2000 Legislative Session: 4th Session, 36th Parliament
HANSARD
The following electronic version is for informational purposes
only.
The printed version remains the official version.
(Hansard)
SUNDAY, SEPTEMBER 17, 2000
Afternoon Sitting
Volume 20, Number 25
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The House met at 2:09 p.m.
Prayers.
The Speaker: I would ask if there are any introductions by members.
Hon. D. Miller: Mr. Speaker, it's not really an introduction. I think all members by now have read the press. There has been a terrible tragedy at Prince Rupert. Seven young people were swept into the ocean, and three are still missing. I would simply ask all members to join with me in sending their own prayers for the families and these young people, and hope that some of them are found alive.
Hon. U. Dosanjh: Hon. Speaker, I know Kim Emerson is recovering from a procedure that he underwent at the hospital. He's doing well, and on behalf of all of us, I want to wish him well and a speedy return to the Legislature. We'll miss him.
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Hon. I. Waddell: Hon. Speaker, I rise on a very happy note. I believe all members in the House will join with me in congratulating Victoria's Simon Whitfield, who not many hours ago won a gold medal in Sydney in the 2000 Olympics in the men's triathlon -- the first-ever event. We should congratulate him.
Simon is a member of PacificSport centre in Victoria. It's a centre for training national athletes. I want to personally congratulate Roger Skillings, Simon's coach, and some of the people there
L. Boone: Although we weren't expecting to be in this chamber, we were expecting to be in this city today. So I would really hope and ask that all members here give my partner, Mr. Fred Bagg, a very warm welcome to this precinct.
E. Gillespie: I'm happy to introduce my son Ceilidh Curtis, who travelled with me to be here today on this very important occasion.
Hon. J. MacPhail: Hon. Speaker, it gives me great pleasure to welcome lots of friends in the gallery today, but particularly one -- and I hope no one else takes offence. He's reformed himself into a sensitive New Age guy: John Shields. Welcome.
DEBATE ON SUPPLEMENTARY BUDGET ESTIMATES
Hon. P. Ramsey presented a message from His Honour the Lieutenant-Governor: supplementary estimates for the fiscal year ending March 31, 2001, recommending the same to the Legislative Assembly.
Hon. P. Ramsey moved that the said message and the estimates accompanying the message be referred to Committee of Supply.
Motion approved.
B. Penner: Hon. Speaker, I rise to present a petition. I've circulated a petition in my community of Chilliwack, which has been signed by over 3,000 people, calling on the B.C. government to take all reasonable steps to prevent the construction of a new gas-fired electrical generating plant in the community of Sumas, Washington, which threatens the air quality in the Fraser Valley.
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Hon. D. Lovick: I call Committee of Supply.
The House in Committee of Supply B; T. Stevenson in the chair.
The committee met at 2:15 p.m.
SUPPLEMENTARY ESTIMATES: MINISTRY OF
HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
On vote 36(S): ministry operations, $290,000,000.
Hon. M. Farnworth: As the Finance minister has indicated, we are here today for a very important reason. We are here today to take another strong step toward putting British Columbia's health system back on track. We are here today to make it possible for our hospitals and health providers to get the resources they need so that they can give British Columbians the care they deserve. Finally, we're here today to continue building on our new way of doing business in B.C., moving away from confrontation to negotiation and consultation, and to resolution and progress.
Last week we saw the direct benefits of working in cooperation with the federal government to put the needs of B.C. patients first. The multi-year agreement that we secured with Ottawa means that for the first time in many years people in our province will benefit from stable, predictable federal funding for health care.
We are here today to turn over nearly $70 million in federal funding to our health authorities as quickly as possible so that they can purchase urgently needed hospital equipment. That equipment ranges from high-tech MRIs and CT scanners that better diagnose illness and disease to vital bed lifts that protect our health workers from strain and injury. We're also here to authorize $180 million in provincial dollars to help our hospitals and health providers continue to meet the most pressing, immediate demands of patients, and an additional $40 million to help our health authorities in smaller cities and rural communities recruit and retain the physicians and specialists that they need.
We know that the last few years have been particularly hard on our health system. We know that our hospitals have been struggling to maintain consistently high levels of service to B.C. patients. I have nothing but the greatest respect for the 100,000 women and men who have chosen to stay in our health care system and for the dedication they bring to their jobs every day. Many of them have told me that one of the most immediate challenges our hospitals face is keeping oper-
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ating rooms open and staffed and recovery beds open so that the people they serve have timely access to the surgeries they need.
As a government we share that goal. We believe that all British Columbians deserve timely and appropriate access to high-quality health care. That's why, once the Legislature approves this spending, $180 million will be flowing to our health authorities to help them address key surgical wait times.
Obviously there's no one-size-fits-all solution to improving patient care, but there is plenty of common ground -- replacing old and outdated equipment, bringing in new diagnostic tools, increasing capacity in operating rooms, training more critical care nurses and other staff. These are all essential ingredients to improve patient care and initiatives which I believe everyone in this Legislature can willingly endorse.
We're also here today to allow health authorities outside Victoria and the lower mainland to access their share of the $40 million we've set aside to help them recruit doctors and specialists. We recognize that British Columbians, particularly in small communities and rural centres, depend on a small number of these vital health professionals for a vast array of health services. And we recognize the necessity of allowing smaller communities to enhance their recruitment and retention packages through bonuses and incentives. That's why we want health authorities to be able to provide these incentives as soon as possible, wherever possible.
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Taken together, we're talking about putting $290 million into our health care system right now to ease the pressures in our hospitals and to improve patient care around our province. The Premier has indicated that this is just the beginning, that this is phase 1 of a comprehensive B.C. health action plan, a plan that you'll be hearing much more about in the days and weeks ahead. It's a plan that has guided our activities ever since our new Premier took office early this spring and directed that we rebuild the relationships that are the cornerstones of health care delivery in British Columbia.
I would remind everyone here that we've begun that work with the British Columbia Medical Association, when in March the government ratified an agreement with the BCMA that increased the available amount for this fiscal year by $40 million, funded a 2 percent fee increase for doctors and added an additional $8 million for doctors' malpractice insurance. We understood that this agreement would bring an end to the withdrawal of physicians' services around the province. Unfortunately, this deal has not been a deal. The agreement failed to secure the reliable delivery of patient care, just as subsequent negotiations with various doctors' groups have failed.
Now, attempts to mediate with rural doctors through the BCMA under terms that would mean that a deal truly is a deal have also failed. But we are not giving up. In fact, we are taking action on two fronts. On Friday the Premier announced the establishment of an inquiry into the best way to negotiate contracts between the government and doctors and to give B.C. patients the certainty they need and deserve. Today we want to give our health authorities access to $40 million so that they can start making agreements with the individual specialists and physicians who are ready and willing to make a commitment to the reliable, consistent delivery of patient care.
The need for a commitment to patient care underscored our negotiations with the federal government this spring. In June we presented the federal government with a paper entitled "British Columbia's Strategies for Action on Healthcare," which outlined exactly how we would invest any restored federal dollars to benefit B.C. patients and their families. We know that the dollars we're talking about today will not meet every current and future demand on our health care system. Even while that money is being used to ease the existing pressures in our hospitals, we must be acting to eliminate that pressure from building in the future. That's why we'll be enhancing the health care services that keep people out of hospital. We'll be working with health care authorities to free up acute care beds so that those beds are ready and able to receive people who need acute care services.
But whether patients need life-saving emergency surgery or an annual flu shot, they share one common need. They need nursing services. And to deliver health care either in the hospital or out in the community, our health system relies on an adequate supply of appropriately trained nurses. That's why our B.C. health action plan builds on existing initiatives to recruit and support new nurses and nurses currently working around our province, particularly in our more rural areas.
The plan recognizes the unique challenges of providing a full range of health services in smaller communities, and it does this by looking at things like introducing specialized training programs for rural nurses and other health care providers. It looks at telemedicine and physician outreach programs and at innovative new ways to enable people to access reliable and accurate health information and advice from their own homes. It looks at ways to address the rapidly rising costs that threaten to overwhelm our provincial drug plan, and it looks at better ways to meet the needs of people with mental illness.
Like the funding we're discussing here today, some of the actions in the B.C. health action plan are fairly straightforward and will have immediate benefits for patient care. Other activities we must get to work on now, knowing that we will see the benefits to patients and to our health system over the longer term.
For example, we're working to enhance Prince George Regional Hospital as a northern teaching centre, because there's clear evidence that physicians who do their training in rural settings are much more likely to stay and practise in a smaller community. We won't have those regionally trained physicians in the field tomorrow. But if we start now, we will have them there soon, to the direct benefit of the people who live in smaller communities throughout British Columbia.
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As the Premier has said, our goal is not only to get our health system back on track but also to get it moving smoothly into the future. As Health minister, my vision is of a health system where all British Columbians are able to access the health care they need where and when they need it. Investing in our hospitals, our nurses, our doctors and our health care workers is an important step toward achieving that vision. We will always need to bring people to health care facilities to get specialized tests and treatment, but it's essential that those facilities be well equipped, well resourced and well managed. I believe the dollars that we're talking about today will go a long way to restoring the public's confidence in the ability of those facilities to meet our acute care health needs.
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I also understand the need to bring health services, particularly preventive and primary health services, out to where people live. Our B.C. health action plan contains many exciting and innovative initiatives to do just that. I look forward to sharing those with you in more detail in the near future.
If there's one thing I've learned as Health minister, it's that our health system is an organic whole in that everyone must feel that they're able to participate. If B.C. patients are truly going to benefit from the delivery of the right care at the right time in the right place, each part of the system must depend on every other part. Today we're talking about steps to relieve the immediate pressures on our hospitals -- the heart of our health care system. With that heart beating strong, as it were, our health system has the ability to do great things.
I don't believe for one second that the people of this province want us to give up on publicly funded universal health care. They tell us time and time again that it is the most valuable and most highly valued public service that we have. What they want is for us to make that system work, to make medicare work not just for themselves, not just for their elderly parents, but for their young children and for everyone in British Columbia. It's a fair and reasonable demand. We're here today because we're committed to meeting it now and in the future, and we're going to do just that.
C. Hansen: The minister made a very telling comment in the early part of his introductory remarks to this debate. He talked about getting the health care system in British Columbia back on track. We have had nine years of NDP government in this province that has put it off the rails in the first place. We see nothing in the documentation that's before us today, in terms of the very flimsy health action plan that the minister is talking about, that is actually going to get our health care system in this province back on the rails.
The one thing that this government brags about in health care -- and it's probably the only claim that they have in health care that they perhaps can be proud of -- is that British Columbia is the only province in Canada that every year has increased its Health budget over the last decade. I'm surprised that we don't see more members of the government benches applauding that, because that's the only thread that they have to hang onto when they go around their constituencies and people start demanding answers as to why this government has allowed health care to deteriorate year after year after year.
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This is the only province in Canada that goes from crisis to crisis to crisis in health care. In fact, I learned just recently from somebody who is very well versed in the inner operations of the Ministry of Health
Everybody saw those problems coming -- everybody except this government. I'm not convinced that this government didn't see them coming too, because, you know, there are people that actually thrive on an aura of crisis. There are people who just can't operate unless their life is in turmoil. Just when their life seems to start taking a normal, stable mode, they have to invent their own crises. Hon. Chair, I believe that is exactly what is before us today.
We have a tremendously cynical move by this government to trump up yet another crisis in health care rather than dealing with it on a rational and orderly basis. As we go through this debate, we will start to explore some of the actions that this government has taken and the way that they've taken them to actually cause the crises in this province, to get worse in health care.
I want to go into a bunch of areas, but perhaps I can start by asking the minister specifically about the strategic planning process of his ministry. I have heard the minister say, I've heard this Premier say, and in fact I've heard many members of this government's benches say time and time again that money alone will not solve the problem, that we cannot solve the problem unless we have proper planning in health care, unless we address some of the fundamental underlying issues as to why it is that in this province we continue to spend more and more money on health care year after year. Yet we see wait-lists growing, we see health care deteriorate around this province, and we see the stability of health care diminish. Patients this year feel less confident about their health care system than they did last year, and they felt less confident last year than they did the year before. In fact, they have felt less confident about their health care system every year that this party has been in office.
So my question to the minister is: this health action plan that he has put forward -- is that the planning process that is somehow supposed to give us in the official opposition some comfort and the public some comfort that the additional dollars being spent on health care in fact are going to be spent towards achieving some long-term goals, so that we'll actually start to see some improvements in health care instead of the steady erosion that we have seen over these past ten years?
Hon. M. Farnworth: Well, the member asks a number of interesting points, and he makes a number of interesting comments. One of the things that I'd like to talk about first is that this province has been increasing health care funding every year since we've taken office. It's been a challenge to meet the needs of services for everyone that wants them in British Columbia, as it has right across this country, because we have seen the removal of $26 billion in health transfer payments by Ottawa during that period. The provinces, including British Columbia, have had to try and make that up. That has been a very difficult task; however, we've done that.
The health action plan, hon. Chair, is based on a number of principles, principles that are designed to ensure that we modernize and strengthen B.C.'s public health care system to improve patient care, that we support and respect the more than 100,000 women and men who deliver health care, that we maximize preventive care and wellness, that we reform primary care to provide the right care at the right time in the right place, that more innovation and not just money is what's required in the system; and to stop the creeping privatization that threatens medicare. Those are the basic principles around our health action plan.
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Attached to that are a series of priorities: hospitals, nurses, doctors, rural care, primary care, continuing and home care, privatization, and drug use and costs.
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C. Hansen: If this minister goes out to the public with a health action plan that is the sum total of less than two and a half pages -- and much of that is double-spaced -- the public is not going to get any consolation from this. A little bit later my colleague from Okanagan-Vernon is going to ask some specific questions about the health action plan. We want to find out what's really meant by these words, because it's really pretty thin gruel.
I want to point out one quote in here which I think probably summarizes a lot of what the public approach to this is today. It's under the title of "Rural Care," which is obviously something that is extremely topical these days, and there is a huge anxiety on the part of those in rural British Columbia in terms of how they can access necessary health today, never mind this month or next year or the year after. But under "Rural Care" it says
It says: "B.C.'s health action plan recognizes the unique needs of residents of rural and smaller communities." That's quite profound; it recognizes unique needs. "We will ensure health authorities have access to funding to train rural health care providers." That's all well and good. There are no details as to what that's all about. But here's the line that I think really delivers the message. It says: "In addition, residents of rural areas will have access to self-care and wellness material to help them and their families access health services." Do you know what that says to British Columbians in rural and remote British Columbia? It's something they've always known. They have to be self-reliant, because they will not be able to depend on this government to assist them. Simply providing them with information as to how they can fend for themselves is probably the best thing that this government can offer. As I mentioned, my colleague will go into that document in more detail later on.
I want to talk about the funding letters for the health authorities around this province. We are now into the sixth month of the fiscal year, and the health authorities still do not have their funding letters. We raised this several times during the regular session of the House earlier this year. The last time we raised it was on May 17. The minister at that time said: "The allocations won't be done until
Well, the next two and a half weeks, hon. Chair, would take us into the first week of June. Here we are in September, and the health authorities still have not been given their budgets. They were told in March by the deputy minister that they should continue to maintain services that were provided last year -- that there should be no service cuts. It also assured the health authorities that they would receive an increase in funding to cover the collective agreement settlements that click into effect this year. But that was it.
I'd like to ask the minister: why is it that these health authorities have had to wait until halfway through the fiscal year until they are being told what their budget amounts are? In fact, we still don't know what they are yet; we're still waiting for those letters. I'd like the minister to give us yet another prediction as to when those letters are going to go out.
Hon. M. Farnworth: One of the nice things is that we will be able to write cheques for approximately $70 million for new equipment as a result of the agreement that we got in Ottawa, along with the rest of the provinces. It's interesting, because the opposition said that we'd never get that agreement -- that we wouldn't get that money coming into the system. That was very much a cornerstone of
Interjection.
Hon. M. Farnworth: Your Health critic stood up repeatedly and gave the same speech throughout communities throughout British Columbia -- and I know, because I've heard it -- saying that in the fall, I -- using my first name -- would be standing up blaming Ottawa that we didn't have money to give the health authorities, because we wouldn't get an agreement with Ottawa. Well, the fact is that we did get an agreement with Ottawa that allows us to invest $70 million in equipment, and that is part of the funding announcements. The health authorities will be receiving their letters next week.
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C. Hansen: So here we have a situation where they can't send out the funding letters, because they're not sure how much money is going to be in the pot. Well, the responsible thing to do would have been to send out the funding letters based on the funding that was in the pot and then, when the additional moneys were found -- as they came from Ottawa -- reconvene the House, do the supplementary estimates, as we are, and then advise the health authorities how much their increased budgets would be.
Hon. Chair, I would like to ask the minister if he thinks it is responsible management of government to deny the health authorities their budget letters until halfway through the fiscal year.
An Hon. Member: What about that stable, predictable, long-term funding they spoke of?
Hon. M. Farnworth: I'd like to thank that member. I'll address that comment, and then I'll answer the member's question.
The fact of the matter is that now that we have this agreement with Ottawa to restore the transfer payments to British Columbia and the other provinces, we actually now have stable, long-term funding that the provinces can rely on, which was something that you said wouldn't happen.
In answer to the member's first question, we did in fact send out letters at the beginning of the year, and we did work with the health authorities. Now we're able to send out another letter outlining additional funds that they will be able to access and will be receiving next week.
C. Hansen: And we will get into some of the details of that.
I'd like to ask the minister what the cumulative operating debt of the 52 health authorities was in the last fiscal year, the 1999 fiscal year ending March 31, 2000.
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Hon. M. Farnworth: It was $49 million.
C. Hansen: I'm wondering if the minister could tell us what the accumulated debt is of the health authorities around the province for the year ending March 31, 2000.
Hon. M. Farnworth: It's $79 million in unrestricted assets.
C. Hansen: I just wanted to check -- $79 million? Thank you. So basically the debt from previous years was $30 million; then we added $49 million in the last fiscal year alone.
Could the minister advise us: in the consolidated statements that were produced by the Minister of Finance a couple of weeks back
Hon. M. Farnworth: Health authorities are not consolidated on the books of the province.
C. Hansen: Could the minister tell us who is responsible for the debt of the health authorities?
Hon. M. Farnworth: The health authorities.
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C. Hansen: So what you're saying is that
Hon. M. Farnworth: The province is the major funder of the health authorities. The health authorities are not part of the consolidated statements of the province; nor in fact do I believe that they're part of the consolidated statements of any province in the country.
C. Hansen: This $49 million debt that was incurred last year by the health authorities is the responsibility of the provincial government. If you look at the consolidated statements that came down a couple of weeks ago
Now, the reason I'm asking these questions is that I want to
Hon. M. Farnworth: It's $180 million.
C. Hansen: That's an interesting number, because that's the number that the minister is proposing as the increase in the transfers to the health authorities in the supplementary estimates that are before us today. In other words, what the minister is telling us is that the projected debt, according to his numbers, is $180 million of deficit. So we're going to transfer an additional $180 million to the health authorities as a result of these supplementary estimates today, and all that's going to do is cover the existing deficit that they are already building up.
The minister's been talking about all these new programs. In his introductory remarks he was talking about how we were going to address wait-lists and open operating rooms. I think every single health problem under the sun was going to get solved by this amount that was in the supplementary estimates today. And yet what we now find out is that the number is exactly the same. The deficit that's out there, the $180 million deficit of the health authorities, is the same number as he is proposing to transfer to the health authorities.
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Could the minister tell me one of two things? If this new money is not going to go to covering their deficit operations that they're running up, how are those deficits going to get covered? If that's not the case and in fact this is money that's going to cover all these wonderful new initiatives that the minister plans to announce over the next few weeks, as he outlined in very sketchy form in his opening remarks, then the question is
Hon. M. Farnworth: The $180 million the member talks about, first off, is a projection. It is not an actual one. It is just that. And the funding is based on the provision of a level of service that's been achieved through discussion between the ministry and the health authorities to ensure that we are not only maintaining the same service levels that were provided last year and delivering the same number of services as last year but also accomplishing what we want to this year in terms of upgrading the opportunities and programs that health authorities can deliver -- to upgrade nurse training, for example -- and in terms of being able to open more operating rooms. All those things are included in that.
It also doesn't include the amount of money that's spent on equipment, which in this case is $70 million, which goes to the hospitals and the health authorities throughout the province. So it's a combination of two things, which you're not taking into account. One is equipment, which is $70 million, and two is a level of service designed to ensure that we're meeting the needs of the patients of British Columbia and are able to do things such as open more operating rooms, which is what you were just talking about.
C. Hansen: I'm not sure that the minister himself followed his explanation in the last response that he gave, because it didn't exactly make a lot of sense. The minister is talking about nursing training; he's talking about wait lists; he's talking about ORs -- all these wonderful things. And yet the health authorities were already projecting a $180 million debt.
If you go back to last March, the deputy minister sent out a letter to all of the health authorities in the province, basically
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saying that the funding letters were going to be delayed. In that letter from the deputy minister it said that they should maintain service levels. So the health authorities, who the minister tries to say are somehow independent of the provincial government, are basically taking their marching orders from the Deputy Minister of Health in the province. They are continuing to maintain services on the expectation that they are going to be funded over and above what was there last year, in order to maintain those service levels. So as they are maintaining service levels, they realize that they're going to go in debt to do that.
Actually, let me just touch on one point before I continue on that theme. Could the minister explain to us how and under what authority the health authorities incur their debt? If a health authority is going to go into debt in order to cover its operations, who do they have to seek permission from in order to incur that debt, and how is that debt financed?
Hon. M. Farnworth: I come back to the point I made a moment ago. The $180 million is a projection on the basis of a level of service that's been agreed to between the health authorities and the ministry in terms of what they're anticipating in terms of services to deliver this coming year -- that is, no cuts. Where possible it's improvements in service, meeting the needs in each of those communities.
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It includes in the development of those services such things as upgrading of nurses' skills and training of nurses' skills, which are included in that. And for the member's benefit, I will read out some of those initiatives that are included in that. The Fraser Valley health region, for example, has
a training-on-site recruitment and retention program. They estimate that requires, to implement that program, around $200,000; that's included in it. In the case of Okanagan-Similkameen health region, they're looking at recruitment and retention dollars of around
An Hon. Member: So today's news is old news.
Hon. M. Farnworth:
Hon. Chair, the Cranbrook health council -- $390,300 for training. Again, that's what they anticipate they need in training and upgrading nurses in their community. That's included in their budget request and is part of the money that they will be receiving this year.
C. Hansen: So what the minister is saying is that the health authorities are maintaining services; those were his words. And in doing so, they were providing these things like nursing training and other things. The minister, in his opening remarks, was trying to pretend as though these were some great new initiatives, not just maintaining service levels -- that in fact there were going to be all kinds of new services provided, that there was going to be additional health care, that somehow the public should look forward to much better access to health care as a result of these new moneys that have come from Ottawa.
But in fact what he just said is that this is just maintaining our existing things that would have gone on anyways; that the health authorities, in maintaining their previous operations, were running up this $180 million debt; and in maintaining their services there were things that they had to do anyway, such as training. Now the minister is trying to pretend that there is a whole bunch of new activity in health care, that there is a whole bunch of new initiatives that are somehow going to make health care delivery in this province better.
The reality is that it's not the case, that in fact all of this money is going to simply maintain service levels that were already inadequate last year, which the public has already spoken out on and said they think that health care is in a shambles in this province. So simply maintaining last year's service levels is not adequate and certainly is not what the minister and this government are trying to pretend is happening in the announcements that are being made day after day in terms of some kind of new initiatives coming into this province.
So I'd like to ask the minister: what elements of this are in fact new services, not maintaining existing service levels? What's actually new that's being announced today, hon. Chair?
Hon. M. Farnworth: In terms of what new services are being provided and what new capacity is being provided to health authorities, I'd like to point out the following things. First off, in terms of the equipment that's going to health authorities, that's accomplishing a number of things. It's meeting their requirement for new equipment, and there's $70 million there to do that. Of that, $19 million is for high-tech equipment, for MRIs and CT scanners; $17 million is for equipment to improve health and safety in the workplace -- i.e., electronic beds and lifts and things like that to make the working environment not only safer but more efficient -- and $34 million is for clinical equipment, i.e., ultrasounds and X-ray machines.
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So all that is new, going into the system. The budget of $180 million is determined on the basis of: what are the needs? And it's done on the basis of a number of things, including the growth in population and demographics which, when that takes place, results in extra services being required and being able to be funded. So all those services are new.
In terms of being able to maintain existing service volumes, that's roughly about $23 million in order to do that. A hundred and twenty million dollars meets population and demographic increases, and so with that comes the capacity and the ability to meet the new demands on that. Within that $180 million, not only is it meeting the existing needs as determined by the health authorities, but it is then also able to provide new services and existing capacity to meet population and demographic changes.
C. Hansen: Hon. Chair, I know that there are a lot of people around the province who are following this debate today on the broadcast. I just want to paint a picture as to what goes on here, because I think it also tells something. The time when the TV is actually just focused on the Chair is the time that it takes the minister to be briefed on how to answer these pretty basic questions. The minister has now been in this portfolio for eight months, and I would think that some of the financing arrangements between the ministry and the health authorities would be pretty much top of mind for him. I'm quite surprised that he's relying as much as he is on briefings by officials as we go through this process.
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The minister just said that what we're talking about is just maintaining services. Whether it's demographic changes, whether it's population growth
I want to come back to another question that I asked earlier, which the minister did not answer. That is: who authorizes the health authorities to incur debt? You know, the minister mentioned that up to the end of the last fiscal year, there were already accumulated deficits by the health authorities of $79 million. Who authorized the health authorities to incur that debt in the first place, and what is the process?
Hon. M. Farnworth: The expenditures by the health authorities throughout the province are on the basis of the delivery of services. We monitor them quite closely in terms of: are they going to be in a deficit or a non-deficit position? And we work with them to ensure that there's cash flow there to meet their needs as is required. As I said, throughout the year we work with them and continue to ensure that the provision of services, which are demand-driven, are met as needed.
C. Hansen: I will repeat my question for the benefit of the minister. When a health authority goes into debt, as they have done to the tune of $79 million up to the end of last March, who authorizes the health authorities to incur that debt in the first place? And how do they go about getting permission to incur that debt?
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Hon. M. Farnworth: The board makes the decision to run a deficit. It's a deficit they're running; it's not a debt which they are carrying. They make the decision to run the deficit.
C. Hansen: There's a bunch of mixed messages in there. They can make a decision to run a deficit, but then that doesn't result in a debt. So if they run a deficit, what is it if it's not a debt at the end of the year? And how is it covered? How is it financed?
We'll come back to some of the other things that he said in that last answer in a second.
Hon. M. Farnworth: The health authorities can run a deficit, and it's the basis of the funding they receive versus the value of the services they get. We do not, though, allow them to accumulate debt in the sense that they can go and borrow money to cover that. So that, hon. member, is how the board makes a decision to get the deficit. But in terms of whether they can go, then, and incur debt by borrowing to cover that deficit, no, they can't do that.
C. Hansen: Who, then, does cover the debt? Where does this debt go if it's not financed? Who pays for it? Do they just go to the photocopier in the administrative offices of the health region and start cranking out dollar bills? I don't think so. If they are running a deficit, somebody has to cover it. My question is: who does?
Hon. M. Farnworth: The health authority covers its deficit -- because they don't accumulate it as debt -- when they get their budget from us.
C. Hansen: So in other words, they can run up the debt
Hon. M. Farnworth: The member keeps saying that the hospital authorities run debts or have debt. It's a deficit they run, and it's covered from the appropriation that the ministry gives to the health authority. The health authority then covers the deficit if there is one. When they find out whether or not
[1510]
C. Hansen: So if we go back to last fiscal year, where the minister advised us earlier that the accumulated deficit of the health authorities was $49 million that in fact the provincial government through the ministry covered that $49 million deficit of the health authorities from last year. That's what the minister just said.
Could the minister tell us how and when the government covered the $49 million operating deficit of the health regions from last year?
Hon. M. Farnworth: They are able to carry forward that deficit. And at the same time, what the province does is indicate to the health authorities to expect to be able to deliver a particular set level of service. That level of service is based on the needs of the different health authorities based on the region, the population and the demographics -- all those things going into it, in part so they can expect to receive moneys from us. At the same time, we indicated to them that there would be additional funding coming to the province, which we passed on to the health authorities when we reached an agreement with Ottawa.
