2009 Legislative Session: Fifth Session, 38th Parliament
HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

official report of

Debates of the Legislative Assembly

(hansard)

Wednesday, February 25, 2009

Afternoon Sitting

Volume 38, Number 11

[ Page 13981 ]

WEDNESDAY, FEBRUARY 25, 2009

The House met at 1:33 p.m.

[Mr. Speaker in the chair.]

Prayers.

Statements

ANTI-BULLYING DAY

Hon. G. Campbell: Mr. Speaker, I just wanted to take a moment to say that next year it will be all right if you decide to break with tradition and wear pink on this particular day.

It is, I think, really incredible what's happened over the last year. This is the second annual Anti-Bullying Day organized by Christy Clark and CKNW. There are 100,000 people around the world that are now part of this movement. In British Columbia alone, 21,000 people bought T-shirts as part of the anti-bullying initiative. It's happening in all of our schools. It's something that I think is important.

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We've got a long way to go, but we've taken important steps down the right direction. Boards of education across the province have zero tolerance for bullying. In places like Vernon they have a special course that takes place on cyberbullying. In Surrey they have a resource for parents in 14 separate languages about how they can stand up to bullying and stop bullying. In Victoria young kids are taught to walk away, to ignore it and to seek help.

All of those things, I think, are sending a very loud and clear message that bullying is not acceptable in the workplace, at school or in our communities in the province of British Columbia. I want to say thanks to everyone who has been part of Anti-Bullying Day today.

Introductions by Members

N. Macdonald: Joining us are Kathy Charlton and Laurence Charlton. They've come all the way from Golden, and I'd like you to join me in making them welcome.

Hon. M. de Jong: We're very pleased to have joining us in the precincts today representatives of the B.C. Police Association. They have been here meeting with Members of the Legislative Assembly. They are Tom Stamatakis, Daryl Daniels, Matt Kelly, Don Mackenzie from my hometown of Abbotsford, Steve Morgan, Dhillon Sihota, Pat Mahane, Ray Banwary and Shaun Clater. I hope all members of the House will make representatives from the B.C. Police Association most welcome.

D. Chudnovsky: I'd like to let the House know that joining us today in the gallery is Tim Barnett, who was a New Zealand Labour Party MP between 1996 and 2008 — in opposition for the first three years and in government for the last nine. Tim chaired the New Zealand Justice and Electoral Committee for six years and was senior government Whip for three years.

He's going to be taking up a new challenge in the next couple of weeks, moving to Cape Town, where he'll be working with an international AIDS organization. He's here with his partner Ramon Maniapoto. Would the House please make them very welcome.

Hon. R. Cantelon: Joining us today are 44 students and their parents from the explorer program at G.P. Vanier Secondary School in Courtenay. Please make them very welcome.

S. Herbert: I rise today to welcome some young folks to this House: my constituency assistants Sian and Ryan, and their friends Lena and John. I call them young folks today because when one of my colleagues was looking for me earlier, I heard that I was referred to as having breakfast with a couple of young folks.

Now, they're not particularly young, and neither am I, in terms of the population of our province. But in this House we certainly are, and I hope next time around we have even more young folks here.

V. Roddick: In the House today is a very important person in my life. My husband Noel Roddick is in the gallery — husband for 44 years and counting the days where he no longer has to drive Miss Daisy. Will the House please make him very welcome.

Hon. G. Hogg: I have two sets of introductions to make today. Firstly, the White Rock Ambassadors are here joining us, and the B.C. Liberal caucus had the pleasure of having them adorn our picture with respect to Anti-Bullying Day today. They made us all look a little bit better. Would the House please welcome the ambassadors from the city of White Rock.

Secondly, we are joined by two insurance brokers from the city of White Rock. They are active people in our community and do enormously good work with the Peace Arch Community Services. Would the House please make Dianna and Jack Zimmer feel most welcome.

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R. Thorpe: Joining us today in the press gallery is Rob Turner. Rob is a reporter from the Westside Weekly in West Kelowna. Would the House please make him welcome.
[ Page 13982 ]

Statements
(Standing Order 25b)

Anti-bullying activities
of Boys and Girls Clubs

R. Thorpe: As the Premier mentioned earlier, today is Pink Shirt Day. It originated in Nova Scotia by two young men who stood up to bullying in their school. A new student being bullied was harassed even more when he came to school wearing a pink shirt. These two young men purchased 50 pink T-shirts and enlisted fellow students to wear them in support of the new student. Pink Shirt was launched and has made its way across Canada.

Boys and Girls Clubs in British Columbia are joining together to honour Pink Shirt Day. The initiative began last year with the Vancouver Boys and Girls Club.

In the Okanagan, local organizations are working hard to support anti-bullying. The Okanagan Boys and Girls Clubs have purchased 500 pink T-shirts this year with the theme of Pink Shirt Day: "Bullying stops here." Okanagan Boys and Girls Clubs have encouraged community supporters to wear the shirts today.

As a father and a grandfather of three who bring joy to our lives, I was pleased to join my colleagues earlier this afternoon in the Legislature to stand up against bullying.

In celebrating its 50th anniversary, I want to acknowledge the outstanding community work the Okanagan Boys and Girls Clubs do in providing a safe, supportive place where children and youth can experience new opportunities, overcome barriers, build positive relationships, and develop confidence and skills for life.

Club 180 in Kelowna, a program for at-risk and street-involved youth aged 13 to 18, and the Westside Youth Centre have worked to promote bully awareness and anti-bullying.

In closing, I want to acknowledge these community organizations for their commitment and service to our youth and community. We can all be part of the solution. Together we can make a difference for our children and our grandchildren.

DAY OF PINK

S. Herbert: I rise today to celebrate the Day of Pink, an international day of action against bullying, discrimination and homophobia in our schools, workplaces and communities.

Today started — and I'd like to correct the hon. Premier — because a community had had enough. All due respect to Christy Clark. They stood with their classmate who had been bullied because he wore a pink T-shirt to school. They turned out en masse in solidarity with him, wearing pink shirts as well, to show that bullying must stop. It is nice to see so many of my colleagues in pink today. A little more colour does this place wonders.

It's important that we remember that today is not just about bullies but also about the power structures in our communities which allow bullying, power structures which make it easy to discriminate against people because they are different or made to be seen as an "other" and not one of us.

The Day of Pink is about standing up and speaking out. It's about taking action to end discrimination in our communities and to become more understanding and celebratory of our province's great diversity.

On a more personal note, I was bullied and have been a bully as well. I've had homophobic slurs hurled at me while in high school and every so often still do in my constituency today, and my constituency is one of the most accepting places in the province, I believe. These attacks hurt me, but I can only imagine the impact they have on people who don't have the same resources, privileges and access to justice that I do.

We have a long way to go to end discrimination. Many in our province are still bullied today. For many it is not easy to go on, and that is why today is so important. For those watching at home and those here in the House, we must stand together and speak out for diversity and against bullying, discrimination and homophobia, and support the many, many organizations that are doing so much with so little to make B.C. a truly welcoming province.

BURNABY CENTRE FOR MENTAL HEALTH
AND ADDICTIONS

J. Nuraney: On Monday I had the pleasure of attending the celebration of the first anniversary of the Burnaby mental health and addictions centre in the company of our hon. Minister of Health Services.

This centre accommodates 100 clients who suffer from either mental illness or addiction or both. I was very impressed by the excellent services offered by this centre to treat people who suffer from these illnesses and have come to us seeking help.

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I saw firsthand the difference that treatment, counselling and support make in the lives of those afflicted. I also admire the courage of these people who have come forward seeking help after acknowledging that they have a problem. The mental health and addictions centre not only helps their clients overcome their problems but gives them back their dignity, life and aspirations.

The Holy Koran says that if you save one human being, you are saving humanity. I applaud the Ministry of Health Services, the doctors, counsellors and support staff for delivering this very unique service. This is the only centre in Canada of its kind, and I ask all members to join me in wishing them continued success in their very important work.
[ Page 13983 ]

HUMAN TRAFFICKING

C. Trevena: Trafficking is a terrible crime. We've been hearing people railing daily in this House and in the media about gang shootings. But human trafficking, the movement of people against their will, doesn't often make it onto the radar — the movement across international borders, across provincial borders and even within communities.

It's the third most lucrative source of income for organized crime. A pimp moving a woman from one community to another is trafficking that woman. Women who are enticed to a country to work as waitresses or models and then prostituted are trafficked. People lured to a place who end up working in sweatshops, unable to leave, are trafficked.

People are being exploited against their will — not free to leave the situation they're trapped in, not free because of threats of violence, not free because they don't know the laws or the language and don't know whether they would have protection, not free because they fear being sent home more than the situation they're in.

It's usually women who are trafficked, although there are men and children involved. People who are vulnerable, who are poor — they are the most likely victims. Think of the aboriginal women who disappear, of immigrants you may have seen who have been cowed and fearful.

There's the UN protocol against trafficking, of which Canada is a signatory. That defines trafficking as including three elements: the act of trafficking — the recruitment, transport, harbouring or receiving of people; the means — using force, abduction or deception; and the purpose — exploitation.

In B.C. there is a small office working hard to raise the issue of trafficking to bring together individuals and departments to find ways of ensuring that the UN protocol is enacted. The office to combat trafficking in persons is an underfunded arm of the provincial government but plays an important role in raising awareness of the crime and the violation of human rights. It works with police and border officials, with other ministries and other governments, with non-profits in legal aid and human rights — groups whose own funding is being cut.

Last fall the B.C. office organized an international conference which brought together police, judiciary and women's organizations to discuss the problem. B.C. does have a role to play, and I hope the whole House will act on that role.

TEACHER APPRECIATION

R. Hawes: Just a quiz. Who won the Best Actress Award in 2002 or the MVP in the Stanley Cup in 2001? Do you know who the National League batting champion was in 2005? My guess is that you've forgotten.

But my bet also is that if you were to think of a school teacher from your youth that made a difference, her name or his name would spring right to the top of your mind. The point is that you don't have to be famous or be a household name or win great awards to be unforgettable or leave an indelible mark on someone's life.

For hundreds of people in Mission, Claire Clemo was the teacher that made a profound impact on their lives. She taught school in Mission for decades and was the kind of teacher who cared deeply about every student, and more importantly, they all knew that. Every day as she walked to school, there would be a group of students waiting on the corner for her so they could walk to school with her. They just wanted to be with her.

My Claire Clemo was Mr. Burnham. He was my grade 6 teacher, and I remember him like it was yesterday, which…. I can tell you, it wasn't yesterday. He, like Claire Clemo, really cared. He might have been a little stricter than her. He might have thought the best attitude adjuster out there was the strap, but overall he was a great teacher.

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All of us here have a Claire Clemo. Today there are Claire Clemos teaching schools all over British Columbia, and years down the road our kids and grandkids will all remember their names. Each of us should take a moment now and remember the Miss Clemos both past and present. We all owe them our gratitude.

To the Solicitor General. I will be giving a heads-up to the Solicitor General when he gets back. Miss Clemo has instructed me to tell him she wants cellphone use removed from automobiles, and no one wants to disappoint their Miss Clemo.

PEDDER BAY MANUFACTURED HOME PARK

M. Karagianis: I rise today to share with the House the story of Pedder Bay, a community in my constituency.

For years Pedder Bay has been home to nearly 30 manufactured homes — a great, friendly and affordable place where neighbours knew each other by name and looked after each other.

That all came crashing to an end about two years ago when the homeowners were served notice of eviction by the landowner. Under the Manufactured Home Park Tenancy Act, owners are eligible for only 12 months of pad rental as compensation. That works out, in their case, to about $3,000 per manufactured home and isn't nearly enough.

The homeowners challenged the eviction in the Supreme Court of British Columbia, and they lost. Now many of the owners are faced with the enormous and heartbreaking task of picking up and moving on. Some of them are trying to move homes that, because of their aging condition, are simply not movable. Some are facing mortgage debt on homes that no longer exist. Without
[ Page 13984 ]
adequate compensation, the residents are facing the loss of affordable independent living, bankruptcy and the loss of equity. Some are going to be homeless.

I asked the former Minister of Housing to act, but no help has been forthcoming. Market forces have pushed property prices upward, putting more and more manufactured home parks at risk. Each time it happens, as in Pedder Bay, we lose affordable housing.

It saddens me greatly — the loss that is now being suffered by Terrill, Maureen, Jean, Christine, Diane, Arlene and the other residents of Pedder Bay. I promised that their voice would be heard in this Legislature on this day. I would like all of us to take one moment and put ourselves in their place.

Oral Questions

GOVERNMENT ACTION ON GANG VIOLENCE

C. James: Tomorrow the Prime Minister is coming to B.C. to announce an anti-gang strategy. While he's here, our top cops, the Solicitor and the Attorney General, are headed in the other direction — going to Ottawa.

My question is to the Premier. Why can't his government get his act together around fighting gang violence?

Hon. G. Campbell: The Solicitor General and the Attorney General will both be in Ottawa tomorrow, meeting with their federal counterparts to encourage prompt action on not just changing the Criminal Code but doing other improvements to the justice system so we can focus on gangs, so we can focus on organized crime, so we can change the bail laws, so we can keep people behind bars who should be behind bars.

I can guarantee this. When I meet with the Prime Minister tomorrow, he will not just hear B.C.'s voice, but as he has in the past, I'm sure he'll act on B.C.'s recommendations.

Mr. Speaker: Leader of the Opposition has a supplemental.

C. James: I'd ask the Premier where he has been for the last 18 months on this issue. Where have he and his government been on this issue? While people were crying out for action to deal with the killings that were going on, this government was nowhere. Big announcements, very little action.

We met today with police. They told us there's a serious front-line staff shortage across this province. My question again is to the Premier. How can British Columbians trust him to fight gang violence when the province is hundreds of officers short and his top cops have left town?

Interjections.

Mr. Speaker: Members.

Hon. G. Campbell: I'm glad to hear that the Leader of the Opposition is finally paying attention to this issue.

What has happened over the last number of years?

Interjections.

Mr. Speaker: Members.

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Hon. G. Campbell: In the last number of years we've hired 950 extra police officers. Unlike the protestations we hear from the Leader of the Opposition today, her party — her opposition — voted against every single one of those additional police officers.

This is a government that has been working to change the Criminal Code federally. We've been advocating that for a number of years now. We are continuing to push for that, and we are finally getting action on that. I hope that federal parliamentarians will act as well, so we can make sure that our communities are safe and secure for everyone who lives there.

Mr. Speaker: Leader of the Opposition has a further supplemental.

REDEPLOYMENT OF POLICE
AND JUSTICE SYSTEM RESOURCES

C. James: I'll tell you what the public got from this government. They got an announcement Friday, and they got budget cuts to crime and safety on Tuesday — four days later.

The B.C. Liberals should have been pressing Ottawa years ago, but they waited until the last minute, and they can't even get there on a day when the Prime Minister is in town. The Premier's strategy relies on federal money and redeployment. As we know, B.C. is already hundreds of officers short. Can the Premier tell us once again where these redeployed officers are going to come from?

Hon. G. Campbell: If the Leader of the Opposition had spent the time — she claims she cares about this — to read and understand the budget…. You're simply wrong. You don't understand the budget. You don't understand where the funding is coming from. You don't understand where the federal funding comes from. You don't understand how we're providing over $200 million of additional traffic fines to provide for local police officers — 950 additional police officers.

Interjections.
[ Page 13985 ]

Mr. Speaker: Members.

Premier, just take your seat for a second.

Interjections.

Mr. Speaker: Members. Members.

Continue, Premier.

Hon. G. Campbell: So 950 additional police officers; $66 million for integrated task forces focused on gangs, on motorcycle gangs, on organized crime; $185 million for capital to put people behind bars.

I think the Leader of the Opposition, again, if she really cares about having safe and secure communities…. We have to have secure jails to put the bad guys in, the criminals in, and her party has got to stop opposing those jails.

Interjections.

Mr. Speaker: Members.

M. Farnworth: The Premier stands in this House and says that they've added 950 officers in British Columbia. Yet he cannot answer how many of those are new and how many of those are just replacing officers who are leaving through attrition at a time when 35 percent of police officers in this province are due to retire in the next five to ten years.

My question to the Premier is this. Are the front-line police in this province wrong when they say that there's a shortage of up to 900 officers in the province of British Columbia?

Hon. G. Campbell: Let me try and take the opposition through this.

So 950 additional officers up to this year, 168 additional officers are being added now, and 131 are being added to the organized gang task force. That is on top of the ten additional prosecutors. More police, more prosecutors, more jails, a tougher Criminal Code — all of those things are required for us to deal with gangs in British Columbia.

[1400]

Interjections.

Mr. Speaker: Members.

The member has a supplemental.

M. Farnworth: Well, what we've seen from this government is that 16 months ago there was a press conference down at E division, with the government and the Solicitor General saying: "We're taking action." Sixteen months later we saw the same thing, only this time the Premier was standing up there on a Friday afternoon saying: "We're going to take action."

Then on Monday we see the Solicitor General saying, "I'm going to sit on a report around gun violence," and then the Attorney General tabled a report that says: "Guess what. Sentencing's just fine in British Columbia." The next day we see a budget that cuts services to prosecutors and the Solicitor General and Attorney General ministries over the next three years. That's been this government's record. That's been their response.

The real issue has been the Premier saying that he will redeploy. That's his solution, at a time when police officers in this province are saying that we are 900 officers short. Can the Premier tell us: when we're 900 officers short, where are the redeployments going to come from?

Hon. G. Campbell: You know, no amount of bluster is going to overwhelm the facts. The facts are that there are 130….

Interjections.

Mr. Speaker: Members.

Premier, just take your seat for a second.

Let's just reflect for a second on how we're acting.

Continue, Premier.

Hon. G. Campbell: On top of the 950 additional officers that have been hired over the last number of years, there are 131 new officers that are part of the Integrated Gang Task Force. Let me underline that — new officers. There are ten new prosecutors who will be on the anti-gang prosecution unit. Those are additions to what was there in the past which the opposition evidently didn't think were necessary to support in the past. I'm glad they're supporting them now.

I hope that the opposition leader will talk to her candidates and say, "We can't put people behind bars if we don't have secure prisons," and tell them to stop opposing the jails we need to put the criminals in jail.

B.C. HYDRO RATES

J. Horgan: Last week the Minister of Energy said: "Everybody has to deal with these tough times we're in." I just want to throw some numbers at the minister so that he can reflect on the fiction that this budget portrayed to the people in British Columbia.

Last year B.C. Hydro rates, up 6½ percent. This year and the next year, up another 14½ percent. Can the minister tell me how dealing with an economic downturn is assisted by increasing hydro rates for individuals, for families and for industry by 21 percent? How does that help industry? How does that help families?

Hon. B. Lekstrom: Once again the member, like last week, has his numbers wrong. The reality is that what we're dealing with…. We don't set rates, unlike the pre-
[ Page 13986 ]
vious government in the 1990s. What we deal with is the B.C. Utilities Commission, and the application is before them today. So it is not up to me. It is not up to this House to determine those rates.

