhail: Yes, and how much was paid? That's what I'm asking for. In estimates last year the minister estimated about $1.6 million was going to be paid, but I'm asking what the reality is after a year of experience.

6826 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 Hon. C. Hansen: That is information that would be part of the data that will be provided with the final financial statements from each of the health authorities. We do not have those yet. Certainly, through public accounts, there would be an opportunity to review that, but I haven't got the data at my fingertips now. We expect it will be coming in the next weeks or months. J. MacPhail: I know the minister there has a docu- ment that assembles all of the health authority budgets. With our limited research capacity we haven't done that.

Let me ask it this way then. This government is taking great pride in getting the budget, the money, to the health authorities early so they can put their budg- ets in. It's all supposed to be much better and much more open and transparent than it was in the last ad- ministration. If the minister can't report to me about what the experience was for '02-03, perhaps he can tell me what the health authorities have budgeted for '03-04 for the costs of board members. Hon. C. Hansen: I'm advised that it is not a sepa- rate line item in the budgets. It is included in the ad- ministration line that I referred to earlier.

We don't have that as a separate and distinct line that I could make available. We have given to the health authorities their budgets, their allocation of funds, based on the population needs–based funding formula. It's up to them to determine how best to allocate that to meet their administration and operational needs, but they must stay within the compensation guidelines that I outlined earlier. J.

MacPhail: How is it, then, that the public — let alone the opposition — is supposed to find out about how much this is costing the public with the govern- m e n t ' s c h a n g e t o n o w p a y i n g p e o p l e w h o u s e d t o b e volunteers? Hon. C. Hansen: Certainly, it's easy enough to cal- culate what the maximums would be if all of them were to use those maximums. We can certainly en- deavour to get, once the year-end numbers are final- ized, that line broken out from each of the health au- thorities.

If the member would want to make that re- quest, we can endeavour to get it to her once that in- formation is available to us. J. MacPhail: Yes, please. We would like that infor- mation to see what the experience rating is and the experience usage is. I want to move to non-executive compensation now. We've had a bit of discussion about how, in cer- tain areas, health support services…. The minister said yesterday that they're 30 percent higher, and then he also said that British Columbia nurses are either the highest or second highest.

I want to put that in context with whether that indeed holds up to scrutiny and whether there are individual compensation levels that are high but there are less people doing the job. There- fore, people are having to work harder doing that job. [1120] I need to lay out my case a little bit first. This is information from CIHI, I think — yes, the Canadian Institute for Health Information — and i t ' s u p t o d at e as of 2002. I am using a prop, but I will try to describe it i n w o r d s .

T h e c h a r t s f r o m C I H I o f p u b l i c s e c t o r c o m - pensation in health expenditures by use of funds are done in current dollars, and it's got hospitals and insti- tutions. Of course, I'm not dealing with those. Then it goes: "Physicians and other professionals." I'm comparing British Columbia, the percentage change, to all of Canada. If I could just read…. I'm sorry. This takes a moment, Mr. Chair, not because of poor research but because of me. I'm just going to deal with percentage changes — okay? It covers the years from 1975 through to 2002.

Over the years, the changes in physicians in British Columbia from about the mid-eighties through to 2002 have exceeded the rest of Canada, and I'm happy with that on the percentage changes. That includes right up to the years 2001 and 2002, where the physician compensa- tion for all of Canada in the year '01 was a 7.8 percent increase and a 7.1 percent increase in '02. That was in Canada. In British Columbia it was 12.1 percent in '01 and 14.7 percent in '02. I think the difference is be- tween…. This is overall compensation — the money paid.

Of course, that can be affected by the number of people being paid as well as the percentage that they earn individually. In the case of other professionals, other profession- als in British Columbia would have received, starting in 1991, an increase of 13.4 percent in 1992, and in the r e s t o f C a n a d a t h e y r e c e i v e d a n i n c r e a s e o f 1 1 . 4 p e r - cent. So in 1992 there was a differential of about 2 per- cent — not quite, but yes, let's say 2 percent — better- ment.

After that, it's about standard until 1999, in which case the increase for other professionals went up by 19.7 percent here in British Columbia, and in the rest of Canada it went up by 7.8 percent. That was when, the minister may remember, there was compensation for nurses — the increase in nursing compensation. So I agree. There's a difference in that year, in 1999, and the difference is about 12 percent greater compensation. However, then we go down to the year 2000, which is about the same both in British Columbia and nationally. W e g o t o 2 0 0 1 - 0 2 .

I n t h e r e s t o f C a n a d a i n 2 0 0 1 , other professionals' salary compensation increased by 3. 6 p e rc e nt . H e re i t d e c l i ne d b y 2 p e rc e nt . I n 2 00 2 t he percentage paid to other professionals in all of Canada declined by 4.4 percent, and in British Columbia it de- c l i n e d b y 2 2 . 8 p e r c e n t , f o r a n e t c h a n g e o f m i n u s 2 4 percent in '01-02 here in British Columbia and a net change in the rest of Canada of minus 1.2 percent. [1125] The reason why I'm suggesting this is because nurses, particularly, would start to say that even….

