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, APRIL 3, 2002

Afternoon Sitting

Volume 5, Number 6

CONTENTS

Routine

Proceedings

Page

Introductions by Members

Tributes

Kenn Borek

B. Lekstrom

Statements (Standing Order 25 B )

Cruise ship industry in Nanaimo

M. Hunter

Fish habitat protection on Vancouver's North Shore

R. Sultan

U.S. duty on tomatoes

V. Roddick

Oral Questions

Severance payments for civil service employees

J. MacPhail

Hon. S. Santori

Hon. C. Hansen

Severance payments for health authority administrators

J. Kwan

Hon. C. Hansen

Referendum on treaty negotiations

B. Lekstrom

Hon. G. Plant

Maternity and midwifery services

J. Wilson

Hon. S. Hawkins

Hon. S. Bond

Report on core review of Workers Compensation Board

P. Wong

Hon. G. Bruce

Tabling Documents

Auditor general report No. 6, 2001-2002, Information Use by the Ministry of Health in Resource Allocation Decisions for the Regional Health Care System

Petitions

J. Kwan

Committee of Supply

Estimates: Ministry of Health Services (continued)

P. Bell

Hon. C. Hansen

P. Wong

S. Brice

J. MacPhail

B. Kerr

S. Orr

R. Lee

R. Harris

I. Chong

Hon. K. Whittred

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Human Resources (continued)

Hon. M. Coell

J. Kwan

V. Anderson

Estimates: Ministry of Attorney General and Ministry Responsible for Treaty Negotiations

(continued)

J. Kwan

Hon. G. Plant

B. Penner

B. Belsey

R. Lee

[ Page 2399 ]

WEDNESDAY, APRIL 3, 2002

The House

met at 2:03 p.m.

Prayers.

Introductions by Members

Hon. G.

Abbott: I'm happy today to join with the Ministers of Health in making some

introductions. As you may know, Mr. Speaker, the World Health Organization has

designated Sunday, April 7, 2002, as World Health Day. This year's World Health

Day is going to emphasize the importance of sport and physical activity in a

healthy lifestyle. Certainly, that's a priority for our government, and we share

that priority with many non-profit service organizations in the health, sport

and recreation communities.

There are

several representatives of these groups today in the gallery. I would like the

House to join in welcoming Sandra Stevenson, who is the CEO and president of

Sport B.C.; Gary Young, who represents the B.C. Recreation and Parks

Association; Allan Courbold, manager of the Vancouver Island region of the

Canadian Cancer Society, B.C. and Yukon Division; Patty McGowan, area manager

for the Heart and Stroke Foundation for B.C. and the Yukon; and Arthur Burgess

and Dorothy Burgess from the Canadian Diabetes Association.

[1405]

These

individuals work closely with the College of Family Physicians of Canada —

B.C. Chapter, the Premier's sports award program and the Vancouver Whistler 2010

Bid Corp. to raise awareness about World Health Day. I ask all members of the

House to join me in welcoming them to the Legislature today.

Belsey: Mr. Speaker, as you know, there are few times that I have the

advantage to stand up in the House and introduce guests from the north coast.

Few people want to leave the north coast — the clean water, clean air and

clean living — but I have a couple of guests that have come down, plus my

wife. I'd like to introduce Judy Fraser, who worked hard on my campaign as a

scheduler and coordinator — she worked very hard; her husband, Paul; and my

wife, Lonie. Please join in making them welcome.

Visser: It's not often that I, like the member for North Coast, get to rise

and introduce some guests in the House. Everybody says that their guests come

from the most beautiful part of the province. I have to say today's guests are

from Kyuquot, which is, without question, one of the nicest spots on this

planet. It's on the west coast of Vancouver Island, in the riding of North

Island. I asked them today at lunch how they'd like to be introduced. They said:

"In Spanish, hopping on one foot." I said I didn't think I could do

that.

In the

gallery today are Tania Jack, Henry Jack, Josh Gillette, Devon Hansen, Irene

Hanson and Arlene Smith, students in grades 11 and 12 in Kyuquot; their teacher

Brenda Gilman; elder and teacher Ann Cox and a third teacher, Dirk Zand. They're

all here from Kyuquot. Would the House please make them welcome.

Roddick: In the House today — from beautiful, green, sunny Delta — is

the president of the Delta Chamber of Commerce, Gerry Beltgens. He also, along

with the chamber's support, is project coordinator of the Delta portal project,

a strategic plan for post-secondary education in Delta. Will the House please

make him welcome.

Tributes

KENN BOREK

Lekstrom: I rise today with a note of sadness to report on the untimely

death of one of our pioneers in the north, Mr. Kenn Borek, who was killed on

Easter Sunday in a tragic car accident along with his daughter, Carleen. Kenn

contributed to the development of the north in many ways, beginning his business

in 1955. He was involved in construction in the oil field industry, the

agricultural industry, the real estate industry and the aviation industry. Kenn

contributed to the north as a pioneer and to opening it up and accessing the

resources that help benefit all of us as British Columbians.

Kenn is a

friend I've known all my life. I've grown up with his family, and I can tell you

he was a man of honour and integrity. He went about his business and worked

every day of his life. Up until his untimely death, both he and his wife,

Rosella, were out at work every day in Dawson Creek, running a worldwide

business from what we consider the true beauty of the north. He maintained his

lifestyle and his home there with his family. I would ask the House to join me

in passing our deepest condolences to the Borek family, in our thoughts and

prayers.

Statements

(Standing Order 25

b) CRUISE SHIP INDUSTRY IN NANAIMO

Hunter: Today I'm going to borrow a phrase from the Minister of Energy and

Mines. I want to tell the House about more good news from Nanaimo. As we all

know, as surely as the swallows return to Capistrano, cruise ships start

returning to British Columbia in the spring. Well, today the first cruise ship

to ply B.C. waters in the 2002 season arrived in the port of Nanaimo. The Spirit

of Columbia , owned by Cruise West in Seattle, with 80 passengers from all

over the U.S.A. aboard, docked in Nanaimo for the first of a number of pocket

cruise ship visits through 2002. Pocket cruises are a major growth sector within

the cruise ship industry. The 143-foot Spirit of Columbia will operate

out of Nanaimo on local cruises in southern B.C. for the

[ Page 2400 ]

month of April before repositioning on Alaska cruises for the summer.

[1410]

I want to

praise all the people in Nanaimo who have worked so hard to attract the pocket

cruise industry to my home port. Tourism Nanaimo, in particular, and the Nanaimo

Port Authority really deserve the bright sunshine that greeted the vessel and

its passengers this morning. Many other organizations and local businesses were

involved in helping to sell Nanaimo to Cruise West as a destination during the

spring and fall shoulder seasons. This commitment to the development of the

tourism industry and its potential in Nanaimo and the mid-Island is just one

more sign of a growing confidence in British Columbia.

We have a

magnificent product to sell in this province, and in Nanaimo, as today's event

shows, we have the motivated people to sell our local product. I'm delighted

that Tourism Nanaimo, in cooperation with all its business partners, is leading

the way in the British Columbia tourism sector with an aggressive approach that

is creating new opportunities and helping to build new businesses. I am

confident that those who are visiting Nanaimo for the first time today on the

inaugural visit of the Spirit of Columbia will have been impressed by the

warmth of their welcome to Nanaimo, the harbour city and the gateway to

Vancouver Island.

FISH HABITAT PROTECTION

ON VANCOUVER'S NORTH SHORE

Sultan: I rise to commend the 250 eager youngsters who recently descended

upon Edgemont Village in North Vancouver to adopt a fish. I was one of them. The

idea was to register at a booth opposite Delany's, get a diploma from the North

Shore Coho Society, then hike down to McKay Creek where volunteers from the

North Shore Fish and Game Club helped each youngster transfer a salmon fry into

the creek, all the while receiving a lesson in fish habitat protection.

Brilliant

educational strategy. In three hours about 400 chum fingerlings were sent on

their way to the Pacific Ocean. North Shore creeks are home to Dolly Varden, all

species of salmon, cutthroat and rainbow trout, and steelhead. Their enemies are

people who dump chlorinated hot tub water onto the front lawn where it ends up

God knows where, old paint and crankcase oil into storm drains, and the

thoughtless encroachment of buildings, driveways and parking lots and loss of

streamside vegetation.

Those

things don't help very much, but on the North Shore we're demonstrating that

development and fish can coexist and prosper. Some would have us believe this is

impossible: "Either kill the fish and let development prosper, or kill the

development and let the fish prosper." You don't have to kill one to save

the other. For example, encouraging negotiations are underway with Seaspan to

relocate the mouth of McKay Creek away from the ditch cutting through their

marine basin. If these negotiations are successful, an estimated four to six of

our adopted fish, and maybe even one of mine, will return home in four years to

a restored natural estuary on Burrard Inlet.

Did you

know that virtually every North Shore creek has a resident fish population?

Otter know. They regularly clamber up McKay Creek catching fingerlings and

crayfish right alongside the Sears parking lot. The hills are alive, and on the

North Shore we intend to keep it that way.

U.S. DUTY ON TOMATOES

Roddick: I am very pleased that the United States International Trade

Commission has determined that anti-dumping duties imposed on the B.C.

greenhouse tomatoes shipped to the United States were not warranted. Duties on

British Columbia and other Canadian greenhouse tomatoes will cease within ten

days, and liquidation of previous bonds and the return of all duties will be

completed within 30 days. This is an excellent news story for my constituency,

for British Columbia and for Canada. I wish to extend my appreciation to all

those in the greenhouse industry who worked tirelessly on this case for their

victory.

[1415]

Tomatoes

are the central product of the B.C. greenhouse industry, an industry which

employs 5,000 British Columbians directly and indirectly. A North American

tomato trade working group has been formed to help resolve trade negotiation

problems and misunderstandings by consultation and negotiation.

This

commonsense approach was first advocated by our Minister of Agriculture, John

van Dongen, at the Canada–United States–Mexico tri-national agricultural

accord meeting in Mexico last September 2001. Basic common sense prevailed

throughout these discussions. A wonderful example was set by a member of the

commission. She walked into the hearings one day with two tomatoes, plunked them

down and said to everyone present: "All right, which is greenhouse, and

which is field?" No one could tell. Her comment: "Then why are we

here?" May further dealings with our North American trade partner use this

as an example.

Mr.

Speaker: That concludes members' statements, hon. members.

Oral Questions

SEVERANCE PAYMENTS FOR

CIVIL SERVICE EMPLOYEES

MacPhail: Last week the Minister of Finance told me to ask this question of

the Minister of Management Services.

Can the

Minister of Management Services confirm that in B.C. the law stipulates that

public sector employees will not receive severance if they leave their jobs

voluntarily?

Hon. S.

Santori: If the public service employee leaves voluntarily, I believe that

the severance pay is

[ Page 2401 ]

included within the understanding of a collective agreement.

MacPhail: That's not the part of the law that I'm talking about, but I will

make the law in B.C. very clear. The Public Sector Employers Act regulations say

that employees who retire or resign voluntarily are not eligible for severance.

Can the

Minister of Management Services, who is responsible for enforcing this act,

explain why the chief operating officer of the Central Island portion of the

Vancouver Island health authority, Grant Roberge, received a 16-month, $300,000

severance package following his decision to quit?

Hon. C.

Hansen: The health authorities, as the member knows very well, fall under

the responsibilities of the Ministry of Health Services.

