British Columbia Hansard — Tuesday, May 24, 2011

H0524pm-09

British Columbia — Debates (Hansard)

Third Session, 39th Parliament official rePort of Debates of the Legis Lative a ssemb Ly (hansarD) the honourable bill bari Soff, SPeaker iSSn 0709-1281 Tuesday, May 24, 2011 Afternoon Sitting Volume 22, Number 9

Pro Vince of britiS h colu Mbia (entered c onfederation July 20, 1871) lieutenant -Go Vernor h is h onour the h onourable Steven l.

Point, obc Third Session, 39th Parliament SPeaker of the leGiS latiVe a SSeMbl Y h onourable bill barisoff eXecutiVe council Premier and President of the executive c ouncil .............................................................................................................. h on. c hristy c lark Deputy Premier and Minister of finance ............................................................................................................................h on. k evin f alcon Minister of a boriginal r elations and r econciliation ...........................................................................................................h on.

Mary Polak Minister of a dvanced e ducation .................................................................................................................................h on. n aomi Y amamoto Minister of a griculture ........................................................................................................................................................... h on.

Don Mcr ae a ttorney General ........................................................................................................................................................... h on. barry Penner, Qc Minister of c hildren and f amily Development ................................................................................................................ h on.

Mary Mcn eil Minister of c ommunity, Sport and cultural Development .................................................................................................. h on. ida c hong Minister of e ducation .........................................................................................................................................................h on.

George a bbott Minister of energy and Mines and Minister r esponsible for h ousing.........................................................................h on. r ich c oleman Minister of environment ....................................................................................................................................................h on. Dr. t erry l ake Minister of f orests, l ands and n atural r esource o perations......................................................................................h on.

Steve Thomson Minister of h ealth .................................................................................................................................................... h on. Michael de Jong, Qc Minister of Jobs, t ourism and innovation ................................................................................................................................... h on. Pat bell Minister of l abour, citizens' Services and o pen Government .............................................................................. h on.

Stephanie c adieux Minister of Public Safety and Solicitor General .................................................................................................................h on.

Shirley bond Minister of Social Development and Minister r esponsible for Multiculturalism ............................................................ h on. h arry bloy Minister of t ransportation and infrastructure ................................................................................................................h on. blair l ekstrom leGiS latiVe a SSeMbl Y l eader of the official o pposition ......................................................................................................................................................a drian Dix Deputy Speaker .................................................................................................................................................................................... l inda r eid a ssistant Deputy Speaker ..................................................................................................................................................................Dawn black Deputy c hair, c ommittee of the Whole ...................................................................................................................................Douglas h orne c lerk of the l egislative a ssembly...................................................................................................................e.

George MacMinn, obc, Q c c lerk a ssistant ..................................................................................................................................................................................r obert Vaive c lerk a ssistant and l aw c lerk................................................................................................................................................. ian D. izard, Qc c lerk a ssistant and c lerk of c ommittees ............................................................................................................... craig h.

James (on leave) c lerk a ssistant and a cting c lerk of c ommittees ................................................................................................................. k ate r yan-l loyd Sergeant-at-a rms ................................................................................................................................................................................. Gary l enz

alP habetical liS t of MeMberS a bbott, h on. George (l) ........................................................................ Shuswap a ustin, r obin (nDP) ................................................................................ Skeena bains, h arry (nDP) ....................................................................Surrey-n ewton barisoff, h on. bill (l) ............................................................................Penticton barnett, Donna (l) ................................................................ c ariboo-c hilcotin bell, h on.

Pat (l) ..................................................... Prince George–Mackenzie bennett, bill (l) .............................................................................k ootenay e ast black, Dawn (nDP) ................................................................n ew Westminster black, iain (l) .............................................................. Port Moody–c oquitlam bloy, h on. h arry (l) ............................................................burnaby-l ougheed bond, h on.

Shirley (l) ...........................................Prince George–Valemount brar, Jagrup (nDP) ................................................................ Surrey-fleetwood c adieux, h on. Stephanie (l) ................................................Surrey-Panorama c antelon, r on (l) ..............................................................

Parksville-Qualicum c handra h erbert, Spencer (nDP) ................................Vancouver–West end c hong, h on. ida (l) ..................................................... o ak bay–Gordon h ead c houhan, r aj (nDP) ........................................................... burnaby-e dmonds c oell, Murray (l) ..............................................Saanich n orth and the islands c oleman, h on. r ich (l) ........................................... f ort l angley–a ldergrove c onroy, katrine (nDP) .............................................................. k ootenay West c oons, Gary (nDP) .........................................................................n orth c oast c orrigan, k athy (nDP) ..................................................... burnaby–Deer l ake Dalton, Marc (l) ..............................................................

Maple r idge–Mission de Jong, h on. Michael, Qc (l) .............................................. a bbotsford West Dix, a drian (nDP) ............................................................Vancouver-kingsway Donaldson, Doug (nDP) ......................................................................... Stikine e lmore, Mable (nDP) ................................................... Vancouver-kensington f alcon, h on. k evin (l) ..........................................................Surrey-c loverdale f arnworth, Mike (nDP) ............................................................

Port c oquitlam fleming, r ob (nDP) .......................................................... Victoria–Swan l ake f oster, eric (l) .......................................................................Vernon-Monashee f raser, Scott (nDP) ............................................................a lberni–Pacific r im Gentner, Guy (nDP) .........................................................................Delta n orth h ammell, Sue (nDP) .................................................... Surrey–Green t imbers h ansen, c olin (l) ............................................................

Vancouver-Quilchena h awes, r andy (l) ............................................................... a bbotsford-Mission h ayer, Dave S. (l) .................................................................... Surrey-t ynehead h eed, k ash (l) ................................................................ Vancouver-fraserview h ogg, Gordon (l) ............................................................... Surrey–White r ock h organ, John (nDP) .......................................................................

Juan de f uca h orne, Douglas (l) ..............................................c oquitlam–b urke Mountain h oward, r ob (l) .....................................................................r ichmond c entre h untington, Vicki (ind.) ..................................................................Delta South James, c arole (nDP) .........................................................Victoria–b eacon h ill k aragianis, Maurine (nDP) ........................................e squimalt–r oyal r oads k rog, l eonard (nDP) ........................................................................... n anaimo k rueger, kevin (l) ............................................... k amloops–South Thompson kwan, Jenny Wai ching (nDP) ...........................

Vancouver–Mount Pleasant l ake, h on. Dr. t erry (l) .....................................k amloops–n orth Thompson l ali, h arry (nDP) ..........................................................................f raser-n icola l ee, r ichard t . (l) .......................................................................burnaby n orth l ekstrom, h on. blair (l) .......................................................

Peace r iver South l es, John (l) .........................................................................................c hilliwack l etnick, n orm (l) ........................................................k elowna–l ake c ountry MacDiarmid, Dr. Margaret (l) ......................................... Vancouver-fairview Macdonald, n orm (nDP) ....................................c olumbia r iver–r evelstoke Mcintyre, Joan (l) ..................................................West Vancouver–Sea to Sky Mcn eil, h on. Mary (l) .................................................Vancouver–f alse creek Mcr ae, h on.

Don (l) ................................................................... c omox Valley Mungall, Michelle (nDP) ..........................................................n elson-creston Penner, hon. barry, Qc (l) ....................................................c hilliwack-h ope Pimm, Pat (l) ..........................................................................Peace r iver n orth Polak, h on.

Mary (l) ...............................................................................l angley Popham, l ana (nDP) ...................................................................Saanich South r alston, bruce (nDP) ................................................................

Surrey-Whalley r eid, l inda (l) .............................................................................r ichmond e ast r outley, bill (nDP) .................................................................. c owichan Valley r outley, Doug (nDP) ............................................n anaimo–n orth c owichan r ustad, John (l) ........................................................................... n echako l akes Sather, Michael (nDP) ......................................... Maple r idge–Pitt Meadows Simons, n icholas (nDP) ...................................

Powell r iver–Sunshine c oast Simpson, bob (ind.) .....................................................................c ariboo n orth Simpson, Shane (nDP) .....................................................Vancouver-hastings Slater, John (l) ..............................................................boundary-Similkameen Stewart, ben (l) ..................................................................... Westside-kelowna Stilwell, Dr. Moira (l) ......................................................... Vancouver-l angara Sultan, r alph (l) .....................................................

West Vancouver–capilano Thomson, hon.

Steve (l) ........................................................k elowna-Mission Thorne, Diane (nDP) .................................................c oquitlam-Maillardville Thornthwaite, Jane (l) .......................................... n orth Vancouver–Seymour t revena, c laire (nDP) .................................................................... n orth island van Dongen, John (l) .............................................................a bbotsford South Y amamoto, hon. n aomi (l) ................................. n orth Vancouver–l onsdale Y ap, John (l) .......................................................................r ichmond-Steveston Vacant ...............................................................................Vancouver–Point Grey liS t of MeMberS bY riD in G a bbotsford-Mission .......................................................................r andy h awes a bbotsford South .....................................................................John van Dongen a bbotsford West ......................................................h on.

Michael de Jong, Qc a lberni–Pacific r im ..........................................................................

Scott f raser boundary-Similkameen .....................................................................John Slater burnaby–Deer l ake ................................................................... k athy c orrigan burnaby-e dmonds ......................................................................... r aj c houhan burnaby-l ougheed ...................................................................h on. h arry bloy burnaby n orth .............................................................................. r ichard t . l ee c ariboo-c hilcotin ........................................................................Donna barnett c ariboo n orth ................................................................................ bob Simpson c hilliwack ...............................................................................................

John l es c hilliwack-h ope .......................................................... h on. barry Penner, Qc c olumbia r iver–r evelstoke .................................................. n orm Macdonald c omox Valley...........................................................................h on. Don Mcr ae c oquitlam–b urke Mountain .....................................................Douglas h orne c oquitlam-Maillardville...............................................................

Diane Thorne c owichan Valley ................................................................................ bill r outley Delta n orth ......................................................................................Guy Gentner Delta South ...............................................................................Vicki h untington e squimalt–r oyal r oads .....................................................Maurine k aragianis f ort l angley–a ldergrove ...................................................h on. r ich c oleman f raser-n icola........................................................................................ h arry l ali Juan de f uca .....................................................................................John h organ k amloops–n orth Thompson ............................................ h on.

Dr. t erry l ake k amloops–South Thompson ...................................................... k evin k rueger k elowna–l ake c ountry ...............................................................n orm l etnick k elowna-Mission .............................................................. h on.

Steve Thomson k ootenay e ast ....................................................................................bill bennett k ootenay West ............................................................................ k atrine c onroy l angley.......................................................................................h on. Mary Polak Maple r idge–Mission .....................................................................

Marc Dalton Maple r idge–Pitt Meadows ........................................................Michael Sather n anaimo ......................................................................................... l eonard k rog n anaimo–n orth c owichan ......................................................... Doug r outley n echako l akes ..................................................................................