C. Hansen: Maybe I can try to help the minister answer some of these questions. First of all, when a health authority is going to incur a deficit, they've got to get the permission of the Ministry of Health to do it. That is, I think, direct evidence that in fact this is debt of the province that is being incurred.
When the minister talks about a $49 million collective deficit of the 52 health authorities, what he's saying is that the health authorities on April 1, the first day of the fiscal year, don't start out with nothing. They started out with minus $49 million for this current fiscal year. The dollars that flow out of this year's budget of the provincial Ministry of Health are in fact
[1515]
That is why, if you look at health regions around the provinces, they are having to ask for cash advances simply to meet their payrolls this year. They're operating not only with
[ Page 17192 ]
that $49 million debt that they've got to carry forward from last year, but in addition to that they were running up -- using the minister's number -- a $180 million projected deficit this year. When you start allocating the resources to the health region on a monthly basis, it is simply inadequate for them to meet their basic needs.
I know of one case in particular where a member of a health board who is very much a friend of this government actually had to phone the Minister of Health -- or the ministry, at least; I'm not exactly sure -- to say: "Look, we don't have enough cash in our bank account to meet our payroll." Does the minister think that is a responsible way to manage health care services in British Columbia today? Is he proud of that kind of administration of health care cash in British Columbia? And is that the kind of standard that we can look forward to in the future?
Hon. M. Farnworth: That's why, hon. Chair, we are proud of the fact that we have reached an agreement with Ottawa to ensure stability of funding from the federal government to the provinces that allows the province now to project out in terms of the moneys that we're getting from Ottawa over a five-year period, which allows us to predict with greater stability the amount of money that's flowing into the health care system. It's something, I would point out, that's been very much a cornerstone of what we have been trying to do since the beginning of the year.
What's also important is that the $180 million that's put into the system in terms of operating moneys this year is based on a projection not of cutting services at all but, rather
C. Hansen: Quite frankly, hon. Chair, it's a lot of smoke and mirrors. What we are seeing in the $180 million is
I think, clearly, it's evidence that the minister doesn't understand the way the finances of health authorities work. I think he's quick to make announcements. He's quick to put out press releases which somehow are supposed to give the pretext that this government is doing something to improve health care in British Columbia -- to use his words, to get it back on track. There is nothing in this to get anything back on track. It's simply trying to keep the train rolling down the side of the embankment, hon. Chair.
Earlier the minister listed a breakdown on the equipment side. He was listing amounts for MRIs, and he was listing amounts for other equipment, which is the $70 million portion of the supplemental estimates. I'm wondering if the minister could arrange for me to receive a copy of that list and the various breakdowns. I would like to get into a breakdown of the $40 million that we have going into the Medical Services Plan. I would also like to get a breakdown of the $250 million going into acute and continuing care, of which we know $180 million is going to the health authorities. We also know that $70 million is going to equipment. The minister outlined some of the equipment, and I'm wondering if he could undertake to have a copy of that made and sent over to me so that we can use that to ensure that our time here can proceed as quickly as possible.
[1520]
Hon. M. Farnworth: I want to make a couple of points. The member keeps saying or wanting to make the point that somehow the $180 million doesn't provide new services. The fact of the matter is that it does just that; it does provide new services. It's based on need. For example, in the case of the South Fraser district, their budget and their projected deficit were based on having to provide a level of service to meet the needs of one of the fastest-growing populations in the province -- not on the basis of being funded last year and having funding cuts take place but, rather, on: "What does it mean if we want to not only provide the same level of service but recognize that the population is growing at the same time, that it is aging at the same time?" -- and that requires more services to be delivered to meet the needs of that population group. That is, in fact, what the basis of the budget takes place on.
In terms of the answer around the issue of equipment, the member can receive a breakdown into general categories in terms of where the funds for equipment are going, but the specific breakdown in terms of each health authority and each particular piece of equipment will be available to him next week.
C. Hansen: Actually, I find that last comment quite surprising, because the reason we're here on a Sunday afternoon is that the minister says that
I guess the point that I was trying to make
Hon. M. Farnworth: Had the hon. member come in a moment earlier and heard the question, he would have recognized that it said "to equipment," and I outlined where equipment was going. I said that on specific pieces of equipment on
[ Page 17193 ]
a health authority basis, I'll be able to provide that information to the member next week. In terms of the allocation around equipment, in terms of the broad basis of the allocation of equipment and where it's going, I've already mentioned that in this House, and I'm quite happy to tell the member where it's going. But in terms of the exact allocation of what particular piece of equipment, that will be made public next week. Information that I'm able to provide him at this particular time, I will.
G. Campbell: I do want to go back with the minister to the issue of health authorities and their budgets. I think that the difficulty here is with regard to what the minister considers a level of service. I would expect that the ministry would be concerned with the level of service to patients -- not to institutions, but to patients -- and to the needs of patients in British Columbia, whether they live in rural communities or urban communities. When the minister says, "We are providing a new level of service because there might be more people," what he is saying is: "I am providing the same level of service to more people, and that may cost us more money." Does the minister agree with that?
[1525]
Hon. M. Farnworth: It's not only a question of providing existing levels of service to an existing population group, but in terms of
G. Campbell: Hon. Chair, I think the important thing to recognize here is that actually we are striving to understand what on earth is taking place here. We have the minister telling us, on the one hand, that there are new dollars. On the other hand, there's a $180 million deficit. On another hand, the $18 million deficit is actually providing new services, which were really old services, to a different number of people in different regions.
So let's cut to the chase. I'm sure the minister has spent some time talking with the Health Association of B.C. I'm sure he's spent time talking with health authorities. Does the minister recall in the spring when the health authorities came to him and said: "We cannot maintain service to people; we cannot maintain service to patients with the current budgets which you have allocated"? The health authorities said to the minister that they believed they were facing
Hon. M. Farnworth: The hospitals or health authorities, at the beginning of the year, outlined what was required for us, and it would be correct to say it would be around $180 million. But it's not just to say that the $180 million is to provide exactly the same level of service that you provided the previous year. Rather, it's not only to provide the level of service that was delivered the year before but also to take into account the change in population that's currently taking place and the ability to provide additional services to meet those changes in population and, in a number, to increase services in areas where you're now able to do so because of the changes that have taken place.
G. Campbell: But the minister confirms that the health authorities did say there was going to be a deficit; they were facing a deficit. The minister then, I assume, said to them: "Carry on with your program. We think we're going to receive dollars from the federal government. And when that happens, we will provide that, so that your deficit will be covered from the dollars from the federal government." Is that not correct?
Hon. M. Farnworth: They gave us advice on what it would cost to maintain not only existing levels of services but also the types of services that you would want to see in place, given the change that takes place over the coming year in terms of population, in terms of demographic and in terms of the service levels that they want to provide within their communities.
[1530]
G. Campbell: At the end of the day, though, I think the minister has got to admit that what has really taken place is that all of the $180 million that we're talking about today has been consumed with the health authorities' budgets, which were established prior to this. This is not about new programs; it is about maintaining old programs. It is about maintaining services to patients in the province or to health authorities in the province of British Columbia on the basis of individual patient needs. It is not about brand-new dollars; it's about the dollars the health authorities identified that they needed in March of this year.
Hon. M. Farnworth: No. This is about not only the provision of existing services and the ability to provide the existing level of service but also the new services that are required to be provided due to things such as population growth and demographic change. And what it resulted in, hon. Chair, was an 11.2 percent lift in the health authorities' budgets -- $489 million, of which $120 million is for new services, and on top of that, $70 million in new equipment, which also allows new things to be done.
G. Campbell: I want to focus on the $180 million. I'm sure we're going to get to the $70 million eventually, but let's not keep on trying to confuse the facts. The fact is that the health authorities came to this minister in the spring and told him that they were looking at about a $200 million deficit if they were going to maintain services to patients across the province of British Columbia. That's what they said. They didn't say: "We have a $200 million deficit if we maintain services and add services and add this and this and this." It was simply to maintain services across the province.
I think that for the minister to try to pretend that that was not the message that he received from health authorities is less than straightforward to the House, and it doesn't help us move forward and create a stable, solid foundation for improvement of health services to patients in the province of British Columbia. It certainly doesn't create a sense of confi-
[ Page 17194 ]
dence in this House when the minister doesn't understand how his own budgets work. The fact of the matter is that the Health ministry approved health authorities going ahead without a finalized budget that they knew was going to create a $180 million deficit -- according to the minister, but according to some health authorities, substantially greater deficits -- in those authorities across the province.
When did the minister approve the health authorities moving forward on that basis? And why would he approve them moving forward without a finalized budget that says: "This is your budget for this fiscal year. This is how you are required to provide services to patients. These are the dollars that you will need to make sure that patients in the province of British Columbia get the care they need, when they need it, where they live"?
Hon. M. Farnworth: The advice the health authorities gave us at that time was the best advice that was available to them, not just on the provision of existing services but on the provision of services to take into account growth in population in the communities, and the new services that are provided because that takes place. At that time, I was comfortable enough with the deputy minister telling them that they should proceed on that basis, because we were far enough along in our discussions with Ottawa to know that we were going to get an investment on the restoration of transfer payments, which in fact took place, allowing us to invest $70 million into equipment, for example.
The end result
[J. Cashore in the chair.]
Interjections.
Hon. M. Farnworth: It's really interesting listening to the members opposite say "$180 million." They don't want to talk about $70 million, and they don't want to talk about this, but the $180 million
[1535]
I'd like to give some examples of them. It allows for a 6.1 percent increase in cardiac surgery. Those are procedures that weren't done last year. It allows for a 5 percent increase in angioplasty. It allows for a 5.7 percent increase in cardiac pacemakers. It allows a 10 percent increase in the number of cardiac electrophysiologies done. It allows a 33 percent increase in the number of pacemaker extractions done. It allows a 100 percent increase in the examinations for brachytherapy for prostate cancer. It allows us to do 14.9 percent more screening mammographies than the year before. Those are new procedures, new services that weren't there the year before. That's what the budget decisions of this year allow us to do.
An Hon. Member: That's the budget we already debated.
The Chair: Before the opposition leader continues, I'd like to call on all members to go through the Chair with their remarks.
G. Campbell: Through you, Mr. Chair, I would like to ask the minister: if he knew all of this during the spring session of the House -- we had a debate on the estimates of the Health ministry, which is something that is critical to all of us -- why didn't he share that information with the House at the time? Why did he make the health authorities feel that they had to go around him to share that information with the public, and why wasn't he straightforward with us with regard to the fact that we were clearly $180 million short in terms of the budget that he'd allocated to meet the needs of patients?
Even with the litany that the minister just went through
Hon. M. Farnworth: We made it clear at the beginning of the year that we were in discussions with Ottawa to get more money into the health care system, and what I said a moment ago was that the issue around the health authorities at the beginning of the year and their request was their best estimate. It's just that: a projection. It's to ensure that there's a level of service that's delivered, including new services based on population demographic. That is in fact what has taken place. In fact, the health authorities are very happy with the fact that we have been able to address issues such as equipment funding, which is something we were working on at a time when that opposition said we would never get an agreement to do just that.
M. de Jong: I've listened carefully through the course of this debate. Here's one of the extraordinary things that I've learned. We have called this House into session for an extraordinary session on a weekend, and that's okay. We have been called specifically to discuss a supplementary allocation of spending to the Health ministry in the amount of $290 million, and the government and minister don't want to talk about $180 million of that $290 million. It's an extraordinary state of affairs and one that I think speaks volumes about the true state of affairs within government and within the ministry.
[1540]
I came here with a couple of specific objectives in mind, because I was told
I came here with a couple of objectives, because one of the things I was told -- one of the things I heard from the
[ Page 17195 ]
Premier and from the government -- was that we had to come here today because: "We want to write the cheques tomorrow."
Interjections.
M. de Jong: "We want to write the cheques tomorrow." There are people watching from all over the province because that interests them, because whatever we discuss here, presumably we can agree that some of those funds -- all of those funds -- are needed and are going to be put to work. So here's my question for the minister. The chair of my regional health board is watching, and apparently he's going to get a cheque tomorrow. That's why we had to come here today. How much is he getting in the Fraser Valley health region? How much money is George Peary, as the chair of that body, going to get tomorrow?
Hon. M. Farnworth: He's getting a lot more than he would if you were sitting on this side of the House, because five years ago you said that federal transfer cuts didn't go far enough.
Interjections.
The Chair: Order, hon. members.
M. de Jong: I'm going to give the minister one more chance, because I know he has an answer. I know he wouldn't call this House on a Sunday on the assurance that cheques were going to be written on a Monday
Hon. M. Farnworth: There's $180 million of new funding going in to this year -- $489 million total. That will be announced tomorrow. Then George Peary will find out, once this has been voted on and approved.
Hon. Chair, we have listened to the member opposite go on about nine years of speeches and broken promises. Well, you know, what we've heard from them is a litany of one. Five years ago federal transfer cuts didn't go deep enough. And where did those transfer cuts go? They went to health care. They were health dollars that this province was shortchanged on, and that member and his colleagues said that they didn't go far enough.
We've been engaged in restoring that money with Ottawa this year, and we have done that constructively and achieved that goal. And tomorrow, once this money has been voted on by this House, once this money has been passed by the House, then we will be in a position to cut the cheques and pass on restored dollars to those health authorities to deliver the services that the member wants to see delivered.
Interjections.
The Chair: Hon. members, it's difficult for the Chair to hear the debate. I would ask that hon. members speak through the Chair when they speak.
[1545]
M. de Jong: This government -- and maybe it wasn't the minister; maybe it was a desperate Premier -- has the audacity to call back the House on the basis that it purported to want to take some action on Monday. There was an urgency; there was a need for immediacy. We were going to write the cheques. And the minister responsible for the amount of money this House is being asked to appropriate by virtue of this vote can't tell us what the amount of those cheques will be.
Interjections.
M. de Jong: Some of my colleagues say: "He won't tell us." I refuse to believe that. If he even knew, I have to presume that as an hon. member, he would tell us. His own colleagues -- he didn't see it; he was pointed in this direction -- who represent constituencies right across the province of British Columbia, are shocked. I saw the look in their eyes. They thought they were going to leave here when this debate was completed and they were going to be able to tell their health authorities how much money they were going to get. But none of us know. We are being asked to debate a supplementary estimate, a supplementary appropriation of money for the government to spend, and the government can't tell us how it intends to spend it. What an abuse! What an abuse of the privileges of every single member of this House! And if you need any further evidence about what a sham this has become, you need look no further than the minister's inability to answer that basic question.
Interjection.
M. de Jong: Lots of photocopying.
The Premier said we're going to use this money to reduce waiting lists for equipment for hospital buildings. Well, you know what? In Abbotsford they want to know how much they're getting tomorrow for their hospital building, and they thought they would get those answers as a result of a debate that apparently we had to have on a Sunday, because on Monday the cheques were going to be rolling out.
I think the minister must be embarrassed.
Interjection.
M. de Jong: Well, one of the former members of the cabinet says we'll find out tomorrow. Let's start with that. Is the minister prepared to stand in the House today and tell members of this House and health authorities right across the province that if this supplementary appropriation passes, they will get their cheques tomorrow, even if he doesn't know how much they are going to be?
Hon. M. Farnworth: What's embarrassing is the histrionics of the hon. member. What's embarrassing is his refusal to recognize that the $290 million infusion into health care in British Columbia is a significant and important event that (1) needs the approval of this Legislature and (2) recognizes the significant work that has been done between this province and other provinces with the federal government in getting a restoration of transfer payments -- transfer payments that were cut in '94-95 and had taken $26 billion out of the health care system, which they said at that time did not go far enough.
That's what's embarrassing now -- to listen to the bleating of the member opposite, to somehow suggest that we're
[ Page 17196 ]
not being forthcoming in telling him where that money is going. Tomorrow, when this vote is done, we will be in a position to start to notify the health authorities exactly of the specific dollar amounts that they are getting. But what I can tell the hon. member that this money going into the health care system is going to be able to do in terms of services is an 11 percent increase in pediatric service. That's what this money is going to be able to do. That's what the health authorities in Abbotsford are going to be able to look forward to. It's going to be able to see a 24 percent increase in marker screening. It is going to see a 14 percent increase in renal dialysis, in our ability to provide renal dialysis for people on kidney services -- on kidney dialysis. That's because we are investing $290 million into the health care system and $180 million into the acute care system. That's significant, and that's what we're here doing today. He will have the specifics on a particular number available to him tomorrow, when the health authority knows as well.
[1550]
M. de Jong: Hon. Chair, I think we've just had the entire debate summarized in an aside comment from the minister. You know what he said to my colleagues? "Let's pass it first." Isn't that typical of the NDP? Isn't that typical? "Pass it first, and we'll worry about the details later." Well, you know what? We don't trust them anymore, Mr. Chair. We've set some kind of record here today. It usually takes at least a couple of weeks or months to catch the government out on misleading British Columbians. But no, it's happened within the span of about 36, 48 hours.
This is the news release that the government issued on September 15, 2000 -- the Premier quoted. I'm not making up the quote. It's his news release. "I hope this new spending receives speedy passage," the Premier said. "When Ministry of Health officials go to work on Monday, I want them to be able to start cutting cheques to B.C.'s health regions." Well, if they do, I guess they're sending them blank, because the minister can't tell them how much to put in the cheques.
I just want to make sure we all understand. There aren't going to be any cheques in the mail tomorrow. The ministry doesn't know how much it's sending. The ministry doesn't know where they're sending it. In fact, the ministry and the government don't really know anything at all. What the government knew was that British Columbians are fed up with their mismanagement and that we better be seen to be doing something. Maybe while people are channel flipping from football game to football game, it'll help us a little bit if they see us sitting in Victoria on Sunday. Maybe that'll help. Maybe we can create an illusion of action, kind of like the illusionary action plan that we've already discovered contains no real new funding.
I had a whole series of questions about how that funding was going to break down in Abbotsford, the various envelopes that the Fraser Valley region was going to receive, but I can't even get a global figure. And absent that information, the minister still presumes to stand here with a straight face and say, as he did just a moment ago: "I can't really tell you much, but I'd really like you to give me the money." Well, Mr. Chair, it is awfully difficult when basic questions -- basic information about how this money could be put to work and would be put to work in my community
I have a hospital just across the river from me -- actually the hospital I use, the Mission hospital. I don't suppose we'll hear a great deal from the member who represents that community today. But one of the things I wanted
[1555]
Interjections.
M. de Jong: My colleagues say I'm being too harsh, so I'll ask
Hon. M. Farnworth: You know, I'm listening to the member rant and carry on in his sort of histrionic fashion, which he likes to do. But he seems to be missing one of the key fundamental points in this whole thing, this whole debate. A moment ago I just outlined for him where moneys are going on a provincewide basis.
The specific allocations to the health authorities will start tomorrow. But where the money is going, as I just told him a few moments ago, is in an increase in renal dialysis, an increase in cardiac surgeries and an increase in procedures performed in B.C. hospitals. It's an 11.2 percent lift over last year's budget; that's a significant lift to each health authority in this province, whether it's his Abbotsford health authority, whether it's the Mission health authority -- whatever health authority. Once we have finished this debate, I'll be more than happy to get the hon. member the specifics for any particular institution that he wants.
M. de Jong: Well, now I am confused. I won't prolong this. Is the minister saying that the information about funding on a region-by-region basis, the regional breakdown, is available, and he doesn't want us to have it until tomorrow? Is that what he's saying?
[T. Stevenson in the chair.]
An Hon. Member: Wait for it. He's going to say: "Stay tuned."
Hon. M. Farnworth: No -- you lose. I'm going to say that we are putting the final touches on the allocations in terms of some of the projects and programs that will be going forward, and you will be notified of the specific allocations, starting tomorrow.
M. de Jong: Well, I am baffled. Can the minister indicate what additional information the ministry intends to receive today on Sunday, between now and tomorrow, that will allow it to make those decisions? What exactly is the ministry waiting for?
[1600]
Hon. M. Farnworth: It's a very complex process. We are reviewing to make sure that everything has been done cor-
[ Page 17197 ]
rectly, because when you're putting an additional $17 million in new equipment money into the system, the equipment lists alone are enormous. You want to make sure that everywhere is getting the maximum amount of equipment that they can get. In terms of when you're putting in an additional $180 million in terms of patient care, you want to make sure that each health authority is getting everything that it is entitled to; that will be completed by tomorrow. And the member will start to get the specific allocations. He can have his specific allocation for Abbotsford; it will be ready tomorrow.
M. de Jong: What time?
Hon. M. Farnworth: In your case, hon. member, I'll make a special appointment sometime after 3 o'clock.
M. de Jong: Hon. Chair, just so the minister understands, I don't actually want any special treatment. I want to be able to debate this piece of supplementary appropriation with some information at my disposal. That's what I want to be able to do, and that's what every member of this assembly wants to be able to do.
Hon. Chair, I am exercised enough about this that I think the minister or the ministry deserves an opportunity to call their records, because I'm not sure the minister has been clear about whether or not a list, a regional breakdown on this funding, exists. If it does, maybe we should recess for 15 minutes and he can check, because every single member of this assembly deserves to have that fundamental information available to them.
I'll tell you what's abundantly clear: there ain't going to be no cheques issued tomorrow. For the sake of an hour -- 15 minutes or an hour -- I'd like to have that information. So I'm going to suggest to the minister that we take that recess so that we can have that complete set of information regarding the regional breakdown for this funding. To be perfectly blunt, I'm a little bit sick and tired of the games that are being played here.
Hon. M. Farnworth: I want to make sure that that member does not get special treatment, because we are debating a significant amount of money coming into the health care system. The specific amount for each hospital, for example, will not
Interjections.
Hon. M. Farnworth: Just relax.
An Hon. Member: Where?
Hon. M. Farnworth: The member asks where. It's an 11.2 percent increase, on average, for every health authority in the province, which is over and above what we had last year. And that's a significant amount of money. That's what's important. That money is going into the system to provide more services than we've been able to provide before.
Interjections.
Hon. M. Farnworth: The member asks why and where. Well, the reason is because we have an agreement with Ottawa which is allowing for the restoration of transfer payments back to the provinces, which have been cut and put enormous strain on the provinces. Where? It's going to be into every single health authority in this province -- the cheques, which are going to start to go out tomorrow.
M. de Jong: Well, hon. Chair, I guess it's abundantly clear to everyone by now that we have been called here under horribly false pretences. There are, I think, in the neighbourhood of 50 regional health authorities
[1605]
An Hon. Member: Fifty-two.
M. de Jong: It's 52, I'm told.
Who were led to believe that as a result of this debate -- particularly the specific amount included within it but actually the whole amount -- they would learn about moneys that would be coming in their direction. That was the information. That was the promise. That was the indication in the Premier's own news release. That was the urgency.
I just want to remind all hon. members that this government, which has said that we're going to do things differently
G. Campbell: I just want to try and get the minister focused on what really should be, I think, the fundamentals of accountability. First, we have to know what is expected to be spent. In terms of this particular discussion we've been talking about $180 million. Second, we should know where it is going to be spent. Where does the minister intend to spend those dollars? We've found out today that he intends to spend those to cover the deficits which he's known about since the spring. Third, we should know where geographically it's going. There are 52 separate hospital authorities in this province, all of whom have been told that they are going to get resources tomorrow, and the minister is saying today: "Trust me." I want to tell the minister that we don't trust him, the public doesn't trust him and patients in British Columbia don't trust him.
One of the critical things that we have to do to start rebuilding confidence in our health care system is be straightforward and upfront with people. Once again, the minister has failed that most fundamental test. The reason that we are as skeptical and the public is as skeptical as I am suggesting today is that it was in May of this year that this minister -- not one of the previous five or six ministers but this minister -- said that every single health authority would have their budgets completed within two and a half weeks. Two and a half
[ Page 17198 ]
weeks would have taken you to the first week of June. This minister failed to provide those health authorities with the resources and with the definite budgets that they needed. He has failed to give them the security they can use to plan for the year. He's failed to give them the security that they need to plan for the patients that are needing their services across the province of British Columbia. He's failed the caregivers, whether they be nurses or doctors or physiotherapists. He's failed the employees, and most importantly, he's failed the people of the province of British Columbia.
This Premier has said that he wants to be open, so my question today to the minister is simply this: "Tell us what you are spending." And you know today. We watch the paper flow around; we watch the staff trying to figure out how you spend money and where you spend it and who has authority. We can see that here. They can't see it at home, but we can certainly see it here. This minister knows where he's spending that money. This minister knows the equipment that he's planning to buy with that money and where he intends to allocate it.
And if he doesn't, he should. We believe he does, and I believe that he has an obligation to this Legislature, to every member of this Legislature, every member on the government side and every member on this side, every single one of whom cares about health care and cares about the patients of British Columbia. He has an obligation to give us that information.
[1610]
Hon. M. Farnworth: Well, I guess what we're seeing is the new era of the opposition -- and I make the point being "error." Because listening to the Leader of the Opposition
Interjections.
Hon. M. Farnworth: Your Leader of the Opposition said, in response to the transfer cuts of five years ago, that they did not go far enough. And this province has been paying the price for those transfer cuts for the last five years.
Interjections.
The Chair: Order, members. Order.
Hon. M. Farnworth: We were told earlier this year that the provinces would not be getting an agreement with Ottawa, that there was no way we could get this money into the health care system, that there was no way that the government would see this money. Well, guess what. We've got an agreement with Ottawa, and it's seeing a significant amount of money being invested into health care this year in terms of equipment, directly from Ottawa and for the following five years, starting with an additional $425 million. This province this year is putting in an additional $180 million on top of that and another $40 million to deal with physicians.
The $180 million is being allocated on a health authority basis, on an average lift of around 11.2 percent. I know
An Hon. Member: How do you know that?
Hon. M. Farnworth: Well, do the math, hon. member. Take the money
In terms of the health authorities, specific allocations will be available tomorrow. In terms of what it means, though, for health authorities, it's a significant increase. In the case of the Fraser Valley
Interjections.
The Chair: Order, members.
Hon. M. Farnworth:
Interjections.
The Chair: Order, members, please. Let the minister speak, please.
L. Boone: Point of order, Chair.
The Chair: Sorry, member.
Interjections.
The Chair: Members.
L. Boone: Point of order.
The Chair: I recognize the member for Prince George-Mount Robson, who is now in her correct seat. Thank you.
Point of Order
L. Boone: Hon. Chair, in the fray that was going on there, I heard a member refer to the minister as a fraud. I do think that is unparliamentary language, and I would ask that
Interjections.
The Chair: Thank you, member.
L. Boone: I would ask that the member retract this.
Interjections.
[1615]
The Chair: Thank you, members.
The Chair did not actually hear the member referring to the minister as a fraud. However, if I'm incorrect, and the member wishes to withdraw, please do so.
G. Campbell: Unfortunately, I think what we reap today is the benefits of a government that refuses to include the
[ Page 17199 ]
people of British Columbia in any discussions about health care. The minister displays an appalling ignorance of what many British Columbians have recommended as ways of curing the health care crisis that has been created by the NDP over the last little while.
The minister may have noticed that people in rural communities across this province are not getting the care that they need and that they deserve and that they pay for. The minister knew for four years that that has been a brewing crisis. The opposition recommended to the minister two years ago that $100 million be put on the table and that the Legislature, all of us together, go out and work with those communities to provide a positive, constructive, thoughtful response. Instead the minister has gone from one community to the next, from one crisis to the next, and more important than that, patients in every single one of those communities have been put at risk because of this minister's and this government's incompetence.
Just in the last couple of weeks the dean of nursing has pointed out quite clearly that this government doesn't get it. It was four years ago that this side of the House said to this government: "We should be investing in training nurses. We should be trying to hire 2,300 additional nurses between 1996 and the year 2000." And this minister finally figured it out last year and managed to get about 25 percent of what he'd allocated. That's the crisis in health care in British Columbia: it's this minister and this government's incompetence.
The last minister who I recall being as forceful about how he wasn't going to give information to us was the minister responsible for B.C. Ferries. It was the minister who said, "Everything was taken care of. Trust us, it's only going to be $210 million. Oh no, it's going to be $290 million. Oh my goodness, it's 468 million bucks," which that group of incompetents wasted and is not available for health care, is not available for patients in the province of British Columbia.
So I want to help the minister. I want the minister to get how you actually try and run an accountable, thoughtful, organized, constructive government service. You decide what you're trying to deliver in terms of services to people, to patients across this province regardless of where they live. We do not support the two-tier health care system that this government has put in place between rural and urban communities.
