Hansard -- Tuesday, May 13, 2003 a.m. -- Vol. 15, No. 10 (HTML)



CONTENTS

	Routine Proceedings
		Page

Petitions		6705
	G. Trumper Hon. S. Hawkins Hon. M. Coell

Committee of the Whole House		6705
	Industry Training Authority Act (Bill 34) Hon. S. Bond J. Kwan

	Proceedings in the Douglas Fir Room

Committee of Supply		6714
	Estimates: Ministry of Health Planning Hon. S. Hawkins J. MacPhail K. Manhas

G. Trumper: I have a petition I would like to submit from school district 70 on public education for our future.

Hon. S. Hawkins: I rise to table a petition from residents of Sunrise Village in my constituency, who wish to express their concern over changes to Bill 71, the Manufactured Home Park Tenancy Act.

Hon. M. Coell: I'd like to table two petitions this morning. One is from Saltspring Island; 168 people are concerned about public education funding. Another is from 2,580 persons regarding Bill 71 and its regulations affecting manufactured home lot renters. If I could table both those petitions.

Hon. G. Abbott: In Committee A, I call estimates debate on the Ministry of Health Planning, followed by estimates debate of the Minister of State for Mental Health, followed by estimates debate of the Minister of State for Intermediate, Long Term and Home Care.

In Committee B, I call committee stage debate on Bill 34 to be followed by committee stage debate on Bill 29.

The House in Committee of the Whole (Section B) on Bill 34; J. Weisbeck in the chair.

Hon. S. Bond: I would like to introduce the staff who are with me today here in the chamber: my deputy minister on my right, Gerry Armstrong; and the director of the industry training branch, Stuart Clark.

J. Kwan: Section 1 deals with the definitions of the act. "Accredited program" means a program designated as an accredited program under the regulations. What changes will occur to the current rules for accreditation?

Hon. S. Bond: The accredited programs are a new definition. The programs that will be captured in that category are ones that meet national standards. The Red Seal trades that are currently designated will move into that category known as accredited programs.

Hon. S. Bond: We certainly will have employers involved in the Industry Training Authority. The authority will make recommendations to the minister in terms of the programs that would then be moved into the accredited category. Those would be in addition to the current Red Seal–designated trades.

J. Kwan: Can the minister please advise: who are the people involved in the Industry Training Authority?

Hon. S. Bond: Certainly. Until the legislation is passed at this point in time…. It will put in place the Industry Training Authority. We have received a number of names from around the province — lots of names. At this point in time there are lists of people. My job as minister will be to choose the nine best people in the province who have a vision for industry training and who also have expertise and are just excellent at looking at the whole area of skills and trades training. The authority is not in place yet until legislation is dealt with. Then we'll be moving forward with a process to select the nine people.

J. Kwan: With the nine people that are to be selected, are there categories of people from whom the minister would choose? If so, what are the categories?

Hon. S. Bond: Actually, no, there are not categories that will be represented, because in looking at how we're going to move the system forward, we need the best nine people we can find. We'll be looking at their expertise; we'll be looking at their background. Obviously, there are a number of areas we'll be looking at. In essence we want nine people with a vision for looking at a new model of training in this province. No, there will not be categories of people represented on the board.

Hon. S. Bond: Well, actually, it's going to be a challenging but exciting opportunity because at this point we have at least 60 or more names of people that have been suggested to us from across the province. We will be using the board resourcing and development office and the principles that we use as government to look at a merit-based selection process. We're certainly not short of people who are interested and who would do a great job in this process. We will be looking at using the board resourcing and development office and the principles that are used for selection across government.

J. Kwan: The minister says there are some 60 names that have come in from across the province. What's been the process to solicit these names?

Hon. S. Bond: Certainly, as we have consulted around the province, it's been very clear to everyone that we were going to create a new model in the province. In our discussion paper it was clear that we would use the Industry Training Authority model. In fact, people have asked: "Is there a process for input of names?" We said: "Yes, just send them in." In fact, we've received unsolicited names. We've had people volunteer. We've had an assortment of ways of gathering those names. As we consulted, people asked: "Can we contribute names?" We said yes.

J. Kwan: I'm a little bit worried about the process, then. It's similar to the Pharmacare system. The Minister of Health advises that the information has gone out to the doctors and to the pharmacies, but yet we know there are people who don't know about it. Information has not gone out because it's on the basis of what telephone numbers and addresses the ministry might have so they could send the information to the various doctors. I, for one, know that there are doctors that don't have access to the information.

I have no assurance in this system, in this approach, that people actually know about it and that people actually would have an opportunity to participate. What's the accountability process? Aside from the flaw I see with the process of soliciting names, what's the accountability process of the authority to the ministry?

Hon. S. Bond: As we looked at an industry training authority, accountability is an important factor. We know that this legislation, when it is passed, will ask the authority to create a three-year business plan which will be presented to government. They will be expected to identify target growth in the number of people trained in the province of British Columbia. There will be an expectation to see an increase not just in quantity but in quality of programming.

They will have to present a three-year service plan — a business plan, in essence — to government. That is an accountability measure that is similar to all of those that are in place in ministries as we speak.

J. Kwan: What oversight is included to prevent colleges or delivery institutions from monopolizing the process and, therefore, the outcomes?

Hon. S. Bond: Certainly, the Industry Training Authority will be working to look at a number of options, including private trainers. Currently, we have an excellent example with Kwantlen University College partnering with four joint boards in the province to look at partnerships in training.

We certainly don't expect there to be a monopoly. We would know the Industry Training Authority will be looking at the most efficient and innovative ways of training workers in the province. The decisions would be made by the Industry Training Authority about who will offer those training programs.

J. Kwan: What oversight mechanisms are going to be in place? The minister says she's confident that that won't happen in terms of monopoly with the process. What process is going to be in place to prevent that?

Hon. S. Bond: To clarify my answer — and I apologize for that; I wandered slightly there — in essence the Industry Training Authority is ultimately accountable. Through the use of the three-year service plan that will be presented to the ministry, our job will be to hold them accountable to the targets and to the improvements and decisions that are presented to the ministry through the three-year business plan.

J. Kwan: Yes. I understand that part of the process would be a three-year business plan which has to be approved by the minister and go through the process there. But within that plan, how will the ministry — the minister herself — ensure that there will be oversight mechanisms to prevent a monopoly taking place? Will there be certain guidelines that the ministry will actually establish? How will that take place?

Hon. S. Bond: The multi-year business plan will include, and must include, a statement of how the authority proposes to meet the goals of increasing both quality and quantity of training received by trainees in British Columbia. The annual report will also report back to the ministry their progress in meeting these goals. Ultimately, it will be the job of the Industry Training Authority to determine who is in the best position to offer training in the province, be it private or public through colleges and institutions in this province.

We think there is going to be an absolute opportunity for both private trainers and colleges and institutes to be part of the training process, and we don't expect that to change. It exists currently, and we don't expect that to change.

J. Kwan: So far, the minister has given no reassurances as to what the process would be to ensure that there would be no monopolizing of the process. She says that it likely won't happen. She has faith in the authority. The ministry will have a review to ensure quality and quantity. But she has said nothing so far about what process would be in place to prevent the monopolizing of the process.

Is the minister just counting on goodwill, then, that it likely wouldn't happen? What if it does happen? What are the fallback positions of government, and how would they handle that?

Hon. S. Bond: I'm certainly not going to predetermine who's in the best position to do training in the province of British Columbia. The Industry Training Authority will be responsible for choosing and designing programs that meet the needs of learners in this province. It will include a combination, as it does now, of public institutions and private trainers in the province.

At the end of the day, what matters is the quality of the opportunity and the embracing of a new model. In fact, the Industry Training Authority will be held accountable for making those decisions.

J. Kwan: In other words, there is no oversight mechanism to prevent monopolizing of the process. That's what the minister is basically saying. She has nothing in place, and she doesn't anticipate that there will be anything in place to prevent that from happening. If I'm wrong in understanding that, I would ask the minister to please correct me. So far, she has said nothing would be in place to prevent the monopolizing of the process and, therefore, the outcomes. Okay.

I want to ask the minister about appeal boards. According to the definitions section, "appeal board" means the Industry Training Appeal Board established under section 10. Could the minister please advise: will apprentices be able to appeal directly to this board?

Hon. S. Bond: The short answer is yes, they can, but obviously they would be expected to follow due process in getting there. Ultimately, yes, they could go directly to an appeal board.

Hon. S. Bond: It is a streamlined, two-step process. Initially, there would be an internal review. If the person wishing to appeal is not satisfied, they would then go directly to the appeal board on the second step.

Hon. S. Bond: Actually, the grounds for reconsideration and appeal are noted in section 11, and they would include refusal to award an industry training credential or recognition credential, suspension or cancellation of a credential, refusal to register a trainee, cancellation of the registration of a trainee and revocation or cancellation of the registration of an industry training agreement. There are certainly clear criteria and reasons for reconsideration and appeal.

J. Kwan: Is it just what's listed under section 11 that would be appealable? For any other issue that surfaces, then, is there no mechanism for complaints to be registered and matters to be reviewed and looked into?

Hon. S. Bond: Those are the specific areas. In looking at the appeal process, we tried to be as inclusive as possible of issues that may well affect an apprentice or a trainee. We believe that covers a broad enough spectrum to handle the majority of issues related to training.