John r ustad n elson-creston ........................................................................Michelle Mungall n ew Westminster ..............................................................................Dawn black n orth c oast....................................................................................... Gary c oons n orth island .................................................................................. c laire t revena n orth Vancouver–l onsdale ........................................h on. n aomi Y amamoto n orth Vancouver–Seymour .................................................

Jane Thornthwaite o ak bay–Gordon h ead ............................................................ h on. ida c hong Parksville-Qualicum ..................................................................... r on c antelon Peace r iver n orth ................................................................................Pat Pimm Peace r iver South ...............................................................h on. blair l ekstrom Penticton................................................................................... h on. bill barisoff Port c oquitlam ..........................................................................Mike f arnworth Port Moody–c oquitlam ...................................................................... iain black Powell r iver–Sunshine c oast ................................................. n icholas Simons Prince George–Mackenzie .............................................................h on.

Pat bell Prince George–Valemount ...................................................h on. Shirley bond r ichmond c entre ............................................................................ r ob h oward r ichmond e ast ................................................................................... l inda r eid r ichmond-Steveston ..............................................................................John Y ap Saanich n orth and the islands .....................................................

Murray c oell Saanich South ................................................................................ l ana Popham Shuswap ...............................................................................h on.

George a bbott Skeena .............................................................................................. r obin a ustin Stikine ........................................................................................Doug Donaldson Surrey-c loverdale .................................................................h on. k evin f alcon Surrey-fleetwood ...............................................................................Jagrup brar Surrey–Green t imbers ..................................................................Sue h ammell Surrey-n ewton ................................................................................. h arry b ains Surrey-Panorama ........................................................ h on.

Stephanie c adieux Surrey-t ynehead ........................................................................... Dave S. h ayer Surrey-Whalley.............................................................................. bruce r alston Surrey–White r ock ....................................................................... Gordon h ogg Vancouver-fairview ................................................ Dr. Margaret MacDiarmid Vancouver–f alse creek ........................................................ h on.

Mary Mcn eil Vancouver-fraserview ........................................................................k ash h eed Vancouver-hastings ....................................................................Shane Simpson Vancouver-kensington .................................................................Mable e lmore Vancouver-kingsway..........................................................................a drian Dix Vancouver-l angara .................................................................Dr.

Moira Stilwell Vancouver–Mount Pleasant ..........................................Jenny Wai ching kwan Vancouver–Point Grey ...............................................................................Vacant Vancouver-Quilchena ................................................................... c olin h ansen Vancouver–West end ...............................................Spencer c handra h erbert Vernon-Monashee ...............................................................................eric f oster Victoria–b eacon h ill .......................................................................c arole James Victoria–Swan l ake.........................................................................r ob fleming West Vancouver–capilano ............................................................. r alph Sultan West Vancouver–Sea to Sky ........................................................

Joan Mcintyre Westside-kelowna .............................................................................ben Stewart Party Standings: l iberal 48; n ew Democratic 34; independent 2; Vacant 1

CONTENTS t uesday, May 24, 2011 a fternoon Sitting Page Routine Business introductions by Members ..................................................................................................................................................... 7321 t abling Documents ................................................................................................................................................................. 7321 office of the Merit c ommissioner, interim report introduction and first r eading of bills ................................................................................................................................ 7321 bill 14 — c oastal f erry a mendment a ct, 2011 Statements (Standing order 25b) ......................................................................................................................................... 7322 c hild and Y outh in care Week c. t revena Potlatch celebration on haida Gwaii c. h ansen Service fair for low-income families in Victoria c.

Jame s Vic Green and a ctn ow b.c. program D. barnett environmental protection of f raser r iver estuary V . huntington n echako l akes school district J. r ustad oral Questions ......................................................................................................................................................................... 7324 business plan for b.c. c arec ard initiative a. Di x h on. M. de Jong M. f arnworth f unding for programs at c apilano u niversity M. Mungall h on. n. Y amamoto r . flemin g Vancouver floatplane terminal contract S. c handra h erbert h on.

P . bell J. h organ Government action on homelessness and affordable housing S. Simpson h on. r . c oleman Grant's law and protection for workers r . c houhan h on. r . c oleman Orders of the Day c ommittee of Supply .............................................................................................................................................................. 7329 e stimates: Ministry of h ealth M. f arnworth h on. M. de Jong D. Donaldson D. Thorne c. t revena D. black

Proceedings in the Douglas Fir Room c ommittee of Supply .............................................................................................................................................................. 7351 e stimates: Ministry of t ransportation and infrastructure (continued) h. b ains h on. b. l ekstrom M. Sather b. r alston r . flemin g D. Thorne b. Simpson G. Gentner V . huntington

7321 tueSD a Y , MaY 24, 2011 The h ouse met at 1:34 p.m. [Mr. Speaker in the chair.] Routine Business Introductions by Members Hon. P . Bell: [Mandarin was spoken.] Thank you for your tolerance, Mr. Speaker. i think of that as my revenge to the member for burnaby n orth. What i just tried to say was: ladies and gentlemen, i introduce today Vice-Governor Song and 14 people from h ebei province in c hina. We continue to build a strong relationship and increase levels of trade. My c hinese is not very good, so i will say this again in english: would the h ouse please make them feel very, very welcome. [1335] Hon.

I. Chong: i'm delighted to introduce in the precinct 45 students from a school not in my riding but that i have a close connection with. They're from r eynolds Secondary School in Victoria — the member for Saanich South's riding. They're f rench immersion sciences humaines — their f rench immersion class 11. They are here with their teacher Selena Jensen. i know that later today they will be meeting with the Minister of e ducation but are here today to see what we do and also to learn about how the l egislature works in general. i would ask the h ouse to give them a very warm welcome as they visit us here today.

M. Elmore: i'm very pleased to welcome to Victoria and to their tour in the l egislature a number of students from John o liver School in V ancouver-k ensington as well as their teachers or staff members: k laus k lein and l iane l angton, who are staff with the t ake a h ike pro- gram; as well as students Puneet a ujla, isaiah c artier, o tis Graydon, r ueben l obe, Dylan Mct avish, John Phun, Jordan r eid, Jean-l uc St. Jacques and ben c arter. The t ake a h ike program was founded ten years ago. Students combine adventure-based activities with aca - demic and leadership training.

These students have volunteered at community centres; senior centres; the food bank; elementary schools, where they help run sports programs; and the children's festival, as well as a number of outdoor activities: camping, hiking, kayaking and rock climbing. They recently completed the West c oast t rail, and i'm very pleased that they've invited me on their next hik - ing adventure, probably on the n orth Shore. i'm looking forward to that. i ask everyone to please give them a warm welcome. P . Pimm: it's with great pleasure that i rise today to introduce two guests. first, i would like to introduce the hon.

Jay h ill, who served as my MP for 17 years and was h ouse l eader in o ttawa. h e was a great asset to our province and to c anada. Would the h ouse please make him welcome. Secondly, i would like to introduce h anif l adha with ccS Midstream Services. This company is involved with soil remediation in our area and does a great job of look- ing after our environment. Please help me welcome him to our h ouse and his first question period, so everybody be nice today. L.

Krog: Joining us in the gallery today is an old friend of mine from r ichmond, a real political junkie and one of those bright techie guys who works in a world that i don't understand — Dale Jackman. Hon. H. Bloy: i'm proud to join some of the other members in the h ouse. My wife and i became grandpar- ents again late last week, for the second time. i can tell you that my son Jeremy and his wife, Jen, and their first child, our first grandchild, James, are all fine, and they welcome Jackson r obert to the world. Tabling Documents Mr. Speaker: h on.

Members, i have the honour to present an interim report of the office of the Merit c ommissioner. Introduction and First Reading of Bills bill 14 — c oa Stal f err Y aMenDMent a ct, 2011 h on. b. l ekstrom presented a message from h is h onour the a dministrator: a bill intituled c oastal f erry a mendment a ct, 2011. Hon. B. Lekstrom: i would move that the bill be introduced and read a first time now. Motion approved. [1340] Hon. B.

Lekstrom: i'm pleased to introduce bill 14, the c oastal f erry a mendment a ct, 2011. a mendments to the c oastal f erry a ct are needed to provide the b.c . ferries commissioner, as he requested, with the mandate to undertake a review of the act to recommend changes to better balance the interests of ferry users with the finan- cial sustainability of the ferry operator. it's also to provide the b.c . ferries commissioner with the time necessary to conduct the review before issuing the final price-cap

british c olumbia Debates7322 t uesday, May 24, 2011 decision for the next four-year performance term com - mencing april 1, 2012. it will establish an interim price cap of 4.15 percent for all routes for 2012-2013. a s well, it will provide the b.c. ferries commissioner with the financial resources necessary to undertake the review, and it will constrain the ferry operator from discontinuing services or asking for extraordinary fare increases until the commissioner releases a final price-cap decision. i will provide more information as these amendments go to second reading. Mr.

Speaker, i would move that the bill be placed on the orders of the day for second reading at the next sit - ting of the h ouse after today. bill 14, c oastal f erry a mendment a ct, 2011, intro - duced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the h ouse after today. Statements (Standing Order 25B) chil D an D Youth in care Week C. Trevena: This week marks b.c.'s first c hild and Y outh in c are Week. This is a significant statement which should not be treated lightly.

There are more than 8,300 children and youth in b.c. who are in the care of the government. a disproportionate number of them are aboriginal. We have a huge responsibility to ensure that those children and youth are given the best start they can have. More often than not, children and youth who are in care have faced traumatic situations in their lives, situations that many of us as adults simply cannot envisage.

Sadly, looking at statistics, those children who have been in government care face more health risks, have a greater likelihood of substance abuse, are much less likely to graduate from high school and are more likely to at - tempt suicide. We have a duty to both protect and to nurture those children and young people. That means providing stabil- ity. it means guaranteeing education. it means treating children and youth with dignity and respect, not just ensuring that their basic needs are met. it also means ensuring that their rights are respected and that they know what they are.

We should adhere to the un rights of the child, and young people should be made aware of them.

We are lucky in this province to have, after many bat- tles, an excellent r epresentative for c hildren and Y outh — an independent, articulate person who acts as a watch - dog for children and young people in care, a voice for those least heard. e veryone wants to have as normal a life as possible — family care rather than institutional, keeping families together rather than breaking up the natural relation - ships. but it's incumbent on us during this week and all weeks to make sure this is never done simply as a way to reduce costs. in the long run, everyone knows if there's no invest - ment in young people, the later costs — whether through the criminal justice system, the health care system, so - cial services — are immense. c hildren and youth in care are often among our most vulnerable citizens, but they deserve the same start in life that every child and young person wants and deserves. l et's hope that this first c hild and Y outh in c are Week makes a difference for the many thousands who need more than a proclamation.

Potlatch celebration on haiD a GWaii C. Hansen: This past weekend i had the pleasure of attending an event that for more than half of the past 120 years would have been illegal in british c olumbia. it was a potlatch that was held on h aida Gwaii. it was very special occasion for me, as in 2006 at a cere - mony in Skidegate, i was given the h aida name of n ang k 'ang.gudang.as, and in o ctober of 2008 i was adopted into the clan of the Gidins of Skidegate, one of the eagle clans. a t that potlatch the Gidins of Skidegate were celebrat- ing as Sid crosby became their new chief, c hief Wigaanad.