The

severance provisions that were put in place for Mr. Roberge flowed directly from

the contract that was put in place while the previous government was in office.

We are obligated to abide by those contractual obligations.

Mr.

Speaker: The Leader of the Opposition has a further supplementary.

MacPhail: In fact, the previous government put in the law that I am talking

about.

Maybe the

minister needs a few more facts. Following a management review, Mr. Roberge

decided that he didn't like his new job, and he quit. Under the law, he should

have been given a going-away party. Instead, he was handed a $300,000 severance

cheque.

Given that

Mr. Roberge's severance package is in violation of the law, will the Minister of

Management Services — who the Finance minister says is responsible for

administering the law — step in and investigate? And if it contravenes the

law, will he see to it that Mr. Roberge's severance payment goes to patient

care?

Hon. C.

Hansen: There was a significant change in Mr. Roberge's responsibilities. It

was considered to be constructive dismissal, and therefore the provisions that

were in his contract had to be implemented and were actioned.

[1420]

SEVERANCE PAYMENTS FOR

HEALTH AUTHORITY ADMINISTRATORS

J. Kwan:

Health authorities around the province are refusing to answer questions around

severance payments. However, we do know that many health administrators are

being handed some very hefty severance payments and pay raises as well — a pay

increase of $45,000 per year for the CEO of the Vancouver coastal health

authority. And last week the Minister of Finance, with no notice or any details,

rushed through a bill paying almost $100 million in severance costs.

Would the

Minister of Management Services, in what is fast becoming the most expensive and

secretive government in Canada, like to tell British Columbians how many more

health administrators are getting…

Interjections.

Mr.

Speaker: Order, please. Order.

J. Kwan:

…backroom severance payouts that contravene the law?

Interjections.

Mr.

Speaker: Order. Hon. members, we cannot hear the question. Would the member

please repeat her question.

J. Kwan:

Would the Minister of Management Services, in what is fast becoming the most

secretive government in Canada, like to tell British Columbians how many other

health administrators are getting backroom deals, payouts that contravene the

law?

Hon. C.

Hansen: Those contracts are being put in place by the respective health

authorities under the direction of the chairs of the health authorities. We have

made a commitment that we're going to ensure that our top administrators are

remunerated in a way that's comparable to other jurisdictions and industries.

The instructions to the health authorities are that those contracts have to be

consistent with the guidelines set down by government.

J. Kwan:

The law is clear. Severance must not be paid if an employee leaves his or

her job voluntarily. We have evidence that the law is not being followed. Money

should go to patients; instead, it is going to severance. The minister refuses

to answer the questions, he refuses to step in, and he refuses to investigate.

I'll give him one more chance: will the Minister of Management Services, who is

responsible for the public…

Interjections.

Mr.

Speaker: Order, please.

J. Kwan:

…service severance, order a full investigation into these secret backroom

severance payouts so that British Columbians can have confidence that the law is

being followed?

Hon. C.

Hansen: As I reminded this member's colleague, the health authority

operations are a responsibility of the Ministry of Health Services. The

instructions we have given to the health authorities are that their contracts

have to be consistent with the guidelines that have been set down by government.

We made a commitment to British Columbians that we're going to

[ Page 2402 ]

reduce the amount of administration in health care so that dollars can be

focused on patient care.

As we go

through that readjustment process, there are people whose positions are going to

become redundant. The commitment we've made is that we will treat them fairly,

that they will be paid severance where that's appropriate and is required, and

that we will make sure those dollars, in the future, get redirected into patient

care, because that's the bottom line for us as a government.

REFERENDUM ON TREATY NEGOTIATIONS

Lekstrom: My question is to the Minister Responsible for Treaty

Negotiations. A number of my constituents have been phoning my office to seek

clarification on some of the questions in the treaty referendum. For instance,

the referendum asks whether fair compensation for unavoidable disruption of

commercial interests should be ensured. Can the Minister Responsible for Treaty

Negotiations explain or provide an example of what is considered unavoidable

disruption of commercial interests?

Hon. G.

Plant: Traditionally, government pays compensation for expropriation of

privately held land, but there are many people and businesses in British

Columbia who hold licences or leases of Crown land. That may be an agriculture

lease, a forest licence or sometimes a permit to occupy some waterfront for the

construction of a wharf.

We, as

government, are putting forward in this second principle the proposition that we

licences are respected. But if it becomes necessary to make a treaty provision

that has the result of making it impossible for someone to exercise their rights

under a lease or a licence, then we're saying that government should compensate

for that interruption.

Mr.

Speaker: The member for Peace River South has a supplementary question.

Lekstrom: As well, some British Columbians may be unaware of the tax

exemptions that are currently available to aboriginal people in this province.

Can the Minister Responsible for Treaty Negotiations outline the existing tax

exemptions available to aboriginal people and which of those exemptions he feels

should be phased out?

[1425]

Hon. G.

Plant: Well, under the Indian Act of Canada and also as a part of our

constitutional structure, there are some exemptions for taxes afforded to

aboriginal people. For example, aboriginal people who earn income on a reserve

don't have to pay income tax on that income. There are also exemptions for sales

tax for the purchase of goods in some circumstances. We think — and the

province has been consistently at the table for a number of years arguing this

— that all Canadians should move forward towards tax equality.

This

question, which is the eighth principle in the referendum, asks British

Columbians to confirm that their negotiators should be at the table working with

the federal and first nations negotiators to achieve a phase-out over time, in a

fair and measured way, of these tax exemptions to facilitate the integration of

aboriginal people into the larger economy of British Columbia.

MATERNITY AND MIDWIFERY SERVICES

Wilson: My question is to the Minister of Health Planning. In the New Era

document the government committed to providing all British Columbians,

regardless of where they live, with reliable, high-quality health care. Like so

many of its other health care policies, the previous government failed to

address the needs of new and expecting mothers.

Can the

Minister of Health Planning tell us what she is doing to ensure that maternity

care services are available to the women of this province when and where they

need them?

Hon. S.

Hawkins: We recognize the need for health care providers across the

province, and certainly in communities that are underserved and need maternity

care.

announced a nursing strategy last year. In that, we had grants for training

specialty care nurses, including nurses in labour and delivery. Those grants

were given to health authorities. We sent a team of recruiters offshore, and we

received about 46 specialty care nurses, including labour and delivery, out of

that recruitment effort. The Minister of Advanced Education has announced a

satellite medical school program at UNBC. Starting in 2004 we will be entering

24 medical students into that program to train in rural medicine. Today we're

announcing a new midwifery degree program at UBC, and we will be offering,

hopefully in conjunction with UBC, a rural component so people will get the care

they need where they need it.

Mr.

Speaker: The member for Cariboo North has a supplementary question.

Wilson: My supplementary is to the Minister of Advanced Education. Rural and

northern regions of B.C. have experienced a series of challenges in being able

to retain health care professionals, including midwives.

Could the

Minister of Advanced Education tell my constituents what this government is

doing to encourage midwives to practise in northern and rural British Columbia?

Mr.

Speaker: I must remind all hon. members that a supplementary question must

be a supplementary to the original question. However, the Minister of Advanced

Education may answer if she pleases.

[ Page 2403 ]

Hon. S.

Bond: In the work that the Minister of Health Planning is doing, certainly

there is a focus on looking at what the specific needs of those in rural and

remote communities are. Our announcement about the medical program was the first

one of those components. What we're going to do is work with the University of

British Columbia with this particular degree program to look and make sure there

is a rural training component.

More

importantly, the incentives that we're using. In August of last year we created

a forgivable loan program in this province for health care professionals who

agree to serve in underserved communities in the province. We are going to

extend that forgivable loan program to include midwives who complete this

particular degree to encourage them to serve in rural and remote parts of this

province.

REPORT ON CORE REVIEW OF

WORKERS COMPENSATION BOARD

P. Wong:

My question is to the Minister of Skills, Development and Labour. Last year the

minister announced that as part of the core services review process, the

operation of the Workers Compensation Board would also be reviewed. The minister

also indicated that he expected to receive this report in January.

Can the

Minister of Skills, Development and Labour update us on the status of this

report?

[1430]

Hon. G.

Bruce: The reports — there are two of them, one by Allan Winter and one by

Allan Hunt — have been deposited with my staff. One of the two reports deals

with the issue of service delivery, as you are well aware, and the other is in

respect to governance and benefits. We're taking the recommendations from that

now.

conjunction, as well, we're reviewing with the royal commission so that we can

bring forward changes to the House that will improve WCB both for the employees

that find themselves having to utilize WCB and for the employer community that

funds it.

Mr.

Speaker: The member for Vancouver-Kensington has a supplementary question.

P. Wong:

The minister has also indicated in the past that he expected this review will

provide ideas for improving the WCB system. Many of my constituents are

interested in the findings of the review and what the government intends to do

with it. Can the Minister of Skills Development and Labour tell us when he

expects to make this report public?

Hon. G.

Bruce: The changes will be significant. There's probably not a person in

British Columbia that knows there isn't a need for significant change in

operation of the WCB so that it can better represent the people it is supposed

to look after. Those reports will be made available probably within the next

month and a half.

[End of question period.]

Tabling Documents

Mr.

Speaker: I have the honour to present report No. 6 of the auditor general,

2001-2002, Information Use by the Ministry of Health in Resource Allocation

Decisions for the Regional Health Care System .

J. Kwan:

I seek leave to table letters.

Mr.

Speaker: Hon. member, is it in the form of a petition?

J. Kwan:

Yes, in the form of a petition.

Mr.

Speaker: No leave is required. Please proceed.

Petitions

J. Kwan:

I table 180 letters from parents who are appalled by the government's move to

reduce the number of years a single parent can stay at home with their children.

They point out that the inevitable result of this policy change will be

"burnt-out single parents and emotional breakdown and damage to the

parent-child relationships."

Orders of the Day

Hon. G.

Collins: For the information of members, in Committee A I call Committee of

Supply. We'll be debating the estimates of the Ministry of Human Resources,

followed by the Ministry of Attorney General. In this House I call Committee of

Supply for the estimates of the Ministry of Health Services.

[1435]

Committee of Supply

The House

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

The

committee met at 2:39 p.m.

ESTIMATES: MINISTRY OF

HEALTH SERVICES

(continued)

On vote 31:

ministry operations, $10,053,791,000 ( continued ).

[1440]

P. Bell:

The recently announced medical training program that will be a co-op venture

between UBC and UNBC will likely have some impact on rural and remote health

care, particularly that at Prince George Regional Hospital. I wonder if the

minister could tell us

[ Page 2404 ]

what some of the implications of that doctor training program might be on the

north, specifically as it relates to Prince George Regional Hospital.

Hon. C.

Hansen: This is very exciting news for Prince George and, indeed, for the

northern half of the province generally. This allows Prince George to develop

itself as an academic centre for training doctors. That, in turn, has all kinds

of ramifications.

First of

all, it will allow students from the north to be able to study medicine closer

to home. What we have found in research that's been done around the world is

that medical students who train in rural, remote and northern parts of, in this

case, the country have a higher propensity to stay and work in those areas. I

think it's good news when it comes to recruiting new doctors for the future

needs of the northern part of the province. There is a strong emphasis on rural

medicine that will be there for the training done at UNBC.

The other

side of it, from which I think residents of Prince George will see a more

immediate benefit, is that many of the best doctors in the world seek out

positions that have an education component to them. Doctors who are not only

among the best in their particular fields are also some of the best instructors.

