2003 Legislative Session: 4th Session, 37th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, MAY 15, 2003

Afternoon Sitting

Volume 15, Number 14

CONTENTS

Routine

Proceedings

Page

Introductions by Members

Introduction and First Reading of Bills

Coquihalla Highway Administration Clarity Act, 2003 (Bill M202)

J. MacPhail

Statements (Standing Order 25 b )

Asian Heritage Month and World Partnership Walk

P. Sahota

Vancouver school board alternative budget

J. Kwan

Tabling Documents

Vancouver school board alternative budget

J. Kwan

Statements (Standing Order 25 b )

Langford Lavender Festival

A. Hamilton

Oral Questions

B.C. Rail line between North Vancouver and Squamish

J. MacPhail

Hon. J. Reid

Environmental protection

J. Kwan

Hon. J. Murray

Transportation infrastructure improvements in Cariboo area

J. Wilson

Hon. J. Reid

Auto theft prevention

B. Locke

Hon. R. Coleman

Film industry in B.C.

K. Krueger

Hon. R. Thorpe

Dental services at Children's Hospital

J. Kwan

Hon. C. Hansen

Committee of Supply

Estimates: Ministry of Health Services (continued)

J. Kwan

Hon. C. Hansen

J. MacPhail

Hon. G. Cheema

[ Page 6843 ]

THURSDAY, MAY 15, 2003

The House

met at 2:05 p.m.

[J.

Weisbeck in the chair.]

Introductions by Members

Hon. S.

Bond: I am delighted today to introduce two very special guests in the

visitors' gallery. Today, with my colleagues from Prince George North,

Vancouver-Burrard, Penticton–Okanagan Valley and Kelowna–Lake Country, it

was a pleasure to have lunch with His Excellency Vladimir Kotzy, the ambassador

of the Czech Republic, and his wife Michaela.

Interjections.

Hon. S.

Bond: Yes, we are enthusiastic. I want to tell you that it was a wonderful

opportunity to visit with His Excellency and his wife, and I want you to know

that their five years in Canada are coming to an end and that they'll soon be

returning to their home in Prague. But I want you to know something. They are

grandparents who have brought their grandchildren to Canada to play hockey. His

Excellency's wife takes figure skating lessons, and she's proud to say that her

coach is Donald Jackson. They are a remarkable couple. It was a true pleasure to

welcome them to the Legislature. I know you will want to help me in making them

feel very welcome in the gallery today.

Hon. G.

Campbell: I just wanted to take a moment to say to Ambassador Kotzy how

pleased we are that you understand Canada, how pleased we are that you're here

in British Columbia and how pleased we are that on July 2 we'll be in Prague and

that you'll be able to join us as we are awarded the 2010 Olympic and Paralympic

Games in the Czech Republic. Most importantly, we're really looking forward to

your wife coming back as a member of the Czech Olympic team. I'm sure she'll

look great standing in No. 2, because Canada is going to win the gold medal in

that event too.

J. Les:

It's my very great pleasure this afternoon to introduce to the House about 80

people who are in the gallery this afternoon. These are the constituency

assistants to the various government members. They've been in Victoria for the

are available to them as we collectively serve our constituents in the future. I

would ask the House to give all of our wonderful constituency assistants a very

warm welcome.

Brice: I am pleased today to recognize the efforts of an ambitious Vancouver

Island resident from Ladysmith. Over the past nine days Mike Pellatt has been

travelling via wheelchair from Campbell River to Victoria to raise both

awareness of and funds for amyotrophic lateral sclerosis, ALS. The efforts of

such dedicated people as Mike Pellatt help to raise funds for much-needed

research into this debilitating disease. Well done, Mike. I ask all members to

join in welcoming him to this Legislature and thanking him for his remarkable

effort.

J. Kwan:

I have the pleasure to introduce nine longtime advocates for children in our

education system. They are Adrienne Montani, the chairperson of the Vancouver

school board; Jane Bouey, school trustee of the Vancouver school board; Pat

Gudlaugson, Vancouver Elementary School Teachers Association; Jim Gill,

Vancouver Secondary Teachers Association; Jean Dandrea, CUPE Local 15; Mike

Potts, CUPE Local 407; Burt Johansen from the trades; Patti Lefkos, Vancouver

Elementary Principals and Vice-Principals Association; and finally, Annie Ehman,

district parent advisory council. Would the House please give them a warm

welcome.

Hon. J.

Murray: It's my privilege to introduce today Mr. John Sager, who has had a

very distinguished 30-year career in business and government — most recently

as my ministry's manager for toxics, special waste and pesticides. There's a

title. John also was recently a member of the contaminated-site review panel

that came out with an excellent set of recommendations for modernizing and

improving our management of contaminated sites. Would the House please make Mr.

Sager — John — very welcome.

[1410]

Hon. G.

Plant: In addition to my constituency office staff, who have already been

introduced by my colleague opposite, today represents the annual visit inside

this room of my ministry office staff. I hope the House will make Gail Dawson,

Jo-Ann Clar and Cheryl Ryder; my executive assistant, Stephanie Lysyk; and my

ministerial assistant, Joan Dick, all very welcome to the chamber.

Hayer: I would like to introduce to the House two of my strongest supporters

and greatest volunteers. My right hand, my wife Isabelle Hayer, is here, and

my son Alexander Singh Martinez Hayer is here. His doctors told him to take a few

days' break from his regular hospital treatment and to get ready for his bone

marrow transplant session in June. I know that Alex would like to thank all the

members of this House and staff and press who have gone out of their way to

express their sympathy and their support. I would like the House to welcome both

Isabelle and Alex during their stay in Victoria.

R. Lee:

In the gallery today is Mr. Bill Yuen, former Vancouver school trustee and

returning officer for Elections Canada. He is in Victoria today to attend a

Canada Post conference. Would the House please make him welcome.

J. Bray:

Joining us in the members' gallery today is no stranger to the precincts now.

This gentleman has become a very vocal peer advocate for those living with

mental illness. He has met with several ministers, and he is really moving the

issue of people living with

[ Page 6844 ]

mental illness to the forefront in the media and bringing dignity and respect

to people living with mental illness. I would ask the House to please welcome

again Terry Colburn to the precincts.

P. Bell:

The Premier often talks about welcoming young people back to the province of

British Columbia, and I can tell you that I am very, very excited today to be

able to reintroduce to the House my daughter, who has been gone from British

Columbia for four years but who is back, eager to look for work and excited

about all the new opportunities provided to young British Columbians. So I would

ask that the House please make both Donna Bell and her boyfriend, John Muirhead,

very, very welcome. Welcome back.

Mayencourt: In the gallery we have a visitor from the Red Cross. This young

lady works in a program called RespectED. I and the member for Surrey–Green

Timbers and the member for Columbia River–Revelstoke had the pleasure of

meeting Desiree Sattler on our safe schools task force tour. So would the House

please make this young lady welcome.

Deputy

Speaker: I would like to welcome all the rest of the members in the House.

Introduction and

First Reading of Bills

COQUIHALLA HIGHWAY

ADMINISTRATION CLARITY ACT, 2003

J. MacPhail

presented a bill intituled Coquihalla Highway Administration Clarity Act, 2003.

MacPhail: I move the bill standing in my name on the order paper entitled

Coquihalla Highway Administration Clarity Act, 2003, be introduced and read a

first time now.

This bill

amends the Ministry of Transportation and Highways Act to ensure that the

revenue stream from the tolls on the Coquihalla Highway cannot be leased,

contracted out, sold, auctioned off or otherwise granted to an entity other than

the provincial government.

I was in

Kamloops earlier this week, and the growing anger at this decision to sell off

the Coquihalla and increase tolls was palpable. Residents say they weren't

consulted. They say it will take money out of their pockets and hurt their

economy. And they say the tolls they pay should not pad the bottom line of a

private company. That's why today the opposition is moving to table a bill that

would ensure all tolls collected by the government remain in public hands.

The

Coquihalla has already been paid for. It belongs to the people of British

Columbia. As a vital transportation link between the lower mainland and the

interior, it is critical to the long-term economic health of our province. It

should not be sold off to pay for this government's record deficits and failing

economic policies.

[1415]

Motion

approved.

MacPhail: I move that this bill be placed on the order paper for second

reading at the next sitting of the House after today.

Bill M202

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

Statements

(Standing Order 25

b) ASIAN HERITAGE MONTH AND

WORLD PARTNERSHIP WALK

Sahota: As mentioned by my colleagues yesterday, May is Asian Heritage

Month, and a number of events and celebrations are taking place around the lower

mainland in recognition of the influence of the Asian culture and civilization.

A number of my constituents are involved in some of these wonderful and worthy

projects.

Starting

tomorrow is the International Dalit Conference in the lower mainland. It is

community-based, and its objective is to bring Dalits, which are often referred

to as the lower castes, together from around the world to discuss such issues as

human rights and social justice. What better place to have this conference than

right here where we embrace all people, regardless of their race, religion or

caste.

The second

event is a World Partnership Walk, which will take place on Sunday, May 25 at

Stanley Park. This walk was started 19 years ago by five women from the lower

mainland who wanted to make a difference in the world. Today the World

Partnership Walk is Canada's largest event helping people in developing

countries around the world, and it is held in ten cities across the country.

This year the Premier is an honorary walker and is lending his support to raise

awareness of this important issue, and my Burnaby colleagues and I have formed

the B.C. Liberal MLA team to help raise awareness for this worthy cause. The

funds raised will help people who live on little more than their determination

and perseverance to break the cycle of poverty. It supports sound long-term

projects in parts of the world where access to clean water can be a distant

dream. The funds raised also contribute to programs in areas like health care

and education and pay special attention to the plight of women and children in

developing countries.

These are

complicated and important issues, but I want to pay special tribute to B.C.'s

Ismaili community, which has been at the forefront and leading the charge as

they work together to find solutions. On May 25, come and participate in a

worthy cause and be part of the solution.

VANCOUVER SCHOOL BOARD

ALTERNATIVE BUDGET

J. Kwan:

Earlier today members of the Vancouver school board came to the Legislature —

and they are

[ Page 6845 ]

here now — to present and discuss their alternative budget, titled the

three-Rs budget. The Vancouver school board has put together a comprehensive

picture of a system not being properly supported by this government.

With the

support of groups like the district parent advisory council, the Vancouver

Teachers Association, the B.C. Principals and Vice-Principals Association as

well as many others, the Vancouver school board is calling on the province, the

minister and all MLAs in this chamber to reinvest, renew and rebuild public

education in B.C.

It is time

this government realizes that imposed cost pressures and a two-year funding

freeze have greatly reduced the capacity of educators to give children the

opportunities they deserve. They came here today to ask MLAs to help restore

educational services, which have been cut by $25.8 million in Vancouver alone

since the last election.

supporting the three-Rs budget, all of the MLAs in this House can give back

instructional supplies and classroom services.

We need to

learn from mistakes in other provinces. In Ontario, a funding freeze much like

the one we have seen in B.C. forced boards to make significant cuts to the

education system. Ontario now faces a bill of over $1 billion just to reverse

the damages done by the funding freeze.

The message

from Ontario and the message from the Vancouver school board today is clear.

Immediate attention and action is required to prevent cuts to vital services for

our children and our communities. The three-Rs budget is ready to go. The work

has been done. It's time to act.

Tabling Documents

J. Kwan:

With that, I'd like to table the budget now so all MLAs can take the time to

review it.

