2005 Legislative Session: First Session, 38th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, NOVEMBER 14, 2005

Afternoon Sitting

Volume 4, Number 7

CONTENTS

Routine Proceedings

Page

Introductions by Members

Statements (Standing Order

25 B )

Candidates for municipal

elections

Karagianis

Contributions of senior citizens

D. Hayer

Role of civilian peacekeepers

Trevena

Hidden Heroes education project

Cantelon

Passing the Fire initiative for

Canadian volunteerism

Simons

Response to racist brochure in

Langley

M. Polak

Oral Questions

Handling of child welfare case

after death of sibling

C. James

Hon. S.

Hagen

Review of children's deaths by

coroner

A. Dix

Hon. S.

Hagen

Hon. J.

Les

Austin

Gentner

J. Kwan

Farnworth

Worker deaths and safety issues

in forest industry

Puchmayr

Hon. M.

de Jong

Simpson

Relocation of regional fire

commissioners

Macdonald

Hon. J.

Les

Role of B.C. Utilities Commission

in sale of Terasen Gas

C. Evans

Hon. R.

Neufeld

Tabling Documents

Statement of votes, 38th general

election

Statement of votes, 2005

referendum on electoral reform

Committee of Supply

Estimates: Ministry of Health

Hon. G.

Abbott

Cubberley

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Public

Safety and Solicitor General (continued)

Hon.

J. Les

G. Gentner

M. Karagianis

N. Macdonald

C. Wyse

J. Kwan

Estimates: Ministry of

Education and Minister Responsible for

Early Learning and Literacy

Hon. S. Bond

J. Horgan

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MONDAY, NOVEMBER 14, 2005

The House met at 2:03 p.m.

Introductions by Members

Hon. M. Coell: I have three guests in the Legislature. I'd like the Legislature to please welcome Arthur Wiens, and Laura and Al Radzanowski.

N. Simons: I'd just like to draw the attention of the House to two guests from the Kootenays who are here representing TASK, the Tourism Action Society in the Kootenays: Deborah Paynton and Eileen Fletcher, the executive director. I would like the House to please make them welcome.

Hon. J. van Dongen: I have two introductions today. I would like to acknowledge His Excellency Dave Reddaway, high commissioner for the United Kingdom to Canada, visiting us in the gallery. He is accompanied by Martin Cronin, the recently appointed consul general of the U.K. based in Vancouver. I am pleased to say that we had a productive meeting with these two gentlemen and the Attorney General, and I would like to ask the House to please make them very welcome to the Legislature.

I would also like to welcome 40 grade 12 law students who are visiting from my constituency, from Robert Bateman Secondary School. They are accompanied by teachers Doug Primerose and Ms. Sherry Dunn. They are actually here for a two-day trip to visit the provincial Legislature and also to visit the Provincial Court and sit in on hearings in the Provincial Court. I'd ask the House to please make them welcome as well.

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L. Krog: I note we have on the floor of the House today the distinguished conflicts commissioner. I'd ask the House to make him welcome.

Statements

(Standing Order 25

b) CANDIDATES FOR MUNICIPAL ELECTIONS

M. Karagianis: I'm sure it's no surprise to anyone that municipal elections are once more upon us, with only a few days to go. I stand in the House today to actually celebrate several well-known municipal leaders who are retiring from politics and not running in the upcoming election.

Hon. M. de Jong: Voluntarily.

M. Karagianis: Voluntarily, actually, prior to the ballots being cast. It truly is a celebration for them. I'm sure that it's taken a lot of anxiety out of their days.

First and foremost, Carol Pickup is very well known as a community leader here in the region. Carol has celebrated over three decades in local politics, from school trustee through to municipal council. Carol was a career nurse who started her political life at the school board and then moved — as many politicians have done, some in this House here — into a larger seat in politics.

Carol has been a fierce advocate in this region for affordable housing, for the arts, for community outreach and for environmentally responsible government. She has also been a mentor and sometimes critic of many of us in the region and is a formidable force, as many of us know. But she has always managed to help us all achieve excellence or strive for excellence in our role as local government, and for that we love and applaud her.

Within my own community of Esquimalt, Mr. Jim King has spent two decades — 21 years, in fact — as a municipal leader. Jim, who was a war hero and a prisoner of war, has been fiercely dedicated to his community for the 21 years that he's served. He's participated quite vigorously at CRD and library board, and I know that anyone who has served with Jim will join me in celebrating his retirement after a very illustrious career in local politics.

The third person I'm celebrating today doesn't have as many years.

Mr. Speaker: Thank you, member.

M. Karagianis: Okay. Thank you very much.

CONTRIBUTIONS OF SENIOR CITIZENS

D. Hayer: Mr. Speaker, thank you for the opportunity to salute our seniors, who have contributed so much to make B.C. the best place on earth to call home.

Last Friday, like so many others, I participated in the Remembrance Day ceremonies to honour those who sacrificed so much to bring the freedoms we enjoy today. Regrettably, there are fewer and fewer of those veterans, those senior citizens, to personally thank for all that they selflessly accomplished so many years ago for all Canadians. But every minute and every day, there is someone new in British Columbia joining the ranks of senior citizens.

Yet their contributions don't stop at the point that they retire. Our seniors are our most willing and most dedicated volunteers. They are our mentors who pass on lessons learned and their vision for the future. Like the veterans who went to war for us, we must remember the seniors who fought their own personal battles on the way to success and accomplishment.

We must remember them, and I am pleased to say that in the past six months this government has continued its support for seniors, with an additional $242 million over three years to improve their lives. These increases and others over the past four years are just one way we can say thank you to all who built our country and our province and made our communities a better place to live. As our economy gets even better,

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this government will be able to give even more to this most important segment of our population.

I ask all members in the House to join me in saluting our seniors.

ROLE OF CIVILIAN PEACEKEEPERS

C. Trevena: On Friday many of us were at Remembrance Day services. We wore a poppy to remember veterans who gave their lives for our freedom and our future.

[1410]

But I also wore my poppy to remember friends and colleagues who have died in areas of conflict — people who are not members of the military but who worked for the United Nations and other international organizations trying to help people suffering from war and trying to help people rebuild civil society.

Two years ago a car bomb killed Sergio Vieira de Mello, the head of the UN in Iraq. Friends and colleagues of mine died with him. I miss them, and I miss their energy and their commitment to those concepts of civil society which we take for granted here in Canada.

Every day civilian peacekeepers are working in countries before they descend into war or after a conflict has torn them apart, helping to develop human rights and to build democratic structures, working in hospitals and in schools — creating a foundation for those societies. Civilian peacekeepers, whether working for IGOs or NGOs, are in conflict zones with little protection. There are, of course, security precautions, but they weren't enough to help Chris Klein-Beekman from Courtenay, who died working for UNICEF in Iraq, nor the Canadian nurse Nancy Malloy, killed in Chechnya working for the Red Cross.

Civilian peacekeepers do not wear bulletproof vests. They don't carry guns. They're aware of the risks, whether in Afghanistan, Haiti, Iraq or Kosovo. It's hard work. It's uncomfortable living. There's often no heat, no water, no electricity. There is no quick victory; there is no quick fix. The work doesn't produce results for many years, but individuals still make that commitment to help the victims of war and assist in building civil society from the ruins.

Peacekeeping has become a Canadian icon. We're rightly proud of our blue-bereted military. We mark their achievements and remember their losses. So I'd ask the House to join me in also remembering, this year and in the future, the commitment given and the lives lost among civilian peacekeepers.

HIDDEN HEROES EDUCATION PROJECT

R. Cantelon: I stand today to talk about a program, which is working in school district 68, called Hidden Heroes. Now, hidden heroes are ordinary people and children who do small, everyday things that make a positive difference in their own lives or the lives of people they touch. The Hidden Heroes education project is a three-stage program that encourages children to seek out and write about hidden heroes in their lives. The goal is to improve student literacy as they work through the project.

In the first stage, students are motivated to seek out, interview and write or speak about a hidden hero in their life. They are encouraged to identify the positive values that make this person a hidden hero. In the second stage, they identify their own positive values and become hidden heroes themselves and then write about that experience. In stage three, they post their stories on the Hidden Hero website.

This program helps students to achieve several provincial learning outcomes, such as social responsibility, social studies and literacy. I have a great example of a young hidden hero. A grade three student revealed that she has four piggy banks: one for herself, one for her education, one to buy presents for her family and a fourth to help needy children at Christmas. At the end of the year, with matching donations from adults, she now has raised over $300 in her fourth pot for Christmas food baskets.

I'd like to thank Mr. Bill Robinson for founding the project, for helping students with literacy and for helping them to see the good features in those around them and in themselves.

PASSING THE FIRE INITIATIVE

FOR CANADIAN VOLUNTEERISM

N. Simons: In late October, 32 community leaders representing three generations in every region of the province participated in the 2005 volunteerism academy called Passing the Fire. The academy, presented by the B.C. Network for the Canada Volunteerism Initiative, provided a unique opportunity for participants to meet one another and to share ideas on how to increase the capacity of organizations to involve volunteers. Over 150 applications to the academy had to be pared down to 32, which is a testament to the strong interest in volunteerism here in British Columbia.

They included Natalie Lidster of Kamloops, who started a program in her school that encourages students to volunteer, and Rose Bortolon, a Brownie leader from Prince George, as well as David Stewart of Kaslo who, among other things, volunteers with the B.C. Choral Foundation. I ran into two participants from Powell River who are both active in their community: Barb Rees, a writer and coach who founded the Powell River Writers Festival — which, by the way, will be held for the third time this April — and Pat Hull, who chairs the United Way in Powell River and is also the chair of the chamber of commerce there.

[1415]

They have returned home ready to pass on the fire, to spread the message of volunteerism, its intrinsic value and its central role in our communities. Volunteerism builds connections between individuals. It also strengthens ties between cultures and brings communities together in good times as well as in the bad times.

The goals of the Canada volunteerism initiative are to encourage Canadians to participate in voluntary organizations, to improve the capacity of organizations

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to benefit from the contribution of volunteers and to enhance the actual experience of volunteering. Accomplishing these goals will allow people to connect with their communities to build a caring and tolerant society, where volunteerism is an integral part of life.

RESPONSE TO RACIST BROCHURE

IN LANGLEY

M. Polak: At the beginning of this month residents in my constituency received an unwelcome reminder of the hatred and intolerance that still exists even in a tolerant community such as Langley. A flyer denouncing mixed-race marriages, gays and lesbians, and minorities was delivered to the mailboxes of unsuspecting Langley residents. The flyer urges Canadians to join the fight against a Third World immigration invasion and promotes a homophobic, anti-Semitic, white supremacist American group.

Arlene and Hank Van Hove brought the hate literature to the attention of the Langley RCMP. Mr. Van Hove's reaction, as recorded by the Langley Times newspaper, is echoed by constituents across my riding. He said: "Our neighbours are Indo-Canadian, and they had this in their mail too. I'm embarrassed this was in the mailbox. This needs to be cut at the bud before it gets out there."

