Hansard -- Wednesday, May 14, 2003 p.m. -- Vol. 15, No. 12 (HTML)



CONTENTS

	Routine Proceedings
		Page

Introductions by Members		6773

Introduction and First Reading of Bills		6774
	Community Services Labour Relations Act (Bill 61) Hon. G. Collins Transportation Statutes Amendment Act, 2003 (Bill 64) Hon. J. Reid Miscellaneous Statutes Amendment Act (No. 2), 2003 (Bill 66) Hon. G. Plant

Statements (Standing Order 25b)		6776
	Nurses in B.C. R. Hawes Korean Heritage Day H. Bloy Chinese Heritage Day P. Wong

Oral Questions		6777
	Funding for child protection services J. MacPhail Hon. G. Campbell Funding for child protection and community living services J. Kwan Hon. G. Campbell Assistance for leaky-condo owners T. Bhullar Hon. G. Abbott Police force integration in lower mainland J. Nuraney Hon. R. Coleman

Tabling Documents		6779
	Property Assessment Appeal Board, annual report, year ended December 31, 2002

Third Reading of Bills		6780
	Industry Training Authority Act (Bill 34)

Committee of Supply		6780
	Estimates: Ministry of Health Services (continued) J. MacPhail Hon. C. Hansen J. Kwan K. Manhas

Mr. Speaker: I would like to welcome a group of 25 public servants from various ministries who are joining us in the gallery this afternoon. These guests are attending the parliamentary procedure workshop for public service sessions today. I hope the House will make them very welcome.

Hon. J. Murray: I would like to recognize today in the public gallery representatives from the Greater Victoria Bike to Work Society. The member for Victoria-Hillside has been a strong supporter of the society's work over the years, and today she and I had a chance to join society members and some of the bike-to-work team leaders to promote commuter cycling.

Victoria, I understand, is now the number one city in Canada for commuter cyclists. This is a positive thing in terms of environment but also in terms of people's health, so I'm a very strong supporter of Bike to Work Week. It's May 26 to June 1. Last year Victoria's Bike to Work Week campaign drew 304 teams. As of today they have 200 teams registered, and they are aiming to beat last year and have more than 304. I encourage everyone to consider the benefits of bicycling and cycle commuting.

I would like the House to please recognize president, David Cubberly; vice-president, Rob Wickson; coordinator, Linda Saunders; Tom Sutton and Joan McIntosh who have joined us in the House today. Please make them welcome.

Hon. G. Campbell: Today I'd like to recognize special visitors from the United Kingdom who are in the gallery with us. His Excellency Sir Andrew Burns, the high commissioner for the United Kingdom, is with us. Sir Andrew is accompanied by James Rawlinson, the British consul general in Vancouver.

Although the high commissioner is nearing the completion of his posting in Canada, we hope he'll make many return visits to this great Pacific province. He will always be welcome. I want to thank the high commissioner for the work that he's done on behalf of the United Kingdom in building stronger relationships with British Columbia, and I know that this Legislature would like to wish him well in the future.

J. MacPhail: I join with the Premier in wishing the high commissioner the best.

I'm very much looking forward to celebrating with all of my colleagues a great meal, because it's Asian Heritage Month. I see the gallery is full of citizens of Asian heritage coming and joining us. I can hardly wait to sit and chow down and celebrate, which is only one part of celebrating Asian heritage as well. I am delighted to join with my colleagues throughout the House to welcome all guests here to celebrate with us Asian Heritage Month.

Hon. G. Campbell: My second introduction today marks a very important milestone in scientific research for British Columbia. Visiting the precinct today is Dr. Marco Marra of the B.C. Cancer Agency research centre and the director of B.C.'s Michael Smith Genome Sciences Centre.

As I'm sure members of the House will know — and British Columbians, I know, take great pride in this — Dr. Marra is the head of the B.C. cancer team which was the first in the world to sequence the coronavirus genome which was widely believed to be, indeed, the cause of SARS.

Dr. Marra was born in Fort St. John, British Columbia, and returned to British Columbia from the U.S. to work with the late Dr. Michael Smith at UBC. Dr. Marra is joined by the president and vice-president of Genome B.C., Dr. Alan Winter and Mr. Bruce Schmidt. Genome B.C. is in Victoria to co-host a caucus briefing.

I know that all British Columbians take pride in the work they've done, and we look forward to the discoveries of the future. Please make them welcome.

Hon. L. Stephens: In the precincts today we have 60 visitors — grade 6 students and five adults from Langley Fundamental School in my constituency. They're accompanied by their teacher, Mrs. Merkel. Would the House please make them welcome.

J. Les: In the gallery today we are joined by two members of the communications team with the Fraser health authority. They are Sydney Tomchenko and David Plug. Would the House please make them welcome.

Hon. C. Hansen: There's a gentleman in the gallery today who's very important to my office, and that's because he's the father of my ministerial assistant, Kim Chan. I hope everyone will welcome Mr. Douglas Chan.

J. Kwan: I join with my colleagues to welcome the many community leaders who are here to celebrate Asian Heritage Month. In addition, I would also like to introduce Aaron Jasper, who is a community activist who believes in equality and social justice, and he's in the gallery today. Would the House please welcome all these guests.

I. Chong: In keeping with the welcomes of the people who are here to celebrate Asian Heritage Month, there are a number of representatives from a number of the associations in Vancouver here in Victoria. While I can't name them all, I would like to list off the various organizations that they represent. We have the Vancouver Chinatown Business Improvement Association

Society, Lees Association of Vancouver, Canadian Chinese Business Development Association, Vancouver Chinatown Merchants Association, Chinese Benevolent Association of Vancouver, Chinese Benevolent Association of Canada, Chinese Consolidated Benevolent Association of Victoria, Chin Wing Chun Tong Society, Richmond Asia Pacific Business Association, Sunbrite Business Association, Tsung Tsin Association of Vancouver, Association of Chinese Canadian Professionals, Teo Chew Society of Vancouver, Chius Benevolent Association, Soo Yuen Society, Lower Mainland Grocers Association and Toi Shan Benevolent Association. I know they're either in the precincts or they could be having a tour of the buildings. I would hope all members here make them welcome.

K. Manhas: I'd like to introduce to the House today two people who are very important in my life. With us in the gallery are my parents, Karm and Devi Manhas. This is the first time since I've been elected that I've had the honour of introducing them to the House. I would like to just say how much I appreciate all the support that they've been to me. I'd like the House to please join me in giving them a very warm welcome.

R. Lee: Today we have many visitors to the House from the Chinese Canadian communities to celebrate the Chinese heritage day. Some are from the Chinese news media. We have Woody Lo, Bill Kong, Samson Wong from Fairchild TV, Michael Liu, Kenneth Fung from Ming Pao Daily News, Jane Zhang, Frank Huang from Global Chinese Press, Richard Qun Li from Dawa Business Press and also Rina Ho from China Journal Canada.

We also have a few performers today for the celebration: Mr. Chai Man Cheng and Mrs. Chuen Ying Cheng, plus two more performers, and also Mr. Yukman Lai. He's a great Chinese calligrapher. Later the members can ask him to write their name in Chinese. You are very welcome to Also, Mrs. Li Ying Wang is going to sing a few Italian songs too. Would the House please make them welcome.

S. Orr: I want to also join the minister in welcoming some Bike To Work Week members in the House, particularly one who is actually a good friend, Rob Wickson, who used to be a past president of the chamber of commerce. We have a habit in the Bike To Work Week where the minister, who took off on her fabulous bike…. But we also do it by car. We like to see who gets there first. And guess who got there first. The car.

R. Stewart: It's my pleasure to introduce Derek Morton and Susan House from the Catholic Health Association of B.C. These folks came and spoke with a number of members today about the vital role of denominational health in British Columbia's health care system. Would the House please make them welcome.

Eight or nine years ago I was president of the Canadian Home Builders Association of B.C. Things have improved a lot since then for the association — well, for the home building industry, if not for me. I'm pleased to introduce M.J. Whitemarsh, Pat Caporale and Peter Schultz of the Canadian Home Builders Association of B.C., who are here to discuss with us continuing to work with our government on trades training.

D. Hayer: It gives me great pleasure to introduce 100 grade 4 students visiting the parliament buildings from Coyote Creek School in my constituency of Surrey-Tynehead. Joining them are their teachers Mr. Kai Chan, Mrs. Jill Marsden, Miss Marianne Smith and Mr. Marcus Berndt, as well as 31 parent volunteers who have taken time out of their busy schedule to accompany these students. Would the House please make them very welcome.

J. MacPhail: I am delighted, and I know many of my colleagues who were elected at the same time as I was in 1999 will welcome Frank Garden, who is a former MLA with those of us who were here from 1991 to 1996. He is here today. He is accompanied by his son who I know as Kenny but wants to be introduced as Ken. So would the House please make them welcome.

J. Weisbeck: On behalf of my colleague from Kelowna-Mission. There are a number of students from the Kelowna Christian School in the precinct somewhere — 35 students along with Mr. B. MacArthur, their teacher. Would the House please make them welcome.

Hon. G. Collins presented a message from His Honour the Administrator: a bill intituled Community Services Labour Relations Act.

Hon. G. Collins: I move that the bill be introduced and read a first time now.

Hon. G. Collins: It's my pleasure to introduce Bill 61, the Community Services Labour Relations Act. Last October government appointed a public administrator for the Community Social Services Employers Association. Part of his mandate was to recommend ways in which the bargaining structure in the community services sector could be modernized. Over the last six months the administrator has engaged in extensive consultations with employers and unions to ensure that community services labour relations structures are streamlined and reflect service delivery structures. This legislation puts in place the necessary legal structure to fulfil that task.

This act deems the Community Social Services Employers Association to be the sole accredited bargain-

ing agent with the exclusive authority to bargain on behalf of unionized agencies in the sector and to bind them to a collective agreement. The act establishes a total of three bargaining units, one for each of the three broad service areas in the sector. These service areas are community living, aboriginal services and the general category, general services, covering such areas as child and family services, women's services and other services. Cabinet will have the ability to consolidate these bargaining units into a single unit if it is deemed to be a more effective structure.

The legislation creates an association of unions and the requirement that all unions representing employees in the sector belong to that association. The new association of unions will have 30 days from when this act comes into force to agree to the articles of association. If they're unable to agree to the articles within this time frame, this legislation provides that the Labour Relations Board may determine the articles of association within the subsequent 30 days.

The act ensures that collective agreements cannot prevent agencies from using volunteers so long as the use of volunteers does not result in the layoff of an employee. The act also clarifies the status of employees, family home providers, contractors and government for the purposes of collective bargaining and labour relations. This legislation will modernize and streamline social service labour relations, freeing up resources for agencies to concentrate on the work they do best — caring for society's most vulnerable.

I move that the bill be placed on orders of the day for second reading at the next sitting of the House after today.

Bill 61 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Hon. J. Reid presented a message from His Honour the Administrator: a bill intituled Transportation Statutes Amendment Act, 2003.

Hon. J. Reid: I'm pleased to introduce Bill 64, the Transportation Statutes Amendment Act, 2003. This bill addresses a number of transportation-related priorities. Consistent with our new-era commitment to cut the regulatory burden and red tape by one-third within three years and revitalize our economy, this bill amends the Railway Act to remove 162 unnecessary or outdated regulatory requirements and to eliminate red tape.

The Railway Act was largely written and enacted in the early 1900s. Over time many provisions of the act have fallen into disuse, and railways are no longer subject to provisions that either are out of date or constitute an unwarranted degree of regulation in today's highly competitive commercial transportation environment.

The act also repeals the Riverbank Protection Act, which will eliminate an additional 66 obsolete requirements. The repeal of this act will not remove dike protection rights. Those rights are protected under the Dike Maintenance Act and the Drainage, Ditch and Dike Act. The Ministry of Water, Land and Air Protection is now responsible for the management of dike repair.

A third change is to the Highway Act. It's to exempt snowmobile trails from being considered as public highways. This amendment assists the Ministry of Sustainable Resource Management's work with the B.C. Snowmobile Federation to develop a back-country snowmobile tourism industry. This exemption is similar to the one previously provided to the Trans Canada Trail and will allow all previously created snowmobile trails protection against being defined as a public highway in the future.

We are also proposing amendments to the Greater Vancouver Transportation Authority Act to facilitate the addition of the proposed Richmond airport–Vancouver rapid transit project into the GVTA's existing strategic transportation plan.

Finally, the bill proposes changes to the Transportation Investment Act, the Ministry of Transportation and Highways Act and the Weed Control Act to facilitate a Coquihalla Highway long-term services and operations agreement. These amendments will ensure that a new operator has the authority to collect and retain toll revenues and will facilitate the implementation of a frequent traveller pass. They will also ensure that the operator has the necessary authority and responsibility for weed control on the right-of-way.

I move that the bill be placed on the orders of the day for second reading at the next sitting of the House after today.

Bill 64 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Hon. G. Plant presented a message from His Honour the Administrator: a bill intituled Miscellaneous Statutes Amendment Act (No. 2), 2003.

Hon. G. Plant: I move that the bill be introduced and read a first time now.

Hon. G. Plant: I am pleased to introduce Bill 66, which amends the following statutes: Barbers Act, Cemetery and Funeral Services Act, Commercial Trans-

port Act, Correction Act, Cosmetologists Act, Election Act, Estate Administration Act, Expropriation Act, Family Relations Act, Forest Act, Freedom of Information and Protection of Privacy Act, Insurance (Motor Vehicle) Act, Interjurisdictional Support Orders Act, Liquor Control and Licensing Act, Lobbyists Registration Act, Motor Vehicle Act, Museum Act, Offence Act, Patients Property Act, Public Guardian and Trustee Act, Supreme Court Act and Trustee Act. Members will have to hold their suspense until second reading, when I will elaborate on the nature of these amendments.

Mr. Speaker, I move that bill be placed on the orders of the day for second reading at the next sitting of the House after today.

Bill 66 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

R. Hawes: Mr. Speaker, May 12 to 18 is National Nursing Week. This is the week that we all pause to reflect on the critical role that nurses play in delivering a health care system that works for all of us.

Every second of every day throughout our province, British Columbians depend on the care, compassion and advocacy provided by our nurses. Whether it be in hospital emergency rooms, care homes, schools or private residences, these dedicated men and women ease the pain and suffering that patients and their families often face. They play a critical role in preventative care. In an emergency, nurses have always answered the call with extreme bravery, such as with the recent challenge of SARS.

We know there's a growing nursing shortage, and that's why our government has taken action and continues to address this. I'm proud to say that our government has both recognized the value of nurses and responded positively to nursing shortages. We have given a 22 percent pay increase to nurses, making them among the most highly compensated in Canada. Over the past two years we have spent $42 million towards a nursing strategy, $15 million of that on equipment such as patient lifts and hospital beds to reduce the number of nurses' injuries.

This year we've added 547 new seats, totalling 813 nursing seats added in educational institutes in B.C. over the last three years. We've offered student loan forgiveness to nurses locating in areas of critical shortage. We're helping non-practising RNs to recertify, finding roles for injured RNs, providing a nurse grant program and promoting skill upgrades, and — probably the most exciting — we've added 30 seats for nurse practitioners.

With the legislation introduced in the House yesterday, this would allow for the development of regulations for this new program in nursing through the Registered Nurses Association of B.C. In short, this government understands the value of nurses, strongly supports May 12-15 as Nurses' Week and completely endorses its theme "Nursing: at the heart of health care."

H. Bloy: I rise today in the House to invite my colleagues to take part in the rich cultural diversity of British Columbia. On May 31 people throughout the lower mainland of British Columbia will come together to celebrate Korean Heritage Day at the Plaza of Nations. The Korean community is a huge part of my riding. There are hundreds of small businesses that virtually drive the economy of Burquitlam. Koreans, new and old, have built their lives in the thriving community and are proud of their achievements.

On May 31 all Koreans from around B.C. will come together to celebrate their cultural heritage and to share stories of how B.C. has helped shape their lives. The day itself will be exciting and full of events — traditional Korean drum and mask dance, performers — and traditional Korean instrumental music performances will play as the crowds view traditional Korean activities. Of course, there will be great Korean food that I enjoy when I am in the Burquitlam riding. I know there will be great food at this event. There'll be arts and crafts and games to entertain young and old alike.

All along North Road in my riding of Burquitlam, you can see the contributions of the Korean community everywhere you look. They have a cultural heritage that is tied to their origins, but they also have a lasting legacy in their new home of British Columbia.

This year marks the fortieth anniversary of diplomatic relations between Korea and Canada. I am happy to rise today and voice my support for Korean Heritage Day and encourage my colleagues to do the same.

P. Wong: Today is a very special day. My hon. colleagues the members for Burnaby North and for Oak Bay–Gordon Head and I have been in contact with the leaders of the B.C. Chinese community to organize a celebration of Asian heritage. B.C. is home to a significant population of Asian immigrants. There are over 350,000 Chinese Canadians living in B.C. and more than one million throughout Canada.

Those of us that live in the lower mainland and Victoria benefit from Asian cultural influence on a daily basis, where there is shopping, recreation, art, literature and all the other aspects of our lives. In the workplace Chinese immigrants contribute immensely to the B.C. economy. They are hard-working and dedicated and lend their considerable talents and expertise to every field of human endeavour. The unique thing about this influence is that it has spanned nearly 5,000 years.

The Chinese are renowned throughout the world and throughout history as innovators, thinkers and

artists. Chinese language, arts, poetry and traditions have survived and flourished for millennia. It's for this reason that we organized a Chinese heritage day. Through you, Mr. Speaker, my hon. colleagues and I would like to invite all MLAs and Legislature staff to join us in today's celebration and to enjoy the displays of music, calligraphy, dancing and arts as well as the sampling of traditional Chinese food and delicacies.

We are honoured to be joined today by many special guests from the Chinese community, including the consul general of the People's Republic of China and several entertainers and artisans. It's well known that the government of British Columbia is committed to expanding our economic and cultural ties to Asia. This is wise for many reasons, not the least of which is B.C.'s close geographic proximity to Asia, the untapped Chinese market for B.C. exporters and the strong cultural ties between our two nations.

I would encourage all of our colleagues and staff to attend today's celebration and to learn more about the Chinese culture.

J. MacPhail: In 1997 the Premier used a report of the child advocate to attack the government for not spending enough on child protection. Today, of course, the Premier doesn't have to care what the child advocate thinks, because he has eliminated her job.

Just how many children will suffer as a result of that cut alone will never be known. We do know that as a result of this government's budget cuts, supported by every Liberal MLA in this House — the member for Saanich South, the member for Hillside, the member for Prince George — by next year there will be $200 million less for children and families than in 1997, the year the Premier made those remarks.

Will the Premier admit that as a result of his cuts, he is putting child protection at serious risk? Will he live up to his promise and restore the funding he has cut, with the support of every single Liberal MLA, that used to protect children at risk?

Hon. G. Campbell: I appreciate the question. First, I want the member opposite to know that this government's first and foremost responsibility and our obligation, which we intend to meet, is to protect children in British Columbia.

Hon. G. Campbell: The previous government, as you'll know, actually had six separate Ministers of Children and Family Development over a five-year period. We wanted to bring in both stability and programs that would meets the needs of children and that would keep children in their families as long as possible. Professionally, as you know, that is the best thing for children. We want to make sure that what we are doing works in the best interests of children, that children are protected, that we work with professionals and that we deliver those services in the most cost-effective way possible. We will continue to do that.

J. MacPhail: Isn't it funny the difference six years makes in terms of what this Premier now thinks is important? When the Premier was the Leader of the Opposition, he agreed with the child advocate and said that the government should spend more money. He has cut $200 million from the funding that was in place in 1997.

Let me quote the Premier then. He said: "Big changes cost money if we're going to protect kids." Yesterday Craig Meredith, the executive director of the Federation of Child and Family Services, echoed that sentiment, saying there was no way the government could make the cuts they're contemplating while going through a massive reorganization. In 1997 big changes cost money. Now there is $200 million less than existed in that very year.

Will the Premier acknowledge today that big changes do cost money — as he once told this House over and over — and restore the cuts he's made to the Ministry of Children and Family Development's budget for child protection?

Hon. G. Campbell: There is no question that we had to make changes in the way the last government dealt with children. We wanted to keep children in their families. We wanted to give social workers the power they needed to provide the professional advice and assistance to families that was required. We want to be sure that children are protected. We want to work with regional agencies in delivering those services in the most cost-effective way possible. We wanted to, in fact, remove the bureaucratic and administrative burden that got in the way of protecting children.

That's what we intend to do. I want the member opposite to know this — that this government's first and most critical concerns are the protection and safety of children in the province and the strengthening of families in British Columbia. That's our goal, that's our objective, and we're going to do everything we need to meet it.

J. MacPhail: I would actually say that it's probably a priority far behind the tax cuts this Premier gave on

day one to his rich friends. That was the first priority of this Premier, and look how that's failed.

Here's a whole litany of quotes from this Premier when he was in opposition. Let me remind the Premier, again, what he told this House as Leader of the Opposition. He said this. He said that he would reach out to all members of the House, to all members of the child care community, to all citizens of British Columbia who want to help in solving this problem. Now that he's Premier…. [Applause.]