That's an additional dimension that will help the northern health authority to

recruit some of the top doctors to come to Prince George to provide medical

service and a teaching component as well.

P. Bell:

I'm wondering, specifically from a layperson's perspective: if one were to visit

PGRH four or five years from now, would one see student physicians in the

hospital actually practising and performing various functions? What would one

see from a layperson's perspective?

Hon. C.

Hansen: Because this particular program at UNBC is going to have a family

practice and a rural practice focus to it, many of these medical students will

be working in family physician offices throughout the north — not necessarily

just in Prince George. There are also opportunities in other communities. They

will also be doing, particularly in their third and fourth years, a significant

amount of work in the hospital. Obviously, they would be there under the

guidance of a doctor who would be responsible for the work they're doing while

they are in hospitals. It will certainly be an added benefit to the residents of

Prince George in those years to come.

The other

thing that's very important is that there will be an increased number of

students graduating from this program who will choose to stay in the north and

in Prince George, which is certainly a benefit to meeting our future needs.

[1445]

P. Wong:

In many cases the minister has said he wants to put the patients first. It's

also the ministry's mandate to allow more choices in the health system. Since

acupuncture and Chinese traditional medicine have been recognized by the

previous provincial government and are self-regulated like any other medical

profession, I would like to ask the minister whether, in fairness, there is any

possibility that this category of medical treatment be included in the ten-times

visit covered by the MSP similar to the podiatrists, massage therapists and

natural therapists.

Hon. C.

Hansen: We are not at this time looking at expanding coverage. We clearly

have some budget constraints that we're trying to deal with. That was part of

why the coverage for supplemental benefits was changed last December.

We are

working closely with the Tzu Chi Institute in Vancouver. We provide some funding

to that organization. We are working with them to determine the best ways that

some of the traditional Chinese therapies and procedures could be integrated

into western medicine. There's some wonderful work that's being done. Hopefully,

over time that work will lead to a better integration of traditional Chinese

practices with western medicine.

P. Wong:

Can the minister tell me the progress of recruiting foreign nurses and medical

professionals? Has the ministry made use of the provincial immigration program

to recruit more health professionals to meet the increasing needs of the aging

population?

Hon. C.

Hansen: We are using the B.C. provincial nominee program to assist in

recruiting nurses to come to Canada to work in British Columbia. There was a

recruitment drive that was launched last fall to a variety of countries, which

was quite successful. Many of those new recruits are now making arrangements to

take up positions in British Columbia, so that has been a success.

We are also

working with HRDC and Health Canada to find ways that we can further facilitate

new Canadians coming to British Columbia to take up positions where there are

shortages in various health professions.

P. Wong:

Does the ministry have any arrangement with foreign overseas hospitals to have

some kind of training programs before these people are training nurses coming to

Canada?

Hon. C.

Hansen: The ministry itself does not have any direct responsibilities in

this area, but obviously there are several areas that we work closely with. One

is HEABC, which has a program called Health Match B.C. where they try to recruit

professionals, whether it's doctors or nurses, to come to British Columbia. We

certainly have relationships with organizations in other countries that can

assist us in recruiting nurses to come to British Columbia.

[1450]

There is

not currently training being done, but there is some testing that gets done in

their home countries or countries of origin so that some of the credentialing

work, particularly around nursing with the RNABC, can be done as soon as

possible.

[ Page 2405 ]

Brice: I'm following on my colleague from Prince George North's discussion

about UNBC and the great news about the training of doctors, particularly for

remote, rural B.C. and Vancouver Island. As we travelled with the select

standing committee, we became even more aware that the doctor forms an important

part of a team. Undoubtedly, in preparation for those newly minted physicians

that will be clamouring to teach in remote and rural B.C. — which is of course

what we're all hoping for — can you give us some idea of what is in the works?

We heard they have trouble even with home care support. Obviously, a nurse is an

important part of that team, as is anybody on the health care team that is going

to be able to pull off a really good, solid program for the folks who live in

the north.

Hon. C.

Hansen: There are a bunch of initiatives that are underway. I've pulled out

four that are just examples of the kind of things we're trying to do to ensure

that we have an adequate number of health professionals going to rural

communities.

The first

one that we brought in just last fall was the student loan forgiveness program

so that health professionals who agreed to practise in underserviced parts of

the province can have their student loans forgiven over a period of five years.

The second

one, which I mentioned earlier, is the expansion of the medical school. It's a

benefit not just to Prince George, but it's a benefit to northern communities

because many of those students will wind up doing some of their training in

family practices throughout the north.

The third

one, as an example, is called the northern isolation travel assistance program.

That's for locums who are willing to go into some of the smaller communities to

provide relief for doctors in these communities. Typically, there's not enough

doctors in a small community to cover each other off. It's an important program

to allow for locums to come in from outside the region, to fill in for them

during that period of time.

The final

example is all around the telemedicine project, which I think is really quite

exciting for rural health. Using those video links, it gives the doctors in

those communities better support from the top specialists in the province. When

they have to make those judgment calls, they know they've got that backup of

very high-level support.

[1455]

It's also a

valuable tool for continuing medical education. Those video links will be used

so that physicians can actually get additional training in their communities.

They don't have to leave their communities and patients to come to Vancouver or

some other centre to get education that they may require to meet the needs of

their communities.

MacPhail: Just to confirm with the minister in terms of the opposition's

approach to these questions. Although the rest are very useful, I'll be

continuing with appointments, then performance contracts and the accountability

framework. That will complete the health authorities portion of our discussion.

appointments, I note from an examination of the appointments made that two out

of about 57 appointments are for first nations. There used to be in place the

Aboriginal Health Council of B.C. that worked very closely with health

authorities on a provincial strategy around aboriginal health issues. The

Aboriginal Health Council of B.C., as the minister is aware, no longer exists.

With just two health appointees who are first nations, what is the minister's

plan to ensure the health goal of improving aboriginal health?

Hon. C.

Hansen: I guess the question is built around the appointments to the health

authorities. Certainly, I have met one of the two individuals the member refers

to, who I think will be a very solid and very beneficial contributor to the work

of the health authorities in question.

In terms of

our approach to aboriginal health generally, which is where I think the member

may be going on this, it is true that we chose not to continue with the council.

The program dollars that were in place are being regionalized so that they will

be administered through the health authorities. Too often we've seen aboriginal

health issues wind up being sort of disconnected from the rest of health

services. When we start looking at some of the outcomes in aboriginal

communities, clearly we're not doing a very good job of meeting the health needs

of aboriginal communities. We want to make sure that those are integrated into

the work of the health authorities at the regional level so that they don't get

lost, and those programs don't fall between the cracks.

September of this year each of the five regional health authorities has to

submit to us a plan for how they are going to ensure better aboriginal health

programs and, ultimately, better health outcomes. We have built into the

ministry service plan specific targets around aboriginal health. It will be

expected that health authorities will meet those targets.

[1500]

I think the

final thing I can say in this area is that we also had a very excellent and

constructive meeting with the First Nations Summit, with the entire cabinet.

Health issues were certainly part of that discussion. That has subsequently led

to a couple of meetings between the ministry and the chiefs council on health.

That falls under the First Nations Summit. There's been some excellent dialogue,

and we're certainly looking forward to moving forward in a way that will produce

better outcomes in the future. As I think we all know, we've got a long way to

go before aboriginal health outcomes will be anything near what they are for the

rest of the province.

MacPhail: I do know that we will be discussing matters further under the

aboriginal health programs. I am specifically asking about this matter under the

appointments to health authorities. Not only in the past was there a designated

first nations, aboriginal ap-

[ Page 2406 ]

pointee on each health council and regional health board — that's now gone

— but the Aboriginal Health Council was also supposed to take a broad

provincial perspective to the delivery of on-the-ground health services. Now

that's gone.

Let me say

that I wish the minister well in the new health authorities. I do. I hope that

the appointees prove effective. All we can do is give them a chance. That's

exactly my starting point. The two first nations appointees out of the 57 are

excellent appointments as well.

But the

Aboriginal Health Council was the glue that held together a strategy of health

programs for aboriginal, first nations people across British Columbia. Now

that's gone, and the money they were responsible for is gone as well. Aboriginal

dollars are being put into the health authorities, and those health authorities,

save for two positions out of 57, have no experience in first nations health

delivery.

Yes, I do

know that the minister and the cabinet met with the First Nations Summit and

discussed with political leaders on-the-ground delivery of health programs. I'm

not going to ask about health programs right now; we can talk about that in a

bit.

The

Aboriginal Health Council also reports to the First Nations Summit, the UBCIC

and the UNN. They are the people who actually have the experience — the

clinical, technical and community experience — for delivering the programs.

The First Nations Summit political leadership isn't a replacement for that. It

would be like the cabinet micromanaging health programs. That's what the First

Nations Summit is. It's the political body. They do their jobs extremely well,

but they don't deliver health services, nor have they ever said they could or

would.

We now have

done in the area of aboriginal health delivery exactly what the minister says

he's getting out of the business of doing himself — stopping the

micromanagement of health care delivery through politics.

Hon. C.

Hansen: I would be the first one to agree with the member in terms of the

importance of government not trying to micromanage health care delivery. We had

that discussion in a couple of other contexts yesterday. The discussions we've

had with some of the aboriginal leaders were around how we ensure that the needs

of the aboriginal populations get met and that we start to see better health

outcomes.

Currently,

the Ministry of Health Planning is working with aboriginal health stakeholders

to develop what will be known as the provincial aboriginal health services

strategy. The steering committee that is in place developing this strategy

includes representatives of the First Nations Summit, the Union of B.C. Indian

Chiefs, the Métis Provincial Council, the Aboriginal Peoples Council and

provincial health organizations such as the Community Health Associates of

British Columbia, as well as provincial advocacy organizations such as the B.C.

Aboriginal Network on Disability, the Council of Aboriginal Women and the Red

Road HIV/AIDS Network. That is a strategy that's coming together.

[1505]

The

fundamental shift taking place in health care delivery is that we are giving

that responsibility to the health authorities. It is vitally important that we

not try to micromanage that from Victoria or from the minister's office, but

instead that we ensure aboriginal programs are integrated in a real way with the

program delivery of the health authorities so that aboriginal people from around

the province can get equal access and equal benefit and we can start to see

changes in the dismal record we have when it comes to health outcomes in this

area.

MacPhail: I know it's hard to get an answer and also listen to the question.

assertion was about the fact that the minister's suggestion that the First

Nations Summit could deliver health care programs and that that's the place to

negotiate the delivery is the same as having the cabinet deliver health care

programs. I'm urging the minister that it isn't the appropriate body to do that.

I wish him

well in his aboriginal health strategy. However, a couple of points to note:

funding ended for the aboriginal programs on March 31. There's been a stay of

execution, I believe, till June sometime. After that there's no guarantee for

any funding. In fact, when I met with aboriginal health organizations, they

suggested to me that they were…. Oh no, it wasn't even that the funding was

continued; it was that they'd get an answer in June about the continuation of

their funding. They have two choices: either to end the program or to go into

their own resources to sustain the program until June. Now we hear that the

strategy won't even be in place until September, and that causes me a great deal

of concern. It will be one that I will be monitoring very closely.

My last

point for the minister to observe is this: the very people who have been

dismissed from the Aboriginal Health Council are now being asked by the Ministry

of Children and Family Development to replicate the structure, on a regional

basis, that the Ministry of Health Services has just ended. Literally the same

people who have been done out of the job by the Ministry of Health Services are

being asked to set up exactly the same structure for the Ministry of Children

and Family Development. Again, they are confused about what real role this

government wants first nations, aboriginal people to play in the delivery of

social services.

