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



CONTENTS

	Routine Proceedings
		Page

Introductions by Members		6843

Introduction and First Reading of Bills		6844
	Coquihalla Highway Administration Clarity Act, 2003 (Bill M202) J. MacPhail

Statements (Standing Order 25b)		6844
	Asian Heritage Month and World Partnership Walk P. Sahota Vancouver school board alternative budget J. Kwan

Tabling Documents		6845
	Vancouver school board alternative budget J. Kwan

Statements (Standing Order 25b)		6845
	Langford Lavender Festival A. Hamilton

Oral Questions		6845
	B.C. Rail line between North Vancouver and Squamish J. MacPhail Hon. J. Reid Environmental protection J. Kwan Hon. J. Murray Transportation infrastructure improvements in Cariboo area J. Wilson Hon. J. Reid Auto theft prevention B. Locke Hon. R. Coleman Film industry in B.C. K. Krueger Hon. R. Thorpe Dental services at Children's Hospital J. Kwan Hon. C. Hansen

Committee of Supply		6848
	Estimates: Ministry of Health Services (continued) J. Kwan Hon. C. Hansen J. MacPhail Hon. G. Cheema

Hon. S. Bond: I am delighted today to introduce two very special guests in the visitors' gallery. Today, with my colleagues from Prince George North, Vancouver-Burrard, Penticton–Okanagan Valley and Kelowna–Lake Country, it was a pleasure to have lunch with His Excellency Vladimir Kotzy, the ambassador of the Czech Republic, and his wife Michaela.

Hon. S. Bond: Yes, we are enthusiastic. I want to tell you that it was a wonderful opportunity to visit with His Excellency and his wife, and I want you to know that their five years in Canada are coming to an end and that they'll soon be returning to their home in Prague. But I want you to know something. They are grandparents who have brought their grandchildren to Canada to play hockey. His Excellency's wife takes figure skating lessons, and she's proud to say that her coach is Donald Jackson. They are a remarkable couple. It was a true pleasure to welcome them to the Legislature. I know you will want to help me in making them feel very welcome in the gallery today.

Hon. G. Campbell: I just wanted to take a moment to say to Ambassador Kotzy how pleased we are that you understand Canada, how pleased we are that you're here in British Columbia and how pleased we are that on July 2 we'll be in Prague and that you'll be able to join us as we are awarded the 2010 Olympic and Paralympic Games in the Czech Republic. Most importantly, we're really looking forward to your wife coming back as a member of the Czech Olympic team. I'm sure she'll look great standing in No. 2, because Canada is going to win the gold medal in that event too.

J. Les: It's my very great pleasure this afternoon to introduce to the House about 80 people who are in the gallery this afternoon. These are the constituency assistants to the various government members. They've been in Victoria for the last two days learning more about government programs and all of the things that are available to them as we collectively serve our constituents in the future. I would ask the House to give all of our wonderful constituency assistants a very warm welcome.

S. Brice: I am pleased today to recognize the efforts of an ambitious Vancouver Island resident from Ladysmith. Over the past nine days Mike Pellatt has been travelling via wheelchair from Campbell River to Victoria to raise both awareness of and funds for amyotrophic lateral sclerosis, ALS. The efforts of such dedicated people as Mike Pellatt help to raise funds for much-needed research into this debilitating disease. Well done, Mike. I ask all members to join in welcoming him to this Legislature and thanking him for his remarkable effort.

J. Kwan: I have the pleasure to introduce nine longtime advocates for children in our education system. They are Adrienne Montani, the chairperson of the Vancouver school board; Jane Bouey, school trustee of the Vancouver school board; Pat Gudlaugson, Vancouver Elementary School Teachers Association; Jim Gill, Vancouver Secondary Teachers Association; Jean Dandrea, CUPE Local 15; Mike Potts, CUPE Local 407; Burt Johansen from the trades; Patti Lefkos, Vancouver Elementary Principals and Vice-Principals Association; and finally, Annie Ehman, district parent advisory council. Would the House please give them a warm welcome.

Hon. J. Murray: It's my privilege to introduce today Mr. John Sager, who has had a very distinguished 30-year career in business and government — most recently as my ministry's manager for toxics, special waste and pesticides. There's a title. John also was recently a member of the contaminated-site review panel that came out with an excellent set of recommendations for modernizing and improving our management of contaminated sites. Would the House please make Mr. Sager — John — very welcome.

Hon. G. Plant: In addition to my constituency office staff, who have already been introduced by my colleague opposite, today represents the annual visit inside this room of my ministry office staff. I hope the House will make Gail Dawson, Jo-Ann Clar and Cheryl Ryder; my executive assistant, Stephanie Lysyk; and my ministerial assistant, Joan Dick, all very welcome to the chamber.

D. Hayer: I would like to introduce to the House two of my strongest supporters and greatest volunteers. My right hand, my wife Isabelle Hayer, is here, and my son Alexander Singh Martinez Hayer is here. His doctors told him to take a few days' break from his regular hospital treatment and to get ready for his bone marrow transplant session in June. I know that Alex would like to thank all the members of this House and staff and press who have gone out of their way to express their sympathy and their support. I would like the House to welcome both Isabelle and Alex during their stay in Victoria.

R. Lee: In the gallery today is Mr. Bill Yuen, former Vancouver school trustee and returning officer for Elections Canada. He is in Victoria today to attend a Canada Post conference. Would the House please make him welcome.

J. Bray: Joining us in the members' gallery today is no stranger to the precincts now. This gentleman has become a very vocal peer advocate for those living with mental illness. He has met with several ministers, and he is really moving the issue of people living with

mental illness to the forefront in the media and bringing dignity and respect to people living with mental illness. I would ask the House to please welcome again Terry Colburn to the precincts.

P. Bell: The Premier often talks about welcoming young people back to the province of British Columbia, and I can tell you that I am very, very excited today to be able to reintroduce to the House my daughter, who has been gone from British Columbia for four years but who is back, eager to look for work and excited about all the new opportunities provided to young British Columbians. So I would ask that the House please make both Donna Bell and her boyfriend, John Muirhead, very, very welcome. Welcome back.

L. Mayencourt: In the gallery we have a visitor from the Red Cross. This young lady works in a program called RespectED. I and the member for Surrey–Green Timbers and the member for Columbia River–Revelstoke had the pleasure of meeting Desiree Sattler on our safe schools task force tour. So would the House please make this young lady welcome.

Deputy Speaker: I would like to welcome all the rest of the members in the House.

J. MacPhail presented a bill intituled Coquihalla Highway Administration Clarity Act, 2003.

J. MacPhail: I move the bill standing in my name on the order paper entitled Coquihalla Highway Administration Clarity Act, 2003, be introduced and read a first time now.

This bill amends the Ministry of Transportation and Highways Act to ensure that the revenue stream from the tolls on the Coquihalla Highway cannot be leased, contracted out, sold, auctioned off or otherwise granted to an entity other than the provincial government.

I was in Kamloops earlier this week, and the growing anger at this decision to sell off the Coquihalla and increase tolls was palpable. Residents say they weren't consulted. They say it will take money out of their pockets and hurt their economy. And they say the tolls they pay should not pad the bottom line of a private company. That's why today the opposition is moving to table a bill that would ensure all tolls collected by the government remain in public hands.

The Coquihalla has already been paid for. It belongs to the people of British Columbia. As a vital transportation link between the lower mainland and the interior, it is critical to the long-term economic health of our province. It should not be sold off to pay for this government's record deficits and failing economic policies.

J. MacPhail: I move that this bill be placed on the order paper for second reading at the next sitting of the House after today.

Bill M202 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

P. Sahota: As mentioned by my colleagues yesterday, May is Asian Heritage Month, and a number of events and celebrations are taking place around the lower mainland in recognition of the influence of the Asian culture and civilization. A number of my constituents are involved in some of these wonderful and worthy projects.

Starting tomorrow is the International Dalit Conference in the lower mainland. It is community-based, and its objective is to bring Dalits, which are often referred to as the lower castes, together from around the world to discuss such issues as human rights and social justice. What better place to have this conference than right here where we embrace all people, regardless of their race, religion or caste.

The second event is a World Partnership Walk, which will take place on Sunday, May 25 at Stanley Park. This walk was started 19 years ago by five women from the lower mainland who wanted to make a difference in the world. Today the World Partnership Walk is Canada's largest event helping people in developing countries around the world, and it is held in ten cities across the country. This year the Premier is an honorary walker and is lending his support to raise awareness of this important issue, and my Burnaby colleagues and I have formed the B.C. Liberal MLA team to help raise awareness for this worthy cause. The funds raised will help people who live on little more than their determination and perseverance to break the cycle of poverty. It supports sound long-term projects in parts of the world where access to clean water can be a distant dream. The funds raised also contribute to programs in areas like health care and education and pay special attention to the plight of women and children in developing countries.

These are complicated and important issues, but I want to pay special tribute to B.C.'s Ismaili community, which has been at the forefront and leading the charge as they work together to find solutions. On May 25, come and participate in a worthy cause and be part of the solution.

J. Kwan: Earlier today members of the Vancouver school board came to the Legislature — and they are

here now — to present and discuss their alternative budget, titled the three-Rs budget. The Vancouver school board has put together a comprehensive picture of a system not being properly supported by this government.

With the support of groups like the district parent advisory council, the Vancouver Teachers Association, the B.C. Principals and Vice-Principals Association as well as many others, the Vancouver school board is calling on the province, the minister and all MLAs in this chamber to reinvest, renew and rebuild public education in B.C.

It is time this government realizes that imposed cost pressures and a two-year funding freeze have greatly reduced the capacity of educators to give children the opportunities they deserve. They came here today to ask MLAs to help restore educational services, which have been cut by $25.8 million in Vancouver alone since the last election.

By supporting the three-Rs budget, all of the MLAs in this House can give back much-needed services to special education, English as a second language, instructional supplies and classroom services.

We need to learn from mistakes in other provinces. In Ontario, a funding freeze much like the one we have seen in B.C. forced boards to make significant cuts to the education system. Ontario now faces a bill of over $1 billion just to reverse the damages done by the funding freeze.

The message from Ontario and the message from the Vancouver school board today is clear. Immediate attention and action is required to prevent cuts to vital services for our children and our communities. The three-Rs budget is ready to go. The work has been done. It's time to act.

J. Kwan: With that, I'd like to table the budget now so all MLAs can take the time to review it.

A. Hamilton: On July 12 and 13 the city of Langford invites one and all to their second annual Langford Lavender Festival. You can catch the free bus provided by B.C. Transit from the western exchange or drive down Veterans Memorial Parkway, which the province of British Columbia partnered with Langford and local business to construct, and participate in festivities.

The annual festival is a celebration of community pride and spirit. It takes place in Veterans Memorial Park, the centrepiece of their downtown beautification project. This festival brings together businesses, volunteers from the Royal Canadian Legion, Rotary, Kinsmen, Lions, Juan de Fuca Rec, the RCMP, Langford volunteer fire rescue, various non-profit groups and the families of Langford to celebrate the pride they feel for their community.

Saturday will begin with a pancake breakfast and then a parade through city centre to Veterans Memorial Park. At this beautiful park location, you can visit an arts and crafts fair with local artisans, kids activities coordinated by Juan de Fuca Rec, wine information from local wine specialists, music in the park, great entertainment and family fun for all. Later that night there will be a Lavender Cup feature race at the Western Speedway, and I definitely won't be driving. An adult dance will be in full swing at the Langford Legion.

On Sunday there are more of the same activities at the park and a giant garage and bake sale scheduled to help the legion. The proceeds from the Langford festival will enable various community organizations and service clubs to raise funds to support their activities and enable the Langford beautification and festival committee to support community projects. Last year proceeds were designated to assist the funding of phase one of a new skateboard park near Belmont school.

Langford is proudly celebrating ten years as a municipality during this second annual festival. In the past ten years Langford has grown from 14,000 to 20,000 residents and has balanced economic growth and new commercial developments along with residential development and green space. What other municipality can boast three lakes within walking distance of their city hall, a national award-winning trail system, and a new fire hall, police building and city hall?

I urge all to come and celebrate with us the community pride and spirit that make things happen.

J. MacPhail: In the secret proposal from the CN to buy B.C. Rail, the company proposed abandoning the rail line between North Vancouver and Squamish in order to build a highway to the Olympics. The minister responsible for B.C. Rail hasn't said whether or not she would allow such a move. Can the Minister of Transportation tell the House what the consequences will be if the B.C. Rail line between North Vancouver and Squamish is abandoned?

Hon. J. Reid: We have said that when we get the Olympic bid, we're going to have to provide a third lane of traffic for the Olympics. We're looking at that third lane of traffic to be that railway line for the dura-

tion of the Olympics. For roughly two weeks in time, that will become a road. Other than that, it will operate as a railway.

J. MacPhail: This isn't a Minister of Transportation; she's the fairy of transportation. She can build a road in two weeks and then have it abandoned in two weeks. Isn't that interesting? This government has been spreading misinformation about B.C. Rail in a desperate attempt to weasel its way out of the Premier's election promise not to sell B.C. Rail.

