2002 Legislative Session: 3rd Session, 37th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

WEDNESDAY, MARCH 6, 2002

Afternoon Sitting

Volume 3, Number 21

CONTENTS

Routine

Proceedings

Page

Introductions by Members

Introduction and First Reading of Bills

Deregulation Statutes Amendment Act, 2002 (Bill 8)

Hon. K. Falcon

Statements (Standing Order 25 B )

Youth traffic safety

K. Krueger

Pacific NorthWest Economic Region

B. Penner

Pulp mill investment in Prince George

P. Bell

Oral Questions

Funding for mental health services

J. Kwan

Hon. C. Hansen

Capital funding for health care projects

J. MacPhail

Hon. S. Hawkins

Hon. C. Hansen

Gravel extraction from Fraser River

J. Les

Hon. S. Hagen

Funding for policing in small communities

D. Chutter

Hon. R. Coleman

Lobbyists registry

J. MacPhail

Hon. G. Plant

Point of Order

Hon. G. Cheema

Second Reading of Bills

Medical Services Arbitration Act (Bill 9)

Hon. C. Hansen

J. MacPhail

Introductions by Members

Second Reading of Bills (continued)

Medical Services Arbitration Act (Bill 9)

B. Lekstrom

J. Kwan

L. Mayencourt

Committee of Supply

Estimates: Ministry of Health Planning

Hon. S. Hawkins

J. MacPhail

L. Mayencourt

B. Locke

R. Visser

J. Kwan

Point of Order

Hon. C. Clark

J. MacPhail

Point of Order

Hon. C. Clark

J. MacPhail

Committee of Supply

Estimates: Ministry of Health Planning

(continued)

Hon. S. Hawkins

J. MacPhail

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Sustainable Resource Management

J. Kwan

Hon. S. Hagen

P. Bell

B. Bennett

Estimates: Ministry of Provincial Revenue

Hon. B. Barisoff

I. Chong

R. Lee

Estimates: Ministry of Management Services

Hon. S. Santori

J. Bray

I. Chong

R. Lee

Estimates: Ministry of Public Safety and Solicitor General

Hon. R. Coleman

D. Jarvis

B. Penner

K. Stewart

R. Lee

[ Page 1531 ]

WEDNESDAY, MARCH 6, 2002

The House

met at 2:02 p.m.

Prayers.

Hon. G.

Campbell: Hon. Speaker, as you've already heard, the government is in

possession of a secret New Democrat report which suggests that the leader of the

New Democrats is in fact celebrating a milestone in her life. Let me say that

all members of this House, I'm sure, want to wish the member for

Vancouver-Hastings all the best on this exceptional day and this exceptional

milestone. We hope that she has plenty of time for her family and for her

personal life. In fact, she can take as much time as she wants for that.

[Laughter.]

Let me also

say that we also wish many happy returns of the day to the member for

Chilliwack-Sumas.

J. Kwan:

I, too, would like to join with the House in celebrating and honouring the

member for Vancouver-Hastings.

MacPhail: Did you leak it?

J. Kwan:

I must admit it was the NDP caucus leak. Likewise there was a Liberal leak, and

today we are also celebrating the Minister of Sustainable Resource Management's

birthday. So we, too, would like to wish him a very happy birthday.

[1405]

Mr.

Speaker: The Premier rises on a point of order. [Laughter.]

Hon. G.

Campbell: Thank you, hon. Speaker. I just wanted to point out that our

birthdays were bigger than their birthdays.

J. Kwan:

I'm sure that on this auspicious day somebody up there was looking out for all

of us, because there is now a balance in the House on both sides. I'm sure both

members are thrilled to bits that they get to celebrate their special day here

with all of us in this Legislature. I must say, though, specifically of the

member for Vancouver-Hastings, that she doesn't look a day over 20. And let me

tell you, she does not act her age. Happy birthday and many happy returns.

Introductions by Members

Hon. T.

Nebbeling: We have four guests in our gallery. Two of them are from

Scotland. They are Margaret Mackay and Chrisie-Ann MacArthur. They are together

here as guests of Norm and Maureen Morrison. Norm and Maureen Morrison are from

North Vancouver, and they are the parents of my executive assistant, Tim

Morrison. I would like the House to make them very welcome.

Hon. G.

Plant: I am informed that we're joined today in the House by some articling

students from the legal services branch, as well as some co-op students who are

here to no doubt learn about this particular institution and the marvellous way

it functions. The articling students are Bobby Bandechha — I apologize if I've

mispronounced that — Debbie Chan, Martin Schmieg, Suzanne Sheena, Jennifer

Wispinski and James Chen. The co-op students are Becky Black, Joanne Caen and

Joseph Rochon. My goodness, I'm not doing very well. I really do hope that we

will all welcome them and George Faddis, who is the senior solicitor

accompanying them today.

J. Bray:

It's my pleasure to rise and introduce 32 grade 11 students from a local school

in my riding that is celebrating its 126th continuous year of service. These 32

grade 11 students are from Victoria High School, and they're accompanied by

their teacher, Mr. Brian Bradley. I'd ask the House to please make them welcome.

Mayencourt: It gives me great pleasure to introduce a very fine friend of

mine — in fact, my best friend — Marc Seguin. He is visiting here from my

riding of Vancouver-Burrard. By strange coincidence, it is also his birthday. We

celebrated today by taking a tour of the Legislature and actually going up to

the very top, where Captain Vancouver sits on the top of the rotunda. I'd just

ask that the House make him feel very, very welcome.

Mr.

Speaker: It almost calls for a rendition of Happy Birthday , except

I've heard some of the members sing.

Introduction and

First Reading of Bills

DEREGULATION STATUTES

AMENDMENT ACT, 2002

Hon. K.

Falcon presented a message from Her Honour the Lieutenant-Governor: a bill

intituled Deregulation Statutes Amendment Act, 2002.

Hon. K.

Falcon: I move that Bill 8, intituled Deregulation Statutes Amendment Act,

2002, be read a first time now.

Motion

approved.

Hon. K.

Falcon: I am pleased today to introduce Bill 8, Deregulation Statutes

Amendment Act, 2002. Bill 8 amends several statutes to remove nearly 600

outdated or unnecessary regulatory requirements and red tape as part of our

commitment to restore British Columbia's economic competitiveness and

prosperity.

[1410]

Bill 8 is

but one step towards meeting our new-era commitment to cut the regulatory burden

and red tape

[ Page 1532 ]

within this province by one-third within the next three years.

Hon.

Speaker, we define red tape as those non-essential procedures, forms, licences

and regulations that add to the cost of dealing with government, and anything

that is obsolete, redundant, wasteful or confusing and that diminishes our

province's economic competitiveness and stands in the way of job creation or

simply wastes taxpayers' time and money.

Bill 8 cuts

red tape by repealing the following statutes: the Community Regulation Act; the

Cultural Foundation of British Columbia Act; the Curfew Act; the Dogwood,

Rhododendron and Trillium Protection Act; the Library Foundation of British

Columbia Act; the Ministry of Industry and Small Business Development Act; the

Ministry of International Trade, Science and Investment Act; the Northern

Development Act; the Pawnbrokers Act; the Premier's Advisory Council for Persons

with Disabilities Act; the Public Service Bonding Act; the Special Enterprise

Zone and Tax Relief Act; the Tobacco Fee Act; the Trade and Convention Centre

Act; the Universities Real Estate Development Corporation Act; and the

University Endowment Land Park Act; and by amending the following statutes: the

Dike Maintenance Act; the Drainage, Ditch and Dike Act; the Financial

Institutions Act; the Health Act; the Livestock Act; the Local Government Act;

the Municipalities Enabling and Validating Act (No. 3); the Name Act; and the

Wills Act.

Hon.

Speaker, I move that the bill be placed on the orders of the day for second

reading at the next sitting of the House after today.

Bill 8

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

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

Statements

(Standing Order 25

b) YOUTH TRAFFIC SAFETY

Krueger: Children born in 1986 are receiving their driver's licences in B.C.

today. People too young to be prosecuted in adult court for offences are hopping

behind the controls of high-performance cars and letting their hormones and

blissful sense of invulnerability hurtle them down the road.

In the

middle seventies my wife and I started our family in Prince George, and there

was at that time a horrific sequence of car crashes where young lives were

snuffed out, young bodies shattered and young faces disfigured for life. There

is no grief so inconsolable as a parent's grief over a dead child.

The

community, the police, the experts, the injured and their families came

together. They struck a theme called "Take the Car Out of Carnage" and

attacked the behaviours which were killing the kids, and it worked.

ICBC took

up the challenge and expanded it provincewide. The people leading the traffic

safety initiatives were few but dedicated and talented. Teachers, communities

and police pitched in, and it worked. Recognizing that some adults won't change,

the program focused in part on curriculum.

When my own

children were babies, they always had infant car restraints. They grew up

hearing the traffic safety messages. If they thought I was tempted to run a

yellow light, they'd yell: "Fools rush in, dad." They'd watch the

speedometer and shout: "Speed kills, dad." Once when I protested that

it was too much trouble to fasten all the car seats for a half-block trip, there

was a shocked silence. Then a little voice said: "Dad, does God say it's

okay to break the law if you're just going five doors down to grandma's

house?"

In the

early nineties a new hotshot executive at ICBC killed the program. The word was:

"Elementary school kids don't drive." The kids getting driver's

licences today were seven years old when that stupid decision was made. Today

they are wrapping high-speed cars around poles, racing in city streets, drinking

and driving and ignoring safety equipment in their highly engineered vehicles.

The grief of their shattered parents, friends and families cries out to

government — a caution to us all. No corporation operating for profit has a

mandate to teach traffic safety to six-year-olds, but in 2012 they'll get

driver's licences.

PACIFIC NORTHWEST ECONOMIC REGION

Penner: Shortly after last year's election the Premier asked me to lead

B.C.'s participation in the Pacific NorthWest Economic Region, or PNWER for

short. PNWER, formed in 1991, consists of five U.S. states: Washington, Oregon,

Idaho, Montana and Alaska; two Canadian provinces, B.C. and Alberta; and the

Yukon territory.

It's been

said that if PNWER were a nation, it would rank twelfth in the world among

leading industrial countries with a population of 19 million people and a gross

regional product of $671 billion (U.S.).

[1415]

Last year

B.C. hosted PNWER's annual summer meeting at Whistler, and it was a huge

success. More than 800 delegates attended, including U.S. Ambassador to Canada,

Paul Cellucci, two Governors and hundreds of state legislators.

The Premier

used this opportunity to communicate key messages to our neighbours, and we are

still getting very positive feedback from our American counterparts on his

speech. Since then, PNWER has taken the lead in organizing a regional

partnership for infrastructure security. Post-September 11 it's become very

obvious to all of us in the Pacific Northwest that we have a common interest in

protecting our interconnected pipelines, power lines and telecommunications

networks. Following a meeting of key public and private sector stakeholders on

November 30, PNWER will host a table-top security exercise entitled "Blue

Cascades" this May. The Canadian and U.S. federal governments have shown

tremendous interest in this initiative.

[ Page 1533 ]

I'm slated

to become president of PNWER at this summer's annual general meeting in

Portland. I've already been making efforts to meet with legislators at various

state capitals. This gesture has been very warmly received, and our neighbours

are glad that B.C. is once again engaged in the region. When I was in Olympia

just a couple weeks ago, I was told it was the first time in their memory that a

British Columbia MLA had spoken with them and met with them during their

session. PNWER is a great vehicle for promoting B.C.'s interests in the region

and for reiterating the Premier's commitment to re-establishing B.C.'s presence

in the Pacific Northwest.

