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

The following electronic version is for informational purposes only.
The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY



CONTENTS

	Routine Proceedings
		Page

Committee of Supply		6819
	Estimates: Ministry of Health Services (continued) J. MacPhail Hon. C. Hansen J. Kwan

	Proceedings in the Douglas Fir Room

Committee of Supply		6831
	Estimates: Ministry of Health Services — Mental Health; and Intermediate, Long Term and Home Care (continued) Hon. G. Cheema B. Locke K. Krueger J. Kwan L. Mayencourt R. Stewart

Hon. M. Coell: I seek unanimous leave of the House to permit Section A of the Committee of Supply to sit and consider a portion of vote 29 relating to the estimates of the Minister of State for Mental Health and the estimates of the Minister of State for Intermediate, Long Term and Home Care at the same time that the estimates of the Ministry of Health Services are being considered in Section B, and that an official record be kept of the debates in Section A.

Hon. M. Coell: I would call in Section B of the chamber of the assembly the estimates for the Ministry of Health Services and in Section A, the Douglas Fir Committee Room, the estimates for the Minister of State for Mental Health followed by the Minister of State for Intermediate, Long Term and Home Care.

J. MacPhail: If I could, for the minister and his staff, outline pretty much the order…. There may be a bit of variance, but I'll do it again. Wait-lists, executive salaries…. Under that subhead would be compensation for non-executives as well, provincial comparisons of wages, then health authorities — just individual health authority by health authority. One, in the old days, might have called it local issues.

The new federal money. We discussed Romanow a little bit and the accord that arose out of that. Under the federal money, last night, in reorganizing my work…. I will, as we're discussing the new federal money, talk about accountability throughout that as well.

A few more issues around physicians: on call, ER and then primary care. The compensation issues will be under executive and non-executive compensation.

I think that's it. As I understand it, in Committee A my colleague the member for Vancouver–Mount Pleasant is discussing issues as well. I don't think there'll be any overflow, unless some of those will come back here.

On the wait-lists, we had quite a toing and froing on wait-list calculations here in the Legislature already, through question period. Let's move the discussion on. Checking on the government website from the Ministry of Health Services, there has been no update or change recorded since we had this discussion in this chamber around April 10, 2003. No matter what statistics you use, no matter how you calculate it, for the wait-lists the total increase is 19.8 percent. The reason why I say no matter how you calculate it is that if you redo the calculation based on the government's current report and you use that same way of calculating it before this government took over, the increase is still 19.8 percent.

Let me ask the minister, in terms of wait-lists and wait times, what resources are being directed toward this issue. The reason why I distinguish between wait-lists and wait times is because I accept the premise that increasing wait-lists is not necessarily an indicator of bad delivery of services. If the wait-lists are increased but the wait times are shortened, then that's fine. That means that the population is growing or aging, and therefore the wait-lists are also getting longer. One also has to look at wait times for surgery.

Hon. C. Hansen: Clearly, wait-lists are an issue that I know provincial governments have wrestled with for many years. It's not unique to British Columbia, and all provinces are trying to meet those challenges. One of the things we have is really the inability to assess need. Not everyone on a wait-list is in need of equal priority. It's certainly not a chronological need — that the faster you get on a wait-list, the sooner you get access to surgery. It's that people really differ in their individual needs.

There is considerable work being done by all the health authorities. It's being led by the provincial health services authority. It is a major initiative to look at how we prioritize wait-lists to ensure that those who need quicker access get quicker access. The work that is being done is set out in schedule A of our service plan. That gives a bit of the background around this collaboration around surgical and procedural services. It's schedule A of the performance agreement with the health authorities. I should correct myself — not the service plan.

We have certainly been working throughout the province to try to increase surgical capacity and find the most appropriate location for surgery. We have opened, for example, the ninth operating room in Kelowna at a cost of $6 million. There are other facilities around where we are focusing the kind of surgical procedures that can be offered. Summerland hospital is a perfect example of that — where they are doing day surgeries, primarily elective surgery. It becomes far more predictable for both the patients and the physicians. They can count on having more predictable access.

The net result of some of the changes we've made is that the number of surgeries that are performed in Brit-

ish Columbia has increased by 9 percent over the last year. So we are making some progress in terms of increasing surgical capacity. The work that's being done by the PHSA around the protocols is going to feed into the western Canada wait-list project. Out of that, we anticipate that very soon we will start the rollout of some of the protocols that will assist physicians in getting access to surgical care in a timely fashion for their patients, depending on their relative need compared to other patients. It is an area where there's a lot of work being done, but clearly a lot of work continues to have to be done.

The last thing I would point out is that the wait-list registry we have on our website is the only one of its kind in Canada. That was implemented by the previous government. The member may have been the minister at the time. I can't recall. It is a useful tool for patients to be able to identify which physicians have longer wait-lists than other physicians. But the methodology in terms of having a measure that is sound in its methodology…. We really can't say the methodology that drives that wait-list registry is a sound indicator, although I know it's certainly useful to compare from one year to the next.

The bottom line is that the number of surgeries are up, and we are working on a more systematic approach to wait-list prioritization.

J. MacPhail: I'm wondering whether the minister could read schedule A from the performance agreement into the record or at least give me the highlights of it. We don't have that performance agreement.

Hon. C. Hansen: The performance agreement is on the website for the various health authorities. This is the same wording that's consistent with all of the health authorities. Its expected performance is to collaborate with the PHSA and other regional health authorities and ministries to develop measures of performance for surgical and procedural services in the province's hospitals. The process will include the establishment of measures of the performance of the system in response to emergency treatments and procedures and the development of principles for establishing priority of care for non-emergency conditions and cases.

The product during this last fiscal year will be the development of measures of the response of the health care system to emergency surgical and procedural needs to agreement on the principles to be used by the health authorities in classifying cases as emergent or urgent/elective, a plan to measure the appropriateness and outcomes of selected procedures and adoption by the health authorities of these outputs and standards.

J. MacPhail: Perhaps the minister could describe for us, then, whether there is a health authority that has the best practices in this area. Are there areas of the province that are moving quickly in this area and from which others could gain a best practice model?

Hon. C. Hansen: I have to apologize to the member. As I was reading from the performance agreement, I got to the fourth bullet, flipped the page and realized that I had the wrong page. There is a continuation, which I will finish just so it's on the record. It probably showed when I sort of stopped mid-sentence and realized I wasn't reading the right thing there.

What I read out earlier was the performance…. It was the products, the initiatives that had to be taken in the '02-03 fiscal year. It continues with the '03-04 fiscal year — that is, the continuation and completion of deliverables identified in '02-03, assessment of population need and utilization rates of surgical services that will assist in the formulation of guidelines for surgical concentration and location of core specialty services, development of provincial access standards and definitions for wait-time measurement that will assist in the formulation of guiding principles for the prioritization and wait-listing of surgical cases, and the introduction of surgical and procedural measures and standards. In the '04-05 fiscal year it will be demonstrated improvement in the performance of the surgical services. So that is in the performance agreements for the health authorities.

To answer the member's specific question about what health areas are having better progress when it comes to wait-list management, the Vancouver coastal health authority has done a lot of work in the last number of years around the appropriateness of surgical procedures. The interior health authority is probably the furthest along when it comes to its surgical review, but all of the health authorities are engaged in that. Also, the Vancouver coastal health authority is well along on its surgical review. I guess the one facility in the province that is leading when it comes to developing a needs-based approach to wait lists is B.C. Children's Hospital. Because so much of the surgery they are faced with is critical at certain ages in the growth of a child, they have really developed some of those protocols to try to make sure that access to surgical care is needs-based and not just chronologically driven.

J. MacPhail: Let me put some stats on the record here, then. These are the stats from the minister himself. In May 2001 there were 66,126 patients waiting for surgery. That amount as of February 28 this year was 73,669, so the wait-lists have grown but also the times for some of the surgeries. The wait times for surgeries are up substantially, as well, in almost every category — except cancer, which is great news. That's 1.3 weeks, and 1.3 weeks is greater than eight days, so the cancer wait time is less by a day or so — and also neurosurgery. In every other category, the wait times are up.

The combination of an aging population, a population that could have access to greater surgical techniques and technology and therefore be healthier, and

also the funding for access to those services are the inputs around what happens to the direction of wait times and wait-lists. Yesterday we heard that the budget for physician services is increasing at about the same rate as the population growth, maybe just a little bit less — no, about the same. So what about utilization rates? What about utilization rate increases in terms of physician services, and what about operating time itself? What's happening around the province in terms of overall operating time available?

Hon. C. Hansen: To address the member's first question regarding utilization rates, what we have budgeted for is a 0.9 percent increase in utilization in terms of the Medical Services Plan. In terms of surgical capacity in the province, I think the outcome — the output, which is the important part — is the fact that the number of surgeries performed in the province is up by 9 percent year over year.

I think we can look at specific cases — cardiac surgery, for example. In March 2001 we had performed 1,334 cases in the 2000-01 fiscal year. By the '02-03 fiscal year, that had increased to 1,480 cases. In terms of hip replacements, the same story. There is an increase from the number of procedures that were done in 2000-01 to the '02-03 fiscal year, and the same is true of knee replacements.

The member is right. Median wait times do go up, and the number of people on those lists does go up. We are increasing surgical capacity throughout the province, but the fact of the matter is that the demand for some of these services is rising even faster if you look at the number of people on the wait-list. Again, that's one of the reasons why we need better methodology to determine what is a true measure of the number of people in need of a surgical procedure, because right now that methodology is really driven by the self-reporting of doctors. We don't have an indication as to what kind of duplication there may be on those lists. We don't have an indication as to the number of patients that may have been on a particular surgeon's list that, in fact, have already got their procedures done.

The methodology that's there now, which drives the wait-list, is really not very sound. That's part of the reason why we're developing new measures and new tools, so we can actually get something that really withstands the test of scrutiny with regard to how the wait-lists come together.

J. MacPhail: If the population is growing by about 1.4 percent — that's the Finance ministry's — and then a 0.9 percent increase in the utilization rate, what other factors have gone into the physicians' budget that would make the lift less than 1½ percent? I think it's a 1.3 percent lift.

Hon. C. Hansen: What we have in terms of an increase for the medical fee-for-service portion of the Medical Services Plan…. When we talked last night, I indicated that budget was up by about…. I think we had a population increase of 1 percent. We discussed that last night. We also had the utilization increase of 0.9 percent. We have a reduction that then comes in, which is moneys that were in the base budget for last year, so therefore they were annualized into this year.

We wound up with the base budget being about $12.5 million higher than utilization actually worked out to be in the end for last year, but that was already in our base budget. That then brings it down by about 0.5 percent.

There are some other minor adjustments. The rural locum program, for example, is seeing an increase of almost $1 million. Physician benefits…. It's basically to sort out some of the potential unresolved issues that are still being worked out in terms of implementation of agreements, which we talked about last night, and there are some funds, as well, that allow for that.

If you add all those things together, it's the increase of 1.9 percent in demand pressures, both population growth and utilization, and we wind up with some of those. The biggest one is the offsetting saving from what was underutilized in last year's budget, and the net result is an increase of 1.44 percent.

J. MacPhail: What protocols is the government working on, then, with physicians around surgical procedure management? The minister raises matters such as that perhaps there are duplicate wait-lists, postings or whatever. What's the government doing with physicians to manage and put a proper face on surgical wait-lists?

Hon. C. Hansen: The provincial surgical and procedural services project is one where there is an interdisciplinary group that has come together to look at how we best approach the management of wait-lists.