Deputy

Speaker: Member, you need leave to table that.

J. Kwan:

I ask leave to table the budget.

[1420]

Leave

granted.

Statements

(Standing Order 25

b) LANGFORD LAVENDER FESTIVAL

Hamilton: On July 12 and 13 the city of Langford invites one and all to

their second annual Langford Lavender Festival. You can catch the free bus

provided by B.C. Transit from the western exchange or drive down Veterans

Memorial Parkway, which the province of British Columbia partnered with Langford

and local business to construct, and participate in festivities.

The

annual festival is a celebration of community pride and spirit. It takes place

in Veterans Memorial Park, the centrepiece of their downtown beautification

project. This festival brings together businesses, volunteers from the Royal

Canadian Legion, Rotary, Kinsmen, Lions, Juan de Fuca Rec, the RCMP, Langford

volunteer fire rescue, various non-profit groups and the families of Langford to

celebrate the pride they feel for their community.

Saturday

will begin with a pancake breakfast and then a parade through city centre to

Veterans Memorial Park. At this beautiful park location, you can visit an arts

and crafts fair with local artisans, kids activities coordinated by Juan de Fuca

Rec, wine information from local wine specialists, music in the park, great

entertainment and family fun for all. Later that night there will be a Lavender

Cup feature race at the Western Speedway, and I definitely won't be driving. An

adult dance will be in full swing at the Langford Legion.

On Sunday

there are more of the same activities at the park and a giant garage and bake

sale scheduled to help the legion. The proceeds from the Langford festival will

enable various community organizations and service clubs to raise funds to

support their activities and enable the Langford beautification and festival

committee to support community projects. Last year proceeds were designated to

assist the funding of phase one of a new skateboard park near Belmont school.

Langford is

proudly celebrating ten years as a municipality during this second annual

festival. In the past ten years Langford has grown from 14,000 to 20,000

residents and has balanced economic growth and new commercial developments along

with residential development and green space. What other municipality can boast

three lakes within walking distance of their city hall, a national award-winning

trail system, and a new fire hall, police building and city hall?

I urge all

to come and celebrate with us the community pride and spirit that make things

happen.

Oral Questions

B.C. RAIL LINE BETWEEN

NORTH VANCOUVER AND SQUAMISH

MacPhail: In the secret proposal from the CN to buy B.C. Rail, the company

proposed abandoning the rail line between North Vancouver and Squamish in order

to build a highway to the Olympics. The minister responsible for B.C. Rail

hasn't said whether or not she would allow such a move. Can the Minister of

Transportation tell the House what the consequences will be if the B.C. Rail

line between North Vancouver and Squamish is abandoned?

Hon. J.

Reid: We have said that when we get the Olympic bid, we're going to have to

provide a third lane of traffic for the Olympics. We're looking at that third

lane of traffic to be that railway line for the dura-

[ Page 6846 ]

tion of the Olympics. For roughly two weeks in time, that will become a road.

Other than that, it will operate as a railway.

Deputy

Speaker: The Leader of the Opposition with a supplemental.

MacPhail: This isn't a Minister of Transportation; she's the fairy of

transportation. She can build a road in two weeks and then have it abandoned in

two weeks. Isn't that interesting? This government has been spreading

misinformation about B.C. Rail in a desperate attempt to weasel its way out of

the Premier's election promise not to sell B.C. Rail.

The

opposition has come into possession of a highly confidential B.C. Rail

briefing…

Interjections.

Deputy

Speaker: Order, members. Order, please.

Proceed.

MacPhail: …document prepared for the government, which strongly warns

against abandoning the line between North Vancouver and Squamish. Let me quote

from the document. Abandoning the North Vancouver to Squamish line "would

place the B.C. Rail enterprise at a severe business risk and eventually put B.C.

Rail out of business."

Now that

I've refreshed the minister's memory, perhaps she can explain to the House —

and in particular to her backbench colleagues, the communities and those who

represent the communities that depend on B.C. Rail — how she could allow such

a vital, profitable service to be put at risk by the Liberal Party campaign

backers like CN?

[1425]

Hon. J.

Reid: Freight rail service in British Columbia is an important part of our

infrastructure that needs investment and that needs to be sustainable, and

working with communities, working with industry, we're looking for a partnership

for operations. The province will retain ownership of the rail bed, the

right-of-way and the tracks.

Deputy

Speaker: Leader of the Opposition with a further supplemental.

MacPhail: I was always told that this fairy queen of transportation, who can

make a road come and a rail line change in two weeks, read her briefing notes.

It's not subject to freedom of information, but it is a briefing document from

the rail corporation to this minister. Now, that briefing document goes exactly

against what this minister and the Premier have said.

Everyone

knows that CN is the frontrunner on the fire sale led by this government of B.C.

Rail. This document explicitly warns that shutting down B.C. Rail's North

Vancouver to Squamish line will lead directly to an enormous competitive

advantage to CN. CN gave the Liberals more than $36,000 last year alone.

Will the

minister guarantee to this House today that under no circumstances will the new

private sector operators of B.C. Rail be permitted to shut this line down no

matter how much money they donated to her party's election machine?

Hon. J.

Reid: Indeed, the rail line and the integrity of the rail line are important

to communities — are important to this province — and the mistake that the

member is making is confusing a document from CN that is not a proposal to

government. Government does not consider it a proposal, has not considered it

and is not interested in that. We are today putting out a call for expressions

of interest. We are working with communities, and we are working with industry

to make sure there is a sustainable…

Interjection.

Deputy

Speaker: Order, please.

Hon. J.

Reid: …rail system for the future in British Columbia.

ENVIRONMENTAL PROTECTION

J. Kwan:

Leading environmental groups today gave this government and this minister a

failing grade on environmental stewardship. To the Minister of Water, Land and

Air Protection: why should British Columbians have any faith in her when

advocates for clean water say that B.C. is the only government in Canada to

weaken drinking water regulations since the Walkerton tragedy?

Hon. J.

Murray: Here's why British Columbians should have faith in me and in this

government: we have an environmental record of which we are extremely proud.

Interjection.

Deputy

Speaker: Order, please. Order.

Hon. J.

Murray: I'm glad the member opposite asked that question: what is our

record? We have improved the recycling of polluting substances with our used oil

stewardship program. We have accelerated protection of wildlife habitat under

the new Forest and Range Practices Act. We have improved the tools that we have

for identifying and solving water quality risks, including source-water

protection. We have increased the targets for clean energy from 10 percent under

that member's government…

Interjection.

Deputy

Speaker: Order, please.

Hon. J.

Murray: …to 50 percent of new energy….

Interjection.

[ Page 6847 ]

Deputy

Speaker: Order, please.

The member

for Vancouver–Mount Pleasant has a supplemental.

J. Kwan:

Get the facts on the table. The report card on B.C.'s two-year environmental

record: energy and climate change, fail; health and pollution, fail; enforcement

and public participation, fail; wildlife and parks, fail; resource management,

fail. The report card from B.C.'s most respected environmental organizations is

an indictment of this minister and this government.

Interjections.

Deputy

Speaker: Order, members. Let's hear the question.

Interjection.

Deputy

Speaker: Member for Vancouver–Mount Pleasant, you have the floor.

[1430]

J. Kwan:

The report card also highlights this government's decision to roll back

standards to prevent pulp mill toxins from flowing into B.C. waters. B.C. now

has some of the weakest pulp mill effluent standards in the industrialized

world. Again, to the Minister of Water, Land and Air Protection: why does the

minister continue to ignore her own report's recommendation to address the

discharge of what's known as toxic black liquor from pulp mills into B.C.

waters?

Hon. J.

Murray: The member opposite is quoting from a report from an environmental

group, and I want to point out that some environmental groups work very

constructively with government, and some use very questionable tactics to try

and pressure government.

Interjections.

Deputy

Speaker: Order, please.

Hon. J.

Murray: This member is quoting from a report…

Interjection.

Deputy

Speaker: Leader of the Opposition, would you please come to order. Let's

hear the answer.

Hon. J.

Murray: …that is critical of our government actually dealing with the pine

bark beetle in forests. If that member's government had dealt with this issue

ten years ago, we wouldn't have the biggest environmental nightmare of this

decade.

Interjections.

Deputy

Speaker: Order, please. Order, please. Let's hear the question. Leader of

the Opposition, would you please come to order.

TRANSPORTATION INFRASTRUCTURE

IMPROVEMENTS IN CARIBOO AREA

Wilson: My question is to the Minister of Transportation.

For a great

many years residents of the Cariboo have depended on the Marguerite ferry

to cross the Fraser River. While very nostalgic residents have voiced concern,

this ferry service was plagued with service capacity problems and undeniable

financial challenges. Can the Minister of Transportation explain to the

residents of the Cariboo region how industry and residents are benefiting from

infrastructure improvements even without the ferry service?

Hon. J.

Reid: This member has strongly represented the needs of his community —

the industry, the agriculture, the forestry and the roads in this area.

The West

Fraser Road and the Soda Creek Road are going to see an investment of $750,000

this year. This ferry service ends every winter. It is only a passenger ferry

service, and it does not allow for the transport of commercial or industrial

vehicles. The investment into these roads will help the communities and will

help the residents. As this ferry has not been operating since last October and

doesn't operate every winter, the residents of this area are well prepared to

use the road.

AUTO THEFT PREVENTION

Locke: My question is to the Solicitor General. ICBC has recently released

figures that show that auto theft is increasing. During 2002, stolen vehicles

increased by 7 percent. This means that vehicle thefts have risen 25 percent in

the past two years alone. The trend must stop. A rise in auto thefts results in

higher costs for ICBC and puts pressure on the insurance rate for all consumers.

Can the Solicitor General tell us what action is being taken to combat this

problem?

Hon. R.

Coleman: Last month the auto theft task force was renamed and made more

permanent. In cooperation with police and ICBC in the province of British

Columbia, it is now called the Integrated Municipal Provincial Auto Crime Team.

This group is integrated with seconded officers from both the RCMP and municipal

forces to work across boundaries with regard to statistics in auto theft where

we've been able to use this team and the bait car program, which we've also put

into place.

We do find

we can push back and reduce auto theft in communities like Vancouver where we

actually have, with the bait car team, been able to reduce it by 30 percent. It

is an ongoing problem. The only way you can approach it is by having good

statistical information to deal with crime community by community and to use an

integrated operation so that you can push back on it, and that's exactly what

we're doing.

[ Page 6848 ]

[1435]

FILM INDUSTRY IN B.C.

Krueger: Kamloops and region have been delighted for the past number of

weeks to host Robert Redford and Jennifer Lopez as they film the movie An

Unfinished Life . I've been a fan of Mr. Redford since Lassie was a pup, and

probably his dinner invitations are piling up in my mailbox while I've had to be

here listening to the Leader of the Opposition. Sadly, I haven't seen them yet.

Our

economy, locally, has certainly been benefiting as an $18 million expenditure

has occurred in our area, and of course we're absolutely delighted with that.

Provincewide, the industry comes in at about $1 billion a year for British

Columbia.

People are

concerned about the rising value of the Canadian dollar and wondering how that

is going to impact this vital industry in our province. I wonder if the Minister

of Competition, Science and Enterprise could tell the people of B.C. what he

thinks about that risk.

Hon. R.

Thorpe: Our dollar remains very competitive with the competitive

jurisdictions of the world — namely, Australia and Europe. In fact, our dollar

has risen by 10 per cent while other currencies have risen by 17 percent to 24

percent.

