Hansard -- Thursday, March 11, 2004 a.m. -- Vol. 22, No. 1 (HTML)

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

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY


CONTENTS

	Routine Proceedings
		Page

Introductions by Members		9407

Committee of Supply		9407
	Estimates: Ministry of Health Services (continued)
	Hon. S. Brice
	D. MacKay
	V. Roddick
	J. MacPhail

	Proceedings in the Douglas Fir Room

Committee of Supply		9416
	Estimates: Ministry of Community, Aboriginal and Women's Services (continued)
	Hon. M. Coell
	J. Kwan

Clerk of the House: Pursuant to standing orders, the House is advised of the unavoidable absence of Mr. Speaker.

J. Bray: Joining us in the gallery today we have 30 seniors from my community from the New Horizons Society, who are here touring the Legislature. I understand they've completed their tour, and they're just seeing what's going on in the chamber. Their coordinator is Mr. Frank Gascoyne. I would ask that the House please make them all very welcome.

Hon. G. Abbott: For the information of members, in this House I call estimates debate for the Minister of State for Mental Health and Addiction Services and in Committee A the estimates debate of the Ministry of Community, Aboriginal and Women's Services.

Hon. S. Brice: I would like to put on the record a statement regarding the work of this office. I rise here today to outline the achievements and challenges in the area of mental health and addiction services in this province.

Our goals parallel those set out in all the initiatives for the Ministry of Health Services. We want to build a mental health system that is sensitive to the needs of individuals, families and communities and is effective and sustainable in the long term. We are creating a system that meets the needs of individuals and their families respectfully, effectively and proactively. Through that system we will measure success in the numbers of youth who grow up free of mental illness and addiction; the numbers of individuals who are successfully reintegrated into supportive, caring communities; and the eradication of the stigmas and prejudices that are too often faced by individuals who experience mental illness and/or addictions.

B.C. has made substantial progress in mental health and addiction services over the past two years. We, with the staff, have worked with the ministries, health care professionals, provincial mental health and addiction stakeholder groups, and community leaders to revitalize British Columbia's mental health system. Together they have been transforming a disjointed system into one that is recovery-oriented, evidence-based and best meets the needs of all British Columbians.

This government recognized early that mental disorders are the fastest-growing category of disability claims in B.C. Our research found that 70 percent of people who use community addiction services are also clients of the community mental health system. It made sense to bring together the management of mental health and addiction services, so as of August 2003 the health authorities have been integrating mental health and addiction services across the province. That single step was cost-effective and made sense both to individuals who access these services and to their families.

My role of advocating for mental health issues across ministries is exemplified in the child and youth mental health plan. The lead ministry is the Ministry of Children and Family Development, but I work closely with the minister on mental health issues.

Research clearly tells us that early years of life are the most important. The system must be redesigned and re-engineered to allow mental health problems to be identified and treated early in childhood and adolescence. With early intervention, the long-term prognosis for management of mental illness is greatly improved. Children and youth have too often been overlooked when it comes to mental health initiatives.

In February 2003 this government launched Canada's first child and youth mental health plan through the Ministry of Children and Family Development. The five-year plan describes a framework for service delivery changes and a plan for resourcing and implementation. Children and youth with mental illnesses often face difficult transitions as they move between hospital and community mental health services and into the adult mental health and addiction system. B.C. children's and women's hospital is carrying a part of our commitment to young people.

Already under development is the child, adolescent and women's mental health centre, which is expected to open early in 2006. The provincial health services authority committed $13 million to create this centre, and the B.C. Children's Hospital Foundation has committed an additional $6 million to support the centre. The new centre will offer a full range of mental health assessment and treatment services, including a child and adolescent psychiatric emergency unit, outreach services, specialty clinics and an eating disorders program.

Creative and dynamic new programs are being provided to meet the varied needs of health care cli-

ents. I would like to mention in particular B.C. Women's Hospital and Health Centre. Last year Canada's first program for substance-using women and their babies opened at B.C. Women's Hospital. Fir Square, as it has been named, is designed to help substance-using women and substance-exposed newborns stabilize and withdraw from substances, keeping mothers and their babies together whenever possible. This forward-looking program is the only one in Canada and only one of two such programs in the world.

For many years Riverview Hospital played a central role in mental health treatment. Over those years, a tremendous amount of good work was done. However, the facilities are institutional and outdated. Current mental health evidence-based practice identifies that individuals are more effectively cared for within their communities, in smaller facilities and in a more homelike environment. The model of care is moving away from large institutions like Riverview to smaller facilities located within communities. This redesign of the system will support individuals to access a full range of services closer to home and nearer to their families and friends.

The new model for delivering specialized mental health services in B.C. is becoming a reality. This includes the development of a range of community services which provide health promotion, prevention, early identification and treatment, rehabilitation, relapse prevention and supports for self-management. There are secondary facilities which provide emergency acute care, assessment and short-term stabilization and linking to community services. Thirdly, there are tertiary facilities which provide specialized assessment and treatment for individuals who have complex mental, physical and substance-use disorders.

The Riverview Hospital redevelopment project will allow us to move away from institutionalized care for people with mental illness. The Riverview redevelopment project steering committee is responsible for guiding the development of tertiary mental health services across the province by 2007-08. The committee is chaired by the provincial health services authority and includes representatives from health authorities and the Ministry of Health Services.

To date, approximately 75 patients have been transferred from the old facilities at Riverview Hospital to three new tertiary psychiatric centres recently opened throughout the province. Seven Oaks, near Victoria, opened 24 new specialized mental health beds in August of 2002. Iris House, near Prince George, opened with ten new beds in April 2002 and expanded with an additional ten beds in April of 2003. Ten of the 20 beds are for tertiary rehabilitation. South Hills Tertiary Psychiatric Rehabilitation Centre in Kamloops opened 40 new beds in April of 2003. The Royal Inland Hospital 44-bed acute tertiary mental health facility in Kamloops — the tender for that closes in May — is estimated to cost approximately $15.7 million. The Seven Sisters 20-bed residential facility in Terrace is scheduled to be completed this October, with a total cost of $2.5 million.

Bulkley Lodge, a 14-bed psychogeriatric renovation in Smithers, is expected to be completed in October, with a total project capital cost of $1.7 million. North Peace Care Centre, a six-bed psychogeriatric renovation in Fort St. John, will also be completed in October, with a total project capital cost of $1.5 million.

Next week, on March 15, I will be participating in the grand opening of Harbour House, a specialized facility in Trail which will provide rehabilitation and residential services for adults and seniors. These new facilities promote mental wellness and recovery and are designed to provide a homelike atmosphere with all the amenities that we all look for in our own living spaces.

In addition to providing new mental health facilities within communities, we are committed to assisting individuals who no longer require care at Riverview Hospital. The Access project provided funding through the provincial health services authority to facilitate successful community placements for individuals from Riverview and forensic psychiatric hospital who had not had the opportunity to return to their home communities. The Ministry of Health Services provided $4.05 million of annualized funding to provide supports for these individuals in their home community under the Access project for the 2003-04 fiscal year.

The PHSA has identified that the Access project has successfully discharged 146 individuals to enhanced community placements as of February 2004. This means that 146 British Columbians are leading healthier and more independent lives.

Knowledge and understanding of the symptoms of mental illness and addiction are the key factors in early intervention strategies that can assist health professionals in determining the very best options to meet client needs. Research tells us that depression and anxiety disorders are the most prevalent mental disorders in our communities. Sadly, they are largely undiagnosed and untreated. Consequently, many people are leading lives that are unfulfilled, both in their families and at their places of work.

In response to this issue, in October of 2003 we released strategies designed to help the public and health care professionals respond to these disorders. We will be continuing our work to implement the depression and anxiety disorders strategy in the coming years. It will require the involvement of all the community, general practitioners and specialized health care providers.

We are also working on a provincial planning framework for the prevention and treatment of problem substance use and addiction. This framework will be a valuable tool for the health authorities as they work to build a system that meets the widest range of client needs.

On May 4, 2003, we announced the development of the provincial mental health and addiction information plan. It was implemented in partnership with the B.C. Partners for Mental Health and Addictions Information. Working with these six provincial mental health and addiction organizations, we have created a single

source of reliable, evidence-based information and education. The provincial health services authority is now taking on the important work of the B.C. Partners.

Mr. Chair, all these projects and efforts are revitalizing the way we prevent and reduce the impact of mental illness and addiction in B.C. These initiatives are progressive steps to ensuring that individuals and families are supported to manage their health and, when they need care, ensuring that they're able to access a system that is respectful and supportive. We continue to work towards our vision of a truly effective, efficient, recovery-oriented system of care for individuals facing mental health and addiction challenges. I look forward to the discussion of these important issues.

D. MacKay: Thanks to the minister for the lead-in to her new ministry, and congratulations on assuming her new position.

I was actually quite interested in some of the comments she made about the $1.7 million for the Bulkley Lodge at Smithers. I'd just like to pursue that for a moment. Is this renovations to the existing facilities, or is it additional to the existing facility?