The minister has to know the services that are required by patients in communities under his responsibility. The minister has to know how much money will be required. The minister has to know where he's going to allocate those resources. And the health authorities have got to be given the responsibility and the opportunity to make those allocations in a thoughtful and constructive way. The Legislature, when they approve that resource, that vote, has an obligation. And indeed the minister has a responsibility to share information with the Legislature, so we can help the minister. I understand that the minister may care more about his riding than the riding of someone on this side of the House. But I don't think British Columbians think that way for one single minute; they want every British Columbian to be cared for.
For this debate to be constructive, all we are asking the minister to do is something that should be fundamental to how a parliamentary democracy works. We want the minister to say: "This is what we are spending. This is where we are spending it." We know today. The minister knows today, and he should stop the charade that he doesn't. The minister should tell us exactly what he is going to allocate. What are the strings that are going to be put on these resources to health authorities? He knows that today. When the minister does that, we can have an open, honest, straightforward debate that may actually give British Columbians a sense of hope that we can take care of patients and put the minister's politics on the back burner.
[1620]
Hon. M. Farnworth: Hon. Chair, I'd like to make the following point to the hon. member: this is supplementary estimates. We've already been through an estimates debate that outlines exactly where funding goes and exactly what the priorities and policies are, exactly where the priorities are, and the policies and procedures in terms of what programs are being offered by the ministry, in terms of what programs are funded by the ministry and in terms of the role of the health authority. The reason we are here, hon. member, is because there is $290 million in additional funding going into the health care system to fund the priorities that we debated earlier in estimates.
Interjection.
The Chair: One moment, minister; please take your seat. Members, when the Leader of the Official Opposition spoke, no one interrupted at all. I'd ask that you please listen to the minister.
Interjection.
Hon. M. Farnworth: Perhaps, hon. Chair, I will sit down, and you could repeat your comments for the hon. member.
But where I was going in what I was saying was that we have already in this House debated estimates -- debate in terms of what the policies of the ministry are, where the funding allocations go in terms of broad policy objectives and what it is we are trying to achieve. This is supplementary estimates, because there is an additional $290 million going into the system -- $180 million going into the acute care system, the hospitals, health authorities of the province -- to fund those initiatives and those policies that are currently in place and have been debated in this House during the estimates process.
A. Sanders: We are here on an emergency basis, and we are here with 48 hours' notice, to look at the spending of $300 million within the Ministry of Health. That in itself is an emergency. Unfortunately, the minister has been unable to give us any idea of where that money is going, other than in large amounts. There is no allocation to any of the districts and none of the information that we've actually come here on Sunday for.
There has only been 48 hours' notice for members to find information, to get their thoughts together and to investigate why we're coming back. In fact, most of us had no idea of the content of the information until we arrived here today at 1 or 2 o'clock.
In 1990 the Members' Conflict of Interest Act passed in the B.C. Legislature. Section 9 of that act requires a member who has reasonable grounds to believe that he or she is in a conflict of interest to bring that matter before the assembly. As
[ Page 17200 ]
a health care provider, I wish to acknowledge that I have tried to seek information as to whether I had any conflict in participating in a supplementary debate. Because it has been the weekend, I've been unable to get that advice or to seek any answers from the conflict-of-interest commissioner. But based on past practices and past rulings and on my efforts, unsuccessfully, to seek a ruling, I wish to provide and proceed with discussion of the health action plan which has been brought to this House today by the Premier.
Under standing order 18, I may speak in debate and propose amendments. We are not talking about a supply bill; we're just doing the estimates, so there should not be any problem there. And under standing order 18, I am not entitled to vote upon any question in which I have a pecuniary interest. I would not choose to vote if I felt that was the case.
One of the most disappointing things about today, for me personally, has been the acquisition of the B.C. health action plan. This is a three-page document that is supposedly going to outline a brand-new direction in an $8 billion ministry. Health care is probably the most important thing to every single British Columbian. There is no one in this province who does not worry about their health care system and how they're going to get health care when they need it. When I look at this three-page health action plan, I find absolutely no action whatsoever.
My first question to the minister is: what is the budget for advertising that presumably will begin tomorrow, from what the minister said
[1625]
Hon. M. Farnworth: It will come out of the Health communications budget.
A. Sanders: Could I have the figure, please?
Hon. M. Farnworth: This is a supplemental estimates, and I will get that
Interjections.
Hon. M. Farnworth: In answer to your question, this is a supplemental estimates debate, and that allocation, in terms of coming out of the Health communications budget, would have been something that we would have discussed earlier, in the previous estimates debate on Health. However
Interjections.
The Chair: Members, please
Hon. M. Farnworth:
A. Sanders: If the minister has suggested there's an 11 percent lift, would he then propose there'll be an 11 percent lift to the communications budget to advertise the plan in accordance with the new money?
Hon. M. Farnworth: No.
A. Sanders: How many commercials can British Columbians expect to be run tomorrow on the health action plan?
Hon. M. Farnworth: I'd like to make one point clear for the hon. member. There is a communications budget in the Ministry of Health. That's already been debated, in terms of the estimates that have already been passed by this House. I told the member that I would get the budget number for her on exactly what it is, in terms of what we spend on communications.
In terms of the money that's being requested today -- the supplemental estimates approval for the $290 million -- none of that money is going to communications. All of this money is going to three areas. One is for $70 million to equipment. There's $40 million for the physicians' package and $180 million to the acute care system. It is not going to the ministry or to the ministry's communications budget for ministry operations.
A. Sanders: Will there be commercials on the health action plan tomorrow?
Hon. M. Farnworth: There will not be commercials around the allocation of this money to health authorities tomorrow.
The budget for communications for the Ministry of Health for the year is $2.9 million.
A. Sanders: Will there be television ads this week on the health action plan or allocations of this money?
Hon. M. Farnworth: I'll just repeat for the hon. member: there's $2.9 million in the communications budget which was passed earlier this year, but none of the money we are allocating here today will go to commercials. It is all going to health authorities, to equipment and to physicians.
[1630]
A. Sanders: What advertising was scrapped in order to fit the $2.9 million advertising budget from the previous estimates?
Hon. M. Farnworth: The ministry's communications budget of $2.9 million is set at the beginning of the year and was debated during our last estimates. That is not based on whether or not there's supplemental estimates and whether there's additional money coming into the system. So that budget is set. I'll repeat my answer for the hon. member that of the moneys that we are dealing with here today, none is going to advertising. None of that money is going to communications. All of that money is going to the priorities we have outlined and which are the priorities of British Columbians, which are to see more money going to equipment, to see money going to physicians and to see money going into the health authorities to provide patient care.
A. Sanders: Will you be advertising the B.C. health action plan?
The Chair: Member, the Chair doesn't really see the relevance of the line of questioning in regards to the Medical Services Plan or the acute and continuing care, which is what we're debating.
Hon. M. Farnworth: I'll repeat again for the member: none of the money that we are debating here today is going
[ Page 17201 ]
into communications. During the course of the year there is a communications budget in place; there is a communications budget within the ministry of $2.9 million. From time to time during the year we do advertise around important issues -- whether it is preventive health care, whether it is around primary care issues, whether it is, for example, the flu vaccination season and the flu vaccination program that we're doing, which is coming up. All of those things are part of the health action plan, and that's part of the ongoing ministry operations that we do through the course of the year. But there is nothing from today's allocation that is going into any communications budget.
A. Sanders: Sometimes what's not said is more important than what is said, and I look forward tomorrow to watching the commercials on the B.C. health action plan and all of the new and wonderful information that this government will be putting forward as to how we will see improvements in a system where there are no additional moneys. We've made that very clear today. There is no new money; there are no new initiatives. There is status quo and perhaps, in some communities, less than status quo, and time will show that.
I think the thing that should never be forgotten here is that we're talking about real people. We may in here talk partisan politics, and we may talk rhetoric. We may talk about what our opinions and our ideals and our values are. But we're talking about people's lives who live in Quesnel and Prince George and Vanderhoof and the Kootenays and the lower mainland and the Okanagan. We're talking about people who try to get their babies delivered in areas where they can't get care.
We talk about people who have brain tumours, who have to travel from Terrace down to Vancouver to try and get care. We talk about the unsaid difficulties they had in getting health care in British Columbia, both from a financial and a geographic point of view. Never forget that that's what you're here for. Never forget that we're talking about people. We're not talking about the NDP or the B.C. Liberal Party; we're talking about people and their lives and what's going on for them in their communities where they live. Right now and in the last nine years, in terms of their health care, they have seen deterioration after deterioration. This is not a situation that we should be proud of, and the fact that we're here today is not for an emergency but for a nine-year festering illness that this government has put on health care in British Columbia.
Hon. Chair, this is not an emergency debate. There is nothing new going on, especially in the rural areas. Nine years ago, in 1991 when this NDP government was elected, there was the start of a class warfare against rural physicians and physicians in general. I can remember the Minister of Finance -- I think at that time the Minister of Health -- talking about greedy doctors in the north wanting more compensation for on-call work. I remember discussions with those same ministers about overdoctoring in Quesnel, a community that in 1991 was told it was overdoctored -- overdoctored.
[1635]
I can remember a number of issues to get rid of doctors in the north so that we could get rid of all of those doctors based a lot on the kinds of economics of Robert Evans and many others: limiting billing numbers, stopping immigration, stopping in-migration of physicians from other provinces, stopping graduation or at least limiting the number of graduates from medical schools, providing capitation proration and saying that there are too many doctors in British Columbia.
Well, the chickens have come home to roost. Let's look at some of those communities. Ten years ago Quesnel was a community that had a hospital for potentially 100 beds. There had been a hospital there for over 100 years in some form. Within a period of three or four years they went from a hospital of potentially 100 beds -- with 72 beds open -- to a place of somewhere around 29 to 38 beds. They went from having a relatively stable group of overdoctored physicians, who were no longer there.
We found fuel from the Ministry of Health at that time, saying that there were too many doctors, and these doctors were expecting too much to work in communities like Prince George, Williams Lake, Quesnel and other places in rural British Columbia. We heard it in the House, we heard it in the press, we heard it in the ads, and we certainly heard it in the rhetoric of negotiations.
Now what do we have? We have a community with no stability, a community that would like to have recruitment of individuals to live there as a retirement community. But guess what retired people want; they want health care. We have a community that this summer had no ICU. We have a community where if you went with a suspected heart attack into the ICU, where there was no specialist, you were flown to Vancouver for your overnight care and then had to figure out how to get home. We have a community that was unable to look after itself in any way, shape or form. People do not go to communities where they don't feel safe. And what we've got in rural British Columbia right now is no stability and no feeling of safety, especially for the group of folks who are getting over 50 and have additional health care needs.
Hon. Chair, when I was in Quesnel not very long ago, what I found was that there were very few nurses in the hospital. Not only were there 30 beds with patients, with a psychiatric patient next to a medical patient next to a surgical patient, and no ICU, but the nursing supervisors were working as general duty nurses because there were no nurses in the hospital. So what does all that mean?
And what does this government have as a solution after nine years of a chronic problem for communities in northern British Columbia? They have the B.C. health action plan. This is the plan that we're going to see lots of advertising on over the next little while, because it has principles, priorities and implementation strategies -- lots of things that you can wrap commercials around that really don't mean very much.
I'd like to ask the minister a few questions about some of this material and really what the principles mean in terms of real-life values. The first principle in this report says that the B.C. health action plan is to "modernize and strengthen B.C.'s public health care system
Interjections.
The Chair: Members, just keep it a little quieter, please. Thank you.
Continue, member.
A. Sanders: First question: what does this principle mean, to "modernize and strengthen B.C.'s public health care system to improve patient care"? It means nothing at all to me. What does it mean to the minister?
[1640]
Hon. M. Farnworth: I think what the member needs to realize is that one of the key principles and the one that she
[ Page 17202 ]
just talked about is that we want to ensure that British Columbians have access to the latest and most up-to-date procedures, that the quality of health care is something they can count on and that it's there when they need it. That, I think, is an underlying principle in our entire approach to health care.
I think one of the key things that we need to recognize is that we have put in place a plan that will deal with that. One of the cornerstones of that plan has been to ensure that we bring stability to the system, because we have a very good system in this province, and we have a very good health care system in this country.
One of the things we have been working very hard
What's also important is that, look, this is urgent; it can't wait until next year. The member's comments around "false pretences" are just straight nonsense, because what we have been doing is ensuring that in our discussions as a government and our policy as a government, health care is our number one priority. That's why we went out and got the agreement with Ottawa. That's why we worked constructively to get that agreement with Ottawa to restore the transfer payments at a time when a lot of observers in the system said that that couldn't take place. Well, in fact it has. That brings the stability that we need into the system which I'm talking about.
However, the full impact of that agreement doesn't start to make itself felt until next year, and so we had to take action this year to make that take place. That's why the funding is being asked for in these supplemental estimates today: so that the health care action plan -- which is based on the principles that you're now asking questions about and is also based on a cornerstone of restoring some of the financial and fiscal integrity into the system which disappeared with the elimination of transfer payments and the cuts that took place five years -- can take place.
Interjection.
Hon. M. Farnworth: The hon. member says: "That's not where it disappeared to." Well, $26 billion was removed from the system -- $26 billion for the integrity of the health care system
A. Sanders: It's refreshing to hear the minister recognize that maybe perhaps there is an emergency. It's important to also remind that minister that in December of 1999 the then Premier of the NDP, the member for North Coast, said there was no health care crisis. That has been the stand of this government since 1991 when they took power: "There is no health care crisis." I quote the member for North Coast: "There are some difficulties, clearly. You can't deny that there were some problems in emergency rooms this past week. Does that constitute a crisis? I don't think so. We are going to fix it."
That's the kind of rhetoric that we have heard over the last nine years. It hasn't changed. There's been too much health care, too many health care workers, too much going on, and this government has tried to do everything it can to decrease the amount of health care delivered to British Columbians. And guess what. It's worked.
[1645]
Let's look at the examples of how it's worked: (1) a $125 million, seven-year mental health plan that never existed, (2) a lack of long term care beds identified in 1991 in the Seaton report that have never been fixed and that we are having trouble in acute care because of at this time, (3) hospital equipment that is so poor that developing nations have rejected taking it secondhand. We have had rejected medical equipment from Third World countries -- equipment that's being used in the Victoria region hospital district.
We have had wait-lists grow under this government. Since 1996 we have had wait times increase substantively for surgery. From 1995 to 1999 median wait times have jumped 26.9 percent for general surgery, 38.7 percent for urology surgery, 53.7 percent for knee replacement, 71.4 percent for gynecologic surgery, 82.4 percent for hip replacement and 126.3 percent for neurosurgery. These are according to the government's own wait-list times.
Under this government we have had, for the first time in a century according to the president of St. Paul's Hospital, St. Paul's in an untenable position of operating over budget, with a $7 million deficit. We've had emergency room crunches in 1999 where the president of Vancouver General has said: "In my 28 years in this field in the lower mainland, this is the worst experience that I have ever had as an administrator." At the same time we have had a Premier at that time, the Premier from North Coast, who said that there was no health care crisis. We have had nine years of mismanagement of health care that is extreme, severe and has example after example after example.
When I look at a principle of the B.C. health action plan brought forward today after nine years of trying to tinker with the system
Another principle is to maximize preventive care and wellness. Could the minister please explain to me what on earth that means?
[ Page 17203 ]
Hon. M. Farnworth: The member made a number of comments in her statements that I'd like to address. But in response to her specific question, I think one of the key things that's important in terms of ensuring that we have a healthy and well population is that they have access to the information they need to ensure that at a basic primary public health level those services are there for them.
I'll give the member some examples of initiatives that have been undertaken in this past year, which will illustrate what I'm talking about. There has been the new cardiac information centre that has opened up at St. Paul's, for example, which allows the public access to the latest information in terms of cardiac procedures -- what they should do, what to expect. There have been similar initiatives taking place in terms of treating Alzheimer's -- to help Alzheimer's patients. There is the province's initiative, for example, around the flu strategy and the information that's required around that. Those are very important basic health care elements that need to be dealt with.
The member also made her comments and her points around wait-lists, for example. The preliminary data to June 2000 indicates a reduction in wait times for a number of surgical procedures, including hip and knee replacement surgery and cardiac surgery. Waiting times were up slightly in 1999; they did increase. But the data to date shows that so far this year, in the year 2000, they have in fact come down. Between 1995 and 1998 they remained steady.
[1650]
We are very concerned about ensuring that what we do improves services to patients. That is the goal of our health action plan, and that is one of the key principles upon which it is built. That's one of the reasons -- because the member also talked about the ability to access services and wait times -- why we're putting the $40 million on the table for doctors: to ensure that there are physicians in communities throughout British Columbia, to provide significant incentives and significant retention and recruitment bonuses to attract physicians to those places and keep them in those communities. That is also part of it. That's another concrete area where the government is showing its commitment to improving patient care and access to the services that they require.
A. Sanders: I think the minister should recognize that the wait-list times went up significantly under the NDP, and if they've come down a little bit in terms of percentile, that's good, because they're coming down from very high levels. The numbers I have given are from the Ministry of Health's own statistics.
With respect to rural care and initiatives that are going on in trying to improve rural care, I think there are two things that need to be recognized. Number one, the government created the problem in rural care, which wasn't there in 1991. It was created under this government, and now they're trying to escape from it or trying to save it before it's an autopsy. The second is that the member for Vancouver-Point Grey, the Leader of the Official Opposition, two years ago suggested a long-term, five-point plan -- $100 million -- into looking at the rural doctor situation and consultation with communities through the select standing committee. If that had been done two years ago, we wouldn't be here today.
When I look at this maximized preventive care and wellness, what the minister said does not give me any information whatsoever. In fact, I don't intend, actually, to get any information, because I don't think there is any to get. What I want to know are some specifics. Preventive care to me means things like physiotherapy, massage therapy and a number of other initiatives. Are there going to be additional moneys going to those areas that are not covered or are partially covered now by MSP premiums?
Hon. M. Farnworth: The answer to the member's question is that in the overall health budget that we debated in terms of estimates, there are moneys allocated to deal with the specific issues that the member raised. However, this particular allocation that we are debating here in supplemental estimates is to do three things. It is to put new equipment into hospitals and health authorities' hands throughout the province; that's $70 million. It is to put $180 million into the health authorities to deliver services in the acute care sector, and it is to put $40 million into physicians' recruitment and retention so that we can deal with the issue of physicians in rural communities. So the things that the member asked about are funded out of the regular health budget that we debated earlier this year.
[1655]
A. Sanders: Again, none of those initiatives will maximize preventive care and wellness. With respect to the minister, he keeps coming back to the $70 million for equipment. When you're having your used ultrasound equipment rejected in Haiti and Cambodia and east Africa as unusable, probably it is time in British Columbia hospitals to upgrade and get something that could be used on real people at a time that was appropriate and could do important investigation.
The minister
One of the priorities that the document mentions is hospitals: "New funding, prevention and innovation will help reduce pressures
Hon. M. Farnworth: All of them. If that's their need, that's where the money will go.
A. Sanders: Is there an outline of the number of additional emergency beds that will be available to the individual hospital regions?
Hon. M. Farnworth: The health authorities will be telling us within the next month where it is they intend to spend the money. The money will be allocated on the basis of where their need is and where their pressures are, and it will vary from health authority to health authority. They will tell us where they will allocate the money within 30 days.
A. Sanders: Does the minister understand, hon. Chair, that if there is a $180 million deficit within the regions this
[ Page 17204 ]
year and we're putting $180 million in, there will be no new beds in the emergency of any hospital in any region in British Columbia unless something else is cut?
Hon. M. Farnworth: We are talking about moneys to the health authorities that will fund services that they have identified -- services that they want to provide. That will mean beds opening up, and it will mean operating rooms opening up. It's on their priorities. That's where the money is going. They have identified what their requirement is, and they are the ones who will make that determination within the next 30 days. So in fact it will mean beds opening up; it will mean operating rooms opening up. That's what this does.
A. Sanders: It would be really nice to receive one fragment of evidence that that is going to occur. I will suggest that this time next spring we'll be standing in this House debating the estimates of Health, and there will be no new beds in any emergency department unless something else has been cut, because there is no new money.
How many additional long term care beds are there in the priorities to free up acute care beds as a result of the health action plan?
[1700]
Hon. M. Farnworth: Again, I'll come back to the answer that I gave a moment ago, and that is that the health authorities will submit their allocations, how they intend to allocate the money, within 30 days. Again, it depends on the needs of the particular health authority as to where they put the allocation to meet the pressures. At the same time, within the ministry's regular budget there is the work that's taking place on long term care, continuing care. That's something that continues to proceed. But in terms of this allocation that's here today, that decision will be made by the health authorities.
A. Sanders: Once again, if I look at my region, we are over 100 long term care beds short, and we are certainly not the worst-off in the province. The South Okanagan is even worse. How many new long term care beds will there be to free up our acute care for people who are sick and need those acute care beds?
Hon. M. Farnworth: That decision is made by the health authority, and they will make that based on the need in their region and on the priorities in their region. So they will make that allocation within the next 30 days and let us know.
At the same time, the work -- we have been ongoing since, you know, the beginning of the year -- that has been part of the regular health care budget, in terms of the changes and the impact that will have on the system, will continue. So it's a question of: what are the health authority's priorities? When are they going to implement it? They make that decision and submit that to us in the next 30 days.
A. Sanders: Hon. Chair, I think at this point it's clear to me that I'm not getting any more long term care beds in the North Okanagan. And there won't be any more emergency beds than we already have unless other things are cut and the health region decides that we are going to have an additional emergency bed at the expense of something else.
One thing we do have in our region is a hospice house that's been built by private funds. The regional health board will not fund its operating costs, nor will government. Hospice is one way that we could free up acute care beds by having dying patients go to hospice, which is a much more suitable service. Could the minister explain to me how hospice fits into the health action plan?
Hon. M. Farnworth: Again, the health authorities will come back and let us know where hospice care, palliative care, fits in within their overall plan for their particular region. I can tell the member that again that is something they come back to us with within the next 30 days.
A. Sanders: Well, hon. Chair, in our region the regional health board has said it has no money for funding hospice. So we have a six-bed hospice facility already built by private funds that stands vacant, while we have people on extensive waiting lists for surgery. We have a waiting list of 1,400 people in the Vernon-North Okanagan area.
One of the priorities in the health action plan has been prevention and innovation, at a time when what government really, truly needs is manpower. What initiatives is the minister going to put forward to get manpower within health care?
Hon. M. Farnworth: Actually, I want to get manpower and womanpower into the system. I want to ensure that both men and women have the opportunity to enter the health care system.
[1705]
An Hon. Member: People power.
Hon. M. Farnworth: People power: that's a good phrase, hon. member.
There's a number of initiatives that are underway. First, in terms of nurses, as the member knows, there are the 400 seats that have come on stream this September to deal with part of the issue around getting nurses into the system.
The second portion, or one of the key issues that we're dealing with here today, is the $40 million that's allocated for recruitment and retention of physicians in rural and small-town British Columbia. It's a way of ensuring, with an average of $40,000 per physician, that we can attract physicians to communities throughout British Columbia, whether it's Cranbrook, Fort St. John, Prince Rupert, Terrace, 100 Mile -- wherever it is. We see this as one -- not the only, but one -- of the ways in which we can deal with the issue around attracting people to communities in British Columbia. That's why in today's supplemental estimates there's $40 million which is earmarked for physicians.
An Hon. Member: Do you think that's reasonable?
A. Sanders: The member for North Coast asked me if it's reasonable. What I find reasonable is to do what you say you're going to do. If you're going to hire 400 nurses, you don't hire 104. Last year this government said 400 new nurses would be practising in British Columbia; we have 100 additional RNs. For the last five years we've been short of nurses, and you don't have the solution. You don't even have an idea of how to fix the problem. You've created the problem.
[ Page 17205 ]
This side of the House said in 1996 that we needed to hire 2,300 additional nurses. We would have done that if this side had been in government, and we wouldn't be in the situation this government has caused.
Hon. Chair, over the last four or five years we've been trying to retain nurses. What initiatives that we have not previously had up until this time are being brought in, in the supplemental estimates, to retain nurses?
Hon. M. Farnworth: Well, again, you know, we hear about a new era from the opposition, and again, I'll point out another error from the member's comments. She says only 104 have been hired. Well, in fact, we've made 87 percent of the target; 347 nurses have been hired in the first two components of what we said we wanted to do. So I guess that's the "new error" from the opposition.
In terms of the money that's going to the health authorities and money that's included in this allocation, there is about $26 million for current training of nurses in the system. That allows for the upgrading and retraining of nurses, who can do more work and can do different positions that they have been able to do previously. On top of that, as was announced earlier this year, the 400 new training seats came on stream.
It's very important, I think, that we get something on the record. The Leader of the Opposition mentioned something before about the province not "getting it," quoting an individual from UBC. I think it's important to comment
Interjection.
Hon. M. Farnworth: The member says it's the dean of nursing. That's true -- the dean of nursing from one particular school who felt that her program should be increased at her school.
[1710]
Well, one of the things we feel very strongly about on this side of the House is that every British Columbian who wants to enter nursing should have the opportunity to do that, and you don't accomplish that by ensuring that all the spaces or a big chunk of the spaces are located in one school in British Columbia down on the lower mainland.
We do get it. We get it that a kid in the northeast part of the province, if they want to enter nursing school, should be able to access a nursing program in their part of the province. We get it that if a kid in the Kootenays wants to go to nursing school, they should be able to enter that program in that part of the province. We get it that on Vancouver Island, if a young person wants to enter nursing, they should be able to enter nursing here on Vancouver Island. We do get it. That's why the 400 spaces for nursing this September that came on stream are spread around the province as opposed to being concentrated in just one place.
An Hon. Member: Where are they?
An Hon. Member: Name names.
Hon. M. Farnworth: The member says: "Name names." Well, here we go: BCIT, 31 spaces; Camosun College, 24 spaces; University College of the Cariboo, 20 spaces; College of the Rockies, eight spaces; Fraser Valley, 22 spaces; Langara, 16 spaces; College of New Caledonia, 20 spaces; North Island College, eight spaces; Okanagan University College, 20 spaces; Selkirk College, eight spaces; UBC, 20 spaces; University of Victoria, 20 spaces. That's over and above what they're already offering. In the case of UBC that represents a 30 percent increase in spaces in the nursing program. That's a concrete demonstration of what it is we are doing -- one of the things we have to be doing -- to deal with the nursing shortage we face in this province.
Interjection.
Hon. M. Farnworth: The member says: "And tuition rates have been frozen."
What's important, hon. Chair, is that this is one of the key areas in which we're making investments. The health authorities are working in terms of what they're doing with nursing and nurses in the system in terms of their upgrading and the ability for retraining.
Interjections.
The Chair: Order, members. Order, members.
Take your seat please, member. We won't continue, members, until we can hear the speaker.
A. Sanders: Two points need clarification from the minister:
1. He has said that there were 300 additional nurses in British Columbia last year. It's important for the public to recognize that that's 300 nurses who were on casual who have been given full-time employment with benefits. They are the same 300 nurses that we were overworking last year who are now working in the system in a different context. It's the same faces.
2. The member for North Coast has asked us what our solution to the problem is, and I think that's fair. In 1996 we said: "Hire 2,300 nurses." And you're going to train 400? That is 1,900 additional nurses we need, and a program to bring them to the province, which you guys don't have any idea how to do -- absolutely none, and you've demonstrated that very well over nine years.
Interjection.
The Chair: Member, if you could take your own seat to heckle. Thank you.
A. Sanders: The action plan has a number of comments on primary care. One is primary care reform, and what I'd like to know from the minister, for all of those people interested, is: what does that actually mean?
[1715]
Hon. M. Farnworth: This is an area of health care that will be receiving, I believe, a great deal of attention over the coming years. It's something that the province has been working on with Ottawa, and I'm pleased with the particular separate funding that Ottawa has committed to this important area. It means improving the level of care that people get at their first contact with the health care system -- for example,
[ Page 17206 ]
pregnant women -- dealing with basic health care issues at that very first point of entry and how we change the way some of that care is delivered.
It can mean issues such as licensed practical nurses, for example, and promoting and enhancing the level of care that's already delivered. This is an area where next year we will start to see the first tranche of money flowing, which is negotiated under the federal government. It's $800 million spread over a number of years, and that money is targeted to deal with primary care.
That's where we're going, and the health action plan is a key component in terms of how we will be dealing with that money and allocating that money when we receive it.
A. Sanders: To most of those in the know, hon. Chair, primary care reform is really talking about rostering or capitation. To the minister: which one is it?