The other initiative that's underway is the western Canada wait-list project. I remember I was talking to one of the doctors from B.C. who is very much a part of that, and I asked him: "Why is it taking so many years for that to roll out?" He explained that one of the reasons is that they are testing it. They're doing pilots with some of the protocols that have been developed. They want the protocols to be looked at as sound and based on good evidence.

This is not some policy that's being sort of imposed out of 1515 Blanshard Street on the physicians of the province. A really important process is to get physician buy-in. There's been a lot of work done to make sure that's communicated around the province so when it does roll out, the physicians will see the merit of it from the time that it's first launched. That's the western Canada wait-list project.

If we look at the provincial surgical and procedural services project, which is running parallel to that…. Obviously, they are learning from each other, and these efforts will become very much integrated. The steering committee will oversee a variety of expert panels and task groups that are working. Their task is to develop provincial definitions for elective, urgent and emergent

surgical cases; provincial access standards and definitions for wait-time measurement and benchmarking; provincewide measures and key indicators on the performance of surgical and procedural services; assessment of population needs and/or utilization rates of surgical services; guiding principles for the prioritization and wait-lists of surgical cases; establishment of guidelines for surgical concentration and location of core specialties; reporting requirements and information resources for continuous improvement of surgical and procedural services; feasibility plans and processes for practice guideline development; and surgical and procedural services and related outcome analysis and the evaluation framework to measure the effectiveness of improvements to the system.

That wait-list project…. The steering committee is made up. It includes doctors. It includes nurses. It includes health administrators. There's a director, for example, in transition planning, and there's been a lot of work that's gone into that process. I think we'll start to see the benefits of that unfold over this coming year.

J. MacPhail: When's the next provincial-territorial ministers' meeting and/or federal-provincial-territorial ministers' meeting?

Hon. C. Hansen: The next formal meeting of federal-provincial Health ministers is going to be in September. It is normally held in September. That's certainly my experience in these years. I think this year it will be held in Halifax. There are from time to time other teleconferences involving all of the Health ministers. When issues come up, we certainly do meet via telephone as well.

J. MacPhail: I wanted to ask the minister whether he would consider raising this topic. As I recall, there is a view, and it may be supported by studies — I'm sorry, I'm doing this from memory — where a certain portion of people on wait-lists for surgery end up getting better without the surgery. They don't die. They end up actually not needing the surgery and still living. There's also a portion that die.

What I'm wondering is this. One of the silver linings that we could take from the situation that occurred in Ontario as a result of the SARS epidemic and the quarantining of whole hospitals there is an examination of what actually has happened to surgical wait-lists in that province. Here's what I mean, and I'm just asking the minister whether he would consider raising this matter. There has been a massive amount of time in Ontario when surgeries weren't performed as a result of the SARS epidemic. That is my understanding. Therefore, is Ontario doing any study of the special effects that that had on surgical wait-lists?

It's a terribly unique challenge for which I feel the pain of people in Ontario, including the doctors and nurses who are there, but maybe there is something to be learned from this particular period of time as well. I'm wondering if I'm making myself clear to the minister.

Hon. C. Hansen: The short answer is yes. I would be pleased to ask that of my colleague in Ontario. I'm quite sure they would be undertaking that kind of review, because obviously it is a major challenge for the Ontario health care system.

One of the things we have in British Columbia is probably the best wait-list data compared to other provinces. I know we talked about the challenges that we have in B.C., but we're actually further ahead than other provinces. One of the things we have learned in this province from the challenges around the SARS outbreak is that the way we have structured our health care system in British Columbia is a real advantage — the fact that we have the six health authorities. There is the ability for instant and effective communication among those health authorities and the ability to identify who exactly in this structure needs to know and needs to take action so that decisions can be made very quickly. We certainly saw that in British Columbia. I think it's a credit to those individuals that we were able to contain the SARS outbreak as effectively as we did in British Columbia.

In Ontario they have a very different structure. It is really quite fractured. They don't have the integration of facilities that we have in British Columbia. They may have a bit bigger challenge of doing the analysis of an impact on wait-lists just because of the way their health system is structured.

They do have a very good cardiac registry and cardiac wait-list management — probably the best in the country. I know that other provinces are certainly learning from that Ontario example. That may be one area in particular where the review of the impact on wait-lists might be very instructive and something we can learn from in all provinces.

J. MacPhail: I think this will be the last area of wait-lists and wait times that I want to discuss. It's the issue of private surgery versus public surgery. I've had many, many letters on this topic, but I've taken one that's current and is highlighted in the media and also pretty much covers the range. It's a letter to the minister dated March 27, 2003, and it was copied to me as well and to the Premier. There have been news articles on it as well. I'll just read it into the record.

Hon. C. Hansen: I think a bunch of issues flow out of that letter the member has read. One of them is the whole issue of the Canada Health Act. We have made a commitment to support the Canada Health Act and its principles. When we hear of cases that could be potentially in violation of the Canada Health Act — when patients report those to us — we do investigate and do follow up on those. I'm not saying that this particular case is or is not, because obviously we would want to do a proper investigation before there's any determination along that line.

But the crux of the issue here is really the allocation of operating room time. The system we have had in British Columbia up till now has really been very ad hoc. The amount of operating room time a physician can get access to is often based on just their historical patterns of practice. When you wind up with a new procedure that comes in or perhaps a new specialist who comes to the province who has unique skills, his ability to get adequate operating time is often frustrated by some of those who are driving the status quo that had been there previously.

It is our intention that out of the provincial surgical and procedural services project, we will be better able to determine how to prioritize procedures to ensure that people do get access to medically necessary procedures in a timely fashion. We're not there yet obviously. So I hope that out of this review, our approach to allocating operating room time to physicians will be based more on need rather than just on historical precedents.

J. MacPhail: Flowing from that, could the minister, for the record, put his government's interpretation of what the law is around private versus public access to surgery? I'll do that first.

Hon. C. Hansen: The Canada Health Act dictates that a medically necessary procedure that is provided to a Canadian citizen must be funded publicly. Regardless of whether that surgery is performed in a privately owned clinic, whether it's performed in a privately owned doctor's office or whether it's performed in a publicly owned hospital, that surgical procedure must be covered and paid for by the public purse, and there can be no additional charges directly to the patient. The other thing to point out is that the Canada Health Act covers hospitals and doctors' fees only. I think there are a lot of Canadians who tend to think that somehow the Canadian medicare system, or the Canada Health Act, covers the full scope of health care services. In fact, it covers medically necessary services provided by doctors or in hospitals in Canada.

J. MacPhail: Does the minister have statistics about the growth in private clinics in British Columbia in the last year or 18 months?

Hon. C. Hansen: The provincial government does not directly license private clinics; nor is there sort of an official registry of something that is defined as a private clinic or private surgical centre. The licensing requirement is that the physicians that provide services in any facility in the province…. That service has to be authorized by the College of Physicians and Surgeons. We don't keep a registry per se, but I think that during the 1990s there was an increase in private clinics from 26 — I think the number was — to about 50. My understanding is that in the period over the last 18 months or two years that the member indicated, there may have been an increase of about four or five, but we don't have an exact number.

J. MacPhail: The review the minister is doing — will it incorporate the aspect of privately funded surgical increase, surgical operating time as well?

Hon. C. Hansen: It will look at all of the publicly funded surgical procedures, regardless of where they get performed. One of the things we did was develop a protocol for the health authorities to guide them in the issues they have to address before they can contract out any surgical procedure to a private surgical centre.

What we have said to the health authorities is that they may use private surgical centres, provided they can demonstrate it is more cost-effective and will not have a negative impact on the services provided in our publicly owned facilities, and that they have to be consistent with the Canada Health Act. Therefore, there can be no additional charges assessed.

The short answer to her question is yes, the surgical review that's undertaken will look at all surgeries that are funded out of the Ministry of Health Services budget. As the member will know, there are organizations in Canada that are exempt from the Canada Health Act. Workers Compensation Board is probably the most significant case in British Columbia where they can go directly to private clinics. In fact, I believe that in British Columbia, they're probably the largest client of the private clinics.

J. MacPhail: The last area I have on surgical wait-lists — and just for the information of the minister, we'll be going to salaries next, executive and non-

executive — is organ and tissue transplants. The record is improving here in British Columbia, which is wonderful news. There are more people waiting, but that can't be the responsibility of anything other than availability. The median wait time is down, which is great. I'm wondering if the minister could tell me about the government's organ and tissue donors. What changes have occurred in the last year in terms of encouraging donors, and what's the trend?

Hon. C. Hansen: The B.C. Transplant Society certainly has an ongoing public relations campaign to encourage more people to sign up as organ donors. It is an area where we still have a long way to go. We are making progress in terms of a greater percentage of the population that have registered. I apologize, but I don't have the exact number as to where we're at right now in terms of what percentage other than the fact that it is increasing as a result of the very good efforts of the B.C. Transplant Society.

One of the big challenges we have is actually a good-news story, and that's that the number of people being killed in car accidents in British Columbia continues to drop. As a direct result of that, which is good news, there are fewer and fewer organs available for transplant. The B.C. Transplant Society is doing a lot of work around policy development and evolution around living donors, for example, and they have recently added more flexibility to enable non-related living donors to be part of that program.

In terms of tissue banks in the province, there is now much better coordination as a result of the incidents that we had at the ear bank in British Columbia, which I think was a real…. It was an opportunity for us to double-check that other tissue banks in the province have proper information and are keeping appropriate records, and that is the case. We have put the coordination of that under the B.C. Transplant Society as well, so there is better oversight and better coordination. I guess the bottom line is, as the member said, that it is a good-news story in that we are getting more British Columbians signed up as organ donors and that people are getting access to donors with shorter wait times.

J. MacPhail: Moving to compensation now, I want to start in reverse order of compensation — for the minister to outline in his budget what the severance costs are allocated for this year and for whom the budget for severance is targeted.

Hon. C. Hansen: Each health authority has estimated severance and restructuring costs over a three-year period for this. The budget we are estimating for that three-year period for severance and restructuring is $81 million. Most of that was actually booked in '01-02, and some of it was booked last year, because accounting rules allow for that to be booked providing there is a specific plan for that to be drawn down over the ensuing years.

J. MacPhail: There was an article in the newspaper that said that…. It's dated March 3, 2003, and I didn't see any correction by the government. This government's great at issuing letters to the editor, and credit to them for correcting the record. There was none in this particular case. The article said: "B.C.'s six health authorities will pay laid-off staff up to $225 million over three years."

Hon. C. Hansen: The ministry staff sitting beside me have big smiles on their faces, because what they had handed me was the briefing note which the member will recall from her experience in cabinet. The second bullet says that a Province story, March 3, continues to use the $225 million figure, stating: "B.C.'s six health authorities will pay laid-off staff up to $225 million over three years." It then goes on to say the correct number is $81 million, so the articles that came out in March are not correct.

J. MacPhail: I guess you've got to get that public affairs bureau on to writing more letters to the editor, because it's become a congenial truth, as they say in a book about spinning out there.

Hon. C. Hansen: First of all, the letters to the editor. I do write a lot more letters to the editor than you ever see. I just wish they all got published, but that's part of the challenge.

No, that does not include the most recent, because that is out for ratification. We're still waiting to see what the results of that will be.

J. MacPhail: There have also been stories — and these are very recent stories; they're not New Democrat–generated stories, either — about the increase in compensation at the health authority level and also about the numbers of people who are getting increases.