Hon. S. Brice: Obviously, the member points out the major capital investment that we are making in this important area. The capital planning for the 17 psychogeriatric beds, nine of those in the Bulkley Lodge…. The plan is to transfer the patients, to begin in 2004.

D. MacKay: So we're renovating nine of the existing rooms to accommodate patients from Riverview, to bring them closer to home. Is that what I understood?

Hon. S. Brice: Just one minor correction there. The 17 psychogeriatric beds is actually 14. The ones of particular interest to the member, the ones at Smithers, are part of the Riverview Hospital redevelopment capital funding allocation. And in response to the member's question, yes, this will be bringing people back closer to home.

D. MacKay: We're not creating any new facilities to accommodate people with mental illness; we're just relocating them from Riverview back to the communities. They're taking up a space at the Bulkley Lodge that was formerly there for people with extended care. I guess that's the question. We're not adding on to the additional facility. We're just renovating the rooms to accommodate the needs of the nine people, I think you said, that would be transferred back to the Bulkley Lodge.

Hon. S. Brice: The member is correct. The funds will be used to upgrade and make the facility compatible with the needs of those who will be living in that facility.

D. MacKay: That's nine renovated beds at the Bulkley Lodge in Smithers. How many beds will be available in Terrace and Prince George to accommodate those with mental illness?

Hon. S. Brice: The questions posed by the member refer to new mental health facilities. In some communities we're doing renovations. In some there are new facilities being constructed. It's done, of course, on an assessment from the health authority to determine just exactly what the capacity is in the community.

In Prince George, Iris House first had ten new beds. It had an additional ten beds, so there are 20 new beds in Prince George. In Terrace, at Seven Sisters there were 20 additional beds — residential. Seven Sisters is a 20-bed specialized service residence providing a homelike environment for patients with a mental illness. Each patient will have his or her own private room, kitchen and living facilities.

I'm looking to see if I can get more detail for you about the Terrace facility. In Terrace it's located at the Mills Memorial Hospital site for that facility.

D. MacKay: If I heard the answer correctly, the only new facilities that are being built are at Prince George. Is this the only new place where we're going to see additional beds being added to the system?

Hon. S. Brice: No. New facilities are at both Prince George, 20 new spaces, and Terrace. Seven Sisters is also new.

D. MacKay: I'm just wondering about the occupancy at the present time, because I'm getting concerns from people who live in my part of the province that they're not able to access mental health facilities in the region. We can't seem to get them into the Terrace facility. We're holding them at the Bulkley Valley District Hospital, because there's nobody in Terrace that can accommodate people with mental problems. The question is: are we at capacity in Terrace now? Do you know?

Hon. S. Brice: The member is correct. There has not been capacity in the area. The health authorities are taking their time assessing what is required. This new 20-bed facility will add considerably to the capacity of the area, and that facility has not yet been occupied.

D. MacKay: The issue of staff to look after the patients once they're in there seems to be becoming an issue. I wonder if the minister is familiar with the Terrace situation. It would appear that we're building facilities to accommodate those who are already identified as having needs where they can get long-term care, but we don't seem to be addressing the situation to address people who are coming into the stream and being identified with mental illness. It goes back to the issue I just spoke about, where we can't get our people in to see anybody in the Terrace area. I assume it's because there's nobody there who can look at them and help them.

Is the minister familiar with the staffing capacity at the Terrace facility right now? What is the situation there?

Hon. S. Brice: Obviously, the issue of capacity in the north is a longstanding issue and one that is going to take some time to resolve. It is a capital plus an operating issue, and both of these things are important to come together.

For the patients who are moving from Riverview to their community, the capital is being provided as well as operating, so it should be well supported. I'm advised that this facility is due to open next October, so that is good news for that community.

Building on this facility, there are other initiatives going on. The member will, of course, be aware of the telehealth initiatives. We in the province are looking to train more psychiatric nurses as part of the team that needs to be built — the building blocks to build a good, strong, community-based mental health support system for the communities in the north. As Riverview is redeveloped, the staff at Riverview are given opportunities to take the employment opportunities that move as the patients are moved closer to community.

D. MacKay: Again to the minister: the actual staffing capacity at the Terrace Mills Memorial Hospital. Does she know if in fact we have a psychiatrist there who can look at people from the region for assessment?

Hon. S. Brice: Recruitment in the north continues, of course, to be a significant problem. No, I can't tell you the specifics, but I will endeavour to get that to you just as quickly as I can — about whether or not there is a psychiatrist at that particular facility.

I can tell you there have been considerable resources focused on this issue — the rural incentive program to attract doctors to the north, a specialist locum initiative. One of the specialties that has been specifically identified within that program is the need to attract psychiatric medical practitioners. There is also the program of Health Match, which endeavours to identify specialized, trained professionals from across the country and further afield with needs in this province.

I can tell you there are many fronts working on this issue, and we will endeavour to get the specific information requested by the member to him just as soon as that's available.

D. MacKay: The resources being put into the problem…. I can appreciate that. I don't know what to tell constituents when they come to me and say they can't get their children or spouse into a facility because there's nothing available. As I said, we're holding patients at the Bulkley Valley District Hospital who should be in a mental facility, because we can't get them into a bed. This is creating some anxiety for people who live in the north, because of the lack of mental health facilities to accommodate them. So I appreciate the answers, and I look forward to seeing some movement to be able to accommodate some of these people that do need the assistance.

What I would like to do at this time is move to addiction services for a moment and just ask the minister some questions on the safe injection site in Vancouver. First of all, what is the cost to the taxpayer for that safe injection site in Vancouver? What does the provincial government contribute to that program?

Hon. S. Brice: The federal research trial that the member refers to at the supervised injection site does have a significant commitment from this province. There was slightly over $1 million in capital committed to this project and a sort of one-time commitment the Premier made to allow the authority to make adjustments and to endeavour to fold this in, if it is the desire of the regional health authority there to have this on an ongoing basis. There was a $2 million, as I say, one-time operating commitment. Approximately $1.55 million of that was expended, with approximately half a million dollars coming in the next budget year.

I have to ask. The number of people that are actually using the safe injection site — are the numbers increasing or are they decreasing?

Hon. S. Brice: The numbers have been steadily increasing as this program is identified and is meeting the needs of a particular client base. Currently, there are 2,800 registered participants. That breaks down to approximately 500 visits a day. One of the statistics that has been somewhat surprising and of interest to those who are monitoring this federal research trial is that 40 percent of those using the facility are women.

D. MacKay: I wonder if the minister could advise me how long this trial is going to carry on. What period of time are we looking at?

Hon. S. Brice: This is a three-year evaluation project, and the federal government has put resources in — $1.5 million — to support this scientific research pilot project. At the end of three years and in light of that research, there will have to be a determination about whether or not this continues to be a valuable part of the health care system meeting the needs of that particular client group. The member might be interested to know that some of the things the researchers will be looking at will be whether it reduces overdoses; improves the health of injection drug users; increases their appropriate use of health and social services; and reduces the health, legal, social and incarceration costs associated with problematic substance use.

D. MacKay: Just looking at the response to the question, for those people who have the addiction, is there anything in that program that helps them? Is

there counselling available to these people to try to get them off the drug? Or do they just go in there and shoot up a drug they buy off the street, and all we're doing is providing them with a clean needle so they can shoot up a drug they bought illegally off the street?

On one hand, we spend considerable money fighting the grow ops of marijuana in our province, yet on the other hand, this program, with funding from the federal government and the province, seems to be saying it is okay to have in your possession a drug that's illegal. Heroin is an illegal substance, as is cocaine, and goodness knows what else they're shooting up in those galleries. Those are illegal drugs.

I wonder: is there something in the plan that is going to target the individuals using the drugs to try to take them off the drugs? Do we just continue to provide them with clean needles so they can carry on with a habit that is costing them and the taxpayers of the province considerable money?

Hon. S. Brice: The range of services actually provided at the site include, of course, injection supervision with emergency response for drug overdose; injection-related first aid — for example, wound care; and here, interesting for the member's question, access and referral to primary health care, addictions treatment services and mental health providers; harm reduction teaching and counselling; and needle exchange.

As I mentioned in a previous response, the project will ultimately be evaluated on whether or not it does improve the health of injection drug users and increase their appropriate use of health and social services. We're talking about a client population here, many of whom have not accessed any health services for some time. This is seen as an opportunity for many of them to have an initial contact with a health care provider who can, at the appropriate time and if it is possible, move them on to wellness.

V. Roddick: I only have one question, then over to my colleague from Vancouver-Hastings.

Several beds were designated to be moved from Riverview to the newly expanded and, I might say, beautifully upgraded Delta View hospital at Highways 10 and 99 in Delta South. Could the minister please tell me when and how these transfers are taking place and the number of beds that will actually be available?

Hon. S. Brice: The movement of patients in the Riverview redevelopment project has had, core to the program, the need to very carefully plan for the transfer of the patients, many of whom have lived at Riverview for some considerable time. The planning is comprehensive. It involves the families, it involves the receiving facility, and each patient has an individualized care plan to accommodate the relocation.