On November 11 we remembered all those who have fought and in some cases died to preserve the freedoms that we hold dear. They fought to ensure that people from all races, colours, creeds and backgrounds would be free of tyranny and oppression. Indeed, there are those in places around the world where they are still fighting.

We are fortunate that incidents of hate mail such as this are rare. At the same time, we must remember that a part of the battle for peace and understanding is fought by each one of us in our day-to-day lives. It is not enough to condemn the cowardice displayed by the authors of this message. We must move forward, each one of us, employing the bravery of understanding, acceptance and love.

Oral Questions

HANDLING OF CHILD WELFARE CASE

AFTER DEATH OF SIBLING

C. James: Last week we learned some disturbing new information about this government's handling of child welfare. The Ministry of Children and Family Development took over responsibility for Jamie Charlie and lobbied the court to keep him in the home of his sister's killer. Can the Minister of Children and Family Development explain why his ministry would lobby the court to keep the child in the home of a man who was under investigation for the murder of a child?

Hon. S. Hagen: As the Leader of the Opposition knows, there is a court case involved in this particular case. However, what I can say is that the government has appointed a blue-ribbon panel to review our child-death review system, public reporting and advocacy roles. That panel will be reporting out early in the spring. I suggest that we let that panel do its work and bring back any recommendations that it may have.

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

C. James: I think there is a great deal of concern about the number of reviews and the number of panels that are now going on and the fact that Jamie Charlie has not been included. We saw the child and youth officer actually ask the Attorney General to expand her mandate so that she could review the issues around Jamie Charlie. At that time we heard the Attorney General say it wasn't necessary for them to do that.

It's time for the minister to stop hiding behind the reviews that he claims are going on. He's the minister; he's in charge. He should be able to answer the question. Again, he'll now have had time to have his staff answer this question, so I'd like to ask it once more of the minister. Why did the government leave Jamie Charlie in that home for five months?

Hon. S. Hagen: As the Leader of the Opposition should know, the child and youth officer is investigating and reviewing what happened in the death of the child but also why the brother was left in the home of the child. As a matter of fact, one of her members, the member for Vancouver-Kingsway, is involved with that.

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

[1420]

C. James: The reason that the child and youth officer came forward to ask for that change of the mandate is because we asked the question. That was not part of the mandate, and the government was not going to look at this issue. Today I met with Harvey Charlie, the grandfather, who raised concerns again about the independence of the reviews that are going on. Mr. Charlie made it very clear that he and his family do not have faith in this government and its ability to do an independent review.

So again, I would like to ask the minister why we currently have eight separate reviews going on and why his government won't call one independent review to make sure the public and the Charlie family get answers to this case.

Hon. S. Hagen: In fact, all of these reviews are independent reviews. When the coroner decides to do an inquest or review, the coroner decides that, without any prodding or political interference from government. When the child and youth office decides to do a review, they do that under instruction of the Attorney General, under

section 6 of the act. On top of that, this government has undertaken a full blue-ribbon panel

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that will look at how this government deals with child death reviews. We expect to have that report early in the spring.

REVIEW OF CHILDREN'S DEATHS

BY CORONER

A. Dix: When the Premier and the government eliminated the children's commissioner, over 500 case files were simply abandoned, and at least 80 ongoing child death reviews were closed and not completed. These are the children this government forgot, this Premier forgot. My question is to the Solicitor General. Who made this mean-spirited decision to abandon these children and their families?

Hon. S. Hagen: The coroner reviews every child's death in the province of British Columbia — every child's death. The coroner will review the deaths as he can carry out the procedure. We don't interfere politically with that procedure. We expect the coroner to do his job and report out.

Mr. Speaker: The member has a supplemental.

A. Dix: They did interfere politically. They eliminated the children's commissioner. They eliminated the child advocate. They cut the ministry budget by 23 percent in 2002. They intervened politically.

My supplementary question is to the Solicitor General, the minister responsible for the coroner's office and for the reviews. In 1996 the current Premier went on the attack, demanding to know why 49 child deaths had not been reviewed between the time of the Gove commission report and the formation of the Children's Commission. The first thing the Children's Commission did was review those 49 cases in its first six months. However, when the Premier eliminated the Children's Commission this time, they left dozens of open cases. These cases, I say to the Solicitor General, have names.

What is the Solicitor General prepared to do now to ensure that these case files he didn't know about, according to the chief coroner a few minutes ago, one month ago…? He didn't even know about them one month ago. What is he going to do to see that these files are recovered and the public learns what happened to these forgotten children?

Hon. J. Les: First of all, I want to reassure everyone in this House and indeed all British Columbians that no child death goes unreviewed in British Columbia. We have ensured throughout that every child's death is reviewed through the coroner's office, as in fact has occurred for years here in British Columbia.

With respect to a number of files that may still be needing some form of conclusion, when that matter was brought to my attention I asked the coroner to come back to me as quickly as possible with solutions as to how that could be accomplished, and I expect to be working with him to achieve that in the very near future.

[1425]

R. Austin: At least 500 case files were lost, and at least 80 child death reviews were never completed. On November 8 the chief coroner himself, Terry Smith, said that any outstanding Children's Commission investigations were closed and were never transferred to his office. The Minister of Children and Family Development has said in this House that nothing was lost when the Children's Commission was closed. He has said that his ministry is the most open of its kind in the world. If that's the case, can the minister explain why his government deliberately chose to abandon at least 80 ongoing files?

Hon. S. Hagen: As the Solicitor General has stated, all children's deaths are reviewed by the coroner's office. With regard to the broader perspective of how we do things in British Columbia, we've set up a blue-ribbon panel, which will look at the child-death review process and will bring back any recommendations, and we will consider those recommendations.

Mr. Speaker: The member has a supplemental.

R. Austin: We obviously have some serious discrepancies here. The chief coroner last week told reporters that his office started from zero when it comes to child death reviews. The result is at least 80 forgotten children. He also said the Children's Commission's database of information on child deaths was never incorporated into the coroner's child-death review system. In addition, the coroner's office was given insufficient funding to deal with the transition and no legislative authority to access the proper records or hold in-camera meetings.

Can the Solicitor General explain why the coroner's office was not given the resources needed to complete child death reviews?

Hon. J. Les: The fact of the matter is that the coroner's office has always had the resources required to review child deaths in British Columbia. The coroner is going to continue to do that work in the province, and we look forward to working with him to accomplish that, as I've already said.

With respect to any other issues in terms of reporting out and those types of matters, I am sure that will form a significant part of the work of the Hughes panel that is currently out there in the province and that we expect to hear from early in the spring.

G. Gentner: On October 24, 2005, the Solicitor General said in this House that "no child's death in the province has gone unreviewed as a result of the transfer of those responsibilities to the coroner's office." You heard it again here today. We have to give the Solicitor General an opportunity here. Would the Solicitor General like to take the opportunity now to retract that

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statement, given everything we have learned today? Here is your chance.

Hon. J. Les: It remains the case that no child's death in British Columbia goes unreviewed by the coroner's office.

Mr. Speaker: The member has a supplemental.

G. Gentner: It's unfortunate where it could be that on that side of the House, less is more.

In 2002 the government eliminated the Children's Commission and its $4 million budget. The coroner's office was given $200,000 to take over child death reviews. But at the same time its overall budget was cut by $800,000. Since then, the coroner's service has released one child death review. Now the chief coroner has said: "We're now at a point where we need to start doing the fuller reviews." The government's overhaul of this system has been a failure — a complete failure. The coroner has not been able to do the job, and 80 forgotten children are the result.

Hon. Speaker, does the Solicitor General agree that it's time to bring back the Children's Commission?

Hon. J. Les: Along with everyone in this House, I await the recommendations of the Hughes report, which we expect early in the new year.

J. Kwan: Let's give a name to one of those 500 nameless, forgotten children. Austin Martel died during a superbug outbreak at the Children's Hospital in 1998. His Kitimat family told the Province newspaper on October 22 that they had believed the child fatality review was to be completed, until they received a letter dated September 24, 2002, from a chief investigator, John

Greschner, who told her the review would not be completed as a result of the elimination of the Children's Commission. This is on record.

[1430]

I'd like anybody from the government bench to please stand up and accept responsibility for that decision and explain to the family of the little child whose life was lost why the investigation was not completed and why it was cancelled in 2002.

Hon. J. Les: I am not intimately familiar with the specifics of the case that the member cites. However, I can assure her that that very unfortunate death, too, would have been thoroughly reviewed by the coroner's office.

Mr. Speaker: The member has a supplemental.

J. Kwan: I don't know how it is that the Solicitor General says he is not familiar with the case, but yet he stands in the House and says with certainty that the review was done. In fact, the family of that little child said the review was cancelled as a result of the government's elimination of the children's commissioner's office. In fact, some 500 cases were lost in this process, and at least 80 cases — ongoing investigations — were not completed because of the loss of the children's commissioner.

The government wants to do the right thing, or at least they say they want to do the right thing. Well, they have an opportunity to do that. Will the government finally act now to honour the lives of those children who have been forgotten, whose lives have been lost in the shuffle, to ensure that those 500 lost files are recovered and fully investigated by an independent children's commissioner? That work is not being done right now.

Hon. J. Les: Listening carefully to the member opposite's question, there is only one thing I agree with her on, and it is that this government, in fact, wants to do the right thing. We want to make sure that in each and every one of those kinds of cases, the facts come out, and that is why there are several reviews ongoing at the moment.

What I find somewhat unfortunate is that what we see is a series of drive-by allegations by members opposite. I think it is clear for anyone who wants to review the files that in every one of these cases, a full and thorough coroner's investigation is done.

M. Farnworth: The Solicitor General has just stated that he wants to see the right thing done. He's stated repeatedly that the chief coroner reviews every death. Well, in March of 2005 the chief coroner pledged to review the cases that were lost in the transition period, but since that time he has admitted that he has neither the legislative mandate nor the budget to do it. So if the minister is concerned about the right thing being done, will he pledge to this House today to immediately give the chief coroner the resources and the mandate that he needs to do those reviews?

Hon. J. Les: We work with the coroner's office on an ongoing basis to ensure that the resources are there that they require. With respect to any legislative or perhaps regulatory changes that are needed, I think the members opposite would agree with me that it is appropriate to wait until the Hughes report comes in early in the new year so that we can do all of these things in context.

Mr. Speaker: The member has a supplemental.

M. Farnworth: So the minister is saying to this House that those cases that were lost in the transition — which he says should be reviewed and, in fact, must be reviewed — have to wait for another inquiry, when he knows what is required and what the chief coroner has said about the mandate and, in particular, that the resources need to be there.

My question, again, to the minister is: will he commit to this House, and not delay, that those resources and the mandate should be given to the chief coroner today?

[1435]

Hon. J. Les: I have already said to the House that I have asked the chief coroner to come back to me with

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what his requirements would be to conclude any outstanding files he has in his office. To that end, I have already committed additional resources to that office so that the work can begin as quickly as possible.

WORKER DEATHS AND SAFETY ISSUES

IN FOREST INDUSTRY

C. Puchmayr: Since the House rose on November 3, the death toll in the forest sector has continued to climb. Two weeks ago a Helifor helicopter broke apart in midair in Bella Coola, plunging two of the young men to their death. Now we have just heard yet another tragedy, bringing the total to 37. I thank the Minister of Labour for that briefing earlier.

