2000 Legislative Session: 4th Session, 36th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, MAY 16, 2000

Afternoon Sitting

Volume 19, Number 18

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The House met at 2:08 p.m.

Hon. M. Farnworth: In the gallery today we have Leslie Gibbenhuck, chair of the Children's Liver Alliance in Canada. She is visiting us from Penticton, along with her 11-year-old son, Jarad. Leslie has been an activist regarding hepatitis C since she found out that her son contracted the disease in 1995. Jarad was actually infected during an operation in 1988.

Accompanying Leslie and Jarad are friends Ron Thiel and Sue and John White. They will be meeting with me tomorrow morning, and they are visiting here today. I would ask the House to please make them most welcome.

B. Barisoff: On behalf of the B.C. Liberal caucus, I'd like to welcome all those people who are here for Agriculture Day, whether they're here in the gallery or outside. We have people from all over the province representing agriculture. It's a fine day, and we'd like to welcome them all here. Will the House please make them welcome.

Hon. C. McGregor: It's my pleasure to introduce two guests from the Kamloops area who are here for Agriculture Day today and for our real extravaganza last evening. I'd like the House to welcome Doug Haughton, who represents the B.C. Cattlemen's Association, and Leo Sunder, who represents the Associated Ginseng Growers of B.C. Would the House please make these visitors welcome.

[1410]

Hon. A. Petter: It's my pleasure to introduce one person who's here because of Agriculture Day and two people who are here just because it's a nice place to visit. The first is a constituent of mine, Judy Galey of the B.C. Potato and Vegetable Growers Association of Victoria, who, as I say, is here for Agriculture Day. The second introduction relates to my mom, Elizabeth Petter, and her friend Dede McBride, who's here visiting from Trail. I'd ask the House to join me in making all three of these visitors welcome.

R. Thorpe: I would like to join with the minister in welcoming Leslie Gibbenhuck and Jarad. I've known them for over five years. Leslie has worked tirelessly on behalf of hep C victims, not only in Penticton and in the province of British Columbia but across Canada. I would like to acknowledge her work and let everyone know that she'll be conducting a seminar tonight to assist 86 to 90 claimants in this work. So Leslie, welcome; Jarad, welcome. Would the House please make them welcome.

Hon. J. Doyle: In the gallery today I have a very good friend of many, many years from Golden, Roy Short, down here visiting his elderly mother for Mother's Day. So welcome, Roy. With Roy is his brother-in-law Fred Halderson, who lives in Victoria. Please make them welcome.

G. Hogg: There are 77 vibrant, active and inquisitive grades 4 and 5 students from Star of the Sea School here today, along with their teachers, Mrs. Fraser, Ms. Dayton and Mr. Durante, and many of their parents. Would the House please make them welcome.

Hon. J. Sawicki: To my distress, I don't actually have any agricultural land left in my riding, but my colleague from Burnaby-Edmonds always shares Burnaby's Big Bend with me. On behalf of him and myself, I would like to welcome to the House Herb Van der Ende of United Flower Growers in Burnaby and Casey Van Vloten of the B.C. Landscape and Nursery Association in Burnaby.

B. Penner: It's my distinct pleasure today to introduce my parents, Wilf and Frieda Penner, who have taken the day off from their apple orchard in Chilliwack to travel to our provincial capital. They are joined by my uncle and aunt, Art and Margaret Penner, who are visiting from Harrison Hot Springs. Would the House please make them welcome.

E. Gillespie: I'd like to introduce two delegates who are here from the Comox Valley as part of B.C. Agriculture Day, George Hamilton and Jeff Hamilton, cranberry growers in the valley. Would the House please make them welcome.

A. Sanders: I'd like to welcome Mr. Melanson and the Silver Star Elementary grade 5 classroom; I think there's a number of parents as well. I hope they have a good day in Victoria and all the best.

Hon. H. Lali: Today in the Legislature is Mr. Ernie Willis. He's a director of the B.C. Cattlemen's Association, and he's also a constituent of mine from the Princeton area. Would the House please bid him welcome.

M. Sihota: In the chamber today is Mr. Peter Volk. The Volk family has deep roots in my constituency, in Metchosin. In fact, Hermann Volk was the first mayor of the community of Metchosin. He was an active farmer in the chicken business, as, of course, is Peter Volk. I'd like all members to please give him a warm welcome.

Hon. C. Evans: I waited to see who other people would introduce. I'll just read a short list of people I don't think have been introduced yet that I've been having meetings with today: Herb Barbolet, Farm Folk/City Folk -- proving that Agriculture Day is for city people too; Russell Husch of the B.C. Fruit Growers, from Lake Country; Morris Hanson, a B.C. milk producer from my own constituency of Creston; Thal Poonian, an orchardist from Kelowna; my dear friend Lyle Price, from Port Alberni; and Ivar Rage, Western Greenhouse Growers, Port Alberni.

I'd like the House to make them welcome, but I'd also like to make sure all MLAs visit the displays downstairs over the course of the rest of the day. Will the House please make these growers welcome.

[1415]

B. Goodacre: I have three introductions. Visiting from my riding and my hometown of Smithers is Paul Davidson, whose family runs a dairy and beef farm just outside of Smithers. Paul and I, 12 years ago, were on the same championship hockey team in the Smithers hockey league. My wife Mary-Etta Cloud is visiting here with her sister DeLois Burggrof from Fairbanks, Alaska. I'd like you to make all three of them welcome.

D. Zirnhelt: Representing cattlemen from the Cariboo and Chilcotin, Harold Starr and Mark Nairn are in the precincts today. Please make them welcome.

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Oral Questions

FUTURE USE OF JERICHO LANDS

G. Campbell: Hon. Speaker, the Jericho lands are 38 acres of provincially owned land in my constituency in the city of Vancouver. They are immediately adjacent to 52 acres of federally owned land. Previously, the government had committed to a full and open public process to examine the redevelopment of those lands to meet the social, physical and economic needs of the neighbourhood and the community. Unfortunately, this government has broken that commitment. BCBC is now trying to ram through a subdivision that speaks more to the government's need for cash than to good public policy.

My question to the minister responsible for BCBC is: can he explain why the government has broken its commitment to the people of Vancouver? Why is he trying to rush through a single-family subdivision which will not meet the needs of the community, the city or the province?

Hon. P. Ramsey: This issue of what we shall do with Jericho lands has indeed been a topic of much discussion both in this chamber and elsewhere. BCBC has been working with the city, with community groups, with first nations and with others, consulting thoroughly on how they should move ahead. No decisions have been taken on what direction they should move. They are looking at all options, including the possibility of development on the site.

The Speaker: The Leader of the Official Opposition with a supplemental question.

G. Campbell: What BCBC is presenting to the community is a single-family subdivision proposition. Only 10 percent of the people there support that kind of development. As the government tries to ram through this single-family development, what happens is that we lose opportunities for seniors housing we lose opportunities for young family housing and we lose opportunities to properly plan public spaces. Surely the minister understands that the need for million-dollar homes is pretty slight in terms of public policy in British Columbia.

My question to the minister is: will he stop the subdivision application today? Will he enter into a true and open public planning process with the city, with the neighbourhood, with the feds and with aboriginal communities if he so desires, so that we can have a proper plan for the future of the city and the province?

Hon. P. Ramsey: I'm pleased that the Leader of the Opposition has recognized the need for social housing, even though the critic speaks against the establishment of social housing in British Columbia. The use of Jericho lands is an issue in which many have a stake, and many should have their voices heard -- including the neighbourhood, first nations, the city of Vancouver and those who care deeply about these lands. This is not something that I think should be a partisan process.

I invite the Leader of the Opposition or members of the opposition to meet with me or BCBC and give their views on how we move forward, using Jericho lands well to meet the needs of the province and of the people of Vancouver.

The Speaker: Leader of the Official Opposition with a further supplemental question.

G. Campbell: The problem with the minister's response is that it is not representing what the government's position is. They are trying to ram through a single-family subdivision. The minister knows -- or the minister should know -- that the province undertook to have a major, open public process which included the city, the neighbourhood, aboriginal communities and the province. That is not taking place today.

[1420]

If the minister believes it's taking place today, he's clearly not being well informed by his officials. His officials have said clearly: "This is something that we are putting forward. It's going to be a single-family subdivision." That's the only choice they have given the neighbourhood. Will the minister undertake to stop the subdivision today and allow for a full public process to take place so that those lands will be socially beneficial as well as economically beneficial to the province?

Hon. P. Ramsey: Again, I think it's good that the Leader of the Opposition has recognized that there's more to land use planning than satisfying one's developer friends. It's a slight change from when he was mayor of Vancouver. Let me say again that this is the Liberal opposition that spoke of social housing as a waste of taxpayer dollars.

We are committed to moving forward on development of Jericho lands but doing so in a way that is sensitive to the needs of the neighbourhood, to the city and to first nations in the area, because this is a very high-profile issue that we need to deal with sensitively.

MANAGEMENT OF

IMPROVEMENT DISTRICTS'

SINKING FUNDS

G. Farrell-Collins: As usual, what the government says and what the government's actually doing often are two different things. That's certainly the case in this situation.

I have another question for the Minister of Finance. About 80 of B.C.'s small improvement districts have borrowed approximately $10 million over the years to build infrastructure or improve infrastructure such as septic tanks and water mains. The residents of these improvement districts are now faced with paying huge lump sum payments when their bonds come due. Will the Minister of Finance explain why his government mismanaged these sinking funds? And will he explain why his government mismanaged the people of those improvement districts, who are facing huge lump sum payments because his government didn't manage those sinking funds properly?

Hon. P. Ramsey: I know there are a number of districts that are concerned about this. I think there are four or five around the province; it is a small number. The difficulty is this: those financing instruments are indeed held by others in the public sector as well. There's not an easy and obvious fix to this. The ministry is working closely with those districts to try to find an answer that makes sense to the taxpayers of those districts.

The Speaker: The Opposition House Leader with a supplemental question.

G. Farrell-Collins: It would have made sense to the taxpayers of those districts if the Ministry of Finance had done their job. Their job was to make sure that at the end of the day, when those bonds came due, those districts had put enough

[ Page 15663 ]

money in to pay off the principal on those bonds. That was the job of the Ministry of Finance. They set the rates; they managed those debts for those small communities. They can't afford a huge debt management division like the Ministry of Finance has, so the Ministry of Finance say they'll do it for them. Why did the Ministry of Finance fail year after year after year in the 1990s to adjust the rate so that ratepayers in those areas wouldn't be left holding the bag for a huge lump sum payment that few of them, if any, can afford to pay?

Hon. P. Ramsey: The allegation of fiscal mismanagement is simply and utterly false. I invite the member opposite to come and talk to folks in the ministry, officials who have been dealing with this issue, because that is simply wrong. Yes, that is an allegation that has been made by a couple of regional districts. We in the Ministry of Finance are working with them to find a solution. They're working with the improvement districts, the Ministry of Municipal Affairs and the B.C. Investment Management Corporation to identify some options to deal with this situation in a constructive and professional manner.

