2009
Legislative Session: First Session, 39th Parliament
HOUSE BLUES
This is a DRAFT TRANSCRIPT ONLY of debate in one sitting of the Legislative Assembly of British Columbia. This transcript is subject to corrections, and will be replaced by the final, official Hansard report. Use of this transcript, other than in the legislative precinct, is not protected by parliamentary privilege, and public attribution of any of the debate as transcribed here could entail legal liability.
(HANSARD)
THURSDAY, NOVEMBER 19, 2009
The House met at 10:03 a.m.
[Mr. Speaker in the chair.]
Prayers.
Orders of the Day
Hon. M. de Jong: In Committee A, I call Committee of Supply — for the information of members, the estimates of the Ministry of Energy, Mines and Petroleum Resources — and in this chamber, Committee of Supply, the estimates of the Ministry of Health. [DRAFT TRANSCRIPT ONLY]
Committee of Supply
ESTIMATES: MINISTRY OF HEALTH SERVICES
The House in Committee of Supply (Section B); C. Trevena in the chair.
The committee met at 10:05 a.m.
On Vote 34: ministry operations, $14,008,318,000.
Hon. K. Falcon: I'm joined today by members of my staff. I'd like to take a moment to introduce them now. I'm joined by my deputy minister, John Dyble. I'm also joined by my executive financial officer, Manjit Sidhu. I'm also joined by my assistant deputy minister of health authorities, Wendy Hill, and Executive Director of Health Authorities Rebecca Harvey. [DRAFT TRANSCRIPT ONLY]
I'd also like to recognize the Ministry of Health Services staff for the excellent work that they do every day, not just the staff in the ministry but really the staff throughout all the health authorities, who each and every day, particularly now in trying circumstances dealing with the H1N1 pandemic, I think, have responded as they always do and have done an exceptional job of dealing with what has been a real challenge to the system. We could not provide any of the services that we provide without their dedication and hard work. [DRAFT TRANSCRIPT ONLY]
Just briefly, I want to touch on some of the health achievements that we're very proud of. Since 2001 we have performed thousands of more surgeries. Since 2001 we've invested over $5 billion in capital investments to expand, modernize and upgrade our hospitals and facilities. We have increased access to health professionals and doubled the number of training spaces for doctors and nurses. [DRAFT TRANSCRIPT ONLY]
What that has meant in real terms is that between 2001 and 2008, the number of doctors in the province of British Columbia has increased by 14 percent, while at the same time the population growth has increased by 7 percent. There are 22 percent more nurses practising today in British Columbia than there were in 2001. [DRAFT TRANSCRIPT ONLY]
We have supported our B.C. seniors with the addition of more than 6,000 new beds and units across the province of British Columbia to provide more and complete housing options for seniors. We've completely renovated or replaced an additional 6,000 units, which will provide a level of service and an upgrade that will more accurately reflect the reality of the care that's necessary for those in our senior population. [DRAFT TRANSCRIPT ONLY]
We're very proud of the fact — and all British Columbians, I think, are proud of the fact — that we have the most favourable cancer outcomes in North America right here in British Columbia. [DRAFT TRANSCRIPT ONLY]
So we do have an outstanding health care system in the province of British Columbia that we can all be proud of, but we also still face significant challenges in ensuring a health system that is sustainable in the long term. Total health care spending will rise this year to over $15.9 billion and to $17½ billion by 2011. That is an 87 percent increase since 2001. [DRAFT TRANSCRIPT ONLY]
What is clear is that there's not necessarily a correlation between better outcomes and more money, and I always believe that the United States is the best example of this. They certainly have the most expensive system of advanced nations in the world, but in spite of having the most expensive system, they also have some of the poorer outcomes on some of the key indicators that one would look at to determine whether the investment is achieving the results one would like to see. [DRAFT TRANSCRIPT ONLY]
So for example, on issues like life expectancy, if you look at the Organization for Economic Cooperation and Development countries, you will find that, in Canada, we rank No. 8, while in the United States, they rank 22nd. So that is a very important principle that there is not a direct correlation between the total dollars spent and the health outcomes one wishes to achieve. [DRAFT TRANSCRIPT ONLY]
It's one of the reasons why government is continuing to be committed to bringing innovation and fresh thinking to the delivery of our health care system. Innovations in areas like purchasing, for example, can play a critical role. [DRAFT TRANSCRIPT ONLY]
[1010]
So by requiring that there be a joint procurement process between all the health authorities on shared services contracts, we have already seen savings of just over $89 million over the next five years. That is $89 million that can be reinvested into providing improved care for patients. Those kinds of initiatives we are going to continue. We're also helping to make our health care dollars stretch farther and to preserve the priority health care services that patients depend on. [DRAFT TRANSCRIPT ONLY]