What is the Minister of Labour doing today to address these unacceptable numbers?

Hon. M. de Jong: Thanks to the member and his colleague for attending earlier.

Yes, sadly, another fatality — this time north of Kamloops in a very remote area involving an individual in the falling sector, the fifth falling fatality this year. The numbers continue to mount. From all of us in this House, of course, our condolences, thoughts and prayers to the families.

I think the member is aware that we have begun a very intensive collaboration with the stakeholders, including the steelworkers union. I have directed WorkSafe B.C. to devote additional personnel and resources specifically to the forest sector and, of course, the forum that is being organized. It all seems to pale when you consider the tragic loss that, again, occurred yesterday. But suffice to say, we are resolved — and, I think, members on both sides of the House — to take the steps necessary to curtail an unacceptable level of carnage in the woods.

Mr. Speaker: The member has a supplemental.

C. Puchmayr: Between 2001 and 2004 there have been 45 fewer workplace inspections, written orders are down 49 percent, and employer penalties are down by 36 percent. Does the Minister of Labour agree that the reduction in inspections in orders in forestry are causing alarm and are resulting in the increase in fatalities in our forests?

Hon. M. de Jong: Well, it's certainly one part of a very complicated equation that people have focused upon. As I've just indicated to the member and the House, I have made a very specific request of WorkSafe B.C. in the last two and a half weeks to address that and devote some additional resources.

But I think it goes beyond that. The member, I'm sure, recalls our discussion earlier today where I talked about the changes in the forest sector, the differing harvesting practices but also the differing look of the industry and how there are far more contractors, smaller operators and our overall regulatory process. I acknowledge to him we have to ensure that it is one that matches that structure and takes proper account.

So I am hopeful and optimistic that with all of the stakeholders, committed as they are, and this member, committed as he is, we can wrestle this to the ground in a very meaningful way. The test for that will be when we don't have to stand up and talk about specific fatalities as, unfortunately, we have to do today — the day after yet another one.

B. Simpson: As the minister has indicated, our hearts do go out to the families of those who have lost their lives in our forest sector. However, I note that the minister admitted that the sector has changed dramatically over the last number of years. During forestry estimates, I asked the Minister of Forests and Range about those changes and whether or not it was time to look at those changes with respect to forest safety. The minister's response was that he did not feel compelled to take immediate steps because "we have a year that's outside the normal cycle."

To the Minister of Forests and Range: what constitutes normal with respect to forest worker deaths, and what number will it take before the minister takes concerted action to look at the policy changes that have occurred over the last four years?

[1440]

Hon. M. de Jong: While I appreciate the question and the fact that it is essential we have the discussion, no one is claiming any proprietary interest in this. What we want to do is try and address a problem that, quite frankly, has become very much a part of the culture of operating in the forests.

Ironically, if we looked at the numbers last year, we could conclude that there was no problem at all, but those numbers were unacceptable. They were very low, by forestry standards. In my view, they were still unacceptable.

I don't think any of us should be satisfied. This is one thing that the steelworkers union, Mr. Hunt, the Forests Minister and I agreed on absolutely. No one should be satisfied until a forest worker can go to his or her workplace and know with some degree of certainty that they're going to come home and see their family at night and that they can do so safely.

B. Simpson: Again, I appreciate the minister's heartfelt response and the minister's own words that the government is resolved to do what it takes. Well, there are voices upon voices who are pointing out that forest policy changes have been implicated in the spike of deaths that we're seeing in the forest sector.

To the Minister of Forests and Range: will his ministry conduct an independent and comprehensive review of those forest policy changes to see what, if anything, they are contributing to unsafe conditions in our forests? My question to the minister is: what does the government have to lose if indeed it does that review and it actually contributes to reducing the number of deaths?

Hon. M. de Jong: Again to the member, there is — and I hope I can be clear about this — no hesitation on

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the part of this minister, the Forests Minister or any member of this government to examine every facet of how our forest industry operates to ensure that we bring down a level of injury and fatality that is unacceptable. The member heard me, just an hour or two ago, talk about how we have a system that was built around the notion of the WCB safety officer going to the MacMillan Bloedel safety officer for a discussion. Our industry doesn't look like that anymore.

There is absolutely no hesitation on the part of this government or any member of it to ensure that we have a regulatory system in place that properly takes account of those changes and that ensures that people operating in the forest sector can do so safely.

RELOCATION OF

REGIONAL FIRE COMMISSIONERS

N. Macdonald: This government says that it does not download programs and services onto communities, but the relocation of regional fire commissioners to Victoria is a download onto communities. A question for the Minister of Community Services: why is her government relocating our regional fire commissioners to Victoria?

Hon. J. Les: The member and I had a brief opportunity to discuss this during, I think, the week that the House rose. I've had a brief discussion with the office of the fire commissioner since. I have not yet got all of the answers that I'm looking for in response to the member's question. It does, however, have to do with ensuring that we have a core group of people within the fire commissioner's office that have the level of expertise we want them to have. With respect to ensuring that, we need to sometimes make sure that we have enough of those people together in one place.

I can assure the member that the residents of his riding are in no way going to suffer as a result of that. With respect to any other issues surrounding that issue, I'll commit here and now to get back to the member with those answers.

ROLE OF B.C. UTILITIES COMMISSION

IN SALE OF TERASEN GAS

C. Evans: For weeks now, every time that the opposition has raised questions put forward by citizens about the sale of Terasen Gas to Kinder Morgan of Texas, the Minister of Energy has assured us that the B.C. Utilities Commission will be looking after the concerns of the public.

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The public — because they trust the minister — believed him, and 8,000 of them wrote in asking the Utilities Commission questions about jobs and taxes, the relationship of the sale to softwood, trade disputes, foreign ownership and the implications of NAFTA. Then the Utilities Commission said: "These questions are beyond the scope of this review." Then they said that because there were no questions, there didn't have to be any answers, and because there were no answers required, the sale was permitted. Kafka couldn't have designed such a bureaucratic nightmare of over there, over here — where absolutely nobody has to answer anything.

My question to the minister — I bet it doesn't surprise you that there's a question — is: now that the B.C. Utilities Commission has declined to consider the questions and concerns of British Columbians — I am sure the minister did not mean to mislead the House when he said that they'll look after it — could he lead the House now and tell us, if the Utilities Commission does not consider the concerns of British Columbians, who will look after the public interest in the sale of Terasen Gas?

Hon. R. Neufeld: As I've said to this member — and I don't know if he's hard of hearing or he just can't remember it on a daily basis almost — the Utilities Commission is responsible for looking after British Columbians' interests and will continue to look after British Columbians' interests as they relate to the sale of natural gas from Terasen as it moves forward. I think the member is aware that the process is not finished. There's still Investment Canada, which has to make a decision on this issue. But if the Utilities Commission Act was such a mess — and is such a mess — why didn't you, when you were in government…? Your government spent ten years actually circumventing….

Interjections.

Mr. Speaker: Members, members.

Continue, minister.

Hon. R. Neufeld: The government that you were part of spent ten years circumventing the B.C. Utilities Commission process. You issued orders from the Ministry of Energy and Mines office at the time to do specific things. So you circumvented it. If you didn't like the legislation then, as you're saying now, why didn't you change it then to what corresponded with what your government thought it should be?

Mr. Speaker: The member has a supplemental.

C. Evans: Whether I'm hard of hearing or not or whether I was part of a government or not is irrelevant. There are citizens — 8,000 of them; I've read the letters — and they live in the constituencies of all the members opposite and of the members of cabinet. They are not New Democrats. They're regular people; they belong to all parties. They even live where that member lives. For 100 years…

Interjections.

Mr. Speaker: Members.

C. Evans: …the people who governed in British Columbia have been trying to take power from Ottawa.

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What we just heard that minister say is: "We don't have to decide. We give it over to Ottawa." Hon. Speaker….

Mr. Speaker: Does the member have a question?

C. Evans: I might get to one. Is the minister saying that if the 8,000 citizens who wrote letters — and the members of this Legislature who have an opinion — wish to have that opinion registered, we need to leave this capital city and our province and go to Ottawa to make our complaints known, because he won't listen to them?

Hon. R. Neufeld: I'll remind the member again, in case he's forgotten, that the B.C. Utilities Commission is responsible for looking after the public's best interests in the province. In their approval of the sale, they actually put some conditions on the sale. Interesting — right? So they are, first, keeping the finances of Kinder Morgan and Terasen separate in order to protect Terasen's credit rating and the rates to customers. Get it? Second, they're keeping a separate board of directors from Kinder Morgan. Third, things like offices and customer billing information cannot be moved from their current locations without prior approval from the commission, to protect customer privacy.

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Mr. Speaker, just quickly. If anyone ought to go to Ottawa, maybe that member ought to go to Ottawa and talk to Jack Layton.

[End of question period.]

Tabling Documents

Mr. Speaker: I have the honour to present the statement of votes for the 38th general election and the statement of votes for the 2005 referendum on electoral reform.

Orders of the Day

Hon. M. de Jong: Mr. Speaker, in this chamber I call Committee of Supply, for the information of members, on the estimates of the Ministry of Health and in Committee A — the little House — continued estimates debate on the Ministry of Solicitor General.

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Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

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

The committee met at 2:58 p.m.

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

Hon. G. Abbott: If I may just make a few introductory comments, Madam Chair. First of all, I would like to introduce the staff that's with me here. On my immediate right is Penny Ballem, who is the deputy minister for the Ministry of Health. To my far left are Manjit Sidhu and Dave Woodward, who are assistant deputy ministers. Actually, Dave is an associate deputy minister. Manjit is an assistant deputy minister with the ministry. Of course, there's a cast of thousands elsewhere to assist in finding all of the answers that are important around the Ministry of Health.

[S. Hammell in the chair.]

This is my first set of estimates as a Minister of Health. This is a very large, challenging and exciting ministry. I have very much enjoyed the five months, I guess, that I've had the honour of being the minister responsible for Health in the province. One of the reasons why it has been a very satisfying and very exciting position to hold is that I have a remarkably capable executive in the Ministry of Health to support my efforts as minister.

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I am impressed every day by the excellence in the Ministry of Health, beginning with Penny and right down through the ministry. We have a very committed, very knowledgable and very talented organization that I think is doing an excellent job for the citizens of British Columbia in providing services that are very much valued by the citizens of this province. I do want to thank staff at the outset for their excellent work.

I want to say at the outset, as well, that I'm looking forward very much to the questions and comments from the Health critics opposite and, of course, from other members of the assembly on both sides of the Legislature. Health is something that all of our constituents, I think, typically value as the most important public service that we can offer to the people of the province. I'm very much looking forward to their constructive questions and comments.

I'll also begin with the startling admission that I have always found the estimates process to be actually one of the most valuable things that we do in this legislative chamber. I recall that on advising my colleagues of that back in about 1996, they thought I was utterly bizarre and perhaps quite unstable to think that estimates might be a particularly productive part of what we do in this chamber.