The opposition has come into possession of a highly confidential B.C. Rail briefing…

J. MacPhail: …document prepared for the government, which strongly warns against abandoning the line between North Vancouver and Squamish. Let me quote from the document. Abandoning the North Vancouver to Squamish line "would place the B.C. Rail enterprise at a severe business risk and eventually put B.C. Rail out of business."

Now that I've refreshed the minister's memory, perhaps she can explain to the House — and in particular to her backbench colleagues, the communities and those who represent the communities that depend on B.C. Rail — how she could allow such a vital, profitable service to be put at risk by the Liberal Party campaign backers like CN?

Hon. J. Reid: Freight rail service in British Columbia is an important part of our infrastructure that needs investment and that needs to be sustainable, and working with communities, working with industry, we're looking for a partnership for operations. The province will retain ownership of the rail bed, the right-of-way and the tracks.

J. MacPhail: I was always told that this fairy queen of transportation, who can make a road come and a rail line change in two weeks, read her briefing notes. It's not subject to freedom of information, but it is a briefing document from the rail corporation to this minister. Now, that briefing document goes exactly against what this minister and the Premier have said.

Everyone knows that CN is the frontrunner on the fire sale led by this government of B.C. Rail. This document explicitly warns that shutting down B.C. Rail's North Vancouver to Squamish line will lead directly to an enormous competitive advantage to CN. CN gave the Liberals more than $36,000 last year alone.

Will the minister guarantee to this House today that under no circumstances will the new private sector operators of B.C. Rail be permitted to shut this line down no matter how much money they donated to her party's election machine?

Hon. J. Reid: Indeed, the rail line and the integrity of the rail line are important to communities — are important to this province — and the mistake that the member is making is confusing a document from CN that is not a proposal to government. Government does not consider it a proposal, has not considered it and is not interested in that. We are today putting out a call for expressions of interest. We are working with communities, and we are working with industry to make sure there is a sustainable…

J. Kwan: Leading environmental groups today gave this government and this minister a failing grade on environmental stewardship. To the Minister of Water, Land and Air Protection: why should British Columbians have any faith in her when advocates for clean water say that B.C. is the only government in Canada to weaken drinking water regulations since the Walkerton tragedy?

Hon. J. Murray: Here's why British Columbians should have faith in me and in this government: we have an environmental record of which we are extremely proud.

Hon. J. Murray: I'm glad the member opposite asked that question: what is our record? We have improved the recycling of polluting substances with our used oil stewardship program. We have accelerated protection of wildlife habitat under the new Forest and Range Practices Act. We have improved the tools that we have for identifying and solving water quality risks, including source-water protection. We have increased the targets for clean energy from 10 percent under that member's government…

J. Kwan: Get the facts on the table. The report card on B.C.'s two-year environmental record: energy and climate change, fail; health and pollution, fail; enforcement and public participation, fail; wildlife and parks, fail; resource management, fail. The report card from B.C.'s most respected environmental organizations is an indictment of this minister and this government.

J. Kwan: The report card also highlights this government's decision to roll back standards to prevent pulp mill toxins from flowing into B.C. waters. B.C. now has some of the weakest pulp mill effluent standards in the industrialized world. Again, to the Minister of Water, Land and Air Protection: why does the minister continue to ignore her own report's recommendation to address the discharge of what's known as toxic black liquor from pulp mills into B.C. waters?

Hon. J. Murray: The member opposite is quoting from a report from an environmental group, and I want to point out that some environmental groups work very constructively with government, and some use very questionable tactics to try and pressure government.

Deputy Speaker: Leader of the Opposition, would you please come to order. Let's hear the answer.

Hon. J. Murray: …that is critical of our government actually dealing with the pine bark beetle in forests. If that member's government had dealt with this issue ten years ago, we wouldn't have the biggest environmental nightmare of this decade.

Deputy Speaker: Order, please. Order, please. Let's hear the question. Leader of the Opposition, would you please come to order.

For a great many years residents of the Cariboo have depended on the Marguerite ferry to cross the Fraser River. While very nostalgic residents have voiced concern, this ferry service was plagued with service capacity problems and undeniable financial challenges. Can the Minister of Transportation explain to the residents of the Cariboo region how industry and residents are benefiting from infrastructure improvements even without the ferry service?

Hon. J. Reid: This member has strongly represented the needs of his community — the industry, the agriculture, the forestry and the roads in this area.

The West Fraser Road and the Soda Creek Road are going to see an investment of $750,000 this year. This ferry service ends every winter. It is only a passenger ferry service, and it does not allow for the transport of commercial or industrial vehicles. The investment into these roads will help the communities and will help the residents. As this ferry has not been operating since last October and doesn't operate every winter, the residents of this area are well prepared to use the road.

B. Locke: My question is to the Solicitor General. ICBC has recently released figures that show that auto theft is increasing. During 2002, stolen vehicles increased by 7 percent. This means that vehicle thefts have risen 25 percent in the past two years alone. The trend must stop. A rise in auto thefts results in higher costs for ICBC and puts pressure on the insurance rate for all consumers. Can the Solicitor General tell us what action is being taken to combat this problem?

Hon. R. Coleman: Last month the auto theft task force was renamed and made more permanent. In cooperation with police and ICBC in the province of British Columbia, it is now called the Integrated Municipal Provincial Auto Crime Team. This group is integrated with seconded officers from both the RCMP and municipal forces to work across boundaries with regard to statistics in auto theft where we've been able to use this team and the bait car program, which we've also put into place.

We do find we can push back and reduce auto theft in communities like Vancouver where we actually have, with the bait car team, been able to reduce it by 30 percent. It is an ongoing problem. The only way you can approach it is by having good statistical information to deal with crime community by community and to use an integrated operation so that you can push back on it, and that's exactly what we're doing.

K. Krueger: Kamloops and region have been delighted for the past number of weeks to host Robert Redford and Jennifer Lopez as they film the movie An Unfinished Life. I've been a fan of Mr. Redford since Lassie was a pup, and probably his dinner invitations are piling up in my mailbox while I've had to be here listening to the Leader of the Opposition. Sadly, I haven't seen them yet.

Our economy, locally, has certainly been benefiting as an $18 million expenditure has occurred in our area, and of course we're absolutely delighted with that. Provincewide, the industry comes in at about $1 billion a year for British Columbia.

People are concerned about the rising value of the Canadian dollar and wondering how that is going to impact this vital industry in our province. I wonder if the Minister of Competition, Science and Enterprise could tell the people of B.C. what he thinks about that risk.

Hon. R. Thorpe: Our dollar remains very competitive with the competitive jurisdictions of the world — namely, Australia and Europe. In fact, our dollar has risen by 10 per cent while other currencies have risen by 17 percent to 24 percent.

Under the leadership of our Premier, our government has made sure we have a competitive tax policy that attracts the film industry to British Columbia. In fact, we increased regional tax credits to assist areas like Kamloops, Trail and other areas of the province where we've had shootings this year. At the present time we have 31 productions underway in British Columbia, and all studios in Vancouver are booked. In addition, Canadian programs like Da Vinci's Inquest, Cold Squad and Edgemont have renewed their contracts as we go forward.

This is a billion-dollar industry, and later today our government will release the information on the year 2002, which shows that once again it's a $1 billion industry in British Columbia.

J. Kwan: Two thousand children a year are treated at Children's Hospital for dental disease. Many of these children are treated for a condition known as severe dental decay, which primarily affects low-income kids. Untreated, the health and well-being of these children can be severely affected.

That's why doctors, health professionals and advocates for children are very concerned that Children's Hospital may have to cut in half dental services to kids to deal with budget cuts — a cut that will affect approximately 900 kids a year. The only other option available to these kids is to have private treatment, which can cost up to $600 — way too much for these families.

For the sake of children's health, will the Minister of Health Services take action to ensure that Children's Hospital has the funding to deliver proper dental care to children in B.C.?

Hon. C. Hansen: The provincial health services authority has been reviewing surgical procedures, generally, and trying to determine whether we have the appropriate utilization of our hospital-based services. The review of that has determined that there are significant numbers of children who have been referred for surgical dental care in a hospital operating room when in fact that is not necessary.

Throughout the health care system we're trying to make sure that we get proper utilization of services, and we have determined that about 50 percent of those dental surgeries can be properly provided in community-based clinics.

Hon. G. Collins: I call Committee of Supply. For the information of members we'll be debating the estimates of the Ministry of Health Services.

J. Kwan: Just prior to the break we were looking into some of the wage differentials, particularly the ones that exist between women and men, that impact the health care sector. Aside from the wage rollback, I was speaking particularly about the fact that many of the health care workers, who are primarily women — and immigrant women, for that matter — will be faced with a reduction in salary. Also, in the comparisons between provinces, I was speaking to the cost of living and particularly the housing component — earlier, before the break.

In essence, when you account for the cost-of-living differences in Canada for these workers, effectively the wages for the support workers — who are essential to our health care system — are not really as high as the minister and this government like to make it.

The minister actually said that there is a pending agreement with health care workers with HEU and

that that information would be forthcoming. When does the minister anticipate information from that agreement to be released?

Hon. C. Hansen: I don't have any particular inside knowledge with regard to when that ratification vote is going to be released. I did see a media report today that quoted — I guess the title is secretary-treasurer, is it? — Mr. Allnutt of the HEU. I'm not sure of his actual title. It quoted him as saying…. I understand today is the last day for voting on that ratification. It also indicated in the media report that results would be announced tomorrow. That's the only source of information I have.

J. Kwan: I'd like to actually canvass for a few moments on a different track — on the issues that impact my community more significantly. That is, of course, the drug addiction question. Earlier this week we debated a bill with the Minister of State for Community Charter. Part of the changes in that would give municipalities a lot of authority to determine what services would be provided. Particularly when it deals with health care services, the ramifications I'm concerned about would be to let municipalities or jurisdictions put in regulations or bylaws to prevent services from being delivered in their own community.

The example I use with the Minister of State for Community Charter is Surrey, where they have put in a bylaw to prevent methadone services from being delivered. Really, they're getting around it by increasing the fees — exorbitant amounts of fees — for people to get their business licence. Therefore, in essence, people are not able to provide those services in their community. Where issues become a health concern, the legislation does allow a provision for the minister to act, and that is the Minister of Health Services. I'm wondering whether or not this minister would be looking into that matter and taking action to ensure that members in the community actually have access to the health services required.

Hon. C. Hansen: My ministry has been very much involved in the development of the Community Charter to make sure that the health issues are, in fact, protected. I'll just quickly read for the member some background as it pertains to the Community Charter.

"Local governments will be able to regulate in areas of concurrent authority. In order to do that, there must be a regulation drafted giving them authority in public health matters. A municipality may only adopt a bylaw in one of the concurrent spheres if the bylaw is (1) approved by the minister responsible, (2) in accordance with an agreement with the minister responsible or (3) in accordance with the minister's regulation."

So municipal bylaws cannot override provisions of another act. All specific conditions and restrictions established in other legislation still apply. Local government will not be able to approve a bylaw that is less stringent than what provincial legislation currently or in the future sets out.

J. Kwan: I'm familiar with the Community Charter and the piece that the minister read out. We debated that extensively — I think it was last Wednesday — in the House until 9 o'clock.

But the issue I'm asking the Minister of Health about is this. When a health risk service is as a result of municipal government's changes either in bylaw or by regulation, and therefore it poses a health risk for their community, then I understand from the Community Charter and through our debate that the Minister of Health Services can actually intervene. So in the case where it relates to methadone services and other services — I just use methadone services as one example, but there may well be other examples that we can utilize at another time — I would like to have the assurance from this minister that, in fact, he will intervene and that he would ensure that there's…. Maybe the minister can advise what mechanism he would put in place to make sure that health risks are being monitored and therefore, when intervention is required by the minister, he actually has the information to do so.

Hon. C. Hansen: Certainly, we rely on our local health officials to report to us on any actions taken at a local level that may compromise access to health care delivery. That system has certainly worked effectively. We do get that information in a very timely way.

When there are issues where a municipality may be taking an action that could be compromising health care delivery, we certainly undertake to meet with the municipality. I cannot comment on the specific issue that the member is talking about with regard to business licence fees, because that is before the courts right now.

But I can comment on the other issue which I think she may get to, and that's the bylaws around disclosure of patient information around the dispensing of methadone. We have met with the municipality. My deputy minister went out to Surrey to meet with the municipality around that. Certainly, there was very strong opposition expressed by the College of Physicians and Surgeons and also by the College of Pharmacists in that regard. Rather than taking a confrontational approach, we have tried to work through this, and we think we're going to make the progress necessary to ensure that those health care services continue to be delivered.

J. Kwan: I wonder if the minister could commit in this House that he would have either himself or his staff advise the opposition in terms of the progress that's being made in this regard. This is particularly important for myself in Vancouver–Mount Pleasant, as the minister can anticipate. We have a huge problem and challenge in our community. In the downtown east side community we continuously get attacked by others to say there are too many services in the downtown

east side, but at the same time other communities are not stepping up to the plate to provide the services that are needed. Therefore, we actually have a situation where it creates a loop. It's a circular loop where we can't really tackle the problem unless the other community steps up to the plate. We really need this minister and this government to hold the other municipalities accountable.