Hon. M. Farnworth: It does not have to do with capitation. What it has to do with is optimizing the accessibility of primary care and recognizing that the ways in which primary care and your first contact with the system are delivered need to change and can change and can vary from place to place. One of the areas where a lot of work is being done in terms of changing the way that primary care is delivered and the primary care form is around nurse practitioners, for example, and in terms of how we deal with people in the system -- as I said a moment ago, around pregnant mothers, for example.
Primary care is one of the areas of the health action plan that we know we have to focus on. It's one of the areas that we know needs an investment of moneys over and above what provinces are already doing. That's why, aside from the $425 million that has been restored to the provinces to deal with the transfer payment cuts
A. Sanders: One of the issues in primary care that we have been talking about a lot is the rural doctor problem. The minister has mentioned nurse practitioners and how that particular kind of nurse is going to solve all the problems we have and make everything better.
I'm interested in how the minister is going to solve the present problems in the rural situation, where we have practitioners in Prince George being paid $40 an hour for on-call and someone in Quesnel being paid nothing or having no bargain for on-call. How has the minister planned, in this rural initiative, to solve that particular problem?
[1720]
Hon. M. Farnworth: There is $40 million of funding in these supplemental estimates today to deal with rural physician issues in communities such as Quesnel, Terrace, Whistler -- right across the province -- to ensure that we are able to compensate, recruit and retain physicians in small communities throughout British Columbia. We believe that this package is one of the most comprehensive ones that has ever been put forward by a provincial government and that it will meet the needs of the physicians of British Columbia and the citizens of their communities. If the member thinks that it's not enough money -- if the member thinks that $40 million is not enough -- I'd like her to say so.
A. Sanders: The minister has mentioned a number of issues which I'd like to address. One is an innovative approach to community care and residential beds for the elderly, as part of his solution to continuing care and home care and freeing up of acute care beds. To the minister: does this mean that the ministry will be, with the supplementary estimates, encouraging private-public partnerships within the regional health districts?
Hon. M. Farnworth: This money is for patients in the public health care system.
A. Sanders: That doesn't answer the question I asked. Will the ministry be encouraging or discouraging private-public partnerships put forward by the regional districts?
Hon. M. Farnworth: Could the member be a bit more specific about in what particular area she is wanting us to encourage private-public partnerships?
A. Sanders: Again, as the minister has said many times today, it's what the region wants. Many of the regions have suggested private-public partnerships to solve some of the ailments within their operating system, such as laundry. One of the things that they've found in many of the regions is a very significant ideological bent against private-public partnerships by the Ministry of Health in British Columbia.
In this document, "B.C.'s Health Action Plan," under the statement of innovative approaches to community-based care and residential beds, does the minister mean encouraging the use of private-public partnerships to free up more money to look after people?
Hon. M. Farnworth: The reason this money is going into the system is to strengthen the public system to stop the privatization that we are seeing happening. We have said -- for example, in the areas around continuing care and in expansion of the continuing-care system, long-term care -- that we want to see public-private partnerships, particularly in the non-profit sector, who can build beds, for example, and take some of the pressure off the system. But the allocation of this particular money that we're talking about here today, this money going into the system, is to strengthen the public system.
A. Sanders: To remind the minister, on May 16, 2000, in this House the minister said the following: "I'd like to inform the member" -- for Okanagan-Penticton -- "that we've just had a conference call with the industry -- all health authorities were represented on this call -- informing them that P3 partnerships would in fact be considered
[1725]
The final area that I would like to look at in this manifesto is drug use and costs. This, to me, is by far the most reprehens-
[ Page 17207 ]
ible section of this entire document. It reads like some kind of paranoid statement put forward at some AGM somewhere by some group concerned about multinationals and international trade and international corporations. I quote from the document:
What on earth is this ministry trying to communicate with drivel like this?"British Columbia's provincial drug plan, along with those of other provinces across the country, is at risk from inappropriate drug use and runaway drug costs driven up by the practices of multinational pharmaceutical companies. In the past five years, British Columbia's total drug plan costs rose by nearly 70 percent, from $392 million in 1995 to $661 million this year. Many new drugs provide little additional benefit over existing medications
. . . . Actions will focus first on marketing by the multinational drug industry and prescribing trends."
Hon. M. Farnworth: I want to correct some of the comments the member made a moment ago around public-private partnerships. She was inaccurate. The comments that I made in May are in fact correct. What we are talking about here is the privatization of medicare and hospitals. The issue around long-term care or continuing care is exactly as I said it was in May. What we are opposed to is the privatization of the hospital system, the medicare system, which we believe should remain public in this province and in this country. I would be interested to know whether in fact that side of the House feels exactly the same way, because comments
An Hon. Member: We'll get to ask those questions at a later date.
Hon. M. Farnworth: The member says: "We'll get to ask those questions at a later date." So does that mean that British Columbians are going to have to wait to find out whether you're going to allow the privatization of the health care system until you're on this side of the House? Or can we take at face value the statements that your Health critic made recently, saying that there is a place for private health care in British Columbia on the Liberal side?
An Hon. Member: The Premier said that. Maybe you said that too.
An Hon. Member: You said that too.
Hon. M. Farnworth: No, I didn't say that. I know what I said, and that was not it.
In terms of what the member raised and the questions she's asking around pharmaceuticals, I think it's important to point out that one of the key areas that this province has been leading the initiative in over the past several years has been controlling the cost of pharmaceuticals in the health care system through reference-based pricing to ensure that we have low cost drugs and the ability to deliver them to the people of British Columbia.
Pharmacare costs have been one of the most dramatically increasing sectors of the provincial health care plan not just here in British Columbia but right across the country. So in terms of developing a health action plan and in terms of one of the areas where the province has been working with the federal government, in terms of not only just the restoration of transfer payments but in terms of what actions we should be taking as a province and as provinces to deal with that, there is a unified position emerging amongst the provinces in dealing with pharmaceuticals.
I would just like to read into the record what that is so that you know, because I don't think you do know what the challenges facing us are around pharmaceuticals and what we as British Columbia
An Hon. Member: You don't even know where your money's going.
[1730]
Hon. M. Farnworth: Yes, we do. And we know what the problem is here in B.C., and we know how it needs to be dealt with, with other provinces. Hon. Chair, for the hon. member's information, it's quite simple. The provinces have agreed to work together to develop strategies for assessing the cost-effectiveness of prescription drugs, possibly including the creation of a common intergovernmental advisory process to assess drugs for potential inclusion in government drug plans. They will be informed by an examination of current best practices and various means of addressing drug purchasing costs.
The federal government will strengthen the surveillance of the therapeutic effect of drugs on Canadians after they have been approved for sale in Canada, and this will complement ongoing work to ensure the optimal use of pharmaceuticals in health care so that we as provinces don't get whipsawed. This is a fundamental area of the health action plan as to what we need to be doing to ensure that our health care system remains sustainable, because increasingly
An Hon. Member: We know that.
Hon. M. Farnworth: Oh, the member says "We know that," but her colleague sitting next to her says: "Well, we don't know that." And the member for Okanagan-Vernon is busy saying that a drug strategy is drivel. What's drivel, hon. Chair, is an inability on the part of the opposition to face that pharmaceuticals are one of the biggest challenges we face as a provincial government and the country faces with a national health care program. That's why we're working not just here in British Columbia, with the initiatives that we have already undertaken
A. Sanders: Hon. Chair, when we look at pharmaceuticals
In the summer estimates we went into in very significant detail the pharmacoeconomics initiative committee and the therapeutics initiative committee. We went into the details that we in British Columbia don't cover drugs that are covered in all sorts of provinces, in addition to the fact that we find
[ Page 17208 ]
reasons not to cover drugs that have in some cases the best scientific research backing them while we cover other drugs that do not. For the minister to suggest that this process in British Columbia is streamlined, effective and sensible is less than honest.
I'm going to turn this over to the member for Vancouver-Quilchena. I'm disappointed to see that this is all that the Ministry of Health has learned over the past nine years with respect to how to manage health care: a three-page document that reads like a wish list and doesn't give us any substantive evidence that we're going to have anything better than what we started with -- and perhaps something quite a bit worse.
I'll turn this over to the critic of the Ministry of Health, the member for Vancouver-Quilchena.
C. Hansen: When I was participating in these debates earlier this afternoon, I asked the minister for a line-by-line breakdown of how some of these moneys are going to be allocated. I was of the impression that he was obviously reading off of a document. I thought that was a document that he would be able to share with us. I didn't realize that perhaps it had some confidential information on that page that he didn't want to share. Perhaps it's the funding allocation for each of the health regions around the province that he tells us is still being sorted out -- yet they're going to announce them tomorrow.
My knowledge of the operations of government is that this will be the first time in history that government is going to make up the numbers in the morning and announce them in the afternoon. It's with some skepticism that I take that response.
I would like to get into a breakdown of these items in the supplementary estimates in terms of where they are going -- the global numbers. I know the minister's already said he can't tell us what's going to each individual health authority, which is regrettable. But let's see if we can't get to some other breakdowns of those numbers.
[1735]
While staff are pulling that together, let me ask a more general question. It's a quick question, and that is
Hon. M. Farnworth: I'll give you the answer, and then, if we can take a quick break, that would be great.
There won't be one.
The committee recessed from 5:36 p.m. to 5:42 p.m.
[T. Stevenson in the chair.]
C. Hansen: Hon. Chair, just before we recessed, the minister had indicated that after the $180 million is allocated to health authorities, there would be zero projected deficit. I think this reinforces what we said earlier -- that this is all not for new programs. The public can't expect an increase in service as a result of this flurry of announcements. Rather, all they're doing is covering existing service levels.
But I do want to move on to the line-by-line breakdown of these dollars. I'm wondering if the minister could start with that $180 million and give us as much breakdown as possible. In the announcement that was made, the Premier had indicated that there was going to be
The $180 million will be used to train more critical care and operating room nurses. How much is being allocated to that purpose, to improve access to operating rooms? How much is being allocated to that objective and to reduce waiting times for surgeries? Could the minister give us a breakdown of the $180 million in certainly as much detail as he can on that, on where those dollars are going to go?
Hon. M. Farnworth: In terms of being as specific as I can, I'd like to come back to the comments that I made to the member for Okanagan-Vernon before -- that is, one of the key things is determining the specific allocations, even in the broad sense. It's where the health authorities feel their priorities are, where the health authorities are going to allocate that money. They will be doing that over the next 30 days when they come back to us.
In terms of the $120 million that we anticipate is going to population and demographic increases and the service requirements that that does, the health authorities will be looking at their own health authority to see what's required and where those pressures need to be addressed. If it's wait-lists for a particular type of surgery, for example, then they will come back and tell us that. If it's in terms of opening up operating rooms, they will come back and tell us that. They will be doing that in the next 30 days.
[1745]
C. Hansen: So in other words -- I think my colleague from Matsqui underscored this earlier -- there are no cheques being issued tomorrow. There's, like, zero. In the press release when they talk about the Premier's comments about being in a position to cut cheques tomorrow
Hon. M. Farnworth: Well, what's important is that the member understands that they will start being notified of the exact amount of money that they will start getting tomorrow, so that they know. Then they start getting
C. Hansen: I found it regrettable that the minister couldn't give us more detail on the allocation of the $180 million, because what in essence he's asking this House for is a blank cheque. I would expect that we would have dollars allocated to this. To say that we're going to go out and do this consultation with the health authorities, and they're going to
[ Page 17209 ]
tell us what they need, and yet all they're really doing is covering the debt that's already been incurred
Whatever decisions are made in terms of the allocation of this $180 million -- will that be annualized dollars?
Hon. M. Farnworth: The answer to your question on annualized dollars is yes, they will be. What's also important to point out -- and the member keeps wanting to get into specific allocations -- is that we are dealing with the needs as of what we've been told by the health authorities and work that has taken place within the ministry, and we're here debating the broad sum of $290 million. We've broken it down and told you that $40 million is for physicians; that $70 million is for equipment; that $180 million is for the health authorities; that within that $180 million, $120 million of that will go and deal with population and demographic increases. The health authorities will be submitting where those allocations will be over the next 30 days.
Yet the member and members before in particular want the specific number, and they want to know exactly
C. Hansen: How, then, do you know that $180 million is adequate? How is the $180 million arrived at, then, in order to cover these increased costs by the health authorities? Or is it just a number you've pulled out of the air? I know the minister said earlier that it's a projected deficit, but those projected deficits of the health authorities obviously have to be the accumulation of 52 separate numbers. Is that how the $180 million was arrived at? And if it was, then why can't the minister give us the 52 different numbers that add up to $180 million?
[1750]
Hon. M. Farnworth: The member keeps using the term deficit. Deficit would only be there if we didn't provide the funding that we're talking about, and that's what we're doing today. What's important is that we received advice on the amount of money that is required in the system from the health authorities themselves, through a number of committees that work between the health authorities and the ministry. That's what has been taking place. That's why they will then be determining what their allocation is over the next 30 days, what they're going to do with it on the basis of what the pressures are in your system and how they're going to go forward from there.
With that, unless the member has any more questions on this particular area, by agreement, I move that the committee stand recessed until 6:40 and sit thereafter until adjournment.
Motion approved.
The committee recessed from 5:52 p.m. to 6:41 p.m.
[T. Stevenson in the chair.]
C. Hansen: During the dinner break I was able to catch one of the television newscasts. I was interested to hear the Premier of our province, in a media scrum earlier this afternoon, explaining why we're here today. He said -- I think I've got this roughly written down properly -- "It's about being able to cut the cheques on the first day of the week." That's tomorrow. Now, is the Premier of the province misleading us and the public? Or has the Minister of Health failed to properly brief the Premier on what is really happening in this whole scenario?
Hon. M. Farnworth: No. There are cheques that will be going out, and the ability to access funds is going out. If the member remembers what we're debating here in terms of where the money is going, there are three key areas. There is $180 million to the acute care system, there's $70 million to equipment, and there's $40 million for physicians. I think one of the first ones going out the door will be the $40 million to health authorities for physicians -- and to be notified that that allocation is there and that that offer is on the table and that they can start to access it. So that's one of the first things that in fact will be taking place.
Then we've got the money for the health authorities, and then later will be equipment.
C. Hansen: The minister raised the subject of the $40 million for the Medical Services Plan. Is that annualized dollars?
Hon. M. Farnworth: It's annualized dollars, and it's annualized this year. The total is $50 million, but this year the annualized cost is $40 million.
C. Hansen: My understanding of the annualized amount of the Prince George settlement is that it's about $8 million. It's a $10 million package, but since it took effect on June 12 of this year, in fact there's only $8 million that has to be allocated in this year's budget to meet the terms and conditions of the Prince George agreement.
So in terms of the $40 million, what the minister is saying is that there's $32 million that's going to flow to the health authorities to fund the agreement that was rejected by the doctors. So once the health authorities get this money
[1845]
Hon. M. Farnworth: The cost this year would be $32 million, going retroactive to June 22, which is the date of the Prince George settlement. And then annualized, it's $40 million.
C. Hansen: There's $8 million that is needed this year for the $8 million annualized package for Prince George. The other $32 million would go towards the physician settlement in the other communities that are currently in dispute. And the minister is saying that whatever agreement is put in place
[ Page 17210 ]
for those other communities is also going to be retroactive to a certain extent. Or is it going to start from here and go forward to the end of the fiscal year?
Hon. M. Farnworth: No, it will start from June 22, the same date as Prince George.
G. Campbell: My question to the minister is revolving around the same issue. Part of the so-called health action plan press release says: "B.C. will continue its efforts to increase the number of doctors practising medicine in underserved areas of the province
Hon. M. Farnworth: It's been better than other provinces'. We have entered into agreements around northern interior allowances and rural agreements which have been negotiated. It has been a recognition that we do need to be doing more to attract and retain physicians to rural communities of British Columbia. That's why this additional money is in here today.
G. Campbell: Can the minister tell me when he discovered that there was a problem with rural health care and physician services and nursing services in rural communities in the province?
Hon. M. Farnworth: I think it's fair to say that the issue of rural doctors and physicians has been an issue in parts of this province for a number of years. It's an issue, in fact, right across this country and is not unique to British Columbia.
G. Campbell: Well, in view of the attitude that the government has taken towards doctors, let me ask the minister if he's surprised at the response that we've received from doctors when a minister of the government says that doctors are ethically reprehensible and professionally disgraceful. Is that the way we are building a new environment of trust and confidence between doctors and the health service providers of British Columbia?
Hon. M. Farnworth: I think what's important is that we recognize that physicians are an important part of the health care system in British Columbia. And they are one
K. Krueger: You called them greedy -- right?
Hon. M. Farnworth: I listened to your leader and didn't heckle him. I would kindly ask you to extend the same courtesy
K. Krueger: You called them greedy.
Hon. M. Farnworth:
The Chair: Member for Kamloops-North Thompson, please.
Hon. M. Farnworth: What is important is that we have a package in place that recognizes the role of recruitment and retention of physicians to small communities and rural communities right across the province of British Columbia. We recognize that there are a number of issues that need to be addressed. They can be dealt with in a variety of ways. One is in terms of ensuring, in terms of compensation, that there are compensation levels that will keep physicians in rural B.C. and make recruiting of physicians to rural B.C. easier than it has been in the past.
[1850]
The second has been to
We also need to ensure that we are competitive, not only here in British Columbia but right across the country, in terms of what we are paying physicians. That's one reason why this package is on the table.
Third, we need to have a national physician resource strategy that recognizes that we are in a tight market with regards to physicians not just here in British Columbia but on a global basis. So there needs to be better coordination between provinces in terms of (1) training a physician and (2) retaining physicians within the country itself.
G. Campbell: I think the point that needs to be made is that as we continue efforts to increase the numbers of doctors practising in underserved areas of the province, as we increase the numbers of physicians that are available to provide for patients with needs in this province, I think the minister should acknowledge the fact that the environment that has been created by his government with physicians has been appalling. We are losing physicians in record numbers from rural communities and also from the province of British Columbia. If the minister would forget about the institutional egos and talk with individual physicians around the province, I am sure he would discover that there is a long way to go. Let me just ask the minister if he thinks it's appropriate for a Minister of Finance for a government to say that the doctors' behaviour is reprehensible, for a former Premier of the province of British Columbia to say that there is no crisis -- just within the last year -- and for the minister to say the doctors are greedy. Is that a way that we establish an environment of trust between physicians who, the minister seems to recognize from his answer, are a required component of an excellent health care system?
Physicians are in demand not just in the province of British Columbia but in all of our country and around the globe. We are in a global competition for the best possible physicians we can get, and we have a government that decides the way to attract people is to say that they are ethically reprehensible and professionally disgraceful. How does that work in the minister's action plan to establish better relationships with doctors?
Hon. M. Farnworth: I think what's important is that we create an environment to encourage physicians to remain here in British Columbia and to locate here in British Columbia. The fact of the matter is that from the period of '92 to '97 we have actually had a net increase in the number of physicians
[ Page 17211 ]
moving into British Columbia. The rate in which they leave the province has been virtually unchanged from '91-92 to now. It's the same.
An Hon. Member: We've had an increase in population.
Hon. M. Farnworth: And we've had an increase in physicians. We are the only province, apart from Ontario, where that has taken place.
What's important is not only that we have an environment for physicians in terms of compensation that is competitive within Canada and comparable to other provinces -- which is in fact what we're doing -- but that we recognize the challenges in rural British Columbia. This is why we have negotiated with the BCMA the rural interior agreements and the northern allowances -- and those are in place -- and why we have said we recognize the recruitment and retention problems, which is why there's the $40 million within this money that's available for the health authorities.
But we also need to be training more physicians here in British Columbia. The biggest incentive, I think, in terms of our ability to ensure that we have physicians in small and rural towns in British Columbia is to train more here. You know what, hon. Chair? It's this minister and this side of the House that said that, and that side of the House had to wait before they said: "Gee, maybe it's a good idea that we train more physicians."
We have been meeting, for example, with the dean of the medical school at UBC as to the best way in which we can look at expanding the number of places within medical school in B.C. We recognize
Interjection.
[1855]
The Chair: Member for Kamloops-North Thompson, we've gone over that. Thank you. If we could listen to the minister, and then we will listen to the Leader of the Official Opposition.
Hon. M. Farnworth: What is important is that we recognize that we need to be training more physicians. That's what physicians are saying and telling us: we have to increase the supply of physicians here in British Columbia, increase the supply of specialists being trained right here in British Columbia. I have said that publicly here in B.C., and it's been acknowledged that I'm the first Health minister in this province, probably since Pat McGeer, to say that.
Second, we need to be training more physicians across Canada, because I also think it's important that we have the capacity to be doing that, and we need to be doing it in a coordinated way. It doesn't make sense for one province to be training, whether it's nurses or health care workers or doctors, and other provinces not doing that, because we just end up poaching off each other. That's why we need a national strategy.
An Hon. Member: We're poaching off them.
Hon. M. Farnworth: The member comments: "We're poaching off them." Well, we poach off each other, and that's what's been happening in this country because we don't train enough here at home in B.C. That has been the approach of successive governments in British Columbia going back to the days of W.A.C. Bennett, because we have traditionally relied on physicians coming from outside of the province. That has to change. That's been very much something that we recognize. So we are creating an environment that will see more physicians trained here in British Columbia, which is what we need to do. We recognize that we need to be competitive in terms of the compensation that we're offering, and we are. We have the second-highest-paid physicians in the country after Ontario, and we have recognized that there need to be special incentives in rural and remote communities in the province. We are prepared to do that and have been doing that in terms of the northern allowances and rural agreements. That's why there's $40 million in this supplementary estimates to allow health authorities in the province to continue to address the issues of recruitment and retention.
G. Campbell: The minister has said that he has acknowledged
Currently we have about 300 physicians a year who are retiring. We train 120. Can the minister tell me how many places he will be informing the University of British Columbia -- which is the only med school we have right now
[1900]
Hon. M. Farnworth: Well, I have a couple of points for the Leader of the Opposition. First, try being a little less selective in the facts about nine years. The fact of the matter is that we have not been training enough physicians in this province going back well over two and a half decades. In fact, at the beginning
An Hon. Member: When did you say that?
Hon. M. Farnworth: Several months ago, upon becoming minister -- which I haven't heard from the opposition.
[ Page 17212 ]
What's important is that we need to train more physicians. So we have been meeting with the UBC med school on exactly what's required to do that. We cannot do that this September. We're already into the school year. But in terms of the coming school year, the coming academic year
K. Krueger: Perhaps you won't be government that long.
Hon. M. Farnworth: I certainly do hope that we are government, because I know one thing, hon. member: if that member's sitting over here, there certainly won't be any increase at the medical school at UBC. One thing is for certain: given the choices that they've been saying they're going to make in terms of where they're going to make cutbacks, it isn't going to be going to a medical school at UBC. We need to put in place the programs to train more physicians, and that's what I said. I've been working within the ministry, and we're working with the UBC medical school to make that happen. My goal is to start to see that increase happen for the start of the next school year.
In the meantime, however, one of the areas where we want to try to make progress is in terms of training of specialists. One of the opportunities in the package that's before us today is that the money will allow physicians to increase their experience in terms of rural practice, to expand their abilities to offer more service and to have a higher trained skill of physician in communities than we are currently able to deliver. So that is an important component in the $40 million package that's there. On top of that we have the rural agreement program and the ability of upgrading physicians in that program as well.
So we do recognize, and we are moving. What we're saying is that we have to move forward as a province but also on a national basis, and that's what physicians are saying as well. The province can't deal with it just in isolation. So we have to have a national program.
Interjections.
Hon. M. Farnworth: You know, either they want to hear the answer, or they can natter away till the cows come home, hon. Chair.
What's really frustrating is listening to an opposition that doesn't want to recognize that the efforts we are making as a government are second to none of any province in this country in terms of what we are putting forward as a package around recruitment and retention to ensure that centres such as Prince George can attract the physicians and, in particular, the critical mass of specialists that are required to be there, so that they can fulfill the role as a training and referral centre and that we don't have a turnover in specialists -- to ensure that that training role can be fulfilled.
On top of that what we're doing is ensuring that we build on the agreements that are currently in place, which is around some $35 million in incentives and bonuses that already exist in communities in the rural part of the province, and $40 million on top of that, which is the most competitive package in this country. That, coupled with training more physicians in British Columbia as well as nationally, is one of the key things that we have to do in terms of increasing the supply of physicians.
G. Campbell: Tenth out of ten -- only this minister would say: "Isn't this great? We're striving to get up to be No. 9." We're No. 9. After nine years we are the worst per capita in training physicians. This government holds responsibility for nine years of failure to train physicians; the minister should start by recognizing that.
The second thing that the minister should start by recognizing is that physicians have asked for this for some time. The minister says, "I acknowledged this in February," when he became minister; now he's acknowledging it in September. I'm sure we'll have another acknowledgment next spring, and we'll have more acknowledgments the fall after that. The question is: when do we get started on training physicians that will meet the needs of British Columbians in the province?
[1905]
Hon. M. Farnworth: You know, listening to the Leader of the Opposition talk about physicians is a little galling, considering what he has said repeatedly in the past about funding for health care, about transfer payments and about what's enough for health care. We have been meeting with UBC in terms of how we move forward in training of more physicians. We all recognize that you can't expand the school of medicine overnight, that it needs to be done properly. And that work is taking place right now. Our goal -- as I said during the estimates debate that we previously debated, earlier this year -- is to have that in place for September of this year. What we're also working on, though, is: how do we get more specialists into British Columbia? How do we increase the number of specialists, and can we do that before then?
You know, the one thing that he also says
And we are addressing the needs in rural parts of the province by some initiatives that build on previous initiatives to the tune of $40 million. That is a significant commitment by the province of British Columbia to ensure that there are physicians in rural communities right across the province. That is a significant investment by the province in terms of keeping physicians here. And it will allow communities in particular, such as Prince George, to fulfil their role as a training and referral centre, so that they have the critical mass of specialists required to make that happen.
G. Campbell: One of the things that I think we all count on our doctors to do is to look at the facts and look at the symptoms and then to diagnose the problem. The problem that I'm sure every doctor in the province will be facing, who's bothering to listen to this discussion, is that this minister doesn't understand the facts, doesn't understand the problem and doesn't understand that his government's responses to their issues have in fact made the situation worse. And his rhetoric continues to make the situation worse.
I can move off the training portion and simply say this: the minister has done nothing, zero, nada. Deciding that you've acknowledged that your government has failed to supply training for physicians for the last nine years is worth nothing to any patient anywhere in the province of British Columbia. So let's be clear about that.
[ Page 17213 ]
Now, say we train the physicians. Say that we have the minister moving beyond acknowledgement to action sometime in the future ether. Well, then what happens? Then what we've done is created an environment where physicians can't practise medicine. Has the minister heard the physicians talk to him about that? They don't have access to operating rooms. They don't have the kind of support they need. They don't have the resources they need to provide patients with the care that patients demand, deserve and require in the province of British Columbia.
Hon. M. Farnworth: You know, I listened to the Leader of the Opposition going "yadda, nada, nothing, zero," and the only thing that he brings to the debate is constant negativity. Not once has he outlined what he would do in terms of training physicians in this province. Not once has he said what his plan is to increase the supply of physicians in British Columbia. Not once has he said what his plan is to increase the number of specialists in British Columbia.
What I have said we are doing in a comprehensive manner is to make it attractive for physicians to remain here in British Columbia in small and rural communities, which is building on the agreements that are currently in place, agreements which this government has negotiated over the last several years. That's why there's $40 million here to help continue that, to make sure that we have the most competitive package in the country, to build on the fact that we already have the second most physicians in the country and have had a net in-migration of physicians -- along with Ontario, the only provinces to have that take place.
[1910]
I've also said what's important is that we want to address the issues that physicians have been saying are of concern to them around things such as equipment, access to operating rooms and working conditions. That's why we are announcing, or why we are debating here, $70 million in equipment to go into the health care system. That's why there's $180 million going into the system. That's why there's a $40 million package on here.
I've also said that we need to train more physicians here in British Columbia. We've been working with the UBC medical school on the best way to do that. But what's here and now, what we're debating here and now, is the supplemental estimates of $290 million that will go a long way to addressing concerns that physicians have around working environment, whether it's equipment or whether it's the $40 million for the physicians' settlement for recruitment and retention in rural British Columbia. Those are significant steps forward.