Hon. C.

Hansen: I just wanted to correct a point that the member had made. There has

been no curtailment of money for these aboriginal health programs that we've

been discussing. What has happened is that the dollars have been transferred to

the health authorities, and the contract obligations that were there before have

been transferred to the health authorities. As we move forward, those health

authorities will determine what services they wish to contract for and through

whom, in order to make sure that aboriginal British

[ Page 2407 ]

Columbians get the services they need. There is no intention of curtailing

anything as of March 31. It is simply a transfer of who's responsible for the

administration of those provisions.

[1510]

I also

wanted to add that I met with the Aboriginal Health Council prior to the

election in my capacity as opposition critic. Every individual that's part of

that council, in my view, is dedicated to the province and dedicated to ensuring

that the needs of aboriginal communities get met. They're fine individuals who I

think have provided a very good service. The fact that we're changing the way

these programs are administered is in no way a reflection on the quality of the

individuals involved. I have no doubt that even if the contracts in the future

are set up in a way that — perhaps in health care — doesn't include the

skills that these individuals have, they will continue to be involved in their

communities. If it's through contracts with Children and Family Development,

then I applaud that, because clearly they have a tremendous contribution to

make.

MacPhail: As a final note in this area of aboriginal appointments, the

minister may want to make that clear to the organizations I met with just

several days ago, who assume that their funding is kaput March 31 and that

there's no guarantee of funding in the future — no guarantee. If that's not

the minister's intent, all he has to do is call them up and tell them that.

I've done a

quick analysis of the health authorities, and I note there is a wide range of

communities that have no representation as appointments at all. The Premier made

it very clear that the appointments to health authorities were not going to be

based on communities. There would not be a community factor for representation.

Fair enough, but I note that communities such as Hope, Williams Lake, Courtenay,

Port Hardy — no representation on any board. Burns Lake, Powell River,

Kitimat, Chilliwack — no representation on any health authority. Trail — no

community representation on their health authority. Golden, Kimberley, Mission,

Squamish. These are just a few communities that have no representation on any

health authority. Oh, I'm sorry. Trail does have a representative on the

provincial health authority but not on the interior health authority.

These are

fairly substantial communities. I know that the communities may feel they have

health needs that need to be addressed. How will the health authorities

represent those communities without any human appointment to the health

authority? Will there be travelling meetings? Will there be subcommittees?

There's a lot of people whose communities are not represented.

Hon. C.

Hansen: If you take the six health authorities and there are nine appointees

to each of those health authorities, although that's not a number that's etched

in stone, that makes a grand total of 56 appointments for the health

authorities. Clearly, it's not possible to have an individual from every single

community. Nor would I think it desirable, because part of the intention of

appointing people to these health authorities is to find people who aren't going

to take a specific, narrow view of how health care should be delivered.

We want

individuals on these boards who are going to look at the region as a whole, so

in trying to select individuals, we made an effort to get a balance of

individuals from different health service delivery areas within the regions. We

also made sure every single one of the five regionally based health authorities

had somebody from that region serving on the provincial health services

authority, so we did try to find that balance.

We have

also said to the health authorities, to the CEOs, that they need to ensure they

develop a comprehensive program of consultation with the communities that fall

within their jurisdiction. It's important that the health authorities have

regular contact with community leaders and with mayors and council, for example,

throughout the region to ensure there is a good liaison. We will be holding the

health authorities accountable for having good consultation mechanisms so all

those voices can be heard.

MacPhail: My final question on health authority appointments: is the

minister in discussions with physicians about the fact that there is not one

physician appointed to any health authority?

[1515]

Hon. C.

Hansen: We also made a decision that in appointing someone to the boards, we

wanted to avoid having somebody who had a financial, contractual…or received

remuneration from the health authority. As a result, it was felt that physicians

who were active and practising in that health authority — say, had hospital

privileges in that authority — would be avoided so that there would not be a

sense that there may be a conflict — or open the board up to a perception of a

conflict of interest. There is not a policy that says physicians cannot serve on

these boards. In fact, we have some doctors, although they are not actively

practising within that particular health authority.

MacPhail: Well, I didn't notice any medical physician, MD, on any board. I

noticed some PhDs, which is good. I had a discussion with the Premier and then

the Minister of Health Planning about the fact that there was a letter received

from physicians — I think it was the medical society — about their dismay at

being barred from appointment.

My question

was: is the minister in discussion with physicians about representation on the

health authorities, or have the physicians abandoned that issue?

Hon. C.

Hansen: I am aware of the letter that came in and the view that was

expressed. I've certainly had lots of discussions with physicians over the last

number of weeks on other subjects. This one hasn't been pursued in those

particular face-to-face discussions,

[ Page 2408 ]

but I am aware of the concern. I think there was initially a concern that

somehow we were just saying that no doctors could serve on boards. That's not

the case. What we were trying to do was avoid appointing anyone that would have

a contractual…or receive remuneration from the health authority for which they

were serving on those boards.

MacPhail: I'm going to move to the issue of performance contracts and

accountability framework. Of course, my colleagues in this chamber have already

asked questions about that, so I don't plan on repeating those questions. What

I'm not clear on, even after the debate of yesterday, is how the accountability

framework relates to performance contracts. Does the accountability framework

get set first, and then performance contracts are developed in the context of an

accountability framework?

Hon. C.

Hansen: The accountability framework is not a document per se. It is, in

fact, a series of initiatives. It is a framework in the sense that it's the

accountability process upon which we will build a whole bunch of initiatives,

some of which have already come forward. They are specific plans and policies

around the area of mental health, for example, where the seniors initiative is

out. We're also working on a youth and transition strategy in the area of home

and community care. There are new assessment tools being implemented to ensure

there's consistency throughout the province. In the area of acute care we are

developing access standards to ensure that British Columbians, regardless of

where they live in the province, get access to necessary health care services in

a consistent way throughout the province. There are also guidelines that will be

established for the health authorities regarding the provision of care

throughout their regions.

[1520]

The

performance contracts will flow from those. As you may know, in our service plan

we have set out specific targets for a variety of areas throughout health care

that the ministry itself will be held accountable for.

The

ministry, in turn, will be developing the performance contracts with those

specific targets so that when you see the performance contracts for the health

authorities, they will reflect that. If you add up the targets of the six health

authorities, they will, in total, be driven towards meeting the targets we have

set for ourselves as a ministry in our service plan. From our accountability

framework flows our service plan, which is on our website. From the service plan

flow the performance contracts for each of the health authorities, and as soon

as those are finalized, those will also be posted on our website.

MacPhail: Well, it's a complex route. I wonder whether the minister or his

staff had any time to reflect on the legislation that would…. Well, let me ask

this question. The minister said, in answer to some questions from his

colleagues yesterday, that it's the health authorities — i.e., the boards —

that would be held accountable and that the performance contracts would be with

the health authorities. I assume he means the boards of directors. I'm sorry;

are they called directors? Has the minister had a chance to reflect on whether

any legislation change would be needed to hold the health authorities

accountable?

Hon. C.

Hansen: There is not a change in legislation that's required to put the

performance contracts in place. The performance contracts will be signed by the

chair of the health authority, by the CEO of the health authority, by myself as

Minister of Health Services and by the Deputy Minister of Health Services.

MacPhail: Let me tell the minister where I'm going on this. The health

authorities have a budget of — we agreed yesterday — about $5.946 billion.

If the health authorities improperly spend or overspend, who's responsible for

that? If there's no legislative responsibility for overspending transferred to

the health authorities, does that mean the Minister of Health Services is

responsible for that and that, for instance, his pay would be affected by that?

Hon. C.

Hansen: The answer is yes. The authority that is being exercised by the

chairs of the board and by the boards themselves is in fact delegated authority.

I as the Minister of Health Services am ultimately responsible and accountable.

In terms of the pay, as we will be building into the performance contracts, one

of the things we're looking at is a hold-back of the CEO's pay so that if they

don't meet the standards they have committed to — and that's not just the

financial outcomes but also the health outcomes they have to deliver on — they

will see a reduction in their paycheque as a result of that. They will not get

what's being held back.

In turn, if

the Ministry of Health Services in this year does not meet its targets in terms

of living within its budget, then I as the minister will not receive the portion

of my pay that is being held back for this current fiscal year. So there are

ramifications, and I think it's more than the financial side of not receiving a

paycheque. I know, for me, if I wasn't to receive the portion that is being held

back from my pay now, the embarrassment of it would be much greater than the

financial implications, although it might mean there's a couple of bills at the

end of the year I wouldn't be able to pay as quickly as I might like to.

Clearly,

these are ramifications that, while they are real, are also powerful in the

sense that it sends a message that we expect accountability, and we expect

people to deliver on their targets.

[1525]

MacPhail: Well, that's reassuring, because it would be unfortunate if the

public had as an answer: "Well, the overspending or inappropriate spending

that arose is the responsibility of the health authority, and there's nothing

that the government can do about it or be held accountable for." I'm

reassured by the minister's comments.

[ Page 2409 ]

Because

almost all targeted funding is gone for health authorities…. I was looking at

the budget letter that the newly remunerated Phil Hassen received June 19, 2001.

It's a very, very specific targeted funding budget, and that's gone. Fair

enough. The minister said that the new way of doing it is to make a lump sum

payment to the health authority and then, as I understand it, ensure delivery of

services through the performance contract.

I don't

know the answer to this, so it's not a trick question: what if the health

authority doesn't spend according to the performance contracts, the CEO gets his

salary reduced and the minister gets his salary reduced? What does that do for

the services?

Hon. C.

Hansen: The other tool we have to deal with a situation like that is to

remove the board or chair. We put in place some very competent individuals as

chairs and to serve on these boards. I am very confident that under their

leadership, we will see that kind of accountability. We will see targets being

met. These individuals will ensure that the senior management and executive

staff in their particular health authority are going to be delivering on the

patient care that is expected of them. But ultimately, if for any reason that

was not to happen, we certainly would have the opportunity at the end of the day

to replace board members or chairs. Given the quality of the people there, I

don't anticipate that's ever going to be required.

MacPhail: Just for the Minister of Health Services' information, I'll be

exploring that matter very thoroughly with the Minister of State for Mental

Health in terms of how that works. Unfortunately, we've already received

information where money that is the current spending on mental health is being

deleted in substantial numbers from health authority budgets. We'll put that to

the test with the Minister of State for Mental Health.

Again, we

will watch this very carefully over the coming year where there's an

accountability or a performance framework through a contract. I say this with

cynicism: there are certain contracts the government feels the necessity to

honour regardless of their lawfulness. There are other contracts that this

government decides to break regardless of their lawfulness — one way or the

other. It's a very mixed perception that British Columbians have about how this

government views contracts. I will be monitoring that very carefully.

I know that

the minister has given this information, but I can't remember it right now: when

will the performance contracts be made public?

[1530]

Hon. C.

Hansen: At this point there is not a specific date that is proposed for the

release of them. They're still being worked on. Certainly, it's my expectation

at this point that those documents would be made public within six to eight

weeks, as long as there are no unforeseen delays that come along in that

process. That's the expectation.

MacPhail: Will health authorities be holding public meetings on a regular

basis?

Hon. C.

Hansen: There is a requirement in the act for them to hold public meetings.