But I've always felt that, and I continue to feel that estimates is a very important part of our work here and that there frequently is — how shall we put it — a more constructive climate or culture around the estimates process than one finds, for example, in question period, although it has changed somewhat, as well, over the years. In any event, I'm certainly looking forward to this process and the opportunity we'll have in the hours ahead to canvass areas of health care that are important to the members opposite and certainly important to all of their constituents.

Health is a major priority for our government. That goes without saying but is perhaps better for the saying of it. It is the largest element in the provincial budget. Somewhere, I believe, between 43 and 44 cents of every

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tax dollar in the province is expended on the health care system, and that's good. Over time it continues to grow as a share of the provincial budget. I used to recoil somewhat more about that particular fact when I was a minister for other things, but now that I'm Minister of Health, it doesn't seem nearly as scary a prospect as it once did.

We have seen the health budget grow dramatically. Even over the first four years of our government we have seen health care expenditures grow dramatically. When we took government in 2001, the budget for health was $8.3 billion. Today it is $11.75 billion — a 38-percent increase over the past five years.

The health care system is also a huge employer in our province. About 120,000 people are directly employed in the health care system, and every day those 120,000 people set out to provide the very best health care they can to the citizens in this province. I think we actually have an excellent health care system in this province. I don't think I would claim, nor do I think many would claim, that the health care system is perfect, but it's a great system and one that we can be very proud of.

Every day there are tens of thousands or possibly hundreds of thousands of interactions within our health care system. The great majority of those — a very, very high percentage of those — would be very satisfactory interactions in the system. They're that way because, across the province, there are doctors, nurses, orderlies, administrators and front-line health care workers in home care and elsewhere who are doing their very best every day to provide excellent health care to the people that they serve. So I think British Columbians do have a right to be very proud of the quality of care that is produced by the health care system in B.C.

Again, I think if one looks comparatively at where British Columbia sits in terms of outcomes produced by our health care system, British Columbians would be very proud and pleased by how well we are doing. Ours are among the best health care outcomes in Canada.

[1505]

The other area where I think British Columbians should rightly be particularly proud is in the research area. British Columbia — and members opposite may know it, but if they don't, I think it's something they would want to know — has built an international reputation for the contributions which British Columbia's researchers make in the area of health. It is absolutely remarkable, particularly in areas like cancer, what we have been able to do as a relatively small piece of the world — four million people. Our contributions by those four million British Columbians to the world of health care research have been absolutely remarkable.

I had the pleasure to attend an awards event with the B.C. Cancer Agency just over a week ago and talk to Dr. Simon Sutcliffe from the B.C. Cancer Agency. We were talking about the quite remarkable contributions that had been made, and I asked him, both in a relative sense and in an absolute sense, how the world views British Columbia and Canada as contributors to the world of cancer research. His answer was pleasant from my perspective — more than pleasant, remarkable — that not only in a relative sense but in an absolute sense, British Columbia and Canada lead in many areas of cancer research internationally.

We are doing things in British Columbia which, not just in a relative sense but in an absolute sense, are world-leading, and every British Columbian should be proud of that fact. We're not only doing an exceptional job of managing the illnesses of people who are unfortunate enough to be stricken by cancer, but we are also undertaking remarkable research projects — not only in cancer but a whole range of other science-based and health-based activities — and really leading the world in terms of what we are able to produce. We should be very proud of that as well.

Across the health care system one can see how not only the research results but the day-to-day management by the doctors, nurses, orderlies and so on of the health care system are leading to excellent results. British Columbians, compared to all other jurisdictions in Canada, lead the longest, healthiest lives of Canadians. We should be celebrating that fact each and every day.

If you're a British Columbian, you're apt to live longer and healthier than other Canadians. In terms of physical activity — and I was very proud of this as former Minister of Sport — we lead the nation in terms of physical activity and the benefits that obviously can be derived healthwise from that. We lead the nation in terms of healthy body weights. Obesity and overweight have very much become huge issues for Canadians as well as people across the world. Again, relatively speaking, British Columbians are doing well.

We also have the lowest smoking rate in Canada, at about 16 percent, and again, that's something we should be very proud of. It's also a fact that helps to drive cost down in our system, because British Columbians are living healthier as a consequence of not being addicted to cigarettes.

We should be happy about all those things. But is there room for improvement? Absolutely, and we have committed to some very ambitious goals as a government to try to lower the number of people who smoke, increase the number of people with healthy body weights, have more people eating healthy balanced diets and have people get more physical activity. All of those will be important drivers in terms of health care costs and health care outcomes five years from now, ten years from now, 20 years from now.

We need to convince British Columbians…. I'll speak a little bit more later on this around ActNow B.C. We need to convince people that they need to take control of their own lifestyles in order to have health outcomes five years from now, ten years from now and 20 years from now which are satisfying to them and satisfactory to their families, and so on.

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We have committed to improve in all of these areas to be the healthiest jurisdiction, we hope, to ever host a Winter Olympics and Paralympic Games, in 2010. This

[ Page 1718 ]

is an ambitious plan, but we know that British Columbians are giving a lot of thought to their personal health, and we want to encourage them to do that.

The other point I want to make as we begin here is that human resources are really the foundation to a great and improving health care system in this province. We currently have about 8,000 physicians in this province. Again, relatively speaking, we have a pretty good distribution of those 8,000 physicians. There may be some corners of the province where it's difficult for people to get access to physicians, and even in some urban areas there may be difficulties in that regard, but we know that in British Columbia we do have either the second- or third-highest number of physicians per capita compared to other jurisdictions in Canada.

We want to ensure that every British Columbian has access to a physician, and we want to ensure that our future needs are met in terms of physicians. There are many physicians in this province who are, like me, into their mid-50s and are contemplating retirement at some point. We need to ensure that we are educating young physicians to, again generationally, take the place of those who may retire over the next decade. That's a very important thing to do.

I am happy to report that our government has, in fact, stepped up to the plate in a very substantial way in respect to that. We have committed to doubling the number of medical graduates in this province from the current 128 per year to 256 per year by 2007. This is a very important and very expensive commitment, as well, but one that we feel is absolutely vital in terms of ensuring that doctors, who are very much the foundation of a health care system, are available to the public.

I do want to thank our partners in that: the University of British Columbia, the University of Victoria and the University of Northern British Columbia. By 2009, I understand, UBC Okanagan will also be a part of this, so that's excellent as well.

Similarly, nurses are a vitally important part of health care in British Columbia. Currently there are about 37,000 nurses that work in this province, and they do a great job for us. Since 2001, to ensure that we have sufficient quantity of nurses, $67.1 million has been spent on recruitment, retention and education for nurses in this province. There are occasions when there are shortages of nurses, but happily, that is becoming less the case. There was an artificial restriction on the number of nurses being educated back in the 1990s. Only 85 new nursing seats were added through the period of the 1990s.

Just prior to the 2001 election, as some may recall, some 400 seats were proposed for addition, but there was a real shortage in terms of having all of the skills and education and knowledge associated with nursing available to the public.

Since 2001 we have made a huge commitment around educating more nurses. We have added 2,511 seats — not to be too precise about this, but 2,511 nursing seats — to educational institutions across this province. That's going to be enormously important in terms of meeting human resource needs. That's a 62-percent increase in the number of nurses being educated in this province. We have also, I should note, recruited nationally and internationally another 600 nurses to assist us in ensuring that we have an adequate number of health professionals to deal with the challenges that we face each and every day.

[1515]

I know the opposition has appointed a critic for mental health, and I think that's great. I look forward to his thoughtful questions in the House.

I just want to make a few comments around mental health. Again, this is an area that has probably in the past — and I'm talking historically now — not received the attention and the resources that are commensurate with its importance. We know that many more British Columbians are affected by mental health disorders, including depression, than one might have thought. Some would estimate as high as one in five British Columbians would at some point in their lives be affected by a mental disorder.

We need to try to move away as a society from the stigma that is often associated with mental illness, and I think we need to make some cultural adjustments, not only in the way we look at this as a government but also in the way that society looks at and manages these challenges.

I'm proud of the work that the ministry has been doing in respect to mental health. Over $1 billion is devoted annually to mental health and addiction issues in this province. There is a strong correlation, often, between mental health challenges and addiction challenges. I have seen educated estimates that range between 30 and 60 percent, roughly, in terms of the correlation between those two challenges.

In either event, we often need to look at some of these challenges from a holistic perspective, involving not just addictions treatment or mental health treatment but also issues of housing, employment and counselling for better physical health. A whole range of issues comes into play in terms of turning around some of the lives.

I'm proud of the new facilities we have seen brought on line over the past few years and which continue to come on line today. For example, Seven Oaks in Saanich; Iris House in Prince George; South Hills in Kamloops; Seven Sisters in Terrace; the Kamloops neuropsych centre, which is going to be coming into stream soon; Delta View in Delta; and Sandringham in Victoria — all important, new, regional mental health facilities in home-like kinds of settings, which I think are a very important part of helping manage mental health challenges and helping people to return, when they're ready, to a broader role in society.

There are lots of issues, and I won't go through them now. I'm sure that the mental health critic will canvass lots of these areas, including devolution of Riverview, as we move through this. I note also that the opposition has a critic for seniors and seniors' health and long-term care. I think that's very good as well.

I am, as a former Minister of Housing, particularly proud of what we have been able to do over the past five years in terms of Independent Living B.C. That is a partnership between the Ministry of Housing, B.C.

[ Page 1719 ]

Housing and the Ministry of Health. I think there have been some remarkable changes made in that area, possibly not fast enough for some, but there have been huge investments made. Each and every day we see more and new and better facilities which are coming on stream as a consequence of that huge investment, both on the Ministry of Housing side and the Ministry of Health–health authority side. Over the past four years we've completed well over 4,000 new or renovated units.

[1520]

It would be difficult to overstate the challenge we faced when we came into government in 2001 in terms of meeting the needs for not only numbers of units for the frail elderly but also the condition of those units. There were not sufficient resources, in my view. We may vigorously debate this in the hours ahead, but there were not, in my view, anywhere near the resources devoted to this important area between 1991 and 2001. Only 1,400 additional units were added over those ten years.

Worse, what we found on doing an inventory — a first-ever comprehensive provincial housing inventory for residential care and assisted living in 2002 — was that many of those units and buildings failed to meet building and fire codes. We also found that about 50 percent required major upgrades to meet the level of care needs that the patients or clients required. That was a challenge.

We saw, in many instances, the closure of four-bed and eight-bed wards, to be replaced, often and most commonly, by either single units or, on occasion, two-bed units. Again, this is a very important change in both the quantity and the quality of the units available for the frail elderly. In addition to the now 4,000-plus that have been either newly built or renovated from inadequate stock, right now around the province there are another 52 projects where shovels are in the ground in various stages of completion. We'll see another 2,100 units completed by December of 2006.

Even with the units that have come on stream today, I'm happy to report that the wait times for assisted living and residential care are way down from when we took office. It was about a year wait time when we took office. It is now down, typically, across the province to between 30 and 90 days. There's substantial progress. As we see the balance of those units come on stream between now and December 2008 — another increment of approximately 2,200 more units coming on stream between December '06 and December '08 — we will see that situation improve even more.