G. Campbell: I appreciate the comments of the minister, because it gives me a chance to reiterate some of the positive suggestions we have made on this side of the House. We suggested two years ago, when five rural communities were without physicians' services for over five months, that this government start to take those rural people's needs seriously. We suggested the government put $100 million on the table. The minister will say: "Well, that's $100 million." I'll tell you where you have got it, minister. Stop subsidizing business to the tune of a billion bucks. Stop wasting money on three fast ferries that don't work and that cost half a billion bucks. There is lots of money for health care if we had a government that was competent, that could provide it to patients when they needed it. So take the $100 million.
Recognize for a change that here's the new government; here's the new Premier, supposedly -- all you nice, open, new guys. And actually start having the legislators in the province of British Columbia help solve some of these problems, because the minister doesn't get it. Doctors say he doesn't get it, nursing professionals say he doesn't get it, nursing trainers say he doesn't get it, patients say he doesn't get it, people on wait-lists say he doesn't get it. This minister and this government have failed the people of British Columbia for nine years.
So why not even go to the government's own back bench and ask them to help solve the problem, because they'll tell them some good things? Some of the people, I'm sure, in Cranbrook will tell you what's going on in Cranbrook. You'll find the members from Prince George -- whether it's Prince George North, who actually thinks doctors are simply reprehensible, I guess
Here's an $8 billion budget; here is a huge, important service we provide to the people of British Columbia. And not once in the last seven years has this government even called the Health Committee of the Legislature to work with patients and doctors and nurses to hear what their ideas are -- not once.
Now the minister comes into the House and says, "I've got $40 million. All this takes is $40 million. Aren't I wonderful? It's $40 million" -- the same minister, hon. Chair, that told us a while ago it wasn't a matter of money. You know what? At the end of the day, the minister is correct, because unless we can secure doctor services and nursing services and professional care-giving services in those rural communities, people in rural British Columbia are going to continue to be the brunt of a two-tier health system between urban and rural parts of this province. That is wrong, and that should change, and the minister is not going to change it
The minister has decided that he is going to try and force doctors to take this. I can tell the minister: doctors have already said that he doesn't get it, that he's failing. And when he fails, it's not the doctors we're failing.
[1915]
The objective here is not to take care of doctors; it's to take care of patients. It's to take care of the young woman from Vanderhoof who didn't have services, so that when she was having her first child, she had to go to Prince George. She had to rent a motel room for a while, to see when she might be able to deliver her first child. She had to leave her family at home and her support at home and her husband at home. That's the quality of service that this minister and this government have provided. It's the same government that says to someone who breaks their leg in Prince George: "You've got to go to Kamloops for care." That's wrong.
Unless we are going to create an environment so that doctors in rural communities understand that they are supported by this government, not treated as reprehensible people, not called greedy by the minister
[ Page 17214 ]
So what do they want? They want to be sure they can have the training they need. They want to be sure they get properly reimbursed for on-call. They want to be sure that they can even count on the government to make sure that the tools and facilities they need are there in rural communities. They can't do any of those things.
They can't even count on this minister's government to keep their word about a negotiating plan. The first time the government finally figured out, "Maybe we should negotiate in a sensible and straightforward way. We're going to start October 1
Doctors want to be dealt with as professionals. They want to be dealt with, and they're for their communities. And this government continues to fail to do that. The minister knows that. He is sitting in his place tonight, and he knows that his plan will not work, yet he's trying to pretend that it will. When will the minister sit down and work with physicians, work with people in the rural communities to come up with the plan that will actually encourage people to practise medicine in rural communities in British Columbia, instead of deriding them and calling them greedy and calling them reprehensible?
Interjection.
The Chair: Members
Member for Kamloops-North Thompson, two or three times this evening your remarks have been quite borderline. But that particular one was a very personal attack on the minister. I would ask that you be very careful from here on in with your heckling.
Hon. M. Farnworth: Well, the kind of rhetoric that the Leader of the Opposition has just been engaging in didn't work on Rafe Mair the other day, and it doesn't work in here. What's important is that we recognize that in order to retain physicians and recruit them to rural British Columbia, we have to have the best plan possible and the best -- and effective -- programs possible to make that happen. That's why that $40 million is here. That's why it builds on the plans around the northern agreement and the rural agreements that were negotiated with the BCMA earlier on.
We believe that the best way to get those agreements is through negotiation with an association that represents its members so that we can have a comprehensive package that can be applied right across British Columbia and that can ensure that we are, as I said earlier, competitive with other provinces, that we're training our own physicians here in British Columbia and that we can ensure that the services that are required in remote and rural communities are there when people need them.
But what the Leader of the Opposition is saying is that
[1920]
Does he think that that is not important and should not be the case? Because if he doesn't, stand up in this House and say so. Those are two key elements of the government's position:
1. We must have confidence that an agreement entered into is going to be respected and that we know that there will not be service withdrawals. That is not an unreasonable request on the part of the government.
2. The government has put forward a $40 million package -- a solution -- to deal with these issues that will stand up to comparison right across the country and within British Columbia. We are agreeing to mediation to do that, and we want to work to ensure that that takes place. But if he doesn't think that's enough, if he thinks that we should be putting more money on the table, then stand up and say so.
You know, we have put forward a proposal that will deal with issues of recruitment and retention. And we have said we are dealing with issues around training and that we are working nationally to ensure that there's a national strategy to deal with physicians as well. If the member says we should be putting more money into the rural doctors' dispute, stand up in this House and say it.
G. Campbell: Just so the minister knows, this member advocated two years ago that we put $100 million into the rural health care crisis, and this government has not done that.
Hon. M. Farnworth: Not two years ago; this dispute, this solution, this $40 million, right now. Is it enough, or do you think there should be more? Stand up and be clear.
G. Campbell: This is about making sure that patients get the care that they need and they deserve. This is about creating a health care environment in this province that allows physicians to practise, to have a family life, to have the training that they need, to make sure the facilities are there for patients across the province of British Columbia.
I can tell you, hon. Chair, there is no question about this side of the House. We would not have wasted half a billion dollars on three boats that don't work and then had the gall to tell patients in British Columbia that there's not enough to take care of them in Cranbrook or Vanderhoof or Mackenzie or Burns Lake or Terrace or Smithers or any of the other rural communities of this province. This side of the House would put our resources into quality health care and attracting physicians, attracting nurses -- and not just training them but giving them the opportunity to practise their professions. The question to the minister is: why doesn't he understand that they have to create an environment to attract physicians and nurses and physiotherapists and caregivers across the province, to every region of the province? Will the minister do what he has to do to make sure that happens? That's what this side of the House would do.
Hon. M. Farnworth: I see that the member has broadened his comments to include health care professionals right
[ Page 17215 ]
across British Columbia. And that's fine because that's what this money here today is about. It's about putting equipment into hospitals and improving working conditions. It's about being able to hire more nurses. It's about expanding opportunities for health care professionals by making working conditions better.
But the fundamental point that we have been discussing for the last several minutes has been physicians and making this province an attractive place for physicians in British Columbia, and the member has not been clear. I have made it clear on this side of the House. There's a $40 million package for physicians in rural British Columbia, for recruitment and retention, to make sure that we are an attractive province to stay in. And I've put that in the context of other initiatives being taken right across the spectrum to make health care a more inviting place and working conditions better.
[1925]
But the question he fails to answer when he presses the government is that very question: does he feel that the $40 million package
Interjections.
The Chair: Members. Members, please.
Hon. M. Farnworth: Hon. Chair, I've obviously hit a raw nerve, judging from
Interjections.
The Chair: Minister, would you take a seat for just a moment, please.
The minister continues. Thank you.
Hon. M. Farnworth: As I said, I've obviously hit a sore nerve, given the support the Leader of the Opposition is getting from his back bench.
But the question still is
Interjection.
Hon. M. Farnworth: The member says: "Where did we arrive at the number?" On advice from the health authorities.
But the question is: does the Leader of the Opposition think that $40 million is too much money for the physicians? Does he think it's enough, or does he think it should be increased? Not what was said two years ago, not what was said a year ago
Interjections.
The Chair: Order, members.
Hon. M. Farnworth: Does he think this $40 million package is enough, or does he want it increased?
C. Hansen: I would like to say that the member for Coquitlam-Maillardville -- sorry, the minister
The minister should be reassured that there will be a time soon when the official opposition will be able to ask questions of the individual who is currently the Leader of the Opposition, but I won't guarantee that the minister will be part of that official opposition when the time comes.
I would like to follow up on this point about the $40 million in terms of the communities that are still awaiting settlement so that they can have some stability. This isn't about a head-butting exercise between the Minister of Health and doctors in this province, but that's what we've seen. In the middle of this we have patients. We have individual citizens who live in Prince Rupert, Smithers, Kitimat, Terrace. You can go across all 12 communities that now have withdrawal of services by doctors. While this head-butting exercise is going on between the minister and the doctors, it's the patients in those communities that are paying the price.
The reason that those communities have solid support for their doctors is because they recognize that what the doctors are doing is standing up for long-term stability in the delivery of health care in those regions. They realize that if they don't stop the bleeding now in terms of doctors that are leaving the province and doctors that are not coming to the province in the first place, then those communities are going to be in big trouble. People that live in those communities recognize that that's the reality.
The minister has come up with, out of the ether, this number of $40 million to put on the table. Boy, he's been tough. He says: "That's it; there's not another dime that's going to go in above the $40 million." My question to the minister is: what if this doesn't work? What if the doctors in all of these communities say no? I say all of the doctors in these communities say no.
The strategy that he's trying to pursue right now is the strategy that this government has pursued for the last nine years, and it's a strategy of divide and conquer when it comes to their relationship with the doctors. They deliberately exacerbated the relationship between specialists and general practitioners in this province. They deliberately exacerbated the relationship between urban and rural doctors in British Columbia. My bet is that they deliberately set out to undermine the BCMA and to undermine the relationship that the BCMA had with doctors in British Columbia. Well, you know what? To a large extent this government succeeded. Now all British Columbians are paying the price for that.
Interjection.
[1930]
My question to the hon. minister is
When this minister stands up with his bravado and says there is not one dollar more than the $40 million, what is his contingency plan for ensuring that there is stable delivery of health care in those communities that are now affected?
Hon. M. Farnworth: We have just achieved in this province the biggest component of stability for the health care system in recent memory, and that is the restoration of the transfer payments to the province of British Columbia and the provinces right across the country. That was done in part by the leadership shown by this provincial government in work-
[ Page 17216 ]
ing constructively with Ottawa and the other provinces -- by taking a leadership role in the pressure areas facing us in the health care system and identifying what some of those key pressures were that needed to be funded by the restoration of transfer payments and where we would put the money. You're seeing the results of that here today.
What communities have been telling us is that we need to deal with things such as equipment. What communities, health care workers, physicians, nurses and ordinary citizens have been saying is: "Improve working conditions. Get more equipment into hospitals. Make British Columbia a more attractive place for physicians to stay, to live and to work." This money, $70 million, is going to equipment. That will have a significant impact in this province. That's just the start, because it's $70 million this year and then $70 million next year, to begin with.
There's $180 million going into the health care system. There is a $40 million package for physicians. Now, I know physicians care about their patients, and what they want to see is a system that (1) recognizes their worth and (2) provides them a place where they can practise medicine with the equipment that they require. I know that physicians will look at the $40 million in the broader context.
We have tried negotiations; we still want to do negotiations. We have said we'll do mediation; that's the approach that we are taking, not a heavy-handed hammer but rather an approach that says: "Look, we're doing this on equipment; we're doing this on health authorities. We've negotiated an agreement with Ottawa. And as part of that package, there's $40 million for you."
Here's what it means, because I think it's important, because the Leader of the Opposition wouldn't say whether it's enough. He wanted to talk about two years ago; he wanted to talk about a year ago. Not then, not a year ago, but here and now the offer that's on the table
Interjections.
Hon. M. Farnworth: Perhaps the Health critic will answer the question that his leader wouldn't answer. Is an agreement in a northern community, where a physician who billed $300,000 last year and would have received an additional $47,000 under the old agreement, because of where they were located, under this agreement would now bill the system that $300,000 plus $101,000 more
[1935]
C. Hansen: You know, I ask a question about a contingency plan in case the $40 million doesn't result in a settlement with the doctors in those communities, and we wind up with this diatribe which we have heard repeated over and over again today by this minister. I think it's the only part of his briefing note he read, obviously, before we got here today.
So if the minister wants to continue to give those kinds of rambling answers to questions, we are going to be here a long, long time. If he wants to answer our questions, we can get on with this business, and we can get back into our communities and start doing the work of our constituents. But with that kind of an answer that we got to the last question, it actually shows disrespect for this House.
Now I will ask the question again. If the $40 million to settle the doctors' disputes in those communities does not result in those doctors going back to work, what is the minister going to do?
Interjections.
The Chair: Order, please. Members -- all members in the House -- order, please.
Interjection.
The Chair: Order, member.
Hon. M. Farnworth: Thank you, hon. Chair. Again I obviously have hit a nerve.
The point I'm making is that we have a fair offer on the table.
Interjections.
Hon. M. Farnworth: I'm wondering here which question I'm going to answer -- whether it's the critic, who just asked the question, or it's the member for Richmond East, who's also asking a different question. But the point, you know, hon. member
Interjection.
The Chair: From your own seat, member, please.
Hon. M. Farnworth: Heckle from your own seat -- yeah.
Anyway, hon. Chair, the answer to the member for Richmond East's question, which I've told her before and I've answered before, is that the $40 million figure came about through consultation with the health authorities. They're the ones who live in those communities. They're the ones who work with those physicians. They're the ones who understand the local situations.
The question that the critic asked is very important. We have said there's a $40 million package there that's part of a bigger package. That's what we believe physicians have to look at. We believe physicians care about their patients. We believe that physicians will recognize the investments of the $70 million that's being made in equipment, the $180 million that's being approved here today to go into the acute care system and that will deal with working conditions, which is one of the key things they've been saying.
But we also know that we can't rest on that, and that health authorities have to have contingency plans. There are contingency plans in place. If they have to be implemented, they will be implemented, to ensure that patient care is maintained and that emergency services are provided. And we will continue to do that.
What's also important is recognition that the package we've put on the table is fair. If the member thinks it's a rambling answer to ask if they think that our offer on the table is a fair one
[ Page 17217 ]
it will address the recruitment and retention issues facing British Columbia, which is why we said we would agree to go to mediation and why we believe that this package will stand up to any comparison made within British Columbia and across Canada with any other province. If the member feels that this package is not enough, tell us.
C. Hansen: The bottom line is that there needs to be a package that will ensure stable delivery of physician services in these communities. That is what it is all about. You can't just come up with a number of $40 million and drop it out of the air and sort of say: "That's it." It's a question of what is necessary to ensure stable physician services in those communities. We have not seen that yet.
[1940]
Hon. Chair, I'm not sure that we're going to make much progress on that.
I want to go back to a discussion that we had just before dinner about the accumulated deficits, as we were calling it, of the various health authorities. I have a document which is
Column 4 gives us the accumulated deficit positions of just the health regions. We're not even talking about the other health authorities around the province. It shows the capital health region at an accumulated deficit of $48 million; Central Vancouver Island health region at $23.7 million; Fraser Valley health region at $13.7 million; North Okanagan health region at $1.6 million; the North Shore health region at a deficit of $8.6 million; Northern Interior regional health board at $9 million; Okanagan-Similkameen at $13.7 million; Simon Fraser region, $37.9; South Fraser health region, $31 million -- $31.4 million, if you want to get more precise; Thompson health region, $11.8 million; the consolidated Vancouver-Richmond health board, $5 million; and the cluster of boards that fall under Vancouver-Richmond -- Providence Health Care, at $22.8 million, the Vancouver Hospital and Health Sciences Centre at $55.9 million, Women's and Children's Hospital at $21.5 million and the B.C. Cancer Agency at $11 million.
Well, that totals up to $317 million -- $317,203,134. I'm wondering if the minister could explain to us why this chart showing the accumulated deficits of the region totals up to $317 million, when his numbers that he gave us earlier refer to $79 million as the accumulated deficits.
Hon. M. Farnworth: The numbers we gave you earlier were the accurate numbers that show the true financial position of each of the health authorities.
[J. Cashore in the chair.]
C. Hansen: I invite the minister to do some checking as to where these particular numbers would have come from, and I would welcome a communication from the minister's office to explain the discrepancy between those numbers.
I want to move back to the issue of doctors. Of course, the agreement with the Prince George doctors took effect at the end of June. I'm wondering if the minister can tell me when the Prince George doctors are actually going to see dollars flow.
Hon. M. Farnworth: They're in discussions with the health authority currently, and once that's completed, then things will start to flow.
C. Hansen: The minister was talking earlier about the cheques being ready to cut. Is there a question in terms of how much money should flow? What would be an outstanding issue at this point that would actually prevent the dollars from flowing to the northern interior health region?
[1945]
Hon. M. Farnworth: In the case of Prince George, there was a memorandum that was agreed to, which was the June 22 date. That has to be interpreted into a contract, and it's that work that is currently taking place.
C. Hansen: But certainly the dollars, as I understand it, will flow according to the agreement that was penned, and I'm wondering what would be the issues around a contract that might undo the agreement that has already been initialled.
Hon. M. Farnworth: It's a case of taking the memorandum and turning it into a contract. Part of that involves agreeing on the allocation of the resource within that cap; that is still taking place. In the case of the money that we are talking about here today that we have said is available to other health authorities, that detailed work has already taken place on a community-by-community basis.
C. Hansen: In other words, what the minister is saying is that money is going to flow to the regions where there is no agreement, but money's not going to flow to region where there is an agreement. That's in essence what the minister is saying to us.
Hon. M. Farnworth: In fact, the doctors wanted to sit down with the health authority and work out the issue of allocation -- in this case on the on-call -- within that cap, so that's taking place. What we're saying is that for the money that's here today, that can go out to the health authorities, the detailed work on a community-by-community basis has already been done. So it's not a question of saying that money is flowing to one community and not to another. The money is there, the agreements have been signed, and the issue that is outstanding in the case of Prince George is being resolved between the physicians and the health authority. It's by mutual agreement that that's what they wanted to do.
C. Hansen: But in the other communities, there is no agreement. The health authorities, presumably with the help of the ministry, have obviously crunched some numbers, and they have by edict decreed what they think is appropriate for doctors in those communities. But there's no agreement. In Prince George there is at least an agreement, and yet you're flowing money to the other health regions -- the various regional health authorities -- but you're not flowing money to the northern interior. There seems to be a blatant contradiction to me, and I am wondering if the minister can explain the rationale for flowing money to one but not to the other.
[1950]
Hon. M. Farnworth: The Prince George money can be flowed to the health authority in the same way that money
[ Page 17218 ]
can be flowed to the other health authorities. I think what's important and what's important to recognize -- and it comes back to my comments earlier -- is that there's $40 million to deal with recruitment and retention in rural communities in British Columbia that we have said we would like to resolve through negotiation. We have said that we can still go to mediation; that is not a problem. We can compare that package as to how it compares within British Columbia and how it compares with every other province across the country.
But by approving this money here in this chamber and flowing it to the health authorities, the health authorities are in the position to make an agreement with physicians in those communities, who recognize that this is a generous offer. This is a package that will provide recruitment and retention incentives, so they can avail themselves of that. It comes back to my question that I asked the leader before, which he wouldn't answer and which you have not answered. That is, if you don't think this is enough money, stand up here and say so.
C. Hansen: What we have said is that adequate resources have to be put on the table to solve the problem -- not posturing, which is what this government is doing. They're posturing. It's all about a public relations campaign, but in the end, patients don't get stability of service that they require.
When the minister was talking about the Prince George negotiations, he indicated that the negotiations that were still taking place were on the allocations of those dollars in terms of how they get disbursed on the on-call basis. I think that was the point that he made. Is that the only issue that is preventing the finalization of this? And basically once that is done, will the dollars be able to flow?
Hon. M. Farnworth: The dollars can flow right now. But I want to reiterate the point, because the member says we need stability, and we do need stability. That's why the biggest agreement to bring stability to the health care system is the one we just signed with the other provinces and with the federal government to restore the transfer payments.
My question again comes back. What we're saying is that to bring stability to the system, there is $290 million in money going into the system -- $70 million to provide new equipment in hospitals, $180 million into the system and a $40 million package to provide stability to physicians in rural communities. And the member says that we should have adequate resources to ensure that. Well, my question then becomes: do you think
Interjections.
The Chair: Order, members. Order, order.
Hon. M. Farnworth: I guess it keeps coming back to touching that nerve. We feel that $40 million is enough; we feel that $40 million will do the issue. I've just given you the answer. We feel it is enough. My question is one that I keep hearing when they say: "We have to put enough resources in." Is $40 million, in the opinion of the opposition, enough? Is it fair? Or is it not enough?
Interjections.
The Chair: Would the hon. member please sit down.
I want to say to hon. members that it's very difficult to hear the debate. Kamloops-North Thompson, I find that your voice is drowning out the sound, and I can't hear the debate. I would ask that members who have something to say take their places and say it through the Chair at the appropriate time.
C. Hansen: The minister, I think, has the concept of estimates all wrong. This is the opportunity for the official opposition to ask questions of the minister. The problem is that the minister hasn't been able to answer very many of them today, unfortunately. So when the minister starts resorting to asking questions of the opposition, we know that he's really grasping at straws. I want to move on a bit, though, because obviously we're not getting very far on that one.
In Prince George, as is the case in many other communities, there are many people who cannot get a family doctor. In Prince George alone there's more than 10,000 people who cannot get a family doctor because of the doctor shortages. Yet the ministry has imposed a cap on the number of patients a doctor can see in any given day, which of course applies to physicians throughout the province -- except it does not apply to physicians in NIA communities. So if we have a shortage of doctors, and we've got families who cannot access a family physician and typically have to rely on an emergency room for their basic primary care needs, would the minister explain why that cap has been kept in place in other non-NIA communities that are facing physician shortages?
[1955]
Hon. M. Farnworth: This policy was proposed by the BCMA and agreed to by the government to facilitate good patient care.
C. Hansen: Perhaps the minister could explain to us, then, why this provision wasn't applied to NIA communities. The minister always seems to be very quick to criticize the BCMA and then sort of runs and hides behind their skirt when it feels convenient. So could the minister explain to us why this cap was put in place for non-NIA communities when it's obvious that there are so many other communities in this province that are facing physician shortages?
Hon. M. Farnworth: Again, this is in part because of a recommendation by the BCMA. The issue in smaller communities, particularly very small communities, is that there is no other physician for anyone to go see.
But what's important is a point that the member made around criticizing the BCMA and using the BCMA argument. I believe very much that the BCMA is the organization the province should be dealing with. We are working to ensure that we have a very good relationship with them. From time to time there are differences, and from time to time there are issues that come up. But I want to make one thing clear: I think the BCMA is the organization we as a province want to be dealing with. I see the BCMA as the organization that should be representing physicians and that we should be negotiating agreements with. We want to ensure that that relationship continues and in fact strengthens and that we can find ways of avoiding some of the problems that we currently face.
That's why -- what I come back to
[ Page 17219 ]
we do. That's bound to happen in any relationship between organizations. But the specific answer to the question that you asked is: because the recommendations from the BCMA
C. Hansen: That arrangement goes back a couple of years. When that arrangement was put in place, there were not 10,000 individuals in Prince George who did not have access to a family doctor. That's the case today: families cannot get access to a doctor. Given that that situation exists today, will the minister review the cap on billings that has been placed on doctors in Prince George and in other underserviced communities around the province? Will the minister undertake to ensure that that review is done, with a view to removing that cap so those 10,000 people in Prince George can get access to a family doctor?
[2000]
Hon. M. Farnworth: We're more than happy to sit down with the BCMA and discuss these issues. I'm quite happy to do that. But what's also important is that that's why we have this package here. That's why we have recognized that we need to deal with issues around recruitment and retention. That's why, for example, in the case of Prince George, there's the family practice teaching unit there to enable more physicians to be trained, to enable more physicians to locate in communities such as Prince George. We are working on these problems, and we take them very seriously. As I said, I'm more than happy to sit down with the BCMA.
C. Hansen: I would like to move on to the issue of locums. One of the issues that has really caused a lot of the frustration and burnout on the part of physicians in some of these smaller communities is the lack of access to locums. I'm wondering if the minister could explain to the House how locum coverage is paid for in British Columbia.
Hon. M. Farnworth: There are two ways: either physicians make their own arrangements, or they arrange locums through a program we have for northern communities, which is heavily subsidized by the government.
C. Hansen: There is certainly, in some of the Dobbin communities, support for locum coverage. But in most of these northern communities the locums, if they are available -- there are very few that are actually available to come into these communities -- will either come in at their own expense, or the doctor that is seeking coverage would cover their transportation costs. On top of that, they can bill for their fee-for-service, but the doctors will wind up covering all of the overhead costs. As the minister well knows, usually about 50 percent of doctors' billings go directly into overhead cost, so in fact it is the physicians themselves that wind up heavily subsidizing the cost of locums coming into these communities.
I'm wondering what plans the minister has to increase the supply of locums that are available to these communities, so that we can stop burning out our physicians that are trying to meet patient needs in these communities.
Hon. M. Farnworth: Well, I'll mention a couple of increases. We've increased the rural agreement to expand the number of locums, and that's something that we're doing.
I must admit that I am surprised by the member's comment that overhead is 50 percent of physicians' billings, because that's increased from 30 to 40 to 50 in terms of what the generally accepted amount is, and that doesn't bear any relationship to what the BCMA informs the government the typical overhead is.
C. Hansen: I don't think that the minister has adequately addressed the issue of locum supply, which certainly is critical in British Columbia, because it is causing a lot of the burnout that we see around the province. But I will leave it at that, because I would like to move on.
At the time of the withdrawal of services in Williams Lake, the minister, after first of all saying that Prince George was isolated, that there was no new money and that the Prince George settlement would not impact on any other part of the province
Hon. M. Farnworth: Nothing has changed. It was the application of the Prince George model that was used. What we have said is that we will apply that to communities to deal with the needs of the communities. But we've also said that Prince George is unique and has special characteristics because of its nature, not only as a referral centre but as a training centre.
[2005]
C. Hansen: I want to move on to a document that was sent out by the Ministry of Health to the health authorities around the province on the day that the negotiations broke off with the eight doctors that were representing various communities around British Columbia, with the assistance of the BCMA, trying to facilitate those negotiations. This document, on the first page, starts out with key messages that are coming from the ministry to the health authorities. The first key message that is on this document states: "This is a very generous offer from the Ministry of Health. It is a big step towards addressing some of the persistent problems facing doctors in our communities." I'm wondering if the minister could explain. Given that the $40 million offer addresses only some of the persistent problems, could the minister outline what the other persistent problems are that the $40 million offer does not address and perhaps may have to be resolved from some other source?
Hon. M. Farnworth: No, the other persistent problems are what we are here talking about today, which are equipment and the issue around bringing more equipment into B.C. hospitals and making sure we have the latest equipment. That's what the $70 million is about.
C. Hansen: The other key message in here says that the proposal deals with the problems on a priority basis. With this offer, communities facing "the worst situation" would get the most help first. I'm wondering if the minister could explain to us how they determine what communities have a situation that is worse than another community.
[ Page 17220 ]
Hon. M. Farnworth: There were a number of things that happened to determine where specific problem areas are. The ministry staff worked with the health authorities to identify where there are key shortages. In the case of Prince George, for example, there should be 55 specialists. There are 18 vacancies. So we determine what is the number of vacancies and what is the shortage of specialists. We looked at things such as degree of isolation, distance from other communities. All those things go into the mix in terms of determining levels of need and determining the size of the problem.
C. Hansen: Could the minister explain if this is an arbitrary ranking on the part of the ministry? Or is it in fact a ranking that was done in consultation with health care professionals generally across British Columbia?
Hon. M. Farnworth: It's not just the ministry. It's the staff talking to the health authorities, to CEOs, to health care professionals and identifying what the problems are and where the problem areas are, so that we get a sense of what's required. And that is one of the key bases for which the $40 million
When the members says, "What are the resources? We need adequate resources," well, we've identified where the problem areas are, and we've identified the resources to fix or to deal with the problem. We have confidence in that number.
You know, I say to the member: does he think it's enough? And if he doesn't, then tell us if it should be more.
[2010]
C. Hansen: On the second page of this document of key messages it states that the present dispute is not part of any ongoing negotiations. Then, actually on the very same page, it also says that the Ministry of Health's estimates for the doctors' demands is $236 million. So I'm wondering how the minister can square those two statements. Either it is or it isn't part of any other ongoing negotiations, and either it does or doesn't wind up with a cost of $236 million to the province for the implementation of an agreement that would come out of those negotiations.