Through the leadership council, there have been discussions around how those

should take place. We certainly have advised the health authorities that we

expect them to live up the requirements of the act, which is for public meetings

to be held.

MacPhail: Mr. Chair, I'll be moving on. As we agreed, we'll leave community

care and adult mental health policy for the Minister of State for Intermediate,

Long Term and Home Care. The next one is public health. I'm working from the

general responsibilities list now. There's public health, and I think the other

one that's the direct responsibility of the Minister of Health Services is adult

addiction policy.

In public

health, I have one area I want to explore, and that's the controversy around the

immunization program for children. It's a prevention program that includes

vaccinations for diseases like meningitis and chicken pox. There has been some

confusion about whether or not the government is proceeding with this. Could the

minister update us on what the status of that program is?

Hon. C.

Hansen: Certainly, there are three new vaccines that have been approved.

They were approved last fall, so they have been reviewed by the committees

within the report to the provincial health officer. They certainly have felt

there's merit in these vaccines. They certainly have proven they could be

effective.

We are

working now to determine how we can implement a vaccination program. Partly,

we're looking at where we can find the appropriate budget for it, because it is

a very expensive program. We're also looking at how that program should best be

phased in. There's some work being done on it now as a result of the

recommendations that have come forward, but there are no specific decisions that

have been made regarding the timing or the manner in which this would be phased

in.

MacPhail: I understand that the headline saying the program is killed is

incorrect, because the program didn't exist. I'm not in any way suggesting that

the media has this story correct from either the front end or the back end. I

would just like exactly what is happening. What are the three new vaccines that

have been approved — and that is approved by whom? Is it just that they're

able to be sold?

[1535]

Hon. C.

Hansen: The vaccines were approved by Health Canada, so they were licensed

for use in Canada last fall. Of the three vaccines we're talking about, one is

for varicella, or chicken pox. Another is conjugated pneumococcal vaccine, and

the third is a conju-

[ Page 2410 ]

gated meningococcal vaccine group C. These have been reviewed by the advisory

committee to the provincial health officer. Their recommendations are that these

have merit, so we're trying to look at how we can move forward.

MacPhail: Let me just ask: what parts of the reports are accurate? It's very

interesting. As an MLA I have received quite a few calls in my office from

concerned parents on this. I don't think that the parents were actually

concerned before the stories, so it's one of the areas where a little bit of

information causes alarm. We need to straighten this out.

The three

have been approved by Health Canada. The B.C. Centre for Disease Control

reported that the vaccine program had been frozen for three years, and that

freezing meant that the plans to move forward to provide these three vaccines

was gone because in a frozen budget one can't increase vaccination. What's wrong

with that report?

Hon. C.

Hansen: The budget that is in place for the Centre for Disease Control

currently reflects the programs that have been approved. If we were able to move

forward on this, then clearly we've got to find the financial resources to make

it happen. In the health budget over the next couple of years, it's going to be

a zero-sum game. It's all about priorities. If it is determined that this is a

higher priority than other programs, then clearly we would have to be shifting

the dollars so that the Centre for Disease Control had the financial resources

necessary to deliver on this program.

MacPhail: Does the minister have a ballpark budget of what the program would

cost to implement fully?

Hon. C.

Hansen: The ballpark is about $25 million in the first year, and then it

would decrease over a number of years because it is a one-time vaccination

program. Once an individual has it once…. It would be decreasing over time,

but it's $25 million in year one.

MacPhail: Just to be clear. What's back on track is the consideration of

this vaccination program in the context of, if the vaccination program goes

ahead, the health authorities have to find either efficiencies or savings or

cuts elsewhere to pay for it.

[1540]

Hon. C.

Hansen: First of all, this program has never been off track. The advice that

came from the advisory committee was a short while ago, and the ministry has

been actively considering how we could move forward on their recommendations.

When it comes to the dollars, if we are able to move ahead on this program, then

we would have to find the dollars from within the entire $10.2 billion health

budget. It's not saying that the provincial health service authority would have

to find it, although if that's where we found something of lesser priority, then

that would certainly be an option. But that's not the only option when it comes

to finding the dollars necessary.

MacPhail: What is the time frame for the minister's search for the funds?

Hon. C.

Hansen: The work is being actively pursued. Certainly, the value of the

immunization program is recognized. It's all about priorities. It's a big

challenge for the ministry to try to find something of lesser priority because

it does mean shifting dollars. We're moving as quickly as possible. Whether it's

a case of weeks or months, I don't have an answer for that yet. We are certainly

trying to come to a conclusion as quickly as possible so that we can move

forward on it.

MacPhail: My other area on public health that I'd like to ask the minister

about is public drinking water. I was told that in one set of estimates, all of

which blend together in moments of great excitement, the Minister of Health

Services was ultimately responsible for ensuring the safety of our drinking

water. There's been a report out with substantial recommendations on drinking

water in the province. One of the recommendations was to not only start to

enforce the Drinking Water Protection Act but also to strengthen the act. What's

the status of protection of public drinking water in this province today?

Hon. C.

Hansen: I noticed how the member was very careful not to get into

legislation. I compliment her on her choice of words to achieve that goal.

certainly are looking at the recommendations of the task force that was charged

with that responsibility. I think drinking water is something that is becoming

top of mind for every Canadian as a result of the issues coming out of

Walkerton. We're anxious to move forward on the recommendations. It's one that

while the legislation itself is the responsibility of the Minister of Health

Services, it also clearly affects other ministries. There's been a series of

meetings to try to move forward on the recommendations, and we hope to be able

to do that very shortly because we certainly see it as a priority for British

Columbians. We're anxious to have a response to the report out as quickly as we

can.

MacPhail: Does the minister anticipate some action in the coming weeks or

the coming months?

Hon. C.

Hansen: Certainly, there is action that has already taken place. I think we

have a very solid network of oversight when it comes to the quality of our

drinking water. I think we have one of the best systems in Canada in terms of

our multi-barrier approach. We don't just rely on any one program to ensure safe

drinking water.

[1545]

We are

looking at ensuring that we have good source water. We're also ensuring that

there are proper

[ Page 2411 ]

chlorination programs in place, that there's proper monitoring in place and

that the alarm bells will go off at a variety of levels if there is any way that

we find the quality of drinking water has been compromised in this province.

We're anxious to strengthen that. Some of the recommendations coming out of the

task force will allow us to do that. In some cases, we're going to be able to

move forward within a matter of weeks. Others, particularly around legislative

amendments, will certainly be put in place as quickly as we can get them onto

the agenda.

MacPhail: I'd like to move now to adult addiction policy, which I understand

includes smoking as well. What is the status of the stop-smoking programs in the

government? Also, what is the status of the court case against the tobacco

companies?

Hon. C.

Hansen: There has been no reduction in the tobacco reduction programs that

were in place from the previous administration. In fact, we've certainly tried

to move forward on a couple of initiatives. One that the member may be familiar

with is a curriculum program around B.C. tobacco facts. I had the privilege of

speaking to the school principals association when they met in Victoria and of

announcing that the last

part in that program for grades 8 to 12 is soon to be

released. That will be available to schools very soon.

One of the

things that has changed is that we are working very closely with the federal

government. As the member will know, the federal government has put forward some

communications initiatives, on which we're working closely with them. We have an

official from the ministry who sits on the federal minister's advisory committee

in this area. We're certainly anxious to continue to encourage British

Columbians to stop smoking.

The other

question the member had was around the tobacco litigation. Not only is that

continuing, but we are actively pursuing partnerships with other provinces

across Canada to join us in that litigation. The federal government has

certainly expressed interest and is cooperating to try to help us in any way to

move that litigation forward. Ultimately, we hope that will bring some justice

to British Columbians who have suffered the effects of tobacco on their health.

MacPhail: Can the minister point out in either the Estimates or the Supplement

to the Estimates where I can be reassured that there has been no cut

to the tobacco reduction strategy dollars?

Hon. C.

Hansen: There is not a specific line item in the Estimates , just

as there was not a specific line item in the Health budget for any of the years

gone by. That is partly within the wellness and prevention division of what is

now within the Ministry of Health Planning. There are also programs within the

individual health authorities that they are administering.

The member,

if she has been through the service plan of the ministry, will note that we've

also set a very specific target for the ministry when it comes to the future

reduction of tobacco use in the province.

[1550]

MacPhail: Have the dollars been regionalized?

Hon. C.

Hansen: There has not been any additional regionalization of the dollars

with regard to tobacco or smoking-cessation programs. The health authorities,

through their ongoing public health programming at the community level,

certainly put funding into this area, and they continue to do that. The

contracts that we have are administered centrally by the ministry, as well as

the curriculum development program that we have in place and some of the other

central programs that we have there. There has not been any additional

regionalization of the smoking-cessation dollars.

MacPhail: The reason I'm asking is because I note the absence of any mention

of tobacco reduction in the description under the subvote for regional health

sector funding. It's on page 144 of the estimates. There's a footnote

description of what regional health sector funding includes in that subvote, and

it very clearly says that the regional health services are responsible for

alcohol, drug and gambling addiction services but not tobacco. Why?

Hon. C.

Hansen: Tobacco is not specified in the description that comes with it, but

it certainly is expected that the health authorities will continue with the

programs that they have had in the past. It's not a shift in policy at all. I

would also like to point out that we have set a specific target within our

service plan, and there will be specific targets within the performance

contracts for each of the health authorities to achieve with regard to smoking

cessation. There is that obligation that they are taking on, and they can't

achieve those targets if they were not to continue with the programs that

they've had up till now.

MacPhail: Would the minister mind pointing out to me in the service plan

what the target is for tobacco reduction?

[1555]

Hon. C.

Hansen: In the service plan it actually falls under goal 2, which is to

improve health and wellness for British Columbians, and item No. 5, which is

smoking rates.

[B.

Lekstrom in the chair.]

The target

for '02-03 is to reduce smoking prevalence by 1 percent per year from a

year-2000 baseline to 19 percent for a population aged 15 and older and to 17

percent for youth aged 15 to 19. The target for the '04-05 year is a smoking

rate for age 15 and older of 17 percent and for age 15 to 19, 15 percent. The

overall target in addition to that is to reduce smoking rates in the

highest-rate regions toward the mid-range. There

[ Page 2412 ]

are certainly some regions of the province where smoking rates are higher,

and we are asking them to give special attention to that challenge.

MacPhail: Thank you for the reference. I've found it as well. I read where

the smoking rate for adults is 18 percent, the lowest in Canada and the

second-lowest in North America, for which we should all take credit. It's

wonderful.

What's the

smoking rate for youth 15 to 19 now?

Hon. C.

Hansen: I am informed that for the age group 15 to 19, in 1999 it was 20

percent, and in the year 2000 it was 18 percent. Apparently, the number for the

year 2001 has just been released since our service plan was finalized and made

public. That rate is now at 17 percent.

MacPhail: We've reached the target, which is good news. The minister was

giving me the information for the ages 15 to 19, I assume.

Interjection.

MacPhail: Yes, so we've reached the target for '02-03. That's good news,

because we're supposed to be at 17 percent in '02-03.

I would

urge the minister. I don't know whether the minister knows this, but my only

plea for change, which I made in a concerted way to the Premier, was this

government's address of smoking…. I made the plea. I said that if I could ask

the Premier to change one thing…. The minister knows full well that I've been

on full flights of requests in all sorts of areas. If I had one wish to make, it

would be that this government put every possible effort they could into reducing

the harm through tobacco use. That was my closing comment to the Premier.