Innovative, rapid-access breast cancer clinics are changing the way patients access the health system and reducing wait times from referral to diagnosis. In some parts of B.C. we're redesigning the way that emergency patients are assessed and treated by directing patients with less serious needs to separate areas of the ER, which reduces wait times for all patients. [DRAFT TRANSCRIPT ONLY]
Pay-for-performance initiatives are rewarding hospitals for meeting patients needs by getting patients care faster through the emergency departments. That increases patient satisfaction, but it also improves throughput and, ultimately, the benefit that flows as a result of that to patients. [DRAFT TRANSCRIPT ONLY]
Through various investments that we've made in surgical innovation — for example, at St. Paul's Hospital — we've seen referral wait times that are down, surgeries that are up and recovery times that are shorter for patients in need of distal extremity surgeries. It's an operation that I had the opportunity to tour recently and was extremely impressed with the work that's been done. [DRAFT TRANSCRIPT ONLY]
We're looking at other ways to reduce the strain on our health system. One of the things we all recognize is that we see more chronic conditions. The cost of treating those diseases obviously costs the province and our health system billions of dollars every year. A study published in the Archives of Internal Medicine just this year found that certain factors can dramatically decrease the chances of developing chronic disease. [DRAFT TRANSCRIPT ONLY]
This is something that I am very passionate about and something that I think government really has to reflect on and drive our system to recognize the reality of what this study has determined. Essentially, it says that individuals who exercise for about 30 minutes a day, control their weight to a healthy level, don't smoke and stick to a reasonably healthy diet can reduce their chance of developing chronic disease by up to 80 percent. That is the whole range of chronic disease, from cancer to cardiac to Alzheimer's to hypertension and all of the diabetes. [DRAFT TRANSCRIPT ONLY]
All of the chronic care issues that we deal with in the health system…. Many of them can be dramatically reduced through changes in behaviour. It's something that I think we have to take serious note of and improve on some of the many initiatives that we've undertaken to try and deal with that. [DRAFT TRANSCRIPT ONLY]
A sustainable health care system is really the challenge of our current generation. As I mentioned in my opening remarks, just two years from now, in 2011, we will see total health care spending in B.C. that has increased since 2001 by 87 percent. That is not a braggart's statistic; that is a worrisome statistic in many ways. [DRAFT TRANSCRIPT ONLY]
I think we owe it to our children and our grandchildren to make sure that the excellent system of health that we have today will also be there when our children and our grandchildren grow up and have the opportunity, hopefully, to receive the same kind of excellent care that British Columbians receive today. [DRAFT TRANSCRIPT ONLY]
So with those, hopefully, brief opening remarks, I welcome any questions that the opposition Health critic or other members of the House may have in respect to the budget and programs of the Ministry of Health Services. [DRAFT TRANSCRIPT ONLY]
A. Dix: I just wanted to congratulate the new Minister of Health Services, because this is his first set of estimates, on his appointment, and the new deputy minister, Mr. Dyble and welcome him and congratulate him for this appointment. I think one of the most difficult, challenging and important jobs in government is Deputy Minister of Health. I just wanted to congratulate him. You know, the nice thing about it is you get to instruct a lot of people who are paid more than you. So it's good. [DRAFT TRANSCRIPT ONLY]
[1015]
Just for starters, just kind of a curiosity question: can the minister tell me where the B.C. family residence program is at? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: The B.C. family residence program, for the benefit of members, is essentially a travel assistance program to help children with their travel and accommodation costs for families that are required to travel for specialized medical care that's available in the Lower Mainland. This is a service that will available for families from across the province. We're working with a number of non-profit service providers right now, and we will be launching the program on April 1 of next year. [DRAFT TRANSCRIPT ONLY]
A. Dix: I just want to ask about this, because as the minister will know, the program was committed to in September 2008. It was committed to now 14 months ago by the Premier in his UBCM speech as an essential priority. Then in the budget of February 2009, and I'll just quote from the budget: "The ministry will be required...." For this year — we're talking about this fiscal year, in the budget year we're debating, because apparently the program won't be up this year. [DRAFT TRANSCRIPT ONLY]