J. Kwan: In the case where a complaint comes forward and it does not fall under one of those categories, are there other mechanisms to which apprentices could bring their complaints? Would that be directly to the ministry — in that case, to the minister? What other mechanisms would be available to them?

Hon. S. Bond: We believe that we have been broad enough in the description of the criteria for appeal. Having said that, obviously there are other avenues available to an apprentice or trainee. They're always available, and that is, obviously, through the ombudsman. In a very serious issue, if it's an issue of law, they can go to court for a judicial review. We believe that the two-step process and the criteria listed there are broad enough to encompass the appeals that may come from a trainee or apprentice.

J. Kwan: If it is not covered under the categories listed under section 11, then the other avenues the minister is suggesting are the ombudsman's office or the court. Is there no other avenue to which an apprentice can bring the matter? Could the person bring the complaint directly to the minister's attention and have the minister look into the issue and, therefore, the complaint? That could be deemed to be an internal review, if you will — perhaps a less onerous and expensive process for the apprentice to take up.

Hon. S. Bond: The internal review that I refer to, and that the legislation does, is a review that relates to the Industry Training Authority. If I were to receive a particular concern or complaint, I would refer it back to the Industry Training Authority for an internal review.

Certainly, our expectation is that if an apprentice or a trainee has an issue they are concerned about that falls outside the parameters of this, their first step would be to at least take it to the Industry Training Authority for consideration in the internal review process.

Hon. S. Bond: The first step, again, is to go through the two-tiered process of the administrative review by the CEO and an independent appeal. If it's determined at that point by the Industry Training Authority that it is outside the scope of appeal, they would have to go through the ombudsman.

J. Kwan: So there is no other appeal mechanism if it is not listed under section 11 for appeals, then. Okay.

Hon. S. Bond: I'm wondering if you could help me by clarifying what specific decisions you are talking about being made public.

Hon. S. Bond: It is not our intention to make public the specific decisions of an individual appellant. Obvi-

Having said that, should the decision have broader implications and applications across the system, it would be expected that the Industry Training Authority would make those public.

Hon. S. Bond: Certainly, if it were precedent-setting from the perspective that it changed the system significantly or had a very broad, general application to other apprentices and trainees, it would be expected to be made public.

J. Kwan: Will responses to complaints — internal, particularly — as well as the appeal process be in writing?

Hon. S. Bond: While I do expect the Industry Training Authority to give definition to the process, that is the usual practice, and one would expect that those comments would be made in writing.

Hon. S. Bond: In fact, it's clarified even more specifically in section 11 under "Reconsiderations and appeals" that an individual who is affected by any of the decisions must receive written notice of the decision within 30 days. We certainly do expect, and legislation will guarantee, that that is done in writing.

J. Kwan: That is the case with respect to appeal decisions, but I'm also talking about the internal complaint decisions as well.

Hon. S. Bond: In a similar fashion, I would expect the Industry Training Authority to respect the course and practice of natural justice and would assume those responses would be in writing as well.

J. Kwan: In the definitions section "authority" means the Industry Training Authority established under section 2. What mechanisms are in place to maintain a broad cross-section of labour and industry representation on this board?

Hon. S. Bond: In fact, the nine people that we will select to sit on the board will represent the nine best people we can find in the province who will look at this with both vision and determination as we move the model forward. There is no intent to look at specific sectors or membership in that way. We want to look for nine people who will do an excellent job, who have vision and certainly significant expertise.

J. Kwan: Then we have no assurance from the minister that there would be broad representation on the authority. I understand the issue of merit. One would assume that in ensuring merit, you could also achieve the goal of broad representation. Just because you have different sectors involved, it doesn't mean that those individuals from different sectors would not come with the merit required to do the job. One would assume that you can achieve all of these goals

Hon. S. Bond: I would absolutely expect the board to represent a broad range of perspectives, but unlike previous legislation we will not be tying the board to particular organizations or groups. We will obviously be looking for broad representation and people with expertise, and we will be using the principles that exist in government through the board resourcing and development office process.

J. Kwan: Well, I hate to say this, but the reality is that I have no comfort in the ministry and this government ensuring that there is broad representation. This government talked about how they would be merit-based on their boards and agency appointments, and so on and so forth, but the reality is that we've actually seen the government engage in those appointments in a very patronage-like and a very partisan way. We've seen it from the Premier's office with the communications officers. The minister has said they would be non-partisan in their nature. However, the government actually fired all the communications officers from each branch and embarked on an order-in-council process in rehiring them, which is a partisanship approach.

When the minister says we will ensure that somehow merit will be there and that broad representation will be there, without that being specified in legislation, I quite frankly don't have the level of comfort the minister may have to ensure that there's broad representation.

On another definition, then. On the next one, it's the chief executive officer that I'd like to canvass questions about. According to the legislation, chief executive officer means "the chief executive officer appointed under section 4." Will the CEO have experience in apprenticeship or come from within the public service?

Hon. S. Bond: I just want to comment on the fact that I am extremely proud of this government's record as it looks for absolute expertise and fantastic people across the province to work on boards and commissions. I can assure you that the ones I'm responsible for, in terms of the institutions I serve, are an amazing, astoundingly talented group of people. I have utter confidence that the board, the authority that's chosen here, will be excellent people with personal experience and expertise.

In terms of the chief executive officer, it will be appointed by the board of directors of the authority, and I am certain they will be looking for the best person for the job.

J. Kwan: Just like the minister feels that there are all the safety measures in place to ensure that the appointments of the authority representatives are going to be broad-based and merit-based, as I said, I have little confidence in this government.

This government says it's protecting education. The reality is that they're not. Schools are closing. This government says it's protecting health care. The reality is that they are not. We actually saw last week that respite beds are being closed down. The government says it's protecting those who are most vulnerable. The fact is that in Human Resources, under that ministry, welfare recipients are being cut back.

There's a whole array of examples I can draw from where I have no comfort whatsoever from this government's assurance that they're protecting certain things, that they're ensuring that the best is happening and being offered and that the people this government deemed to be priority areas are getting the resources they need. The reality, as I see it, varies significantly from what this minister and this government see.

Leaving that aside, the minister says that she, again, has the assurance or the confidence that the CEO would be appointed by someone who is qualified to do so, but the question is: will the CEO have experience in apprenticeship? Is it anticipated that the CEO would come from within the public service? Is it anticipated that the CEO would come from outside the public service? What is the minister's anticipation?

Hon. S. Bond: Well, we're going to put together an authority of nine people who have incredible experience and expertise in skills and training in British Columbia. They will be looking for a chief executive officer who will also demonstrate a broad range of experience and expertise, and I certainly am not going to prejudge who that might be.

Having said that, the authority will certainly be experienced. They will be capable, and they will have a broad range of perspectives in industry training. I'm certain they will be able to look for a person with exactly those attributes.

J. Kwan: I'm not asking the minister who that individual's going to be. I'm asking what the expectation of the minister is and what qualifications that individual is to have. Is the minister anticipating that this person would come from within the public service or from outside the public service? A fairly simple question, I think.

Hon. S. Bond: Certainly, as I said — and I will say it one more time — I want the Industry Training Authority to find the best possible chief executive officer for the Industry Training Authority. I know they will look for people with experience and expertise and will find the best person for the job. I am not going to presuppose whether that person's going to come from inside the system or outside the system. I expect them to find the best person for the job.

J. Kwan: So the minister is not prepared to provide a list of qualifications this individual ought to have or is expected to have, and the minister is not saying whether this person's coming from inside or outside the public service.

You know, the truth of the matter is that nobody's saying to the minister: "Give us a prescribed name of who is to be appointed." We're asking for some broad understanding of the qualifications that are expected of the CEO and whether that person is to come from within or outside the ministry. Even at that level, the minister doesn't know what the answer is.

Well, then let's move on to the next definition I want to canvass the minister about: industry training credential. According to the definitions section, it means "a credential awarded under section 8(1)(g)." Could the minister advise: will the new credential affect previous journeyman status, and if so, how?

Hon. S. Bond: No, it will not affect the journeyman TQ. What it will do, from a very exciting perspective, is allow additional opportunities.

Let me give you an example of that. We've created an opportunity in the province now for applied degrees. It won't affect the journeyman TQ, but what it will do…. We're encouraging colleges right now to say, "Look at ways that you can take a new credential and add it to a TQ" — for example, a journeyman TQ — and have that person have the opportunity to get an applied degree in addition to that. So we see it as enhancing. It certainly does not affect the journeyman TQ.

J. Kwan: Under the definition of "industry training recognition credential," according to the legislation it means a credential awarded under section 8(1)(h). Could the minister also answer the same question for this definition: will the new credential affect previous journeyman status and, if so, how?

Hon. S. Bond: Again, this will not affect the journeyman TQ, but it has enormous possibility. What it says is that this will recognize prior learning. It will give people the opportunity to have a skill set that they currently have recognized. It is not intended to impact the journeyman TQ, but to increase opportunity and to recognize a skill set where it exists.

J. Kwan: Does this term have relevance to industry needs as well as industry acceptance?

Hon. S. Bond: The major reason we started looking at redesigning the model and enhancing the current training model is that we do want our credentials to

recognize skill sets that already exist. That just makes great sense. When someone has a skill set and they're at a certain competency level, that should be recognized.