This past weekend c hief Wigaanad became the first chief in many decades to raise a new totem pole. Saturday mor- ning the ropes and pulleys were all in place as hundreds of people showed up to pull on the ropes to raise the pole. The pole has two distinct rings at the top to indicate that c hief Wigaanad was hosting his second potlatch. The potlatch that afternoon and evening lasted nine hours. The clan prepared food to feed a thousand guests. There was an abundance of salmon, halibut, octopus, crab, prawns and many other h aida delicacies, including herring roe on kelp, or k'aaw, as the h aida call it.

There was singing and dancing that showcased the richness of the h aida culture. The masks and button blankets were beyond what anyone could find in any museum today. a t the end of the evening every guest left with gifts of art prints, carvings and blankets. a nd to think that from 1889 to 1951, the potlatch was illegal in c anada. This l egislature, along with the Parliament of c anada, took many unfortunate actions to stamp out the languages and the rich cultures of our first n ations communities.

This past weekend i witnessed a h aida culture that is moving confidently into the future, as young h aida are embracing the traditions and learning the language. i left tremendously proud of my chief, c hief Wigaanad, who demonstrated that he is one of the strong h aida leaders who will lead the h aida n ation into the future. [1345]

british c olumbia Debatest uesday, May 24, 2011 7323 Ser Vice fair for lo W-inco Me faMilieS in Victoria C. James: i'm pleased to talk about an important in - itiative in my community called Project c onnect.

Project c onnect has been held for the last three years and is a popular service fair for people living homeless and in extreme poverty. it's organized by the Greater Victoria c oalition to end h omelessness and offers a long list of much-needed services for hundreds of individuals each time it's held. in 2010 the coalition noted there was a need for a similar event outside the downtown core for families living in poverty.

So in a pril of this year c oalition c onnect for f amilies was held at the Victoria n ative f riendship c entre in partnership with the burnside Gorge c ommunity a ssociation. o ver 250 families representing over 700 individuals attended this very successful event. o ver 30 service pro- viders volunteered their time — everything from haircuts to acupuncture treatments and foot care; c arec ards and birth certificate replacements, a service my office is pleased to assist with; resumes; family portraits; money management; and, of course, entertainment and food for the families.

The generosity of several community sponsors led to the success of c oalition c onnect, a true commun - ity partnership. Donations meant the families received a reusable grocery bag containing much-needed items, including shampoo, toothpaste, toothbrushes, children's books, school supplies and baby wipes. both burnside Gorge and the Victoria n ative f riendship c entre offered staff to help organize the event, and event coordinators Mary Gidney and n icole Jackson worked above and beyond to ensure the day went well.

Special recognition must also be paid to key volunteers Deb n elson and Joy Spencer barry, along with 75 other volunteers. i ask the h ouse to join me in thanking all those in - volved in this extraordinary initiative and to join with me to work towards the day when Project c onnect and c oalition to end h omelessness are a thing of the past because adequate services and supports are in place for everyone in our community. Vic Green anD actno W b.c. P ro GraM D. Barnett: t oday it gives me great pleasure to speak about a constituent of mine, Mr.

Vic Green. a bit of background. in June 2006 the provincial government, under the Ministry of h ealth, initiated a program called a ctn ow, which went on to be recognized by the World h ealth organization as a best-practices model for health promotion. a n opportunity was given to local governments to re- ceive pedometers free, to either give them or sell them to promote active lifestyles. a t that time i was mayor of a small community, and i am proud to say that we ob - tained 2,000 pedometers and sold them for $5 each. Mr. Vic Green, who is a very active senior, a member of b.c.

Power h ydro Pioneers purchased pedometers for himself and his wife, irene. h e has kept track of his total daily kilometres for a year. h is total for twelve months was 1,559.63 kilometres or an average of 4.3 kilometres per day. t oday Vic celebrates his 79th birthday. h e was also a volunteer firefighter for 50 years, and both he and his wife are active square dancers and involved in many other community activities.

Vic says at that the a ctn ow program has helped him, his wife and others become active on a daily basis. t oday he says he is virtually pain- free and mobile. enVironMental Protection of fra Ser ri Ver e Stuar Y V . Huntington: Some 30 years ago continuous habitat losses in the f raser r iver e stuary resulted in the creation of the f raser r iver estuary management plan or freMP .

That plan has, until recently, permitted development to take place more or less in parallel with the need to pro - tect the environmental values of the estuary. but freMP doesn't work the way it used to, and de - velopments in the l ower f raser r iver now threaten our beloved river. We are failing to provide the protection this world-class river so desperately needs and, in par - ticular, failing to protect that

section of the river from h ope to Steveston. o ur f raser r iver still supports the world's largest single- river salmon runs. it is one of two of c anada's largest estuaries of global significance. it is c anada's largest waterfowl overwintering area, and it is a vital recrea - tional and economic driving force in b.c.'s economy. [1350] Despite the brilliance of the f raser ecosystem, we are seeing one of the largest threats to the estuary in the last 30 years — the proposal to ship toxic jet fuel in barges and tankers from international sources into the estuary.

This development is unprecedented in its risk to the fish, wildlife and public safety of the estuary, yet has been expedited with inadequate public input. The applicant even obtained construction permits before the environ - mental assessment is complete. We are also witnessing the mining of gravel bars in the c hilliwack

section of the river. in spite of the studies to the contrary, we are told this reduces flood risk. Those same studies caution that many of the gravel bars are key habitats for salmon, sturgeon and eulachon. We desperately need a l ower f raser r iver environ- mental management plan stretching from Steveston to h ope. We have taken our river for granted for too long, and without conservation leadership, our children will wonder what happened to this world-class legacy.

british c olumbia Debates7324 t uesday, May 24, 2011 nechako lake S School DiStrict J. Rustad: Y ou can find innovation in school districts around the province, but i would like to take a moment to boast about school district 91 in n echako l akes. They have been front-runners in many activities, often setting a template for other districts to follow. l ast week i had the pleasure of joining 35 students from across the district in one such endeavour. Project h eavy Duty celebrated their 25th year in operation, ex - posing students to a world of heavy equipment operation and the many careers available.

Students experience skidders, loaders, feller bunchers, gravel trucks, excav - ators, backhoes, graders, earth-moving machinery and bobcats. a mong other things, they travelled to endako Mines to learn about mining and spent some time at l&M l umber to see what's involved in the sawmilling business.

Project h eavy Duty would not be possible without the terrific support from local businesses and individuals, such as: Yrb Vanderhoof; h enry k lassen Sawmills; bid c onstruction; the b.c. a mbulance Service; Vanderhoof c o-op; endako Mines; k & D c ontracting; h arry o c ontracting; Vanderhoof fire department; a mbroy c onstruction; Gordie Peters l ogging; Gulbranson l ogging; f raser l ake Sawmills; Pitka l ogging; and of course, the maintenance department at school dis - trict 91. i would like to thank all the volunteers who've made Project h eavy Duty possible, especially Darren c arpenter.

There is a significant need for students to choose ca - reers that are fulfilling but also that meet our economic needs. School district 91 is working with industry and communities to meet those challenges. Their leader - ship in P hD, e-bus and project agriculture, which is celebrating its 20th year this year, is phenomenal. n ow school district 91 is taking on a new role, engaging in c hina to build an international school and to attract for- eign students to attend schools here in b.c.

Please join me in congratulating school district 91 in all of their endeavours and in thanking the staff, volun - teers and businesses that are making such a difference for our students. Oral Questions buS ineSS P lan for b.c. carecarD initiatiVe A. Dix: a s much as i'd like to ask questions about the formerly revenue-neutral hS t , today it appears i'm go - ing to be asking questions of the Minister of h ealth. Just a really simple one to start with for the minister. c an he table with the h ouse his business plan for the introduc - tion of the new c arec ard plan? Hon.

M. de Jong: t o the hon. opposition leader, i presume his interest in the matter is tied in part to the fact that he, as i do, finds it unsatisfactory that there are over nine million c arec ards floating around british c olumbia for a population in excess of four million people. The government has decided to take steps to try and address that. During the course of this discussion, the estimates that will follow and the bill that is before the h ouse, which gives rise to that transition, will give us ample opportunity to discuss the matter in detail. Mr. Speaker: l eader of the o pposition has a supplemental. A.

Dix: i guess the better question would be: is there a business plan? because the minister said earlier today, based on anecdotal evidence, he thought the amount of fraud in question was between $50 million and $100 million. h e got the margin of error down to 100 percent. h e got it down to 100 percent. The ministry has identi - fied last year $936,000 worth of c arec ard fraud. [1355] The ministry suggested… interjections. Mr. Speaker: Members. A. Dix: …to the public yesterday that they thought they could save $10 million a year on $150 million worth of expenditure.

So i guess the question to the minister is very simple. is there a business plan, given the completely contra - dictory information his ministry has put out about this plan over the last three days? Hon. M. de Jong: Well, i can begin by assuring the member that any document i table will have an accur - ate date on it. interjections. Mr. Speaker: Members. c ontinue, Minister. Hon.

M. de Jong: The c anadian h ealth c are a nti- fraud a ssociation is an agency that is dedicated to examining matters such as this. it estimates that british c olumbians lose upwards of $300 million plus to health care fraud every year. n ow, maybe they're wrong. Maybe it's $200 million.

Maybe it's $100 million. f raud, by its very nature, is a difficult matter to quan- tify, but we believe that by taking steps to update and upgrade the c arec ard in a manner in which many other provinces already have and add an enhanced security feature that is actually good for patients' safety, that that is the right thing to do.

british c olumbia Debatest uesday, May 24, 2011 7325 We've indicated what the cost of that is. We think it is a good investment on behalf of the taxpayers to support publicly funded health care. Mr. Speaker: The l eader of the o pposition has a fur- ther supplemental. A. Dix: The minister is saying that the ministry has found $936,000 worth of fraud and that he believes, ac - cording to the report, that there's close to $300 million worth of fraud. So that is, shall we say, a giant gap.

What we would like to know is — since this apparently has been going on year after year after year — where is the business plan, and where is the evidence? isn't it rea- sonable that the Minister of h ealth today table in this h ouse and table with the people of british c olumbia, in advance of spending $150 million, what the business plan is for this initiative? Hon. M. de Jong: Part of the reason we are con - fronted by the situation that presently exists relates to a decision that was made, i will assume in good faith, in the mid-1990s. interjections. Mr. Speaker: Members. c ontinue, Minister. Hon.

M. de Jong: i would have thought that some of the members, at least, would like to reminisce about those halcyon days. The decision was made at that time to eliminate the expiry date on c arec ards. n ow, as i say, i presume and accept that the decision was made in good faith. in fact, what we are now confronted with is a proliferation of c arec ards in british c olumbia, which we believe en - hances the possibility of fraudulent access to our publicly funded health care system.

