2000 Legislative Session: 4th Session, 36th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

SUNDAY, SEPTEMBER 17, 2000

Afternoon Sitting

Volume 20, Number 25

[ Page 17185 ]

The House met at 2:09 p.m.

Prayers.

The Speaker: I would ask if there are any introductions by members.

Hon. D. Miller: Mr. Speaker, it's not really an introduction. I think all members by now have read the press. There has been a terrible tragedy at Prince Rupert. Seven young people were swept into the ocean, and three are still missing. I would simply ask all members to join with me in sending their own prayers for the families and these young people, and hope that some of them are found alive.

Hon. U. Dosanjh: Hon. Speaker, I know Kim Emerson is recovering from a procedure that he underwent at the hospital. He's doing well, and on behalf of all of us, I want to wish him well and a speedy return to the Legislature. We'll miss him.

[1410]

Hon. I. Waddell: Hon. Speaker, I rise on a very happy note. I believe all members in the House will join with me in congratulating Victoria's Simon Whitfield, who not many hours ago won a gold medal in Sydney in the 2000 Olympics in the men's triathlon -- the first-ever event. We should congratulate him.

Simon is a member of PacificSport centre in Victoria. It's a centre for training national athletes. I want to personally congratulate Roger Skillings, Simon's coach, and some of the people there . . . . I'm told I have to take the button off here. I'll end by saying to Simon personally: Good on you, mate. You really did it for Canada.

L. Boone: Although we weren't expecting to be in this chamber, we were expecting to be in this city today. So I would really hope and ask that all members here give my partner, Mr. Fred Bagg, a very warm welcome to this precinct.

E. Gillespie: I'm happy to introduce my son Ceilidh Curtis, who travelled with me to be here today on this very important occasion.

Hon. J. MacPhail: Hon. Speaker, it gives me great pleasure to welcome lots of friends in the gallery today, but particularly one -- and I hope no one else takes offence. He's reformed himself into a sensitive New Age guy: John Shields. Welcome.

DEBATE ON SUPPLEMENTARY BUDGET ESTIMATES

Hon. P. Ramsey presented a message from His Honour the Lieutenant-Governor: supplementary estimates for the fiscal year ending March 31, 2001, recommending the same to the Legislative Assembly.

Hon. P. Ramsey moved that the said message and the estimates accompanying the message be referred to Committee of Supply.

Motion approved.

Petitions

B. Penner: Hon. Speaker, I rise to present a petition. I've circulated a petition in my community of Chilliwack, which has been signed by over 3,000 people, calling on the B.C. government to take all reasonable steps to prevent the construction of a new gas-fired electrical generating plant in the community of Sumas, Washington, which threatens the air quality in the Fraser Valley.

[1415]

Orders of the Day

Hon. D. Lovick: I call Committee of Supply.

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

The committee met at 2:15 p.m.

SUPPLEMENTARY ESTIMATES: MINISTRY OF

HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

On vote 36(S): ministry operations, $290,000,000.

Hon. M. Farnworth: As the Finance minister has indicated, we are here today for a very important reason. We are here today to take another strong step toward putting British Columbia's health system back on track. We are here today to make it possible for our hospitals and health providers to get the resources they need so that they can give British Columbians the care they deserve. Finally, we're here today to continue building on our new way of doing business in B.C., moving away from confrontation to negotiation and consultation, and to resolution and progress.

Last week we saw the direct benefits of working in cooperation with the federal government to put the needs of B.C. patients first. The multi-year agreement that we secured with Ottawa means that for the first time in many years people in our province will benefit from stable, predictable federal funding for health care.

We are here today to turn over nearly $70 million in federal funding to our health authorities as quickly as possible so that they can purchase urgently needed hospital equipment. That equipment ranges from high-tech MRIs and CT scanners that better diagnose illness and disease to vital bed lifts that protect our health workers from strain and injury. We're also here to authorize $180 million in provincial dollars to help our hospitals and health providers continue to meet the most pressing, immediate demands of patients, and an additional $40 million to help our health authorities in smaller cities and rural communities recruit and retain the physicians and specialists that they need.

We know that the last few years have been particularly hard on our health system. We know that our hospitals have been struggling to maintain consistently high levels of service to B.C. patients. I have nothing but the greatest respect for the 100,000 women and men who have chosen to stay in our health care system and for the dedication they bring to their jobs every day. Many of them have told me that one of the most immediate challenges our hospitals face is keeping oper-

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ating rooms open and staffed and recovery beds open so that the people they serve have timely access to the surgeries they need.

As a government we share that goal. We believe that all British Columbians deserve timely and appropriate access to high-quality health care. That's why, once the Legislature approves this spending, $180 million will be flowing to our health authorities to help them address key surgical wait times.

Obviously there's no one-size-fits-all solution to improving patient care, but there is plenty of common ground -- replacing old and outdated equipment, bringing in new diagnostic tools, increasing capacity in operating rooms, training more critical care nurses and other staff. These are all essential ingredients to improve patient care and initiatives which I believe everyone in this Legislature can willingly endorse.

We're also here today to allow health authorities outside Victoria and the lower mainland to access their share of the $40 million we've set aside to help them recruit doctors and specialists. We recognize that British Columbians, particularly in small communities and rural centres, depend on a small number of these vital health professionals for a vast array of health services. And we recognize the necessity of allowing smaller communities to enhance their recruitment and retention packages through bonuses and incentives. That's why we want health authorities to be able to provide these incentives as soon as possible, wherever possible.

[1420]

Taken together, we're talking about putting $290 million into our health care system right now to ease the pressures in our hospitals and to improve patient care around our province. The Premier has indicated that this is just the beginning, that this is phase 1 of a comprehensive B.C. health action plan, a plan that you'll be hearing much more about in the days and weeks ahead. It's a plan that has guided our activities ever since our new Premier took office early this spring and directed that we rebuild the relationships that are the cornerstones of health care delivery in British Columbia.

I would remind everyone here that we've begun that work with the British Columbia Medical Association, when in March the government ratified an agreement with the BCMA that increased the available amount for this fiscal year by $40 million, funded a 2 percent fee increase for doctors and added an additional $8 million for doctors' malpractice insurance. We understood that this agreement would bring an end to the withdrawal of physicians' services around the province. Unfortunately, this deal has not been a deal. The agreement failed to secure the reliable delivery of patient care, just as subsequent negotiations with various doctors' groups have failed.

Now, attempts to mediate with rural doctors through the BCMA under terms that would mean that a deal truly is a deal have also failed. But we are not giving up. In fact, we are taking action on two fronts. On Friday the Premier announced the establishment of an inquiry into the best way to negotiate contracts between the government and doctors and to give B.C. patients the certainty they need and deserve. Today we want to give our health authorities access to $40 million so that they can start making agreements with the individual specialists and physicians who are ready and willing to make a commitment to the reliable, consistent delivery of patient care.

The need for a commitment to patient care underscored our negotiations with the federal government this spring. In June we presented the federal government with a paper entitled "British Columbia's Strategies for Action on Healthcare," which outlined exactly how we would invest any restored federal dollars to benefit B.C. patients and their families. We know that the dollars we're talking about today will not meet every current and future demand on our health care system.

Even while that money is being used to ease the existing pressures in our hospitals, we must be acting to eliminate that pressure from building in the future. That's why we'll be enhancing the health care services that keep people out of hospital. We'll be working with health care authorities to free up acute care beds so that those beds are ready and able to receive people who need acute care services.

But whether patients need life-saving emergency surgery or an annual flu shot, they share one common need. They need nursing services. And to deliver health care either in the hospital or out in the community, our health system relies on an adequate supply of appropriately trained nurses. That's why our B.C. health action plan builds on existing initiatives to recruit and support new nurses and nurses currently working around our province, particularly in our more rural areas.

The plan recognizes the unique challenges of providing a full range of health services in smaller communities, and it does this by looking at things like introducing specialized training programs for rural nurses and other health care providers. It looks at telemedicine and physician outreach programs and at innovative new ways to enable people to access reliable and accurate health information and advice from their own homes. It looks at ways to address the rapidly rising costs that threaten to overwhelm our provincial drug plan, and it looks at better ways to meet the needs of people with mental illness.

Like the funding we're discussing here today, some of the actions in the B.C. health action plan are fairly straightforward and will have immediate benefits for patient care. Other activities we must get to work on now, knowing that we will see the benefits to patients and to our health system over the longer term.

For example, we're working to enhance Prince George Regional Hospital as a northern teaching centre, because there's clear evidence that physicians who do their training in rural settings are much more likely to stay and practise in a smaller community. We won't have those regionally trained physicians in the field tomorrow. But if we start now, we will have them there soon, to the direct benefit of the people who live in smaller communities throughout British Columbia.

[1425]

As the Premier has said, our goal is not only to get our health system back on track but also to get it moving smoothly into the future. As Health minister, my vision is of a health system where all British Columbians are able to access the health care they need where and when they need it. Investing in our hospitals, our nurses, our doctors and our health care workers is an important step toward achieving that vision. We will always need to bring people to health care facilities to get specialized tests and treatment, but it's essential that those facilities be well equipped, well resourced and well managed.

I believe the dollars that we're talking about today will go a long way to restoring the public's confidence in the ability of those facilities to meet our acute care health needs.

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I also understand the need to bring health services, particularly preventive and primary health services, out to where people live. Our B.C. health action plan contains many exciting and innovative initiatives to do just that. I look forward to sharing those with you in more detail in the near future.

If there's one thing I've learned as Health minister, it's that our health system is an organic whole in that everyone must feel that they're able to participate. If B.C. patients are truly going to benefit from the delivery of the right care at the right time in the right place, each part of the system must depend on every other part. Today we're talking about steps to relieve the immediate pressures on our hospitals -- the heart of our health care system. With that heart beating strong, as it were, our health system has the ability to do great things.

I don't believe for one second that the people of this province want us to give up on publicly funded universal health care. They tell us time and time again that it is the most valuable and most highly valued public service that we have. What they want is for us to make that system work, to make medicare work not just for themselves, not just for their elderly parents, but for their young children and for everyone in British Columbia. It's a fair and reasonable demand. We're here today because we're committed to meeting it now and in the future, and we're going to do just that.

C. Hansen: The minister made a very telling comment in the early part of his introductory remarks to this debate. He talked about getting the health care system in British Columbia back on track. We have had nine years of NDP government in this province that has put it off the rails in the first place. We see nothing in the documentation that's before us today, in terms of the very flimsy health action plan that the minister is talking about, that is actually going to get our health care system in this province back on the rails.

The one thing that this government brags about in health care -- and it's probably the only claim that they have in health care that they perhaps can be proud of -- is that British Columbia is the only province in Canada that every year has increased its Health budget over the last decade. I'm surprised that we don't see more members of the government benches applauding that, because that's the only thread that they have to hang onto when they go around their constituencies and people start demanding answers as to why this government has allowed health care to deteriorate year after year after year.