Under the

leadership of our Premier, our government has made sure we have a competitive

tax policy that attracts the film industry to British Columbia. In fact, we

increased regional tax credits to assist areas like Kamloops, Trail and other

areas of the province where we've had shootings this year. At the present time

we have 31 productions underway in British Columbia, and all studios in

Vancouver are booked. In addition, Canadian programs like Da Vinci's Inquest,

Cold Squad and Edgemont have renewed their contracts as we go

forward.

This is a

billion-dollar industry, and later today our government will release the

information on the year 2002, which shows that once again it's a $1 billion

industry in British Columbia.

DENTAL SERVICES AT

CHILDREN'S HOSPITAL

J. Kwan:

Two thousand children a year are treated at Children's Hospital for dental

disease. Many of these children are treated for a condition known as severe

dental decay, which primarily affects low-income kids. Untreated, the health and

well-being of these children can be severely affected.

That's why

doctors, health professionals and advocates for children are very concerned that

Children's Hospital may have to cut in half dental services to kids to deal with

budget cuts — a cut that will affect approximately 900 kids a year. The only

other option available to these kids is to have private treatment, which can

cost up to $600 — way too much for these families.

For the

sake of children's health, will the Minister of Health Services take action to

ensure that Children's Hospital has the funding to deliver proper dental care to

children in B.C.?

Hon. C.

Hansen: The provincial health services authority has been reviewing surgical

procedures, generally, and trying to determine whether we have the appropriate

utilization of our hospital-based services. The review of that has determined

that there are significant numbers of children who have been referred for

surgical dental care in a hospital operating room when in fact that is not

necessary.

Throughout

the health care system we're trying to make sure that we get proper utilization

of services, and we have determined that about 50 percent of those dental

surgeries can be properly provided in community-based clinics.

[End

of question period.]

Orders of the Day

Hon. G.

Collins: I call Committee of Supply. For the information of members we'll be

debating the estimates of the Ministry of Health Services.

[1440]

Committee of Supply

The House

in Committee of Supply B; H. Long in the chair.

The

committee met at 2:44 p.m.

ESTIMATES: MINISTRY OF

HEALTH SERVICES

(continued)

On vote 29:

ministry operations, $10,038,097,000 (continued) .

J. Kwan:

Just prior to the break we were looking into some of the wage differentials,

particularly the ones that exist between women and men, that impact the health

care sector. Aside from the wage rollback, I was speaking particularly about the

fact that many of the health care workers, who are primarily women — and

immigrant women, for that matter — will be faced with a reduction in salary.

Also, in the comparisons between provinces, I was speaking to the cost of living

and particularly the housing component — earlier, before the break.

[1445]

In essence,

when you account for the cost-of-living differences in Canada for these workers,

effectively the wages for the support workers — who are essential to our

health care system — are not really as high as the minister and this

government like to make it.

The

minister actually said that there is a pending agreement with health care

workers with HEU and

[ Page 6849 ]

that that information would be forthcoming. When does the minister anticipate

information from that agreement to be released?

Hon. C.

Hansen: I don't have any particular inside knowledge with regard to when

that ratification vote is going to be released. I did see a media report today

that quoted — I guess the title is secretary-treasurer, is it? — Mr. Allnutt

of the HEU. I'm not sure of his actual title. It quoted him as saying…. I

understand today is the last day for voting on that ratification. It also

indicated in the media report that results would be announced tomorrow. That's

the only source of information I have.

J. Kwan:

I'd like to actually canvass for a few moments on a different track — on

the issues that impact my community more significantly. That is, of course, the

drug addiction question. Earlier this week we debated a bill with the Minister

of State for Community Charter. Part of the changes in that would give

municipalities a lot of authority to determine what services would be provided.

Particularly when it deals with health care services, the ramifications I'm

concerned about would be to let municipalities or jurisdictions put in

regulations or bylaws to prevent services from being delivered in their own

community.

The example

I use with the Minister of State for Community Charter is Surrey, where they

have put in a bylaw to prevent methadone services from being delivered. Really,

they're getting around it by increasing the fees — exorbitant amounts of fees

— for people to get their business licence. Therefore, in essence, people are

not able to provide those services in their community. Where issues become a

health concern, the legislation does allow a provision for the minister to act,

and that is the Minister of Health Services. I'm wondering whether or not this

minister would be looking into that matter and taking action to ensure that

members in the community actually have access to the health services required.

[1450]

Hon. C.

Hansen: My ministry has been very much involved in the development of the

Community Charter to make sure that the health issues are, in fact, protected.

I'll just quickly read for the member some background as it pertains to the

Community Charter.

"Local

governments will be able to regulate in areas of concurrent authority. In order

to do that, there must be a regulation drafted giving them authority in public

health matters. A municipality may only adopt a bylaw in one of the concurrent

spheres if the bylaw is (1) approved by the minister responsible, (2) in

accordance with an agreement with the minister responsible or (3) in accordance

with the minister's regulation."

municipal bylaws cannot override provisions of another act. All specific

conditions and restrictions established in other legislation still apply. Local

government will not be able to approve a bylaw that is less stringent than what

provincial legislation currently or in the future sets out.

J. Kwan:

I'm familiar with the Community Charter and the piece that the minister read

out. We debated that extensively — I think it was last Wednesday — in the

House until 9 o'clock.

But the

issue I'm asking the Minister of Health about is this. When a health risk

service is as a result of municipal government's changes either in bylaw or by

regulation, and therefore it poses a health risk for their community, then I

understand from the Community Charter and through our debate that the Minister

of Health Services can actually intervene. So in the case where it relates to

methadone services and other services — I just use methadone services as one

example, but there may well be other examples that we can utilize at another

time — I would like to have the assurance from this minister that, in fact, he

will intervene and that he would ensure that there's…. Maybe the minister can

advise what mechanism he would put in place to make sure that health risks are

being monitored and therefore, when intervention is required by the minister, he

actually has the information to do so.

Hon. C.

Hansen: Certainly, we rely on our local health officials to report to us on

any actions taken at a local level that may compromise access to health care

delivery. That system has certainly worked effectively. We do get that

information in a very timely way.

When there

are issues where a municipality may be taking an action that could be

compromising health care delivery, we certainly undertake to meet with the

municipality. I cannot comment on the specific issue that the member is talking

about with regard to business licence fees, because that is before the courts

right now.

[1455]

But I can

comment on the other issue which I think she may get to, and that's the bylaws

around disclosure of patient information around the dispensing of methadone. We

have met with the municipality. My deputy minister went out to Surrey to meet

with the municipality around that. Certainly, there was very strong opposition

expressed by the College of Physicians and Surgeons and also by the College of

Pharmacists in that regard. Rather than taking a confrontational approach, we

have tried to work through this, and we think we're going to make the progress

necessary to ensure that those health care services continue to be delivered.

J. Kwan:

I wonder if the minister could commit in this House that he would have either

himself or his staff advise the opposition in terms of the progress that's being

made in this regard. This is particularly important for myself in

Vancouver–Mount Pleasant, as the minister can anticipate. We have a huge

problem and challenge in our community. In the downtown east side community we

continuously get attacked by others to say there are too many services in the

downtown

[ Page 6850 ]

east side, but at the same time other communities are not stepping up to the

plate to provide the services that are needed. Therefore, we actually have a

situation where it creates a loop. It's a circular loop where we can't really

tackle the problem unless the other community steps up to the plate. We really

need this minister and this government to hold the other municipalities

accountable.

I'm

concerned about it, because the Community Charter allows for broad powers. I'm

not necessarily opposed to municipalities having broad powers, but I do oppose

it when they actually limit access to health care services that would be

critical because they have a NIMBY — not in my back yard — approach to it,

and that's simply not acceptable. I would appreciate for the minister to

intervene when access to health care services is being limited by municipalities

and for the minister to advise us accordingly of all the actions either his

ministry or he himself is taking to prevent that.

Hon. C.

Hansen: I agree with the member's remarks entirely, and I will certainly

undertake to have somebody from my ministry contact you to make sure you're

fully up to date on what's happening on that front.

J. Kwan:

I would like to thank the minister for that commitment.

On this

issue, while I've got the opportunity, I would like to ask the minister if he

could please advise this House what the status is with respect to the

development on harm reduction initiatives to address the drug issue,

particularly in Vancouver, on things like heroin maintenance, safe injection

sites and other initiatives like that.

Hon. C.

Hansen: I know we did canvass the supervised injection sites fairly

comprehensively this morning, so I won't repeat that. I don't know if there's

additional information you're seeking in that regard, but I would certainly

endeavour to answer any additional questions you may have.

With regard

to harm reduction generally, the Vancouver coastal health authority is trying to

maintain and indeed enhance strategies in the downtown east side. There is the

contact centre that has been established. The needle exchange program is

ongoing. They are currently undergoing a review of the various contracts that

are for groups working in the downtown east side to try to see if there are

areas of lower priority where funds could be diverted to the areas of higher

priority and higher need.

I know

there has been a lot of talk about…. There are so many…. I was going to say

dozens; there are actually hundreds of great organizations that are trying to

make a positive contribution to the downtown east side, but there has also been

a concern about possible overlap and duplication. We're trying to look at if

there is duplication or if there is funding that's going into areas that may no

longer be as high a priority, whether or not we can reallocate some of those

dollars to some of the other strategies in the downtown east side that are of

higher priority. That is work that is ongoing by the Vancouver coastal health

authority.

[1500]

J. Kwan:

To clarify then, there are no additional moneys for new initiatives on the harm

reduction front for the downtown east side community; rather, it's reallocation

of existing funds. Is that what the minister is advising?

Hon. C.

Hansen: All of the health authorities in the province received an increase

in their budget last year. They all received an increase in their budget again

this year. They will have the challenge of trying to identify their areas of

priority in terms of how those dollars get spent within that area. If they

determine that there are priority areas for new and additional moneys on some of

these programs, they certainly have the authority to do that.

In addition

to that, one of the things we have done is transferred — this is the area of

addictions funding, which is obviously a component of this — contracts that

used to be administered directly by the ministries of Health. They have now been

transferred to the health authorities. That transfer resulted in about 35 FTEs

being transferred. The total cost of contracts and addiction services that were

transferred over to the health authority was $19.6 million. They will be looking

at how those particular contracts integrate with other work they have been doing

in the past or other contracts they have. Generally speaking, they've got two

options. They can either allocate a portion of their increased funding towards

these programs, or they can find those resources by reallocating existing

funding within their budget.

J. Kwan:

Could the minister please advise what the status is with respect to the NAOMI

project? The minister, I think, knows what that is, so I don't need to explain

it.

Hon. C.

Hansen: That particular proposal is sitting with the federal government. We

have not seen any progress on that particular file for many months now, and

basically the ball is with the federal government to move that forward. We're

waiting for feedback from Ottawa in that regard.

J. Kwan:

Does the NAOMI project have the support of this minister and this government?

Hon. C.

Hansen: The NAOMI project is a trial that is being proposed by the federal

government. If they determine that it is a legal and desirable health care

service, then the province will do its part to facilitate implementation of it.

J. Kwan:

When the minister says that the province will do its part to facilitate its

implementation, does that include funding?

[ Page 6851 ]

[1505]

Hon. C.