Just as the h ealth critic, who i expect we're going to hear from in just a moment, said a few days ago: "i think a system that's much more focused on ensuring that people have a card, and that it's the right card…. We do it with drivers' licences. We do it with credit cards." That is the underlying principle behind precisely what the government is doing, and i would hope the mem - bers would accept that. [1400] M. Farnworth: f orgive us on this side for being a little skeptical, but when it comes to numbers, this gov - ernment's record is not quite up to par, not quite up to scratch.

Thursday the minister announced the program. h e said $10 million. t wo hours later it was changed to: "Well, there's an additional $28 million for the next five years." That's $150 million. Y et by the ministry's own figures, $936,000 in fraud last year. The minister has stood up here in the h ouse today and said that it could be upwards of $300 million. Y et the number that they used over the weekend was $240 million. The numbers around this initiative keep changing faster than the Premier has got positions on the hS t .

The public has a right to know, on an initiative like this — everyone supports cracking down on fraud — that the government has done its homework; that they've put together a business case; that they've looked over the last five years, for example, at what type of fraud is taking place and how much fraud is taking place so that when they make an investment of $150 million, we know exactly what it's for and where it's going. The question is really simple. Did the government do a business plan?

Did the government do any reports on the amount of fraud taking place? a nd if so, will the minister table them here in the h ouse? Hon. M. de Jong: Presumably the member agrees with the proposition that having twice as many c arec ards floating around the province as there are citizens is an unsatisfactory situation. Presumably he also agrees with the proposition that fraud, by its very nature, is difficult to definitively quantify. in fact, the analysis, as best we can, has been conducted. The analysis around costs.

There is a cost. it is a sig - nificant cost to move from an antiquated c arec ard to one that contains a picture, to one that contains a smart chip that will allow for better procedures in emergency rooms, that will provide for more ready access to patients' health care records. a ll of that does come at a cost. it is in the neighbourhood of $20 to $30 per card, and that cost will be borne over the next five years as drivers' licences come up for renewal and people have the op - tion of combining two cards into one. Mr. Speaker: The member has a supplemental. M.

Farnworth: The minister may have trouble quan - tifying fraud, but i can tell him this. The public have no trouble quantifying the fraud around the hS t that was perpetrated on them before the last election. What it comes down to is that the minister made an announce - ment on Thursday about $10 million and c arec ards, and since that announcement we have seen number after number, figure after figure. it has changed more than bids and figures around the b.c. Place roof. So the question the public has is: on what basis did you make the decision?

Was it on the basis of studies done by the ministry on the nature of fraud, on the types of fraud? Was it just pulled out of a hat? The public de - serves the right to know. a gain, was there a business plan done? if not, just say so. if there was, table it in the h ouse. finally, finally, table any studies that you've got on fraud. Were they done?

british c olumbia Debates7326 t uesday, May 24, 2011 Hon. M. de Jong: i think the last time the member and i were discussing fraud, it was originating out of n anaimo. but that was another time, another place. [1405] interjections. Mr. Speaker: Minister, just take your seat. interjections. Mr. Speaker: Members. c ontinue, Minister. Hon.

M. de Jong: i can assure the member, this h ouse and british c olumbians that i, the government and the ministry, having examined all of the available evidence, are firmly of the belief that by taking this step and by making this investment on behalf of british c olumbians, the savings in eliminated fraudulent activity will more than offset the investment that we are making on behalf of british c olumbians — period. That's why we've made the decision to proceed. funD in G for Pro GraMS at caP ilano uniVerS it Y M.

Mungall: This evening c apilano u niversity is con- templating a major cut to programs, and 1,100 seats are at risk. f our hundred of them are in adult basic edu - cation, a program that provides learners with the basic skills to go on to university, trades and job training. c apilano u niversity president k ris bulcroft said that the program cuts are necessary because provincial funding hasn't kept pace with rising costs of providing an educa- tion to adults. c an the minister commit today to increasing the cur- rent levels of funding in order to ensure that each one of these students has access to fundamental education pro- grams like adult basic education?

Hon. N. Y amamoto: a s the former board chair of c apilano, i'm actually delighted to have the opportunity to speak about c ap and what this government has done to post-secondary education in the last decade. Since 2001 this government has invested almost $21.8 billion in post-secondary education. We've also invested almost $2 billion in student financial aid. Despite the global economic uncertainty, this government has pro - tected core funding for post-secondary education. c apilano has been and continues to be a provincial leader in innovative student-centred programming.

This government and c apilano u niversity will continue to partner in providing high-quality post-secondary education at c apilano u niversity. Mr. Speaker: The member has a supplemental. M. Mungall: it seems that the minister is still stuck on page 1 of the briefing note. l ast week in estimates the minister said she knew of no adult basic education program being cut. t wo days later she's defending those exact cuts in the news.

She even went on to say about the funding: "We actually haven't seen the cuts." Well, the minister might as well be running with scissors, because shortfalls and failure to keep up are certainly effective ways that the b.c. l iberals are making cuts and costing schools, students and families more. h ow can the minister be so off the mark when it comes to the situation at c apilano u niversity? She even noted that she was on the board there. Will she commit today to protect the 400 adult basic education seats at c apilano u niversity? Hon. N.

Y amamoto: i'm pleased to say that b.c.'s post-secondary institutions continue to benefit from the largest investment in post-secondary education in this decade. Since 2001 this government has overseen the creation of over 33,000 seats in post-secondary edu - cation in b.c. [1410] t o the member opposite: i'd be happy any day to compare this government's record on post-secondary education against yours. R. Fleming: e verybody knows that the number one barrier to getting into the job market in british c olumbia is getting a high school diploma, and without one, 85 percent of any job openings are already closed.

So how can this minister…? h ow can she oversee the elimina - tion of 400 adult education seats in her own back yard in n orth Vancouver and deny that there are cuts going on in the ministry? The question for the minister is: what does this cut do for raising adult literacy? What does it do for tackling chronic poverty in british c olumbia? h ow is it good for families wanting an opportunity for a better life in her riding and in the province of british c olumbia? Hon. N.

Y amamoto: The member opposite is simply wrong. a s i've said, this government has continued to protect core funding for post-secondary education in b.c. c apilano u niversity, like other post-secondary insti - tutions, makes its own decisions. They're autonomous. They make their own decisions regarding staffing, pro - gramming and administration. i'm confident that the budget decisions that c apilano u niversity adminis - tration has made will ensure that c apilano u niversity students will get a high-quality post-secondary educa - tion in b.c. Mr. Speaker: The member has a supplemental.

british c olumbia Debatest uesday, May 24, 2011 7327 R. Fleming: The minister is quite wrong. The province of british c olumbia is the principal funder of c apilano u niversity and other institutions in british c olumbia. h ere's what the c apilano board of governors is dis - cussing tonight. They are discussing a seat reduction of 1,100 seats at the institution — for students with disabil - ities, for students seeking to get a high school diploma so they can go on to earn a trade or to pursue advanced education at another stage at that institution or another one.

That's what the president of c apilano u niversity says. So who's right? Who's wrong? is it the minister, or the president of c apilano u niversity, who says that it's fund- ing cuts that are causing an 1,100-seat reduction in the institution in her riding? Will she stand up today in the h ouse and stand up for adult literacy and students in british c olumbia and in n orth Vancouver? Hon. N.

Y amamoto: The member opposite is wrong. c apilano u niversity will still be offering the abe, the adult basic education, programs at all their campuses, and they will be fulfilling a hundred percent of their commitment to the government to provide adult basic education on their campuses. Vancou Ver float Plane terMinal contract S.

Chandra Herbert: My question is a simple one. it's reported that the b.c. l iberals are giving nearly $4 million of british c olumbians' money to the private for- profit Vancouver h arbour flight c entre to subsidize an airport which will start gouging the public with the highest fees in all of b.c. when it opens tomorrow. This shakedown will hurt tourism businesses on the Gulf islands, n anaimo, Victoria, c omox, Sunshine c oast, to name just a few. Will the minister tell this h ouse how many millions of dollars the b.c. l iberals are giving away? Hon. P .

Bell: This issue was canvassed thoroughly in estimates and again in question period two weeks ago. i assure the member opposite that i'm not going to reveal any of the details on this until the negotiation is com - plete. in fact, there are meetings going on today between all of the parties, and we're still optimistic that we'll find a positive outcome. Mr. Speaker: The member has a supplemental. S. Chandra Herbert: So i get this. The b.c. l iberals are negotiating how many millions of our dollars they're giving away for a botched P3 project which is gou - ging the public — the worst rates in all of b.c.

This is astounding. [1415] n ow, we understand that b.c. l iberals often say there's no money for education, no money for health care, but a private floatplane operator service company calls up and says, "We need subsidies here for your botched project," and they get them. This is outrageous. When will the b.c. l iberals call a halt to this ri - diculous giveaway that they're trying to do to fix their botched project? Will the minister do this today? Hon. P . Bell: The floatplane industry is an import - ant industry in british c olumbia for the tourism sector.

There is in the order of 350,000 passengers per year that are carried between Vancouver and Victoria and other centres around the province. c ertainly, in speaking to the tourism industry, i know how important it is. We are looking to find a collaborative solution to this, and i'm not going to discuss the terms of that until we complete that in this h ouse. J.

Horgan: Y ou'll forgive me if when i hear that the b.c. l iberals are working for a positive outcome that i'm not convinced the taxpayers are the end result of that. i want to ask the minister a simple question, following on my colleague from Vancouver–West end. if h arbour a ir, which carries 85 percent of the traffic in and out of the harbour, is not participating in this negotiation, then how can we possibly get an outcome that's positive for everyone? Hon. P . Bell: The member opposite is obviously not reading his media clips. if he was, he'd know that h arbour a ir is part of the negotiation. Mr.

Speaker: The member has a supplemental. J. Horgan: i was just there the other day signing the petition to see if i could do something to get some sense into this minister's head. When he talks about a posi - tive outcome, perhaps they could have used some of that massive cost overrun at the convention centre to subsid- ize this profitable organization that's at the front of the line. i want to know if the minister can quantify just how much Pavc o is authorized to give away of taxpay - ers' money to get a deal with a positive outcome for everyone? Hon. P .

Bell: This issue, as i said previously, has been canvassed extensively in the estimates process, in ques - tion period two weeks ago, and again today. i've been very clear with my answer. u ntil we complete the ne - gotiation between the various parties, i'm not going to disclose the level of those negotiations. That would not be appropriate to do. We do care about the tourism industry. We know it's a key contributor to the overall provincial economy, and

british c olumbia Debates7328 t uesday, May 24, 2011 i would think that the member opposite would respect that and make sure that we get a positive outcome for everyone in british c olumbia. Go VernMent action on ho MeleSS neSS an D affor Dable hou Sin G S. Simpson: We saw the homelessness count that came out in Metro Vancouver today, and we saw some progress around sheltered homelessness in the province.

What we know is that that has largely been due to the Vancouver heat shelter strategy, and it has been a good strategy. h owever, the other thing that's been dismaying in this report is that it shows that there really has been no progress on the larger question of homelessness since 2008. The numbers are essentially the same. h on. Speaker, the problem here, though, and it's laid out in the report to some degree, is what may be right over the horizon. My question is to the h ousing Minister. Mr.