They would even challenge the government saying how much — whether the compensation is the best —

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6827 but they would also make this claim. It's that there are fewer percentage points of the overall health budget going to health professionals in British Columbia as a percentage of the overall budget, and that's because they're having to work harder. Hon. C. Hansen: F i r s t o f a l l , I w a n t t o s e e k s o m e clarification from the member. Is the CIHI data that she's referring to actual real dollars, or is it referring to changes in the percent of budget? J. MacPhail: Percentage of the budget. Hon. C. Hansen: The total health budget.

Okay, that's helpful. I find that intriguing, but certainly we did, in those years, increase the health budget considerably. We increased it by $1.1 billion, so the total size of the budget went up considerably. But at the same time, for the bottom line you have to come back to the numbers we talked about last night. There are 538 additional nurses employed in British Columbia just last calendar year alone compared to previous. So we have seen a steady increase in the number of nurses employed in our health sector.

The other side of it is that the com- pensation increase, with their latest increase, was 22.6 percent in terms of what it cost. So I find that number, as a reduction in the percent- age of budget, intriguing. I've always enjoyed CIHI numbers. I like to go in and pull them apart sometimes, and I plan to do it with that one. But I don't have a quick explanation for the member as to why that would have shown a minus 22 percent increase at a time when not only were we hiring more nurses and employing more nurses, but the wage and benefit cost for those nurses has gone up considerably.

I do want to comment quickly on her reference to physician compensation. In British Columbia we now have the highest per-capita budget for physician com- pensation of any province in Canada. We're actually, I believe, about 19 percent higher than Ontario, and we're about 42 percent higher than Alberta when you come to the per-capita cost of physician service in Brit- ish Columbia. J. MacPhail: Y e s , a n d I k n o w i t c a n a l w a y s b e i n - terpreted by the questions that the opposition asks that they're picking favourites in the delivery of health care as a result of staff, and I'm not at all.

My point would actually be reinforced by the last point the minister made. I am going to make copies of these and give them to the minister over the lunch hour, if I may, be- cause it is very interesting research. Thank you to those who did the research. My point would be that physician compensation has not only kept pace in British Columbia, but one could claim it has led the country, both by his statements and this evidence. But that is not true of other professionals in the system, particularly in the last two years.

Based on the minister's last comments about nurs- ing compensation, I do need to read into the record a letter sent to the Premier by the British Columbia Nurses Union from their president, Debra McPher- son. This was January 17, 2003. It followed ads at the beginning of this calendar year. The government ad on January 17…. I won't read the first paragraph; it was about other incidents that were going on at the time. [1130] The second paragraph starts: "Dear Premier: "The ads paid by taxpayers appeared again late last week and throughout the weekend in major B.C. daily newspapers.

They contain outright falsehoods, misstatements of facts and distortions. The British Columbia Nurses Union has received several complaints about the ads from members of the public. "Government ad: 'Nurses wages have increased 23 percent and are now the highest in Canada with starting compensation pay and benefits of $73,650 per year.' "Fact: in B.C. a starting registered nurse or registered psychiatric nurse earns $46,416 per year. For an experienced front-line registered nurse, the highest wage rate is paid in Ontario.

"Fact: benefits such as MSP premiums, extended health and vacation time boost the costs to employers of a starting nurse to about $57,500. "Fact: the government produced its $73,560 figure by computing the cost to employers of about 1.3 nurses. In this figure, they are including the cost of replacing a nurse with another nurse when she goes on vacation, sick leave or maternity leave. None of that additional money goes into the pocket of the nurse who's away, and not all RNs are even replaced when they are away." Then they go on to talk about another aspect of the government ad.

"'Specific actions we are taking include adding 1,266 new nurse training spaces.' "Fact: since taking office, the number of new spaces implemented by the government for RNs and RPNs beginning their training in B.C. is less than 100. The 1,266 new nurse training spaces claimed by your government mostly consist of new first-year spaces funded by the previous government and additional spaces in the second and third years to enable those additional first- year students to continue their studies. The figure also includes spaces for licensed practical nurses and spaces for RNs needing short refresher programs.

"Government ad: 'Helping 400 former nurses return to the job.' "Fact: while the government has provided refresher training to enable these 400 nurses to return to the job, there is no information about how many of them were actually given jobs. At the same time, the government was cutting almost 400 full-time RN positions from the health care system. "If you do genuinely seek to rebuild trust with British Columbians, I expect you will be instructing your officials to act accordingly and remove this ad from publication.

I hope for an early reply to my request." I raise that only because of the discussion that we had last night. It was a good discussion around com- pensation and nursing and the future of nursing in this province. We did receive feedback overnight — talk about instant communication — from nurses in the system. I compared that with what I know about what

6828 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 CIHI is saying about overall percentage allocation of the health budget to other professionals. [1135] I'm wondering: where does one resolve these mat- ters? Where does a nurse resolve this matter in terms of not only compensation but working conditions as well? Hon. C. Hansen: I think the member's specific question was: where do nurses go to pursue compensa- tion issues? I think we went through some of those bodies last night, so I won't repeat that whole answer.

But certainly, through their union they have relation- ships with human resource officers in facilities, and through the HEABC they have the ability to discuss issues around their collective agreement. So they do have the avenues — through their supervisors, in a direct sense. They also have access through their union, whether it's through the shop stewards or through the bargaining committees directly to the HEABC. The member talked about the ads and the infor- mation in the ads. Basically, the information that was in those ads was checked very carefully, and it is based on factual information. The letter Ms.