Hansen: This proposal is a research proposal that the federal government is

obviously looking at. If the federal government makes a determination that this

research project should go forward, it's our hope they will also provide the

necessary operating funds for that. I guess in the hypothetical situation that

they don't, it becomes one of the additional challenges that we have in terms of

determining if available funds can be identified from within budgets and moved

around from other projects. It's our hope and our expectation at this point that

if the federal government is going to proceed with this research, they would

also fund it.

J. Kwan:

Will the minister undertake to have these discussions with the federal

government to move it forward? Maybe he's already done that; I don't know. If he

has, could he advise: when did that take place? If he hasn't, will he undertake

to engage in discussions with the federal government to move these kinds of

projects forward?

Hon. C.

Hansen: Our provincial health officer, Dr. Perry Kendall, is on the Advisory

Committee on Population Health, and one of items on their issues of concern is

the NAOMI trials. That has been discussed, I gather, by the advisory committee,

so we have an ongoing dialogue with Health Canada in that regard.

J. Kwan:

Yes, I understand the various committees are still having their discussions.

That was the case when we were in government as well. Perry Kendall has done an

exemplary job in trying to advocate for changes at the provincial level, the

municipal level and the federal level.

What I'm

wondering at the political level, though, is whether or not the Minister of

Health Services will engage in a discussion with his federal counterpart,

because we actually, at the end of the day, need a political decision on that. I

wonder whether or not the Minister of Health Services will advance the NAOMI

project and commit to having a discussion with his federal counterpart.

Hopefully, we can see results soon. This is what I'm driving at.

Hon. C.

Hansen: I don't know when I would next be meeting with the federal Health

minister, but I'll certainly find an opportunity to raise this subject.

J. Kwan:

A quick way of doing it, also, is the telephone. I thank the minister for that

commitment to engage in those discussions. When the minister does, would he also

undertake to advise the opposition?

My interest

is not political in nature. My interest here is really just to see these

projects move forward, because they do make a difference in our community. They

save lives. They've been evidence-based in other jurisdictions as well, so it's

not political that I'm trying to raise these matters.

One more

issue, though. These issues are close and dear to my heart. They impact many of

my constituents in my own community. The last question I'd like to ask the

minister around this is, of course, the notion of stimulant maintenance. The

other addiction challenge we face in our community is addiction to cocaine, and

I know there's been research done around that stimulant and the maintenance of

that. Could the minister please provide his perspective on that and whether or

not he supports stimulant maintenance in that regard?

Hon. C.

Hansen: I must confess that is a new subject to me. I would certainly

appreciate any background information the member may have, and I'll undertake to

review it if she has material she can send to me.

J. Kwan:

Yes. Actually, I do have a study with respect to stimulant maintenance. I'd be

happy to pass it on to the minister and his officials for them to review and

respond to it accordingly. Okay.

[1510]

MacPhail: I have a document here that I received last year. It's called

Summary

of Reported Health Authority Activities: Fiscal Year Ending March 31, 2002 .

It's a

summary document all on…. I'm sorry, Mr. Chair. I'm moving to the

individual health authorities now and issues around that. It's a

summary

document, though. On the top line are all the six health authorities, and then

down the left-hand side are breakouts of revenues, expenditures, financial

status, acute care, mental health, home and community care. It's got the changes

from the previous year. Is such a document ready yet for the fiscal year ending

March 31, 2003?

Hon. C.

Hansen: I think what she's referring to is sort of broadly what we've pulled

in, and it's before it becomes data that is really solid. It is used internally

within some of the health authorities to give them rough indicators. It's also

the first stages in the data that eventually flows to CIHI and is then reviewed

to make sure that it is, in fact, sound data and that it is comparable with

other jurisdictions, for example, before CIHI produces its numbers.

I think

what she's referring to is data that is generated on an ongoing basis, that is

extremely raw and that is not really the basis upon which we can draw long-term

conclusions. But it does provide the health authorities with some indicators on

different time schedules.

The short

answer is that it's very, very raw data, I gather.

MacPhail: Well, actually, it isn't. This document is dated August 9, and

it's a complete

summary of the fiscal year-end. I'm not trying to use it to

embarrass anybody. It's just a good document to work from; that's all. Given the

fact that the regional health authorities are not here to answer questions

directly, it's a

summary document with which I can work and the opposition can

work in discussing these matters.

[ Page 6852 ]

Will this

not exist for the fiscal year ending March 31, 2003?

Hon. C.

Hansen: I gather that these reports are cranked out on an ongoing basis and

are used within the ministry and within the health authorities.

MacPhail: Okay. I'm going to continue to FOI them, because I think they're

very useful.

I want to

start with the Vancouver Island health authority, please. There are reports that

the Vancouver Island health authority will have a surplus ending March 31, 2003.

If so, what is the surplus?

Hon. S.

Hawkins: I ask leave to make an introduction.

Leave

granted.

Introductions by Members

Hon. S.

Hawkins: Today one of the classes from my constituency was here. It was Dr.

Knox Middle School.

[1515]

Unfortunately,

due to unforeseen circumstances, they couldn't come to see me. I do want to

acknowledge that I hope they have a great time here in Victoria and they take

back good memories. Unfortunately, they couldn't see how the Legislature was

run, but they were in my thoughts. I just want everyone to welcome them and make

sure that maybe next time they come, we will let them into the buildings.

Debate Continued

Hon. C.

Hansen: The year-end surplus for the Vancouver Island health authority is

$700,000 on a base budget of $988 million.

MacPhail: I've got the performance agreement between the Ministry of Health

Services and the Vancouver Island health authority. I'm wondering if I could go

through the targets, starting at page 5 on their year ending '03, "Expected

performance."

The first

target is: "Increased use of needs-based and evidence-based best practices

to achieve." There was no expectation in the year '02-03. The

expectations begin this year. I'll move on to the next one, which is:

"Improved continuity of care measured by the proportion of persons

hospitalized for a mental health diagnosis who receive community or physician

follow-up within 30 days of discharge." The target for '02-03 is 3 percent.

I couldn't

get the base targets last year in estimates. The minister and I had quite a

discussion around base targets so that I would know — or the public would know

— what the increase is, how to meet the increase. I guess that must have been

figured out in order to say how that performance target is met. Perhaps the

minister could give me the base and then whether this target was met.

Hon. C.

Hansen: I am advised that all of the health authorities are on target with

regard to meeting that commitment. What I don't have right here is the baselines

for each of the health authorities. I can provide for her the rollup for the

province. That is, in 2000-01, a baseline of 70.9 percent. By 2001-02 we were at

72.6 percent. For 2002-03 it is partial data only, so it is at 73.1 percent, but

they are projecting a 3.1 percent increase from the baseline.

[1520]

Just to put

this in context, in most of the performance indicators, wherever we could

possibly do this, we tried to find an outside independent source for data. We

were trying wherever possible not to use our own internal data for these

measurements so that we could rely on objective, independent sources.

I think one

of the good sides of that is it does give the public more confidence in the data

and the performance evaluation. The downside is the timeliness of that. So in

the case of getting those numbers from CIHI, we're looking actually towards the

end of the calendar year before we'll probably get some definitive numbers. But

so far our projections show that we are on target to achieve those goals.

MacPhail: I'm sorry. At the beginning, did the minister say those were

provincial stats? He's nodding yes.

Will the

individual authorities be expected to meet their own targets?

Hon. C.

Hansen: As I understand it, there wasn't a different baseline for each

health authority in the province. The health authorities were actually given the

provincial baseline, and they were all expected to make their target

improvements from that baseline. So when we do get final data from our various

independent sources — which, as I say, will probably be towards the end of the

calendar year — that will be put into an accountability report to determine

with certainty that the health authorities are meeting their targets or to

identify areas where they are not meeting targets. It is our expectation that

that information will become public as part of their accountability not only to

us, as government, but to the public generally.

MacPhail: Let me just ask another point of clarity, then. I am going to go

through all of these targets for the Vancouver Island health authority. But

would the minister then be giving me information…? I mean, we're still going

to do it. But will the information he'll be giving me be provincial information,

and therefore am I to conclude that these targets are the same for every health

authority?

Hon. C.

Hansen: Most of the expectation targets are common across all of the

performance agreements. There are some specific ones where they vary from

[ Page 6853 ]

health authority to health authority. Just one example is actually the next

one that we would have come to, which is the Riverview replacement units.

Certainly, in cases like that, each health authority has its own targets.

[1525]

MacPhail: Thank you. That helps a lot.

So the next

one is — I'll just read it into the record — for the Vancouver Island health

authority: "Development of Riverview replacement units and selected

locations to be achieved over the three-year period." The target for '02-03

was 33 units.

Hon. C.

Hansen: The Seven Oaks facility was opened. That has 24 units, so they are

falling short of their target for that year, and they're going to have to make

it up.

MacPhail: I understand that these are three-year plans, but this is the

first year that we've had to see the success of the targets.

Sorry, I

missed my page here. The next performance is in the area of home and community

care. There are other targets, but these ones are just specific to numbers. Or

does the minister want me to ask this one of the minister for…? Okay.

"Increase the proportion of home and community care clients with high care

needs, requiring care at the IC 2 level or higher, living in their own home

rather than in a facility. This is indicated by the number of high-care-needs

clients at home as a percentage of high-care-needs clients in total."

The target for '02-03 was a 2 percent increase.

Hon. C.

Hansen: Based on the interim data, they are ahead of that objective.

MacPhail: On Vancouver Island. Thank you.

"Public

Population Health" — no, that's fine. Then the sixth one. "Support

and Administrative Service. Expected performance: reduce the annual expenditure

for support and administrative services, excluding information systems."

Oh, that's a target for '04-05 by at least 7 percent.

Does the

minister have an update for Vancouver Island on that? I do accept it's a target

for '04-05.

Hon. C.

Hansen: Yes, they are on track. All of the health authorities are actually

on target to meet that 7 percent expenditure reduction in administrative and

administrative support services.

MacPhail: Next I'll turn to my health authority, the Vancouver coastal

health authority. What surplus or deficit is the Vancouver coastal health

authority running at the end of '02-03, please?

Hon. C.

Hansen: At this stage, they are projecting a $4.4 million surplus on a base

budget of $1.6 billion.

[1530]

MacPhail: I just want to bring to the attention of the minister something I

received from my own health authority. I do raise it with the greatest of

respect. It's from the communications department of the Vancouver coastal health

authority, and it is to me as an MLA. It's the Vancouver coastal health one-year

anniversary spotlight on Vancouver, April 2003. I read the letter, and it is

targeted specifically to members of the Legislature. It says:

"It

is very likely that the April one-year anniversary of the announcement of

health care redesign will prompt a review of progress to date in building

equitable access to a high-quality patient-centred system of care that is

sustainable. In that regard, I am writing today to share with you what I hope

will be helpful information on our progress.

"Members

of the Legislative Assembly play a critical role in advancing

recognition of health accomplishments and improving public confidence in their

health care system. Accordingly, I want to provide you with at-a-glance

information on Vancouver coastal health authority achievements for patients

and their care at a broad level, as the case may be, within your community and

the constituency you represent."

It's

very much targeted toward me as an MLA. However, it's completely irrelevant to

the performance agreement of the Vancouver coastal health authority. The first

thing I did was get out the performance agreement in my own health authority

and compare it, and it was impossible to compare. This may be useful. I'm not

sure. Regardless, it's an interesting document, but there's not one overlap

between this, which is their record of achievement as professed by them…. I

can't figure out anything about what it has to do with their achievements in

terms of the performance agreement. So I was interested in that, because it is

specifically targeted to me as an MLA. I only make note of that. The only

advantage to the minister to have that information is that it could have

shortened estimates if there was an overlap, so there could be something in it

for him if he gets that corrected. Anyway, we have to go through this for my

own health authority as well.