Wayne Wright, who is the chair of the Metro V ancouver housing committee and the mayor of n ew Westminster, is quoted as saying in the report: "The lack of affordable rental housing in the region is putting low-to-moderate-income young people, families and seniors at risk of homelessness. a ddressing this needs to be a priority for all levels of gov- ernment as well." This government has done little when it comes to fam- ilies, seniors and youth. c an the minister tell us when he's going to introduce programs for families and sen - iors and youth? Hon. R.

Coleman: Well, this is the same member opposite who three years ago, along with his former colleague from Vancouver-kensington, i think was the riding…. They were claiming there were 15,000 home - less people in the city of Vancouver. [1420] t oday we have done a homeless count, and the hous - ing…. it shows us that homelessness is down in british c olumbia, a trend that has not been achieved anywhere else in n orth a merica, hon. Member.

Y ou know, i thought for once the member opposite would actually stand up and say that the fact that street homelessness in the city of Vancouver has dropped by 82 percent is a good thing, and actually compliment the government. i thought he might want to reflect on the 6,000 people who were previously homeless in 2008 but who have been connected to housing and support in the last three years in british c olumbia and changed their lives. i thought he might want to reflect on that. a nd he doesn't have to ask me, hon. Member. Mr. Speaker: Thank you, Minister. Hon. R. Coleman: o h.

That's okay. i've got more. interjections. Mr. Speaker: Members. Members. Grant'S la W anD Protection for WorkerS R. Chouhan: i want to ask a question to the Minister of l abour. i can't find her or see her there. i hope she'll be back soon. Mr. Speaker: Member. interjections. Mr. Speaker: Members. Member, just take your seat for a second. by the rules of the h ouse you do not indicate whether a minister or a member is in or out of the h ouse, please. c ontinue, Member. R. Chouhan: Sorry about that, Mr. Speaker.

Since its proclamation in 2005 Grant's law has pro - vided necessary protection for gas station workers requiring two workers on site on night shifts. Despite strong opposition from workers and the labour com - munity, the Minister of l abour is choosing to review the current regulation and considering exemptions that would water down the existing regulations. My question is to the Minister of l abour. Will the minister commit today to protecting vulnerable work - ers by scrapping the review and ensuring enforcement of the law in order to save lives? Hon. R. Coleman: h on.

Speaker, i will take the ques - tion on notice for the minister, but i would be happy to expound on the great achievements of h ousing in the province of british c olumbia, if you'd asked me a question. Mr. Speaker: The member has a supplemental. R. Chouhan: My question is to the Solicitor General now. Despite the government's so-called families-first agenda, the b.c. l iberals refuse to listen to public opin - ion. The workers' safety should be paramount for any government.

We need to take real, concrete steps to ensure that these workers are protected and that the cur- rent regulations are enforced. t o the Solicitor General: will there be any action taken by the government to protect the workers' lives? We have seen in the past that Grant's law has worked to protect those workers. Will there be any action taken in the near future to scrap the review of these regulations?

british c olumbia Debatest uesday, May 24, 2011 7329 Hon. R. Coleman: i've already taken it on notice for the minister responsible, and i'll do it again. [end of question period.] Orders of the Day Hon. R. Coleman: This afternoon, we'll be discussing or actually telling people the rest of the stats on housing in the province…. n o, i'm kidding, Mr. Speaker, but we would be happy to. [1425] in this h ouse this afternoon we'll begin the estimates of the Ministry of h ealth, and in c ommittee a we'll be doing the estimates of the Ministry of t ransportation and infrastructure, continued.

Committee of Supply e Sti Mate S: Mini Str Y of health The h ouse in c ommittee of Supply (Section b); l. r eid in the chair. The committee met at 2:30 p.m. on Vote 32: ministry operations, $15,566,169,000. M. Farnworth: i'd like to start off by….

We can't seem to get away from each other in this place. f or the last few years it was as Solicitor General, and now it's for the Ministry of h ealth. i know that the minister is basically still new in the portfolio, as am i in the critic area that i'm in. i can commit to him that i will not be raising questions as to how we both ended up in these respect - ive positions. Suffice it to say that for the next few days we will be discussing Ministry of h ealth estimates.

My office has, i think, communicated with him about some of how it should unfold. t omorrow we'll be dealing with seniors issues, by and large, most of the day, and then Thursday morning, public health issues. t oday, just to give an outline of some of the topics that i would like to try and get through — and i know that we're not going to be able to get to everything be - cause we are somewhat constrained for time — i want to talk a bit about the minister's office; the business plan; the health accord; long-term funding; patient-focused funding; c arec ard; skills and shortages — doctors, nurses, the health professions. a lso, probably we'll fin - ish on facilities — Surrey Memorial, r oyal c olumbian, the major hospitals. if we can cover that today, i think that will be great.

This afternoon i think there'll also be an opportunity, on a lot of those sort of regional facility questions, for my colleagues to get into asking some questions. So if that's fine with the minister, if other staff are re - quired…? We can begin. Hon. M. de Jong: t o the hon. member, the critic: i, too, anticipated the possibility of facing off with him in this chamber, perhaps under different circumstances. but here we are in these circumstances. i would like, however, to simply do this: introduce the officials that are here at the moment with us.

Graham Whitmarsh is the deputy minister; Michael MacDougall, chief operating officer; Manjit Sidhu, aDM, financial and corporate services division; and John bethel is the chief administrative officer. The program that the hon. member has laid out for discussions is one that makes sense for me. if we come to an area where we feel it is helpful for the discussion to draw on the expertise of another official, i am reli - ably advised that there is a veritable armada waiting in another room, and we can draw on that expertise as it is required. i'm looking forward to the discussion today and tomorrow. M.

Farnworth: i'd like to begin my opening question with, i mean, the obvious, which is that health care is the largest component of government spending in the province of british c olumbia. indeed, it is in any prov - ince. The rate of growth in the health care budget has been significant every year for the last 30 years, and it's projected to continue that way. i was interested that during the leadership campaign there were some questions, comments, from the current Premier, about tying the health care budget to the rate of economic growth.

So my question to the minister is: is that a practical and doable suggestion by the Premier — to tie health care spending to the rate of economic growth? [1435] Hon.

M. de Jong: The member fairly, i think, points out the challenge that we face. i say "we" as a society. h e has first-person experience with this as a former h ealth Minister: the, some would say, exponential growth in health care spending which tracks the demographic evolution of our society. h owever, the need to try and constrain the rate of that growth is very real. t o acknowledge that addressing the health care needs of british c olumbians isn't merely a function of moving on the wishes that we all have as car- ing members of this l egislature and society generally…. There must be a matching ability to pay.

The notion that our ability to spend is tied to govern - ment revenue — which, in and of itself, is tied to growth in the economy — is perhaps an imperfect concept but not one without merit. So our ability to pay is tied ultim- ately to the revenues that government collects, and that is tied to growth in the economy.

british c olumbia Debates7330 t uesday, May 24, 2011 The member will, i'm sure, agree that the pressure that is being placed on government operations generally be - cause of the growth in health care spending is very real and something that has presented challenges, obviously, to this government over the last decade and to govern - ments before this one over the last 30 or 40 years. M. Farnworth: The minister's point, i think, is well taken. Government is responsible for paying.

There is an ability-to-pay aspect to the delivery of health care in the province, but it is also the service that most british c olumbians rely on most and expect to be there when they need it.

When the Premier of the province says, "l et's tie health care spending to the rate of growth," that has some significant implications on the delivery of health care in b.c. i think, if you look at the latest figures, that would have resulted in about a $518 million cut to the delivery of programs in british c olumbia if the govern- ment were to adopt a position of tying health care to the rate of growth in the province. c an the minister tell us: has the Premier been briefed on the impact of that type of approach to health care spending in the province? The Chair: h on.

Members, if i might take this oppor- tunity to welcome 35 students visiting us today. f emida Jagani is the teacher. it's the az-Zahraa islamic a cademy in the riding of r ichmond e ast. i'd ask the h ouse to please make them very welcome. Hon.

M. de Jong: There are a couple of ways, i think, to try to fairly address the point that the hon. member has made. first of all, i'm reminded that there is a differ- ence if you benchmark against real GDP versus nominal GDP . it will take keener economic minds than mine to lay out accurately and in detail all of the differences, but i am advised that when you talk about nominal GDP , it actually tracks fairly closely. i think a couple of things have happened, though.

The experience of September 2008-2009 and what it did fis - cally and economically — not just to the province; the country, n orth a merica and the world — was clearly abnormal. [1440] So part of the role one could argue for government when confronted by that sort of calamitous change in economies, in economic performance, is to smooth out some of those radical changes, and that is a valid argument. but it is equally valid — and my point — for governments to strive, through three-year economic planning and forecasts, to try and draw some param - eters around the growth that is taking place. one of the things that i have learned over the last number of years — generally, as someone sitting at a cabinet table in a department of government that has been adversely impacted by the growth in health care spending — is if you go on the street and stop ten people, probably eight or nine of them would very fairly, very honestly, tell you that in their view, health care spending has been cut in b.c. — and say that at a time where over the last ten years it has almost doubled from $9 billion to closing in on $18 billion.

There's a reason for that. People don't make that up to be purposely dishonest. it's a perception they have, but it's also a reflection on the fact that those costs continue to grow at an alarming rate. it is, in my view, legitimate for government — gov - ernments across the country, for that matter — to speak about the need to constrain in some reasonable manner the rate of that growth and to draw some parameters around it, or the impact that growth in spending and health care is having on other public services is going to continue and to amplify. M.

Farnworth: i appreciate the minister's answer, and i understand exactly what he's saying. h ealth care spending is growing exponentially, faster than the rate of growth that's taking place, but overall, as a percentage of our GDP , it's remained fairly constant. i think one of the questions, though, if you ask the public is: are we getting the best bang for the dollar? a re we being innovative in terms of how we spend our health care dollars? i think some of those questions we'll be dealing with later.

The issue that i think people want to have some confidence in is that the head of government truly understands the role and nature of health care spending in the province today, how people value it. The fact that there are….

Y ou know, a simplistic idea of saying, "l et's just tie it to the rate of growth," has some very import - ant consequences. i think one of the things that we will certainly look for and i think the public is certainly looking for is that the Minister of h ealth, in his role as Minister of h ealth, is making the Premier acutely aware of the impact of state- ments such as that and of decisions that may go down that path will have on the delivery of health care services in the province. t o that end, i'd like to ask the minister…. a gain, dur- ing the campaign the Premier indicated that she wanted to create a subcommittee on health care spending to look at spending. h as that taken place? is the minister aware if there are plans to put in place that subcommit - tee that the Premier talked about during her leadership campaign?