J. MacPhail: Let me begin by congratulating the member for Saanich South on her appointment as Minister of State for Mental Health.

How much money does the minister receive under the current budget for mental health through the regional health authorities?

Hon. S. Brice: As the member knows, there is no specific line for mental health funding. The mental health budget goes out as part of the global funding and is allocated to the health authorities on a population- and needs-based funding basis. I would be pleased to provide the member with the details on that.

J. MacPhail: I don't think that the opposition would ask that question would come as any surprise to anybody. We've been pursuing this issue since the government's election.

Just to recap, for those who haven't been privy to that ongoing discussion, up to 2001 the budgets for health specified a line for mental health funding. There was a clear, delineated line for funding for mental health. It was operational money; it wasn't capital expenditure. Then this government changed funding to allocate about $5 billion or $6 billion of the $10 billion overall health care funding — it might be more; it might be $7 billion — to regional health authorities and removed the delineation of funding for mental health from public purview. They shipped the global funding to the regional health authorities and said: "If you want to know what's being spent on mental health, ask the regional health authorities. It's their responsibility."

Here we are debating the budget for '04-05. We've had regional health authority experience for '02-03 and '03-04. This will be the third year, '04-05. I'd like to know how much is being spent on mental health.

Hon. S. Brice: If you look at mental health and addictions spending across all of the programs and health authorities, we are spending approximately $1 billion a year on mental health and addiction services.

Hon. S. Brice: The breakdown, for the member's benefit: going out to the health authorities, approximately $620 million; tertiary redevelopment, $4 million; Pharmacare, $137 million; MSP, approximately $200 million; and prevention and public health, about $34.5 million.

J. MacPhail: I assume the Pharmacare drugs are the ones that are under plan I — is it plan I? I'm doing this from memory — with the drugs for schizophrenia. I hope I've got the initial right. There was a plan put in place in the 1990s where Pharmacare would cover

drugs for the treatment of mental illness. Is that the Pharmacare fees that are being charged — the $137 million?

Hon. I. Chong: Visiting us today — and I think they have just entered the gallery and are seated or being seated — are a group from my riding, the Uplands Probus Club — Probus standing for professional and business persons. There are about 30 adults here. They've just had a tour of the Legislature, and they have now joined us in the chamber to watch the proceedings of the estimates. For many of them, this is their first time to the Legislature. They are here with the president of their club, Ms. Marilyn Pattison, and one of their organizers, Barbara Struthers — a group of 30 of these adults. I ask the House to please make them welcome.

Hon. S. Brice: The Pharmacare numbers that were provided to the member cover plan I and plan G — plan I for the general and plan G for the special mental health drugs.

J. MacPhail: The health authority, $620 million for '04-05 — does that include operating and capital?

Hon. S. Brice: The $622 million referred to '03-04. The dollars expended and expected to be expended on mental health and addiction services are not forecast. It is accounted for at the end. It does not include capital.

Hon. S. Brice: There has been $138 million committed over the five-year plan. As health authorities identify needs and make plans, there will be takeup on those committed funds. To date, $20 million has been expended.

J. MacPhail: I'm sure the minister and I were dealing with the same box. That was mental health capital funding. That was my question, and that was her reply. So $20 million of the $138 million has been spent.

Just to confirm, I'm dealing with the figure of $620 million, not $602 million? Sorry —$620 million?

J. MacPhail: So for '03-04 the estimated expenditures for Mental Health and Addiction Services, operating, is $622 million. Can the minister break down services for mental health and operating costs for addiction services? They were separate budgets previously.

Hon. S. Brice: No. The figures are not broken out separately. We as a government have made a commitment to a strong integration of mental health and addiction services. Many of the programs are interlinked at the health authority level, and determination is made about those expenditures. We know that for the best patient outcomes, given the number of people who have both a mental illness and an addiction, those dollars need to go in tandem.

J. MacPhail: Does the $622 million include the $10 million trust fund set up for excellence in addictions research? It was set up in 2001. I'm not quite sure what the title is now. It was done with all of the authorities, the experts in addiction services, and a $10 million trust fund was set up.

Hon. S. Brice: No, it does not. As a trust fund, it is set up as quite separate from government and does not form part of the operating budgets.

J. MacPhail: Given the fact that these are retrospective numbers, which makes sense, how much is the overall increase for regional health authority budgets for '04 and '05 — the overall increase?

Hon. S. Brice: The '03-04 budget allocations to the health authorities were $6.117 billion; in '04-05, $6.139 billion. That's prior to capital.

J. MacPhail: I'm looking at the resource summary of the plan. Sorry. I just turned to it — the resource summary on page 12 of the service plan. This is operating expenses, and that's what I want to talk about — operating. I think that's what the minister said. It says regional health sector funding was $6.594 billion in '03-04 — the restated estimates — and '04-05 estimates are $6.495 billion. What's the difference between that and the figures the minister just gave me?

Hon. S. Brice: These questions, which are of a general nature regarding the Ministry of Health Services, would more appropriately have been put to the minister responsible for that. I will not be getting into those types of issues.

J. MacPhail: Okay. Well, the minister is part of the cabinet. She's part of the team for Health Services.

My only point is this, Mr. Chair. The minister has just stated figures that are completely different than what's in the document they published February 17 that shows a $100 million cut to health authority budgets. My point in saying that the minister has offered me a retrospective look at mental health funding…. I was

going to ask her a prospective question about how mental health funding will be affected when the regional health authority's budgets look like they're being cut. How about tackling that question?

Hon. S. Brice: To just repeat, we have figures showing '03-04 from $6.117 billion going up to $6.139 billion. That is not a cut; that is an increase. The reference to the figures that the member has mentioned were well canvassed with the Minister of Health Services and the member for Vancouver–Mount Pleasant, and I would suggest that's where the member should find that information.

J. MacPhail: It's an interesting trend this government is making where they say: "Oh, well. If someone else has asked the question, you don't get an answer if you're asking the same question." I wonder why. It seems every chance that this government has to have an open discussion in the forum where they're only held accountable…. We can't find out what's going on in the caucus meetings — turns out those are secret. Can't find out what's going on in cabinet — that's secret. Can't find out what's going on here. There is a two-person opposition, and if we don't actually check everybody's records every night, this government refuses to answer questions.

I wonder if they would actually like to refer to the period of '96-2001 when 30-odd opposition MLAs would come in and repeat the same questions day after day. The government side, the then government side, didn't say, "Oh, well. Your colleague already asked that question," or "We may have said it," and then answered the question."

Well, I have no idea why the minister is trying to say that the budget is $6.117 billion this year just finished, and it is going up to $6.139 billion. There is no documentation of that anywhere in the documents they produced in the budget — nowhere, absolutely nowhere.

Anyway, even if that is their justification, on a more than $6 billion budget they're adding, it seems to me, $22 million. What would that be as a percentage? It's a 0.003 percent increase, I think; I'm doing this out of my head. Let's move on. New minister, same old tactics by the government, but let's cut her some slack.

It's a $22 million increase on a $6.1 billion budget, a 0.003 percent increase. How much is the minister asking of that to go to mental health?

Hon. S. Brice: First off, I just want to reiterate that the regional health sector budget, which did actually have in it some accounting changes…. That issue was well canvassed with the Minister of Health Services and the member for Vancouver–Mount Pleasant. I'm certain that the Hansard will be able to rectify any misunderstanding the member might have in that regard.

The increase in dollars to the health authorities will not be specifically designated, but the health authorities are expected to operate on principles of best practices for prevention, for primary care, for rehab. The wonderful thing about the regionalized approach is that the health authority is responsible for all the health care needs of all the people living in their area. It just makes not only good health care sense but good sense to the health authorities from their own bottom line to meet the patients' needs where they are best served, as opposed to having it spill over into the acute care system. They are also to develop a provincial tertiary system which meets the needs of all British Columbians, as has been already stated in this House this morning. The member from the north pointed out the particular shortcomings of the health care and mental health services to his constituents.

As well, the health authorities will be expected to use community-based services. Information research shows that British Columbia is one of the heaviest users of acute care services for mental health patients. We do not feel this is always the most appropriate service for people, and the health authorities, when they're looking at their whole range of options to best serve the needs of the folks who need mental health services, will be looking to those community services.

J. MacPhail: When the previous Minister of State for Mental Health fired the mental health advocate, he then said he was going to become the mental health advocate inside his government. Does this minister hold that same point of view?

Hon. S. Brice: I consider advocacy both within other ministries and between government and the community as my number one commitment. The previous Minister of State for Mental Health did an amazing job of reaching out into the community and into the various agencies. While I have been only a brief time in this role, I have had many opportunities to meet with the stakeholders, and without exception they remark on the fabulous work done by the previous minister of state. Of course, my goal will be to work on that good basis.

The former Minister of State for Mental Health set about to bring partners together, many partners who had at previous times been fractured and fragmented particularly in the areas of information education on mental health. He brought them together to work cooperatively, to share funding and to make commitments to each other to maximize the dollars for the benefit of patients.

Yes, indeed, advocacy for mental health and addiction issues is absolutely at the top of the agenda as I go forward.