I invite the member opposite to join this problem-solving in a constructive and professional manner.

K. Krueger: Don't tell us it isn't true. The improvement district of Clearwater borrowed $125,000 in 1981. Because of this government's mismanagement of their sinking fund, they will have paid out $516,000 on that $125,000 by the time the bond expires, and they'll still owe $63,000 of the principal. Will the Minister of Finance explain to the residents of Clearwater why his government's negligence has cost them $63,000?

[1425]

Hon. P. Ramsey: I sort of thought we'd be hearing from Kamloops-North Thompson eventually, since this is indeed one of the districts, up in Clearwater, that has been working with the ministry to find a solution for it. I invite this member to look at some constructive and professional options to it. The money that this improvement district owes is owed to the school district in the region. There is not an easy and obvious solution to this. We are going to be working with the improvement district, with the school district and with, as I said, B.C.

Investment Management Corporation to find a solution for this difficulty. But to pretend that this happened in a vacuum and that this is somehow mismanagement is simply completely false. I invite the member opposite to lower the volume, crank up the constructive side, and let's find a solution for this.

The Speaker: The member for Kamloops-North Thompson with a supplemental question.

K. Krueger: Here's a couple of the solutions that the minister's ministry has suggested: "Existing sinking fund balances could be allowed to fall short of the target amount or the shortfall refinanced at maturity." There's classic NDP money management -- just borrow it over again.

In 1981 the Casino waterworks district borrowed $10,000 to purchase a water holding tank. That bond matures in 2006. And when it does, after paying some $30,000 in interest and principal payments, the district's 25 families will still owe approximately $6,000 or $240 per family, because this government wasn't doing its job. They borrowed $10,000, they paid $30,000, and they still owe $6,000.

You ask us for solutions. The only solution to this government's incompetence is resignation -- and let a real government get on with the job. Will the Minister of Finance tell the residents of the Casino waterworks district and the residents of every other improvement district why this government failed them and what he intends to do to clean up this mess?

Hon. P. Ramsey: Perhaps the member would like to talk to the person who was Minister of Finance on December 11, 1981, when the sinking fund was established -- 1981, hon. member.

The school district in the area requires and relies on repayment of this debt for part of its own financing. This is a complex and interconnected series of arrangements. We are seeking progressive and constructive solutions. I invite the member to join in those rather than continue the rhetoric.

PROPOSED SUMAS POWER PLANT AND

FRASER VALLEY AIR QUALITY CONCERNS

J. van Dongen: Next month the Washington State Energy Facility Site Evaluation Council begins hearings into the planned Sumas 2 gas-fired power plant located just south of Abbotsford. This power plant raises serious air quality concerns for Fraser Valley residents in an already smog-ridden airshed. We understand that this government will not be intervening in the Washington State review process. Will the Environment minister explain to the citizens of the Fraser Valley why she is not standing up and doing everything possible to fight against this proposal?

Hon. J. Sawicki: Certainly the MELP staff has been involved in the concerns and shares the concerns over air quality and other issues regarding this project. We have in fact been coordinating all of the interests around this proposed project and putting forward our comments to Washington State. They have sent back the draft environmental impact statement. So we are involved; we are taking leadership. Clearly the hon. member recognizes that this project is taking place across the 49th parallel, and therefore the federal government is involved as well.

[1430]

The Speaker: The member for Abbotsford has a supplemental question.

J. van Dongen: The minister says it's involved, but they're not taking a position. B.C. Hydro has said that it wouldn't build a similar plant in the Fraser Valley because of air quality concerns. This minister has rejected standing up for air quality in the Fraser Valley, while other agencies such as the city of Abbotsford have sought intervener status in this U.S. process. Will the minister admit that the real reason her ministry has not sought intervener status is because this government actually favours allowing this U.S. company to proceed, in spite of the fact that it will make a bad air quality situation even worse?

Hon. J. Sawicki: It is absolutely outrageous to suggest that this government does not pay attention and is not concerned about air quality. We are the government that has taken initiatives on greenhouse gases and climate change. We have taken the initiative on vehicle emissions. We are taking the initiatives to help people get out of their cars.

Certainly I appreciate that Abbotsford is concerned about this project. We share that concern, and that's why this minis-

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try has been working cooperatively with every other level of government to ensure that we express the very serious concerns we have with this project.

The Speaker: The bell ends question period.

Tabling Documents

Hon. M. Farnworth: Hon. Speaker, I have the pleasure to table two reports: first the Ministry of Health and Ministry Responsible for Seniors 1998-99 annual report, and also -- to retable -- the Ministry of Health and Ministry Responsible for Seniors performance plan 2000-2001, which also includes the environmental scan of 2000-2003.

Hon. D. Lovick: By leave, I call the first report of the Select Standing Committee on Agriculture and Fisheries.

Leave granted.

Reports from Committees

B. Goodacre: I move that the first report of the Select Standing Committee on Agriculture and Fisheries be adopted.

Hon. Speaker, this report describes work conducted by the Select Standing Committee on Agriculture and Fisheries from July 1998 through March 2000 with respect to the development of a new agrifood policy for British Columbia. The report represents a selection of the many views of the agrifood industry and the citizens of British Columbia that were expressed to the committee during its public consultation process. It demonstrates the substantial volume and wide diversity of opinions and issues which were raised.

The committee welcomes the opportunity to educate and advocate on behalf of agriculture in British Columbia. We respect the contribution made by the agrifood industry to the economy of our province and to our society as a whole. We intend to continue our examination of the evidence before us, and we will work towards developing a new vision of a comprehensive agrifood policy that will serve all British Columbians today and into the future.

I appreciate this opportunity to move the adoption of the committee's report, and I would like to thank the Deputy Chair and all members of the committee for their input and dedication throughout the process, as well as the office of the Clerk of Committees for their ongoing assistance and support.

The Speaker: Speaking on the motion, I recognize the hon. member for Okanagan-Boundary.

B. Barisoff: Hon. Speaker, as Deputy Chair of the committee, I'm pleased to rise in support of the motion to adopt the committee's first report to the Legislative Assembly.

In July of 1998 the committee embarked on a remarkable public consultation process which took us to 14 communities in each of the agricultural regions of the province. Our first report illustrates a wide range of ideas presented to us, including input from young organic farmers to the major industry associations, from large grocery retailers to organizers of local farmers' markets, from food processors and distributors to interested consumers.

The response from these and other components of the agrifood sector has been very strong to date. We have accumulated over 600 submissions, representing every portion of this great industry. But this first report highlights only a cross-section of the many issues which are currently under our consideration. The committee still has a lot of work to do, but I am pleased, on behalf of my caucus colleagues, to join the member for Bulkley Valley-Stikine in presenting this first report to the House today.

[1435]

The Speaker: Seeing no further speakers, the question is the adoption of the report.

Motion approved.

Hon. C. Evans: Permission to make a ministerial statement?

Leave granted.

Ministerial Statement

AGRICULTURE DAY

Hon. C. Evans: Hon. Speaker, when the Minister of Mines gets up in the morning, he can check the price of gold and silver and lead and zinc and a half-dozen stock prices and take the temperature of his industry. When the Minister of Forests wants to know what's happening, it's even easier, because the price of studs is on the radio. The industry is centralized enough that the CEOs and half the workers would fit in a small hall.

Agriculture isn't like that. Last year, if you had friends growing apples or ginseng or wheat, you would have to hear from them about the price of their produce, because it's not on the news. If you heard it at all, you might have thought that farming was finished.

Yet the industry grew. It is because we are producing more than 200 commodities and more than 4,500 products that not one or even six indices can tell you the state of the industry. Thanks to the diversity of production, the nature of the land base, the independence of the producers and the rules around supply management, neither are we a corporate or a centralized industry, with 97 percent of farming remaining a family business. The Minister of Agriculture couldn't meet all the employers in any building smaller than B.C. Place.

A couple of weeks ago the member for Oak Bay-Gordon Head held a forum on GMOs. The people in the audience wanted to talk about the corporate bad guys, food quality and health, and the WTO. But the farmer on the panel wanted to talk about the price of milk. I don't know of any other industry where the work of production is all at the level of family business, yet the value is all taken out at the level of corporate enterprise.

Even the independent wholesalers and distributors have disappeared from the marketplace in recent years. Now in

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many places you cannot sell food to the retail store literally across the street from the farm, unless it's been bought first through a central desk in Toronto or Saskatoon or Oakland, California.

Farming changes, yet the industry grows. Producers adapt. This continues to be the only resource industry that has employed more people every year for 20 years.

In 1999 the people who farm this province produced the highest net cash income for B.C. agriculture ever in the history of the province. It was up 24 percent, or $87 million, over the year before and 53 percent over the five-year average.

How did they do it? That story is too complicated to tell in a short ministerial statement. What do they need from us? The answer to that question is viability. How to get there is up to all of the leadership on this floor, everyone up in the gallery and the consumers and citizens watching this on TV.

This is not the work your grandparents did. This is not pastoral, and it is not about lifestyle. This is about business and people and land and product and governance.

[1440]

I have chosen not to use this time to relate the good works of the last year, although I am very proud of what we continue to accomplish. Instead I have used the time to talk about the industry and this event in order to encourage everyone to meet everyone and to learn from one another.

I know that ministers and MLAs are busy and that every hour is just another cause requiring your attention. But remember, hon. members, that at least we woke up here. Our guests come to town only once a year, and they come from all over the province. They come inside this building for a dialogue with all of us. Let's make it happen, let's make it work, and let's keep doing it.

B. Barisoff: Hon. Speaker, thank you for the opportunity to respond to the minister's statement on agriculture. First, I'd like to commend the Agriculture Council and the Pendrays for the fine barbecue last night. Their efforts show their true commitment to the industry, enlightening us all about their concerns.

There is no doubt that we have some crucial issues facing us regarding the survival and growth of the agriculture industry in this province. Some of these include; the family farm: the grain farmers in the Peace River, because of their close proximity to Alberta; the tree fruit industry in the Okanagan and the effect that it could have on the tourist industry; and the chicken industry on Vancouver Island.

But we do have some bright spots: the grape and wine industry in the Okanagan and other parts of the province -- we have been able to produce some of the finest wines in the world -- and the greenhouse industry in Delta and the Fraser Valley. Who would have thought B.C. Hot House would export tomatoes, cucumbers and peppers to the U.S., particularly to California?

However, there is a lot more to do in establishing a provincial agriculture policy that works, one that encourages growth and rewards innovation and hard work. Unfortunately, governments have the reputation of slowing down progress and getting in the way of it -- in some cases, even destroying the entrepreneurial spirit that has made this province and country great.

We all must be committed to take the steps to do what is necessary to reverse this trend, particularly in an industry that is so vital to all British Columbians. Developing a provincial agricultural policy that works would be a strong step in that direction. However, we have a lot facing all members of this Legislature. Members should remember that farmers are the backbone of B.C. We must continually remind consumers where their food actually comes from and must support the B.C. farmers.