Hon. M. de Jong: The hon. member correctly points out that several months ago the now Premier spoke, as part of this discussion, about her interest in looking at the possibility of establishing a committee to examine overall health spending, trends in health spending. The

british c olumbia Debatest uesday, May 24, 2011 7331 member or his colleague will be able to put this question to her directly next week, but again, i think, it's a reflec - tion of the ongoing concern around accelerating growth in health care spending. [1445] The specific question is whether such a committee presently exists. it does not. There are discussions taking place about the possible composition and mandate, but i think the member's specific question was whether that committee presently exists and is meeting. it does not. i hasten to add the obvious.

The Premier is set to take her seat in this chamber on Monday of next week, i be - lieve, and has obviously had a full plate these past six or seven weeks. M.

Farnworth: i, too, look forward to the Premier taking her place in this chamber and being able to an - swer, or not answer, questions both in question period and in other parts of our legislative program. in the service plan…. i mean, when we're talking about health care, we're not just talking about delivery of service; we are talking about the dollars and cents that go to it and the fact that there are considerable cost pressures on our health care system that aren't going away anytime soon. The government has made a great deal about the challenges posed by cost increases in our health care system.

So can the minister provide an over- view of what areas are seeing the highest rates of cost inflation? The 2011-2012 service plan says that we must use in - novation to make strategic changes to keep costs under control. c an the minister tell us what specific initiatives are being undertaken to control costs? Hon.

M. de Jong: Member, apologies for the delay. i'm going to do this in two parts. i think the mem - ber asked, first: what are the cost drivers, essentially; and then: what is government doing in response? if i can, let's deal in general terms with cost drivers and perhaps explore that a little bit and then get to some of the initia- tives that are being pursued in response to that. first, the obvious is our demographic changes, and the member will be alive to this, i suppose, as we all are. We are an older population. We are living to be older.

The member knows all about the data that relates to our usage of the health care system as we get older — today's 60 was yesterday's 50, and all of those terminologies. So demographically those changes are driving costs. [1450] u tilization, i'm reminded, doesn't just relate to the fact that people are older and, therefore going to the doctor more. We are using medical services more as 30- and 40-year-olds than was previously the case. So we are more apt to access health care providers and health care services than was previously the case. Drug costs, of course, continue to escalate.

We have seen some examples of that recently and some examples relating to rare disease and rare drug treatments that cost $300,000, $400,000 or even half a million dollars a year. Those are exceptions, but it doesn't take many ex - ceptions along those lines to represent significant cost drivers. The fourth thing that i'll mention is inflation. one can argue that generally speaking, general rates of inflation have been trending to the lower side. but as again i'm reminded, on a budget the size of health care, even 2 percent represents a significant cost.

Within health care delivery itself — whether we're talking about technology, equipment or professionals — in some cases those inflationary costs have increased by far more than 2 percent per annum. So there is a built-in inflationary component that is, i'm advised, unique to health care services and, in some cases, health-related equipment and technology that is also a factor. There are four areas. i know that the member may want to ask about any one of those or may want me to move on to some of the things that government is doing in response. M.

Farnworth: There are a couple of areas where i will ask some particular questions around those general areas the minister has outlined. but i think it's probably best that i let him go through the specific initiatives that they're undertaking with regard to them, and i'll see whether they cover off the questions i have or whether i have additional questions related to them. Hon. M. de Jong: in response to the four areas of pres- sure that i mentioned, the h ealth Ministry, i think, has done a reasonably good job over the last year or couple of years trying to establish the basis upon which to re - spond to that.

This is, by definition, fairly general, and we'll drill down from there. f our pillars against which we try to measure our re - sponse and our actions. firstly, and i would say arguably most important, health promotion and effective health promotion. Prevention and self-management. This may be unnecessarily apocalyptic on my part, but i would say this based on what i have seen at least as a participant in this chamber over close to 18 years and a member of cabinet for a decade. if we continue to simply try to fund disease management, we are not going to be able to do it.

We're going to eviscerate other departments of gov - ernment and then run out of money. it just won't be possible, given the aging demographic. So prevention, health promotion…. it is challenging, because it is ob - viously a longer-term solution, and the challenge is diverting scarce resources today from other areas. [1455] When we talk about spending $20 million plus on funding a program to help people quit smoking…. n ow, i think you can make an argument. We have the lowest

british c olumbia Debates7332 t uesday, May 24, 2011 incidence of smoking in the country, at 15 percent. if you could take that number down to 12, i think you'd, arguably, save billions of dollars in terms of health care costs down the road. The challenge is finding the $20 million or $25 million today, which needs to come from somewhere. That's a prevention strategy today, a prescription for health — aligning patients and families with their doc - tors so that they can help. There's an incentive to build a health care prevention plan. So that's one — effective health promotion and prevention.

Quality primary and community-based care is the second of the four pillars. The highest-quality hospital care is the third, and improved innovation and effi - ciency, generally, within the delivery of health care in b.c. Those would be the four general pillars, principles, against which actions are measured and considered be - fore proceeding. M. Farnworth: The member raises a couple of inter - esting topics. i just want to touch on the one in terms of spending the money on the smoking cessation. i agree.

The costs you save over the long term are significant. o ne of the challenges that we face, of course, is…. it's like anything. There is also an incremental cost. often it's very easy to spend an initial sum of money to get people to change their habit, and you'll make significant progress on a broad base of people who will change in response to efforts by government to get them to change. but then you also come to trying to get from 20 per - cent down to 10.

That 10 percent is much harder and requires incrementally a greater amount of money being spent in order to achieve that. it may well be worthwhile, and spending that money is no doubt a good thing to do, but it's a lot more effort than it was to get the original 30 or 40 percent to change their habit. So when the ministry does programs like that, do they take into account any analysis of the incremental difficulty in reaching that goal when they make the de - cision to spend the money in those particular areas? i'll use the smoking one as an example.

Were there studies done saying: "o kay, if we took that $20 million, we can get it down, and we've got some empirical evidence to back that up"? Hon. M. de Jong: i'll begin by acknowledging and agreeing with what i think was the underlying prop - osition, which is, as i understand it, that as you move from the 30 percent to the 20 percent to the 10 percent, it gets tougher.

There's probably a hard-core group of smokers out there that you're not going to change. f or whatever reason, they have come to the conclusion that they either don't have to or don't want to, or they are im- mune, or they don't care. [1500] i guess the philosophical question that flows from that, if you get to that point, is to what extent the rest of society should contribute to the cost associated with that choice. but that's probably another conversation that we can have. it's an interesting one, because as you work your way down….

We're still at the point, though, where we believe that by removing, dare i say, some of the impediments — or i could say even excuses — that people might utilize to explain their refusal or inability to quit…. The funding announcement of several weeks ago was designed to address some of those impediments. There are some people who may have trouble fiscally, may not have the money to purchase some of the services that are available to help quit. We think this is a good invest- ment. i have to say this: we have not set a target.

We have not said: "a s a result of this, by 2014 we expect the rate of smoking to be 14 percent or 13 percent." We had actually just this morning in Vancouver a family who accessed Quitn ow at the time when the mother was pregnant, before the funding announce - ment. it's a very compelling story. They decided that they were going to avail themselves of the program and have had their last cigarette together, the mother and the father, and are now raising, i think, three children. So we think the investment is worth it. i understand the member's point.

There is a tempta - tion to say: "Well, surely set a target." i think this might be one of those examples where we believe the invest - ment is sound, and if we can reduce by it 1, 2 or 3 percent, the investment is worthwhile. M. Farnworth: i accept the minister's comments on this. i guess the point i'm trying to make is that…. Given the statements that have been made about lim- ited health care resources and making sure we get the maximum benefit for our dollar, one of the things i want to make sure the ministry is doing is some really good, solid analysis on programs before they're unveiled.

That’s so people know — is it new money, is it money that's been reallocated from somewhere else, or is there a sense of goals that are achievable? — that given com - peting choices, we're actually going with the best choices that will make the longest difference to our health care system and to the health of the population over a long time. t alking about smoking…. i think that has to continue to be a priority in terms of reducing the incidence of the rate of smoking in the province of british c olumbia. but when you look at that and you compare it to, for example, childhood obesity and unhealthy eating habits…. if you've got a pot of money that can go to changing the habits of a population, what i'm wonder - ing is, does the ministry do studies that say: "Y ou know what?

We actually can get a bigger bang for our dollar in this area that's going to have a significant impact on our

british c olumbia Debatest uesday, May 24, 2011 7333 health care system down the road, dealing with a prob - lem that we all know is far more prevalent today than it was 20, 25 years ago"? So when these types of decisions are made, is the an - alysis taking place in a comparative look at how that money could be spent in terms of trying to achieve long- term health care goals? [1505] Hon. M. de Jong: Well, a couple of things come to mind. The member, and i think quite properly, raised the issue of obesity. i'll say this as a general statement. h ere's what my sense is.

The single most important thing we can do to improve health outcomes rests in education. The better educated someone is, the better educated a family is, the better equipped they are to make sound decisions. So the linkage between education and health outcomes is, i think, a very strong one and one that has been established empirically. o besity.

Y ou look at the fact that…. i think the latest study i saw showed that somewhere between 45 percent and 50 percent of british c olumbians qualify as being overweight or obese. l ook, i teeter on the brink, so i'm hesitant about preaching. o ur lifestyle has changed. i live in a bbotsford. The closest thing we have to a rush hour within town is at three o'clock when school is out. n o one walks home anymore. That's got to have an impact. The modes of entertainment that young kids are drawn to now are as likely to involve the computer screen as they are a baseball diamond or a soccer field.

So the role for parents, for caregivers to ensure that children have access to that physical activity is more important now than ever. i'm told, through some of the analyses and stud - ies that i have been given, that the ministry has been undertaking that, along with obesity, sodium intake is a huge problem. it's not the stuff you shake on your steak — although i suppose that amplifies the problem. it's the built-in sodium content in manufactured foods. We talk about sugar and how it contributes to obesity, bad teeth and dental hygiene.

Salt has…. in terms of hypertension, heart disease, the linkage is as direct. So one of the things the member will see in the weeks and months ahead is a concerted effort on the part of the ministry — and i think it's valid to talk a little bit about this because we will be utilizing some resources — to provide information to people about the impact of sodium and salt in their diets and smart decisions that they can make in choosing the correct kind of foods and manufactured foods. c heck the sodium content on the back of the box.

These are all things driven by studies and driven by the data that has been collected. c hanging the behaviour is what represents the biggest challenge — the combin - ation of encouraging people, providing them with the information they need to make wise choices — and not always resorting to the heavy hand of the state to compel behaviour but assisting people in making smart deci - sions on their own. Those are all part and parcel of the health promotion and prevention agenda that the min - istry is endeavouring to set for itself. M.

Farnworth: The issue of health promotion is an important one, and making changes in lifestyle, i think, is one of the keys, too, in dealing with long-term health care costs and also the long-term health of the public at large. We have some ability to do that, and i think that gov - ernment does need to take an active role in that regard. That's why, when we do, we need to make sure that we're spending our dollars where we're going to get the most bang for the buck. That's why i'm asking: are studies be- ing done?