I recall from the days when we were in government, there was a similar discussion around these matters in the area of education. It may be before even this minister's time. It may have been from the term 1991 to '96. But the then-opposition, now government, made a huge and legitimate stink, in my view, about compensation in the education field at the school board level at the same time when funding was not increasing at the same level for kids in the classroom. The result was that the government of the day, the then administration, did a review and put a cap on administration costs. That resulted in what, for parents and teachers, became — and, actually, school board trustees didn't object either — an effective way of having a balance between administrative costs going to executives and services going into the classroom.

Now the bad news is that this government, just in the last session previous to this one, removed that administration cap. That's why I was exploring earlier on with the minister at great length about the cuts in administration. Were they cuts to administration — i.e., executive management people — or were they cuts to

Can the minister please tell me: what is the direction in terms of executive compensation increases in those who are making more than $100,000 now than a year ago — and how many?

Hon. C. Hansen: The member's specific question, if I'm right, was the number of people in the health sector earning over $100,000 a year now compared to before. What I have before me is the number of senior employees earning over $125,000. I have that as of…. Well, it would have been within the last couple of months. What I don't have at my fingertips is a comparison to what was there previously, but I've got a couple of things that would be indicators of that. Incidentally, most of the employees earning over that amount are, in fact, doctors who are directly employed by the health authorities.

There are other things that I can point to. One of the things in the financial statements that are provided by the health authorities…. There is actually a separate line item for administration, which would include the salaries, for example, of the top executives. There are separate line items for finance, human resources, systems support, communications, which we talked about as well.

In the line item for administration, which is one of the reportable line items, in every single one of the health authorities, that declines from the year 2000 through to 2003. Just as an example, the interior health authority goes from $29.5 million down to $22.1 million; northern health authority from $12.8 million down to $7.3 million. Now, the provincial health services authority, as we talked about before, starts out at $9.7 million, and it goes up to $15 million and down to $14 million. That's because they were structuring. They were starting out as a brand-new organization, which we discussed last night.

Vancouver coastal health authority goes from $38 million down to $21.6 million; Vancouver Island, $22 million. It actually comes down slightly from $22.2 million down to $22 million. If you look at that provincewide, the provincial totals for that administration line go from $133 million down to $102.7 million.

As was just pointed out to me, what we predicted when we did the rollout of redesign of the health authorities in December 2001 is that there would be savings of $15 million, and we've obviously already exceeded that.

There is also a study that was done for the Health Employers Association of B.C. in March of this year. It was done by Mercer Human Resource Consulting. What that shows is that in the employer group 1 — that's all of your top CEOs and senior executive members — using this compensation strategy, the market data illustrates that HEABC's midpoint/job rates are significantly below the market in aggregate as follows: 14 percent below the median for the health sector in Canada, slightly above the median for the B.C. public sector, and 17 percent below the median for the private sector.

J. MacPhail: Is that a public study? I'd be interested in seeing it, if it is.

Hon. C. Hansen: At this point the document is still going forward for review by PSEC, and I'm not exactly sure of the time line of that, so we're not sure if it will be publicly released. At this point we don't see any reason why not, but that determination is yet to be made.

J. MacPhail: In the area of compensation — before I move to the non-executive compensation — this government changed the way health authority board members are compensated. In fact, they weren't compensated before, and now they are compensated.

We now have a year of experience in terms of health authority board members. Could the minister bring me up to speed on what last year's experience has been in now compensating health board members?

Hon. C. Hansen: The workload that we are asking of our board members and our chairs of the health authorities is really quite considerable. These are not jobs and responsibilities that take a couple of hours a week. I know the chairs and the boards put in hundreds of hours in terms of their responsibilities, and it was a decision we made at the time that we would provide them with some compensation for that. It certainly is not considerable.

Certainly, there's none of them that would do it for the money. It is basically, I think, a token recognition of the time that they put into it. On an hourly basis, it certainly wouldn't amount to very much.

J. MacPhail: Just because the Liberal government appointed these people doesn't mean that the people who did it in the 1990s are any less dedicated, and they didn't get paid. So I'm asking what the payment is.

Hon. C. Hansen: I agree with the member. I certainly had the pleasure of working with many of the board members and chairs that served on the other 52 health authorities, and I have great respect for the dedication they put into those jobs at that time.

The remuneration. The chair is paid an annual retainer of $15,000. Directors are paid an annual retainer of $7,500. The board and committee meeting fees are $500 per meeting. Other meeting fees are $250. The maximum payments that can go out to these individuals is $45,000, plus travel fees and expense reimbursement per fiscal year. For directors that amounts to a maximum of $25,000.

J. MacPhail: Yes, and how much was paid? That's what I'm asking for. In estimates last year the minister estimated about $1.6 million was going to be paid, but I'm asking what the reality is after a year of experience.

Hon. C. Hansen: That is information that would be part of the data that will be provided with the final financial statements from each of the health authorities. We do not have those yet. Certainly, through public accounts, there would be an opportunity to review that, but I haven't got the data at my fingertips now. We expect it will be coming in the next weeks or months.

J. MacPhail: I know the minister there has a document that assembles all of the health authority budgets. With our limited research capacity we haven't done that. Let me ask it this way then. This government is taking great pride in getting the budget, the money, to the health authorities early so they can put their budgets in. It's all supposed to be much better and much more open and transparent than it was in the last administration.

If the minister can't report to me about what the experience was for '02-03, perhaps he can tell me what the health authorities have budgeted for '03-04 for the costs of board members.

Hon. C. Hansen: I'm advised that it is not a separate line item in the budgets. It is included in the administration line that I referred to earlier. We don't have that as a separate and distinct line that I could make available. We have given to the health authorities their budgets, their allocation of funds, based on the population needs–based funding formula. It's up to them to determine how best to allocate that to meet their administration and operational needs, but they must stay within the compensation guidelines that I outlined earlier.

J. MacPhail: How is it, then, that the public — let alone the opposition — is supposed to find out about how much this is costing the public with the government's change to now paying people who used to be volunteers?

Hon. C. Hansen: Certainly, it's easy enough to calculate what the maximums would be if all of them were to use those maximums. We can certainly endeavour to get, once the year-end numbers are finalized, that line broken out from each of the health authorities. If the member would want to make that request, we can endeavour to get it to her once that information is available to us.

J. MacPhail: Yes, please. We would like that information to see what the experience rating is and the experience usage is.

I want to move to non-executive compensation now. We've had a bit of discussion about how, in certain areas, health support services…. The minister said yesterday that they're 30 percent higher, and then he also said that British Columbia nurses are either the highest or second highest. I want to put that in context with whether that indeed holds up to scrutiny and whether there are individual compensation levels that are high but there are less people doing the job. Therefore, people are having to work harder doing that job.

I need to lay out my case a little bit first. This is information from CIHI, I think — yes, the Canadian Institute for Health Information — and it's up to date as of 2002. I am using a prop, but I will try to describe it in words. The charts from CIHI of public sector compensation in health expenditures by use of funds are done in current dollars, and it's got hospitals and institutions. Of course, I'm not dealing with those. Then it goes: "Physicians and other professionals."

I'm comparing British Columbia, the percentage change, to all of Canada. If I could just read…. I'm sorry. This takes a moment, Mr. Chair, not because of poor research but because of me. I'm just going to deal with percentage changes — okay? It covers the years from 1975 through to 2002.

Over the years, the changes in physicians in British Columbia from about the mid-eighties through to 2002 have exceeded the rest of Canada, and I'm happy with that on the percentage changes. That includes right up to the years 2001 and 2002, where the physician compensation for all of Canada in the year '01 was a 7.8 percent increase and a 7.1 percent increase in '02. That was in Canada. In British Columbia it was 12.1 percent in '01 and 14.7 percent in '02. I think the difference is between…. This is overall compensation — the money paid. Of course, that can be affected by the number of people being paid as well as the percentage that they earn individually.

In the case of other professionals, other professionals in British Columbia would have received, starting in 1991, an increase of 13.4 percent in 1992, and in the rest of Canada they received an increase of 11.4 percent. So in 1992 there was a differential of about 2 percent — not quite, but yes, let's say 2 percent — betterment. After that, it's about standard until 1999, in which case the increase for other professionals went up by 19.7 percent here in British Columbia, and in the rest of Canada it went up by 7.8 percent.

That was when, the minister may remember, there was compensation for nurses — the increase in nursing compensation. So I agree. There's a difference in that year, in 1999, and the difference is about 12 percent greater compensation. However, then we go down to the year 2000, which is about the same both in British Columbia and nationally.

We go to 2001-02. In the rest of Canada in 2001, other professionals' salary compensation increased by 3.6 percent. Here it declined by 2 percent. In 2002 the percentage paid to other professionals in all of Canada declined by 4.4 percent, and in British Columbia it declined by 22.8 percent, for a net change of minus 24 percent in '01-02 here in British Columbia and a net change in the rest of Canada of minus 1.2 percent.

The reason why I'm suggesting this is because nurses, particularly, would start to say that even…. They would even challenge the government saying how much — whether the compensation is the best —

but they would also make this claim. It's that there are fewer percentage points of the overall health budget going to health professionals in British Columbia as a percentage of the overall budget, and that's because they're having to work harder.

Hon. C. Hansen: First of all, I want to seek some clarification from the member. Is the CIHI data that she's referring to actual real dollars, or is it referring to changes in the percent of budget?

I find that intriguing, but certainly we did, in those years, increase the health budget considerably. We increased it by $1.1 billion, so the total size of the budget went up considerably. But at the same time, for the bottom line you have to come back to the numbers we talked about last night. There are 538 additional nurses employed in British Columbia just last calendar year alone compared to previous. So we have seen a steady increase in the number of nurses employed in our health sector. The other side of it is that the compensation increase, with their latest increase, was 22.6 percent in terms of what it cost.

So I find that number, as a reduction in the percentage of budget, intriguing. I've always enjoyed CIHI numbers. I like to go in and pull them apart sometimes, and I plan to do it with that one. But I don't have a quick explanation for the member as to why that would have shown a minus 22 percent increase at a time when not only were we hiring more nurses and employing more nurses, but the wage and benefit cost for those nurses has gone up considerably.

I do want to comment quickly on her reference to physician compensation. In British Columbia we now have the highest per-capita budget for physician compensation of any province in Canada. We're actually, I believe, about 19 percent higher than Ontario, and we're about 42 percent higher than Alberta when you come to the per-capita cost of physician service in British Columbia.

J. MacPhail: Yes, and I know it can always be interpreted by the questions that the opposition asks that they're picking favourites in the delivery of health care as a result of staff, and I'm not at all. My point would actually be reinforced by the last point the minister made. I am going to make copies of these and give them to the minister over the lunch hour, if I may, because it is very interesting research. Thank you to those who did the research.

My point would be that physician compensation has not only kept pace in British Columbia, but one could claim it has led the country, both by his statements and this evidence. But that is not true of other professionals in the system, particularly in the last two years.

Based on the minister's last comments about nursing compensation, I do need to read into the record a letter sent to the Premier by the British Columbia Nurses Union from their president, Debra McPherson. This was January 17, 2003. It followed ads at the beginning of this calendar year. The government ad on January 17…. I won't read the first paragraph; it was about other incidents that were going on at the time.

I raise that only because of the discussion that we had last night. It was a good discussion around compensation and nursing and the future of nursing in this province. We did receive feedback overnight — talk about instant communication — from nurses in the system. I compared that with what I know about what

CIHI is saying about overall percentage allocation of the health budget to other professionals.

I'm wondering: where does one resolve these matters? Where does a nurse resolve this matter in terms of not only compensation but working conditions as well?

Hon. C. Hansen: I think the member's specific question was: where do nurses go to pursue compensation issues? I think we went through some of those bodies last night, so I won't repeat that whole answer. But certainly, through their union they have relationships with human resource officers in facilities, and through the HEABC they have the ability to discuss issues around their collective agreement. So they do have the avenues — through their supervisors, in a direct sense. They also have access through their union, whether it's through the shop stewards or through the bargaining committees directly to the HEABC.