[1430]

This is the only province in Canada that goes from crisis to crisis to crisis in health care. In fact, I learned just recently from somebody who is very well versed in the inner operations of the Ministry of Health . . . . This individual's perception was that nothing gets done in the Ministry of Health recently that has not pertained to a crisis. If you look at the various crises that have developed in health care over these last couple of years, every single one of them is a product of the actions of this government. Every single one of those crises could have been prevented.

Every single one of those crises we could have foreseen. We knew the problems that were coming, whether it was the nurses' crisis or the shortage of nurses, whether it was the growing frustration of doctors in northern and remote communities in this province. These are not big surprises. This wasn't the tidal wave or the earthquake that suddenly sort of zapped in and caused something that nobody saw coming.

Everybody saw those problems coming -- everybody except this government. I'm not convinced that this government didn't see them coming too, because, you know, there are people that actually thrive on an aura of crisis. There are people who just can't operate unless their life is in turmoil. Just when their life seems to start taking a normal, stable mode, they have to invent their own crises. Hon. Chair, I believe that is exactly what is before us today.

We have a tremendously cynical move by this government to trump up yet another crisis in health care rather than dealing with it on a rational and orderly basis. As we go through this debate, we will start to explore some of the actions that this government has taken and the way that they've taken them to actually cause the crises in this province, to get worse in health care.

I want to go into a bunch of areas, but perhaps I can start by asking the minister specifically about the strategic planning process of his ministry. I have heard the minister say, I've heard this Premier say, and in fact I've heard many members of this government's benches say time and time again that money alone will not solve the problem, that we cannot solve the problem unless we have proper planning in health care, unless we address some of the fundamental underlying issues as to why it is that in this province we continue to spend more and more money on health care year after year.

Yet we see wait-lists growing, we see health care deteriorate around this province, and we see the stability of health care diminish. Patients this year feel less confident about their health care system than they did last year, and they felt less confident last year than they did the year before. In fact, they have felt less confident about their health care system every year that this party has been in office.

So my question to the minister is: this health action plan that he has put forward -- is that the planning process that is somehow supposed to give us in the official opposition some comfort and the public some comfort that the additional dollars being spent on health care in fact are going to be spent towards achieving some long-term goals, so that we'll actually start to see some improvements in health care instead of the steady erosion that we have seen over these past ten years?

Hon. M. Farnworth: Well, the member asks a number of interesting points, and he makes a number of interesting comments. One of the things that I'd like to talk about first is that this province has been increasing health care funding every year since we've taken office. It's been a challenge to meet the needs of services for everyone that wants them in British Columbia, as it has right across this country, because we have seen the removal of $26 billion in health transfer payments by Ottawa during that period. The provinces, including British Columbia, have had to try and make that up. That has been a very difficult task; however, we've done that.

The health action plan, hon. Chair, is based on a number of principles, principles that are designed to ensure that we modernize and strengthen B.C.'s public health care system to improve patient care, that we support and respect the more than 100,000 women and men who deliver health care, that we maximize preventive care and wellness, that we reform primary care to provide the right care at the right time in the right place, that more innovation and not just money is what's required in the system; and to stop the creeping privatization that threatens medicare. Those are the basic principles around our health action plan.

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Attached to that are a series of priorities: hospitals, nurses, doctors, rural care, primary care, continuing and home care, privatization, and drug use and costs.

[1435]

C. Hansen: If this minister goes out to the public with a health action plan that is the sum total of less than two and a half pages -- and much of that is double-spaced -- the public is not going to get any consolation from this. A little bit later my colleague from Okanagan-Vernon is going to ask some specific questions about the health action plan. We want to find out what's really meant by these words, because it's really pretty thin gruel.

I want to point out one quote in here which I think probably summarizes a lot of what the public approach to this is today. It's under the title of "Rural Care," which is obviously something that is extremely topical these days, and there is a huge anxiety on the part of those in rural British Columbia in terms of how they can access necessary health today, never mind this month or next year or the year after. But under "Rural Care" it says . . . . And I am going to read the entire

section on "Rural Care." This is the health action plan from this government on rural care, and I want to pick this one out because I think it teaches us a lesson about where all of this is coming from.

It says: "B.C.'s health action plan recognizes the unique needs of residents of rural and smaller communities." That's quite profound; it recognizes unique needs. "We will ensure health authorities have access to funding to train rural health care providers." That's all well and good. There are no details as to what that's all about. But here's the line that I think really delivers the message.

It says: "In addition, residents of rural areas will have access to self-care and wellness material to help them and their families access health services." Do you know what that says to British Columbians in rural and remote British Columbia? It's something they've always known. They have to be self-reliant, because they will not be able to depend on this government to assist them. Simply providing them with information as to how they can fend for themselves is probably the best thing that this government can offer. As I mentioned, my colleague will go into that document in more detail later on.

I want to talk about the funding letters for the health authorities around this province. We are now into the sixth month of the fiscal year, and the health authorities still do not have their funding letters. We raised this several times during the regular session of the House earlier this year. The last time we raised it was on May 17. The minister at that time said: "The allocations won't be done until . . . . " Then he stopped, and then he started a sentence again. He said: "First off, we have to finish meeting with the health authorities, and it's expected that that will be completed within the next two and a half weeks."

Well, the next two and a half weeks, hon. Chair, would take us into the first week of June. Here we are in September, and the health authorities still have not been given their budgets. They were told in March by the deputy minister that they should continue to maintain services that were provided last year -- that there should be no service cuts. It also assured the health authorities that they would receive an increase in funding to cover the collective agreement settlements that click into effect this year. But that was it.

I'd like to ask the minister: why is it that these health authorities have had to wait until halfway through the fiscal year until they are being told what their budget amounts are? In fact, we still don't know what they are yet; we're still waiting for those letters. I'd like the minister to give us yet another prediction as to when those letters are going to go out.

Hon. M. Farnworth: One of the nice things is that we will be able to write cheques for approximately $70 million for new equipment as a result of the agreement that we got in Ottawa, along with the rest of the provinces. It's interesting, because the opposition said that we'd never get that agreement -- that we wouldn't get that money coming into the system. That was very much a cornerstone of . . . .

Interjection.

Hon. M. Farnworth: Your Health critic stood up repeatedly and gave the same speech throughout communities throughout British Columbia -- and I know, because I've heard it -- saying that in the fall, I -- using my first name -- would be standing up blaming Ottawa that we didn't have money to give the health authorities, because we wouldn't get an agreement with Ottawa. Well, the fact is that we did get an agreement with Ottawa that allows us to invest $70 million in equipment, and that is part of the funding announcements. The health authorities will be receiving their letters next week.

[1440]

C. Hansen: So here we have a situation where they can't send out the funding letters, because they're not sure how much money is going to be in the pot. Well, the responsible thing to do would have been to send out the funding letters based on the funding that was in the pot and then, when the additional moneys were found -- as they came from Ottawa -- reconvene the House, do the supplementary estimates, as we are, and then advise the health authorities how much their increased budgets would be.

Hon. Chair, I would like to ask the minister if he thinks it is responsible management of government to deny the health authorities their budget letters until halfway through the fiscal year.

An Hon. Member: What about that stable, predictable, long-term funding they spoke of?

Hon. M. Farnworth: I'd like to thank that member. I'll address that comment, and then I'll answer the member's question.

The fact of the matter is that now that we have this agreement with Ottawa to restore the transfer payments to British Columbia and the other provinces, we actually now have stable, long-term funding that the provinces can rely on, which was something that you said wouldn't happen.

In answer to the member's first question, we did in fact send out letters at the beginning of the year, and we did work with the health authorities. Now we're able to send out another letter outlining additional funds that they will be able to access and will be receiving next week.

C. Hansen: And we will get into some of the details of that.

I'd like to ask the minister what the cumulative operating debt of the 52 health authorities was in the last fiscal year, the 1999 fiscal year ending March 31, 2000.

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Hon. M. Farnworth: It was $49 million.

C. Hansen: I'm wondering if the minister could tell us what the accumulated debt is of the health authorities around the province for the year ending March 31, 2000.

Hon. M. Farnworth: It's $79 million in unrestricted assets.

C. Hansen: I just wanted to check -- $79 million? Thank you. So basically the debt from previous years was $30 million; then we added $49 million in the last fiscal year alone.

Could the minister advise us: in the consolidated statements that were produced by the Minister of Finance a couple of weeks back . . . ? Where does the $49 million of operating debt on the part of the health authorities show up in those consolidated statements of the provincial government?

Hon. M. Farnworth: Health authorities are not consolidated on the books of the province.

C. Hansen: Could the minister tell us who is responsible for the debt of the health authorities?

Hon. M. Farnworth: The health authorities.

[1445]

C. Hansen: So what you're saying is that . . . . These are creatures of the provincial government. The boards are appointed by the provincial government. And yet you're saying that the provincial government . . . . In other words -- let's get this right -- if a supplier is providing a service to a health authority, the supplier basically has no guarantee from the provincial government that any outstanding debts are going to covered. Is that true?

Hon. M. Farnworth: The province is the major funder of the health authorities. The health authorities are not part of the consolidated statements of the province; nor in fact do I believe that they're part of the consolidated statements of any province in the country.

C. Hansen: This $49 million debt that was incurred last year by the health authorities is the responsibility of the provincial government. If you look at the consolidated statements that came down a couple of weeks ago . . . . The Minister of Finance was bragging about a surplus of $52 million, when in fact what should have been added into that is a $49 million deficit that was racked up by the health authorities. In fact, if they had brought in the debt last year, as they rightfully should have, that would have put the province's books into a deficit position last year.

Now, the reason I'm asking these questions is that I want to . . . . I don't want to dwell on the last fiscal year; I want to dwell on this fiscal year. I'm wondering if the minister could tell us . . . . Prior to these supplementary estimates being brought in and allocated to the various health authorities, could the minister tell us what the projected deficit is for the operations of the 52 health authorities this fiscal year?

Hon. M. Farnworth: It's $180 million.

C. Hansen: That's an interesting number, because that's the number that the minister is proposing as the increase in the transfers to the health authorities in the supplementary estimates that are before us today. In other words, what the minister is telling us is that the projected debt, according to his numbers, is $180 million of deficit. So we're going to transfer an additional $180 million to the health authorities as a result of these supplementary estimates today, and all that's going to do is cover the existing deficit that they are already building up.

The minister's been talking about all these new programs. In his introductory remarks he was talking about how we were going to address wait-lists and open operating rooms. I think every single health problem under the sun was going to get solved by this amount that was in the supplementary estimates today. And yet what we now find out is that the number is exactly the same. The deficit that's out there, the $180 million deficit of the health authorities, is the same number as he is proposing to transfer to the health authorities.