We expect the Industry Training Authority, as the model is developed, to design credentials that reflect not only industry's needs but also the needs of learners in this province, because the nature of learning has changed. So, in essence, the Industry Training Authority will begin to work to develop credentials that reflect the needs of industry but will also look at a new way of allowing opportunity for learners in the province.

J. Kwan: So then it would be the authority who would be establishing the standards and, therefore, the credential criteria for people to be qualified and recognized under this section?

Hon. S. Bond: Yes, the board will establish the standards. They will be high standards. A person will have to demonstrate their capability and be measured against those standards before a credential would be awarded.

J. Kwan: How will we ensure that there is a minimum standard that is being applied?

Hon. S. Bond: Any standards that currently exist would be maintained, and as new credentials are developed…. The goal of the program is to maintain high standards that would be developed in consultation, obviously, with industry and with education.

The business plan will also have to demonstrate for us in the ministry the fact that there is quality. Part of their business plan will be about, obviously, quantity. We need to increase the number of trained workers, but it will also have to demonstrate quality. One of the principles of the new model is that we maintain or enhance the standards of training in this province.

J. Kwan: Is it anticipated that as standards are being developed, they would replace the existing standards, or would they be additional?

Hon. S. Bond: The intent is certainly not to lower standards or to change existing standards. As new credentials are developed and new programs are offered, obviously, standards need to be developed for those. In fact, those standards initially will have to be approved by the minister. So any new credentials and the standards that accompany them will require ministerial approval.

J. Kwan: I'm still not clear. When the new standards are being established — as they are being approved by the minister — will they then replace the old standards?

Hon. S. Bond: Certainly, we don't anticipate changing standards. We anticipate developing standards for new credentials. But the possibility does exist, should technology or a particular skill set change or if there is some technological change. We don't expect a major changing of standards. We're looking at developing new standards for new credentials that will exist under the new model.

J. Kwan: In the definitions section there are several different terms: the accredited program as one term, the industry training credential, the industry training recognition credential. Then we have "recognized program." Recognized program means a program designated by the authority under section 8(1)(a).

Could the minister tell this House what a recognized program is? Aren't all programs and credentials recognized? What is the distinction, and why is there a distinct and separate definition for that?

Hon. S. Bond: The distinction is that the accredited programs consist of the 45 Red Seal trades. The recognized programs are current programs — 150 of them, in fact — that were initially designated by the Industry Training Authority. They are training programs for trades and occupations that were designated by the Industry Training and Apprenticeship Commission under the ITA Act. They are programs that are regional in scope as well as just-in-time, customized training, etc.

There are 150 programs that were designated. They are not Red Seal. We, in essence, wanted to set up the Red Seal programs under the accredited program category, indicating that they are set apart and significant, and to recognize — simply carry over — the 150 that were set apart by the Industry Training Apprenticeship Act.

J. Kwan: Will the process for getting the nationally certified Red Seal certification be the same as before, or is it different under this act?

Hon. S. Bond: Certainly, at this point the process is the same. We anticipate that it will always be the case.

Having said that, the new model allows for a new route to take your Red Seal exam. So what currently exists will remain in place. We hope to be able to enhance that with another route to the Red Seal. This is not simply our process; we are partners in this process. In fact, British Columbia has the lead on seven Red Seal trades. We don't anticipate the process changing. The existing process will continue, but we are going to add new opportunities for trainees to take the Red Seal, in addition to the current practice.

J. Kwan: Would it be fair to say that under this new legislation, it would therefore be easier for a person to attain the Red Seal recognition because there would be new avenues for the person to pursue the Red Seal recognition?

Hon. S. Bond: It's certainly not about it being easier. What it is about is increased opportunity and flexibility.

We want people in this province who have a demonstrated set of skills or a high level of competency to be able to put themselves in the position to write for the Red Seal. So in fact, it is not about easy. It is not about that kind of approach. It's about how we allow more people and encourage more people to be able to be in the position to take advantage of a Red Seal opportunity.

J. Kwan: Well, the reason why I'm asking some of these questions is that the opposition has received information from various people who are concerned about this piece of legislation, and it appears that the proposed new model has not won the kind of broad-based approval that a new trades or skills development strategy needs to succeed. Just by way of an example, in April of 1997 an industry-sponsored survey of some 300 building contractors — and the majority of which are non-union — found that some 73 percent of the building contractors think the apprentices should be required to learn all facets of the trade before being granted journeyman status.

Many people question the value of overhauling the current curriculum to achieve the changes that the minister is looking at. Some have voiced a concern that they are worried that this new process — or, as the minister puts it, new opportunities — actually makes the national certification of Red Seal more difficult rather than more accessible for people. If it's more difficult, the concern is that this will, of course, erode people's ability to work not only in this province but in other provinces as well, which is why I'm canvassing these questions with the minister with respect to the different approaches and different new accreditations that would be developed and devised under this new act.

The minister says that to achieve the Red Seal recognition, there will be new opportunities to do so. Is that the case, then, for recognized programs as well, that there would be new opportunities and therefore new programs for a person to be designated by the authority as a recognized program?

Hon. S. Bond: Yes, it does apply to recognized programs, because the principles of the new model are the same, whether it's an accredited program or a recognized program. We believe it's important to recognize competency. If a person is competent, our job is to find a measurement for that set of skills, and when we can measure and deem that person competent in his skill, they should receive a credential for it.

So, yes, we're going to build in flexibility. We're going to build in new pathways to credentials, but I want to say it again: the existing system in terms of the Red Seal will continue, and apprenticeship will continue. We are simply saying we need to develop a set of principles and standards for measuring competence, not simply time-based training.

J. Kwan: How will the minister ensure that those recognitions will also be acknowledged in other provinces?

Hon. S. Bond: We are working continuously with both our provincial and federal counterparts. We want to ensure not only that our workers are of excellent quality but that they have the ability to be mobile in the country, so obviously that will be a significant principle. We will continue to work with the federal and provincial and territorial governments as the model unfolds. Labour mobility is important, and in fact, again, British Columbia is a lead province on the subject of labour mobility.

J. Kwan: Do we have assurances from the federal government at this time that they'll be working with us to that end?

Hon. S. Bond: We continue to work with the federal government. As a matter of fact, my staff has meetings with the federal government and the directors of apprenticeship as soon as next week as we continue to dialogue about the changes. I should say that certainly people are discussing the legislation and the potential that we are introducing in British Columbia, and I think there's an exciting opportunity for us to increase the partnerships we have across Canada as a result of this legislation.

J. Kwan: This legislation, as I understand it, promotes and advocates for partial trades training for apprentices. Such partial credentials will likely not be recognized in the other provinces and, therefore, would seriously limit the mobility of B.C. workers.

Could the minister please advise: is that the intent of the legislation — to allow for partial credentials? On the issue around credentialing, including partial credentials which could limit the mobility of workers across the country, how would the minister address that?

Hon. S. Bond: The model does embrace the principle of progressive credentialing. That's just the way learning has evolved on the academic side as well. What it doesn't do is take away from the fact that the existing apprenticeship and training model today will continue, so where an individual chooses that particular method of training, that's exactly what will happen.

We are not alone in looking at the possibility of progressive credentialing and looking at particular skill sets being recognized. Other provinces across Canada have already begun that process, in fact, to try to meet the needs of individual learners and employers across the country. We are looking at progressive credentialing. We are, though, maintaining the current apprenticeship and training model where that's appropriate.

J. Kwan: What the minister may call opportunities, if you will — as she likes to provide different labels to these different approaches under the government — others would look at as, really, a big issue of deskilling of workers in B.C. Already there's a big shortage in the

The new legislation, as I understand it, also takes away the legal requirement for mandatory journey-level trade qualifications for electricians, plumbers, sprinkler system installers, steam fitters, pipefitters, sheet metal workers, roofers and refrigeration mechanics. Is that the case?

Hon. S. Bond: I'd just like to ask the member if the question could be clarified. I did hear the list of designations, and those are certainly in the compulsory trade category in the current legislation. If you could just clarify the question, it would be most appreciated.

J. Kwan: As I understand it, the new legislation takes away the legal requirement for mandatory journey-level trade qualifications for the list of trades that I mentioned. Is it the case that this legislation does that?

Hon. S. Bond: What the legislation does is treat those trades the same now as we treat any other trade in the province. Issues of worker safety and safety standards will be managed through a different mechanism.

Hon. S. Bond: We will be working in collaboration with my colleague in CAWS under the Safety Authority Act.

Hon. S. Bond: Under the new system, how it will differ is that employers are required to register and employ only qualified workers. In fact, under the new Safety Authority Act, employers who do not do that will be subject to enforcement and, eventually, fines. We actually think that those standards will be enhanced under the new mechanism.

J. Kwan: What is the mechanism to monitor outputs such as increased completion numbers versus just more names on the roster to artificially inflate the numbers? How will the minister put in that mechanism to ensure people actually have increased completion numbers?

Hon. S. Bond: Just as we monitor the accountability of institutions in this province, we issue each year a budget and accountability letter. We did that for the first time this year. The Industry Training Authority will be expected to present to us a three-year business plan. Our initial targets are a 10 percent increase in growth over each of those years, so we would expect to see demonstrated in the business plan a 30 percent growth in the number of trainees in the province over a three-year period.