I'm concerned about it, because the Community Charter allows for broad powers. I'm not necessarily opposed to municipalities having broad powers, but I do oppose it when they actually limit access to health care services that would be critical because they have a NIMBY — not in my back yard — approach to it, and that's simply not acceptable. I would appreciate for the minister to intervene when access to health care services is being limited by municipalities and for the minister to advise us accordingly of all the actions either his ministry or he himself is taking to prevent that.

Hon. C. Hansen: I agree with the member's remarks entirely, and I will certainly undertake to have somebody from my ministry contact you to make sure you're fully up to date on what's happening on that front.

On this issue, while I've got the opportunity, I would like to ask the minister if he could please advise this House what the status is with respect to the development on harm reduction initiatives to address the drug issue, particularly in Vancouver, on things like heroin maintenance, safe injection sites and other initiatives like that.

Hon. C. Hansen: I know we did canvass the supervised injection sites fairly comprehensively this morning, so I won't repeat that. I don't know if there's additional information you're seeking in that regard, but I would certainly endeavour to answer any additional questions you may have.

With regard to harm reduction generally, the Vancouver coastal health authority is trying to maintain and indeed enhance strategies in the downtown east side. There is the contact centre that has been established. The needle exchange program is ongoing. They are currently undergoing a review of the various contracts that are for groups working in the downtown east side to try to see if there are areas of lower priority where funds could be diverted to the areas of higher priority and higher need.

I know there has been a lot of talk about…. There are so many…. I was going to say dozens; there are actually hundreds of great organizations that are trying to make a positive contribution to the downtown east side, but there has also been a concern about possible overlap and duplication. We're trying to look at if there is duplication or if there is funding that's going into areas that may no longer be as high a priority, whether or not we can reallocate some of those dollars to some of the other strategies in the downtown east side that are of higher priority. That is work that is ongoing by the Vancouver coastal health authority.

J. Kwan: To clarify then, there are no additional moneys for new initiatives on the harm reduction front for the downtown east side community; rather, it's reallocation of existing funds. Is that what the minister is advising?

Hon. C. Hansen: All of the health authorities in the province received an increase in their budget last year. They all received an increase in their budget again this year. They will have the challenge of trying to identify their areas of priority in terms of how those dollars get spent within that area. If they determine that there are priority areas for new and additional moneys on some of these programs, they certainly have the authority to do that.

In addition to that, one of the things we have done is transferred — this is the area of addictions funding, which is obviously a component of this — contracts that used to be administered directly by the ministries of Health. They have now been transferred to the health authorities. That transfer resulted in about 35 FTEs being transferred. The total cost of contracts and addiction services that were transferred over to the health authority was $19.6 million. They will be looking at how those particular contracts integrate with other work they have been doing in the past or other contracts they have. Generally speaking, they've got two options. They can either allocate a portion of their increased funding towards these programs, or they can find those resources by reallocating existing funding within their budget.

J. Kwan: Could the minister please advise what the status is with respect to the NAOMI project? The minister, I think, knows what that is, so I don't need to explain it.

Hon. C. Hansen: That particular proposal is sitting with the federal government. We have not seen any progress on that particular file for many months now, and basically the ball is with the federal government to move that forward. We're waiting for feedback from Ottawa in that regard.

J. Kwan: Does the NAOMI project have the support of this minister and this government?

Hon. C. Hansen: The NAOMI project is a trial that is being proposed by the federal government. If they determine that it is a legal and desirable health care service, then the province will do its part to facilitate implementation of it.

J. Kwan: When the minister says that the province will do its part to facilitate its implementation, does that include funding?

Hon. C. Hansen: This proposal is a research proposal that the federal government is obviously looking at. If the federal government makes a determination that this research project should go forward, it's our hope they will also provide the necessary operating funds for that. I guess in the hypothetical situation that they don't, it becomes one of the additional challenges that we have in terms of determining if available funds can be identified from within budgets and moved around from other projects. It's our hope and our expectation at this point that if the federal government is going to proceed with this research, they would also fund it.

J. Kwan: Will the minister undertake to have these discussions with the federal government to move it forward? Maybe he's already done that; I don't know. If he has, could he advise: when did that take place? If he hasn't, will he undertake to engage in discussions with the federal government to move these kinds of projects forward?

Hon. C. Hansen: Our provincial health officer, Dr. Perry Kendall, is on the Advisory Committee on Population Health, and one of items on their issues of concern is the NAOMI trials. That has been discussed, I gather, by the advisory committee, so we have an ongoing dialogue with Health Canada in that regard.

J. Kwan: Yes, I understand the various committees are still having their discussions. That was the case when we were in government as well. Perry Kendall has done an exemplary job in trying to advocate for changes at the provincial level, the municipal level and the federal level.

What I'm wondering at the political level, though, is whether or not the Minister of Health Services will engage in a discussion with his federal counterpart, because we actually, at the end of the day, need a political decision on that. I wonder whether or not the Minister of Health Services will advance the NAOMI project and commit to having a discussion with his federal counterpart. Hopefully, we can see results soon. This is what I'm driving at.

Hon. C. Hansen: I don't know when I would next be meeting with the federal Health minister, but I'll certainly find an opportunity to raise this subject.

J. Kwan: A quick way of doing it, also, is the telephone. I thank the minister for that commitment to engage in those discussions. When the minister does, would he also undertake to advise the opposition?

My interest is not political in nature. My interest here is really just to see these projects move forward, because they do make a difference in our community. They save lives. They've been evidence-based in other jurisdictions as well, so it's not political that I'm trying to raise these matters.

One more issue, though. These issues are close and dear to my heart. They impact many of my constituents in my own community. The last question I'd like to ask the minister around this is, of course, the notion of stimulant maintenance. The other addiction challenge we face in our community is addiction to cocaine, and I know there's been research done around that stimulant and the maintenance of that. Could the minister please provide his perspective on that and whether or not he supports stimulant maintenance in that regard?

Hon. C. Hansen: I must confess that is a new subject to me. I would certainly appreciate any background information the member may have, and I'll undertake to review it if she has material she can send to me.

J. Kwan: Yes. Actually, I do have a study with respect to stimulant maintenance. I'd be happy to pass it on to the minister and his officials for them to review and respond to it accordingly. Okay.

J. MacPhail: I have a document here that I received last year. It's called Summary of Reported Health Authority Activities: Fiscal Year Ending March 31, 2002. It's a summary document all on…. I'm sorry, Mr. Chair. I'm moving to the individual health authorities now and issues around that. It's a summary document, though. On the top line are all the six health authorities, and then down the left-hand side are breakouts of revenues, expenditures, financial status, acute care, mental health, home and community care. It's got the changes from the previous year. Is such a document ready yet for the fiscal year ending March 31, 2003?

Hon. C. Hansen: I think what she's referring to is sort of broadly what we've pulled in, and it's before it becomes data that is really solid. It is used internally within some of the health authorities to give them rough indicators. It's also the first stages in the data that eventually flows to CIHI and is then reviewed to make sure that it is, in fact, sound data and that it is comparable with other jurisdictions, for example, before CIHI produces its numbers.

I think what she's referring to is data that is generated on an ongoing basis, that is extremely raw and that is not really the basis upon which we can draw long-term conclusions. But it does provide the health authorities with some indicators on different time schedules.

J. MacPhail: Well, actually, it isn't. This document is dated August 9, and it's a complete summary of the fiscal year-end. I'm not trying to use it to embarrass anybody. It's just a good document to work from; that's all. Given the fact that the regional health authorities are not here to answer questions directly, it's a summary document with which I can work and the opposition can work in discussing these matters.

Hon. C. Hansen: I gather that these reports are cranked out on an ongoing basis and are used within the ministry and within the health authorities.

J. MacPhail: Okay. I'm going to continue to FOI them, because I think they're very useful.

I want to start with the Vancouver Island health authority, please. There are reports that the Vancouver Island health authority will have a surplus ending March 31, 2003. If so, what is the surplus?

Hon. S. Hawkins: Today one of the classes from my constituency was here. It was Dr. Knox Middle School.

Unfortunately, due to unforeseen circumstances, they couldn't come to see me. I do want to acknowledge that I hope they have a great time here in Victoria and they take back good memories. Unfortunately, they couldn't see how the Legislature was run, but they were in my thoughts. I just want everyone to welcome them and make sure that maybe next time they come, we will let them into the buildings.

Hon. C. Hansen: The year-end surplus for the Vancouver Island health authority is $700,000 on a base budget of $988 million.

J. MacPhail: I've got the performance agreement between the Ministry of Health Services and the Vancouver Island health authority. I'm wondering if I could go through the targets, starting at page 5 on their year ending '03, "Expected performance."

The first target is: "Increased use of needs-based and evidence-based best practices to achieve." There was no expectation in the year '02-03. The expectations begin this year. I'll move on to the next one, which is: "Improved continuity of care measured by the proportion of persons hospitalized for a mental health diagnosis who receive community or physician follow-up within 30 days of discharge." The target for '02-03 is 3 percent.

I couldn't get the base targets last year in estimates. The minister and I had quite a discussion around base targets so that I would know — or the public would know — what the increase is, how to meet the increase. I guess that must have been figured out in order to say how that performance target is met. Perhaps the minister could give me the base and then whether this target was met.

Hon. C. Hansen: I am advised that all of the health authorities are on target with regard to meeting that commitment. What I don't have right here is the baselines for each of the health authorities. I can provide for her the rollup for the province. That is, in 2000-01, a baseline of 70.9 percent. By 2001-02 we were at 72.6 percent. For 2002-03 it is partial data only, so it is at 73.1 percent, but they are projecting a 3.1 percent increase from the baseline.

Just to put this in context, in most of the performance indicators, wherever we could possibly do this, we tried to find an outside independent source for data. We were trying wherever possible not to use our own internal data for these measurements so that we could rely on objective, independent sources.

I think one of the good sides of that is it does give the public more confidence in the data and the performance evaluation. The downside is the timeliness of that. So in the case of getting those numbers from CIHI, we're looking actually towards the end of the calendar year before we'll probably get some definitive numbers. But so far our projections show that we are on target to achieve those goals.

J. MacPhail: I'm sorry. At the beginning, did the minister say those were provincial stats? He's nodding yes.

Hon. C. Hansen: As I understand it, there wasn't a different baseline for each health authority in the province. The health authorities were actually given the provincial baseline, and they were all expected to make their target improvements from that baseline. So when we do get final data from our various independent sources — which, as I say, will probably be towards the end of the calendar year — that will be put into an accountability report to determine with certainty that the health authorities are meeting their targets or to identify areas where they are not meeting targets. It is our expectation that that information will become public as part of their accountability not only to us, as government, but to the public generally.

J. MacPhail: Let me just ask another point of clarity, then. I am going to go through all of these targets for the Vancouver Island health authority. But would the minister then be giving me information…? I mean, we're still going to do it. But will the information he'll be giving me be provincial information, and therefore am I to conclude that these targets are the same for every health authority?

Hon. C. Hansen: Most of the expectation targets are common across all of the performance agreements. There are some specific ones where they vary from

health authority to health authority. Just one example is actually the next one that we would have come to, which is the Riverview replacement units. Certainly, in cases like that, each health authority has its own targets.

So the next one is — I'll just read it into the record — for the Vancouver Island health authority: "Development of Riverview replacement units and selected locations to be achieved over the three-year period." The target for '02-03 was 33 units.

Hon. C. Hansen: The Seven Oaks facility was opened. That has 24 units, so they are falling short of their target for that year, and they're going to have to make it up.

J. MacPhail: I understand that these are three-year plans, but this is the first year that we've had to see the success of the targets.

Sorry, I missed my page here. The next performance is in the area of home and community care. There are other targets, but these ones are just specific to numbers. Or does the minister want me to ask this one of the minister for…? Okay. "Increase the proportion of home and community care clients with high care needs, requiring care at the IC 2 level or higher, living in their own home rather than in a facility. This is indicated by the number of high-care-needs clients at home as a percentage of high-care-needs clients in total." The target for '02-03 was a 2 percent increase.

Hon. C. Hansen: Based on the interim data, they are ahead of that objective.

"Public Population Health" — no, that's fine. Then the sixth one. "Support and Administrative Service. Expected performance: reduce the annual expenditure for support and administrative services, excluding information systems." Oh, that's a target for '04-05 by at least 7 percent.

Does the minister have an update for Vancouver Island on that? I do accept it's a target for '04-05.

Hon. C. Hansen: Yes, they are on track. All of the health authorities are actually on target to meet that 7 percent expenditure reduction in administrative and administrative support services.

J. MacPhail: Next I'll turn to my health authority, the Vancouver coastal health authority. What surplus or deficit is the Vancouver coastal health authority running at the end of '02-03, please?

Hon. C. Hansen: At this stage, they are projecting a $4.4 million surplus on a base budget of $1.6 billion.