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Could the minister tell me one of two things? If this new money is not going to go to covering their deficit operations that they're running up, how are those deficits going to get covered? If that's not the case and in fact this is money that's going to cover all these wonderful new initiatives that the minister plans to announce over the next few weeks, as he outlined in very sketchy form in his opening remarks, then the question is . . . . It's either one or the other.

The money's either going to cover off the deficits of the health authorities or it's going to pay for the new and wonderful things that the minister says are going to solve all our problems in the acute care system in the health authorities. So could the minister tell us which it is?

Hon. M. Farnworth: The $180 million the member talks about, first off, is a projection. It is not an actual one. It is just that.

And the funding is based on the provision of a level of service that's been achieved through discussion between the ministry and the health authorities to ensure that we are not only maintaining the same service levels that were provided last year and delivering the same number of services as last year but also accomplishing what we want to this year in terms of upgrading the opportunities and programs that health authorities can deliver -- to upgrade nurse training, for example -- and in terms of being able to open more operating rooms. All those things are included in that.

It also doesn't include the amount of money that's spent on equipment, which in this case is $70 million, which goes to the hospitals and the health authorities throughout the province. So it's a combination of two things, which you're not taking into account. One is equipment, which is $70 million, and two is a level of service designed to ensure that we're meeting the needs of the patients of British Columbia and are able to do things such as open more operating rooms, which is what you were just talking about.

C. Hansen: I'm not sure that the minister himself followed his explanation in the last response that he gave, because it didn't exactly make a lot of sense. The minister is talking about nursing training; he's talking about wait lists; he's talking about ORs -- all these wonderful things. And yet the health authorities were already projecting a $180 million debt.

If you go back to last March, the deputy minister sent out a letter to all of the health authorities in the province, basically

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saying that the funding letters were going to be delayed. In that letter from the deputy minister it said that they should maintain service levels. So the health authorities, who the minister tries to say are somehow independent of the provincial government, are basically taking their marching orders from the Deputy Minister of Health in the province. They are continuing to maintain services on the expectation that they are going to be funded over and above what was there last year, in order to maintain those service levels. So as they are maintaining service levels, they realize that they're going to go in debt to do that.

Actually, let me just touch on one point before I continue on that theme. Could the minister explain to us how and under what authority the health authorities incur their debt? If a health authority is going to go into debt in order to cover its operations, who do they have to seek permission from in order to incur that debt, and how is that debt financed?

Hon. M. Farnworth: I come back to the point I made a moment ago. The $180 million is a projection on the basis of a level of service that's been agreed to between the health authorities and the ministry in terms of what they're anticipating in terms of services to deliver this coming year -- that is, no cuts. Where possible it's improvements in service, meeting the needs in each of those communities.

[1455]

It includes in the development of those services such things as upgrading of nurses' skills and training of nurses' skills, which are included in that. And for the member's benefit, I will read out some of those initiatives that are included in that. The Fraser Valley health region, for example, has

a training-on-site recruitment and retention program. They estimate that requires, to implement that program, around $200,000; that's included in it. In the case of Okanagan-Similkameen health region, they're looking at recruitment and retention dollars of around . . .

An Hon. Member: So today's news is old news.

Hon. M. Farnworth: . . . $239,000 for this year. That's to provide more than they were providing before, hon. member, and it's to meet the needs of this year. So we have stability now with Ottawa. We can add on that base next year and each year after that for certainty over the next five-year period, hon. member.

Hon. Chair, the Cranbrook health council -- $390,300 for training. Again, that's what they anticipate they need in training and upgrading nurses in their community. That's included in their budget request and is part of the money that they will be receiving this year.

C. Hansen: So what the minister is saying is that the health authorities are maintaining services; those were his words. And in doing so, they were providing these things like nursing training and other things. The minister, in his opening remarks, was trying to pretend as though these were some great new initiatives, not just maintaining service levels -- that in fact there were going to be all kinds of new services provided, that there was going to be additional health care, that somehow the public should look forward to much better access to health care as a result of these new moneys that have come from Ottawa.

But in fact what he just said is that this is just maintaining our existing things that would have gone on anyways; that the health authorities, in maintaining their previous operations, were running up this $180 million debt; and in maintaining their services there were things that they had to do anyway, such as training. Now the minister is trying to pretend that there is a whole bunch of new activity in health care, that there is a whole bunch of new initiatives that are somehow going to make health care delivery in this province better.

The reality is that it's not the case, that in fact all of this money is going to simply maintain service levels that were already inadequate last year, which the public has already spoken out on and said they think that health care is in a shambles in this province. So simply maintaining last year's service levels is not adequate and certainly is not what the minister and this government are trying to pretend is happening in the announcements that are being made day after day in terms of some kind of new initiatives coming into this province.

So I'd like to ask the minister: what elements of this are in fact new services, not maintaining existing service levels? What's actually new that's being announced today, hon. Chair?

Hon. M. Farnworth: In terms of what new services are being provided and what new capacity is being provided to health authorities, I'd like to point out the following things. First off, in terms of the equipment that's going to health authorities, that's accomplishing a number of things. It's meeting their requirement for new equipment, and there's $70 million there to do that.

Of that, $19 million is for high-tech equipment, for MRIs and CT scanners; $17 million is for equipment to improve health and safety in the workplace -- i.e., electronic beds and lifts and things like that to make the working environment not only safer but more efficient -- and $34 million is for clinical equipment, i.e., ultrasounds and X-ray machines.

[1500]

So all that is new, going into the system. The budget of $180 million is determined on the basis of: what are the needs? And it's done on the basis of a number of things, including the growth in population and demographics which, when that takes place, results in extra services being required and being able to be funded. So all those services are new.

In terms of being able to maintain existing service volumes, that's roughly about $23 million in order to do that. A hundred and twenty million dollars meets population and demographic increases, and so with that comes the capacity and the ability to meet the new demands on that. Within that $180 million, not only is it meeting the existing needs as determined by the health authorities, but it is then also able to provide new services and existing capacity to meet population and demographic changes.

C. Hansen: Hon. Chair, I know that there are a lot of people around the province who are following this debate today on the broadcast. I just want to paint a picture as to what goes on here, because I think it also tells something. The time when the TV is actually just focused on the Chair is the time that it takes the minister to be briefed on how to answer these pretty basic questions. The minister has now been in this portfolio for eight months, and I would think that some of the financing arrangements between the ministry and the health authorities would be pretty much top of mind for him.

I'm quite surprised that he's relying as much as he is on briefings by officials as we go through this process.

[ Page 17191 ]

The minister just said that what we're talking about is just maintaining services. Whether it's demographic changes, whether it's population growth . . . . That's all this $180 million does, which I think is the point that I was trying to make earlier. This is not about better health care that British Columbians can expect; it's about maintaining a system that is already woefully inadequate.

I want to come back to another question that I asked earlier, which the minister did not answer. That is: who authorizes the health authorities to incur debt? You know, the minister mentioned that up to the end of the last fiscal year, there were already accumulated deficits by the health authorities of $79 million. Who authorized the health authorities to incur that debt in the first place, and what is the process?

Hon. M. Farnworth: The expenditures by the health authorities throughout the province are on the basis of the delivery of services. We monitor them quite closely in terms of: are they going to be in a deficit or a non-deficit position? And we work with them to ensure that there's cash flow there to meet their needs as is required. As I said, throughout the year we work with them and continue to ensure that the provision of services, which are demand-driven, are met as needed.

C. Hansen: I will repeat my question for the benefit of the minister. When a health authority goes into debt, as they have done to the tune of $79 million up to the end of last March, who authorizes the health authorities to incur that debt in the first place? And how do they go about getting permission to incur that debt?

[1505]

Hon. M. Farnworth: The board makes the decision to run a deficit. It's a deficit they're running; it's not a debt which they are carrying. They make the decision to run the deficit.

C. Hansen: There's a bunch of mixed messages in there. They can make a decision to run a deficit, but then that doesn't result in a debt. So if they run a deficit, what is it if it's not a debt at the end of the year? And how is it covered? How is it financed?

We'll come back to some of the other things that he said in that last answer in a second.

Hon. M. Farnworth: The health authorities can run a deficit, and it's the basis of the funding they receive versus the value of the services they get. We do not, though, allow them to accumulate debt in the sense that they can go and borrow money to cover that. So that, hon. member, is how the board makes a decision to get the deficit. But in terms of whether they can go, then, and incur debt by borrowing to cover that deficit, no, they can't do that.

C. Hansen: Who, then, does cover the debt? Where does this debt go if it's not financed? Who pays for it? Do they just go to the photocopier in the administrative offices of the health region and start cranking out dollar bills? I don't think so. If they are running a deficit, somebody has to cover it. My question is: who does?

Hon. M. Farnworth: The health authority covers its deficit -- because they don't accumulate it as debt -- when they get their budget from us.

C. Hansen: So in other words, they can run up the debt . . . . They can decide to do that themselves -- to run up a deficit in their operations -- and then the ministry simply covers it. The money comes from the ministry, and it covers off the deficit that they're accumulating. Is that what I hear the minister saying?

Hon. M. Farnworth: The member keeps saying that the hospital authorities run debts or have debt. It's a deficit they run, and it's covered from the appropriation that the ministry gives to the health authority. The health authority then covers the deficit if there is one. When they find out whether or not . . . . If, during the year's projection, it looks like the value of service that's going to be provided is greater than the money they're receiving and that they will be in a deficit position, then they work with us in terms of how to manage that particular issue. That's what takes place.

So next year, when funding comes from the province, if there's a deficit, they can cover that outstanding deficit at that point.

[1510]

C. Hansen: So if we go back to last fiscal year, where the minister advised us earlier that the accumulated deficit of the health authorities was $49 million that in fact the provincial government through the ministry covered that $49 million deficit of the health authorities from last year. That's what the minister just said.

Could the minister tell us how and when the government covered the $49 million operating deficit of the health regions from last year?

Hon. M. Farnworth: They are able to carry forward that deficit. And at the same time, what the province does is indicate to the health authorities to expect to be able to deliver a particular set level of service. That level of service is based on the needs of the different health authorities based on the region, the population and the demographics -- all those things going into it, in part so they can expect to receive moneys from us. At the same time, we indicated to them that there would be additional funding coming to the province, which we passed on to the health authorities when we reached an agreement with Ottawa.

C. Hansen: Maybe I can try to help the minister answer some of these questions. First of all, when a health authority is going to incur a deficit, they've got to get the permission of the Ministry of Health to do it. That is, I think, direct evidence that in fact this is debt of the province that is being incurred.

When the minister talks about a $49 million collective deficit of the 52 health authorities, what he's saying is that the health authorities on April 1, the first day of the fiscal year, don't start out with nothing. They started out with minus $49 million for this current fiscal year. The dollars that flow out of this year's budget of the provincial Ministry of Health are in fact . . . . Forty-nine million dollars of that money is going to allow them to just simply cover their debts from the previous year. They're already starting out, in terms of health care spending in those regions, from a minus $49 million position.