Mr.

Speaker, I'll endeavour to keep members up to date with future progress of

PNWER, as time permits. Thank you.

PULP MILL INVESTMENT

IN PRINCE GEORGE

P. Bell:

As the Minister of Energy and Mines would say, more good news. Actually, it's

great news. Today the Prince George Citizen published an

article

indicating that a major B.C. forest company is considering the possibility of

building a new pulp mill in Prince George with a possible investment of $1

billion.

An Hon.

Member: More great news.

P. Bell:

More great news.

This isn't

even close to being a done deal yet, but for the first time in ten years it

demonstrates a willingness by the private sector to invest in our province. We

need to do whatever it takes to bring this project to fruition, and I am

personally committed to working with this company. Projects like this are key to

revitalizing the economy of B.C. This government, through its deregulation

initiative, can ensure that B.C. will secure projects of this nature.

It's

interesting to note that there was not a single pulp mill or, in fact, any

private sector investment of this nature in the nineties in B.C. In fact, this

project alone would exceed the entire investment made by the province's forest

industry in either 1998 or 1999.

I believe

that the willingness of the private sector to consider this type of investment

demonstrates their belief that this government is on the right track. With this

type of investment B.C. will enter a new era of prosperity — more great news.

Mr.

Speaker: That concludes private members' statements.

Oral Questions

FUNDING FOR MENTAL HEALTH SERVICES

J. Kwan:

In years previous, including last year, the budget document specifically stated

the amount of money to health care, particularly to mental health. Yesterday we

heard from the Minister of State for Mental Health a rhetorical commitment from

him to fund mental health services at the necessary level.

We know

from the government's own document that hospital beds will close and the waiting

lists will grow. We know that the health authorities are being forced to make

cuts. We know that from the Minister of Health Services, who says it will be up

to the regional authorities to decide where they spend the money.

Can the

Minister of State for Mental Health tell us exactly how much money the health

authorities are getting for mental health services?

Hon. C.

Hansen: As part of the redesign of the way health care is working in British

Columbia, we're actually giving the authority to the health authorities around

the province to make sure that they integrate care.

[1420]

As the

member knows, mental health is very much….. It's very important that care be

integrated with other care delivery at the community level. We're doing that,

but the one thing I'd like to point out is that in terms of the funding for the

mental health plan, this is the first time…. It's one of the few areas where

dollars are actually targeted within the performance agreements with the health

authorities.

addition, this is the first time that we've rolled out three-year funding. It's

the first time that we have set out targets in terms of outcomes that we expect

the health authorities to deliver on.

J. Kwan:

Nowhere in the estimates book does it identify the amount of money dedicated to

mental health services. Last week we saw the downloading from the Minister of

Education of funding and of decisions to cut programs in the areas of school and

education, just so she can rise up and say: "Hey, you know what? We didn't

make these cuts. The health regions did. The regional authorities did."

The CEOs of

the health authorities are accountable only to the Minister of Health. What

assurance can the Minister of State for Mental Health give this House that the

decisions of the CEOs will be made in the best interests of those individuals

and families who need mental health services in their communities?

Hon. C.

Hansen: Unlike the previous government, we're not measuring the success of

programs by how much money is spent on them. But the money for mental health is

protected. The money for mental health has been transferred to the health

authorities. The health authorities will be held accountable for delivering on

those programs. More importantly, they'll be held accountable on delivering

better outcomes for patients.

To answer

the member's last question, when it comes to accountability — unlike the

previous government, which tried to blame the health authorities — this is a

government that's going to be accountable for the improved health service

delivery in this province. That's what we will achieve.

[ Page 1534 ]

CAPITAL FUNDING FOR

HEALTH CARE PROJECTS

MacPhail: We have a different story today. Not one single dollar is targeted

for mental health in the budget — not one single dollar.

But the

budget documents also have a startling message for small communities. The

message is that if you want to keep your hospital, you'll have to pay with deep

cuts to services. The confidential documents confirm that the health regions

don't get any funding for capital expenditures. Some small communities all over

the province are right now fighting to save their hospitals. Each MLA knows

this.

A question

for the Minister of Health Planning. The Minister of Health Planning has

completely washed her hands of this problem by saying, "That's not our

issue; it's the responsibility of the regional health authorities," just

like they did in education. To the Minister of Health Planning: why are British

Columbians footing the millions of dollars for her ministry when she doesn't

hold herself accountable to anyone for the cuts her government is making?

Hon. S.

Hawkins: I'm surprised that this member has the audacity to ask about how

money is spent in health care when they didn't know what they were doing. They

never planned for health care. We've inherited a system from them that left a

fragmented, uncoordinated, unmanaged health care system. We've done more in the

last nine months in planning, managing and setting up the foundation for a

system that's going to deliver better health care.

You know

what? When we went around the province, what people told us was that they wanted

the politics out of health care decision-making. We've given it to good people

to look at the needs of their communities and manage and help us make those

decisions. We expect them to be accountable for them. We expect them to help us

deliver better patient outcomes than the last ten years.

MacPhail: So far we know from the government: no money for mental health in

the budget. No money for capital expenditures in the budget.

Interjections.

Mr.

Speaker: Order, please.

[1425]

MacPhail: The budget documents also lay out in detail every capital project

that now won't get funding or will get closed down unless it's paid for with

deep cuts in services. The Ministers of Health say: "There's no problem.

The regional health boards will make the decisions." Guess what. The

regional health boards don't have any local representation — none whatsoever.

We know from the Premier yesterday that they're not going to get local

representation.

To the

Minister of Health Planning: will she commit that she will direct health regions

to conduct formal public hearings on the decisions to cut capital programs so

that the public can actually be heard, so that local communities can have at

least one iota of input into the cuts that are being made in their communities?

Hon. C.

Hansen: I find it surprising that this member is going to stand up and

criticize our approach to capital spending when, after the 1996 election, the

first thing they did as a government — 28 days after the election — was

freeze every single health capital project that they had promised.

We are

honouring the commitments to the projects that were in construction, which were

already committed to by the previous government — whether they were

well-thought-out or not — because we have those obligations.

Second, we

made a limited…

Interjection.

Mr.

Speaker: Order, please.

Hon. C.

Hansen: …number of promises to voters in this province around capital

projects, and those are going ahead, funded under the former model — which is

a model that's driven out of Victoria, where the debt-servicing costs are not

carried by those communities and regions that are impacted by it but are carried

by Victoria.

What the

member saw in my briefing documents were projects that the previous government

had committed to. They were not proceeding on them. They had not proceeded on

them. The member says that "with funding…." That's like saying:

"I've got cheques in my chequebook — means I must have money in my

bank." That's NDP philosophy.

The list of

capital projects that were listed in my briefing books that are not committed to

under the old model are being reviewed by the health authorities as to whether

they make sense on going forward in the future. There have been no projects

cancelled. There are projects that are being reviewed at the health authority

level.

GRAVEL EXTRACTION FROM FRASER RIVER

J. Les:

My question today is to the Minister of Sustainable Resource Management. I'm

picking on the minister today — not because we happen to share a birthday.

It's much more down-to-earth than that.

Until a few

years ago gravel was removed from the Fraser River. This activity had been going

on for many, many decades and obviously is necessary to manage the river so we

don't have problems with flooding and seepage. It creates a lot of jobs and also

provides a lot of material for the construction industry.

[ Page 1535 ]

For the

past four years, however, this activity has been banned by the federal and

provincial governments. During that period of time we've been assured over and

over again that this activity would be allowed to recommence. To date, nothing

has happened.

Can the

minister tell my constituents why gravel is still not being extracted today from

the Fraser River?

Hon. S.

Hagen: I'd like to thank the member for Chilliwack-Sumas for the timely

question on a very important topic. It's particularly important to the people

who live along the Fraser and the municipalities along the Fraser.

As the

member knows, the parties have gone through lengthy consultations and have

looked at all of the scientific data. Last fall an agreement was reached to

allow gravel extraction to resume subject to a number of requirements, including

appropriate permitting and consultations.

In this

process opportunities for gravel extraction were found for both the spring and

the fall of this year, 2002. It's my understanding that the consultation

requirements of the federal government are presenting a challenge for the spring

window, and I would refer the member to the

article in the Vancouver Sun

this morning where it lays out some of the problems the feds are facing. It also

quotes the mayor of Chilliwack, who says: "If first nations want to take

the gravel out, that's perfect. I don't care who gets the royalties. The

gravel's got to come out of the river for flood protection."

I can

assure the member that we are working cooperatively with the federal government

to ensure that this is dealt with as quickly as possible.

Mr.

Speaker: The member for Chilliwack-Sumas has a supplementary question.

J. Les:

I thank the minister for his response, Mr. Speaker. However, the window of

opportunity this spring is almost closed. With these missed opportunities

mounting, so are the economic costs and, obviously, the potential for flooding.

What steps

does the minister propose to take so that gravel can once again be removed from

the Fraser River?

[1430]

Hon. S.

Hagen: I understand and I share the member's frustration, believe me. Last

fall I was under the impression that we would be able to extract gravel in a

substantial manner, with no negative impacts on the environment, beginning early

this year. What I can assure the member and his constituents and all of the

people who live along that area of the Fraser is that this government will do

everything possible to ensure that gravel extraction begins as soon as possible.

He also understands that the provincial government has in fact issued the

relevant permits, and we'll continue to work with the federal government to

ensure that federal permits are issued as soon as possible.

FUNDING FOR POLICING

IN SMALL COMMUNITIES

Chutter: My question is for the Solicitor General. A number of mayors and

constituents in my riding have called my office to ask about the government's

plans to change the funding formula for policing in small communities. Could the

Solicitor General tell us what changes, if any, have been made and how they will

affect policing services in these communities?

Hon. R.

Coleman: Through to the member, there have been no changes made to the

policing formula in the province of British Columbia to date. What we did is….

Back in the UBCM convention in the fall, in September, the Premier and I met

with 14 communities who were facing the challenge of coming close or going over

the threshold of 5,000 people. When a community reaches 5,000 they automatically

pay 70 percent of their policing costs. There are 700,000 people in this

province living in communities under 5,000 in rural areas, which pay little or

no policing costs. We undertook to look at the formula in conjunction with UBCM,

come up with a consultative process and move forward through the next year or so

to come up with something that might work for those communities.

Mr.

Speaker: The member for Yale-Lillooet has a supplementary question.

Chutter: Under the previous government, changes were often made to

provincially funded local services with little or no assistance to help with the

transition. Could the Solicitor General tell my constituents how he intends to

help small communities implement these changes through the transition to

policing services?

Hon. R.

Coleman: The first thing, to the member, is that I would caution him on

prejudging the process and what would be required as we go down this path. The

reality is that we have sat down with the UBCM, through the president of the

UBCM, and agreed that as we come through with a number of options and funding

formulas, we will take those funding formulas — after we've had a look at them

and the Ministry of Finance has had a look at them — forward to a symposium of

smaller communities throughout the province, as coordinated by the UBCM, so that

we can have that consultative process take place. When we have completed that

consultative process, we will then go forward and find a funding formula that

works for communities, one that allows us to engage in our long-range plan for

policing in British Columbia, which would be a five-year plan for policing that

works for everyone in British Columbia. And as we complete that…

Mr.

Speaker: Thank you. Thank you, hon. member.

[ Page 1536 ]

Hon. R.

Coleman: …process, we will then come up with a phase-in plan that will

work for everyone that would be affected by that funding formula. My concern

would be that as….