What I do want to tell the member — and again, I said this last week to him — is that B.C. Hydro is one of the finest Crown corporations in North America, one that's looked up to, one that we all support and one that has allowed us to have the competitive advantage when it comes to hydro rates.

We will commit and remain committed to that premise. We are going to ensure that we have some of the most competitive hydro rates in North America, not only attractive for the ratepayers of this province, our small business and our large industrial sector, but we're going to maintain that Crown corporation in the hands of public ownership in this province. We've enshrined that in legislation.

Interjections.

Mr. Speaker: Members.

The member has a supplemental.

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J. Horgan: It's pretty rich, coming from the member from the parallel universe there. He just signed an order-in-council last week directing the Utilities Commission to ignore a 1.63 percent increase in return on equity. That's a direct interference in the regulatory process. It's a direct hit on industries.

Markets are disappearing. Commodity prices are falling. Our mines and our mills are in distress, and the response from this government — the stimulus response from this government — is to increase carbon taxes and to increase hydro rates. How can the minister look at himself in the mirror when last week he signed an order taking the Utilities Commission out of the equation? What are you thinking?

Hon. B. Lekstrom: Once again, you're wrong. The 1.6 percent that you're referring to is a return on equity. It has nothing to do with the rate increase, and I want to be very clear.

We have to make sure that you understand, and I'm trying to do my best, because right now you don't, Member. I do want to reiterate that the 1.6 percent return on equity that you're referring to is not a rate increase and is not going to be recovered through rate increases. We have asked B.C. Hydro, like we have asked all the ministries all through the government, to do what they can to find efficiencies to operate in these difficult economic times that we're in.

If you took the time, the information is on the website. Please do your homework before you come and try and mislead the public, because that's exactly what you've tried to do.

IMPACT OF CARBON TAX
ON FOREST INDUSTRY

B. Simpson: The Premier's carbon tax is not revenue-neutral for the forest sector. There's a problem in the revenue neutrality. See, you have to make money in order for it to be revenue-neutral. If you lose money, it's a pure additional cost to the company at the worst possible time.

The Minister of Forests stated last November: "We need to get the forest industry working under the right framework." Does the Premier believe that this non-revenue-neutral carbon tax and increased hydro rates are the right framework for a forestry sector in an unprecedented downturn? Is that the right framework?

Hon. P. Bell: Again, the member is dead wrong. This is the same opposition that last fall voted against a 50 percent reduction in the school taxes for heavy industry that across the province meant $25 million in reduced cost to our heavy industry.

Interjections.

Mr. Speaker: Members.

Continue, Minister.

Hon. P. Bell: This is the same government that has made the key decisions around making sure we have a stumpage system in place on the coast that works, taking the average stumpage rate over the last 12 months from $17 a cubic metre down to $5 a cubic metre.

This member needs to get his facts straight. He's dead wrong. This government is committed to making sure we have a forest industry that works. They should start voting in favour of the things that we're doing to revitalize this industry.

Mr. Speaker: The member has a supplemental.

B. Simpson: The minister must have been asleep when we voted last fall in favour of those tax reliefs that were in the Premier's bill. I'm really unclear why the Premier and the Forests Minister….

Interjections.

Mr. Speaker: Members.

B. Simpson: I'm really unclear why the Premier and the Forests Minister want to invite the Americans to once again come up here and put a charge against us under the softwood lumber agreement every time they say they are changing the stumpage system.

John Allan, head of Council of Forest Industries, calls the carbon tax a millstone around the neck of the industry. Avrim Lazar, the head of the Canadian Forest
[ Page 13987 ]
Products Association, says that the tax will hurt the B.C. industry and that it is not revenue-neutral.

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Rick Jeffrey, the head of Coast Forest Products Association, calls for a freeze on the tax and says that it will be $100 million in added cost to the industry. Central Interior Logging Association says: "Get rid of the tax as fast as you can." That's the industry.

Is this minister going to stand and allow the Premier's stubbornness on this issue to get in the way of common sense? Will the minister stand today and tell this House the carbon tax is a great thing for a forest industry in crisis in B.C.?

Hon. P. Bell: You know, if the member opposite would take a little bit of time to look at the real opportunities associated around working with a carbon-constrained environment for the forest industry, he'd realize that this is the best opportunity for the forest industry moving forward into the 21st century.

We have a pellet industry in this province that's growing each and every day. Some 1.4 million tonnes of pellets produced last year, and they're all going into the European market. Why is that? It's because they have a cap-and-trade system in the European market that respects the value of carbon, the same cap-and-trade system that this opposition voted against last year.

They should be paying attention to what the new forest industry of the 21st century looks like and supporting the opportunity. A carbon tax is part of that.

BUDGET PROVISIONS FOR CARBON TAX
REBATES TO SCHOOL DISTRICTS

N. Macdonald: The Premier told boards of education that they would recoup the money that they'll be charged for the gas tax. They were told that every penny would come back to them. They want to know that the government has actually set aside the funding to fulfil that promise. The budget doesn't mention it.

Can the Finance Minister tell this House how much he has budgeted over the coming three years to offset the cost of the gas tax to school districts?

Hon. S. Bond: In fact, we've been working very closely with boards of education across the province to make sure that we have a climate change charter that they agree with. We are finalizing the details around boards signing that charter, and we intend to honour the commitment to take care of the carbon tax rebates to boards of education.

Mr. Speaker: The member has a supplemental.

N. Macdonald: We're talking about a promise that was made by the Premier last September, and now we're finding out that it is not funded in the budget. The question is this. The minister will know that the rebates for municipalities are expressed in a budget as a line item.

Prince George school district — this is a district that the minister will be familiar with. This is what the chair has said: "An imposed carbon tax without some offset refund or financial subsidy works against us in providing the basic programs for students."

The budget is increasingly seen as a sham. The minister has made a commitment that is not there in the budget. It should be in the budget.

Why is it not there? How much is it going to cost? Where will we find it in the budget? If it is not there, there is no reason why we would give any trust that it is going to be a commitment that this Premier keeps. So tell us where it is. Where's the money?

Interjections.

Mr. Speaker: Members.

Hon. S. Bond: Indeed, the funding is contained in a budget that brings record levels of funding to education in British Columbia. In fact, it's contained in a budget with which this government has created the largest-ever budget for public education in the history of British Columbia.

As we look at this budget, we see that over the next three years, when we look at education funding, $800 million will go to education, both K-to-12 and post-secondary. That's where the money is. This opposition should vote in favour just once for record levels of funding to education.

BUDGET PROVISIONS FOR CARBON TAX
REBATES TO MUNICIPALITIES

B. Ralston: Can the Finance Minister explain why the funding to offset the cost of the gas tax for local government remains stagnant over the next three years while the carbon tax will triple?

[1415]

Hon. C. Hansen: The commitment that we made to municipalities is that for those municipalities that sign on to the climate action agenda and commit to be carbon-neutral by 2012, we will reimburse them for the full cost of their carbon tax. That commitment stands.

Mr. Speaker: Member has a supplemental.

B. Ralston: Table 1.11 in the budget. The money returning to municipalities is flatlined over the next three years. The minister clearly will not answer the question. This is another case of budget numbers that don't add up.
[ Page 13988 ]

So can we assume that people will be paying the Premier's carbon tax twice — once at the pumps and again through property tax — or is this a case where the minister wants us, as the Attorney General suggested, to look beyond the numbers?

Hon. C. Hansen: Perhaps the member wasn't listening to my previous answer. I said that municipalities who committed to becoming carbon-neutral by 2012 would be eligible for full carbon tax rebate. We fully expect, and we actually know, that municipalities are looking at how to reduce their carbon consumption, because they, like every other consumer of fossil fuels in British Columbia, obviously would like to reduce their carbon footprint so that they pay less in carbon tax. Therefore, what is projected in the budget is entirely appropriate.

BUDGET PROVISIONS
FOR CHILDREN AT RISK

N. Simons: Yesterday the Minister of Children and Family Development seemed to be caught unaware of the crisis his social workers are facing in his ministry. An internal report from senior ministry staff confirms that social workers are so overworked that they can't support foster homes, nor can they support children in care adequately. It describes overcrowded foster homes, high rates of burnout, in some cases lower standards than the ministry's own.

We all know this is a dangerous combination. Yet this government is weakening the oversight even more by slashing programs and the budget regarding this particular area.

How can this minister say that children are a top priority for him or his government, when on one hand it identifies serious problems in the ministry, and on the other hand it reduces the budget to address those serious problems?

Hon. T. Christensen: The member's wrong again. The budget for the Ministry of Children and Family Development is going up. It's a bigger number next year than it was last year. That's an increase.

Interjections.

Mr. Speaker: Just take your seat.

Continue, Minister.

Hon. T. Christensen: As the ministry introduces additional funding and as we have over the last three years, we actually review the difference that that funding is making in meeting the needs of children and families across the province. We actually undertake a number of reviews to look at social worker caseloads, to look at how it is that we can better meet the needs of children and families.

We then take that information, and it informs our budget submissions. What we've seen over the last four years in particular is a dramatic increase in resources to the Ministry of Children and Family Development to enable our social workers, our child protection workers, our contracted agencies to do the important work that they do with thousands of children and families across our province each and every day.

Mr. Speaker: Member has a supplemental.

N. Simons: For the giddy apologists for the ministry who believe that there's an actual increase, if you look beyond the numbers, you see the faces of children. You know they're the ones that are going to suffer with it.

[1420]

As it is, social workers are unable to meet the standards set by this ministry in 80 percent of the cases. This is unacceptable in this province. The leaked document refers to contracted agencies hiring foster parents who have been previously rejected by the ministry.

Once again to the minister: will he recognize what everyone else in the province recognizes — that this ministry needs to be properly resourced and this minister needs to pay proper attention to the needs of children in this province?

Hon. T. Christensen: It is interesting to note what the report in fact says. It identifies where some challenges are. It identifies that the system requires more innovation in how we deliver residential services, because we can't simply continue to do things exactly the way we've done them in the past.

It notes that children-in-care expenditures have increased significantly and that these increased costs are supporting the achievement of better outcomes for children in care. Increased funds for transportation and shelter are allowing children and youth to stay closer to their families and communities. Increased child-specific services are addressing the individualized needs of children and youth in care. And finally, more relief has enabled foster parents to maintain their commitment to children and youth in the face of increasing demands.

So we know that the additional resources are making a difference. But what this report does not do is say that an incredible amount of additional resources is required. What it says is that we can't do business as we've always done and we need to find innovation in the system. That's what we're committed to do.

There's more funding. There are more social workers. There are more programs. There are thousands more children served, and there are fewer children across British Columbia needing to come into care.
[ Page 13989 ]

FERRY FARES

G. Coons: One of the pillars of this Premier's so-called economic plan last fall was a mere few weeks' relief from crippling ferry fares. But ferry fares went up by 50 percent on February 1, and they're going to rise again on April 1. With tourism numbers plummeting, retail sales dropping and thousands of workers losing their jobs, coastal communities want relief.

My question is to the Premier. How does jacking up ferry fares help families and small business in coastal communities struggling to make ends meet?

Hon. C. Hansen: One of the things that the Premier introduced last October 22 as part of the economic measures was a reduction in ferry fares for the months of December and January to actually allow more B.C. families to travel during that period of time — an important economic stimulus.

I'd also point out that in the budget are actually more dollars in the subsidy to the B.C. ferry corporation from the province to provide for the brand-new ferry that's going to be put into service to serve the north coast. I know from talking to people that live in that member's riding that the residents of the north coast are looking forward to this new and enhanced ferry service that's going to be provided for them.

[End of question period.]

Hon. S. Bond: I seek leave to make an introduction.

Mr. Speaker: Proceed.

Introductions by Members

Hon. S. Bond: In the House today I am pleased to welcome 16 teachers from across British Columbia who have been selected to participate in the eighth British Columbia Teachers Institute on Parliamentary Democracy. They will be with us for the remainder of the week, expanding their knowledge on our parliamentary and political systems.

They are joined by three of their peers who are acting as facilitators: Mr. Tom Cikes, Ms. Caroline Ross and Mr. Dameon Lorensen. They are also joined by a colleague from south of the border, Mr. Michael Wallace from the University of Washington, who is here to observe and learn about our system of governance.

I trust that many of my colleagues will have the opportunity to meet with them during the institute, and I know they will want to make them very welcome to the House today.

D. Routley: I seek leave to make an introduction.

Mr. Speaker: Proceed.

D. Routley: I'd like the House to help me welcome to the precinct 28 students from Alex Aitken School in my constituency and 12 of their teachers and parents. They visited us, and I asked them if they'd be here for question period, and they said no. Maybe that was a good thing.

[1425]

I did relate to them a story that was told to me by Mr. MacMinn, and that is to expect that in this chamber we have heat, and there is anger in parliamentary democracy. That is because we have the right to challenge our government as a free society, and that is so that we don't have blood in our streets. We have anger….

Mr. Speaker: Member. Member, it's an introduction.

D. Routley: Yes. So they're not here for question period, but I'd like you to help me make them welcome to the precinct.

S. Fraser: I seek leave to present a petition.

Mr. Speaker: Proceed.

Petitions

S. Fraser: I have a petition. Another thousand British Columbians have joined tens of thousands of others supporting safe antifreeze legislation to protect our companion animals, wildlife and children.

Orders of the Day

Hon. M. de Jong: I call Committee of Supply — for the information of members, continued debate on the supplementary estimates, continuing with Health and moving at some point next to Labour.

Committee of Supply

SUPPLEMENTARY ESTIMATES:
MINISTRY OF HEALTH SERVICES

(continued)

The House in Committee of Supply; K. Whittred in the chair.

The committee met at 2:28 p.m.

On Vote 37(S): ministry operations, $120,000,000 (continued).

Hon. G. Abbott: As we concluded these supplementary estimates yesterday afternoon, the opposition Health critic put a number of dubious assertions into the record, and I thought I'd begin today by responding to at least a couple of them. Among other things, the
[ Page 13990 ]
member argued that the drop in British Columbia's level of funding relative to other jurisdictions had compromised services. He said, among other things, that there are real consequences to doctors and nurses and others.

[1430]

I wanted to speak briefly to those two points. I think I've heard this member and other members of the opposition articulate the notion that if we are at the eighth place in terms of per-capita funding rather than second place, that is a very bad thing, and that we should be the highest per-capita funder in the nation — or at least, I think, the second-highest funder. I presume that would be an appropriate conclusion to draw from the member's assertion, which he makes on a regular basis. I would presume that to be so.

He may strive — and I presume the opposition may strive — to have the most expensive health care system in Canada. If they do, I guess that's a good thing for them to put on the record here subsequently. Certainly, I would welcome, along with 4.3 million other British Columbians, some clarity about what exactly the New Democratic Party proposes for health care in the province of British Columbia. That would be interesting.

I've never strived to see it be the most expensive. I've always strived to see it be the best, most effective health care system in the nation. I'm very proud to say that British Columbia does in fact have the very best health care delivery in the nation, and it is not just an assertion that I would put forward.

The Conference Board of Canada, in the most comprehensive analysis of health care delivery systems — I think there were 119 different indicators that were used by the Conference Board in their very comprehensive analysis of health care delivery systems — found British Columbia to be, by some considerable measure, the very best health care delivery system in Canada. We can be very proud of that, regardless of whether we have the most expensive or the least expensive health care system in Canada.

I understand that the Conference Board of Canada has been in the field and will be releasing at some point, hopefully later this spring, an additional report which will again confirm that British Columbia has the very best health care delivery system in the nation.

It's not just the Conference Board of Canada. The Cancer Advocacy Coalition of Canada has found British Columbia to have the very strongest delivery in terms of cancer care services.

So whether it's cancer or any in a range of health care challenges, British Columbia — and again, I'm very proud to say it — has the very best health outcomes in the entire nation. British Columbians live longer. They live healthier than any other jurisdiction in Canada and are indeed among the longest-lived and healthiest of jurisdictions in the entire world.

There was recently a report — I think it was from the Cascadia Institute — that talked about health outcomes, that pointed to British Columbia. Were it a nation, it would be in second place among nations overall on the entire face of the world, second only to Japan in terms of life expectancy and health outcomes. That's a delightful thing.

In fact, I understand that among men, British Columbians are the longest-living on the face of the earth. That's a wonderful thing too. Most wonderfully, we still live four and a half years less than British Columbia women. That's really an outstanding relationship there, I think, hon. Chair. Even in our latter years we're particularly thoughtful about giving you some peace in those latter years. That's typical of British Columbia men to be so thoughtful in that way.

An Hon. Member: It's selfless.

Hon. G. Abbott: It's selfless, absolutely.

But British Columbians are very healthy, and that's a wonderful thing.

To the member's point around this. He says the more you spend, the better your health care system. At least that's the conclusion I draw, and he can correct me in his subsequent remarks, should he wish.

I point out to him, and these are OECD numbers, Organization for Economic Cooperation and Development numbers. They're from 2003, but I suspect that in the general realm they remain applicable. Canada's overall average is $2,998 per capita for health care. The United States, by contrast, is $5,711 per capita.

[1435]

I suspect the member — again, he can correct me — would agree with me that the United States does not provide the best health care in the world. In fact, the United States has some of the worst health outcomes, I suspect, among western nations. If the proposition is that you spend more and you get better, it's just not so. I think the member may want to rethink his point around that.

However, if the member believes that there should be bigger dollars attached to the health care system, I'd love for him to tell us that. I'd love for him to tell us whether $14 billion for the Ministry of Health Services alone is not enough. Or if $17 billion overall for the delivery of health care services is not enough, he should let us know. He should tell us how much he would add, where he would add it and where the dollars would come from to add those services. I'd be delighted to know that.

The member also said: "Well, this is going to have consequences for doctors and nurses and so on." Well, the biggest thing that has a consequence to doctors and nurses and so on in the province of British Columbia is the absolute failure of the New Democratic government of 1991 to 2001 to add any physician or nurse training and education spaces throughout that entire decade.

When the NDP came to power in 1991, the UBC medical school was comprised of 128 students. When the NDP left office in 2001, the UBC medical school was
[ Page 13991 ]
still comprised of 128 students. I'm proud to say that we've doubled the number of medical spaces at UBC, at the University of Northern B.C., at the University of Victoria and very soon at UBC Okanagan. We will not only be doubling to 256, but we'll be adding more on top of that as well.

Interjection.

Hon. G. Abbott: I know the hon. member is saying: "Why didn't we add spaces in the 1990s?" He'll have to ask his former government about that. They didn't.

On international medical graduates, something which I'm sure the member is keenly interested in, two IMG spaces under the NDP government. Today, 18 IMG spaces in the province of British Columbia. We're building that. We're building an even stronger relationship with international medical graduates.

On nurses. Now, imagine this. At a time when this jurisdiction should have been building the cadre, the component of nursing support in this province, recognizing that demographics were shifting, recognizing that we were becoming an older society, what did the NDP government do for ten years?