[1515]

That is why, if you look at health regions around the provinces, they are having to ask for cash advances simply to meet their payrolls this year. They're operating not only with

[ Page 17192 ]

that $49 million debt that they've got to carry forward from last year, but in addition to that they were running up -- using the minister's number -- a $180 million projected deficit this year. When you start allocating the resources to the health region on a monthly basis, it is simply inadequate for them to meet their basic needs.

I know of one case in particular where a member of a health board who is very much a friend of this government actually had to phone the Minister of Health -- or the ministry, at least; I'm not exactly sure -- to say: "Look, we don't have enough cash in our bank account to meet our payroll." Does the minister think that is a responsible way to manage health care services in British Columbia today? Is he proud of that kind of administration of health care cash in British Columbia? And is that the kind of standard that we can look forward to in the future?

Hon. M. Farnworth: That's why, hon. Chair, we are proud of the fact that we have reached an agreement with Ottawa to ensure stability of funding from the federal government to the provinces that allows the province now to project out in terms of the moneys that we're getting from Ottawa over a five-year period, which allows us to predict with greater stability the amount of money that's flowing into the health care system. It's something, I would point out, that's been very much a cornerstone of what we have been trying to do since the beginning of the year.

What's also important is that the $180 million that's put into the system in terms of operating moneys this year is based on a projection not of cutting services at all but, rather . . . . It's not only delivering services as they were delivered last year and ensuring that there are no cutbacks but taking into account that because we have an increase in population and an increase in the demographic, that requires more services to be delivered -- that we're able to fund and deliver those particular services. That is one of the crucial things that needs to be recognized in this year's funding allocation.

That's exactly what this does. This is a projection based on needs related to the fact that, as I said, we are growing and increasing the amount of service that needs to be supplied.

C. Hansen: Quite frankly, hon. Chair, it's a lot of smoke and mirrors. What we are seeing in the $180 million is . . . . Either the announcements that the minister has made about increased services have no substance to them, or the minister is simply telling the health authorities to simply go ahead and continue to run up deficits this year in excess of what were run up last year. I think any health care administrators in this province who have been trying to cope with this system over these last six months -- to cope with the lack of certainty, I'm sure -- have absolutely no sense of satisfaction over what they've heard over the course of the last hour and 15 minutes of this debate.

I think, clearly, it's evidence that the minister doesn't understand the way the finances of health authorities work. I think he's quick to make announcements. He's quick to put out press releases which somehow are supposed to give the pretext that this government is doing something to improve health care in British Columbia -- to use his words, to get it back on track. There is nothing in this to get anything back on track. It's simply trying to keep the train rolling down the side of the embankment, hon. Chair.

Earlier the minister listed a breakdown on the equipment side. He was listing amounts for MRIs, and he was listing amounts for other equipment, which is the $70 million portion of the supplemental estimates. I'm wondering if the minister could arrange for me to receive a copy of that list and the various breakdowns. I would like to get into a breakdown of the $40 million that we have going into the Medical Services Plan. I would also like to get a breakdown of the $250 million going into acute and continuing care, of which we know $180 million is going to the health authorities.

We also know that $70 million is going to equipment. The minister outlined some of the equipment, and I'm wondering if he could undertake to have a copy of that made and sent over to me so that we can use that to ensure that our time here can proceed as quickly as possible.

[1520]

Hon. M. Farnworth: I want to make a couple of points. The member keeps saying or wanting to make the point that somehow the $180 million doesn't provide new services. The fact of the matter is that it does just that; it does provide new services. It's based on need.

For example, in the case of the South Fraser district, their budget and their projected deficit were based on having to provide a level of service to meet the needs of one of the fastest-growing populations in the province -- not on the basis of being funded last year and having funding cuts take place but, rather, on: "What does it mean if we want to not only provide the same level of service but recognize that the population is growing at the same time, that it is aging at the same time?" -- and that requires more services to be delivered to meet the needs of that population group.

That is, in fact, what the basis of the budget takes place on.

In terms of the answer around the issue of equipment, the member can receive a breakdown into general categories in terms of where the funds for equipment are going, but the specific breakdown in terms of each health authority and each particular piece of equipment will be available to him next week.

C. Hansen: Actually, I find that last comment quite surprising, because the reason we're here on a Sunday afternoon is that the minister says that . . . . I think it was the Premier that said that they had to start cutting cheques tomorrow. And yet now we find out that they really don't have any plan to cut anything.

I guess the point that I was trying to make . . . . My question wasn't trying to trap the minister. It's simply . . . . Normally, when we go into an estimates process, the ministry staff is very helpful and very cooperative. We usually wind up with briefings that take place ahead of time, where we can get a lot of that detail out of the way rather than taking up the time in the chamber. So certainly in terms of the breakdown as to how his $290 million is being allocated, I guess I would welcome any documentation that could be sent over to me so we can make this process move along faster.

While the minister is arranging for that to be done, just send me whatever you can, and it'll help move things along more quickly. While the minister's considering that, I will defer to my colleague the Leader of the Opposition.

Hon. M. Farnworth: Had the hon. member come in a moment earlier and heard the question, he would have recognized that it said "to equipment," and I outlined where equipment was going. I said that on specific pieces of equipment on

[ Page 17193 ]

a health authority basis, I'll be able to provide that information to the member next week. In terms of the allocation around equipment, in terms of the broad basis of the allocation of equipment and where it's going, I've already mentioned that in this House, and I'm quite happy to tell the member where it's going. But in terms of the exact allocation of what particular piece of equipment, that will be made public next week. Information that I'm able to provide him at this particular time, I will.

G. Campbell: I do want to go back with the minister to the issue of health authorities and their budgets. I think that the difficulty here is with regard to what the minister considers a level of service. I would expect that the ministry would be concerned with the level of service to patients -- not to institutions, but to patients -- and to the needs of patients in British Columbia, whether they live in rural communities or urban communities. When the minister says, "We are providing a new level of service because there might be more people," what he is saying is: "I am providing the same level of service to more people, and that may cost us more money." Does the minister agree with that?

[1525]

Hon. M. Farnworth: It's not only a question of providing existing levels of service to an existing population group, but in terms of . . . . If a particular population is increasing due to demographics and to an increase in age and an increase in the number of people, you also end up getting a critical mass, at certain numbers of people, that allows you to deliver the services that are required and that wouldn't otherwise be able to be delivered effectively because there's not, in essence, a critical mass of people there to provide that service.

So in some hospitals or some health authorities, for example, if a population increases to a certain point, it makes sense . . . . You are able, then, to fund additional services going in to meet the needs in that particular area,

whereas before, the base was not large enough to provide that level of service.

G. Campbell: Hon. Chair, I think the important thing to recognize here is that actually we are striving to understand what on earth is taking place here. We have the minister telling us, on the one hand, that there are new dollars. On the other hand, there's a $180 million deficit. On another hand, the $18 million deficit is actually providing new services, which were really old services, to a different number of people in different regions.

So let's cut to the chase. I'm sure the minister has spent some time talking with the Health Association of B.C. I'm sure he's spent time talking with health authorities. Does the minister recall in the spring when the health authorities came to him and said: "We cannot maintain service to people; we cannot maintain service to patients with the current budgets which you have allocated"? The health authorities said to the minister that they believed they were facing . . . .

"If we maintain service at the level that we had in the 1999-2000 fiscal year"-- if they maintained that level of service -- "we are facing about a $200 million deficit." Does the minister recall the health authorities telling him that?

Hon. M. Farnworth: The hospitals or health authorities, at the beginning of the year, outlined what was required for us, and it would be correct to say it would be around $180 million. But it's not just to say that the $180 million is to provide exactly the same level of service that you provided the previous year. Rather, it's not only to provide the level of service that was delivered the year before but also to take into account the change in population that's currently taking place and the ability to provide additional services to meet those changes in population and, in a number, to increase services in areas where you're now able to do so because of the changes that have taken place.

G. Campbell: But the minister confirms that the health authorities did say there was going to be a deficit; they were facing a deficit. The minister then, I assume, said to them: "Carry on with your program. We think we're going to receive dollars from the federal government. And when that happens, we will provide that, so that your deficit will be covered from the dollars from the federal government." Is that not correct?

Hon. M. Farnworth: They gave us advice on what it would cost to maintain not only existing levels of services but also the types of services that you would want to see in place, given the change that takes place over the coming year in terms of population, in terms of demographic and in terms of the service levels that they want to provide within their communities.

[1530]

G. Campbell: At the end of the day, though, I think the minister has got to admit that what has really taken place is that all of the $180 million that we're talking about today has been consumed with the health authorities' budgets, which were established prior to this. This is not about new programs; it is about maintaining old programs. It is about maintaining services to patients in the province or to health authorities in the province of British Columbia on the basis of individual patient needs. It is not about brand-new dollars; it's about the dollars the health authorities identified that they needed in March of this year.

Hon. M. Farnworth: No. This is about not only the provision of existing services and the ability to provide the existing level of service but also the new services that are required to be provided due to things such as population growth and demographic change. And what it resulted in, hon. Chair, was an 11.2 percent lift in the health authorities' budgets -- $489 million, of which $120 million is for new services, and on top of that, $70 million in new equipment, which also allows new things to be done.

G. Campbell: I want to focus on the $180 million. I'm sure we're going to get to the $70 million eventually, but let's not keep on trying to confuse the facts. The fact is that the health authorities came to this minister in the spring and told him that they were looking at about a $200 million deficit if they were going to maintain services to patients across the province of British Columbia. That's what they said. They didn't say: "We have a $200 million deficit if we maintain services and add services and add this and this and this." It was simply to maintain services across the province.

I think that for the minister to try to pretend that that was not the message that he received from health authorities is less than straightforward to the House, and it doesn't help us move forward and create a stable, solid foundation for improvement of health services to patients in the province of British Columbia. It certainly doesn't create a sense of confi-

[ Page 17194 ]

dence in this House when the minister doesn't understand how his own budgets work. The fact of the matter is that the Health ministry approved health authorities going ahead without a finalized budget that they knew was going to create a $180 million deficit -- according to the minister, but according to some health authorities, substantially greater deficits -- in those authorities across the province.

When did the minister approve the health authorities moving forward on that basis? And why would he approve them moving forward without a finalized budget that says: "This is your budget for this fiscal year. This is how you are required to provide services to patients. These are the dollars that you will need to make sure that patients in the province of British Columbia get the care they need, when they need it, where they live"?