"The ministry will be required to achieve administrative savings of $48 million, of which $35 million will be redirected to health authorities to enhance patient care and the remaining $13 million will be allocated to establish a B.C. family residence program for family members travelling to regional health centres." [DRAFT TRANSCRIPT ONLY]
I guess what I'm asking is: were those $48 million achieved? Because if the reason.... What is the reason why the government has not fulfilled its commitment — its budget commitment, the Premier's personal commitment at UBCM and its election commitment — to bring in this program this year? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: This isn't a budget issue. Actually, the budget dollars that were committed by the Premier will be there. They are there. It's really a question of making sure that, before we launch the program, we get it right. We're working with a number of service providers in terms of how best to deliver the service. Those discussions are informing us to make sure that we get the project right and make sure it meets the needs of families from across the province. [DRAFT TRANSCRIPT ONLY]
As I say, we will be launching that program on April 1 of next year, and we're very excited about getting that project underway, fully funded for the delivery and benefit of families right across the province. [DRAFT TRANSCRIPT ONLY]
A. Dix: Presumably though, given that the Premier announced it in his UBCM speech in 2008…. Then the government was very specific in its budget about the money this year and that it would be in this year's budget, and they were very specific to the number as to where the savings in the Ministry of Health would be found to pay for the program. They're very specific about that, $13 million — right? — for this year. [DRAFT TRANSCRIPT ONLY]
Let me just read to the minister from his platform, the B.C. Liberal campaign platform. By the way, this campaign platform was released at VanDusen gardens, I believe, in April, six months after the Premier announced the program — at least. Seven months after the Premier announced the program. [DRAFT TRANSCRIPT ONLY]
It said: "A B.C. Liberal government will create a new program to provide new travel and accommodation assistance to families that must travel long distances." This is a campaign commitment for this year by the government. "The new $13 million B.C. family residence program will be launched this summer to provide those families with new travel and accommodation support, starting at B.C. Children's Hospital." So that's on page 17 of the minister's election platform. [DRAFT TRANSCRIPT ONLY]
[1020]
In other words, the Premier announces it. We have a budget. They're specific as to the number in the budget — right? Then they announce, in the election campaign seven months later, that it's going to start…. In the election campaign, this was the promise they made to people in rural B.C.: "It's going to start this summer." [DRAFT TRANSCRIPT ONLY]
You know, I understand that programs are difficult to start, but presumably, when the minister and his colleagues and the Premier made this very specific commitment in the election campaign for this year, they knew all that. [DRAFT TRANSCRIPT ONLY]
I'm just curious to know when the decision was made — given the April promise that the program would be starting this summer — not to go ahead with the promise. Can the minister maybe detail for us the $13 million in savings that the Ministry of Health made in order to pay for it? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Look, Member, I'm very proud of the fact that we did make a commitment and we're delivering on that commitment. We are making sure that there will be a program in place that will serve families right across the province of British Columbia. But I'll tell you this. We're not just going to stagger forward and throw something out there without making sure that it's done properly. [DRAFT TRANSCRIPT ONLY]
I don't make apologies for that. There are logistics involved to make sure that you put the program in place so that the day it opens, it is going to be serving families appropriately and it's going to work for the benefit of families. [DRAFT TRANSCRIPT ONLY]
Sometimes we would hope that you can get those logistics worked out very quickly. Sometimes they may take longer. But I'll tell you this: it's better to make sure you get it right. I make no apologies for that. [DRAFT TRANSCRIPT ONLY]
We're keeping that commitment. On April 1 of next year, families across the province can look forward to just a fantastic program of subsidized travel and accommodation for those families that have children that are dealing with issues and complications of illnesses that need to be treated in the Lower Mainland. We're going to deliver on that. [DRAFT TRANSCRIPT ONLY]
A. Dix: The commitment was specific, and it was for this summer. So that commitment has been broken. I mean, it was. It's in the platform. I could list off probably 50 campaign websites it exists on that said they'd be starting the program this summer. [DRAFT TRANSCRIPT ONLY]