The member talked about the ads and the information in the ads. Basically, the information that was in those ads was checked very carefully, and it is based on factual information. The letter Ms. McPherson has written discussing that…. I think her analysis of it is, by and large, fairly accurate. We are looking at the total compensation cost to the health sector, so we're not looking at each individual nurse. You know, they, too, have had a significant increase, as I mentioned earlier.

The issue around training spaces. I find it curious when the member somehow argues that licensed practical nurses are not real nurses. They are professionals, they are professionally trained, they are professionally credentialed through their college, and I have the highest respect for the work done by licensed practical nurses in this province. I think the challenge we have is to make sure we utilize the right health professional in the right spot.

I also just want to touch back on our CIHI data. What she's talking about is not a 22 percent reduction in compensation for other health professionals; she's talking about a reduction in the percentage of the overall health budget that's going to health professionals. Nurses in this province are making significantly more than they were making two years ago.

J. MacPhail: Once again, I have said over and over in this House that I take no position on the allocation of resources between LPNs and RNs — none. I'm not a health professional; I have no ability to make that allocation. I'm not sure how the minister interpreted that what I was saying in any way indicated that. I'm just saying there has to be a proper, professional analysis of allocation of resources that has the best patient care at the heart of that analysis. That's all I've said over and over again.

My point relating to the individual compensation of nurses versus the overall allocation of health care dollars from the overall budget to delivery of health professional services other than physicians is this. If there is a declining percentage of the overall budget being allocated to health professionals other than physicians, it means that perhaps some may be getting paid more, but there are fewer overall doing the work. I raise that issue only to have an answer to how those matters of workload are resolved. There used to be joint working committees, pursuant to the collective agreement, which discussed matters of workload. They were outlawed under Bill 29. That was my only point in raising that.

Hon. C. Hansen: The number she cannot refute is that there are more nurses working in the system. There are more registered nurses; there are more licensed practical nurses. From the stats I read out last night, we may have actually seen a decline in registered psychiatric nurses, but there was an increase last year alone of 538 nurses, and they are being paid more. I don't think the member's argument holds water when you look at the actual stats in terms of the number of staff that are in the system.

The other thing I should point out, which really has a direct effect on that overall cost to the system, is things such as overtime, which is down 29 percent — the number of overtime hours in the province. We have seen long-term disability drop by 50 percent in this last year. I think that indicates that nurses are working in better and more appropriate environments. Just as an example, the overhead lifts, which we talked about last night as well — those not only reduce workplace injuries but also reduce the workload for individual nurses. We are using technology better.

You can't draw the conclusion that the percentage of the overall health budget that is allocated to a particular sector — let's say other health professionals — should automatically increase at the same rate as the overall budget increases. It should be making sure that we have the appropriate number of health professionals doing the right job to meet the needs of patients in the province. As we discussed last night, we still do have nurse shortages in the province, and vacancies. I forget the number now, but it was about 300, or whatever that was we discussed last night.

J. MacPhail: That's all fair comment by the minister, and I will await the explanation around workload issues. The one thing we can determine is that the percentage of the overall budget going to health care professionals has fallen by 24 percent in the last two years. The minister may be right — I take him at his word — that there are more nurses working in the system now and less long-term disability and overtime. Excellent. But at the same time, more work is being done in the system. The minister just claimed that there were 9 percent more surgeries being done.

It's not a static situation. I don't in any way claim it to be a static situation. There are trends, and that's why I used percentages as opposed to overall dollars, because the only way you can determine trends is by looking at percentage change. So I leave that for the minister. I'm hopeful that there is some forum for these

The other area that my colleague and I can't leave without some discussion is the overall matter of compensation for health care support workers. I actually have to go on record thinking that — perhaps not this minister — the Premier has had a particular and personal attack on the Hospital Employees Union. I was shocked that the Premier of this province, who is supposed to be the statesperson representing all of British Columbians, used the opportunity of a televised address to attack the Hospital Employees Union. I was completely taken aback by it. I, who have tried often and almost always to support those in my party, have at times taken a position different than my government, but I was surprised that MLAs in the Liberal government allowed the Premier to get away with that. It was completely unnecessary. It was a cheap shot, and it was perhaps not telling the whole truth, either.

I'm wondering whether the minister, in his allegations of always saying that people who perform housekeeping tasks, dietary tasks, laundry and security make 30 percent more on average — and he used it yesterday — or his officials have done any allocation of that figure as it relates to paying women an equitable wage.

Hon. C. Hansen: I guess the short answer is that we certainly haven't been driving the changes around support staff based on an approach on groups that, because they may be more than 50 percent women-dominated…. We want to make the right decisions based on how to get the most cost-effective services that are required to support the delivery of health care to patients in British Columbia.

It's not a case of using that budget to drive a program to support one particular sector in our labour force or another sector in the labour force. We are looking for the most cost-effective delivery of care, and whether a particular sector is predominantly female or otherwise was not part of our considerations.

J. MacPhail: This government does go on about how the health support service workers are paid 30 percent more. Let me tell you about what happened in terms of wage differentials, gender-based wage differences, from 1991 to 2001. Why is it important? Well, let me just tell the minister — well, not tell the minister, as I'm sure he knows this — why it's important for British Columbians.

I hope there isn't one MLA, either Liberal or New Democrat, who would now say the work that health support service workers provide is not important. They cannot be written off as glorified toilet-cleaners anymore, and I know that even the Liberal MLAs have stopped saying that. They're key to the well-being and integrity of our safe health care system, of safe delivery of health care services.

Who are the health support service workers in our province? Well, 27 percent are visible minorities, 31 percent are immigrants and 85 percent are women. I don't agree that they're older women. The average age is 47 years, and that's not an older woman by any stretch of the imagination. Anyway, they are women in their forties who are visible-minority immigrants. That's who they are, and thank God they're doing the jobs.

They're tough jobs. They're important jobs, and they're highly unrewarded jobs from a public perception. In order to have these valuable jobs done, from 1991 to 2001 the government of the day took a position that those jobs should be adequately compensated — not overcompensated but adequately compensated — and here's what happened. Because of the profile of who was doing the jobs, the government of the day approached it from a point of view of wage equity, gender-based wage payments, and looked at it from that point of view.

Here's what happened, Mr. Chair. In the gender-based wage differential…. What do we call it? The wage gap. The wage gap between men and women. Here's what happened. Housekeeping aide, 1991: the wage gap between men and women was 16 percent. By 2001, the wage gap was 3.7 percent. Nursing assistant: the wage gap in 1991 was 29 percent between men and women in a comparable job of the same value.

We're not making up new worlds here. These apply across the world. Nursing assistant, 29 percent. That differential had decreased to 11 percent by the year 2001. Food service worker: the gender wage gap in 1991 was 10 percent. That had decreased to 0.2 percent in 2001. Laundry worker: the gender-based wage gap was 14 percent in 1991. In 2001 it was 1.9 percent. Clerk 2, medical records: in 1991 the wage gap was 14 percent. That had been reduced in 2001 to 1.1 percent.

I'm always fascinated in the discussions that my colleague and I have with the Minister of State for Women's Equality around progress in this area, but if ever there was progress made on the basis of compensating people for the value of the work — regardless of who they are, what gender they are or from whence they came — that work took place and progressed properly from 1991 to 2001. Our system could not survive without these workers.

I hope both the Premier, who takes it upon himself to attack those people who work in our health care system and our members at the Hospital Employees Union, and this government, who uses those workers as an example of how overpaid British Columbia health support service workers are, take into account that any reversal of their wages will be a direct attack on women and a widening of the wage gap.

Hon. C. Hansen: We did earlier discuss the package that is out for ratification by members of the HEU now. We don't know what the result of that ratification will be. But if that package is ratified by the membership in the HEU, they will still be the LPNs, the housekeepers, the cooking staff, the laundry workers, the cleaners, who…. I agree with you. They are a valuable part of our health care system, and it is an essential

part of our health care system that we have those support services. But if this package is ratified by the HEU membership, those B.C. workers will still be the No. 1 paid in those categories of any province in Canada. I think the women who provide those services — or anyone who provides those services, male or female — will certainly be able to enjoy the highest wages in Canada for those particular categories if this ratification, in fact, is approved.

I can't sit back and just let the minister's comments slide when he rose up and responded to my colleague the Leader of the Opposition around the wage-equity piece, when he said that the government, in this sector, happens to have these wages reduced through Bill 29 and other measures. It just so happens to be targeting women in this instance, although it's not the government's intent to target women.

You know, the reality is this. The principle of pay equity deals with women — women as a class — versus the male counterpart, and that's where the wage gap comes in. Over the last ten years tremendous effort has been put to try and actually narrow that gap between men and women for work of equal value.

We happen to be discussing the health care sector, and as my colleague identified, the health care support workers happen to be primarily women, immigrant women and, one may argue, perhaps middle- to older-aged women, 47 — although not old, by no stretch of the imagination are they deemed to be old, not at all. So we happen to be deliberating about this class of women, if you will, in the workforce who are faced with wage cuts.

The minister says that…. That is an aside on the issue around the principle of wage equity that I want to ask the minister to address. There's another issue here. He says their wages are actually the highest, but you have to also take into consideration cost-of-living expenses. For housing alone — even in Ontario, if you compare Ontario — our costs are a lot more expensive than that of the other provinces. I won't take the time to read from our research the housing costs and the cost-of-living differentials between the provinces. That makes a big difference. When you account for that, the wages all of a sudden actually slide right back down in terms of the cost of living.

There are two points that I think the minister needs to address on that note. I would hope that we've moved to a point where the Liberals and all MLAs support wage equity and would put measures toward moving and advancing and narrowing the wage gap between men and women for work being done of equal value as opposed to actually widening that gap. That's what's happening right now when the government rolls back wages for this sector of workers in our community.

Hon. C. Hansen: I think that if this package gets ratified, we can still point to British Columbia as the province that has the highest wage and benefit rates for employees in this sector. I think we have to be careful when we start looking at cost-of-living factors with various cities across Canada. In fact, there was a study done of medium-size cities throughout North America. What it showed was actually that the two cities in North America with the lowest cost of living in that size of community were Kamloops and Chilliwack — as cost of living.

When you start to compare from province to province, there are lots of factors that come into that. I think the bottom line is that we still have wage rates in this province that are well above other provinces in Canada. Do you want one more?

J. Kwan: I appreciate the minister's response, but I do want to put this on the record. We're comparing Canada. The minister's comment is that we have the highest wage for this group of workers in Canada, which is why I want to put on record the cost-of-living expenses. Just take as an example — I wasn't actually going to read this onto the record, but I will, given that the minister says we have to be careful about those comparisons — that in Canada, just on housing alone, the interprovincial comparison of wages, minimum wages and housing costs for B.C. is $1,538. For Alberta it's $1,152; Saskatchewan, $980; Manitoba, $1,022; Ontario, $1,366; Quebec, $995; New Brunswick, $891; Nova Scotia, $891; P.E. I., $891; Newfoundland, $891. The average for Canada is $1,218, and B.C., once again, is $1,538.

There's a substantive difference in terms of just one element of the cost of living, which is around housing, that I've highlighted here. When you add in, again, the wage differences between men and women, I don't think anybody in this House would assume that somehow women will require less money to survive for performing the same work of equal value. Women ought to be paid the same amount. We're trying to narrow that gap and not widen it, but yet we see this Liberal government turning back the clock for one sector of women in the health care support services sector. They are all the folks that my colleague had mentioned — the laundry support, the housekeeping support and so on.