Hon. M. Farnworth: The advice the health authorities gave us at that time was the best advice that was available to them, not just on the provision of existing services but on the provision of services to take into account growth in population in the communities, and the new services that are provided because that takes place. At that time, I was comfortable enough with the deputy minister telling them that they should proceed on that basis, because we were far enough along in our discussions with Ottawa to know that we were going to get an investment on the restoration of transfer payments, which in fact took place, allowing us to invest $70 million into equipment, for example.

The end result . . . .

[J. Cashore in the chair.]

Interjections.

Hon. M. Farnworth: It's really interesting listening to the members opposite say "$180 million." They don't want to talk about $70 million, and they don't want to talk about this, but the $180 million . . . . Well, the $180 million is part of a $489 million lift, or 11.2 percent, to the health authorities' operating budget. It provides $120 million in new services that weren't there last year. It allows the health authorities to maintain not only the same level of services that were done last year but new services that weren't there last year.

[1535]

I'd like to give some examples of them. It allows for a 6.1 percent increase in cardiac surgery. Those are procedures that weren't done last year. It allows for a 5 percent increase in angioplasty. It allows for a 5.7 percent increase in cardiac pacemakers. It allows a 10 percent increase in the number of cardiac electrophysiologies done. It allows a 33 percent increase in the number of pacemaker extractions done. It allows a 100 percent increase in the examinations for brachytherapy for prostate cancer. It allows us to do 14.9 percent more screening mammographies than the year before.

Those are new procedures, new services that weren't there the year before. That's what the budget decisions of this year allow us to do.

An Hon. Member: That's the budget we already debated.

The Chair: Before the opposition leader continues, I'd like to call on all members to go through the Chair with their remarks.

G. Campbell: Through you, Mr. Chair, I would like to ask the minister: if he knew all of this during the spring session of the House -- we had a debate on the estimates of the Health ministry, which is something that is critical to all of us -- why didn't he share that information with the House at the time? Why did he make the health authorities feel that they had to go around him to share that information with the public, and why wasn't he straightforward with us with regard to the fact that we were clearly $180 million short in terms of the budget that he'd allocated to meet the needs of patients?

Even with the litany that the minister just went through . . . . I would suggest to the minister that that litany is probably . . . going to meet the needs -- the demographic increases and population increases -- so patients get a standard of care which should be fundamental to health authorities and to the patients in the province of British Columbia. He misled us in the spring with regard to that.

Hon. M. Farnworth: We made it clear at the beginning of the year that we were in discussions with Ottawa to get more money into the health care system, and what I said a moment ago was that the issue around the health authorities at the beginning of the year and their request was their best estimate. It's just that: a projection. It's to ensure that there's a level of service that's delivered, including new services based on population demographic. That is in fact what has taken place.

In fact, the health authorities are very happy with the fact that we have been able to address issues such as equipment funding, which is something we were working on at a time when that opposition said we would never get an agreement to do just that.

M. de Jong: I've listened carefully through the course of this debate. Here's one of the extraordinary things that I've learned. We have called this House into session for an extraordinary session on a weekend, and that's okay. We have been called specifically to discuss a supplementary allocation of spending to the Health ministry in the amount of $290 million, and the government and minister don't want to talk about $180 million of that $290 million. It's an extraordinary state of affairs and one that I think speaks volumes about the true state of affairs within government and within the ministry.

[1540]

I came here with a couple of specific objectives in mind, because I was told . . . . I should say, first of all, that when I heard the minister make his initial remarks, it reminded me of speeches that we have been hearing from Ministers of Health on the NDP side of the House for nine years now -- nine years of promises about how this time we're going to make it work; this time it's going to get better; this time wait-lists are going to be reduced. Every single time it gets worse and worse. I haven't heard anything from the minister, not one thing, that suggests to me that this time is going to be different.

I've heard lots to suggest that we're engaged in another NDP public relations exercise. I've heard enough to convince me that this is a government that, as it comes to the end of its mandate, is so concerned -- is so desperate -- that it will go to any length and do anything to pretend, to be seen to be doing something. But people are seeing through it. They're seeing through it, Mr. Chair.

I came here with a couple of objectives, because one of the things I was told -- one of the things I heard from the

[ Page 17195 ]

Premier and from the government -- was that we had to come here today because: "We want to write the cheques tomorrow."

Interjections.

M. de Jong: "We want to write the cheques tomorrow." There are people watching from all over the province because that interests them, because whatever we discuss here, presumably we can agree that some of those funds -- all of those funds -- are needed and are going to be put to work. So here's my question for the minister. The chair of my regional health board is watching, and apparently he's going to get a cheque tomorrow. That's why we had to come here today. How much is he getting in the Fraser Valley health region? How much money is George Peary, as the chair of that body, going to get tomorrow?

Hon. M. Farnworth: He's getting a lot more than he would if you were sitting on this side of the House, because five years ago you said that federal transfer cuts didn't go far enough.

Interjections.

The Chair: Order, hon. members.

M. de Jong: I'm going to give the minister one more chance, because I know he has an answer. I know he wouldn't call this House on a Sunday on the assurance that cheques were going to be written on a Monday . . . . I know he wouldn't do that unless he had an answer for a very basic question: how much is the cheque going to be?

Hon. M. Farnworth: There's $180 million of new funding going in to this year -- $489 million total. That will be announced tomorrow. Then George Peary will find out, once this has been voted on and approved.

Hon. Chair, we have listened to the member opposite go on about nine years of speeches and broken promises. Well, you know, what we've heard from them is a litany of one. Five years ago federal transfer cuts didn't go deep enough. And where did those transfer cuts go? They went to health care. They were health dollars that this province was shortchanged on, and that member and his colleagues said that they didn't go far enough.

We've been engaged in restoring that money with Ottawa this year, and we have done that constructively and achieved that goal. And tomorrow, once this money has been voted on by this House, once this money has been passed by the House, then we will be in a position to cut the cheques and pass on restored dollars to those health authorities to deliver the services that the member wants to see delivered.

Interjections.

The Chair: Hon. members, it's difficult for the Chair to hear the debate. I would ask that hon. members speak through the Chair when they speak.

[1545]

M. de Jong: This government -- and maybe it wasn't the minister; maybe it was a desperate Premier -- has the audacity to call back the House on the basis that it purported to want to take some action on Monday. There was an urgency; there was a need for immediacy. We were going to write the cheques. And the minister responsible for the amount of money this House is being asked to appropriate by virtue of this vote can't tell us what the amount of those cheques will be.

Interjections.

M. de Jong: Some of my colleagues say: "He won't tell us." I refuse to believe that. If he even knew, I have to presume that as an hon. member, he would tell us. His own colleagues -- he didn't see it; he was pointed in this direction -- who represent constituencies right across the province of British Columbia, are shocked. I saw the look in their eyes. They thought they were going to leave here when this debate was completed and they were going to be able to tell their health authorities how much money they were going to get. But none of us know.

We are being asked to debate a supplementary estimate, a supplementary appropriation of money for the government to spend, and the government can't tell us how it intends to spend it. What an abuse! What an abuse of the privileges of every single member of this House! And if you need any further evidence about what a sham this has become, you need look no further than the minister's inability to answer that basic question.

Interjection.

M. de Jong: Lots of photocopying.

The Premier said we're going to use this money to reduce waiting lists for equipment for hospital buildings. Well, you know what? In Abbotsford they want to know how much they're getting tomorrow for their hospital building, and they thought they would get those answers as a result of a debate that apparently we had to have on a Sunday, because on Monday the cheques were going to be rolling out.

I think the minister must be embarrassed.

Interjection.

M. de Jong: Well, one of the former members of the cabinet says we'll find out tomorrow. Let's start with that. Is the minister prepared to stand in the House today and tell members of this House and health authorities right across the province that if this supplementary appropriation passes, they will get their cheques tomorrow, even if he doesn't know how much they are going to be?

Hon. M. Farnworth: What's embarrassing is the histrionics of the hon. member. What's embarrassing is his refusal to recognize that the $290 million infusion into health care in British Columbia is a significant and important event that (1) needs the approval of this Legislature and (2) recognizes the significant work that has been done between this province and other provinces with the federal government in getting a restoration of transfer payments -- transfer payments that were cut in '94-95 and had taken $26 billion out of the health care system, which they said at that time did not go far enough.

That's what's embarrassing now -- to listen to the bleating of the member opposite, to somehow suggest that we're

[ Page 17196 ]

not being forthcoming in telling him where that money is going. Tomorrow, when this vote is done, we will be in a position to start to notify the health authorities exactly of the specific dollar amounts that they are getting. But what I can tell the hon. member that this money going into the health care system is going to be able to do in terms of services is an 11 percent increase in pediatric service. That's what this money is going to be able to do. That's what the health authorities in Abbotsford are going to be able to look forward to. It's going to be able to see a 24 percent increase in marker screening.

It is going to see a 14 percent increase in renal dialysis, in our ability to provide renal dialysis for people on kidney services -- on kidney dialysis. That's because we are investing $290 million into the health care system and $180 million into the acute care system. That's significant, and that's what we're here doing today. He will have the specifics on a particular number available to him tomorrow, when the health authority knows as well.

[1550]

M. de Jong: Hon. Chair, I think we've just had the entire debate summarized in an aside comment from the minister. You know what he said to my colleagues? "Let's pass it first." Isn't that typical of the NDP? Isn't that typical? "Pass it first, and we'll worry about the details later." Well, you know what? We don't trust them anymore, Mr. Chair. We've set some kind of record here today. It usually takes at least a couple of weeks or months to catch the government out on misleading British Columbians. But no, it's happened within the span of about 36, 48 hours.

This is the news release that the government issued on September 15, 2000 -- the Premier quoted. I'm not making up the quote. It's his news release. "I hope this new spending receives speedy passage," the Premier said. "When Ministry of Health officials go to work on Monday, I want them to be able to start cutting cheques to B.C.'s health regions." Well, if they do, I guess they're sending them blank, because the minister can't tell them how much to put in the cheques.

I just want to make sure we all understand. There aren't going to be any cheques in the mail tomorrow. The ministry doesn't know how much it's sending. The ministry doesn't know where they're sending it. In fact, the ministry and the government don't really know anything at all. What the government knew was that British Columbians are fed up with their mismanagement and that we better be seen to be doing something. Maybe while people are channel flipping from football game to football game, it'll help us a little bit if they see us sitting in Victoria on Sunday. Maybe that'll help.

Maybe we can create an illusion of action, kind of like the illusionary action plan that we've already discovered contains no real new funding.

I had a whole series of questions about how that funding was going to break down in Abbotsford, the various envelopes that the Fraser Valley region was going to receive, but I can't even get a global figure. And absent that information, the minister still presumes to stand here with a straight face and say, as he did just a moment ago: "I can't really tell you much, but I'd really like you to give me the money." Well, Mr. Chair, it is awfully difficult when basic questions -- basic information about how this money could be put to work and would be put to work in my community . . . . When those questions can't be answered, it's really difficult.