McPher- son has written discussing that…. I think her analysis of it is, by and large, fairly accurate. We are looking at the total compensation cost to the health sector, so we're not looking at each individual nurse. You know, they, too, have had a significant increase, as I men- tioned earlier. The issue around training spaces. I find it curious when the member somehow argues that licensed prac- tical nurses are not real nurses.

They are professionals, they are professionally trained, they are professionally credentialed through their college, and I have the high- est respect for the work done by licensed practical nurses in this province. I think the challenge we have is to make sure we utilize the right health professional in the right spot. I a l s o j u s t w a n t t o t o u c h b a c k o n o u r C I H I d a t a . What she's talking about is not a 22 percent reduction in compensation for other health professionals; she's talking about a reduction in the percentage of the over- all health budget that's going to health professionals.

Nurses in this province are making significantly more than they were making two years ago. J. MacPhail: Once again, I have said over and over in this House that I take no position on the allocation of resources between LPNs and RNs — none. I'm not a health professional; I have no ability to make that allo- cation. I'm not sure how the minister interpreted that what I was saying in any way indicated that. I'm just saying there has to be a proper, professional analysis of allocation of resources that has the best patient care at the heart of that analysis. That's all I've said over and over again.

My point relating to the individual compensation of nurses versus the overall allocation of health care dol- lars from the overall budget to delivery of health pro- fessional services other than physicians is this. If there is a declining percentage of the overall budget being allocated to health professionals other than physicians, it means that perhaps some may be getting paid more, but there are fewer overall doing the work. I raise that issue only to have an answer to how those matters of workload are resolved.

There used to be joint working committees, pursuant to the collective agreement, which discussed matters of workload. They were out- lawed under Bill 29. That was my only point in raising that. [1140] Hon. C. Hansen: The number she cannot refute is that there are more nurses working in the system. There are more registered nurses; there are more li- censed practical nurses. From the stats I read out last night, we may have actually seen a decline in regis- tered psychiatric nurses, but there was an increase last year alone of 538 nurses, and they are being paid more.

I don't think the member's argument holds water when you look at the actual stats in terms of the number of staff that are in the system. The other thing I should point out, which really has a direct effect on that overall cost to the system, is things such as overtime, which is down 29 percent — the num- ber of overtime hours in the province. We have seen long-term disability drop by 50 percent in this last year. I think that indicates that nurses are working in better and more appropriate environments.

Just as an example, the overhead lifts, which we talked about last night as well — those not only reduce workplace injuries but also reduce the workload for individual nurses. We are us- ing technology better. You can't draw the conclusion that the percentage of the overall health budget that is allocated to a par- ticular sector — let's say other health professionals — should automatically increase at the same rate as the overall budget increases. It should be making sure that we have the appropriate number of health profession- als doing the right job to meet the needs of patients in the province.

As we discussed last night, we still do have nurse shortages in the province, and vacancies. I forget the number now, but it was about 300, or what- ever that was we discussed last night. J. MacPhail: That's all fair comment by the minis- ter, and I will await the explanation around workload issues. The one thing we can determine is that the per- centage of the overall budget going to health care pro- fessionals has fallen by 24 percent in the last two years. The minister may be right — I take him at his word — that there are more nurses working in the system now and less long-term disability and overtime.

Excellent. But at the same time, more work is being done in the system. The minister just claimed that there were 9 percent more surgeries being done. It's not a static situation. I don't in any way claim it to be a static situation. There are trends, and that's why I used percentages as opposed to overall dollars, be- cause the only way you can determine trends is by looking at percentage change. So I leave that for the minister. I'm hopeful that there is some forum for these

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6829 matters to be discussed since Bill 29 outlawed the workload committee. The other area that my colleague and I can't leave without some discussion is the overall matter of com- pensation for health care support workers. I actually have to go on record thinking that — perhaps not this minister — the Premier has had a particular and per- sonal attack on the Hospital Employees Union.

I was shocked that the Premier of this province, who is sup- posed to be the statesperson representing all of British Columbians, used the opportunity of a televised ad- dress to attack the Hospital Employees Union. I was completely taken aback by it. I, who have tried often and almost always to support those in my party, have at times taken a position different than my govern- ment, but I was surprised that MLAs in the Liberal government allowed the Premier to get away with that. It was completely unnecessary.

It was a cheap shot, and it was perhaps not telling the whole truth, either. [1145] I'm wondering whether the minister, in his allega- tions of always saying that people who perform house- keeping tasks, dietary tasks, laundry and security make 30 percent more on average — and he used it yesterday — or his officials have done any allocation of that fig- ure as it relates to paying women an equitable wage. Hon. C.

Hansen: I guess the short answer is that we certainly haven't been driving the changes around support staff based on an approach on groups that, because they may be more than 50 percent women- dominated…. We want to make the right decisions based on how to get the most cost-effective services that are required to support the delivery of health care to patients in British Columbia. It's not a case of using that budget to drive a pro- gram to support one particular sector in our labour force or another sector in the labour force.