Here's what they did. In 1993, 839 nursing graduates in the province of British Columbia. In 2001 that had declined to 574, a 265-graduate decline, a decline of 32 percent at a time when that government should have been building for the doctors and the nurses and the health professionals in British Columbia. They failed pathetically, and I am not going to stand by and hear hectoring from the other side about doctors and nurses.

The biggest element in having the doctors and nurses of our fair province have satisfactory, productive lives is having other doctors and nurses to support them. I'm glad we've made the changes we have. I'm proud of those, and I challenge the NDP to tell us what their vision for the future is. Are they going to cut nursing spaces again? Are they going to cut physician spaces again? Or are they going to recognize the reality that they failed in the 1990s?

A. Dix: It's good to know what the standard here in terms of the scope of debate has become. We are debating, for people who might be asking themselves at home. It's always the minister's desire to filibuster his own estimates, which I think is a reflexive thing from his time as opposition. He likes to come in and give long, discursive remarks about this harkening back to the past — the long past and the near past and so on.

[1440]

What we are talking about here, just for people at home so that they understand, is a $120 million supplementary estimate. We had exactly this debate last year, the exact debate the minister just had for me, where he said: "Oh, the NDP wants more money for health care." "More money for health care" — that's what he said.

And now we're debating a mid-year infusion of money by the ministry because he didn't budget enough, presumably. He didn't budget enough. That's what we're doing here. That's the purpose of this debate — to debate the $120 million. The purpose of the debate is not to acknowledge…. The minister talked about the Conference Board of Canada, a report which showed B.C. to be number one in Canada, which was based on 2001 statistics. That's how we got the gold medal, because in 2001 we had the best health system in Canada.

They've been dealing with that for seven years, and they're using our record, which was number one in Canada, as a defence for their position of reducing the quality of health care in British Columbia. That's what they're doing.

Returning to the debate. Far be it from me…. The minister got very huffy yesterday afternoon. Fair enough. We all have a right to get huffy in these long debates. That's all right, people diverting from the purpose of the debate and everything else.

I want to be specific, just to return to the purpose of the debate. This $120 million in question. It's not in a special account. There were no specific strings attached by the Ministry of Health with respect to this $120 million. It was like the original budgeted allocation. It was like that. It was sent to the health authorities. Of course, there's a letter of expectation and all the other things, but there was nothing specific with respect to this $120 million that tied the health authorities to a particular course of spending with respect to the $120 million.

Hon. G. Abbott: I made this very clear. The member may have been out of the room when the member for Delta North asked me this question in a number of different ways. It is on the record on numerous occasions that we did not attach a particular directive or yardstick to where they would spend it. We left it to the discretion of the health authorities to determine where the pressures were that they faced or the opportunities they had in terms of advancing diagnostics, reducing wait times for surgical procedures — wherever they believed the best use could be made of that $120 million.

A. Dix: So really just in the budget. We're not going to have a full-blown estimates debate here. I don't think we should, but the point is that there's a…. And I look forward to it. And when the Minister of Health is an opposition critic and I'm the Chair of the Health Committee, we'll have an exciting time, I'm sure, in the House after the next election.

The point I'm making is that there is no difference between the money, the $9 billion and the $120 million. It's money that is, to use the term, commingled. I think the questions that we ask about the operating budgets of the ministry are relevant here, and that's the point. Some of our members will be asking questions with
[ Page 13992 ]
respect to particular questions on the operating budget, and those seem to me to be consistent with a reasonable discussion and debate.

I'll just let the minister know that we were hoping to conclude this debate this afternoon, but that really depends on him more than me, given past history.

I just want to get into these issues a little bit by health authority. I want to ask a specific question about the Vancouver Coastal Health Authority. The minister will know, because he's not signed off on successive deficits in the Vancouver Coastal Health Authority, but they have somehow happened in the ether. He'll also know that Providence Health Care has run deficits.

Can the minister just talk a little bit about the discussions they had with Vancouver Coastal? Can he say to what extent did the money that flowed to the Vancouver Coastal Health Authority flow to Providence Health Care, of which the ministry is the main source of revenue? To what extent did it flow to Providence in this budget, $35 million of which is allocated for Vancouver Coastal Health?

[1445]

Hon. G. Abbott: Providence Health Care, as I think most know, operates as a service provider within the bounds of Vancouver Coastal Health, through Mount Saint Joseph and through St. Paul's. They are a service provider to Vancouver Coastal Health Authority. Vancouver Coastal Health received, I believe, $35 million of the $120 million. How that was distributed within Vancouver Coastal Health Authority…. We don't have any figure here with respect to what Providence may have received, directly or indirectly.

A. Dix: The minister will agree with me, because the purpose of the money — he described it yesterday, and I don't know if it was unexpected — was to address an increase in emergency room visits, address an increase in ambulatory care visits, to increase day surgeries and increase residential care. Although, of course, Vancouver Coastal Health being in deficit, essentially, the effect of it presumably was to also reduce the operating deficit of Vancouver Coastal Health.

I don't know if there is an answer, because the money is just out there, but would it be possible for the minister's staff to just let me know in the next couple of days? We don't have to dwell on this today, but is it possible to let us know to what extent…? I think it's almost certain that if some of that money was flowing for some of those purposes, St. Paul's and Mount Saint Joseph would have got some of it.

Can the minister endeavour just to get back to us and let us know what the situation is there?

Hon. G. Abbott: I always want to be constructive, but I just want to make sure that I understand what it is here. You would like to get as much information as we can gather over the next couple of days with respect to what portion of that might have been utilized within the Providence portion of Vancouver Coastal Health?

Yes. Okay. I'm glad to do that.

A. Dix: He'll know that, obviously, there's a significant amount of pressure. These are important hospitals in Vancouver Coastal Health — Mount Saint Joseph particularly, in my constituency as an MLA. They go through all of the struggles of the other hospitals. St. Paul's has its own set of struggles.

I think it's slightly different on emergency room utilization. Emergency room visits and an increase in emergency room visits was a driver in the decision to provide this money. Can the minister tell me, just in terms of emergency room visits, as between the hospitals…. That's, I guess, a key question in terms of if you were focusing some of this money at Vancouver Coastal Health on dealing with the consequences of emergency room visits.

One of the things we've seen at St. Paul's Hospital in recent years was something of a decline in emergency room visits, partly because other hospitals may have been seen as more attractive in terms of the emergency room, for whatever reason.

Again, we don't have to waste a lot of time in the House, but I think it would be useful for us to understand where those increases in emergency room visits were. I spent some time in all of the hospitals in Vancouver Coastal Health over the past year. At Lions Gate Hospital, I know, when I was there during this fiscal year, they talked about a dramatic increase there year over year in emergency room visits.

The minister will know that what happens…. That really creates a burden in terms of the hospital in all kinds of ways. It means that, obviously, when you have an increase in emergency room visits — not obviously, but in this case, it appears — you can get an increase in admissions from emergency room. Those cases can be very expensive for hospitals. That's one of the main cost drivers, I assume, in terms of the emergency room visits.

We've seen that a little bit at Lions Gate, I think. From what they were telling me at the time, they were just blown away at the time by the increase in emergency room visits that they were facing, which they hadn't expected when I was there. Whether that sustained itself or whether that was a recent thing, I don't know.

St. Paul's is recovering. They seemed to have had a dip in emergency room visits at some point, and they seem to be recovering from that. In terms of the visits they receive, whether that's recovering or not is another question. But they've seen that.

[1450]

Vancouver General Hospital has seen a significant increase, I think, in emergency room visits. That has a
[ Page 13993 ]
real impact, because we know that Vancouver Coastal Health got the lowest lift of all the health authorities in the regular budget, although I think it's fair to say that in this money they got their fair share of that. They got $35 million of it.

I think it would be very important, as we're trying to examine what's going on in health care at Vancouver Coastal Health, in addressing this emergency room visits issue, to see what's happening at the different hospitals — in particular, Providence Health Care.

It's the reason I was asking the question. What's going on at their facilities — St. Paul's and Mount Saint Joseph's? What's happening in terms of visits? Whether, within the Vancouver Coastal Health system, Providence Health was getting its share of the extra money if they were, in fact, seeing an increase in services and visits….

Does the minister have sort of a breakdown by hospital? Perhaps he might be able to provide that, and we'll go back and list off some other specific things we'd like to learn.

Hon. G. Abbott: The member is correct that the demand on emergency rooms is a big part of the overall challenge in health care today. British Columbia sees annually close to two million visits to emergency departments — that in a jurisdiction of just over four million people. So they are heavily utilized and at times very, very challenging places to work and to visit.

We're attempting to secure, and we will…. What I'll do is present it to you in a subsequent answer. It's coming through; it's just not here yet. We don't want to hold things up while we wait for the precise breakdown, but the year-over-year growth in emergency room visits is a big concern. It's pretty clear that in some cases where people are unable to access a family physician they are utilizing emergency rooms as default access to medical services. So that's a concern.

One of the big initiatives of the Ministry of Health is the expansion of primary care through the creation of integrated health networks involving not only physicians but nurses, pharmacists, physiotherapists, dietitians and others who try to deal with the needs of those with chronic diseases. Because we know from the utilization data that a lot of health care demand is driven by those who have either a chronic disease or, even more often, by those with multiple chronic diseases.

We believe integrated health networks are the way to go. We have about 25 in place now, and we're aiming to have many more in place this year and next year.

Let me have a look at these numbers, and I'll get back to you on the next question.

A. Dix: Just to follow up on the issue of emergency rooms. One of the more unique things about Vancouver Coastal, as opposed to other health authorities — although other health authorities suffer from this problem — is the significant number of admissions to emergency rooms.

The minister talked about the fact that people didn't have their own family doctors. One of the significant problems that emergency rooms had in Vancouver Coastal Health was the significant number of admissions for people suffering from mental health issues. According to CIHI, there was a report of 50 percent higher than the national average in terms of such admissions.

I guess when we're talking about utilization, one of the concerns…. I want to ask the minister, because ultimately, what I think everybody in the House would hope is that there would be mental health services in the community that would hopefully lessen this. We had, as the minister will know, the Lost in Transition report from the Vancouver police department, which detailed some of the issues they have.

[1455]

It does seem to be the case that Vancouver Coastal Health, in its emergency room pressures, has a significant pressure around the lack of mental health services. I just want to ask specifically: as Vancouver Coastal Health used this money — admittedly, they didn't have as much to use, because they were dealing with their deficit issues — was that one of the issues they were facing? Clearly, it's one of the major issues with respect to emergency room visits, particularly in the city of Vancouver.

Hon. G. Abbott: I'll give the member an answer to his earlier question while we get a fulsome answer to the most recent question he has posed.

In terms of Vancouver Coastal Health Authority and some of the larger facilities that one might reference within it. This is Richmond Hospital — the three years '05-06 and then '07-08. The first year for Richmond: 42,612; then 43,759 and 44,537 — so growth over the three years.

For Mount Saint Joseph: 17,091, followed by 18,175, followed by 18,669 — so a modest increase over time. St. Paul's: 60,045, dropping to 59,898, dropping to 58,750. So it's just very modest, almost a plateauing of the numbers there.

At Vancouver General Hospital, where one would have concern around growth in demand: 65,724, then 66,890, then 70,188. So there's a substantial increase there.

I think the member also asked about Lions Gate. In '05-06, 40,800; next year, 39,478; next year, 39,405. So something akin to plateauing there as well.

A. Dix: I think my colleague from Burnaby just has a brief question about his constituency. Then we'll return to this emergency room question.

R. Chouhan: My question is about this $120 million amount that we're talking about. Does this address issues like the Burnaby seniors wellness program that
[ Page 13994 ]
we have had going on for the last many years, run by retired doctors who are helping seniors? Fraser Health has been funding it for many years for about the amount of $35,000 a year. Last year it was reduced to $30,000. So would this address a program like that?

Hon. G. Abbott: As we noted in previous answers with respect to if there were specific allocations from the province or specific direction from the province with respect to "Spend your dollars here, or spend them there, or spend them elsewhere," no, we did not.

If Fraser Health chose to utilize some small portion of their allocation for that purpose, that is something they could certainly do if they believed it a priority. I know the program in question did get funded by Fraser Health, but I think Fraser Health agreed to fund it well before the 120 allocation went out.

[1500]

A. Dix: Just to continue on. I know that the minister was going to get back to me on the issue of…. I think in part it's an issue of acuity and the qualitative nature of emergency room visits, which is a real struggle in Vancouver Coastal Health.

Something a doctor told me, and it seems to be borne out by the figures, is that one of the problems in congestion in some parts of B.C. is ALC beds. This isn't a particular problem in Vancouver Coastal Health relative to other health regions.

They said that in Vancouver Coastal Health, their big struggle was dealing with what they consider to be inadequate mental health services. It's a serious issue, and it's one that as a society, we're trying to address. Is there a sense that it's not just the increase in emergency room visits that emergency rooms are struggling with but the qualitative difference?

St. Paul's Hospital, for example. Having spent time in the emergency room there and spent quite a bit of time in the hospital recently as a friend visiting…. Doctors would tell you that their struggles deal with a lot of mental health admissions out of the emergency room, as do other emergency rooms. I'm wondering if this ongoing struggle and the struggle to find adequate services in the community isn't a driver here.

Clearly, this $120 million wasn't a change in terms of the way mental health services were funded in Vancouver Coastal Health. In fact, if you look at their service plan for this year, which includes the period in which the $120 million is dealt with, they say that looking forward to '09-10…. I think it's a $3 million increase on a $214 million base for mental health, which would be just under 1.5 percent.

I wanted to ask if one of the drivers and one of the issues for Vancouver Coastal Health, in their struggle to meet their budget allocations — which required, in part, the $120 million — isn't this issue of mental health services. Because the minister didn't mention it, that doesn't mean it didn't exist. This money is, as I said, commingled with all the other money.

Whether mental health services, in fact, received some of this money or whether the fact of the lack of mental health services isn't one of the factors driving emergency room visits, particularly in some of the hospitals such as Vancouver General and St. Paul's….

Hon. G. Abbott: I think this can be helpful in terms of answering the member's inquiry. This is the number of in-patient mental health cases over six years. This is between 2001-02 and 2007-08, so the increase over that period is 9 percent. It is from 26,488 cases to 28,907 cases. That is a substantial number of unique mental health acute patients, increased by 11 percent from 18,356 in '01-02 to 20,378 in '07-08. Again, over a long period of time, there was some increase.

We would probably surmise that most of those cases came through the emergency department. We don't know that conclusively, but we would surmise that. The issue of mental health and addictions is a big challenge. We devote, as the member probably knows, about $1.2 billion annually to mental health and addiction services, so it's a big part of what we do. It's about a 42 percent increase since 2001. We are devoting a lot of resources there.

Among the portions of the continuum that we have tried to strengthen…. As an example, for adult community health beds, a 57 percent increase. We've gone from 2,836 community adult mental health beds in 2001 to a total of 7,776 in 2008. So that is a very dramatic increase in the capacity we have around community mental health beds.

[1505]

For community addictions beds — and I know the member knows this well — about 60 to 70 percent of people who have a mental health challenge will also have an addictions challenge. We also have community addictions beds increase by 150 percent from 2003, from 874 beds in 2003 to 2,186 today — again a huge increase.

There are also a couple of other pieces we have added that we believe are going to have beneficial and long-lasting and long-term impact on the demand often on the big city emergency departments. One is — and the member for Burnaby-Willingdon spoke of it earlier today in the member's statement — the Burnaby centre for those with a dual diagnosis — that is, individuals who are affected by a severe mental health disorder but also a concurrent addiction.

I was there for the first-year anniversary celebration a couple of days ago. One of the speakers was named Fred, a wonderful guy who has gone through the program — graduated from the program at Burnaby. He overcame a severe mental illness as well as a cocaine addiction.
[ Page 13995 ]

That's just a tremendous reflection not only of Fred's courage but also of the effectiveness of a program that tries to address the concurrent challenges. I think what has been found by the professionals in the field is that it's difficult to deal with the mental health issue until the addiction issue is dealt with and vice versa.

It is a remarkable new facility, where 100 people are currently resident and making their way through various stages of treatment and withdrawal treatment and recovery. So that's one addition.

It's a first in Canada. Very proud that we did it. I think it is going to help. It will have a very beneficial impact on the emergency departments and other areas of health care.

The other piece that we have recently added is a facility called the Crossing at Keremeos — not surprisingly, located near Keremeos. It is a long-term youth residential treatment centre for young people who are recovering from their addictions. It will over time serve many, many young people. We hope, through programs and facilities like that, to try to reverse some of the demand curve that we see in this area.

A. Dix: One of the things that we struggle with as MLAs sometimes is the lack of access to these very resources when people seek our assistance. Some of the most heartbreaking discussions you can have as an MLA are about that — about trying to get access to those kinds of services, especially when people who are struggling are seeking help and sometimes can't find it. The minister will know this. This isn't news.

The reason I was asking these questions about Vancouver Coastal Health emergency is in part…. It was almost a year ago now — the beginning of this fiscal year, just a few months before this money was allocated — that the Vancouver police department authored a report called Lost in Transition.

Here's what it says. It said that of 1,154 calls done in the study period, 31 percent involved at least one mentally ill person — which increased significantly in some areas of the city such as the Downtown Eastside where 49 percent of calls involved mental health issues.

They describe a lot of costs, and what they say is:

"The key finding of this research is that there's a profound lack of capacity in mental health resources in Vancouver. The result is an alarmingly high number of calls for police service to incidents that involve mentally ill people in crisis. VPD officers, along with the citizens with whom they come in contact, are bearing the burden of a mental health system that lacks resources and efficient information-sharing practices, often with tragic consequences."

[1510]

These issues are really serious, and the minister will know this. It's something that those of us who live in Vancouver know quite a bit about.

One of the things it leads me to ask, though, is in terms of the emergency room portion of this. I think it stopped in '07-08, but it would seem, anyway, as he described the data, that the number — as a percentage of the overall admissions — of mental health admissions to acute care hospitals in Vancouver Coastal Health was growing in a manner consistent with those.

It also seems to me that some of the hospitals in Vancouver Coastal Health which face an inordinate share of that burden really struggle with it. The reality of that on the ground for emergency rooms, especially when emergency rooms are jammed — as they frequently are these days — is really problematic.

I think it's one of the reasons why you clearly want to address the bottlenecks in emergency rooms. This is one of the key entry points in dealing with any emergency room. It's one of the key entry points, as the minister suggests. That's where many of the admissions for mental health come into the acute care sector. It's through an emergency room. Clearly, if emergency rooms are jammed, that's another part of the problem. Obviously, it's an incentive to deal with emergency rooms.

I think it also says — and I think the minister in his answer is acknowledging this — that dealing with that emergency room crisis…. We all know this involves in some parts of B.C. dealing with the ALC question. In other parts of B.C. it may be dealing with mental health services questions well beyond the emergency room.