I have a hospital just across the river from me -- actually the hospital I use, the Mission hospital. I don't suppose we'll hear a great deal from the member who represents that community today. But one of the things I wanted . . . . They're very concerned. They're very concerned in Mission about the future of their hospital and how this funding might impact on their ability to carry on with the services they provide and add to those services. I thought that maybe I'd come here today and that I'd get some answers for them.

I'd get some answers about how this money specifically was going to be put to work to assist the Mission Memorial Hospital. The minister can't answer that question. In fact, he can't answer anything at all.

[1555]

Interjections.

M. de Jong: My colleagues say I'm being too harsh, so I'll ask . . . . I can ask the question. I can ask the question about how much of this funding that the minister is asking us to appropriate to his ministry's use today will be available to hire additional nursing staff for the Mission Memorial Hospital. How much?

Hon. M. Farnworth: You know, I'm listening to the member rant and carry on in his sort of histrionic fashion, which he likes to do. But he seems to be missing one of the key fundamental points in this whole thing, this whole debate. A moment ago I just outlined for him where moneys are going on a provincewide basis.

The specific allocations to the health authorities will start tomorrow. But where the money is going, as I just told him a few moments ago, is in an increase in renal dialysis, an increase in cardiac surgeries and an increase in procedures performed in B.C. hospitals. It's an 11.2 percent lift over last year's budget; that's a significant lift to each health authority in this province, whether it's his Abbotsford health authority, whether it's the Mission health authority -- whatever health authority. Once we have finished this debate, I'll be more than happy to get the hon. member the specifics for any particular institution that he wants.

M. de Jong: Well, now I am confused. I won't prolong this. Is the minister saying that the information about funding on a region-by-region basis, the regional breakdown, is available, and he doesn't want us to have it until tomorrow? Is that what he's saying?

[T. Stevenson in the chair.]

An Hon. Member: Wait for it. He's going to say: "Stay tuned."

Hon. M. Farnworth: No -- you lose. I'm going to say that we are putting the final touches on the allocations in terms of some of the projects and programs that will be going forward, and you will be notified of the specific allocations, starting tomorrow.

M. de Jong: Well, I am baffled. Can the minister indicate what additional information the ministry intends to receive today on Sunday, between now and tomorrow, that will allow it to make those decisions? What exactly is the ministry waiting for?

[1600]

Hon. M. Farnworth: It's a very complex process. We are reviewing to make sure that everything has been done cor-

[ Page 17197 ]

rectly, because when you're putting an additional $17 million in new equipment money into the system, the equipment lists alone are enormous. You want to make sure that everywhere is getting the maximum amount of equipment that they can get. In terms of when you're putting in an additional $180 million in terms of patient care, you want to make sure that each health authority is getting everything that it is entitled to; that will be completed by tomorrow. And the member will start to get the specific allocations. He can have his specific allocation for Abbotsford; it will be ready tomorrow.

M. de Jong: What time?

Hon. M. Farnworth: In your case, hon. member, I'll make a special appointment sometime after 3 o'clock.

M. de Jong: Hon. Chair, just so the minister understands, I don't actually want any special treatment. I want to be able to debate this piece of supplementary appropriation with some information at my disposal. That's what I want to be able to do, and that's what every member of this assembly wants to be able to do.

Hon. Chair, I am exercised enough about this that I think the minister or the ministry deserves an opportunity to call their records, because I'm not sure the minister has been clear about whether or not a list, a regional breakdown on this funding, exists. If it does, maybe we should recess for 15 minutes and he can check, because every single member of this assembly deserves to have that fundamental information available to them.

I'll tell you what's abundantly clear: there ain't going to be no cheques issued tomorrow. For the sake of an hour -- 15 minutes or an hour -- I'd like to have that information. So I'm going to suggest to the minister that we take that recess so that we can have that complete set of information regarding the regional breakdown for this funding. To be perfectly blunt, I'm a little bit sick and tired of the games that are being played here.

Hon. M. Farnworth: I want to make sure that that member does not get special treatment, because we are debating a significant amount of money coming into the health care system. The specific amount for each hospital, for example, will not . . .

Interjections.

Hon. M. Farnworth: Just relax.

. . . be made available to him. But I'm more than happy to provide global amounts, and we are quite willing to provide the global amounts. We're not going to get into specific allocations for particular hospitals. What is important -- the fact we're able to debate -- though, is that there is a significant amount, $290 million, going into the health care system, and we do have the opportunity to debate that.

An Hon. Member: Where?

Hon. M. Farnworth: The member asks where. It's an 11.2 percent increase, on average, for every health authority in the province, which is over and above what we had last year. And that's a significant amount of money. That's what's important. That money is going into the system to provide more services than we've been able to provide before.

Interjections.

Hon. M. Farnworth: The member asks why and where. Well, the reason is because we have an agreement with Ottawa which is allowing for the restoration of transfer payments back to the provinces, which have been cut and put enormous strain on the provinces. Where? It's going to be into every single health authority in this province -- the cheques, which are going to start to go out tomorrow.

M. de Jong: Well, hon. Chair, I guess it's abundantly clear to everyone by now that we have been called here under horribly false pretences. There are, I think, in the neighbourhood of 50 regional health authorities . . .

[1605]

An Hon. Member: Fifty-two.

M. de Jong: It's 52, I'm told.

Who were led to believe that as a result of this debate -- particularly the specific amount included within it but actually the whole amount -- they would learn about moneys that would be coming in their direction. That was the information. That was the promise. That was the indication in the Premier's own news release. That was the urgency.

I just want to remind all hon. members that this government, which has said that we're going to do things differently . . . . Let's just remind ourselves about what we have seen here today in response to a pretty basic question, which is: "How much of these funds are going to individual regional boards?" The minister has replied thusly: "We're pretty close, and I know, but I'm not going to tell you; in fact, I'm not going to tell you until the debate is over." That's the new openness, Mr.

Chair: "We're not going to tell you until the debate is over." If people needed any further evidence that it's business as usual from a group of incompetents that have driven health care in this province into the ground, that is the evidence that confirms it.

G. Campbell: I just want to try and get the minister focused on what really should be, I think, the fundamentals of accountability. First, we have to know what is expected to be spent. In terms of this particular discussion we've been talking about $180 million. Second, we should know where it is going to be spent. Where does the minister intend to spend those dollars? We've found out today that he intends to spend those to cover the deficits which he's known about since the spring. Third, we should know where geographically it's going.

There are 52 separate hospital authorities in this province, all of whom have been told that they are going to get resources tomorrow, and the minister is saying today: "Trust me." I want to tell the minister that we don't trust him, the public doesn't trust him and patients in British Columbia don't trust him.

One of the critical things that we have to do to start rebuilding confidence in our health care system is be straightforward and upfront with people. Once again, the minister has failed that most fundamental test. The reason that we are as skeptical and the public is as skeptical as I am suggesting today is that it was in May of this year that this minister -- not one of the previous five or six ministers but this minister -- said that every single health authority would have their budgets completed within two and a half weeks. Two and a half

[ Page 17198 ]

weeks would have taken you to the first week of June. This minister failed to provide those health authorities with the resources and with the definite budgets that they needed. He has failed to give them the security they can use to plan for the year. He's failed to give them the security that they need to plan for the patients that are needing their services across the province of British Columbia. He's failed the caregivers, whether they be nurses or doctors or physiotherapists. He's failed the employees, and most importantly, he's failed the people of the province of British Columbia.

This Premier has said that he wants to be open, so my question today to the minister is simply this: "Tell us what you are spending." And you know today. We watch the paper flow around; we watch the staff trying to figure out how you spend money and where you spend it and who has authority. We can see that here. They can't see it at home, but we can certainly see it here. This minister knows where he's spending that money. This minister knows the equipment that he's planning to buy with that money and where he intends to allocate it.

And if he doesn't, he should. We believe he does, and I believe that he has an obligation to this Legislature, to every member of this Legislature, every member on the government side and every member on this side, every single one of whom cares about health care and cares about the patients of British Columbia. He has an obligation to give us that information.

[1610]

Hon. M. Farnworth: Well, I guess what we're seeing is the new era of the opposition -- and I make the point being "error." Because listening to the Leader of the Opposition . . . . They're saying that the government has not been investing into health care and doesn't want to invest in health care; you can't trust the government on health care. Well, this opposition and this opposition leader, who are suddenly portraying themselves as a defender of health care in British Columbia, are the same ones who said that the federal transfer cuts did not go far enough. And those are transfer payments that went . . . .

Interjections.

Hon. M. Farnworth: Your Leader of the Opposition said, in response to the transfer cuts of five years ago, that they did not go far enough. And this province has been paying the price for those transfer cuts for the last five years.

Interjections.

The Chair: Order, members. Order.

Hon. M. Farnworth: We were told earlier this year that the provinces would not be getting an agreement with Ottawa, that there was no way we could get this money into the health care system, that there was no way that the government would see this money. Well, guess what. We've got an agreement with Ottawa, and it's seeing a significant amount of money being invested into health care this year in terms of equipment, directly from Ottawa and for the following five years, starting with an additional $425 million. This province this year is putting in an additional $180 million on top of that and another $40 million to deal with physicians.

The $180 million is being allocated on a health authority basis, on an average lift of around 11.2 percent. I know . . . .

An Hon. Member: How do you know that?

Hon. M. Farnworth: Well, do the math, hon. member. Take the money . . . . The member says: "How do you know that?" You take the money that we're adding this year to last year. It's 11.2 percent. It's not that difficult to do.

In terms of the health authorities, specific allocations will be available tomorrow. In terms of what it means, though, for health authorities, it's a significant increase. In the case of the Fraser Valley . . .

Interjections.

The Chair: Order, members.

Hon. M. Farnworth: . . . I think it's about a 10.7 percent increase. On the North Shore it's about an 11.2 percent increase. They are significant increases. In terms of equipment, hon. Chair, $70 million for new equipment; $19 million is going to high-tech equipment. That's a significant number. It's $19 million more than if we didn't have an agreement with Ottawa. There's $17 million to improve health and safety.

Interjections.

The Chair: Order, members, please. Let the minister speak, please.

L. Boone: Point of order, Chair.

The Chair: Sorry, member.

Interjections.

The Chair: Members.

L. Boone: Point of order.

The Chair: I recognize the member for Prince George-Mount Robson, who is now in her correct seat. Thank you.

Point of Order

L. Boone: Hon. Chair, in the fray that was going on there, I heard a member refer to the minister as a fraud. I do think that is unparliamentary language, and I would ask that . . . .

Interjections.

The Chair: Thank you, member.

L. Boone: I would ask that the member retract this.

Interjections.

[1615]

The Chair: Thank you, members.

The Chair did not actually hear the member referring to the minister as a fraud. However, if I'm incorrect, and the member wishes to withdraw, please do so.