Orders of the Day

Hon. D. Lovick: Mr. Speaker, I call Committee of Supply. In Committee A we are debating the estimates of the Ministry of Attorney General. In Committee B, in this chamber, we are debating the estimates of the Ministry of Health.

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

[1445]

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

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

Hon. M. Farnworth: Once again we return to the scintillating debate that is Health estimates.

J. van Dongen: Before the lunch break we were discussing MSA hospital. We talked about the deterioration of the physical plant there. We talked about the very significant population increases in our region. We talked about potential savings in terms of operating costs -- which I believe to be significant -- that we think can be achieved with a new facility. I'll certainly look forward to further discussions with the minister when some of those further analyses are complete.

I want to just touch base on another issue which is very much population-driven -- that is, the operating budgets for the Fraser Valley health region -- and again emphasize the very, very significant impact of a 5 percent-plus annual population increase in our area. On operating budgets, as with capital requirements, that is a very significant increase. If you're not living through that, you may not fully appreciate the implications of that major population increase for our managers and staff in the region.

The ministry has over the years . . . . Previous ministers . . . . In fact, two ministers back, the minister had indicated that she felt that a population-based funding formula was the right approach and that it was a fair and better system than the current formula for allocating available funds. I know there's been some further discussion of that. In fact I have a

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letter from the minister's predecessor -- about a year ago now -- confirming, in response to my letter, that a population-based funding formula is absolutely the right way to go.

That letter talked about ongoing discussions in the ministry. I know this has been raised by other members, but I wonder if the minister could confirm these discussions. What kind of date can we expect for closure on the discussions? What kind of implementation plan would the ministry envision to get to this population-based funding formula?

[1450]

Hon. M. Farnworth: In response to the member's concerns, I can say that it is a challenging issue for a number of reasons, not the least of which is trying to gain consensus among the different health authorities in the province -- the CHCs and CHSSs -- as to how a population funding formula should work and what criteria should be included in it. That's really one of the key areas in terms of how funding is allocated in a population-based model: what socioeconomic indicators are used to make that formula.

Throughout the province there are different demographics, different populations, different age groups and different incidents of illness -- those sorts of things. Those all come to bear on the funding model.

Having said that, we have a committee in place. We are working on issues around funding and funding models. There is still a fair bit of work to do at this particular point in time. I can't give the member a firm date, other than to say that if you're to move in this direction and you're to try and make changes or if you're to try and put together something that will meet the needs of your health authority -- and I recognize that it is a fast-growing one, as is the one that I represent -- it has to be done on a consensus basis. To try and impose something, I think, would have extremely negative consequences.

There's a considerable amount of work to be done. I can't give the member a definitive time line with this particular point.

[S. Hawkins in the chair.]

J. van Dongen: While the minister was responding, I dug out my letter. It was a letter of April 22, signed by the minister's predecessor. I just want to quote from that letter: "Your points regarding funding pressures for high-growth areas are valid and recognized by the Ministry of Health. Discussions are underway concerning the potential to expand the application of population-based funding." I know that in previous correspondence -- and I'm certain that the minister and his staff are aware -- there have been a number of occasions where the ministry has confirmed that population-based funding is a reasonable objective for a funding formula.

The minister, in his response a moment ago, talked about the need to get consensus. I want to put to him this question. I think it's fair to say that the ministry needs to consult with all of the stakeholders, all of the agencies involved and all of the regional boards. But is the minister being realistic -- or does he think he's being realistic -- in thinking that he can achieve a consensus before he implements some new formula?

Hon. M. Farnworth: I certainly think you have to give it your best shot, and consensus is always desirable -- more desirable than having to impose something. One of the problems around the funding formula or moving to a populationbased formula is that it creates two things. One, you have to agree on the formula to take into account the factors that we discussed a moment ago.

I'll use an example; that's our case. In your area and my area, if we were to focus on the fact -- heavily weighted towards the fact -- that we're fast-growing areas, you and I might agree and think that's a great thing. We can go home. Your health authority is happy; my health authority is happy. But it creates winners and losers, so an area that's growing slower . . . . It could just as easily be someone from . . . . It could be the member for Prince George-Omineca, where there's a different set of circumstances. They are going to be jumping up and down saying: "Well, wait a second. This negatively impacts on my particular region."

One of the challenges we have is, as much as possible, to try and get consensus that this is the right model to go to and then also recognize that you're going to have . . . . Whenever you change a system, there are always winners and always losers. If there are going to be losers in the change of the formula or in the changing way the allocation is made, you want to identify how areas are going to impacted, and try and make sure that you're able to mitigate and resolve those issues that are going to impact on those particular authorities.

One of the ways you do that is by thoroughly examining the change you want to make, have a good idea of how that change is going to impact on particular health authorities and then be able to say to those that are being negatively impacted: "Okay, here's how we're going to resolve those sorts of things."

[1455]

If you can show how it'll work and how you're going to resolve the negative impacts, that means to me that you're getting close to building a solid consensus. There's no point in making a change that says, "Okay, we're going to recognize that there are pressures in some health authorities," and not be able to answer the questions or deal with the negative consequences that are certainly going to be there in other health authorities which would be impacted adversely.

J. van Dongen: My sense of the history of this issue and this discussion, though, is that there hasn't been as much debate about what the end objective as a formula should be as there might have been on how to get there. I think a lot of the comments that the minister just made, which I tend to agree with, speak more to transition than they do in terms of the overall objective as to where we need to get to in terms of a funding formula. Certainly it wouldn't be logical and sensible to establish a new funding formula to make the whole change overnight -- in one year.

[T. Stevenson in the chair.]

I think you have to establish an objective and then figure out a gradual way to move the various regions in those directions. There may be regions where the new funding formula indicates that there be no increases in their budget as time goes down the road. But they would then have the opportunity to make management decisions within their operation that will bring their cost per capita more in line with the rest of the province on a gradual basis.

Surely that's not an unreasonable approach. On the other hand, where you have regions that are seriously lacking,

[ Page 15667 ]

based on the new funding formula, they would be brought up on a gradual basis in terms of their budget so that they're not running out and having a significant increase in one year. But it seems to me that the issues the minister speaks about are transition issues. I wonder if the minister could clarify the distinction I'm trying to make here.

Hon. M. Farnworth: I think the discussion, in terms of the objective . . . . The member talks about the issue around the objective. That's been very much part of the discussion, and the ministry is aware that it does take time to get to a particular point where there may be an agreement, and a consensus can emerge. One of the things we have to do, I think, is recognize that we have to move the system along and get some cooperation. The discussions are taking place in terms of how a formula could look and what should be the key socioeconomic indicators taking place.

In terms of actual movements at the current time, there are a number of examples of work in fact currently taking place. Each year, in terms of money on the margin that is available to be expensed by the Ministry of Health to health authorities for particular services, the idea is to try and bring up those areas that are underfunded and are outside the mean or the provincial average.

We talked about an example of that earlier this morning in terms of orthopedic surgeries and how we can recognize and reconcile that some parts of the province have longer wait-lists. What I've said is that that money is now built into the base. So what we are doing is a review of where the money went and looking at reallocating it this year so that it goes to authorities and regions that are on the long side of the average in terms of a wait, for example. So we are moving to bring them up more to the provincial average.

That approach is taking place and will continue to take place in the same context as we are also engaged in the discussions that I think will eventually lead us to a point where there is a high degree of consensus.

[1500]

J. van Dongen: In response to the minister, I would say that I derive my

interpretation on this issue from the fact that I think a number of ministers now have made some pretty unequivocal statements about the population-based funding formula. Again, I agree with the minister that there are transition issues, some of which he spoke to, and that the ministry -- whenever there are supplemental dollars available -- is trying to bring up certain regions on particular issues. I would certainly encourage the minister to get hold of this issue and make a decision on it and establish an agenda for the ministry on it that can be worked at on an annual basis.

It's an equity issue. It's an issue not just for citizens in these rapid-growth regions but also for staff, for doctors and for regional managers who face particular pressures from these funding inequities.

I want to just make a few comments on the other issue I raised, which is radiation therapy. I've engaged in some correspondence with the minister and his predecessor over the last six or eight months. I would say that during that time, I've had more complaints or concerns from citizens about waiting times for cancer treatments than I have had in the previous four and a half years. We've certainly forwarded to the minister some of the particular situations. In the course of the correspondence . . . .

I'm looking at a letter dated February 3 that came, again, from the minister's predecessor and another letter dated March 9, from this minister, that I thought provided some useful information on this issue. There are a couple of issues that I found interesting. One is the letter of February 3, and I quote: "There is a worldwide shortage of radiation oncologists and radiation therapy technicians."

In subsequent correspondence the minister and I talked about this issue of recertification. There doesn't seem to be any easy mechanism for people who have already been trained in radiation therapy to get recertification. They may have been a practising technician for five years and, in one case, took leave to have a family and then are prepared to get back in to the workforce. Here we have a situation where we have a worldwide shortage, and that's been confirmed in other places by other people. People who want to get back into radiation therapy can't get back in without taking the whole course completely over from start to finish. I'm aware of three people who are in that situation.

There may be some legitimacy to the answer; I don't know. But at the same time that this is going on and at the same time as we have this worldwide shortage, in the minister's own words, we appear to have a move by the Cancer Agency to upgrade training to a degree-type program and establish higher training requirements. I wonder, given the shortage of staff -- and the minister took great pains to say that it wasn't a funding issue; it was a shortage of technical staff -- if this is appropriate.

I know from previous discussions that the ministry has representation on the Cancer Agency, but I wonder if the minister would comment on those issues around training and recertification It's something that still concerns me.

Hon. M. Farnworth: A couple of points in response. I'll deal with the specific first and then the generic -- the broader picture. The accreditation requirements for what the member has been talking about -- radiation and the technologies around it -- are set nationally. They are not set by the province. We work with the Cancer Agency in ensuring that they're delivered and that standards are met.

Those standards are in place to reflect the changes that take place due to technology, the changes that take place in terms of therapy, and to ensure that we have a high standard of education and technical expertise when people receive accreditation and then go to work in a hospital or an institution in this province and indeed right across the country.

[1505]

I know that some people have wanted a shorter course, and I can understand that. But the rules around accreditation are set nationally, and we play a role, but we don't have the final say on that. So that, I think, is the specific case that the member's referring to.

On the broader question, though, we have a very serious issue that we need to deal with. It revolves around not just the retraining of staff or the re-accreditation of staff but also the recruitment of health care professionals into a wide range of positions, right from nurses and physicians to specialists and technicians in our health care system. That's something we have right across the country.

As the letter you read from stated before, this particular specialty has a worldwide shortage. One of the things we need to do in B.C. is train more people. In fact, all the

[ Page 15668 ]

provinces have to be doing that. That is something that we are working on within the ministry and are attaching a great deal of importance to.

One of the examples . . . . We've seen the increase in the spaces around nursing and the ability there, where there is a flexibility, and there is the ability of the province to deal with the training of nurses. Amongst the 400 seats, for example, 75 percent are for refresher courses for the situation that the member talked about -- people who have left the profession and are coming back into the profession. The result of that is that we can train 75 in one class. It takes six months, and then we get another 75 coming through.