Mr.

Speaker: Thank you, hon. member.

LOBBYISTS REGISTRY

MacPhail: Mr. Speaker, a couple of days ago now, we saw the details of the

government's determination to privatize health care services in British

Columbia. We saw that $700 million worth of services are up for grabs. I'm sure

that the private sector is salivating at the windfall of generosity. I'm sure

that their lobbyists will soon be beating a path to the doors of the CEOs of the

health authorities.

To the

Attorney General: last year the Lobbyists Registration Act was passed. So when

will it be proclaimed — before or after the coming frenzy that will be hitting

our health authorities?

Hon. G.

Plant: We're working on it, Mr. Speaker.

[End

of question period.]

Orders of the Day

Hon. G.

Collins: In Committee B, this House, I call Committee of Supply. First of

all, I call second reading of Bill 9, Medical Services Arbitration Act. For the

information of members we'll be moving after that, if it passes, into Committee

of Supply and be debating the estimates of the Ministry of Health Planning.

Committee A, Douglas Fir Room, I call Committee of Supply. For the information

of members, we'll be discussing the Ministry of Sustainable Resource Management,

followed by — if time allows — the Ministries of Provincial Revenue,

Management Services, and Public Safety and Solicitor General.

MacPhail: Sorry, Mr. Speaker. Did the House Leader call Committee A now?

Mr.

Speaker: No.

[1435]

Hon. G.

Collins: Mr. Speaker, just so we don't have to disrupt the House when 4

o'clock comes, we have an agreement that Committee A will start at 4 o'clock,

just for members' information.

Mr.

Speaker: Thank you. Committee of Supply in Committee A at 4 o'clock.

Mr.

Speaker: The Minister of State for Mental Health rises on a point of order.

Point of Order

Hon.

G. Cheema: I have an obligation to declare an interest and withdraw from the

debate on Bill 9, so that's what I'll be doing.

Second Reading of Bills

MEDICAL SERVICES ARBITRATION ACT

Hon. C.

Hansen: I move that Bill 9, Medical Services Arbitration Act, be read for a

second time.

On February

8 of this year, an interim decision was handed down by former Chief Justice

Allan McEachern in a process of binding-interest arbitration between the

province of British Columbia and the British Columbia Medical Association with

regard to doctors' compensation issues. This binding-interest arbitration was

triggered by a clause in the framework memorandum between the government and the

BCMA which had been signed by the previous government.

Yesterday

our government responded to Mr. McEachern's interim arbitration decision. Our

response is in three parts.

We will

provide an increase of $392 million for doctors' compensation in the coming

fiscal year and retroactive compensation for the 2001-02 fiscal year.

Secondly,

we are introducing this legislation — Bill 9, the Medical Services Arbitration

Act — to remove the risk of unsustainable increases in health care cost and

inflexibility that prevents us from creating a health system that puts patients

first as a result of binding-interest arbitration that could occur in the future

between governments and doctors.

Finally, we

are making a commitment to strengthen the relationship among government, doctors

and health authorities to serve the interests of patients.

Doctors are

an important and integral part of our health care system. Our government and all

British Columbians place great value on the work that they perform. The actions

that we are taking in response to the arbitrator's interim award reflect that

value.

indicated in the provincial budget presented on February 19, government will

provide doctors with funding increases worth an additional $392 million for this

coming year. This represents an extremely generous settlement, one that is more

than fair for doctors in British Columbia, who will continue to be among the

highest-paid in Canada.

Among the

provinces, currently British Columbia spends the most per capita on doctor

service. It ranks second on fee-for-service payments per physician and has the

most generous benefit package of any province. We are doing this because we

value doctors. We want to attract and retain doctors to give patients in the

province the health care that they depend on. We want to ensure that we are

providing an attractive and competitive quality of life for our health care

professionals, particularly in rural and remote communities.

[1440]

For the

current fiscal year, 2001-02, doctors will receive almost immediately a 6.2

percent payment based on their fee billings for the period from April 1, 2001,

to October 30, 2001, and, as soon as possible in the future, a further 11.6

percent payment retroactive to November 1, 2001. Eighty million dollars will be

provided retroactively for on-call services in the 2001-02

[ Page 1537 ]

fiscal year. We will discuss the distribution of this funding with the BCMA

and health authorities. These amounts that we are committing to are consistent

with the arbitrator's decision.

Although

the arbitration decision neglected to allocate any increase to physicians on

salaries, sessional payments or service contracts, government has decided to

allocate a comparable retroactive increase to those physicians so as not to

create inequity with fee-for-service physicians, which leads me to talk about

the very significant problems the arbitrator's decision presented for

government, doctors and health care generally in this province.

Our first

concern is that the interim decision mandated an initial package of compensation

and hinted at further increases of a magnitude that the taxpayers of this

province simply cannot afford. It did not create an affordable, sustainable

framework for the relationship between physicians and government. Health

spending has more than tripled in British Columbia since 1985 from the $3

billion that was allocated that year to more than $10 billion in 2002. Health

spending now accounts for 41 percent of the total provincial budget.

Health

spending in B.C. now absorbs all our revenues from the provincial income tax,

federal transfers, MSP premiums, tobacco tax and the recent increase in the

provincial sales tax combined. In fact, the increased compensation pressures for

doctors and other health professionals in the coming year is greater than all of

the new revenue that will be generated by increases to the MSP premiums, the

provincial sales tax and the tobacco tax combined. The $392 million increase in

physician funding alone represents almost all of the revenues derived from the

increases in the sales tax, which was $250 million, and the increase in the

tobacco tax, which was $150 million.

We cannot

continue to allocate more and more funding in the way we have, because these

increases are simply not sustainable. In today's environment the risk of further

increases through this arbitration process creates uncertainty for physicians,

for patients and for taxpayers. Further increases of this magnitude are

unaffordable, and an uncertainty inherent in the arbitration process prevents us

from putting the province's financial house in order. Furthermore, the

arbitrator's decision did not allocate funding increases in a way that begins to

address inequities, shortcomings and the need for health care system redesign

and financial certainty.

Doctors

have told us that the way physicians are currently compensated is not working

for many of them. For example, the interim decision discussed on-call

compensation on an hourly basis. This would lead to a piecemeal process where

some communities would be left with only part-time, sporadic coverage. Patients

need to know that a doctor will be there for them and their families in an

emergency. We need to work with the BCMA towards a sustainable on-call model.

As well,

compensation increases for doctors in alternative payment situations have lagged

well behind fee increases. We want to create greater flexibility in the area of

physician services to make it easier for doctors to participate in new ways of

working and being compensated.

One of the

things that we have made quite clear, Mr. Speaker, is that we're not going to

force any doctor off fee-for-service, because there are many doctors in this

province that see that as the mode of operation that they think is most

important to them, but we certainly want to recognize there are more and more

doctors who want to move towards alternative payment arrangements and out of the

fee-for-service model. They are looking for new opportunities to provide care in

alternative ways and greater balance in their lives than they can find in the

fee-for-service system.

The

arbitrator's interim decision did not address these structural problems in the

ways in which physicians are compensated, and we have been left with the status

quo. This will prevent us from managing health care dollars properly and

effectively to meet patient needs. That is why we have introduced this

legislation, the Medical Services Arbitration Act, to remove the option of

binding-interest arbitration from key agreements between the government and the

BCMA.

[1445]

Bill 9, the

Medical Services Arbitration Act, cancels the binding-interest arbitration

process between the government and the BCMA and the February 8 interim award

decision. It removes particular sections and specific wording from key

agreements between the government and the BCMA that would permit or require

binding arbitration as the ultimate way to settle our differences. Sections of

these agreements that provide for a process of rights arbitration to settle

differences within existing agreements are not affected by this legislation.

We are

going to fund the amount of the 2001-02 retroactive payments in that decision,

but for the future we have to work with doctors to reform the system to change

the way health dollars are allocated, to make the dollars work for patients and

to make health care sustainable. Binding-interest arbitration is also not the

best way to build the relationship of trust and cooperation we need in British

Columbia to save and renew a public health care system. Doctors are an integral

and important part of our health care system, and we need them to be part of the

changes we are committed to making in our health care system. The funding

enhancements we are providing are an opportunity for government, health

authorities and doctors to work together to achieve common goals.

Government

will begin immediately to work with the BCMA on the distribution of retroactive

payments for fee billings for 2001-02, as well as any changes in fee-for-service

rates to take effect after April 1, 2002. We wish to use this new allocation to

address some of the significant inequities among physicians. We will

[ Page 1538 ]

work with the BCMA and the health authorities on the new rates for

alternative payment methods: service contracts, sessional payments, salaried

arrangements and also remuneration for rural and remote doctors. We will work

with the association to consider the best way to distribute and implement the

non-fee items of the $392 million increase, including the design of new

provincewide on-call programs.

Doctors

have been urging us to make these reforms. We need their help to do this. It is

time for doctors to share the responsibility of helping us make these new

dollars for medical services work for patients. We need to work together to

design programs that will compensate doctors appropriately and fairly for

delivering the right services when and where patients need them. Our government

has made a commitment to British Columbians to create a health system that is

sustainable and that puts patients first.

Bill 9,

which will remove the risks of binding arbitration to sustainability and

flexibility in our health system, is an important step towards that goal. I urge

all members to support the passage of this legislation.

Mr.

Speaker: Second reading of Bill 9 continues with the Leader of the

Opposition.

MacPhail: Well, isn't this interesting — this piece of legislation.

I was

listening very carefully to the Minister of Health Services, who I guess has a

new responsibility for negotiating with the doctors. I wonder when that changed;

it was the responsibility of the Minister of Health Planning, according to their

own website. Here we have the Minister of Health Services standing up and

literally negotiating through legislation. I was listening very carefully to see

whether he was going to describe any recent meetings that had actually occurred

up to and including today. Maybe he was excluded from those meetings; I don't

know.

[1450]

Here he is

somehow saying if you put velvet over a hammer, that's fine, and that doctors

should be grateful because there's what the public may see as a substantial

amount of money involved here. In one way, yes, the doctors did get a velvet

glove over their hammer. Previous health care workers just got the hammer. Yes,

this Minister of Health Services, while bringing in legislation that's

unprecedented…. Once again, that's true: the government is a first in Canada.

There's no question about it. They can take pride in being first in bringing

down the hammer on doctors. There's no question about it. Doctors are supposed

to be grateful because they covered that hammer with a glove. They got money;

they got a substantial amount of money. We'll talk about that in a moment.

They got a

nice letter from the Minister of Health Services. The other health care workers

— whether it be nurses or lab technologists, health care aides, housekeepers,

laundry workers — didn't get a letter. They got a piece of legislation without

any notice whatsoever — a complete shock to them, not even a phone call. Oh

yes, I'm sorry. There was a phone call at 11 a.m. when the legislation was

introduced at 1 p.m. That's true; they did get that phone call.

They didn't

get a nice letter explaining why it was necessary. Doctors got that, and doctors

are supposed to be grateful for that, I guess. They're supposed to be grateful

for the velvet glove, and they're supposed to somehow be quiet because the

minister is out there spinning that each doctor gets an average of $50,000

increase. Lots of British Columbians would say: "Wow, $50,000. That's more

than I make in a year." That's what the minister's counting on — that

that's where the debate will go.

But what

exactly did the minister do? What did this government do, actually? I'm not

actually sure whether the minister has direct responsibility for this issue,

unless he was part of these very recent discussions up to and including today. I

don't think he was.