G. Campbell: Unfortunately, I think what we reap today is the benefits of a government that refuses to include the

[ Page 17199 ]

people of British Columbia in any discussions about health care. The minister displays an appalling ignorance of what many British Columbians have recommended as ways of curing the health care crisis that has been created by the NDP over the last little while.

The minister may have noticed that people in rural communities across this province are not getting the care that they need and that they deserve and that they pay for. The minister knew for four years that that has been a brewing crisis. The opposition recommended to the minister two years ago that $100 million be put on the table and that the Legislature, all of us together, go out and work with those communities to provide a positive, constructive, thoughtful response.

Instead the minister has gone from one community to the next, from one crisis to the next, and more important than that, patients in every single one of those communities have been put at risk because of this minister's and this government's incompetence.

Just in the last couple of weeks the dean of nursing has pointed out quite clearly that this government doesn't get it. It was four years ago that this side of the House said to this government: "We should be investing in training nurses. We should be trying to hire 2,300 additional nurses between 1996 and the year 2000." And this minister finally figured it out last year and managed to get about 25 percent of what he'd allocated. That's the crisis in health care in British Columbia: it's this minister and this government's incompetence.

The last minister who I recall being as forceful about how he wasn't going to give information to us was the minister responsible for B.C. Ferries. It was the minister who said, "Everything was taken care of. Trust us, it's only going to be $210 million. Oh no, it's going to be $290 million. Oh my goodness, it's 468 million bucks," which that group of incompetents wasted and is not available for health care, is not available for patients in the province of British Columbia.

So I want to help the minister. I want the minister to get how you actually try and run an accountable, thoughtful, organized, constructive government service. You decide what you're trying to deliver in terms of services to people, to patients across this province regardless of where they live. We do not support the two-tier health care system that this government has put in place between rural and urban communities.

The minister has to know the services that are required by patients in communities under his responsibility. The minister has to know how much money will be required. The minister has to know where he's going to allocate those resources. And the health authorities have got to be given the responsibility and the opportunity to make those allocations in a thoughtful and constructive way. The Legislature, when they approve that resource, that vote, has an obligation. And indeed the minister has a responsibility to share information with the Legislature, so we can help the minister.

I understand that the minister may care more about his riding than the riding of someone on this side of the House. But I don't think British Columbians think that way for one single minute; they want every British Columbian to be cared for.

For this debate to be constructive, all we are asking the minister to do is something that should be fundamental to how a parliamentary democracy works. We want the minister to say: "This is what we are spending. This is where we are spending it." We know today. The minister knows today, and he should stop the charade that he doesn't. The minister should tell us exactly what he is going to allocate. What are the strings that are going to be put on these resources to health authorities? He knows that today.

When the minister does that, we can have an open, honest, straightforward debate that may actually give British Columbians a sense of hope that we can take care of patients and put the minister's politics on the back burner.

[1620]

Hon. M. Farnworth: Hon. Chair, I'd like to make the following point to the hon. member: this is supplementary estimates. We've already been through an estimates debate that outlines exactly where funding goes and exactly what the priorities and policies are, exactly where the priorities are, and the policies and procedures in terms of what programs are being offered by the ministry, in terms of what programs are funded by the ministry and in terms of the role of the health authority. The reason we are here, hon. member, is because there is $290 million in additional funding going into the health care system to fund the priorities that we debated earlier in estimates.

Interjection.

The Chair: One moment, minister; please take your seat. Members, when the Leader of the Official Opposition spoke, no one interrupted at all. I'd ask that you please listen to the minister.

Interjection.

Hon. M. Farnworth: Perhaps, hon. Chair, I will sit down, and you could repeat your comments for the hon. member.

But where I was going in what I was saying was that we have already in this House debated estimates -- debate in terms of what the policies of the ministry are, where the funding allocations go in terms of broad policy objectives and what it is we are trying to achieve. This is supplementary estimates, because there is an additional $290 million going into the system -- $180 million going into the acute care system, the hospitals, health authorities of the province -- to fund those initiatives and those policies that are currently in place and have been debated in this House during the estimates process.

A. Sanders: We are here on an emergency basis, and we are here with 48 hours' notice, to look at the spending of $300 million within the Ministry of Health. That in itself is an emergency. Unfortunately, the minister has been unable to give us any idea of where that money is going, other than in large amounts. There is no allocation to any of the districts and none of the information that we've actually come here on Sunday for.

There has only been 48 hours' notice for members to find information, to get their thoughts together and to investigate why we're coming back. In fact, most of us had no idea of the content of the information until we arrived here today at 1 or 2 o'clock.

In 1990 the Members' Conflict of Interest Act passed in the B.C. Legislature.

Section 9 of that act requires a member who has reasonable grounds to believe that he or she is in a conflict of interest to bring that matter before the assembly. As

[ Page 17200 ]

a health care provider, I wish to acknowledge that I have tried to seek information as to whether I had any conflict in participating in a supplementary debate. Because it has been the weekend, I've been unable to get that advice or to seek any answers from the conflict-of-interest commissioner. But based on past practices and past rulings and on my efforts, unsuccessfully, to seek a ruling, I wish to provide and proceed with discussion of the health action plan which has been brought to this House today by the Premier.

Under standing order 18, I may speak in debate and propose amendments. We are not talking about a supply bill; we're just doing the estimates, so there should not be any problem there. And under standing order 18, I am not entitled to vote upon any question in which I have a pecuniary interest. I would not choose to vote if I felt that was the case.

One of the most disappointing things about today, for me personally, has been the acquisition of the B.C. health action plan. This is a three-page document that is supposedly going to outline a brand-new direction in an $8 billion ministry. Health care is probably the most important thing to every single British Columbian. There is no one in this province who does not worry about their health care system and how they're going to get health care when they need it. When I look at this three-page health action plan, I find absolutely no action whatsoever.

My first question to the minister is: what is the budget for advertising that presumably will begin tomorrow, from what the minister said . . . ? What's the budget for advertising for the health action plan, and where will those funds come from?

[1625]

Hon. M. Farnworth: It will come out of the Health communications budget.

A. Sanders: Could I have the figure, please?

Hon. M. Farnworth: This is a supplemental estimates, and I will get that . . . .

Interjections.

Hon. M. Farnworth: In answer to your question, this is a supplemental estimates debate, and that allocation, in terms of coming out of the Health communications budget, would have been something that we would have discussed earlier, in the previous estimates debate on Health. However . . .

Interjections.

The Chair: Members, please . . . .

Hon. M. Farnworth: . . . as I said, I will get the communications budget figure for you.

A. Sanders: If the minister has suggested there's an 11 percent lift, would he then propose there'll be an 11 percent lift to the communications budget to advertise the plan in accordance with the new money?

Hon. M. Farnworth: No.

A. Sanders: How many commercials can British Columbians expect to be run tomorrow on the health action plan?

Hon. M. Farnworth: I'd like to make one point clear for the hon. member. There is a communications budget in the Ministry of Health. That's already been debated, in terms of the estimates that have already been passed by this House. I told the member that I would get the budget number for her on exactly what it is, in terms of what we spend on communications.

In terms of the money that's being requested today -- the supplemental estimates approval for the $290 million -- none of that money is going to communications. All of this money is going to three areas. One is for $70 million to equipment. There's $40 million for the physicians' package and $180 million to the acute care system. It is not going to the ministry or to the ministry's communications budget for ministry operations.

A. Sanders: Will there be commercials on the health action plan tomorrow?

Hon. M. Farnworth: There will not be commercials around the allocation of this money to health authorities tomorrow.

The budget for communications for the Ministry of Health for the year is $2.9 million.

A. Sanders: Will there be television ads this week on the health action plan or allocations of this money?

Hon. M. Farnworth: I'll just repeat for the hon. member: there's $2.9 million in the communications budget which was passed earlier this year, but none of the money we are allocating here today will go to commercials. It is all going to health authorities, to equipment and to physicians.

[1630]

A. Sanders: What advertising was scrapped in order to fit the $2.9 million advertising budget from the previous estimates?

Hon. M. Farnworth: The ministry's communications budget of $2.9 million is set at the beginning of the year and was debated during our last estimates. That is not based on whether or not there's supplemental estimates and whether there's additional money coming into the system. So that budget is set. I'll repeat my answer for the hon. member that of the moneys that we are dealing with here today, none is going to advertising. None of that money is going to communications.

All of that money is going to the priorities we have outlined and which are the priorities of British Columbians, which are to see more money going to equipment, to see money going to physicians and to see money going into the health authorities to provide patient care.

A. Sanders: Will you be advertising the B.C. health action plan?

The Chair: Member, the Chair doesn't really see the relevance of the line of questioning in regards to the Medical Services Plan or the acute and continuing care, which is what we're debating.

Hon. M. Farnworth: I'll repeat again for the member: none of the money that we are debating here today is going

[ Page 17201 ]

into communications. During the course of the year there is a communications budget in place; there is a communications budget within the ministry of $2.9 million. From time to time during the year we do advertise around important issues -- whether it is preventive health care, whether it is around primary care issues, whether it is, for example, the flu vaccination season and the flu vaccination program that we're doing, which is coming up. All of those things are part of the health action plan, and that's part of the ongoing ministry operations that we do through the course of the year. But there is nothing from today's allocation that is going into any communications budget.

A. Sanders: Sometimes what's not said is more important than what is said, and I look forward tomorrow to watching the commercials on the B.C. health action plan and all of the new and wonderful information that this government will be putting forward as to how we will see improvements in a system where there are no additional moneys. We've made that very clear today. There is no new money; there are no new initiatives. There is status quo and perhaps, in some communities, less than status quo, and time will show that.

I think the thing that should never be forgotten here is that we're talking about real people. We may in here talk partisan politics, and we may talk rhetoric. We may talk about what our opinions and our ideals and our values are. But we're talking about people's lives who live in Quesnel and Prince George and Vanderhoof and the Kootenays and the lower mainland and the Okanagan. We're talking about people who try to get their babies delivered in areas where they can't get care.

We talk about people who have brain tumours, who have to travel from Terrace down to Vancouver to try and get care. We talk about the unsaid difficulties they had in getting health care in British Columbia, both from a financial and a geographic point of view. Never forget that that's what you're here for. Never forget that we're talking about people. We're not talking about the NDP or the B.C. Liberal Party; we're talking about people and their lives and what's going on for them in their communities where they live.

Right now and in the last nine years, in terms of their health care, they have seen deterioration after deterioration. This is not a situation that we should be proud of, and the fact that we're here today is not for an emergency but for a nine-year festering illness that this government has put on health care in British Columbia.