As always, the Liberals are completely wrong in praising this Premier. Now that he's Premier, the government is conducting a review of the child protection budget behind closed doors, away from public scrutiny and without the input of any front-line workers and the families they support.

British Columbians want to know that it wasn't just politically convenient for him to make the promises that he did. Will he commit today to a review process that will involve the public and the front-line child protection workers in a public and transparent way, like he promised when he was in opposition? Will he also commit that his government will provide the funding those experts say is necessary, just like he promised when he was in opposition?

Hon. G. Campbell: First, I think anyone who really cared about children would understand that a revolving-door ministry policy, which the previous government had, of six ministers in five years certainly didn't put children at the top of anybody's list.

Secondly, let me say this. We said that we thought that all British Columbians deserve to be included in the discussion about how we could take care of our children. This government has talked, discussed and consulted with 14,000 British Columbians across this province — 14,000 people who put children at the top of their agenda, who want to deliver services in the most cost-effective way possible, who want to remove the bureaucratic and administrative burden so that children can be cared for first. That is what this government is committed to, and if the member opposite has suggestions for improvements, we would be glad to hear them.

Not only is the child protection in danger of collapsing, according to those on the front lines, but so far those services in the community-living sector for people with developmental disabilities are having problems as well.

A few weeks ago the Minister of Children and Family Development told this House that all was well, that he had worked successfully with the Interim Authority on Community Living to reduce budgets while protecting these services. But an e-mail obtained by the opposition and sent late last week from the Interim Authority for Community Living tells a different story. These are the government's own hand-picked appointees, and they reported that they have no confidence that next year's budget targets can be met without risk to the safety and security of individuals.

Again, to the Premier: if he won't listen to the opposition, if he won't listen to the front-line workers, will he listen to the warnings of his own hand-picked appointees that the safety and security of people with developmental disabilities are at risk if the government proceeds with the cuts?

Hon. G. Campbell: I know this is difficult for the members opposite. The reason you put a plan in place, the reason you put people together to try and implement the plan…

Hon. G. Campbell: …is to learn from the people. The reason that this government is undergoing a review is to be sure that what we are doing is putting the interests of children and people in need first.

Mr. Speaker: Member for Vancouver–Mount Pleasant has a supplementary question.

J. Kwan: This assessment of the budget crisis comes directly from the people responsible for implementing the new regime. They say that the safety and security of individuals and families are at risk. This e-mail goes on to say: "The interim authority is not being consulted on the budget review that culminates Friday, when Treasury Board meets to make decisions about the ministry's budget."

Over and over again, the Premier said he would consult. He just said in this House today that he would spend what it took to take care of and protect kids and people with developmental disabilities. This Friday the fate of child protection and community living hangs in the balance. Again to the Premier: will the Premier keep his promise and ensure that his own hand-picked appointees, the interim authority, will be consulted and be at the table on May 16 for the Treasury Board meeting and that he will ensure that the cuts to child protection and community living are restored so that vulnerable kids and their families get the protection they need?

Hon. G. Campbell: …a plan was laid out — a three-year plan — which includes community living, which includes protection of children across this prov-

ince. The government will be pursuing that plan. The government is aware of a number of issues that people have brought forward.

Hon. G. Campbell: The government will continue to make sure that as we move forward and make decisions, the best interests of the community living sector as well as children in need that need to be in care are taken into consideration.

T. Bhullar: My question is to the Minister of Community, Aboriginal and Women's Services. It's regarding those awful leaky condos. Can the minister please tell the House the status of the leaky condos that the government has undertaken and if the minister has reached any conclusions?

Hon. G. Abbott: The issue of leaky condos certainly remains a major and difficult issue. We estimate at this point that some 65,000 homes and families are affected in some measure by leaky-condo syndrome. The cost of that is certainly at least $1.5 billion and possibly up to $1.6 billion, so it's a huge issue for a lot of families.

To date, through the homeowner protection office, the province has invested $293 million in no-interest loans. We have also put out $7.7 million in interest rebates, PST rebates, to families that have been affected by that. As well, HPO has invested a lot of resources in research and education to ensure that we can remediate those homes properly and ensure that the problem doesn't continue in the future.

We are continuing to work, as well, with the federal government to try to strengthen their partnership. I'm working in particular with the new secretary of state for housing, Steve Mahoney, to see if we can get a GST equivalent to the PST rebate, to get more action on leaky co-ops and to move ahead and try to resolve this situation, which unfortunately affects many British Columbians.

J. Nuraney: My question is to the Solicitor General. The proposed integration plan for RCMP in the lower mainland is anticipated to create more efficient and effective law enforcement in Burnaby. However, there are some concerns about the potential cost to the taxpayers and the possibility that some members of the force may be required to work outside the municipality.

Will the Solicitor General tell this House the steps he is taking to consult with the municipalities to alleviate these fears?

Hon. R. Coleman: First of all, there are a couple of issues with regard to this, which are out in the public today. One of them is a management structure which is being worked on with the Mayors' Consultative Forum on the lower mainland of British Columbia. That management structure actually got in the way of the real discussion that is important to communities, and that is the integration of specialized services in policing across borders.

The reality is that if we integrated policing on the lower mainland in the RCMP areas and in our municipal forces, the public would see no difference in policing. They would still see their officer on their street. They'd still see their community policing officer, still see their school liaison. What they wouldn't see is that finally we broke down the borders so sex offenders can't move from one community to another and not be followed by police because somebody sets up an artificial border in crime. We would actually track homicides in a manner that we would not have homicides fall through the cracks for investigation, because we'd actually be integrated in policing.

Those are the goals that are the priorities for public safety which will be put together. Anyone that doesn't understand where integration should go should take the opportunity to review the Oppal report so we can move forward in integration in policing.

Hon. S. Hagen: I have the honour to present the annual report of the Property Assessment Appeal Board for the year ended December 31, 2002.

Hon. G. Collins: Pursuant to standing order 81.1, I rise today to inform the House of the government's intentions for the conclusion of the spring sitting of the Legislature.

Mr. Speaker, it's no surprise that the government intends to complete the supply debate as well as the final Supply Act. There are currently ten bills before the House now, which the government intends to pass by the end of May. Those are Bills 29, 39, 40, 45, 50, 51, 58, 61, 64 and 66. There are or will be introduced this spring a total of approximately 20 to 25 pieces of legislation which the government intends to leave on the order paper and pass in the fall sitting of the Legislature.

I look forward to working with the opposition to determine an orderly conclusion of those ten pieces of legislation by the end of May 29, Thursday.

J. MacPhail: Well, Mr. Speaker, I can't let it pass without commenting on what the Government House Leader just did.

J. MacPhail: I'm not debating it; I'm commenting, just the same way the Government House Leader did.

After today there are 21 hours of debate left. Fully 40 percent of the budget still has to be debated. The Health estimates — that's what. There were 20 to 25 pieces of legislation introduced. Through incompetence by the Government House Leader….

Mr. Speaker: Order, please. Order. Hon. member, it's not debatable. This is not debatable — sorry.

Hon. G. Collins: In this chamber I call Committee of Supply. For the information of members, we'll be debating the estimates of the Ministry of Health Services. I'd also like to advise the House that at 6:30 p.m. we'll be calling Committee of Supply in Committee A as well.

The Chair: Before we begin, earlier on during introductions I introduced some visitors from the Kelowna Christian School on behalf of my colleague the member for Kelowna-Mission, and they hadn't arrived in the chamber yet. They have arrived now, so I'd like to welcome the 75 guests from the Kelowna Christian School, along with their teacher, Mr. B. MacArthur. Would the House please make them welcome.

J. MacPhail: I must say, just to begin, I have had the wind taken out of my sails completely because of the absolutely horrendous task my opposition colleague and I have ahead of us, how much work has to be done in this chamber and how this government has completely shut down any ability to have a legitimate debate. I put this not because of the Minister of Health Services. He happens to be the person….

The Chair: Member, excuse me, but I think the Speaker had ruled earlier that this was a non-debatable item. I'd like you to proceed along with vote 29.

J. MacPhail: Yes, thank you, Mr. Chair, and I will. I'm trying to explain how the debate will go with the Minister of Health Services. I have all of this work to do. It is quite overwhelming, is what I want to say, because of the way this House is being run.

Did the minister have a chance to get the information on the affidavits for Pharmacare for me?

Hon. C. Hansen: Yes, we do have that. As of May 11, there have been 1,011,813 families registered. As the member will know, one consent form is required per family of those one million families. Of the ones we sent out for pre-registration, these were individuals who had been on premium assistance previously, so we automatically enrolled them in the program because we already had that information.

We then had to send out the consent forms for their verification. Of those 442,000 families, we have received consent forms back for 294,000. There was undeliverable mail for 49,000, so we are still waiting for the return of 99,000 for those individuals.

Those are not necessarily all that would be in a position to benefit from the Fair Pharmacare financial assistance. It may be that those overwhelmingly who need that assistance are, in fact, in there with their consent forms already returned.

Of the other non–premium assistance registrations, we have 569,721 families registered. There were mail-in registrations which come in with the consent forms attached to them numbering 106,000. In addition to that, we've already received back consent forms from 182,000, so we're awaiting return of about 277,000 consent forms from those families.

What I want to underscore is that when a family registers, whether they register through the website, whether they register by the phone systems or whether they're the ones who were previously on premium assistance who we automatically registered, those families automatically get benefits. We don't wait for the consent forms to come back in before they get their eligibility.

We are certainly pleased with the response we have to date, particularly when you take into consideration that many of the families for whom we are waiting for consent forms in fact signed up in the last stages of April.

Actually, I've just had this highlighted for me…. I'm going to have to figure out exactly what that meant, but I think the information that I gave to date summarizes what the member's question was from the other day.

P. Wong: I'm pleased to introduce guests in the gallery. Joining us today is Mr. Johnny Fong, philanthropist and also organizer of the Better Community Partnership Outreach Network. Together there's Dr. Joseph Hui, Mr. Albert Fok, Ian Cheung, Chris Chung, Albert Tsang and Zi Fu Zhang. Would the House please give them a most warm welcome.

J. Kwan: The numbers that the minister gave indicate that there is chaos and confusion with the Pharmacare system. There are hundreds of thousands of people who are not yet registered. They have actually not been registered onto the Pharmacare program. Yet the minister says: "Don't worry; everything will be fine."

Just to note the issues that people take, let me read onto the record a letter — not from a constituent of my colleague from Vancouver-Hastings or myself — in terms of how they feel about the Pharmacare program. I would like the minister to respond to this document. It reads:

For the protection of the individual, I'm not going to say who the individual is. I would like the minister to respond, because the minister continuously says how the Pharmacare program benefits people, when in reality it doesn't. Here's an example of one individual and his family, where he's saying that he's actually getting hurt by this government's new policies.

Hon. C. Hansen: To speak to the specific example that the member has raised — a family that has an annual income of $43,000 a year — under the old Pharmacare plan they would have faced an annual maximum ceiling for their drug expenditures of $2,000. Under the new Fair Pharmacare program that maximum ceiling actually comes down by $250 to $1,750.

J. Kwan: I'm going to yield the floor to the member for Port Coquitlam–Burke Mountain. He wishes to have the floor for about ten minutes. I'll follow up with my questions with the minister in a few moments.

K. Manhas: I appreciate the member yielding the floor. I just have a series of questions to ask. I'm not sure if this is the appropriate time, but….

K. Manhas: No? I yield the floor back, and I will ask the questions at the appropriate time. Thanks.

The Chair: Member, proceed, if you have some questions. Member for Port Coquitlam–Burke Mountain, proceed, please.

K. Manhas: Thanks, Mr. Chair. I've been speaking with the Fraser health authority regarding their plans

to more fully utilize the Eagle Ridge Hospital. Eagle Ridge is a state-of-the-art facility that provides service to the 200,000 people in our burgeoning Tri-Cities area and beyond. For years since it opened, it's remained underused, and large areas of the hospital have never been opened. I understand the FHA will be looking to provide more services at Eagle Ridge and more fully utilize the potential of the hospital in the years ahead. As the area grows, the need for these services continues to grow.

Utilizing the Eagle Ridge Hospital fully just makes sense. Residents in the Tri-Cities who've worked so hard to build and support the hospital will receive the care they need close to home. Patients will be the winners, and B.C. taxpayers win from their investment in this wonderful modern facility. I'd like to ask the minister if he will urge the health authority to follow through on that plan to fully utilize the Eagle Ridge Hospital facility.

Hon. C. Hansen: For those who are trying to follow the debate, we're going to try to work through with the Pharmacare discussion, and then we may get on to some of these other issues. Just to give the member a quick response to that particular issue, we are looking throughout the whole province at how we best utilize the hospitals we have.

In the past we had a system where every hospital was trying to be an island unto itself, and we were lacking the interconnectivity among our hospitals so that we could best make sure that patient needs were met. Certainly, Eagle Ridge is a hospital that has tremendous capacity, and when we look at the communities that are serviced in the immediate area of Eagle Ridge Hospital, we see some tremendous population growth.

Certainly, the Fraser health authority is looking at how it can best organize the delivery of services so that residents in those communities get access to timely care and effective care and that we also make the best use of those available facilities. That is part of the plan that is being rolled out.

K. Manhas: I will ask the rest of my questions when the minister has finished with debate on Pharmacare.

J. Kwan: I'm sorry. Maybe the minister can give his response again to the letter I read onto the record, and then we can start from there. There was just a bit of confusion prior to that.

Hon. C. Hansen: I guess the member, before she read that letter, was making the point about the thousands of B.C. families that are not yet registered under the Fair Pharmacare program. I know we did have a chance to review that with her colleague the other day. Basically, there are about 1.6 million families in British Columbia, and we know that the majority of families will not have either income levels low enough or prescription costs high enough to put them in a category that would make them eligible for financial assistance under Fair Pharmacare.

We expect there are going to be many families who will make a decision not to register for Fair Pharmacare until such time as they need those benefits. We have set up a system where they can register very quickly if they should wind up with unforeseen or unexpected costs that would put them into that range.

But to answer the member's specific question — the example she raised with the family that had an income of $43,000 — under the old Pharmacare system they would be facing an annual ceiling of $2,000 before Pharmacare would have clicked in with 100 percent benefits. Under the new Fair Pharmacare program they would in fact hit a ceiling at $1,750 a year. Then after that point, they would not have to pay anything under Fair Pharmacare. So in fact, the annual maximum they would have to pay for their benefits decreases under Fair Pharmacare by about $250 a year.

J. MacPhail: Is the minister having a chance to clarify…? Perhaps the minister could tell me how the correspondence is going with individual citizens writing in about Pharmacare. I know the opposition has received…. Well, it was hundreds of letters a few weeks ago. It's probably well over the thousand mark now. I'm wondering whether the minister could update us on how his correspondence branch is going to clarify all of this so that if indeed, as he claims, this fellow has this information wrong, he's getting it straightened out. How quickly are those letters being answered?

Hon. C. Hansen: The member may have had the same experience when she was Minister of Health, but the correspondence that comes into my office always staggers me when I see the numbers. I'm told it's in the range of about 16,000 letters a year that come in specifically addressed to me, and I know that the four Health ministers combined actually get more correspondence than the Premier does. I'm not sure what that means, but keeping up with that is indeed a challenge.

What we found with the Fair Pharmacare program is that we were getting some letters from people that were concerned, and we're trying to get answers and information back to them as quickly as we can. What we have found is that most people are actually phoning in for information. I fully appreciate that there was a period of time in late April when it was extremely challenging to get through on the phone lines. We are now over that hump, and people, generally speaking, can get a timely response to their telephone inquiries.

In addition to that, one of the things we're doing in the ministry — because it is much more time-sensitive — is when we receive a letter on a particular subject like Fair Pharmacare, for example, someone in the ministry will actually phone that person back and provide them verbally with the information they need and give them an opportunity to ask subsequent questions. We are trying to get back to them on a timely basis.

I know there are some letters that come in that are very complex and do require a fair amount of work in order to get a substantial response back to them. I know there are times when I'm signing replies to letters that are sometimes over two months old, but we're trying to make them the exceptions.

J. Kwan: For the person who sent the opposition the letter with his concern around the Pharmacare costs, if he and his family in fact got it wrong, I'd like the minister to please provide a name and contact so that we could provide the individual with the contact information so that he can get his information straightened out and make sure he's not paying more than he should be.

Hon. C. Hansen: Certainly, if the member would want to forward that letter to me, I would be pleased to have a very specific response to that individual's particular family circumstance. Just to repeat what I said before: with a family income of $43,000 a year for a non-senior family, under the old plan they would have been paying a maximum of $2,000 a year for their drug costs. Under Fair Pharmacare that comes down by $250. If they wanted to check that out, they could go into the calculator that is on our website, and they could actually punch in their own family numbers to get that information.

J. Kwan: I appreciate that information, but I would also like to have a contact name and number for the individual. Should I advise the individual that he should be contacting the deputy so that he can get his situation straightened out?

Hon. C. Hansen: If he dials the 1-800 number, that'll save him the long distance costs — 1-800-387-4977 — and he can certainly get that information verified.

J. Kwan: I was actually hoping for more of a direct and personal approach to the individual. These are people who are actually having difficulties with the system, as the minister knows. The 1-800 number is just a general number for people to sign on. I would much prefer — and I would assume that the individual who's written to us with his concerns and problems and challenges would want — someone who can respond to him directly and not sort of be routed through a 1-800 number.

Hon. C. Hansen: If the member would like to provide me with his telephone number, I would actually undertake to call him personally myself.

J. Kwan: I will certainly check with the individual to make sure he's okay on the confidentiality issue, which is why I'm asking for the number so that the individual can touch base with the minister as opposed to providing the information. But I am assuming, given that the minister is prepared to phone the individual, that the person can actually phone the minister, then, in that case so that the logic flows either way. I will follow up on that accordingly.

Hon. C. Hansen: The member was a former member of executive council, and I'm sure she appreciates how complex life is when people try to phone in to reach the minister. I don't know how to facilitate this, but if she wants to get the individual's permission to pass that information to me, I would make a commitment to the member that I will call that person.

J. MacPhail: Here's a further twist on the minister suggesting that once you've got premium assistance, everything is okay. People are finding it hard to get their premium assistance applications approved. Let me read this letter into the record. It was from a few weeks ago. We received it at the end of last month. It's to the ministry. This is about Pharmacare.

Just as an aside, that's what the minister's saying, and everything just flows smoothly from that. Well, I carry on with this letter:

Hon. C. Hansen: Thank you, and I know we had visited this briefly the other day when we started the estimates process, but the use of line 236 is actually something that was started around the premium assis-

tance application system. That calculation of net income is not something we as a province do, but it is, in fact, something that's determined by the federal government on their tax forms. So it does include some other outside revenue sources, but it also includes some expenses. I know one of the expenses that is included, before you get to line 236, is authorized child care expenses that could be deducted.

I want to come back to the point the member made at the start of that question, and that was around whether or not an individual who had applied for premium assistance but that had not yet been processed…. They would not have wound up as an automatic registrant in the Fair Pharmacare program, but the fact that individual phoned into Fair Pharmacare means they could actually register right then. So the fact that somebody was eligible for premium assistance doesn't preclude them from the ability to do an on-line registration or a phone registration. In fact, many premium assistance recipients have done that — just phone and confirm that they are registered. There's certainly no disadvantage to the individual — the fact that he duplicated what would not have been necessary if his premium assistance application had already been processed.

J. MacPhail: What is the backlog with MSP applications for premium assistance?

Hon. C. Hansen: Certainly, the processing of documents and correspondence generally, and things like registration of births, have been a big challenge for us in the MSP.

Just a snapshot in time: as of March 3 there were 13,000 premium assistance applications that would have been pending. I should note that in that branch, we give top priority to processing premium assistance applications, and we also give top priority to things like birth registrations and that. There are other things that do take a much longer period of time. I know the example that the member cited where it was taking months — that does happen. Sometimes there is additional information that is required before an application can be processed.

One of the things we are doing is to try to deal with this backlog in a more effective way. One of the things that we did, for example, was implement a call centre. We went out for a request for proposal and got a firm that was going to field calls, provide information on the MSP side of it and also help speed up the processing of documentation. I'm the first one to admit that that is a part of the ministry that continues to be a big challenge for us, and we are certainly taking the steps to try to make sure that the processing of that information is done in a more timely fashion in the future.

J. MacPhail: It is with a sense of frustration that I rise again to make my point about why the ministry didn't first of all take on the pharmaceutical companies or try to reduce drug costs before they took on British Columbians in this "Fair" Pharmacare program that is in…. I mean, I know the minister does a yeoperson's job of trying to sell that everything is fine, but it isn't.

We have chaos in the Fair Pharmacare system, and the drug companies are sitting out there not being addressed at all in terms of lowering their drug costs. The government hasn't done a thing with the Morfitt report. The government doesn't even know whether it has asked the drug companies to invest in British Columbia in research. Yet we're proceeding holus-bolus on this Fair Pharmacare program.