I mean, what are these logistics? Presumably, there was policy work done on this, because that's the way these things work. You know, there's a UBCM speech. It's a major policy announcement by the Premier of the province — right? — in September 2008. Then they're specific in the March budget, and they say it's for this year — $13 million for this year. Oddly, it disappears in the September budget. It's one of those things that's not there in the September budget. [DRAFT TRANSCRIPT ONLY]
So I'm just curious to know: at what point did they decide? Presumably, the minister is saying that they decided after May 12 not to go ahead in the summer, because the Premier would have informed people that he was going to change that promise if he'd made that decision before May 12. [DRAFT TRANSCRIPT ONLY]
Given that this was a platform commitment, to start this summer, I'm curious to know — because lots of people need travel right now as well — at what point did they discover…? Because what the minister is saying is that nine months into the process, they discovered that it was too complicated for the Ministry of Health to figure out this year. At what point in the process did they give up on this campaign commitment? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: I'm kind of fascinated by this line of questioning. It's interesting that during the entire decade that the member was part of a government, there was no program available whatsoever. In fact, there wasn't even a program up in northern B.C. to actually provide travel to get people back and forth to some of their scheduled medical appointments, which we now have — called Health Connections. [DRAFT TRANSCRIPT ONLY]
So you might not be surprised to find that I'm not going to take too well to a lecture about the timing of our implementing a very important program. The fact of the matter is that we're working with volunteer organizations to make sure we maximize the benefits and the service that will ultimately be delivered for the benefit of families right across the province. [DRAFT TRANSCRIPT ONLY]
It is this government that is bringing in the program. It is this Premier that announced it, this government that said we're going to do it. I make no apologies for making sure we do it correctly. I mean, I would certainly expect that British Columbians would want to make sure we do that. [DRAFT TRANSCRIPT ONLY]
One of the ways we want to make sure we do it correctly is working with volunteer organizations to maximize the benefit and the services that can be delivered to families right across the province. We don't entirely control that agenda, because we're working with volunteer organizations. [DRAFT TRANSCRIPT ONLY]
I can tell you this. When we launch this program in April of next year, it is going to be a program that, like the Health Connections program, will deliver very beneficial services for the people of this province, delivered by this government. [DRAFT TRANSCRIPT ONLY]
[1025]
Again, Member, you were involved in the last government. You had a decade to do this. I'm not sure why you decided not to. But we are actually doing that, and I'm proud of that. [DRAFT TRANSCRIPT ONLY]
A. Dix: It's not a lecture; it's a question. The minister didn't answer it. The question, precisely, is: at what point did they decide to abandon their election campaign promise to start this program in the summer? Announced in October…. [DRAFT TRANSCRIPT ONLY]
I guess the second question is, because it's very specific here: who will be funding the program when it's put in place? Will it be funded, because it's a Children's Hospital program, by Provincial Health Services Authority, or will it be funded directly by the Ministry of Health? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: It will be funded by the ministry. And as I say, we're very proud of the fact that we're going to be launching this incredibly positive program for the benefit of families across the province. [DRAFT TRANSCRIPT ONLY]
When you understand that this is added on to our Health Connections travel program…. This, to remind the member, provides $6 million annually to four health authorities to provide transportation options for rural residents. [DRAFT TRANSCRIPT ONLY]
This is part of an effort to ensure that the services that many in the Lower Mainland or on Vancouver Island take for granted are readily available and respectful of the fact that for families with young children that are ill that are having to receive medical services in the Lower Mainland, we'll have a program available for them that will subsidize travel and accommodation costs. I think it's something that is going to be a very, very good program that we're proud to deliver. [DRAFT TRANSCRIPT ONLY]
Again, I know the member is excited about the fact that…. Why didn't it launch immediately? Well, because to do so would have been irresponsible. We want to make sure we launch the program, make sure that we do our homework, that we work with the volunteer organizations to ensure that we maximize the benefits and the service that will be available to families that will utilize the program. [DRAFT TRANSCRIPT ONLY]
A. Dix: Well, you know, somebody is going to be disappointed with the minister calling a specific campaign pledge on timing irresponsible. But this question doesn't come from me. It comes from his platform, his commitment to British Columbians. [DRAFT TRANSCRIPT ONLY]