J. MacPhail: Well, one wonders why he got fired, then. Let me just put that to the test for the minister — her advocacy.

Given the minister's statement that there is an extra $22 million in the regional health budgets on a budget of $6.1 billion — a 0.003 percent increase — on a popu-

lation of four million in British Columbia, that's an extra five and a half dollars per person into the health care system from last year to this year. Five and a half dollars per person, and that's to cover all of the pressures that regional health authorities face. What portion of that increase in funding of five and a half dollars per person for the entire year is this minister advocating going to mental health?

Hon. S. Brice: British Columbia, as everyone in this House knows, is spending the third highest per capita on health care. Only Newfoundland and Manitoba exceed the per-capita costs for health care spending in the country. Additional money is coming from the federal government as well.

The whole point of the redirection of health care and health care spending in this province hinges on the notion that there are better ways to provide services. The regional health authorities will be looking for innovation, partnerships, new ways to provide more and better services for mental health patients than has been done in the past. Once again, I would refer the member to the statistics that show that within the country, our acute-days-in-hospital, facility length-of-stay are the highest in Canada. That is not necessarily the best for the patients. There are other ways of providing supports and programs that will better meet the needs of those suffering from mental illness.

J. MacPhail: That's what I'm asking the minister to explain to me. Maybe I'll probe a bit further on that from her own letter that she received from the Premier on January 26 with her appointment. Given the fact that the health care budget for regional health authorities is increasing by five and a half dollars per person in British Columbia for the entire year, the minister has quite a task ahead of her. I think she is going to have to find money from other sources, but all of her actions require work. It's not a monitoring system. It's not a developing….

Here it is: "Continue to develop a more effective system of mental health services, which includes community, primary, secondary and tertiary services." Let's just go on that. What is the plan for that?

Hon. S. Brice: I am actually very pleased that the member has made reference to the letter, because it does give me an opportunity to reinforce the fundamental platforms for our reform of mental health services in the province. As the member stated, it's to continue to develop a more effective system of mental health services, which includes community, primary, secondary and tertiary services. It is also to improve the education, prevention, self-management and treatment of depression, anxiety disorders and substance use disorders; and, in concert with local governments, to develop an integrated mental health and addiction service system.

Now, those are the platforms on a go-forward basis. Each regional health authority is being required to develop plans, which they work on in concert with the Ministry of Health Services. The goal will be to reinvest and to rework the services so that we get optimal service to the most people.

J. MacPhail: I guess I'm going to have to be a little more specific in my questioning because I'm actually asking the minister how she is going to achieve that — the more effective system of mental health services. It doesn't work to say: "Just leaving it up to the regional health authorities." No, the government's not allowed to give that as an answer anymore. Courts don't allow you to do that. The generally accepted accounting principles don't allow the government to do that anymore.

We'll get into more detail around that one. That's a big topic, and of course we do have the performance measures released in February of this year. Perhaps what I will do is use the report on the health authority performance agreements for '02-03, which was released last month. Maybe we'll use that as a way of actually going into detail on how this minister's going to achieve the directions she has been given by the Premier in the actual, more effective system of mental health services when the increase in the overall budget for everything the health authorities do is $22 million.

Well, here's an easier one, or a smaller, more self-contained one. It's not easier. I don't mean in any way to suggest that. "Improve the education, prevention, self-management and treatment of depression, anxiety disorders and substance use disorders." Let's take them separately, because they are separate illnesses.

Depression. What's the plan for the treatment of depression from this government, and what are the resources being assigned to it?

Hon. S. Brice: The role of the ministry is to provide stewardship, set direction and provide data, policy and framework. The ministry works with the health authorities to help them along. There have been some very good pieces of work already instigated. There are clinical practice guidelines for physicians, and that's for diagnosis and management of major depressive disorders. It has been developed under the auspices of the guidelines and protocols advisory committee, and the working group includes psychiatrists, psychologists, general practitioners and a representative from the Canadian Mental Health Association.

There are the depression patient guide and self-management tools, and those are part of our chronic disease management initiative. This patient guide will be linked with the self-care depression patient guide developed by MHECCU and the mental illness depression and anxieties disorders toolkits developed by the B.C. Partners for Mental Health and Addictions Information.

As well, there is the depression and anxieties disorders business case and snapshot. Here the idea is to identify the burden of disease; the scope of the problem in B.C.; economic considerations; and evidence-based practices such as early intervention approaches, includ-

ing workplace strategies, potential for effective management approaches and risk analysis.

There is a depression and anxieties disorders registry. The Ministry of Health Services has developed a depression and anxiety disorders registry linked with the 2000-01 Canadian community health survey. It is a database, and it will examine the relationship between depression and/or anxiety disorders and health care utilization. It will provide an operational tool for physicians to measure over time their effectiveness. It will provide a provincial tool to measure physician progress over time.

As well, there is the collaborative which has Ministry of Health Service staff developing options to implement a depression, anxiety disorders and addictions collaborative. The collaborative will be guided by evidence to optimize outcomes while making the best use of available resources.

J. MacPhail: What's the resource allocation to that whole plan? How much money is being allocated to implement that?

Hon. S. Brice: The dollars that are required to implement these very worthy initiatives will come from a variety of sources. As I outlined previously, there will be specific allocations. Obviously, some of the dollars will come from the health authorities and some from MSP, Pharmacare. There is the self-care information allocation of $1.5 million to the Partners program. So it's depending on where it is appropriate.

I can't emphasize enough that we are redesigning the way in which these services are provided and that there will be a variety of sources. In fact, in any one of those initiatives, there might be more than one funding source, depending on just exactly where the appropriate funding comes from.

That's right; this is the actual breakdown. We had gone through that. I won't need to enter that into the record again unless the member requests it.

J. MacPhail: Let me take this approach. Given the fact that the regional health authorities' $6.1 billion budget is being increased by $22 million overall — a 0.003 percent increase — will the strategy to improve education, prevention, self-management and treatment of depression be funded from money that was previously allocated to other health care needs?

Hon. S. Brice: The major investment in mental health that the province does — in fact, $1 million a year — is not necessarily all being utilized to the best advantage. Let me just take you back, if I could, to the issue of length of stay. B.C. exceeds all other provinces in the length of stay in the acute care facilities. If some of that money can be freed up and used for other more effective programs, it unleashes additional dollars that can be used creatively.

Certainly, from the Ministry of Health Services and in collaboration with myself, there are initiatives such as I have elaborated on, but those are to start the redevelopment happening. The actual change in the way business is done to work with best practices and to ensure improved outcomes — that has to occur at the health authority level.

J. MacPhail: Okay. Well, let me try a different approach to this. We're talking about depression still — the strategy to enhance treatment, education and prevention of depression. What change in the Medical Services Plan budget is there for treatment of depression?

Hon. S. Brice: Improved services, particularly those that deal with major depression disorders, are something which has been identified by the ministry and physicians. Obviously, the physicians play a huge role in this — $392 million allocated for doctors' fees, and certainly every doctor got a minimum 9 percent increase last year.

The clinical practices guideline that I referred to previously was developed in conjunction with the medical community. The diagnosis and management of major depression disorders…. These clinical guidelines are now developed, and the expectation is that they will be used. I have every reason to believe that professionals will take those very seriously and make them an important part of their practice.

The general practitioners special services committee is working on an initiative to improve primary care, and a huge part of that is the treatment of depression. I think it's pretty well understood that depression and anxiety play a huge role in the lives of many people and that much of the time it is undiagnosed and untreated. As I say, the Medical Services Commission, with the clinical practice guidelines for physicians, has the professional direction there for the doctors. I have great confidence that this will make a big difference in the way in which physicians treat the issue of depression.

J. MacPhail: In terms of the clinical practice guidelines, is there any change in what physicians have available to them in the treatment of depression — longer periods of consultation, GPs being allowed to bill for time to discuss depression? Are there any changes in that area that are reflected in the MSP budget?

Hon. S. Brice: The member raises, of course, an ongoing issue. Certainly, government is interested in advancing an agenda which would allow doctors to bill for more time to consult with patients. Of course, the BCMA controls that budget. The government has allocated large resources to cover off doctors payment. Physicians are also committed to being able to provide better service to their patients and to spend time with them.

This is something which is going to have to be negotiated with the BCMA. They're going to have to reallocate the resources, because government is convinced that the dollars allocated are the maximum that are going to be. The envelope is there. The guidelines for depression are available to the physicians. They want to get there. There's going to have to be collaboration between government, physicians and the BCMA to have that happen.

J. MacPhail: Mr. Chair, noting the hour, I move the committee rise, report progress and ask leave to sit again.

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

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

Hon. M. Coell: A member asked me to provide some information on actuals for child care for the budget. I thought I would do that to start off with. We had been talking, going back as far as 2000-01 through, so what I thought I would do is give the budget for those years and then the actuals for those years. I think it will make for interesting conversation after that.