Let's talk

about this. I actually had some more interest…. I'm approaching this from a

local MLA's point of view too, so I have some extra questions on performance

targets in this. One is emergency health services. I'm looking at page 4 of the

Vancouver coastal health authority performance agreement. It says:

"Expected

performance. Within the process directed and supported by the provincial

health services authority, collaborate with the Ministries of Health and other

health authorities in developing guidelines to better manage demands on the

emergency health services in the acute hospital system. The process will

include a review of literature and research as well as practices and

performances in other jurisdictions.

"The

product during (a) 2002-2003 will be a set of guidelines for

best practices in the management of emergency health care, including reporting

requirements, measures and assessments of service coordination. These

guidelines will be adopted by the health authorities."

[1535]

[K.

Stewart in the chair.]

Hon. C.

Hansen: There has been a tremendous amount of work done on this by not only

the Vancou-

[ Page 6854 ]

ver coastal health authority but indeed all of the health authorities under

the direction and leadership of the provincial health services authority. They

have done guidelines, and as they rolled through this process, they realized

that would become an ongoing process to enhance those guidelines.

Specific to

Vancouver coastal health authority, they have completed phase 1 of their

emergency services planning project that was completed in November, which made

recommendations on the required emergency department capacity — how this

capacity should be sited, and the required systems to ensure accessible,

high-quality, appropriate, coordinated and cost-effective emergency room

services. Phase 2, involving the implementation of the phase 1 recommendations,

is currently underway and is expected to be completed in March of 2004.

MacPhail: Will that be made public?

Hon. C.

Hansen: The answer is yes. The provincial health services authority will be

posting this information as soon as they get loose ends pulled together on it. I

should also point out that it is going to be an evolving process. It's not going

to be sort of static guidelines that then sit in perpetuity. This is an ongoing

process to make sure that it's current and that we can learn and enhance these

guidelines as we go forward.

MacPhail: In noting the time left for us to debate matters until the

conclusion of this session, I will be spending less time than I would have liked

on the issue of ambulance services. We will be concentrating on that in the next

set of estimates, but I do want to ask this. Part of the emergency health

services performance targets says: "Measures may include an implemented flu

season response plan, regular sample surveys of the movement of selected marker

conditions throughout the emergency system and a reduction in the wait times and

periods on diversion in the emergency departments. The work will include

representation from B.C. Ambulance Service."

Is there

any update on those? Those indicators aren't necessarily assigned to any

particular year, but I'm wondering whether the minister has any update on any of

those targets. We have been through a flu season, and I'm just wondering whether

there's any analysis done.

Hon. C.

Hansen: Just to touch on a couple of the points. For flu season we actually

expanded the immunization program to include other individuals that are

qualified for free flu vaccine in this last year. We were certainly fortunate

that the flu season wasn't as bad. It did happen. It was actually a little later

this year than it has been in previous years, so it did impact in a significant

way on some of our emergency rooms. We're certainly learning, and the response

plans that are being developed as part of this process are taking that data into

consideration.

The other

thing is in terms of the time it takes for someone to be treated and their

throughput in the emergency room system. We set targets. Specifically, in

Vancouver coastal they set targets for themselves in terms of what appropriate

wait times are in their emergency rooms, and they're making progress in that

regard.

[1540]

Also, with

regard to B.C. Ambulance Service, they are very much integrated with this

process of emergency rooms. They are obviously a key element in making sure that

both ambulance wait times and wait times for patients generally are down at our

emergency rooms. Much of that becomes part of that bigger puzzle, which is

getting access to admit patients into acute care beds on wards, and that then

gets blocked or frustrated by patients who can't be discharged because of lack

of community care beds.

We are

working on all elements of that, but it almost has to happen in a parallel

process, where all of these stages within the health care system have their

challenges addressed so that ultimately it comes back to the emergency rooms. I

recall when the St. Paul's emergency room shut down for a 14-hour period, I

think it was, in November of 2001 or thereabouts. One thing I learned from my

discussions with those front-line workers the following day was that while they

see the pressures, the real problem is elsewhere in the system and being able to

get patients through the emergency room in a timely fashion. So we're certainly

making good progress in that regard as a result of this whole program review.

J. Kwan:

What about in the area of surgical procedures? Let's start with that as well.

With the service plan, there are targets that the government has outlined. How

are we doing with respect to trying to meet those targets?

Hon. C.

Hansen: Again, we did spend a fair amount of time this morning on this

around the provincial surgical and procedural services project. I was able to

report that the Vancouver coastal and the interior health authorities are making

good progress around the development of this surgical review. I think it's well

on track, and I expect that under the leadership of the PHSA we'll be able to

put a comprehensive provincial approach in place that will allow us to deal with

wait-lists more effectively and to integrate the findings and the results of the

Western Canada Waiting List Project. The net result is to ensure that people get

timely and effective access to care.

J. Kwan:

Is it still anticipated, in terms of time lines, that '03-04 will see the

introduction of these measures and standards, and that then in '04-05 you can

see demonstrated improvements in terms of the performance of these surgical

services?

[1545]

Hon. C.

Hansen: The target in '02-03 was the development of measures. There's

been a lot of work done in the development of those measures, so we are

[ Page 6855 ]

well into that process. If you'll note, the '03-04 target is continuation and

completion of those deliverables, and that is underway. Finally, in '04-05 the

demonstrated improvement — we anticipate that will be met.

J. Kwan:

The minister is saying they're actually on target with respect to this plan, and

then we can expect to see the demonstrated improvement of performance in this

area in '04-05.

While we're

talking about performance measures, could the minister please advise why

mortality rates for children were deleted as part of a health performance

measure?

Hon. C.

Hansen: Infant mortality was never dropped from the performance measures.

When we developed the performance measures for the health authorities, what we

tried to do was identify areas where we had particular challenges in the health

care system. We wanted to make sure the health authorities paid specific

attention to those specific challenges so we could see measurable improvement in

those areas.

Infant

mortality is one that is measured by the provincial health officer as part of

his regular report. We obviously want to make sure that infant mortality is as

low as it can possibly be in this province.

What we did

in the performance contracts was put in place a specific measure for aboriginal

infant mortality. That was an area where there was a population that had a

different outcome than the general population, so we wanted to make sure the

health authorities focus particular attention on infant mortality.

Certainly,

as a reportable measure it continues to be reported in the same way as it has

for the last number of years. I'm not sure how far it goes back in the annual

report of the provincial health officer.

J. Kwan:

My understanding was that infant mortality was deleted. If I'm mistaken in that,

I stand corrected. Maybe the minister can advise, then, what the measurements

are now in terms of performance in health services for British Columbia. What

are the performance measurements right now?

Hon. C.

Hansen: Maybe I should get some clarification. I'm not sure what she means.

Maybe she could rephrase the question or restate the question.

J. Kwan:

My understanding was that infant mortality was deleted as a performance measure

for health service and its delivery. If I'm mistaken in that, I stand corrected.

The minister advises that the measurements have stayed constant for the last

number of years. If that's the case, maybe the minister can refresh me in terms

of what those measurements are and list them for me.

[1550]

Hon. C.

Hansen: The infant mortality was never a performance measure for the health

authorities. What was in there was aboriginal infant mortality. I did not say

that it was constant. What I said was that we tried to identify areas that were

of a particular challenge, where we wanted health authorities to focus on them.

Aboriginal infant mortality is one that is not consistent with infant mortality

for the general population. It's an area where we felt the health authorities

should pay some particular attention. That's why we put that in as a particular

performance measure for them so that they would focus on that particular

challenge within the health care sector.

J. Kwan:

Could the minister please advise, then, what measures are being used right now?

Hon. C.

Hansen: If the member is referring to the performance agreements of the

health authorities,

schedule A, which sets out those performance indicators,

consumes seven pages. I can certainly send a copy to the member if she would

like me to pass it over to her. There's a whole range of different indicators

that I would be pleased to provide her with.

J. Kwan:

Sure, I'll take a look at that. Then maybe I'll come back to it. I'll find the

document I just came across saying that the performance measures have actually

changed and that infant mortality has been deleted as one of the measurements.

Anyway, I'll take a look at that and perhaps come back to it if need be.

Let me ask

the minister. In the performance agreement the next sections, of course, deal

with mental health and home and community care. Now, I just want to be clear and

seek advice from the minister. Should I be asking the minister the questions

here around these areas, or should I wait to ask the two ministers of state in

these areas the questions?

Hon. C.

Hansen: It's really up to the member. I have responsibility for the

relationship with the health authorities. The Minister of State for Mental

Health has responsibility for that sector and the development of policy and,

therefore, was very much an integral part of developing the performance measures

we have set out. It's up to her. I can try to answer them. Perhaps if there are

areas that the minister of state is better able to, we can defer, and he can

pick them up when you ask him questions.

J. Kwan:

Then in the area of mental health services first, could the minister please

advise how much money is being allocated from his budget for mental health

services?

Hon. C.

Hansen: I can refer the member to page 14 of the service plan for the

ministry. In there what we have done is set out all of the mental health service

funding. If you look at the chart on the bottom of that page, in the coming

year, '03-04, there is $1.067 million for mental health services.

J. Kwan:

How much of that is being allocated to the Vancouver coastal health authority?

[ Page 6856 ]

[1555]

Hon. C.

Hansen: We do not allocate from the ministry a line item that says there has

to be a specific allocation of their financial resources to mental health

funding. What we have done in this chart on page 14 is with the information

provided to us by the health authorities in terms of how they have allocated

their budget and what the funding levels for the mental health services would be

for the province. The only item that we've actually allocated in a specific

sense in the last year is the area of addictions, which was administered

centrally by the ministry. It has since been transferred to the health

authorities. In that regard, that one item alone was $19.6 million that was

transferred to the Vancouver coastal health authority vis-à-vis addiction

services.

J. Kwan:

If the budget for mental health services for the Vancouver coastal health

authority is about $1.6 billion, how could the minister…? Sorry. Actually,

that's not the money for the coastal health authority. The minister doesn't know

how much of that $1.6 billion is being directed towards mental health services

in each of the regions.

How can the

minister be sure that mental health services are actually being protected within

his budget and that services are being delivered?

Hon. C.

Hansen: We have specific targets and outcome measures in the performance

agreements. They're indicators in terms of appropriate delivery of mental health

services, so we are holding the health authorities accountable for delivering

services. I guess part of the big shift that we are doing as a government is no

longer focusing on how much money we spend on programs as a definition of a good

program, but rather we're looking at the outcomes of that.

[J.

Weisbeck in the chair.]

With our

population needs–based funding allocations, we have made sure that each of the

health authorities gets a fair allocation of the Ministry of Health Services

budget. Then we give them the flexibility to determine how they can best meet

the needs in their region within that budget. We hold them accountable by

measuring outcomes that are set out in the performance agreements.

J. Kwan:

In the performance measures outlined in this service plan, or performance

agreement as you call it, I already see shortcomings in terms of how you make

sure that people in the area of mental health services are actually getting the

services they need. The measurements don't necessarily give you the ability to

capture the reality of what's going on.

Let me

first ask a broad question of the minister. Does the minister not see some of

the shortcomings in terms of the performance measures that are outlined in this

service plan?

Hon. C.