From the numbers I've heard, there are hundreds of thousands — almost 100,000 people under the premium assistance program and several hundred thousand people on the non–premium assistance program — who haven't put in their affidavits yet. Over 300,000 — in fact, well over 300,000 as I calculated the number — families do not have affidavits in yet, so there's going to be a whole backlog and retroactivity that's going to have to be absorbed in terms of calculating payments under Pharmacare. We have a backlog in even the applications for premium assistance, as the minister has just admitted. That's a backlog. That's not even someone who is applying for premium assistance as we look forward.

It is not working, and for the life of me, I cannot figure out and have not received an adequate answer from this government about why they chose to go after citizens before they chose to go after the drug companies.

Let me read this letter that was sent several weeks ago and received last month from a constituent of the member from Dewdney-Alouette riding. It's a three-page letter, and I'm not going to read it into the record. However, the minister was copied on it. I am not going to editorialize, but I will edit to make the point.

It goes on for several more pages. I just want to reassure the minister. I want to ask the question about the 1939 versus 1940 as a result of this letter, but the minister can be reassured that this couple got the accurate calculations of what they now owe under the program.

Hon. C. Hansen: I appreciate the example to give me an opportunity to respond to that. When the member started that particular question, she was talking about why we're doing nothing to reduce drug costs. I should point out to the member, as she knows, that drug costs for brand-name drugs in Canada are actually not set by the provincial government. They are set by the Patented Medicine Prices Review Board, which is a federal body that actually establishes the prices. As a result of that, we in Canada do have the benefit of prices that are significantly lower than what our neighbours to the south pay as a result of that pricing regime.

I wrote this down. She says: "Why do we go after citizens instead of the drug companies?" We're not going after citizens. What we're doing is actually providing a system which will see 282,000 families in British Columbia pay less than they were paying under their previous plan.

But I want to come to the specific example she raised, because when she talks about how that senior couple was paying $275 deductible before, that's $275 each. So about $550 is what they would have been paying as their ceiling for the two of them before. Rather than having an individual deductible, we're now going to a family deductible so that regardless of who has the higher drug consumption, it can go towards achieving that deductible.

She also mentioned — she quoted in the letter — that this family was facing a new deductible of $1,500. Well, that would put them in an income category of between $72,500 a year and $77,500 a year. That's the income category for seniors that would result in them being faced with a deductible of $1,500 a year. I should point out to the member that the average income, the median income, for a senior in British Columbia is about $23,000 a year.

Some people have asked us: why did we pick $33,000 as the threshold at which the amount that a senior household would pay goes to a different category? The reason is that at $33,000 a year, you're actually capturing 69 percent of British Columbia senior families that earn $33,000 or less. In fact, the numbers for non-senior families just came out yesterday with the StatsCan numbers. It shows, I think, that in British Columbia we're now up to about $54,000 a year for the average income for a family.

Under this new Fair Pharmacare system, most senior couples, families, earning $33,000 a year or less will see more financial assistance. The maximum they will pay per year will, in fact, come down. The same can be said for non-senior families earning up to about $50,000 a year. They will also see greater financial assistance under Fair Pharmacare because the maximum they pay will come down.

J. MacPhail: Well, I guess the member from Dewdney-Alouette can decide whether that satisfies his constituent's complaint.

J. MacPhail: I'm sorry? Well, I'm reading from a letter from the constituent. I'm not allowed to say the member's name. He sits right there. It's his constituent that I'm reading the letter from, and we'll see whether that satisfies them or not.

I would just perhaps advise the minister of this. While he throws figures out about how fair this is, I haven't had one person — not one person — say to me: "Isn't this better?" Not one.

J. MacPhail: Thank you. I'm sorry; the riding is Maple Ridge–Pitt Meadows. Thank you very much. I appreciate that.

I read the letter into the record from the woman from the seniors organization, in the Kelowna Daily Courier, saying that some of her fellow seniors are prone to complaining — but other than that, no. So I guess this minister or this government or these MLAs sitting here, as I read their constituents' letters into the record, can decide whether the minister's answers satisfy that or not.

I will tell you these are people who know they're worse off. I suspect, although it doesn't say here, that

these may be public employees. The letter I just read may be public employees who paid a great deal in terms of the work conditions to get pension benefits, who gave up a great deal in other areas to get their pension benefits and are now having them eroded away over and over by this government. That's what it sounds like to me.

This minister stands up and says, I guess: "If there are two retirees who have a pension, they're considered rich." That's what he's doing. The very rich in this province, because of this government, needed to get richer — according to the government. Those at the high end needed to get a huge tax break, and they worked real hard to make that happen the first day they were in office. But the public service pensioners need to be brought down to the average, I guess, across Canada. So that shows where this government's priorities are.

This will be my last one on Pharmacare, because it's not a particularly satisfying exercise. Those who have had their letters read into the record have communicated with me that the work that was done a couple of days ago was not satisfactory at all. Of course, given the limited time we have here, I have to pace myself. There are so many issues.

Hon. C. Hansen: I was busily trying to scribble down those numbers as she was reading them off, and I suddenly realized I was coming to well over 100 percent. I did get a bit lost in terms of the calculations there.

Just to respond in a general sense, for individuals that have third-party insurance programs that doesn't change, they still get the benefit of those third-party insurance programs. Clearly, we know that's going to be a challenge for some of those third-party insurers, because for some of their members they will, in fact, see Fair Pharmacare picking up a greater share.

For example, any family that's earning under $50,000 a year, as I mentioned earlier. For an employee that has a third-party insurance plan and that's earning over $50,000 a year, there may be more that the third-party insurer is going to have to pay. I guess those families that do have extended health have that benefit of having their third-party insurer pick up at least a major portion of their drug costs until Fair Pharmacare clicks in.

I think we've got to back up a little bit and just look at what Pharmacare is all about, whether it's the old Pharmacare program or the new Fair Pharmacare program. What it's about is not saying that the provincial government is going to pay for all their prescription costs. No province could afford to do that in this country. What we want to be able to do is recognize, first of all, that prescriptions are a necessary part of a good health care system and make it so that families can get access to the medications they need based on their ability to pay.

For lower-income families we want to provide more financial assistance. For higher-income families that have more ability to pay, we expect that they will pick up a greater percentage of their costs. If those higher-income families have the additional benefit of having a third-party insurer, then that's all the more benefit for them. The Fair Pharmacare program, as far as I'm concerned, is exactly that, and it's fair.

I also wanted to comment on the member's point about the letters she gets and the conversations she's had — that she's had nobody talk about Fair Pharmacare being fair. That actually reminds me of my days in opposition. You tend to get letters from people who look at the world as where the glass is half empty. I think in this case, if they really want to look at Fair Pharmacare, they're going to find that that glass is 98 percent full and maybe 2 percent empty. Hopefully, we can still keep trying to address the 2 percent to make sure that it is indeed fair for everybody.

J. MacPhail: Well, isn't it interesting that the minister says that some things may not change because people have third-party insurance? He's wrong on that again as well.

Let's be clear. It's not like people are going to be paying less for their drugs. The Fair Pharmacare isn't reducing the cost of drugs. They're just shifting who pays for it. This government hasn't done anything to tackle the cost of drugs, but they've gotten out of the business of covering it, out of their share of it, so private insurers have to pick up a cost.

Believe you me, private insurers are going to be back at the table negotiating whatever contracts they have with employers to say: "Sorry. Either your premiums are going to go up for that coverage, or else you're going to have less coverage." That's exactly what they're doing. Every third-party insurer, private insurer, is doing that right now.

I'm well aware of British Columbians having access to their MLAs to raise their concerns about government policy. I'm well aware that because there are two of us and 75 of the government, perhaps my colleague from Vancouver–Mount Pleasant and I get more than we would normally get as individual MLAs. But it isn't

We will get to the stage of talking about the overall well-being of seniors in this province as it relates to their Pharmacare costs, their access to nursing homes, home care, etc., — all sorts of things. In the opposition we don't have time to indulge in terms of raising issues that are negative just for the sake of being negative.

I have to move on now to the issue of privatization in our health system. It is my view that it looks like health privatization is going to result in the layoffs of thousands of skilled and experienced health care workers over the next few months. This is even in the context of the recent renegotiations.

The government has argued that the health authorities need more flexibility, that workers are overpaid compared to the national average and that government is "not in the laundry business." On the basis of that, these Liberals have torn up collective agreements, and then that allowed for paving the way for mass layoffs and privatization. But I have yet to see this government make a case for health care privatization. Any aspects of the health services have yet to see a case made for privatization, and that's what I want to explore now. I haven't seen the government produce any evidence that such a policy would be cost-effective and would improve patient care. In fact, I would say they haven't proved that it would be cost-effective or improve patient care. One or the other would be a start, but neither has been proven by this government.

Actually, I would say that the early adventures into privatization have been stunningly deficient. The provincial health services authority cancelled a housekeeping contract for the new building at the Children's and Women's Hospital with A&A Laundry Ltd. just weeks after it was awarded. K-Bro Linen Systems was awarded a ten-year contract for hospital laundry in the Fraser Valley. They haven't particularly been compliant with a good-quality product — washing soiled birthing linens in domestic-grade machines in a seniors care facility, for instance.

There are major requests for proposals pending — I think they're still pending; the minister can correct me — for security, housekeeping and food services in the lower mainland and in the Fraser Valley. I assume they're still pending because we haven't heard anything, but we anticipate that those contracts will be awarded over the next few days and weeks.

Let me begin exploring this topic by asking whether the ministry has carried out or contracted for any research, economic impact studies or best practices surveys. Have they generated any other reports or analyses that support privatization of health services as leading to either greater cost-effectiveness or improved patient care?

Hon. C. Hansen: I think the first thing I want to point out is really very important, and that's that this government is not privatizing the delivery of health care services in this province. We have certainly had requests from some of the health authorities that they be allowed to look at some of the clinical services that could be shifted over to the private sector — surgical services, for example. We've said we don't have a problem with that, providing it's publicly funded, it's within the context of the Canada Health Act and it is more cost-effective than could be provided in our publicly owned facilities.

So far there have really been no initiatives that have been undertaken in that regard, because I think when you start getting down to it, the economics of it aren't there for most services. There may be some examples that will come forward in the future, but certainly to date there has not been any privatization of the delivery of health care services. If there is some in the future, it's on the margins. We're not talking about any kind of a significant shift at all from what British Columbians are used to, and certainly not away from what British Columbians expect, and that is that they get access to their medically necessary health care services in a manner that is fully funded by the government.

We have, of course, gone to look at some of the support services that we require. In the past we have certainly rented commercial space in order to house services that are provided, and we contract that from the private sector. We are now looking at how we can provide services such as landscaping around our health care facilities, security services — in some cases the health authorities are looking at laundry services, as the member mentioned — and housekeeping services.

It's not driven by any kind of a philosophical desire to shift from the current system as we have known it to one where these support services are all contracted out. It is saying, "How can we get the best value for each and every dollar that we have in the health budget?" — because every dollar that we save, when it comes to providing these support services, is a dollar that we can make sure gets redirected into direct patient care.

This is a process that is certainly open on the part of the health authorities. They've gone out with a tendering process around this, and that is an open and transparent process. The bottom line is that if it doesn't wind up with cost savings, the health authorities are not under any obligation to go down that road — certainly not by any directive from this government.

The member will know that the Hospital Employees Union has approached government with a proposal around how some of those cost savings can be realized in ways that may at least reduce the number of positions that may have been otherwise contracted out. The member knows that is currently out for ratification. We'll see what happens when those votes get counted.

J. MacPhail: I'm sorry. My question was around research about this direction leading to greater cost-effectiveness — not ideological. I'm not asking ideological questions; I'm asking practical questions. This trend, just as the minister describes what he is doing….

What research does he have to show greater cost-effectiveness going in that direction or greater patient

care? FOI requests to the minister came back filled with not a shred of evidence that any studies or analysis had been done.

Hon. C. Hansen: Actually, there has been a lot of analysis done. We have certainly looked at the experience in other jurisdictions across Canada that do contract out a range of support services.

We have also looked at what some of the cost structures are, comparing British Columbia with other provinces across Canada on what the support services cost on an hourly wage basis and also the benefit package that support workers realize in British Columbia compared to all of those other jurisdictions. When you start to look at that research, what it shows is that our cost structure in British Columbia is about 30 percent higher than the Canadian average, and it's about 20 percent higher than the next most generous province.

There has also been work done that I have seen — we didn't commission it — which compares the cost of support services in our health sector to support services in other sectors. I think some health care workers come back with a legitimate argument that you can't compare apples and oranges between the health sector and the hospitality sector, but certainly we've looked at some of the research that's been done in that area.

All of these things have led us to the conclusion that we can get much better value for the taxpayer when it comes to providing those support services. We don't have to go out and commission some three-year study. We know that the cost savings are there. They will be realized by an open and transparent process of inviting competitive bids. We've even invited the unions to submit bids, and my understanding is that in some cases there have been bids coming in from union members in the province in response to some of these RFPs.

J. MacPhail: I'm not quite sure why the minister keeps referring to unions. I'm making the case here…. He has a relationship with the HEU and the unions BCNU and HSA. I'm asking these questions on behalf of patients.

Is the minister somehow suggesting that if this government pays reduced wages, that's more cost effective? There's a difference between actually providing cost-effective services and paying lower wages. That's what I'm asking the minister for: what studies does he have to show that the cost of providing housekeeping services in other jurisdictions, while they may pay lower wages, is more cost-effective? That's all I'm asking. There are contractors in between. FOI requests came up with zero studies to show that.

Hon. C. Hansen: Our review of the circumstances in other provinces is that there is quality service provided around those support services in other provinces, whether it's within their in-house staff that provide those support services or whether they are contracted-out services. That is, what is key are the performance guarantees that are put in place to make sure we get quality service for what the taxpayers are paying. Whether an individual is working in a private company that is contracting a service to government or whether government directly employs those individuals does not in itself dictate whether you get a quality service on behalf of the taxpayers.

What we are saying is that we want quality service — and we're not going to compromise that — and we want to get it in the most cost-effective manner possible to ensure that taxpayers get the best value for their dollar.

J. MacPhail: My question was about what studies or analyses he has to prove that point. If the minister has those analyses and studies, how come FOI requests turned up nothing — not a shred of evidence — to that effect?

Hon. C. Hansen: I'm not aware of what FOI requests may have come in, in this regard. But if an FOI request came in, asking for studies we have undertaken with the specific focus the member talked about, we haven't undertaken studies. We've done a review of experience in other jurisdictions and learned from that analysis.

Let's use an example. If we have a hospital somewhere in British Columbia, and it goes out and hires staff on its payroll to provide a landscaping service to keep the lawns mowed and the gardens tended in front of the hospital, I don't need an expensive government study to tell me that if we go out with an open tendering process where there are competitive bids — the existing employees may bid on that, or some new group of employees may bid on that — we will find out from that process whether or not we can get better value for the taxpayers. If we can, then the dollar saved can be redirected into direct patient care.

J. MacPhail: It is so disingenuous for this minister to get up, as he's done for the last two years, and use the issue of landscaping and contracting out. That's like 0.01 percent of the health care budget. But he likes to do that, because it meets the nod test to the public: "Oh yeah. Anybody can cut grass." Well, duh. But he uses that to justify the hundreds of millions of other dollars he's planning to contract out and privatize. It's just completely disingenuous for the minister to keep standing up and doing that. But he does it, and no one except the opposition challenges him.

By the way, there were FOI requests, exactly as I asked the minister in this estimates debate, and they came back with zilch in terms of the ministry having any studies, any analysis or any best practices surveys that would support the direction the government's going in.

Now, the ministry service plan lays out successive but not defined percentage cuts at the health authority

level to both administration and support services. Some of the performance agreements that occurred between the government and the health authorities set that cut at 7 percent. Could the minister tell me what proportion of those cuts will be borne by health care executives/administration and what portion will be paid for by the support service workers?

Hon. C. Hansen: The 7 percent reduction in administration costs that the member refers to does not refer to support services at all. That is entirely within the administration and administration support budgets.

J. MacPhail: So there will be a cut of 7 percent in administration costs across the health authorities? And what will that affect? What happens with that cut? What's the effect of it?

Hon. C. Hansen: The 7 percent reduction in administration costs will take place over the three-year period. So we're now about a year into that process since we first announced it.

It's around the areas of finance, human resources, payroll costs, and a lot of those savings are actually driven by the fact that we've reduced the number of health authorities from 52, which were in place before, to the six health authorities that we have currently. That has allowed us to streamline the way things get done. It allows us to use technology in a better way, and as a result, we anticipate there will be savings in the range of about 7 percent.

J. MacPhail: Well, we've had the six authorities for over a year now. What have been the administrative savings?

Hon. C. Hansen: I am advised that all of the health authorities are on track to meeting their 7 percent reduction over that three-year period. The fiscal year for the health authorities ended at March 31, and we are still waiting for their final wrap-up numbers. Part of their performance review that we will be undertaking when we get those finalized year-end statements is to be certain they are, in fact, achieving those goals. I'm advised that all of the health authorities are well on track and have no concerns that they'll be able to reach the 7 percent target.

J. MacPhail: Well, what has happened to executive compensation, for instance? I know in my own health authority, a couple of VPs were fired, given big severance packages, and the new people replacing them earned even more. So what's happening with executive compensation?

Then another issue…. I would be hard-pressed in the Vancouver coastal health authority to understand where the administration costs are coming from, given public reports. Public reports show that VPs are fired — at least two, with big severance packages — and their replacements are paid even more. There's a huge communications shop in the Fraser health authority. You know, we have a situation where the Fraser health authority has paid out severance, but they also have a ten-person communications shop.

There's a huge number of executive hires in the provincial health services authority. So perhaps the minister could reassure all of us, who may be fearmongering by just noticing on the surface what's happening, by giving me specifics on the cuts in administrative costs. Are there limits, for instance, on what one can pay for communications?

Hon. C. Hansen: You know, this actually is driven by the fact that we had 52 health authorities in the past, and those 52 health authorities were reorganized into five regional health authorities in the province. Where we had 52 CEOs in the past, we now needed five CEOs for those regional health authorities. So there were some good people who were working hard for the health care system in this province, who became redundant through that process. They were terminated, and they were paid severance in accordance with their contracts. Even though some of those severance payments seem high, they still wind up with a saving to the health care sector, and it is part of achieving that 7 percent goal.

I'm glad the member mentioned the provincial health services authority, because that's the sixth health authority, and that's not regionally based. That provides all of the very complex care and the tertiary and quaternary care for the entire province. That is a brand-new facility. It wasn't a case of sort of morphing one of the old health authorities into this new body.

Basically, all of the executive positions in the provincial health services authority were, in fact, new hires because that entity didn't exist previously. You wound up with some of the agencies being moved in, but the executive level, under Lynda Cranston's immediate supervision, was newly hired to that provincial health services authority.

The net result of this whole process is that you are going to see fewer executive staff in the health care system compared to the number of executive staff that we had when there were 52 different health authorities.

J. MacPhail: The minister is making that assertion without any evidence — zero evidence. I'm just asking for the evidence. That's what I'm here for. Show me the evidence. You said there's going to be less. Prove it.

The example the minister gave at my health authority is not accurate. The Vancouver coastal health authority fired two VPs and replaced them. They weren't suitable. I can't remember what it was. They didn't fit in with the new way of doing business. So that's not a valid example.

One wonders why, with the creation of a provincial health services authority that's an amalgamation of very competent agencies, one would then put another layer of major administration over that rather than just reallocating people from the system — not pay them

severance. Were these bad people? They weren't political appointees. Certainly, the two VPs in the Vancouver coastal health authority had years and years of health experience over several governments. I don't even know who they were. What's with that?

Hon. C. Hansen: We have a policy within the health sector that if somebody moves from one of the former health authorities, for example, over to a new health authority, they do not get severance. In fact, I know of at least one example where an individual who became redundant was paid severance, and when he was hired with a different health authority, the severance, which was a salary continuation, terminated.

We have in British Columbia a pool of very competent health executives and people that are in health management, and they do move between positions. There are circumstances that happen in health where somebody will be terminated from their position because they don't fit in with that particular executive team. We see that throughout government. Certainly, it was the case while the minister was in executive council, and we have those occasions that happen now. By and large, what we have seen in terms of the executive restructuring is a reduction in the total number of executive positions starting right from the CEO level, where we've gone from 52 down to six.

J. MacPhail: Just to remind the minister, it's the law that people can't take severance, move into a public sector job and then get a salary. The law was brought in by the previous administration and failed to be enforced by this government until they were caught out.

Just give me the example, then. Tell me where I'm wrong at the Vancouver coastal health authority with the firing of the two VPs late last year. I can't remember whether it was December or earlier this year. Two VPs were fired, and they were replaced. Why were they fired? What happened? How much money did they get?

Hon. C. Hansen: I am advised that the two positions she's referring to have not been replaced by anyone outside. There may be people filling those functions obviously, but they have not been replaced from individuals outside. These two terminations happened after the end of the last calendar year and therefore fell under the new requirements regarding severance payments. The severance that was paid, I know, was in accordance with that. I don't have the exact dollar amount with me other than I know it was the amount they were entitled to under those new guidelines.

J. MacPhail: I didn't say that they were filled from outside. I said that the job is still being done. There are people filling those jobs at the VP level being paid as VPs because the government fired the two previous ones. That ain't health care. That isn't good health care dollar management — is what I would say.