In any event, I don't want to belabour this. I do note the time, so, Mr. Chair, I move that the committee rise, report progress and ask leave to sit again. I'd like to be able to come back in the afternoon.

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

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

ESTIMATES: MINISTRY OF
HEALTH SERVICES —
MENTAL HEALTH; and
INTERMEDIATE, LONG TERM
AND HOME CARE
(continued)

The Chair: We're sitting here in relation to the unanimous consent being given to Section A of the Committee of Supply to consider the portion of vote 29, Health Services, related to the Minister of State for Mental Health and the Minister of State for Intermediate, Long Term and Home Care. Following completion of the discussion this morning, I will be making an informal report to the Chair of Section B in the House as to the status of the discussion in Section A.

Hon. G. Cheema: I'm willing to answer any questions from any member of this House.

B. Locke: I will continue from the previous day. My question to the minister is: is there a policy that methadone must be used in treatment programs, even when the facility does not want to take in clients that are currently on methadone?

Hon. G. Cheema: The health authorities target funding for addiction treatment programs that provide care for patients with the highest need. This includes patients with a concurrent disorder, patients with multiple addictions and patients with multiple treatment failures. Intensive residential treatment facilities funded by the health authorities cannot refuse patients because they are taking prescribed medication. This includes medications like Olanzapine for schizophrenia and Wellbutrin for depression or methadone for heroin addiction.

However, there are many supportive recovery facilities in B.C. that are not funded by health authorities but receive funding through the Ministry of Human Resources or through gaming. These facilities may or may not be licensed. The medication policy would not apply to these facilities.

B. Locke: Can the minister comment on needle exchange programs, and what is their role in the drug strategy?

Hon. G. Cheema: Needle exchanges are one part of the harm reduction, and we value these programs. For example, we have one program in Surrey. That program has been proven very effective and has won international awards as well. I think they do a great job, and this helps to reduce the infection of HIV and other infectious diseases. We want to continue with these programs. They're very effective.

K. Krueger: I recently had the great privilege and joy of opening two brand-new buildings in Kamloops — two of the three construction projects for the tertiary psychiatric facility for the southern interior which is being built there. I wanted to start off by thanking the minister for that promise being kept. We were delighted that patients were moving immediately into the two buildings that we were opening. I just wanted a status report for my constituency and Mr. Speaker's constituency as to what the feedback is from the families and patients.

Hon. G. Cheema: This is something that was promised a long time ago. It's my understanding that this project was promised by three Ministers of Health and about three Premiers in the past, and that promise was never kept. I think the community of Kamloops was let down, and they were very concerned when we came into power whether we would do that or not. I think that with the help of the members from Kamloops…. Both the members were very effective at keeping us fully informed. We had an initial meeting, which was, I think, in the month of August or September of 2001. We met with all the key players. Then we made the decision that we will be fulfilling that promise.

This is something so important not only for Kamloops but also as a part of the Riverview redevelopment project. We opened two facilities two to three weeks ago. The Premier was there along with the member for Kamloops–North Thompson. We were very pleased to see how this new facility will provide

It's my understanding that this project is moving very well. Patients are being transferred to that facility. I just want to put on the record some of the feedback I got from the new place. We call this place the South Hills facility in Kamloops. One of the patients said: "As a result of this new facility…." This patient had not seen his family for the last 23 years. This was something that was very important to him. When this patient went to the new place, he was very happy to see his family. I think that's something we wanted to do as a sign of respect and also a sign of caring, and we are very proud of that.

One patient, who had been at the Riverview Hospital for 40 years — four zero, 40 years at this institution — said that this was the best place he had ever lived in, in his life. The patient said, after his arrival: "I finally feel that there is a hope for recovery for me." I think that says a lot about mental health in this province. I think that's what we wanted to achieve.

There are many facilities across the province. They are home-like facilities. I think you need to go and see those facilities. You have seen them, but I would ask any other member, if they have time, to go and visit these places and talk to the patients, talk to the families.

This facility is based in the middle of the neighbourhood, a residential place, and I think that will help us to remove the stigma from mental illness. I want to say thank you to the member and his staff in his office, to the Hon. Speaker and his staff, and to many advocates in the area who have been very effective in reminding us that we should always fulfil our promise. I say we were grateful that we were able to do that. This will serve patients in this province in a very respectful way.

K. Krueger: My thanks to the minister. Kamloops is grateful — and the southern interior and, I'm sure, the families of those patients — but it's especially heartening to hear that feedback from the patients themselves. It's delightful that the families are reunified to the extent they can be, and I'm very proud of the government for that.

I understand we've opened facilities in Prince George and Coquitlam similar to the South Hills facility. Those were earlier than ours. I wonder what the experience has been there.

Hon. G. Cheema: As I said earlier, the Riverview redevelopment project is one of the major components of our mental health plan. We made the promise during the campaign that we would be implementing the mental health plan. We realized that not only do we have to redevelop this hospital, but we also have to spend money in communities around this province, and to develop modern facilities like South Hills in Kamloops, Connolly Lodge in Coquitlam, Iris House in Prince George and Seven Oaks in Victoria, we are spending an additional $138 million.

I'll just give you a few examples of how some of the patients are feeling in Connolly Lodge. Over half of the patients were ready for discharge within a year. Originally, it was expected that the discharge could not have occurred for at least two years. That's a huge improvement.

Environment plays a strong role in the recovery of these patients. If you look at these facilities, they are home-like. There is a kitchen in the centre, you have a nursing station, and then you have a very accommodating place. These are nice places and patients feel good. I think they feel, some of them for the first time in their lives, that they are being respected. We expect these things to get better in the future also.

Riverview Hospital, you should know, also has a graveyard. I think it says a lot that in the past when patients were sent to this institution, some of them never expected to come back. That's what we are changing. We think that these patients have a place in the communities. Some of them may never leave a facility, but they should be given a full chance.

The recovery rate is remarkable. I will give you an example from Iris House in Prince George. We opened a facility last year. There were ten beds, and we opened another phase of ten beds. The patients are so happy. Some of them are participating in the religious activities. They will go and be a part of the community. Families are happy. The community in the surrounding area has also developed a new level of respect. I think that's part of my responsibility, to ensure that the issue of stigma is also removed. I think we are making progress, but it will take some time. So far our experience has been very positive.

We have done something which no other government has done in the past: any patient from Riverview Hospital will only be moved if there is an agreement between the patient and the family and the receiving community. I think that's significant. Not a single patient has moved without the consent of all the partners.

I must say that the work done by the provincial health services authority — under the leadership of Wynne Powell, Lynda Cranston and Leslie Arnold…. I call them the magnificent trio. They have done a tremendous job of putting this plan into action.

K. Krueger: All of that is very heartening. I was tremendously impressed with the facilities. They are the type of buildings I think anybody would feel very comfortable living in. They're beautifully done — really nice.

I wonder if the minister could give my constituents an update on the time line for the 44-bed acute care addition to Royal Inland Hospital, which constitutes the third pillar of this facility.

Hon. G. Cheema: These 44 tertiary acute care beds will be located on the Royal Inland Hospital site. Currently this project is in design, and we expect completion of this project by the fall of 2004. That will give Kamloops 44 plus 40 beds; that's 84 beds. That was our

I am so happy that this is something…. Again, I must say that the member from Kamloops and his colleagues in the area have worked very hard to make sure that we fulfil that promise. I think it's good for the community; it's good for the patients. This will also bring a lot of money to the community, when we have these 44 plus 40 beds operating. That's good for patients.

K. Krueger: In speaking of this whole project, the minister has quite rightly spoken of the benefits to patients first. They are obviously the fundamental priority for everything we're doing there.

The minister just touched on the economic factor as well. Certainly, in heartlands communities there has long been a feeling that government could be doing a whole lot more locally than it's done over the decades and that a lot of economic activity is needlessly corralled down here at the south end of Vancouver Island. It is the second priority after patient care, but this is a tremendous boon to our local economy, and we really appreciate it.

People have heard different numbers as to what the long-term economic impact will be. I wonder if the minister has available to him an estimation of what the annual payroll will be for this facility when it is fully operational.

Hon. G. Cheema: I don't know the exact number, but I will get the numbers for the member from the staff. We'll keep him fully informed. This project is in the process of going ahead. As the patients are going to be moving, the money will flow with them. We are not aware of the exact amount at this time.

K. Krueger: Fair enough. In conclusion, then, I do want to extend my thanks and the Speaker's thanks and the thanks of our many constituents. This is a major promise that was made, and it has been kept very early. We're proud of the minister's work and his staff, and we just want to say thank you.

J. Kwan: Let me ask the minister some broad questions, and then we'll go into some of the specifics. Could the minister please advise: how much out of the Health Ministry's budget is being allocated for mental health services?

Hon. G. Cheema: The expenditure for mental health for 2000-01 was $854,600,237. The projected expenditure for 2003-04 is $1.067 billion. That is about a 17.6 percent increase over 2000-01.

J. Kwan: The minister gave the numbers for 2000-01 as $854 million-plus and '03-04 as $1.06 billion. What's '02-03?

J. Kwan: Just so that I get the numbers correct: 2000-01, $854 million; '02-03, about $1 billion; and then '03-04, about $1 billion. Is that correct?

Hon. G. Cheema: For 2001-02, it's $924 million. For 2002-03, it's $1.005 billion and for 2003-04, $1.067 billion.

J. Kwan: Could the minister give us a further breakdown of those numbers by region?

Just to further clarify, when I say by region, I mean to each of the health authorities.

Hon. G. Cheema: We don't have the exact amount of how it's going to flow to each health authority. Once this budget process is approved, then the funding is going to be going to them on the basis of population numbers.

J. Kwan: The budget was introduced back in February. It is now May, and the minister still does not know how his budget is being broken down to each of the different health regions? I find that incredible, actually, for the regions not to know. They must know. It's been several months since the budget has been introduced.

If the minister doesn't know, how could he calculate, then, on the basis of what the needs are in the community? How did he come up, for this year's budget, with almost a billion dollars? Under what projections?

He must have some idea. I'm not looking for an exact figure to the penny. Some ballpark numbers would be adequate, and I would assume that the minister would know and have that information.

Hon. G. Cheema: Let me just explain to the member again that this is the estimated expenditure for next year. Once this process is approved, the health authorities will be spending that much money across the province. We are looking at the outcomes and the performance measures part of the mental health spending. At this time I don't think we have any of the numbers to explain to the member.

J. Kwan: Let me just get this straight. We're debating the Ministry of Health Services debate in the big House. The health budget is about 40 percent of the entire budget. In this small House we're dealing with one segment of that health budget, which is the health services for mental health — for the Ministry of State for Mental Health.

I understand how the process works. I understand that this is a projection for next year. I understand that this is how these numbers come together. I understand that's how governments plan to move forward, that they have these estimates in their own minds and how, therefore, they could meet their budget targets.

That's what these things are called. Estimates are called budget targets. If the minister doesn't have budget targets, how does he expect that he would ac-

tually meet those targets? How does he get the reassurance that the services the community needs are actually being met? He has no idea whatsoever what those targets are.

How could a minister do his job if he doesn't have that information? I am completely perplexed as to how it could be that the minister does not have those budget targets. How can the minister sit in this House and assure the community — British Columbians — that their services that they require would be fulfilled — that they would be met? How could the minister say that?

Well, maybe the minister can't say that. Maybe he'll just say: "Hey, you know what? I don't know what my budget is. I don't know what's going on out in the broader public. I don't know what services you need. Therefore, I don't know how to meet your needs in our community." Is that the situation the minister is faced with now?