We are look- ing for the most cost-effective delivery of care, and whether a particular sector is predominantly female or otherwise was not part of our considerations. J. MacPhail: T h i s g o v e r n m e n t d o e s g o o n a b o u t how the health support service workers are paid 30 percent more. Let me tell you about what happened in terms of wage differentials, gender-based wage differ- ences, from 1991 to 2001. Why is it important? Well, let me just tell the minister — well, not tell the minister, as I'm sure he knows this — why it's important for British Columbians.

I hope there isn't one MLA, either Liberal or New Democrat, who would now say the work that health support service workers provide is not important. They cannot be written off as glorified toilet-cleaners any- more, and I know that even the Liberal MLAs have stopped saying that. They're key to the well-being and integrity of our safe health care system, of safe delivery of health care services. Who are the health support service workers in our province? Well, 27 percent are visible minorities, 31 percent are immigrants and 85 percent are women. I don't agree that they're older women.

The average age is 47 years, and that's not an older woman by any stretch of the imagination. Anyway, they are women in their forties who are visible-minority immigrants. That's who they are, and thank God they're doing the jobs. They're tough jobs. They're important jobs, and they're highly unrewarded jobs from a public percep- tion. In order to have these valuable jobs done, from 1991 to 2001 the government of the day took a position that those jobs should be adequately compensated — not overcompensated but adequately compensated — and here's what happened.

Because of the profile of who was doing the jobs, the government of the day approached it from a point of view of wage equity, gender-based wage payments, and looked at it from that point of view. H e r e ' s w h a t h a p p e n e d , M r . C h a i r . I n t h e g e n d e r - based wage differential…. What do we call it? The wage gap. The wage gap between men and women. Here's what happened. Housekeeping aide, 1991: the wage gap between men and women was 16 percent. By 2001, the wage gap was 3.7 percent.

Nursing assistant: the wage gap in 1991 was 29 percent between men and women in a comparable job of the same value. [1150] We're not making up new worlds here. These apply across the world. Nursing assistant, 29 percent. That differential had decreased to 11 percent by the year 2001. Food service worker: the gender wage gap in 1991 was 10 percent. That had decreased to 0.2 percent in 2001. Laundry worker: the gender-based wage gap was 14 percent in 1991. In 2001 it was 1.9 percent. Clerk 2, medical records: in 1991 the wage gap was 14 per- cent. That had been reduced in 2001 to 1.1 percent.

I'm always fascinated in the discussions that my colleague and I have with the Minister of State for Women's Equality around progress in this area, but if ever there was progress made on the basis of compen- sating people for the value of the work — regardless of who they are, what gender they are or from whence they came — that work took place and progressed properly from 1991 to 2001. Our system could not sur- vive without these workers.

I hope both the Premier, who takes it upon himself to attack those people who work in our health care system and our members at the Hospital Employees Union, and this government, who uses those workers as an example of how overpaid British Columbia health support service workers are, take into account that any reversal of their wages will be a direct attack on women and a widening of the wage gap. Hon. C. Hansen: We did earlier discuss the pack- age that is out for ratification by members of the HEU now. We don't know what the result of that ratification will be.

But if that package is ratified by the member- ship in the HEU, they will still be the LPNs, the house- keepers, the cooking staff, the laundry workers, the cleaners, who…. I agree with you. They are a valuable part of our health care system, and it is an essential

6830 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 part of our health care system that we have those sup- port services. But if this package is ratified by the HEU membership, those B.C. workers will still be the No. 1 paid in those categories of any province in Canada. I think the women who provide those services — or anyone who provides those services, male or female — will certainly be able to enjoy the highest wages in Canada for those particular categories if this ratifica- tion, in fact, is approved. The Chair: Member of the opposition. J. Kwan: Thank you, hon. Chair — for Vancouver– Mount Pleasant. J.

MacPhail: And a proud member of the opposi- tion. J. Kwan: Yes, 50 percent of it all. I can't sit back and just let the minister's comments slide when he rose up and responded to my colleague the Leader of the Opposition around the wage-equity piece, when he said that the government, in this sector, happens to have these wages reduced through Bill 29 and other measures. It just so happens to be targeting women in this instance, although it's not the govern- ment's intent to target women. You know, the reality is this.

The principle of pay equity deals with women — women as a class — ver- sus the male counterpart, and that's where the wage gap comes in. Over the last ten years tremendous effort has been put to try and actually narrow that gap be- tween men and women for work of equal value. We happen to be discussing the health care sector, and as my colleague identified, the health care support workers happen to be primarily women, immigrant women and, one may argue, perhaps middle- to older- aged women, 47 — although not old, by no stretch of the imagination are they deemed to be old, not at all.

So we happen to be deliberating about this class of women, if you will, in the workforce who are faced with wage cuts. [1155] The minister says that…. That is an aside on the issue around the principle of wage equity that I want to ask the minister to address. There's another issue here. He says their wages are actually the highest, but you have to also take into consideration cost-of-living ex- penses. For housing alone — e v e n i n O n t a r i o , i f y o u compare Ontario — our costs are a lot more expensive than that of the other provinces.

I won't take the time to read from our research the housing costs and the cost- of-living differentials between the provinces. That makes a big difference. When you account for that, the wages all of a sudden actually slide right back down in terms of the cost of living. There are two points that I think the minister needs to address on that note. I would hope that we've moved to a point where the Liberals and all MLAs support wage equity and would put measures toward moving and advancing and narrowing the wage gap between men and women for work being done of equal value as opposed to actually widening that gap.