Just with respect to the money. So $13 million — is that annual funding from the Ministry of Health? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: The answer is yes. That is our estimate of the annualized cost. [DRAFT TRANSCRIPT ONLY]
A. Dix: It was suggested this year that the ministry was going to save — and this was a budget commitment by the ministry — $13 million this year. So is the money going to be forwarded prior to — in this budget year? [DRAFT TRANSCRIPT ONLY]
In other words, when the ministry made its commitment in the February budget commitment this year…. They're talking about this year's budget, the one we're debating in this Legislature — or at least its predecessor document, you understand. [DRAFT TRANSCRIPT ONLY]
"The ministry will be required to achieve administrative savings, and that $13 million will be allocated to establish a B.C. family residence program for family members." Is it the case that the administrative savings were…? They went ahead with those because those didn't involve any consultation with non-profit organizations — right? [DRAFT TRANSCRIPT ONLY]
Did they take the $13 million? Did they put it away in this year's budget? Did they save the money, put it away, and are they providing it for this program in advance of April 1, 2010? I'm just trying to establish when the program will start. The minister made a commitment to make these administrative savings, and I'm just trying to establish where those are. [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: The member should know that I think it's a responsibility of government to constantly be doing everything it can to try and generate administrative savings. We always must be challenging ourselves to try and do more with the dollars that we have available. [DRAFT TRANSCRIPT ONLY]
We start from that position that we have a responsibility to try and do better with the dollars we have. There are massive amounts of dollars — I enunciated those in my opening comments — that are going into the health system. I can tell you this. We have got to challenge ourselves and challenge the health authorities all the time to make sure that even with the dramatic increases in budget lifts that they're receiving…. There are always demands. You know, in the health system there will never be any shortage of demands, but we will be challenging them to try and do more with the dollars they have available. [DRAFT TRANSCRIPT ONLY]
As I mentioned, this is a $13 million annualized program. We have the dollars available for the program. The program will launch on April 1. The moment that program launches, the dollars are there, and we will continue to fund that into the future. [DRAFT TRANSCRIPT ONLY]
[1030]
A. Dix: The minister again didn't answer my question, so I just wanted to ask it again, and maybe be more precise. Perhaps it's the case that I wasn't sufficiently clear, and that's the reason he didn't answer that question. That's at least in the range of possibilities. [DRAFT TRANSCRIPT ONLY]
The February budget, which the government campaigned on, said that the ministry will be required to achieve administrative savings of $48 million, and $13 million of those would be applied to this program in this fiscal year. Can the minister detail what those $48 million in savings were? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Of the $48 million in savings the member itemized, $35 million of those savings that we've generated we have forwarded to the health authorities in additional funding, and $13 million is available to fund this program once this program begins on April 1. [DRAFT TRANSCRIPT ONLY]
A. Dix: That $13 million — that's why I asked the minister this precise question. Is the $13 million in this year's budget or next year's budget? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: We've got the dollars in savings this year, but the program doesn't actually start until April 1 of next year. [DRAFT TRANSCRIPT ONLY]
A. Dix: Are the dollars being put into a special account for next year's first-year operating cost launch, or will they come out of the ministry vote next year? That's the question. Apparently, the savings were found this year — the $13 million savings. So what happens to that $13 million in savings, in fact? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: There will be some expenditures undertaken this year — things like making sure there are specialized motor coaches purchased, etc. But the balance of the savings that we have generated for this year will be utilized to manage pressures. [DRAFT TRANSCRIPT ONLY]
Next year on April 1, when the program is up and running, they will get the full $13 million necessary to get the program operational — except, of course, for some of the sunk dollars that we put into it now to ensure that it's going to be up and running April 1. [DRAFT TRANSCRIPT ONLY]
A. Dix: Just to finish on this. This is presumably why, in the September budget, this requirement for the ministry to save this money was deleted. The ministry discovered at that time that the government wasn't going to follow the commitment. [DRAFT TRANSCRIPT ONLY]
[1035]