In 2000-01 the budget was $117.85 million, and the actuals were $121.788 million, and this is for child care subsidies. In 2001-02 the budget was $126.402 million, and the actuals were $119.637 million. In 2002-03 the budget was $107.302 million, and the actuals were $93.106 million. In 2003-04 the budget was $104.2 million. We don't have the actuals for that year as yet. The budget for 2004-05 is $106.7 million. Those are for the child care subsidies for those years — the budgets and the actuals.

I can go further. The operating fund budget and actuals. The budget for 2000-01 was $39.67 million; the actuals were $33.713 million. In 2001-02 the budget was $62.583 million, and the actuals were $50.604 million.

The budget for 2002-03 was $50.95 million, and the actuals were $45.065 million. The budget for 2003-04 was $48 million, and the budget for 2004-05 is $47.6 million.

Capital funding was the other area that was of interest. The budget for 2000-01 was $1.49 million; the actual was $3.635 million. In 2001-02 the budget was $1.99 million; the actual was $1.701 million. The budget for 2002-03 was $1.49 million; the actual was $1.525 million. The budget for 2003-04 was $2.5 million, and $1 million of that was a one-time funding grant. The budget for 2004-05 is $1.5 million.

The other area that was of interest was the quality support services, and this would be the child care resource referral budget. For 2000-01 the budget was $6.49 million; the actuals were $6.888 million. In 2001-02 the budget was $13.12 million; the actual was $8.379 million. The budget for 2002-03 was $13.12 million; the actual was $8.826 million. For 2003-04 the budget is $9 million, and the budget in 2004-05 is $7 million.

Hon. M. Coell: The licensed spaces, the numbers…. I've gone back to 1998 for the member, when we had 67,964. In 1999 it was 71,355. In the year 2000 it was 72,979. In 2001 it was 72,965. In the year 2002 it was 79,661.

Hon. M. Coell: In 2000 it was 72,979; in 2001 it was 72,965; in 2002 it was $79,661; and in 2003 it was $80,230. I think, if I'm correct, those were the numbers that were asked for at our last meeting.

J. Kwan: I just want to double-check one thing. Previously, the minister gave the figure $13.12 million

for the year '03-04 for the child care resources and referral budget. Today he gave $9 million. I just want to double-check that. Is it $9 million? I presume the latter figure is the correct one.

Hon. M. Coell: I'm working from a different table, and these would be the actual budgets after they have been adjusted. The actuals are the actual expenditures.

J. Kwan: So for '03-04 the budget was $13.12 million, but the actual was $9 million.

Hon. M. Coell: We don't have the actuals, because the year hasn't come to an end as yet. We don't have those numbers. We just have the budgets for '02-03, '03-04 and '04-05.

Could the minister tell me, and I think he may have these numbers, the actual spending for the overall child care budget that includes the subsidies — the child care resources and referral, operating, etc.? The minister formerly gave me the budget for that overall budget. If I could get the actuals, then.

Hon. M. Coell: Okay. The program total for 2000-01. The budget was $165.5 million; the actual was $166.24 million. In 2001-02 the approved budget was $204.095 million, and the actual was $180.321 million. In 2002-03 the budget was $185.989 million, and the actual was $148.522 million. The budget for 2003-04 is $173.564 million, and the budget for 2004-05 is $162.802 million. When you look at your budget and actuals, there is a fair variance over that time period, which is, I think, what the member was looking for.

J. Kwan: I'm just trying to get all the base numbers correct, and then I'll proceed with questions around this.

Does the minister have the breakdown of the dollars from the federal government under the early childhood development agreement? We have the information from the minister on the multilateral agreement, and I'm interested now in getting the information on the early childhood development.

Hon. M. Coell: Just referring the member to British Columbia's Annual Report on Early Childhood Development Activities — 2002/2003. The program areas are broken into four places: pregnancy, birth and infancy; early childhood development, learning and care; parental and family supports; and community supports. That's how the government has reported out to the federal government on what was spent in each one of those program areas.

J. Kwan: Page 20 lists the federal government's contributions. All of it is federal government contributions on that page?

Hon. M. Coell: Maybe I could draw the member's attention to the early childhood development learning care portion of that. The base is what the federal government asked out of B.C. in 2000-01 to tell them what we were spending in all these program areas. Those are actually what the province was spending in those years. They call that their base year. Of that group of numbers, the $146.719 million, our ministry's portion was $126.606 million of that year. Then when you look at the same programs in 2002-03, this ministry's base would have been $108.455 million, so there's a reduction of $18 million in that year.

If you look at the entire government underexpenditure for that year, because some funds shifted to other programs within government and within different ministries, we would be underspent in that year by…. I draw the member's attention to the last page of the report — page 22, the increase in government spending in all ministries. You can see that the baseline for all ministries was $297.748 million and the increase in all ministries was $347.921 million, for an overall increase of $50.173 million — over all government.

Our ministry would have seen a change of less $18 million, but when you're in estimates with Children and Families, Education and Health, you would see the increases in those ministries in areas that would reflect the federal and provincial agreement on spending.

J. Kwan: Let's go through this step by step, because I'm not 100 percent clear on the situation here.

Let's start with what I thought was called the early childhood development agreement, which is now actually called early childhood development, learning and care. Just so we're clear with the different names of the agreements, that was the first agreement, right? The

second agreement…. Okay, maybe even the names are confusing. I'll just let the minister clarify that.

Hon. M. Coell: There are actually just the two agreements. What we were looking at on pages 20 and 22 of the program summaries was the areas within ministry that are designed…. They're not new programs. Pregnancy, birth and infancy is an area where funds were spent, and then the early childhood development, learning and care is an area in which funds were spent. There really are only the two programs, and this is the analysis of the first program.

J. Kwan: So the first agreement from the federal government is called the early childhood development agreement, right? If it is, then that's the name I'll refer to it by. If it's not the right name, then the minister can tell me what the right name is, and then I'll refer to that first federal agreement with that name, so we know which agreement we're talking about.

Hon. M. Coell: The first agreement is really called the early childhood development initiative, but I think we both know what agreement we're going to be speaking of.

J. Kwan: Okay. The federal agreement is called the early childhood development initiative. British Columbia, as I understand it, received $39.9 million dollars in '01-02. Am I right?

J. Kwan: As I understand it, those are all of the moneys that were received under that agreement from the federal government. There were no more dollars from the federal government in subsequent years. In subsequent years the agreement became the early learning and childhood care multilateral framework. Or were there other moneys that came under this first agreement from the federal government that I'm not aware of?

Hon. M. Coell: Actually, the agreement continues on. You're correct in that it was $50.2 million in 2002-03. In 2003-04 it's $66.1 million. In 2004-05 it should be $66.1 million. In '05-06 it should be $66.6 million. It was a total agreement, when it's completed at the end of '06 year, of $291 million. Just to add, that number may vary because they count the number of children under six. That number could vary up and down to some extent, not a lot.

J. Kwan: That is in addition to the multilateral agreement. The numbers the minister gave me earlier on the multilateral agreement are in a completely separate agreement. That number totalled $121 million over five years.

Hon. M. Coell: That's correct. We're looking at $117.6 million. That would be in the range of the federal government, counting children under six. It could go up to $121 million or down to $117 million.

J. Kwan: On that basis, could the minister, starting with the year '01-02 for the federal early childhood development initiative…. That $39.6 million, where did it go?

Hon. M. Coell: If you look at tables 20 through 22, that actually has all of the government programs and where that money went. There was an increase of $50 million in that one year. Most of the increases, when you look, are at MCFD for where those funds were added to the budgets. That might be an area you could canvass with that minister or ministry when we get to it. I can talk about any changes in our ministry from the ministry's standpoint.

Health Services and MCFD were the major beneficiaries of that new program funding spending.

J. Kwan: I'm just trying to decipher these charts here and to pinpoint exactly where the federal dollars went. Am I right, then, to interpret that the new dollars listed under page 20, which totals $32.199 million, is the area of increase?

J. Kwan: All of those new dollars are federal moneys listed in that chart? In other words, there are no provincial moneys on page 22. All of that is federal moneys. Those were the federal moneys from the early childhood development initiative.

Hon. M. Coell: Yes, that's correct. The grand total would be $50.173 million. You'd take either the additions or subtractions from programs through the first three charts, plus the one on page 22, to get to the grand total of $50 million. That's where the new moneys went in spending.

J. Kwan: I'm just trying to sort this out here. The minister says there is a grand total of 50 million new dollars. Those are federal moneys but we only got $39.6 million. Where else did the other $10 million come from?

Hon. M. Coell: In '01-02 the addition was $35.9 million. This one is the 2002-03, and it's the additional $50 million.

Early childhood development initiative, '01-02 — I thought it was $39.6 million. And then in '02-03 it's $52.5 million. It still doesn't make sense to me. I'm sorry.

The chart on page 20 gives you the baseline for 2000 and '01. Then it gives you, I think, the budget for '02-03. The baseline is not anything, in other words. All this chart gives you is the '02-03 number, which is $50.173 million. If we're looking at two years of the federal moneys, it should be a total of — let me just add it up here — $92.1 million. But it's only $50.173 million, so we're short over $30-some million.