What

exactly did the government do in this piece of legislation? Well, they put our

whole health care system at risk. Whether we approve of it or not, physicians

are the gatekeepers of our health care system, and that's an issue to be

debated. As it stands now, physicians are the gatekeepers to virtually every

aspect of our health care system that this government is currently funding. They

eliminated funding for the services that aren't physician-directed, such as

massage therapy, podiatry and physiotherapy.

Here we

have the gatekeepers of our health care system with no avenue open to them for

dispute resolution ? none whatsoever. I suppose they could try to come into the

Legislature, storm the doors of the Legislature and have a say in terms of what

their negotiations should be, what their compensation should be.

Or maybe

there are going to be some Liberal MLAs who are actually going to rise and

negotiate on behalf of the physicians in their communities, because this is

where the negotiations are being done. We just heard it from the Minister of

Health Services. He's started negotiating with the doctors in a piece of

legislation.

I'd like to

know ? perhaps just help me; it's true I'm getting old…. When there is the

ability of 76 ducklings in a row to bring down the hammer of legislation on the

one hand and doctors' rights to negotiate on the other hand, how could anyone

possibly call that negotiations? To date, what we have seen by this Liberal

government is their way of negotiating: to slap down the most draconian

legislation in the Legislature, ram it through with their unbelievable majority

and say: "Well, we tried. That was negotiation. We tried. What do you mean

we didn't negotiate? Of course we negotiated. Didn't you see that discussion we

had in the Legislature? How dare you say we didn't negotiate?"

That's all

doctors have available to them now. That's all they have. What does that do to

our health care system, with doctors as gatekeepers? Mr. Speaker, I want to make

it very clear that I am using the term gatekeeper in a very positive way. The

physicians in our society take their role as gatekeepers, initially, in

[ Page 1539 ]

the health care system extremely responsibly and seriously.

Let's just

see what the gatekeepers of our system now have available to them and what that

means for our system. I guess they don't have arbitration because, as the

minister just said, there are risks to arbitration. Yeah. When you enter into a

dispute resolution mechanism where there are two parties, unless you're some

sort of bizarre, authoritarian, tyrannical group, you expect there to be give

and take, that you don't have the ability to impose your will unilaterally. When

you have negotiations there has to be some dispute resolution mechanism.

Sometimes there are risks in a dispute resolution process, but unless you're

some sort of dictatorship, that's what taking a balanced approach is all about.

[1455]

It turns

out that this government is a dictatorship. That's what we know today. This is

the new addition to the extreme Liberal agenda: they truly are dictators. Even

though Bills 27, 28 and 29 were unbelievably draconian, this government has

actually outdone itself in this legislation by outlawing any sort of dispute

resolution. That's brand-new.

Here we

have physicians with no dispute resolution mechanism. The government is saying

they're going to negotiate and therefore are clearly admitting there are matters

unresolved. What may the doctors have available to them? I don't know. I only

know what's been reported. Many of them — or some of them, actually…. I

won't exaggerate. There's no need to exaggerate on this piece of legislation;

it's so extreme in itself. What some physicians are saying is that they'll be

forced to withdraw their services. There we have the whole health care system

being put at risk because of this legislation. Nobody else is putting it at

risk. The government can't stand up and say: "Look what happened in the

past. It was the last ten years that created this." I'm surprised the

minister didn't actually mention fast ferries. He knows why he can't. It's

because this is entirely of this government's making.

Let's just

talk about when situations like this have arisen in the past, when previous

governments have negotiated contracts with the physicians. Previous governments

were actually honest with physicians during an election and said, "If we're

elected, we won't be honouring that contract," and then entered into

negotiations with the doctors and settled the matter by agreeing to arbitration.

That's the difference: honesty during the election about what they were going to

do, unlike this government who said, "Don't worry, doctors; we're your best

friends," then moments after they were elected said that this arbitration

process is good news. Not only is the arbitration process good news, the

arbitrator himself is the appropriate person, so…. Misleading during the

election, misleading after the election, and then the big hammer of dictatorship

— that's what happened today.

Maybe this

minister wasn't paying attention in 1991. He could have replicated what happened

in 1991, which is when the then Leader of the Opposition said: "We won't

honour that contract. It's an evergreen contract with no chance of negotiation.

If we get elected we won't honour it, but we'll enter into negotiations with the

doctors." That's exactly what happened, and then the matters were put to

arbitration, and arbitration continues until today.

I dare any

government member to stand up and say that somehow that was bad and this is

good. I dare any government member to do that. They won't be able to, because

then they'd have to admit that they lied during the election.

I'm sorry,

Mr. Speaker. My apologies. I withdraw.

They misled

the public during the election. They misled the public when they appointed the

arbitrator. Today we have the truth.

[1500]

The

Minister of Health Services thinks it should all go away because he's putting

$392 million on the table. That's today. Who knows what the heck he'll do six

weeks from now? Maybe the Minister of Finance, who's really in control of this

file, will come to the Minister of Health Services and say: "I'm sorry. You

know what? Our economic agenda is failing even more miserably, and we can't

raise taxes again so soon after we raised taxes the last time. I'm sorry.

There's no money available. You'll have to go in and renege on what you

committed to the doctors." What avenue will the doctors have available to

them if that happens?

You know

what? I'm not making that scenario up — given what the government's

performance has been and what their actions have been today — where the

Minister of Finance woke up one morning and said: "Oh my god, I've got to

deal with this arbitration. Let's raise taxes." Didn't he say he had 24

hours to think about that? I guess he was cranky. He didn't have a good sleep.

He forgot that he knew all very well and good what this arbitration was going to

cost. He woke up and said: "Oh, I'm going to raise taxes."

He's taking

a lot of heat now for breaking that promise and raising taxes. Who knows? Maybe

the Minister of Finance will have another bad sleep and have to come back in and

say: "Oh, I'm sorry. I have to reverse myself again. You can't have that

money, Minister of Health Services, to give to the doctors. Just go and tell

them, will you?" The doctors will say: "But you said you'd

negotiate." And the Minister of Health Services will say: "Well, I am

negotiating. I'm telling you I don't have any money to give you. What do you

think I'm doing? Of course I'm negotiating." They'll say: "But you're

not negotiating. Negotiating is give and take and listening to reason and

understanding what the pressures are on the system." He'll say: "Well,

I've just heard from the Minister of Finance that I don't have money, so thank

you very much for coming to negotiations. Goodbye."

What will

the doctors be able to do if that scenario occurs? Nothing — nothing legal,

anyway. And that's

[ Page 1540 ]

where our health care system rests today — nothing legal.

I expect

that as British Columbians understand this and as they get beyond this veil that

the Minister of Health Services is trying to put over this scenario by saying,

"It's $392 million, and it's an average of $50,000 per doctor. What is your

problem…?" As the public lifts that gauze that this government tries to

put over every draconian action they take and when they see how our health care

system is at risk, they will be even more frightened today than they were

yesterday. Believe you me, there are fears about our health care system like

I've never seen before.

Somehow the

government thinks they can do all this because they have an inability to pay.

Well, my gosh. They didn't have an inability to shovel it off the back of a

truck to corporations on day one in office. They didn't think for a moment that

there would be any problem just taking the big public purse and emptying it onto

the desks of the corporations, saying: "Here, take this money. Don't worry.

It's only day one. We know what we're doing. But don't worry. We'll be able to

fill that public purse up again."

You didn't

have any trouble doing that. All of a sudden, now there's no money. There's no

money to honour the arbitration. I wonder if those two events are linked. I

wonder if there's a linkage between their going into that big corporate

boardroom on Howe Street and taking the purse, clunking it down and shaking it

so it's almost empty and now opening it and saying: "Oh my gosh, there's no

money." I wonder if the government links those two events. Well, the public

does.

[1505]

Do the

doctors have any other avenue where they can actually bring their expertise to

the attention of the public? Well, no. Yesterday we learned from the Premier

that physicians are barred from sitting on health authorities. They're not going

to be able to sit on health authorities. The physicians themselves said it was

awful during the 1990s, because they had one representative guaranteed on each

health authority, but they didn't get to choose; they only had input into.… A

range of people could be nominated for that. This scenario of disbarment from

health boards was worse. Well, their worst nightmare has come true. The Premier

confirmed it yesterday. Physicians will be barred from representation on health

authorities. So that avenue is closed to them. Doctors won't be able to go to

health authorities and say: "My gosh, the government's being a dictator in

terms of how we're treated. Can I make my point at the health authority?"

They won't have any avenue there either. So what will doctors be able to do?

Nothing legal. Nothing legal.

I remember

clearly the now Premier, then Leader of the Opposition, saying during the

dispute where the doctors did withdraw their services in northern B.C:

"Give them 100 million bucks for that on-call issue. Put a hundred million

dollars on the table and deal with that part of the problem." I wonder how

that compares with what the Minister of Finance is giving doctors today. But

that was then. He was spending, I guess, other people's money. The now Premier

was spending other people's money back then. Somehow, when it's his own

responsibility he doesn't want to actually take that responsibility. He wants to

bring the heavy hand of legislation down onto physicians.

In speaking

with the B.C. Medical Association — my office spoke with them just this

afternoon — they have some concerns. There's no question. Some of the concerns

they've already listed in public about breaking the Canada Health Act and there

being no dispute resolution mechanism. They have some questions, as well, and

they're questions that should be part of negotiations with the dispute

resolution mechanism. But they don't have any avenue here. Certainly, the

Liberal MLAs aren't speaking on their behalf and aren't bringing their points of

view forward. Or maybe this will be the exception when Liberal MLAs whose health

care is being affected will actually get up and speak. They have some concerns

that the arbitration had a payment for matters such as on-call and recruitment,

and they're wondering…. The government yesterday announced a similar amount of

money, but is that for one year? Is it for two years? Is it an ongoing payment?

Is it a one-time payment? No answers — none.

[H. Long in the chair.]

Again, as

the Minister of Health Services conducts negotiations in this chamber, which he

did in his opening remarks, there are questions from the doctors themselves

about whether there is a provincewide formula on how to apply the on-call

provisions. Will it be a community-by-community negotiation where one community

will be pitted against another? Will there be any discussion about levels of

service that need to be provided? Agreements that are already in place for

on-call and attraction and retention — do they prevail, or are they wiped out

by the fiat of this legislation? Are some of them wiped out? Are all of them

wiped out? How do those things work?

[1510]

If the

doctors don't agree and go, "Aye, aye, sir," what do they do? Will we

now have a situation where Richmond can afford to pay more for doctors on call,

and therefore all the doctors from Bulkley Valley–Stikine will leave and go to

Richmond? That could be a possibility. Who knows what this government's got in

its mind? Who knows, and when will we hear about it? Will we hear about it

during some lobbed question from a backbencher to a government minister? I can

just imagine it: "Tell me, Minister of Health Services…. My community

doesn't have any doctors left in it because you didn't honour the on-call

arbitration clause. What are you going to do about that?" Of course that

will be after the fact, when all the doctors have left the community. Is that a

potential scenario? You bet it is.

physicians themselves point out here in our conversation with their association,

it took the government three weeks to consider the arbitration. Now,

[ Page 1541 ]

in one day — maybe a couple of days…. I bet you anything that this will

have royal assent by tomorrow. I bet you anything that we'll see the

Lieutenant-Governor in here rushing through royal assent for Bill 9. It took

them three weeks to consider the arbitration, and now they're pushing through

their response to the arbitration — that heavy hand of legislation — without

any opportunity for the public to absorb what's happening here — none of it.