Hon. Chair, this is not an emergency debate. There is nothing new going on, especially in the rural areas. Nine years ago, in 1991 when this NDP government was elected, there was the start of a class warfare against rural physicians and physicians in general. I can remember the Minister of Finance -- I think at that time the Minister of Health -- talking about greedy doctors in the north wanting more compensation for on-call work. I remember discussions with those same ministers about overdoctoring in Quesnel, a community that in 1991 was told it was overdoctored -- overdoctored.

[1635]

I can remember a number of issues to get rid of doctors in the north so that we could get rid of all of those doctors based a lot on the kinds of economics of Robert Evans and many others: limiting billing numbers, stopping immigration, stopping in-migration of physicians from other provinces, stopping graduation or at least limiting the number of graduates from medical schools, providing capitation proration and saying that there are too many doctors in British Columbia.

Well, the chickens have come home to roost. Let's look at some of those communities. Ten years ago Quesnel was a community that had a hospital for potentially 100 beds. There had been a hospital there for over 100 years in some form. Within a period of three or four years they went from a hospital of potentially 100 beds -- with 72 beds open -- to a place of somewhere around 29 to 38 beds. They went from having a relatively stable group of overdoctored physicians, who were no longer there.

We found fuel from the Ministry of Health at that time, saying that there were too many doctors, and these doctors were expecting too much to work in communities like Prince George, Williams Lake, Quesnel and other places in rural British Columbia. We heard it in the House, we heard it in the press, we heard it in the ads, and we certainly heard it in the rhetoric of negotiations.

Now what do we have? We have a community with no stability, a community that would like to have recruitment of individuals to live there as a retirement community. But guess what retired people want; they want health care. We have a community that this summer had no ICU. We have a community where if you went with a suspected heart attack into the ICU, where there was no specialist, you were flown to Vancouver for your overnight care and then had to figure out how to get home. We have a community that was unable to look after itself in any way, shape or form.

People do not go to communities where they don't feel safe. And what we've got in rural British Columbia right now is no stability and no feeling of safety, especially for the group of folks who are getting over 50 and have additional health care needs.

Hon. Chair, when I was in Quesnel not very long ago, what I found was that there were very few nurses in the hospital. Not only were there 30 beds with patients, with a psychiatric patient next to a medical patient next to a surgical patient, and no ICU, but the nursing supervisors were working as general duty nurses because there were no nurses in the hospital. So what does all that mean?

And what does this government have as a solution after nine years of a chronic problem for communities in northern British Columbia? They have the B.C. health action plan. This is the plan that we're going to see lots of advertising on over the next little while, because it has principles, priorities and implementation strategies -- lots of things that you can wrap commercials around that really don't mean very much.

I'd like to ask the minister a few questions about some of this material and really what the principles mean in terms of real-life values. The first principle in this report says that the B.C. health action plan is to "modernize and strengthen B.C.'s public health care system . . . . "

Interjections.

The Chair: Members, just keep it a little quieter, please. Thank you.

Continue, member.

A. Sanders: First question: what does this principle mean, to "modernize and strengthen B.C.'s public health care system to improve patient care"? It means nothing at all to me. What does it mean to the minister?

[1640]

Hon. M. Farnworth: I think what the member needs to realize is that one of the key principles and the one that she

[ Page 17202 ]

just talked about is that we want to ensure that British Columbians have access to the latest and most up-to-date procedures, that the quality of health care is something they can count on and that it's there when they need it. That, I think, is an underlying principle in our entire approach to health care.

I think one of the key things that we need to recognize is that we have put in place a plan that will deal with that. One of the cornerstones of that plan has been to ensure that we bring stability to the system, because we have a very good system in this province, and we have a very good health care system in this country.

One of the things we have been working very hard . . . .

One of the cornerstones to the implementation of the health care plan has been the work that's taken place to date in terms of restoring the issue of transfer payments with Ottawa so we get a balance back in the system, which allows us greater stability in terms of how we deliver health care services not just here in B.C. but right across the country; a recognition of the pressures that we face on the system here in B.C. and the way in which those pressures impact upon other systems in the country as well, so that we can work to ensure that not only are we doing what's required within British Columbia to meet the challenges in our own province but also in terms of how those pressures impact on other provinces and how we can work better to ensure that we meet those pressures.

What's also important is that, look, this is urgent; it can't wait until next year. The member's comments around "false pretences" are just straight nonsense, because what we have been doing is ensuring that in our discussions as a government and our policy as a government, health care is our number one priority. That's why we went out and got the agreement with Ottawa. That's why we worked constructively to get that agreement with Ottawa to restore the transfer payments at a time when a lot of observers in the system said that that couldn't take place. Well, in fact it has. That brings the stability that we need into the system which I'm talking about.

However, the full impact of that agreement doesn't start to make itself felt until next year, and so we had to take action this year to make that take place. That's why the funding is being asked for in these supplemental estimates today: so that the health care action plan -- which is based on the principles that you're now asking questions about and is also based on a cornerstone of restoring some of the financial and fiscal integrity into the system which disappeared with the elimination of transfer payments and the cuts that took place five years -- can take place.

Interjection.

Hon. M. Farnworth: The hon. member says: "That's not where it disappeared to." Well, $26 billion was removed from the system -- $26 billion for the integrity of the health care system . . . puts a lot of integrity into the system in terms of our ability to meet the financial commitments that are required in the health care system. So $26 billion had been taken out, and it has been a major initiative on the part of this government in terms of restoring and putting health care back to where British Columbians expect it to be -- to do . . . .

As I said, No. 1 is the development of the plan, and No. 2 is how we're going to finance the plan. A key cornerstone of that is the implementation of the federal funding. So that's what's taking place. In terms of the principles, they're very straightforward, and they're based on what we have heard from British Columbians -- what they want the basis of the health care system to be.

A. Sanders: It's refreshing to hear the minister recognize that maybe perhaps there is an emergency. It's important to also remind that minister that in December of 1999 the then Premier of the NDP, the member for North Coast, said there was no health care crisis. That has been the stand of this government since 1991 when they took power: "There is no health care crisis." I quote the member for North Coast: "There are some difficulties, clearly. You can't deny that there were some problems in emergency rooms this past week. Does that constitute a crisis? I don't think so. We are going to fix it."

That's the kind of rhetoric that we have heard over the last nine years. It hasn't changed. There's been too much health care, too many health care workers, too much going on, and this government has tried to do everything it can to decrease the amount of health care delivered to British Columbians. And guess what. It's worked.

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Let's look at the examples of how it's worked: (1) a $125 million, seven-year mental health plan that never existed, (2) a lack of long term care beds identified in 1991 in the Seaton report that have never been fixed and that we are having trouble in acute care because of at this time, (3) hospital equipment that is so poor that developing nations have rejected taking it secondhand. We have had rejected medical equipment from Third World countries -- equipment that's being used in the Victoria region hospital district.

We have had wait-lists grow under this government. Since 1996 we have had wait times increase substantively for surgery. From 1995 to 1999 median wait times have jumped 26.9 percent for general surgery, 38.7 percent for urology surgery, 53.7 percent for knee replacement, 71.4 percent for gynecologic surgery, 82.4 percent for hip replacement and 126.3 percent for neurosurgery. These are according to the government's own wait-list times.

Under this government we have had, for the first time in a century according to the president of St. Paul's Hospital, St. Paul's in an untenable position of operating over budget, with a $7 million deficit. We've had emergency room crunches in 1999 where the president of Vancouver General has said: "In my 28 years in this field in the lower mainland, this is the worst experience that I have ever had as an administrator." At the same time we have had a Premier at that time, the Premier from North Coast, who said that there was no health care crisis. We have had nine years of mismanagement of health care that is extreme, severe and has example after example after example.

When I look at a principle of the B.C. health action plan brought forward today after nine years of trying to tinker with the system . . . . The first principle is to "modernize and strengthen B.C.'s public health care system to improve patient care." I would have to say that this government has done everything but that over the last nine years. I cannot find one example where something is improved from how it was nine years ago with respect to how people feel about the care they're getting in British Columbia. That is unconscionable.

Another principle is to maximize preventive care and wellness. Could the minister please explain to me what on earth that means?

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Hon. M. Farnworth: The member made a number of comments in her statements that I'd like to address. But in response to her specific question, I think one of the key things that's important in terms of ensuring that we have a healthy and well population is that they have access to the information they need to ensure that at a basic primary public health level those services are there for them.

I'll give the member some examples of initiatives that have been undertaken in this past year, which will illustrate what I'm talking about. There has been the new cardiac information centre that has opened up at St. Paul's, for example, which allows the public access to the latest information in terms of cardiac procedures -- what they should do, what to expect. There have been similar initiatives taking place in terms of treating Alzheimer's -- to help Alzheimer's patients. There is the province's initiative, for example, around the flu strategy and the information that's required around that. Those are very important basic health care elements that need to be dealt with.

The member also made her comments and her points around wait-lists, for example. The preliminary data to June 2000 indicates a reduction in wait times for a number of surgical procedures, including hip and knee replacement surgery and cardiac surgery. Waiting times were up slightly in 1999; they did increase. But the data to date shows that so far this year, in the year 2000, they have in fact come down. Between 1995 and 1998 they remained steady.

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We are very concerned about ensuring that what we do improves services to patients. That is the goal of our health action plan, and that is one of the key principles upon which it is built. That's one of the reasons -- because the member also talked about the ability to access services and wait times -- why we're putting the $40 million on the table for doctors: to ensure that there are physicians in communities throughout British Columbia, to provide significant incentives and significant retention and recruitment bonuses to attract physicians to those places and keep them in those communities.

That is also part of it. That's another concrete area where the government is showing its commitment to improving patient care and access to the services that they require.

A. Sanders: I think the minister should recognize that the wait-list times went up significantly under the NDP, and if they've come down a little bit in terms of percentile, that's good, because they're coming down from very high levels. The numbers I have given are from the Ministry of Health's own statistics.

With respect to rural care and initiatives that are going on in trying to improve rural care, I think there are two things that need to be recognized. Number one, the government created the problem in rural care, which wasn't there in 1991. It was created under this government, and now they're trying to escape from it or trying to save it before it's an autopsy.

The second is that the member for Vancouver-Point Grey, the Leader of the Official Opposition, two years ago suggested a long-term, five-point plan -- $100 million -- into looking at the rural doctor situation and consultation with communities through the select standing committee. If that had been done two years ago, we wouldn't be here today.

When I look at this maximized preventive care and wellness, what the minister said does not give me any information whatsoever. In fact, I don't intend, actually, to get any information, because I don't think there is any to get. What I want to know are some specifics. Preventive care to me means things like physiotherapy, massage therapy and a number of other initiatives. Are there going to be additional moneys going to those areas that are not covered or are partially covered now by MSP premiums?

Hon. M. Farnworth: The answer to the member's question is that in the overall health budget that we debated in terms of estimates, there are moneys allocated to deal with the specific issues that the member raised. However, this particular allocation that we are debati