Hansen: Probably if I read this short paragraph, it might answer the

member's question:

"The

proportion of patients that have community or physician follow-up within a

four-week time frame is intended to be a measure of improved continuity of

care, as it measures the health system's responsiveness and continuity of care

for people with a mental health diagnosis. A high rate of community or

physician follow-up indicates the hospital and community or physician services

are well coordinated and that community or physician services are available

and accessible. By ensuring a high rate of follow-up after hospitalization for

clients hospitalized with a serious mental health diagnosis, health

authorities can expect to impact positively on quality health outcomes and

reduce the need for hospital readmissions."

addition to the indicators that we've got in our performance agreements, there

is also a considerable amount of work done by MHECCU, based at UBC, to

evaluate outcomes in the area of mental health. Certainly, we rely on

basically the whole range of reports that we get back, which are actually

indicators that we are seeing improvements to the system.

[1600]

J. Kwan:

I'll use one example here in terms of problems that I have with some of the

performance measures outlined in this performance agreement. Under the mental

health services component, expected performance is measured by increased use of

needs-based and evidence-based best practices to achieve…. Then it goes on to

list sub (i), sub (ii) and sub (iii). Sub (

i) states: "Increase in early

intervention capacity as evidenced by the decrease in average patient age at

first contact with a physician or health service provider for serious mental

illness."

Let me just

stop here and ask the question: how does one define a serious mental illness so

that you can actually determine whether or not early intervention took place?

Hon. C.

Hansen: The definition of serious mental illness is actually a protocol that

is fairly well established. There are diagnostic codes for various mental

illnesses so that the physicians that are doing diagnosis will assess their

patient and determine their particular illness.

It is based

on the reporting of those diagnostic codes that we have measurables. We then

compare it against the age. One of the objectives for good mental health

services is to make sure that people get diagnosed as early as possible, because

the earlier they can get into treatment the better we are able to manage their

long-term illness.

J. Kwan:

Then under sub (ii) it says: "Decrease by 4 percent over three years in

the alternate level of care days spent by mental health and alcohol and drug

clients in hospitals once the primary need for in-patient care has completed,

specifically: target '02-03, zero; target '03-04, 2 percent; and then target

'04-05, 2 percent." This is a measurement of how many days are being spent

in the hospital.

The

minister earlier also referenced a performance measure in terms of how often a

person is readmitted,

[ Page 6857 ]

yet in this performance agreement it doesn't actually state that. What I'm

worried about is that there are other ways — there need to be other ways —

to do a measurement, to do a true assessment, of what is really going on and

whether or not the needs of the community are being met. Yet it's not stipulated

in this performance agreement specifically. How does the minister get the

assurance or the reassurance that the performance is actually satisfactory?

Hon. C.

Hansen: Again, what I'll do is read you what is referred to in this document

as the indicator rationale as to why that particular indicator is seen as

appropriate.

"ALC

measures are commonly used as an indicator of inefficiency in hospital care

and provide a measure of more cost-effective use of hospital and community

resources. Current mental health reform efforts are intended to provide more

community resources for people with serious mental illness. Over the long run,

improved access to these services in the community should reduce the

unnecessary use of hospital beds by mental health patients."

[1605]

What's

important about the indicator is that it's measuring system change. When we talk

about health status…. The provincial health officer's report, as the member

will know, is very comprehensive. It actually measures health status, but what

we're looking for are indicators of how the health authorities are effectively

managing change in the system that will lead to enhanced health status in the

future.

J. Kwan:

Well, let me use an example, then. In my community, actually, there are a lot of

people who are multi-diagnosed. They may have a mental illness. They may have an

alcohol and drug problem or childhood traumas amongst a variety of things. The

list is endless.

In many

cases, because these individuals are so complex in terms of their health needs

and because they're so marginalized, they often actually don't get the service

they need until they're in a crisis situation where they end up in an emergency

situation. Sometimes they may not even end up in the hospital, because they live

in such situations that they can't get the assistance they need. So in those

cases, where's the measurement in terms of a performance measure to ensure that

those individuals are getting the kind of care they need?

Oftentimes

they are the people who fall through the cracks. Because they are

multi-diagnosed and each of their challenges is so severe, people may actually

cast aside their mental illness, as an example, and really just look at them as

alcohol and drug problems. So I'd like the minister to clarify how we ensure

that population base gets the care they need and how that is measured.

Hon. C.

Hansen: I know we had the discussion earlier about what may be appropriate

for the Minister of State for Mental Health, and there is a lot of policy

development work around dual diagnosis that is in progress now. We have set a

goal of 2004 to have completed a best practices for concurrent disorders,

including substance misuse and mental illness. That is a project that's being

worked on, and my colleague the Minister of State for Mental Health will

certainly be more familiar with that than I am at this point.

When we're

talking specifically about the performance measures, hospitalization and

hospital use is one of the performance measures. If we have effective community

programs in place for those with mental illness or dual diagnosis, then we will

see a reduction in the utilization of hospital care. The whole purpose behind

the programs in the mental health plan is to ensure that people get care and

support in the communities so they are not hospitalized. So that's why part of

the purpose of measuring hospital use and readmission is directly relevant as an

indicator to ensuring we are in fact managing these better at the community

level rather than at the acute care level.

J. Kwan:

Yes, it's one measure that is being used and can be used. The point, though,

that I'm making is that where those individuals, who may not end up in a

hospital bed…. It doesn't mean that adequate care is being given to those who

need services. It does not mean that at all, just because you don't end up in an

acute situation.

[1610]

The other

point I want to make, in terms of the performance measure, is where a person has

multiple diagnosis, they may actually have a severe mental health issue. But

because of the way our society is, quite frankly, and sometimes the way

governments tend to be, I think there's an order — a hierarchy, if you will

— of what society deems to be deserving and undeserving individuals. If you're

a person with multiple challenges such as addiction challenges as well as mental

health challenges, sometimes the addiction problem can overshadow the mental

health problem. When that happens, that person is not identified as an

individual with a mental health challenge, just as someone who is a drug- or

alcohol-addicted person. In our society and particularly in our community, many

people look at this group of people as castaways. Somehow they're unimportant

and really are non-human beings, if you will.

Nowhere in

this instance, then, are we measuring and evaluating whether or not this group

of people is getting the services that it needs. I think these are the people

that, because they're so marginalized, actually fall into the gaps, and problems

actually surface in our system and therefore cost the system more money down the

road.

I don't see

an opportunity within this performance agreement that will target that

population base. Am I missing it? Is it in here somewhere, and I'm missing it?

If it's not in here, can the minister advise me, and give me assurance, of how

that population base will get the adequate services that it needs?

Hon. C.

Hansen: I think the points that the member makes are very valid. This is

exactly why we have

[ Page 6858 ]

transferred addiction services to the health authorities — to make sure

that we do have an integration of those programs at the community level. We

actually had addiction services that were being managed out of Children and

Families, and mental health was being managed out of the provincial Ministry of

Health, so we shifted those programs over to the health authorities. Mental

health services were located with the health authorities, but the addiction

service was transferred, first of all, to the Ministry of Health Services and

then subsequently to the health authorities themselves so that those programs

could be better integrated.

I think it

also speaks to the challenge around measuring the inputs that we wind up with

programs where you try to measure inputs. Are you measuring inputs on a program

that's aimed at addiction or aimed at mental health, when in reality you have

programs aimed at both and that really achieve the same objective, and that's

integrated care?

But there

are other performance measures that certainly are public, which impact on this.

One of them is around suicide rates. Our objective, obviously, is to make sure

that through proper programs and proper support at the community level, we will

see suicide rates come down. If you look at patients in the criminal justice

system — which is something that's tracked by the Solicitor General — again,

a reduction in the number of individuals with mental illness or dual diagnosis

or addictions in the criminal justice system…. If we see those rates come

down, it will be evidence that our community-based programs are working better.

There are

also issues around transmissible diseases, which are reported annually by the

provincial health officer.

I think

that by ensuring we can manage those programs in an integrated fashion at the

community level, we are going to have better success in ensuring that those

individuals get the supports they need. The net result should be that some of

these various indicators are going to show positive changes.

[1615]

J. Kwan:

Yes, that's the theory, and I suppose that's the goal of what we're trying to

achieve here — both the minister and the health authorities. My concern,

though, is that in the community, and particularly — again I use my own

community as a base because that's the one I know best — when I look around my

own community, the challenges are enormous. There are many people who are

multi-diagnosed, and I actually foresee further problems coming down the road. I

don't see in this performance agreement that the measurements that need to be in

place will actually give me the level of comfort that this population base will

be taken care of.

The other

challenge that's coming and is not too far away is the changes in the Ministry

of Human Resources when the two-out-of-five-year provision comes in. Next year

individuals who are on income assistance for more than two years within the

five-year period will no longer be qualified for income assistance, and often

these are the people who are faced with multiple challenges. Some of them are

individuals with mental health issues; some of them are people with alcohol and

drug addiction problems — the whole range of problems that people are

sometimes faced with through no fault of their own, really. It's just the

challenges they're faced with.

Those

individuals already in the system — and I know of some of them through the

human resources applications side — are not deemed to be persons with

permanent disabilities, because their drug and alcohol addiction problems

overshadow their other problems. The Minister of Human Resources has already

said and sent them letters to say that people with alcohol and drug addictions

are not deemed to be people with disabilities, nor are they even deemed to be

the people who are unable to work — not on a permanent basis but on a

temporary basis. Really, they will actually be cut off of the income assistance

programs after they've been on income assistance for two years with the new

changes, and then they're going to be on the streets. That combined with the

problems they have…. Again, many of these individuals also have mental health

issues.

I wonder:

how will this population base get the service they need, and how can we be sure

they will? Does the minister not see that the problems for these individuals

will actually even be worse? When they get cut off of income assistance, the

complexity of their problems would be even further exacerbated. How do we deal

with that?

Hon. C.

Hansen: The performance indicators were really designed to be indicators of

system change. It would be absolutely impossible to put a performance agreement

in place that measures every single outcome. Obviously, we want better outcomes

across the health care system, and I appreciate the comments the member has made

about the plight and the challenges that individuals with dual diagnoses are

facing. I believe our health care system is responding to that. We obviously

don't have instant answers or quick fixes, but I think we're making some very

good progress in that regard.

I would

certainly refer the member to page 14 of the service plan, where we set out, as

part of that section, the steps that are being taken by the health authorities

to address some of these issues.

So I think

there is progress being made. It continues and will continue to be a big

challenge for the health authorities, but we believe that the performance

indicators that we put in place capture the broad context of the system change

that is desired. We do have, as I indicated, other outcome measures, whether

it's from MHECCU or whether it's the provincial health officer's annual report

or whether it's other reports that we can refer to from time to time to give us

the confidence that in fact these individuals are getting better care than they

did the year before.

J. Kwan:

I appreciate the fact that these performance measures are targeted towards

changes in the

[ Page 6859 ]

institution, but the reality is that whatever change is happening

institutionally, the bigger issue for me is: how is that impacting the community

on the ground? That's really, at the end of the day, where we need to look at

whether or not changes are effective. Government can stand in the House or

anywhere else and wave these numbers and say how great it is that we have

reduced the number of days that people require in the hospital, but when I go

out into my community and see a boatload of people on the streets without the

assistance they need, I get no comfort, quite frankly, from those numbers. They

don't mean anything to me, nor does it mean anything to our community, broadly

speaking.