I should point out that in the legislation, we've also included a new aspect. Previous to this, logs and records of training in the province were kept for apprentices only. This legislation requires there to be records of training done in any facet in the province. So, in fact, we are building a system that would allow us to monitor the increase in numbers. That's also great news for people who train as we look at progressive credentials, because they will have an ongoing cumulative record of the training that they do. Employers will also have access to that, so that in one place they will be able to look at the skills, competencies and credentials of trainees in this province.

J. Kwan: When the minister says that the numbers will be monitored, is that the trainees who have completed the program successfully or just the number of people who signed on to the program for training?

Hon. S. Bond: Well, in fact, one of the things that has driven the look at a new model in this province is completion rates. It is important to us that people who begin programs complete them, and if they don't, we want to find ways to either assist or help change the model so we have more successes.

Currently, in terms of apprenticeship in the province, almost half of the people that start an apprenticeship don't finish it. What we want to do is track completion. Obviously, that's important because British Columbia needs more trained workers.

We also want to provide resources to people who need assistance along the way. Let me give you a practical example of that. If, along the way, there's a particular section of a skills training component that a student or learner cannot complete — and they can't pass the test because of a particular area of need in terms of a skills set — we want that person to be able to receive the kind of training that helps them in that area, to help them complete the training program rather than have them drop out and have to start all over again. We're looking at ways of meeting learners' needs, helping them build on the skills sets they have, and where there are areas where they need additional assistance, we want to provide training opportunities that meet those needs. The current system does not allow us to do that.

J. Kwan: Does the minister mean to say that when a person goes through the testing that is required to earn their trade certificate and in the process is found to be deficient in a particular area, the person will get partial certification in one area? And then in the other area, where the person is deficient, they will have to go back to receive further training? How would that work?

Hon. S. Bond: In an apprenticeship now, if you go back to the classroom and take an eight-week period in terms of the training that you have…. If there is one particular area that you do not complete successfully, you simply lose all of the credit, all of the recognition

for the skills in the eight-week period. I guess the analogy would be that if you're a college student and you take five classes and complete four of them, and one of them you don't, you go back and take the one class over again. You still get credit for the four that you've successfully completed.

We're simply saying that we want to design and have a system that recognizes a skills set — a competency-based system. We want to help that individual gain the credential — gain the competence they need in the one area that they need it in. In essence, we want to build more flexibility into the system, and we simply can't help people in that way currently.

J. Kwan: How would it count in terms of the numbers that the minister was suggesting she would like to see increased in terms of trainees in the areas? If a person goes through a program and partially completes one area but not another, is that person counted as a trainee who has completed part of the…? How would that count towards the number counting that the minister would be utilizing to define success under this new model?

Hon. S. Bond: Currently, in this system we register approximately 16,000-plus apprentices. There are 8,000 other trainees in the province of which there is no record in the sense of monitoring and tracking their success rate or the fact that they have completed a particular credential.

We are going to create, with the Industry Training Authority, objective, verifiable systems where we can monitor and track the success of those trainees as well as apprentices in the province of British Columbia. Certainly, as new credentials are developed, we will measure against that particular credential the number of successful completions we have.

We will have a much better system in place to measure our success. It's in all our best interests to set a target and make sure we're meeting it because, in essence, the reason for the redesign of the program is to meet the needs and future needs of British Columbia's industry. The system will be objective, verifiable and designed with the Industry Training Authority.

J. Kwan: The minister didn't answer my question. I asked the question that if a person goes through the system and partially completes the program but does not, on the other half…. How would that person count? Is that a person who has completed the program or a person who has just entered into training and has not completed the program? Would the minister please clarify?

Hon. S. Bond: I guess it's a definitional thing. It's not a matter of partial anything. It's a matter of a particular skill set, a particular credential. A student enrols, they complete, and we record their success. In essence, students will be able to take particular courses, certificates, and build on them — add them together. At the end of the day one of the credentials we'll be measuring is TQ. It isn't a matter of partial. It's a matter of using training methods relevant to a particular skill set. Those will be measured and identified, and there will be a completion rate at the end of that.

J. Kwan: The minister just said, though, that they will be looking at developing and devising a model that would assist individual trainees who do not complete various components within a program. To that end and to facilitate opportunity, as the minister likes to call it, there will be other means to help and resources to assist — to quote the minister directly — that trainee with completion.

For the purposes of counting towards the 10 percent increase the minister is targeting, I'm particularly interested in how you would count each individual as they enter into the program. When a person has not completed the program — in my view, partial completion, because as the minister says, some components the trainee has successfully completed…. Therefore, to not hamper the individual from advancing, they would isolate the components that the trainee has not completed. Given that it's one program in its entirety, in that instance would that trainee be counted as someone who has not completed the program or someone who…?

J. Kwan: I'm just trying to remember what I was asking before the fire alarm went off. I think I was asking the minister about how you sort out an individual trainee who enters into a program and partially completes certain sections of the program but not other components within it.

How would that person be counted in the minister's approach to keeping track of how many trainees have entered into the system and how many have actually completed the program? Would that particular trainee be counted as someone who has completed a program or not?

Hon. S. Bond: People would be counted when they have completed a credential. When they've met all of the component pieces to meet a particular credential, then they would be counted.

J. Kwan: In the instance where the person has not completed the entire program, that person would not be counted as an individual who has completed the program. Am I right?

Hon. S. Bond: Yes. In fact, until a person has completed a credential, they would not be counted.

J. Kwan: How would the minister ensure that there's no double-counting? When the minister says "a credential," does that mean that if a person has completed one course, then the person who's completed that course would be counted as a person who has completed a particular program? If the person takes another course, is that counted as two people who have completed a program? How will the minister ensure that there's no double-counting?

Hon. S. Bond: We will count a student as completed as they receive a diploma or a credential or a certificate or a TQ. When they've completed that particular credential, they will be counted.

J. Kwan: In theory, a person could be counted twice or three or four times. If a person completes one credential, that's one individual. But if the same person embarks on another area, because now the act actually allows for the separation of the different trades, then that person could be counted twice — or three times, for that matter. But yet, there are not really three people who are able to perform the job; there is only one person. Is there that possibility here, or am I wrong? Would the ministry be looking at the individual and following that particular individual through the course of the different kinds of training that the individual may embark on?

Hon. S. Bond: In fact, we need to count both. We need to count volume. In other words, we need more people in the training system, so yes, we do need to track individuals and the number that enter the system and complete.

We also want to track increased opportunity and volume, in essence, of opportunity for people along the way, so we'll be tracking individual trainees as they move through a progressive credentialing system. If they complete one TQ, they will be counted as one TQ. If they complete a second TQ, obviously we're counting a second TQ-trained person in the province in terms of those skill sets.

We are going to track individuals. We're also going to track the number of people coming into the system and the steps that they complete along the way.

J. Kwan: What I want to make sure of is that there are no artificial numbers here, because one person who may be trained in two or three different areas doesn't mean that there are three people who can perform the various jobs in the province. Rather, there's only the one person who could perform in the variety of areas, who is trained in a variety of areas. We want to be sure that there's no artificial inflation of the numbers in terms of completion of programs. That's why I'm asking these questions of the minister.

Let me ask the minister this question: who will define a trade? Is it the authority who will be doing that work?

Hon. S. Bond: Yes, the Industry Training Authority does have the ability to designate trades. They can do it as either recognized, which they have the ability to do, or — if they choose to suggest it to the minister — seeking accredited designation. They would need to bring that designation for approval to the minister.

J. Kwan: Ultimately, it's the minister who defines a trade. It's the minister's approval that would allow for the trade to be defined.

Noting the hour, I move that the committee rise, report progress and ask leave to sit again.

Committee of the Whole (Section B), having reported progress, was granted leave to sit again.

Committee of Supply A, having reported progress, was granted leave to sit again.

Hon. S. Hawkins: It certainly is a pleasure to take part in estimates again for the Ministry of Health Planning for the fiscal year 2003-2004. I am really pleased to speak to our plan and our budget for what will be the third estimates of this ministry. Before I begin, I'd like to introduce the staff who have joined me.

To my right is our deputy minister, Dr. Penny Ballem. Seated behind her are our chief nurse executive,

Anne Sutherland Boal, and Tamara Vrooman, who is Deputy Minister of strategic initiatives and corporate services. I want to thank them, and all the staff in the ministry, for all the hard work they've done over the past year.

As you know, the Ministry of Health Planning was created as an expression of our government's commitment to addressing the immense pressures on the health care system by leading planning processes for specific initiatives as well as comprehensive system planning. From the start we certainly knew we had to address some serious shortages in health human resources, a poorly structured regionalized health authority system and a lack of accountability within the health care system.

We certainly have made some very significant progress. We now have a simplified health governance structure, which is functional and well managed, and it is accountable for results to patients and to government. The 2003-04 service plan and budget will take us, I believe, further toward a better-managed health care system. The operating budget for my ministry for the fiscal year 2003-2004 is $24.154 million. That's a 4.2 percent increase over last year. We're going to use that funding to develop plans that address our commitment to design a patient-centred, cost-effective, equitable and sustainable health care system in this province.

I'm also pleased to present the 2003-04 service plan for the Ministry of Health Planning. As members are aware, the Ministry of Health Planning previously issued an interim service plan on February 18, and the plan has now been updated. The key change from '02-03 and the interim '03-04 plans is that core businesses are restructured to better define the role of the ministry versus the role of our partners. New strategic priorities are incorporated into this plan, and performance measures and targets are updated to reflect the ministry's new strategic priorities.