That's what's happening right now when the government rolls back wages for this sector of workers in our com- munity. Hon. C. Hansen: I think that if this package gets ratified, we can still point to British Columbia as the province that has the highest wage and benefit rates for employees in this sector. I think we have to be careful when we start looking at cost-of-living factors with various cities across Canada. In fact, there was a study done of medium-size cities throughout North America.

What it showed was actually that the two cities in North America with the lowest cost of living in that size of community were Kamloops and Chilliwack — as cost of living. When you start to compare from province to prov- ince, there are lots of factors that come into that. I think the bottom line is that we still have wage rates in this province that are well above other provinces in Can- ada. Do you want one more? J. Kwan: I appreciate the minister's response, but I do want to put this on the record. We're comparing Canada.

The minister's comment is that we have the highest wage for this group of workers in Canada, which is why I want to put on record the cost-of-living expenses. Just take as an example — I wasn't actually going to read this onto the record, but I will, given that the minister says we have to be careful about those comparisons — that in Canada, just on housing alone, the interprovincial comparison of wages, minimum wages and housing costs for B.C. is $1,538. For Alberta it's $1,152; Saskatchewan, $980; Manitoba, $1,022; On- tario, $1,366; Quebec, $995; New Brunswick, $891; Nova Scotia, $891; P.E.

I., $891; Newfoundland, $891. The average for Canada is $1,218, and B.C., once again, is $1,538. There's a substantive difference in terms of just one element of the cost of living, which is around housing, that I've highlighted here. When you add in, again, the wage differences between men and women, I don't think anybody in this House would assume that some- how women will require less money to survive for per- forming the same work of equal value. Women ought to be paid the same amount.

We're trying to narrow that gap and not widen it, but yet we see this Liberal government turning back the clock for one sector of women in the health care support services sector. They are all the folks that my colleague had mentioned — the laundry support, the housekeeping support and so on. In any event, I don't want to belabour this. I do note the time, so, Mr. Chair, I move that the committee rise, report progress and ask leave to sit again. I'd like to be able to come back in the afternoon. Motion approved. The committee rose at 11:59 a.m.

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6831 The House resumed; Mr. Speaker in the chair. Committee of Supply B, having reported progress, was granted leave to sit again. Committee of Supply A, having reported progress, was granted leave to sit again. Hon. R. Coleman moved adjournment of the House. Motion approved. Mr. Speaker: The House is adjourned until 2 p.m. today. The House adjourned at 12 noon. PROCEEDINGS IN THE DOUGLAS FIR ROOM Committee of Supply The House in Committee of Supply A; H. Long in the chair. The committee met at 10:10 a.m.

ESTIMATES: MINISTRY OF HEALTH SERVICES — MENTAL HEALTH; and INTERMEDIATE, LONG TERM AND HOME CARE (continued) The Chair: We're sitting here in relation to the unanimous consent being given to

Section A of the Committee of Supply to consider the portion of vote 29, Health Services, related to the Minister of State for Mental Health and the Minister of State for Intermedi- ate, Long Term and Home Care. Following completion of the discussion this morning, I will be making an informal report to the Chair of

Section B in the House as to the status of the discussion in

Section A. Hon. G. Cheema: I'm willing to answer any ques- tions from any member of this House. B. Locke: I will continue from the previous day. My question to the minister is: is there a policy that metha- done must be used in treatment programs, even when the facility does not want to take in clients that are cur- rently on methadone? Hon. G. Cheema: The health authorities target funding for addiction treatment programs that provide care for patients with the highest need. This includes patients with a concurrent disorder, patients with mul- tiple addictions and patients with multiple treatment failures.

Intensive residential treatment facilities funded by the health authorities cannot refuse patients because they are taking prescribed medication. This includes medications like Olanzapine for schizophrenia and Wellbutrin for depression or methadone for heroin addiction. However, there are many supportive recovery fa- cilities in B.C. that are not funded by health authorities but receive funding through the Ministry of Human Resources or through gaming. These facilities may or may not be licensed. The medication policy would not apply to these facilities. B.

Locke: Can the minister comment on needle ex- change programs, and what is their role in the drug strategy? Hon. G. Cheema: Needle exchanges are one part of the harm reduction, and we value these programs. For example, we have one program in Surrey. That pro- gram has been proven very effective and has won in- ternational awards as well. I think they do a great job, and this helps to reduce the infection of HIV and other infectious diseases. We want to continue with these programs. They're very effective. B. Locke: Those are all of my questions. K.

Krueger: I recently had the great privilege and joy of opening two brand-new buildings in Kamloops — two of the three construction projects for the tertiary psychiatric facility for the southern interior which is being built there. I wanted to start off by thanking the minister for that promise being kept. We were de- lighted that patients were moving immediately into the two buildings that we were opening. I just wanted a status report for my constituency and Mr. Speaker's constituency as to what the feedback is from the fami- lies and patients. [1015] Hon. G.

Cheema: This is something that was prom- ised a long time ago. It's my understanding that this project was promised by three Ministers of Health and about three Premiers in the past, and that promise was never kept. I think the community of Kamloops was let down, and they were very concerned when we came into power whether we would do that or not. I think that with the help of the members from Kamloops…. Both the members were very effective at keeping us fully informed. We had an initial meeting, which was, I think, in the month of August or September of 2001. We met with all the key players.