[1620]

While I

appreciate what the government and this minister are trying to do to change

institutionally and to get better numbers accordingly, that doesn't extend

necessarily to what is happening on the ground. Those are the concerns that I'm

bringing forward.

In the

service plan on page 14, which the minister references — in writing — the

goal here is to try and integrate and to combine their services by providing a

continuum of services between community-based care and hospital care, and to

coordinate all of those things. How do you know that this is actually being done

is the question I'm asking. Yes, one measure is to say: "Well, let's look

at the hospital admissions." How many people have gone to the hospital? As

I say, there are a bunch of people who may not use the hospital system and

already, as it exists now, are not using the hospital system, but it does not

mean that they are getting the care.

I guess my

point is that I have no reassurance from this plan and from the words of the

minister that somehow that population base will get the services they need.

Maybe I can canvass these questions with the Minister of State for Mental

Health. I know that earlier in the small House I started to ask the Minister of

State for Mental Health some questions around these issues, but then I was

advised by the Government House Leader to hold off my questions until the

following Monday when we are back. I'm prepared to do that. Maybe I can canvass

with the minister of state further on the performance issues related to this

population base not only in my community but in other communities as well.

I want to

then move to the question around Riverview replacement units. In this document

here it talks about the development of Riverview replacement units in selected

locations to be achieved over the three-year period. Riverview is, as we know,

being shut down. The beds are being shut down. Could the minister please advise

about the patients who have left those beds as they are re-entering into the

community?. What kind of tracking system is in place to follow these patients to

see what their needs are and to ensure that the services are available to them

to meet their needs?

Hon. G.

Cheema: I was just watching the channel, and I was very astonished to see

this member asking questions about performance measures about mental health.

They had ten years to quote even a single measure, and they had no measurement.

We have done a lot of stuff for mental health, and I will just answer the

question now.

I don't

want to go into a path where I just have to repeat all their message, but let me

just give her the information about the Riverview Hospital. The Riverview

Hospital redevelopment project is a part of our commitment, and we are spending

$138 million on that project. By the end of five to seven years, we'll end up

having 116 more beds in this province. When these patients are being moved into

the community, into the smaller facilities — for example, in Kamloops or in

Prince George, in Iris House or in Connolly Lodge — these patients are

receiving the care they need.

We are

basing our care on best evidence practices. That means these patients will not

only get more modern facilities, but their care will be even better than before.

This year we have funded about $3 million as transitional funding for these

patients. Members should know that. It was their plan, and if she had read that

plan, it would make very clear that we are meeting all those eight goals in that

plan. We have met each goal in that plan.

[1625]

So far we

are tracking those patients, and those patients are receiving care in a very

meaningful way. I'll give you two examples. In Kamloops two weeks ago, we

transferred about 23 patients. One of them said it's the first time in that

patient's life that he was able to see his family in 23 years. That's the kind

of care we are providing. One patient said that in 40 years of his life, this is

the first time he thinks he's being respected as a person. That's the kind of

care we are providing.

Our

Riverview redevelopment plan is on track, and we are monitoring the plan. We

have a team in place at the Riverview Hospital. That team is being organized by

Leslie Arnold. There is a committee where the patients and the families as well

as the caregivers and the receiving end of the community are participating, and

no patient will be transferred without the approval of that process.

J. Kwan:

I'm delighted that the Minister of State for Mental Health is prepared to take

questions on this issue, notwithstanding that the Government House Leader

advised the opposition caucus to not ask questions in the small House of the

Minister of State for Mental Health.

Now that

we're into mental health services, let me actually get into the meat of it,

because the Minister of State for Mental Health just rose in this House to say

that he was astonished that the opposition have questions for him around mental

health issues and performance measures. I have a boatload of questions for this

minister around performance measures and the impacts of what's happening in our

community with all the cuts in services that are taking place right now across

British Columbia.

Let me go

to the minister of state, then. I'm happy to do this debate accordingly, as

such, around that. Let

[ Page 6860 ]

me ask the Minister of State for Mental Health a question around performance.

I was just canvassing with the Minister of Health Services around how you

measure the people with dual diagnoses who fall through the gaps. They don't get

the services they need now, because they're somehow deemed to be devalued as

human beings, and they fall through the cracks right now in our own community.

How do we ensure that the services they need are actually being provided for

under the performance plan as stated in this ministry's performance plan today?

I'd like the Minister of State for Mental Health to answer that question.

Hon. G.

Cheema: I understand that the Minister of Health Services has answered all

those questions already.

J. Kwan:

Sorry, the minister didn't answer my question.

Hon. C.

Hansen: You know, I do have responsibility for performance measures, and we

have canvassed those across a range of things, including mental health. I think

it's important to underscore that these performance measures are the first time

that our health care system has had performance measures that are holding the

health authorities accountable. It's not to diminish all of the other reports

and outcomes that are presented, whether it's through the provincial health

officer's report or other sources. This is an added dimension to the health care

system.

I think

we've been through why we have certain indicators. I know that the member is

concerned about how much time we have available to discuss the whole range of

the $10.5 billion Health Services ministry budget. If she wants to ask exactly

the same questions of the minister of state as she asked of me, then it's

obviously going to consume a lot of those available hours.

J. Kwan:

You know what? I asked the Minister of Health Services questions, and he was

trying to answer them. He was; there was no doubt about that. Then the Minister

of State for Mental Health comes into the House and says he was watching on

television and that he was astonished that somehow I would ask questions around

performance in relation to mental health services.

You know,

in the small House earlier this morning, I just started to canvass questions

with the minister. I think I got in two questions with the Minister of State for

Mental Health in the small House. Then I was advised by my staff that the

Government House Leader would prefer for the opposition caucus to not ask

questions of this minister at this time and to wait until when we come back in

the last week of May. Then I yielded the floor to the government members to ask

the questions.

So as we're

getting into the mental health services component of the performance agreement,

I asked the Minister of Health Services whether or not I should canvass these

questions here, and he advised: "Sure, you can bring some of the questions

forward, and you can, of course, ask further questions of the Minister of State

for Mental Health." I'm prepared to do exactly that.

[1630]

As I'm

asking these questions, I am completely shocked that the Minister of State for

Mental Health would come into this House and criticize the opposition for asking

questions on how to measure performance measures for mental health service and

its delivery in British Columbia. It's his job to ensure that services are being

delivered and that there are adequate performance measures in place so that we

know that the system changes, the institutional changes, the Minister of Health

Services is trying to put in place are actually yielding the kind of results we

all hope for.

Without

those performance measures in a way that we can actually see the changes in our

community, you can wave all these numbers saying how great we are all you want,

but it doesn't make one iota of difference when I see in my own community that

people are not getting the services they need. I want reassurance in this House,

from this Minister of State for Mental Health, how he's going to provide those

performance measures. I'm waiting for an answer from the minister of state now.

Hon. C.

Hansen: I think, as we discussed earlier, there are all kinds of different

ways that that gets measured. Unfortunately, some of them are as tragic as

things like suicide rates. Obviously, we want to make sure our programs bring

those rates down. The performance measures for the health authorities are broad

indicators. We've never expected them to be the be-all and end-all of measuring

outcomes, because we do have all of these other vehicles.

Again, you

know, we do have that kind of accountability. Over time we certainly, I think,

all want the same objective. That's to see better health outcomes for

individuals with mental illness, for individuals with dual diagnoses and indeed

for all patients in British Columbia, regardless of what kind of medical

conditions are affecting them.

J. Kwan:

The Minister of Health Services actually did provide some areas in terms of

performance measure. What he also said, though, when I asked the question around

dual diagnoses and multiple diagnoses, was that the policy development in that

work is undertaken by the Minister of State for Mental Health. In my own

community there are a lot of people who are faced with multiple diagnoses. As I

mentioned before, they could be dealing with a mental health challenge; they

could be dealing with a drug and alcohol challenge; they could be dealing with

childhood traumas. The list can go on and on and on.

The

Minister of Health Services had deferred some of these questions to the Minister

of State for Mental Health. Now that the Minister of State for Mental Health is

here, I want to pose these questions to him. How will he ensure that the

multiple diagnoses community population base get the services they need? How do

we ensure that the people who may be faced

[ Page 6861 ]

with a drug and alcohol challenge that sometimes overshadows their mental

health challenge, so they get ignored by the system…? People who are faced

with alcohol and drug challenges sometimes are cast aside as unimportant people,

as people we can just throw away, as throwaways, as though somehow they're not

relevant. How will they get the services they need? In his own service plan, how

do we know they are getting the services they need? I'm expecting the Minister

of State for Mental Health to rise in this House to answer my questions.

Hon. C.

Hansen: I rise to seek some guidance here, because I just want to get an

understanding as to how the opposition anticipates the estimates debate

unfolding. Earlier I tried to address as many of the member's questions as I

could around performance measures, because I do have responsibility for them. I

did happen to mention that there was work being developed regarding guidelines

— our aim is to have those ready in 2004 — around issues of dual diagnoses.

What I indicated at the time is that my colleague the Minister of State for

Mental Health is far more familiar with that than I am, so she may want to ask

those questions.

It was my

understanding that we were going to work through the estimates debate as it

pertained to my responsibilities in the ministry, and that would be followed

with questions to the Minister of State for Mental Health and the Minister of

State for Intermediate, Long Term and Home Care. If we are at that stage now and

you would like to move on to Mental Health, I am certainly prepared to allow

that to happen.

[1635]

MacPhail: We are dealing with a procedural matter here. The opposition has

fewer than 15 hours left to debate matters till the end of next week. We are

trying to work cooperatively with the government in terms of how that proceeds.

The opposition member for Vancouver–Mount Pleasant took her guidance from the

Government House Leader that these questions would be asked and answered on

Monday in Committee A. That was thrown into chaos and confusion by the Minister

of State for Mental Health coming into this chamber and starting to answer

questions.

We assumed

there had been some change on the government side in its direction of how we

conduct these debates. We don't have the luxury of stalling or stonewalling or

filibustering. We simply don't have that luxury. However, it is the member for

Vancouver–Mount Pleasant's obligation to ask these questions. She sees it as

her personal obligation.

We are not

finished with the Minister of Health Services, but she will proceed to ask her

questions of the Minister of State for Mental Health. He's here, and she will

proceed. When those questions are finished, I will return to the debate with the

Minister of Health Services, as he and I have agreed.

J. Kwan:

Following on the issue around mental health services, I'd like the Minister of

State….

The

Chair: Minister, you have to be in your proper chair. Thank you.

J. Kwan:

Following the discussion around mental health services and performance measures,

I'd now like the Minister of State for Mental Health to please answer the

question in the scenario that I just outlined for people with multiple

diagnoses.

Hon. G.

Cheema: For mental health we have put in performance measures taking into

view that we are changing the system. These are the agents of change, and there

are many. It's not one, two, three or four. There are many of them. I'll just

give a few examples. For example, we can monitor the suicide rate. We can

monitor how patients are receiving community care in the community. We can

monitor the cause of premature death due to mental illness. We have a way of

monitoring through the mental health community consultation unit through UBC. We

have many ways to monitor these performance measures.

What we

have done — what the member was asking — is that for the first time, we have

merged mental health and addictions together. The member is right that there are

a lot of patients who have dual diagnoses. This should have been done a long

time ago. As of last April, we have done that. We know there are about 70

personality patients in the addictions system. They also have a mental illness.