In alignment with our vision for B.C.'s health care system, this year's plan reflects the ministry's reorganization of its core business. Performance measures include the development of standards, long-term planning for health care service delivery and public satisfaction measures for health care across our province.

The ministry's primary function is stewardship over the health care system. We provide direction and support to our partners, and we monitor and evaluate the impact of services delivered to the public.

Since June 2001 the government has been introducing ambitious and wide-ranging health care system reforms. The innovations and improvements associated with these reforms reflect our government's desire to create a publicly funded health care system that is patient-centred; that provides accessible, high-quality services; that results in improved health and wellness; and that is sustainable and affordable over the long term.

This service plan for the Ministry of Health Planning and its companion document, the service plan for the Ministry of Health Services, continues with reform efforts begun in 2001. It sets out the priority strategies for the health care system for the next three years and articulates the respective responsibility of the ministries of Health and their health system partners in achieving these priorities. These strategies support the attainment of the government's goals and strategic objectives as well as fulfilling our obligations under the first ministers' accord on health renewal.

To reflect the corresponding roles of the two ministries, elements of this plan — the vision, the mission, values, ministry goals, planning context and core businesses — are also included in the service plan for the Ministry of Health Services. Each plan also shares common goals and objectives. However, most strategies and performance measures are different, reflecting the separate roles each ministry has in meeting the common goals, but it is important to review the two ministries' plans in unison.

To fulfil its stewardship function my ministry is organized into four main areas. The first is planning, policy and legislation. This area develops planning approaches and tools, policy, legislation and intergovernmental positions to strengthen the health system management. This division also establishes the broad accountability framework for the entire health system, develops specific standards for quality and access and leads the planning of health human resources.

The strategic change initiatives area develops long-term plans in collaboration with health authorities and other key providers. It oversees specific projects designed to improve quality, access or efficiency. This division also leads planning initiatives, undertakes time-limited management projects and provides project management expertise for all areas of the Health ministries.

The office of the provincial health officer and population health and wellness provides independent advice to government on health issues. It monitors and reports on the health of the people of B.C. It identifies the need for legislation or a change of policy or practice respecting health in British Columbia and works with regional medical officers and the B.C. Centre for Disease Control to fulfil their legislative health protection and disease control mandates. The information collected also feeds into the ministry's long-term planning and strategic change initiatives by calling attention to urgent and emerging health issues.

This business area also includes the population health and wellness division. This division is responsible for developing and evaluating major provincial strategies and works with the health authorities to protect and improve the health of British Columbians and reduce future demands for health care services.

Vital statistics is also in the Ministry of Health Planning. The Vital Statistics Agency provides a system for the registration and certification of vital events for the province. It also provides vital events data, statistical reports and health status indicators to support planning needs.

Our service plan lays out the strategies and performance indicators to measure progress against three

critical health system stewardship objectives. The first is clear direction. Government strategic direction must be clearly defined and communicated in order to guide service delivery. The second is appropriate support. We have to make sure supports are in place to facilitate the achievement of our strategic priorities and ensure barriers to change have been removed. The third is monitoring and evaluation. It is critical that our health care system be monitored and evaluated so that system corrections can be made and services meet the public's needs and are sustainable into the future.

In my service plan there are 13 strategies in support of these stewardship objectives and we'll report on 11 performance measures to track our progress in achieving our objectives over time. For example, we're committed to the development of a long-term, comprehensive directional plan for our health care system. We are committed to ensuring our regulatory and policy frameworks provide flexibility for the appropriate utilization of the private sector in providing health care services, and we are committed to the development of coordinated, systemwide approaches for responding to major public risks and epidemics.

How will this progress be measured? Our progress and performance in achieving the results for our Health service plan efforts will be measured and reported on at various levels of the system. The refinement of ministry service plan performance measures, done in collaboration with health authorities, will assist the system on focusing on priority, populations and measuring the success of service improvements and health reform fund initiatives. Performance measures are also included in health authority performance agreements and will be reported on annually through performance reports. This year, for the first time, performance measures have been developed for the ministry's various functions, not just for services delivered by partners.

Our long-term planning focuses on a sustainable public health care system, including strategies for prevention and chronic disease management. To ensure quality care, the government is also committed to a long-term health human resources plan to ensure that B.C. has the health professionals we need. Our government is committed to working with our health authorities, our health professionals and other partners to implement these service plans and achieve our vision for a better health care system in B.C.

We'll also have a measure of comparable health through reports such as How Healthy Are We? You'll remember that we released a report last September that provides information on everything from life expectancy to teen smoking. This was done by all of the provinces. It found that life expectancy of British Columbians, at an average of 80 years, is Canada's best, and B.C. also has among the best cancer survival rates in Canada. Challenging areas, as well, were included in that report. That included increasing lung cancer among women and an increase in the number of positive HIV tests.

I'd like to talk briefly about the changes and the progress we've made over the past year. Last December, you'll recall, we released a report called The Picture of Health detailing our vision for modernizing public health care and the steps we're taking to implement our new-era commitments for a high-quality, accessible health care system that meets patients' needs. Our new-era platform outlined 46 specific health care measures. We've already acted on over half of these commitments. The key elements of the plan include action on areas of great importance to my ministry. Those areas are human resources, primary care, aboriginal health, chronic disease management and preventive health and wellness. We have made a great deal of headway in each of these areas and more.

With respect to health authorities, I'd like to start by quoting from my first estimates opening remarks in 2001. I said we would "take the first steps to simplify the organizational complexity in the province's health system" and "draw clearer lines of accountability to ensure British Columbians are receiving the greatest possible value from their investment in health." Well, it's starting to work. Health authority performance agreements and acute care accessibility standards, their three-year service redesign plans and budget management plans are in place and are being refined.

We'll continue to focus on accountability for health dollars spent. We'll do this through refinement of our objectives, strategies and performance measures for health authorities. I know the health authorities have been working very hard to achieve some incredible goals in a very short time, and I recognize that many people have had to make difficult decisions to help keep our health system accountable for the long term.

On the human resources front we've implemented strategies to recruit, retain and educate more health professionals. I am very proud of our nursing strategy, which has been very successful and has contributed to significant improvement in B.C.'s nursing situation. I know that our nursing directorate and our chief nurse executive have worked very hard on this in collaboration with nurses, educators and administrators around the province.

The government has committed $21.5 million towards ongoing and new recruitment and education programs to increase the supply of nurses. Within just one year the province has gained an additional 530 RNs, RPNs and LPNs who are licensed to practise. Over the past two years more than 1,266 new seats have been added to basic and refresher programs for RNs and LPNs. Last year's nursing strategy provided 315 nurses with speciality training in critical and emergency care and helped nurses on workers compensation and long-term disability return to work.

This year we continue to build on our successes with ongoing funding for our return to nursing and speciality education programs. As well, we've added a pharmacology course upgrade for LPNs and a first nations nursing initiative. We've also expanded the loan forgiveness program for recently graduated nurses and physicians to include LPNs this year. Alto-

gether, these programs will continue to make a very significant contribution to nursing in British Columbia.

Our nursing strategy is one part of a broader human resources plan. With respect to physicians, in 2002 we reached an agreement with doctors that commits $392 million in new funding. This means an average increase of $50,000 for each of B.C.'s 7,800 doctors. On top of that compensation package we recently announced over $58 million in incentives for rural physicians to ensure that communities with an identified need have timely access to care.

We're working to increase physician-training spaces in medical schools. We'll increase the number of spaces from 128 to 224 as part of the province's $134 million investment to almost double medical school spaces in B.C.

The focus of our service plan is preventive health: doing what we can to prevent people from ever getting sick in the first place. We want to prevent or reduce injury and illness and help people to better manage illness when it does occur. To achieve that we're focusing on our chronic disease management program. I'm pleased to tell you that we have made solid progress toward implementing this program. An important tool is the new provincial chronic disease management website. Both physicians and patients around the province can now log on to find lots of helpful and frequently updated information. For instance, the website includes concrete information on the best practices for managing diabetes and chronic heart failure. We have a wonderful new section highlighting patient success stories to provide that inspiration to patients so that they do know there is help and success.

We've also developed patient registries for both diabetes and congestive heart failure. Response to these, as well, has been excellent. More registries for asthma, depression and chronic kidney disease are now on the drawing board. Initial work has begun on the complex but important task of developing a registry of co-morbidity so we can track and assist patients who suffer from more than one chronic illness — for example, patients who suffer from both diabetes and depression.

Clinical guidelines. With the support of the Medical Services Commission, hundreds of doctors have helped us develop new clinical guidelines for the treatment of diabetes. They continue working to develop up-to-date clinical guidelines for the remaining eight chronic diseases that we have prioritized. Their work clearly shows that by making small, targeted investments over the next two years, we will see substantial cost savings very soon. More importantly, patient health will be greatly improved.

Primary care renewal continues to be a strong focus. To date we have seven project sites for the primary care demonstration project set up throughout B.C. This joint research project between Health Canada and my ministry will test new ways of funding and delivering primary health care services. We've also created a detailed and impressive primary care website, which can be linked via the Ministry of Health Planning website.

We've also added new vaccines to our health care system prevention program. Our government recognizes that protecting British Columbia's children from very serious diseases such as meningitis and pneumonia is important. The provincial and territorial governments across Canada were hopeful that the recent federal budget would provide that funding for a national childhood immunization strategy and a vaccine purchase program.