There have been huge investments made there, and rightly so. I think both the quality and quantity for the resources available to the frail elderly are going to be dramatically improved as a consequence of these investments.

Another area which I'm sure the members opposite may wish to canvass is the issue of surgical wait times. This has been a big interest to me as incoming Health Minister. I think the ministry has been doing remarkable things in terms of trying to meet unprecedented demand for surgical procedures in this province.

The first thing that one might note, for example, if you compare what we are doing in terms of surgeries in different areas to what we were doing back when we took government: surgeries in the area of knee replacements are up 65 percent over 2001 — a lot more surgeries being undertaken in that area. Hip replacements are up 35 percent over 2001; cataracts, up 20 percent; coronary bypass, up 7 percent; and perhaps most interesting of all, angioplasties, up 52 percent from what was done back in 2001.

Though the consequence of those additional resources being devoted to better surgical wait times has been very good in some areas, it remains a challenge in some other areas. In cataracts we've seen the average wait time across the province reduce from about 12 weeks down to about eight weeks, but for cancer radiation it's down from about two weeks to one week or less now, which is excellent. Similarly on cardiac, there are very good results in terms of reduced wait times.

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Where we continue to have a big challenge is in the area of hips and knees, the orthopedic surgeries. Again, while the number of surgeries is up dramatically for hips, at 65 percent, and knees, at 35 percent, nonetheless, we are able only to hold the wait times relatively static as a consequence of a demand curve that is growing as fast as or faster than we can provide more procedures.

This is a challenge, and I would submit to the House, in the best non-partisan sense that I can, that it is going to be a continuing challenge for all members of this House and for any future government in this House. We have, really, two demographic waves that are going to always challenge us and really demand all of the ingenuity and all of the innovation that we can muster as governments or potential governments.

The first demographic wave is the one that my mother is a part of. She's 83. She is part of the fastest-growing demographic group in the province, which is the 80-plus group. Not only are British Columbians living longer than ever before, but they're living healthier than ever before. Their expectations about living long are greater than ever before, and they are demanding surgeries at a later age than we would ever have contemplated ten, 15 or 20 years ago. That group is growing quickly. That's a great thing, but it means some demands for, particularly, hip and knee surgeries. So we're going to be challenged in that area.

The second demographic wave that is coming at us is the group that I'm delighted to be a part of, which is the postwar baby-boomers. Actually, I can see a number of people around this chamber who might fall into that esteemed category — not looking at you, Mr. Clerk, not at all. You're well beyond that, I think. No, I'm just kidding. That group is now in their early, mid- or late 50s or early 60s — the postwar baby-boomers. If you look at the utilization of health care services by age groupings, what we find is that as we get to be approximately 60 to 65 to 70, the rate at which we utilize

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health services climbs dramatically. For that group — which, again, I'm a part of — we are going to see those continuing challenges.

It's a challenge, but again, to place it in perspective: in British Columbia, if you need a surgical procedure, approximately half of them are done immediately. They are done on an emergency basis and done immediately. Of the remainder, 50 percent will be done within one month, and this is on average; 75 percent in less than three months; 90 percent in less than seven months; and 97 percent in 12 months. So relatively speaking, we are doing well on wait times, but there are some challenges, and I do hope the members of this House have some suggestions on additional things we might do.

The principal thing we intend to do as a government….

Is that red light for me? No. Is it? Oh, really? I didn't know there was a time limit on introductory speeches.

An Hon. Member: There is now.

Hon. G. Abbott: There is now. This is something new. I'll try to wrap up here in a moment.

We're going to work hard through ActNow B.C. to ensure that in smoking cessation, exercise, healthy body weight and fetal alcohol syndrome, people have the information they need to understand how they can largely determine their own health outcomes.

I want to close with this quote. This is from Edward Stanley, the Earl of Derby, from 1873. It's good that even belatedly we recognize the genius of Earl of Derby. "Those who think they have not time for bodily exercise will sooner or later have to find time for illness."

I hope you can forgive me for going over time, Madam Chair, in sharing that important quote with you. I look forward to the questions from the members of the chamber.

[1530]

D. Cubberley: I want to thank the minister for his comments, for his thoughtful introduction. Like him, this is my maiden voyage as well. I've been on the opposite side of the House and haven't dealt with Health estimates before, so I beg everybody's indulgence of my missteps as I go along through the process.

The minister's comment at the very end about the quote reminded me of one that I keep pinned up nearby, which is from somebody less auspicious than his source. It runs that the human body is the only machine that wears out through lack of activity. I think it's something that, as we go through the prevention side of the estimates, we may want to keep in mind and that we can come back to.

Anyway, I also really do thank the minister for thoughtful comment. I didn't mind the filibuster. It was informative. I want to thank him and his staff for having provided all three of the critics with a very helpful briefing prior to the estimates, which will make it less cumbersome than it would have been without the briefing.

Stewardship of public health care is a collective responsibility. Each government that takes it on anew takes it over from a prior government, and probably, in some real sense, we're all standing on the shoulders of those who went before us. I know that the minister was canvassing some of the things that he was quite proud of and that are special about the B.C. system. He was talking a bit about health research, which is obviously becoming more acknowledged as an area of excellence.

I had other things going through my mind at the same time, thinking about things that do distinguish us. One of them, which I believe was a Social Credit innovation originally, was to establish the Centre for Disease Control, which I think showed immense value during the SARS outbreak, both in preventing it from taking hold here and in being able to call in plays, as it were, from British Columbia to a situation in Toronto. It certainly made me feel very proud and made me aware that some of these larger-scale apparatuses that can be put in place can have immense benefit when we're challenged with something like a SARS epidemic or like the pandemic that may be on the horizon.

As you know, the public in Canada and, I think, both parties in the Legislature care deeply about the health care system and are very attached to it. Quite apart from the sense of crisis that some on the far right like to sow about public health care, I think Canadians, by and large, are very attached to the system and are very satisfied with it, although they have concerns. Some of those concerns will be mirrored in some of the directions of questioning that we will take in the House during estimates.

Health care affects everyone at numerous points in a life, from cradle to grave. I know, for myself personally, that it's had an impact at many different points, whether dealing with a broken bone that I got from a cycling accident three years back or watching my own son born in a hospital or dealing with my own parents struggling to age in place and deal with end-of-life care. You engage with the health care system at many different points, and it's a wonder that it is there and that it can be there for all of us.

I think it remains the most important issue to most people in society throughout most of their lives that they have access to high-quality care in a timely manner. They might not use that exact language, but they will come up with something that equates to that if they're asked about it. I think that in a very basic sense the health care system that we have — a public health care system — reflects our commitment to one another and is arguably our most important social program. While it does absorb an enormous stock of resources, it's carrying out a very, very broad and diverse service to virtually everyone who's living.

Of course, that kind of system places an enormous responsibility upon all decision-makers and on the minister in particular. I recognize that. There's obviously the responsibility to show good stewardship of the system and to provide leadership, and that's an

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ongoing challenge. It means planning well both for what you're dealing with now but for what's coming, as the minister said, in three years' time, in five years' time. The waves of things coming at us are only likely to increase.

[1535]

Of course, you've got to pull together the resources to address issues as they arrive in real time. And they do. I can see the deputy's brow furrowing, and I'm sure she's had to deal with a bit of that. Of course, the minister has to engage in a spirited defence of the system's accomplishments — because they are many, and it's important to remind us of that — and, at the same time, be involved in implementing strategies that provide for renewal and lead a process of change in complex institutions.

If we think about the four strong winds of change in modern health care that have been identified by close observers as affecting public health care systems worldwide, they're certainly continuing to blow through our system today. Our collective challenge is to ensure that the changes that they prompt in system design serve the ends for which the system was conceived, while improving the efficiency and the effectiveness of the means by which they're achieved.

Stewardship is very much about both continuity and change, about preserving the best features, certainly the defining features, of a single payer, publicly administered and — largely not-for-profit — delivered system of health care while implementing new approaches that respond to new technologies and new techniques constantly coming on stream, capturing new benefits and extending avenues of care into entirely new dimensions that may have been unimagined ten years ago.

So there are numerous challenges facing public health care, but I think there's a sense of optimism out there. If you clear through the rhetoric on the extreme right about the system imploding, falling apart and being unaffordable, and look at what's actually happening with it, there's a sense of optimism and opportunity out there in the new resolve at the level of the federal government to put new resources into addressing the more pressing challenges that we face in health care.

I welcome that initiative — we do on this side — because it begins to redress the historic imbalance that was created in the '90s, which perhaps the member will remember. Although if he was elected first in '96 — I don't know — it occurred before he became a member.

Interjection.

D. Cubberley: I have that effect on people, Mr. Clerk.

The federal transfer payments were unilaterally cut back, and it forced very, very difficult choices on the decision-makers of the '90s who chose to attempt to, as best they could, offset the missing federal money but, of course, were forced into compromises nonetheless because, in a real sense, health care spending had been reduced. In turn, over time that has created lots of bottlenecks that may not have been there had federal funding been sustained. The return of the federal funding, I think, or a portion of it, hopefully allows us to begin to direct resources towards those problems that were created in part or seeded initially by those cuts.

For me, and for us, estimates debate provides an opportunity for all of us to come closer to what the government sees as its priorities for health care. It's a very good chance to have an open exchange that I think can grow awareness and understanding, perhaps on both sides, and possibly even extend common ground — who knows? I'm an optimist. It can also clarify differences and the substantive policy issues, if there are substantive policy issues, that lie behind those differences.

With that, I would just like to say that we're proposing that we begin in the following manner — and I put this out so that the minister and staff can think about how this might flow — to approach general health issues, which is artificial as a distinction, by looking at the provincial budget, initially the update and some of the large numbers that are in there; federal funding agreements and the kinds of moneys that are coming on stream for what activities; wait-time reduction, wait-list strategies; primary care reform; health authorities; B.C. Ambulance; capital projects and P3s; alternative service delivery, including MSP; prevention; public health; and Pharmacare.

[1540]

Now, we're going to try and jam all of that up to Wednesday evening, and then Wednesday evening to Thursday morning swing into seniors health — so the aspects of Pharmacare, community care, assisted living, Bill 73, palliative home support and seniors' fall prevention. Then on Thursday morning and afternoon, mental health, including Riverview redeployment, community care and housing, interaction with the criminal justice system, addiction services and the specific issue of crystal meth.

Never having done it before, this is all guesstimated as to how the time would go. I know there are other members who will want to get their oar in the water, probably on both sides of the House, so we'll have to see how that all works out. But I would think we'd probably try to get to the end of the wait-time stuff by the end of this evening, if not into primary care, but we'll see how that goes. If they're long questions and short answers, we'll just have to….

Interjection.

D. Cubberley: Was that a warning?

To begin with a higher-level review of projected spending levels that are shown in the service plan update from September 2005, just looking at the coarse numbers, regional health sector funding is projected to go up by $700 million in '05-06, then by $250 million and then by $90 million in '07-08. I'm interested to know what's in that $700 million — whether some portion of that is to provide for incremental costs for delivery of the same services. Some of it is presumably for

[ Page 1722 ]

some elements of new services. So if you could comment on what's in there, that would be a good start.