Hon. G. Cheema: I will just try to answer again. There is a 3 percent increase in the budget for mental health from last year. That's about $62 million more than last year. Mental health is very complex. We are developing community services. We are spending money on the acute hospital beds. We're spending money as part of the Riverview redevelopment project. I have told them, member, that this year there is going to be a 3 percent increase over last year. That's about $62 million more than last year.

J. Kwan: I'll continue on with these questions with the minister in a minute. I just need to speak with somebody outside who's waiting for me. I'll yield the floor to the member for Vancouver-Burrard for a few minutes. I'll come back.

L. Mayencourt: There has been a lot of discussion recently about the Eating Disorder Resource Centre, which has been located in St. Paul's. Maybe I could begin by giving a little background. St. Paul's Hospital has been a centre of excellence for the eating disorder clinic that resides at St. Paul's. It's a very valuable service. There are a lot of British Columbians that have a variety of eating disorders. This has been a very valuable resource in my community.

As kind of an offshoot of that, the executive director of that clinic had created a resource centre. There was some concern and an announcement that St. Paul's Hospital, which is going through some challenges in terms of how much space they have to offer…. One of the sacrifices they have made is the Eating Disorder Resource Centre. I wonder if the minister could tell us what the ministry is doing about maintaining the Eating Disorder Resource Centre in Vancouver and what future plans he has for that particular resource.

Hon. G. Cheema: Thank you for the question. In February 2003, St. Paul's Hospital provided a notification of the need to relocate the Eating Disorder Resource Centre. At that point, the PHSA began work to find a new location for the centre. I know that the member for Vancouver-Burrard has been very active in working to ensure that a new location for the centre is found. The centre will be temporarily moved to a children and women's centre and is presently being funded by the health authority.

As the member knows, on May 8 the Duke of York and the Premier performed a sod-turning ceremony for the new child, adolescent and women's mental health centre that we are building on the children and women's site. For this I would like to commend — I call them three magnificent leaders of the provincial health services authority — Lynda Cranston, Wynne Powell and Leslie Arnold. They are a most successful and dedicated trio for mental health.

I would like to also recognize Dr. Derryck Smith for advocating for this project for many, many years. Our government recognizes the importance of this project, and we have acted to see it happen. The Eating Disorder Resource Centre will be located permanently to this new facility when it's completed in 2005.

J. Kwan: Sorry, my apologies. I've just been advised that the Government House Leader would prefer that I ask the questions of the minister Monday when we get back. Therefore, I'm going to yield the floor to the government members to ask the questions relating to the minister's estimates at this time. I'll come back and ask my set of questions from the opposition caucus Monday when we get back.

L. Mayencourt: Thank you to the member for Vancouver–Mount Pleasant. I appreciate the opportunity to canvass these estimates at this point.

To the minister, thank you for that answer on the Eating Disorder Resource Centre. I think it's something that we have…. It's a very significant resource that's very valuable in my riding, but I also understand the challenges St. Paul's is facing. I'm grateful that we have this resource centre moving up to B.C. Children's and Women's Health Centre. That's a great thing for us.

The next area I wanted to ask the minister about has to do with something that was canvassed here a little bit earlier today, but I do want to just ask a few questions. It has to do with the plan for taking folks out of Riverview and putting them into the community. I know that having these folks in the community does work very well. As a matter of fact, I've been with the minister. We've gone to the downtown east side, and we've visited St. James Community Services Society, which has a number of these facilities, at varying levels, to help individuals living with mental illness. It has been very successful.

In a very non-partisan way, I also want to commend the member for Vancouver–Mount Pleasant because I know she's been involved with St. James and also with another agency, called the Unity Housing Society, in the downtown east side, which has created five individual homes in the Strathcona area and which

allows individuals with mental illness to sort of take control of their lives, take control of their home. They have a number of individuals that live in these homes. I think it's very healthy. They have a non-profit agency that helps them administer the dollars and such.

I am really interested. As I go around my community and we talk to people about decommissioning Riverview, there is concern in the community. It revolves around some of the things that happened in the mid-eighties through the nineties in which there was a feeling that, you know, we were putting people in the community but weren't really giving them the resources to be able to succeed.

Now, I know, having my experience with St. James, having my experience with Unity, having my experience with the Coast Foundation and many others, that in fact there are great people trying to provide that kind of supportive environment for people living with mental illness. I wonder if the minister could please tell me a little bit about that decommissioning and the resources that are going to be available to build facilities and to provide that supportive environment for those individuals as they move from Riverview into the community.

Hon. G. Cheema: I think the member is right that in the past, when attempts were made to downsize this hospital, the community placements were not there. A lot of people feel that this may happen again, and I think that's one thing we should always be aware of. I am also concerned about that.

Our government has made a commitment that we will not send any patient into the community as part of the Riverview redevelopment project without having a community placement in place. I'll give you some examples. The Ministry of Health Services has committed over the next five years to redevelop Riverview Hospital. We will be spending an additional $138 million to have this facility across the province, because you can't take one patient from this institution and take them back to their community without having a proper place. That's number one.

Number two. This year, in 2002-03, $10.25 million was allocated to reallocate 82 mental health beds to the following health authorities. To the northern health authority, we gave $1.125 million for ten beds. The interior health authority will receive $5 million for 40 beds, and Vancouver Island health authority will receive $4.125 million for 33 beds. Money will flow with patients. You should have assurance that these patients will be taken care of close to their homes in those modern, home-like facilities. We feel that, eventually, they will go back to their communities and be a part of the community. That will be helpful for the patients.

This year we also provided transition funding that….The provincial health services authority provided an additional $3 million in transitional funds to facilitate this development.

L. Mayencourt: I want to thank the minister for his comments. The minister raises a very excellent point. You know, in the past people did have a…. As people came out of Riverview, the placements were not made into the community in appropriate settings, in some cases — I guess, perhaps, in many cases.

I agree with him that that could happen again, but as long as we're vigilant about it — and I know that the minister really is vigilant about it — we can do a much better job. It's all in the interest of helping those people that reside at Riverview who do want to live in a less institutional environment. I support that. I want to support the minister in his vigilance on this particular item.

When we look at setting up these new facilities — and I know we've opened a number of them in the past few months…. The member for Kamloops–North Thompson just spoke about one in his community that he's very proud of, and I think all British Columbians would be very proud to see that kind of facility in their neighbourhoods.

How are we working with the community groups that represent mental health consumers in terms of developing those spaces and deciding where they're going to be located? What's the process we're going through in that regard?

Hon. G. Cheema: Responsibility for the redevelopment of Riverview Hospital lies with the provincial health services authority. From day one they have led a process that is very inclusive. This process has families' involvement, involvement of the caregivers, the care providers and the various health authorities across the province. This is being led by Leslie Arnold. She is now the person in charge of this redevelopment project.

There is ongoing consultation with all the community groups and all the mental health organizations in the province to have their input. Ultimately, our objective is — again, I will repeat that — that no patient will be sent to any community without the patient's approval, without family's approval and, also, without approval of the receiving end of the community. I think that's a good process which will ensure that patients are taken care of and that we are not forcing them to leave the institution.

Our objective is to take them as close to their homes as possible. In some places it may not be next door, but at least they will have more comfort with the understanding that their families are very close. They can visit them, and I think that will be very helpful for the patients.

This process is ongoing, and if there are any difficulties or deficiencies, we'll correct those. I don't want us to ever say that this is something we have done and we don't need to worry. We should be always worried and always cautious and always careful.

These are patients who have been in that institution anywhere from ten years to 20 or 40 or 50 to 60 years.

Somebody has even been there, I was told, for 87 years. If you go and visit that facility, you will see how difficult it would be for anyone to even visit that place. That facility represents buildings and also had a good past, but I think we need to move on. Our objective is that those patients are real people. They're human beings, and we need to give the proper care. To provide them with the proper care, we have to have proper facilities. We have to have the care which is based on the best practices. That's what we are trying to do at this time.

We have to watch. We all have a responsibility to ensure that we do it properly, and that's what our government…. Our Premier is very firm on that. No patient will be moved without having proper placements in the community. That includes the proper care providers, and the funds will flow for that. I think that's something we need to continue to work on.

I have full confidence, because as of today we have not had any major setbacks, and I think that's an achievement. We have transferred many patients, as I told you earlier, to Seven Oaks in Victoria. Some patients have been transferred to Prince George. We are in the process of transferring patients to Kamloops. So far, our experience has been very positive, but we need to be careful and very cautious.

L. Mayencourt: You've mentioned Leslie Arnold a couple of times in the discussion here today. I've had the opportunity to meet Leslie, and I've also had the opportunity to speak to a lot of people that have been working through that process. There's an element of planning and process and all of the things that are needed to make this all happen. Underscoring that, or adding to that, is the sense of compassion I get from hearing the minister today and the sense of compassion I get when I hear of the work that Leslie is doing through the provincial health services authority.

I know that we've set some money aside. I know that we've developed a plan. I know that we're consulting with individuals affected by that plan, and I also know that we're moving forward with something that really comes from the heart, which is to provide the most appropriate housing and supports for those individuals living with mental illness.

I commend the minister on becoming one of the most passionate advocates for people living with mental illness that this province has ever seen. I am very grateful for the hard work he continues to do and will continue to do.

I think it's really important, when we think about the decisions we make today, that we're actually the start of a legacy. The legacy I would envision for this minister and for this government is that we did the right thing — we consulted with people; we included them in the process; we made sure they got the appropriate whatever; we put the money to work for these people — and that we did it, also, with this compassion. I just want to say that that's a really important thing for me, as it is for any member of any family that has someone living with a mental illness, so it's worth it to do this.

Another area that I have been interested in for the last little while has been the notion of something called mental health courts. In the last couple of years we developed something called drug courts to help individuals living in the downtown east side, particularly, but actually in other areas as well. What it does is allow an individual that's been arrested for possession or trafficking or what have you to come to a kind of community court which has more of a supportive kind of role. What that entails is that an individual would, through that court, make a deal with the judge who oversees that court to seek treatment, to access resources that exist in the community that might assist them in dealing with their addictions and those sorts of things.

As the minister has said on many occasions, there's often a very strong linkage between people that are addicted to drugs — substances — and mental illness. A lot of times we have people that are self-medicating for depression or anxiety disorders by getting involved in the drug scene.

There has been some work done in a couple of jurisdictions. Toronto is one that comes to mind, but also there's been a new initiative in Washington State to deal with that. It's called the mental health court system. Has the minister considered the possibility of creating mental health courts as a complement to the drug court program that we started under the Vancouver agreement?

Hon. G. Cheema: Before I answer that question, I just want to give a brief summary about the consultation process for the Riverview Hospital redevelopment. In our view, the most important thing is the patients and their families. Without consulting them, we have not moved and we will not move.

Part of the redevelopment project is to have ongoing consultation. The next consultation will take place on June 25. I would ask the members: if they have time, then they can come and watch and participate in those consultations. It's so important that, at the end of the day for mental health, it's for the patient and the family.

Who do you call after 5 o'clock? Sometimes you can't get hold of your doctor. You can't get hold of your psychiatrist. Who do you call? You call your family. That's why we want to ensure that the families are an integral part of this process. We may not do all the things at a fast speed. I don't mind that. I think with mental health we need to be very careful, very cautious, and we have to look to the future.