That funding didn't materialize, and our government committed to new funding targeted to implement the high-priority expanded vaccination program for meningococcus group C and pneumococcus. The new vaccine programs are now anticipated to cost $9.9 million in 2003-04 and $16.8 million the following year. We believe this is a critical prevention initiative for our province's children.

Meningococcus C and pneumococcus are the major causes of bacterial meningitis in B.C., and pneumococcus is responsible, as well, for many thousands of childhood ear and throat infections and pneumonias, doctors' office visits and hundreds of hospitalizations every year. The new vaccination program will help our kids to stay healthier and out of doctors' offices and hospitals.

I'm also pleased to report that B.C. is the first jurisdiction in Canada to invite youth and athletes to take the tobacco-free sports challenge. This program is part of our government's new-era commitment to health and wellness and to supporting British Columbians who choose healthy living, participate in physical activity and play it clean. Reducing tobacco use in youth is seen by this government as a critical measure in promoting better health outcomes. After all, the highest proportion of smokers in B.C. and Canada are young people ages 20 to 24, with 27 percent using tobacco. That is a disturbing trend, and we want to address it head-on.

We also recently issued — and we're very proud of this — the B.C. First Nations Health Handbook. It's a companion guide to the B.C. HealthGuide. This was a very successful collaboration of the Ministry of Health Planning and the First Nations Chiefs Health Committee. The B.C. First Nations Health Handbook is part of our government's new-era commitment to materially improve the quality of life, education and health care for first nations people and to make a real difference in the lives of aboriginals both on and off reserves. The handbook is one step by the ministry and the First Nations Chiefs Health Committee to address aboriginal health issues.

B.C. HealthGuide Online at www.bchealthguide.org also links patients to information on 2,500 health topics, and the B.C. NurseLine is staffed 24 hours a day by registered nurses with translation services in 130 languages, including 17 first nations languages. They can be reached toll-free at 1-866-215-4700.

All of the initiatives I've mentioned have a single main purpose, and that's to ensure we're using our health care resources in effective ways that improve the

health of our citizens. We're committed to making sure that our health care system is planned in a thoughtful, sensitive way that's responsive to patients and meets their needs.

The goals, the objectives, strategies, measurements and targets that I am presenting today are testimony to that commitment. In this, my third time in estimates, I can say that it's increasingly satisfying to see progress being made toward the meaningful and important kinds of changes we planned two years ago, and I'm looking forward to another year of exciting initiatives and change.

I certainly am pleased to answer any questions the members have concerning our plans for the coming year. That concludes my opening comments.

J. MacPhail: I have had a chance to look at the service plan. I'm wondering if the minister, in sort of the vernacular, can advise us of what changes, what questions we should refer to the Minister of Health Services and not here. What parts of responsibility that she had last year are now with the Minister of Health Services?

Hon. S. Hawkins: The only changes over the last year are that the rural physicians initiative went to Health Services and vital statistics was moved over to the Ministry of Health Planning.

J. MacPhail: So the minister still has responsibility for the emergency room strategy, or has that gone to Health Services as well?

Hon. S. Hawkins: That was always in Health Services. I think the minister addressed that last year.

J. MacPhail: What questions would be appropriate to this minister around physician planning or physician negotiations — anything?

Hon. S. Hawkins: There is a lot of planning happening around physician training. What this ministry does is looks at the need and works with Advanced Education and with medical and pharmaceutical services to look at THE planning of training seats for medical students.

J. MacPhail: Good. Let me explore that, because I heard stuff about nurses. I've actually heard lots of questions about nurses but not about physicians.

Perhaps the minister could update me about the planning for physician services in British Columbia.

Hon. S. Hawkins: to be very specific, the responsibility for this ministry is to look at planning for integrated training of physicians, not physician services. We're working with Advanced Education. We're certainly working with medical services to look at the needs into the future. We're looking at the kinds of physicians we need to train, where we need to train them and how many may be required. Those are the kinds of decisions around planning that are made in this ministry.

J. MacPhail: What is the status of investigation into those various aspects of physician planning?

Hon. S. Hawkins: There is a bunch of initiatives that are happening on the federal-provincial-territorial level. We are leading a committee to share data on physicians. At HRDC there is a sector analysis being done, and it's continuing this year. There are ongoing discussions with the faculty of medicine with respect to needs — certainly, we are planning on an ongoing basis with respect to how many medical students and how many residencies are needed — and, on another level, with the provincial health services authority and the health authorities. They give us specific information on critical shortages. One example is thoracic surgeons. There are 11 in the province, and we work with Health Services to look at how we can organize them to make sure they are in places that best benefit patients across the province. With thoracic surgeons, we have regionalized their programs in the province.

Hon. S. Hawkins: We are heavily involved in primary care planning. That certainly involves physicians. We have the primary health care transition fund, which I know the member is very familiar with. We are working with health authorities to identify their needs and projects in the various health authorities and are involving physicians with that. That certainly ties in very closely with the health human resources planning we're doing. We know we need more primary care resources out in areas not only in the lower mainland but outside the lower mainland, and we're certainly working with the health authorities to identify those needs.

J. MacPhail: I would appreciate a little bit more detail. If the minister wants to refer me to the Health Services minister, I'm fine with that. We had the honour of having the Deputy Minister of Health appear before the Select Standing Committee on Health, and that was very useful. The deputy minister gave me the report on the primary care reform projects, but it was from 2001. Since that time there's been an infusion of federal dollars, and I would appreciate an update on the specifics of primary care reform with some examples, please.

Hon. S. Hawkins: Just to let the member know, the Ministry of Health Services is responsible for implementation of the primary care projects, but the Ministry of Health Planning has been working with the health authorities on their specific plans. They've been asked to submit plans. We have budgeted $27 million in '03-

04 for primary care projects for the health authorities. As the member knows, there is $90 million a year that is available for this province to access out of that primary care transition plan — that's federal money.

So far we've only accessed half a million, so $500,000 is what has come through for planning. For '03-04 we expect the health authorities to start implementing those plans. Every single one of the health authorities has submitted their plans, and they'll start implementing them over the next year.

J. MacPhail: So $27 million is budgeted for this year for primary care reform, and the federal government is providing $19 million per year. Can the government of British Columbia carry that over, and is that why it is $27 million? Or are there some B.C. dollars going to primary care reform?

Hon. S. Hawkins: The member is correct — $74 million was given to B.C., and we can draw it down as we use it. That's why it's budgeted for $27 million this year in the Ministry of Health Services.

J. MacPhail: By saying that, is the minister suggesting I should direct my questions to the Minister of Health Services on primary care reform? I'm fine with doing that.

Hon. S. Hawkins: Yes, the budget allocation is in his vote. The health authorities have submitted their plans, and they will be given that portion of the money to implement their plans.

J. MacPhail: Okay. I just want to make sure. There are some policy issues around primary care reform, but they should be referred to the Minister of Health Services as well.

J. MacPhail: Thanks. What about nurse practitioner reform? Who should I question on that?

J. MacPhail: Sorry, do have I to wait for the announcement? Is that what I'm being told?

Hon. S. Hawkins: As the member knows, last July I put out a White Paper on the Health Professions Act. It was amendments to the act. That draft has been on the Web now for about eight months. Within that draft is the enabling provision to designate a new profession called the nurse practitioner. It is my intention to bring that legislation forward. When we do, we will have a new category in the nursing profession, and that will be the nurse practitioner.

J. MacPhail: The minister may note that I ask questions about primary care reform and nurse practitioners together. Are any of the announcements linked? Is there linkage of change between the institution of nurse practitioners and primary care reform?

Hon. S. Hawkins: Absolutely. Primary care and the new role of a nurse practitioner are linked. They all go a long way to making sure patients get the most appropriate choice of health care providers. Certainly, Health Services is working closely with the Ministry of Health Planning to make sure that we do provide the kinds of professionals our patients need in this province. We're also working, as the member knows, with the Ministry of Advanced Education for providing seats for this new designation when the announcement is made.

J. MacPhail: What role is this minister playing in the Pharmacare changes? Specifically, I note that one of the joint responsibilities in this new service plan — it's No. 15 — is to improve registration services to the public. Just what role the minister plays in Pharmacare in that area…?

Really, my question perhaps is more along the lines of what I saw on the minister's website that we took off late last week, which is that the planning, policy and legislation division develops the policy legislation and intergovernmental positions that allow these plans, standards and positions to be acted upon.

As the minister may know, I have referred several times to a study out of Quebec, the Robyn Tamblyn study, about the effects of changes to Pharmacare policy on acute care and emergency admissions. Is there any sort of study being done to examine Pharmacare changes this government has brought in, specifically in this minister's responsibility?

Hon. S. Hawkins: I'm not responsible for the registration for Fair Pharmacare. That's completely Health Services. However, as far as evaluation, this ministry is responsible for a contract with the Centre for Health Services and Policy Research. They hold the linked databases, and they will be doing an evaluation on the Fair Pharmacare changes for this government. This ministry is also working with the College of Pharmacists of B.C. to enhance access to the PharmaNet database to allow us to evaluate or assess the Pharmacare changes as well. Those are the two ways we are looking at the Pharmacare changes.

J. MacPhail: What was that first centre — the Centre for Health Services? Perhaps the minister could tell me who they are, what the nature of the contract is, what the funding for it is and how the long the study will take. The same with the pharmacists association.