I just make that point. I think we have short-term money here that deals with an emergency room bottleneck that has a bunch of causes. I want to ask the minister, in the case of Vancouver Coastal Health, since it goes into a big fund, whether there was any increase in the late year in terms of the investment by Vancouver Coastal Health and mental health services. That doesn't appear to be reflected in the '09-10 budget, which we'll be dealing with at some time in the future.

Was it dealt with at all by this, and was it a consideration by the minister when they'd made the decision to vote the $120 million estimate we're dealing with today?

Hon. G. Abbott: I want to address a few of the points the member makes. I should clarify for the member. The numbers that I gave him earlier in respect of in-patient mental health cases between '01 and '08 and unique mental health acute care patients between '01 and '08 were for the province of British Columbia. It wasn't for Vancouver Coastal. That's across the province, just so I don't mislead the member on that point.

I appreciate the member's comments with respect to the Vancouver police department. I was fortunate, along with the Minister of Housing, to meet directly with Chief Chu and others from the Vancouver police department to have a look at their report.

The member may recall that in their report, the Vancouver police department used kind of a prototypical example of the most challenging client-patient that they deal with. They didn't provide his real name, but they gave him a pseudonym. He was an individual who had, as I recall, a couple of very serious mental illnesses —
[ Page 13996 ]
schizophrenia and bipolar disorder or something along that line — plus addictions to alcohol and drugs. He was a very difficult individual who was in and out of prison, hospital, the forensic psychiatric centre, etc.

[1515]

He was the kind of patient that we had in mind as we move forward with the Burnaby centre for dual diagnosis. This was an individual who, when he went into a community-based mental health or addictions bed, was not manageable within that environment. He was an individual who, driven by both mental illness and addiction, acted out in very antisocial ways, so he couldn't be managed within that.

To me the challenge here is always to build the continuum. That continuum goes from something as straightforward as daytox services or community counselling kinds of things to, at the other end of the spectrum, Insite as an example.

We believed there was a place in the continuum for the better management of individuals who had the dual-diagnosis challenge. That's why the Burnaby centre is there today and was able to recently celebrate its first anniversary. That was huge. It's a very big piece in this.

I think that generally speaking, Vancouver Coastal Health do a very good job on mental health and addictions. They are, I'd say, kind of in the vanguard around the range of services and how those are undertaken.

Again, I guess I'd say this about the $120 million. It was not intended specifically to address mental health and addictions issues, but mental health and addictions do form an important part of the core of services that are provided by Vancouver Coastal Health.

Again, the dollars that went out are about 1.5 percent of the overall budget. So it would be unrealistic to say for that portion of money that it was going to resolve a bunch of issues. As we talked about yesterday, I think it's helpful. Undoubtedly, it was helpful in the area of mental health and addictions, just as it would have been in other areas for Vancouver Coastal Health.

The dollars they received out of the $120 million are significantly less than the $85 million lift that they're likely to see in '09-10 and further dollars out in '10-11 and '11-12. It is the lift to the base that has the greatest impact, and I expect that again we're going to see Vancouver Coastal Health continuing to be innovative leaders in this area of mental health and addictions services.

A. Dix: Of course, a lift to the base is less than the accumulated deficit over the last three years.

The minister referred yesterday as a driver of the decision to allocate the $120 million — that it addresses the 3.3 percent increase in emergency room visits and the 2.5 percent increase in ambulatory care visits….

What I wanted to ask the minister, because we had some of the same discussion in the estimates which came prior to this, is: was that increase predicted or not? In other words, when the health authorities with the minister came to Treasury Board and through the process, did they anticipate that? Or to what extent was that increase in visits unanticipated?

Clearly, the health authorities, as the minister will know, asked for more money than they got. I'm asking whether that was a mid-year change and there was a significant increase in emergency room visits that hadn't been predicted before April. Or did that occur subsequent to the minister's budget allocation?

[1520]

Hon. G. Abbott: We anticipate that the growth in demand in emergency rooms will be generally reflective of population growth in an area. I read out to the member early on in our discussion this afternoon the figures for St. Paul's, Mount Saint Joseph, Lions Gate, Vancouver General Hospital and Richmond. In some cases, there's a modest increase; in other cases, a modest reduction.

Vancouver General Hospital would be the one where there was quite a pronounced rise year over year, at least for the one year. Typically, we would look at population growth as one of the principal drivers in whether we should anticipate emergency room growth.

The health authorities and the Ministry of Health don't just wait for the demand to appear and then try to deal with it. I think that right across the board, there's a whole range of programs that we have undertaken to try, first of all, to avoid emergency room visits where it is possible; and secondly, when we do have emergency room visits, try to have the patient base sorted by acuity.

They're called the CTAS levels 1 to 5, with CTAS 1 being the most critical patients — heart attacks or severe trauma from an automobile accident, that sort of thing — down to 5, which would be the earache or a sore finger or a couple of stitches from a hockey game, that kind of thing. There's a lot of work being done in those areas.

In terms of trying to avoid hospital visits, one of the biggest things, again, is around the primary care alternative — trying to have new forms of practice that involve health practitioners other than physicians, but including physicians; and trying to build a support network for people with chronic diseases, who often drive the bulk of visits to emergency departments.

That is a hugely important piece, and it is having an impact. As we have more and more integrated health networks across the province, it will continue to be valuable as well.

In terms of managing the demand when it gets there, St. Paul's is a good example of an emergency department that has undertaken some very important changes in order to try to move people as efficiently as possible through their emergency department. They were the first to do overcapacity protocol in the province. That's not something I disparage. Actually, I think an overcapacity protocol is a very good thing.
[ Page 13997 ]

Dr. Innes and others were able to develop ways of managing that additional pressure that's sometimes on emergency departments, but they have also undertaken what's called a fast track for the CTAS levels 4 and 5 so that those with minor injuries get streamed out and get attention to theirs very quickly. Those who have very serious issues, who clearly are going to be either in intensive care or in acute care for a period of time, are also taken into their own stream and get the attention they need.

The 3s are often older patients with multiple chronic conditions, who need some attention but also need some observation for a period of time to understand what their health care needs are. That also is an important program that I think health authorities have really been trying to better understand and better manage.

There is lots of work underway, and we do hope, consistent with the experience in New Zealand, that as we get more and more primary care alternatives in place, we'll start to see significant reductions in demand on emergency rooms. That's been the clear experience in New Zealand, and we hope it's going to be the case here.

[1525]

A. Dix: But precisely just to the question. I'm trying to get at whether it was changes in the number of emergency room visits or estimates of those changes that occurred between the budget and the supplementary estimate. The minister has suggested that that was one of the things that it was to deal with.

In that period, did we see an unexpected growth in emergency room visits that had been unpredicted by the health authorities? Or what was expected when the Minister of Finance and the minister tabled their budget in the spring of 2008?

Hon. G. Abbott: Again, we were responding to general pressures and, as well as general pressures, the opportunities that could be produced by having an incremental $120 million to work with. As we talked about yesterday in these supplemental estimates, one of the areas that most commonly was utilized by the health authorities in terms of their share of the $120 million was getting more people access to diagnostics like MRI and CAT scans more quickly so that where surgery was required, their surgery date could be advanced. The number of surgeries was topped up.

Is that a pressure? Yes, it is a pressure, knowing that because of the aging population, we're going to see more and more demand for some of these procedures. It made a whole lot of sense to try to get some incremental dollars to try to ease the downstream pressures on diagnostics and on surgical departments. But there are pressures across the board.

I can just add a bit of clarification from the question earlier. For Vancouver General Hospital, '07-08, total admissions — 27,000. The mental health admissions of those 27,000 were 2,700 — so about 10 percent — and 95 percent of mental health admissions are made through the emergency department. That's consistent with what we discussed earlier but just a little better explanation of what happened earlier.

I'm not sure exactly what the member's thesis is, and maybe he will make it plainly apparent here shortly. I think the question was: did something extraordinary happen between the time of the budget and the time of the $120 million to prompt the $120 million? No, it was a range of pressures and a range of opportunities. Happily, at that point in time — amazing how things change over a period of six months — we had the resources to provide some incremental dollars, and we took good advantage of it.

A. Dix: To finish on mental health and addictions, the health authorities are of course not the only elements of a mental health plan, but they're key elements. Perhaps the minister, looking at the past year, can let us know the new ten-year mental health plan.

There was an RFP for it — you're in process there — in the fiscal year in question. Maybe the minister can let us know when we might expect to see that.

Hon. G. Abbott: I can answer the one question posed by the member earlier, and that's that $5.2 million went to Providence. That's the figure we have.

In terms of the ten-year mental health plan, there is a draft ten-year mental health plan. It's been posted on the Web. You could access it through the Ministry of Health Services site. I think consultation documents have gone out to a wide range of stakeholders, and there's probably a period of six weeks or something in which we'll be hearing back. Then hopefully, we'll be giving life to the plan at some point after that.

A. Dix: To move to the Fraser Health Authority for a moment, one of the main cost drivers for Fraser Health in the 2008-09 budget was the opening of the Abbotsford Hospital. I just want to ask the minister: how many beds at the hospital at present are operational?

[1530]

[S. Hammell in the chair.]

Hon. G. Abbott: Abbotsford Regional Hospital. The capacity at the old hospital, the Matsqui-Sumas Abbotsford Hospital, was 188. The Abbotsford Hospital currently has 261 beds operating. That's 73 net new beds, and I understand that, overall, the facility can be expanded to 300.

A. Dix: The reason I ask the question is just that at the time of the announcement of money, the chair of the
[ Page 13998 ]
Fraser Health Board said, with respect to Abbotsford: "These funds will help us deal with this never-ending onslaught of new customers." With the extra money, Fraser Health is committed to opening the additional beds, the incremental beds, from 260 to 300 this year.

I just wanted to ask: what is the intention of the government? The old MSA Hospital had 202 beds. It was downgraded to 188, and there are, of course, 42 admission hospitals. Prior to 2002…. Now, there's no question that the building of a new hospital is better than the old hospital, but I guess the question…. It's just a really specific question about the 300 beds.

The chair of the Fraser Health Authority was kind of asked at the time whether this allocation of money would assist in increasing the number of beds to 300, and he seemed to suggest that it would. In fairness to him, I say to the minister — and the minister will know about this as a politician — that the commitment…. The first line of the quote is in quotes, and the second line of the quote isn't. It's just a commitment from Fraser Health.

I just wanted to ask what the time line is on the increase to 300 beds. People in Abbotsford tell me, anyway, a little bit of frustration, with having a new hospital and not being able to find a bed. When is that intended to be? Is it, as seems to have been suggested by the chair of Fraser Health, going to happen before this fiscal year or calendar year? It's a little unclear.

As I say to the minister…. He may not have heard. The part where he made the commitment in the Abbotsford news article wasn't in quotes. The minister will know about that. There's the part in quotes, and then there's the commitment. So in fairness to Mr. Barefoot, sometimes that happens. The minister will be familiar with that. But anyway, when are we getting to 300 beds at Abbotsford?

[1535]

Hon. G. Abbott: To the member's question. I am going to respond, even though it may be on the border of the discussion around the $120 million. Nevertheless, you know how cooperative I am and how collaborative and conciliatory I am to those of you on the opposition.

There is provision within the Fraser Health budget for the Abbotsford Hospital. There was a specific allocation within the budget for them to open up the new beds at Abbotsford.

When the additional increment — was it between 271 and 300? — would come on stream is a function of the demand-and-supply analysis that Fraser Health will do. When they believe they need the capacity and it's appropriate to expand the capacity to meet demand, that's when it will happen. It will be a Fraser Health decision.

A. Dix: So what the minister is saying is that, shockingly, the story in the Abbotsford News might be wrong and that there is no plan in this fiscal year to increase that capacity. He's saying that the need, according to Ministry of Health and the Fraser Health Authority, is now 300. I think you don't just need the demand. You also need resources to open those beds. I think that's fair to say. It's something the minister always repeats, I think.

I just want to be clear that there is nothing coming in the short run that will move us from the 261 that we're at now to 300, that there is nothing planned — nothing announced in this fiscal year anyway — because we're talking about this supplementary estimate and what the chair of the Fraser Health Authority Board said about the Fraser Health expenditure of this supplementary estimate in this fiscal year.

Hon. G. Abbott: The member asks compound, complex questions, many of which are actually well beyond the parameters of a supplemental estimates debate on $120 million.

To address the first part, which allowed him to get his foot in the door, there is not, within the $120 million, allocation for beds at Abbotsford. I am not going to play the game of responding to newspaper articles and quotes that are partly in quotation marks and partly a characterization of what the board chair may or may not have said.

If the member can send me…. I don't know the article. I don't know exactly what may have been said. The member said some of it. We couldn't really hear it over here. But you know, I have all the respect in the world for Mr. Barefoot. He's doing a great job. He's been an exceptional chair at Fraser Health.

I have 100 percent confidence in Nigel Murray and the team at Fraser Health in terms of them making decisions around if and when to add capacity, whether it's at Abbotsford or Peace Arch or Surrey Memorial or Ridge Meadows — wherever it is. They are an exceptional team, and they will make the allocative decisions around if and when to add beds here or there or elsewhere.

A. Dix: Just because the Minister of Health asked and because, of course, it's specifically relevant to this $120 million supplementary estimate…. It is $40 million of that estimate that went to the Fraser Health Authority.

When the Fraser Health Authority chair was speaking about that, he said: "With the extra money…." No, wait a second. Let me give him the whole quote. I want to get it right. Again, none of this is from me. It's from the Abbotsford News, August 4, 2008.

"'The volumes continue to grow,' Barefoot said. 'These funds will help us deal with the never-ending onslaught of new customers.' With the extra money, Fraser Health is committing to opening the additional beds at the new Abbotsford Regional Hospital and Cancer Centre this year."

[1540]
[ Page 13999 ]

We're talking about the operating side, obviously, not the capital side. Now, this was in August 2008, so he could mean the calendar year. But that hasn't happened, because we're still at 261. He could mean the fiscal year 2008-2009, or he could mean something else.

What the minister is saying — just to be clear — is that right now there are no plans to move to 300 that he's aware of.

Hon. G. Abbott: I know Mr. Barefoot very well. I have an exceptionally good relationship with Mr. Barefoot, but I have no psychic connection to Mr. Barefoot in terms of knowing exactly what he had in mind. If the member wrote to Mr. Barefoot, I'm sure that he could get a fulsome explanation of exactly what Mr. Barefoot had in mind when he made that statement — recorded accurately, undoubtedly, because it always is in the media; undoubtedly recorded appropriately by the Abbotsford newspaper.

A. Dix: While he may not be a psychic, of course, the minister is the person chosen, for the moment and for the next month or so, to answer questions about these budget allocations of the Fraser Health Authority here in the House. We're not asking him to be a psychic. We're just asking him to do what he's supposed to do, which is to tell us where this money which Mr. Barefoot said was going to open the beds — whether that would open the beds.

I just want to focus a little bit on the Fraser Health Authority. The minister said yesterday, with respect to the Fraser Health Authority, in part, that the infusion — again, as in Vancouver Coastal Health — was to deal with a 3 percent increase in emergency room visits.

I just wanted to ask two questions. I'll try and keep it to two, and I'll try not to make them compound because I know that's a problem.

The first thing is that during this period the Fraser Health Authority put out and then withdrew an RFP for portables at Royal Columbian Hospital. I believe they withdrew it. I want to ask the minister — this part of the money deals with the emergency room visit portion — how that came about. The front end was publicized, and the back end was not, which is fair enough.

Maybe he could describe, in Fraser Health…. Maybe the staff could provide later the kind of detail we provided on all the hospitals. But which hospitals in Fraser Health are the major drivers of that 3 percent increase in emergency rooms that prompted this $120 million allocation?

Hon. G. Abbott: We do have detail on all the emergency departments in Fraser Health Authority. We can provide all of this to the member, but I don't think he's necessarily interested in Fraser Canyon Hospital and so on, all the detail.

Interjection.

Hon. G. Abbott: You are? Okay, fine. Ask me about it after, then, and I'll give you the figures.

[1545]

I understood, hon. Chair, that the member was interested in the big ones. Oh, he was kidding. Okay, fine.

The busiest hospital is Surrey Memorial. I think we probably would have anticipated that. In '05-06 we have seen 64,914 emergency room visits; in '06-07, 69,585; and in '07-08, 72,496. Quite dramatic growth there at Surrey Memorial Hospital — one of the reasons, I should note, why we have committed to increasing the size of the Surrey Memorial emergency department fivefold in a project the Premier recently announced.

The other sites where we see substantial increases. Royal Columbian Hospital, '05-06, 55,116; '06-07, 58,040; and '07-08, 60,131. Again, substantial increase there.

The third and third-largest of the numbers. Burnaby Hospital, '05-06, 54,975; increasing in '06-07 to 55,769 and in '07-08 to 59,906.

Those are the three largest hospitals and the busiest emergency departments in Fraser Health.

Maybe while I'm on my feet…. One of the programs that we hope to undertake through the innovation and integration fund for the Lower Mainland is an extension of an emergency room program called pay for performance. It has enjoyed some success, as the member knows, at Vancouver General and Lions Gate. We're looking at that for possible expansion to Royal Columbian Hospital as well, because it has worked quite effectively in the sites that it's been attempted. We hope that it can be of value at Royal Columbian and elsewhere as well.

A. Dix: Just on this issue of increase in emergency room visits. Does the government keep provincewide statistics of what are called different things in different hospitals? They're sometimes code purples. They're sometimes something else. Does the ministry keep comparative data about the numbers of code purples or the equivalent of code purples across health authorities to help it assess not just the demand for emergency rooms but the sort of peak demand or the crisis demand that hits emergency rooms at different times?

The minister will know, because it's a hospital a little down the road from his constituency, but not that far down the road…. At Vernon Jubilee Hospital they had a spate of those in 2008 — a bushel, a large number. Does the ministry keep that data? Do the health authorities keep that data, and if yes, would the minister be prepared to share it with the House? I think it's a practical illustration of the issues in emergency rooms.

On top of that, because I guess the second issue…. The minister refers to pay for performance. The doctors at Royal Columbian — they've toured me around; I know the minister has met with them — say that the key issue for them is that they have patients ready for admission, and there are times when there's just no
[ Page 14000 ]
room on the wards. That's kind of the issue there, I think, although some other measures…. I don't think anyone at Royal Columbian would ever say no to more resources, given their circumstances.

I just wanted to ask the minister if provincewide information around code purples or other protocols exists.

Hon. G. Abbott: Just to give the member some information around those protocols. I mentioned earlier St. Paul's Hospital, where Dr. Grant Innes and the emergency department team there pioneered a process which they called overcapacity protocol.

[1550]

Basically, what occurs with the implementation of overcapacity protocol is that when the volumes within the emergency department reached a certain point, there was agreement across all parts of St. Paul's Hospital, including the acute care wards, that the pressure would be mitigated by having all parts of the hospital participate in managing that patient load. They called that overcapacity protocol.

Over time we have seen overcapacity protocols utilized in a variety of settings. In some facilities they will call it code gridlock. In some facilities they will call it code purple. But there is no standard, currently, with respect to exactly what in a given facility will trigger what they may term a code purple.