In essence, the 75 seats that are there will in fact generate 150 people coming back into the profession with their skills upgraded and with the standards that we require.

With other technicians and other technologies, it's not quite that simple, because we're dealing with a national accreditation standard which has strict requirements. The bigger picture, though, is that we do need to start addressing the areas of skill shortages right across the health care spectrum.

J. van Dongen: In response to the minister, I know that the standards are set nationally. I tried to find the source of my information here. My understanding is that the motivation and the initiative for degree status is coming from British Columbia. That's my understanding. I would think, again, that when we have a shortage, (

a) we would be careful about that, and (

b) surely people who have already had five years of practice, plus the training they needed to get into that practice, shouldn't have to take a full course again to get accredited. That would be my thought. As I understand it, there is nowhere in Canada that people can be trained for recertification. I would hope that within British Columbia we would try to accommodate that.

[1510]

I only have one other comment on this. I'm going to send a copy of a letter to the editor that was printed in the Vancouver Sun on December 7, 1999. Along with some of the ongoing questions I have had, this letter caused me great concern. It's a letter written by a Robert Modrow, who is the head of the health and policy management division at the faculty of medicine at UBC. He writes a very strong letter, which I'm not going to go into, suggesting serious concerns about the cancer treatment that we have in this province and about the operations of the agency.

I don't want to go into the details of the letter, but I'm going to pass a copy on to the minister, and I'm going to ask him to take a look at it. I don't know this Robert Modrow, but it certainly raises concern. He's a physician of some stature at the University of British Columbia.

My final question to the minister. I'm not up to date as to what the waiting lists are right now at the Fraser Valley Cancer Centre. But there certainly has been, as I said, a lot of evidence of concerns. I know that a new machine is supposed to come, I think, late this year, in December 2000 -- if the minister could confirm that.

My question is: if the waiting lists continue to be as long as they have been, where they're causing very, very serious concern for people that are facing serious cancers -- prostate cancers, melanoma cancers -- wouldn't we consider sending some of these people to Bellingham, where the waiting list is seven to ten days? Wouldn't we consider funding that through our medicare system? I know that about five years ago, when there was a long waiting list -- I think the circumstance then was the start of the Fraser Valley Cancer Centre -- that was done.

I wonder if the ministry would consider that, if these waiting lists continue to be as long as they have been in recent months.

Hon. M. Farnworth: I thank the member for the letter. I will certainly look into the issues that are raised in it.

I can tell the member that there are a number of things that are currently taking place. We work very closely with the cancer centre in terms of identifying where we need to have new facilities and in terms of bringing new equipment and new radiation machines on stream. The waiting lists are actually down to what they were two months ago, and we are monitoring them, as we always do. The radiation machine that the member talks about coming on stream this year is earmarked for Surrey, and it will be opening later this year. So that will help in terms of dealing with the issue around the ability to get treatments.

Second, we are actively working with the Cancer Society in terms of identifying those regions of the province where we need to have additional facilities. The planning work is currently underway. I think it's fair to say that probably the main area, if not the next area, that should be getting a facility will in fact be the member's own area, the Abbotsford-Matsqui area, to deal with the rapid growth in population in the Fraser Valley.

As well, next March we will have the cancer centre here in Victoria, which will be opening. That will also have a significant impact upon the ability to provide radiation therapy and cancer therapies to patients here on Vancouver Island and will reduce the need to send them from the Island to the mainland.

[P. Nettleton in the chair.]

So there are a fair number of . . . . There are two significant projects coming on stream, and planning is underway to deal with some of the other growth areas of the province -- yours being the prime example.

L. Stephens: I have some specific questions that I'd like to ask the minister as they relate to Langley. They are around the capital plan, the funding formula, long-term care, home care, emergency rooms and wait-lists and their shortage, and adult day care services.

I'd like to start with the capital plan and, first of all, say thank you very much for the $1.8 million that was announced about three weeks ago to renovate Langley Lodge. It's an old facility, but it's one that has served the community well. It does need some renovating, so that was greatly appreciated, as was some renovation money for the south tower up at the hospital. That's another area that is badly in need of a facelift. The announcement's there, but they don't have the cheque yet. They're very anxiously awaiting the money to be deposited, so they can get on with the repairs that need to be done.

[1515]

The other area in the capital plan that we are looking for and waiting for is to develop the shelled-in space that is at the hospital and also to have the planning funds to replace the south tower which is going to have to be done fairly soon. I wonder if the minister could talk a little bit about what the time line may be for the development of the shelled-in space and the replacement of the south tower.

[ Page 15669 ]

Hon. M. Farnworth: That particular project isn't in this fiscal year's capital plan, but the health authorities are submitting their requests for the next capital plan, and I expect it will be part of that. At that time it will be reviewed in the context of the other projects that are in there. I know that if the member lobbies as hard on this one as she did for previous ones -- the ones she commented about a moment ago -- that certainly helps.

L. Stephens: The minister can be assured that I will be lobbying very hard for these new facilities for the residents of Langley. I know the minister knows that the area is growing very rapidly. We're one of those communities that continue to find those pressures with health services, as a lot of others do. But ours is particularly acute and, I think, for one very significant reason. And that is the funding formula that the South Fraser region continues to suffer from, if I can put it that way. The per-population funding formula does not serve our area well, and this has been historical and ongoing.

I know the ministry is struggling to come up with another way of addressing this issue, but the longer it continues, the worse it's going to get.

I want to let the minister know that we do have to have some resolution to that funding formula problem -- the sooner, the better -- so the region can plan for the kind of services that are required. They're being severely hampered delivering those services for that very reason. We just don't get the dollars that are required to provide the services to the expanding number of people in our communities.

That is an issue that I know the CEO of the region has addressed and that other members who have hospitals and services in the region have addressed to the minister as well. Perhaps the minister would comment on what his views are on the funding formula and when we might expect to see some changes.

Hon. M. Farnworth: As I said a few moments ago to the member for Abbotsford, I am aware of the concerns around the funding formula and the importance of trying to ensure that the funding formula is as equitable as possible, and there is work ongoing in the ministry around that.

There are a number of key issues that need to be resolved which have to be taken into consideration, not the least of which is what factors and how you weight those individual factors in the development of a funding formula. As I stated a few moments ago, part of the problem is that you and I may agree on a funding formula, but it has impacts on other parts of the system. We have to identify what those impacts are, which authorities are affected by a change to a new funding formula, for example, and then we have to look at how you mitigate that.

I have said that what I would like to do, as much as is possible, is move to a consensus around what a potential change might be, because there are all kinds of variations that you can do.

I understand the concern the member has. It's a legitimate one, and there's a lot of interest in that. We have to make sure, whatever changes we do, that we know the impact of those changes and that we're able to address those areas that will be impacted negatively.

[1520]

L. Stephens: One of the areas that perhaps the minister could look at . . . . I know that what this means is that if you give to one, you have to take away from another. I doubt very much if you're going to get any agreement as to who gets money taken away from their region. There is the option of putting more money into those regions that are underfunded. There is an option, in effect, of red-circling those regions that do have funding that you can move to other places. They remain static, and you keep adding funding, per year, to those regions that need the extra funding.

Those are a couple of ways that the minister might like to look at solving this problem. It's going to have to get resolved, because in our area we have a need for another 400 long term care beds, and that's just to bring us up to provincial standards. After that we're going to need another 100 every year for the population aging in our area. Could the minister comment on how that might happen?

Hon. M. Farnworth: A couple of points. The issue around long-term care and continuing care and home care is one that I think is of critical importance in the coming years, and it's one that we are devoting a lot of time and energy to -- to ensure not only that we do have the framework and the plans in place but that we can actually start to see results on the ground. That's why I think it's also fair to point out that the $62 million tower is coming on stream. That will have an impact on the south side of the Fraser and will help in terms of dealing with the issue that the member raises. I think it's important to note that.

The second, though, is that we have to build on our framework study, which was completed late this past year, and look at how we now start to implement that and develop the plans that are required to implement changes in terms of meeting the need for long term care beds. That's going to take place. In fact, I think it's about a couple of months away yet from that being completed.

On the bigger picture, I think that what we have to recognize is that the ideal solution -- the ultimate solution -- is to ensure that people are receiving the appropriate level of care at a particular time in their lives when they need it. That means yes, there are acute care beds when you need acute care beds; there are long term care beds when you need long-term care. You have sub-acute care. You also have home care and home support, and we are innovative and are able to look at different ways of ensuring that people as much as possible can remain in their home and receive the care they need on that basis.

Then when they need to move to an institution or facility, it's there, available for them.

[1525]

L. Stephens: I know that it's a big problem all across British Columbia -- the issue about continuing care. I'll reiterate that Langley is growing rapidly. They have been able to make some calculations. They've come up with the fact that home nursing is 25 percent underfunded, community rehabilitation is 25 percent underfunded, and home support is 33 percent underfunded. We are way below the provincial averages and the provincial standards in any of the benchmarking rules that you'd care to look at.

I'd like to know if the minister is looking at private-public partnerships when it comes to long term care facilities, whether or not the government is moving down that road and whether or not we can expect anything like that in Langley.

Hon. M. Farnworth: The issue around P3s is one I've addressed a couple of times today. I can tell you that the

[ Page 15670 ]

ministry's had a conference call with the industry, in which health authorities participated. P3s are part of the solution, and they can look at doing them. I have said in the last couple of days that there is a role for them. They are not the whole answer; they are part of the solution. What we have to do is recognize the scope of the challenge and the scope of the pressures and ensure that there's a range of facilities, community services and the ability to meet those through innovation and, in some cases, funding.

I know that there are particular problems. There are pressures in the South Fraser health region. I can tell you that they have received extra consideration on the amount of funding for community services in their budget of the past year. That increase is some

10 1/2 percent.

L. Stephens: Does the minister know how many P3s have actually been approved and how many are in the process of happening?

Hon. M. Farnworth: I'm aware that there's one in Parksville. There's the one in Kelowna, which is nearing completion. I've also met in the last couple of weeks with a number of health authorities who have asked me about proposals involving P3s. They are coming to me with the details of them, and I have said that I would like them to do that.

L. Stephens: I'm going to sound repetitive here, but the lower mainland desperately needs long term care beds. I know the minister knows that it has a huge impact on the acute care hospitals. Just to give you an idea, at my hospital in Langley 1,300 to 1,400 people are on the wait-list for surgery. That's for eye surgery, orthopedic surgery, urology surgery. There's a nine-month wait-list for orthopedic surgery in Langley. I'm told that there's a three-month wait-list in Vancouver, but for Langley it's nine months for orthopedic surgery.

I know the minister knows that if home care isn't here, if continuing care isn't there, they're all backed up into the acute care beds in the hospital. It means there aren't any beds for surgical patients, and we end up with these wait-lists. I'd just like the minister to really put his mind to solving this problem of continuing-care beds.