If I could please have from the minister…. I'm not suggesting now…. I want proof that there are fewer executives with the six health authorities than there were with the 52. I want a cost for that as well.

Now, the minister has said on more than one occasion…. He tried to slough it off by saying that it was just landscaping that they were contracting out, but they're contracting out laundry. The minister has said on more than one occasion that this government's not in the laundry business, and therefore the government is contracting out laundry services.

I'm wondering whether the minister has any view on the recent SARS outbreak and the way that kind of spread of a virus so quickly would be affected by contracted-out laundry service.

J. MacPhail: Well, let me ask this then. If a hospital is under quarantine, then supplies from outside, like laundry from outside a hospital, can be brought into a quarantined hospital. Is that correct?

Hon. C. Hansen: There are lots of supplies that come into hospitals from outside of the hospital. We bring in bandages. We bring in sterile gauze. We bring in all kinds of equipment. Certainly, we would not contract for any of those supplies from any supplier that would in any way compromise the degree of sterilization that is necessary to ensure a safe and effective health care system.

J. MacPhail: The minister stands up and says categorically that the contracting out of housekeeping services and laundry services, where they're provided by bringing those services from outside to within, is completely unaffected by SARS.

Hon. C. Hansen: I should point out to the member that in the past…. In fact, the majority of laundry that is done for our hospitals in the lower mainland is done on Tilbury Island. That is a facility that is owned by the health authorities. Most of the dirty laundry from our hospitals gets trucked to Tilbury Island. It gets cleaned and sterilized and properly packaged to ensure that it is transported in a way that does not compromise the sterility of those laundry items. Then it's brought back to the hospitals.

Certainly, sterilization and safety and cleanliness are obviously the number one concern, regardless whether it's done by an outside contractor, whether it's done by a government-owned facility that's away from the hospital or whether it's done by a laundry facility that's right in the hospital.

The other thing I should point out to the member is that when you get economies of scale, where you have larger volumes of laundry that are being put through a laundry facility, you can in fact invest in the kind of technology that gives better sterilization results than

you would get by having a small laundry located inside every single small hospital throughout British Columbia.

J. MacPhail: So there's been no direction whatsoever, either to the contracted services or to a rethink by the health authorities, about laundry services or housekeeping services as a result of SARS?

Hon. C. Hansen: The challenge of SARS in our health care system is actually something that has really, I think, shown the professionalism and the integrity of our front-line nurses and doctors as well as our provincial health office and the B.C. Centre for Disease Control, who have done an absolutely outstanding job at making sure this challenge was met and SARS was contained. We have in place an expert clinical advisory team that's looking at all of the clinical issues around SARS in terms of how to make sure that we get the best information from around the world that's being gathered and that we do everything we can to make sure it is contained. We have shown success in that regard.

I should point out to the member that infection control in our hospitals is not something new. We have very effective infection control protocols in our health care facilities. It is as a result of that standard, which we have had in place up till now, that we have in fact been able to deal with the SARS challenge as effectively as we have in this province. Certainly, there is nothing we would do to compromise those standards.

J. MacPhail: I'm curious. K-Bro Linen Systems — they operate out of Alberta — has now got a ten-year contract to do hospital laundry in the Fraser Valley. Did K-Bro take the laundry from the quarantined ward and move it to Alberta, and was that okay with Alberta?

Hon. C. Hansen: While SARS presented some new challenges for our health care system around how to make sure it was properly contained and staff were properly protected, when it comes to the treatment of linen that may have been exposed to SARS, the health care system has always treated that linen — or, indeed, any other materials that are potentially contaminated and sent out of the hospital…. The health care system has always treated them as if they were containing contagious materials.

Just as an example, the problems that hospitals have with staph infection is something that requires the highest level of rigour being applied to make sure that, first of all, anyone handling those materials is protected. It really doesn't matter where they're being handled, whether it's in the basement of a hospital or it's in Calgary, Alberta. The same kind of precautions have to take place to make sure staff are protected from any contaminants that may be in that linen. They are then processed and treated in a way that we are 100 percent sure that what comes back to our hospitals to be used again has been processed to the degree of sterilization that's necessary.

J. MacPhail: So there was no issue whatsoever about hospital laundry moving from British Columbia to Alberta. That was my question.

Hon. C. Hansen: There were no new and unusual challenges because of SARS because, basically, SARS required that the material be treated with the highest level of vigilance and care. That is the way we have always treated laundry, regardless of where it's been processed.

J. MacPhail: To carry on about the K-Bro Linen Systems out of Alberta. When they took over the laundry last year and shipped it to Alberta, they promised that they would be building a new facility in the lower mainland in the near future.

The Fraser health authority said they would save $2.1 million in capital costs by contracting out the laundry. We have information that they subsequently sold the laundry equipment at Chilliwack Hospital. I'm wondering whether the minister is aware of the price they got for this equipment and the name of the buyer, given that this is an area the minister uses as an example that would save the taxpayers a great deal of money.

Hon. C. Hansen: This is certainly an area that is 100 percent within the responsibility of the Fraser health authority and not something we would try to manage from the ministry. As a result, I don't know the details around how they may have disposed of that equipment, but if the member would like more information, I could certainly try to get her more information from the Fraser health authority.

J. MacPhail: Will the CEOs be coming here to debate, so I can ask the CEOs questions directly? It's about — what? — $6 billion or $7 billion of tax money that flows to the regional health authorities. Is the minister not prepared to answer questions about the regional health authorities?

Hon. C. Hansen: I'm sorry. I apologize if the member took my response in a way that I didn't intend. I don't shirk the responsibility I have for this $10.4 billion budget we have in the Ministry of Health Services. Certainly, I will endeavour to provide the member with answers to all of her questions, including issues that affect individual health authorities. It's just that that particular level of detail I don't have at my fingertips right now, but I can certainly undertake to try to get information for her from the health authority.

J. MacPhail: Well, it is level of detail that is costing millions of dollars of taxpayer money. So, yes, I do want an answer, Mr. Chair. Here we have a situation where the government said it was getting out of the laundry business because that was cost-effective. Through the

Fraser health authority, they contracted out its service for laundry for ten years to K-Bro. They shut down the laundry equipment in Chilliwack Hospital. They sold some of the equipment, my information is, to K-Bro, so K-Bro could use this equipment in their new facility in the lower mainland to clean laundry.

That's why I wanted to know what the price was that the government got for this sale. Was it a fire sale? Was it a buck? Was there an assessed value? Otherwise, the government has given away equipment to a laundry service so that that laundry service can be contracted out. And that's saving tax dollars? That's why I want the information to prove me wrong in that area.

Now, the Tilbury Regional Laundry, a highly efficient hospital laundry service. That was transferred by legislation to the Vancouver coastal health authority, and of course, the Vancouver coastal has awarded its biggest hospital laundry operations to K-Bro, the firm I was just talking about. What are the plans for Tilbury laundry service?

Hon. C. Hansen: Actually, I can advise the member that the Tilbury Island laundry facility is obviously still operating and providing a service to the health authorities. I know that in the past Tilbury Island was actually owned jointly by several of the health authorities, and I know that ownership is now being shifted.

The official that can help me with some of the additional details has just slipped out of the room, but if the member would like to go on to another question, I would be pleased to come back to this when I am able to give her a more substantive answer.

J. MacPhail: Then let's go on to the example of the public-private partnership in the area of infrastructure for the health care system — the building of the hospital at Abbotsford, which is to be done under a public-private partnership. Could I have an update on that, please?

Hon. C. Hansen: We went out with a request for expression of interest for firms that would like to be part of providing this new 300-bed hospital in Abbotsford. The deadline has now passed for the submission of those expressions of interest. We are now going through a process of reviewing each of those proposals. It is the intention of Partnerships B.C. to short-list to four organizations. They might be individual companies or consortiums. Then we would be issuing a specific request for proposal to each of those four on the shortlist. That will eventually lead to a successful organization that will build that new and wonderful facility for the Fraser Valley.

Hon. C. Hansen: As I indicated earlier, the expressions of interest are now being reviewed. We expect to be able to finalize a shortlist from those expressions of interest by the end of June, at which time the RFP would be issued to those four proponents. They would have to submit their proposals in the fall of this year, and then there is a fairly lengthy process of trying to review the overall details that come back in response to the RFP.

J. MacPhail: Okay. So this is year two of a four-year mandate, and it looks like…. Will the request for proposals be…? Is the time line…?

Mr. Chair, I just want to tell you that I did ask these questions of the minister responsible for Partnerships B.C. and didn't get any answers.

Will the time line be that the requests for proposal will be awarded by the end of this fiscal?

Hon. C. Hansen: Actually, I'll just read this whole note for the member: "The project is proceeding according to the major scheduled milestones. Evaluation of the expressions of interest and selection of the four proponents should be concluded at the end of May 2003. The release of the request for proposal is scheduled for June 30, 2003, and the target for financial close and the start of the implementation phase is October of 2004. The opening of the new facility is scheduled for December of 2007."

J. MacPhail: I noted a difference in the budget and fiscal plan document this year of the overall government fiscal plan as it relates to capital expenditures. Last year the Abbotsford hospital was in there for $211 million, and there was nothing in there for the Vancouver Convention and Exhibition Centre. That's reversed this year. The Abbotsford hospital, booked at $211 million, is gone, and the Vancouver Convention and Exhibition Centre has been put in the government's capital expenditures for $230 million.

Is the request for proposals for a $211 million structure now all privately funded? This question is arising out of the changes to this government's fiscal plan.

Hon. C. Hansen: The new Abbotsford hospital will be a P3. This is a facility where the capital component will be provided by the consortium or the company that is building it. It will not be a capital expenditure of the Ministry of Health Services either now or in the future. Certainly, we do address it as a major capital project of the ministry. If the member wanted to refer to page 44 of my ministry service plan, she will see that it is acknowledged as a capital expenditure, but as such it is not going to be a charge against the capital budgets of the ministry in the future because of the fact that it is being delivered as a public-private partnership.

The Chair: If it's the will of the committee, we'll have a short five-minute recess. All those in favour? We'll be reconvening at 20 to.

Hon. C. Hansen: I did promise the member I'd give her an answer about the current status of Tilbury. That laundry facility continues to provide laundry services, as they have done in the past, for the various facilities in the Vancouver coastal health authority. In terms of the day-to-day operations at Tilbury, there has been no change.

J. MacPhail: The reason why I'm asking about the change in the listing of the Abbotsford hospital — that it's now a capital expenditure, but it's not part of the government's capital expenditure — is an acknowledgment, of course, and the minister confirms it, that it's a P3. The Vancouver Trade and Convention Centre, which couldn't be done as a P3, has been added to the government's capital expenditure list.

What I'm curious about is more information about how this P3 is going to be paid. Of course, the process for even expressions of interest…. You've got to pay to get in. You have to pay 250 bucks, I think, to attend an information meeting about the Abbotsford hospital. There is no information anywhere that has flowed out of that meeting, not on a website or anywhere else, so that's why I'm asking these questions.

Is the minister confident, after receiving expressions of interest, that his government's calculation of $211 million is the price tag for the hospital?

Hon. C. Hansen: We don't know that. That's the whole purpose of going out with a process of looking for expressions of interest and then subsequently the RFP process. It is certainly conceivable that we may wind up with private sector partners that will come to the table and will be able to find efficiencies to bring it in at less than that. It's also conceivable it could be more than that. We certainly wouldn't want to prejudge that at this point, because that's what tendering is all about. It's to get the best price for the quality of product that we will insist upon.

J. MacPhail: Well, that's a bit troubling. The government had a figure of $211 million that it booked and then removed. Then they contracted PricewaterhouseCoopers. They put together a quarter-of-a-million-dollar report recommending a P3 for the MSA replacement project. They made the recommendation despite marginal cost advantages over a traditionally procured hospital, which was booked at $211 million. There are some that would say that even those marginal advantages could rapidly disappear with only minor variations in the financial modelling.

What I'm trying to figure out is: who's actually in charge here on this? PricewaterhouseCoopers gets a contract; says, "Oh yeah, P3 works," and now PricewaterhouseCoopers is allowed to bid on that very project as a proponent or a consultant to a proponent. I'm just trying to nail it down. Who's determining what the cost of this is going to be, whether it be private or public? At the end of the day, if it's a privately financed partnership, the taxpayers still pay for it through operating leases. They still have to pay something for the profit of the private sector operator. We have a situation here where PricewaterhouseCoopers gets to say, "Yeah, go ahead with a P3," and then PricewaterhouseCoopers gets to be a proponent.

Let me just quote what the government document has said, by permitting the PricewaterhouseCoopers to be on both side of the issue. It says: "In order for them to have the opportunity of participating as a respondent team member, such consultations have undertaken to implement internal policies and procedures to protect and/or return or destroy all confidential information which they obtained in the performance of such work and services." I guess PricewaterhouseCoopers is responsible for that itself.

Now, one of the reviews of public-private partnerships, and the success or lack of success, comes out of the United Kingdom. A major criticism of private financing initiatives, or PFIs — that's what public-private partnerships are called in the United Kingdom — has been the ability of consultants like PricewaterhouseCoopers — they don't list PricewaterhouseCoopers, but companies like them — to work with local health authorities to put P3 business cases together and then switch sides and work with investors to put together the consortiums to build and operate the hospitals.

As far as I can tell, it's happening here in British Columbia with this P3 at MSA hospital. What are the mechanisms that have been put in place? What reassurances has this government got about the PwC double role?

Hon. C. Hansen: In terms of the safeguards that are put into the whole process of evaluating bids and that, there is, first of all, a probity auditor in place to oversee the process. We have also contracted with process advisers from Partnerships U.K. and also from Australia, because they have had experience with this approach to building large hospitals in those particular jurisdictions.

The other thing is that the work that PricewaterhouseCoopers has done does not give them, in any way, an unfair advantage over any of the other proponents that may be wanting to participate in this process. The report that was done by PricewaterhouseCoopers is certainly available to all the proponents that are responding to the expression of interest. At the time that PricewaterhouseCoopers undertook that project, there was an understanding that they would not be prevented from bidding on it subsequently, but they would also not have any unfair advantage as a direct result of that.

J. MacPhail: I'm wondering whether the minister could specify how that prevention of the unfair advantage is prescribed in the EOI — expression of interest.

Hon. C. Hansen: Basically, it is through the sharing of the report that PricewaterhouseCoopers did, which ensures that the other bidders on the project would

have access to that information as well. It would mean that PricewaterhouseCoopers would not have any unfair advantage with information that would not be made available to the other proponents as well.

J. MacPhail: Did all the other proponents have access to all the internal documents that PricewaterhouseCoopers had — all of the correspondence, all of the calculations? The report that was published had working documents behind it. Are the working documents distributed as well?

Hon. C. Hansen: The member read out the requirements that PricewaterhouseCoopers had with regard to working documents and papers that they were required to either return or destroy. PricewaterhouseCoopers is a large, reputable, international organization that deals in a whole range of different issues, and they have staff who are obviously dedicated to different types of work that they do. We certainly have no reason to believe that they would have retained any materials in contravention of the agreements we had with them.

The other thing is that when the companies came to apply for information that would allow them to respond to the EOI, those companies were made aware both of PricewaterhouseCoopers's involvement previously with the report and of the fact that PricewaterhouseCoopers was permitted to be part of a consortium that may in fact respond to the bid. We have not had any complaints expressed to us by any of those organizations with regard to the involvement of PricewaterhouseCoopers.

J. MacPhail: Now, the government has completely removed from its books the cost of the MSA hospital. It was on the books as government infrastructure costs last year, not this year. There's nothing booked for the MSA hospital in terms of government debt or government responsibility.

In doing my research, I found out that in countries — particularly in the United Kingdom but in some areas of the United States as well — where a private partner goes bankrupt, then the government has to bail that private partner out. In fact, there is a point of view amongst auditors general that given that trend, governments should be booking the value, or at least a portion of the value, of the project as if it were government money itself being spent.

What discussions has this minister had with the auditor general around accounting for the cost of the MSA hospital? Perhaps he could detail those for me — dates, times and results.

Hon. C. Hansen: The responsibility for how government capital gets booked in the finances of the province is the responsibility of the Minister of Finance. I have not had any discussions with the auditor general in that regard, because it would be inappropriate because that is the responsibility of the Minister of Finance.

Hon. C. Hansen: I guess the short answer to the member's question is that I have not had specific discussions with the Finance minister with regard to how he should be doing his job, because I have full confidence in him. I was just checking with ministry staff with regard to what discussions may have been at the officials level. The way we are presenting our budget with regard to the capital costs certainly met with the approval of the Ministry of Finance, and indeed they structured that particular section of these estimates.

J. MacPhail: Well, I guess I'll have to ask the auditor general that question, then. I'll write a letter to the auditor general on that. Certainly, in the discussions with the Minister of Finance and Partnerships B.C. sitting right there, there was no indication that they'd done anything with the auditor general on this matter — none. I hope somebody has.

I just want to go back to…. My staff was a bit taken aback by the minister's response when he said that the 7 percent administrative cut was just for administration and that it had nothing to do with support services. Has that changed? Is there a new provincial health services authority contract?

Just let me read the executive summary of it. It says here: "Administration and support expenditures are to decline by $22.5 million by '04-05. The Ministry of Health Services performance contract requires a 7 percent reduction by this time. Reductions arise from merger savings, contracting out of support functions, shared services with other health authorities and general efficiencies and reductions offset by the resources required to establish the provincial health services authority." Is that document wrong?

Hon. C. Hansen: No. That is correct, and that's entirely consistent with the answer I gave her previously. What I said at the time was that it was a reduction of administration and administration support, and that is to be achieved through…. Some of the examples I gave were some of the consolidations around payroll and human resources.

Some of that involves the contracting out of those administrative support services. I'm not sure if the member is referring to the fact that the words "contracting out" get mentioned. We have contracting out with regard to support services such as security, landscaping or laundry, but we also have contracting out within administration, which could be, for example, around payroll management.

J. MacPhail: I guess the minister just forgot to list that it could include housekeeping, laundry services and food services. Let me ask the question again, then, because under this particular performance agreement

the provincial health services association plans to fully contract out food, housekeeping, plant and transcription services. So what percentage of the 7 percent in administrative cuts is going to cuts that affect support services like food, housekeeping, plant, transcription or landscaping? Let's not forget landscaping.

Hon. C. Hansen: Just to repeat what I said earlier, the 7 percent savings that we are expecting the health authorities to achieve are around administration costs and administration support. Of all the items that she listed there, the one that I'm not sure about is transcription, but I think that may well fit into the definition of administration support, so that may be part of the 7 percent savings. In terms of the other items she mentioned — housekeeping, laundry — that would not be included in that target of the 7 percent savings.

J. MacPhail: Sorry, I am really confused now. So there's 7 percent in cuts to things other than the support services that I listed like housekeeping, laundry and plant? The minister is going to have to start again.

A 7 percent cut in administrative services…. Administrative services in the hospital, according to this government, includes — and I will read it — "food, housekeeping, plant and transcription services." Just let me read further on — this is interesting: "Administration and support, as defined by the Minister of Health Services, includes executive administration, corporate functions such as finance and patient care support functions."

J. MacPhail: I'm reading from the provincial health services authority '02-03 budget management plan.

Hon. C. Hansen: I guess we're having some difficulty trying to determine exactly what document she may be quoting from. I can quote for her what our performance agreement with the PHSA says. It's under "Expected performance," and it says: "To reduce the annual expenditure for support and administrative services (excluding information services) by the '04-05 fiscal year by at least 7 percent of these expenditures incurred in the fiscal year 2001-02."

I will reiterate what I said before. That 7 percent reduction in administrative support services includes things such as payroll, human resources, the support for executive offices, the financial management — those types of things. It is not including the savings that may result from contracting out or other efficiencies in the services that are there to support the clinical functions. The one I did mention that she listed off — transcriptions — is one area that may, in fact, fall under administrative support rather than support for the clinical functions, although that may differ from health authority to health authority as to which category they may put that particular item in.

J. MacPhail: Then what I would appreciate is the minister showing me an updated document — because this is from last year — from the provincial health services authority that does not include patient care support functions in that 7 percent and as they are listed in this document.

Hon. C. Hansen: I would be pleased to do that. Actually, if the member would oblige me with a copy of that particular document, then I'll know exactly which one she's referring to, and I will endeavour to get that information back to her. I'm not sure if it will be before we finish estimates, but I'll certainly make sure she gets it.

J. MacPhail: I want to move to physician issues. What is the status of negotiations with physicians in this province?

Hon. C. Hansen: We have now completed the negotiations with the BCMA with regard to the working agreement and all of the subsidiary agreements that flow from that. We're still working through some of the implementation of that, but the agreements themselves have been concluded. I guess it becomes the ongoing, story because we expect to be back into negotiations for the next round in October of this year.

J. MacPhail: Negotiations start in October of 2003. I can look it up, but perhaps the minister's staff can do this. What's the change in the physicians' services budget, which would be the medical services budget, year over year?

Hon. C. Hansen: The Medical Services Plan budget last year increased by $392 million to bring it to its 2002-03 level of $2.515 billion. This year in the budget for '03-04, it increases to $2.551 billion, and that reflects increases in population, demographics and basically utilization rates.