J. MacPhail: I just want to bring to the attention of the minister something I received from my own health authority. I do raise it with the greatest of respect. It's from the communications department of the Vancouver coastal health authority, and it is to me as an MLA. It's the Vancouver coastal health one-year anniversary spotlight on Vancouver, April 2003. I read the letter, and it is targeted specifically to members of the Legislature. It says:

It's very much targeted toward me as an MLA. However, it's completely irrelevant to the performance agreement of the Vancouver coastal health authority. The first thing I did was get out the performance agreement in my own health authority and compare it, and it was impossible to compare. This may be useful. I'm not sure. Regardless, it's an interesting document, but there's not one overlap between this, which is their record of achievement as professed by them…. I can't figure out anything about what it has to do with their achievements in terms of the performance agreement. So I was interested in that, because it is specifically targeted to me as an MLA. I only make note of that. The only advantage to the minister to have that information is that it could have shortened estimates if there was an overlap, so there could be something in it for him if he gets that corrected. Anyway, we have to go through this for my own health authority as well.

Let's talk about this. I actually had some more interest…. I'm approaching this from a local MLA's point of view too, so I have some extra questions on performance targets in this. One is emergency health services. I'm looking at page 4 of the Vancouver coastal health authority performance agreement. It says:

Hon. C. Hansen: There has been a tremendous amount of work done on this by not only the Vancou-

ver coastal health authority but indeed all of the health authorities under the direction and leadership of the provincial health services authority. They have done guidelines, and as they rolled through this process, they realized that would become an ongoing process to enhance those guidelines.

Specific to Vancouver coastal health authority, they have completed phase 1 of their emergency services planning project that was completed in November, which made recommendations on the required emergency department capacity — how this capacity should be sited, and the required systems to ensure accessible, high-quality, appropriate, coordinated and cost-effective emergency room services. Phase 2, involving the implementation of the phase 1 recommendations, is currently underway and is expected to be completed in March of 2004.

Hon. C. Hansen: The answer is yes. The provincial health services authority will be posting this information as soon as they get loose ends pulled together on it. I should also point out that it is going to be an evolving process. It's not going to be sort of static guidelines that then sit in perpetuity. This is an ongoing process to make sure that it's current and that we can learn and enhance these guidelines as we go forward.

J. MacPhail: In noting the time left for us to debate matters until the conclusion of this session, I will be spending less time than I would have liked on the issue of ambulance services. We will be concentrating on that in the next set of estimates, but I do want to ask this. Part of the emergency health services performance targets says: "Measures may include an implemented flu season response plan, regular sample surveys of the movement of selected marker conditions throughout the emergency system and a reduction in the wait times and periods on diversion in the emergency departments. The work will include representation from B.C. Ambulance Service."

Is there any update on those? Those indicators aren't necessarily assigned to any particular year, but I'm wondering whether the minister has any update on any of those targets. We have been through a flu season, and I'm just wondering whether there's any analysis done.

Hon. C. Hansen: Just to touch on a couple of the points. For flu season we actually expanded the immunization program to include other individuals that are qualified for free flu vaccine in this last year. We were certainly fortunate that the flu season wasn't as bad. It did happen. It was actually a little later this year than it has been in previous years, so it did impact in a significant way on some of our emergency rooms. We're certainly learning, and the response plans that are being developed as part of this process are taking that data into consideration.

The other thing is in terms of the time it takes for someone to be treated and their throughput in the emergency room system. We set targets. Specifically, in Vancouver coastal they set targets for themselves in terms of what appropriate wait times are in their emergency rooms, and they're making progress in that regard.

Also, with regard to B.C. Ambulance Service, they are very much integrated with this process of emergency rooms. They are obviously a key element in making sure that both ambulance wait times and wait times for patients generally are down at our emergency rooms. Much of that becomes part of that bigger puzzle, which is getting access to admit patients into acute care beds on wards, and that then gets blocked or frustrated by patients who can't be discharged because of lack of community care beds.

We are working on all elements of that, but it almost has to happen in a parallel process, where all of these stages within the health care system have their challenges addressed so that ultimately it comes back to the emergency rooms. I recall when the St. Paul's emergency room shut down for a 14-hour period, I think it was, in November of 2001 or thereabouts. One thing I learned from my discussions with those front-line workers the following day was that while they see the pressures, the real problem is elsewhere in the system and being able to get patients through the emergency room in a timely fashion. So we're certainly making good progress in that regard as a result of this whole program review.

J. Kwan: What about in the area of surgical procedures? Let's start with that as well. With the service plan, there are targets that the government has outlined. How are we doing with respect to trying to meet those targets?

Hon. C. Hansen: Again, we did spend a fair amount of time this morning on this around the provincial surgical and procedural services project. I was able to report that the Vancouver coastal and the interior health authorities are making good progress around the development of this surgical review. I think it's well on track, and I expect that under the leadership of the PHSA we'll be able to put a comprehensive provincial approach in place that will allow us to deal with wait-lists more effectively and to integrate the findings and the results of the Western Canada Waiting List Project. The net result is to ensure that people get timely and effective access to care.

J. Kwan: Is it still anticipated, in terms of time lines, that '03-04 will see the introduction of these measures and standards, and that then in '04-05 you can see demonstrated improvements in terms of the performance of these surgical services?

Hon. C. Hansen: The target in '02-03 was the development of measures. There's been a lot of work done in the development of those measures, so we are

well into that process. If you'll note, the '03-04 target is continuation and completion of those deliverables, and that is underway. Finally, in '04-05 the demonstrated improvement — we anticipate that will be met.

J. Kwan: The minister is saying they're actually on target with respect to this plan, and then we can expect to see the demonstrated improvement of performance in this area in '04-05.

While we're talking about performance measures, could the minister please advise why mortality rates for children were deleted as part of a health performance measure?

Hon. C. Hansen: Infant mortality was never dropped from the performance measures. When we developed the performance measures for the health authorities, what we tried to do was identify areas where we had particular challenges in the health care system. We wanted to make sure the health authorities paid specific attention to those specific challenges so we could see measurable improvement in those areas.

Infant mortality is one that is measured by the provincial health officer as part of his regular report. We obviously want to make sure that infant mortality is as low as it can possibly be in this province.

What we did in the performance contracts was put in place a specific measure for aboriginal infant mortality. That was an area where there was a population that had a different outcome than the general population, so we wanted to make sure the health authorities focus particular attention on infant mortality.

Certainly, as a reportable measure it continues to be reported in the same way as it has for the last number of years. I'm not sure how far it goes back in the annual report of the provincial health officer.

J. Kwan: My understanding was that infant mortality was deleted. If I'm mistaken in that, I stand corrected. Maybe the minister can advise, then, what the measurements are now in terms of performance in health services for British Columbia. What are the performance measurements right now?

Hon. C. Hansen: Maybe I should get some clarification. I'm not sure what she means. Maybe she could rephrase the question or restate the question.

J. Kwan: My understanding was that infant mortality was deleted as a performance measure for health service and its delivery. If I'm mistaken in that, I stand corrected. The minister advises that the measurements have stayed constant for the last number of years. If that's the case, maybe the minister can refresh me in terms of what those measurements are and list them for me.

Hon. C. Hansen: The infant mortality was never a performance measure for the health authorities. What was in there was aboriginal infant mortality. I did not say that it was constant. What I said was that we tried to identify areas that were of a particular challenge, where we wanted health authorities to focus on them. Aboriginal infant mortality is one that is not consistent with infant mortality for the general population. It's an area where we felt the health authorities should pay some particular attention. That's why we put that in as a particular performance measure for them so that they would focus on that particular challenge within the health care sector.

J. Kwan: Could the minister please advise, then, what measures are being used right now?

Hon. C. Hansen: If the member is referring to the performance agreements of the health authorities, schedule A, which sets out those performance indicators, consumes seven pages. I can certainly send a copy to the member if she would like me to pass it over to her. There's a whole range of different indicators that I would be pleased to provide her with.

J. Kwan: Sure, I'll take a look at that. Then maybe I'll come back to it. I'll find the document I just came across saying that the performance measures have actually changed and that infant mortality has been deleted as one of the measurements. Anyway, I'll take a look at that and perhaps come back to it if need be.

Let me ask the minister. In the performance agreement the next sections, of course, deal with mental health and home and community care. Now, I just want to be clear and seek advice from the minister. Should I be asking the minister the questions here around these areas, or should I wait to ask the two ministers of state in these areas the questions?

Hon. C. Hansen: It's really up to the member. I have responsibility for the relationship with the health authorities. The Minister of State for Mental Health has responsibility for that sector and the development of policy and, therefore, was very much an integral part of developing the performance measures we have set out. It's up to her. I can try to answer them. Perhaps if there are areas that the minister of state is better able to, we can defer, and he can pick them up when you ask him questions.

J. Kwan: Then in the area of mental health services first, could the minister please advise how much money is being allocated from his budget for mental health services?

Hon. C. Hansen: I can refer the member to page 14 of the service plan for the ministry. In there what we have done is set out all of the mental health service funding. If you look at the chart on the bottom of that page, in the coming year, '03-04, there is $1.067 million for mental health services.

J. Kwan: How much of that is being allocated to the Vancouver coastal health authority?

Hon. C. Hansen: We do not allocate from the ministry a line item that says there has to be a specific allocation of their financial resources to mental health funding. What we have done in this chart on page 14 is with the information provided to us by the health authorities in terms of how they have allocated their budget and what the funding levels for the mental health services would be for the province. The only item that we've actually allocated in a specific sense in the last year is the area of addictions, which was administered centrally by the ministry. It has since been transferred to the health authorities. In that regard, that one item alone was $19.6 million that was transferred to the Vancouver coastal health authority vis-à-vis addiction services.

J. Kwan: If the budget for mental health services for the Vancouver coastal health authority is about $1.6 billion, how could the minister…? Sorry. Actually, that's not the money for the coastal health authority. The minister doesn't know how much of that $1.6 billion is being directed towards mental health services in each of the regions.

How can the minister be sure that mental health services are actually being protected within his budget and that services are being delivered?

Hon. C. Hansen: We have specific targets and outcome measures in the performance agreements. They're indicators in terms of appropriate delivery of mental health services, so we are holding the health authorities accountable for delivering services. I guess part of the big shift that we are doing as a government is no longer focusing on how much money we spend on programs as a definition of a good program, but rather we're looking at the outcomes of that.

With our population needs–based funding allocations, we have made sure that each of the health authorities gets a fair allocation of the Ministry of Health Services budget. Then we give them the flexibility to determine how they can best meet the needs in their region within that budget. We hold them accountable by measuring outcomes that are set out in the performance agreements.

J. Kwan: In the performance measures outlined in this service plan, or performance agreement as you call it, I already see shortcomings in terms of how you make sure that people in the area of mental health services are actually getting the services they need. The measurements don't necessarily give you the ability to capture the reality of what's going on.

Let me first ask a broad question of the minister. Does the minister not see some of the shortcomings in terms of the performance measures that are outlined in this service plan?

Hon. C. Hansen: Probably if I read this short paragraph, it might answer the member's question:

In addition to the indicators that we've got in our performance agreements, there is also a considerable amount of work done by MHECCU, based at UBC, to evaluate outcomes in the area of mental health. Certainly, we rely on basically the whole range of reports that we get back, which are actually indicators that we are seeing improvements to the system.

J. Kwan: I'll use one example here in terms of problems that I have with some of the performance measures outlined in this performance agreement. Under the mental health services component, expected performance is measured by increased use of needs-based and evidence-based best practices to achieve…. Then it goes on to list sub (i), sub (ii) and sub (iii). Sub (i) states: "Increase in early intervention capacity as evidenced by the decrease in average patient age at first contact with a physician or health service provider for serious mental illness."

Let me just stop here and ask the question: how does one define a serious mental illness so that you can actually determine whether or not early intervention took place?

Hon. C. Hansen: The definition of serious mental illness is actually a protocol that is fairly well established. There are diagnostic codes for various mental illnesses so that the physicians that are doing diagnosis will assess their patient and determine their particular illness.

It is based on the reporting of those diagnostic codes that we have measurables. We then compare it against the age. One of the objectives for good mental health services is to make sure that people get diagnosed as early as possible, because the earlier they can get into treatment the better we are able to manage their long-term illness.

J. Kwan: Then under sub (ii) it says: "Decrease by 4 percent over three years in the alternate level of care days spent by mental health and alcohol and drug clients in hospitals once the primary need for in-patient care has completed, specifically: target '02-03, zero; target '03-04, 2 percent; and then target '04-05, 2 percent." This is a measurement of how many days are being spent in the hospital.

The minister earlier also referenced a performance measure in terms of how often a person is readmitted,

yet in this performance agreement it doesn't actually state that. What I'm worried about is that there are other ways — there need to be other ways — to do a measurement, to do a true assessment, of what is really going on and whether or not the needs of the community are being met. Yet it's not stipulated in this performance agreement specifically. How does the minister get the assurance or the reassurance that the performance is actually satisfactory?

Hon. C. Hansen: Again, what I'll do is read you what is referred to in this document as the indicator rationale as to why that particular indicator is seen as appropriate.

What's important about the indicator is that it's measuring system change. When we talk about health status…. The provincial health officer's report, as the member will know, is very comprehensive. It actually measures health status, but what we're looking for are indicators of how the health authorities are effectively managing change in the system that will lead to enhanced health status in the future.

J. Kwan: Well, let me use an example, then. In my community, actually, there are a lot of people who are multi-diagnosed. They may have a mental illness. They may have an alcohol and drug problem or childhood traumas amongst a variety of things. The list is endless.