I'd like to make a few comments about the home care issue. We're not seeing the funding for home care in Langley either. What is happening is that I'm getting a significant number of constituents who are calling the office. These are senior women particularly, who are having to look after their partners who have been discharged from hospital without any real follow-up to their continuing level of health care. What it amounts to is that home care is being, if you like, downloaded onto the backs of the women in this province. That's the effect of no funding and no direction to deliver the home care services.

I wonder if the minister could comment on what may be in the plans to address that issue of home care.

[1530]

Hon. M. Farnworth: At the beginning of this year $6.7 million was put into the budget to go to community support home care and home support nursing. So that money's in the budget.

The issue is an important one, and it's one that I want to comment on briefly. It is very much part of where I see us having to go over the next year in terms of identifying where some of the key pressures on the system are and resolving the funding which is required for them. It's one of the areas that I want to work closely with the federal government on. We've indicated to the provinces that this is an area of interest to them as well, because -- you're right -- in terms of ensuring that people are not taking up spaces in acute care beds . . . . This is crucial in terms of ensuring that doesn't happen.

It's one of those things that we know is going to play an increasing role in our health care system over the coming years and decades.

One of the things that I want to put on the table . . . . I think it's important to raise it at this particular point, and it's why I am so keen to pursue this issue with the federal government. One of the things that happens as people approach retirement age is that they start to look at where they're going to retire. Within British Columbia quite often, people moving from the lower mainland want to move up into interior communities or onto the Island to smaller communities. Some people decide that they want to move from the suburbs, that they want to be in downtown Vancouver, closer to the activities they like.

We can deal with that within the province by reallocating moneys and recognizing that there are certain areas of the province that are growing faster than others. We can budget and allocate accordingly.

One of the things that we don't have control over is the fact that people also view British Columbia as a destination place to retire to. We know that we're going to see -- in fact, we already have seen -- a dramatic increase in the number of people who retire to communities throughout British Columbia, to the Okanagan or the Island or wherever, who are coming from other provinces. That places strains on our system here in B.C. We can meet those needs.

But I also think that it's not unreasonable for this province to ask, in discussions with Ottawa, if there's money coming in from the federal government into health care. In essence it's funding formula that we are talking about. We want to talk about it going to home care and long-term care -- that there's a recognition for those provinces that will be net recipients of retirees in this country.

I think that's something that we have to start to deal with now and get the recognition from the federal government that if they're playing a role -- and we encourage them to do so -- those provinces where people like to retire to are not penalized because they're attractive destinations, but rather that that is also factored into funding decisions that are made.

L. Stephens: Yes, that is an area that I think the ministry needs to be looking at. My understanding is that part of the provincial, territorial and federal talks around the whole issue of health care across Canada is doing exactly that -- looking at ways of providing services to all of the areas of the country that will address the needs of those various parts of the country and the kinds of pressures that are present within them. British Columbia, of course, would fall into that category. I'm hoping . . . . I'm sure that the Minister of Health for the province of British Columbia is doing that.

I encourage him in his pursuits, and I wish him well -- to make sure that British Columbia does get its fair share. Those of us on this side of the House are always looking to get our fair share from the federal government, whichever one they may be.

The nursing shortage is one I'm sure the minister has heard repeatedly, and I'm just simply going to say that this is a very big issue for us in Langley as well. It seems that the

[ Page 15671 ]

casualization of the nursing staff is a big factor in the difficulties that we're experiencing. I know the minister has probably heard this many times before, but the elimination of the LPNs and the aides and the other helpers that were on the wards, on the floors, has contributed significantly to the difficulties that we're seeing around the nursing staff.

[1535]

In Langley, for instance, six nurses have quit in the emergency ward over the last six months. Six of our nurses have left. It was just impossible. Our emergency ward is acting as a front end to get into the hospital, and that's for a bed; it's for long-term care; it's for the surgeries; it's for everything. We've had ours expanded, and as I'm sure the minister knows, it's a very, very nice emergency ward. But it continues to come under tremendous stress for all of those reasons that I've just talked about. Our nurses are finding it very, very difficult to continue on.

What they have found is that they're spending two hours doing non-nursing jobs during an eight- or 12-hour shift, because they just simply don't have the kind of resources there that allow them to do the job they are to do. I wish the minister could comment on what he plans to do to provide relief to the nurses in the hospital. I'm not talking so much about making sure we have more nursing spaces in our post-secondary institutions. But what is the minister going to do to try and alleviate the tremendous pressures that our nurses are finding in the wards today?

Hon. M. Farnworth: There's a number of measures and issues that can be taken both in the short term and in the long term. One is that I'm actually meeting with your particular health region in the very near future, because they have undertaken some innovative changes in their management and their approach that have been very successful in dealing with some of the issues around staffing. I want to look at them, and I think they will in fact be at the innovation forum. I think that's a model that can be used in other parts of the province.

They have actually taken a leadership role, and I'm very pleased with what we've seen from them and the work. So I'm meeting with them to discuss that; that's taking place in the near future.

There's a number of other options that we are working on. For example, there are issues around working conditions; those can be addressed in some way by the occupational health and safety fund, which is about $11 million. That has the ability to address some of the particular working and lifting concerns and the physical concerns that nurses and other health care workers have within the system. That's what it's there for, so that's in place.

The second -- or the third, as the member pointed out -- is to address the issue of nursing supply in the province. We have added the 400 new seats this year. We're working with HEABC, the Nurses Union and RNABC to look at ways in which that can be built on, and there are a number of ideas and a number of ways in which we are doing that. Those we are working on and can implement in the near future.

Finally, over the long term, I think it comes down to what I have said repeatedly, and that is to do more -- not only in this province but in other provinces across the country -- in terms of training the people that we need here at home so that we're less reliant on people from outside the country. There is a worldwide shortage of trained staff. It is only going to get worse as the baby boom population works its way through, not just here in Canada but in the United States and Europe, the Middle East and many other places. There's a big demand for people.

So that's what needs to be done, and it needs to be done in concert with each other so that one province isn't out of step with the others -- and to try to avoid some of the pitfalls that we have had in the past.

[1540]

L. Stephens: The other area I want to talk just very briefly about is the adult day care services. We have a very nice Langley Senior Resource Centre in my community. It's always busy. It provides tremendous services to the seniors of the area. Right now they're serving 175 clients over budget -- client-days served over budget. We have 100 clients waiting for day care services. I wonder if the minister would comment on adult day care. It's another way to keep people in their homes and people in their communities. Is there anything the minister can tell us about adult day care services, particularly in my community?

Hon. M. Farnworth: One of the points that's worth noting at this time is that a lot of the decisions are made at the local level, where they should be. Adult day care is important. I think there has been a recognition by a number of health authorities of the importance of adult day care. I know that your particular health region has allocated, I think, $163,000 for this year to provide adult day care services. Clearly you can always provide more, but I think they have recognized the importance of it, and they are funding it.

They're doing it on the basis of what they can allocate out of the resources that they have available to them. There was funding provided at the beginning of this year, which is annualized and goes into the base. They have that ability to do that.

Again, that also comes down to what we were talking about, I think, in a general discussion of where we're going in health care. We need to ensure that there are those levels. Different levels of support are required. It may be day care in one community and home support in another. It's part of that continuum of care that we need to see developed. It is an important issue, and it's one that I recognize is important. And so does your health region, because they are doing some very good work in that area.

L. Stephens: Just one final comment. Everything that we've really talked about comes down to the funding issue and the funding formula and the per-population base -- the way it is now -- and what it means to the South Fraser region and my community and all those others that make up that region, whether it's day care services, whether it's home care services or community care -- all these kinds of things.

That's really the nub of it. I just wanted to reiterate to the minister that that is a very serious problem for us in all of these areas and really does need to be addressed as soon as possible. I'm going to encourage the minister to do that. If it means that his consultations and his lobbying to the federal government are a large part of that, I encourage him to do that and to be successful as well. I'm sure that those of us on this side of the House would be happy to help, to assist in any and every way, to make sure that we get the kind of health care in British Columbia that we deserve.

Hon. M. Farnworth: I thank the member for those comments, because they are important. It is important that we

[ Page 15672 ]

bring the federal government back to the table in terms of restoring the partnership in health care funding in this country, because they do have a long-term role to play.

If any members on that side -- and I know there are a few -- have influence with the Mike Harris government in Ontario . . . .

Interjection.

Hon. M. Farnworth: Not that member, I know, but there are others. They could tell the Health minister or the Harris government to quit pointing fingers at Ottawa and to get on board with the rest of the provinces that are trying to develop a constructive plan that can see the restoration of health care funding in the country.

K. Whittred: I want to make a few comments regarding the health services from the North Shore region. At the risk of being repetitive, I will not comment on the area of home care and long-term beds. I think that that probably has been covered. I will simply put it on record that this is also an issue on the North Shore.

[1545]

Similarly, the cost to the region of training nurses runs the region something in the neighbourhood of $600,000 to $700,000 a year. This of course is all part of the ongoing crisis surrounding the nursing shortage.

What I really wanted to focus on today are some issues surrounding Lions Gate Hospital, particularly its status within the community of hospitals. Before I get too far into this, I should simply ask whether or not the minister has received the abundance of correspondence that I have received surrounding this issue. I simply want to have a notion of how much background I have to give on this issue.

Hon. M. Farnworth: We receive -- and I receive -- a ton of correspondence. I know that I've received correspondence from Lions Gate in North Shore around trauma, for example. So I would not be in the least bit upset if the member wanted to focus on specific areas of correspondence or feels the need to give particular background. If it's helpful in moving our estimates along, I'm more than happy to oblige.

K. Whittred: There are really three interlocking issues that I wish to discuss, all of them involving the status of Lions Gate Hospital as a tertiary hospital -- that is, a hospital that offers a wide variety of complex services. The second is the absence of an MRI at Lions Gate to support complex procedures. The third is simply the status of Lions Gate Hospital as a neurological service hospital. These three things can be looked at separately; they can also be looked at as very much part of some very similar kinds of issues.

Let's focus first of all on the MRI, because that probably is the most useful. I can offer several opinions about why Lions Gate deserves to have an MRI. Amongst them is that it is designated among the community of hospitals as a tertiary hospital, and therefore it should have the support. I believe the government's own Hay report acknowledged that. It clearly advised the ministry that any hospital providing neurological and oncological services should have an MRI.

A second argument would be that Lions Gate is designated as a trauma hospital, and I believe that the designation of trauma is due to its proximity to major ski hills and so on. And it's also part of provincial emergency preparedness in the event of a major earthquake. Lions Gate is designated as the trauma centre to provide critical care to everybody who lives north of Burrard Inlet.

Thirdly, it is historical. For as long as I can remember, Lions Gate Hospital has offered a range of neurological, orthopedic and oncological services -- to name three of the more complex ones.

[1550]

Another argument I can give is that Lions Gate is involved in some very high-profile research. Amongst this is a trial regarding strokes. I'm just looking for the passage here in my correspondence about this particular study. It is something called HALT. Here it is: "Lions Gate Hospital is involved in a large clinical trial aimed at minimizing brain tissue damage after stroke and is the number one hospital in Canada, and number three in North America, with respect to patient numbers in the trial.