J. MacPhail: I'm just doing it in my head — $36 million on about $2.5 billion. What percentage is that?

Hon. C. Hansen: Population growth is projected, based on B.C. Stats numbers, at 1 percent.

Let me just raise some issues. Physicians have not asked me this, but I have found this journal that I use. I

actually read it. It's called the Medical Post. I'm only going to talk about issues that have arisen this year — actually in the last couple of months.

Let me read the first one. It's about physicians being able to do their jobs in this province. I hope the minister doesn't think that just because I'm reading this into the record, I'm taking a particular point of view. I put this forward only because this is the physicians' own journal in which they discuss issues amongst themselves. It's not something that we buy at Safeway or anything.

This is about rural physicians struggling with regionalization. That's why I asked the minister, first of all, about what the increase in the budget was going to be this year. This is dated February 25, 2003, from the Medical Post.

I understand this last piece is legislation before the House, so I'm not asking the minister to respond to that. I do want to ask the minister…. This is from about two months ago, and I actually remember Dr. MacDiarmid from the news. She was a very effective spokesperson when my party was in government, so she certainly is balanced in her approach. There are several other articles like that about rural physician issues. When I was in Prince George, they were particularly at the top of mind amongst the physicians.

Maybe the minister, first of all, would like to make general comments about that article.

Hon. C. Hansen: First of all — just to point out a couple of inaccuracies in the article — the Castlegar hospital is not closing. In Nelson there was reference to there not being on-call coverage. There is on-call coverage. I think that as of February, that may not have been finalized with certainty going forward because that whole new on-call arrangement was still being sorted out at that point. It was sorted out, and it is retroactive.

There was a reference to her concern around the Health Professions Act. I should point out that my colleague Sindi Hawkins, the Minister of Health Planning, tabled that act the other day with the full support of the B.C. Medical Association and the College of Physicians and Surgeons. I think that particular doctor may have a different view of it now that she has had the opportunity to see the legislation that has come down.

I would like to speak more generally just in response to what's happening in the Kootenay-Boundary area and then rural practice generally in the province. In the Kootenay-Boundary area, because of the consolidation of services around the new West Kootenay–Boundary Regional Hospital in Trail, we have been able now to recruit five additional specialists to come into Trail so that residents of that part of British Columbia who used to have to travel out of that region — either to Calgary or to Vancouver or perhaps to Kelowna — to get access to surgical procedures now are able to get access right in their own region within an easy driving distance of their own residence.

As a direct result, we actually see the number of patients that are being transferred out of that region reducing because we're able to attract the specialists — and then get the care they need. That's exactly what the whole redesign of health care has been all about. Certainly, I have had great feedback from doctors throughout the province about the direction we're going with that consolidation of services. What it means for the individual physician is that we are getting away from the expectations that are placed upon them to be a sole specialist in a community that expects them to be available 24 hours a day, seven days a week. That just leads to burnout.

The other thing we have done is the new rural incentive program for rural doctors. It's a total package; I think it's about $56 million, if I remember right. For the first time, we are now providing locum support for

locum specialists in rural communities to come in to give relief to those specialists so that they can actually travel either just to have a vacation with their family or to go for continuing medical education so they can stay current with their programs.

We have provided a signing bonus of $10,000 for any doctor that wishes to come and practise in one of those rural communities. There's a northern isolation travel assistance to provide for doctors who travel to get access to education programs.

The whole package was one that I've had tremendous feedback about from physicians throughout the province. I just happen to notice the date of my press release that announced the new rural program, and that was February 17, 2003. The member indicated that the article she was quoting from was February 23. I wouldn't be surprised to learn that the interview with that doctor actually took place before this new rural package for doctors was announced.

J. MacPhail: Perhaps the minister can tell me: what are the doctors saying in the Kootenay-Boundary area now?

Hon. C. Hansen: I'm glad she asked. I was actually in Castlegar two weeks ago last Saturday, I think it was, and I had the opportunity to meet with some of the doctors. They are generally supportive of the initiatives we've taken. I think there was lots of anxiety around the changes that took place. Certainly, we heard those, but I think what we're starting to see now is better patient care as a result of the changes.

Their patients are going to get access to care within the region they live in instead of having to endure the cost of a flight to Vancouver or perhaps an air ambulance flight to Vancouver. They're actually seeing that their patients can get better access to care within the region. It may not be in their specific community, but it is certainly something that's being received.

Just as a point of interest, I had similar feedback from municipal leaders in those various communities. Initially, there was lots of angst. They still have some concerns that we're trying to address around things like ambulance service and that, but by and large, people are starting to see that the sky hasn't fallen, that they still get access to the care they counted on in the past and, in fact, are getting better access to care closer to where they live rather than having to fly out of the region.

J. MacPhail: We'll get to the wait-lists. Perhaps we'll wait for that for the minister to describe how this has affected the wait-lists at the Trail hospital if, indeed, he says it's improved there — or provision of surgery is there. Certainly, there was no evidence of that on the ministry's own website in the last documents we found at the end of April.

There's another article from this same journal, dated May 6, 2003, from a doctor who is from Gibsons, who said that training in rural medicine is essential. The article is entitled "Rural Hospitals Must Adapt to Survive." "Historically, the training has been underground," he said. "People who were going to practise in rural areas and wanted extra skills would find sponsors or patrons in the urban teaching centres and, under their tutelage, would be taught to do things."

What has replaced that? Secondly, on those specialists who arrived in Trail, when did they arrive?

Hon. C. Hansen: The specialists in Trail had been recruited over this past year. Some of them are actually there. When I was up there, there was an announcement that one of them had just arrived very recently, if my memory serves me right. Recruiting physicians isn't something where you sort of phone up somebody in the Yellow Pages, and they show up the next day. Recruitment is an important process. Several of them are already in place, and I think I'm right in saying that there are some that are scheduled to arrive in the near future.

The member talked about the physician in Gibsons. Under the new rural incentive agreement, that physician in Gibsons would benefit from the rural education action plan, which provides $2.25 million toward training for rural physicians to cover costs like income loss, overhead, tuition, travel expenses, accommodation. It also funds undergraduate medical students gaining real-practice experience and a bursary for residents willing to practise in a rural community after graduation.

It also provides physicians in rural communities up to $5,200 per year for education that upgrades their skills and enhances their credentials. In addition to that, there is a rural GP locum program that provides for financial assistance for locums that want to come into that community to spell off those physicians while they travel to get the necessary education.

Hon. C. Hansen: The rural incentive program is now in place. We announced the agreement with the B.C. Medical Association in the middle of February.

J. MacPhail: Sorry, I was asking…. The minister mentioned some training programs there. This — the rural incentive program — is about putting money in doctors' pockets who are already working in that community or willing to move there. But what's the training aspect of it?

Hon. C. Hansen: I did mention that there was a $10,000 recruitment bonus for a physician willing to go to one of the rural communities. They get a signing bonus when they sign up.

The doctors' rural incentive agreement is a whole broad range of things and includes financial assistance for education programs. The two I mentioned, the rural education action plan and the rural continuing medical education program, are for doctors who are practising in those rural communities. This is the financial assis-

tance that they get to enable them to access medical education programs that are approved by, actually, the College of Physicians and Surgeons. They're provided by a whole range of organizations, providing they qualify for the college. Anyways, if the member would like more detail on those programs, I've certainly got lots more detail on each of them.

J. MacPhail: Yes, that was exactly my question. The point that this doctor from Gibsons was making is that the training is necessary. It's not just about money, but the access to the training is necessary. It used to be done, as I see him describing it, sort of like an apprenticeship, but that no longer is possible — an apprenticeship where you attach yourself to a senior doctor who will provide you with that training. What is the exact circumstance under which rural physicians get to spend their rural training money? What programs are in place?

Hon. C. Hansen: We don't prescribe the training that a doctor has to take once they're practising in a community. That training is acknowledged and approved to be eligible as continuing medical education by their own organizations.

One example here is what's referred to as the enhanced skills program. It provides funding for two- to 12-month training periods. The program provides the following benefits to rural physicians: a bursary of up to $2,250 per week, which may be applied to cover income loss, overhead and tuition; travel costs of up to $1,500 for one return trip from the physician's community; up to $1,000 per week for accommodation and board.

Another is the rural traineeship program, funding for training periods of one week to two months. The program provides the following funding benefits to rural physicians: a bursary of $2,250 per week, which can be applied to cover income lost, overhead and tuition; travel costs of $1,500 for one return trip; and $1,000 per week for accommodation and board. Those are the same benefits, but there are different programs available provided through some of our teaching hospitals and through other organizations that meet the CME requirements.

J. MacPhail: Perhaps the minister could update the House on another hot spot around rural physician recruitment and physician issues: Prince George.

Hon. C. Hansen: There is no longer a separate dedicated Prince George agreement. That was in place up till…. I guess it was actually the end of last year that it expired. We continued the terms of the Prince George agreement until such time as the new doctors rural incentive agreement could be put in place. What we have now is one agreement for rural communities throughout British Columbia, and Prince George is considered one of those communities.

One of the things that happened in the past was that there were locum benefits for specialists in Prince George but not in other communities in the province. At the same time, there was support for locum coverage for GPs in other communities but not in Prince George.

Now there is a consistency so that…. It's recognized that Prince George has some challenges when it comes to recruitment and retention, but so do other communities in the province. What we have in place now is a framework that really allows all communities to be looked at within that framework to allow for recruitment and retention according to their particular challenges. The Prince George doctors now are covered under the master rural incentive agreement that we have concluded with the B.C. Medical Association.

J. MacPhail: I was aware that I was asking how that change has affected the workload of physicians in the Prince George area and/or the relationship of the Prince George doctors with the northern health authority. I have a list of circumstances that describes the situation, but it's from January of 2003, so I'm asking the minister. I mean, I don't want to go over the top. It's extremely negative, so I want to know what's changed.

Hon. C. Hansen: Actually, what's changed is that we have now concluded the rural doctor incentive agreement in February. In fact, I went up to Prince George on the Sunday, I recall, to meet with the Prince George doctors to outline for them what the new agreement would entail and how they would be affected by that.

Generally speaking, the feedback we've had since from Prince George physicians has been favourable. They have call groups that are now working. The northern health authority is actively recruiting new physicians, and I understand they've had some success with that under the new agreement. Also, they're getting some assistance from the provincial health services authority with regard to new agreements for pediatrics and obstetrics.

J. MacPhail: I don't know. It's hard to get beyond sort of cheerleading. I understand that it's the minister job to cheerlead. Well then, I'll read into the record some of the concerns they had, and the minister can answer whether they have been resolved. This is dated 2003. I might just say that the response publicly to the agreement the minister announced up there was…. I'll just read into the record. It says:

There's another news article from the Prince George Citizen that said that the doctors say the government will finally figure it out and just restore the old agree-

ment. That's all I have from the reaction to the minister's visit up there. But I'll read it into the record:

Hon. C. Hansen: First of all, to address the whole issue of recruitment, Health Match B.C. has been doing a fabulous job for the province in assisting communities to recruit the doctors and nurses they require. Some of the stats I saw recently indicate the success that they've had in finding physicians for these communities.

In the past Prince George did have their own isolated program, but in fact, the strength of Health Match B.C. is that it can recruit from the world to British Columbia and then find the most appropriate communities. Rather than every community in the province going out to the world trying to recruit their doctors, certainly Health Match B.C. can provide a much more effective service for that.

We have also put in place, again as part of the doctors rural incentive agreement, a rural retention program which allows us to provide funding for communities that are having specific challenges around recruitment. We have built into the budget moneys to help those communities where they see the necessity.

One of the things that we have put in place, which I'm very proud of, we refer to as B.C. Bedline. One of the things you'd hear from doctors around the province in the past is that they would spend hours on the phone calling different hospitals to try to find a bed for their patient who required a higher level of care or access to different care. B.C. Bedline is a computerized registry of all the available beds at our larger acute-care hospitals in the province. With one phone call, doctors can actually find out where a patient can be sent in order to get the care they need.

One of the interesting things is that B.C. Bedline has resulted in a significant reduction in the number of patients that we have had to send down to the United States. As the member will know, that is very, very expensive care — with the bills that we get from U. S. hospitals — when for lack of access to a facility in Canada, we have to send a patient south of the border. With B.C. Bedline we now know where the beds are available. It's been a wonderful addition to the health care system.

The goal, of course, is to reduce the number of patients that need to be transferred out of the Prince George area or the north generally. We want to make sure that we build up capacity in the north so they can be properly treated. When I was in Prince George recently, I had the chance to go through the new addition to Prince George general hospital. I think, off the top of my head, that's a 20 some-odd million-dollar expansion — new emergency room, new clinical space, new diagnostic facilities, new MRI. They will certainly have new facilities in order to better meet the needs of patients in those areas. I know that what the member was quoting from was a few months old, and I think there's been some pretty good news.

The other one I should comment on with regard to Prince George is the new working group that we have put together, which is chaired by Prince George Mayor Colin Kinsley. He is looking at the whole development of the northern medical program at the University of Northern British Columbia and how they can build on that as a vehicle to recruit and retain the doctors that are needed.

What I find from those discussions are people excited about the new medical school. They're excited about the expansion of the facilities. They're excited about the ability to attract new specialists into that community. The bottom line is going to mean that we're going to be able to deliver better health care in Prince George, and fewer patients are going to have to transfer out of that community in order to get access to the care they need.

J. MacPhail: Well, then let me ask specifics around particular areas of practice, and maybe that can focus the discussion a little bit with concrete examples. By the way, the renovation refurbishment of $50 million was budgeted in the 1999 budget, and the then Minister of Finance balanced that budget.

Obstetrics and family practice. Actually, the second-to-last time I was up in Prince George this problem was occurring. I'm just reading from the medical society's document here, "Obstetrics and Family Practice:" Large proportion of days uncovered in December and ongoing days without coverage mark the first uncovered days of any department in two years. Regional hospital status must include 24-hour obstetrics. Does the hospital now?

Hon. C. Hansen: I think one of the big challenges that we had around the December period was the uncertainty around the future of the Prince George agreement and what kind of a compensation package would be there. The feedback I've had from the Prince

George area is that now that the new rural incentive agreement is in place, there's certainty around what the remuneration package is for specialists in the Prince George area. As a result, they're able to go out with more success to recruit the specialists they need.

We currently have two obstetricians practising in Prince George. They are in the process now of recruiting a third obstetrician. I mentioned earlier the relationship they have built with the PHSA to make sure they get the coverage they need while they're in the recruiting process to make sure they get that third obstetrician available.

There is also, as I mentioned earlier, the specialist locum program that is in place to provide a guarantee of $1,000 a day for a specialist to come into one of those designated rural communities — of which Prince George is one — to provide locum coverage, if there are gaps. In addition to that, they get $1,000 — I believe it is — for travel support, and they get any fee-for-service billings over and above the $1,000 a day that would be realized.

So the package is there. It's not sort of a one-off thing, but it certainly allows us to meet the needs of Prince George while they're recruiting that third obstetrician.

Hon. C. Hansen: The short answer is that the challenge they've had around obstetrics is being dealt with, and patients in the Prince George area are getting the care they need. There is the transitional plan that's in place to make sure there is continuity of coverage, and, obviously, everybody is looking forward to the stability that will come when the third obstetrician actually starts their practice in Prince George.

J. MacPhail: Okay. The next complaint they had was around the department of pediatrics — that they were short three pediatricians. Also, the nursing shortage in the department of medicine is the worst in 20 years, and there is a lack of nursing staff in special care nursery, labour and delivery.

Hon. C. Hansen: The situation, as I described for obstetrics, is the same as it applies to pediatrics. We currently have two, and we're in the process of recruiting a third pediatrician for Prince George. Again, the PHSA, working with Children's and Women's hospital, is trying to make sure there are transition plans so they get the coverage and continuity they need.

With regard to nursing, that is an ongoing challenge that we have. Prince George certainly has seen some success over the last couple of years. They have a net increase in the number of nurses they've been able to recruit. They've also had a significant number of their nurses that have been able to go through and complete the specialized training necessary to fill some of those critical areas.

In addition to that, the member will know we've expanded the number of nurses in training in British Columbia by 1,813 seats at our universities and colleges. The expansion of the program specifically at UNBC and College of New Caledonia is actually working very well to ensure that nurses who are trained in those communities are able to stay and work in those communities.

The other area that seems to be a substantial complaint is in the area of psychiatry — that six more psychiatrists are required. What's the status of that?

Hon. C. Hansen: Psychiatry continues to be a big challenge for northern communities. In fact, it is a challenge for the whole province to have an adequate number of psychiatrists available to meet our needs. Northern communities are particularly difficult to recruit for those necessary psychiatrists.

One of the innovations that we have been pioneering in British Columbia is telepsychiatry. That is one area of telemedicine that is showing considerable promise and effective clinical care. We are working with MHECCU at the University of British Columbia to make sure that there are the appropriate clinical supports for family practitioners throughout those northern communities.

J. MacPhail: The last area before we recess is the area of operating room capacity. The reason why I raise this is because the Northern Medical Society makes the link between operating room capacity and the new physician training that will go on via UNBC. The doctors make it quite clear that they're 100 percent behind the medical school, as is everyone, and that it will be a long-term solution to decades of physician staffing problems in the north.

But they make this claim that the facility — the physical construction — is the easy part. The demands for teaching will be a marked increase on the hours that local physicians will have to put in. It will also require specialists, and they can't recruit specialists without the sixth operating room.

Apparently, unless the minister tells me otherwise, the northern health authority administration cancelled the sixth operating room funding. It was in place and open, and it's been cancelled.

Hon. C. Hansen: Clearly, the expansion or the inauguration of the northern medical program at UNBC is a great opportunity for the community to attract new specialists that look at the opportunities of combining clinical services with teaching and research, which is another big opportunity for them.

That is part of the work that's being done by this working group chaired by Mayor Kinsley — to look at how they build on that opportunity to get new physicians to come to the Prince George area. When it comes to surgical capacity, one of the things that was pointed out to me when I was up there is that it becomes sort of a chicken-and-egg challenge for them. On the one hand, because they send patients, say, down to the lower mainland to get access to surgery, the net result of our population-needs-based funding is that dollars will flow to the health authority in which that care gets provided, regardless of where those patients come from in the province.

The catch-22 for the northern health authority is that they need those dollars in order to build up their capacity in Prince George so that they don't have to send as many patients out. We're actually working with them now to develop an argument for ensuring that the dollars flow to them initially so that they can build the capacity and keep their patients there in Prince George — or other northern communities, for that matter — rather than sending them out as frequently as they are to hospitals in the south.

Hon. C. Hansen: Just to give a response to the member's question about nursing positions at Prince George Regional Hospital, there are currently 15 nurse's positions that are being advertised externally. There are 20 nursing positions that have been posted internally. The total nursing positions at PGRH is 270 FTE equivalents.

There is a nurse refresher program that is in place, and that's a program that has had tremendous success provincewide in getting nurses who have allowed their credentialing to lapse to get back into nursing. There is a new class that's just getting started. They've got 12 to 15 enrollees in that program.

There is also an OR nurse-training program that is underway to address OR staffing shortages. There has been no reduction in operating room services at PGRH, and they are continuing to use overtime and casuals. The hope is that some of those overtime rates will come down as some of these additional nurses are recruited and complete their respective training programs.

J. MacPhail: I'd like to give this to the Minister of Health Services. I promised I would — the provincial health services authority document that I was referring to earlier. For the minister, I've just photocopied the sections to which I was referring, but the document is labelled.

If we could just for a few moments, then, carry on about nursing and nursing shortages. Maybe I should just see whether…. No. Sorry. I did put on the highlighted concerns from the Prince George–area doctors. I think perhaps what I'll serve as notice is that I'll be exploring in more detail the concerns around mental health services, but with the Minister of State for Mental Health later on.

There's been much discussion — some of it in question period and some of it through member statements — about nursing and how this government has done a lot to allay the nursing shortage here in British Columbia. I'm wondering whether the minister can spend some time with me explaining, though, how the displacement of nurses is affecting the complement of nurses throughout the province, because what we do know is that there are approximately a thousand beds throughout the province that have been closed. Now, the minister may stand up and say: "Oh, but beds have been reopened elsewhere." I actually don't know whether he'll say that or not. I didn't find any evidence of that, but I'm willing for him to make that point.

I have in my research tallied up that there's been about a thousand acute care beds closed. That has led to the displacement of about 730 nurses. However, with the nursing shortage one could leap to the conclusion that, well, those 730 nurses can just find jobs elsewhere. But there are dislocation issues and relocation issues associated with getting a nurse to move from a hospital in Trail, for instance, or let's say Nelson, and have to relocate to Kelowna.

Bill 29, which was introduced by this government on January 28, 2002, was a piece of legislation that, upon close scrutiny, pretty much allowed the government to reassign nurses for a very long period of time without any access to her declaration of rights, other than to refuse and then perhaps be laid off. Then, finally, the relocation area for which a nurse must be relocated in order to save her job grew greatly. I really want to spend some time with the minister where he explains to me how Bill 29 and the changes in the collective agreement have affected relocation of RNs. Let's just start with RNs.

Hon. C. Hansen: The member's question was a very broad question, and I'm trying to think of how to structure an answer in a way that doesn't take two and a half hours to give. It obviously is a very complex subject.