Hon. M. Coell: You'd have to go to the first…. There are two year-end reports. If you went back to British Columbia's Annual Report on Early Childhood Development Activities - 2001/2002 and you went to their back page, page 24, you'd see that the new moneys spent were $33.579 million. That would be that year. Then you would jump forward to the year 2002-03, where the federal moneys were $50.173 million. That would be the total you're looking for, I believe.

J. Kwan: Okay. Let's just take one year at a time. Let's just do '01-02. Let's set aside this second report for '02-03, and let's just do '01-02, which is this report, the colourful one.

According to this report, on the last page, as the minister advises, the new moneys from the federal government were $39.6 million. The province put $33.579 million into new programs. There is approximately $4.5 million that's not spent. Where did it go?

Hon. M. Coell: I guess the easy answer is that the total amount of money we're going to get is $291 million. We have to spend that over five years, so if it wasn't spent in that year, it will be spent in another year.

J. Kwan: For this year, actually, it's more than $4 million. It's actually $6.021 million that's underspent in total.

Okay, I'm just going to cast that aside for a minute and go to the '02-03 book, which shows that the spending for the federal government is $50.173 million, which is also an underspending of about, I don't know, $2.2 million or $2.3 million or so. I'll get the exact number in a sec. I'll just do the subtraction here.

Hon. M. Coell: I think that's one of the good things about this program. If you don't spend the money in one year, you have the opportunity to spend it…. We still have three years left on that agreement, so that money would be spent in one of those three years or spread out along those three years.

What the federal government's going to want — and we desire to do the same thing — is that at the end of the agreement, we can show where the $291 million was spent. It may go up. As you saw earlier, we have budgeted $66.1 million, $66.1 million and $66.6 million. That may change in the out years if there is a year where you don't spend exactly what you budgeted. As I say, I think that's one of the beauties of this particular agreement and the next one. You've got some flexibility to spend in the years out towards the end of the program.

J. Kwan: Well, I'll tell you where things trouble me. I'm glad that the moneys could be spent in future years, but I'll tell you, if you look at the trend line of what the government is doing overall, it is extremely troubling. We just went through the baseline for a number of areas: the subsidies area, the operating budget for child care providers, the child care resource and the referral areas. In all of the numbers over the years since 2001-02, the budget number is down, and the numbers in terms of the actual spending are down.

The government is cutting child care funding supports all over the place. Whether it be subsidies or operating dollars for child care providers or programming, the government is cutting those substantively. The government is underspending its own budget substantively, I might add. Not only that, the government is underspending federal government moneys, which I find shocking, to be honest with you.

The trend line here is disturbing. It's true that the federal government dollars could be used elsewhere. That, in addition to the underspending of the ministry budgets, is a disturbing situation. Then, of course, the budget has already been reduced to begin with, so the actual reduction is more substantive than what the budget numbers are. That's because the actual numbers are even below what the budget numbers are.

Take an example on the subsidy side. The budget for '01-02 was $126.402 million. The actual was $119.637 million. Then the following year, '02-03, was budgeted for $107.302 million. The actual was $93.106 million. There's a disturbing trend here with all of this — on the budgeting side, on the actual spending side and on the federal government dollars side.

Setting aside the federal moneys for one moment…. I suppose I could take some time to do the subtractions in each of the boxes here for the two years to find out exactly where the federal dollars went. That will take me some time to do that, so I'll set that aside for one moment.

Let me just ask the minister, then, about the budgets of…. Let's use subsidies to start off with. For '01-02 and '02-03 the budgeted dollars are substantively reduced from '01-02 to now, and the actual spending is significantly less.

The government actually changed the criteria for people to be eligible for the subsidy so that it's harder for people to get the subsidy. Yet the budget dollars are not even spent, even though it's a reduction. I'll get to that in a moment. Even the budgeted dollars are not spent, but the government made the criteria even more difficult for people to access the subsidy. Why did the government do that?

Hon. M. Coell: I think I would draw the member's attention to the operating funding as well as the subsidy. You can see that government did change their priorities, and she is correct. What we've done is put a priority into the operating funding, moving it from an actual in 2000-01 of $33.713 million to $47.602 million in this year's budget.

She's correct. I mean, we changed the criteria, but at the same time, we increased funding in other areas in this budget. Granted, there aren't a lot of different categories in this budget. There are only three or four major ones.

You can see that there was a priority change. When you look at the overall budget change from 2000-01 to the budget this year, 2003-04, it's about a $1.2 million reduction. There has been a shifting of priorities within the budget.

J. Kwan: No, actually. The baseline I'm using is the '01-02 budget, when the government took over after the election. The base budget I'm using for subsidy is $126.402 million in the year '01-02. That year the government underspent its own budget in the area of subsidy. The actual was $119.637 million. If you look at the operating budget, the '01-02 budget, the operating budget for child care providers is $62.583 million.

If you sort of use the logic that the minister is comparing to the '04-05, it's actually not an increase in budget because '04-05 is $47.6 million. It's a reduction of almost $20 million. Then, if you look at the overall number of all of these programs, in the '01-02 it was $204.095 million, and then in the '04-05 it's actually $162.802 million. That's not accounting for the additional $10 million from the feds. Even if you do account for the additional $10 million from the federal government, it's $172 million. That is a reduction of approximately over $30 million.

It's not an increase. I actually don't see an increase anywhere in the child care sector here in terms of the budgeting — in any of the categories. Where did I go wrong? I don't see an increase anywhere.

Hon. M. Coell: What I was looking at — and I'll just rephrase it — were the actuals for 2000-01, which was $166.024 million, and the budget for this year, at $162.802 million. That's about 98 percent of what that budget was, so there has been a reduction of about $1.2 million in the overall budget. As you can see, over the years there has been a shifting of priorities. There was a change in criteria, which the member has pointed out. At the same point, we have tried to take and increase the operating funding for people providing seats.

That's where I'm coming from when I look at this sort of trend budget that we've got in front of us. I would say that there are different ways of looking at it, but I was looking at actuals spent in 2001 and what we're projecting to spend this year.

J. Kwan: Well no, actually. If you want to look at the trend…. I don't have the numbers prior to 2000, but if you just look at '01-02…. Let's look at it this way. This is all of the programs inclusive. The budget for 2000-01 was $165.5 million. The actuals were actually $166.024 million. It's actually an increase in the budget spending rather than a decrease.

Since then, if you look at the government's record on that, the budgeted number and actuals actually went down. The budgeted number for '01-02 was $204.095 million, which incidentally was the previous government's budget that this government adopted after they came into power and then just tabled it. Under the NDP it was $204.095 million. The actuals, though, when you look at that disturbing trend, are actually down. The actual spending is $180.321 million, whereas the year before the actuals went up.

If you look at the following year, the budget from this government in '02-03 — which I would say is the first real budget that the government tabled — was $185.985 million, a significant reduction from the '01-02 budget of $204.095 million. If you look at the actuals, it is frightening. The actual is $148.522 million — almost $40 million less in the actual spending than the budgeted number.

There are no increases here. It is a reduction twice over — a reduction from the budgeted numbers and then a reduction in the actual spending of the budget itself. So it's a reduction twice over. There is no increase here no matter how you look at it.

That's the reality if you want to compare trend lines. That's the trend under this government. Child care programs' spending and budgets have been reduced significantly from the previous administration. If the argument is that the government has realigned the programs, the reduction in actuals shouldn't be that significant from what the government had budgeted it to be. Yet it is — to almost $40 million in '02-03 and about $20 million in '01-02. That's a significant amount of money.

Jesus, that's your $60 million, approximately, right there. This government now claims that $66 million is being reinvested into other areas — health care, education and to reduce wait-lists, they say. It took $20 million to reduce wait-lists. Did it come from child care? Is this the savings the government had?

Maybe the minister can explain to me how it is that the actuals in every category are underspent in child care? In the meanwhile, child care advocates are saying: "Do not cut child care as deeply as you are cutting." The government cut it anyway. Not only does it reflect in its budget numbers, but its actual spending is way less. Child care, as I said, got hit twice over — from a budgeted number and the actual spending of it. How could that be?

Hon. M. Coell: The criteria did change for the subsidy program. As you look at the trend, the capital funding is increased. Basically, what we have done…. I think the member knows that when you look at the

actuals in any years, it's very much demand-driven. Those are the people who applied and achieved a subsidy. What we've done is looked at what is actually happening. We have a budget of $106.7 million this year. We believe that's what will be applied for and the subsidy will be under the criteria that we've provided.

J. Kwan: The only reason why demand is down is because government changed the criteria to make people not eligible anymore — not because the people don't need it but because they are no longer eligible under the criteria. That's why demand is down. It makes no sense to say that though the actuals numbers are down, it is the fault of the people who couldn't qualify. It's this government who changed the criteria; they didn't. In fact, they wouldn't have wanted the government to change criteria at all. That doesn't make sense and it doesn't wash.

It's not acceptable. It's not an acceptable rationale for this government to justify why the actuals are down. The government consciously made a change in its decision on the eligibility criteria for people for child care subsidies. The minister said they did it because there was a shifting of priorities into other areas in child care. If you look, then, in other areas — whether it be subsidies, child care resources and referral, or operating budgets for the child care facility — you would think that all of those numbers added together would be relatively the same. Well they are not.