Radiologists at Vancouver General have said that the patient referrals comprise the highest number of all their referring clinicians." That is, the highest number of referrals to VGH come from Lions Gate, a staggering total of about 25 percent of their total numbers. So that is one more argument.

A final argument I can give about the need of an MRI for Lions Gate Hospital is that it is one part of the province where demographically we have a very aging population. In fact, I believe that West Van is, if not the highest, the second-highest. About 25 percent of West Van's population, I believe, is in the senior category, and North Van is also above the provincial average. Given the demographics and the knowledge that an aging population demands greater services of almost every variety, that is simply one more argument.

With those arguments, I'm going to ask the minister for his comments as to where Lions Gate stands in the waiting list, if you like, for an MRI. I forgot to mention that of the five hospitals in the province that offer neurological services, Lions Gate is the only one that doesn't have an MRI.

Interjection.

Hon. M. Farnworth: It's really unfortunate that in the course of a civilized debate around estimates, in terms of health care, there's always one in every crowd that can't resist the opportunity to make a comment.

What I was going to say, before the interjection, was that the member made a very good case for an MRI, particularly when she said " . . . around an aging population." I was won by the argument when the member for North Vancouver-Seymour pointed to himself as a member of that aging population. I would have thought that would have been reason enough to put an MRI onto the North Shore.

Anyway, hon. member, what I can tell you is that the issue around MRIs is an important one. Every community in this province would love to have one. Everywhere thinks they're unique and special, and in many cases they are. We recognize the importance on the North Shore; they are on the list -- okay? They are not at the absolute top of the list, but neither are they at the absolute bottom of the list.

An Hon. Member: Somewhere in the middle, then?

Hon. M. Farnworth: We have a three-phase approach right now. I would say that they are at phase 2.

[ Page 15673 ]

Having said that, one of the areas we are focusing on . . . . British Columbia is playing a role in terms of the other provinces, and this has come back to the ability to get more money into the system. We've been engaged in discussions with Ottawa. They are very interested in British Columbia's proposal for a national infrastructure program that can fund technology, amongst other things. There has been a rapid advance in technology over the last decade; it has made significant advances.

We want to ensure that we have a good standard, not only in this province but right across the country, in access to technology. One of the things we're trying to advance is that . . . . We see a partnership that can allow us to do more with the allocation that we have in terms of new equipment, so we can expand that, so we can increase the level of technology available to hospitals and facilities, and so we can get more MRIs, CT scans and those sorts of pieces of equipment into place.

[1555]

They are expensive. I can tell the hon. member that, for example, in our area, the lower mainland, you're looking at a cost of about $2.5 million to get one. When you start to multiply that around the province, it adds up. If we were, for example, to see a 50-50 partnership between us and the federal government, we could do a lot more in terms of providing that type of equipment. That's something that we are working on; there's a very cooperative approach taking place in that regard. It's part of the BCR plan in terms of securing funding. In the immediate, we recognize the importance of it.

I know the role that Lions Gate Hospital plays, particularly around trauma, neurosurgery and those types of activities. It is on the list, and it will get there.

K. Whittred: You have said that we will get there. May I ask: in what time line?

Hon. M. Farnworth: The speed with which we can get one depends upon two things. One is that in any one year the funds are available. That's why I'll repeat that we're working hard to try and get that partnership around an infrastructure program that would allow us to do more. If, for example, we were looking at . . . . Let's say in the next two years we were looking at being able to provide two or three. If we had a 50-50 cost-sharing agreement, we could do as many as six. I think it's a question of the resources we have and how we can leverage them. But rest assured, it is a priority with the ministry.

It is something that we are actively focused on in terms of trying to get to our hospitals the level of equipment and technology that's available, to raise the standard. We're working on it.

K. Whittred: The minister has said that this is a priority. I'm afraid that the people on the North Shore -- particularly the North Shore health region administrators -- do not feel this is a priority. The feeling of the people in the region is that the North Shore itself is really assuming a great deal of the cost of the neurosurgery. In fact, I believe that the region has said that the funding for the neurosurgical program costs the region something in the area of $600,000 a year, which the ministry isn't funding.

This is not just a North Shore issue; the North Shore is just part of a family of hospitals. My fear -- and the correspondence that I get from the doctors, from the health region people -- is that if this is not addressed fairly quickly, we're going to see a disappearance of services from Lions Gate Hospital which are going to have to be absorbed someplace else, either at VGH or St. Paul's Hospital or Burnaby or . . . . They've got to be absorbed someplace.

This really gets down to the ministry's sort of overall picture of how services are divvied up in the lower mainland and the responsibilities that various hospitals are expected to assume. I think that we have to look at this in a slightly broader frame than just one hospital.

[1600]

Hon. M. Farnworth: It is taken on a provincewide approach. Equipment and technologies such as MRIs and CT scans are done on that basis. It's not done on an ad hoc basis; it's done on an assessment of the needs in terms of the province and the ability to provide the types of services that are available.

I'd just like to point out, in terms of the list, because I know the member for Port Moody-Burnaby Mountain said: "Well, if you're in an NDP riding, you'll get one; and if you're not, you won't . . . . " Just as much for the House's edification as hers is that the list of the top three, if you like, right now is: Surrey Memorial; Kelowna -- which, the last time I checked, we don't hold; and VGH, which riding, the last time I checked, is also held by the Liberal Party. So it's done on the basis of where the key pressures are and on the basis of what's required around the system.

I'd also like to point out, because it's worth coming back to, these types of machines, they are expensive. You're looking at $2.5 million a machine in the lower mainland. In other areas of the province where we have the regional district funding that comes into place, and there's a 60 percent grant, you're looking at a cost of probably around $1.5 million. On top of that you have to add the operating costs, so that's a significant expenditure in any one year. And you have to balance those expenditures against the other requests coming from members of where to go.

Let me tell you, hon. member: your MRI is a priority. We view equipment and technology as a priority. It is on the list, and if we can do more with a partnership agreement, then I'm quite sure that we'll be able to meet the needs of Lions Gate Hospital sooner rather than later.

K. Whittred: I am very pleased, Mr. Chair, to hear his comments around technology and the importance of technology in this day and age as it relates to diagnosing and treating many illnesses.

I want to just read one of many instances that have been sent to me that sort of illustrate what the minister has been saying. It says:

"The patient below had a known bone marrow disease" -- something I cannot pronounce -- " and was presented with progressive leg pain and weakness and with symptoms of bladder dysfunction and cord compression -- a medical emergency. He underwent X-rays which were unremarkable and subsequently, an invasive test, a myelogram, where X-ray dye is instilled into the spinal fluid. He required resuscitation during the procedure, as his blood pressure suddenly dropped. The myelogram revealed a block of the spinal fluid at the lower- to mid-thoracic level.

A CT revealed a soft tissue mass, possibly a malignant transformation of his disease. An "MRI was subsequently required and confirmed the soft tissue mass as benign blood-producing marrow elements outside the bone marrow -- due to the patient's disease, and not cancer. This saved the patient unnecessary and dangerous treatment and allowed appropriate therapy."

[ Page 15674 ]

It goes on to say:

"If the patient had the most appropriate investigation to begin with -- the MRI -- he would never have needed the myelogram, which almost killed him, or the CT scan, which was misleading."

So there we have an example of the importance of technology. It also shows the importance of this technology and this diagnostic procedure being available to all people on an equal basis.

I'm just going to conclude this part of my questioning to the minister by asking . . . . Also on the North Shore, not very far from Lions Gate Hospital, we have a private MRI facility which treats Workers Compensation patients and ICBC claims. I wonder if the minister would comment on why the needs of those people are more urgent than other people who are receiving treatment at Lions Gate Hospital.

[1605]

[T. Stevenson in the chair.]

Hon. M. Farnworth: In terms of when and where an MRI should be done, that is, in part, a decision that the physician makes and is based upon the patient and done on that basis. In terms of technology and the issues around WCB, they operate under

an act, and they are outside the Canada Health Act.

I think it comes back to our question around levels of technology and our desire to see more technology. This is an issue, as I have said, that I have raised as a priority within the ministry. It's one that we are taking a leadership role on with other provinces. I have spoken about this not only with health authorities but with the BCMA, for example. They are supportive of the approach to get more technology into our institutions.

In terms of discussions with the federal government, this is definitely on the priority list around getting more technology into the hospitals and getting more MRIs and more CT scans into the hospitals. There is considerable work being done on that. I know that the Canadian Medical Association, for example, is encouraging the federal government to do exactly the same, and I can tell you that I have been very encouraged by the response I have had back from Minister Rock on this particular issue. We are working very hard, because it is a priority for us.

K. Whittred: I will conclude my remarks there. I would thank the minister for his answers to my questions. I will conclude on a happy note by saying that the adult day care centre which was promised to my community four or five years ago is nearing completion, and for that we are pleased.

D. Symons: We go from the North Shore now to the south shore and the sunny climes of Richmond. I have a few questions relating to hospital care. In a sense it centres around Richmond General Hospital, but it really involves the whole hospital system in the lower mainland. I'd like to go through it with the minister quite quickly and give a thumbnail sketch of two incidents that will give the idea of what I'm leading up to.

If we go back to about the beginning of this year, a gentleman from Richmond was admitted to Richmond hospital. I believe he was diabetic. He was suffering from malnutrition and was in hospital for a while when it was discovered that he needed to have a dialysis treatment. They arranged with St. Paul's Hospital to have him transferred to St. Paul's for treatment. Just minutes -- within an hour, anyway -- of the time he was to be transferred to St. Paul's, St. Paul's phoned up to Richmond and said: "I'm sorry, we have no bed; we can't take him." They were told to look somewhere else. They basically canvassed all the hospitals around the lower mainland and couldn't find any.

They started going further afield and found a hospital in Bellingham that would take the person. But an order came . . . . I announced this to the minister the other night. I've got the name of the person in the ministry, but it's not in my head right now. He said, "I'm sorry, you cannot send him to Bellingham" -- which isn't that far from Richmond, actually. "You must find somewhere in British Columbia."

Another day had gone by, by the time they finally found a bed for the person in Kelowna. They medevacked the person up to Kelowna and got him on the dialysis machine. Unfortunately, the patient died a few days later. The relatives, the family, found that once he died, the medical system that medevacked him up there said: "The body is yours now; you can take him back to Richmond, where he originally came from." The hospital system took him up there but left the patient in the morgue in Kelowna, which was another shock to the family. That story had a not very happy ending.

[1610]

The other related story -- and you'll see in a moment the connection between these -- happened on April 13, I believe. A doctor about a half mile away from Richmond hospital had a patient start to hemorrhage in her office and sent the patient down by ambulance to the Richmond hospital, which I believe treated her for the hemorrhaging but said that they had no bed for her. Again, the situation was that they started looking around the whole lower mainland and could not find a bed for this patient. They were about to medevac this person out of the Vancouver region, as well, when a bed became available. I'm not sure in which hospital they found a bed.