Hon. M. Farnworth: This was an attempt to negotiate a rural agreement. And as I said, we are confident in our numbers. The $236 million is the ministry's cost of what the doctors' proposal would cost the province. So that's why we have come forward with a detailed
C. Hansen: But certainly the BCMA proposal that was made to the government on August 27, the last position that was put forward by the BCMA, does not cost $236 million. So either we have negotiations that are not part of any ongoing negotiations or they're not
Hon. M. Farnworth: As I said, and I'll repeat, we were attempting to negotiate a rural agreement that dealt with the issues in rural communities. The proposal of August 27 took that agreement outside the realm of just rural communities and impacted provincewide. We have looked at the cost within the ministry and are confident in that number -- that that would be the impact of their proposal on the province. So we have been clear all along that we will deal with the issues around need, that we will deal with the issues around recruitment and retention problems. And that's why we have confidence in the $40 million figure that's there and why we are confident enough that we're prepared to go to mediation -- that the package is fair, that it can be compared within British Columbia, that it can be compared provincewide and that, as the member insists that it needs to do, it provides adequate resources to those communities.
C. Hansen: I think one of the things that's clear if you look at the process that was taking place in those negotiations is that they were actually making some progress. A lot of the issues had been agreed to. What seemed to happen on Wednesday, August 30, is that there was a cabinet meeting. Prior to that cabinet meeting those negotiations seemed to be moving forward. BCMA actually tabled their position to government on that Wednesday. But there seemed to be a very dramatic change of approach on the part of government at the end of that cabinet meeting.
[2015]
I would like to ask the minister: what was it that happened at that cabinet meeting that precipitated the government walking away from the negotiating table and not responding to the BCMA position that was put on the table? To date they have never responded to that position that was put on the table. So could the minister explain to us: why is it that patients in communities around British Columbia are now suffering from the withdrawal of services that was precipitated by a breakdown in negotiations that -- certainly to my read of it -- resulted from the government refusing to respond in any way to the final position that was put forward by the BCMA?
Hon. M. Farnworth: At the negotiations in August we received the proposal of the two negotiators. The BCMA negotiator and the government negotiator discussed the proposal. The government put forward the elements of the proposal that were not acceptable to the government, and we were informed by the BCMA negotiator that these talks were adjourned. That's exactly what happened.
C. Hansen: But basically you've got the health care of individuals around British Columbia at stake. And yet the government chose not even to respond to that proposal. In the interests of patients around British Columbia who are relying on stable delivery of health care, why would the ministry not even so much as respond to the proposal that had been put forward by the doctors?
Hon. M. Farnworth: We responded by saying that our proposal still stands, and we outlined what our proposal was. The BCMA's proposal was outlined to us, and the negotiators said: "Here are the elements we have a problem with." The BCMA adjourned. We said that our proposal still stands.
That's what we're debating here. That's what this money is for: to deal with issues of recruitment and retention, to
[ Page 17221 ]
ensure that we can provide and meet the needs of patients through an adequate supply of physicians. This money does that. We have confidence in it. It will provide the resources that are required to communities. That's what the member has been saying needs to happen -- adequate resources. If he doesn't feel that there are adequate resources -- if he feels that there are not enough resources here -- then tell me, as Minister of Health, that $40 million isn't enough.
C. Hansen: If it doesn't lead to stable patient care in these communities, then it's not enough. How many times do we have to say that? It's about patient care. I think the minister seems to be missing that.
In coming up with the $40 million, it's my understanding that the government included the 109 vacant doctors' positions in British Columbia to arrive at the $40 million annualized number. I'm wondering if that's accurate and how the minister proposes to retroactively allocate doctors' fees to 109 doctors that aren't there.
Hon. M. Farnworth: The recruitment program has to be able to provide the same bonuses and incentives to new doctors that they recruit as it does to the existing ones.
C. Hansen: In other words, the $40 million is annualized on the basis of all of these positions being filled, including the 109 vacant positions. I'm wondering if the minister could explain to us how you wind up with the $32 million that is going to flow to the health regions to be spent in this calendar year. Is that not in fact providing funding to the health regions for 109 positions that are vacant?
[2020]
Hon. M. Farnworth: The package has to provide on an annualized basis the same incentives for those who are existing as those who we hope to recruit. That has to be factored into the package. It ensures some stability, and the health authorities have some certainty around the funding that they're going to receive. That's what this is all about: certainty to communities, so they know they have the resources to recruit and retain physicians in their communities. This number of $40 million has been arrived at through exhaustive work by the ministry, and if the member doesn't think the resources are enough, then tell me.
C. Hansen: I was looking for a fairly straight answer to what I thought was a simple question. In the $32 million that is part of what we're approving today -- $32 million that will flow to the health regions in this fiscal year to provide funding for doctors in those communities retroactive to June 22 of this year
Hon. M. Farnworth: It's so that you have the money to flow to the physicians when they recruit them so that they have the ability to get people and bring them into the system and can give them the same bonus and payments as those who are existing.
C. Hansen: Not in way of a question, but I'll sum up here what I've just heard from the minister, and then I'm going to pass it to my colleague from Prince George-Omineca.
What the minister is saying is that in fact in the dollars that are flowing to the health authorities out of this $32 million, there is actually more money than is required against the minister's formula. So in fact there is more money there to try to address some of the issues that are still on the table. I think that's probably good news. Let's get on with the job of bringing stable patient care to these communities.
P. Nettleton: It's a good thing to have an opportunity to put a couple of questions briefly to the minister on behalf of the folks I represent. I'd like to frame them quickly, if I may, not only in the context of my experience -- representing, as I do, the residents of Prince George-Omineca and living, as I do, in Fort St. James, one of the communities affected by the northern rural doctors' dispute some time ago -- but more importantly, on behalf of my constituents. I would like to pose a couple of questions in the context of our experience in that area.
Things really began to come to a head in northern British Columbia throughout the 1990s. The Northern Rural Doctors Group was formed in October 1997 involving communities, most of which I represented -- namely, Vanderhoof, Fraser Lake, Fort St. James, Mackenzie and Burns Lake, which lie outside of Omineca. Twenty-three physicians from these communities resigned hospital privileges effective January 31, 1998, and this action spread to various other areas in the province. Lucy Dobbin was appointed to prepare a report addressing many of the problems and the issues at the heart of this dispute, and she issued a report in May 1998. I'm sure the minister is familiar with that report. Eventually agreement was reached at a meeting between the Ministry of Health and rural doctors -- in the minister's office, I'm told -- which happened, apparently, on June 12, although implementation of that agreement was not until September of 1998.
[2025]
Apparently, this agreement affected those communities qualifying for northern and isolation allowance, which is tied into one of the questions that has been addressed here repeatedly throughout the course of these discussions -- that is, the question of recruitment and retention of physicians in northern and rural parts of the province.
Some further limited progress was made concerning the formal rural negotiations in 1999, and this led to the subsidiary rural agreement -- subsidiary to the terms of the main table framework agreement, which was ratified in the spring of 2000 and laid out the rules for further negotiations, including various binding arbitration clauses.
We then had the Prince George situation, which began at the beginning of this year. We're all quite familiar with that; it's fresh in our minds and memories, I believe. It threatened to have a medical manpower or physician meltdown, especially in several care specialties. A special task force on physician retention and recruitment issued a report that formed the basis of the Prince George solution, which was negotiated in the spring or summer of 2000. Although settled in principle -- as has been pointed out tonight, it has concluded -- the money has not yet begun to flow to physicians in Prince George.
So I'm a little concerned when the minister makes reference to the Prince George agreement and the Prince George model and points to that, implicitly at the very least, as some kind of a measure of his and his government's success in
[ Page 17222 ]
addressing the questions of recruitment and retention in northern and rural British Columbia, specifically Prince George. I think it's much too early to say, in fact, whether that agreement will have the desired effect of dealing with the outflow of not only specialists but also health care professionals generally in the Prince George region, which has been pointed to -- and quite accurately so -- as a referral centre and a centre for health care throughout the north. So I have some concerns, as I say, with respect to that.
Certainly one of the concerns that the docs in the communities that I represent have with respect to the Prince George agreement, which is something else that needs to be addressed, is that it provides a disincentive for docs to locate outside of Prince George, in that the docs outside of Prince George, in towns like the town I live in -- Fort St. James -- will in fact be getting less money for on-call than docs in Prince George, living in the larger centre. The initial agreement with the northern rural doctors during their dispute, of course, had the effect -- at least initially and for some time -- of creating something of an incentive for docs to locate outside of Prince George in smaller communities such as Fort St. James. So that's something that needs to be addressed.
The whole question, in my view, with respect to recruitment and retention underscores this government's failure to develop, in a timely fashion, a comprehensive strategy to deal with recruitment and retention, which is really a big part of the problem. This government's patchwork, piecemeal approach throughout the north has been inefficient, ineffective and threatens the health and well-being of folks that I represent and folks throughout the north -- folks that other people on the other side of the House represent. I don't know how it is that some of you are able to answer the questions that I'm sure your constituents have for you with respect to health care delivery. Given that you've been in the position you have been in for some years, I can tell you that, speaking for myself, I have some real concerns about your inability to deliver in northern and rural British Columbia.
[2030]
I have heard nothing with respect to the request for dollars for the health care action plan that deals with the question of recruitment and retention. As I say, your obsession with the $40 million question underscores your failure to develop, in a timely and comprehensive fashion, a strategy for health care delivery, speaking for myself in northern rural British Columbia.
I have heard nothing that provides me with any sense of hope or optimism for the folks that I represent -- when I go back to my riding sometime in the next few hours or days -- with respect to the nursing shortage in Prince George, which, again, is part of the problem with respect to health care delivery -- this government's failure to deliver in northern and rural British Columbia. I've heard nothing that gives me any sense of assurance that I can go back to my constituents and speak to them about the need for dollars for long-term continuing care.
I think of Vanderhoof. I think of the Omineca Lodge facility. I think of the petitioning by various community leaders -- not just the mayor and council and others from Vanderhoof but folks throughout the region -- for a multilevel-care facility. Talk about stonewalling. We've heard nothing by way of a commitment, even though this has been a priority for the Northern Interior regional health board for some time. Certainly it's a priority for the residents of this region, as demographics are shifting and changing. This is something, again, that's been talked about during the course of the debate and the discussions tonight -- the need to address those problems.
Again, the fact that there's no new money doesn't provide me with any sense of optimism or hope. Frankly, I'm glad that the folks I represent can't see the minister now, as I'm talking about an issue that's very serious, not only for me but for the residents I represent. I won't say anything further than that, minister, but I'm looking to the minister -- and more importantly, the folks I represent are looking to this minister -- for a commitment with respect to a multilevel-care facility in Vanderhoof. I would remind the minister of the need to do just that. I see nothing with respect to a strategic health care plan for the north.
At this point I will allow the minister to respond to my concerns.
Hon. M. Farnworth: I listened to the member's comments, and I note them with some interest. I know how concerned he is about health care in the north. And you know, we share that concern. That's why we're here today. That's why we have been aggressive in obtaining, I think, the biggest amount of funding and the most important agreement in terms of assuring stability in the health care system -- the one we just negotiated with the other provinces and Ottawa -- which is why we're here today to see the injection of $290 million into the health care system to deal with problems, to deal with issues, to deal with moneys that will have an impact in communities such as his and the ones that he represents: $70 million for equipment, $180 million into the acute care system and $40 million for physician recruitment and retention in rural communities.
I've heard him outline problems as he sees them, and he should know that the key issue in Prince George is Prince George's role as that referral training centre. One of the things that we're trying to ensure in Prince George is that it can fulfill that role by having the requisite number of specialists on a long-term basis to train more physicians, who in turn can practise in rural communities throughout this province. That's what we're trying to achieve. So that's what this money is for: to do just that.
Now, does the member not support that approach? Does he not feel that the Prince George agreement is a good one? Does he not feel that those are good objectives in the case of Prince George? Do you support that Prince George objective? Because if you don't, let me know. The $40 million I come back to is designed to recruit and retain physicians in this province, in the communities that you represent. If you don't think it's enough money, let me know. If you think I should take money out of equipment and move it to doctors for recruitment and retention, let me know. If you want the money moved from other areas, let me know.
What I've outlined to you is what we are doing to ensure
[2035]
Interjection.
Hon. M. Farnworth: The member says: "Give it a rest." I'll give it a rest when I hear an answer. Do you think that the $40 million is enough to go for physicians? Do you support $70 million
[ Page 17223 ]
Interjections.
The Chair: Hon. members, could we please speak only through the Chair.
Hon. M. Farnworth: Seventy million dollars is worth talking about. There's a lot to say. It's a lot of equipment. It's equipment that can go into that member's community. It's equipment that can go in and improve working conditions for physicians, which he's been asking for. That will make it in part easier to recruit and retain physicians in British Columbia, and as I've said, we see Prince George as the training centre for putting more physicians into rural communities throughout B.C.
R. Neufeld: I have a few questions for the minister, and hopefully, we can keep on topic. Just a couple of remarks. The minister constantly asks us to answer the question of whether or not it's enough money. The interesting part is that we came down to Victoria to come into the Legislature to ask questions about the amount of money that's being spent in each health region, and we can't get that information tonight. It's constant when you ask this ministry for information about how they're funding health care that they don't have it, or they'll get it to you, or "We're still working on it." Then for the minister to stand here and constantly say, without giving us any information, "Is it enough or not?" is rather hysterical to say the least.
It's absolutely unbelievable that the minister would stand there and think that we would be able to give an answer about it when he and his ministry won't even give us the information, the simple information, that we're asking for tonight, like: how much are the cheques -- the ones that the Premier said on TV tonight were cut? How much are the cheques? Why don't you stand up and tell us how much the cheques are? It's pretty simple. The Premier said that they're cut, that they're ready to go out tomorrow. He was on TV just at 6 o'clock. So I guess that you just don't want to tell us any information. Then you stand up and ask whether it's enough or not. That's not good enough, and the minister knows that full well.
This whole thing is a charade. It's political by nature, and it's an absolute, bloody sham. He should be ashamed of himself, to be part of a government that would even call the Legislature back on a Sunday afternoon and then not have the information -- to start with, say they don't have the information, and then ten minutes later say: "We have it, but we're not going to give it to you, but we want you to answer questions." It's absolutely bizarre. But why should we be surprised? I've been here for nine years, and you continually surprise me, daily, as you do British Columbians, as health care tumbles. And you try to tell British Columbians that you really care.
I heard the minister talk a bit earlier about the amount of money that doctors were going to receive. I heard the number of $101,000, on average. Did I just misunderstand the minister or
The minister is nodding; I did misunderstand him. The minister is saying, then, that it's the commonly spoken number of $40,000, on average. Is that kind of the number that he's been talking about all afternoon?
And the minister, I believe, is nodding yes. Well, I understand, the doctors in Fort St. John were under the last agreement signed with this government, which gave them approximately $45,000. Now we've come in with a new agreement that says: "We're going to give you $40,000, and you have to relinquish the one you signed before that you were getting $45,000 for."
[2040]
The minister talked constantly about: "When is a deal a deal?" I guess the doctors are asking: "When is a deal a deal?" The minister talks about the doctors wanting $236 million. Now, according to my doctors that I speak to, that's not what they're asking for. They're asking for the hospitals to be opened so that they can do their work. But what is it, Mr. Minister? Is it a deal? Is it a deal? Is what you signed with Fort St. John doctors something that you're going to live up to? Or do you want them to take something new?
The Chair: I would just remind hon. members to go through the Chair when making their remarks.
Hon. M. Farnworth: I want to tell the member that a deal is a deal. And on the basis of the numbers that we have worked on, on this agreement, every physician in Fort St. John will get more under this new agreement than they got before.
R. Neufeld: I'll carry on to other issues that are on the provision of health care in the northeast. I'm going to make some assumptions here, because the minister won't tell us what the numbers are. But the North Peace health council is running about a $250,000 deficit, and they're bringing forward, I believe, a $160,000 deficit; that's about $410,000. And I understand that they're going to have a magical number somewhere around $500,000. But that's just something that I heard; I'm not exactly sure about that. So would that mean that the $500,000 is just going to cover the $410,000 shortfall, and there's only $90,000 more in the whole Fort St. John region of about 25,000 people to provide new health care? Or is the $500,000 -- and I'm assuming it's $500,000 -- for all new health care? And if that is the case, what happens to the $410,000? That's one part of the question.
Secondly, we fly an awful lot of patients to Grande Prairie, Edmonton, Calgary -- all over Alberta; that slash and burn in health care, Alberta. In fact, the last I heard, we had plugged Grande Prairie, and we were referring them to Edmonton. Will this new money actually help so that we don't have to transfer as many patients as we do from the northern part of the province -- that's Fort Nelson and Fort St. John, the two largest communities that I represent? Will that stem the tide of transfer of regular patients -- I don't mean specialized care, because we all understand when they have to go for specialized care -- to Alberta so that these patients will actually be able to stay in their hospitals in Fort St. John and Fort Nelson and receive the care that they should be receiving in the communities where they reside? Will the money, the phantom money that you're going to send tomorrow -- the Premier has said the cheques are cut, that it's on its way -- stem the tide and allow the doctors to go back in the operating rooms, to hire the nurses that we need? We're short a whole bunch of nurses, and the minister knows it. Is it enough money to provide that basic service?
This is nothing extra; this is no frills. Will it provide the basic service that those people need and should receive in the communities that they live in? I want the minister to remember that I'm not talking about specialized care; I'm talking about average care. I'm talking about sometimes delivering babies, when they have to be flown from Fort Nelson to
[ Page 17224 ]
Grande Prairie. I'm talking about those kinds of things. I'd like the minister to confirm for the people in the North Peace that they are actually going to be able to stay at home and get the regular health care that they should be receiving at home and not in Grande Prairie, Edmonton and Calgary.
[2045]
Hon. M. Farnworth: What we are discussing today is funding that will allow health authorities -- in this case the member from North Peace -- to provide existing services and new services, and that will allow there to be care in those communities for people who need it. What we're debating today is to bring stability to communities to ensure that with new equipment and with money coming into the system, care can be better provided to people there, to ensure that they can receive care in their local communities. It's part of the government's ongoing commitment to deal with not just the pressures on the hospital system but also, as we discussed in estimates earlier this year, continuing care and long-term care as part of that equation.
It's also why we had the funding and made the announcement around telepsychiatry earlier this year, which a number of communities in your constituency benefited from -- so that they can start to access the services that many in the lower mainland take for granted. This is a way to do that. That is definitely what we are trying to do.
[T. Stevenson in the chair.]
R. Neufeld: I would like to spend a lot more time, but there is a bit of a time frame that we have to work in here. The member talked about an 11 percent increase in mammography services across the province. The minister is well aware that we have a problem in the northeast with mammography services. Last year in estimates we dealt a bit with mammography services in Fort Nelson and Fort St. John. I want to know: with this 11 percent increase, will the British Columbians that actually live along the Alaska Highway all the way up to Fireside -- the areas that I represent, the Yukon border -- be able to access or have access to the mobile mammography unit? Those people live hundreds and hundreds of miles away from any community. Will they actually be able to receive services now that you're talking about increasing the budget by 11 percent?
Interjection.
J. Wilson: It's been a rather interesting day. We were called back here on a Sunday to debate something that was critical for our health care system -- to get money out in this province. As a supplementary estimate, you would expect some numbers to come out, some answers that we can take back to people in our constituencies to give them some comfort or at least explain to them where they're going and what they can expect out of this government in the next year.
What did we learn? We've learned that the Premier is promoting B.C.'s health action plan. Apparently his communications with the Minister of Health are somewhat iffy, if they are there at all, because obviously the Minister of Health really doesn't know what's going on. The Premier has said that there will be cheques in the mail on Monday. That means that they know how much, where it's going and that it's simply a matter of mailing it out once this has passed. The Minister of Health is not releasing those numbers, not releasing those figures so that we can take this information back to our communities and share it with them.
[2050]
When I look at this B.C. health action plan, I get a sick feeling in the pit of my stomach. I have shivers running down my back. It's scary. We look at the third item on it: we're going to "maximize preventive care and wellness." Does that go beyond the government telling British Columbians -- if I might have the attention of the minister for a moment -- that they should eat well, that they should exercise and that perhaps they should think about some immunization, because if you need a bed in a hospital in British Columbia, especially northern and rural British Columbia, you may not get one? Does it go beyond that? I don't think so.
The level of service that we have witnessed deteriorate in this province is unacceptable. We've learned that we've got $180 million going into the system. A lot of people thought that was new money. We find out today that it's not. We have deficits, we have anticipated deficits, and it may not even cover all of that. What does that leave the system to work with? We're not going ahead; we're going backwards, just like we have been for the last few years.
We have witnessed nothing here today that would indicate to me anything new with this government. They talk about being a new government. I've only been around this scene for four years. And what have we seen each year? It's something called lip service. Every year they pay lip service to the people of British Columbia without any intention of fulfilling their promises of doing things to correct the mess they created in the first place. And today we're no further ahead. We're probably further behind than when we started.
We have a real crisis situation in rural health care in this province. The community of Quesnel is suffering like they have never suffered before. We have no ICU in our community. Why? No staff was available to run the ICU this summer; it was shut down.
Now, I have a couple of questions for the minister. People in my constituency are very concerned about this. They would like an answer. If he doesn't have an answer, we can understand that. He's not prepared; he doesn't have all of his figures in front of him. The question I have is: will the ICU in G.R. Baker Memorial Hospital be reinstated, or will it not?
Hon. M. Farnworth: The short answer for the hon. member is yes, they will be able to.
J. Wilson: That's excellent news. Now, my next question is: when?
Hon. M. Farnworth: As soon as they are able to recruit the ICU nurses, they will be able to reopen.
[2055]
J. Wilson: I assume, then, that the ministry is working hard at recruiting. So far over 30 people have been sent out of G.R. Baker Memorial Hospital who required intensive care. They were shipped out of there. Yes, it didn't cost them anything to leave, but they had to find their own way home. The cost of doing that would have paid for the staffing that was required to keep that unit up and running. To say, "Yes, as
[ Page 17225 ]
soon as we can find staffing," doesn't give me a lot of comfort. It could be six months; it could be two years down the road.
The other question I have for the minister is: considering the fact that this $180 million is going to go out and cover projected deficits from the various regions, the boards, can we at G.R. Baker Memorial Hospital expect the operating deficit that will occur there to be covered in full by this $180 million?
Hon. M. Farnworth: The hospital and the health authority can count on the money coming to them being able to cover the services that they would normally be supplying this year, as well as the additional services that they are expecting to deliver.
S. Hawkins: It's been a very frustrating day. This government called the House back for estimates of new spending, and we're getting the same kind of answers to questions that are asked during regular estimates. Frankly, we're getting no answers here tonight.
It's really galling to hear the minister sit there and say that they're meeting patients' needs when he knows darn well that this government has fallen short of meeting patients' needs across the province. In fact, this government is responsible more than any other for widening the gap between rural and urban health care. Frankly, every corner of the province
It doesn't matter how much money this government has thrown at health care -- in fact, the budget has gone up every year. Health care services and the quality of care have deteriorated. This minister, if he doesn't know that, should get that message today. We get calls every day -- and I'm sure those members over there do too -- from either patients or families or doctors saying that people aren't getting the care they need when and where they need it.
And frankly, I'm disappointed. There have been specific questions asked, and this minister comes to the House yet again with no answers. I've got specific questions -- follow-up questions, actually -- from my health region. We canvassed this through estimates; I believe it was on May 16. And here it is September, and my health region still doesn't have its budget. My health region is sitting in an $11 million deficit position.
I'm wondering, because I asked this in the summer. We have a new cancer centre. It's been operating for a couple of years in Kelowna. In estimates in May, I asked the question. The health region identified a need for six beds. This government is saying there's new money going into the system and new money going to health authorities, so that was one of the priority identified needs. And I want to know: is this so-called new money going to fund any of those six cancer beds that were identified?
[2100]
Hon. M. Farnworth: The health authority in Kelowna will be receiving its allocation. They will be getting back to us within a month on how they intend to expense that allocation. It will be done on the basis of the needs within the health authority, and they may well decide to expense moneys on the beds the member is talking about.
S. Hawkins: What is the lift that the health region is going to get?
Hon. M. Farnworth: Starting tomorrow, there will be moneys going out the door in three areas. The first is doctors, and they will note what their portion is from the $40 million. They will be notified of what their lift is on their operating budget, and that will come very quickly as well. Then equipment will follow shortly after that, and they will let the province know within 30 days how they intend to allocate their moneys, based on their priorities.
S. Hawkins: How come we're here today and we're not hearing from the minister specific numbers? Why does the minister not have that information for us here today for estimates? Why is it tomorrow, tomorrow? That was the same answer we got back in May. It is now six months into the budget year. You've got new money to spend, and you can't even tell us what the lift is that our health region is going to get. When are you going to sit down and do your homework?
Hon. M. Farnworth: We're here debating the infusion of $290 million into the system. As I've said to the hon. member, the specific lifts will be going out in the next day or so. The first ones going out will be the physicians, then the health authorities, then equipment. It will be done in that order. They will know. And they will be responding to us within the next 30 days on exactly how they intend to spend their allocation, exactly what it is they intend to spend their money on. They will make their decisions on how they spend that money on the basis of what the need is in their local area.
S. Hawkins: I'm having a real difficult time with this, because my region is sitting at a deficit of $11 million, and this minister is talking about new money that's going to come to my region. He has not even given me comfort that there's going to be any new money. He has not even given me comfort that there's going to be $11 million to cover the deficit. What we're getting is a smoke-and-mirrors game here today. It's all a sham. We're coming in here today to discuss estimates for this new spending, and we're getting absolutely nowhere. I'm asking some very specific questions that my region is asking, and the minister is telling me it'll happen maybe in 30 days. Well, in May he told us it was going to happen maybe in two weeks. It's now six months later in the budget year, and we're getting absolutely no answers, hon. Chair.
There are all kinds of issues that we discussed back in May. We discussed the need to fund regional hospitals as regional facilities. He knows very well, because of the cancer centre, because of the kinds of services Kelowna General Hospital provides, that we function more as a macroregional area. We service patients from Thompson, from the Cariboo; we work with patients in the Kootenays, in North Okanagan. Do you know why we're getting all those patients? It's because specialists and doctors are leaving those areas. So hospitals like Kelowna General Hospital in my region are bearing the burden.
[2105]
We are running a deficit. Money does not follow patients as they cross the regional boundaries. This minister hasn't even given me comfort today that any money going to go the region is actually going to meet the deficit or provide for new services. Can this minister tell me that there's going to be
[ Page 17226 ]
enough money to cover the deficit and enough money for this region to actually provide any new services? I understand that the region did receive $16 million, I believe, about a month ago; $7 million of that went for an HEU adjustment. A lot of this money, I understand, is actually going to go to meet deficits or contracts, and very little is for new services.
When the minister gets on his TV ads tomorrow and in the paper bragging about all this new money, and patients are actually going to have high expectations thinking they're going to get new services, guess what. They're going to find that the government pulled the wool over their eyes again. This minister isn't answering any questions here tonight -- not one. All I'm asking for is some comfort that the $11 million of that deficit will be covered -- that's in services that are just being provided for status quo -- and that there is going to be money for some new services like those cancer beds that are needed, like the ICU beds that are needed, like the OR space that's going to be needed, like nurses that are needed for ICU. This minister isn't able to answer any of those questions.
I have absolutely no confidence that there's actually going to be money going out tomorrow or that there's going to be money at all provided for new services. Can the minister respond to that?
Hon. M. Farnworth: First off, if we vote the money, it'll be going out. There will be money. Second point, we're not dealing with deficits; we're dealing with the projected spending over the course of the year, and we're halfway through the fiscal year. That spending is for existing services and new services. That's what the allocation will be dealing with.
The other point that I want to make for the hon. member -- and I'm keeping my answers brief -- is that there is recognition of the fact that Kelowna is a regional centre. Money does follow patients. There is recognition that Kelowna has to deal with patients from outside its area; that is taken into account.
L. Stephens: I'm pleased to take my place in the debate tonight. I'm not going to go over a lot of the issues that my colleagues have raised. But I do want to put on the record the fact that I think those of us in the South Fraser region are going to be very interested to see what kind of money comes our way. I know the minister is aware that our particular region, for a very long time, has talked about the inequities of funding, so this particular money that he is releasing tomorrow, presumably -- he says he is -- will go a long way to address that.
Before I ask some specific questions, I do want to say that I think that this particular day we are at is one of gross political posturing on behalf of that government over there.
An Hon. Member: Shame!