In many cases, because these individuals are so complex in terms of their health needs and because they're so marginalized, they often actually don't get the service they need until they're in a crisis situation where they end up in an emergency situation. Sometimes they may not even end up in the hospital, because they live in such situations that they can't get the assistance they need. So in those cases, where's the measurement in terms of a performance measure to ensure that those individuals are getting the kind of care they need?

Oftentimes they are the people who fall through the cracks. Because they are multi-diagnosed and each of their challenges is so severe, people may actually cast aside their mental illness, as an example, and really just look at them as alcohol and drug problems. So I'd like the minister to clarify how we ensure that population base gets the care they need and how that is measured.

Hon. C. Hansen: I know we had the discussion earlier about what may be appropriate for the Minister of State for Mental Health, and there is a lot of policy development work around dual diagnosis that is in progress now. We have set a goal of 2004 to have completed a best practices for concurrent disorders, including substance misuse and mental illness. That is a project that's being worked on, and my colleague the Minister of State for Mental Health will certainly be more familiar with that than I am at this point.

When we're talking specifically about the performance measures, hospitalization and hospital use is one of the performance measures. If we have effective community programs in place for those with mental illness or dual diagnosis, then we will see a reduction in the utilization of hospital care. The whole purpose behind the programs in the mental health plan is to ensure that people get care and support in the communities so they are not hospitalized. So that's why part of the purpose of measuring hospital use and readmission is directly relevant as an indicator to ensuring we are in fact managing these better at the community level rather than at the acute care level.

J. Kwan: Yes, it's one measure that is being used and can be used. The point, though, that I'm making is that where those individuals, who may not end up in a hospital bed…. It doesn't mean that adequate care is being given to those who need services. It does not mean that at all, just because you don't end up in an acute situation.

The other point I want to make, in terms of the performance measure, is where a person has multiple diagnosis, they may actually have a severe mental health issue. But because of the way our society is, quite frankly, and sometimes the way governments tend to be, I think there's an order — a hierarchy, if you will — of what society deems to be deserving and undeserving individuals. If you're a person with multiple challenges such as addiction challenges as well as mental health challenges, sometimes the addiction problem can overshadow the mental health problem. When that happens, that person is not identified as an individual with a mental health challenge, just as someone who is a drug- or alcohol-addicted person. In our society and particularly in our community, many people look at this group of people as castaways. Somehow they're unimportant and really are non-human beings, if you will.

Nowhere in this instance, then, are we measuring and evaluating whether or not this group of people is getting the services that it needs. I think these are the people that, because they're so marginalized, actually fall into the gaps, and problems actually surface in our system and therefore cost the system more money down the road.

I don't see an opportunity within this performance agreement that will target that population base. Am I missing it? Is it in here somewhere, and I'm missing it? If it's not in here, can the minister advise me, and give me assurance, of how that population base will get the adequate services that it needs?

Hon. C. Hansen: I think the points that the member makes are very valid. This is exactly why we have

transferred addiction services to the health authorities — to make sure that we do have an integration of those programs at the community level. We actually had addiction services that were being managed out of Children and Families, and mental health was being managed out of the provincial Ministry of Health, so we shifted those programs over to the health authorities. Mental health services were located with the health authorities, but the addiction service was transferred, first of all, to the Ministry of Health Services and then subsequently to the health authorities themselves so that those programs could be better integrated.

I think it also speaks to the challenge around measuring the inputs that we wind up with programs where you try to measure inputs. Are you measuring inputs on a program that's aimed at addiction or aimed at mental health, when in reality you have programs aimed at both and that really achieve the same objective, and that's integrated care?

But there are other performance measures that certainly are public, which impact on this. One of them is around suicide rates. Our objective, obviously, is to make sure that through proper programs and proper support at the community level, we will see suicide rates come down. If you look at patients in the criminal justice system — which is something that's tracked by the Solicitor General — again, a reduction in the number of individuals with mental illness or dual diagnosis or addictions in the criminal justice system…. If we see those rates come down, it will be evidence that our community-based programs are working better.

There are also issues around transmissible diseases, which are reported annually by the provincial health officer.

I think that by ensuring we can manage those programs in an integrated fashion at the community level, we are going to have better success in ensuring that those individuals get the supports they need. The net result should be that some of these various indicators are going to show positive changes.

J. Kwan: Yes, that's the theory, and I suppose that's the goal of what we're trying to achieve here — both the minister and the health authorities. My concern, though, is that in the community, and particularly — again I use my own community as a base because that's the one I know best — when I look around my own community, the challenges are enormous. There are many people who are multi-diagnosed, and I actually foresee further problems coming down the road. I don't see in this performance agreement that the measurements that need to be in place will actually give me the level of comfort that this population base will be taken care of.

The other challenge that's coming and is not too far away is the changes in the Ministry of Human Resources when the two-out-of-five-year provision comes in. Next year individuals who are on income assistance for more than two years within the five-year period will no longer be qualified for income assistance, and often these are the people who are faced with multiple challenges. Some of them are individuals with mental health issues; some of them are people with alcohol and drug addiction problems — the whole range of problems that people are sometimes faced with through no fault of their own, really. It's just the challenges they're faced with.

Those individuals already in the system — and I know of some of them through the human resources applications side — are not deemed to be persons with permanent disabilities, because their drug and alcohol addiction problems overshadow their other problems. The Minister of Human Resources has already said and sent them letters to say that people with alcohol and drug addictions are not deemed to be people with disabilities, nor are they even deemed to be the people who are unable to work — not on a permanent basis but on a temporary basis. Really, they will actually be cut off of the income assistance programs after they've been on income assistance for two years with the new changes, and then they're going to be on the streets. That combined with the problems they have…. Again, many of these individuals also have mental health issues.

I wonder: how will this population base get the service they need, and how can we be sure they will? Does the minister not see that the problems for these individuals will actually even be worse? When they get cut off of income assistance, the complexity of their problems would be even further exacerbated. How do we deal with that?

Hon. C. Hansen: The performance indicators were really designed to be indicators of system change. It would be absolutely impossible to put a performance agreement in place that measures every single outcome. Obviously, we want better outcomes across the health care system, and I appreciate the comments the member has made about the plight and the challenges that individuals with dual diagnoses are facing. I believe our health care system is responding to that. We obviously don't have instant answers or quick fixes, but I think we're making some very good progress in that regard.

I would certainly refer the member to page 14 of the service plan, where we set out, as part of that section, the steps that are being taken by the health authorities to address some of these issues.

So I think there is progress being made. It continues and will continue to be a big challenge for the health authorities, but we believe that the performance indicators that we put in place capture the broad context of the system change that is desired. We do have, as I indicated, other outcome measures, whether it's from MHECCU or whether it's the provincial health officer's annual report or whether it's other reports that we can refer to from time to time to give us the confidence that in fact these individuals are getting better care than they did the year before.

J. Kwan: I appreciate the fact that these performance measures are targeted towards changes in the

institution, but the reality is that whatever change is happening institutionally, the bigger issue for me is: how is that impacting the community on the ground? That's really, at the end of the day, where we need to look at whether or not changes are effective. Government can stand in the House or anywhere else and wave these numbers and say how great it is that we have reduced the number of days that people require in the hospital, but when I go out into my community and see a boatload of people on the streets without the assistance they need, I get no comfort, quite frankly, from those numbers. They don't mean anything to me, nor does it mean anything to our community, broadly speaking.

While I appreciate what the government and this minister are trying to do to change institutionally and to get better numbers accordingly, that doesn't extend necessarily to what is happening on the ground. Those are the concerns that I'm bringing forward.

In the service plan on page 14, which the minister references — in writing — the goal here is to try and integrate and to combine their services by providing a continuum of services between community-based care and hospital care, and to coordinate all of those things. How do you know that this is actually being done is the question I'm asking. Yes, one measure is to say: "Well, let's look at the hospital admissions." How many people have gone to the hospital? As I say, there are a bunch of people who may not use the hospital system and already, as it exists now, are not using the hospital system, but it does not mean that they are getting the care.

I guess my point is that I have no reassurance from this plan and from the words of the minister that somehow that population base will get the services they need. Maybe I can canvass these questions with the Minister of State for Mental Health. I know that earlier in the small House I started to ask the Minister of State for Mental Health some questions around these issues, but then I was advised by the Government House Leader to hold off my questions until the following Monday when we are back. I'm prepared to do that. Maybe I can canvass with the minister of state further on the performance issues related to this population base not only in my community but in other communities as well.

I want to then move to the question around Riverview replacement units. In this document here it talks about the development of Riverview replacement units in selected locations to be achieved over the three-year period. Riverview is, as we know, being shut down. The beds are being shut down. Could the minister please advise about the patients who have left those beds as they are re-entering into the community?. What kind of tracking system is in place to follow these patients to see what their needs are and to ensure that the services are available to them to meet their needs?

Hon. G. Cheema: I was just watching the channel, and I was very astonished to see this member asking questions about performance measures about mental health. They had ten years to quote even a single measure, and they had no measurement. We have done a lot of stuff for mental health, and I will just answer the question now.

I don't want to go into a path where I just have to repeat all their message, but let me just give her the information about the Riverview Hospital. The Riverview Hospital redevelopment project is a part of our commitment, and we are spending $138 million on that project. By the end of five to seven years, we'll end up having 116 more beds in this province. When these patients are being moved into the community, into the smaller facilities — for example, in Kamloops or in Prince George, in Iris House or in Connolly Lodge — these patients are receiving the care they need.

We are basing our care on best evidence practices. That means these patients will not only get more modern facilities, but their care will be even better than before. This year we have funded about $3 million as transitional funding for these patients. Members should know that. It was their plan, and if she had read that plan, it would make very clear that we are meeting all those eight goals in that plan. We have met each goal in that plan.

So far we are tracking those patients, and those patients are receiving care in a very meaningful way. I'll give you two examples. In Kamloops two weeks ago, we transferred about 23 patients. One of them said it's the first time in that patient's life that he was able to see his family in 23 years. That's the kind of care we are providing. One patient said that in 40 years of his life, this is the first time he thinks he's being respected as a person. That's the kind of care we are providing.

Our Riverview redevelopment plan is on track, and we are monitoring the plan. We have a team in place at the Riverview Hospital. That team is being organized by Leslie Arnold. There is a committee where the patients and the families as well as the caregivers and the receiving end of the community are participating, and no patient will be transferred without the approval of that process.

J. Kwan: I'm delighted that the Minister of State for Mental Health is prepared to take questions on this issue, notwithstanding that the Government House Leader advised the opposition caucus to not ask questions in the small House of the Minister of State for Mental Health.

Now that we're into mental health services, let me actually get into the meat of it, because the Minister of State for Mental Health just rose in this House to say that he was astonished that the opposition have questions for him around mental health issues and performance measures. I have a boatload of questions for this minister around performance measures and the impacts of what's happening in our community with all the cuts in services that are taking place right now across British Columbia.

Let me go to the minister of state, then. I'm happy to do this debate accordingly, as such, around that. Let

me ask the Minister of State for Mental Health a question around performance. I was just canvassing with the Minister of Health Services around how you measure the people with dual diagnoses who fall through the gaps. They don't get the services they need now, because they're somehow deemed to be devalued as human beings, and they fall through the cracks right now in our own community. How do we ensure that the services they need are actually being provided for under the performance plan as stated in this ministry's performance plan today? I'd like the Minister of State for Mental Health to answer that question.

Hon. G. Cheema: I understand that the Minister of Health Services has answered all those questions already.

Hon. C. Hansen: You know, I do have responsibility for performance measures, and we have canvassed those across a range of things, including mental health. I think it's important to underscore that these performance measures are the first time that our health care system has had performance measures that are holding the health authorities accountable. It's not to diminish all of the other reports and outcomes that are presented, whether it's through the provincial health officer's report or other sources. This is an added dimension to the health care system.

I think we've been through why we have certain indicators. I know that the member is concerned about how much time we have available to discuss the whole range of the $10.5 billion Health Services ministry budget. If she wants to ask exactly the same questions of the minister of state as she asked of me, then it's obviously going to consume a lot of those available hours.

J. Kwan: You know what? I asked the Minister of Health Services questions, and he was trying to answer them. He was; there was no doubt about that. Then the Minister of State for Mental Health comes into the House and says he was watching on television and that he was astonished that somehow I would ask questions around performance in relation to mental health services.

You know, in the small House earlier this morning, I just started to canvass questions with the minister. I think I got in two questions with the Minister of State for Mental Health in the small House. Then I was advised by my staff that the Government House Leader would prefer for the opposition caucus to not ask questions of this minister at this time and to wait until when we come back in the last week of May. Then I yielded the floor to the government members to ask the questions.

So as we're getting into the mental health services component of the performance agreement, I asked the Minister of Health Services whether or not I should canvass these questions here, and he advised: "Sure, you can bring some of the questions forward, and you can, of course, ask further questions of the Minister of State for Mental Health." I'm prepared to do exactly that.

As I'm asking these questions, I am completely shocked that the Minister of State for Mental Health would come into this House and criticize the opposition for asking questions on how to measure performance measures for mental health service and its delivery in British Columbia. It's his job to ensure that services are being delivered and that there are adequate performance measures in place so that we know that the system changes, the institutional changes, the Minister of Health Services is trying to put in place are actually yielding the kind of results we all hope for.