Then we made the decision that we will be fulfilling that promise. This is something so important not only for Kam- loops but also as a part of the Riverview redevelop- ment project. We opened two facilities two to three weeks ago. The Premier was there along with the member for Kamloops–North Thompson. We were very pleased to see how this new facility will provide

6832 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 the best possible compassionate care which is based on best practices. It's my understanding that this project is moving very well. Patients are being transferred to that facility. I just want to put on the record some of the feedback I got from the new place. We call this place the South Hills facility in Kamloops. One of the patients said: "As a result of this new facility…." This patient had not seen his family for the last 23 years. This was some- thing that was very important to him.

When this pa- tient went to the new place, he was very happy to see his family. I think that's something we wanted to do as a sign of respect and also a sign of caring, and we are very proud of that. One patient, who had been at the Riverview Hospi- tal for 40 years — four zero, 40 years at this institution — said that this was the best place he had ever lived in, in his life. The patient said, after his arrival: "I finally feel that there is a hope for recovery for me." I think that says a lot about mental health in this province. I think that's what we wanted to achieve.

There are many facilities across the province. They are home-like facilities. I think you need to go and see those facilities. You have seen them, but I would ask any other member, if they have time, to go and visit these places and talk to the patients, talk to the fami- lies. This facility is based in the middle of the neighbourhood, a residential place, and I think that will help us to remove the stigma from mental illness. I want to say thank you to the member and his staff in his office, to the Hon.

Speaker and his staff, and to many advocates in the area who have been very effec- tive in reminding us that we should always fulfil our promise. I say we were grateful that we were able to do that. This will serve patients in this province in a very respectful way. K. Krueger: My thanks to the minister. Kamloops is grateful — and the southern interior and, I'm sure, the families of those patients — but it's especially hearten- ing to hear that feedback from the patients themselves. It's delightful that the families are reunified to the ex- tent they can be, and I'm very proud of the government for that.

I understand we've opened facilities in Prince George and Coquitlam similar to the South Hills facil- ity. Those were earlier than ours. I wonder what the experience has been there. Hon. G. Cheema: As I said earlier, the Riverview redevelopment project is one of the major components of our mental health plan. We made the promise dur- ing the campaign that we would be implementing the mental health plan.

We realized that not only do we have to redevelop this hospital, but we also have to spend money in communities around this province, and to develop modern facilities like South Hills in Kamloops, Connolly Lodge in Coquitlam, Iris House in Prince George and Seven Oaks in Victoria, we are spending an additional $138 million. [1020] I'll just give you a few examples of how some of the patients are feeling in Connolly Lodge. Over half of the patients were ready for discharge within a year. Origi- nally, it was expected that the discharge could not have occurred for at least two years. That's a huge im- provement.

Environment plays a strong role in the recovery of these patients. If you look at these facilities, they are home-like. There is a kitchen in the centre, you have a nursing station, and then you have a very accommo- dating place. These are nice places and patients feel good. I think they feel, some of them for the first time in their lives, that they are being respected. We expect these things to get better in the future also. Riverview Hospital, you should know, also has a graveyard. I think it says a lot that in the past when patients were sent to this institution, some of them never expected to come back.

That's what we are changing. We think that these patients have a place in the communities. Some of them may never leave a fa- cility, but they should be given a full chance. The recovery rate is remarkable. I will give you an example from Iris House in Prince George. We opened a facility last year. There were ten beds, and we opened another phase of ten beds. The patients are so happy. Some of them are participating in the religious activi- ties. They will go and be a part of the community. Families are happy. The community in the surrounding area has also developed a new level of respect.

I think that's part of my responsibility, to ensure that the issue of stigma is also removed. I think we are making pro- gress, but it will take some time. So far our experience has been very positive. We have done something which no other govern- ment has done in the past: any patient from Riverview Hospital will only be moved if there is an agreement between the patient and the family and the receiving community. I think that's significant. Not a single pa- tient has moved without the consent of all the partners.

I must say that the work done by the provincial health services authority — under the leadership of Wynne Powell, Lynda Cranston and Leslie Arnold…. I call them the magnificent trio. They have done a tre- mendous job of putting this plan into action. K. Krueger: All of that is very heartening. I was tremendously impressed with the facilities. They are the type of buildings I think anybody would feel very comfortable living in. They're beautifully done — really nice.

I wonder if the minister could give my constituents an update on the time line for the 44-bed acute care addition to Royal Inland Hospital, which constitutes the third pillar of this facility. Hon. G. Cheema: These 44 tertiary acute care beds will be located on the Royal Inland Hospital site. Cur- rently this project is in design, and we expect comple- tion of this project by the fall of 2004. That will give Kamloops 44 plus 40 beds; that's 84 beds. That was our

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6833 promise. I think that's another fulfilment of our prom- ise. I am so happy that this is something…. Again, I must say that the member from Kamloops and his colleagues in the area have worked very hard to make sure that we fulfil that promise. I think it's good for the community; it's good for the patients. This will also bring a lot of money to the community, when we have these 44 plus 40 beds operating. That's good for patients. [1025] K.