If you look at our Riverview redevelopment project, at the end of five or six years we are going to have more capacity in the province. I think that's very positive. If you look at the other provinces, they are also moving in the same direction, but they are losing capacity. We are increasing capacity, and according to my information at this time, we'll have an additional 116 beds by the end of five or six years. I think that's

There is more awareness about mental health. Once you raise awareness, you are going to have more people coming out, so we need to look to the future. We need to have all the community services put in place. We need to educate the public, and we need to ensure that we don't do harm to these patients. I think that's the key for me. It is not to do any harm, because you can't just leave them in the community without having a proper placement.

I was telling the member from Kamloops: can you imagine somebody who has not met with their family for 23 years? Whose fault is that? It's not that patient's fault. It's not the family's fault. It's the fault of the system. The system was able to put that patient at this institution, and it never understood that this patient needs to talk to his or her family. I think that's what we need to be focusing on. It's not about one patient; it's about the whole family, about the community.

If you were to go to that institution, once you got there you would see the long keys. Those long keys are reflective of the power over patients. That's not very good. That's not the way we should treat anybody. That's something I want to change there. People should be respected.

How do you respect them? You respect them by providing the best possible care. Providing care for mental health is not about a patient. It's about the family; it's about the community. When we bring patients home, we are bringing hope back to them. That hope must be backed by medical evidence, the best practices and also compassion. I think the combination must be the right combination; otherwise, we will be doing a lot of damage. I think we need to very careful and very cautious, and we need everyone to be helpful.

All the mental health organizations in this province are our partners. They are working with us; they are not working against us. I think that's the key. If you would look at their past relationship with the previous government, it was very different. With our government they are our partners. Five or six of these organizations are helping us. They have played a key role in the past to be an advocate for mental health all across the province.

I want to highlight the Canadian Mental Health Association. They have done a tremendous job. But we don't recognize them, because they don't make the front page of the story. If we have to transfer a patient today to Seattle for a bypass, that will make a story — the front-page story. Do you think anybody with schizophrenia or other treatment will make a front-page story? It will not. I think that needs to be changed.

I'm determined that at the end of our term we should be able to talk openly about mental illness. As I have said many times, nobody is immune to this difficulty. This is not something to be afraid of. This is like…. I'm a diabetic. If I can say that I'm a diabetic, if I have a depression, I should be able to say that openly.

That was not happening in the past. Who was talking about mental health in this province except the mental health organizations and Rafe Mair? We should never forget his contribution to the debate about mental health. As I said, it's about the patient, the family, the community and the society in which we live. In a country like Canada, in a province like British Columbia, if we are not compassionate about one of the most important issues we face as a society, I think we are failing.

I want us to do it well. I'm not one of those who will make noise every day. As I said in my opening remarks, it has been frustrating at times because it takes time to have a cultural shift. People don't understand. They don't want to talk about this issue. It's very difficult, but they have no choice. It's part of their life. It's part of their family. It's part of the community. It's part of the process.

I just want to come back to your question about mental health courts. The Ministry of Health Services is focusing on helping health authorities to develop the continuum of evidence-based community mental health services. We have done only very initial work on this project. I think more needs to be done. We need to be very careful when we compare our system of care with Washington. We need to be, again, very careful and cautious on those projects.

As you have said, three provinces — Ontario, New Brunswick and Alberta — have established those courts. We will see how they are functioning. We shall learn from them and bring their experience to B.C. and work with the ministries of Solicitor General and Attorney General to ensure that we develop a program which is Canadian-based, which meets our goals and our objectives and which is also part of our cultural shift. In the long run we can achieve those results that you think we should be achieving.

Ultimately, all these things are good, but if you don't have a service in the community, we will not be serving those patients. Again, I just want us to be cautious and careful, look at the evidence, understand how others are functioning, learn from them and then bring those programs to B.C.

L. Mayencourt: Thank you to the minister. In listening to your opening remarks — I want to come back to that in a moment, but right now I'm sticking with the mental health–courts issue — I'm glad the minister is looking at the models that have been created in the three Canadian provinces that have implemented mental health courts. I know that when I look at the drug court, whether that's in British Columbia or some other jurisdiction, the successes are modest. But there's something about saving the life or the future for one individual which is really quite beautiful and really worth doing.

I'm glad that we're taking a look at the practices that have been developed in Alberta, Ontario and New Brunswick, because I think we can learn from each other. We don't have to reinvent the wheel all the time. It is something I feel would be worth exploring. I hope the minister will have an opportunity to visit those

jurisdictions to see how that plan is working, talk to some of the people who have perhaps come out of that program, or the mental health court, and see what it does for those jurisdictions.

No matter how modest the success is, it's a great way to plug people into services. It's a great way to plug them into resources that are available in the community. It's a great way to provide people with a future, and I think that's really one of the things the minister is on record as wanting to do. I think that's what he's doing with placing, getting people to be able to be in the community, to be reconnected with their families. It's creating a future for them — a future that is not…. If you're in Riverview and you mention the fact that at Riverview there is a cemetery, you know, that's a real indication that you're here for a long time and then forever. Really, when we do just a little bit extra in looking at alternative justice or a means for justice for people with mental illness, I think that's important — just as we do that with their housing needs, just as we look at that for some of the services in their community.

I'd like to go back to your opening comment, to my question, which talked about the fact that part of your job is to increase awareness in the community. The minister and I have had the great opportunity to visit some of the wonderful services that are out there. One that I can particularly remember is our visit to Coast Foundation and another to St. James.

What's happened as a result of my own awareness of those agencies is this great appreciation for the people who are living with mental illness and are accessing those services. Another side benefit of that has been that when someone comes to my office or some individual lets me know that they have a mental health issue or problem that they're trying to resolve or whatever, I have somewhere to take them. I haven't just sent them. I have physically taken folks over to the Coast, for instance, and seen from them the magnificent transformation that happens when they find a community.

I applaud the work that this ministry is doing in supporting places like Coast Foundation, and many others, in creating things like clubhouses and the resource centre that's on Seymour Street. They are small steps, but they're important steps. They make a huge difference for those individuals. I think that's very important.

Also, the awareness and the lessening of the shame, if you will, that's so often attached to families when someone has a mental illness…. I think the minister knows that I have a family member who lives with a mental illness. I've known him all my life, of course, but I've had the opportunity to sit down with him and talk about his own experience and be able to show him some resources that are in the community so that he can get rid of that shame. I also had a brother with diabetes, and nobody hid that under the carpet. I've had many experiences with people with illnesses — particularly AIDS and so on — where there's a great deal of…. You know, they don't want to tell people about it. We've come a long way. I'm grateful that….

When we look at British Columbia and we look at any jurisdiction, one in five people is going to be affected by mental illness. What are we hiding it for? We should be trying to find a way to do that. I appreciate his efforts in increasing awareness and in helping lessen some of the shame that is attached to that.

Just recently the minister and I were fortunate enough to attend the Coast Foundation's Courage to Come Back Awards. It's my favourite dinner of the year. I do a lot of fundraising in my community, and I go to a lot of things, but I've got to tell you that this is a pretty incredible thing. There was a young woman there who is living with schizophrenia. She's a very bright woman who has done a tremendous amount of work as an advocate, as a consumer. She didn't make the front page, but she did make it to page A20. It's an important story. I think those are great. They're humble starts to a better life for a whole bunch of people.

I'll take the minister up on the opportunity to join in on the June 25 consultation, because I think that is a really important way to learn a little more of the good work that Leslie is doing and also to hear from some of the front-line workers a little more directly, I guess, about that process.

The next area I wanted to ask about is controversial; it's supervised injection sites. I know the Vancouver coastal health authority has made a recommendation to Health Canada with respect to a couple of safe injection sites, or supervised injection sites, within my community. One of those is going to be the Dr. Peter Centre. That's a less contentious one. Another is going to be located in the downtown east side.

I wonder if the minister could speak to something that comes up for me a little bit, and that is people saying, "You know, if we open these places up, it's going to be like a magnet. We're going to be drawing people from across Canada, coming here because this is a place where they can go to a safe injection site that has ready availability of drugs," and so on. How does the minister feel about British Columbia going it alone on this? Or is this something he expects Health Canada to ensure is happening not just in the downtown east side?

Hon. G. Cheema: This is, again, a very important question which the member has asked me. I share this responsibility with Mr. Hansen, and yesterday, I guess, the member for Vancouver-Hastings was asking the same questions.

Our policy issue on this project is that this site is going to be part of the federal government's initiative. This is going to be approved by them. This has to be legal and also on a trial basis. Last week Mr. Hansen sent a letter to the federal minister also, indicating the same views. We hope that within sixty days, Vancouver will know whether they are going to get the site or not. I was talking to Dr. Anderson who is part of our team. He has indicated there has been a positive experience in Europe, but we need to look at the experience in Canada.

We are going to be part of the federal government's process, and we are waiting for their reply. Certainly, we would encourage that the other parts of Canada should be part of these sites also. That will give us some comparison, and we can examine how we are doing.

Vancouver coastal health authority has put aside $1.2 million to be a part of this injection site. We hope that once the positive news comes from Ottawa, we'll then be partners with the federal government and the municipality. I know that Mayor Campbell has been very active on this file, but we haven't heard anything official yet. However, I think our main objective, again, is patient health and safety. Supervised injections must be part of the health care system. They must be properly evaluated, and they must be legal. That's our objective.

L. Mayencourt: I'm glad to hear that. I had a community meeting with some residents — I guess it was on Saturday or Sunday — who live in the neighbourhood around the downtown east side. They are individuals that really care about their community, and they want to see a safe environment. They've really appreciated some of the hard thinking and openness that has been demonstrated around the discussion around supervised injection sites.

I guess the feeling I got from that was that they didn't want to be the only one. They wanted to ensure that we as government recognized and communicated to our federal counterparts that there is a responsibility to tie this directly to research, to make sure that it's getting the kinds of results that we need and that it's not only the downtown east side that's being part of this — that there is some value in doing this in other communities.

I would just like to reinforce that that's a view that seems to be held in my community. We're willing to give this a go, but we want it to be a scientific trial. We want it to be managed very properly. We want it to tie back to some of the other harm reduction strategies that we have for injection drug users. We want it tied to some of the health initiatives like the community clinic so that when someone comes in and accesses those services, they aren't just there injecting but also accessing some other form of health….

Many times I've talked to many, many addicts, and we talk about things. They're all in their head saying: "One day I'm getting out of this. One day I'm getting off of this." That's encouraging to me. If we have a vehicle such as the safe injection site which can be used as a way of helping people access treatment, addiction services and general health care services, I think that that's a plus for that neighbourhood. If it's managed well, I think it will fit in okay with the neighbourhood.

One of the concerns in that community — and I'm just going to highlight it for the minister; I don't know if he's able to comment on it or wants to comment on it — is that while we have a recommended site on East Hastings, a group has decided they would open their own. It's basically an illegal safe injection site or supervised injection site on Carrall Street. People in that community are a little concerned about that. They don't mind the idea. They know they have to take a very holistic approach to addiction services, but they're concerned about this site. I guess my concern is when you do that sort of thing, you might put in jeopardy all of the goodwill that goes towards a supervised injection site that is legal, that has harm reduction as part of its strategy and that refers people to resources and such. Could you comment on that, minister?

Hon. G. Cheema: As I have already indicated to the member, I share this responsibility with Minister Hansen. Yesterday he was able to put the same views as I have already indicated. Our main objective is, again…. We are going to be part of the federal government's initiative. To answer his specific questions on this illegal site on 327 Carrall Street, this site is not exempted under section 56 of the Controlled Drugs and Substances Act. To ensure the patients' health and safety, supervised injection sites must be part of our health system, they must be properly evaluated, and they must be legal. Unfortunately, this site will not meet those criteria.