Without those performance measures in a way that we can actually see the changes in our community, you can wave all these numbers saying how great we are all you want, but it doesn't make one iota of difference when I see in my own community that people are not getting the services they need. I want reassurance in this House, from this Minister of State for Mental Health, how he's going to provide those performance measures. I'm waiting for an answer from the minister of state now.

Hon. C. Hansen: I think, as we discussed earlier, there are all kinds of different ways that that gets measured. Unfortunately, some of them are as tragic as things like suicide rates. Obviously, we want to make sure our programs bring those rates down. The performance measures for the health authorities are broad indicators. We've never expected them to be the be-all and end-all of measuring outcomes, because we do have all of these other vehicles.

Again, you know, we do have that kind of accountability. Over time we certainly, I think, all want the same objective. That's to see better health outcomes for individuals with mental illness, for individuals with dual diagnoses and indeed for all patients in British Columbia, regardless of what kind of medical conditions are affecting them.

J. Kwan: The Minister of Health Services actually did provide some areas in terms of performance measure. What he also said, though, when I asked the question around dual diagnoses and multiple diagnoses, was that the policy development in that work is undertaken by the Minister of State for Mental Health. In my own community there are a lot of people who are faced with multiple diagnoses. As I mentioned before, they could be dealing with a mental health challenge; they could be dealing with a drug and alcohol challenge; they could be dealing with childhood traumas. The list can go on and on and on.

The Minister of Health Services had deferred some of these questions to the Minister of State for Mental Health. Now that the Minister of State for Mental Health is here, I want to pose these questions to him. How will he ensure that the multiple diagnoses community population base get the services they need? How do we ensure that the people who may be faced

with a drug and alcohol challenge that sometimes overshadows their mental health challenge, so they get ignored by the system…? People who are faced with alcohol and drug challenges sometimes are cast aside as unimportant people, as people we can just throw away, as throwaways, as though somehow they're not relevant. How will they get the services they need? In his own service plan, how do we know they are getting the services they need? I'm expecting the Minister of State for Mental Health to rise in this House to answer my questions.

Hon. C. Hansen: I rise to seek some guidance here, because I just want to get an understanding as to how the opposition anticipates the estimates debate unfolding. Earlier I tried to address as many of the member's questions as I could around performance measures, because I do have responsibility for them. I did happen to mention that there was work being developed regarding guidelines — our aim is to have those ready in 2004 — around issues of dual diagnoses. What I indicated at the time is that my colleague the Minister of State for Mental Health is far more familiar with that than I am, so she may want to ask those questions.

It was my understanding that we were going to work through the estimates debate as it pertained to my responsibilities in the ministry, and that would be followed with questions to the Minister of State for Mental Health and the Minister of State for Intermediate, Long Term and Home Care. If we are at that stage now and you would like to move on to Mental Health, I am certainly prepared to allow that to happen.

J. MacPhail: We are dealing with a procedural matter here. The opposition has fewer than 15 hours left to debate matters till the end of next week. We are trying to work cooperatively with the government in terms of how that proceeds. The opposition member for Vancouver–Mount Pleasant took her guidance from the Government House Leader that these questions would be asked and answered on Monday in Committee A. That was thrown into chaos and confusion by the Minister of State for Mental Health coming into this chamber and starting to answer questions.

We assumed there had been some change on the government side in its direction of how we conduct these debates. We don't have the luxury of stalling or stonewalling or filibustering. We simply don't have that luxury. However, it is the member for Vancouver–Mount Pleasant's obligation to ask these questions. She sees it as her personal obligation.

We are not finished with the Minister of Health Services, but she will proceed to ask her questions of the Minister of State for Mental Health. He's here, and she will proceed. When those questions are finished, I will return to the debate with the Minister of Health Services, as he and I have agreed.

J. Kwan: Following on the issue around mental health services, I'd like the Minister of State….

J. Kwan: Following the discussion around mental health services and performance measures, I'd now like the Minister of State for Mental Health to please answer the question in the scenario that I just outlined for people with multiple diagnoses.

Hon. G. Cheema: For mental health we have put in performance measures taking into view that we are changing the system. These are the agents of change, and there are many. It's not one, two, three or four. There are many of them. I'll just give a few examples. For example, we can monitor the suicide rate. We can monitor how patients are receiving community care in the community. We can monitor the cause of premature death due to mental illness. We have a way of monitoring through the mental health community consultation unit through UBC. We have many ways to monitor these performance measures.

What we have done — what the member was asking — is that for the first time, we have merged mental health and addictions together. The member is right that there are a lot of patients who have dual diagnoses. This should have been done a long time ago. As of last April, we have done that. We know there are about 70 personality patients in the addictions system. They also have a mental illness.

In the past the two systems were working independently of each other. Now that we have one system, we can monitor these patients in a much more effective way. As time goes on, we'll be able to evaluate further. This process is just starting. This is something that should have been done a long time ago. I think we are making progress, but time will tell how many of these performance measures we can use in the future.

J. Kwan: The Minister of State for Mental Health can stand in this House and be the cheerleader for the government about what a great job they're doing. But the reality is this, and I cite this from my own community experience. We have people in our community, as I said earlier, who are faced with multiple challenges.

Many of these individuals tend to fall through the cracks because they are very marginalized. Oftentimes their drug addiction problems overshadow their mental health problems, but it does not mean to say that they do not have a mental health challenge. These individuals are sitting in our community, not getting the access and support that they need. How will the minister know that they are getting the services they need? He can talk all he wants about the institutionalized change or even the government cabinet responsibility changes. But what I want to know is: how is that affecting people on the ground? When I see people on the ground not getting the services they need, then I want

to know how that performance measure is being put to the paper. How does the minister know he's actually doing such a great job — he often likes to claim he's doing a great job — when the evidence tells you otherwise?

V. Roddick: We have in the House today 33 grade 7 students from South Park Elementary in sunny Tsawwassen. They are accompanied by six selfless parents: Maureen Lavendure, Darlene Martel, Kim Slater, Debbie Stevens, Susan Vanderwerff and Hagai Amir. They are led by teacher Lionel Brown, who has been enthusiastically educating next year's — believe you me, September is only four months away — high school students about our historic Legislature since the early 1990s. Will the House please make them all very welcome after a tumultuous morning and afternoon, because they were supposed to be here during question period.

Hon. G. Cheema: As I have already indicated, there are many performance indicators that we can measure. They are through Vital Statistics, through Stats Canada, through the database, through MHECCU. I'll give the member a few examples now.

For the dual diagnosis, the Vancouver Island health authority is already into the process. It's been almost one year that they've been working on a dual diagnosis plan so that patients who have a dual diagnosis can get treatment. The Fraser health authority is almost halfway through to have a plan. I think it's important to recognize that as of only last year, as of last April, we were able to put addictions with mental health. I think we are making progress, but it will take some time to have more measurements put in place, and we have to just see how it will reflect in the community to improve services for patients.

J. Kwan: Then what evidence does this minister have that he's doing a great job? How can he throw his pompoms around and say, "Hooray, the government's doing a fantastic job," when he doesn't even have the performance measures in place to see what kind of job he's doing?

The minister has no answer for that. So then he cannot rise in this House or any other place to say that he's doing a fantastic job when he doesn't have a performance measure to see how he's doing. The performance measures are not even ready for him to look at and review whether or not there's an adequate resource in our community and whether the services required by the community are being met. So he has no basis — no evidence — to support his claim other than just his own cheerleading for his government in a partisan way, without any evidence to back it up.

Obviously, the minister can't answer the questions around performance measures because he doesn't even know what they are. So let me ask the minister this question in terms of the impact on the community for people with mental health needs.

Arrowhead Centre Society. That society had its funding pulled by this government, and they've had to shut. As a result, we have a void in our community which needs this service. The Arrowhead Centre Society had written a letter to the Minister of State for Mental Health. I'd like to put this letter on the record, and I'd like the minister to respond to it. It says:

This was actually written on December 3, 2002. The opposition posed these questions to the minister during question period, but of course we had no answer from the minister. So now is an opportune time for the minister to answer these questions and respond to this letter in full.

Hon. G. Cheema: As I have said on many occasions, we are changing the system in this province. One

of the ways to measure the effectiveness of the change is to let the health authorities develop programs that are cost-effective and that also provide care based on best evidence practices.

Let me just give you a few examples of the money we are spending on the North Shore. The budget for all mental health and addiction services on the North Shore was $14 million. Out of that $14 million, the B.C. Schizophrenia Society's North Shore branch got $65,000. B.C. Schizophrenia Society, B.C. office, got $16,191. North Shore Neighbourhood House got $10,000. Gastown Vocational Services got $52,629. Canadian Mental Health Association skills contract got $270,000, and the Canadian Mental Health Association consumer support got $70,000. Our objective is to provide the best possible care, and we are letting the health authorities decide. I don't think we should be in the process of deciding where the money should go. Our objective is to provide the best possible care based on the best practices.

J. Kwan: The member for Powell River–Sunshine Coast's reputation is at stake here. The answer that the minister has given actually doesn't address the question that's being put forward from the Arrowhead Centre Society or from the opposition.

Maybe the Minister of State for Mental Health actually didn't get all of the questions, because it was a lengthy letter that I read into the record. Let me break it down for the Minister of State for Mental Health one by one so that he can address these issues. First, let me just put it on the record once again.

The letter states: "It has been reported to me…. " It says that Mr. Long — that's the member for Powell River–Sunshine Coast — stated in a public television interview that due to the outcry, the funds for the Arrowhead Centre Society were restored. Now I'd like the minister to please confirm whether or not the moneys for Arrowhead Centre Society have been restored.

Hon. G. Cheema: Let me just explain to the member again. We are not in the process of deciding which organization is going to get the money or not. It's up to the health authorities to make those decisions.

Let me again explain to this member that despite all her questions about this place — which has done good service; we are not questioning what they have done in the past — there are many programs in the area. For example, there are outreach programs in Sechelt. There are case management programs there. There are vocational programs in that place. We have crisis programs there. We have psychogeriatric programs there. There is a housing program. There is individual counselling and a group therapy program in that area. There is availability of psychiatry in that area. The ministry of children and family services also runs a program for children.

Our view about mental health and health in this province is: let the health authorities decide. We have given them all the tools to deal with the issues. We have given them the funds. They're the ones that will be monitoring. Our role is to ensure that the policy framework is consistent across the province, and that's what we have done. We are not going to be changing on that. I don't think that politics should be playing a role in deciding where the money should go.

J. Kwan: The minister once again did not answer the question. Was the member for Powell River–Sunshine Coast wrong when he said in a televised interview that the funding for Arrowhead Centre has been restored? Did he provide misinformation to the public? Did he lie? If he didn't, the letter goes on to say: "If, in fact, the funding was restored, then the society has not received a penny of it." They're worried that there's a misappropriation of funds, that somehow they just disappeared into thin air.

The Minister of State for Mental Health ought to be concerned about that. You would think he would actually check into this situation, as he received this letter back in December. The letter's dated December 3, 2002.

Has he not looked into it? Does he not know what's happened? If I were the minister, I would be looking into this situation to make sure that if, in fact, the funds have been restored, they're actually there for the society to spend, and they didn't just somehow disappear into thin air.

Hon. G. Cheema: I think it would be helpful for the member to understand that we work from a different perspective. This government is not in the process of telling any health authority what to do.

All through the province we have been very consistent. We have given the health authorities the tools to manage health care, and we are not going to change on that. Each member of this House advocates on behalf of their patients. There are many services available across the province. We want to ensure that the money and all the funds are used in the most effective way and that all the treatment facilities are based on the best-evidence practices. That's my job. We know that we will continue to monitor those, and there will be better outcomes in the future.

J. Kwan: I wish the Minister of State for Mental Health would get off his script. I know that he's being given a script, because he is the cheerleader for the government and has to throw his pompoms around. But you know what? In the estimates process what he has to do is actually answer the questions. He can't just get up here in the House and say: "But you don't understand; this is how our system works." I'm asking a very specific question of the Minister of State for Mental Health.

Did the member for Powell River–Sunshine Coast lie to his community in a televised statement when he

said that those moneys had been restored? Yes or no? It's a simple answer the minister needs to give — yes or no. Did the member for Powell River–Sunshine Coast lie in the television interview when he said that the Arrowhead Centre Society's funding has been restored?

The Chair: Member, I think that what you're stating there…. You're asking a member to state that another member is lying. I think that's inappropriate and unparliamentary for this House. I'd ask you to form another question, and please withdraw that.

J. Kwan: Let me put it in a different way, as suggested by my colleague the Leader of the Opposition. Was the member for Powell River–Sunshine Coast deliberately wrong in his television interview when he said that the Arrowhead Centre Society's funding was restored?

Hon. G. Cheema: The member from Powell River is an honourable member of this House. He's always advocating on behalf of his patients. We all are advocating on behalf of our patients. Our objective as a government is to ensure that the funds are spent in the most effective and most efficient way. We want to ensure that the money will go where it's most needed.

I have explained to this member many times. I have given her the breakdown of the money we are spending on the North Shore. We are spending close to…. Out of $14.1 million I have given her the breakdown of each and every organization. I don't think I can do more than that. If the member still has a problem, she can continue to ask the same question. My answer is not going to change. We are not going to be telling any health authority how to conduct their business.