Krueger: I n s p e a k i n g o f t h i s w h o l e p r o j e c t , t h e minister has quite rightly spoken of the benefits to pa- tients first. They are obviously the fundamental prior- ity for everything we're doing there. The minister just touched on the economic factor as well. Certainly, in heartlands communities there has long been a feeling that government could be doing a whole lot more locally than it's done over the decades and that a lot of economic activity is needlessly cor- ralled down here at the south end of Vancouver Island.

It is the second priority after patient care, but this is a tremendous boon to our local economy, and we really appreciate it. People have heard different numbers as to what the long-term economic impact will be. I wonder if the minister has available to him an estimation of what the annual payroll will be for this facility when it is fully operational. Hon. G. Cheema: I don't know the exact number, but I will get the numbers for the member from the staff. We'll keep him fully informed. This project is in the process of going ahead. As the patients are going to be moving, the money will flow with them.

We are not aware of the exact amount at this time. K. Krueger: Fair enough. In conclusion, then, I do want to extend my thanks and the Speaker's thanks and the thanks of our many constituents. This is a ma- jor promise that was made, and it has been kept very early. We're proud of the minister's work and his staff, and we just want to say thank you. J. Kwan: Let me ask the minister some broad ques- tions, and then we'll go into some of the specifics. Could the minister please advise: how much out of the Health Ministry's budget is being allocated for mental health services? Hon. G.

Cheema: The expenditure for mental health for 2000-01 was $854,600,237. The projected ex- penditure for 2003-04 is $1.067 billion. That is about a 17.6 percent increase over 2000-01. [1030] J. Kwan: The minister gave the numbers for 2000-01 as $854 million-plus and '03-04 as $1.06 billion. What's '02-03? Hon. G. Cheema: Mr. Chair, '02-03 is $1.005 billion — approximately. J. Kwan: Just so that I get the numbers correct: 2000-01, $854 million; '02-03, about $1 billion; and then '03-04, about $1 billion. Is that correct? Hon. G. Cheema: For 2001-02, it's $924 million.

For 2002-03, it's $1.005 billion and for 2003-04, $1.067 bil- lion. J. Kwan: Could the minister give us a further breakdown of those numbers by region? Just to further clarify, when I say by region, I mean to each of the health authorities. Hon. G. Cheema: We don't have the exact amount of how it's going to flow to each health authority. Once this budget process is approved, then the funding is going to be going to them on the basis of population numbers. J. Kwan: The budget was introduced back in Febru- ary.

It is now May, and the minister still does not know how his budget is being broken down to each of the dif- ferent health regions? I find that incredible, actually, for the regions not to know. They must know. It's been sev- eral months since the budget has been introduced. If the minister doesn't know, how could he calcu- late, then, on the basis of what the needs are in the community? How did he come up, for this year's budget, with almost a billion dollars? Under what pro- jections? He must have some idea. I'm not looking for an exact figure to the penny.

Some ballpark numbers would be adequate, and I would assume that the min- ister would know and have that information. [1035] Hon. G. Cheema: Let me just explain to the mem- ber again that this is the estimated expenditure for next year. Once this process is approved, the health authori- ties will be spending that much money across the prov- ince. We are looking at the outcomes and the perform- ance measures part of the mental health spending. At this time I don't think we have any of the numbers to explain to the member. J. Kwan: Let me just get this straight.

We're debat- ing the Ministry of Health Services debate in the big House. The health budget is about 40 percent of the entire budget. In this small House we're dealing with one segment of that health budget, which is the health services for mental health — for the Ministry of State for Mental Health. I understand how the process works. I understand that this is a projection for next year. I understand that this is how these numbers come together. I understand that's how governments plan to move forward, that they have these estimates in their own minds and how, therefore, they could meet their budget targets.

That's what these things are called. Estimates are called budget targets. If the minister doesn't have budget targets, how does he expect that he would ac-

6834 B RITISH COLUMBIA DEBATES T HURSDAY, MAY 15, 2003 tually meet those targets? How does he get the reassur- ance that the services the community needs are actually being met? He has no idea whatsoever what those tar- gets are. How could a minister do his job if he doesn't have that information? I am completely perplexed as to how it could be that the minister does not have those budget targets. How can the minister sit in this House and assure the community — British Columbians — that their services that they require would be fulfilled — that they would be met? How could the minister say that?

Well, maybe the minister can't say that. Maybe he'll just say: "Hey, you know what? I don't know what my budget is. I don't know what's going on out in the broader public. I don't know what services you need. Therefore, I don't know how to meet your needs in our community." Is that the situation the minister is faced with now? [1040] Hon. G. Cheema: I will just try to answer again. There is a 3 percent increase in the budget for mental health from last year. That's about $62 million more than last year. Mental health is very complex. We are developing community services.

We are spending money on the acute hospital beds. We're spending money as part of the Riverview redevelopment project. I have told them, member, that this year there is going to be a 3 percent increase over last year. That's about $62 million more than last year. J. Kwan: I'll continue on with these questions with the minister in a minute. I just need to speak with somebody outside who's waiting for me. I'll yield the floor to the member for Vancouver-Burrard for a few minutes. I'll come back. L.