Such an

open and accountable government…. Isn't it interesting? What's open and

accountable about this government ramming through a major, major change to our

health care system — which is perhaps as debilitating as we have ever seen —

by making it illegal for the gatekeepers of our health care system to have any

way to resolve their concerns?

There are

another couple of points that I need to make, but I need to yield for an

introduction.

Hamilton: I seek leave of the House to make an introduction.

Leave

granted.

Introductions by Members

Hamilton: It is my pleasure to welcome to the House a group of exchange

students from the city of Quebec, accompanied by teachers Rob House, M. Bruno

Audet and Stéphane Gradine, who are visiting Esquimalt high school in my

constituency. Would the House please make them welcome.

Deputy

Speaker: Thank you very much, member, for yielding the floor.

Debate Continued

MacPhail: Where is the openness and accountability here? This is why I was

pursuing the Premier so carefully in his estimates yesterday about the health

authorities and about what community representation there will be on the health

authorities, so that communities would actually have some local voice in what's

happening to their health care system. The Premier stood up — I was shocked,

actually — and said, "We're not having constituency-based health

authorities," as if it were a crime to have community input, community

representation. We will not be doing representation from communities. So we

don't have any physicians, health care workers — health care workers are

precluded from sitting on the health authorities too — or community

representatives on the health board.

I said:

"We now have a health board that stretches from the west coast to the

Alberta border, with dozens of small communities in there, and they're not going

to get representation on the health board." I guess there's no community

input through the health authority, and there's certainly no opportunity for the

public to have their voices heard on this legislation. I predict that we'll see

the Lieutenant-Governor marching down the aisle here tomorrow. If I'm wrong,

I'll be delighted, but I predict she'll be here.

[1515]

Why is

that? To preclude physicians from taking this government to court. Not only do

they not like to negotiate, they don't like that messy court stuff where they

have to be held accountable through our legal system. They like just to say, by

the stroke of a pen: "Oh, we're sorry. You can't bring any legal challenges

to this legislation." That's a new and improved…. Actually, it isn't new

and it isn't improved. It's the same sort of bar to any court challenge that

existed in Bills 27, 28 and 29.

We have an

arbitration system here that isn't working, says the government. It was too

risky. Oh, I feel so badly that it was so risky. Arbitration doesn't work; job

action doesn't work. What does work if someone disagrees with this government,

and who gets to determine? Do the physicians now go into negotiations about how

the fees are changed as a result of this lift? Is it across the board, or has

that already been determined for what the government is doing out of its own

playbook? Will that create confusion and trouble? I wonder if there'll be

services that the government is saying now won't be listed. Will there be

delisting of services? Will MSP now cover only this range of services as opposed

to the full range of services that it now covers?

These are

questions that I have, but I know I won't get answers to them, and I know the

public won't get answers to them either. The best the Minister of Health

Services can do is say: "Aren't we nice guys because we gave you so much

money? Don't worry. We'll go into negotiations. We won't give you any

opportunity to resolve those negotiations, but don't worry. Turn on your TV, and

you can see the negotiations as they happen in the Legislature." I predict

that this legislation will be law as quick as you can say "breaking a

contract."

Mr.

Speaker, my colleague from Vancouver–Mount Pleasant and I will be voting

against this legislation, as we have for every piece of legislation that is

another broken promise by this government and that breaks another legal binding

arrangement.

Lekstrom: I rise in the House today to express my concern about Bill 9 and

voice my opposition at this point.

Although I

find the decision of the arbitrator to be quite amazing, circumstances were not

taken into account in this decision, which has brought about Bill 9. There are

sections of Bill 9 where I stand — and I've spoken in this House before — on

my basic principles of existing agreements. For that reason — although I

believe Mr. McEachern erred significantly in the decision of this arbitration by

not taking into consideration the province's ability to pay and the financial

situation — the way I read the document, I have grave concern with that.

I do have

fundamental principles that I've spoken about before on the issue of existing

agreements. For

[ Page 1542 ]

that reason I rise today to speak in opposition to Bill 9, and I will not be

supporting this bill, Mr. Speaker.

J. Kwan:

I want to just review for the House a little bit of the record of this

government to date on all matters relating to negotiations or agreements —

just to see, really, the sorry state that this Liberal government has brought

British Columbia to.

[1520]

Casting our

minds back to last year, we'll recall that there was an emergency session called

in this Legislature. It was to deal with the nurses. The Liberal government says

the nurses are demanding too much, and we cannot honour what you're demanding

because British Columbians cannot afford to do so. This Liberal government has

demonstrated through those actions that they have no capacity to negotiate with

the nurses, the health care workers or the health care professionals in British

Columbia — irrespective of the fact that they mouth the words that they value

the work of these health care professionals and the nurses in their jobs and the

work that they do and how they care for the patients.

At the same

time they find they have zero ability whatsoever to engage in, quite frankly,

good-faith negotiations with the health care workers, the nurses and the health

professionals. What did they decide to do? They decided to bring in legislation

in an emergency sitting in this House with a big hammer that came crashing down

on these workers who provide for quality care, the full range of quality health

care services to patients in British Columbia and to their families.

Then, when

we engaged in that debate, I recall asking: "Why don't we engage in the

process of arbitration wherein when you have a dispute between parties, you go

to a third party, somebody who is not biased one way or the other with any side,

and bring this third party in and ask him, her or them — it could be a panel

of people — to review the matters and then make recommendations?" If

those recommendations were not binding, at least you'd then have a starting

point to engage in discussions and negotiations and hopefully bring the parties

closer. Well, the government then said: "No can do." They couldn't do

that, because the parties are too far apart, and that wasn't possible.

Then we

said: "Okay, what about taking the option of a binding arbitration? If you

think you cannot negotiate bringing the parties together, then the fairest way

to go through the process of a dispute of this nature is to go to a third party

and then have a completely independent person — a fair-minded person — go

through this process and evaluate the matters and come forward with

recommendations that are binding." Well, government then said: "No,

couldn't do that either." That was with the health care workers, with the

health care professionals, with the nurses. That's what this government did —

came in with a big hammer and legislated what they wanted without negotiation.

Then we saw

later on the same year, last year, the transit issue where — fair enough —

it was TransLink who couldn't bring the matters to resolution. Knowing the

relationship of the Premier and the then chair of the TransLink board, George

Puil, everybody understood that there would be opportunities for this government

to work with TransLink to bring a resolution to the transit dispute. Well, they

couldn't do that either — couldn't lend a hand in that process.

What did

this government do? It came in with an emergency sitting once again in this

Legislature and brought down another hammer, only this time with the transit

workers. They couldn't negotiate. They couldn't go through a fair process of

arbitration for recommendations for further negotiations. They couldn't go

through a process of arbitration with binding recommendations. They couldn't go

through a process of working with the partners in the system to bring forward

resolution to disputes.

Then this

year we have the teachers, the educators in our school system, both K-to-12 and

post-secondary, colleges and universities — all of them, even the groups that

weren't under negotiations. I guess this government couldn't stand the process

of negotiation. So with the teachers, what did they do? They couldn't negotiate

and bring in an agreement with the teachers in the K-to-12 sector. They couldn't

agree to bringing an arbitrator into the process for recommendations. They

couldn't bring an arbitrator for binding recommendations to end the dispute of

the educators and bring resolution to the matter.

[1525]

This

government once again, in another emergency sitting of the House, brought in

heavy legislation — heavy legislation that tore up collective agreements,

which they said they wouldn't do during the election. They forced the teachers

back to work, creating hard feelings with all of the sectors — health care and

education — that provide essential, critical services to British Columbians.

To the

teachers, before they had the emergency sitting, the government said,

"We'll bring in essential legislation that will bring the parties in the

dispute closer together, and we'll be able to find resolution" — only to

find that their own essential services legislation further harmed the process of

negotiations. It further escalated the conflict between the two sides to the

point where this government called the emergency sitting.

With Bills

27, 28 and 29, not only did we see the big hammer being brought down for

educators. Through those bills the government brought down changes —

particularly in the health care sector — to the legislation that they had just

brought in, in the last sitting through an emergency sitting, by tearing up

components of that agreement which they had forced the nurses and the health

care workers to take. They've torn that up and said: "Oh gee, that didn't

work. We were wrong then." Mind you, it was only last summer when that

piece of legislation was brought to this House.

I have to

ask: what works with this government? In all of the sequence around negotiations

in these sectors, this government has proven that they are not able to

[ Page 1543 ]

negotiate with anybody and come to a resolution on any of these issues. They

did not find that there could be any fair approach, even involving independent

people to come into the process. Even then, they thought that couldn't be a fair

approach in settling disputes.

Then, just

when they finished passing emergency resolutions that were debated deep into the

evening, into the early hours of the morning…. No sooner was that legislation

passed than we find ourselves in the House once again with emergency sittings,

tearing up those provisions that this government had brought forward in the

health care sector. "Oops, those didn't work. We didn't know what we were

doing then, so we'll now have yet another emergency sitting with changes to the

legislation."

Now we find

ourselves dealing with the issues with legislation once again, for the doctors.

You know what? This Liberal government is very fond of blaming the previous

government, the previous administration. But let's just review, for a little

bit, the history around the arbitration process with the doctors.

It was in

fact this Minister of Health Services that appointed Justice McEachern to the

process. It was this minister who said that this justice is fair-minded, has a

high level of integrity and has the full support of the provincial government to

move forward on this binding arbitration process. It was this minister who said

that, not the previous administration. It was this minister who had done that

work.

Now, lo and

behold, maybe the member for Vancouver-Hastings was right, because one morning

the Minister of Finance just woke up and decided: "Oh my god, what have we

done?"

[1530]

He'd had a

bad night of sleep — maybe he had a nightmare or two — and he decided that

this arbitration decision was one shock. It was all brand-new information; he

didn't know anything about it. It was as though he had a mind-lapse of some sort

and then decided that the decision from Chief Justice McEachern was a complete

surprise and something that this government could not manage, when in fact it

was this government that engaged in that process as well. They know full well

about the issues the government was faced with around the settlement of the

doctors.

The

government is demonstrating through this process, quite frankly, that they can't

negotiate with anyone on anything at any time at all, whether it be health care

workers, teachers, educators or transit workers. They cannot engage in

negotiations with anyone. They can't utilize any process other than the big

hammer of legislation through the Legislature by bringing the 75 — 75 —

trained seals into this House, thumping their desks and bringing through

legislation.

I'm glad

the member from Dawson Creek has the integrity to stand up in this House and

say: "I cannot support this; it's the wrong approach." I think the

member understands the signals this government is sending to everybody, whether

they're in the public sector or the private sector — that this government has

zero ability to negotiate on anything, at any time, anywhere.

Not only

can they not negotiate, but even after they bring in their legislation and after

they table legislation in this House to say that this is going to work, months

later they discover: "Oh gee, we were wrong. That didn't work. Got to bring

in legislation to wipe that out." It's therefore breaking legislation that

they themselves brought in, tearing up those pieces of agreements — I

shouldn't say agreements; those forced agreements — from this government.

That's the process this government has demonstrated on all negotiations to date,

since they became government — I guess about nine months now.

I worry

from the point of view of the message this government is sending. Not only do

they tear up agreements — which they said they wouldn't do — not only do

they force agreements on people that they cannot engage in negotiations with,

they put in the provisions of the legislation to say to people: "When we

tear up these legally binding agreements with you, you will have no legal

recourse. You will have no ability to sue the government for breach of

contract." This is what this government's approach has been on all issues

to date.