Hon. G. Abbott: First of all, let me thank the member for his thoughtful and generous comments in introducing this

section of the estimates. The staff and I are very appreciative of the opposition for laying out the general order of questioning for us. It is very helpful from a perspective of deployment of staff resources to be able to do that, so I thank the hon. member very much for that.

I also wanted to thank the hon. member very much for his comments in relation to the B.C. Centre for Disease Control. Again, I'm not sure what the starting date on the BCCDC was, but they do just remarkable work. I know we are certainly very proud of what they were able to do when faced with the very, very challenging situation of SARS, but they did a remarkable job then. I think we can all be confident as British Columbians and Canadians that should we at some point face a pandemic kind of challenge, we have a resource like the BCCDC that can be there to assist us.

One of the dangers, of course, in talking about some of the good things going on in B.C. is that inevitably we miss some of the remarkable things going on here. Of course, the work being done at the Michael Smith Foundation is amazing. The work being done in this province on genomics and on unravelling that whole area of health care management is remarkable. The Rick Hansen Foundation does great work on spinal cord injury research. So there are lots of very, very remarkable things being done by the research establishment in British Columbia, particularly at the universities but outside the universities as well.

[1545]

In answer to the member's question in terms of the $700 million, first of all, the largest piece of that will be for the funding increase for health authorities. That would be to address pressures around things like diagnostic and joint wait-lists, youth addictions, palliative care, increased home care, maternity care enhancements, ActNow programs, dental health, hearing screening, FASD diagnosis and assessment, vaccination programs and specific programs as well as those. I won't go through it all.

As well, another important portion of the supplementary estimates will be for Visudyne, postgraduate medical education, Canadian Blood Services, out-of-province claims, autism, NurseLine access, public health and immunization trust programs. So that's another large block of the dollars.

Other things I should mention. The Michael Smith Foundation — $70 million has been committed to Michael Smith. Home and community care are important as well. Over the next two years we're aiming at improving care for seniors who receive services across the continuum of home and community care services.

Funding will include things such as the purchase of equipment — beds and lifts aimed at improving patient care and reducing strain and injuries for health care providers; facility improvements to accommodate higher levels of care; training for case managers; enhanced home care capacity; ensuring adequate home care and residential care capacity while governments and health authorities renew existing facilities.

There is a broad range, as I'm sure the member can appreciate, of things that are being done there, but that probably can give you a pretty good sense of where that approximately $700 million will be devoted.

D. Cubberley: Just to follow that along a little bit, in no particular order, two questions. First, is there any capital spending in that amount at all — minor capital spending? I'm not thinking so much of equipment and beds and the like but more the actual construction of facilities.

The second thing is on home care and community care. Is there a defined increase in the number of hours of home care service and housekeeping services that will be available to people who are eligible for those kinds of services under the moneys being put into health authorities?

[1550]

Hon. G. Abbott: The member asked a couple of questions to which we'll give the best answer we can. He may wish to pursue this further, and we'll try to get more precise as the questioning proceeds.

The answer around if there is capital involved in that $700 million is yes. There's some minor capital particularly involved there. Generally, one would find the major capital, for example, for new institutions or hospitals…. The funding for that would be elsewhere. The $700 million is incremental dollars, but there is some minor capital in there.

The second question the member asked was: could there be enhancement of home and community care with those dollars? Again, the answer is yes, particularly around the tools, the sort of facility amenities that would assist in providing assistance to those needing home and community care. Also, consistent with the standardized assessment tools that we've developed across all health authorities, if there is an unmet need, it could certainly go there. We know that every year we have an aging society where, all things being equal, there's going to be a growing demand, so the dollars here will assist with that growing demand over the next three years.

Also, end-of-life care. We provide, first of all, the coverage for case management, nursing and personal care at the end of life and also for short-term, acute, community mental health home care and short-term, acute home care. So those are all areas where we can do enhancements under the FMM agreement.

D. Cubberley: Just a couple of follow-ons there. Are there any resources that were formerly held in the ministry budget that are being transferred to health authorities through that funding, and is there any of the Riverview devolution money included in that? Is there anything in that money that provides for devolu-

[ Page 1723 ]

tion of the Riverview beds, or would that more likely show up in capital?

[1555]

Hon. G. Abbott: We think the answer to the first portion of the member's question is no, but we may have missed his point. If we have, perhaps he could restate the question, and we can try again. But as we understand the member's question, he is asking whether there had been any sort of pre-existing holdbacks from the province to the health authorities in the area of home and community care that would form a part of the $700 million that we're discussing currently, and the answer to that is no.

There are no sort of residual funds that have not been previously transferred out to the health authorities that would be embraced by this $700 million. Again, I hope we've got the member's question right, and I'm sure he will rephrase if we missed some subtlety there.

Around Riverview, again the answer is no, and I think we understand the member's question clearly in this case. The capital portion of Riverview devolution resides elsewhere. It is $138 million. Operating funds move from the province out through the Provincial Health Services Authority, or PHSA. As beds or patients are devolved or regionalized, moved to regional facilities, the dollars follow them.

D. Cubberley: I'd like the minister to try to help me understand the next line in the general budget, the Medical Services Plan budget, as an entity separate from regional health sector funding. So really, I'm interested to know what's paying for what. What's actually paid for through the Medical Services Plan line item, if you will, and what's paid for through the health sector funding? And what's the division there that occurs?

Hon. G. Abbott: Thank you to the member for his question. In terms of the breakdown of expenditures in the MSP area, which is approximately $2.627 billion, the lion's share of that, close to 68 percent of it, is medical fee-for-service at $1.778 billion; laboratory services, $265 million, which is about 10 percent of the overall; alternative payments, $246 million; rural health, $157 million; physician benefit plans, $68 million; supplementary benefits, $64 million, and that would be chiropractors, etc; out-of-province payments, $26 million — almost $27 million; and primary care reform at $20 million. So that's the breakdown for MSP.

[1600]

D. Cubberley: Just to understand a little better, what caps that amount? Does that have a relationship to what is taken in through MSP premiums? How is that generated?

Hon. G. Abbott: The short answer to the member's question is no. The quantum produced through MSP premiums is $1.438 billion per year, and the expenditures under this general area are $2.627 billion. Obviously, there are additional budgetary provisions that allow us to provide the range of services, etc., that are embraced and that we previously discussed.

The main drivers in terms of whether that number goes up — I was going to say up or down, but it never goes down, only goes up — are the agreements we would have with the B.C. Medical Association and others around fee structures. Those are managed as well as possible by the ministry and by the health authorities. We try to contain these things, but as you know, we are entering into a new round of discussions with BCMA, and the chance of them demanding a reduction in any of their fees is probably scant.

D. Cubberley: If we could just drop down to the next item. I'm conscious of the fact that we're going to canvass this in detail later on, but could you just give me a sense, under Pharmacare, of what the cost drivers are there? I'm just interested in a general sense — it's obviously not going to be one thing — in what's driving it, whether it's new drugs like Herceptin coming into the formulary that are the main drivers, or if it's the expansion of existing drugs just being prescribed more widely. What's the combination of factors that's driving it?

[1605]

Hon. G. Abbott: I thank the member for a very good question. I'm going to have to contain my normal enthusiasm for responding to questions here so that I don't try to answer every conceivable question in this area in one answer and then leave these pre-emptively ending, unlikely as that might be.

Pharmacare is a challenging area for a whole range of reasons. It is a very challenging area of public policy. The Pharmacare area, notwithstanding some changes that have been made in recent years, continues to grow faster than the overall growth of health expenditures. There are a number of factors involved in that.

Basically, it is a price-times-volume equation that drives the overall costs of Pharmacare. but we are also seeing an impact of the things we talked about earlier, which was that not only is our population growing but, by and large, it is aging as well. As we age, our demand for drugs increases as well.

If we look, for example, at the last ten years in terms of B.C. Pharmacare and the growth in Pharmacare expenditure, which over the ten-year period is well in excess of 100 percent — probably about 120 percent over the ten years…. Population has grown, let's say, by about 15 percent; the number of beneficiaries probably by 30 percent to 35 percent; the number of paid prescriptions per beneficiary, about 50 percent; the expenditure per beneficiary, about 75 percent; paid prescriptions by about 90 percent. The combination of all those things leads to an annual growth in excess of 10 percent and, overall, well over 100 percent over a ten-year period.

Pharmaceuticals are a challenge, but in fairness, they often represent an opportunity for managing for better outcomes in the health care system. I'm pleased

[ Page 1724 ]

the member mentioned Herceptin. Of the pharmaceutical announcements we've made in just the last few months, Herceptin is without doubt the most important.

In the area of drug research, we are constantly seeing new proposals from the pharmaceutical industry suggesting that their new formulation should be added to the formulary. Sometimes that has merit, and sometimes it does not. I won't go into the whole business of the common drug review right now.

Suffice it to say that Herceptin is an example of a breakthrough drug. For the treatment of breast cancer, Herceptin represents a huge breakthrough in terms of the impact it will have on particular kinds of breast cancer or, more precisely, on women who have a certain enzyme that promotes the cancer. Herceptin is both a challenge and an opportunity, and we know we'll save lives with Herceptin.

We know, actually, that there will be an offsetting cost saving with Herceptin as well. But where drugs don't have that same kind of breakthrough quality, we have to assess very carefully whether the drug being proposed adds something in terms of the range of the formulary or adds something in terms of at least a break-even or a cost saving. These are all issues, and that, I hope, answers the member's question in terms of cost drivers in the pharmaceutical area.

[1610]

D. Cubberley: I want to go into some questions about capital funding. I need to understand, in order to do that a little bit better, what the next two lines in the budget represent, which are "Debt service costs" and "Amortization of prepaid capital advances."

I'm just trying to understand the system. I note that on page 8, there's a health care facilities item, which is presumably direct capital investment moneys. I'm interested to know what these other entities represent, whether they represent ongoing payment of debt incurred on behalf of capital expenditures and how one puts these things together to get a complete sense of what the capital plan would look like in terms of dollars.

Hon. G. Abbott: My staff have advised that this is absolutely fascinating stuff for accountants, particularly, and for those who get into this particular area, so they would be glad to provide a separate technical briefing around just how all these blocks tie together. The story is apparently fascinating, riveting, for those who deal on a regular basis with them. Happily, I'm not one of those, so I'm going to do the best I can to tell you what this means and then invite your further penetrating questions in this respect.

The debt service costs on the fourth line down that the member asked about, which shows $173.5 million, $169.5 million and $183.2 million. Those reflect our ongoing obligations as we build major facilities. They are reflective of the interest rates either being enjoyed at a particular time or, in the case of the '06-07 plan, anticipated interest rates. Really, the variation there is either real or anticipated interest rates.

The amortization of prepaid capital advances reflects the advances we make to health authorities on a cash basis for the initiation and completion — hopefully, eventually — of projects. That is our best estimate of the amortization of those prepaid capital advances.