For example, in Vernon Jubilee Hospital, whereas the member rightly notes there were quite a number of code purples called, what triggered code purple was a considerably different thing than what would trigger a code purple in Kelowna General Hospital.

I know there is a certain drama associated with the expression "code purple" or "code red" or "code white," which is also a serious code. There's a certain drama there, but there is not at this point a standardization. I understand from staff that in fact the ministry is looking at trying to get some standardization around that, even within health authorities themselves.

The overcapacity protocols were developed by, often, the administration and staff themselves, because they need to be consensual working agreements whereby the nurses buy into it, the doctors buy into it, the care aides buy into it and so on. So there is a kind of cultural shift that tends to occur.

There are always differences between facilities, so there probably wouldn't be a lot of point in counting the number of code purples or code whites or code gridlocks or code anything else until we have some standardization around exactly what's meant by that.

A. Dix: Surely, though, within a particular hospital that would tell you something about gridlock in emergency rooms. So if in a particular hospital…. Let's call it, say, Vernon Jubilee Hospital. One year there were ten, and the next year there were 50, and that's not that far from accurate, I suspect. That would indicate, unless they were changing their terms, that there was a significant increase within that hospital.

I guess what I'm asking the minister is: surely the minister — because these issues, if nothing else, become significant public issues — would have information on each hospital relative to what that hospital did before? As I understand it, they changed the definition in Kelowna at one point, you know, so as to make past comparisons irrelevant. But the question I have for the minister is: does he have data hospital by hospital?

Obviously, that wouldn't compare Vernon Jubilee Hospital and Surrey Memorial Hospital, but I think the people in those communities would be very interested in the relative data about code purple, just as they would about code white, which is something completely different but which would indicate another set of things within a particular hospital. Is a hospital becoming more or less safe, etc.?

Does the minister get that data, and would he be able to share it with the House?

Hon. G. Abbott: Undoubtedly, if we didn't have it immediately at the ministry, we would certainly be able to gather that kind of information from the health authorities. This might be a fascinating area for us to canvass when we get to full estimates and we have an opportunity to have the opposition raise these questions again. I think that would be good.

But let me say this. I don't need to count up the number of code purples to form the conclusion that Vernon Jubilee Hospital is an important hospital that requires very substantial remediation and expansion.

[1555]

Vernon is one of those areas — like the Central Okanagan, like Kelowna — that has grown very rapidly over the past couple of decades. What was an appropriate physical infrastructure for the population of Vernon ten or 20 years ago has now been dramatically outstripped. That is why we have committed to a huge expansion at Vernon Jubilee Hospital — a $160 million project. It's a huge expansion for Vernon Jubilee. It includes an ambulatory tower, it includes additional acute care beds, and it includes a huge expansion of the emergency department at Vernon Jubilee Hospital.

We know, based on a whole range of things — it doesn't have to be as code purple — when reinvestment is appropriate. Certainly, that long overdue reinvestment in Vernon Jubilee Hospital, I'm glad to say, is on the way. The project is being built as we speak.

Similarly, at Kelowna General Hospital, again, a facility serving a community that has expanded hugely in the past 20 or 30 years. We are expending well over a half a billion dollars in the expansion of Kelowna General Hospital. It is a facility that is under pressure.
[ Page 14001 ]

This is remarkably interesting to me, and I hope it is to the member as well. In response to the health innovation fund that we put together a couple of years ago, the nurses, the physicians, the administrators, all of the folks who worked in the emergency department at Kelowna General Hospital sat down — actually, they looked at the national and international experience on emergency departments — and they worked out a process called the streaming process, whereby they make the best possible utilization of the limited space they currently have at for their emergency department.

It has made all the difference in the world in terms of managing those pressures in the emergency department as they look forward to seeing their emergency department expand four or five times in the future in a massive redevelopment of Kelowna General Hospital.

A. Dix: If this was the full estimates debate, I'd ask the minister why the proposal that came forward on the ambulatory tower for Vernon didn't include any acute care beds when they signed the deal. Is the minister saying…? Well, maybe I won't ask him this, but he might in his next answer tell us precisely when he announced…. I know there's the capacity for acute care beds in the tower, but has he announced the number of beds in the tower at Vernon Jubilee Hospital?

Hon. G. Abbott: Hon. Chair, I know the member is probably straining your patience in terms of staying within the bounds of the debate here around the $120 million. But because I'm just that kind of guy and just in that kind of mood today, I would say that I'm pleased to advise the member that we have a written agreement with the regional hospital district, who contributed 40 percent towards the project, about how the phasing will be undertaken with respect to the additional acute care capacity.

A. Dix: He's just inviting the supplementary question of when we'll see the beds. But he can deal with that or not, because of course the minister would not want to stray outside the bounds of the debate.

Since the minister, in talking about what the $120 million was being used for, talked specifically about emergency room visits in Vancouver Coastal Health, in Fraser Health, in Interior Health, in Vancouver Island Health — but not in Northern Health, interestingly — then would he commit to at least providing the information with respect to code purples across the province too?

It seems to me that it's relevant to the question of the $120 million. Obviously, that's information he would seek from the health authorities, but if he would just make a commitment to provide that information, we would be delighted.

Hon. G. Abbott: I'm sorry. Again, I'm not being quarrelsome. I just want to know exactly what the member is looking for.

[1600]

He referenced Northern Health. At Prince George Regional Hospital they have their own form of overcapacity protocol code called, I think, code gridlock. Again, because code purple and code so-on-and-so-forth mean different things in different facilities, does the member wish us to aggregate that data, notwithstanding the fact that there's not necessarily any common definition to those terms?

A. Dix: I don't need him to aggregate it; I just need him to provide it. What we'd like to see at the hospitals is whatever the appropriate code would be — gridlock in Prince George, purple at Vernon Jubilee Hospital, sometimes code orange, and so on….

Can the minister provide comparative data over time about the number of calls of code gridlock in Prince George, of code purple in Vernon, over the last — oh, I don't know — three, four or maybe five years. How's that? It's like a fast-food window of information here. So over five years, just the comparative data by hospital.

Hon. G. Abbott: One learns fascinating things. Apparently, there are at least nine different code colours, and that's good. Okay, very good. I know I'll be glad to, as we move ahead in these months and look forward to gathering again to do full Health estimates….

I'll endeavour to gather all of the appropriate information together so that I can share that with the opposition, or the Health Minister of the day can share that information with the opposition Health critic once again.

A. Dix: Just to be precise, will the minister get the information for us now?

Hon. G. Abbott: The member is asking me: would I get that information for him this hour? I would not, because it's clearly outside the bounds of the debate we are having. I thought the member was asking me: would I gather that for the estimates debate? I'd be glad to do that, but I'm not going to gather it this hour, because it's clearly outside the bounds of what we're discussing.

A. Dix: It's not clearly outside the bounds. This $120 million, the minister said, was in response to increases in emergency room visits. One of the consequences of that, of course, is the dramatic number of code purples we see around the province, so it's reasonable and relevant to that debate.

I can't make the minister answer. I can't make him tell me how bad the situation is in Vernon or Prince George relative to other years — or how good it is, for that matter, because either may be true. I don't have the data.
[ Page 14002 ]

I'm asking the minister — since it's specifically relevant to this $120 million which was specifically designed to address the pressures in the health budget, and he specifically said, in his answers to questions about what it was, that it involved emergency room visits, and code purples are a result, presumably, especially of peak emergency room visits, all of which nicely fit in a tight box within the $120 million — whether he'd simply provide information about how many at each hospital.

Look, the information is the information. I know the minister may fear that it may indicate that the government's performance is not good, but that's not what we're concerned with here. What we're concerned with here is simply getting access to basic comparative information to see and assess how the government is doing in, say, Vernon, or to see and assess how the government is doing with code gridlock in Prince George or other hospitals. All of that seems perfectly reasonable.

Because the minister has asked me to place this within the box of the supplementary estimates, and I've just done that, I make the request again. By "now" I mean something reasonable, like within the next week.

Hon. G. Abbott: I feel like I've just relived an episode of Perry Mason from 25 years ago.

Hon. I. Black: In black and white, except it wasn't this gripping.

Hon. G. Abbott: It perhaps wasn't as gripping. That's true, but nevertheless, that's what I felt and experienced.

J. Horgan: It was 35 years ago.

Hon. G. Abbott: Thirty-five years ago — fine. Rub it in. You're not exactly a spring chicken yourself, Malahat.

[1605]

In terms of the member's request, we don't collect that information. We don't collect it because there's no standardization of what it means. As I mentioned to the member earlier, we are moving forward to a process that will try to standardize what everyone means by those things. At some point, what the member is requesting will make some sense.

That having been said, again, I will attempt to gather, in the weeks ahead, useful information for the member for our discussion when we get out to Health estimates. But we don't collect that data. It's not like we could pull it up out of a book here. We don't collect it.

A. Dix: This is quite surprising. This is a revelation for us here — that the health authorities that report to the minister and whose budgets we are discussing today in these supplementary estimates, this $120 million that we're discussing today….

Is the minister saying to me that the Interior Health Authority does not collect data about the number of code purples in the Interior Health Authority and that he is therefore bereft of that information and that, notwithstanding his usual curiosity about things in the world, he's unable to get that information — that the health authorities are unable to provide basic data, which would tell us what the situation is relative to previous years at, say, Vernon Jubilee Hospital? As the minister knows, it has been fairly catastrophic over the past year for people working there. They do a good job under the circumstances. Absolutely, they do.

Is the minister saying that the health authorities don't keep that data, don't have that data and that he's never expressed curiosity about the relative numbers of code purples as doctors and nurses struggle with those in hospitals across British Columbia?

Hon. G. Abbott: The Interior Health Authority, indeed any health authority, could bury the member in data should he wish to have it. That can undoubtedly happen.

As I have patiently explained on a couple of occasions to the hon. member, we didn't need to count up the number of code purples to decide that we needed major expansion and redevelopment of Vernon Jubilee Hospital to the tune of $160 million. We've done that. We didn't just stand around and belabour the point. We've made the investment. It is going to be huge in terms of emergency department size and management. All of that is very important.

The member has asked a question: does IH count it? Undoubtedly, they do. He asked me for that kind of data from around the province. I said to the member that we'd do our best to gather that. But it's him that's forming the conclusions about what IH may or may not count or what Fraser Health may or may not count, not me concluding that.

Again, he's asking questions which are well beyond the scope of these debates. I've been just remarkably patient and helpful in my answers to him — characteristically so, as some have said — but I think it's unrealistic for him to expect that suddenly all of the health authorities can disgorge volumes of information about what has occurred in their emergency departments over time.

A. Dix: Of course, the minister is wrong. He's right about one thing. We can't make him answer questions that he doesn't….

Hon. G. Abbott: Nor can I make you ask cogent, relevant questions.

A. Dix: Well, listen, this is precisely cogent and relevant to the point. The point is that the minister, in their budget allocations, gave a budget allocation that wasn't adequate for the health authorities. Had they continued
[ Page 14003 ]
on that path, every health authority would have been in deficit, and he tried to make this mid-year correction.

One of the reasons why he underestimated was that he didn't adequately deal with the issue in emergency rooms. That is not according to me, but according to the minister, because I asked the minister. One of the first questions I asked him — and members will remember this — was: well, what's the $120 million for?

And what did he say? He said that it's to deal with pressures such as an increase in emergency room visits in Fraser Health, increase in emergency room visits in Vancouver Coastal Health, increase in emergency room visits in Vancouver Island Health.

[1610]

The natural follow to that would be to ask questions about that increase in emergency room visits and its consequences and, therefore, why we're here in this House today with the $120 million debate that we're having right now.

Having brought the minister back to that, and at the risk…. His generation might be Perry Mason or Elliot Ness or something. In my generation it would be Matlock, I guess. By the way, he's used the Perry Mason thing a couple of times before. I think we need new material — spice it up over there.

The question is very simple. It seems to me that the health authorities get the information. This debate is about their budget allocation. We're simply asking for the information. When the minister says we'll get it within weeks, perhaps the minister can be precise about that. Is that one week, two weeks, three weeks or whenever he feels like it?

If it's whenever he feels like it, then that's an answer, and we can move on. But what it would indicate, of course, to everyone here — on the specific questions we're asking about emergency room visits that caused this $120 million allocation we're debating in the House — is that the government doesn't seem interested in this key information and won't provide it to the opposition because presumably it won't be good news for the government.

So it's very simple. I'm not asking the minister for the world. I'm just asking for something directly relevant to this $120 million allocation. Can he give us the information about code purples or code gridlocks, or whatever they are, around the health authorities? And while he's doing that, because I know how he likes the compound question, will he provide similar information around code whites?

Hon. G. Abbott: I know a little bit about the business of being in opposition. We were there for five years, and I loved estimates just as I know the member opposite loves estimates. You know as well, hon. Chair, that there is really nothing more pleasurable in life — well, there may be one or two things — than estimates. They are invariably a fascinating time.

One of the things that has fascinated me, for example, in these estimates, notwithstanding the boundaries that are occasionally crossed, is that the member has moved strategically from one area of health services delivery to another, starting with mental health and addictions and now emergency departments. Presumably we're going to work our way over to acute care and so on. It's kind of the turning point as one moves from one area to another, and at every occasion the member will say the fact is that the budget is just not adequate.

Again, I want to give him an opportunity, because I know how he loves to be explanatory, just as I am. If, as the member asserts, the budget is inadequate…. That budget, let me remind the House, is for fiscal '09-10 — $480 million.

For '10-11 it's $530 million, and for '11-12, $560 million, for a total of $1.572 billion over the three-year plan. It comprises 90 percent of every incremental dollar and is certainly a huge lift to the health authorities, close to a 20 percent lift over three years,

Again, if it's the member's view that that budget and the budget of '08-09 were not adequate…. I mean, it could be either. It could be '08-09, or it could be the current year, or it could be the three-year plan. But if he believes that it is not adequate, I would very much….

I want to learn from the member. Estimates is one of those unique opportunities in parliamentary life for the government to learn from the opposition. I'd like to know from him what the number is.

If it's not $1.572 billion, what would be the number that he would substitute for that, which would then take on that air of adequacy? If it's $2 billion, that would be useful to know. If it's $2.572 billion, I'd love to know that. I hate the thought that this could potentially be inadequate. I think I could learn a lot by knowing what the member believed constituted adequacy in this area.

[1615]

I'm happy to do that — listen to him — as well as to try to get him what information I can on codes. As well as code white and purple, would the member also want code red, code yellow, code brown, code green, code grey, code black and code orange?

A. Dix: Yes.

It's hard for me, in the context of the debate on the supplementary estimates, to deal with his issues of inadequacy. It's very difficult to me that the minister clearly feels inadequate. That's a more fundamental problem than I can resolve.

I would note to the minister that I'm scheduled on March 13 to be part of a panel that the minister has been invited to as well. I'm scheduled in a debate on March 16. The minister has been invited to debate me. I'm looking forward to meeting him on either of those occasions, or any other occasion over the next little while, to debate health care issues across British Columbia.
[ Page 14004 ]

Here today, this is the extraordinary thing about what the minister just said. These become almost existential questions. Here is the minister. Having presented a budget last year, he's coming to this House with a supplementary estimate that says that budget was inadequate.

We had a debate last year. All of us were there. The officials were there. Lots of the MLAs were there. It was in the Douglas Fir Room. I asked questions, and I said: "I don't think this budget is adequate for Vancouver Coastal Health." The minister said: "You're wrong." He said: "You're wrong."

Hon. G. Abbott: You were wrong.

A. Dix: He still asserts that I was wrong. He's having some cognitive dissonance issues over there, part of his problems with inadequacy perhaps.

He said, "You're wrong," and here we are four months later. He didn't put it in the press release, and I feel badly about that. He didn't put it in the press release when he announced this that the opposition Health critic was right and he was wrong. He didn't put it in there. That would have been big of him.

We are debating estimates that increase those health authority allocations that he said were right last year and had to admit in July were wrong. I find the minister's digression from the supplementary estimates very strange in that regard. Maybe he's just trying to pep things up. I don't know.

But nine months…. What was it? It was April 1, the beginning of that budget year. It was the last week in July when he announced the $120 million. It took him that long to figure out that what I was saying in the estimates debate — for example, about Vancouver Coastal Health — was correct and that what he was saying was wrong. He provided extra money to get through a year that would lead us into a general election, which seems to be what a lot of this stuff is about.

However, all of that said, I take the minister's offer to provide all the information about the codes. I appreciate it and thank him for that and look forward to receiving it shortly.

We were talking about the Fraser Health Authority. I'm going to give way in a moment to my colleague from North Island, who has some questions, and then we'll come back to the Fraser Health Authority. The minister, I know, is paying careful attention, but we really were moving from Coastal Health to Fraser Health. We're at Fraser Health now. So there you go.

The Fraser Health Authority. What the minister said yesterday…. He was addressing a 12 percent increase in ambulatory care visits. Now, this 12 percent increase seems to be a larger increase than share of population would suggest, because the increase that he talked about in Vancouver Coastal Health was 2.5 percent. I wanted to ask the minister, because again, as all the questions have been, this is specifically on the $120 million supplementary estimates.

We have allowed the minister to escape from the box sometimes on the answers, but this is what he said this was about. Can he explain the 12 percent in Fraser Health relative to the 2.5 percent in Vancouver Coastal Health? Both of which are serious, of course, but one is considerably more serious than the other.

Hon. G. Abbott: We'll try to get some information for the member with respect to that.

[1620]

I do need to acknowledge at the outset my disappointment in the member's answer, in that apparently he is able to determine on a regular basis what is not adequate yet is unable to do the same sort of determination around what is adequate.

I'm puzzled by that apparent ability to identify on the one side inadequacy but not the ability to quantify or even speculate on what adequacy might look on the other side. I'm puzzled and disappointed by that, but I guess puzzlement and disappointment often characterize my relationship with the opposition, hon. Chair — you being the exception, of course. But I am disappointed.

I was disappointed as well…. The member has always had a challenge in reconciling our achievement now of 5,800 incremental residential care and assisted-living units. He's in denial on that. I know I've accused him, perhaps unfairly, of unit envy as a consequence of that. He does appear to be possessed by a kind of unit envy in terms of just not being able to accept that not only have we achieved the 5,000 units, but we've gone on now to 5,800, which is delightful.

I know there's rarely poetry in news releases, and I don't often read them, but the member challenged me. He said: "Why didn't you say I was right and you were wrong in the news release?" That perhaps is an interesting omission.

I just was reminded of what I said in the news release, and it did seem strikingly cogent to me, so I'll repeat it for the record. It says:

"In Balanced Budget 2008, government dedicated 68 percent of every incremental dollar of new spending to the public health system for the next three years to support increased services to British Columbians across the province…. As a result of stronger than expected revenues from the oil and gas sector, government has sought $120 million for health authorities to meet increased demands and pressures across the system, including surgeries and diagnostic procedures."