Yet the

process through the justice system is one that we value above all else, I think,

in a democratic system, in a democracy: to have our day in court, to have the

judge make a fair decision on matters of dispute. The government has even

stepped in to prevent that from happening — taking away the right, the

authority, of British Columbians to have their day in court. That's been the

process, to date, with this government.

[1535]

When we

look at the issues around the doctors and the binding arbitration, which this

minister had participated in…. This Minister of Health Services has said he

values and honours the work of Chief Justice McEachern and says that this

government has the full support of this arbitrator, the Chief Justice, in their

work. And only now we find that that, too, was wrong. That was a false

statement. This government perhaps never had the intention of honouring the

arbitration. Perhaps this government never had the intention of coming to an

agreement in a mutually agreeable way with any sector at all, because they know

at the back of their minds that when things don't seem to be going their way,

all they have to do is call in the House and bring in the trained seals and have

the legislation slammed through.

Then all

will be settled, with the exception of the damage that will be left on the trail

— the damage in relation to engaging in negotiations in good faith, the

impression that this government has zero ability, zero intention, to do that;

the damage of sending hypocritical signals to the health care workers, doctors

and teachers — all the people this government has resorted to this tactic with

— to indicate to them that really this government doesn't value their work and

their commitment, further harming the relationship with these sectors when

British Columbians depend on the expertise of these individuals in providing

services; in caring for the patients, the sick and the ill; working with the

families to explain to them the illnesses that their loved

[ Page 1544 ]

ones are faced with and how to manage it; and, in the case of the teachers,

with the students in their learning environment.

This, of

course, comes right on the heels of the shortage of professionals in all of

these sectors. The government, at every turn, has said to these people and is

demonstrating in every shape and way they can that they do not value our

professionals in these sectors. How does this government then expect that we

would be able to attract more doctors, nurses and health professionals into our

communities?

Who would

come to British Columbia when all they see with this government's action is our

contradictory approaches? On the one hand, they mouth the words that they really

value these committed individuals. On the other hand, all they do is slam them

with legislation that, in fact, the government doesn't even bother to take the

time to consult and go through with these different sectors. They don't even

bother or have the courtesy to do that. How is this government expecting that we

will be able to attract health professionals, doctors, to our communities?

Of course,

in the rural communities, the challenge is even greater because of the different

geographic demands. Irrespective, the government is just going to move forward

and send, I would say, a very negative signal — the wrong signal — to all of

these valued professionals in our communities.

Unfortunately,

the people who would have to pay for the mistakes of this government since its

inception are British Columbians: people who need these services, communities

that depend on these services — and in the health care sector, throwing

further chaos into our system and further damaging the delivery of health care.

[1540]

This is all

in the midst of a government's budget that came forward and said that hospitals

will close, wait lists will grow, MSP premiums will grow, Pharmacare services

will be delisted and ambulance service response time will be lengthened. This is

all in an environment that has been created by this government to put further

pressure on the health care system and further stresses into our communities.

So, hon.

Speaker, I will not be supporting this piece of legislation. I think the

government's approach to addressing disputes is the wrong one. If the final

resort of arbitration cannot be honoured, then what mechanism is there to go

through in trying to resolve conflicts and negotiations in a fair-minded and

independent way?

The

minister's answer to that question is to bring in heavy legislation and slam the

people who participated in this process in good faith. The minister's answer is

to simply say to all British Columbians that the word of this government, this

Liberal government, cannot be trusted and that they have zero capacity

whatsoever to negotiate with anybody on any issue at any time, unless, I

suppose, you are big corporation representatives or the wealthiest British

Columbians. In that instance, the government would not even blink or even step

in to take a look at the books before they hand them huge benefits by way of tax

cuts — tax cuts that by far benefit the wealthiest British Columbians and the

biggest corporations in British Columbia. With that group, there is no

negotiation needed or necessary because they have, in my view, already bought

the Liberal Party and the government in terms of favours.

I think it

is shameful — the direction of this government and their ability or, better

yet, inability to engage in negotiations and bring forward mutually agreeable

settlements to all of these sectors.

Mayencourt: I want to take just a moment to make a brief comment about this

particular bill. I've spent a lot of time in the last few weeks speaking with

people in my constituency about this arbitration award. I think most people in

British Columbia agree that we want to have the best possible health care system

and that we want to be able to pay people what they're worth. We've done that

with nurses, with hospital employees and with paraprofessionals, and we are now

doing that with physicians. I think that most British Columbians have come to

the realization that we're in bad shape financially, and it is because of the

previous government.

I would

like to say that the…

Interjections.

Deputy

Speaker: Order, please.

Mayencourt: …Minister of Health Services did not say that we are in this

problem because of fast ferries or Skeena Cellulose or because of all…. But

that is precisely why we're here. The previous government, the government that

these two members represented, oversaw a period of time, a decade, when the

health care system fell apart. Instead of fixing it, they brought in nine

separate Health ministers. That has led to a deterioration of the health care

system in this province. It has also led to the deterioration of our ability to

pay.

Interjection.

Deputy

Speaker: Order, please.

Mayencourt: I have talked with the members of my constituency, and they have

told me that this is a fair increase. It helps the doctors.

Interjections.

[1545]

Deputy

Speaker: Members, would you mind. The member has the floor.

Mayencourt: It is a fair increase for the doctors of this province. I have

spoken to many physicians in my riding who feel that is the case as well.

I am

standing up because I want to make it really clear to the members of this House

that I support the Health minister in his efforts to put patients first and to

protect the health care system that we have fought very

[ Page 1545 ]

hard to preserve. I believe this is one more step along the way to helping us

get there, so I support this bill.

I do not

think that the arbitration…. I have great respect for the Chief Justice who

put together this arbitration report, but I think that what he did not do —

and I think it is a shame — is consider our capacity to pay for this award.

The only way we could pay for this award, Mr. Speaker, is to raise taxes, raise

MSP premiums and raise the cost of health care for ordinary British Columbians.

These members have spoken against that for the last week, so it rings hollow…

Interjections.

Deputy

Speaker: Order, please. Order.

Mayencourt: …to me to hear from these two members that they are the great

defenders of a health care system, when they oversaw its deterioration over the

past ten years.

I support

this bill. I respect very much the comments from the member for Peace River

South, and I understand. This is a free vote, and I am very glad to be able to

stand here freely and support this bill, because I believe that the Health

minister has a clear vision of how to make a better health care system for

British Columbia. I support him, and I support this government in that effort.

Hon. C.

Hansen: I listened very closely to the remarks by the two members of the

opposition. I guess I was looking for their answer as to what they would do if

they were in government. They didn't actually say this, but if you sort of

string all that together, basically what they were saying is: "Just pay

everything. Just pay it without any regard as to where those dollars would come

from." It was as if money grows on trees. I think part of the problem we

inherited is that there were nine or ten years of government where there was

that attitude in the cabinet chamber.

Hon.

Speaker, I want to give the two members credit. They both raised some very good

questions. They raised questions about how the $392 million would be allocated.

I've got to be frank with them. I don't have answers to some of those questions

that they asked. We can certainly get into that when we get into committee

stage, because if you look through the arbitration award that was brought in by

Mr. McEachern, it actually generates more questions than answers. That's one of

the problems we've got with it. In many cases, the questions that were raised,

particularly the questions that were posed by the member for Vancouver-Hastings,

are questions that are not answered in the arbitration. They are going to rely

on negotiations between government and the BCMA in terms of how we actually

implement some of the things he suggested in this award.

I want to

just draw everybody's attention to the four points that are in the terms of

reference that were given to the arbitrator. First of all, the terms of

reference of such an arbitration will include the objective of being consistent

with the law and the terms of the master agreement. That's number one. The

second item in the terms of reference is that it must be reflecting the

financial circumstances of government. Thirdly, the need to provide reasonable

compensation to the physicians for the services rendered. And fourthly, the

operational and medical resource needs of the health authorities. Those are the

four items in the terms of reference.

Maybe I'm

going to be too generous here, but I want to give the previous government some

credit, because they were the ones that put in place those terms of reference. I

would say that even the previous government would not have gone into a binding

arbitration process without some protection for the taxpayer, and they did that.

One of the terms of reference is quite clear that the arbitrator's decision must

reflect the financial circumstances of government. The McEachern report does not

properly reflect the financial circumstances of government. And the fourth item

in here — the operational and medical resource needs of the health authorities

— I would also argue, is not reflected in the award.

[1550]

We have a

couple of options that are there before government. One of the options is that

we try to find some way just to pay for this, which is what the members are

suggesting. That would mean significant tax increases to government. It would

mean significant cuts to health care service delivery in this province. We would

actually have to be diverting health care dollars away from patient care in

order to fund what the arbitrator is suggesting in this report.

The second

option we have would be to appeal the report. Actually, there are grounds for us

to appeal, because in our view the arbitrator did not adequately take into

consideration two of the four items in his terms of reference. I would like to

suggest to the hon. member, who is very concerned about the stability of

physician services in the province, that the most destabilizing option that we

could have done would have been to appeal this decision. It would have generated

months of uncertainty.

Interjection.

Deputy

Speaker: Will the Leader of the Opposition please come to order.

Hon. C.

Hansen: There was uncertainty among physicians in parts of the province

around the retroactive nature and what might come out of the arbitration award.

None of the

options was particularly desirable, but the option that we felt was the most

desirable was to make sure that we could bring certainty to the compensation

issues for doctors, that we could actually put on the table the dollars

necessary to fund phase 1 of the arbitration award — which provides for

retroactive payments to doctors back to April 1, 2001 — and that we can

actually do something that the arbitrator did

[ Page 1546 ]

not even call for: provide for retroactive payments to sessional and salaried

physicians around the province, who have to be dealt with in an equitable way so

that we ensure that the right incentives are there for the kind of remuneration

program and options that doctors are looking for around this province.

We had in

front of us three options, none of which was particularly desirable. I think we

chose the option that is the most responsible and is the most in the interests

of ensuring that doctors in this province are fairly remunerated, that we can

continue to recruit and attract the doctors we need and, most importantly, that

we can ensure that patients throughout British Columbia get the care they need

where they live.

[Mr.

Speaker in the chair.]

[The bells were ordered to be

rung.]

[1555]

Second

reading of Bill 9 approved on the following division:

YEAS

— 67

Falcon

Coell

Hogg

L. Reid

Halsey-Brandt

Hawkins

Whittred

Hansen

J. Reid

Bruce

Santori

van Dongen

Barisoff

Roddick

Wilson

Masi

Lee

Thorpe

Hagen

Murray

Plant

Clark

Bond

de Jong

Nebbeling

Stephens

Abbott

Coleman

Chong

Penner

Jarvis

Anderson

Orr

Harris

Nuraney

Brenzinger

Belsey

Bell

Long

Chutter

Mayencourt

Trumper

Johnston

Bennett

R. Stewart

Hayer

Christensen

Krueger

McMahon

Bray

Les

Locke

Nijjar

Wong

Suffredine

MacKay

Cobb

K. Stewart

Visser

Brice

Sultan

Hamilton

Sahota

Hawes

Kerr

Manhas

Hunter

NAYS — 3

MacPhail

Kwan

Lekstrom

Hon. C.

Hansen: I move that the bill be referred to a Committee of the Whole House

for consideration at the next sitting of the House after today.

Bill 9,

Medical Services Arbitration Act, read a second time and referred to a Committee

of the Whole House for consideration at the next sitting of the House after

today.

[1600]

Hon. M.

de Jong: Mr. Speaker, I call Committee of Supply. In this House, Committee

B, we will be dealing with the estimates of the Ministry of Health Planning and,

in Committee A, the Ministry of Sustainable Resource Management.