What we found in the past was that because the health care delivery system was so fragmented, you wound up with groups of nurses who may have particular specialties they would be able to provide. But because the delivery of those services was not being provided in a coordinated or integrated way, you would wind up with one group here, one group here and one group here that may not be fully utilizing what their particular specialization would be to the full extent of their time on the job. By relocating where some of these services get provided, it's actually able to provide, first of all, more meaningful work for some of these nurses who can actually practise more in their area of specialization.

It also winds up with overtime hours coming down considerably in the province, which we have seen in nursing, and it also provides for better and more stable patient care in those areas because of the stability of being able to staff the shifts. What that meant was that we were trying to build patient care around centres where it made sense rather than trying to say: "Let's move patients to where available human resources might be located."

I'm the first to recognize that it does require some dislocation for nurses. We certainly have heard stories of places where there might be several dozen nurses who may get notices that they would no longer be required at a particular facility, but through the relocation and rehiring and other job opportunities, once you go in a couple of weeks later, after the noise dissipates, you realize that virtually all of those nurses were actually in new positions very quickly.

I think it is obviously a challenge for individual nurses when they're faced with those kinds of changes, and I know the anxiety that comes along with that. Within the health care sector we certainly try to make sure those very treasured health professionals are assisted as they go through those transitions to what may be a new workplace as a result of the change.

J. MacPhail: Well, let's try to deal with some specifics then. The Kimberley Hospital is closed. What happened to the RN staff there?

Hon. C. Hansen: In that particular case in Kimberley, they have bumping rights that allow them to bump into other positions within the health service delivery area. When we start looking at where those bumping rights can be applied, it's not sort of across the whole health region but across that health service delivery area, which would include the East Kootenays. They would have opportunities to be able to bump into positions in Cranbrook, for example. I don't know how many kilometres it is, but it's about a half-hour drive from Kimberley into Cranbrook, where in fact the Cranbrook hospital is strengthening the kinds of services it can provide.

I know that earlier we talked about Trail and the number of new specialists that they've been able to recruit into Trail. There's a similar story in the East Kootenay Regional Hospital with the strengthening of services as a result of the consolidation. There are new opportunities for nurses, and they're able to bump according to their collective agreement.

J. MacPhail: No, Mr. Chair, I don't want to have a speculative discussion. This is a real situation. The Kimberley Hospital has been closed for months. I'd like the information about what actually happened to the RN nursing staff at Kimberley.

Hon. C. Hansen: There are 29,700 registered nurses in the province. I'm afraid that I don't have detail at my fingertips right now as to where each of them may have been employed a year ago and where each of them is employed today. If the member would like that degree of detail, I can certainly endeavour to provide it to her, but I do not have that at my fingertips right now.

J. MacPhail: I find it interesting that the minister and all of the Liberal MLAs, day after day — or at least week after week — get up and laud this government for their nursing strategy. Yet when I ask specifics about the nursing strategy, there's no detail. I have no idea how the minister can flow the good news without knowing what exactly has happened. Well, then I'll read this into the record, Mr. Chair.

These are the questions or the issues I would have around the changes throughout the province that have occurred and have had a direct and immediate impact on nursing in this province. I wanted to ask questions specifically, because when we debated Bill 29 — the legislation that gutted the nurses' contract in terms of layoff rights and relocation rights — the government claimed that this was going to be great for patient care and was going to be good for nurses too.

Well, here we are. This is the first opportunity I've had to ask questions around the effects of Bill 29. Bill 29 has been in place for a year, and hospital closures have been ongoing for the last year as well. As I said already, the cuts amount to over a thousand beds closed — acute care beds. Maybe they're not all acute care beds. I'll take that back.

A thousand beds have been closed and 730 nurses displaced. There have been services cut in the community. Immunization teams have been cut. School nursing coverage has been cut. Case management, mental health nursing coverage for small residential homes has been cut. RN positions have been deleted in extended care units and long-term care units throughout the province, and they are now not being replaced one-for-one with RN positions. We'll get to long-term care when we actually deal with the Minister of State for Long Term Care around that.

Kimberley Hospital has been closed. Delta Hospital ICU has closed. Maybe that has changed in the last couple of months, but perhaps the minister could tell me about that. Sparwood Hospital, which was an acute care hospital, has been reduced to a health care centre. Enderby Hospital has been reduced to a health care centre. St. Bartholomew's Hospital in Lillooet has been reduced to a diagnostic and treatment centre.

Summerland Hospital lost all acute in-patient beds and their emergency room. The Vancouver General Hospital surgical short-stay unit has closed. The Penticton Retirement Centre is being phased out, and there's a loss of 100 long-term care beds. The Richmond Hospital emergency room fast-track unit has been closed, and that has meant a loss of 16 sub-acute beds and four surgical beds.

In the George Derby Centre, which is vets seniors residential care, ten and a half RNs and two nurse-clinician positions have been cut, replaced with other

caregivers. The Kootenay Lake Regional Hospital lost all its surgical services. Castlegar loses all its acute in-patient services. The Ladysmith hospital emergency room has been closed from midnight to 8 a.m. At the Mission Memorial there was a move to convert their acute care hospital to sub-acute status. That was announced, chaos was created, and then that announcement was reversed.

The ALC beds have been closed at St. Joseph's General Hospital in Comox. The UBC hospital status has been reduced to sub-acute. The emergency room at the UBC hospital has been downgraded, and the discharge-planning unit has been downsized. The Gorge Road Hospital is closing this year with, therefore, a loss of 287 long-term care beds. The Cascade extended care unit, which was attached to Burnaby Hospital, has been closed. The Fountainview extended care unit attached to the Shuswap Lake General Hospital has closed. The Victoria General Hospital surgical short-stay unit has closed. The Cumberland Health Centre surgical day care program has been eliminated. ParaMed Home Health Care is withdrawing all B.C. services. The Evergreen House extended care unit at Lions Gate Hospital has closed its 29-bed unit.

We don't have to deal in hypotheticals. These are real examples affecting nurses, RNs, everywhere. What's been the result? What's been the human resources planning around all of these closures, and what has been the result?

Hon. C. Hansen: It's interesting. It must be a little bit depressing to be in the shoes of the Leader of the Opposition when she winds up with people bringing her these gloomy stories, because what I get from nurses around the province is actually a lot of excitement about the changes that are taking place in health care in this province today. Sometimes, I'll have to admit, it's when we're going through a tour of the hospital, and it's at that quiet moment when the registered nurse can pull you aside and say: "You know, what you're doing is long overdue."

Let me just give the member a bit of a list. I'll try to go from memory because I haven't got the kind of list in front of me that she has, so I'm going to miss probably three-quarters of them. I will give her a snapshot of a few of them.

She mentioned some changes that were happening here in Victoria. I had the pleasure of being at the opening of the new diagnostic and treatment centre at Royal Jubilee Hospital, which is providing state-of-the-art ambulatory care. Just to put that into perspective, I want to go back and just give the member some numbers.

Between 1985 and the year 2000 — it was before we formed government; it was actually Socred government, then an NDP government — over that 15-year period in British Columbia, the number of surgical procedures that we were performing went up. But do you know what happened to the number of in-patient bed days? They decreased by half. We had half as many patients requiring overnight stay or half as many bed days required in the year 2000 as compared to 1985.

The reason is that health care is changing. The way procedures are done is changing. A gall bladder surgery used to take six or seven days hospital stay. Today it gets done as an out-patient procedure. There are all kinds of procedures that medical science has revolutionized in terms of how they can be provided. You know what? That means that the way we provide services and facilities has to change as well.

I was just, a few months ago, at the opening of the new ambulatory care centre at Children's Hospital, a fabulous new facility where children from all over the province — in fact, two-thirds of them from outside of the Vancouver region — can actually get care on an out-patient basis where they don't have to sleep overnight on those plastic sheets. They can actually get the care they need and then go home.

We have announced the construction of a new $90 million ambulatory care centre at Vancouver General Hospital. We have an expansion that's underway as we talked about earlier — and the member was right; it is $50 million — at Prince George general hospital — new facilities, new diagnostic procedures, new ambulatory care services that can be provided. If you go to Nanaimo, where there is an expansion of facilities, we opened a new MRI.

You start looking at the new long-term care facilities that are actually going out for RFPs throughout British Columbia. Health authorities are rolling out those announcements for new, state-of-the-art facilities — not the old ones that were built 35 or 40 years ago, which no longer meet the modern needs of our seniors who require that kind of care.

The biggest one, which is the Jim Pattison Pavilion — the Premier and I were there last Thursday — was a facility that was constructed in the late 1980s. That shell sat largely empty for the whole decade of the 1990s. If my memory serves me right, it has 456 new state-of-the-art beds, state-of-the-art technology. The latest in fibre optics is in those walls. You wind up with ceiling lifts over top of every single one of those 456 beds. I'll tell you, I've talked to a lot of medical-surgical nurses in this province, and they very much appreciate those overhead lifts because that makes a big difference in terms of the back injuries they experience and their ability to safely care for their patients in those facilities.

You know, when you start going around this province — and I've only started to tap that list…. Are we changing the way health care is delivered? You're darn right we're changing the way health care is delivered.

When I talk to nurses and doctors and other health professionals, they appreciate the fact that we are bringing health care in this province into the twenty-first century. It's new ways of delivering care, and it's not sort of trying to maintain the status quo that was there before. What I find when I talk to nurses and other health professionals is that they are excited about those changes. It means that they can actually practise the kind of care they would like to practise and that

they know a modern health care system is able to provide. From the feedback that I get, they are excited about those changes.

J. MacPhail: Thanks for that. I'm glad the minister's enjoying his job. However, I asked some very specific questions, and I'm not quite sure why the minister is avoiding answering them. I'm not sure why he's accusing me of being gloomy unless he accuses his own government of being a gloomy, health-cutting government. I'm just reiterating exactly what's happened. It's not made up. These are facts about all the closures I listed here.

What I'm trying to find out from the minister is not the cheerleading, and he's very good at the cheerleading. I'm actually trying to find out what is happening to the nurses in our province who have been dislocated and/or relocated. It's not a matter of me picking and choosing. This is exactly what has happened in the province. The government still faces a nursing shortage.

All I'm asking for him to give is not a rah-rah about what is happening at the Jim Pattison Pavilion. I want to know what's happening to the nurses in the Kootenay-Boundary area, where the government said they require Bill 29 to rip up the contracts in order to deliver better patient care and better utilize nursing resources.

I'm just asking questions. Where do these nurses go? I don't have the answers. It's not as though I'm setting the minister up for a trap. Perhaps he could just answer the question.

Hon. C. Hansen: The bottom line is that we still have a nursing shortage in British Columbia. It's not as bad as it was two years ago. We're actually making some really good progress in terms of recruiting more nurses and training more nurses — educating more nurses, I should say. I know there's some sensitivity that we often use the term "training" when it comes to our health professionals, but really we should refer to it as education.

We do have 538 more nurses last year alone who are practising in British Columbia. We have a great service in Health Match B.C., which I talked about earlier, that actually works with nurses who are dislocated to make sure they get matched up with career opportunities where there are those shortages.

As I indicated, I certainly hear examples about people who are very concerned because there is a certain number of nurses that get dislocated, and when you go back a couple of weeks later, you find out that virtually all of them have been hired. With the ones that haven't, it's because of some unique circumstances that they were not hired.

I recognize that we had very valuable, dedicated nurses in the Kimberley Hospital. I went through that hospital after I became minister, and I had the opportunity to talk to several of them on that occasion. I know how dedicated they are. The fact of the matter is that Kimberley is about half an hour away from Cranbrook, and we had two hospitals that were very close together, which were not being utilized to their potential because resources were spread too thin. We had to consolidate resources into one hospital so that you could get better care for people living in that region.

The fact that we had nurses who were living and working in Kimberley is not justification to continue to maintain a hospital in that community that would employ them. We've worked with those nurses, through Health Match B.C. and through the health authority, to try to make sure they were aware of other opportunities.

Do I have in front of me chapter and verse as to what happened to each and every one of those nurses, as to where they're working now? I'm afraid I don't have that, but if it's important to the member, I could endeavour to get that for her over the coming weeks.

J. MacPhail: I'm not quite sure why the minister is avoiding this question. I'm asking him, in his cheerleading way, to demonstrate the success of Bill 29. That's all. We debated in this Legislature a bill that ripped up the contract of nurses, and the minister claimed it was going to lead to more nurses in the system delivering better health care. All I'm asking is for a year-later update with specifics, and I'm getting generalities — absolute generalities.

I have no idea why the minister is doing that. I'm not trying to trap him. I'm just holding him to account for what he said was going to happen when they passed Bill 29 in 2002 — not the Bill 29 of this year, which changes the way forest workers do their work. I'm asking for specifics because I want to match that versus what the minister claimed was going to happen.

There used to be an organization called the Healthcare Labour Adjustment Agency, and the minister cancelled that, gutted that, stopped the funding. That agency used to actually keep track of the shifts in health care workers. That's gone now. How does the minister know that there are 500-odd more nurses in the system now than there were before?

That's question number one: what is his tracking mechanism? What is the nursing shortage that remains in '03-04? How has that changed from '02-03 both in number of RNs employed and the shortage, in absolute numbers and a percentage? How does that compare with '03-04?

Hon. C. Hansen: Just as a preface to this response, it is a bit frustrating, I must say, when the Leader of the Opposition asks broad questions and asks about six of them at a time and then somehow gets upset when I don't give her specific answers to some kind of broad questions. Maybe she doesn't feel she's asking broad questions, but they're certainly perceived that way.

To talk specifically about the impact of Bill 29…. She wants specifics. The specifics are that overtime is down significantly with regard to nursing. Health authorities, when it came to the fundamental changes that had to be made to make sure that patients got better

care in their communities…. We can consolidate some of these services. That meant that nursing staff had to be moved from one worksite to another worksite. In the past we had things that were as bizarre as the inability to move nurses from one floor of Children's Hospital to another floor of Children's Hospital, because those were considered different worksites.

Bill 29 allowed us to deal with some of those challenges. A lot of the new and exciting changes that we've been able to announce, which actually lead to better patient care, are as a direct result of that flexibility.

The member asked specifically about nursing vacancies. When we took office, there were 1,000 nurse vacancies in British Columbia. As of December 2002 there were 230 full-time and 150 part-time nurse vacancies in the province. I had indicated that there were 538 more nurses practising in British Columbia. She asked me the question: how do we know that? The answer is that the Health Employers Association of B.C. actually tracks the number of nurses working in the province, and their data shows in that calendar year there was an increase by that number.

J. MacPhail: I'm fine to ask questions individually. I was just trying to put my questions in a context that would actually elicit specifics rather than generalities.

So there are 230 full-time and 152 part-time vacancies or casual vacancies? Sorry. Could the minister repeat that, please?

Hon. C. Hansen: As of December 2002 there were 230 full-time and 150 part-time registered nurse vacancies in the province.

J. MacPhail: Okay. The minister says there were 1,000 vacancies in 2001, so that's good progress. That's good. What number of RN positions have been converted to LPN positions as a result of the 1,000 vacancies?

Hon. C. Hansen: I don't have a specific number with that. I guess what's happening across the province is that different health authorities are looking at opportunities to make the best use of available staff.

I know the member will recall when the B.C. Nurses Union engaged in an advertising campaign a couple of years back — a very effective one, I thought — where nurses were actually talking about how they were being asked to do so many non-nursing duties and that registered nurses have a scope of practice, where LPNs can practise about 60 percent of that scope of practice and a registered nurse can do 100 percent.

What I hear from a lot of registered nurses around the province is that they want to be able to practise in their unique scope of practice and allow other health care workers and health care professionals, including LPNs, to provide other services for those other areas that are not unique to registered nurses.

As health authorities are trying to look at the best mix of staff that they can utilize, they're trying to make sure that if it is a requirement that can be done by an LPN, they should be filling that position with an LPN and thereby freeing up our more highly trained registered nurses to do those particular functions that fall within the unique scope of practice of registered nurses.

I apologize to the member. I don't have a specific number. In fact, I'm not sure we could quickly get access to that. We could certainly come up with a number, although I don't have it at my fingertips, with regard to how many licensed practical nurses are practising in British Columbia compared to before.

I can give her current numbers on that. As of February 5, 2003, there were 29,775 registered nurses. There were 5,043 licensed practical nurses and 2,161 registered psychiatric nurses. What I don't have right at my fingertips is how that compares to a year prior, but if the member were interested, I could try to get that for her.

J. MacPhail: The minister must have that, because he could tell me how many vacancies have been filled since they took office. You can't calculate the filling of vacancies without knowing the overall total. You can't, so the minister must have those figures. I'd appreciate the figures for '02-03. No, let's go from '01-02 to '03-04, and that'll be the full two-year term of this government — the first two years. Let's have those same figures for what the complement was in '01-02. The only way the minister can make the claims he does is to understand what the shift has been from those years to now.

Frankly, I'm unwilling to come down on one side of the argument or the other, but what I am told is that of the 600 or so — and it's just a little under 600 vacancies that the minister claims have disappeared or been deleted for RNs — well over half of them have been converted to LPNs, particularly in the extended care area. So the shortage has been done not by employing RNs but by converting to a management practice of having LPNs do the job of what used to be done by RNs.

I will tell you, I don't come down on one side of the argument or the other. I only want the best patient care, and if there is a greater ability to utilize different skill levels and improve patient care, so be it. But it's important that we actually learn exactly what has happened and not just the rhetoric of "these vacancies have been filled."

So I repeat it: '01-02 — what was the complement of RNs, LPNs and psychiatric nurses, and how was that compared to '03-04? What discussions did the minister have amongst professions to make the change from utilizing RNs to LPNs?

Hon. C. Hansen: Well, first of all, as the member knows, each of these professions has a scope of practice, and so it is not a case of taking a position that a registered nurse should be filling and converting that to somebody who is less qualified. It is a case of recog-

nizing that registered nurses are qualified, they're licensed, and they are licensed to practise within a scope of practice that is set by the Registered Nurses Association of British Columbia.

Licensed practical nurses are health professionals who are licensed by the College of Licensed Practical Nurses of B.C., and they, too, have a scope of practice. So no one is asking them to practise outside of their scope of practice, but we have had cases where there are positions that perhaps may have been filled by two registered nurses. It's been determined that it could be filled by one registered nurse and one licensed practical nurse, each operating within their appropriate scope of practice.

So when the member talks about the number of vacancies, we actually keep track of the number of positions that are posted by the health authorities. It's a simple case of calculating the number of vacancies that are out there.

In the last year, I had indicated that the number of nursing positions in the year 2000 went up by 538. Part of that is an increase of — I believe the number is about 250, but I haven't got the exact number at my fingertips — the number of registered nurses in British Columbia, so there was in the last calendar year an increase in the number of registered nurses practising in the province.

I guess the other bit of information that I might be able to share with the member, which is on the same subject, is that the Registered Nurses Association of B.C. went out and did a survey of their graduating students in 1997, and what they determined was that only 24 percent of those nurses were able to get a full-time or permanent position and that the others were only able to get casual positions. When they went out and did the same survey last year of their graduating nurses, they found that 75 percent of the nurses graduating in British Columbia were able to get permanent positions.

One of the reasons for that was Bill 29, and the reason is that in the past, administrators — in order to keep the flexibility in how they could move workforce — just hired casual staff only, and there was a real reluctance to provide registered nurses with permanent jobs because they had no ability. They had no flexibility. Bill 29 gave them the flexibility that meant they could actually deploy their nursing staff where they were most needed in the health care system. As a direct result, they were able to shift that away from hiring casual staff to hiring permanent staff. Certainly, another thing I heard a lot from the registered nurses throughout the province is that there's a real concern about the casualization of nursing that we saw, and we have actually been able to effectively reverse that.

J. MacPhail: Okay, look, if the minister could just…. It's a great success story, so just give me the numbers. If 75 percent of the graduating class who stay in British Columbia are two, then it's not that great a statistic. But if it's 75 percent of the entire graduating class staying in British Columbia and getting full-time jobs — great.

The minister said there was an increase of 538 nurses from 2000, half of whom were RNs. Is that what he said?

Hon. C. Hansen: Yes. I don't have the breakdown of the 538, but approximately 50 percent of them are registered nurses, as a net increase in numbers in this province.

J. MacPhail: Who are the rest — LPNs? Okay, LPNs. That's all I'm asking. On April 1, 2001, how many RNs were there? How many LPNs were there? How many psych nurses were there? How many were there on April 1, 2003? Then we can talk about it. That's all.

What I would also like to know, then, is: how did that shift come? Did the minister sit down with the professional groups representing the RNs and the LPNs and have agreement on the shift in the scope of practice?

Hon. C. Hansen: There has been no shift in the scope of practice. The scope of practice is not set by government. The scope of practice is basically set up. It's been there for years, and it hasn't changed. What each of the health facilities — the employers of LPNs, registered nurses and registered psychiatric nurses — is trying to determine is who the appropriate professional is that can fit into a particular position. If that position can be properly and safely filled with somebody who is a licensed practical nurse, and it's entirely within his or her scope of practice, then they will fill that with that position.