Mayencourt: There has been a lot of discussion recently about the Eating Disorder Resource Centre, which has been located in St. Paul's. Maybe I could begin by giving a little background. St. Paul's Hospital has been a centre of excellence for the eating disorder clinic that resides at St. Paul's. It's a very valuable ser- vice. There are a lot of British Columbians that have a variety of eating disorders. This has been a very valu- able resource in my community. As kind of an offshoot of that, the executive direc- tor of that clinic had created a resource centre.

There was some concern and an announcement that St. Paul's Hospital, which is going through some challenges in terms of how much space they have to offer…. One of the sacrifices they have made is the Eating Disorder Resource Centre. I wonder if the minister could tell us what the ministry is doing about maintaining the Eat- ing Disorder Resource Centre in Vancouver and what future plans he has for that particular resource. Hon. G. Cheema: Thank you for the question. In February 2003, St. Paul's Hospital provided a notifica- tion of the need to relocate the Eating Disorder Re- source Centre.

At that point, the PHSA began work to find a new location for the centre. I know that the member for Vancouver-Burrard has been very active in working to ensure that a new location for the centre is found. The centre will be temporarily moved to a chil- dren and women's centre and is presently being funded by the health authority. As the member knows, on May 8 the Duke of York and the Premier performed a sod-turning ceremony for the new child, adolescent and women's mental health centre that we are building on the children and women's site.

For this I would like to commend — I call them three magnificent leaders of the provincial health services authority — Lynda Cranston, Wynne Powell and Leslie Arnold. They are a most successful and dedicated trio for mental health. I would like to also recognize Dr. Derryck Smith for advocating for this project for many, many years. Our government recognizes the importance of this project, and we have acted to see it happen. The Eating Disor- der Resource Centre will be located permanently to this new facility when it's completed in 2005. J. Kwan: Sorry, my apologies.

I've just been advised that the Government House Leader would prefer that I ask the questions of the minister Monday when we get back. Therefore, I'm going to yield the floor to the gov- ernment members to ask the questions relating to the minister's estimates at this time. I'll come back and ask my set of questions from the opposition caucus Mon- day when we get back. [1045] L. Mayencourt: Thank you to the member for Vancouver–Mount Pleasant. I appreciate the oppor- tunity to canvass these estimates at this point. To the minister, thank you for that answer on the Eating Disorder Resource Centre.

I think it's something t h a t w e h a v e … . I t ' s a v e r y s i g n i f i c a n t r e s o u r c e t h a t ' s v e r y v a l u a b l e i n m y r i d i n g , b u t I a l s o u n d e r s t a n d t h e challenges St. Paul's is facing. I'm grateful that we have this resource centre moving up to B.C. Children's and Women's Health Centre. That's a great thing for us. The next area I wanted to ask the minister about has to do with something that was canvassed here a little bit earlier today, but I do want to just ask a few questions.

It has to do with the plan for taking folks out of Riverview and putting them into the community. I know that having these folks in the community does work very well. As a matter of fact, I've been with the minister. We've gone to the downtown east side, and we've visited St. James Community Services Society, which has a number of these facilities, at varying lev- els, to help individuals living with mental illness. It has been very successful. In a very non-partisan way, I also want to com- mend the member for Vancouver–Mount Pleasant be- cause I know she's been involved with St.

James and also with another agency, called the Unity Housing Society, in the downtown east side, which has created five individual homes in the Strathcona area and which

THURSDAY, MAY 15, 2003 B RITISH COLUMBIA DEBATES 6835 allows individuals with mental illness to sort of take control of their lives, take control of their home. They have a number of individuals that live in these homes. I think it's very healthy. They have a non-profit agency that helps them administer the dollars and such. I am really interested. As I go around my commu- nity and we talk to people about decommissioning Riverview, there is concern in the community.

It re- volves around some of the things that happened in the mid-eighties through the nineties in which there was a feeling that, you know, we were putting people in the community but weren't really giving them the re- sources to be able to succeed. Now, I know, having my experience with St. James, having my experience with Unity, having my experience with the Coast Foundation and many others, that in fact there are great people trying to provide that kind of sup- portive environment for people living with mental ill- ness.

I wonder if the minister could please tell me a little bit about that decommissioning and the resources that are going to be available to build facilities and to provide that supportive environment for those individuals as they move from Riverview into the community. Hon. G. Cheema: I think the member is right that in the past, when attempts were made to downsize this hospital, the community placements were not there. A lot of people feel that this may happen again, and I think that's one thing we should always be aware of. I am also concerned about that.

Our government has made a commitment that we will not send any patient into the community as part of the Riverview redevelopment project without having a community placement in place. I'll give you some ex- amples. The Ministry of Health Services has committed over the next five years to redevelop Riverview Hospi- tal. We will be spending an additional $138 million to have this facility across the province, because you can't take one patient from this institution and take them back to their community without having a proper place. That's number one. [1050] Number two.

This year, in 2002-03, $10.25 million was allocated to reallocate 82 mental health beds to the following health authorities. To the northern health authority, we gave $1.125 million for ten beds. The interior health authority will receive $5 million for 40 beds, and Vancouver Island health authority will re- ceive $4.125 million for 33 beds. Money will flow with patients. You should have assurance that these patients will be t

Document details

Collection	British Columbia — Debates (Hansard)
Citation	H0515am 13
Type	hansard
Volume / chapter	H0515am 13
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	550cfa316fc8f8e09b68805ab94c3494a1226ca2

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