L. Stephens: This is a shameless display. There's no reason to have to come back on a day like today. You could have done it tomorrow. The minister has admitted that the cheques aren't going to be going out tomorrow, and I don't think they're going to be going out the week after that either. I don't think the minister really knows what he's doing. He certainly hasn't provided this House with the kind of information that this House deserves. I don't know why he continues to do that, because he certainly isn't answering questions.
But I have some information here for the minister, and I would like him to try and answer these questions as much as he can. The South Fraser operating budget of $429.2 million for this fiscal year, 2000-01
The ministry said that there was a total lift of 11.2 percent to the health regions. I think at one point he said that there was 10.7 percent for the Fraser Valley. Could the minister clarify that percentage -- how much of that 11.2 percent, in percentage terms? I'm not going to ask him for a definitive dollar amount, because he's not answered any of the members' questions in that regard. But perhaps he can answer what the percentage amount would be, coming to the South Fraser region.
[2110]
Hon. M. Farnworth: Again, I'll make three quick points for the member. First off, they're not dealing with deficits. They're dealing with the projected spending in terms of the provision of existing services and new services for the coming year, and their allocation will deal with that.
Second, they've already received their contract wages, so they've already had their funding for that.
In terms of their allocation, the exact amount, it will be around 11 percent, which is the average across the province. The average lift, I think, is 11.2 percent. They will be notified of that, you know. Well, as I said, the first cheques, if you like, go out tomorrow.
Interjection.
Hon. M. Farnworth: Yours is a special case, hon. member. You wanted a specific time, so I've arranged one for you. But the doctors' allocation is available, then to be followed by the operating moneys and then the equipment after that.
L. Stephens: Well, 11.2 percent isn't really going to cut it. The reason that it isn't -- and I know the minister is aware -- is that our particular region continues to be underfunded from the provincial average.
Just to give you some numbers, in acute care our region has 13 percent lower funding than the provincial average; that equates to $39 million. The continuing-care residential grant per capita is the lowest in the province, 18 percent lower than the B.C. average, and that equates to $23 million. Continuing-care community grant per capita is the second-lowest in the province; it's only beaten by the northern interior region. That's 31 percent lower than the B.C. average, and that equates to $14 million.
So when we look at the greatest need in the South Fraser region, it is clearly in residential care and long-term care. Until that problem is solved in our region, we're not going to be able to solve the closures in the operating rooms. We're not going to be able to address the terrible backups in the emergency rooms.
Last week Langley Memorial Hospital almost had to divert everything from the emergency ward. Last week Surrey Memorial Hospital had to divert twice. They couldn't take any
[ Page 17227 ]
more patients; they had no more beds. Fifteen percent of the acute care beds in our region are taken up with continuing-care patients -- 15 percent. The goal is only 3 percent.
So what I'd like to know is how the South Fraser region is going to solve the problem of providing continuing care and residential care beds to take care of the needs of the overcrowding in the emergency -- the closed operating rooms. How does the minister expect the region to provide those beds to do all of these other wonderful things that he wants done? Who is going to pay?
Hon. M. Farnworth: Well, I'm surprised that the member would say that an 11.2 percent increase in operating funds doesn't cut it; that's a significant increase. That is as big an increase, I think, as anywhere in the country has received. But what I will tell the member is this: we have worked very closely with the South Fraser health authority. They will be informing us within the next 30 days of their priorities for their allocation and how they intend to spend it. I know that it will be based on what they believe are the key priorities in their area.
[2115]
L. Stephens: Mr. Chair, 44 percent of the current budget is taken up by services to the frail elderly. I'm sure that the minister knows that that is the number one priority for our health region. I'm sure he also knows the inequity in the historical funding to our health region. Yes, 11 percent is probably more than the other regions are going to get, but the fact remains that they're always -- and are still, I would suggest to the minister -- in a catch-up position.
So what I would really like to hear is how the minister is going to deal with an area such as ours, which is the fastest-growing in the province -- 37 percent population increase and an aging population. It is nice to have a little bit of extra money, but I'm suggesting to the minister that it's not going to provide the level of care that the minister says he wants to see in this province.
So again I want to ask the minister: what is he prepared to do to help our region provide those long term residential care beds? That is the issue. We are 650 beds short in the region. That backs up all those acute care beds in the hospitals. That means the emergency ward doesn't operate efficiently. It means the operating rooms don't operate efficiently. And that's what the problem is: those long-term residential beds. Our region can't fix that problem, because we are always underfunded. They're always scrambling to keep up with the services that they are trying to deliver, and we can never get ahead on this residential long term care spaces issue. I'd like the minister to give me some suggestions on what he's prepared to do or what the region can do to help alleviate this particular pressure point, because it is very severe.
Hon. M. Farnworth: Well, as the member knows and as I repeat for the member:
1. We will be receiving their priorities, in terms of how they intend to spend their allocation, within the next 30 days.
2. There are things already happening in the South Fraser area which are important and in fact will help to deal with some of the pressures in the member's health authority. For example, the new tower coming on stream at Surrey Memorial will certainly have an impact.
On top of that, I also think it's important to note that it's not just a case of money, but it's also a case of being more innovative, doing new things and doing things differently. South Fraser has been very good at that, and in fact some of the things that they have been doing we have been taking provincewide.
That's where, for example, some of the $70 million that is being spent on equipment comes in and plays a very important role. A significant amount of that is for new beds, new lifting devices and new equipment that can make things run more efficiently. That allows for allocating resources in other parts of the system, improves the working environment and makes it easier, for example, to recruit nurses into the system, which is something that they've attached a priority to. All those things in their own cumulative way have an impact on being able to deliver more care. So those are some of the things that are currently taking place, as well as the impact that the moneys coming into the system will have.
L. Stephens: I appreciate what the minister is saying. But lifting devices and reallocation of equipment such as that do nothing to provide residential care beds -- nothing. It may make the staff's life easier in the acute care hospitals to look after patients, but it certainly doesn't do anything to provide acute care beds in the hospitals, and that's what we're really talking about. Our region has enough acute care beds, if they weren't full of long term care patients. Our challenge is to provide those facilities somehow, someway, and there's a lot of talk about how that could be accomplished. But for the region to even begin to go down that road, they need to be able to provide the current services that are required plus make sure that those patients who require residential long term care actually have a place to go.
[2120]
There's a 20-month waiting list in our region. The shortest waiting list is nine months, and that's for one facility in Surrey. So I want to reiterate to the minister again that until our region addresses that problem, we're going to find and the minister is going to find that we're not going to be able to deliver the kind of services that he wants, and that is making sure that surgical patients move through the system and making sure that the medical patients are moved to where they are needed.
Also, home care and community care is another huge issue for us; there's nothing that I've heard the minister say today that gives me comfort that that is going to be addressed as well. So I'd like to know and certainly the people in the South Fraser region would like to know whether or not the ministry is prepared to come to another arrangement or a separate arrangement with the South Fraser region that acknowledges those pressures that we have to that degree, come to an arrangement and work out a solution to provide those residential care beds for our region.
Hon. M. Farnworth: Hon. Chair, we are always willing to work with health authorities. South Fraser has been very innovative over the years, and we like to try and find ways of working with them. What I expect to happen, because beds are not the only things they require in terms of dealing with the issue that you've raised, is that they'll be coming back to us with their priorities of where they are spending their allocation. If that's their priority, then I expect that it will be in their list. It will certainly be represented there.
But the other things that are in the system
[ Page 17228 ]
do play a big impact, particularly in the long term care sector and in dealing with people, because they improve the working conditions, they reduce injuries. That means you're not hiring as many or bringing nurses in on overtime. You're dealing with and improving patient care in that, because you're not having nurses who are off sick. You are able, then, to have more nurses come into your system. And you're able to hire more effectively and to deliver better patient care. Nurses are telling us that some of the things that contribute to their stress are things such as working conditions, things such as equipment, things such as the types of beds and the lifting equipment -- all those types of things.
B. Barisoff: First of all, earlier on the minister indicated that some of the criteria for the $180 million would direct it in particular to growth areas and areas with particular demographics. Well, in the Okanagan-Similkameen region we have particularly heavy growth. And the demographics are showing that we're probably 600 long term care beds short. Earlier on I heard our opposition critic mention that in the Okanagan-Similkameen we're looking at a $13.7 million accumulated deficit.
The minister said that what was happening and what his direction to the health authorities was, was that they were to maintain or increase the level of service in their particular areas. I'm wondering whether the minister would confirm the $13.7 million deficit and assure the people of the Okanagan-Similkameen area that when this cheque is cut by the Premier's Office tomorrow, this $13.7 million accumulated deficit would be covered so that they could continue to offer the same level of health care that would be offered in the rest of the province.
Hon. M. Farnworth: I repeat for the member: they're not dealing with a deficit; they're dealing with their projected spending for the course of the year to provide the existing level of services and the new services that they expect to be providing in their communities. The allocation will be covering their spending requirements for existing services and the new services they'll be providing.
[2125]
B. Barisoff: I guess that the assurance, then, that I would be getting from the minister is that the existing level of service or the increased level of service in the Okanagan-Similkameen health region would be continued because of this infusion of money that has come from the federal government.
The other question I have for the minister is on the recruitment and retention programs. I happen to know that the recruitment and retention programs, particularly in the South Okanagan, at South Okanagan General, aren't working. I'd like to ask the minister what he's going to do. I heard the member for Cariboo North indicate that recruitment and retention weren't working in that area either, and I'm sure this is probably common throughout the entire province. Would the minister indicate how he's going to make this recruitment and retention program work throughout the entire rural area of the province?
Hon. M. Farnworth: I'd ask the member to clarify. Is he talking physicians or nurses?
B. Barisoff: Nurses.
Hon. M. Farnworth: I can tell the member that as of last week Kelowna General reported that there is not one vacancy in their hospital.
B. Barisoff: I did indicate to the minister that it was the South Okanagan, and I know, in particular, at South Okanagan General. I'm sure that my colleague from Penticton will indicate that Penticton also has the same situation, and I would suppose that Summerland would be in the same kind of situation -- that the recruitment and retention program is not working in these areas.
Hon. M. Farnworth: One of the reasons why we have ensured that there is an equitable spread around the province of the new seats in the nursing training program that came on stream this year is to ensure that people in local areas can have access to entering the nursing training programs. I can tell you that in terms of the South Okanagan it is a desirable place for people to locate and that while from time to time there are vacancies in the hospitals, they don't have the same problems that exist in other parts of the province. We work closely with the health authorities to identify areas when, from time to time, problems do come up. That's one of the reasons why we have put the increase in spaces in place, which South Okanagan will benefit from. It's to make sure that we do have nurses from the local areas to come on stream.
B. Barisoff: Let me assure you, Mr. Minister, that there is a problem, that the recruitment and retention programs are not working in these areas. I know that we live in probably the most desirable area of the entire province, but it's harder and harder to get young people to stay there unless they have full-time jobs committed to them. It's a difficult situation, and it is continuing.
My last question to the minister would be: out of the $70 million equipment fund, how much would be going to the Okanagan-Similkameen health region?
Hon. M. Farnworth: The equipment allocation will be going out very quickly after the health authority announcement and the health authority money and the doctors' money. One of the things I can tell you that they're telling us is important in terms of recruiting and retaining nurses in the system, apart from training, is to improve working conditions. That's one of the things that equipment is intended to deal with, so that nurses who are working there find the working conditions easier. It also makes it easier to bring nurses who have left the system back into the system.
G. Abbott: I think the last response was fairly typical of ones we have been hearing for several hours now. We have been called back to Victoria on less than 48 hours' notice to hear the global responses of the minister here today. He can't tell us what each of our health regions is going to be getting for the health authority or for equipment. We remain in the dark on that. For some reason we had to come back today. The government's not anxious to tell us why that is. For some reason we had to come back today on less than 48 hours' notice to get non-answers to a long series of questions here.
I'm very disappointed by that. All year we've been hearing from the new Premier and his new government that there is going to be a new way of doing business in this province. Clearly the new way of doing business is a lot like the old way of doing business under the NDP in this province. Less than
[ Page 17229 ]
two days' notice and we come -- no answers. The minister's either unwilling or unable to provide us even with answers to the most basic questions, like: how much is the North Okanagan health region going to be getting under the terms of this agreement? He can't even answer that. Apparently
Interjection.
G. Abbott: We have been asking all day, minister; regrettably, we get no answers. The answers we receive are pretty much as tiresome as you are. So I would just restrain yourself for a little while so that we can get on with these questions.
I had some specific questions I was going to ask on behalf of the North Okanagan health region. Obviously they're very interested in what's going on here, but I don't think there's any point in me wasting time on specific questions, because I'm not going to get answers. I want the minister to answer, as succinctly as he can, a couple of process questions I have around what's in store for the health regions.
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The minister has said on a number of occasions today that the health authorities -- the regional hospital districts, the regional health boards -- would be advised of their supplemental funding allocation sometime in the very near future. I think that at times the minister has indicated that some at least will be hearing tomorrow. I'm presuming that probably the date is in fact a little later than that, because the minister at another point indicated that the doctors would be hearing about their supplemental funding allocation and the regions would follow that. The minister can clarify the point on that.
He's laid out the next step in the process fairly clearly. The regions are going to be invited to submit their proposed priorities within 30 days. Now, the first question I have is: are there going to be parameters, conditions, restrictions, constraints around what the regions can propose? In short, if the priorities proposed by the region are not consistent with the priorities of the province, will the regional priorities be rejected?
Hon. M. Farnworth: To clarify: as I said, the doctors' money, I think, is going out first and then the authorities' and the equipment. The answer to this question is: they have a lot of latitude. The main requirement, though, is that it is consistent with their three-year plan. That, you know, is something that they have been working on -- and working closely with the ministry. So I'm not anticipating any problems. In fact, I think the health authorities develop three-year plans for exactly the reason that we're talking about. It's that they know where they're going to allocate their money and the pressures that they're facing, and try and deal with them.
G. Abbott: Hon. Chair, I will be utterly astonished if the discussions between the regions and the province evolve in the way that the minister appears to be suggesting. For example, the North Okanagan health region spent an enormous amount of board time, and some consulting time as well, trying to sort out an acute problem with the laundry system that they have in the North Okanagan region right now. They went through all the processes as a board to work out a plan. That plan was summarily rejected by Victoria. Now, it seems to me that if the health region is not going to be able to sit down and work out a solution to its own laundry problems, I think the likelihood that the list of priorities that they submit to the province
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Now, I guess the next question is this. After the regions submit their priorities, presumably within 30 days, I'm assuming that there will be some turnaround response from the province. Is the province committed to a specified time frame in their responses to the priority proposals of the regions?
Hon. M. Farnworth: We are in fact actually working with them during this 30 days on their priority lists, so that it can be dealt with as expeditiously as possible.
G. Abbott: To conclude the point, then, the minister is saying that in the process that's envisioned here, the province works with the regions during that 30-day period to develop the regions' priorities. In a perfect world, presumably, the region and the province come to some consensus about what that is. If the priorities of the region are at variance with the province, do the priorities of the region prevail?
Hon. M. Farnworth: If they're consistent with their three-year plan
K. Krueger: In the minister's opening remarks for this debate he said that this government was attempting to move away from confrontation toward stable, predictable long-term funding and that it was essentially felt that health regions should be well equipped, well resourced and well managed.
Well, our health region is run by a group of people who were appointed by this government after the duly elected Royal Inland Hospital board was fired. These people have made a number of key mistakes. They fired the administrator of Royal Inland Hospital, Paul Chapin, and had to pay a $500,000 severance package ordered by the courts as a result. They fired the administrator of Ponderosa Lodge, a large extended care facility in Kamloops, and had to pay a substantial severance package to him. They fired the recently appointed manager of Overlander Extended Care Hospital and, I'm sure, paid a substantial severance package to her.
The extended care facilities are in chaos as a result. We canvassed this in the estimates. I understand it's not getting any better. This group of appointees appointed new managers who would apparently do things the way the appointees felt they should be done, and chaos has resulted. So it's hardly been a positive result.
The government released this so-called B.C. health action plan on September 13, 2000, and it promised new funding, more money for operating rooms, more money for critical care beds. It deliberately led the people of British Columbia and the opposition -- in fact, every MLA in this House -- to believe that new money was going to be provided to take care of some of these problems that have been created. There's a wait-list in the Thompson health region for extended care, continuing-care facilities as long as the existing number of beds. That is, if everybody in those beds moved out of them tomorrow, there's a wait-list to fill them all up again right away. Of course, that's not going to happen. So we have a lot of problems.
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The finance committee chair of the Thompson health region said that for the year 2000-01, they will experience a shortfall of $9.5 million at March 31, 2001. And that's just to maintain the status quo; that's not to add any new beds.
The Clearwater hospital was promised by this government eight months before the last election, and it's still not seen a spade in the ground. A psychiatric care, tertiary care facility was promised for Kamloops years ago, and there still hasn't been a spade in the ground.
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Many of the nurses that are graduating at UCC don't even bother sticking around Kamloops and the Thompson health region because their employment is so uncertain. They are victims of what they call the casualization of the nursing workforce in British Columbia, where they are obliged to work as casuals on call rather than being allowed permanent jobs. Why? Because the health region really doesn't have stable funding, and it can't be well equipped, well resourced and well managed. So they go to Australia, they go to Europe, they go wherever they are appreciated. They go to Texas, of all places. They go somewhere where they can have a permanent job, because the ones who stick around end up having to work on call, casualized, working 12-hour shifts, called in, not called in -- lives totally on hold because this government will not fund the health care regions in a stable way. They burn out, and we lose them faster than we can graduate them. This government finally came up with a few extra spaces for UCC, and it's way behind in staffing up the institutions to where they could be to turn out the number of graduates that they're perfectly capable of.
All of these things, I submit, have not been dealt with by this government. And now, to our utter dismay, we come down here today to this emergency special debate where we're supposed to be talking about new money to the health care system, and we find out that all the minister apparently intends to fund is the accumulated deficits of the health regions. Can the minister tell the people I represent and the people that the Minister of Municipal Affairs, the member for Kamloops, represents whether in fact there will be one single, solitary nickel over and above the projected $9.5 million deficit for this year that this government is allotting for all of those problems that he and I debated in the estimates in the spring 2000 session of this Legislature, or whether in fact this has all just been a public relations exercise today? Will there be any additional funding to deal with those problems?
Hon. M. Farnworth: I'm going to keep my answers short because, quite frankly, this member has had
Interjection.
Hon. M. Farnworth: Yes, because I know that that member normally heckles from his own seat. So that's why I am puzzled when I see him sitting in his seat and his voice is coming from somewhere else. I guess he learned to throw it, eh?
Anyway, the member for Kamloops-North Thompson likes to use hyperbole and rhetoric, when in fact what's taking place is that it's not a question of accumulated deficits. It's a question of projected spending by the health authority this year to provide existing levels of service coupled with new services to meet the needs of the health authority that he purports to represent. What we are trying to do is ensure that we can do that and that this is an infusion of cash which brings stability into the health authorities based on a number of things.
First is the restoration of the transfer payments. That is the biggest single thing to ensure stability in health care funding for this province in a number of years -- since the cuts took place in the mid-nineties. That will ensure, not only for the province but for the health authorities, a predictable source of money restored to the health care system.
Second, we are dealing with equipment, which is what the health authorities have been saying they want to see in the system. That will do a number of things: (1) provide better patient care and (2) ensure better working conditions, which can bring more nurses into the system.
Third, the issue of nurses is being addressed through more spaces coming into the system, which are currently on stream -- and again, issues that can be addressed through upcoming contract negotiations about issues the member has raised. That's a good place to do them.
But what we are doing here today is not an emergency. It is not a crisis. It is recognizing that what we are doing is putting into the system the money that we are getting from Ottawa plus provincial resources, through the supplementary estimates process, which is consistent with the budgetary laws of the province, as opposed to doing it the way you don't want it done -- and you are one of the leading advocates of what we shouldn't do -- which is special warrants.
K. Krueger: Clearly the minister has no intention of answering my question, as he hasn't answered anyone's questions all day. The question is
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That was the first question. I'm going to give the minister one more chance to answer it. I don't believe he will, so I'll ask my second question at the same time, which is this: if the minister and his government felt that the appropriate number to settle the issues in Prince George was $10 million -- $10 million for Prince George alone -- then how in the world can they believe that the appropriate number for the whole rest of the province, to settle the rural health care issue, the rural doctors issue, is $40 million? What specifically do they think is going to happen for Clearwater, for Barrier, for Chase, for all the other areas that have to be covered by whatever settlement this government comes up with?
Is this government deliberately provoking doctors? Or is this government so stupid that in spite of the fact that it believes that it's expert in labour relations, it got itself into this whipsaw negotiation situation where it's paid $10 million to one region and now it's trying to settle the whole rest of the province for four times that amount? Would the minister answer that question?
Hon. M. Farnworth: You told us to spend the money there. You told us to spend the money there in Prince George.
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What we're saying, hon. member, is that we are prepared to deal with issues of recruitment and retention in communities right across the province. The question comes back: is what you're saying, then, that $40 million is not enough? Is that what you're saying -- increase the $40 million?
K. Krueger: This government has said, through this minister, that it is not going to blink. This government in fact is operating eyes wide shut. This government cannot resolve the current situation with the offer on the table when it went as far as it did in Prince George. The minister can't blame that on the opposition. What is the minister going to do to make British Columbia a welcoming environment for doctors, rather than estranging them and treating them as enemies, as the minister does when he refers to them as greedy? Does the minister regret making that comment? And what is this government going to do to neutralize those negative remarks and those errors that it has made?
Hon. M. Farnworth: What this government is doing to make an attractive environment for physicians in the province is injecting $290 million into the health care system today: $70 million for new equipment to deal with the issues that physicians have been talking about in terms of equipment in hospitals, to make their working environment better; $180 million to provide existing levels of service and new levels of service so that they can provide more services to patient care and get greater job satisfaction; and $40 million to deal with recruitment and retention, which is the most competitive package in this country and which we have said we are committed to doing. That's what we're doing, hon. member.
J. Reid: It's very frustrating listening to this debate. It's my understanding that the process that's going to happen now is that the health regions are going to be asked to report to the minister what they're already doing. Then the minister will compile that information and put it out as though this is a plan, because this is what's already occurring.
With the lack of information here, there are still some very pertinent questions for the areas -- one to do with equipment for Nanaimo Regional General Hospital. We canvassed this question during the estimates debate. Now that there's money coming for equipment, will Nanaimo Regional General Hospital get its MRI?
Hon. M. Farnworth: The health authorities will be receiving their allocation on equipment. In terms of particular pieces of equipment, the ministry establishes priorities in different parts of the province based on need and access to ensure that there is a reasonable level of access in different parts of the province. All those are taken into account when the allocation is made, and the announcement on that will be made shortly.
J. Reid: There is information that we've been given with regard to this supplementary amount about primary care. Another issue that we talked about in the past was a primary care facility for Qualicum Beach; that has been followed up. The mayor has been in contact with the minister. I asked the question previously. But now that there is a new allocation of money, what is the process for regional districts who want to follow up with these primary care facilities?
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Hon. M. Farnworth: In terms of the money that has been dedicated to primary care, we still have to sit down with Ottawa in terms of specifically how that is to be allocated; we work with them. The money flows this year and over the next five years. For B.C. it will be approximately $19 million to $20 million. It's not part of today's current allocation. That is something that we, the province and the federal government, have to resolve -- the issue of how that's to be allocated. Once that's done, I will be in a position to let the health authorities know how to access that money.
J. Reid: Nurses' training -- at Malaspina College there's a program for training nurses. This last year it was expanded slightly. Does this allocation of dollars include new training spaces for the nursing program?
Hon. M. Farnworth: Training spaces are in Advanced Education. These are the supplemental Health estimates. What we're talking about here is money that health authorities have to train existing nurses within their system in terms of upgrading their skills.
J. Reid: That's really great. As we're planning health care, it's wonderful to know that that's not part of the discussion here -- new nurses and new nursing spaces -- as part of a plan. That's what we're asking: what is the plan? How are we going to meet these needs?
All right. If we can't answer that question, then as far as the plan goes, who is in charge of the plan? At one point you say it's the regional health authorities that are supposed to be directing the plan. Is the province directing the plan? Who is in charge of the plan?
Hon. M. Farnworth: The province develops a provincewide plan to meet the health needs of the province as a whole, and within that the health authorities develop regional plans to deal specifically with the communities within their health authority and the plans that reflect the priorities of the communities in that particular region.
J. Reid: My last question, hon. Chair. Okay, a specific example: we talked about lifting equipment. Well, the province sets the plan. We need lifting equipment. How is that going to be allocated down to the regions so they know what they're going to get? Let's give some kind of specific -- anything at all -- lifting equipment
Hon. M. Farnworth: The health authorities do their health authority plan. Within that plan they look at their equipment and their equipment needs, and they submit an equipment request to the ministry.
I. Chong: I believe the point has been made enough times now such that the minister must really know how frustrating it is for members on this side of the House, who have been trying to receive answers but have only seen incompetence and ineptitude displayed. We were recalled to debate decisive spending of $290 million. But so far all we've seen is a feeble attempt to have us be quiet, to have us not ask questions and to have us just trust him. But we can't trust any member on that side of the House, hon. Chair.
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So what should be clear to this minister is that they have a problem over there. The Premier and the Minister of Health are not even talking from the same page. The Premier says,
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"The cheques are ready to go tomorrow morning," and the Minister of Health says that he hasn't a clue of who gets what for what area and how much.
When a minister comes to this House asking for a spending appropriation, we are quite prepared to approve that, provided that there is debate, provided that we can ask questions and provided that we can get answers. That hasn't happened. A minister should expect that there would be questions, and a minister should expect to provide answers. So either he doesn't know, or he's just participating in another sham. Regardless, it really is a disgrace and an abuse of this House, as has been mentioned by other members already.
On this side of the House there are two members that represent the capital health region: myself, representing Oak Bay-Gordon Head, and my colleague representing Saanich North and the Islands. And I know that other members have asked on behalf of their health regions what amount of this $180 million is going to their regions. So I'm going to try once more, in an effort
I heard him speaking earlier about deficits not really being deficits and that in fact it's forecast spending. But looking at past experience, looking at the capital health region for the year that ended March 31, 1999, there was a real deficit, a $2.2 million deficit. Also for the year ending March 31, 2000, there was a real deficit of $8.6 million. So there's a cumulative retained deficit, as they say in accounting terms, of $10.8 million. So I would like an idea of how this $180 million will change these deficit figures or what new spending will be provided.
I heard earlier tonight on the newscast
Again, because the minister is unable to answer, I'm hoping that after I finish, he will be able to answer. On the subject of the $70 million that is to be spent on equipment, again I would ask the minister if he can provide me with some inkling of what amount is allocated to the capital health region. As we know, earlier this year certain ultrasound equipment was to be sent to medical volunteers in Cambodia, Haiti and east Africa, and they rejected it. That is how well used our equipment is in the capital health region and why we are in dire need of that.
I know that the Minister of Health has been listening, because
So I'd like to know just what amount of money -- perhaps a ballpark figure -- we can expect here in the capital health region. And if he can't give me a specific figure, maybe he can at least admit: is any money going to be coming to the capital health region from the $70 million?
Again, since the minister isn't able to answer, I'll continue with the last point that I want to make, in the hopes that he will be able to answer finally. I know that the minister is listening intently, so I'm going to give him this opportunity to give me this answer in the last area that I would like the minister to respond to. It's in the area of where more moneys are going to fund renal dialysis. Because he mentioned this in his comments earlier tonight, I'm interested in knowing what he means by more funding will be made available for renal dialysis.
Here in the capital health region, plans to renovate the renal dialysis unit facility at the Royal Jubilee Hospital this year were put on hold. In fact, the press release was issued in June. At that time the Attorney General, the member for Saanich South, said that a new plan was forthcoming, one that would accommodate all the new demands made for renal dialysis, and that a new adequate facility really had to be well thought out and planned for. So that was in June.
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We're three months later. I would like to know where that plan is. I would like to know whether some of this money -- whether it's in the $180 million or in the $70 million -- is going to be allocated towards a renal dialysis unit here in the capital health region, because I have received so many calls and so many letters, as I'm sure members on that side of the House have received, such that
If the Minister of Health, when he's able to answer, can provide me with that answer, then I can at least go back to my community and share with them that one area that I would need to provide them an answer on. So I'm hoping that the Minister of Health, now well briefed on these three matters that I've just raised for his attention, can answer that, hon. Chair. And I'm hoping that he doesn't ask another minister to respond, because I really believe it's the Minister of Health that needs to respond to the capital health region issues, because this is the capital city of this province of British Columbia. I'm hoping that the Minister of Health has the courage to stand up and give me those answers, which I really would like now.