The minister makes a good point about kids getting driven to school, as opposed to how when we were kids, we walked to school. in fact, the idea of suggesting to my parents a ride to school would have, no doubt, been met with stunned disbelief and probably a smack across the ear and then being pushed out the door and told: "Y ou will walk, and i don't care if it's raining. When we were kids, it was ten miles to school uphill and ten miles back from school uphill." [1510] it's a different world today. There's an expectation that kids get driven to school, and that has consequences in terms of physical activity.

There's a whole range of issues, which we don't have time for, that we could get into dis- cussing around education, physical fitness and the like. i would note, when the minister said that he was tee - tering on the brink, that during my leadership campaign i put on about 12 pounds, i think, much to my annoy - ance. a habit of wanting to eat n anaimo bars at three o'clock in the morning certainly doesn't help. i think what it does, though, is that it illustrates the challenges that we as a modern society have.

There are roles that government can play, whether it's dealing with tobacco, dealing with alcohol or childhood obesity, consumption of sodium and issues like that.

That's one aspect. a nother aspect that we don't have control over is around demographics and the fact that we are aging as a society, particularly in british c olumbia. i'm wonder- ing: has the ministry done work in terms of how this province is changing demographically, particularly in the population aged over 55, and the trends that we're seeing in british c olumbia in relation to the rest of the country and the impact that that has on health care funding in british c olumbia? Hon.

M. de Jong: Well, there are a couple of things that i can alert the member and other members of the h ouse to. i've got copies of this stuff, so i'm happy to

british c olumbia Debates7334 t uesday, May 24, 2011 provide the member with it. one of the questions was: are we tracking demographic change within the prov - ince? The short answer is yes, in a variety of different ways.

We can see…. i have this very colourful chart that tells me and tells us that in the o kanagan Valley, for example, population is trending a certain way. i'm happy to share that information with the member. on that front, i ask the question generally, and i'm advised that, despite what we may think, we're not par - ticularly out of sync with the rest of the country. it's not a question of british c olumbia having this abnormally high seniors population vis-à-vis other parts of c anada, although i suppose individual communities may vary a little bit. [1515] i wonder if i might use the member's question, though, as an opportunity to at least put on the record this bit of interesting utilization data. a gain, i'll make sure that the member gets this if he doesn't already have it. it speaks to the average cost of utilization for particular age groups. i am between the ages of 45 and 50 now.

People under the age of 45 generally spend, on average, $2,000 ac- cessing health care services; people between the ages of 45 and 64, just over $3,000; people between the ages of 65 and 74, just about $6,000; people between the ages of 75 and 84, $10,500; and people over the age of 85, in excess of $18,000. So it's a dramatic increase through that, particularly 75 to 85-plus.

When you consider that we have just over 1.2 million people between the ages of 45 and 65, that wave is going to move through, and i have seen nothing to indicate, at this point, that those costs are going to come down. but it's interesting. a gain, i will shamelessly use the oppor - tunity afforded by the member to make this point, and it's based on studies from the experts. if each of us exer- cised for 30 minutes a day, controlled our weight, ate reasonably well and stopped smoking, we could reduce our risk of chronic disease by up to 80 percent.

That $18,000 speaks to chronic disease. e verything i've read indicates that that's where that cost comes from. if all british c olumbians had a normal, healthy weight for their height and were physically active and didn't smoke, the studies that the ministry has conducted and accessed say that the province could avoid over $3.8 billion in economic and health care costs every year — almost $4 billion. n ow, the member has been involved in discussions with other ministers and other…. imagine. i have heard debates with ministries where the difference between anxiety and nirvana is $10 million.

We're talking about the potential, if we performed better as a society, for $4 billion in savings and improved health outcomes. The stakes are high. it's why i say that, at the end of the day, the sustainability of health care as we know it is tied to this notion of prevention and well-being. M.

Farnworth: i think the point is well taken that prevention is a key to long-term sustainability not only from a financial setting but also from a healthier popu - lation and better quality of life for people. one of the key issues i think we need to address in terms of demo - graphic changes is how we are changing in this province and the wave that is coming through. i know that one of the questions that is often raised and is of concern, and i guess it will be addressed prob - ably in greater detail tomorrow when we discuss seniors' health issues in much deeper context, is how that impacts people retiring to british c olumbia and the impact that it has on communities and government's response to that. f rom what i'm hearing the minister saying, is that as a province, as a whole, that retiring wave is not seen to be making itself apparent yet in british c olumbia. one thing i know — the minister is in the 45-to-50 demographic, and i'm now slightly moved past that, to the 50-to-55 demographic — is that people do start looking to retire. [1520] They start going: "Y ou know what? i don't like minus 30 in e dmonton or minus 40 in r egina. l et's go some - where where it's not quite so cold and i don't have quite so much snow to shovel." There's only one place in the country that has those wonderful qualities, and that's british c olumbia. is there an expectation, as this wave moves through, that it will impact british c olumbia to a greater extent than other provinces? h as the ministry been looking at that?

Hon. M. de Jong: i'm going to see if i can get the member some definitive demographic data, because quite frankly, it seems to me that as a destination spot for retirees in the country, that should reveal itself in the data. it may be offset by the fact that we're also at - tracting more than our fair share of young families and other immigrants, so that as a percentage of the popu - lation, it doesn't change that much. i think what i want to do is, between today and tomorrow, get some actual demographic

summary material that i can give to the member. i think we can say this, and i agree with the mem - ber. british c olumbia is going to remain a spot that folks on the Prairies will be thinking about coming to, whether it's the o kanagan, the l ower Mainland, c omox Valley. People love coming here, and when they get to a point where they don't want to shovel snow anymore, if they've had any experience in british c olumbia, par- ticularly on the west coast, they are drawn and inclined to come here. M. Farnworth: The minister actually just raised the second point where i wanted to go with this. What i'm trying to get an understanding of is the pressures on

british c olumbia Debatest uesday, May 24, 2011 7335 our health care system right now in terms of popula - tion and demographics. There are funding constraints. There's inflation. There's technology. There are all those things. a nd then there's the response from government in terms of: "o kay, how do we deal with this?" one of the issues the minister just raised is an influx of young families and new immigrants.

That itself brings advantages, but it also brings challenges, in the sense of cultural issues in terms of how health care is delivered but, more importantly, the supply of doctors who are able to work with a particular community, understand the nature of the community, understand the language. [1525] That invariably means physicians or health care pro - fessionals coming from those countries where we're receiving our new citizens from and the issues around qualifications and getting recognized in terms of their ability to practise their profession, in this case health care professions, here in british c olumbia.

My question would be: how has the ministry been re - sponding to those challenges? a re we keeping statistics and looking at analyzing the impact that the significant immigration flow into the province is having on our health care system and the challenges in some of those key areas in terms of how we're able to handle it taking place? h as work been done in that area? The Chair: h on. Members, i believe we've been joined in the gallery by students from Daniel Woodward e lementary School in r ichmond. i'd ask the h ouse to please make them welcome. Hon.

M. de Jong: i'll begin by saying that to my view — and my guess is the member agrees with this — the benefits that accrue from young families immigrating to this province from elsewhere in the world far outweigh some of what might be short-term challenges. a t a time when the ratio between those who are working and those past the age of retirement is far different than what it was 20 or 30 years ago, we are in a position where we not only benefit greatly from people selecting our coun- try and our province as a place they want to come to, but it's actually an essential part of the overall equation for economic success.

We have to be competitive. i think that is, going for - ward, one of the things. We can say it falls outside of the specific realm of health care, but if we're going to get to where we want to be as a province and enhance our stan- dard of living, we are going to need to recognize that it is competitive in terms of attracting people. They have choices, whether they're in health care or any other eco- nomic field. We are, i think, proving that this economic question is one that is not separate and apart from the health care formula.

We are, as the member knows, training more phys - icians domestically, upwards of twice as many as we were a decade ago, and that is significant. i have met a number of individuals who are either enrolled or in the process of graduating from those expanded medical programs for physicians or for nurses, for that matter, who are first-generation — i guess we still use that term — c anadians.

Their families, their parents immigrated here, so they have a cultural awareness that perhaps others don't, and they are in a position to address some of the unique needs that members of particular communities might face. in addition to that, i am advised that some additional steps have been taken on the recruiting front. The num- ber of entry-level residency positions for foreign-trained doctors has tripled from six to 18 — still modest num - bers but a significant improvement from where it was back in the early part of the decade — and 12 of those positions are in family medicine.

So that is significant. [1530] We've endeavoured to expedite the immigration process for internationally trained doctors under the provincial nominee program through the Ministry of a dvanced e ducation and l abour Market Development. My experience has been that there are two components to making this work. one is government — provincial, federal — expediting the entry of someone who wants to come here and practise their profession.

The other is professional, and that is ensuring that there is a regime in place, as administered by the medical college or the self-governing body, that responsibly recognizes those credentials. it is about a balance, because whilst i am one of those persons who historically have been very critical of the phenomenon of the neurosurgeon driving the cab, the grossest example of people's skills going to waste, i know this also. british c olumbians want and expect and deserve to know that the people administering to their needs in medical facilities are properly credentialed.

So finding that balance in a way that meets both of those objectives is important. The short answer: some progress has been made. We are training far more people domestically. Some of those people are uniquely positioned to address some of the unique challenges within particular communities. We are also doing a better job recruiting from afar, though i would say, particularly with respect to the latter, there is still more that can be done. M. Farnworth: i thank the minister for his answer.

We're going to get deeper into that when we talk levels of staffing and doctors and nurses and health care pro - fessionals and the training that's taking place. The point he makes is a good one, in response to my question. That is, we are seeing significant demographic changes in this province that bring with them, i think, significant advantages, both economic and social, but

british c olumbia Debates7336 t uesday, May 24, 2011 also, at the same time, challenges in terms of our health care system. We're seeing it in terms of seniors. We're seeing it in terms of new arrivals. Those are things that the gov - ernment needs to be aware of in determining its health policy because, as the minister stated, there are a num - ber of drivers. That's one of the key ones in terms of health care costs in the province today.

The minister has mentioned some others. inflation. it affects everything, and i think — the minister doesn't have to respond — that it does allow government to give an answer to questions from oppos- ition that we are spending more money today than ever before. While that is true, i think inflation is often a key component of that. one of the areas that i would be interested in hear - ing the minister's comments on is: what is happening in terms of inflation within health care delivery?

Where are the major drivers? is it wages and benefits? is it tech- nology and the fact that 20 years ago a heart monitor was a heart monitor or a bed was a bed, and quite often it had a life expectancy of ten years? n ow, you bring out, say, a heart monitor, and technol- ogy changes it. t wo years later there's a new, improved, better one. i'd like to have a sense of where inflation is, the role of inflation and how it's playing out within our health care system. it does, i think, appear to most people, or to people who look at it and ask questions, significantly higher than other areas of government ser- vice delivery or within the private sector. [1535] Hon.

M. de Jong: Well, again, the proposition that i think the hon. member lays before the h ouse is not one with which i will quarrel. The inflationary trends cut across the various components. i will say, to preface my remarks, that i don't want to leave the impression that the government holds the valuable, incredible people that do the work responsible for the costs. Y es, when wages go up, there are costs. i am told that across the fold a 1 percent increase in wages equates to roughly $150 million. So that's $150 million, but the budget has gone up by a lot more than $150 mil- lion.