Committee of Supply

The House

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

The

committee met at 4:02 p.m.

ESTIMATES: MINISTRY OF

HEALTH PLANNING

On vote 30:

ministry operations, $16,633,000.

Hon. S.

Hawkins: It's a pleasure to introduce the estimates for the Ministry of

Health Planning for this fiscal year 2002-03. Before I begin, I have some

opening comments, and I'd like to introduce staff who have just joined me. On my

right is Penny Ballem, who is the deputy minister, and on my left is Tamara

Vrooman, who is the ADM for corporate services and financial accountability.

There will be other staff, I'm sure, that will be joining us, and I'll remind

myself to introduce them as they do.

I am

certainly looking forward to the opportunity of speaking to our plan and our

budget for the coming year. As you know, the Ministry of Health Planning was

created as an expression of our government's commitment to addressing the

immense pressures on the health care system and on health care providers.

The

ministry is dedicated to planning for the future of health care. We heard that

health planning was desperately needed. It had not been addressed in any real or

significant way in the past decade or longer, and we certainly heard the need

for health planning from patients, health care providers, unions, union members,

administrators and the public when we met with people as we travelled the

province over the past several years. We certainly listened, Mr. Chair, and

we're committed to ensuring that our health care system is planned in a

thoughtful, sensitive way that's responsive to patients and meets their needs.

Our

government's vision for health care in British Columbia is to provide

high-quality, patient-centred care that meets the needs of patients where they

live and when they need it. The Ministry of Health Planning and the Ministry of

Health Services have developed three goals for the health care system, and I'll

outline those goals. The first one is high-quality, patient-centred care. The

second one is improved health

[ Page 1547 ]

and wellness for British Columbians. The third one is sustainable, affordable

public health care.

[1605]

As the

Minister of Health Planning, I was asked to examine all the key aspects of

health care and to lead a planning process that was based on sound information

and a clear understanding of the challenges we face. Let me say that we know the

challenges are numerous.

From the

start I knew we had to address some serious shortages in health human resources,

a poorly structured regionalized health authority system that had inconsistent

levels of care across the province and certainly a lack of accountability within

the system — just to name a few of the challenges we were met with when we

took over.

certainly inherited a fragmented, uncoordinated, poorly managed and poorly

planned health care system. We began to address some of those challenges by

first restructuring the way we governed and delivered health care across the

province.

We had 52

health authorities when we first took over. There were seven community health

service societies, 11 regional health boards, 34 CHCs — community health

councils, as they were called. We had three different governance structures.

They had varying budgets and populations. Many of them were unable to meet the

needs of patients in their areas or meet the needs of health care providers or

even provide the health care providers that were needed in their areas. The

system had way too many walls — walls that divided communities, walls that

divided health care providers — that certainly kept patients from getting the

services they need.

The system,

the old ways, encouraged inefficiency and lack of accountability, and we

replaced that with six health authorities with budgets and populations that we

feel will help us manage our health services in a more efficient and accountable

way. The new structure is simplified, it's functional, and it's highly

accountable to patients and to government. We feel that it provides a clear

mechanism to implement the changes we need to realize our goal of sustainable,

quality health care, and it provides that clear logical line of accountability

that we didn't have before.

We also

recognized early on that our health care providers needed the tools and the

support to do their jobs, so last August we implemented a comprehensive $21

million nursing strategy to recruit, retain and educate more nurses and improve

workplace conditions. We dedicated $15 million in bed-lifts so that our health

care providers could do their jobs more safely.

Our

recruitment for nurses is on target. We have more nurses that are requalifying,

and more LPNs, RNs and resident care aides are being trained. We added 177 more

seats for RNs, LPNs and RCAs in January. That was the hard work of the Minister

of Advanced Education and her staff. We're pretty proud of that.

We're also

working to increase the number of physicians trained in B.C. and to encourage

physicians to work in rural and remote areas by expanding the number of seats at

UBC medical school. Again, the Minister of Advanced Education is working hard on

that, and we expect to increase the current 128 medical seats to 200 by 2004-05.

We're doing

that in order to make sure that we have enough doctors for the long term. We're

involved in a number of initiatives to make sure we get there. They include

expanding the UBC medical seats to the University of Northern British Columbia

and the University of Victoria, so that we're going to have satellite medical

schools. We're cooperating with the UBC faculty of medicine strategic training

initiative to ensure that physicians get the training they need to work in both

rural and urban settings, and we're increasing opportunities at St. Paul's

Hospital to help foreign medical graduates meet their Canadian standards for

certification. We've increased the number of residencies there. There were four;

we've added another two.

[T. Christensen in the chair.]

We did all

this to make sure that we were looking after patients so they had the health

providers needed to help meet their needs. On top of all that we made sure that

our health care providers are fairly paid. In fact, hon. Chair, we have the

best-paid health care providers in almost all the categories in comparison to

other provinces.

We not only

protected the health care budget, as we promised, but we added to it. It's now

up to over 40 percent of the provincial budget. It's now $10.2 billion. When we

hear about cutting the health care budget…. We did not cut the health care

budget; in fact, we've added a billion or so more to the health care budget.

[1610]

My ministry

has also begun a ten-year health human resources plan. We're focusing on

education, recruitment, retention and job design of health care professionals to

address the critical shortages across the province. We expect to have that draft

human resources plan available for consultation in the spring, along with the

health human resources plan.

We're

working with the health authorities to develop long-term plans for facilities,

for capital financing and medical machinery, for equipment and for information

technology. Each of those plans will go a long way to ensuring that we have that

sustainable, effective, accountable system that we know patients deserve and

want, which will take us into the future.

The health

care system we have today certainly worked well to deal with short-term and

acute care problems. It was created to treat catastrophic illness, but it's not

coping well with the kind of demands that are being placed on it today. Today

people are living longer. If you can turn your mind back to about 100 years ago,

the life expectancy was around 48. It's now 78, and as we're living longer, our

system is trying to cope with more long-term chronic health conditions. We

estimate one in four people suffers from some kind of chronic disease —

diabetes or heart disease or

[ Page 1548 ]

asthma, just to name a few. The system isn't organized to do that.

Certainly,

we're working on primary care renewal. We're applying to Health Canada's primary

care health transition fund to access $74 million over the next four years to

assist with primary care reform. Through the provincial health officer, we're

working to develop a prevention and wellness plan that will include

recommendations for addressing chronic disease management and injury and illness

prevention, which are areas that certainly impact the cost pressures on our

system.

We're also

working to encourage British Columbians to take responsibility for their own

health care and to responsibly use the system. We want to make sure that

patients have the kind of information, the confidence and the skills they need

to address their health needs. The continued health of our population depends on

these kinds of preventative measures and on access to quality health services.

We need to

move away from simply measuring inputs — or how much money we spend, how much

money we're putting into the system — to the much-needed practice of linking

resources to patient outcomes. We are moving that way. If you look at our

service plans, we laid out three years where we have goals, objectives,

strategies, measurements and targets that we're hoping to achieve. We've laid

them out clearly, and I'm happy to deal with those in these estimates.

The

operating budget for my ministry for the fiscal year 2002-03 is $16.6 million.

We plan to develop plans that address our commitment to design a

patient-centred, cost-effective, equitable and sustainable health care system in

this province. That's why the ministry was created. That is what we're planning

to do. Staff in the ministry have certainly been working very, very hard. We've

had a busy nine months. We are working very hard to meet some of the targets

that we're going to be responsible for over the next year. Again, for the first

time we've laid them out in service plans over three years.

With that,

Mr. Chair, I will close my opening comments. I look forward to the questions in

these estimates.

I also want

to say "Happy Birthday" to the member across the way. I didn't get a

chance to do that.

MacPhail: I thought I heard the minister say that the vote was…. It's

okay; I've found it. I was looking for the difference between the total vote of

$26 million and the ministry ops of $16 million.

Thank you

very much, and welcome to the minister and her staff.

Could the

minister describe what changes have occurred in her ministry since we last met

in estimates?

[1615]

Hon. S.

Hawkins: I was just trying to make sure I had the changes, because I think

the last time we met was in July.

What we've

done is move the health promotion and protection functions over to the Ministry

of Health Planning as we were separating the functions between the Ministry of

Health Services and the Ministry of Health Planning. We've also aligned the

programs with the provincial health officer's office for better integration, so

that's why we brought them over. The provincial health officer reported to the

Minister of Health Planning, so that's why we moved health promotion and

protection over to my ministry.

We hired a

chief nurse executive. I believe that hadn't been done last time we met. We

moved the legislation and intergovernmental relations functions over to Health

Planning as well, so they are now under the Ministry of Health Planning. I

believe we did have a portfolio for strategic initiatives. It's been developed

more over the last six or seven months. We consolidated the deputy minister's

office. We now have a deputy between Health Services and Health Planning.

MacPhail: It sounds to me like things were moved into the ministry as

opposed to out. Yet the ministry operations is down $10 million. The minister's

office has had no cut, but as far as I can tell, the operations side of the

ministry has $10 million less. Where are those reductions?

[1620]

Hon. S.

Hawkins: We've changed the functions of the Health ministries. We did that

to support the consolidation of the health authorities. We, Health Planning,

took our share of the 37.7 percent administrative cut. We moved some of the

functions from Health Services over to Health Planning. Those were the functions

of planning, strategic initiatives and reporting.

We used to

support the health authorities with those administrative functions, but because

we've reorganized them, they're bigger, and they've got more capacity to support

what they're doing. They've got bigger budgets to work within, and we didn't

want to duplicate what they do. We took our share of a 37.7 percent cut, and the

health authorities are more self-sufficient within the budgets that they were

given.

MacPhail: I recall that the minister announced that with the reorganization

to the six health boards, there would be about $20 million in savings. Is the

37-point-something percent of $20 million booked as savings?

[1625]

Hon. S.

Hawkins: No. The $20 million in projected savings is in the budget of Health

Services because that's the health authorities. What I was talking about was the

budgets between the two ministries. When we divided, each ministry took a 37.7

percent cut in administration. We took our share of that.

MacPhail: That's fine. The $20 million that resulted out of administrative

savings has been booked on the Minister of Health Services.

I'll read

this list slowly to see if it's right.

[ Page 1549 ]

I just

wanted to ask one question before we start. The Premier and I had a good

discussion yesterday on health issues. The Minister of Health Planning was in

the room for awhile. Did the Minister of Health Planning have a chance to review

all of the comments that the Premier…?

Hon. S.

Hawkins: No, I didn't.

MacPhail: The reason I asked that is only this: we spent quite a bit of time

discussing health issues. If we have a break, perhaps the Minister of Health

Planning can examine those comments. He referred a substantial number of matters

to these estimates.

On the

website of the Ministry of Health Planning, I had the last revision as January

7, 2002. Is that the last posting on the website?

Hon. S.

Hawkins: It's my understanding that there were some new changes to postings

on both ministries as of yesterday.

MacPhail: That's true of Health Services, but we pulled this off today. The

only reason I just want it is because often the government ministers refer to

the website. Just so you know, I have examined the website.

I have as

the general responsibilities for the Ministry of Health Planning: strategic

planning; capital planning; program evaluation; accountability system;

provincial health officer; Pharmacare policy; health system structure; health

licensing governance; health promotion and illness prevention; health

protection; children's health; seniors', women's and aboriginal health; and

vital statistics. I'll carry on. The key initiatives are the ministry service

plan, the Premier's dialogue on health care, new B.C. health authorities, B.C.