Here's

where I'm going: the reversal of the WCB ban on smoking was an incredibly sad

day for health in this province — incredibly sad. I fail to understand how

anyone can justify that reversal of the WCB smoking ban as good for the economy.

The number

one health care cost — 100 percent preventable — is the use of tobacco. The

diseases and deaths that arise out of the use of tobacco…. It's the number one

cause of health care costs in this province. On a $10 billion budget, it sure

would be good for the economy if we could reduce the use of tobacco to a point

where there were tens of millions, if not hundreds of millions, more dollars

available to go into the economy through reduced taxes.

I just

didn't understand for one second the argument that the reversal of the smoking

ban that the WCB had imposed was good for the economy. Then, when members stood

up and said, "Oh well, it's good for the economy in certain parts of the

province," again, I didn't understand that. Maybe the minister could help

me.

[1600]

Hon. C.

Hansen: I want to be a little bit careful not to tread into the area of

estimates of another minister. Clearly, I share the member's interest and

concern about smoking-cessation programs. I certainly accept her challenge that

we should be doing everything — and we are doing everything — that we can to

try to reduce tobacco use in the province.

As I said

when the issue was quite topical, my goal as Minister of Health Services is to

try to eliminate tobacco use in the province. That may not be an attainable

goal, given the severe addictions some people have with regard to tobacco use,

but we certainly have to keep striving for that objective.

In terms of

the WCB issues — and the member may want to canvass them directly with the

Minister of Skills Development and Labour — I think it's important that as we

bring in programs, they have to be enforceable. There is much more to be

achieved in terms of tobacco use reduction in this province by ensuring that

programs are attainable. I'm very proud of the fact that the regulations brought

in by my colleague make British Columbia a leader in Canada when it comes to

those types of restrictions, the focus on secondhand smoke and the damage it

does.

We're

certainly in agreement when it comes to what the objective of this government is

— to do everything possible to reduce tobacco use — but we also have to make

sure we do it in a way that will ensure measures are enforceable and will have

the desired results, and not just a rebellion against laws and regulations that

people think are inappropriate. There is that balance, and we've tried to

achieve it. We're certainly determined to move the anti-smoking agenda forward

in this province.

MacPhail: I am limiting my remarks only to what's good for the healthiness

of people and how healthier people make a greater contribution to the economy

through reduced costs. That's the link right here.

Smoking

puts huge pressure on our economy through increased health care costs —

gigantic health care costs. That's the link. I'm not intruding on any other area

here.

We're not a

leader. We could have been a leader in terms of our no-smoking policy by just

allowing the WCB to do their job. The WCB's decision to have a smoking ban in

public places in British Columbia was well researched, well documented and

scientifically based.

In fact,

there's a smoking ban in every public place except in hotels, restaurants and

bars. The economic argument doesn't work even there. The lobbying argument

works. Hotels and restaurants lobbied, but other places would have just as much

right to make the argument that: "Gee, smoking would be good for our

economy if only people could smoke indoors." Nobody was silly enough to

ever make that argument, because they would be laughed out of the province.

Smoking is

bad. I happen to know…. Well, actually I don't know factually, but I suspect

the Minister of Health Services understands fully and supports every single

initiative that goes toward the full elimination of

[ Page 2413 ]

the harm of tobacco use. However, his government chose a path that doesn't

advocate that.

[1605]

I have been

trying to get information about what input the Minister of Health Services had

in terms of the period of time between the government's decision to reverse or

put on hold the WCB decision on the smoking ban, which I think was around

September. Then there was a caucus committee appointed to look at this issue,

and then a final decision to reverse the smoking ban by the WCB was made in

December or January. During that time, what input did the Minister of Health

Services have to the caucus committee on the economic costs to the province of

the use of tobacco?

Hon. C.

Hansen: As much as I'd love to, I'm not going to discuss what discussions

took place in caucus or in cabinet. I'm not at liberty to do that, as the member

knows, but I am a strong advocate for smoking-cessation programs. I think that,

certainly, British Columbia is a leader in this area, and I expect that we'll

continue to be. I have carried that message to federal-provincial conferences. I

have also ensured that other jurisdictions know some of the programs we're

implementing in British Columbia, because we think they should be replicated in

other provinces as well. I will continue to be an advocate for smoking-cessation

programs to ensure that, first of all, our kids don't start smoking and,

secondly, that adults who have been smoking have more and better opportunities

to quit the habit.

MacPhail: Yes, and I'm not questioning that about the minister.

Just for

the minister's information, the caucus committee wasn't a secret caucus

committee. It was a caucus committee that was supposed to investigate the value

of continuing the WCB smoking ban in British Columbia. It was headed up by the

member for Vancouver-Burrard.

Just so the

minister knows, I've asked for the information about who had what input into

that caucus committee on an incredibly serious matter where the government, for

the very first time ever in the history of British Columbia, reversed a WCB

decision.

I got an

answer back. I can't believe that it's right; I actually can't believe that it's

right. That's why I'm asking the minister this question: what input did he have

on this health issue? I got an answer back that there was one submission to the

caucus committee, and on the basis of a submission which we don't even know the

content of, the government reversed a WCB smoking ban. Surely, that can't be

right, but I can't find out. Nobody will tell me it's wrong.

Did the

minister have any input? Did the member for Vancouver-Burrard approach the

minister on what the health costs to the economy were on reversing the smoking

ban?

Hon. C.

Hansen: The caucus committee is exactly that. It was a committee of caucus,

and if the member has questions, she may want to direct a letter to perhaps the

chair of caucus. I, as a member of government and executive council, have

responsibility for the workings of the Health ministry. I don't have

responsibility for the workings of a caucus committee, so I certainly can't

respond to the questions that she's putting forward. There clearly are

opportunities for her to direct those questions to the appropriate individuals.

MacPhail: Well, that's not a good enough answer, because of course it was an

executive council decision that relied on the caucus committee work of the

member for Vancouver-Burrard to reverse the smoking ban, so there's a link. It's

direct; it's A to B.

I sure as

heck hope — and there are other areas that I can explore this in; I prefer to

explore it here — it isn't correct that this government reversed the WCB

smoking ban on the basis of one submission. If that is the case, British

Columbians will be absolutely outraged.

Just for

the minister's information, I have been trying to get somebody to tell me that's

not the case. The information was received through an FOI request, and I didn't

believe it. I didn't believe that it could be just one submission — where the

government takes an unprecedented action.

So anybody

on the caucus committee, run in here and tell me I'm wrong. I'd be happy to be

proven wrong on this issue. The Minister of Health is not comforting me at all

on this issue, because I assume that cabinet fully deliberated on the work of

the member for Vancouver-Burrard before they reversed the smoking ban by the

WCB.

[1610]

Anyway,

that question is out there for anyone who will come in. I know there are lots of

people who listen to every word I say and run here and tell me when I'm wrong

and stupid and off the track or out of order, so have at me.

I will move

to other areas of addiction services, and those are the areas of drug and

alcohol use and gambling. Can the minister please give me what his government's

approach is to these three addictions?

Hon. C.

Hansen: First of all, to deal with the alcohol and drug programs. As the

member will know, this had been transferred over to the Ministry for Children

and Families. I think there are lots of examples that came forward as to why

that was problematic. We transferred the alcohol and drug programs back to the

Ministry of Health, specifically the Ministry of Health Services.

In turn, we

have given that responsibility to the regions throughout the province. Many of

the staff that had worked with Children and Families and were transferred over

to the Ministry of Health Services have now been assigned to the health

authorities. We believe quite strongly that the alcohol and drug programs should

be an integral part of the delivery of health programs generally at the

community level. We believe that is the right place, although the policy and the

[ Page 2414 ]

standards development will certainly continue to be administered centrally by

the ministry itself.

With regard

to gambling addiction, I know this is an area where there is more that needs to

be done. I can remember estimates from years gone by, actually, when I believe

the member was a minister and the member for Kamloops–North Thompson was the

gaming critic, talking about the need for more dollars to be allocated to deal

with gambling addictions.

At our

constituency offices, certainly we've received letters, some real horror

stories, of people whose lives have been destroyed by gambling addictions. There

are increased dollars going to be focused on those programs. The Lottery

Corporation is going to take an active role in ensuring that programs around

gambling addiction are enhanced and adequately funded into the future.

[1615]

MacPhail: That's good news. Could the minister expand a little bit on what

expanded role the Lottery Corporation is taking on funding gambling addiction

programs, and where are those gambling addiction programs? How are they being

delivered?

Hon. C.

Hansen: I apologize for the delay. What I'm trying to do is get as precise

information as possible for the member, although we may not have that right at

our fingertips.

The number

I'd like to give her is how much the Lottery Corporation is allocating for the

gambling program. I will undertake to get that information to her. One of the

examples of a program that is being funded is a toll-free call line for

assistance for either individuals who feel that they are suffering from gambling

addiction or their family members. One of the things the casinos in the province

have been very cooperative on is ensuring that information is posted, giving

people this toll-free line and where they can go to get the help they may

require. That program, as I understand it, has had some initial success, and

we're hoping we can build on that.

I will

undertake to get the member more specifics around the amount of money that's

being allocated and what other programs may be funded out of those dollars.

MacPhail: One of the things the minister may be prepared for is that during

the committee stage of the bill — I think it's Bill 6, the gaming bill — I

will be asking questions about the contribution of the province to gambling

addiction programs, given the expansion of gambling. Either the minister can

provide the Solicitor General with that information, or the minister can

participate in the debate. My concern is that there is no legislated requirement

to provide gambling addiction services under that legislation.

In the area

of drug and alcohol abuse, we did a lot of work in the years 2000 and 2001. The

ministry staff were extremely competent in moving the issues around drug and

alcohol addiction forward and worked very hard to put in place a community-based

discussion document with recommendations on how to change the delivery of drug

and alcohol services. There was, of course, yes, a recommendation to regionalize

the services, but there was also a recommendation that the model for that

delivery be community-based. Are the regional health services being directed to

establish a community-based model? I'm sorry; my apologies — I can't remember

the report. I'm sure Mr. Hazlewood can remember it.

Interjection.

MacPhail: Weaving Threads Together . Right. My apologies. It's a

senior's moment.

What is the

status of the recommendations of the report, Weaving Threads Together ?

[1620]

Hon. C.

Hansen: We are very definitely putting expectations on the health

authorities that these programs be community-based. I share the member's

enthusiasm for the Weaving Threads Together document. I think it's an

excellent piece of work, and there are a lot of individuals around this province

that have dedicated many, many years to alcohol and drug programs and clearly

had a lot of valuable input into that document. In addition to implementing the

regionalization of these programs, we are also looking at how we can move

forward on the other range of recommendations that are in Weaving Threads

Together , so it is very much a living document for us and is guiding us in

our policy development work.

MacPhail: What's the status of the centre for excellence around addictions,

with a board to operate the centre for excellence? What's the status of that?

Hon. C.

Hansen: As the member will know, there is a foundation that was established

by the previous government with funding of $10 million. That was set up at arm's

length from government, so we don't have any direct control over that board or

the money that was allocated. The individuals who are serving on that board have

met recently and are moving forward with ensuring that the $10 million, or at

least interest revenue from the $10 million, will be utilized to provide the

initial work around what hopefully will become the centre of excellence the

member is referring to.

MacPhail: Have there been any changes in the appointments to the board

operating the centre for excellence?

Hon. C.