[1615]

D. Cubberley: If we were to go to the "Health care facilities" item — the $379.7 million in this year — what's its relationship to the amortization of prepaid capital advances?

Hon. G. Abbott: Again, going from the reference point of the close to $380 million on page 8 — $379.7 million — that represents incremental capital spending by the ministry through the health authorities that year. That's just that year. The amortization that's shown on page 7 represents the amortization on that investment plus any historic unamortized facilities expending from the past.

D. Cubberley: Now I have to demonstrate with clarity that I'm a lay person and not an accountant.

The amount that's expended under the item on page 8, which is health care facilities capital, bears a relationship to the amortization of prepaid capital advances? And the prepaid capital advances represent what component of that? I'm trying to understand how it doesn't double-budget something because…. I'm going to leave it there. I'll let you help me out.

[1620]

Hon. G. Abbott: Again, I may not be giving the comprehensive answer that the member hopes for here, and he can persist until he gets the level of detail that will be either satisfying or so perplexing that he'll simply walk away from the area, as I'd actually advise him to, and move on. Anyway, this is very interesting.

Again, on page 8, the $379.7 million reflects the incremental capital spending, one year. The way that capital spending shows up on the income statement on page 7 is through amortization and through debt service costs. Some portion of that, and I think probably about 10 percent — we don't know exactly — would probably reflect the current year's commitments.

So we're dealing with amortization and debt servicing that might go back as far as 40 years — probably not in most instances, but it could in theory. It would represent a portion of the figure you see there. The figures on page 7 represent historical management of the capital.

D. Cubberley: In looking at health care facilities on page 8, investment dropping by $100 million in '05-06, projected to drop…. Perhaps you could give me a sense of why that would be happening and how that lines up with the new money announced for additional beds, hospital commitments that we have and the like.

Hon. G. Abbott: Again from page 8, you'll note that there is a footnote two beside the figure of $379.7 mil-

[ Page 1725 ]

lion. If we go to footnote two, it reads: "Includes $121 million for the transfer of the B.C. Children's and Women's Health Centre site from the province to the Provincial Health Services Authority." The figure there, under the rules of GAAP — generally accepted accounting principles — I gather would oblige it to be shown in this way.

Therefore, if you wanted to come to a more apples-to-apples comparison, you would reduce the approximately 380 by 120 and be down around 260. If the member would like to know more about the bounce from 260 to 280 to 240 to 215, we can do that, but I won't anticipate his question at this point.

D. Cubberley: No, that's helpful, and I should have picked up on note two. I think I have an inherent aversion to reading the fine print in the fine print. That's bad in a decision-maker.

I just want to very briefly ask a question about vital statistics. It's only because it shows up here, and it's probably the most appropriate place. Two questions. One is: is the security problem being handled, and how is it being handled? Maybe I'll just let that stand, and I'll ask the next one.

[1625]

Hon. G. Abbott: The member references the break-ins and attempted break-ins that occurred in the early morning hours of September 14, 2005. The Vancouver vital stats office was broken into. Nothing was taken from that office. The Victoria vital stats office was broken into, and a range of certificate stock…. I won't go through the detail of it unless the member wishes, but birth certificates, marriage certificates and death certificates were stolen in that break-in.

The break-in was obviously of enormous concern not only to the Vital Statistics Agency but to police and others as well. Obviously, this was a very professional break-in that was undertaken, and the perpetrators didn't have the best interests of society in mind when they broke in there. They clearly have nefarious uses in mind for that certificate stock.

We are very concerned about it, and we have undertaken a variety of initiatives in concert with federal and provincial agencies to try to ensure that we can minimize the potential misuse of this certificate stock. The fact that the perpetrators were able to get into the Victoria office and get this material obviously says that there are additional security measures that are needed. Those have been undertaken.

There was an alarm on the building. There was a guard either on the premises or adjacent to the premises, but clearly, any time perpetrators are able to successfully break into a building and seize materials, the adequacy of the security features comes into question. There has been a bolstering of security in those offices to try to deal with what is obviously a pretty sophisticated crime network.

We've undertaken those things. I think it's probably not appropriate to talk a great deal about the additional security provisions that have been put in place, because that would simply invite those who might offend again to have some advantage in terms of understanding what they will face there. That's a general breakdown there, and I'm glad to answer any other questions the member may have.

D. Cubberley: The other question is actually at a much different scale, and it has to do with the future of Vital Statistics. I noted in some of the reading I had done in preparation that when there was an initial briefing around the expressions of interest regarding MSP and Pharmacare privatization, there was a question asked specifically about whether Vital Statistics would be available for privatization.

The answer given by the civil servant at the time was somewhat ambiguous. I simply ask the minister if there are any plans to include Vital Statistics as a possible entity for alternative service delivery.

Hon. G. Abbott: There are no plans for nor in anyone's recollection ever even an intention of undertaking such a privatization.

[1630]

D. Cubberley: Thanks, minister.

Grinding toward the end of this review of the coarse numbers, information systems shows a very substantial jump in '05-06. I'm interested in knowing what's in there. Is that a partial result of the infusion of federal money? What amount within that would be for a specific initiative like the electronic health record? Just to get a sense of what we're embarking on, on that…. That's not a small shift of resources; that's a very large increase. I'm interested in knowing what that's for.

[A. Horning in the chair.]

Hon. G. Abbott: The member is correct, at least in large measure. The increases reflect what is generally characterized as the Infoway initiative, which is a federal-provincial e-health initiative that has been produced out of some of the federal-provincial discussions for health information management. The Infoway initiative involves a commitment from the federal government of about $120 million over the next few years and $30 million from the provincial government over the same period. The figures that the member sees on that line do not reflect all of that money — only a portion of that money.

Staff estimate that about 60 million of the Infoway dollars are reflected in that. So it will continue out beyond the horizon that is contained in this table.

D. Cubberley: Perhaps that's a segue into the federal money and the overall accord, rather than just continuing it along those lines. That's what I'd like to do, then — pass into the first ministers' agreement. One of the things, just to begin, so I have a sense of how this works…. The money that's allocated on an annual basis under the agreement — does it appear, in any fashion,

[ Page 1726 ]

broken out within budgets, or does it disappear entirely? Is it included within these coarser numbers that we've been looking at? Is it fully reflected in there, and is that money, dollar for dollar, incremental to the existing provincial budget, or does it in some cases displace existing provincial funding?

Hon. G. Abbott: The FMM dollars are reflected in the table on page 11. So the answer is yes. All of those dollars are embraced in that table on page 11, and yes, they are all incremental dollars to the provincial health budget.

D. Cubberley: So those would be reflected in the budgets we have just been looking at? All of those dollars are in there?

Hon. G. Abbott: Yes.

[1635]

D. Cubberley: Okay. From reading the text, I understand that this is a ten-year agreement, B.C.'s share of which is approximately $5.4 billion. The top priority is stated as improving access to care and reducing waiting times where they are longer than medically acceptable. It also says that each province is responsible for establishing its own priorities, although that identifies an overarching priority, and then gives five. I believe that cancer treatment, heart surgeries, diagnostic imaging, joint replacement and sight restoration services are identified as important priority areas to be considered.

So I'm interested if the minister would outline B.C.'s priorities in their order of importance, as the government sees them, with a brief explanation for the ranking of those priorities.

Hon. G. Abbott: The member is asking a very important question, and I thank him for that question. I won't do justice to his question, which could be quite broad-based and inclusive in a really good answer. Then again, we would risk that pre-emptive closure of estimates by me giving a really good answer to everything. This is a very important area of public policy, a very challenging area and a very interesting area. I think it's actually quite fascinating how the sort of mechanics of federal-provincial relations flow and how the application of the first ministers' agreement finds its reality on the ground in the health care system in B.C.

I'll begin with an expression that I frequently use. I never tire of it, but I'm sure that staff, particularly, who hear this in my speeches all too often, are perhaps remarkably tired of it. But I'll risk that by saying, to begin, there are no unimportant areas in health care. The five areas which the member mentioned — diagnostics, cancer, heart, joint replacement, sight restoration — are all key areas of health public policy that we will be pursuing in line with the objectives that the first ministers embraced in their accord of September, I believe, 2004.

[1640]

There's a lot of work being done around all of these five major areas. I'm sure the member noted with interest the discussions that went on around the provincial-territorial and federal-provincial-territorial meeting of October in Toronto, where we wrestled with how we would be able to begin to meet the commitment for evidence-based benchmarks in those areas of health management.

There is a lot of very, I think, useful and in some cases quite remarkable work being done around how we manage wait times better in British Columbia, Nova Scotia, Quebec, Saskatchewan and so on, and all the provinces are at relatively different places in terms of how well they are doing in managing their wait times.

I think that in British Columbia we are either doing very well…. In some areas we lead the country. In cancer, we certainly lead the country, and we're doing well in most areas. As I indicated in my opening remarks, where we have a big challenge…. It's partially related to the aging of our society, partially related to the expectations of an aging population, but where we have a continuing challenge is in the orthopedic area.

We really need to think about how we address that with some innovation and ingenuity, but I think there are a lot of great ideas that I hope we can bring to bear on this challenge in the months ahead around better management of those people who have not enjoyed timely service in terms of surgical procedures.

The other thing we need to think about, as well, is that the best outcomes for people's health are not always related to surgeries. There is a whole area of prevention that we need to aggressively address. For generations governments have talked about prevention, but we've never given it the kind of focus we intend to give it in the days ahead. That is, we can sometimes prevent the necessity for a hip or knee replacement if we look at issues like healthy body weights, healthy diets and prevention of obesity issues, which sometimes drive additional demand for procedures.

I salute the health authorities. Some of them are doing some quite exceptional work around the prevention piece — for example, the Interior Health Authority. They saw trip-and-fall injuries among seniors being increasingly a driver in terms of demand for procedures, so they've undertaken some work across their authority to try to use prevention as a way of reducing some of these pressures. That's all part of it too.

I don't do justice to the quite remarkable work that is being done by the staff that are with me today and the quite remarkable work that is being done across the health authorities to try to learn from the experience nationally and internationally and to take those best practices and translate them into better wait-times management in British Columbia.

D. Cubberley: I take from that that the minister is acknowledging the five priority areas that were identified by ministers in discussion and in whatever protocol was signed and assigns them some high priority. The minister has added a caveat that I think is an important one, which is that there are no unimportant areas.

[ Page 1727 ]

By its nature being targeted funding, though, I would assume this would not be spread across the entire health care system, that it would be used for specific interventions in areas where we might deem there to be a higher level of need. Would it be correct to say — apart from the obvious priority which is placed on wait-times reduction here, as represented by the large amount of money put up front, which I want to come back to — that wait-times reduction is at or near the top in terms of priorities for federal investment?

[1645]

Hon. G. Abbott: If the member wanted perhaps to get a better sense, I'd direct him to — and I won't read the portion; my comments will summarize some portions of it — page 9 of the document that he previously referenced. The service plan update, September 2005, has a very useful

section on the first ministers' agreement of 2004, which I think is important in terms of understanding the content, intent and direction of the first ministers' agreement of 2004.