It's hard to express what we were aiming for with the $120 million any better than that. It is a positive thing, and I know many people have said to me: "How can the opposition possibly be opposed to an incremental $120 million that might shorten wait times or, that might speed access to diagnostics? How could they be opposed to that?" I said: "I am sure they're not opposed to that. It is just that they have a difficult way of expressing their support."
[ Page 14005 ]

I look forward to that, and I'm looking forward to getting the information to answer the member's last question as well.

C. Trevena: I am very pleased that the minister is so happy to talk about how wait-lists are going to be cut and how the $120 million is going to be spent to deal with the demands and pressures on delivery of health care in the province. I hope that there would be some answers for my constituency, particularly the hospital in Campbell River.

I'm not going to go into the capital issues but the existing problems facing Campbell River Hospital. There is a wait-list for endoscopies that is now up to two years at the hospital, and I wonder if the minister could guarantee that some of this money will be going for the endoscopy wait-list.

Hon. G. Abbott: The note I have with respect to this states — and the member is obviously interested in it:

"The Vancouver Island Health Authority is advised that urgent and semi-urgent endoscopy cases are seen within the benchmarks set by the wait times alliance — that is, two weeks for urgent and two months for semi-urgent.

"In early January the health authority added an additional 16 procedures per week to help address the wait-list at Campbell River Hospital. VIHA has been looking at wait-lists for endoscopic procedures in hospitals across the Island, and Campbell River has a longer wait-list than one would expect.

"Recently a new wait-list endoscopy project was started in Victoria to better manage patients awaiting the procedure, through the use of a new priority assessment tool to be used by physicians. This project will be expanded to community hospitals, including Campbell River, across the Island and will hopefully relieve pressures on wait-lists."

[1625]

C. Trevena: So I can take it that if I have somebody come to my office who is concerned because they are longer than the two months for a non-urgent wait-list or longer than the two weeks for the urgent endoscopy, they could go to either the health authority or yourself to ensure that the health authority met the time lines that are therefore guaranteed.

Hon. G. Abbott: In almost every circumstance the urgency that is ascribed to either a diagnostic procedure or a surgical procedure will be determined by the surgeon or physician.

I think the first stop in terms of a patient who may be waiting longer than they believe they should be waiting should be to have a fulsome discussion with their practitioner or specialist about why they have a particular wait. Sometimes people believe their procedures are urgent when their physician may not, but that would be first stop.

Beyond that, yes, they could certainly talk to the client care relations officers with the Vancouver Island Health Authority or, if they had a broader question, address it to me at the ministry.

C. Trevena: I thank the minister for that answer.

Who would the doctor who is carrying out the endoscopies — who says that he can't get the time to do them and that he could do more if there were the facilities available — go to?

Hon. G. Abbott: I'm not sure I understood the question, hon. Chair. Was the question: who does the physician go to if they're not satisfied with the operating time that they have in a facility?

C. Trevena: Yes. If the physician knows that he has a long wait-list of patients who need endoscopies and knows there is the ability and the possibility in the hospital to do this but doesn't have access to equipment or time in the hospital, who would the physician go to? Would the physician then go to your ministry or to VIHA?

Hon. G. Abbott: They should contact the health authority.

C. Trevena: I thank the minister, and I will encourage them to do exactly that.

The second wait-list I wanted to ask the minister about is that which we talked about, actually, in the last estimates procedure, and I hope that it will be covered in this $120 million. That is the mammograms at Campbell River Hospital. Again, there is at least a six- to eight-month wait for the regular mammograms and a one- to two-month wait for any doctor-assigned mammograms. I wonder if the minister could give assurances to the people of Campbell River that they will get their mammograms faster than that.

Hon. G. Abbott: First of all, I'm not aware of any portion of the $120 million that would be used for that. But I guess I'll give the member this advice. I know this was raised as an issue in question period. I think it was last year. There are many locations around the province where one can secure a screening mammogram.

It's important to know the difference — and I'm sure the member does — between a screening mammogram and a diagnostic mammogram. Diagnostic is used when there is some reason to be thinking there may be a cancerous growth and one wants to make a prompt determination of that. Diagnostic mammograms are ordered. They typically are done either the day they're ordered or very quickly after.

Screening mammograms are for screening purposes. It is, I guess, rather like some of the tests that I take annually to try to ensure that I don't have a cancer. Typically, there is not an urgency around the screening.

[1630]

But if any client wishes to advance their screening time, for whatever reasons they may have, they should call….
[ Page 14006 ]
I think the number is 1-888-GO-HAVE-1, which is the number for the Canadian Breast Cancer Foundation in their program. If women call that number, they can find out the closest point they can go to at the shortest time. In Vancouver, for example, where there are many, you can pretty much get one that day if you're prepared to drive a little bit longer distance.

Obviously, we want the time to be as short as possible for screening mammograms, but there will be some variation depending on the availability of technicians. By calling the 1-800 number, it is possible to find out where the shortest wait time is in any given location.

C. Trevena: Yes, I think the women who are booking the mammograms are already going through the 1-800 number. They are aware of that and are told that if they book today, they will get a mammogram…. If their anniversary for their mammogram is the beginning of March — they get their card saying: "Your anniversary is coming up beginning the March; book your mammogram" — they won't actually get a mammogram in Campbell River for another six to eight months.

While there is the possibility of them travelling out of town, if they have the ability to travel out of town, to maybe get one quicker somewhere else — whether it's going to be quicker down in St. Joe's in Courtenay or coming down to Victoria to get one quicker — you still have the issue that not all women have the ability to drive down, to leave their community to do this.

I wondered whether the minister can designate some of this money or urge VIHA to designate some of this money to ensure that we have the staff to work in the lab in diagnostics in Campbell River.

Hon. G. Abbott: The Vancouver Island Health Authority will be in receipt of about $95 million additionally this year to maintain and expand services. I should draw the member's attention to a news release of December 12, which is entitled "Campbell River Hospital Home to New Digital Mammography Unit." It reads:

"Women across Vancouver Island, including those living in north Island communities, now have access to faster, more accurate breast cancer screening and diagnosis with the installation of about $3 million in state-of-the-art digital mammography technology at five Vancouver Island acute care hospitals including Campbell River General Hospital.

"With the installation now complete, the Vancouver Island Health Authority is the first health authority in Canada to make the most advanced digital mammography technology available for breast cancer screening and diagnosis accessible to women across the region."

Obviously, there have been some incremental additions to the services at Campbell River Hospital in terms of digital mammography. If there is some continuing issue with timeliness, I'm glad to hear about that and have them address it.

Again, for diagnostic — yes, it is a specified time frame for screening. It is for screening purposes. And again, if there is a greater haste attached to it, people should look at where they can get it additionally.

C. Trevena: Yes, we are very well aware that we have digital screening now and very pleased that this is the case. I think all women who have mammograms are very pleased it's the case.

I just wanted to let the minister know that there are still long wait-lists. I have many women who come to my office who literally can't believe that they call to their local hospital, their local screening, and find that it is, in fact, instead of being an annual checkup — which is very important….

We're very lucky in B.C. I think the minister is well aware and boasts very often of how we have good cancer screening. So if people want their screening, they are very pleased it's digital screening, but instead of being every year it is, in Campbell River Hospital, every 18 months.

[1635]

I would also like to ask the minister on this $120 million. A number of services in the lab in Campbell River Hospital have been transferred to Victoria, and I know that there are instances where having that service in Campbell River would really assist patients who are in the ICU who are having emergency surgery. I wondered if the minister could give some guarantees that this money could be used to ensure more rapid service for people in emergency in Campbell River by reinstating those services in the lab.

Hon. G. Abbott: We believe the question the member is raising is entirely unrelated to the $120 million.

C. Trevena: I would question the minister's rationale on that because it is something that these people who are in emergency, who have emergency operations…. The lab comes in and would be able to deal with the operation quicker if they didn't have to send specimens or material to the lab in Victoria because of the downgrading in the lab in Campbell River. So it is, I would believe, linked to improvement in pressures related to the delivery of health care in the province.

Hon. G. Abbott: Lab resources are configured in a variety of ways across the province, depending on the size of the facilities and the range of procedures that are conducted there. I can't speak to what the relationship would be, within the Vancouver Island Health Authority, between Campbell River and Vic General or Royal Jubilee in relation to how lab services are conducted. I can, however, say with assurance that what the member is concerned about is unrelated to the $120 million.

C. Trevena: I'll follow this one up separately with the minister. I think it would be more helpful than using time here that other people need to ask questions.
[ Page 14007 ]

I would like to go on to another issue at the Campbell River Hospital, and that is one which is very closely related to the $120 million, I would say, and the increased demand and pressures on the delivery of health care. It is the pressure on the number and availability of beds. The Campbell River census is about 57, and it's usually about 81 people who are in the hospital. I wondered how this money could be used to address that pressure on the hospital.

Hon. G. Abbott: The issue is an important one. Undoubtedly, Campbell River Hospital, like every other hospital, benefited in at least some small way from the incremental dollars that were provided to the Vancouver Island Health Authority through the overall $120 million infusion into the health care budgets.

We also know that Campbell River is, yes, at times a very busy hospital, at times over-census, so that is challenging. That is why, as the member knows so very well, over the past couple of years VIHA has been engaged in a range of consultations trying to find a model for redevelopment of both health facilities in Comox and Campbell River.

[1640]

We won't relive all that here. I'm sure the member would find it as interesting and painful as I would to relive it all. But there have been some challenges in VIHA finding a model for redevelopment of either existing facilities or a regional hospital and redevelopment of Campbell River Hospital. As the member knows, there is a proposal which, I think, is currently going through community consultation. I hope it wins the support of the regional hospital district and the municipalities and so on.

There really is some importance and timeliness attached to developing a model which everyone can accept, because undoubtedly some additional acute care beds would be a part of that, and a more efficient hospital setting would be a part of that.

C. Trevena: I thank the minister. No, I don't think either side of the House wants to relive the history of the last six or seven years of the Campbell River and Comox hospital discussions.

That being said, yes, the stakeholders and the community are looking at the proposal and are looking forward to a very healthy discussion with the Vancouver Island Health Authority that said very clearly when they came up with the proposal that it was a proposal and open for discussion and negotiation. That being said, there's going to be some time before, firstly, that proposal is agreed upon with the community, with the health authority and with the regional hospital board; and secondly, that it's built. In the meantime, we still have a 57-bed census regularly at 81 beds.

I wondered how the minister could assist the hospital in ensuring that either census numbers are lifted in the meantime, or that there is some assistance there to ensure that we have enough beds in the hospital.

Hon. G. Abbott: I can only give a kind of higher-level, generalized answer to that question because in the public health care system that we have in British Columbia, we accept patients regardless of circumstance or condition. So if someone requires treatment, we try to provide it.

If it's appropriate to divert, in some cases, from an overcapacity hospital to another health facility, that can be done. So there's a variety of strategies that all health authorities, including Vancouver Island Health Authority, undertake to deal with extraordinary pressures.

We talked about this earlier in relation to Vernon and Kelowna. Sometimes the answer is facility redevelopment, and that probably, in the longer run, is the answer in Campbell River. In the shorter run, the Vancouver Island Health Authority will be looking at demand and capacity management so that they try to make these things work out.

C. Trevena: I thank the minister. I have one final question which I hope the $120 million will be able to help resolve, and that is the issue of physicians in certain locations. I'm specifically referring to the ongoing problem in Port Alice, where there hasn't been a full-time physician for some time. There have been locums, and now even getting a locum is difficult.

Whether some of this money will be going for physician appointment and locum searches through the health authority to ensure that the community gets a full-time physician as soon as possible….

Hon. G. Abbott: While it is unrelated to the $120 million, in my characteristically helpful way, I'll just make these observations. We have made some changes to the locum program, which we believe will be of assistance in helping historically underserviced communities have greater access to locums.

The challenge around locums is that within the kind of pecking order of where they like to go, they do tend to like to go to more populous communities with more recreational facilities, etc. So those that are smaller have historically had more difficulty. We have a new agreement with the B.C. Medical Association which tries to provide additional incentives to go to some of the more remote and smaller communities because it's difficult to get locums to go there. So hopefully that will be helpful in the member's case.

[1645]

The real answer, though, as the opposition Health critic and I agreed earlier, is to expand, as we have, the number of physicians that we educate in the province. We've doubled the number. We're going to continue to make that number grow at UBC Okanagan. That's the
[ Page 14008 ]
longer-term answer — to educate more physicians — and that's what we're doing.

D. Routley: I'd like to speak to the minister about the Cowichan region and some issues that the people and the staff in the hospitals and the facilities face in our region. It's clear from a number of perspectives that Cowichan is an underserved region when it's compared to Nanaimo, Victoria or other areas of the Island. That bears out in emergency room services, in beds per capita, as well as mental health funding per capita.

Cowichan District Hospital's emergency room sees approximately 28,000 cases per year. That compares to Nanaimo Regional hospital, approximately 30,000 cases; and Victoria General Hospital's emergency room, approximately 35,000 cases or visits.

This means that Cowichan, essentially, is within 25 percent of the number of visits to Victoria General Hospital. Unfortunately, Victoria General Hospital enjoys over two times as many staff members in their ER. Nanaimo Regional hospital has almost the same — a few more visits per year than Cowichan District Hospital — but they have almost two times as many staff members.

So the priorities of VIHA and staffing levels supported by the minister seem to leave the Cowichan region in quite a discriminated and shorted position. Can the minister help with explaining why the Cowichan region has less service?

Hon. G. Abbott: I'll try to shed some light, possibly, on some of the reasons why there may be a differential, just in terms of understanding the magnitude of the challenge. For Cowichan District Hospital '05-06 emergency room numbers were 28,277; in '06-07, 27,693; in '07-08, 28,464.

By comparison, Nanaimo Regional General Hospital '05-06, 47,300; '06-07, 45,538; and '07-08, 46,880. For the Victoria General and Royal Jubilee hospitals, the numbers are '05-06, 75,082; '06-07, 75,609; and '07-08, 75,648.

One of the important differences, though, that should be noted between Cowichan, which is a very good community hospital, and Royal Jubilee and Vic General — as well as Nanaimo Regional, for that matter — is that the latter hospitals are trauma centres. If, for example, there is a serious automobile accident somewhere on the Island Highway and people are CTAS level 1 — they're in some danger of expiring from their injuries — they are apt to go to one of those high-end trauma facilities to be dealt with.

Similarly, if someone has experienced a serious cardiac event and requires angioplasty and/or open-heart surgery, again, they're likely to come down to Victoria for that. So the acuity level overall of the patients will be significantly higher in those facilities than one would find in a community hospital, simply because those most serious cases will be often diverted to the regional hospitals for attention.

[1650]

I'm not disparaging the member's assertion. I'm just saying that one has to include a number of factors in consideration of why staffing levels may be at certain levels in certain facilities.

[K. Whittred in the chair.]

D. Routley: In the Cowichan region, represented and served by the Cowichan District Hospital, there's one bed per 1,000 residents. In Victoria there are two beds per 1,000 residents. Is that an acceptable difference?

Hon. G. Abbott: Again, the answer may lie in the complexity of the regional facilities. Typically, when one has a tertiary facility, you will have more serious cases present there and often be diverted there. The stays will often be longer, because as one might predict just from common sense, if an individual has had a serious injury from an automobile accident or if there is a serious surgical procedure that has occurred, typically it will require a longer-term stay than for lower-level-of-acuity issues.

Again, without looking very closely at each facility and understanding the range and complexity of the services offered, it is difficult to form a conclusion about what the appropriate number of beds per thousand would be. Vic General and Royal Jubilee, for example, serve a population base from right across Vancouver Island and, indeed, are often recipients of cardiac patients from the mainland as well. It can certainly work that way.

I guess, additionally, when the Vancouver Island Health Authority is looking at the distribution of acute care beds — again, Vancouver Island Health Authority has been around since January of 2002 — there was a distribution of acute care beds that they had when they were formed. Over time there will be an evolution in the number of beds, but they have to look at where the acute care beds are in Nanaimo, Campbell River, Comox and other areas on the Island and then try to judge appropriately where the appropriate places to do future expansions or redevelopments might be.

D. Routley: I was at the opening of Cowichan District Hospital. It was a Confederation centennial project in 1967. My sister was born just two years earlier in the former hospital, which is now a seniors facility.

At that time, when Cowichan District Hospital opened, there were 141 beds. There are now 98 beds. The plans that VIHA has announced, all the way out to 2020, show only an increase to 115 beds. The area's population is increasing rapidly. Does the minister think that some of the attention of the $120 million in funding should be directed towards increasing and speeding up that plan
[ Page 14009 ]
of expansion, and does he think that that is an adequate service for the area?

[1655]

Hon. G. Abbott: As the member I'm sure would agree, there have been enormous changes in terms of how health care services are delivered since 1967. Indeed, there have been enormous changes since 1987 in terms of how services are delivered.

In 1967 — and I think probably the same would be true in 1987; this is just one example — cataract surgery used to be a major in-patient procedure. It usually involved a stay of several days in a hospital. Today that same cataract surgery is done in an out-patient facility, normally a clinic. It's a procedure of a couple of hours, and people are back on their feet later the same day. It is, indeed, now a minor procedure in the realm of medical procedures, but 20 years ago that was not the case. It was a major in-patient.

If you take the experience with cataract surgery and look across the continuum of surgical procedures, now there are so many minimally invasive procedures that don't require hospital stays. I guess another example would be some of the knee and hip replacements. Now people are back on their feet very quickly.

It is quite amazing how the ambulatory out-patient procedures and facilities have expanded. This is true right across the western world. Not just in British Columbia but across the western world we've seen growth of ambulatory and generally less emphasis on the acute care side of things.

Now, that's not to say — before the opposition Health critic leaps to his feet — that acute care is not important. It absolutely is, and it's important to have the requisite number of acute care beds that are needed to provide services.

In terms of the changes at Cowichan particularly, though, in 1991 there were 135 acute care beds. In 2001 that had been reduced to 105. Today, I'm advised, there are 95. So there have been changes over a couple of decades. I don't think that reflects evil on either side of 2001. It reflects the fact that ambulatory care has taken on an increasing importance over time and, I suspect, will take on an increasing importance in the future as well.

[1700]

The other piece that's important — and I think we'll see more and more of this in the years ahead — is the development of more primary care options in community so that people with multiple chronic conditions don't require the hospitalizations that they currently do. Again, as we discussed earlier in these estimates, the patients who are afflicted with multiple chronic conditions do drive a lot of hospital stays.

D. Routley: Last year there were 109 surgeries cancelled at the Cowichan District Hospital. The former chief of surgery points to the management structure at VIHA as being responsible for a lot of their inability to carry out surgeries, because of the vertical nature of the management of the departments and the lack of permeability horizontally on site. The on-site management of resources is hindered because there's really no connection with a surgery department centred in Victoria controlling that and other aspects centred in other places like Nanaimo.

So we see this continuation of cancellation of surgeries. A lot of that, according to staff and according to patients, is driven by the fact that many seniors awaiting placement are taking up beds in Cowichan Hospital.