The budget is significantly reduced in its overall budget. The budget number has gone down from its height when the government first took office. Its first budget was $204.095 million to a low of $172 million, and that includes an additional $10 million from the federal government. That's about a $32 million reduction, approximately, in child care.

The shifting priority argument doesn't add up. It's $30 million less in child care programs, including subsidies and operating, etc. That's what we have before us. The argument that the subsidy dollars are underspent by almost $17 million in '01-02 and over $10 million in '02-03…. The underspending is because of the criteria the government has imposed that caused people not to be eligible, not because people don't need it, which is a substantive distinction. Isn't that the case? Am I not understanding this correctly?

Hon. M. Coell: The member and I are both aware that the government did make changes to the criteria, and the reason for that is we needed to develop a program that we believed would be sustainable and that would have a budget government could afford. I would draw the member's attention back, when you look at the total child care budget, to the previous government's last year. In 2000-01 it was $166.024 million. This year it's $162.802 million.

Within that budget there have been some changes, and within that budget there have been some shifting of priorities, but the overall projection of child care is down about 2 percent or $1.2 million in this particular budget. The federal funds that came to government have been, for the most part, in other budgets, which I'm sure the member will canvass during their estimates as well.

J. Kwan: No. The minister is wrong. The last budget the previous government tabled was the same budget, the first budget that this government tabled, and it is the '01-02 budget, which shows that the child care dollars are budgeted for $204.095 million. The 2000-01 budget was the last budget that the previous government had completed, and then we went to an election with a budget of $204.095 million for child care. That is what happened. That is the historical context of how to compare it.

If you want to take the previous government's budget, fine. The completed budget is the 2000-01 budget. It was budgeted, and then here's the trend line: $165.5 million budgeted under 2000-01; and actuals, $161.024 million. The amount is not an underspending of child care. It's a slight overspending of child care, I might add.

Then in the '01-02 year the only thing that the previous government had control of was to table that budget, for we'd lost the election. So to finish up the year, it was under the Liberal government's leadership. That budget was $204.095 million tabled, and it finished with actuals of $180.321 million. Here's the trend: underspending of the child care budget of about $20 million.

Then you go to the following year, '02-03, and $185.989 million. That's the budget for child care. Actuals: $148.522 million — underspending, again, of close to $35 million; underspending, again, of the actual budget. There's the disturbing piece here. The government actually hasn't increased child care. They've decreased child care, year over year and over year — twice over — from a budgeted number and the actual spending of it. In spite of what the government claims, the reality is that child care funding went down, and support has gone down.

In fact, there have been letters written to the minister — it would be the former minister, but nonetheless written to the minister — from the child care advocacy folks, and they're hugely concerned with this situation. There was a child care advocacy forum that was held, and it included a variety of organizations: the B.C. Child Care Services Association, the Coalition of Child Care Advocates of B.C., Early Childhood Educators of B.C., School Age Child Care Association of B.C., Westcoast Child Care Resource Centre, the Western Canada Family Child Care Association of British Columbia.

This forum was supported by the Status of Women Canada, the B.C.–Yukon Region through the Coalition of Child Care Advocates of British Columbia and also the Vancouver Foundation. There might be one other organization too, but my eyes are really bad, and the photocopy has really tiny print. I can't read that last one, so my apologies to that organization.

In their document that they sent to the former minister and out to the public about this situation, here's what they've put down: "Under the early child development ECD agreement" — what was known as the agreement is called the early childhood initiative, as we've established in these estimates — "B.C. received $39.9 million in 2001-02 and $51 million in '02-03 from the federal government for early childhood initiatives, including child care." Now, we've re-established those numbers in the estimates. Instead of $39.9 million, it is actually $39.6 million; and instead of $51 million, it is $52.5 million. So they are in the range. They are definitely in the range, and they know what they're talking about.

They go on to say: "The reasonable expectation was that the infusion of these federal funds would mean increased public investment in these aspects of early childhood development. So what is B.C.'s record?"

Let me just stop there and ad-lib a little bit. I think that in our estimates previously…. We started child care issues yesterday, and we talked about that reasonable expectation, that if you get an infusion of federal dollars, those moneys would go into the budget, and so therefore there would be an increase in public spending in the area of child care or early childhood development. The documentation, by the way, that the minister has identified shows all of the programs across government relating to child care or early childhood development, so it's not a skewed look at whether or not all of the dollars from the government are being spent. All of the dollars are documented in these annual reports.

What is B.C.'s record? Now these numbers — I should also just caution members for a moment here, Madam Chair — might be slightly off, as we established earlier. They're a bit off here and there, but generally, I think they are in the ballpark.

In fact, their suspicion is correct, as we had established yesterday. The $7 million cut in the child care resource and referral programs is being…. Sorry. There is a cut of about $7 million in the child care resource and referral area, and the $4 million federal dollars go into that $7 million. So, substantively, federal dollars are going into provincial programs that are being cut by this government.

They're calling on the provincial government "to immediately provide a full and complete accounting of all provincial cuts to child care expenditures" — which I think we actually got today through the estimates — "provide a full and complete accounting of how federal funds have been used to offset provincial cuts to child care" — which we can calculate out, although it would be good, actually, for the minister to provide that information to the child care community — "make a public commitment to stop all further cuts to child care funding and table an expenditure plan for the next three fiscal years showing how funds received under the two federal transfer agreements will be used to build a higher-quality child care system in British Columbia."

I think, in a nutshell, they've actually identified the concerns very well and the reality of what is going in British Columbia, with respect to the lay of the land. The argument the minister advances, to say that child care dollars are being reallocated in other areas within government because their priorities have changed, doesn't wash, because the overall budget of the child care budget from the government is decreasing every year. It's decreasing every year from the base year of '01-02, and the federal moneys are being utilized to replace provincial cuts.

If that's not the case — and maybe I'm wrong — and the federal government dollars are not being used to replace provincial cuts in this area, then logically, the budget numbers for the child care area would increase more than what the provincial government has provided for. That is not the case. It is not the case.

The minister shook his head when I said that federal moneys are replacing provincial cuts. Maybe he

can enlighten me on how that is not the case. Maybe he can show me new numbers that will illustrate that.

Hon. M. Coell: I've listened with interest to the member, but I think the ECD programs — and I want to look in the most broad context here — had four significant areas. They weren't just dealing with the child care subsidy. They were dealing with, actually, the promotion of health — healthy pregnancies, birth and infancy. They improved parenting and family supports. They lengthened early childhood development, learning and care, and they also strengthened community supports for child care.

I think those were the priorities that both the federal and provincial governments agreed to. I'd have to say that the member and I would differ. Her government's priorities as they left office and ours coming in are different. The programs announced in 2001, just prior to an election, we didn't feel were sustainable, and we wanted to make sure that we had a sustainable program going forward and that any new funds that would come in from the federal government went into other areas. They went mostly into the Ministry of Children and Family Development to deal with those other priorities of promoting a healthy pregnancy, birth and infancy, and promoting parenting and family supports.

As I mentioned, we looked at making the child care subsidies sustainable. We believe that the changes we made have done that, and the budget is fairly consistent in that manner over the next three years as well. We also looked at the operating funding. That goes for strengthening community supports, and that's increased from actual of $33.7 million to $47 million this year. So there's a significant change in focus from the subsidy to the operating funding, which I believe helped strengthen community supports.

There are, indeed, different priorities, as one would expect between different governments. That's how we've attempted to make the priorities fit the federal program as well as fit a sustainable child care program in the province.

J. Kwan: Well, let me put this on the record. I actually find it shocking, looking at this — what do you call this? — annual report, B.C.'s annual report on early childhood development. I'm just looking at it now for '02-03.

Here's where the government has taken child care dollars from the federal government and allocated them in areas that, in my view…. It was, under the previous government, funded by Health, by the Health ministry budget, not from a child care budget. Child care immunization. Sure; yes. Child care immunization has something to do with children. I don't dispute that. But that is, clearly, a health-related budget line item. Yet, it is here, under the pregnancy, birth and infancy program, funded from child care dollars.

Midwifery. I don't dispute the value of midwifery. In fact, a friend of mine delivered both of her babies with a midwife. I was there for both of them. It was fantastic to see this miracle take place. I don't dispute funding midwifery. Historically, under the previous government, midwifery was funded under the line item of the Ministry of Health, not from child care budgets.

Let me just put on record, as well, how much these programs are. The child care immunization program: the budget for '02-03 is $9.886 million — almost ten million bucks. Midwifery: $4.595 million — well, $4.5 million. Then you have the autism diagnosis and assessment — formerly under the health care budget; now under the child care budget — $1.112 million. Consultation for complex conditions for children — formerly, again in the health care budget; now under the child care budget — $110,000. The B.C. NurseLine and the B.C. HealthGuide…. God Almighty, if there's anything that I suppose has any reference to children….