J. MacPhail: Maybe the minister could help us, then, to find out if there's been a misappropriation of funds that have gone missing. Where would he direct us to find that out?

Hon. G. Cheema: If this member or her colleague is concerned about missing funds, they should report to the CEO of the appropriate health authority.

J. Kwan: I just want to be clear here. This letter was actually written to the minister himself back in December. The letter is dated December 3, 2002. It is clear in this House that this minister doesn't care about what's happened to the Arrowhead Centre Society — whether or not they got their funds. If they did get their funds and if it's gone missing, the minister is saying: "Well, whatever. It doesn't matter to me. I have already stated that I'm providing X amount to the region, and the rest of it — I don't really care." Where's the accountability?

Maybe the public actually has a better read on what's going on than the minister. We have received another letter, and this is a recent letter dated May 14, 2003. The community has written to the opposition caucus on this. Let me just put this letter on record. I'd like the minister to respond to it. The letter reads:

Now the opposition caucus is asking, on behalf of this individual who's written to us, the direct question to the minister to provide information to this individual on their funding. Is the minister going to restore the funding for Arrowhead Centre Society?

The minister will probably get up, I predict, and say it's not his responsibility; it's somebody else's responsibility. That certainly has been consistent with every other minister in this House — the Minister of Education, to give an example. They'll say: "I didn't close that school; the school trustees did it. Don't blame me when the children don't get the services they need." Is the Minister of State for Mental Health going to take the same tactic? I predict he is, but I hope he's not. After all, he is the Minister of State for Mental Health, and he is responsible for mental health services for the province. I hope he will actually answer the question

for the taxpayer who pays his salary — that he will actually earn that salary by answering the questions in this House.

Hon. G. Cheema: I won't go into my salary or any other minister's salary. I think the public will judge us on our salaries in May 2005.

Let me explain to her again that the decision about any organization in this province…. As far as the funding is concerned, it has to come through the health authorities. The health authority is the one that should be making decisions. We are not going to interfere in that process. I have told this member not once but maybe 20 times. My answer is the same answer. This organization should be in touch with the health authorities, and they should present their case to the health authorities. They will make their decision based on the facts.

J. Kwan: As a matter of fact, this individual has actually touched base with the Vancouver coastal health authority. They have been advised, as well, that they are responsible for the provision of mental health services on the Sunshine Coast. But I quote from the letter: "As of yet, we have not received any proper review of our concern." Now, am I not right in understanding that this is the minister responsible for mental health? If he isn't, will the real minister responsible for mental health please stand up in this House and answer the questions?

Hon. G. Cheema: It's my understanding, again, that the Vancouver coastal health authority has been in touch with this organization, and they have communicated with each other. I will let them make that decision.

J. Kwan: It's interesting. The minister says they have been in touch, but the individuals who are writing…. This is a letter as recent as May 14, 2003. He says he's not actually had a response from the coastal health authority — notwithstanding there are people who have written to this minister in the expectation, of course, that it's for this minister to respond to them. After all, it is this minister who is responsible — is he not? He ought to actually answer these questions for the community. So far not only will he not do that, but he wouldn't do that in this House where it is his responsibility to do so.

I have a whole long list of societies where the funding has been cut. I'll go through each of those respectively with this minister. I want to ask the minister, then, this question. Let's just try and get a broad question on the floor here. What is the breakdown of the budget for the Vancouver coastal health authority for mental health services?

Hon. G. Cheema: As my colleague the Minister of Health Services said, I already answered this question. We do not provide funding to the individual health authorities as one formal line. We are providing funding for mental health based on the population in each and every part of this province.

J. Kwan: Then based on population, what is the population-based funding for the coastal health authority?

J. Kwan: And what is the breakdown of that $1.6 billion for the coastal health authority?

Hon. G. Cheema: We just give them global funding. That's about $1.6 billion, and we let the health authorities decide how they'll be spending the money. We expect them to meet performance expectations and the outcomes from the performance measures. We expect them to spend $1.6 billion in the Vancouver coastal health authority region.

J. Kwan: I want to be clear. Is that $1.6 billion just for the Vancouver coastal health authority or for the mental health funding for the entire province?

Hon. C. Hansen: I think that we somehow got onto the area of questions to the Minister for Mental Health because the member asked a question that was more appropriately answered by the minister, and he happened to be in the House at the time. She's now asking questions that are probably more appropriately answered by the Minister of Health Services.

The global budget for the Vancouver coastal health authority is $1.6 billion. It is based on a population needs–based funding formula that has been developed by the ministry over a number of years. It takes into consideration not only the population base but also demographic factors and other cost drivers within the health authorities. Once that money is allocated to the health authorities, they then have the responsibility to determine how that is best allocated to meet the needs within their particular health authority.

We certainly rely on the experts and the health professionals that are engaged by the health authority to ensure they allocate that budget in a way that meets the needs of the population in that particular area. We hold them accountable for the end results through not only the performance agreements we have in place but also the other outcome measures we have in the health care sector to demonstrate that they are, in fact, spending that money to achieve a better health status of the population.

J. MacPhail: Yes, and I was getting confused when the Minister of State for Mental Health, on being asked a question about the mental health budget, said it was $1.6 billion, but I now understand that it was the Vancouver coastal health authority global budget that's $1.6 billion.

Just to carry on in terms of budgeting, because of course we can't talk about performance measures as indicators of success because the Minister of State for

Mental Health is unable to discuss that, and we can't figure out how much money has been allocated to mental health. We can't examine performance measures because the Minister of State for Mental Health is unable to do that. So we're really left in a quandary, and all we have is the Minister of State for Mental Health saying that everything is going fine. We can't even find out where the money is going. The Minister of State for Mental Health refers us to the regional health authority, and they're not here.

Let me just review how the budgeting on mental health has occurred over…. I'm going to go back a couple of years on this, because there has been a change in the way budgeting is allocated under Health Services.

In the budgets from 1996 onward, the ministry operations for health had a line every year for adult mental health. No, I'm sorry; that was 1997. There was a change where the then-government actually put in a line item for adult mental health. That funding went like this. In 2000-01 the budget allocation — this is across the province — went from $368.57 million for adult mental health to, in '01-02, $405.63 million.

That was carried on. In the first post-election budget by the Liberal government tabled on, I think, July 31, '01, they carried on that practice of isolating adult mental health, and their budget for '01-02 had $405.63 million allocated to adult mental health. That then changed in the '02-03 budget, where mental health was not separated out; it was part of the regional health sector funding.

So the only way that anybody can possibly know what is being spent on mental health is to refer to the regional health budgeting. But they, too, don't have a line for adult mental health, unless I'm mistaken. Could the Minister of State for Mental Health tell us whether the individual regional health authorities themselves specify as a line item how much money they are spending on adult mental health?

Hon. C. Hansen: In the service plan on page 14 is a breakdown of spending on mental health. I think the discussion we had earlier with the member for Vancouver–Mount Pleasant around the dual addictions is sort of a case in point. It is very difficult to say that a dollar in a budget is allocated to mental health. We are trying to build in the accountabilities, and that's part of what is on page 14 to demonstrate how those dollars are being targeted.

We also have to recognize that dollars spent in addiction services can also be beneficial to mental health services, because so many of those things go hand in hand. You can wind up with dollars that are spent in emergency rooms in hospitals, which are also being spent on mental health. It is difficult as we develop the continuity of care across the health care system and integrated care. You can't go by the old ways of doing things, where you actually wind up with line items. I guess it may make accountants happy because they can count beans in certain pots, but when you're trying to deliver a comprehensive health care system, you have to deal with it as a system and not these stand-alone, isolated silos, which was the approach in the past.

J. MacPhail: No, we're not in any way suggesting that there should be silos. Of course, even when line items are reported, it doesn't indicate the way services are delivered. But it does hold the people accountable to the allocation of funds. Page 14 of the new service plan doesn't in any way…. Those are global numbers that actually include capital as well as operating dollars, and that's a new mix as well.

The reason why I think it's important for constituents, let alone the MLAs, to know what the allocation is on a regional basis is to know whether people with mental health problems can be served in their own communities. One of the problems in the past — and I have no idea whether it's been resolved or not — is that people with mental illnesses had to relocate to the lower mainland in order to have adequate treatment for their mental illnesses.

Some of the shifts in funding in the 1990s occurred to deal with that issue. The Quesnel mental health program was set up exactly for that reason. Of course, it's been cut. That funding has gone. The mental health beds in Quesnel have been cut, and the people who may have been served in their own community may have to go elsewhere for treatment.

Let me try to approach this in a different way to see what the government's plan is under mental health treatment. What services are provided for people with a mental illness who require ongoing, constant care? What services are provided region by region?

Hon. C. Hansen: I'll list them. There are outreach programs. There's case management. There are recreation and vocational programs, crisis programs, psychogeriatric programs, housing programs, individual counselling and group therapy programs. We did discuss the whole availability of psychiatry in our earlier discussions. Clearly, that's a challenge in some communities, particularly in northern British Columbia, but telehealth is trying to fill in some of those gaps. We also have specialized programs in the Pharmacare program for anti-psychotic medications. There are areas within public and preventive health and in mental health, and I think all of these come together to provide a care structure that is improving care. Clearly, we still have a ways to go before we get it perfect.

J. MacPhail: That's the message box the Minister of State for Mental Health has used. What I'm looking for is a region-by-region allocation of money for those programs. Here's why. What we're actually trying to do is get a status of the mental health plan that the Minister of State for Mental Health advocates.

He gets quite an easy ride on saying that he's the first one to implement the mental health plan. Well, you can't tell from the service plan about the status of the mental health plan; you can't. Believe you me, I understand that the service plan can't incorporate the

entire mental health plan. I want to know, region by region, what the allocation is to those services. That's what the mental health plan is.

I need to know whether one region has established their after-hours crisis centres. How much money is going specifically to constant patient care needs — that kind of thing. That is what the mental health plan is all about. Is there an after-hours crisis centre that covers the northern health authority? Are there in-patient services? How much money is being spent on that in the northern health authority? Otherwise, we can't possibly know the status of the mental health plan.

Hon. C. Hansen: There is a new way of doing business in this province. I guess that is probably the best way to start the response. We want to focus much more on outcomes. You can measure how much money is spent on a program. You can measure how many FTEs are there. You can measure how many beds are there. That doesn't tell you whether you're actually producing a better health care system. You do that by measuring outcomes, and that's why we have made a fundamental shift in government, not just within this ministry but across ministries, to shift from one that measures all of the inputs to one that measures outcomes.

We have designed a population needs–based funding formula that ensures the health authorities get a fair allocation of the health budget to manage the range of health care delivery challenges that they have in their regions. Included in that is mental health. They then make the determination as to how they can best meet the needs of their population, because I'm the first one to admit that a health care delivery system that we designed to work in Victoria is not necessarily going to work in Vanderhoof or in Smithers. We have allowed for that regional difference in the approaches to how mental health services are delivered.

We want to make sure we get good outcomes, and that's why so much effort is focused on measuring outcomes rather than measuring the inputs. Are there accountabilities? Yes. We are able to report through the health authorities, and when they come out with their final year-end financial statements — which are in the process of being finalized — the member can look back in terms of how they allocated the moneys that we flowed to them through their population needs–based funding. But we are not, in our budgets in the Ministry of Health Services, dictating to the health authorities that they have to spend X amount of dollars in X centre or in X community or in delivering a particular program, because we want to make sure they have the flexibility to deliver programs at the regional and local level that actually meet the needs of the people who live there.

J. MacPhail: I'm getting suspicious of what's happening here, I have to confess. I think somebody's butt is being covered here, and I want answers. I want answers from the person who is getting paid to give these answers.

Then let's look at the accountability of what's going on here, because if we can't rely on allocation of money to the services for mental health, then let's look at the accountability measures or the performance measures. This is when the Minister of State for Mental Health inserted himself into the debate. So let's look at these. We have no idea where the money's going — no idea.

Let's look at the target, then, for my health authority. Let's look at an easy one that should be measured: "Development of Riverview replacement units in selected locations to be achieved over a three-year period, specifically." Sorry, for that one, there's no target for '02-03.

"Improved continuity of care measured by the proportion of persons hospitalized for a mental health diagnosis who receive community or physician follow-up within 30 days of discharge" — increase of 3 percent. Do we have to rely on provincial targets again for that, or is there one for the Vancouver coastal health authority?

Hon. C. Hansen: This is somewhat of a repetition of an earlier question, and the answer is going to be the same, and that's that with these performance indicators, we are confident that the health authorities are on target. We are still waiting for their final numbers. A lot of those depend on external numbers before we can finalize them. That will be reported out in the context of the performance agreements. When those reports are finalized, which we expect to be towards the end of the year, we will be making that information public.

In terms of that particular indicator, health authorities are meeting expectations based on interim data. As of December 31, the Vancouver coastal health authority shows a strong increase in this indicator, so we're fairly confident that it's on target, but we're still awaiting final data.

Hon. C. Hansen: That some of the preliminary information shows they will achieve their target. Before we can finalize that, we need to have the final numbers available to us, and we don't have that as yet.