When this criticism has been brought to this House before or brought to VIHA directly, there was always a finger pointed down towards the private facility — Sunridge, with its assisted living and other beds — as being the panacea for the problem. Everything would be okay when that opened.

Since the opening of Sunridge Place, we see the closure or the attempted closure of Cowichan Lodge. There were 95 residents in Cowichan Lodge a year ago. Now there are 13. The other beds remain closed while seniors are taking up beds in Cowichan Hospital. Surgeries continue to be cancelled, to the great frustration of the surgeons and patients.

Can the minister explain why some of this money couldn't be directed to restaffing and filling those beds at Cowichan Lodge to reduce the load on Cowichan Hospital?

Hon. G. Abbott: I'm attempting to get some more information for the member in respect of the surgeries cancelled at Cowichan Hospital. I'm sure he is correct around the 109 surgeries that were cancelled.

What I'd like to get for him in terms of a comparator is the number of surgeries that were completed at the facility, because it would not be unusual for a hospital to have a small percentage of surgeries that were postponed or delayed in relation to a larger body of surgeries that were performed on time and as predicted.

[1705]

Invariably — and it doesn't matter whether you are at Victoria General or Royal Jubilee or Cowichan District Hospital — there will always be occasions when the surgical slate will be disrupted because there suddenly appears an emergency situation or an urgent situation which requires surgical attention. That happens everywhere. It doesn't happen just in the big tertiary facilities. It will happen in any facility.

We always regret when that occurs, and we always try to take every possible step to avoid the possibility of a surgery being delayed or postponed. But it does happen, and it is understandable, given that sometimes there are more urgent cases that require the attention of the surgeons.

In order for me to understand whether 109 is a disproportionately large number for Cowichan versus
[ Page 14010 ]
other facilities, I need to know what that larger number of surgeries performed as predicted would be.

In terms of the member's suggestion about the disconnect or the presumed disconnect between surgeons and doctors and nurses and so on at Cowichan District versus VIHA, again, I'm glad to make the Vancouver Island Health Authority aware of that concern. I presume that they may have already been alerted by the member as to that concern. If there's an issue there and there's something we can learn from that in terms of doing things better, I'm pleased to do that.

We have a good health care system in British Columbia, and I'm sure we have a good health care system in Cowichan. But large complex systems such as the British Columbia health care system can always be improved, and we've always got to be open to learning from the experience of those who work in those facilities.

In terms of the Cowichan Lodge and Sunridge Place issue, again, if the member wants to debate that issue, I'm glad to spend some time trying to explain once more why I believe VIHA made an appropriate decision by the planned closure of a facility that is not only dated but requiring serious remediation in order to meet contemporary care standards.

They had a new facility, Sunridge Place, which is first-rate from everything I've heard, and I understand that people love living there. I'm sure there will be some who disagree with that, and it's probably inevitable in our world that people have different perspectives on things. But I believe they made the right decision.

In terms of the ALC issue which the member mentioned, alternate-level-of-care patients are those who are in a hospital bed but do not need acute care — who, in reality, need either residential care or, in lesser cases, assisted living. They are in the hospital bed because of the unavailability, currently, of a residential care or assisted-living bed.

We're trying to constantly drive down that number of people who are in that alternate-level-of-care category, and we've been somewhat successful at that. We'd like to be more successful. We have more residential care beds and assisted-living beds coming on line.

With an opening called Selkirk Place here in Victoria yesterday, we have close to 200 additional residential care and assisted-living beds — predominantly residential care. We now have about 5,800 incremental over 2005, so that's helpful.

[1710]

As a consequence of that, we've seen that since 2001 the number of alternate-level-of-care patient days has decreased by 26 percent from 15 percent of total in-patient days down to 11 percent today. That is a different trend line than we saw between 1995 and 2001. In 1995, 6 percent of total in-patient days were ALC days. By 2001 that had increased by 166 percent to 16 percent of total in-patient days.

The ALC rates are important things to manage and try to bring down. We've enjoyed some success there, but we will have to continue to try to do that.

D. Routley: When the announcement was made that Sunridge would be opening, one of the local radio reporters says that he questioned the Health Minister and the Housing Minister and was told that the opening of Sunridge would not mean the closure of public beds at Cowichan Lodge.

In fact, what we saw was the closure of those beds. Now we're back in the same position we were at Cowichan Hospital, with seniors in the unfortunate position of being labelled bed-blockers because they can't get placement.

I have a letter from a family member of a person at Sunridge who was told, when they went there, that there would be two caregivers in each pod, which houses eight to ten residents. Then there would also be a nurse floating in between those pods. Five months after arriving, the staff was cut back. There's only one caregiver on duty at all times, day and night. Residents in some parts of the facility are asked to answer the phones at night.

Costs have been driven up through the pharmacy. Costs have been driven up in terms of cable rental for their televisions. Costs have been driven up even for nail clipping. One of the doctors in the Cowichan Valley calls the facility the hip fracture castle of the world. So I would dispute what the minister has said about the quality of care being given.

The people giving the care are struggling and doing the very best they can, and no one has criticized them — not this member and not the patients' families either. But everyone is pointing to a lack of staffing — everyone. So unless everyone is wrong, there is a problem there.

We were promised in our community that Sunridge would not mean the loss of what is a very beloved institution — Cowichan Lodge. VIHA for their part and the minister for his part have gone a long way trying to downgrade the impression of what that facility is.

The people who work there thought it was adequate. The people who had family members there thought it was adequate. Yes, there were some challenges, but it is a facility that can adequately house the people who are there. The people who work there have told me that they never had a problem with the narrowness of doors or of hallways.

My own grandmother spent her last days at Cowichan Lodge. It was an absolutely wonderful place for her. Now that it's gone, we're forced into this position of having our hospital overloaded again.

Surgery wait-lists for prostatectomy are nine months at Cowichan Hospital. The former chief of surgery resigned a couple of years ago over the lack of services, and in the closing paragraph of his letter of resignation he says: "I am resigning as chief of surgery at CDH
[ Page 14011 ]
because we have done as much as we possibly can, given our sorely inadequate resources, to maintain a surgical program. As of June 1, I will work through political channels to advocate more surgical and medical resources for VIHA in general and CDH in particular."

So we have a very highly respected surgeon who resigned his position as chief of surgery at the hospital a couple years ago over a lack of resources. We were told that we wouldn't lose Cowichan Lodge when Sunridge opened. Every time the criticisms of Cowichan District Hospital were brought to the government or to VIHA, we were told that the new facility would relieve the hospital.

That is not the case. It hasn't relieved the hospital. It's back in the same place, and we've lost the public facility. Or at least we've almost lost it, as 13 residents still keep that facility open.

[1715]

Can the minister just offer something to the people of the Cowichan Valley that would give them the hope that maybe those beds could be re-staffed, that Cowichan Lodge could be filled with patients the way it was — patients appropriate to the facility — and that the pressure be relieved from Cowichan District Hospital? Clearly, the staff, the patients and the whole community are calling for that. Will the minister respond?

Hon. G. Abbott: Again, even though it is probably beyond the scope of discussions here, we are trying to get for the member some indication of ALC rates — current and historic — for Cowichan District Hospital so that we can have some understanding of that in addition to the comparator around the surgical postponements. I won't hold up the proceedings here to await that material.

I would note, though, first of all, that I have heard — and apparently I must be talking to different people than the hon. member — nothing but positives about Sunridge Place, and that is from the family of residents at Sunridge Place. They believe it is a very fine facility, and that the staff are loving and caring and do a great job. That is all I have heard about Sunridge Place.

I don't doubt that the same love and caring existed at Cowichan Lodge. I don't doubt that for a moment, but again, there were numerous facility indices about Cowichan Lodge which suggested its life as a residential care facility was limited. Vancouver Island Health Authority had to make a decision about whether they would put resources into a new modern facility that met contemporary standards or attempt — and it's not clear whether it would be possible to even attempt it — to remediate an older and decaying facility.

They made that decision. Again, the member disagrees with it. I know he's made that very clear, but I believe that Vancouver Island Health Authority made the right decision, and I have not seen any reason to think that that decision ought to be revisited.

N. Macdonald: Thank you, Minister, for taking this question. I just want to follow up on questions from estimates that I asked in spring of 2008. For the minister's reference, I also sent a letter from my office on November 14, 2008. I realize, of course, he gets more than one letter over the course of a period of time.

[1720]

The issue that we talked about then was the Invermere emergency room, which has long needed upgrades. The citizens of Columbia Valley and the doctors have made the shortcomings abundantly clear with that facility.

The hospital's emergency room is inadequate for the permanent population, and health professionals have stated that. The inadequacy is compounded by the large numbers of visitors to the Columbia Valley, which can increase the number of people depending on the services of that facility four- or fivefold.

The community and health professionals had waited patiently for funding through a process run by Interior Health and the Kootenay East regional hospital district. Invermere and District Hospital's emergency room was next on the list, I'm given to understand, for upgrades.

As of October 2008, the Ministry of Health has taken over funding decisions with regard to the projected improvements to Invermere emergency room. The planned improvements are now on hold. What doctors in Invermere have said in a letter to the ministry is that that's unacceptable, and they feel that lives are in danger. So there's clear urgency with the issue.

Presumably, the $120 million that we're dealing with in supplementary estimates is not going to be the source for the funding needed. So the question that I have for the minister is: if not this source of funding, then when can the Invermere emergency room…? When can we expect that money to be forthcoming?

Hon. G. Abbott: I can't speak to when specific capital announcements would be made with respect to Invermere and District Hospital or any other health facility. Those work through processes, and when the processes are complete, then we're in a position to make announcements.

I can tell the member, though — and I hope he can take some solace in that — that the business case development, including schematic design, is underway for the emergency department renovation project at Invermere and District Hospital. The proposal or the idea has been around. It was probably about two months ago that specific funds were dedicated towards the detailed plan and the business case for the emergency department renovation.

I don't think there's any dispute on anyone's part that Invermere ER needs redevelopment — no question about that. The emergency department is a high capital priority for IHA. It is a relatively small project, probably around $4½ million, although that number will be better
[ Page 14012 ]
informed by the business case work and the detailed schematic design work currently underway.

IHA believes that planning and schematic design should be completed probably around April 2009. When the work is done and we have a clearer sense of what's possible there, then potentially it could be announced at some point. But again, government always has to try to weigh the many demands that are made on capital.

There's literally close to a billion dollars in capital expended every year just on health. So the comfort the member should take here is that IH has made this a priority, and I think the case is persuasive for the investment at Invermere.

N. Macdonald: I thank you for taking the question.

As my last question, just to give comfort to people that are in Invermere. The schematic in getting that design work ready indicates clearly that they are on the list. I realize there still has to be a decision around the capital, but very clearly, they're moving through a process where people within the community should have an expectation that at some point in a very reasonable time this upgrade would take place. Very clearly, this schematic is not something that would be done if it wasn't seen as a capital project flowing from it.

[1725]

Hon. G. Abbott: Yes, the people of Invermere should take comfort and confidence from not only IH's identification of this as a high capital priority but also from the government and IH's commitment to do that additional work around constructing the detailed design and the business case. Those don't get undertaken unless there are strong reasons to do it, so I think the people of Invermere can be very confident that this project will be moving forward.

The announcement will be made at an appropriate time, when all issues are resolved. But they certainly can be confident, given the priority given to this and the investment made on planning for it, that it will go ahead at an appropriate point.

A. Dix: I just want to move on to the issue of diagnostics, which the minister cited in describing these $120 million supplementary estimates as sort of a key thing that had been done. I had just a few questions about that.

There's inconsistent information about wait times for MRIs across the province. The Vancouver Island Health Authority says on its website — because this is a standard; it's one of its performance standards — that the average wait time for an MRI on Vancouver Island is 13.1 weeks, which would amount to 92 days. Just to put that in context, according to the CMA, it's 30 days in Ontario.

I'm wondering if the minister has wait-time information, particularly from the Interior Health Authority. The minister will know that they used to post that information. They did for more than a year on their website, and then they withdrew it.

Then the minister referred to this yesterday. We did an FOI. They sent us the FOI. They said that their own information was wrong. So I'm wondering if the minister has an update on that.

At the time, the IHA spokesman was actually asked directly: "Well, what are the wait times if they're not…?" There are varying wait times — anywhere from 100 days to, I think, 260 days within the IHA, according to the website. He said that it's about 120 days. That's four months, or four times the wait time in Ontario.

[H. Bloy in the chair.]

I just want to ask the minister, because this is clearly a focus in an area where wait times appear to be — according to the Canadian Medical Association, anyway — significantly longer in British Columbia than in other places. If the minister could — I'm sure he has this information close at hand — sort of give me the average wait-time data for the other health authorities.

As I say, Vancouver Island very helpfully has it right on their website. Because this relates so directly to the supplementary estimate, I thought the minister would be able to provide that information and give us a benchmark as we discuss how the $120 million was being invested.

[1730]

Hon. G. Abbott: I'll try to provide some information to deal with the member's question. On the Interior Health piece, I'll refer him to a fax dated September 17, 2008, that went from Interior Health to the NDP research office, which advises that they've appended updated and corrected information on wait times for MRIs and provides further information on that. I know that the member uses some numbers which were provided there.

The IHA has provided an explanation which basically says that the number that they had posted is what they believe to be the maximum amount of time that someone would have to wait for an elective or non-urgent MRI — though that's not really, from my perspective, necessarily a satisfactory measure. IHA agrees, and they are trying to get greater clarity around what the average wait time is for diagnostics, meaning MRI scans or CT scans.

In terms of, again, the number of machines, I noted when we talked yesterday that there are now 22 MRI scanners in operation in the province. We celebrated the 22nd one at Peace Arch Hospital last Friday. That has dramatically increased from eight, I think it was, MRI scanners when we took office. Now it's 22. I think we're looking forward to the 23rd not too long from now.
[ Page 14013 ]
That's actually over 133 percent. It's probably approaching 150 percent now.

[1735]

Also, we noted the changes that had occurred in Interior Health in terms of going from one mobile scanner now to four MRI scanners in Interior Health and the addition of the permanent MRI at Prince George Regional Hospital as well. We also noted the huge increase in the number of CT scanners that have been put in place — moving to 49, an increase of 18 CT scanners. More are on their way as well. In fact, numerous additions are coming, including one at Shuswap Lake General Hospital, one at Port Alberni and, I think, Nelson and elsewhere as well.

That's exciting, and that's useful. The number of diagnostic scans has gone up proportionately. It's a huge increase from 37,000 back in '01-02 to 91,000 in '07-08 for MRI scans, a 145 percent increase; and CT scans, an increase from 240,000 in '01-02 to 420,000 in '06-07, a 75 percent increase in the number of scans. So that's a positive.

The consequence of having the additional scans is, of course, that a wait time is going to be a function of the number of people who are awaiting a scan and the number of scans that can be delivered at any point in time. The member, I'm sure, understands that. So wait times may go up and down, depending on the number of people who require, or who have been referred for, scans at any point in time. The issue is an important one. That's why we keep making the investment in scanners. I think that that's a constructive way to move forward in addressing wait times.

A. Dix: Again, on the $120 million request here — or supplementary estimate, which the minister has directly linked to this issue of MRIs and wait times: does the minister know what average wait times are in the IHA, and can he tell us? Does the minister know what average wait times for MRIs are in the Fraser Health Authority, and can he tell us? Does the minister know what the average wait times are in the Vancouver Coastal Health Authority are, and can he tell us? Does the minister know and can he tell what the average wait times are in Northern Health?

We know, because Vancouver Island has posted the data, that the average wait times on Vancouver Island are 13.1 weeks, or somewhat over three times the average wait time in Ontario. So that was the question I had asked. I mean, the minister explained what a wait time is, which someone who is waiting for an MRI presumably also knows very well, and we understand what a wait time is.

The question is: what are the average wait times in the health authorities? Presumably, if you're directing this $120 million to reduce them…. The minister explained yesterday that if you reduce wait times — you do the one-time investment on MRIs as opposed to on emergency rooms — you're actually reducing the list. Can he tell us what the wait-time list is now?

Hon. G. Abbott: Yes, if you are a British Columbian and you urgently need an MRI scan or a CT scan, you will get it immediately. That is the way that we provide medical services in this province. If there is a medical urgency attached to your scan, you will get it straightaway. If there is an apprehension of a cancer, for example, you will get your scan virtually right away.

If you have a sore knee and you think you might have a problem but your specialist is not convinced that you have but he says, "Okay, I'll refer you to a CT scan or refer you to an MRI scan," it's apt to take longer. But if you, in the medical judgment of your specialist, need an MRI scan or a CT scan, you will get it straightaway.

[1740]

A. Dix: So just to be precise, the minister says if he goes on the Vancouver Island Health Authority website, he'll see what the average wait time is in weeks for routine MRIs, and it says 13.1 weeks. I'm asking if other health authorities know what average wait times are.

If the answer is no, that's interesting. But I asked the question the first time, and the minister explained what a wait time is and gave aggregate data like every other health jurisdiction in the world that is using more MRIs now than they used ten years ago. He gave us aggregate data, and that's very interesting.

But I asked him what average wait times were then, and I asked him again. I'm just asking him a third time. If the answer is, "I don't know," that's fair enough, I guess. But I guess what I'd like to know, because the Vancouver Island Health Authority has helpfully posted this on its website. To remind the minister what they say on their website, they say that average wait times are three times longer on Vancouver Island than they are in Ontario, and they're clearly hoping to do better than that.

The minister has suggested that with the investments that come with this $120 million…. That will assist in that, and that would appear to be the case. So if it's 13.1 weeks on Vancouver Island for average wait time for routine MRI scans and that's based on their most recent data available…. It's as of September 2008, and it was published in November 2008. So if Vancouver Island can provide this information, do the other health authorities have this information? That's the question, I think.

Hon. G. Abbott: Again, regardless of what health authority one is in, in the province of British Columbia, if you need an MRI or a CT scan on a medically urgent basis, you will get it immediately. That is the way the system is structured — that those who need the service and need it on an urgent basis get it immediately. If it is an elective call, if it is something that is not necessarily
[ Page 14014 ]
required or if there is an apprehension of something but it may be needed, then the wait time may be longer.

The challenge is that the wait time for a diagnostic procedure will be a function of the number of procedures that are provided within a period over the number of people who are looking for them. If you have an unusually large number of elective diagnostic procedures ordered, then the wait time may be longer. So it will vary among health authorities at particular moments in time. Obviously, they can tell you what it might be at X date, but it's going to change, and it's going to change on a regular basis.

A. Dix: The minister is telling me that wait times change on a regular basis. That's why the Vancouver Island Health Authority reported monthly from April, May, June, July, August and September of 2008 on their website about what average wait times were. Strangely enough, they varied a little bit, but not very much, and you wouldn't expect them to dramatically change in a short period of time.

I mean, the demand…. People don't want to have an MRI. They don't desire it. It's not an exciting thing to do. You have an MRI because you need an MRI and a physician asks you to have an MRI.