I just find it astounding that if anything the government can identify — it appears to me — has one iota of relationship to children, it's being moved from its traditional budget line to the child care budget line. The B.C. NurseLine and the B.C. HealthGuide are funded traditionally by the Ministry of Health. They are now taking moneys from child care money that the government is accounting towards increases from the federal government.

The Healthy Kids dental and optical benefits — again, a Health budget line item now taking money from child care. For the record: the B.C. NurseLine and B.C. HealthGuide, $1.73 million; Healthy Kids dental and optical benefits, $7.473 million; the public health nursing, speech, audiology, nutrition and dental — again, formerly a Health budget item — $70.306 million.

Oh, there's more. Pregnancy outreach program, $2.397 million; parent information publications, $151,000 — formerly funded by the Ministry of Health budget.

I'm not talking about listed under the Ministry of Health; I'm talking about funded by the Health budget. This money that the government is saying is an increase from the federal government is taking dollars from the federal government — money for child care.

What we have is a budget reduction of child care money. We have actual spending reduction of child care money. We have competing demands for federal dollars dedicated to child care money allocated to other areas that have anything to do with children — i.e., the Ministry of Health. The reality is that child care in British Columbia and its related programs are substantively reduced.

In fact, there was a study called Diversity or Disparity?, and they found that new federal funding jump-

started child care spending in most provinces and territories but not in British Columbia. What that study found was that cuts to child care budgets in British Columbia occurred, and the result is an overall loss of spaces and child care support.

An independent study was done to try and trace what happened to the federal government dollars, and here's what they found. They used government data from Statistics Canada and other resources, so they didn't make up the information. It highlighted the need for the federal government to demand more accountability in the agreements it signed.

Hence the new program, called the early learning and childhood care multilateral agreement, was revamped. The conditions within that agreement were revamped to make sure the federal dollars don't go into something that is not directed to its original intention. The language was made tighter to not allow for that.

It goes on to say, from this report: "Provinces shouldn't be eligible for federal dollars while cutting their own child care budgets." The federal dollars were never meant to replace provincial budgets. It was never meant to be that.

We were the former government that negotiated the first agreement. With the dollars that flowed from the first agreement, called the early childhood development initiative…. I think when it was under us, it was called the early childhood development agreement. The dollars there were never meant to replace provincial cuts, which is why you see in the 2000-01 budget that you actually have an increase in the '01-02 budget tabled by the former NDP. The budget, in fact, went above and beyond what the federal government provided for, and the tabled budget for child care services in the 2000-01 budget under the NDP was $165.5 million. In '01-02, with new dollars from the federal government — but not just that; the provincial government increased its own budget — that budget was $204.095 million. This government, when they took over, adopted that budget as its first-year budget. That trend of increases for child care is now gone.

Provinces were never meant to take federal moneys to reduce their child care budgets. That's exactly what this government has done. Finding affordable child care eludes all but, quite frankly, the most affluent families. Modest-income families are allocating more than one-quarter of their annual earnings to child care. That's what the study found. It's a recent study, and it was reported out on October 31, 2003. It's not out-of-date data. It's recent information to show what's happening with the federal dollars.

In British Columbia what's singled out, along with Alberta and Ontario, is that we actually reduce the amount of child care dollars. We reduce that amount. We cut child care budgets. Wouldn't you know it — British Columbia, Alberta and Ontario. I suppose, in political terms, they're the three most right-wing provinces in all of Canada. When I say right wing, Madam Chair, I mean the leadership of those governments. Ontario, of course, has now had an election, and the direction in that may well change. We'll see how that goes.

I now want to ask the minister questions about the actuals versus the budget. The minister claims that the subsidy — and let me start with subsidies again — dollars, the actuals, are lower than what the budgeted dollars were because there is less demand. Didn't the government, the ministry, do some analysis on this when they revamped their criteria to make fewer people eligible and then came up with a budget in that process that they thought they would get close to? Or are they so afraid of not meeting their budget targets that they actually made the criteria even harder than what they thought, and therefore the actuals came out below what the budget calls for?

Why is there such a big discrepancy, aside from the notion that the minister gives me the answer, which is not an acceptable answer, that fewer people apply? Fewer people applied because they were not qualified. That's why — not because the need is not there. Let's be clear. That's not an acceptable answer, and I hope the minister won't rise and give me that unacceptable answer.

Hon. M. Coell: I just want to go back. I'd like to add something to the member's remarks regarding the federal agreement, because I think it's important. In September 2000 the federal, provincial and territorial governments made a joint commitment to improve and expand early childhood development programs and services to children zero to six years of age. The member is, I think, suggesting that money should have been put into child care subsidies, for the most part.

Both the federal and provincial governments had agreed that over a five-year period there would be $291 million coming to British Columbia. I think I may have mentioned that there were four key areas. It wasn't just the child care subsidy. It was promotion of health in pregnancy, birth and infancy; improving parenting and family supports; strengthening early childhood development learning and care; and strengthening community supports.

I think a key component of this — and I think our dialogue is enhanced today because of it — is that we have two reports in front of us. A key component of the agreement was public reporting, so the governments agreed to prepare individual public reports and share a framework on activities and priorities and investment.

I think the difference you see…. I suspect, in looking at the previous government's last budget, that they were intending to spend most of that money on child care subsidies — if you look at the election year budget of 2000 of $4 million — and that was expected to increase over the years.

Well, there was a change of government and a change of priorities. When you look at these two reports, you see where our priorities were. There were

lots and lots of budgets in different ministries that were enhanced, and you would just look at…. Most of them, as I've said earlier, were not in this ministry. They were in other ministries but relating back to the promotion of health in pregnancy, birth and infancy, improving parenting skills. You have other budgets within different ministries that actually had enhanced dollars put into them. You know, you look at MCFD, early intervention therapies — up $4.5 million in one budget. There's a whole range, adding up to $33 million dollars one year and $50 million the next year, where other budgets were enhanced in keeping with the federal-provincial agreement.

We'll see the reports come out over the five years. At the end of the five years there will be public accountability for $291 million, as to how it was spent on these four key areas. It wasn't just to be that $291 million would come to the provincial government and they could use it all for the child care subsidies. That wasn't going to be the case. As you've seen, we've tried to create a child care subsidy line item and a budget that are sustainable. I think that shows that over the last couple of years, and it shows into the future that it's sustainable.

At the same time, in this particular program we're focusing on a multitude of areas throughout government. I know that the member will be canvassing those other ministries and people to get an idea of how those individual line items were enhanced by the federal funding. The federal funding is a good program. I think the federal government is presenting provinces with a very positive initiative here on expanding the health of children. It's not just in one area. It's a very broad program. I think that what staff in the various ministries have done over the last two years has expanded programs for children aged zero to six in a very, very significant way. That's all to do with child care and child health, and I think that's positive for our province.

J. Kwan: You know, the previous government, when we were negotiating with the federal government on the increased dollars in the area of children…. When that first agreement was negotiated — the early childhood development initiative of $291 million — the provincial government went out and did a consultation process and asked community leaders in the field to do with children how that money should be spent. Those community leaders came back and said: "In child care."

It's true. The previous government brought in a program called universal child care, and that's where we put all of the moneys from the federal government and then some. We increased budgets from the provincial government in that area, because everyone said to us that it is vital that you invest in children in the earlier years for their development. Studies have shown that outcomes that yield those positive results are from child care.

Just last Friday, when we left the Legislature here, I was in a community conference organized by parents, the district parent advisory council. They invited Clyde Hertzman, amongst others, to come and speak about where government should focus their energies and attention and what programs should be funded in the best interest of children's development. Wouldn't you know it? The speakers said those early years are vital to maximize the development opportunities for children.

To sum it up in a nutshell, they basically said that children need food in their stomachs, they need stability in their lives, and they need people who can form trusting relationships with them on a consistent basis so that they can build trust and, therefore, confidence for development. Those, above all else, were the most important things for successful early childhood development — even more important than standardized testing and standardized achievements, which I know that the former Minister of Education liked to throw out there. I'll canvass those issues with the Minister of Education.

The point I want to make here is this. Early childhood development, to enhance success, would require financial commitment from governments to put those dollars directly into programs that would enhance their success. When we were going into an election in 2000, people said to us: "Put it in child care, and make it so that everyone could get access to it." That is perhaps one of the greatest legacies that governments could leave for children and their future in their early years. That's exactly what the NDP government did.

Sure, we lost the election. This government said they wanted to realign everything. They threw universal child care out the door. I know that there are members in this government for…. The former Minister of State for Intermediate and Long Term Care had said that child care is for tennis moms. I'm not a tennis mom. I don't even know how to play tennis, but God knows I need child care. It is ignorance at best — this government's perspective with respect to child care.

I don't want to minimize the other programs that…. The government has taken money from the federal government and put it into things like midwifery, the NurseLine and the HealthGuide. I don't want to minimize those initiatives. Those are important initiatives. We funded them when we were in government out of the health care budget, not moneys for child care. It's shameful that that's what this government has done.

I'll have more to ask the minister in this area, Madam Chair. Noting the time, I move that the committee rise, report progress and ask leave to sit again.

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