Hansen: We don't have the power to do that. The way the previous government

set it up was that it was totally at arm's length, so there have been no changes

that I'm aware of. It would have to be the board itself, which serves as the

board of what was constituted as a society, that would make that determination,

but I'm not aware of any changes.

[ Page 2415 ]

MacPhail: In the area of the regionalization of adult addiction services,

does the minister anticipate any change in who delivers those services? Here's

my question: does the moving of addiction services to regional health

authorities from the Ministry of Children and Family Development entail the

transfer of the employees, drug and alcohol counsellors, as well?

Hon. C.

Hansen: What is underway is a transfer of those staff. First of all, they

were transferred from Children and Families to the Ministry of Health Services.

While they are now physically working with the health authorities, there is

still some transition work that's being done around the shifting of those FTEs

from the Ministry of Health Services to the various health authorities, but we

expect that to be completed in the near future.

MacPhail: The minister may note that under general responsibilities, I'm

moving beyond resource allocation because I'm not sure what that means in terms

of something different than discussing the budget. What does resource allocation

mean in terms of his general responsibilities?

Hon. C.

Hansen: Perhaps the member just might explain…. She's obviously referring

to a document that refers to resource allocation. I'm not clear on what the

reference is.

[1625]

MacPhail: Oh, sorry. It's a document that my staff pulled off from the

website. It's a list of the Ministry of Health Services responsibilities. It's

got general responsibilities, programs and services, and major boards and

commissions. It's the document that I've been working from, but it could have

been updated.

Hon. C.

Hansen: The reference is just with regard to the fact that the minister is

responsible for the distribution of the total budget. We've got a $10.2 billion

budget within Health Services, and I have responsibility to ensure that is

allocated across the various programs.

MacPhail: I'm moving now — and I don't mind giving the minister a copy of

this list, because it's the order in which I'm discussing matters — to Medical

Services Plan operations and policy.

I'd like an

update on the discussions with the physicians. We had quite a little

breakthrough last week in terms of physician negotiations. Perhaps the minister

could give us a time line on potential resolution. What are the outstanding

issues? I understand that there's a May 1 deadline for resolution before

physicians may consider job action.

Hon. C.

Hansen: It's certainly everybody's intent that we move forward on these

discussions as quickly as possible. It is the intention of the BCMA and the

intention of government to try to resolve these issues as quickly as can be

done.

The range

of issues on the table is really quite lengthy. I could list them, but it was

included in the press release and the memorandum of understanding that was

released a week ago Tuesday.

The

discussions with the BCMA have begun this week. It's our intention to push them

forward as fast as we can. There is not a specific deadline that we're working

towards other than that we're going to try to get these issues resolved as

quickly as possible because we recognize the anxiety that's out there on the

part of doctors throughout the province.

MacPhail: Yes, I read the news release and the memorandum of understanding

as well. I'm just wondering what progress has been made in terms of whether all

those issues are still on the table. Who's at the table?

Hon. C.

Hansen: The full range of issues that were set out in the memorandum of

understanding are on the table and are being discussed. At the table is, I

assume, the bargaining committee of the B.C. Medical Association, although I'm

not 100 percent certain on that. On the government side these negotiations are

being led by the Health Employers Association of B.C.

MacPhail: Is that Rick Connolly?

Hon. C.

Hansen: No.

MacPhail: Thank you for that enlightening answer.

I'm just

wondering. As I recall, there have been a few people who have had experience

from the government side in these negotiations, such as Ron McEachern, etc. Just

who's at the table? Have we got some new people? Are they starting from square

one in terms of their experience — on our side? Who's bargaining for the

taxpayer?

[1630]

Hon. C.

Hansen: The HEABC has a range of individuals that they use to assist them

with negotiations. I don't have specific names that I could give the member at

this point, other than to say that the HEABC is leading these negotiations.

They, in turn, will be drawing on the expertise of staff in the Ministry of

Health Services as well as the Ministry of Finance, potentially PSERC —

whoever would be the appropriate organizations that can assist them with inputs.

But we will be relying on HEABC to ensure that they have competent negotiators

putting the government's position forward and moving it on. I apologize. I don't

have specific names for her at this time.

MacPhail: The budget under the '02-03 supplement to the estimates is

$2,517,611,000 for the Medical Services Plan. How much did we add by

supplemental

[ Page 2416 ]

estimates? What is the total budget we're working with in '02-03 now, for the

Medical Services Plan?

Hon. C.

Hansen: The total budget for the Medical Services Plan for this coming year,

this year that we've just started, is $2,517,611,000, which the member

indicated.

MacPhail: I'm sorry. That was a supplemental estimate for expenditure in

'01-02. But part of the Premier's announcement was that the funding for doctors

would be ongoing, year after year — the $392 million. That's not reflected.

Hon. C.

Hansen: If you go back to the blue book number from a year ago — and we

can get this exact number — it was approximately $1.9 billion for the Medical

Services Plan. This number, the amount for physicians' services, was about $1.9

billion. The $392 million that we increased the MSP budget by is reflected in

this number of $2.5 billion.

If I can

anticipate where the member might go next with this, she will recall that the

physicians' arbitration came down on a Friday afternoon, as I recall. The budget

had to be finalized the following week. In the interim, between the physicians'

arbitration and the budget numbers being locked in by the Minister of Finance,

he increased this line item by the $392 million.

The

announcement that was made last week was confirming that the $392 million is not

only built into the budget for this coming year but is, in fact, built in for

the years after as well. This number of $2.5 billion reflects that increased

amount. If the member wants more detail, I'll certainly provide it.

MacPhail: I mean no disrespect to the physicians, but they could have

figured that out by reading the supplementary estimates then. Is that the view

of the minister? Instead of worrying, fretting or threatening patient care, they

could have opened up the book and said, "Yes, it's ongoing funding"

— which I find interesting.

Is the

minister sure the full amount is there? Maybe it's because there are other

things in the Medical Services Plan, other than physician payments. Is it the

minister's view that physician payments out of the Medical Services Plan have

been increased over '01-02 by $392 million?

Hon. C.

Hansen: Yes. If you look at the restated budget from last year, it was

$2.244 billion. The increase to the $2.5 billion number that she was talking

about is an increase of approximately $273 million. Also in this budget are the

reductions in terms of the supplementary benefits program. There are some

program reductions outside of physician remuneration that bring that number

down, but the full $392 million is built into the budget for the coming year and

the years after.

[1635]

MacPhail: Great, I understand it now, but in no way do I endorse the fact

that massage therapists, podiatrists, physiotherapists and optometrists have to

pay for the increase for the physicians. However, I do understand it.

I must

express disappointment in the B.C. Medical Association for not understanding

that. They could have understood that and not put patient care at risk, by

accepting the documents that were tabled. It's unfortunate that they chose not

to.

There are

some physicians in the province who have said that unless there is resolution to

their issues by May 1, job action may start again. Is the minister familiar with

that time line?

Hon. C.

Hansen: I certainly read the news reports of that, but I think we're driving

this to try to get the issues resolved as quickly as possible. We will certainly

do that.

We have

already taken action on delivering on some of the commitments. The retroactive

component of the fee-for-service increase for the period from April 1 to

September 31 has already been transferred to doctors, as of last week. We're

certainly anxious to move on addressing these issues as quickly as we can. If

it's possible to get all of these issues resolved within the month, I think that

would certainly be good news for patient care — to bring that kind of

stability. We are working as quickly as we can.

MacPhail: Are there any issues on the table around alternate payments to

physicians?

Hon. C.

Hansen: The answer is yes, and I was just trying to refresh my memory on the

breakdown. Of the $392 million, there is $185 million on fee-for-service

increases for the coming year. There is $80 million to provide for on-call

payments. The balance of $127 million is for a variety of things including

population demographic changes and enhancements to the rural agreement. There is

a significant portion in there for alternative payments to ensure that those

doctors who have chosen alternative payments get the same relative increase as

doctors who are on fee-for-service. We want to make sure that balance is

maintained or, if possible, enhanced, because fee-for-service is certainly an

option that is being chosen by more and more doctors throughout the province and

indeed across Canada.

MacPhail: I have one more question under the Medical Services Plan,

operations and policy, which will conclude my discussions of the Medical

Services Plan. The operation question is…. I am getting a lot of calls into my

office about the fact that people have to pay long-distance charges for MSP

inquiries. The staff has been cut in MSP. I don't even know whether those staff

cuts are actually implemented yet. If they're not, we're in big trouble. I am

getting a lot of calls mainly from poor, dear seniors who are now having to pay

long-distance charges.

[1640]

First of

all, can the minister give us a status update of the cut to the MSP staff? Is

there any chance of re-

[ Page 2417 ]

view of this policy? How much is the government saving from this policy of

charging long-distance to inquire about MSP changes?

Hon. C.

Hansen: The staff changes in MSP with regard to responding to public

inquiries have now been implemented. They have in fact happened.

We are

trying to enhance a variety of services in terms of access to information,

including Web-based. There is 1-800 access to an automated voice information

system. In addition to that, individuals from throughout British Columbia have

the option of going through Enquiry B.C., which is an opportunity to get access

free of charge to information about any government programs. This one is no

exception in that regard.

MacPhail: Oh, gosh, I'd hoped the minister wasn't going to go there, because

I'm now getting complaints. I don't know whether this is accurate or not. I

would love to be able to go back to the couple of seniors who have already

called my office.

Let me just

read this out, if I may. It's a case that's come into my office. This is from my

constituency assistant:

constituent contacted the Vancouver-Hastings community office and asked

about calling the MSP line. Because the toll-free MSP line is now gone,

staff referred him to Enquiry B.C., to be transferred from there to the MSP

info line. Enquiry B.C. was unable to transfer him because the line was

busy, so Enquiry B.C. told the constituent that he could be put on hold

until the MSP line became free, but that he'd have to pay long-distance

charges while on hold."

That's through Enquiry B.C. That's the first one. Since then, we've had four

other calls like this.

Is the

minister aware of Enquiry B.C.'s policy around this matter, or is this an error

that we can get straightened out? I just want to tell the minister that if he

won't reverse the smoking ban policy, this would be another one that he could

reverse.

Hon. C.

Hansen: Maybe the member is not aware that this is an ongoing problem in

terms of trying to access the MSP line. I know; I've received similar letters

over the last six years from constituents with regard to the time it takes to

get through.

That's part

of the reason why we're trying to find new ways of ensuring that information is

available. I know that not everybody has access to Web-based information. The

member mentioned that these were inquiries from seniors in particular. For many

people that do have access to our website, it's got comprehensive information.

If we can free up those people from the telephone inquiries, then it makes sure

that those lines are available for those for whom it is the only vehicle through

which they can get information.

Yes,

there's room for improvement. We're certainly trying to use technology in ways

that will allow information to be accessed more easily in the future. I'm not

saying that's the panacea to the problem, because clearly it's a challenge.

[1645]

MacPhail: Yes, this has been an ongoing problem; there's no question about

it. Since the new government has been in place, there have been substantial cuts

to MSP staff, and there are long-distance charges. Those two changes certainly

don't assist people with greater access.

The other

issue, as I'm sure the minister is aware, is that confidential information is

very hard to access via the Web. General information about changes in fees and

all that is accessible, but it's very hard, if not impossible, through the Web.

There are no privacy or security codes in place — nor am I saying there should

be, but there aren't any to access individual information.