We understand the frustrations of the community, but I think they should wait for the reply from the federal government. As I have said, we are one partner in the whole process. The municipality is going to be involved; so is the federal government. We just need to wait. I was given the understanding that it's a project of about 60 days. They have to wait 60 days after they have submitted their application. We are waiting for their reply.

I will again reinforce the fact that these sites must be legal, they must be a part of the scientific trial, they must be evaluated and they must be part of the health system.

L. Mayencourt: To the minister: I want to thank you, sir, for that. I guess I'm hoping that if there are folks running that site, they will understand that this is meant in the best possible way. That community and Vancouver in general have really said, "Look, we recognize those frustrations," as the minister said, but we have to make a deal with the greater community. There are a lot of people in Vancouver and a lot of people in British Columbia that have reservations about this, and the best way for us to proceed is on this research model that is attached to Health Canada. I think that will sort of tone it down a little bit and make it a little bit easier for people to integrate into their own thoughts and their own feelings about this. We've had to come a long way.

A short while ago the minister brought a group called From Grief to Action here to this House so that members from all parts of the province and their staff would have an opportunity to understand, from the perspective of a family or from a drug user, some of the challenges they're facing. That was a really great edu-

cational opportunity for us. I know that that film — I'll just put a plug in for the CBC — is going to be running on The Passionate Eye on Monday if you're wanting to do that.

I would just really appeal to the individuals that have decided to open that site: work with us, and we think we can deliver something which will be not so inflammatory to the community, which will provide good patient care, which will result in reducing the harm that individuals experience and will, in general, improve the health of that community. I would encourage them to do that.

The minister said that Vancouver coastal has set aside approximately $1.2 million for that site. He also mentioned the mayor of the city of Vancouver, Larry Campbell, who I know has been a very passionate advocate. As a matter of fact, during the election he said: "We're going to have one of these because it's going to save lives." We've set aside $1.12 million. Can you tell me what the city of Vancouver has put aside to assist in the delivery of supervised injection sites in Vancouver?

I'm sorry, but maybe while you're at it, I could also ask the minister or his staff what Health Canada has put aside. Because this is really…. You know, the beauty of the Vancouver agreement is that there are three levels of government kicking in, so is everybody up to the challenge here?

Hon. G. Cheema: The Vancouver coastal health authority has put aside $1.12 million for the capital component of these two sites. We don't know how much municipal government is going to put in. We don't know how much the federal government is going to contribute. That's why we don't need to get overly worried or concerned or overly optimistic at this time. We need to just let the process take its place and take time so that it comes out as a good project.

As I said — I'll repeat it again — our main objective is that the site must be legal, it must be scientific, and it must be part of the federal government's initiative. We would encourage that other cities are also part of this process. For us, addiction is an illness, and we want to treat addiction as an illness, not as a character flaw or something else. That's why we're focusing on the most important issue: the patients.

I agree with the member. We understand the frustration of people. It's very difficult for them to continue to wait and wait and wait. But certainly, these things cannot happen overnight. Again, we need to be very cautious and very careful. My way of proceeding with these issues is that it's better to be careful than to be sorry. I think we need to be mindful of the many issues that will be facing us in the future. We need to be not emotional about these issues but more objective. That will serve us well in the long run.

L. Mayencourt: At this point, we don't have a financial commitment from the city of Vancouver and Health Canada with respect to these sites, or I believe that's what the minister is saying. If they're listening, I would encourage them, because I do think this is a partnership. Everybody has to get in here and work on this problem. It's not strictly a provincial health problem. It is a community problem, and it is a federal government problem as well. I see the minister has a comment to make on that.

Hon. G. Cheema: I just want to reinforce the fact that the Ministry of Health Services has put in $1.12 million for this project — not the Vancouver coastal health authority. I just wanted to correct that. Certainly, I can't speak on behalf of the federal government or the municipal government. We can only advocate for our patients, and that's what we are doing. These are patients, they are real people, and they need all these services. We'll continue to work for them, but we do understand their frustration. I know it's very difficult for them to continue to wait, but we have no choice; we have to.

L. Mayencourt: To the minister: I want to thank you and your staff very much. I think you guys are doing a real bang-up job in trying to be passionate advocates for people with mental illness and people living with addictions. I salute you for that, and I encourage you to keep it up and to continue to work with your federal and civic counterparts. We do have some great challenges, but we also have some really great opportunities. I think we're moving forward in a very positive way.

I know there are other members here who are most anxious to canvass the minister on his estimates, so I'll yield the floor to the member for Coquitlam-Maillardville.

R. Stewart: I, too, want to applaud the minister and the minister's staff for the work they're doing in addictions and the way in which they are making a concerted effort — the best concerted effort that I think has been made in this province — at trying to address those issues and address them properly.

There are serious issues in every community of this province. Coquitlam faces them, and I know that many other communities face them much more. The ministry is doing a tremendous job.

Given the limits of our time, though, I don't want to focus as much on that today as on Riverview Hospital. Riverview Hospital, in my riding, has traditionally been one of the largest employers, one of the largest government facilities and, certainly, a vital part of mental health care in this province as it has been done in past years.

However, having grown up within a mile of Riverview Hospital, I want to describe for the minister that existence as we grew up near this enormous mental health facility in what became urban Coquitlam. We drove by it. We didn't go into it. We didn't even see it. We ignored its existence, by and large, because there was a feeling that the mentally ill in our society would

be shut off. It was, in fact, if you look at the letterhead from 35 years ago, called an asylum. The community that I grew up in knew it was there and ignored it.

Now the community is starting to understand a little bit more the role that Riverview Hospital has traditionally played in mental health services in British Columbia. I think that's important. At the same time I want the people of Coquitlam-Maillardville and the people of British Columbia to understand what the facilities are at Riverview and what form they take.

The commitment of the minister to mental health services in this province is admirable. I applaud the Premier for having appointed a Minister of State for Mental Health. I could listen all day to the Minister of State for Mental Health and the way in which he is passionate about this issue. In fact, with my next question, I may be here all day with the answer.

I want to take the minister back to the visit I joined him on to Riverview Hospital and some of the facilities. As we went through one of the blocks, and we went through the various residential facilities in this block…. This block was being used, of course, for patients. We saw an isolation room. I want the minister to perhaps describe at some point what that was to him.

We saw the typical residential facility, a room about the size of my oldest daughter's bedroom that housed perhaps six or seven adults with small, fabric curtains separating them. No bedside table. No radio or lamp. This is today. I'm not describing the asylum that Riverview Hospital once was years and years ago. I'm describing Riverview Hospital's facilities as they exist today. I recognize that the staff have done a tremendous job there and continue to do a tremendous job, but they, too, lament the quality of the facilities that they've inherited.

We recently visited the site to break ground and open the first new building in 50 years on Riverview Hospital lands. I want the minister, if he could, to describe the clinical effectiveness of the site as it is, the hospital as it exists today — not the new building; the hospital as it exists today.

Hon. G. Cheema: Thank you for that question. I will just take a few minutes to explain to the member.

As he will recall, in June 2001, I think 48 hours after I was given this job, we were both there. We had the tour of the hospital. I have visited that place many times. The first time I visited that place…. If you can go to a room half this size…. There were six beds, with no washroom attached. There was no privacy, and not a single electrical outlet for even a single radio there. The people were not only depressed; they were very worried and very concerned. I think it was sort of a rude awakening for me. I'd never visited that place before. I was terrified. My staff person was with me, and he can tell you that we were totally shocked.

I was given a sample key. That key is about six inches long. I have that key in my office. That key is, again, a symbol of power over patients. It's also a symbol of a past institution; the institution was called an "asylum." That's totally a wrong word for mental health. You know it, members know it, and I know it. We have advocated to stop using that word. I think we feel that it's very wrong to use the "asylum" word for mental health patients. That kind of attitude has been there in the past, and we're changing that.

The quality of life — not only physical space — is detrimental to their mental health. It also gives them no respect, and it sends the wrong message to the families — that we don't care. That needs to be changed.

Our objective is to develop home-like, smaller facilities across the province. They are more human. They have more services. We should treat them as we treat somebody with a heart disease or with arthritis or with diabetes — give them the proper care. That's where I think we are best. That's where we are moving. I think that will help patients. That's where this institution, which has served well in the past….

We were there a week ago with a member, and they were celebrating 90 years of Riverview Hospital. As we both sat there, we were respectful of the past, but we were mindful of the present. We are looking forward to a brighter future. That's where our mental health is moving — towards a brighter future for patients, for equality and, also, respect for patients. That's the key. That's where I would say the member has more knowledge about that institution than anybody in our caucus. I will rely upon him to give us more feedback.

It's my understanding that the process is moving reasonably well, but again, the redevelopment project must proceed with caution, because we don't want to be blamed in five or seven or ten years time for sending patients to their community without having proper community placements. That's our job. We need to be very vigilant. We should watch those things very carefully.

Certainly, I would encourage all of us to visit that institution at least once and see how that place reflects our past. If we are sick, should we be there or not? If I have depression, if I have schizophrenia, if somebody I know has a problem, where would you send them? Would you send them to an outdated institution, or would you send them to a nice, homely, home-like facility somewhere?

That's a decision I think our government has made. Our Premier has made a commitment, and I would highly recommend that every member of this House read the speech the Premier gave last October. That's one of the best speeches I have ever heard from him about mental health issues in this province.

R. Stewart: The minister spoke of a key, a long skeleton key that represented for him — and, in fact, represented for the CEO, Leslie Arnold…. She saw this key as being a symbol of the inappropriateness of some of their facilities.

I also remember this isolation room, and the minister may remember that my question was: "Is the isolation room ever used?" It's a room about the size of a bedroom with rounded corners, very high ceiling, one mattress in the middle of the floor, no sheets — just a

bare, empty room. I asked the CEO if this room was ever used. She said that actually, it gets used quite frequently by patients who want a bit of privacy at some point, because they're in a bedroom setting that has, as the minister said, several people in a room that's too small for several people.

Some of them occasionally would go and actually choose the isolation room over the facilities that the people of British Columbia provided for them to sleep in. That's unfortunate. I know that the staff at Riverview are doing an admirable job. They're working through the difficulties of the aging buildings and the aging facility which was built and perhaps was appropriate in its day.

As we come to grips with mental health for the first time, perhaps, in British Columbia's history in the way in which we're doing it, and as we take mental illness as a true medical illness and try to treat patients with respect and dignity, we should be looking at those facilities with a very critical eye. I will be inviting some caucus members once the House stands down — any that want to come — to have a tour of the facilities there, both the existing older ones and the new facility, Connolly Lodge. Let's have a look at, if we can, getting a feel for the history of mental health issues in this province as they exist in Coquitlam, to see where we're going and whether we're heading in the right direction.

The minister mentioned that we don't want to be sending patients out into the community…. We don't want to be seen as having sent patients inappropriately out of the community. I want to deal with that specifically. I spoke to the minister on several occasions about that, including the last time we visited the hospital, and I've spoken to the CEO about that — about whether in fact the patients that are leaving are going to a facility of their own choice, the voluntary nature of that and the appropriate nature of that. I know other members have raised that issue. I was listening intently during the discussion.

Specifically, the minister mentioned that no patient is being moved without his own consent, his family's consent and the direction of the medical community. I want the minister to reiterate for me why those three are important in this situation. I know in the past a government has released people from mental health treatment into the community, and sometimes it has had disastrous results, individually and for the community. I want the minister to assure me that the current process is the right one.

The Chair: Noting the time at this point, minister, I believe we are going to have to report progress to section B and reconvene.

With that, the House is ready to adjourn on the other side. We will have to rise at this point.

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