In the past

the two systems were working independently of each other. Now that we have one

system, we can monitor these patients in a much more effective way. As time goes

on, we'll be able to evaluate further. This process is just starting. This is

something that should have been done a long time ago. I think we are making

progress, but time will tell how many of these performance measures we can use

in the future.

J. Kwan:

The Minister of State for Mental Health can stand in this House and be the

cheerleader for the government about what a great job they're doing. But the

reality is this, and I cite this from my own community experience. We have

people in our community, as I said earlier, who are faced with multiple

challenges.

[1640]

Many of

these individuals tend to fall through the cracks because they are very

marginalized. Oftentimes their drug addiction problems overshadow their mental

health problems, but it does not mean to say that they do not have a mental

health challenge. These individuals are sitting in our community, not getting

the access and support that they need. How will the minister know that they are

getting the services they need? He can talk all he wants about the

institutionalized change or even the government cabinet responsibility changes.

But what I want to know is: how is that affecting people on the ground? When I

see people on the ground not getting the services they need, then I want

[ Page 6862 ]

to know how that performance measure is being put to the paper. How does the

minister know he's actually doing such a great job — he often likes to claim

he's doing a great job — when the evidence tells you otherwise?

Roddick: I ask leave to make an introduction.

Leave

granted.

Introductions by Members

Roddick: We have in the House today 33 grade 7 students from South Park

Elementary in sunny Tsawwassen. They are accompanied by six selfless parents:

Maureen Lavendure, Darlene Martel, Kim Slater, Debbie Stevens, Susan Vanderwerff

and Hagai Amir. They are led by teacher Lionel Brown, who has been

enthusiastically educating next year's — believe you me, September is only

four months away — high school students about our historic Legislature since

the early 1990s. Will the House please make them all very welcome after a

tumultuous morning and afternoon, because they were supposed to be here during

question period.

Debate Continued

Hon. G.

Cheema: As I have already indicated, there are many performance indicators

that we can measure. They are through Vital Statistics, through Stats Canada,

through the database, through MHECCU. I'll give the member a few examples now.

For the

dual diagnosis, the Vancouver Island health authority is already into the

process. It's been almost one year that they've been working on a dual diagnosis

plan so that patients who have a dual diagnosis can get treatment. The Fraser

health authority is almost halfway through to have a plan. I think it's

important to recognize that as of only last year, as of last April, we were able

to put addictions with mental health. I think we are making progress, but it

will take some time to have more measurements put in place, and we have to just

see how it will reflect in the community to improve services for patients.

J. Kwan:

Then

what evidence does this minister have that he's doing a great job? How can he

throw his pompoms around and say, "Hooray, the government's doing a

fantastic job," when he doesn't even have the performance measures in place

to see what kind of job he's doing?

The minister has no answer for that. So then he cannot rise in this House or any

other place to say that he's doing a fantastic job when he doesn't have a

performance measure to see how he's doing. The performance measures are not even

ready for him to look at and review whether or not there's an adequate resource

in our community and whether the services required by the community are being

met. So he has no basis — no evidence — to support his claim other than just

his own cheerleading for his government in a partisan way, without any evidence

to back it up.

Obviously,

the minister can't answer the questions around performance measures because he

doesn't even know what they are. So let me ask the minister this question in

terms of the impact on the community for people with mental health needs.

[1645]

Arrowhead

Centre Society. That society had its funding pulled by this government, and

they've had to shut. As a result, we have a void in our community which needs

this service. The Arrowhead Centre Society had written a letter to the Minister

of State for Mental Health. I'd like to put this letter on the record, and I'd

like the minister to respond to it. It says:

"Dear

Sir:

"It

has been reported to me that Mr. Long stated in a pub lic

television interview that due to the outcry, the funds for Arrowhead Centre

Society were restored. If this is true, you need to know that the society has

not seen a penny of those funds. If the local mental health office received

them, they were never transmitted to Arrowhead. It strikes me that an

investigation of apparent misappropriation of funds needs to be undertaken.

"Arrowhead

has continued to carry on its care for th e mentally ill here on

the Sunshine Coast in spite of the withdrawal of funding they had previously

received. They cannot continue for a lot longer, and when they have to cease,

you will have nearly 100 mentally ill individuals on the streets of the coast

with no drop-in centre where they can receive any help.

"The

centre presently provides basic meals at least three times a

week for a minimum charge. There are showers in the house, which are the only

ones available to many of the consumers. There are laundry facilities which,

for some, are the only economical facilities.

"One

of the most important services Arrowhead Centre pro vides is the

opportunity to have a place to share concerns with others and receive at least

some sort of help. Many of us in the community are rallying to salvage the

Arrowhead Centre, but funds of the magnitude needed to carry on an appropriate

program with proper supervision and direction are not here.

"Surely

you will want to look into the apparent misappropriation of the

funds directed for this society. To give you some idea of the magnitude of the

situation, I am enclosing a proposed billing for day programming received at

Arrowhead by five of the six residents of Chapman House. They are locked out

of their rooms for the bulk of every day, and they have no place to go other

than Arrowhead and, of course, to roam the streets and malls.

"In

addition to those from Chapman House, there's an aver age use of

the centre by as many as two dozen or more every day. I'm sure you will want

to look into this matter at your earliest convenience, as the funding at

Arrowhead is at the crucial stage of limitation."

This was actually written on December 3, 2002. The opposition posed these

questions to the minister during question period, but of course we had no answer

from the minister. So now is an opportune time for the minister to answer these

questions and respond to this letter in full.

Hon. G.

Cheema: As I have said on many occasions, we are changing the system in this

province. One

[ Page 6863 ]

of the ways to measure the effectiveness of the change is to let the health

authorities develop programs that are cost-effective and that also provide care

based on best evidence practices.

Let me just

give you a few examples of the money we are spending on the North Shore. The

budget for all mental health and addiction services on the North Shore was $14

million. Out of that $14 million, the B.C. Schizophrenia Society's North Shore

branch got $65,000. B.C. Schizophrenia Society, B.C. office, got $16,191. North

Shore Neighbourhood House got $10,000. Gastown Vocational Services got $52,629.

Canadian Mental Health Association skills contract got $270,000, and the

Canadian Mental Health Association consumer support got $70,000. Our objective

is to provide the best possible care, and we are letting the health authorities

decide. I don't think we should be in the process of deciding where the money

should go. Our objective is to provide the best possible care based on the best

practices.

J. Kwan:

The member for Powell River–Sunshine Coast's reputation is at stake here. The

answer that the minister has given actually doesn't address the question that's

being put forward from the Arrowhead Centre Society or from the opposition.

Maybe the

Minister of State for Mental Health actually didn't get all of the questions,

because it was a lengthy letter that I read into the record. Let me break it

down for the Minister of State for Mental Health one by one so that he can

address these issues. First, let me just put it on the record once again.

The letter

states: "It has been reported to me…. " It says that Mr. Long —

that's the member for Powell River–Sunshine Coast — stated in a public

television interview that due to the outcry, the funds for the Arrowhead Centre

Society were restored. Now I'd like the minister to please confirm whether or

not the moneys for Arrowhead Centre Society have been restored.

[1650]

Hon. G.

Cheema: Let me just explain to the member again. We are not in the process

of deciding which organization is going to get the money or not. It's up to the

health authorities to make those decisions.

Let me

again explain to this member that despite all her questions about this place —

which has done good service; we are not questioning what they have done in the

past — there are many programs in the area. For example, there are outreach

programs in Sechelt. There are case management programs there. There are

vocational programs in that place. We have crisis programs there. We have

psychogeriatric programs there. There is a housing program. There is individual

counselling and a group therapy program in that area. There is availability of

psychiatry in that area. The ministry of children and family services also runs

a program for children.

Our view

about mental health and health in this province is: let the health authorities

decide. We have given them all the tools to deal with the issues. We have given

them the funds. They're the ones that will be monitoring. Our role is to ensure

that the policy framework is consistent across the province, and that's what we

have done. We are not going to be changing on that. I don't think that politics

should be playing a role in deciding where the money should go.

J. Kwan:

The minister once again did not answer the question. Was the member for Powell

River–Sunshine Coast wrong when he said in a televised interview that the

funding for Arrowhead Centre has been restored? Did he provide misinformation to

the public? Did he lie? If he didn't, the letter goes on to say: "If, in

fact, the funding was restored, then the society has not received a penny of

it." They're worried that there's a misappropriation of funds, that somehow

they just disappeared into thin air.

The

Minister of State for Mental Health ought to be concerned about that. You would

think he would actually check into this situation, as he received this letter

back in December. The letter's dated December 3, 2002.

Has he not

looked into it? Does he not know what's happened? If I were the minister, I

would be looking into this situation to make sure that if, in fact, the funds

have been restored, they're actually there for the society to spend, and they

didn't just somehow disappear into thin air.

Hon. G.

Cheema: I think it would be helpful for the member to understand that we

work from a different perspective. This government is not in the process of

telling any health authority what to do.

Interjection.

The

Chair: Order, members. Order, please.

Hon. G.

Cheema: Shouting and screaming is not going to be very helpful.

All through

the province we have been very consistent. We have given the health authorities

the tools to manage health care, and we are not going to change on that. Each

member of this House advocates on behalf of their patients. There are many

services available across the province. We want to ensure that the money and all

the funds are used in the most effective way and that all the treatment

facilities are based on the best-evidence practices. That's my job. We know that

we will continue to monitor those, and there will be better outcomes in the

future.

J. Kwan:

I wish the Minister of State for Mental Health would get off his script. I know

that he's being given a script, because he is the cheerleader for the government

and has to throw his pompoms around. But you know what? In the estimates process

what he has to do is actually answer the questions. He can't just get up here in

the House and say: "But you don't understand; this is how our system

works." I'm asking a very specific question of the Minister of State for

Mental Health.

Did the

member for Powell River–Sunshine Coast lie to his community in a televised

statement when he

[ Page 6864 ]

said that those moneys had been restored? Yes or no? It's a simple answer the

minister needs to give — yes or no. Did the member for Powell River–Sunshine

Coast lie in the television interview when he said that the Arrowhead Centre

Society's funding has been restored?

The

Chair: Member, I think that what you're stating there…. You're asking a

member to state that another member is lying. I think that's inappropriate and

unparliamentary for this House. I'd ask you to form another question, and please

withdraw that.

[1655]

J. Kwan:

Let me put it in a different way, as suggested by my colleague the Leader of the

Opposition. Was the member for Powell River–Sunshine Coast deliberately wrong

in his television interview when he said that the Arrowhead Centre Society's

funding was restored?

Hon. G.

Cheema: The member from Powell River is an honourable member of this House.

He's always advocating on behalf of his patients. We all are advocating on

behalf of our patients. Our objective as a government is to ensure that the

funds are spent in the most effective and most efficient way. We want to ensure

that the money will go where it's most needed.

I have

explained to this member many times. I have given her the breakdown of the money

we are spending on the North Shore. We are spending close to…. Out of $14.1

million I have given her the breakdown of each and every organization. I don't

think I can do more than that. If the member still has a problem, she can

continue to ask the same question. My answer is not going to change. We are not

going to be telling any health authority how to conduct their business.

MacPhail: Maybe the minister could help us, then, to find out if there's

been a misappropriation of funds that have gone missing. Where would he direct

us to find that out?

Hon. G.

Cheema: If this member or her colleague is concerned about missing funds,

they should report to the CEO of the appropriate health authority.

J. Kwan:

I just want to be cl