My concern here is on this issue of beds. I live in the riding that contains Vancouver Airport. If we were to have an accident at the airport or if we had a bus accident or a car accident involving multiple vehicles, it seems that we have a hospital system in the lower mainland that at times can't handle one patient. It can't find a bed in all of greater Vancouver for one patient.

I'm really concerned, with the major transportation centre that we have in Richmond, that if there is an accident that involves multiple people, we are in a situation in Vancouver where there are not the beds to deal with these people. What you would have to do, I suspect, is simply ship a lot of people who aren't on life support systems out of the hospital to make space for those that are coming in under emergency situations. We're in a desperate situation. I don't know if the general public understands really how desperate the situation is. If you can't handle one patient without medevacking because there's no bed available, what do you do if you have an accident that involves many people?

The Chair: Just to bring to the attention of the committee, visiting today with us are 35 grade 6 students as well as ten adults from Bothell, Washington. These students are here today to observe our House as well as to have some understanding of comparative government and local history. Would all members please make them welcome.

[ Page 15675 ]

Hon. M. Farnworth: In regards to the first part of the member's comments, clearly we are concerned about the level of care and the availability of beds. Part of that goes to the need to recognize and ensure that we have the appropriate levels of care in place at different points when people need it so that we don't have people blocking acute care beds. That is something that I think all of us are concerned about, and there are strategies in place to deal with that.

The second issue, also part of that, was the question the member raised about renal dialysis and the services that are available to people requiring it. There has been a significant increase in the last couple of years -- in particular in this year's budget. For example, there's new funding of $12.5 million to provide dialysis services, to buy an additional 40 new dialysis machines and to build another 30 dialysis stations.

Is it enough? Let's put it this way: it is one of those issues, one of those health concerns, that we notice . . . . There is an increase in dialysis required as people age. But there are also, at the same time, new advances in technology, new advances in treatment, that are taking place. Dialysis is something that is receiving priority treatment.

[1615]

I must admit, hon. member, that you seem to be having a little difficulty hearing, and if some members on both sides of the House could hush things up a little bit, we could get the message out.

The Chair: I'd just like to reiterate that for members who didn't hear. It is a little noisy in here, and members aren't able to hear each other. So if we could keep that in mind . . . . Thanks very much.

Hon. M. Farnworth: In terms of the second situation the member talked about -- what happens in the event of a major catastrophe or a major accident -- there is a community emergency response system in place that is designed to deal with emergencies. It's something that's done in conjunction with the airport, major hospitals, major trauma centres, and they have plans in place. That is a very important part of emergency preparedness and response planning.

We've just had, for example, Emergency Preparedness Week, part of which we were involved in here in Victoria and in communities right across the province. This type of disaster planning and the ability to cope in emergencies is something that we work on with communities and the private sector, to ensure that we are prepared and ready if and when an emergency happens.

D. Symons: I thank the minister for that answer. I'm aware that there is an emergency plan there. But I guess, because of the two situations I outlined, it seemed that to put one person in was quite a thing. It's different from a disaster, though. I will admit that. I don't know if your disaster plan would basically involve setting up a MASH sort of arrangement somewhere to handle patients on the same basis that we saw happened in Korea on some of those programs.

We seem to have spaces in hospitals that are unutilized. The bed situation seems to be more a staffing situation in the place . . . . There isn't a cubbyhole to put somebody in. At least in the Vancouver area, we have the large tower there. In other communities it may be otherwise. I realize the government is moving toward these issues, but it just bothers me a great deal that patients seem to suffer in this way and the families, in a sense, as well -- the family of the gentleman that died in Kelowna. Kelowna was not handy for them to visit him, let alone the problem, once he died, of dealing with the situation and then having to bring him back to Richmond for funeral arrangements.

A. Sanders: I have a number of letters from constituents that I would solicit the answers for from the minister. The first was a letter addressed to the MLA office asking about the wages for the CEOs and the COOs of the regional health boards. When the deputy ministers got a raise earlier this year, did that raise extend to the CEOs and the COOs in the health regions as well?

Hon. M. Farnworth: No, it did not.

A. Sanders: Is there a list of the salaries for the CEOs and the COOs for the regional health boards?

Hon. M. Farnworth: You can go to or contact the regional health authorities, and they can provide you with the financial statements, which would include the salaries for senior management and, in particular, the CEOs. It will also cost you $5 to get that, but it is available.

[1620]

A. Sanders: I have that information on my own regional health board. I was looking more for . . . . Is it not public information if people wish to look at, collectively, the costs of administration within health care? Is there not, without going to freedom of information, a list available for them to have those figures?

Hon. M. Farnworth: It is public information, but it is held by the individual health authorities that are responsible for hiring their individual CEOs.

A. Sanders: I think Mrs. Paige will be disappointed to hear that it's not public information for all British Columbians.

I have a letter from Dr. David Naismith, and he makes three very important points that I'd like to bring up at this time. The first is that Kelowna has been given some funding to develop a service for therapeutic abortions. Vernon has been providing therapeutic abortion services for Kelowna, Kamloops and even as far away as Nakusp for quite some time, and there has never been any funding for that procedure in the Vernon hospital's operating budget. There still is no funding for it.

During the time when Kelowna is being given funding to develop that and Vernon has been performing the service for many other communities, what are the minister's comments to Dr. Naismith on the fact that there is an inequity in funding for this service?

Hon. M. Farnworth: I'd like to make a couple of points. First off, in terms of the hospital in Vernon, yes, they have been doing the procedure for in fact a great number of years, and so the funding for that service is built into their base. I see the member is shaking her head, but yes, that is the case. Apparently, it is built into their base.

In Kelowna it is a new service that they are providing, so therefore they are being funded for it. Having said that, one of

[ Page 15676 ]

the things that would be interesting to see, for example, is whether or not there is a lessening of the service being performed at Vernon now that Kelowna is able to provide the service. But I can tell the member that when we are looking at this, we try and compare it on an apples-to-apples basis. The funding for the service is built into the base of the Vernon hospital and wouldn't have been in the case of Kelowna, because they haven't been performing this service until recently.

A. Sanders: I think probably that I will not disagree with the minister that it may be built into the base for the people of Vernon to access. But it's not built into the base for the people of Nakusp, Kamloops, Kelowna and all the rest of the area to access, and that is precisely the point.

The second question is about a particular individual, Dr. Splewinski. He is a spinal surgeon. The hospital has refused to grant him privileges for cervical spine surgery based on the cost and the resources being unavailable. In other words, a money and a staff training problem disallows an individual who has special skills to use those special skills within the north Okanagan. This is exactly the kind of case that we find when we talk about "brain drain." We have an individual who has skills, who wishes to use those skills and who will not be able to do so. Is this good use of our highly trained specialists?

[1625]

Hon. M. Farnworth: What I would point out is that the health authority does the credentialing of the individual. The health authority has to take into account a number of things if they're credentialing a particular type of service. Clearly, when you have skilled individuals and the ability to provide a particular service, that's important. But what also has to be taken into account is the overall service level that's provided by the hospital and by the authority. And they have to take into account the impact.

Is there a critical mass in terms of the need for a particular skill set, and is there the ability to fund that skill set? The issue is twofold: the type of service that's being provided at an institution or a particular hospital, and how that fits into the region's ability to fund that in terms of the amount of services that can be provided and what the impact is going to be.

A. Sanders: This is a good point to demonstrate the problem of regionalization and the balkanization of services. Vernon historically had a spinal surgeon, Dr. Van Pettegham, a gentleman who worked at the spinal unit at Shaughnessy Hospital before that hospital was closed. He made a lifestyle-choice change and moved his family up to Vernon. He literally could have gone anywhere in the world, but he chose Vernon because he wanted to bring up his family in the Okanagan. He offered a tremendous service to Vernon, but he offered it also to the province. His wait-lists were 18 months.

They were full of people on WCB and with other kinds of injuries, and he helped people in the mid-years to get back to work and get out of pain.

Due to the same frustration -- we were basically telling this specialist that his services were too expensive for the region to afford in terms of OR equipment and training of staff -- he is now a professor in San Francisco.

We then had a young man come up who also was a spinal surgeon, and he offered his services to our community for a period of several years. He is now in North Dakota. We are looking at a four-year period, and we're on our third spinal surgeon. We're very fortunate to even have this individual.

Now we find that the regional health board, due to its own financial constraints, doesn't feel like serving the rest of the province, primarily because it doesn't have the funds to do so. We are probably going to find that this spinal surgeon goes the way of the two previous spinal surgeons, who headed for places where their work is appreciated.

Orthopedic surgeons have been mentioned. I would mention a Dr. Torstensen; he's our latest orthopedic surgeon. We have a number of them. It's a revolving door in almost every community. He has skills that, again, are highly specialized. They are skills in the revision of defectively functioning artificial joints -- specifically, knee and hip.

When people get an artificial joint, they often think that that's it; they've got it for life. Away they go and everything will be great. The downside to that is that these joints have a shelf life of around five to ten years, and you end up having to have a new joint. The people who are going to become very valuable in this greying of the baby boomers are the people who do revisions on joints that have already been replaced.

At this time, it's in the balance as to whether there will be any funding to enable him to carry this out in Vernon. If it doesn't happen, he has stated that he will not be able to stay, because again, if you develop special skills in your 13 or 14 years of training, there is a real impetus to go out and practise them before you lose them. I would anticipate Dr. Torstenson to be going somewhere else if we do not provide those services.

Has the minister looked at how regionalization is balkanizing services such as this? Whether they be therapeutic abortion or whether they be specialized orthopedic surgery, regional health boards are forced to make decisions not to fund those, because most of the patients would be coming from elsewhere in order for the services to be full.

[1630]

Hon. M. Farnworth: I'll make a couple of points. One, in terms of the provision of services by the regional health authorities, I think one of the key issues that needs to be recognized is: is there a critical mass for that particular service? I think one of the roles of health authorities, in terms of regionalization, is to look at what the pressures are in their area. What are the demographics in their area? What changes are taking place in their area? Health authorities must recognize that those in fact are the types of services that should be offered in their particular community.

The member makes a very good point. We're talking about orthopedics and the need for -- as I am now learning, the correct term is -- orthopods coming into the system. Knees and joints are . . . . In parts of the province where there is an active retiring population that's going to require that, then clearly that's got to be a critical issue that the health care authorities have got to recognize. If you've got the critical mass there, then clearly that's the type of service you want to be encouraging and ensuring that there's a critical mass of people getting that service so you're maintaining the skill level.

The expertise is taking place, but you are also able to attract people. That's one of the key roles of the health authority.

The member raises a point about regionalization. At the same time, there have been, on the other side of the coin, a lot

[ Page 15677 ]

of people raising the issue that regionalization has worked. It is enabling us to realize significant savings that can then be targeted to services that are important in a particular region to help build -- whether it's orthopedics or in the case of spinal surgery -- that type of surgery to take place. I think you've got to look at the whole thing.