Hon. S. Hawkins: The agency I was talking about is called CHSPR. That's the acronym; it's the Centre for Health Services and Policy Research. It's been in place for many years, so I think the member is probably familiar with it. It's at UBC. The director is Dr. Charlyn Black. It has long held linked data — administrative data from MSP, hospital discharges, etc. It also holds the Pharmacare data. It has a contract for $750,000.

What we do is the ministry lays out its needs. One of the needs we've identified is for it to evaluate the changes with respect to the Fair Pharmacare program. They will be conducting some research around that, and they will be doing that with the changes proposed to better access of the PharmaNet data that we're embarking on right now.

J. MacPhail: I want to make note of something. I'm going to start off by using a phrase that my 14-year-old son says just as he's going to comment on how I dress like a nerd: no offence. But it's noteworthy, and I think recognition is deserved that everybody in a position of authority right now is a woman. I think that's very cool. No offence. That's what my son says — no offence — just as he's about to offend me. But I think that's noteworthy.

Hon. S. Hawkins: I think the member probably meant the college, not the association. The College of Pharmacists right now holds the PharmaNet data. They feel it's bigger than what they can handle. They want the responsibility to come back to government. We're going through that process right now.

I believe Minister Hansen tabled that bill in the Legislature yesterday. Working with the privacy commissioner we will be establishing an oversight committee and making sure that PharmaNet data is being used appropriately. Again, that really is in Minister Hansen's purview as far as changes to how the PharmaNet data are going to be utilized in the future.

J. MacPhail: I'd like to talk a little bit about health and wellness. I've got two…. First of all, I'm going to talk about health and wellness and illness prevention, and then I'm going to talk about nursing. I apologize for switching, but I see the chief nurse executive here.

I'm curious to know who amongst the four Health ministers is working with the federal government to advise them on their decriminalization of marijuana.

Hon. S. Hawkins: With respect to the decriminalization issue, the Solicitor General has been working with the federal government on that issue.

J. MacPhail: Is there any sort of cross-government committee on this? This seems to be an issue that's heating up, and I want to make it clear that I have no position on this; it's not as if I'm raising this as a matter of policy. But it is a health issue, the same way the use of alcohol is a health issue and the use of tobacco is a health issue.

I've noted a stark absence, in the discussion around the Prime Minister's move to decriminalize, of any health discussion. Is the Solicitor General charged with the discussions around the health effects?

Hon. S. Hawkins: On the federal level it is the Solicitor General who's been taking the lead. I think generally when we talk about prevention, anything to do with drugs and smoking is obviously something we would be telling children and the public are not safe activities.

As far as decriminalization and this issue, the Solicitor General is taking the lead.

J. MacPhail: Okay. I just want to put on the record that there are health issues associated with decriminalization. They are health issues that have yet to be exposed publicly, both positive health issues such as the medical use of marijuana and perhaps the negative effects of early and protracted use of marijuana and the effects it will have on children. I would actually urge the government to insert themselves, from a health point of view, in this discussion. Decriminalization is one thing that seems to be moving remarkably fast in my books. I want to make sure all aspects of the change are thoroughly explored.

I also note that in any discussions with American officials I've been privy to that they have focused on the issue of the health concerns associated with any change. Perhaps it would give them a leg up in terms of public opinion by virtue of the fact that they approach it from a health point of view and our government both at the provincial and federal level approach it just from a decriminalization point of view. I'm wondering whether the minister could add her thoughts to that.

Hon. S. Hawkins: We are working on a general prevention strategy. Certainly, the area of general addictions is with the Minister of State for Mental Health. We know the World Health Organization has done a lot of work in this area and, certainly, on marijuana. I know that the Minister of State for Mental Health is looking at that and will be integrating that into the addictions prevention strategy.

J. MacPhail: I note the Minister of State for Mental Health is here, so he could be prepared for these same questions when he is up for estimates.

What about the issue of safe injection sites, as it moves forward here in British Columbia? It is a health and wellness issue, harm reduction. The approach now taking place in my community in Vancouver is based upon a four pillars approach, which is prevention, education, enforcement and harm reduction.

It's interesting. I keep waiting for the provincial government's participation in this four pillars approach

to become well known. The Vancouver coastal health authority is at the table — I know that — but what role does the Ministry of Health Planning play in ensuring that the four pillars approach encompasses a wellness and prevention strategy?

Hon. S. Hawkins: A couple of things. This is Minister Cheema's purview, but I can give the member a little bit of information here. There is a summit table, and at that table are the mayor of Vancouver, the CEO of Vancouver coastal health authority and the police. Our deputy, Dr. Ballem, sits at that table. There is a steering committee that is operational, and certainly our provincial health officer, Dr. Kendall, sits at that table. He actually chairs the steering committee.

We are involved in the Vancouver agreement. That is through the Minister of Community, Aboriginal and Women's Services. They are responsible for that, and they are very involved. In our ministry Andy Hazlewood sits on the committee for that. Through the Ministry of Health Services we have funded $800,000 for safe injection sites in Vancouver.

J. MacPhail: I will ask those questions as well of the Minister of State for Mental Health.

What's the status of smoking prevention programs in the province? How much money is allocated to the regional health authorities? I understand they've been delegated to the regional health authorities. What is the overall provincial budget for the anti-smoking programs? What change has occurred since they've been delegated to the regional health authorities?

Hon. S. Hawkins: Our existing strategy is a three-part approach for tobacco reduction. That includes, firstly, legislation and legal action to hold the industry accountable for its actions and the damage its products have done; secondly, the prevention, protection, cessation and enforcement programs; and thirdly, public education with respect to our programs.

We have regional tobacco reduction coordinators. We have transferred $1 million to health authorities to fund local tobacco experts, who work closely with schools and communities. We have a B.C. "tobacco facts" school-based prevention resource developed by the ministry in consultation with the Ministry of Education. It offers lessons in tobacco prevention for students from K-to-12.

We have an aboriginal tobacco strategy as well, because we know that aboriginal people are disproportionately represented in the smoking population. They comprise 8 percent of the smoking population but only 3 percent of the general population. Certainly, when the provincial health officer did his report on aboriginal health that was released in October, that was highlighted there. More than half of our aboriginal teenagers, 54 percent, misuse tobacco, and it's increasing to 65 percent for ages 20 to 24.

We know we have a lot of work to do in that area, and we are working on programs in response to that. The ministry funded the development of an aboriginal tobacco strategy. The program is Honouring Our Health, and it's an aboriginal tobacco strategy for B.C. It was released in January '01. It is being evaluated this year, and it appears to be fairly successful in the communities where it was implemented.

We announced a new program a few months ago called Tobacco-Free Sports — Play It Clean! B.C. is the first jurisdiction in Canada to adopt this international initiative to clear sports of tobacco use. The initiative was launched during National Non-Smoking Week; I believe it was the third week in January when it was launched. We have tobacco-prevention public education resources. We have the poster program. We have websites. We have the Talk About It Tips brochures to help parents talk to their children about what's in tobacco.

Enforcement, as well, is a big part of our strategy. Cessation certainly remains a big part. We have the BC Smokers Helpline. It's a toll-free cessation line operated by the Canadian Cancer Society. We have the B.C. Doctors Stop Smoking Project that continues. It provides cessation tools, procedures and training for doctors and other health professionals. Certainly, the program is administered through this society for clinical provincial preventive health care, and approximately 1,600 physicians actively use the program.

We have Kick the Nic. That's a resource for health and education professionals to support teens who want to quit. It's offered through schools, community centres and friendship centres throughout the province. We have Stopping When You're Ready, and that's training for perinatal workers to counsel pregnant woman on cessation.

There are hospital-based projects as well. There's the northern interior Nicotine Intervention Counselling Centre. It's a pilot program for patients based on the Mayo Clinic model. It targets respiratory, cardiac and diabetic in-patients in the region.

I can tell the member that our budget is $7.1 million for tobacco reduction, plus provincially we have given $1.675 million to the regions. From the federal government the regions get about $0.7 million. In addition, last year we transferred $1.2 million to public affairs, which now holds that money to support publications around public awareness in tobacco reduction. Obviously, the regional health authorities have other programs over and above the money that we give them to do their programs.

We have a lot of partnerships with other organizations that we help fund as well through the BCMA, the Canadian Cancer Society, I think I've mentioned the Helpline, the B.C. School Superintendents Association, Heart and Stroke and B.C. Lung. There are a lot of partnerships being developed there. We believe this is a very important part of what we do, and we're going to continue to be aggressive about it.

J. MacPhail: That's encouraging. What are the statistics around tobacco misuse in British Columbia other than aboriginal statistics, which are alarming?

Hon. S. Hawkins: I think I mentioned this earlier — I'm not sure I did — but in all age groups except ages 20 to 24, B.C. has the lowest percentage of current smokers. Compared to other provinces the national average smoking rate is roughly 21 percent for Canadians aged 15 and over. B.C. is at 17 percent, so we're in good standing there.

The most significant decline in smoking rates since February 1999 occurred in two age groups: British Columbians aged 15 to 19 and British Columbians aged 25 and over. B.C. youth 15 to 19 years have the highest rate of never smoked, 84 percent, while all the other provinces have rates of 59 to 81 percent.

I think where we're seeing our problem is the 20-to-24 age group and women. We're going to have to target that group, and we're certainly aware of that. Young women in B.C. aged 15 to 24 have the lowest smoking prevalence in Canada, 18 percent, but we know that in young women it is increasing. We're certainly cognizant of that and working at strategies to address that.