HealthGuide , reference drug program consultation panel, physician

initiatives and negotiations, and nurse recruitment and retention.

Hon. S.

Hawkins: The list is complete and correct except for the physician

negotiation that Tamara used to report to my side of the ministry. I believe it

was changed yesterday to reflect the current status — that she does report to

Health Services.

MacPhail: That's interesting. The change that moved the physician

initiatives and negotiations away from your ministry occurred yesterday.

[1630]

Hon. S.

Hawkins: I apologize if I wasn't clear. It was an administrative error that

it was listed on the website. The ADM for that used to report to my side of the

ministry way back when. We made the change yesterday to correct and reflect it,

but she actually reports to the Deputy Minister of Health Services.

MacPhail: At least the public is aware of that as of yesterday. Has the

Minister of Health Planning had any involvement, then, in the negotiations prior

to — or, looking forward, will she have had any involvement in those?

Hon. S.

Hawkins: No, I haven't in the past, and I won't in the future.

MacPhail: I note that in terms of the vote, the minister's office

expenditures stay the same. I'm having trouble, I'll confess, understanding, in

the government, the difference between a minister of state and a full minister.

In this particular realm, there are two ministers of state and two ministers.

What is it about the realm of the discussion of this vote that creates a full

minister that's different than the minister of state?

Hon. S.

Hawkins: It's a full ministry because that's what we committed to do. We

committed to planning thoughtfully, sensitively and for the future of health

care in the province. My ministry is responsible for a whole host of plans,

intermediate and long-term, and it definitely requires full-time leadership.

When I

start thinking about everything we've done in the last nine months, hon. Chair,

it's incredible what we've done. We have fully implemented a $21 million nursing

strategy. In that strategy, we have initiatives that have never been implemented

anywhere else across Canada.

With the

Minister of Advanced Education, we worked on a forgivable loan program that I

believe we are having a fairly good uptake on, with nurses and doctors going to

rural and remote areas.

We put in

more dollars to train foreign-trained nurses so that they could get hospital

recruiting of nurses that aren't practising in B.C. but want to get back to the

profession. We put this all together.

In fact,

with the Minister of Community, Aboriginal and Women's Services, we are

aggressively looking at the B.C. provincial nominee program. I understand

there's quite a few nurses that have got through or have applied through that

program.

We gave

nurses and other health care providers the tools to do the job they needed with

the bed lifts.

We went

offshore and aggressively recruited specialty care nurses.

Our major

announcement around the restructuring — a multibillion-dollar restructuring of

health care…. We now have a foundation that is simple, functional,

accountable, streamlined and doing the job. It's getting rave reviews from

people across the province. We have done an incredible amount of work in the

last few months.

We are in

the midst of planning for our human resources strategy. We are in the midst of

looking at primary care renewal. There is a lot of work that goes into that, and

this minister and this minister's office are set up to do that.

[1635]

MacPhail: The reason I'm exploring this is because I was interested in the

opening statement of the minister. There's no question that those are the issues

[ Page 1550 ]

we discussed in our last estimates. I was asking what had occurred in a new

way since then. These questions are kind of provoked by what we've already had

offered to us.

I've also

reviewed the service plans of both the Ministry of Health Services and the

Ministry of Health Planning. In the only internal communications of the

ministry, they refer back and forth between the two service plans.

I hope we

can use this opportunity to explain even more fully the justification of

spending $16 million looking forward and what new work the Ministry of Health

Planning is doing, because it's a substantial…. I understand now that we just

have one deputy minister, and it's nice to see Dr. Ballem again — very nice.

I'm just trying to figure out, in times when we're changing health care spending

everywhere else, some positive suggestions about how to spend health dollars, as

the Premier asked for yesterday. I hope we can concentrate on new work that the

ministry is doing.

The Premier

and I spent quite a bit of time yesterday on health authorities and appointments

to health authority boards. Perhaps the minister could begin by updating all of

us about where we are in terms of moving beyond the six chairs running the

provincial health care system.

Hon. S.

Hawkins: Let me just address the member's previous point about why the

ministry exists. The ministry exists so that there is thoughtful planning for

the future of health care. We made that commitment to patients, to providers and

to the public. We're keeping that commitment.

The

ministry exists because we recognize that there is a need to do long-term

planning. That had not been done. In fact, the Minister of Health Services tells

me that when he started and sat down with his deputy at that time, and we looked

at how we were going to separate the functions between the two ministries, there

was not one FTE — not one full-time-equivalent — that was dedicated to

long-term planning in the old Ministry of Health Services.

Now we have

the functions separated. I would say that we're getting pretty good value for

looking at how we're going to provide and plan for services in the future,

considering the amount of work we have to do and the quality of people we have.

We have excellent people who are dedicating their time and working on the plans

that we have identified as necessary to work on for the long term.

[1640]

The member

asked where we are with respect to the boards for the new health authorities.

She knows that six chairs have been appointed. The boards then, we had

announced, would have nine members including the board chair. The board chairs

are in the process of developing their boards. I understand that those boards

will be appointed before the end of this fiscal year.

MacPhail: Each regional health authority will have nine members. Is that

including the chair? Is it eight plus the chair or nine board members? How is

the recruitment process taking place?

Hon. S.

Hawkins: I did say that the boards would have nine members including the

board chair. We are looking for people with skills, knowledge and abilities.

They have to have strong leadership and fiscal management responsibility and

accountability. They have to be knowledgable about the region and its

population. There has to be involvement in connection with their communities.

They have to be able to commit a reasonable amount of time as board members.

We are

doing that through our resourcing manager. I understand there was very strong

interest in this, and they are working very hard to complete the process. As I

said, I understand that the boards will be appointed before the end of the

fiscal year.

MacPhail: Yes, and that's three weeks away.

The

recruitment was discussed with the Premier yesterday. I asked him a question

about whether there would be community representation. Then I asked him why

physicians were barred from representation. On the first, he said the boards

were not going to be constituency-based — I'm just quoting him — and

secondly, on the physicians, he said there was a legal opinion saying they would

be in conflict of interest, I think, and therefore they were barred. Perhaps the

minister could outline more fully the thinking behind both of those points.

Hon. S.

Hawkins: Physicians are not barred from sitting on the boards. They cannot

sit on the board of their own health authority. That would be a conflict.

As the

member knows, we want to involve physicians, and there are ways for physicians

to get involved in health care. The member knows very well that there are

medical advisory committees that advise the board about the quality and the

needs and the patient impacts of decisions that are being made.

Doctors are

involved, and the Premier is quite right. If they want to sit on their own

board, our advice is that this is a conflict.

MacPhail: Well, it would be a little hard for a physician to sit on a board

other than his or her own, particularly in the north, where a regional health

authority covers an area that's larger than a substantial portion of countries

in the world. I'm not quite sure how a physician in the Northern Interior health

region, for instance, could sit on another health board.

[1645]

Secondly,

what has changed that would require…? Physicians did sit on regional health

boards. I'm not aware of there being any issue with that before. What changed?

Hon. S.

Hawkins: If I didn't make myself clear before, someone with a medical

background is not barred from sitting on the boards. We've had a lot of interest

from physicians that are retired and non-practising,

[ Page 1551 ]

and their names certainly have been considered or have gone forward to the

resourcing director. Again, the boards are being developed right now.

Let me tell

you that we value the input of physicians, and they have access to the board

through their medical advisory committees and through their input in different

committees in the areas where they work. Again, their input is valued. We will

continue to work with them. That's all I have to say on that.

MacPhail: Well, when my question was asked, what had changed beforehand,

because of course….? Sorry.

Hon. S.

Hawkins: I knew there was one other thing.

We have

made it very clear that when we reorganize, we have six health authorities. They

are managing multimillion-dollar — in a couple of cases, I think,

multibillion-dollar — budgets. We wanted to make sure we had people on the

boards who had the knowledge, the skills, the expertise, the background

experience and the leadership, and we wanted to make sure we had a board that

would manage responsibly and take on the accountability. That's not to say that

the kinds of people the member is mentioning don't have that. It's to say that

it is the kind of direction we gave to the board chairs to help develop their

boards.

We want to

make sure that health care is going to be better managed and that there is going

to be accountability, because in the past we've had some experience where it

hasn't been. We've had budgets that have been running deficits for years. We've

had care that hasn't exactly been that full range of necessary care getting

across to different areas of the different health authorities.

We want to

make sure that when we put people in place, they understand they are going to be

responsible, they are going to be accountable, there are big budgets to manage,

and there are services and quality of services to deliver. That is why we are

looking for the kind of people who have that strong business knowledge, those

skills and abilities, and also the sense to access and consult with the kind of

people they need to, to help them make their decisions around patient needs and

decisions for patient care.

And you

know what? The doctors are in the middle of that process, because they do have

representation through their MACs and through the different committees they sit

on in their regions. We look forward to working with them and getting that

input.

MacPhail: I'll try to make my question clearer.

This arises

out of correspondence directly from physicians themselves. I can't remember

whether it was the Medical Society or the BCMA. The letter was written to the

Premier and the minister and actually was copied to me. This was the discussion

we had around that letter yesterday.

So, we're

dealing with physicians, and we're dealing with practising physicians. We're not

dealing with retired physicians, and we're not dealing with physicians who would

have to travel halfway across the province to represent another board. We're

dealing with physicians who are practising in their own community.

In the past

physicians had a dedicated seat on each and every health authority, and they

complained about that to the current Premier, saying that it wasn't good enough

because they didn't get to appoint that physician from amongst their own ranks.

Then they went on to say that they had heard that the situation was going to

grow even worse under this government, because they were going to be barred from

representation. The doctors themselves know very well that they have medical

advisory committees. They know the role they play there, and they are still

dismayed that they are being barred from regional health authorities.

[1650]

What is the

legal opinion? Perhaps the minister could table the legal opinion that shows,

then, what issues arose to create this dynamic that there would be a conflict.

What issues arose in the previous health authorities that gave rise to that view

or that seeking of that legal opinion?

Hon. S.

Hawkins: Let me try and explain again. I understand the concern that

the member is raising. There are a lot of different providers in the health care

system — physicians are certainly one group — that want input. We recognize

that, we will involve them, and we are involving them. They do have access to

the board and the decision-makers. They do have input on the kinds of decisions

we make in order to meet patients' needs, but what we're doing here is looking

for governors. We're looking for people who have the kind of business knowledge,

the skills, the abilities, the fiscal management and the accountability to

govern.

I would

remind the member that in the past…. I know the doctors didn't feel part of

the system. Perhaps one way the past government dealt with that was to put them

on the board, but believe me, the 52 boards weren't working either. It was a

nightmare, and that's what we heard all across the province.

What we're

trying to do now is set up a system where we do have governors, where they do

accept responsibility and where they do have to meet accountability measures.

We are

looking for people across the regions who will provide the kind of skills that

we know will help us better manage the system to keep it on track. The target is

making sure that we're delivering high-quality health services to patients who

need them where they live. That is what we're doing. Certainly, the doctors are

going to be involved in that. They have access to various processes to do that,

and we look forward to working with them.

MacPhail: Is the minister saying that there is no legal opinion for this

shift of view, that the minister herself created this view that they'd be in a

conflict of interest?

[ Page 1552 ]

[1655]

Hon. S.

Hawkins: I don't know what the member is referring to, as far as the legal

opinion. I haven't reviewed the comments from yesterday. I'll take that on

notice once I review the comments.

MacPhail: I assume that the change, which the doctors are protesting now,

from them getting m