All I'm asking the minister…. If the data doesn't exist for other health authorities, that's fine, but Vancouver Island has posted it. They're able to maintain the data. IHA has had, it seems, some difficulty with the data, and they're working on it. But do we have average wait times for the other health authorities? I'm just asking the minister if he could provide that, and if the answer is no, fair enough. We'll move on.

[1745]

Hon. G. Abbott: I'm glad to provide the member with as much information as I can here, but I think we're getting pretty deeply into an area that is not necessarily linked to the $120 million.

Again, I will say to the member that those who need an urgent MRI or CT scan get it straightaway, that there will be variation both among health authorities and across time in terms of what the wait times will be in respect of other health authorities.

We have some information which is point in time. Again, probably VIHA is a good example of a health authority that is doing extensive management of diagnostics and wait times. I think they are doing a very commendable job there. They have probably the best diagnostics program in British Columbia, so that's very good. I'm sure Interior Health and others may be trying to move towards that standard.

Yes, we do have some points in time, but I'd have to refer the member to the websites for the individual health authorities. He can either praise or deplore them, depending on what he sees on there. That's fine; that's what we do.

But I'm not sure what more the member would wish me to do in the context of a debate around $120 million supplemental to the health authority budgets.

A. Dix: It's because some of the health authority websites have the information — at least, Vancouver Island Health Authority does — and others don't, including IHA, which used to have it and took it off their website, presumably because they didn't like the results.

We're talking about the $120 million. And what did the minister say yesterday? He said: "There is a range of things that have been undertaken by the health authorities with their share of the $120 million. Examples would be improving wait times for diagnostics." That's what the debate is about.

When the minister doesn't want to answer a question or refuses to answer questions, that's fair enough if he doesn't know the answer. That's fair enough. But that's what the debate is about. He said that's what it was about. He said that's what the $120 million are for, and that's what we're here to discuss.

I think it's disappointing that we don't know or the minister doesn't know or won't divulge, as if it's some sort of state secret, what the average wait time is for people who need an MRI in the IHA or the Vancouver Coastal Health Authority or the Fraser Health Authority or the Northern Health Authority.

I think that's disappointing, but I'm not overwhelmingly disappointed, as we've been trying to get this information for some time. It was on the IHA website. It wasn't very positive for the government. It was taken off the IHA website. We did an FOI. They sent us an FOI, and then they said the FOI information they sent us was completely wrong and inadequate. Now they don't have the information at all.

[1750]

I thought that this would be a good occasion — given that in this whole estimates debate, one of the key items that's cited by the minister as to how he's spending the $120 million was MRIs — when we might get some answers to some basic questions, but that's fine. It's hard for me to be disappointed in the answers I receive here, because I've now had a few years of experience in this House.

We'll move through the health authorities and just ask some questions specific to them, as reflected in the minister's comments about what the money, this particular $120 million, would be spent on. I want to briefly ask about Langley Hospital. I think the minister was there last week. I might be wrong about that. He might have gone to Langley Hospital.

I want to ask him, because it's not one of the things cited on emergency room visits. Is he concerned with what I think Dr. Chan said was a very dramatic increase in year-over-year visits to Langley Memorial Hospital? At present this isn't a capital question.
[ Page 14015 ]

On the short-term operating side, is this an issue this year in the Fraser Health Authority — the issue at Langley Memorial Hospital — that the minister thinks should be addressed, especially given his recent experience — and might be addressed, in fact? It might be one of the things addressed, as he said, in dealing with the 3 percent increase in emergency room visits in the Fraser Health Authority.

Hon. G. Abbott: First of all, the member misconstrued my remarks in his summary around diagnostics. We have always said, through this debate, that with the $120 million we are able to expand the number of diagnostic procedures, MRI and CT scans, and that remains exactly the case. It is common sense.

It is intuitive that if you have some incremental resources that you can apply to diagnostics and apply to surgeries, then clearly there is a benefit conferred by that. That is what I've said, and I don't know how much clearer I could be about that. In fact, that's what the $120 million was used for.

I know that the member likes to disparage the Interior Health Authority and say: "They don't know what they're doing, and they can't manage their things."

Well, it's great that he says that when in fact what IHA are managing now are CT scanners in Kelowna and Kamloops, permanent MRI scanners in those centres, as well as an MRI that moves between Penticton and Cranbrook. Compare that again back to 2001 when we took office, when we had one mobile MRI scanner cruising around the province between Prince George, Kamloops and Kelowna.

It's always easy to disparage the efforts of the health authority. I think IHA is trying hard to bring their standard, in terms of presenting information around MRI and CT scans, up to probably the best standard that's put out by VIHA.

That's great. I hope they are successful in that, but they've sure got a whole lot more to work with now than they had back in 2001 when they had the one lonely MRI scanner putting on lots of highway miles, cruising between the three health facilities in the province.

I've tried as patiently as I can to say what we do in terms of monitoring the numbers of MRI scans and so on. If the member doesn't want to accept that, that's his privilege, I guess.

[1755]

I did have the opportunity to visit Langley Memorial Hospital last Friday. We had a wonderful event celebrating a major redevelopment of Langley Memorial Hospital. The entire second floor had been redeveloped in a combination of pediatric care and expanded surgical rooms as well as staff rooms and meeting rooms and other things. It's a wonderful project that was a combination of the Fraser Health Authority with funding from the province and the very community-oriented foundation and hospital auxiliary at Langley Memorial.

Dr. Chan did mention during my visit that there's fairly rapid growth in terms of the demand on the emergency department at Langley Memorial Hospital, and he indicated that he and his colleagues look forward to discussing the potential expansion of Langley Memorial's emergency department in the future. I certainly said that I welcomed that discussion as well.

We've probably got the numbers here, and I can pull them up when I respond to the member's next question, but Langley is kind of like Surrey, a rapidly growing urban area. Whenever you have the influx of new citizens and a young family area where lots of children are being born, we get population increases and, subsequently, a predicted increase in demand on ER. I look forward to working with the staff at Langley Memorial to try to meet their needs.

A. Dix: It was reported that Dr. Chan had suggested that there's a 13 percent increase year over year in visits to Langley Memorial Hospital. Is that the case? I presume that's obviously more than emergency room visits, although it would have to include a dramatic increase in emergency room visits, I would guess.

Is that reflected in the information the minister has, given that he referred to the 3 percent increase across Fraser Health? Considering that the 3 percent number includes Surrey Memorial and Royal Columbian, who take up a significant share and have increased significantly more than 3 percent, is that the case?

It may be that the minister doesn't have the information right up to date, but he probably, after that meeting, went and got the information. So perhaps the minister can tell us. That 13 percent is pretty dramatic in a year. As the people at Langley Memorial suggest, aside from population increase, which I don't think would account for 13 percent in a year-over-year number, what was involved there? That seems fairly dramatic.

Hon. G. Abbott: The information I have for Langley Memorial goes back to '03-04, when we had 38,413 visits to the ER. In '04-05 it actually dropped to 36,960. In '05-06 it dropped slightly to 36,722, and it bounced up in '06-07 to 38,100. In '07-08, which is the last year of full accounting of ED visits, it rose to 39,190. So there were approximately 1,000 more visits to the emergency department in '07-08 than there were in '06-07. The numbers are pretty big.

The '08-09 year is only partially completed, and the reporting only goes a certain ways through. It may be that there is going to be a big bump in '08-09; I don't know. Over time it has been growing, but relatively steadily, in Langley Memorial Hospital. That having been said, those are significant numbers when you get up to the 40,000 range.
[ Page 14016 ]

A. Dix: So what the minister is saying is that the 1,000 is a big increase, but it's 3 percent. It's on the Fraser Health…. Year over year it's on the average that I think he was talking about. The 1,000 on 37,000 or 38,000 would be in that neighbourhood anyway.

Is it fair to say that when the doctors at Langley Memorial were referring to that — when Dr. Chan refers to the 13 percent in year-over-year visits — it might be something more than emergency room visits? It's hard to imagine how you get to 13 percent based on a 3 percent annual growth, but I don't know what this year's figures show.

[1800]

Hon. G. Abbott: I would suppose, but only suppose. I think Dr. Chan was talking about the current situation. I think they were probably comparing the first nine months of '08-09 with the first nine months of '07-08. Likely, there had been a jump over that nine-month period. We will be watching this closely as the year is completed and watching the comparative numbers.

We've invested to date, I think, about $300 million, excluding the expansion of Surrey Memorial Hospital. Literally hundreds of millions of dollars have been expended in recent years in upgrading and expanding emergency departments, and clearly, more has to be done.

Royal Columbian, as an example, has an emergency department under enormous pressure because of the volumes that are experienced there. We try to follow closely what's occurring in emergency departments, including Langley Memorial, and if we see evidence that there are going to be long-term increases in the demand on that facility and it requires remediation to expand the capacity, then that's certainly a project we'd look at.

A. Dix: Just a question that I think we slipped by in one of our more animated sessions earlier. Whatever happened to the MASH unit that was going to be set up outside of Royal Columbian Hospital?

I know the minister relentlessly wants to stay within the scope of the supplementary estimates. It's kind of like doing figures in figure skating, the way he does that. But clearly, that emergency room, when we're talking about how the minister describes the expenditure, is central to what the minister must have been thinking of.

I want to ask the minister. An RFP was put out for the temporary facility. Then at some point it was abandoned, I think. It was urgent. There was going to be an RFP, and it was going to be in place in the fall. Then the Fraser Health Authority — and the government, presumably — abandoned that.

I think it might have been during one of those multiple questions I asked, and the minister didn't answer that question. While he's thinking about that question — I think the minister has had hours now to think of his answer — just a second question, so that we'll be able to pile them together here for the minister.

Moving to the Northern Health Authority. One of the things the minister said yesterday was very interesting. He was referring to the $5 million allocation given to the Northern Health Authority. He said they were able to address a 25.5 percent increase in ambulatory care visits.

Now, the minister explained, just a little while ago, wait-time statistics and what they were — without actually providing the statistics, which was kind of interesting, for MRIs. In this case, I just want to ask about the 25 percent increase that he refers to. Is it over one year or over several years? I think he's saying they were able to increase day care surgical cases by more than 6 percent, but that's presumably not with the $5 million.

So there are two questions for the minister, kind of in the short snapper round.

Hon. G. Abbott: I might get whiplash from how quickly we're moving geographically here. We're seeking an answer to the very appropriate question the member poses re Northern Health — trying to get further information on that.

[1805]

While we're doing that, we can utilize the time by talking a little bit about what the member referred to as the MASH unit. I know the member is an irrepressible romantic, but what Fraser Health was proposing had remarkably little comparison to what we know of as MASH units on that now famous television show of years ago. The member opposite earlier described himself as of another generation, so perhaps he did miss the MASH series.

What was proposed initially, as I understand it, by Fraser Health was a new entry area for the emergency department. They do have some issues with congestion in the emergency department. There is clearly a case for a larger remediation of that — an expansion of that facility — because of the numbers that are served at Royal Columbian. Fraser Health was trying to look for some interim solution that would provide them with some additional capacity around the entryway into the current emergency entrance to the emergency department at Royal Columbian Hospital.

My understanding — again, I'm sure I'll be advised and corrected if it's different — was that they were unsuccessful in the RFP in identifying an appropriate solution, which they had requested, and consequently have gone back to the drawing board, so to speak, on the project. I haven't a more recent update than that, but if one comes in, I will certainly share it with the member.

A. Dix: By "unsuccessful in the RFP," is the minister saying that there were no bids — is that what happened? — or that the bids they received were inadequate?
[ Page 14017 ]

Hon. G. Abbott: My understanding is that they did not receive any responses that were satisfactory from their perspective and consequently have gone in a different direction. But again, if the advice I'm providing the member, given that it's probably tangential to our broader discussion anyway…. If I get any information which is inconsistent with the information which I've provided the member, I will correct it, by writing or otherwise.

A. Dix: Just returning to the Northern Health Authority. The minister said they were attempting to address this increase in ambulatory care visits and increasing residential care hours by 2.9 percent and surgical day cases by more than 6 percent. These are three of the ways, the Minister of Health said yesterday, that the $5 million was invested.

Now, those are some expensive care items, and this is $5 million. That's not to say you can't do a lot with $5 million, because clearly you can, especially if you're one of the people who may get access to a surgery or an MRI you wouldn't otherwise get.

Clearly, when the minister said yesterday that they were able to address a 25.5 percent increase, he was presumably not saying that they were able to do that with the $5 million, only that the $5 million was part of that process. I don't need to spend a lot of time on it, but the minister may have an answer on the 25.5 percent and also, maybe, an answer on the other allocations.

[1810]

Hon. G. Abbott: We're still waiting, through the magic of BlackBerry communication, for some additional information for the member.

Just to clarify the point and allow it to keep moving along here, the $5 million figure is obviously incremental to the much larger budget that the Northern Health Authority has. As I said yesterday, the $5 million helped to address — and I listed off — the 25.5 percent increase in ambulatory care visits, the increase in day care surgical cases by more than 6 percent and the increased residential care hours by 2.9 percent. So $5 million didn't do all that, but it helped to do those things. The member understands that.

I still understand the member's question, and it's entirely appropriate. Why the 25.5 percent increase in ambulatory visits? We're still awaiting that information, and we will get it.

Perhaps this member or other members want to take advantage of the time waiting, or would you rather have a break?

A. Dix: I'm always happy to have more questions. You know, I'll try, because we're behind one, to do one at a time now, which is just a new innovation on my part as critic.

The minister cited a whole bunch of things when he talked about how the money would be spent. He didn't talk a lot about home and community care. I ask this because as I reflect through the health service plans for 2008-2009, which are three-year plans, actually…. Their details focus on 2008-2009, which is of course the fiscal year covered by the supplementary estimates, and all the service plans reflect the supplementary estimates.

When you look at home and community care going forward from this point…. For example, in the Interior Health Authority, in their budget for next year, the second year of the plan as proposed, the amount of money in the IHA actually goes down. In most of the other health authorities there are marginal increases — some less than 1 percent, some slightly more than 1 percent. From our experience in the community — and I'm sure this is the case for the minister in Salmon Arm — there's actually a lot of demand, in all kinds of ways, for home and community care.

I'm wondering, when the minister was citing through how this $120 million was spent — I think he mentioned it with respect to the Vancouver Island Health Authority but not with respect to many of the other health authorities — whether it's his view that home and community care is sufficiently funded or in fact can take a cut, or if it's his view, as it is my view, that that's an area of health care where not only is it important to invest, but it's one of the means by which we can reduce costs in acute care.

I guess I want to ask the minister specifically about what he said yesterday with respect to the Vancouver Island Health Authority and why in the other health authorities the focus was elsewhere and whether that reflects any shift on the government's part — whether it's just that there wasn't need for incremental funding in this year, using this $120 million, and that's the reason it wasn't mentioned.

[1815]

I think the concern for a lot of people who look at this area is that you have an Interior Health Authority budget in the coming year which actually sees a reduction — albeit from $142 million to $141 million, so not a giant reduction — but there is inflation, etc., in the budget.

I wanted to hear just what the minister had to say about those budgets in light of the numbers which appear in the plan.

Hon. G. Abbott: I thank the member for the question. In every budget for each of the health authorities, home and community care is divided into two parts. There's a residential portion and a community portion. In the case of Interior Health, as an example, the residential portion is up $15 million year over year, and the community is down $1 million.

I think that when the member looks at this, he should look at this as home and community care, combining those two, because I think what it would reflect in the case of Interior Health is probably their best guess about what the relative split will be in terms of people either accessing care
[ Page 14018 ]
through community care versus accessing care through residential care. Interior Health has had a number of new facilities coming on, so I'm guessing that they're thinking the relative balance is going to shift just a little bit.

Again, these are large…. We're talking hundreds of millions of dollars here, so these are just sort of modest shifts within an area of public health care delivery where there are enormous investments that have been made and are continuing to be made.

I think that the member would find it easier to understand by looking at those two combined, because I noticed myself, in terms of the other health authorities, that there are these little incremental shifts either way on community care versus residential care. In each health authority it's a little different, and I suspect it is a reflection of what they think the relative balance is in terms of people accessing community care versus residential care.

A. Dix: Well, it certainly does. That certainly may be the case. I just say to the minister that…. He's quite right. There are two lines for home and community care, the residential and community line.

I guess the question is: is it really the case, given the population of the IHA, that you can reduce the expenditure on the community side of home and community care year over year, given the evolution of the population? I would suggest that to do that would require real reductions in services, and I think the concern is, if you look at it in some ways, the community dollars. You can touch more people with those dollars.

So it's a little concerning when you see that in the IHA. Then you see, roughly, I'd say, the same balance in the other health authorities. While they don't cut the community care budget year over year, in a general sense there seems to be a shift across the health authorities away from home and community care in the community towards residential. That may just reflect increasing costs on the residential side, but surely it doesn't mean lower demand on the community side.

That's an issue to flag with the minister, and it seems like the minister is warming up for an answer to my previous question. So I'll ask him to respond to that across the health authorities — whether he actually thinks it's reasonable to cut, year over year, the community budget and home and community care.

[1820]

Hon. G. Abbott: This is back to Northern Health now and the issue of the ambulatory visits to Prince George Regional Hospital. The big shift that has occurred in PGRH, probably consistent with other facilities as well — Prince Rupert Hospital and other hospitals — is that there is much more emphasis on ambulatory care.

We see an actual reduction in the number of acute in-patient days, and it's a big number. It's 109,083 down to 102,771 — a reduction of 6,312, or a 5.8 percent reduction in in-patient days. Clearly, there has been a shift underway in Northern Health, which sees more emphasis on ambulatory or day out-patient surgeries versus in-patient days.

A. Dix: It appears that we're coming to the end of these supplementary estimates. I know the minister is shaken by that, but after my recommendation, he'll be going back to his home in Victoria and TiVoing old episodes of Matlock.

In any event, I want to thank the deputy minister and the assistant deputy minister and the staff of the Ministry of Health for their assistance through this debate. We'll have, I think, the vote coming up in a few minutes. I just want to say that I look forward, of course, to receiving the information on all of the different codes that the minister has promised to provide.

The debate about the future of our health care system — hopefully, the minister and I will be able to have it on a number of occasions in the coming months as we come forward to the election campaign. I want to thank him for participating so fully in the debate.

With that, the minister perhaps can move the appropriate motion.

Hon. G. Abbott: I want to thank the opposition Health critic and members of the House who have asked questions during the period. I want to thank the very capable staff from the Ministry of Health who have been assisting me here through the course of the supplemental estimates.

Vote 37(S): ministry operations, $120,000,000 — approved.

Hon. G. Abbott: I move that the committee rise, report resolution and ask leave to sit again.

Motion approved.

The committee rose at 6:25 p.m.

The House resumed; Mr. Speaker in the chair.

The Committee of Supply, having reported resolution, was granted leave to sit again.

Hon. G. Abbott moved adjournment of the House.

Motion approved.

Mr. Speaker: This House stands adjourned until 10 a.m. tomorrow morning.

The House adjourned at 6:26 p.m.

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