Hon. P. Ramsey: I thank the member for her comments. I recognize her strong advocacy on behalf of health services in the capital region. I think, as we look at the allocation of this infusion of federal funds for equipment -- some $70 million, our fair portion of the half-billion dollars that the feds have committed -- and what we've added in from this province, some $240 million from various pots, we will see some significant difference in funding for many of the services the member talks about in the capital region. You know, we're been quite clear. The $180 million is both for existing services as well as for enhancements to services. I think the member, who's advocated well for health care in the capital region, will find that the portion that the capital region gets will do many of the things that she's talked about.
I. Chong: I thank the Minister of Finance for providing that answer. But I would hope that the Minister of Health, if he's able to, would at least provide an answer to the renal
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dialysis unit issue, which I know the Minister of Finance is not as familiar with. So if the Minister of Health could at least provide that or take it on notice that he will get that information to me in the next day or so, then I would accommodate that as well.
Hon. M. Farnworth: The renal dialysis issue that the member raises is in fact a capital issue and is not part of this particular allocation. But I am more than willing to have staff sit down with her at a time that is convenient to her, to show her where it does fit into the system.
R. Coleman: I'm pleased to enter into this debate briefly this evening on two areas. The member for Langley, I think, crystallized rather well the issues in the South Fraser region, which is the region that I represent as well. I know that the member for Surrey-White Rock will have a few questions in a minute.
Recently I had a friend of mine go through a prostate cancer operation. The interesting thing about the prostate cancer operation is that it took place in Bellingham, Washington, at a cost of $18,000. The reason it took place in Bellingham, Washington, for a cost of $18,000 was -- because the doctors in Canada were treating my friend -- because the progression of the cancer made it pretty clear that delays in our system would put his life at severe risk. He had to make a financial decision and go to Bellingham, which he did. He was told by his doctors on both sides of the border that it was a good thing he did that.
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Now, that starts to show me a systemic problem within a system. When I hear the debates that have gone on here today and some of the answers by the minister to the questions of my colleagues, I think that sometimes we forget the human factor in the health care system. The human factor is that the people who need the treatment are not getting it in a timely manner, and their lives are being put at risk.
The interesting thing about the experience in Bellingham was the day I spent on the ward in the hospital in Bellingham. I met three nurses on that ward, all trained in British Columbia, 30 minutes away. All three of them were nurses trained in our education system. All three nurses were working in Bellingham, not because they didn't want to work in British Columbia, but because they couldn't get a permanent, full-time commitment from our health care system for jobs in Canada; therefore they took positions south of the border. Two of the doctors that were involved, one a specialist and one a general practitioner south of the border, were also Canadians. Both were working south of the border because of the uncertainty they would have in Canada relative to their work. To me, that is where the rubber hits the road. It is the services to the patients on the ground that this system has to start paying attention to and get away from the rhetorical discussions and some of the comments that have been made today.
Now, I'm not going to ask the minister anything more than one simple question, and that is: how many nurses in B.C.'s health care system today are on a permanent, full-time basis, and how many nurses are on a part-time basis? How many nurses are sitting there in this on-call situation, being asked to sit on the sidelines and wait for full benefits and full commitment to a job so they can stay in British Columbia for a full-time job rather than having to make the decision like the three nurses in Bellingham had to make?
Hon. M. Farnworth: There are approximately 13,500 full-time and 14,000 part-time, including casual.
R. Coleman: When the ministry makes statements about the shortage of nurses in British Columbia
Hon. M. Farnworth: That's why we increase the funding to hire the additional nurses within the system. That's why we've added the new training spaces to the system. That's why we are encouraging nurses to come back into the system, through things such as equipment and improving working conditions. We want to see more nurses in the system, and we are implementing a nursing strategy to make sure that that happens.
R. Coleman: So over 50 percent of the nurses in this province today are on some form of part-time or on-call work. The minister said we are enhancing the system to create more positions. Are you actually creating positions for those people to take on full-time work? Or are you creating another 300 or 400 new positions? Are you actually taking care of giving some permanence, some stability, to the portion of the 14,000 that are out there that are part-time? Or are you adding the 400 new nurses? That's sort of the question that I would really like the answer to, because if there are 400 new positions, how many of them have you offered to the 14,000 part-timers that you have? Or are you creating them within that system?
Hon. M. Farnworth: Well, the positions that we talked about before, the 384, are full-time nursing positions. But I'd also make the following point for the member's edification, and that is: many nurses want to work part-time or casual. Mind you, I also recognize there are a lot of nurses who want to work full-time as well, and we're looking at ways to facilitate that; I've mentioned some of them. And again, some of those issues also have to be addressed during contract negotiations, in terms of how the contract works as to determining who does work casual and who works part-time and who works full-time.
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R. Coleman: I have a friend that's a nurse and that actually does bed management in a hospital. Seeing the stress of bed management in a hospital, relative to the part-time, the casual part-time, the on-call part-time and then the permanent positions
It seems to be a crisis at that level. And it would seem to me that if you have 12,000 or 14,000 part-time people, by increasing your full-time status for some of those people you could take some of that stress off. I'm wondering what studies have been done to see how you could eliminate that stress by increasing the permanence for some of those people.
Hon. M. Farnworth: Well, we've been working with BCNU and HEABC on exactly the issues facing nurses in the system and how we can deal with some of them.
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R. Coleman: On September 13, 2000, the ministry, from the office of the Premier, issued a press release through the communications branch of the Ministry of Health, titled "Hospitals Targeted for $250 Million Improvement Package." In addition to that press release was an attachment, and the attachment was referred to as the B.C. health action plan. Both of those documents were posted on the web site -- the September 13 news release and the backgrounder of two and a half pages.
Today, this evening during this debate, throughout this day, the document that is entitled "B.C.'s Health Action Plan" has disappeared, is missing in action off that web site. Now we only have the press release. So could the minister tell me: has the B.C. health action plan gone missing in action? Has it gone out of action? Has it disappeared from the landscape, and it was just something that somebody made up to get on a web site for a day, to use for a press release? Or is there any substance to it at all? It has now disappeared from the communications of the ministry.
Hon. M. Farnworth: Well, the B.C. health action plan is very much in action, because it's being put into action tonight with this debate and the passage of $290 million into the health care system to help implement that plan.
R. Coleman: The comment about my friend earlier and the question about the nurses and this whole debate
I guess it's sad that you have to go through this whole
Hon. M. Farnworth: Well, I'll look into why it's not on the screen tonight, hon. member, and I'll let you know. But one thing I can tell you: whether it's on the screen right now or whether it's not on the screen right now, what is important is the fact that the B.C. health action plan is being implemented tonight with the passage of $290 million of additional funding for long-term stability in the health care system. That's what's important to patients, not whether something is on a web site or not. It's that money going into the system that will improve patient care and get equipment into this hospital and put a $40 million package onto the table to ensure we have physicians in small towns and rural towns in British Columbia.
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R. Thorpe: Hon. Chair, just a few quick questions to the minister. Minister, the two-and-a-half-page B.C. health action plan that we have here -- is this the detailed comprehensive plan? Or is this just a summary of the detailed comprehensive plan?
Hon. M. Farnworth: Summary.
R. Thorpe: Then would it be possible for the opposition to receive a detailed comprehensive copy of this action plan? And does this action plan also include time lines for action?
Hon. M. Farnworth: The opposition should have that -- the strategic directions and the accompanying documentation that was given to them during estimates.
R. Thorpe: With respect to the performance plan for 2000-01 and looking at the capital section -- and for staff, it's page 22 -- let me just quote here: "The ministry has a comprehensive capital plan in place, which, at the time of preparation of this document, is under review at Treasury Board and is not available for inclusion." Well, since the Premier has said he wants the facts, all the facts and nothing but the facts, is that comprehensive capital plan, which was supposed to be part of the performance plan, now available for all members of this Legislature?
Hon. M. Farnworth: You may want to go ask your critic, because I know he has it.
R. Thorpe: Actually, I'm asking the questions, minister -- through the Chair, of course. And I was wondering if I could get a copy of that comprehensive capital plan, which the Minister of Finance said we would receive -- comprehensive documentation. I personally would like a copy. Can I have that delivered to me, to my constituency office by Wednesday?
Hon. M. Farnworth: Yes, we will be more than happy to deliver you one. In fact, as I said, one had already been delivered to you and to the request that was made earlier. But I am more than happy to ensure that you get one and, if you want, another copy as well, because, actually, I must admit that I do know that you guys do have a bit of a problem in receiving information, because you
Interjection.
Hon. M. Farnworth: No, no, no. I must take this opportunity on this point. We received a request for information; we sent it to the appropriate number. As it turns out, you guys gave us the wrong number, and it was the wrong address. And you didn't have anyone there to receive it. But I will send you the information.
R. Thorpe: I guess it's like the numbers you gave us with respect to fast ferries, because that number kept changing, and it was the wrong number.
With respect to debate on May 16, we talked about an orthopedic panel. You were going to look at developing acceptable standards. It was your expectation
Hon. M. Farnworth: My understanding is that it is, and I will make sure that the member gets the information.
R. Thorpe: Also, on May 16 we were talking about the 600-bed shortage in long-term care. Let me just quote what the minister said there: "
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which should be ready in the next couple of months." Has that happened? If it has, can I have a copy of it? If it hasn't, when will it happen?
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Hon. M. Farnworth: We are putting the final touches on it, and as soon as I am able to give it to you, I will do so.
R. Thorpe: Obviously a couple of months is six months with respect to this minister.
With respect to brain injury and the brain injury work that's done in the South Okanagan, the minister talked proudly about a working group. Can the minister confirm that that working group did receive an overwhelming attendance? They expected about six to eight people in Penticton on September 14, and they had over 90 people there. Can the minister confirm that he has now heard the voices of those families in the South Okanagan with respect to brain injury, and is any funding included in this $290 million for those folks?
Hon. M. Farnworth: This particular allocation is going to the acute care system and to equipment in the acute care system. What I can tell the member is that that meeting on the 14th was very successful, and there is a follow-up meeting being planned to deal with issues around continuing care. The work is taking place that we told the member would in fact take place. I am pleased with the progress that is being made. I am more than happy to keep the member up to date on the outcome of the meetings.
R. Thorpe: I appreciate the minister's comments. As the minister knows, this is a very near and dear subject. In fact, a very, very close friend has experienced difficulties in this area and actually did attend that meeting on September 14.
Let me just sum up with this last question. We've heard a lot of political rhetoric today from the government -- as a matter of fact, over the last few days -- with respect to this. It's become very, very clear to most British Columbians that this is more about politics than it is about patients. When the Premier said on June 6 in this very House that he wanted "to give British Columbians the facts, all the facts and nothing but the facts
This Premier and this minister have made a lot of comments. I'd like to know today if in fact he's going to live up to that statement, or if it is going to be more broken promises. Will the Okanagan-Similkameen health region receive a cheque tomorrow -- yes or no?
Hon. M. Farnworth: I can tell the hon. member that South Okanagan will start getting moneys tomorrow.
G. Hogg: We've heard much discussion with respect to specifics on this side of the House, but not many specifics are coming from the other side of the House.
I have a couple of questions with respect to the $180 million for services to the acute care sector that is being allocated through the regional health boards. The South Fraser health region, the minister commented earlier, would receive in the neighbourhood of an 11.2 percent increase on the operating budget of some $429 million. They're currently projecting an overexpenditure of some $29 million. That would equate to somewhere in the neighbourhood of a 19 percent overage, so 11.2 percent would not even meet the overages which are currently being projected. While there are not specifics to be given at this point in time, I was wondering if there are some principles with respect to that allocation which can come forward.
Firstly, I would ask whether or not the South Fraser region or others can choose to spend their 11.2 percent on new programs. And will they be given permission to carry their projected overages? Or is there a government edict which will dictate that a percentage, if not all of it, will be required to go to the projected overages?
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Hon. M. Farnworth: We aren't expecting them to have any overages.
G. Hogg: I understand that the minister said that he was not expecting them to have any overages. So the current projected overexpenditure of some $29 million in South Fraser is not expected to be there, and the "deficit" word -- which he has pointed out many times, is not correct terminology
Hon. M. Farnworth: First off, the 11.2 percent is the average increase across the system. The second point I would make is that there are not projected to be deficits. What there is are expenditures that are projected over the course of the year to take into account existing levels of service and new levels of service which the health authorities have been working with the ministry on providing. We are not expecting them to be in a position where they cannot meet the service levels that they are going to be providing and the new services that they will be providing.
G. Hogg: I can appreciate that he's not expecting that. However, there is a $29 million overexpenditure expected -- projected -- at this point in time, and 11.2 percent equates nowhere near 19 percent. So either they're going to have to cut services, because they don't have enough money in this allocation, based on 11.2 percent or even 12 percent or even 15 percent, to come anywhere near the cost of providing the services at the level they're currently providing them
Thirdly, I'll move from that -- and perhaps I can get further clarification at another point in time. Are boards with larger deficits on a percentage-wise basis going to receive a larger allocation? Or is the allocation on a percentage-wise basis going to remain the same?
Hon. M. Farnworth: They're not in deficit positions. There are service levels which they are providing to provide
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existing levels of service and new levels of service, and we are confident that the funding allocations will meet the existing levels of service that they are providing and the new levels of service that they will be providing. The allocation is based on a funding formula, and so they will be
G. Hogg: Perhaps the funding formula has changed and there is some other model, because I have spoken with representatives of the regional health board today who tell me that at their current levels of service, they're going to be in a $29 million overexpenditure. That represents 19 percent of their overall budget. You're telling me it's 11.2 percent, and you're telling me there's not going to be an overexpenditure. So I don't know how
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I'd be happy to have the minister respond to that further, but I have another question, because I know that I'm being pressed with respect to time. With respect to the equipment dollars that are being allocated, are they being allocated based on the capital equipment priority list that each region has submitted and which are then collated at the provincial level -- taken off that list? Or is there some formula with respect to the actual number of dollars which are going to be allocated to those regional boards?
Hon. M. Farnworth: It is the former, not the latter.
G. Hogg: With respect to the former, there are a number of hospital boards and regional boards around this province which have active auxiliaries and foundations that are putting enormous numbers of dollars into the purchase of equipment. Will there be any penalty for those as a result of the fact that they have a foundation? I'll give a specific example. The number one equipment priority for the South Fraser region was a CAT scan machine. In order to have the CAT scan approved, the Peace Arch Hospital Foundation had to put $1.5 million towards that. Will this mean that because that was the number one priority from the South Fraser region, now the government will, out of this allocation, pay for the CAT scan totally, and the regional health board and/or the foundation can look for other expenditures with respect to the money which is currently allocated for that? Or, because the foundation has been successful in raising a lot of money, are they going to be penalized as a result of this process?
Hon. M. Farnworth: No, they will not be penalized.
G. Hogg: More specifically, will this allocation, then, cover the $1.5 million which the foundation previously had to commit? Can they now reallocate that and have that fully funded out of this ministry's $70 million equipment allocation?
Hon. M. Farnworth: I can't get into specifics on what the allocation is, but I can tell the member (1) they will not penalized and (2) there is additional money coming next year of a minimum of $66 million.
G. Hogg: So the principle is that there will be an allocation which will not be based on the amount of money that has been raised locally, with respect to equipment allocations. There will be an equitable distribution of those dollars. Anything that will bring it to the capital equipment level -- percentages and priority lists
Finally, then, I recognize that we're in crisis with respect to health care, and this is a precipitous action in terms of trying to provide a stopgap to that crisis. At Peace Arch Hospital 30 percent of our medical-surgical beds are taken up by people who need residential beds and need to be moved out of there so that we can actually provide the type of care that's needed in that area. I trust and hope that the minister can tell us that the health action plan will start to remedy some of those long-term needs so that we can actually use the resources that we have appropriately, to respond to the needs of people in the communities, rather than having to delay those and have our resources inappropriately utilized because we don't have resources in the appropriate places to respond to the appropriate needs.
So my question is: could you please tell me the action plan is going to put some long-term, positive response to those needs and assure me that that will happen?
Hon. M. Farnworth: We are awaiting the priorities. If it is a priority for the health authority, that's where the money will be going.
D. Jarvis: I just have a couple of questions for the minister. We've been here some eight hours now, and I've heard some horrific stories from other areas. Fortunately, my area isn't quite as bad as they are, but we do have problems. We only had a $2 million deficit last year, which wasn't bad. We have no problems with nurses anymore. We've got a good recruitment going there. However, the question is that
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Hon. M. Farnworth: We do recognize that it is a regional trauma facility and are aware of the requirements and recognize that it is a very good hospital.
D. Jarvis: On that basis, then, can you tell me why to date we do not have an MRI? Will we expect one tomorrow morning?
Hon. M. Farnworth: I will draw your attention to the issue during the last estimates debate, when I said the priority, in terms of our strategy, was to get more equipment money. I said that was a priority with my discussions with the federal government. We now have that agreement. I said at that time that if we get that money, we can do more with what we've got. I'm aware of the needs of your particular facility, and $70 million will go a long way to address the equipment needs of hospitals in British Columbia.
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D. Jarvis: Thank you for the answer, minister, and I will take that as a given that we will see the moneys next week or something like that. My other, last question is a rather simple question. We had approximately a $2 million deficit last year. With our projected spending for this year, can we count on the fact that we will have a balanced budget by the end of next year?
Hon. M. Farnworth: The hospital is not in a deficit position. I am confident that they will be in a balanced position at the end of the year.
L. Reid: My question to the minister begins with a comment that in fact this individual represents a government that began its mandate nine years ago believing that you could somehow have a health care system without physicians. Well, British Columbia families today are bearing the brunt of that. In just a couple of hours a family from Kelowna is on the plane to Sick Kids Hospital in Toronto, because they've been on a wait-list here for a year and a half for heart surgery. It's not that the surgery can't be performed here; it's that the wait would compromise that young man's life.
This government has not even had the decency to respond to the letters from this family. This is a situation where the family's accommodation costs will be borne by them personally, and their airfare will be borne by them personally. They don't have a support system in Toronto. This is the patient that needs to come first. This government truly has to respond to that question.
The minister mentioned earlier that somehow he's going to address the plan for health care. Talk about hospice care in the province of British Columbia. We have many, many individuals in acute care beds today because this government will not come forward with a plan. The hospice plan from the Vancouver-Richmond health board has been in the works, under discussion, for more years than I can count. There is no answer from this government when it comes to a plan that would allow for a less expensive alternative, for a better choice in quality health care for British Columbians. Again, the plan has been abandoned.
The minister talks about equipment purchase. A company in my riding, Millennium Technology Inc., will be able to produce -- and is the only Canadian producer of -- diagnostic high-calibre technology. They're not convinced that any of those contracts will go to tender.
So when the minister stands and talks about being the only person to be really concerned about health care, he's abundantly wrong. There are many, many individuals who have suffered at the hands of this government. If he would choose to respond to any of those three questions, my constituents would be eternally grateful.
Hon. M. Farnworth: In regards to your first question, I'm not familiar with the case. The member has brought it to my attention, so I'll be happy if she would show me whatever correspondence, and I'll look into the matter for her.
In terms of hospice care, it is very much something that I am trying to move forward and see as an integral part of the future of health care in British Columbia and have been working with the providers to find better ways of doing that.
Finally, on equipment, $70 million is a very important commitment by the province. I have never said I am the only person that cares about health care. Why the member would make that statement is beyond me, because I know that all of us in this House care about health care, as do the 100,000 men and women who work in the system in British Columbia, and I recognized that in my opening remarks.
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So, you know, those are the answers to the three questions, hon. member. I know that the moneys we are approving today will have a positive impact on patient care in this province and on improving working conditions for the health care providers of British Columbia.
C. Hansen: This process of debating these supplementary estimates started almost nine hours ago. And in that nine hours we really haven't learned anything new, in that period of time. What we have heard is the minister essentially repeating over and over again the contents of the press release that was issued last week. We all had a chance to read that when that came out.
I'm afraid that the minister's lack of information in terms of how these dollars will be spent is certainly, I think, regrettable, because the government is asking the authority of this chamber for an additional $290 million worth of authority to spend money, yet the minister is not able to bring to us any enlightenment in terms of how those dollars are going to be spent. I think it's maybe best described that this is not really about health care; it's about stealth care, given the secrecy that is still surrounding how much money is being approved and how it will be spent.
We find out today, hon. Chair, that there are no cheques that are going to be issued, in spite of what the Premier said. The cheques are not going to start to flow tomorrow, as the Premier promised.
The only check, I think, for those of us in the opposition and the public generally is a reality check. The reality check is that the dollars that are going to flow are not going to result in better patient care in British Columbia. We're still simply covering deficits that are there. And everything that is being allocated is not going to improve patient care in British Columbia, which of course is sadly lacking.
In fact, the other cheque that comes into this debate today is the blank cheque, because that's what this minister is asking us to approve. It's saying, "Trust me," in terms of how this will be allocated, how much will go to each region.
But throughout the course of this debate, in lieu of specific answers to questions, the minister did promise that he would get information to members. And I hope the minister will take those requests seriously. Certainly there were several requests that I put to the minister that he undertook to respond to, as he did to other members of the official opposition. We will expect that information to be delivered in a timely fashion.
But the minister also raised expectations in terms of what will happen tomorrow. Tomorrow there's going to be all kinds of new information coming out. I gather that between now and tomorrow the officials in the ministry will be able to crank out some of these numbers that the minister doesn't have at his disposal today, but I gather they'll be available tomorrow for announcements to advise health authorities in terms of what they can expect in their allocations.
I wonder if the minister could tell us: what is the process tomorrow in terms of how these dollars will be allocated?
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How will these numbers be communicated to the health authorities? How will they be communicated to the official opposition? And more importantly, how will it be communicated to the public?
Hon. M. Farnworth: In terms of the process, the funding for physicians will be going out. They will be informed by letter of the amount of money that's available to each health authority. Subsequently, there will be a press release going out that will make public those amounts. And then you will know at the same time, once the health authorities have been notified.
C. Hansen: I know that all members of the House, whether they're government or official opposition, are anxious in terms of what kind of dollars will flow to their regions. I'm wondering if the minister could advise us at what time tomorrow that information might be available, and in what context.
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Hon. M. Farnworth: I will endeavour to do that as quickly as possible tomorrow. I know, in the case of one individual, that it's definitely 3 o'clock, and I want to ensure that there's no special treatment. As I said, we'll be endeavouring to get it out as quickly as possible.
C. Hansen: I gather from that comment that at 3 o'clock not just the member for Matsqui will find this information, but it will be public for the entire province. Is that going to be done in the form of a press conference? Is it a letter that's going out? I guess part of it is that I'm wondering: should members of the official opposition be sticking around till 3 o'clock so we can hear the good news for our particular health regions?
Hon. M. Farnworth: The press conference has already been held, and that was last week. I'm not planning on a press conference tomorrow.
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Vote 36(S) approved unanimously on a division. [See Votes and Proceedings.]
Hon. M. Farnworth: I move the committee rise and report resolution.
Motion approved.
The committee rose at 10:52 p.m.
The House resumed; the Speaker in the chair.
The committee reported resolution.
The Speaker: When shall the report be considered?
Hon. P. Ramsey: I move that the report of resolution from the Committee of Supply on September 17, 2000, be now received, taken as read and agreed to.
Motion approved.
Hon. P. Ramsey: Hon. Speaker, I move that there be granted from and out of the consolidated revenue fund the sum of $290 million. This sum is in addition to that authorized to be paid under section 1 of Supply Act, 2000-2001, and is granted by Her Majesty towards defraying the charges and expenses of the public service of the province for the fiscal year ending March 31, 2001.
Motion approved.
Introduction of Bills
SUPPLY ACT, 2000-2001 (SUPPLEMENTARY)
Hon. P. Ramsey presented a message from His Honour the Lieutenant-Governor: a bill intituled Supply Act, 2000-2001 (Supplementary).
Hon. P. Ramsey: Hon. Speaker, though consistent with tradition, this bill does represent a new chapter in financial management and accountability in British Columbia. This government is committed to seeking the approval of the Legislative Assembly prior to legally committing additional funds. The use of supplementary estimates is consistent with the spirit of the Budget Transparency and Accountability Act and a recommendation of both the Enns report and the auditor general.
In some ways this is a historic day in the Legislature of British Columbia. This is the first time in over 100 years that supplemental estimates have been used. The government said during debate in June that supplemental estimates should become the norm in approving additional spending during a budget year and that special warrants should become a thing of the past. Bill 33 demonstrates our commitment to the principle.
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Hon. Speaker, this supply bill is introduced to provide supply for the operation of government programs for the 2000-01 fiscal year, as has been outlined in the supplemental estimates tabled earlier today. It will provide for the additional funds required to defray the charges and expenses of the public service of the province for the fiscal year ending March 31, 2001. I move first reading.
Motion approved.
Bill 33 introduced, read a first time and ordered to proceed to second reading forthwith.
The Speaker: Members, there will be a short recess while we distribute the bill for the members' perusal.
We'll proceed. I have a short statement to make for the guidance of the hon. members, two observations in relation to Bill 33, intituled Supply Act, 2000-2001 (Supplementary). This bill is tantamount to a final supply bill, as it's founded on a single resolution passed in Committee of Supply, adopted upon motion by this House. Accordingly, the bill falls squarely into the class of bills described in numerous precedents as administrative acts only.
Two results flow from this finding, the first being that the bill may pass through all stages in one sitting. Secondly, apart from the brief introductory remarks permitted upon introduc-
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tion of a bill by virtue of practice recommendation 5, the bill is not subject to debate on any of its stages. I refer hon. members to British Columbia Hansard of July 26, 1993, at page 9176; British Columbia Hansard of July 27, 1993, at page 9230; and Parliamentary Practice in British Columbia, third edition, at page 164.
SUPPLY ACT, 2000-2001 (SUPPLEMENTARY)
(second reading)
Hon. P. Ramsey: I move second reading of Bill 33. This supply bill is a supplemental supply bill for the 2000-01 fiscal year, the previous having been passed on July 6, 2000, when the Legislative Assembly previously authorized appropriations for this fiscal year. The bill requests supply of $290 million for voted expenditures, as outlined in section 1 and the schedule of the bill and detailed in the supplementary estimates.
Finally, hon. Speaker, I point out the requirement for passage of the supply bill in order to provide for the additional expenditures of the government for the 2000-01 fiscal year. I move second reading of Bill 33.
Motion approved.
Bill 33, Supply Act, 2000-2001 (Supplementary), read a second time and referred to a Committee of the Whole House for consideration forthwith.
SUPPLY ACT, 2000-2001 (SUPPLEMENTARY)
The House in Committee of the Whole (Section B) on Bill 33; T. Stevenson in the chair.
Section 1 approved.
Schedule approved.
Preamble approved.
Title approved.
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Hon. P. Ramsey: Hon. Chair, I move the committee rise and report the bill complete without amendment.
Motion approved.
The House resumed; the Speaker in the chair.
Bill 33, Supply Act, 2000-2001 (Supplementary), reported complete without amendment, read a third time and passed.
The Speaker: Members, the Lieutenant-Governor is in the precincts and will be entering shortly, if members could keep their seats.
His Honour the Lieutenant-Governor entered the chamber and took his place in the chair.
Clerk of the House:
Supply Act, 2000-2001 (Supplementary)
In Her Majesty's name, His Honour the Lieutenant-Governor doth thank Her Majesty's loyal subjects, accept their benevolence and assent to this act.
His Honour the Lieutenant-Governor retired from the chamber.
[The Speaker in the chair.]
Hon. D. Lovick: Mr. Speaker, it is my duty now to move the penultimate motion of our sitting. I move that this House at its rising do stand adjourned until it appears to the satisfaction of the Speaker, after consultation with the government, that the public interest requires that the House shall meet or until the Speaker may be advised by the government that it is desired to prorogue the fourth session of the thirty-sixth parliament of the province of British Columbia. The Speaker may give notice that he is so satisfied or has been so advised, and thereupon the House shall meet at the time stated in such notice and, as the case may be, may transact its business as if it had been duly adjourned to that time and date. And in the event of the Speaker being unable to act owing to illness or other cause, the Deputy Speaker shall act in his stead for the purposes of this order.
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Motion approved.
Hon. D. Lovick: With that, Mr. Speaker, I would move the House do now adjourn.
Motion approved.
The House adjourned at 11:06 p.m.
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