The final point I'd like to make is that when programs are designed, we've got to make sure that they're designed around a need and not around an individual. One of the problems that can happen is if someone decides to relocate, you have all the support services. Quite often when you're dealing with specialized skills -- or highly specialized skills as opposed to just regular specialized skills -- there's an expensive support service around that. Then you have to find somebody else to fill the place.

As much as we'd like to say, "Okay, let's design a program around an individual," we really have to design a program on the basis of what is required in the health authority, what's required in the population, and ensure on that basis that we can attract the best-qualified people.

G. Clark: I'll be very brief -- very, very brief. I have a constituency issue that I'd like to raise with the minister, and it revolves around health care, so I'll just make a brief comment.

Most people who've looked at the health care system and at some of the challenges facing it recognize that additional home support dollars are critical to the long-term health of our medicare system. In fact, it saves a lot of money in the acute care sector.

Recently I've had a difficult issue to deal with, with a constituent. I live by a veterans' project, a project that was built after the Second World War. Still, many of the people living in the single family neighbourhood that I live in are veterans of the Second World War. As a result of being veterans, they have certain services provided to them.

I have an individual in my constituency, right across the street from where I live, who is very ill and gets extensive home support. Because of that home support, he's able to live at home rather than move into an acute care hospital.

His neighbour, however, is not a veteran. He's almost exactly the same age, in exactly the same circumstances, but he has been reduced to, I think, a few hours a week of home support. In all likelihood, in the next few weeks and months he will have to be admitted to hospital to stay in, probably, Burnaby General Hospital or Vancouver General Hospital. Because he's not a veteran, he's not eligible for the extra services.

When this individual is forced to move into a hospital for long-term care, clearly (1) he's removed from his community, and (2) he moves into a hospital, which is a very expensive proposition, much more expensive than adequate home support for that individual. So he's being forced -- will likely be forced -- to move into a hospital.

His neighbour, by virtue of the fact that he is a veteran, is getting extensive home support; I fully acknowledge that. But that is allowing him to live in his community, in his neighbourhood, in his home. It is saving the taxpayers the thousands of dollars that would otherwise be the case if he went into a hospital.

My simple question to the minister is, I guess, a series of questions, and I'll let him answer them all. Firstly, what is the budget for home support in the lower mainland, and how has it increased over the last few years? Secondly, it's clearly inadequate and needs to be increased further; perhaps the minister could make a comment. Thirdly, and perhaps most importantly for me, how do I answer my constituent who's going to be forced to leave his family home of 40 years and move into the hospital, while his neighbour is allowed to continue to live in that home because he has adequate home support?

[1635]

The Chair: Just to bring it to the attention of the committee visiting us in the precinct this afternoon, at this moment, are 40 visitors, adult Americans with the Elderhostel movement. Ms. Marchand is the coordinator from Duncan, British Columbia. These individuals are here to visit the precinct and also to get to know a little better something about architecture and comparative government here. I hope all members will make them welcome.

Hon. M. Farnworth: I'd like to make a number of points regarding the member for Vancouver-Kingsway's question, because they're important, and they relate in large measure to the discussion that we've been having this afternoon.

In terms of the specific amount of the budget available for home support and home care, that's administered by the Vancouver-Richmond health board. We can get that information for the member and get exactly the amount of money that's being spent. In terms of the money that has been new money for the particular service, earlier this year there was an increase to the Vancouver-Richmond health board of, I think, $6 million. They allocated 10 percent of that to home support, so there's additional new money of $603,000.

Then I'd also suggest that in terms of accessing support and determining the level of support that's available, the health board has an assessment process in place to determine the services that your constituent requires. There's also an appeal process in place if they're not happy with the service. So that's what's there right now.

Clearly, in terms of where we need to go in the debate around delivery of health care services in this province and across this country, home care and home support is one of the key and crucial issues that we want to get more money for. It's very much a crucial part of discussions, in terms of extra funding from the federal government and getting them back to the table and restoring that 50-50 partnership in terms of health care dollars.

That money needs to go to home care and home support, because that is crucial in terms of ensuring that people can stay in their homes longer, that they can receive the level of care that is required to enable them to stay in their homes longer and that at the point that they're required or they require to move to long-term care or continuing care or acute care, the facilities are there, and they can deal with it at that particular time.

[1640]

G. Clark: Just one more follow-up. I appreciate the answer from the member, and I appreciate the need to secure more federal dollars. Perhaps the minister could explain to the House why British Columbia is the only province in Canada that does not support a federal-provincial meeting of Premiers and the Prime Minister on health care.

[ Page 15678 ]

Hon. M. Farnworth: Well, we actually in fact do. In fact, the position of British Columbia has been to try to work and play a leadership role with the other provinces in terms of developing a plan as to where money can go and in terms of how we get more money into health care and to recognize that it's not a question of saying: "Just give us the money."

Rather, there should be some sense of confidence from the public and a recognition, when the provinces agree to receiving funding, that the funding goes entirely into health care, and that we identify some of those key areas in health care where they have to go, that we're not just saying money goes to the same old things, but that we're looking at ways of targeting dollars so they're meeting the needs of appropriate levels of care which we just talked about -- i.e., home care and home support, long-term care -- and that we address issues around technology and information technology, and that with the dollars that are going into health care we are getting the best bang for the dollar.

To that end, B.C. is playing a leadership role with the other provinces in doing that.

We are looking at ways in which health care costs are . . . . What are the cost drivers on the health care system? There are seven areas that have been identified; B.C. has taken the leadership role on three of those. The work is being done that's required to ensure that this takes place and that we're able to come up with a constructive plan that will work right across the country. At the same time, also we know at the end of it that any agreement isn't going to be finalized by the provincial, territorial and federal Health ministers. That would be something that would be done at a first ministers' meeting. It's on that framework that we're very much working to conclude an agreement.

G. Clark: I want to thank the minister very much for his answer. I'm certainly comforted by it. But I just want to, for the record, clarify what he said, because I saw the Premier come out of a meeting with the Prime Minister where he announced that British Columbia, alone amongst the provinces, would not support a Premiers' conference on health care with the Prime Minister. So is the minister saying that that's changed -- that the Premier now supports a federal-provincial meeting on health care of the Premiers and the Prime Minister to deal with this question? Or did I mishear him? I thought he said that British Columbia supported a Prime Minister-first ministers' meeting on health care.

Hon. M. Farnworth: I think the event that the member's talking about is a proposed meeting that would have taken place before the work that's being done by the provincial health ministers had taken place. In fact, British Columbia was not alone in that.

What has emerged as the consensus among the Premiers is that there will be a first ministers' meeting but that we also need work to be done. That work is currently being done, and it's being done on the expectation of trying to come up with an agreement. There is, I think -- as I repeated a moment ago -- the issue around how funds will get to the provinces, and there is not unanimity amongst the provinces on that, but a consensus is starting to emerge.

The second point is that that work needs to take place before any first ministers . . . . I think it's a question of timing. The comments that the member refers to are referring to events that happened, I think, basically a couple of months ago. There's a lot of work being done. At the end of the day, the issue will be resolved at a first ministers' meeting. But the work has to be done at the provincial ministers' level first.

G. Clark: So just to follow up, then, I wonder if the minister could advise the House which other Premiers did not support an early meeting of first ministers on health care. My understanding was that we were the only ones that didn't support a meeting at that time. Secondly, is the minister saying that effectively now, we -- "we" meaning the government -- would support a first ministers' meeting on health care? Or is more work to be done by Health ministers? If that's the case, when will the Health ministers' work be sufficiently far along for British Columbia to call for a first ministers' meeting on health care?

[1645]

Hon. M. Farnworth: I'm not going to get into the details of a conference call between the Premiers which took place in confidence, and one which I wasn't party to. But what I will say is that the issue is one around timing. The issue is: should the first ministers get together with the Prime Minister and talk about health care when there has not been the work done to conclude an agreement? Or is the meeting just going to take place for show?

If a meeting's going to take place, it takes place to achieve something productive. That's what the public wants. The public wants action on health care. They want the provinces and the federal government to get their act together. In doing that, it means that the work has to be done around these: what are the key pressures facing the health care system? What are the cost drivers on the health care system? British Columbia is playing a leadership role on that on three out of seven items. There's no point in the first ministers getting together with the Prime Minister if that work isn't done.

What's required is a sense that we're moving in the right direction, that the groundwork has been done. That's the role that's being done by the provinces and the provincial Health ministers. We're making considerable progress on that.

There have been two meetings already; it's my expectation that there will probably be another one at the end of this month. The goal is to try and get a lot of that work done by June, so that basically anytime after June the first ministers can in fact get together with the Prime Minister and that there is some sort of plan that has a reasonable chance of succeeding and being implemented. That's the approach that I certainly support and that, at the end of the day, will deliver the results that the public of British Columbia and indeed the public across the country expect us to achieve.

A. Sanders: Before I was interrupted, I was talking about orthopedic surgery.

Interjection.

A. Sanders: Before I was rudely interrupted, hon. Chair . . . . I would suggest that the former Premier have a briefing from the minister while he's cooling his heels in the building. Perhaps the answers to those questions would be all apparent.

Nevertheless, I want to comment on a letter from a Mr. John McCourt. The areas that we have problems in, in British Columbia, primarily are orthopedics, ophthalmology and cardiac surgery; all of the vascular surgeries are included in that. Mr. McCourt wrote to the MLA office:

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"I find it deplorable that in December 1999, I was third on a list for an aneurysm repair, and in January 2000, I'm now fifth. I feel that I deserve some answers and am going to complain to as many people as I can think of. As a taxpayer and retired military veteran with 33 years of service, six of those during World War II, I have paid my way in Canada and the province and feel that I, like other citizens, deserve a better health care system than your government is providing.

When I see the amount of money wasted on frivolous spending like fast ferries, yet you cannot find enough funds to resolve the health care situation, but only offer band-aid help, I cannot help but feel very frustrated and resentful."

Dr. Creel is our vascular surgeon. Very commonly we find that we are putting that particular specialist in a position of being more of a philosopher and an ethicist than a practising surgeon. We are asking the lifeboat scenario kinds of questions: who do you operate on first? The 45-year-old man, with two children and a wife, who has a lung tumour that's advanced? The 80-year-old man who has an aortic aneurysm of only five centimetres, not burst? The 60-year-old woman with a need for removal of a bulla in the lung?

You're asking these individuals to make philosophical decisions based on Cartesian logic rather than the training which they've been given. I don't think there are many people out there that are equipped to make those decisions, nor were they ever thinking that they'd be working in that ethically orientated kind of circumstance.

I wonder if the minister has any idea of the enormity of the serious concerns that are facing MLA offices across the province, with Mr. McCourt being a pretty typical example of the kinds of people who write to us.

[1650]

Hon. M. Farnworth: I would answer yes, I am. I'm an MLA myself, and my office receives correspondence and health care concerns from my constituents the same as any other MLA. I might add that being the Minister of Health makes me a natural target for people who are dissatisfied. When they're writing to their MLA or communicating with their local MLA, they are usually copying or faxing me.

A. Sanders: Well, I would certainly urge the minister to be proa