I have one

request, usually, for each set of estimates that seemed to be so easy. I asked

for the audio book policy cancellation to be reversed. I asked the Premier to

reverse the denial of the WCB smoking ban. I'm asking the Minister of Health

Services: out of his $10.2 billion budget, this would be a good one to reverse.

He would be well regarded.

I am with

the minister until 5 p.m.; then I'm going to yield the floor to other members

until the supper break. I have no questions on Pharmacare processing, but I do

have questions on the Pharmacare program, which we'll do after supper. That's

the income testing.

Now I'm

going to go to the ambulance service. For the minister's information, my

questions are the ones that were referred to him by the Minister of Health

Planning, of which I gave the minister a copy. I can certainly go through those.

I do note

that the budget for emergency services — B.C. Ambulance Service — has been

reduced by over $4 million. The questions to the Minister of Health Planning

were based on the Minister of Health Services briefing document. Maybe I should

just read the questions I had into the record.

I'm

referring to the minister's briefing book document, the so-called leaked

document. It says that there were cost pressures over three years on the budget

for emergency health services of $55 million. The Minister of Health Planning

and I then proceeded to discuss the strategies listed there to reduce that cost

by $59.3 million. In other words, the management strategies over the period to

offset the cost pressures would be full; then there would be $4 million in

savings. That's how I read it. Indeed, the budget has been reduced by $4

million.

Are the

management strategies that are outlined in the document — I don't have any

other way of describing it than "the leaked document" — being put in

place as we speak?

Hon. C.

Hansen: With regard to the chart that's at the bottom of one of the pages of

the document she's referring to, under the title of "Emergency Health

Services" there are four tables. The table at the bottom, which is the one

that totals up to $59.3 million of management strategies…. Those are being

implemented to

[ Page 2418 ]

achieve the $59 million saving over the three-year period.

[1650]

MacPhail: Okay, so we are working on all of those strategies. That's a step

forward in information.

What I was

trying to explore with the Minister of Health Planning was that some of those

strategies — for instance, the demand mitigation strategy that says to reduce

demand for services by redirecting low-priority calls to other resources….

Some of these demand mitigation strategies are appropriate for urban settings

but not rural settings. Is an urban health authority being treated exactly the

same way as a health authority that covers mainly smaller communities and rural

communities when it comes to emergency health services demand mitigation

strategy?

Hon. C.

Hansen: There are clearly different needs and different demands put on the

Ambulance Service depending on where you are in the province, and different

regions have different challenges. As I was talking about yesterday, the

Ambulance Service itself is going to go through core review to look at how it

should be structured in the future and what that relationship should be between

the Ambulance Service and the health authorities. Already the health authorities

are focusing in on what they need from the Ambulance Service in order to ensure

a continuity of care from the time an individual is first involved in an

accident or an injury or an event that would require ambulance service to

deliver them to a hospital.

That work

is being done now. We're not pretending there are one-size-fits-all solutions

for the entire province, because clearly issues in the north and the interior

are going to be markedly different than issues in downtown Vancouver.

MacPhail: Is the B.C. Ambulance Service up for consideration for

privatization, contracting out or regionalization?

Hon. C.

Hansen: If the member is aware of the process that goes before a core

review, those basic questions get asked of everything that goes through core

review. This won't be any exception. Clearly, I think that, as I mentioned

yesterday, one of the big strengths of our Ambulance Service is that it is a

comprehensive provincial program. On the other hand, I also think it's one of

the big challenges of the Ambulance Service — that it is provincial, when all

of the other aspects of health care delivery are regionalized. As a result of

the core review process, we will be asking those critical questions and seeking

good expert advice, including advice from those who are on the front lines of

trying to make it work.

As to how

we can structure the Ambulance Service in British Columbia to best meet the

needs of patients, it may well be that at the end of it, it will be status quo.

On the other hand, it may well be that some other form of administering the

Ambulance Service will be arrived at. I wouldn't want to second-guess what would

come out of that process.

MacPhail: These demand mitigation strategies — are they separate and apart

from core review?

Hon. C.

Hansen: Yes, that's right. We are working on trying to ensure that we meet

our budget targets for this year, and these strategies are being developed as we

speak. They're certainly not waiting for the core review process.

MacPhail: Then my concern about the difference between smaller and rural

communities and large urban communities remains. A demand mitigation strategy

such as "reduce demand for services by redirecting low-priority calls"

has a very different application in a rural community than it does in an urban

community. "Longer response times" has a very different application in

a rural community versus an urban community. "Single ambulance response

regardless of acuity of the situation" has a very different meaning urban

versus rural. In terms of these demand mitigation strategies, which are really

cuts — it's a fancy word for cuts to ambulance service — is the minister

taking an approach that recognizes those substantial differences between rural

and urban communities?

[1655]

Hon. C.

Hansen: Strategies are being developed for different regions of the

province. As I mentioned earlier, we do not take a one-size-fits-all approach in

this matter. These are not service cuts we are talking about. What we are trying

to ensure is that there is the appropriate usage of the ambulance service we

have available today. In no way will we want to see patient care compromised,

but we do want to see the appropriate utilization of our equipment, of our staff

and of the dollars allocated in this area.

MacPhail: What does a longer response time mean? The service may be

delivered, but does it mean it's less? I mean, a longer response time may mean

greater crisis for the patient.

Hon. C.

Hansen: We're not planning towards longer response times. What we are

planning for is the ability to properly prioritize calls, so those that are of

the highest priority will actually get the rapid response they need and expect

of our Ambulance Service.

I had the

pleasure of spending about an eight-hour shift with the Ambulance Service in

Vancouver. Part of that I spent at the dispatch office — it was probably about

three hours — sitting with some of the dispatchers as they went through their

job. They are well trained. They have the algorithms that actually allow them to

walk through a situation to determine now, today, what the appropriate response

is for a particular call.

We believe

that by better managing this, we can ensure better utilization of the ambulances

so you don't

[ Page 2419 ]

have two and sometimes three vehicles showing up at one incident, and you

have the right vehicle showing up at the incident. It's also in terms of the

ability to respond in a priority way to the urgent needs first.

It may mean

that if there are calls of lesser priority, which are really around

inappropriate utilization of the Ambulance Service, we'll be able to assess that

at the time the calls come in. They may, in fact, see a longer response time if

there is no requirement for an urgent response. We have the capacity of doing

that. Our staff have the training to do that, and that's part of what we hope to

be implementing to achieve some of these goals.

MacPhail: I note this document suggests that the original budget strategy

was to eliminate approximately 300 paramedics and associated administrative

supports. The document then says: "This is not possible within the current

collective agreement." When does the current collective agreement expire?

Hon. C.

Hansen: In 2005.

MacPhail: Is this then part of the core review approach? Will this issue be

addressed as part of the core review?

Hon. C.

Hansen: We do not anticipate that this would be part of the core review

process. What that process will do is look at what is the appropriate governance

of the Ambulance Service, how the Ambulance Service should best be structured to

meet needs throughout the province. It's challenging some of the assumptions. As

I mentioned earlier, it may well be that at the end of it, we wind up with a

governance and administrative model that's what we have today. On the other

hand, we may determine that there's a better way of meeting the needs of

individual British Columbians with regard to their ambulance service.

[1700]

MacPhail: My last series of questions in this area, before I yield the

floor, is around the issue of paid training budget. I've given those questions

to the minister. Let me just reiterate that the paid training budget has been

cut by half from $8 million to $4 million. I then articulated how I understood

prepaid training to work. This is a particularly rural issue, as I understand

it. In rural areas paramedics only get paid when they're called out.

The answer

I was given to that was yes. The reason why prepaid training is important for

the rural areas and the reason why people agree to commit the time to sit, be on

call and be paid only when they're called out is the opportunity to have

training paid for by the employer, which then allows them to bid on jobs in

larger areas where full-time employment is available. Is that correct?

Hon. C.

Hansen: In fact, we are protecting the funding for training for rural

paramedics in particular. While there is an overall reduction on the amount

spent on training, it is being focused on rural training in particular. In the

past we have provided training programs for about 350 paramedics a year. In this

budget we are actually providing for training of 1,300 paramedics, and those are

from all over the province. Our goal is to ensure that any paramedics that would

like to access training can get access to the paramedic level 1 throughout the

province. I think that's good news for smaller communities throughout the

province. I think it will ensure that the paramedics in those communities have

the opportunity to get to that paramedic level 1, which I think is important to

them as paramedics. It's also important to the communities that rely on them.

MacPhail: That is very good news for rural communities, but it probably

might be seen as robbing Peter to pay Paul for those paramedics who are not in

the rural communities. What does that mean? How will the cuts be imposed to

reduce the paid training budget by $4 million in urban areas only? How does that

get achieved?

Hon. C.

Hansen: The shift taking place is to open up the training system, so there

is increased public access to the training programs. We expect there will be

more individuals recruited into the ambulance service that will have already

undertaken the training required for higher levels of training, which is totally

consistent with other professional groups within our health care system that we

rely on. The training programs that the B.C. Ambulance Service will not fund in

this coming year are the advanced life support paramedic 3; advanced life

support assistant, which is P2; the unit chief course; the duty unit chief

course; and the B.C. Ambulance Service management training. Those are the

programs we will not be funding, and that is resulting in the reductions.

We will

still be able to meet the public need as a direct result of the increased access

to the training programs by individuals who would seek that training before

applying for positions with the Ambulance Service.

[1705]

MacPhail: I heard a story today that if you want to become a police officer,

you have to pay for the training yourself. Let me ask the minister this: who is

affected? I gather that the payment for this training will have to come out of

the pockets of the paramedics. Who is affected by this? People who are looking

to move up the ladder? What type of person in the Ambulance Service now will

have to pay for his or her training that was previously paid by the employer?

Hon. C.

Hansen: What this will enable is that individuals who would either like to

enter the Ambulance Service or are currently in it and would like to advance

would have that opportunity of pursuing training, which they could fund

themselves. That is consistent

[ Page 2420 ]

with most other professions in health care. In the areas of nursing, for

example, there is certainly lots of in-service training provided, but there are

also a lot of individuals who go out and get the training they need so that they

can apply for the positions as they come available.

We have

made a commitment, and we'll continue to commit, to ensuring that an adequate

number of the trained paramedics are available to the system, so if we have a

need within the ambulance system that cannot be filled as a result of

individuals that have accessed the training, then we will certainly be putting

in place the training programs to make sure that the need gets met. We're not in

any way going to put access to these services in jeopardy in the future. This

whole process will be well managed to ensure that the human resource needs of

the Ambulance Service are met into the future.

MacPhail: My two final questions are: one, have the ambulance paramedics

themselves been consulted on this change, and what was their response? And

lastly, when is the core review of the Ambulance Service expected to be

completed?

Hon. C.

Hansen: First of all, the union was advised of the changes that we are

implementing. I also want to underscore the fact that we are enhancing training

for many paramedics throughout the province that is being funded out of this

budget, which includes the increase from the 350 to the 1,300 paramedics that

will be given the opportunity to come up to the paramedic 1 level.

With regard

to the time line on core review, it's not a hard and fast time line, but we

anticipate that recommendations should be coming back to the deputy minister

around the end of April, although that's a tentative target at this point.

MacPhail: I'm going to yield the floor to my colleagues who have questions

for the minister. I will return after the supper recess, whenever I have a

chance, and commence with the Pharmacare changes, just for information of the

minister.

Hon. C.

Hansen: Perhaps just to clarify where we would be going with that discussion

tonight, I have on my list that we had discussed, when we