J. MacPhail: Okay, this is the end of the second year of this government, and I, standing in this House, have not been able to get one answer about changes in mental health care delivery — not one.

I had the same debate last year with the Minister of State for Mental Health. In fact, he was ridiculed in public for his answers, ridiculed not by me but by the media commentary. There were no performance targets available. We certainly were told over and over again that this government was doing things a different way. It wasn't going to be a line item. We weren't going to have measures, said the Liberal government, by the amount of money we put into funding. We're going to have it by outcomes.

Am I hearing that it will be the end of 2003 before we will have any idea about the status of the mental health plan — any idea?

Hon. C. Hansen: As we went through earlier in this debate, we tried to find independent sources. I think people would question data that we had accumulated internally. We wanted to find ways to have third-party information that would verify that performance measures are in fact met. The downside of that is that we don't govern the timeliness with which final data can become available, so it is a lag in terms of what might otherwise be preferable. That's the reality we're dealing with.

To put this into perspective, we never had performance targets for health authorities in this province. This is the first time we have that, so we're in the start of this process. The performance agreements were finalized with the health authorities just last year, and we are now into the very start of the second fiscal year in which those performance targets are being utilized.

I think they will become an absolutely invaluable tool, but we want to make sure they're based on valid numbers. Quite frankly, I know the Leader of the Opposition would be up challenging us if we were trying to use numbers that were in any way subject to question.

J. MacPhail: What this province did have was an annual report from a mental health advocate that answered all of these questions, until the Minister of State for Mental Health fired the mental health advocate, disbanded the office and said he was going to be the mental health advocate for the province. In fact, the annual report of the mental health advocate would answer all of these questions. It wasn't as if the answers came to give a nice, rosy, cheerleading point of view for the government of the day. The report was challenging and provocative. It examined the successes and articulated the failures — both from a funding point of view and a service delivery point of view — and the outcomes. None of that is available under this government. That office is gone.

The Minister of State for Mental Health stood up and said, "I will be the mental health advocate," so I don't think it's that strange that I'm standing up and asking for this information. The model upon which this information was available existed in the mental health advocate's office. I assumed it was transferred to Minister of State for Mental Health. I've been at this for two years now, trying to get the information.

In the first year of estimates that arose, it was pretty difficult to avoid answering the questions around this, because there was a mental health advocate in place. This current government could open up the report and use that as an example to besmirch the record of the previous government.

I'm looking for progress from there, and there's nothing. Perhaps the Minister of State for Mental Health could tell me how much time he spends as the mental health advocate.

Hon. C. Hansen: I just want to go back and revisit the agenda that the member set out as we started this debate. She indicated that she wanted to talk about wait-lists. We've done that. We wanted to talk about executive compensation and non-executive compensation. We've done that. She then wanted to talk about health authority issues, and somewhere in the middle of that….

Well, let me continue. We were then to talk about federal funding and the Romanow report. We were to talk about doctors' issues, and we were to talk about primary care reform.

When we'd finished that, we were then going to proceed with the Minister of State for Mental Health and the Minister of State for Intermediate, Long Term and Home Care. I guess I'm seeking some direction from the member. Is she on this agenda, or is she not on this agenda?

J. MacPhail: That's completely cheeky, and I don't expect it came from the Minister of Health Services. I'm sure he's trying to cover the butt of his colleague the Minister of State for Mental Health. It wasn't us that changed the agenda. In fact, we're actually trying to cooperate. My colleague the member for Vancouver–Mount Pleasant got shut down in Committee A. She said that was fine. She was directed not to ask the questions of the Minister of State for Mental Health until Monday. Then the Minister of State for Mental Health came in and started answering the questions, so we assumed the government's agenda had changed. In fact, the Minister of State for Mental Health made himself available to answer these questions.

You know what? I don't need to play games. Time is too valuable. The Minister of Health Services is covering the butt of the Minister of State for Mental Health to cover up his incompetence. He inserted himself in the debate in a silly, ridiculous way that can't be justified, and the Minister of Health Services legitimately wants to go back to a debate so that the Minister of State for Mental Health can be properly briefed in preparation for these questions for Monday. I'm fine to do that.

For anybody to think that anybody is fooled by this would be to really underestimate — really underestimate — the public who is watching. I might just say that we have already had feedback from the public — I love this technology — who was listening to the debate in Committee A with the Minister of State for Mental Health. It's not as if this issue is going to go away. It is not going to go away. In fact, the questions may get more rigorous if we wait till Monday. According to the government's own agenda, it's been thrown into disarray.

Hon. C. Hansen: I guess it's been a long and tiring week for everybody. When the member for Vancouver–Mount Pleasant asked a specific question that was a bit off the subject that I as Minister of Health Services would want to engage in, I felt that having the minister of state answer that one question might help us to deal

with that particular subject so we could get on with the other areas she's set out in the agenda. When it became obvious that the members wanted then to shift to mental health, I asked for direction from the members as to whether or not they were through with the areas of Health Services. It was the choice of the opposition members to pursue mental health questions at that time.

You know, the estimates process is open, and it's obviously flexible. It's there to allow all members of the House to ask questions. There was an understanding, I thought, that the deliberations for the ministers of state would be done on Monday in the House. If somehow the fact that the minister of state answered one question in trying to be helpful with this afternoon's discussion…. If that somehow threw all of the opposition's approach to these questions off, I apologize for that, but I would certainly like to ensure that we use our time appropriately to do the due diligence on the Ministry of Health Services estimates.

J. MacPhail: Yeah, that would be absolutely appropriate with a cabinet shuffle. The way to get on with the government's agenda would be to remove the Minister of State for Mental Health. Under no circumstances should anybody be under any other illusion than that it was the insertion into the debate of the Minister of State for Mental Health in an attack mode to assert his superiority on this file that changed the agenda. That's what changed the agenda. In fact, it will be with the opposition being forced under time allocation that we will stand down. We will stand down and ask these questions on Monday.

I would only suggest to the Minister of State for Mental Health that it's going to get harder. It's going to get harder because there are more people who can actually view the debate in here and will have a series of questions for him. I expect that's why the government wants to shut down that greater light being shone on the Minister of State for Mental Health right now.

But I'm fine to use the remaining 20 minutes to move on. We'll start up again on Monday with the Minister of State for Mental Health, wherever the government, in its chaotic approach to House management, puts him — wherever. We'll also be spending more time with the Minister of Health Services as well.

I'm on the Fraser health authority plan right now. I'm wondering if the Minister of Health Services could update me on the contracted services being contemplated by the Fraser health authority.

The Chair: Maybe the members can reserve their comments for outside the House, please.

The Chair: Order, members. You'll have a chance to stand up and speak on your own. Thank you very much

Hon. C. Hansen: Some of the outsourcing initiatives of the Fraser health authority include laundry service. That contract was awarded commencing November 16, 2002. Housekeeping services: there was a request for qualifications that's been completed, and the Fraser health authority issued a request for proposal on January 8, 2003. Evaluation of the responses is anticipated to be completed by June of 2003. The security services request for proposal was issued on December 9, 2002, and closed January 31, 2003. Evaluation was completed, negotiations were underway, and I believe that contract has now been awarded. Retail food services: there was a request for proposal issued in February of 2003. The closing date was March, and evaluation of that is underway.

J. MacPhail: What percentage of the Fraser health authority budget will be contracted by those contracts?

Hon. C. Hansen: That's something that really has yet to be determined. As the member's probably aware, some of these contracting-out initiatives are effectively on hold until such time as the outcome of the ratification of the HEU agreement is determined. Depending on the outcome of the HEU, they may or may not be proceeding with some of the contracting-out initiatives.

J. MacPhail: I certainly don't want to get into any discussions until that information is received either, but let me ask a procedural question. If there's a positive outcome to the ratification, what is the process in place for revisiting contracted services?

Hon. C. Hansen: I think it would be inappropriate to speculate at this point until such time as we know the results of that vote.

J. MacPhail: Yeah, we can carry that on when we're back, anyway, so fair enough.

In terms of the Fraser health authority services, I'm particularly interested in…. I haven't asked a question on surgical services yet, expected performances, so I want to….

I know my colleague has explored some of the performance measures, but I want to ask a question specifically on surgical and procedural services. This is standard language, but I want to deal with the standard language as it applies to the Fraser health authority. Here's the standard language:

It's my understanding that there is quite a reallocation of services expected in the Fraser health authority amongst the institutions that exist in the Fraser health authority. Can I please have an update on the reallocation of services as they relate to surgical procedures?

Hon. C. Hansen: The member is right. There is an active review underway to find out what services are most appropriately provided at what facilities. If you look at the geography, particularly of the western end of that Fraser health authority, we have a number of hospitals in a fairly close geographic area in terms of Burnaby and Royal Columbian, winding up with St. Mary's, Ridge Meadows and Eagle Ridge, that there is….

What the Fraser health authority is trying to do is make sure the surgeries are located in the most appropriate venue, so that instead of all of those hospitals trying to be all things to all people, we actually develop specializations in some of them. The member is probably aware that the Fraser health authority just recently concluded an agreement with St. Mary's Hospital around the types of surgical procedures that would be offered at St. Mary's, which are around surgical day services.

They are now looking at what services could perhaps be enhanced at some of those very high-growth sections of their health authority around Ridge Meadows Hospital and Eagle Ridge Hospital. That is not finalized yet. They're still looking at what the most appropriate venue is for the respective services.

J. MacPhail: What are the criteria that the Fraser health authority uses for allocation of services?

Hon. C. Hansen: Some of the things they would be looking at in determining that are what kind of support capacity there is in various hospitals and what kind of technology is available, rather than duplicating the same technology across all of those facilities. They're looking at where the surgeons would best be able to practise.

One of the issues that's quite important now, particularly with the on-call payment structures, is to make sure there are enough surgeons operating in call groups out of a facility to make sure there is appropriate coverage. They're looking at basically how to cut down on duplication. So all of those become factors in determining which hospital is the appropriate location for a particular surgical specialty.

J. MacPhail: What about transportation? Did I hear transportation in that at all?

Hon. C. Hansen: Yes, that is important not only from the perspective of ambulance service but also from the perspective of access for individual patients. What we have seen is that a lot of that surgical capacity has been concentrated in the past in some of the lower-growth communities. When you start looking at the Tri-Cities area, for example, there's been some very, very rapid growth, and really, the expansion of services hasn't kept pace with that. So they're tied to taking those into consideration so that people can get access to care at the most appropriate facility closest to where they live.

Hon. C. Hansen: There are actually two processes that are going on concurrently. At the health authority level itself, they are making that determination. But that fits into the broader framework being developed by the PHSA in terms of access to surgical procedures, which is a framework that's being developed for the whole province, and all of the health authorities are involved in that process. But parallel to that, each health authority is also developing its own surgical access plans.

J. MacPhail: Sorry, I meant within the health authority. Is it physicians? Is it ambulance service or — I don't know — community leaders? Who's involved in the individual plans?

Hon. C. Hansen: Each health authority has an interdisciplinary team working on that. So it does include nurses; it does include doctors. The ambulance service would certainly be consulted. Whether they'd be part of the team or not…. They would be involved, I guess, but perhaps not as a direct member of that review team. So it is interdisciplinary; it's looking at all of the players that really have a vested interest in making sure we've got proper access to surgical care in that region.

J. MacPhail: What was the surplus or deficit of the Fraser health authority, please?

Hon. C. Hansen: The projected surplus for the Fraser health authority is $25.083 million. That is still awaiting finalization, as all of the budget numbers are. I'm trying to think of what the base is for the Fraser health authority off the top of my head. It's just over a billion dollars.

J. MacPhail: It is a number that stands out from the others, though. How did the surplus come about?

Hon. C. Hansen: The Fraser health authority's draft audited financial statement shows a $25.08 million surplus. This improvement is based on strong financial restraints and deferral of planned reinvestments. Also contributing to surplus is better labour utilization and decreased employee benefits, sick and severances, from what was budgeted. The projection includes unexpected

one-time revenues of $6 million and repatriation of $2 million, with regard to ambulance services.

I think one of the things that's important to point out is that this amounts to 0.25 percent of their budget. Certainly, $25 million is a lot of money and seems like a lot of money, but when you start looking at it as a percentage of their budget, I think it is, as I say, a quarter of 1 percent. The other thing that's important to point out is that these dollars don't lapse. The health authorities actually carry those surpluses forward into next year, so that can get spent on patient care in the following year.

Hon. C. Hansen: The CEO of the Fraser health authority is not entitled to any performance payout payments given the structure of his contract there.

J. MacPhail: I'm moving to the interior health authority now. What was the surplus or deficit of the interior health authority?

Hon. C. Hansen: Just to go back to the Fraser health authority for a second, their base budget for last year was $1.328 billion, so that surplus is actually even less than the 0.25 percent.

The interior health authority. Their budget last year was $888.154 million. They are projecting a surplus at year-end of $46.744 million.

Hon. C. Hansen: The surplus resulted from delays, deferrals in some of their planned service reinvestment initiatives, some savings in exceeding planned targets, and some budgeted expenditures and contingencies not being fully required this fiscal year. The ministry has received the IHA's preliminary budget management plan for 2003-04 through to '05-06, and this surplus is offset by planned deficit in fiscal '03-04 in accordance with the financial performance targets.

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

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

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