I think a careful reading of those sections will suggest appropriately that there is a good deal more flexibility in terms of the purpose of those FMM dollars than simply all focusing on the five areas. I think the intention of the agreement was not to be prescriptive, but rather to, in a deliberate way, acknowledge those five areas of challenge and also say very clearly that to be successful in the health care system requires investments across the continuum of care.

For example, home care is a key part of ensuring that people don't end up, inappropriately or otherwise, in acute care beds. And residential care — ensuring that when people need that 24-7 complex care, it's there for them so they are not struggling on their own and perhaps injuring themselves and, again, either needing surgery or finding themselves in a long-term care bed. Also, primary care.

I think all of the participants in the first ministers' agreement understood that primary care is now and will be of growing importance in terms of meeting the health care needs of British Columbians and Canadians in order to ensure that people have healthy lifestyles, that they get the best advice around chronic disease management and that they are managing as well as they can their own health outcomes. I think that's an important piece of what we want to do.

Certainly, identifying the five priority areas was an important part of the first ministers' agreement. But there was a far more holistic understanding of how success in those areas would be achieved, and that would be through the broader continuum of care — including Pharmacare, home care, residential care, all of those pieces — so that the system would not be driven by surgeries.

[1650]

The system should be broad enough and expansive enough that not only do we try to provide surgeries on a timely basis when they're needed but also that the system is constructed in a way that we hope, either by early intervention or lifestyle counselling or other means of prevention, we can, in fact, avoid the necessity for surgery down the line. Hopefully, that helps to answer the member's question.

D. Cubberley: I want to work around this a little bit. We have a bunch of different line items here in the budget that indicate different transfers. What I'm sensing from what the minister's saying is that those are different federal envelopes but that they don't have a particular meaning in terms of any set strategy in any of the priority areas. So none of the money that shows up in there is actually aimed at anything in particular? Is that…?

Hon. G. Abbott: This is going to get a bit complex here quickly as well, but maybe not really.

Again, I'll direct the member to page 11 to start this discourse. The first line, "Canada Health Transfer (One Time)," shows $131,000 — pardon me, $131 million; we don't talk in thousands in this ministry; it's all millions and billions — and $262 million in '05-06. That can be characterized as one-time catch-up money which we can use as we wish.

If the member would then look down the column, instead of across here, for '04-05, the $131 million has been combined with the $559 million under "Wait Times Reduction" for the total, in brackets, of $690.9 million. I understand from staff, if I understand them correctly, that those funds came too late in the fiscal year to actually be expended. What has been done is they've been consolidated as the $690 million and then spread out over the four subsequent fiscal years, beginning at $116 million, then $228 million, then $267 million, then $79.9 million.

In the case of those funds, those are intended to address surgical wait times. So that would be the same for the wait-times reduction in the line above.

[1655]

The Canada health transfer of $295 million can be used across the continuum of care, so it could be used for any and all and more of the areas which I referenced in my previous answer.

D. Cubberley: Just before we go on to the wait times — because we've got a package there that we're going to pursue that's dedicated money, and that's getting a little closer to identifying it as an agreed priority, so I want to come back to that — I did want to ask about the one-time lump sum for home care and catastrophic drugs. Is that, again, money that can simply be spent wherever, or was that aimed at specific things?

Hon. G. Abbott: If we go back to the table on page 11, the $66 million was funds incremental to the first ministers' agreement. Again, the federal government, generally speaking, would like to see this expended in the area of Pharmacare or home care. But it is not completely prescriptive in terms of that, nor is the line now beginning "Deferral of 2004-2005 Funding" — that line going across.

Generally, we are looking at those funds for surgeries, not in a prescriptive, narrow way but in a more

[ Page 1728 ]

holistic way, which might reflect the priorities of the government. If there was an excellent program that minimized injuries produced by an activity, for example, that might be an appropriate way to reduce the need for surgeries.

D. Cubberley: Just on the $66 million, then. If memory serves, I believe there were some cutbacks in the government's first term in home care and home support services. One of the questions would be whether this money would be used to either bring us back up to a prior level or to improve the level of service. This may be money that you're using for that area that you covered off under my initial question about the $700 million to health authorities, where I believe you referenced improved equipment for aging in place — beds and other things that were better both for the person aging in place and for caregivers.

The other thing is whether there is, as a result of that money, any thought of improving catastrophic drug coverage in British Columbia, if any improvement is required. I know that was a particular concern of Romanow and seemed to be shared by the Prime Minister and his Health Minister, that catastrophic drug coverage be put in place. I don't know enough to know whether we are already well-enough provided for in British Columbia and whether that money isn't needed for that purpose, or whether that would be an appropriate use for the federal money, given its earmarking.

[1700]

Hon. G. Abbott: There were several questions embraced in the member's last round. Again, we may not be able to cover them all off in this one answer. I certainly invite him to submit further questions in those areas where he has an interest.

The expression of health care cuts is, I think, frequently a misnomer in relation to virtually any area of health care. As I pointed out at the outset, the expenditure for health care in this province has gone from $8.3 billion in 2001 to $11.75 billion effective with the most recent budget update from the Finance Minister in September. So there has been a very considerable growth in health care expenditures.

Where one occasionally sees concerns with health care spending is where changes have been undertaken that not everyone likes or appreciates, and in the context of the area of public policy, the member references home care. I would note, first of all, that standardized assessment tools for what is needed in home care were developed in the late 1990s under the former government. It was a quite appropriate attempt to bring some fairness and order and better management to an area of public policy that had been a challenge for the former government, as it has been for our government.

One needs to know what the level of need is in order to meet that level of need but not have a disproportionate or exaggerated expenditure of resources where they are not needed.

[1705]

The standardized assessment tools were developed in the late 1990s. They were not embraced, at least fully, by all of the 52 health authorities that existed prior to 2001. In some cases they were embraced, and in other cases they were not. There was some variance among health authorities in respect of how well those standardized assessment tools were adopted and enforced.

When we moved from the 52 authorities to the now six health care authorities across this province, the standardized assessment tools were put in place. As a consequence, I think some people had a sense that their entitlement under the home care program had been altered, and perhaps in some cases it was. It's not a case of there being fewer resources. It is a reallocation of those existing resources and an attempt to ensure that the needs of all British Columbians requiring home care were met.

Some people had become accustomed to having home care aides come in and do extensive housekeeping, and that was no longer envisaged in the policies that were developed in the late 1990s. I know there's been some dissatisfaction among some because of that, and that's a challenge — no question about it. But the aim of the program remains to provide the home care to those who need it and to provide it in a satisfactory and standardized way to those people.

Is the home care system we have perfect? I don't think it is, because we are looking for continuous improvement in home care, as we do in all areas of public health policy. I'm not sure where we want to be or where we need to be in terms of that, but I think there's been great progress made, and I look forward to more progress being made. We need to have the human resources available in the form of home care aide workers and to ensure that they are finding their employment satisfactory and rewarding so that we can keep them working in that area, because it is really a vital part of our health care delivery system to ensure that comprehensive home care is available.

The second major question the member posed — again, it's an important one, and I'm sure he will wish to focus more fully on it in subsequent questions. The catastrophic drug coverage is probably the best in British Columbia of any jurisdiction in Canada. We have undertaken through the Fair Pharmacare reforms to ensure that we come as close as possible to meeting the needs of British Columbians in that drug coverage area.

We have, I think, the most robust formulary in the country in relation to the classes of drugs that have been covered, and in British Columbia all breakthrough drugs are funded through our formulary. That's a very important piece. Again, I made the distinction earlier between the addition of a new drug that, perhaps, in the minds of the manufacturers has some superior traits but that from our perspective…. It's important that they be demonstrated to actually be either a cost saving or have some tangible benefit that would lead to them being recommended by the common drug review.

[1710]

Again, I think we should be proud of the fact that all breakthrough drugs that have been identified

[ Page 1729 ]

through the common drug review process are funded through our program. I'm happy with what we have done in this area of catastrophic drug coverage. I do want to advise the member, though, that our discussions with the federal government and with other provinces continue in this area. It is an area where we would like to see more federal engagement, and for those provinces that do not have the kind of formulary and the kind of catastrophic drug coverage that we do, it's also a very important initiative and one that British Columbia leads in the federal-provincial context.

D. Cubberley: I appreciate the minister's comments, and I certainly share a degree of pride in what's been done with Pharmacare over the years. I think British Columbia has led for a very long time in the area of drug coverage and across many administrations. So I think we can all be proud of the overall achievement. It certainly is the best in the country. I guess we would have to credit, at a certain level, reference-based pricing for being part of the magic of what occurs with that system.

We will have a chance to canvass Pharmacare further, and I don't want to delay there. I just wondered whether that portion of the money might be aimed at some enhancement in British Columbia and, really for my own information, whether any was required. I think the minister has given me a sense that we are at the head of the pack currently, and we plan to stay there, and there are ongoing discussions about things that may come in the future.

I would like to go back for a moment to the home care one, though, just to try and clarify a little bit further. I heard the minister say that there was reallocation of existing resources based on the development of standardized assessment tools in the '90s, that that has begun to take more impact in the government's first term in office and that that is not fully embraced by all people, because the reallocation of some of those services would have pinched some individuals who may not have qualified, once they were brought in, for as much as they did before or for any service.

One of the things he broke out was housekeeping and the idea of care aides or others being involved in actually doing work around the home for people who are receiving a home care service. As a combination of two things, I guess, one of them a life experience which is having dealt with two older parents who, although dealing with some debilitating illnesses over time, successfully aged in place with a large measure of support from their children — in particular, my sister — and providing a whole array of inputs to their life that allowed them to stay in the family home….

It left a very strong conviction with me of the importance of non-medical services in allowing people to successfully age in place.

I combine that with a little bit of randomly acquired…. I won't grace it with the term "knowledge," but let's call it information. While passing through the Edmonton Public Library recently, I grabbed a public health journal, which had a very interesting

summary of studies of home care and housekeeping services and, intriguingly to my mind, rated the housekeeping services and the availability of housekeeping services as of higher priority than medical care in the home in helping people to age in place.

I just want to come back to that a little bit and see if we can have a little bit of further discussion on that. It strikes me that while it's not medically necessary, if the cost-effective strategy is to have people stay in their homes — and I believe that it's really clear that that is the cost; we're not trying to move them along in the continuum; we'd like to hold them in the early phase of the continuum of care — then those kinds of things that enable it, whether they're medically oriented or not, would appear to this lay person to be of great value. I would just invite some further comment on that.

Hon. G. Abbott: Again, I'll try to answer this at a fairly high level, although I'll also answer it at a kind of personal level and give my kind of — I guess vision is a bit grand a word for what I'll provide you — sense of how we need to develop in this area.

[1715]

Before I do that, in my last answer in respect of catastrophic drug coverage, I should have mentioned this because it's actually important. It got lost in my rather longer answer, but it's really key. That is, in the area of drug coverage one of the things that distinguishes British Columbia from some other jurisdictions is that for cancer, cardiac, transplant and renal drug coverage 100 percent of those are covered in British Columbi