That's one part of it. i was in k amloops at r oyal inland and was shown the new ct scanner. The new ct scanner is state of the art; it's fantastic. it replaces the old ct scanner. i can't say this for certain, but it wouldn't surprise me if the new ct scanner was at least 50 percent, and maybe more, more expensive than the old ct scanner. n ow, the technicians and the physicians there pointed out that it represents, as a diagnostic tool, an incredibly more valuable instrument than its predecessor. but the price of this diagnostic equipment is measured in the millions of dollars.

Drug costs have gone up. i am reminded by officials that we have managed to keep those increases in the range of 4 percent. They were, for a period of time some years ago, rising much more rapidly. [1540] e ven that involves asking clinicians to make some very difficult choices about what is going to be covered, what is not going to be covered and which drugs are going to be made available. a nd when it comes to rare diseases, and we've seen some examples of that in the media of late as well, those are very, very difficult deci - sions that have to be made.

So technology, drugs, personnel — but i don't want to overstate that as part of the equation — these are all drivers of the increases that we see. i think somewhere in the member's question was per- haps the underlying notion that with the technology, the equipment, the drugs, there is an element of specializa - tion which means, on many occasions, that the supplier sets the price and that those of us who are consumers of the service or who purchase on behalf of the public are in a position where there is not a lot of room for negotia- tion.

We try to negotiate as aggressively and effectively as we can to get the best value possible for the taxpayers that are paying for it. M. Farnworth: n o, i appreciate the minister's answer, because i think one of the things that's often out there is: "o h, it's just a case of wages driving health care costs." The reality is that an increase in the health care sector…. increases occur in every other sector of government and in the private sector, as well, and other areas of the pub- lic sector, yet health care costs are rising faster than all those other sectors.

There are other factors at play here that i want to get it on the record a bit — issues around drug costs, which we'll explore a bit further this after - noon, and also equipment. in my mind what it speaks to in health care is that we can approach things as a province from a b.c. perspec - tive, or we can recognize that in many cases these are issues and problems that face not just british c olumbia but other provinces as well, other jurisdictions, in terms of the delivery of health care.

That also relates in terms of how we fund health care in b.c. i mean, we've been talking about the cost pres - sures and some of the drivers of costs in health care. one of the things i want to get to in a few minutes is the issue of how we fund it, both at the local and provincial but also at the national level. Just to ask this question in terms of equipment — i think this is the appropriate time to ask it — do we en - gage…?

When we purchase major equipment — ct scans and Mri s, for example — do we do it in isolation as british c olumbia? or do we sit down and work with other provinces — let's say ontario, Quebec, a lberta and Saskatchewan — who are also buying these types of equipment, and say: "Well, let's hang on a sec"? r ather than all of us going to these companies individually as

british c olumbia Debatest uesday, May 24, 2011 7337 provinces, do we get together and go: "Y ou know what? We have more leverage if we work together"? is there any sort of strategy to do purchasing in that regard? [1545] Hon. M. de Jong: it seems to me, first of all, that the short answer is yes, there is collaborative purchasing, but i want to give the member as accurate an answer as possible. i am advised that most of that to date relates to — and i'm not sure i'm using the right term — what i would call consumables and drugs.

We were speaking a moment ago about large-equip - ment purchases. it has not evolved to that point, and one wonders whether the volume is such that it could.

There are procurement practices and policies in place that are designed to elicit the best possible price on that large equipment. but thus far the interprovincial col - laboration on drug pricing and purchasing, a specific agreement with the province of a lberta around the pur- chasing of consumables, is also in place. i'm told, just so the member has some appreciation of the order of magnitude here, that according to the c anadian institute for h ealth information, western government drug plans — b.c., a lberta, Saskatchewan, Manitoba and the t erritories — spent a combined total of $2.2 billion on drug plans in 2007. i guess that has gone up since then, but there are savings that are being realized.

The equivalent figure for all of c anada in '07 was $8.7 billion. There is a joint agreement in place for the purchas - ing of drugs. That seems to have gone reasonably well between a lberta and british c olumbia on consumables, and it remains to be seen whether or not the next step can be taken, as part of that collaboration, around some of the other larger-ticket items, although they are pur - chased far less frequently. M.

Farnworth: i look back to my time as h ealth Minister. it's 12 years ago now, which is a long time. one of the things that struck me during that time was how many of the challenges that we face as a province are shared by other provinces and the need, i think, in many cases for not just provincial and collaborative strategies with one province but a sense of the opportunity that exists, with collaboration on a national scale and na - tional strategies, for dealing with a number of the issues and the challenges that we face in health care. e vents over the last 12 years, i think, have reinforced that idea with me.

While the minister has stated issues on drugs, and we'll come to that in more detail later on, and he's touched on the issue around a lberta with consumables, i actually think that there is a considerable scope. The minister says these purchases are made more infrequently, and i think that yes, that's correct. They are made more infre- quently, but judging from the number…. i think he mentioned $8.7 billion on equipment.

That's a significant amount of money that the provinces spend on equipment, and much of that equipment is very high-tech. it will be order-specific, and its manu - facturing process requires a commitment.

That is one of the reasons why it's expensive. i think there is an opportunity there not just for british c olumbia but the provinces in general, if they work and coordinate their purchases around some of those — par - ticularly expensive high-tech equipment such as Mri s, cat scans, what have you — to be in a position to lever - age savings for the taxpayer in the health care system with regards to that aspect of health care expenditure. [1550] My question to the minister would be: if that has not taken place, would the minister commit to looking at the potential or possibility of those kinds of initiatives or an initiative like that with other provinces?

Hon.

M. de Jong: Just to follow up on a bit of the chronology, which may be relevant to the question that the hon. member has asked, back in July of '09 the gov - ernments of b.c. and a lberta announced an agreement to consolidate the procurement of drugs, supplies and equipment used in hospitals through h ealthPro , a group-purchasing organization owned by participating health agencies. i am advised that Saskatchewan and the Winnipeg r egional h ealth a uthority have since joined that collaboration with b.c. and a lberta. b.c. h ealth Shared Services is now in the process of aligning health authority purchasing with h ealthPro contracts. i'm further advised, and this perhaps goes directly to the point that the member was making, that back in a ugust of last year, at a meeting of the c ouncil of the f ederation, the Premiers for the provinces agreed to establish a pan-c anadian purchasing alliance to con- solidate public sector procurement of common drugs, medical supplies and equipment where appropriate. it seems the foundation has been laid for an expan - sion of this pan-c anadian purchasing strategy. it is firmly established in some areas — like drugs, like con - sumables — and perhaps less established in some of the other areas.

The member will get no argument from me. Where we can, it makes sense for us to consolidate on a national basis. We are an incredibly large geographic nation with a comparably small population, and where we can maxi- mize the benefits by working together, it makes sense to me to do so. M. Farnworth: Thank you for the answer. i hope that british c olumbia is active in terms of driving the initia - tives out of that. i do think, particularly around major equipment, that there is opportunity there for the prov - inces, not just british c olumbia, to improve what we do have but also to use it as leverage.

british c olumbia Debates7338 t uesday, May 24, 2011 i was going to go to the health accord, but what i think i might do at this particular point is segue into — because it crops up in the minister's answers, and it does so because it makes sense — the issue of the other cost driver, which is pharmaceuticals and drugs and the costs that are taking place with drugs. Do we need to get additional staff at all? interjection. M. Farnworth: o kay, in that case, it's probably good to take a little break for five minutes. The Chair: a five-minute recess, hon. Members.

The committee recessed from 3:54 p.m. to 4:04 p.m. [D. black in the chair.] M. Farnworth: before the break we were just starting a discussion on pharmaceuticals, drugs and cost pres - sures on our health care system. c an the minister just outline what's been happening with pharmaceuticals in terms of the rate of increase, the issues around new drugs coming onto the market and the role that pharma- ceuticals are now playing within our health care system? i guess a brief outline of where we are in terms of…. [1605] i remember when i was….

Well, 12 years ago the issue at that point was that pharmaceutical use was coming very close to being the same or would be pass - ing invasive procedures. So just a sense of where we are right now in british c olumbia with the pharmaceuticals within our health care system. Hon. M. de Jong: The member is correct about the increasing order of magnitude. in terms of the raw num- bers we can go back to '91-92. t wenty years ago the cost would have been $228 million. f or budget year 2011 it is $1.1 billion.

So in addition to inflationary pressures, there are some other significantly growing costs ob - viously built in. but i'm reminded…. i should introduce the member in the h ouse to bob n akagawa, who is aDM from the pharmaceutical services division of the ministry. f rom what i've just said, the member will appreciate that he oversees a significant portion of the expenditure of pub- lic moneys. i am advised by him that those costs relate to a var - iety of things: increased costs for specific drugs, but also significant advances and a broader range of pharma - ceutical products — clot busters for heart conditions, statins for cholesterol.

We go through hiV treatment. The development and the advances relate to drugs that are commonly used and especially drugs for very rare conditions, some of which are very, very expensive. So we're looking at about $1.1 billion worth of expenditure for 2010-2011. M. Farnworth: What it shows is that for a variety of reasons the rate of use of pharmaceuticals and the cost to our health care system have increased dramatically.

There are, as the minister rightly stated, drugs that do things that couldn't be dreamed of 20 years ago, that are now able to treat conditions, extend people's lives, qual- ity of health and quality of life and all those things. it's important that we're able to supply and be able to pro - vide that medication to british c olumbians. a t the same time, we've seen the development of new drugs that are often either slightly better or…. The ef - ficacy rate is very similar, yet those are more expensive than traditional drugs that have been in place.

The de - mand for them can have an impact on our health care budget as well. [1610] So governments have had to not only respond to the advances in terms of providing new pharmaceutical treatments but also to deal with the challenges of drugs whose efficacy may be an incremental increase or very similar but yet are heavily marketed compared to drugs that have been around for a long time. a number of remedies or initiatives have been under - taken in this jurisdiction and different jurisdictions to be able to deal with that and deal with the advances and to ensure that we're able to provide as much as possible. i'd be interested to hear the minister's thoughts on, for example, how reference-based pricing is working, any changes around the issue of reference-based pricing, the impact that it's had and studies the ministry has done in terms of the effect of reference-based pricing on the cost of pharmaceuticals in the province of british c olumbia.

Hon. M. de Jong: i'll start here, and there may be questions that flow from this. i think the point can be made that on balance, reference-based pricing does serve us — serve the public, serve the funder — well. but i'm advised that the way it has evolved, new drugs within a particular class of drugs are priced at the same price point,

whereas there used to be a range. t o that extent, referencing the price doesn't result in additional savings. So there's a class of drugs, a new drug comes along, it's fit within that class, and the price point is set. t o that extent, the kinds of savings that

Document details

Collection	British Columbia — Debates (Hansard)
Citation	H0524pm-09
Type	hansard
Volume / chapter	H0524pm 09
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	963af3ed5b2a65e0ca1d2c20f4038585ae855882

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