There are other times when it makes more sense to use registered nurses, because they have a broader scope of practice and they can work across a broader range. Those are management decisions that are made and certainly not something we dictate to them.

The member was asking for specific numbers for April 2001. The best source of that is the Registered Nurses Association of British Columbia. I know they have some of that posted on their website. I'm not sure whether it's specifically for that month, but I will try to track down those numbers for her. I will make sure she gets them as soon as I can get them, which will be over the next couple of days or so.

J. MacPhail: Well, we'll still be at this when we get back after the next week. LPNs — he'll do the same for me, I assume, on that and on psych nurses. Okay, let me put my question this way. The minister said that half of the vacancies for RNs have been filled with an increase of RNs and the other half with LPNs — the nursing vacancy. All right, fair enough.

I think the public — and I take no pride in this — actually believe that when we're talking about a nursing vacancy, it's an RN vacancy. In fact, that is what was the vacancy…. The minister said there was a 1,000-

person vacancy in the year 2000, I think. It was about RNs that we were talking.

Again, I take no position on the use of LPNs or RNs. I only take a position on delivering the best health care. So when the minister said there's been no change in scope of practice, fair enough.

What discussions occurred between the two professions that reallocated positions from being filled by an RN to an LPN or vice versa? As the minister pointed out, several years ago there was a fairly significant campaign talking about who should deliver what services in the nursing field. When the minister was in opposition, he raised those issues in this chamber. Fair enough. But I assume it wasn't done by fiat.

Hon. C. Hansen: Just to give the member a little bit of the history. I guess the context when we formed government is that the wage rates, the wage and benefit costs, for registered nurses was very comparable to that of licensed practical nurses. There really wasn't much differential between the two. Licensed practical nurses during the 1990s had seen some very significant increases in their wages and benefits. We wound up with a situation where managers in the health care system, if they had a choice between hiring a registered nurse or an LPN, would hire the registered nurse because the registered nurse had a broader scope of practice.

But what they were asking that registered nurse to do was not practise in the area that was unique to their scope of practice. So shortly after forming government, we provided nurses in this province with a 22.6 percent increase in their wages and benefits. The net result of that was that there now was a differential so that good managers in the health care system, in order to get the best value for the health dollars, wanted to make sure they used the appropriate nursing professional in the appropriate place.

So it's not a case of saying that somehow we're going to take these nurse vacancies and transform them into something else. It's a case of saying: how do we use nurses in the most appropriate spot? It was not by fiat, as the member said; it was basically made by managers who were trying to provide the best possible patient care for patients.

If you go into a hospital and you ask a patient whether they value the care they got by a licensed practical nurse any less than the care they got from a registered nurse, I think they would probably tell you that they all provide excellent care. I hear nothing but praise for the work that our nursing professionals provide.

I do have some stats for you with regard to numbers. See if I can make sense of this while I'm on my feet here. In December of 2002 compared to December of 2001 — I know that's not the specific month the member was asking for — there was an increase of 238 practising registered nurses in British Columbia. There was an increase in the number of licensed practical nurses in British Columbia of 316, and there was actually a decline of 16 registered psychiatric nurses in that calendar year.

J. MacPhail: Okay, fair enough. I'm actually going to leave the discussion there.

I just find it interesting that when you actually probe the government on what's behind the claims, there's a broader story, a more complex story that emerges. I've sat in this chamber for two years now listening to Liberal MLAs lob softballs across to the Minister of Health Services and the Minister of Health Planning about elimination of the nursing shortage. None of these specifics were ever given about how there's been a change in who does what job — none. These numbers are brand-new as well.

I appreciate the minister, upon some fairly heavy probing, giving me the real facts. It will be interesting to see, the next time some Liberal backbencher gets up and lobs a question about the nursing shortage, whether they will also ask a question about the shift in who does what nursing. In the 1990s the minister is quite right that the wage differential between an LPN and an RN was plateaued by negotiations at 75 percent. I make no comment about whether I agree with that or not. Yes, an LPN's wage is 75 percent of an RN's wage.

J. MacPhail: Well, feel free…. I'll just finish my comments, and he can tell me where I'm wrong.

The issue of delivery of nursing care is actually more complex than just the wage rate. There are staffing levels. There is the acuity of the patient as well. What other health care professionals are around to administer medication, for instance?

I may be wrong, but I recall that the Ministry of Health actually had a working group of the professional body representing LPNs, the professional body representing the RNs and Health ministry professionals trying to work on the issue of what delivers the best patient care in the most cost-effective way and properly utilizing the level of training of the various professions in nursing. Does that exist?

Hon. C. Hansen: No, that body does not still exist — or that process. We now have in place a chief nursing officer for the province, Anne Sutherland Boal. In each of the health authorities they either have or are in the process of putting in place a chief nurse executive to make sure those nursing issues are addressed at the highest level, whether it's at the executive level within the ministry or at the executive level within the various health authorities.

I could also point out to the member that the Canadian Nursing Advisory Committee — CNAC as it is often referred to — in their report that came out in August of 2002…. One of the things that they identified as a priority for British Columbia was to clarify the scope of practice for maximum utilization of all nursing staff,

J. MacPhail: The changes that are taken by converting positions previously filled by RNs and now filled by LPNs — is it considered a management decision, then, to make that change?

Hon. C. Hansen: I think it's inappropriate for the member to say that there is a position that is being converted. We're not talking about filling positions here. We're talking about providing good, effective and safe patient care, and that's what it's about.

It's not a case of saying: "Let's fill all of the slots with a name of an employee." It's a case of saying: "How do we meet the needs of patients on the wards or in the facilities where they're requiring care?" It's up to the management working with the nursing supervisors on the floor to determine what the appropriate mix is between registered nurses, licensed practical nurses and other staff that would be there to assist in the provision of that clinical care.

J. MacPhail: Okay. Maybe I'll just put the Minister for Long Term Care on notice that I'll be discussing this with her, because there were conscious decisions in long-term care to change the complement in institutions from RN to LPN. There were conscious decisions. It wasn't like the minister describes at all. It was a budget exercise, and I want to make sure that the budget exercise took into account patient care.

There was a conscious management decision to say: "That job was an RN before, and we're going to make it an LPN now." The patients haven't changed. The residents haven't changed. Their level of care hasn't changed. It was a management decision change to say what kind of nurse was assigned to look after those patients.

I will read just some of the examples of where that occurred. The Penticton Retirement Centre is being changed in that area. In fact, this document says, basically, that's the philosophy of all the conversions of acute care beds to long-term care beds. That's being done in virtually every single region. I'll have that discussion with the Minister for Long Term Care when she and I get a chance to discuss the issues.

I want to raise a concern that came in over the supper hour as people were watching us talk about obstetrics. The matter I raised was the Prince George situation and the provision of obstetric services. In the course of this, we also talked about, in another area, the shift in services in the Trail area and the centralization of services amongst Trail, Castlegar and Nelson.

A health care worker called in and said there is an ongoing obstetrician shortage in that area as a result of the regionalization of services and that, indeed, it has not yet been resolved. I'm wondering whether the minister could just…. They asked me specifically to ask that question, because they thought the matter…. To them, it appeared that it had been resolved provincewide.

Hon. C. Hansen: I'll go back to the start of her question, first of all, where she was talking about changes in nursing staffing at long-term care facilities in the province. She's absolutely right. There are long-term care facilities that in the past were predominantly staffed by registered nurses, and some of those facilities are finding that they can…. Well, the care that was being provided in the past by those registered nurses was not within the unique scope of practice of a registered nurse but, in fact, could be provided by licensed practical nurses.

Part of it is freeing up registered nurses to be able to work in areas that are unique to their scope of practice, and the other is to try to get the most effective value for the tax dollars by employing the right health professional in the right circumstance. So she's right, but there is no compromise to patient care, because the scope of practice of licensed practical nurses in those situations is entirely appropriate for the care that's being provided in those facilities.

She then jumped to the Kootenay-Boundary area, where she was talking about obstetrical coverage, and she said the shortage of obstetrical care is as a result of the changes we made. That's not the case. There has been a shortage of obstetrical care, and if you look around the province, we're actually starting to deal with some of the shortages by ensuring that we locate services where they can most appropriately be provided.

In the case of Nelson, there has been only one obstetrician practising in Nelson for the last 20 years. That's not sustainable when you wind up with the pressures that are put on a sole practitioner, a sole specialist, in a small community where demands are put on that individual 24 hours a day, seven days a week. We have to make sure we take advantage of ensuring safe patient care on a consistent basis 365 days a year.

We are certainly making sure that GPs are properly trained in obstetrics. We are also trying to recruit midwives. There's a new school of midwifery that is going to be opening in this province to train more midwives for the future to provide obstetrical care. We are also maintaining obstetrical care at the appropriate level in those smaller communities.

What often happens is that when you get into more complex challenges in obstetrical care, it is important not only to have a properly trained obstetrician available but also to have the technology and the support of a properly equipped regional hospital to care for those more complex deliveries.

There was a review done in Nelson that was undertaken by the interior health authority by the B.C. reproductive care program. They went in and looked exactly at the changes that were proposed for Nelson. They made some recommendations to ensure there would be a continuity of safe obstetrical care available to residents of the Nelson area, and the interior health authority is now in the process of implementing every one of the recommendations that were made.

Hon. C. Hansen: Yes. Some of the recommendations that were made actually involve some renovations to the hospital in Nelson, and the health authority is now looking at that. It's a very old hospital that really has not been adequately maintained over the last number of decades, so doing the renovations that are necessary to meet the recommendations of the reproductive care review are not as simple as just getting the contractors in there tomorrow. They certainly are moving with it as quickly as they possibly can to make sure those services are provided in a continuous and safe manner.

J. MacPhail: Perhaps the minister — for those who are watching — can just tell us what the provincial reproductive care program, which is an independent body…. It assesses the well-being of perinatal care in the province. What is their latest report?

Hon. C. Hansen: I'm assuming that the member is referring to the specific report that was done by the B.C. reproductive care program vis-à-vis Nelson and East Kootenay — or just generally?

Hon. C. Hansen: That's something I don't have at my fingertips. I can endeavour to get a copy for the member. The B.C. reproductive care program is not an agency of my ministry. They are independent. Certainly, we work with them and have a lot of respect for the work they do. I can endeavour to get a copy of the report for the member. It may be on the website. I'm just not sure.

J. MacPhail: Yes, I'd appreciate that — or just even the website would be fine. I'll then be able to give that to people who call in and ask me to raise questions about obstetrics in this province.

To conclude tonight on the issue of RNs or nursing in the province, what is the working relationship forum between nurses and the government? One of the issues that I recall arising out of Bill 29 was the disbandment — declaring illegal — work groups that were talking about issues around nursing. Because there were contractual arrangements….

J. MacPhail: Yes. I know how busy the minister is, so I don't hold any spite at all for him not remembering this.

One of the issues that arose out of Bill 29 was outlawing the consultation committee that involved working nurses and the employer on resolving matters such as nursing shortages, allocation for proper resources, etc. We raised it over and over again in the debate — and it wasn't challenged — that the government was outlawing the very bodies, the very working groups that would lead to resolving these matters. So what have they been replaced with?

Hon. C. Hansen: There are now actually three different working groups that are looking at nursing issues within the health care sector. There is the Nursing Advisory Committee of British Columbia, which is chaired by Anne Sutherland Boal, who is the chief nursing officer for the province. It includes the various professional bodies involved in nursing as well as the various unions involved in nursing.

There is also a Nursing Human Resource Working Group that is made up of and includes representation from the unions. It includes representation from educators as well as professional bodies. There are also, as I mentioned earlier, the chief nursing officers in the province who get together on a regular basis to make sure that nursing issues are addressed at the executive levels throughout the various health authorities and at the Ministry of Health Services itself.

J. MacPhail: What would be the recent items — in the last six months — of discussion in those bodies?

Hon. C. Hansen: Okay. These are busy organizations. This is just the start of what would be a very, very long list, but here are just some of the ones that quickly came up. They certainly have, on an ongoing basis, been reviewing the results of the nursing strategy rollout that was first rolled out in August of 2001. Phase two was rolled out, of course, last year. They've looked at the recommendations of the Canadian Nursing Advisory Committee — CNAC — as I mentioned earlier. They have prioritized the top ten recommendations as they pertain to British Columbia.

They have also done a review of the graduate nurse survey, which I was talking about earlier. They have been working with the College of Licensed Practical Nurses as well as the College of Registered Psychiatric Nurses to replicate that survey so they can get feedback from the experiences that graduating nurses have gone through when it comes to finding work opportunities.

They have been addressing the issue of improvements to the loan forgiveness program in the province to make sure that it meets the needs of students. They've been receiving feedback from the visitations to the various nursing schools at the universities and colleges throughout the province to look at issues that our future nurses are facing to ensure they find an environment in British Columbia that's attractive for them so they'll stay here. That's a quick snapshot of some of the agenda items, but I'm sure if we had a lot more time, we could add a lot more to that as well.

J. MacPhail: Where does one discuss in the nursing profession the issues of occupational health and safety? Is that at the local hospital level?

Hon. C. Hansen: I guess to answer the member's specific question as to where occupational health and safety issues get addressed, certainly they have been addressed by the Nursing Advisory Committee. Workplace safety is not something that is given off to one body to worry about so everybody else doesn't have to. It's an integral part of all of the operations of the health authorities.

Now, I guess one of the big advantages of having six health authorities rather than 52 is that each of those health authorities is of a size that they can take on their obligations to ensure that health and safety is maintained not just for nurses but, indeed, for all health professionals.

There is the OHSA, which is the Occupational Health and Safety Agency — is it? I've forgotten what the A stands for. That continues to function and give great advice and input to the health authorities. There are return-to-work programs that have been developed through some of these bodies, working with the WCB, to get nurses who have been on leave with workplace injuries back into the workforce.

One of the other big initiatives we put in place is the ceiling lift program, which was part of the original nursing strategy, and we continue to roll that out. It's certainly an integral part of any of the new facilities we're putting in place. As I mentioned earlier, in the new Jim Pattison Pavilion every single one of those 456 beds have ceiling lifts above them.

J. MacPhail: I probably should have been more specific in my question. I was interested in the aspect of the return-to-work program. I recall the discussion across Canada — well, across North America — that in facing a nursing shortage, one of the issues that needed to be addressed was prevention of injuries that particularly harmed nurses and then an early return to work. That was the context in which I asked, and thank you for the answer. Perhaps I can have an update on that aspect of health and safety for nurses. Return to work — is the time shortened? Are injuries down or up or what?

Hon. C. Hansen: I can report to the member — I'll get to her specific question in a second — that one of the good-news pieces that's coming out is that long-term disability claims in nursing are actually down 50 percent, which is really good news for anybody concerned about workplace injury. That's just over a one-year period.

Just to address the specific question around return to work for nurses, there is a program that we first announced in 2001 but got rolled out in 2002. It's a fund of $1.1 million to provide salaries, benefits and education for one year for nurses on WCB or long-term disability to re-enter the workforce in positions building on their knowledge and skills while accommodating their health care limitations. There were 27 nurses that returned to work in four health authorities as a direct result of that initiative.

Hon. C. Hansen: This is the only program of its type that we're aware of in Canada, so I can't compare it to any other jurisdiction. One of the things that does come out of the CNAC report is that workplace injury and long-term disability are a challenge for all provinces in Canada. I think that was certainly something highlighted by the CNAC report.

I guess our big challenge is, first of all, to reduce workplace injuries in the first place. We're having some success with that. Certainly, our ceiling lift program is going to continue and expand. Workplace education is going to continue to make sure they get the information they need to make sure that workplace injuries are reduced. I can't give you any other information about return-to-work programs in other provinces, other than to say that I know ours is unique, and we're certainly encouraged by its initial success.

J. MacPhail: Just for the benefit of the minister's staff, I'm going to go to midwifery next.

J. MacPhail: Sorry. In terms of overall compensation for RNs, where are we now in the pan-Canadian spectrum?

Hon. C. Hansen: In terms of overall remuneration, it's fair to say that we are either No. 1 or No. 2, depending on what it is you look at. I know there are those who argue that our remuneration package for nurses is the most generous of any province in Canada. I know there are others who will argue that no, they can find examples that might indicate we're No. 2. I think there seems to be the consensus that we're either No. 1 or No. 2, depending on what you look at.

The reason it's difficult to compare is that you can compare specific hourly wage rates for nurses that have been in the system one year, five years or ten years, but then you also have to compare the whole benefit package that is there as well. Sometimes that's difficult, because you're comparing apples and oranges.

J. MacPhail: I'm going to move to midwifery. Could the minister please give me a status update on the establishment of the training program?

Hon. C. Hansen: I don't have a lot of detail at my fingertips regarding the midwifery program at UBC. It does fall under the Ministry of Advanced Education. Obviously, we take a big interest in it. I think part of the future of making sure that we can provide obstetrical care in communities throughout British Columbia…. Part of that answer for the future is to make sure that we have midwives practising in those various communities.

The program at UBC was started last September. It is located in the faculty of medicine, specifically under the family practice part of the faculty of medicine. We believe there are 20 seats in that program, although I'm not 100 percent certain of that.

J. MacPhail: Are we the second province to have midwifery training, or are there others that have come on board?

Does the minister have statistics on the number of registered midwives? And any statistics that he has on caseload and the acceptance of it, like: are there wait lists? Are there midwives in every area of the province now?

Hon. C. Hansen: Some parts of the answer to the member's question sort of fall under Health Planning, but I'm going to endeavour to answer as much of it as I can. I'm told that there are about 70 practising midwives in British Columbia. They are not distributed evenly around the province. They're still largely in urban parts of British Columbia. There are some regional parts of the province that could benefit greatly by midwives, although we have not been able to attract midwives to those particular areas at this point. Hopefully, once new graduates start coming out of the UBC program, we'll be able to address some of those needs.

There are new medical staff bylaws that are being put in place throughout the province in our hospitals. One of the objectives of those new bylaws is to make sure that midwives are fully integrated into the medical staff at those facilities and recognized as full medical professionals within our hospitals.

One other piece of information the member may find interesting is that we have just recently negotiated a new contract with the Midwives Association of B.C. which provides them, I believe, with the first increase in fees they've had since the midwifery program was first established in British Columbia, which I think was about 1997.

What's the relationship between midwives…? I'm not asking the minister…. I'm talking about the professional discussions between midwives and physicians through their professional bodies. There were tensions, and I assumed they would be worked out, but I have no update on that.

Hon. C. Hansen: I think there has been a tremendous change in attitudes towards midwives among other health professionals in the province. I think, clearly, they have demonstrated that they are a valuable part of the health care team in the community. In fact, I can think back on some of the feedback I got when I first became Health critic — I guess that's four and a half years ago or so — and there was a certain amount of lack of support by some health professionals.

What I've found lately is that that has changed considerably. Obviously, there are still pockets, and there are still individuals resistant to change, but I think it has been huge in terms of the increasing support and recognition of the very important role that midwives play in the province.

J. MacPhail: Mr. Chair, I'll give you the order in which I'm going to be discussing things. Should I be discussing palliative care with the Minister for Long Term Care?

J. MacPhail: All right, I'll do that. That's fine, and we've still got that to go.

Safe injection sites and chronic disease management are my next topics. We had a bit of a discussion…. Oh, maybe I'm wrong on this. Were safe injection sites referred to the Minister of State for Mental Health?

J. MacPhail: Yes, okay. I'll do palliative care with the Minister of State for Long Term Care, and we can discuss safe injection sites now.

The question I asked — and the Minister of Health Planning did give me some answer to it — was: what role is the provincial government or the health authorities playing in carrying out what seems to be a given, and that is that there will be a legal safe injection site or sites in partnership with the federal government and the city of Vancouver at the start? What role is the provincial Ministry of Health Services or the Vancouver coastal health authority playing in ensuring it works properly?

Hon. C. Hansen: Just to explain the roles, this is an area that the Minister of State for Mental Health and I are obviously working closely together on, because it falls under his responsibility in terms of his role, but it also falls under my responsibility in terms of the relationship with the individual health authorities. So it has been very much a joint effort.

There is currently a steering committee in place that is led by Dr. Perry Kendall, who is the provincial health officer, who is looking at that issue. It has representation on that from the health authorities. There's also a deputy ministers' summit group that includes the mayor of Vancouver.

I guess the other thing is that we have identified $800,000…. Is it $800,000 or $1.2 million? It's $1.2 million to be available for capital costs that may be associated with supervised injection sites in the province.

I guess the broader context of where we're at with this is that this is an initiative that was undertaken by

the federal government to find a legal framework for trials of supervised injection sites in various locations across Canada. There are applications that have gone in to the federal government which they are looking at, and it's only once the federal government approves a proposal in the context of these trials that we can have a legal facility and a legally sanctioned health care service.

Once there is a legally sanctioned health care service, as identified by the federal government, then we as a province have a role to play in ensuring that there is safe implementation of that federal initiative. Our health authorities are certainly prepared to be partners in that. We have identified where some of the capital moneys could come from with regard to a facility. What is not yet identified is where operating dollars would come from to make sure that this is sustainable over the time frame of the trial.

J. MacPhail: I understand it's the responsibility of the Vancouver coastal health authority to manage this issue from an operational point of view. Are the policy matters associated with this being addressed through the Vancouver agreement, or is there government-to-government discussion around the legalities of this between the federal government and the provincial government?