J. MacPhail: What's the status of the court case suing the tobacco companies?

Hon. S. Hawkins: As the member is probably aware, there was a constitutional challenge as to whether we had the jurisdiction to do what we're doing with the legal case. Unfortunately, the judge who was hearing the case became ill, so it was delayed, but I understand that we're expecting a judgment any day on that challenge.

J. MacPhail: Is it still British Columbia going on its own? If the answer to that is yes, are there other provinces pursuing a similar but separate case?

Hon. S. Hawkins: I can tell you that we've been working very actively with other provinces to get them onside and interested. At this time B.C. is taking the case forward on its own. I believe we are working and sharing information with other provinces. Certainly Newfoundland has passed legislation to date modelled on the B.C. legislation.

At this point other provinces are interested, and we are working hard to get them the information and get them onside. We're working with Health Canada, but B.C. is taking the case on its own.

J. MacPhail: I want to ask some questions around supplementary benefits now and the effect of changes in that area, particularly changes to naturopathic coverage and the ability of naturopaths to practise in British Columbia. Could the minister update those of us here on changes occurring in the practice of naturopathy in British Columbia?

Hon. S. Hawkins: With respect to supplementary benefits, it's better asked of the Minister of Health Services because that is around funding. I would encourage you to do it there.

As far as ability to practise, nothing has changed for the naturopaths or any of the complementary medicine providers. As the member knows, I mentioned earlier that we posted a White Paper on the website last July. We've been working very hard with all of the colleges on the amendments we're proposing for the Health Professions Act. What that will do is bring all of the health professions under one umbrella legislation so that there is consistency, more transparency and more accountability to the public by the colleges.

Certainly, with respect to the changes we are proposing for the Health Professions Act we're proposing a new model for reserved actions. That would be looking at the scopes of practice for the different health professions and modernizing them. That will be the next step after the proposed changes come in. To date there have been absolutely no changes to any of the health professions and their ability to practise what they're doing right now.

J. MacPhail: Let me just explore some of the proposals, then, that are part of the White Paper as they affect naturopaths. The White Paper does suggest, as I read it…. I actually requested a meeting with the naturopaths, because they're a major component of health care delivery in my riding. I'm not sure whether that's because of the diverse ethnic mix of my riding, but certainly there are many in my constituency who rely on and want the right of access to naturopathy, both for illness treatment and for prevention.

As I understand it, the recommendation of the Health Professions Council does recommend a reduction in the scope of practice for naturopathic physicians. I wonder whether the minister…. Apparently, the minister has said…. I know that she agrees with the Health Professions Council recommendation. Why does the government support a reduction in the scope of practice for naturopaths?

Hon. S. Hawkins: There is nothing in the White Paper on the Health Professions Amendment Act that suggests any reduction in any services or scope of practice at this time. What the Health Professions Amendment Act does do is propose a new model of reserved actions within which to prescribe a scope of practice. That's what it does.

I think what the member is referring to, then, is Safe Choices, which was the 1,400-page report that the Health Professions Council delivered to her government, and which we have been working from as far as recommendations to the changes to the act. The changes to scope of practice will be the next step. That will be the changes to the regulations. As the member knows, with respect to the Health Professions Act, none of those changes go forward without full consultation not only of the naturopaths but of all the colleges.

When amendments to the proposed legislation pass, then we will start the next step, which will be consultations. I don't think those consultations will be

short. We're planning to make sure all of the colleges give adequate and full consideration to the changes that are going to be proposed for the scope of practice, if there are going to be any. Yes, the Safe Choices report does make recommendations around some of the procedures the different colleges and health professions are practising. We will be looking at those kinds of recommendations with full consultation with all the colleges.

J. MacPhail: It's the Safe Choices report; I haven't read it. I know the process of the health professions review took almost a decade. I guess it is from that report that the naturopaths are claiming there was a proposal to restrict the right to prescribe drugs on schedules 2, 3 and 4. The naturopaths are suggesting the government will grant drug schedules to nurse practitioners and midwives and maybe even psychologists and pharmacists, but naturopathic physicians would be denied a schedule.

Let me clarify for all of us: what the route is, then. Legislation will be introduced into the House as a result of recommendations from the Health Professions Council. After the passage of that legislation, which is pretty much guaranteed, what happens then? What are the opportunities for the public and the professions to have input to disagree with the Safe Choices report?

Hon. S. Hawkins: Once the proposed legislation is passed, it starts the next process of consultation. That would be looking at the scope-of-practice regulations. I can tell the member that we have met with the College of Naturopathic Physicians, and we're continuing discussions with them. We know there have been concerns raised around their scope. I think the member, as well as other members and myself, would all agree we are concerned, and we should be concerned, about patient safety and public interest. That is the main driver of making sure that we're reviewing scopes of practice, modernizing those scope-of-practice regulations and making sure patient safety is paramount.

I can tell you that some of the regulations — as the member probably knows, because she held this portfolio — are from the early 1900s. Health care has changed a lot. There have been a lot of changes in procedures, a lot of changes in drugs, a lot of changes in the way things are done. I think it's incumbent on us to make sure our regulations and legislation are keeping up to those changes and to make sure that patients are protected and the public interest is served.

Once the proposed legislation moves forward, we will be in in-depth consultation with the colleges. I'm sure the associations will be involved. Certainly the public will have input as well, I'm sure, through communication with the associations and colleges on the scope of practice.

Those are the next steps, but the first step is actually making sure the legislation does move forward and the new reserved actions model is ready for implementation.

I have one quick question. I understand that primary care reform has already come up in these estimates. I'd like to ask a question to find out what specific progress has been made in developing and implementing community health clinics.

Hon. S. Hawkins: I did canvass this with the Leader of the Opposition. The community health clinics or primary care clinics are the responsibility of health authorities. We do have funds we can access federally, $17 million a year up to $74 million. To date we've accessed only about half a million dollars of those funds through the planning.

The health authorities have all submitted their plans for primary care reform, and the Ministry of Health Services has budgeted $27 million in this fiscal year to start implementing their plans. We're working with Health Services and with health authorities on the kinds of needs to be met in the different areas as far as professionals, as far as services. Again, it is really an implementation question, so if you wanted more information, you could ask the Minister of Health Services about that.

J. MacPhail: We were talking about naturopathy here. I want to put on the record some issues, if I may. I'm doing this to seek assurances from the minister that all of these matters can be addressed before final decisions are made around the practice of naturopathy.

One of the concerns raised by patients of naturopaths and also by the physicians themselves was as a result of a letter the minister sent, a letter to the editor that appeared in the Kelowna Capital News on March 28 of this year. The minister again talked, as she did earlier in this debate, about there being potentially harmful procedures. I think in the letter she referred to potentially harmful procedures delivered by NDs, doctors of naturopathy.

I want to make sure that if there are any changes to the scope of practice, those changes are based on real evidence, real complaints and history that gives some support to the suggestion or allegation that there could be potentially harmful procedures. I want to seek reassurances that those who say that have to prove it.

I also want to get reassurances that the changes to the practice of naturopathy — and indeed other supplementary benefits — will involve scope of practice as it relates not only to prescribing drugs but also the ability

to have hospital privileges and be able to refer to medical laboratories and specialists. Really, the scope of practice that the naturopathy doctors, the NDs, want to have input into before changes are made are in the areas of writing prescriptions, referring to medical laboratories, referring to specialists and seeking hospital privileges.

Then I would also ask the minister whether she could advise us of the form of decision-making. She has already promised public consultations, and that's good, but will there be a form of decision-making around scope of practice that will involve some sort of independent body?

Hon. S. Hawkins: I want to assure the member that there are going to be extensive consultations. Whenever there is a change in regulations for the colleges, especially for scope of practice, it is done under the Health Professions Act. That is done with consultation of all the colleges, so all of them will be involved.

With respect to the naturopaths, because I know that's what the member is questioning on this morning, we will be doing extensive consultation locally with practitioners and with the college. Apparently the National Institute of Health in the U.S. has done work on the particular subject of naturopaths. They have done evidence-based papers. We are going to look at the training colleges of naturopathy in Canada and the U.S. to get our evidence base, as well, on what is recognized as naturopathic practice. Certainly, we are going to do the literature search, because there has been international work done on this as well.

The challenge is that we have scope-of-practice regulations — and I'm not saying just for one profession — from 50, 60 years ago, and they don't really define a scope of practice for the twenty-first century. If you recall, perhaps, when you had your meetings with the naturopaths, the Health Professions Council not only recommended things they were concerned about in the different professions but also recommended the ways they would enhance the scope of practice for certain professionals as well. They did make some of those recommendations for the naturopaths. We are going to look at that as well.

I can't tell you that everything that has been recommended in that report is going to happen. That's why we're going to do extensive consultations and make sure that we do have an evidence base and that the decisions are going to be made on an evidence-based basis. What I can assure the member is that there are going to be extensive consultations with the colleges.

We're not going to redo the work the Health Professions Council did. As you know, they worked over ten years, and they had a considerable amount of discussions and consultations. The expertise in that panel, I believe, spoke for itself in that report. We will be using that report as a basis on which to consult in our consultations to finalize those scope of practice regulations.

Noting the hour, Mr. Chair, I move that we rise, report progress and ask leave to sit again.

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