Hon. C. Hansen: There have been lots of ongoing discussions, primarily between the provincial health officer and the medical health officer at Vancouver coastal, with Health Canada around the whole legal framework that the federal government is proposing for this initiative. There has also been a fair amount of discussion at the official level from officials in the Ministry of Health Services itself. That's an ongoing thing.

With regard to the Vancouver agreement, this initiative would fit under that broad umbrella of the Vancouver agreement. The Vancouver agreement, in their strategic plan for the downtown east side, is looking at the four pillars. One of those four pillars is, of course, harm reduction, and the supervised injection sites would certainly fit into that pillar, which falls under that broad umbrella of the Vancouver agreement.

J. MacPhail: So it is this government's position that they remain committed to the four pillars approach — is it?

Hon. C. Hansen: There are certainly initiatives in the four pillars approach that call upon action by the Ministry of Health Services. We're certainly trying to do our part to make sure the needs of the downtown east side of Vancouver are met. We're working closely with other agencies. The lead ministry for the Vancouver agreement is the Ministry of Community, Aboriginal and Women's Services, and we certainly have an ongoing and close relationship with them to try to make sure we're all working together and pulling in the same direction.

J. MacPhail: Has the minister any idea, through the Vancouver coastal health authority, of time lines?

Hon. C. Hansen: The ball is in the federal government's court right now when it comes to reviewing the applications, and we have not been given any indication as to when they're going to complete that process. They did initially indicate that it would be a 60-day review. We haven't had feedback to indicate whether or not they're going to be able to meet that deadline. At this point, there is a certain amount of uncertainty with regard to the time line.

J. MacPhail: Is harm reduction treatment a topic of federal-provincial health services meetings?

Hon. C. Hansen: It is on the agendas of the meetings of the Advisory Committee on Population Health. Actually, our provincial health officer, Dr. Perry Kendall, is at one of those meetings this week. It's not just this meeting, but it has been in other discussions.

I know that at the very first meeting of federal-provincial health ministers that I attended in September 2001, the whole issue of injection drug use and the need for a national drug strategy, including harm reduction, was part of a presentation that Dr. Perry Kendall made to all of the provincial health ministers at that time.

J. MacPhail: The last question in this area before moving to chronic disease management is: are there other jurisdictions considering safe injection sites? I know that Montreal was on a list, but is it actually happening to the same extent as the progress in Vancouver? If not Montreal, are there other areas?

Hon. C. Hansen: We certainly think it would be desirable to have other centres across Canada participating in this trial that the federal government is initiating, because I think that allows us to give some comparative data from the evaluations as to whether there is success or not. There has been rumour of other centres in Canada looking at this, but to the best of our knowledge there are no other applications that have gone in to Health Canada.

I have written to Anne McLellan urging her to encourage that aspect of it. We think that's an important part, because while we've got international experience around supervised injection sites, it's hard to relate that to a Canadian context with certainty that it's in fact going to achieve the results that some people think it will. By having that comparison across Canada with other centres, it would certainly enhance our ability to evaluate the success or otherwise of this project.

J. MacPhail: On to chronic disease management. I'm wondering whether the minister could update the House on diabetes chronic disease management. I put this in the context of a statistic that I became aware of — and maybe it's the study out of UBC that was done

within the last year since we have had a discussion around estimates — that shows that 30 percent of health care dollars go to 5 percent of the population. The majority of that is around chronic disease management. It is an issue of particular concern, one that has been discussed over the last several years. I'd like to start with diabetes chronic disease management.

Hon. C. Hansen: The member mentioned the 5 percent of the population that results in 30 percent of the health care expenditures in the province. That's not specifically around chronic disease, because those suffering from chronic illness would certainly be much greater than 5 percent of the population. That number is a result of some work that's been done in the province looking at those with multiple conditions who are requiring very complex care and who may be finding that care from several different providers without, really, any integration of the care they get.

We've identified that there are about 126,000 British Columbians that fit the criteria of having multiple conditions. It's those individuals that consume about a third of the health care budget, about a third of the hospital visits and about a third of the doctor's visits in the province, so it really has a huge impact. We're looking at strategies, and it's actually set out in our service plan — our initial stages of trying to develop strategies aimed at those individuals and providing them with better care which would also be more cost-effective care. The chronic disease management program could be part of the care that would be provided to those individuals, but it's broader than that as well.

In terms of the chronic disease management strategy for diabetes specifically, I can give you some of the initiatives that are currently underway. The strategy was rolled out in October of last year and is set out on our website. It was put together after some fairly extensive consultations with health care providers and associations and patients themselves. The title is Improving Chronic Disease Management: A Compelling Business Case for Diabetes. Diabetes Care: An Evidence-Based Guideline on Optimal Diabetes Care was released by the Medical Services Commission. A Snapshot of Diabetes Care in British Columbia provides annual information on performance across the primary care system in meeting these standards.

There is a comprehensive chronic disease management website that's been put in place, providing patients and practitioners with information to support self-management and quality care. There is also work been done with the NurseLine, the B.C. HealthGuide program and the Dial-a-Dietician program, which provides information and advice to support self-management by British Columbians who are facing diabetes challenges.

Hon. C. Hansen: At the physician level, they get reports that come back specific to their patients via a secure website that ensures that the privacy is protected. I guess, at a health authority level, they are receiving regular reports in terms of the current level of care in each of their health authorities as they provide to these sectors. Then there are reports that have been developed on patterns of practice for diabetes and congestive heart failure, which is the other area where some progress has been made already.

These reports have been distributed widely and published on the ministry's chronic disease management websites. Reports on asthma, chronic kidney disease, depression and hypertension will be developed within the next 12 months.

J. MacPhail: In the area of diabetes, at the last breakfast conducted for MLAs by the Canadian Diabetes Association, B.C. branch, they raised concerns about changes to Pharmacare with the delisting of testing strips for diabetics and also the elimination of podiatry coverage from the Medical Services Plan. What feedback has the minister had in terms of the consequences, or lack thereof, of those changes in terms of diabetes management?

Hon. C. Hansen: First of all, we did not delist testing strips. Actually, the only change that took place is that we now recognize testing strips as a product that is covered under Pharmacare, which is, I believe, the first non-chemical product that was covered under the Pharmacare program. As a result, it actually saw a reduction in cost for testing strips compared to what was there previously.

In terms of podiatry, we did make some changes. We've actually enhanced the access to podiatry for individuals on premium assistance in that we've been able to increase the amount that would be funded by the provincial taxpayer being paid to podiatrists. As a result of that, there are many podiatrists who have been able to eliminate their co-pay for lower-income individuals who rely on podiatry services.

Generally speaking, you know, when you ask…. There are lots of people that focus on all of the inputs of service, and our focus under the whole chronic disease management strategy is to focus on outcomes. We are tracking how diabetics in the province get access to care — the outcomes they show as a result of more appropriate or better management of their illness so that they can stay less reliant on the medical supports and more reliant on the other things that will help keep them healthy.

J. MacPhail: Is the minister somehow saying that under this government, the coverage for diabetics has improved under Pharmacare as it relates to testing strips? I mean, I didn't make this up. I was at a breakfast with a ton of Liberal MLAs where we were berated for the fact that diabetics who used to get their strips covered now have to pay a dollar a strip for them and that their podiatry, which is a key element of diabetic treatment, is costing them a fortune. I mean, I was quite taken aback. And their costs have gone up, up, up.

Hon. C. Hansen: The changes to how testing strips were covered actually happened…. If my memory serves me right, it would have been in the fall of 2001. What happened previous to that is diabetes testing strips were treated basically as any other product that would be sold by a pharmacist outside of their prescriptions, and there would be a markup and a retail price. The change that we made when we actually covered it under the Pharmacare program was that the pharmacists would be entitled to their wholesale cost plus a markup. I believe it's a 7 percent markup. Then they're entitled to their dispensing fee. What happens is that the individual then gets the coverage under the Pharmacare program as it would apply to a chemical prescription in the same way. It would be subject to a deductible, a co-pay, and once they hit their ceiling for all of their Pharmacare needs, regardless of whether they're testing strips or other medications, they would max out and the Pharmacare program would then cover 100 percent of their costs for the balance of that calendar year.

J. MacPhail: Well, I'll certainly go back and revisit it with the Canadian Diabetes Association, who were claiming that there were huge increased costs because of the change this government brought in. There were 20 MLAs sitting there, of whom I was one, and they didn't challenge it.

J. MacPhail: Yeah, you were there. They were complaining about the increased costs and the lack of podiatry. In fact, there was one impassioned speech from a young woman who was devastated by it.

Who monitors these changes, though, in terms of costs? You know, just the same way that we talked about changes in Pharmacare being monitored as it affects hospital admissions, etc., is someone monitoring diabetes disease management in terms of these changes?

Hon. C. Hansen: The short answer is yes, that is being monitored. It's being monitored at the patient level with the feedback going to the individual physicians, as I mentioned. That data is being looked at on a comprehensive basis. There are regular reports. I guess our goal is to make sure that through the chronic disease management strategy, we are actually able to demonstrate that individuals with diabetes in this province are getting better access to care and are getting better outcomes and more stability in the lives they're able to lead.

Hon. C. Hansen: There is currently a lot of data on the ministry's chronic disease management website. Also, the reports that go to physicians are ongoing. They are secure, and they need passwords in order to access. They're updated on a regular basis. The website itself, that data, will be updated at least on an annual basis.

I guess the other piece of information that was just handed to me is A Snapshot of Diabetes Care in British Columbia, which is an annual publication. It provides information on performance across the primary care system in meeting the standards that are set out in the chronic disease management strategy.

J. MacPhail: I'm going to ask next about arthritis chronic disease management, but first of all, I want to ask the minister whether there's any aspect of chronic disease management generally that has an ethnic sensitivity to it. First of all, we know that first nations — aboriginals — have a much higher level of diabetes than us, but that's not ethnic. I actually do know that the government is doing work with first nations around chronic disease management of diabetes. I'm thinking more along the lines…. My local clinic told me that there's a higher incidence of diabetes in the Asian community. I'm just wondering whether there's a culturally sensitive delivery of any of these programs.

Hon. C. Hansen: It is true that diabetes is more prevalent among the Asian community. In fact, I was at a fundraising dinner — I'm trying to think how long ago that was; it seems like a couple of weeks ago — which was an excellent fundraiser put on by the Canadian Diabetes Association that actually focused in on the fact that the Asian community does have a higher prevalence.

In terms of responding to that, the Vancouver coastal health authority, which has the largest Asian community of any of the health authorities in British Columbia, has engaged experts in multicultural health and is working with those various communities to make sure that there are information and communications pieces appropriate to those various groups within our communities. The other health authorities, obviously, who also have South Asian populations are certainly learning from that experience.

It is an area that we recognize. We hope to be able to do more work in providing health care that is sensitive and informative and education programs that are informative to various ethnic communities in the province.

J. MacPhail: Just before I move to arthritis, what is the overall budget of the government for chronic disease management?

Hon. C. Hansen: I guess the quick answer is that there is a huge percentage of our overall health budget that goes to chronic disease management. I can tell you what we have specifically identified for the rollout of these chronic disease management programs, and that's $11.2 million in this coming year.

That does not include things like the physician visits. It doesn't include the aspect of Pharmacare benefits

— the Pharmacare budget, for example — that goes to chronic disease management. There's a big chunk of the primary care initiatives that would be focused around chronic disease management. But if the member means the specific budget for the rollout of these chronic disease management programs, it's $11.2 million.

J. MacPhail: I think I'll reserve my comments around chronic disease management of depression for the Minister of State for Mental Health.

Arthritis. I didn't notice that there was a specific program for arthritis, or maybe I just missed it.

Hon. C. Hansen: I think I did read out some of the other ones. I may have overlooked that inadvertently. Let me just find this here: "Target populations for this initiative are people living with a single or a combination of chronic diseases — namely, diabetes, congestive heart failure, hypertension, depression, asthma, chronic kidney disease and arthritis."

J. MacPhail: Okay. We've received some questions that the arthritis consumer experts want us to raise, so I'll put them on the record and seek answers from the minister. I certainly claim no expertise in this area whatsoever.

They raise three issues in terms of the chronic disease management for arthritis. The first is surgical wait-lists — that there are people waiting for an orthopedic consult and then even longer for joint replacement surgery. That is of specific concern to the arthritis community.

I'm wondering whether the…. Oh, let me just finish this, then. The wait-list issue represents for these folks…. They go on to cost the system much more because their condition worsens and may require greater post-surgical care than if they had access to surgical assessment and surgery when it was actually needed. That's point No. 1.

Point No. 2 is their suggestion that there is a drug — I'm sure the minister or his staff is familiar with this — that seniors and people at high risk of developing stomach ulcers and stomach bleeding have been denied Pharmacare access to: a class of medications called coxibs. It's the most cost-effective — well, this is what they say — anti-inflammatory treatment since they became available in 2001 in Canada.

This group of people talks about seniors being prone to arthritis. Then there are also non-seniors who are prone to arthritis as well. The group has been advising the Ministry of Health and Pharmacare to develop appropriate access guidelines but report no progress.

Then their third point was: who is the ministry working with to talk about chronic disease management as it relates to the real health care consumers in this process?

Hon. C. Hansen: Just to try to address a couple of the issues the member raised. First of all, there is a working group now that is actively working towards developing the chronic disease management strategy for arthritis. Arthritis Society, for example, is very much a part of that, as are some of the practitioners who specialize in that area.

The member raised the subject of surgical wait-lists. I know that is an area of concern to those with arthritis that are in need of joint replacements or other orthopedic surgeries. I guess this is part of the whole wait-list challenge that we have, but let me just point out that the number of hip and knee surgeries performed in this last fiscal year was higher than ever. The number of hip replacement surgeries increased by 14 percent over last year, and the number of knee replacement surgeries increased by 12 percent.

As the member knows, even though we increase the number of surgeries, we still have real challenges. There is work that has been done by the Western Canada Waiting List Project, which has been ongoing for a number of years now. Actually, I think the member may have been the Health minister when that project was initiated. It is now, I am told, coming to completion, where they're soon to be rolling out protocols around when a person is in need of surgery.

One of the big challenges we've had is that different physicians have different standards as to when they would put their patient on a wait-list. We want to bring some standards to that to ensure that people get access to care on an equitable and appropriate basis regardless of where they are in the province. That wait-list project is to report out, and I think it will help give us better guidelines to ensure that the people who are most in need of care get access to care in a timely fashion.

The final thing that she referred to was the coxibs, or the COX-2 inhibitors. I think the medication she may be referring to is called Celebrex. That is one that has been reviewed on a couple of occasions by the ministry over the last number of years. There have been some real controversies around that particular medication in terms of side effects that had not been previously fully understood or appreciated. That is currently being reviewed by the ministry, although it has not yet been added to the formulary for Pharmacare.

J. MacPhail: I'm just looking at the notes. Here it is. I guess the brand name is Celebrex.

Is it that this group…? I have no idea whether they had a relationship with the Arthritis Society, but should I be referring this group, the Arthritis Consumer Experts, to the Arthritis Society as the people with whom the government consults?

Hon. C. Hansen: I have the highest regard for the B.C. Arthritis Society. I think they do great work both in terms of raising money for research but also in support for individual patients in the province.

I'm not sure if the member knows, but one of the projects that I personally undertook last year was to run the Honolulu Marathon last December as a fund-

raiser for the B.C. Arthritis Society. As a result of the generous contributions of most of my colleagues and all of the friends I used to have, we raised $10,000 for the Arthritis Society. I actually managed to complete the marathon and still walk afterwards.

The Arthritis Society is a great organization, and I certainly commend it to anyone.

Often I find that there are histories to various consumer advocacy groups. Why there is a separate one from the Arthritis Society called Arthritis Consumer Experts…. There may be a history to that, but I will refer them back.

Mr. Chair, that's binder one. Let me just go through with the minister, and we can pick a topic. Let me tell the minister, for his staff's sake, where we'll be going in the next days: wait-lists; executive salaries, although we have spent some time on that. Then I have questions on individual health authorities and then questions on the new federal money. In the context of that, I'll be discussing it leading up the Premiers' meeting and then post-deal. That's how I've got them described here.

Maybe what I'll do is just discuss Romanow with the minister in the ensuing ten minutes or so. That might be able to be done.

Then, after that is doctors' issues in terms of negotiations, not around the broad fee-for-service but around the aspects of fee-for-service. Then I want to also discuss primary care reform.

My colleague the member for Vancouver–Mount Pleasant and I will ask the Minister of State for Mental Health his questions and the Minister for Long Term and Home Care.

A topic that we could possibly complete in ten minutes is the post-Romanow era. The Romanow report was certainly one that I embraced. I'm wondering whether the minister could give me a status update in terms of the federal-provincial discussions on implementing the Romanow report.

Hon. C. Hansen: I guess when we talk about the Romanow report, that sort of flows into the first ministers meetings and the health accord that then flowed out of the first ministers' meetings. By the end of that whole process, there is not necessarily a direct line back to Romanow again. I think that Mr. Romanow himself would probably…. What he saw come out of that health accord may have been, in some respects, different from what he had proposed.

What did come out of that health accord was $10 billion over three years for the provinces. B.C.'s allocation of that was $1.3 billion, which was simply based on a per-capita allocation across the provinces and territories. That $1.3 billion is to flow over a three-year period. In the first year — this year we are now in — we get $130 million that's an increase to the CHST transfers. It's what the federal government talks about as a sustainability increase. That money does not have strings attached to it and, really, is allowed to be used in any way that the provinces see fit.

I'd like to point out, just to put that into perspective, that the $130 million would actually fund our health care system in British Columbia for 92 hours, at least under the last year's budget. We spent about $1.4 million an hour. While $130 million seems like a lot of money, it's certainly not the panacea to sustainability. There is another $130 million, roughly, for the reform package that will flow in this coming year. That reform package is around catastrophic drug coverage. It's around primary care reform and home care support in a post-acute setting.

One of the challenges we've got is that we still don't know from the federal government or from those federal-provincial dialogues what the accountabilities are. There are obviously some strings attached to that reform fund, but we are still working out what the indicators are that are going to demonstrate that, in fact, the individual provinces and territories spending that money are achieving progress in those particular areas. There are still lots of discussions going on to try to sort out some of those details.

Finally, there is an equipment fund in the amount of $60 million in this current fiscal year. That is being allocated to the health authorities on a population needs–based funding formula basis.

In other words, each of the health authorities will get their fair allocation of those available dollars, and they will be able to spend them on what they see as their priority areas, providing they fall within the federal guidelines as to how that fund can be spent. That gives a bit of a snapshot as to where we're at with those.

J. MacPhail: The minister is quite right. I really shouldn't have focused on just Romanow, because there was the Kirby report, and then there's been lots of discussion since.

I will ask about accountability measures as we go through the federal moneys when we reconvene, but there is one short issue I would like to address. That's the issue of electronic health records and a health systems dynamic across Canada. Is that on the table?

Hon. C. Hansen: Through the Canada Health Infoway there are moneys that have been allocated to help develop the electronic health records. There were $500 million allocated to that previously. That was increased in this latest federal budget by $600 million to bring it up to a total of $1.1 billion. The deputy ministers of the provinces are the members of the Canada Health Infoway, so they have a direct impact on the work that is being done there.

There was a very real concern that the whole evolution of electronic health records was really not progressing as fast as we would like to see it progress, so there has been some pressure to try to move that along as quickly as possible. I am pleased to report that Canada

Health Infoway has now chosen three initial projects to get underway, and British Columbia has been awarded one of those projects. That's the development of the provider registry that will become part of the electronic health records system for all of Canada.

In addition to that, there is a lot of work that's being done by the chief information officers and the chief technology officers at the various health authorities in British Columbia. We're not sitting back, you know, waiting for some big national electronic health record initiative. When I was in Kelowna a couple of weeks back, I had a great demonstration of the electronic health records that they have available to physicians throughout the region through Web-based access. It's entirely secure and privacy-protected, but it gives health care practitioners instant information at their fingertips about their respective patients. We are making some really good headway in that regard, and clearly there is a lot more work to be done in the years to come.

J. MacPhail: That provides a natural breaking point in the discussion, so I would say thanks to the minister and his staff.

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

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

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	YEAS — 67

Falcon	Coell	Hogg
L. Reid	Halsey-Brandt	Whittred
Hansen	J. Reid	Bruce
Santori	van Dongen	Barisoff
Roddick	Wilson	Lee
Thorpe	Hagen	Murray
Plant	Campbell	Collins
Clark	Bond	de Jong
Nebbeling	Stephens	Abbott
Neufeld	Coleman	Chong
Penner	Jarvis	Anderson
Orr	Nuraney	Belsey
Bell	Chutter	Mayencourt
Trumper	Johnston	Bennett
R. Stewart	Hayer	Christensen
McMahon	Bray	Les
Locke	Nijjar	Bhullar
Wong	Bloy	Suffredine
MacKay	Cobb	K. Stewart
Visser	Lekstrom	Brice
Sultan	Hamilton	Sahota
Hawes	Kerr	Manhas
	Hunter

	NAYS — 2

MacPhail		Kwan

Official Report of

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