I just want to ask the minister to detail what those $48 million in savings were. I'm sorry — to the minister. I know this is a ministry matter, so we can also defer it until later, because we're going to go to the health authorities in a second. [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: The main savings were realized through reductions in budget as a result of a recruitment lag; reductions in travel budgets, contracting services — both professional and IT — and office and business expenses. These are the areas that were administratively reduced to help meet those targets. [DRAFT TRANSCRIPT ONLY]
A. Dix: This is just out of curiosity, because the minister is so ably assisted. What's the total travel budget for the ministry? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: The total budget is $3.3 million. [DRAFT TRANSCRIPT ONLY]
A. Dix: Presuming there's still travel going on and even though the minister mentioned travel first, I'm guessing that if you're trying to find $48 million in savings, the $3.3 million line item is not the first or the majority or even anything more than a puny percentage of those actual savings. In any event, these savings always appear to be somewhat mythical. [DRAFT TRANSCRIPT ONLY]
We'll move on to something else, with respect to the health authorities. The minister will know that since the election, the government has made the decision to proceed with the harmonization of sales taxes. All of those questions and the detailed questions about the HST, of course, will be appropriately asked to the Ministry of Finance, but there are a couple of detailed questions around things that are specific expenditures of the Ministry of Health. [DRAFT TRANSCRIPT ONLY]
Principally, I would like to ask the minister whether the Ministry of Health has met with health authorities about the consequences on their budgets in this year. Have they met with health authorities? Have they done a report as to the cost of the HST to health authorities this year, and have they met with health authorities about that cost? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: There is no cost impact in '09-10. Of course, the HST would be implemented on July 1 of next year. We are working with the health authorities and with the Ministry of Finance to determine what the possible policy impacts of HST would be. Obviously, Finance takes a big lead on that, but we're working with the health authorities now to try and determine what that would be. Then we would have a discussion with Finance in terms of what measures, if any, Finance may or may not take in terms of remediating whatever the impacts may or may not be. [DRAFT TRANSCRIPT ONLY]
[1040]
A. Dix: Was a report or an estimate shared with the health authorities by the Ministry of Health with respect to the cost to health authorities of the HST in the coming years? Remember that the report would be generated in the money spent in this year's estimates, including the money, staff time and so on of the Ministry of Health. [DRAFT TRANSCRIPT ONLY]
Has an estimate been shared with the health authorities around the overall cost of the HST? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: I'm not sure what report, actually, the member is referring to. There is no official report that I am aware of. I know there's work being done. The health authorities are doing some work to try and determine, from their perspective, what they think the impact is likely to be. [DRAFT TRANSCRIPT ONLY]
As they develop that information, we will certainly aggregate that and share that with the Ministry of Finance, which is the lead ministry on this. The Ministry of Finance will consider that as part of all the submissions they'll be receiving from different groups — from education, health care, etc., — and then make policy decisions on how they wish to deal with it. [DRAFT TRANSCRIPT ONLY]
A. Dix: Just to be precise, then. This work being generated in using the moneys paid for in this year's vote of the Ministry of Health, and then it's a vote assigned to the health authorities…. What is the best estimate on the cost of the HST as reflected in those reports? Presumably, we're well along in the process now, and these are empirical questions that you can find answers to. [DRAFT TRANSCRIPT ONLY]
What estimate is there of the net cost of the HST on the health authorities in the short year, which would be 2010-11, and the following year, which is 2011-12? Given the work that's been done, what's the best estimate of the net cost to the health authorities of the HST? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: I'm informed by staff that they're not aware of a report yet because the work is still ongoing. Really, what is happening is that as they work through to try and figure out what the impacts may or may not be in terms of the health authorities…. They're currently working on that and trying to generate that information. Then we will share that information with the Ministry of Finance. The Ministry of Finance, as they're working through their policy decisions around the HST, will be informed by the different sectors, including health care. [DRAFT TRANSCRIPT ONLY]
But that work is not yet complete. I'm told that they're still generating and working on that effort, at least at the health authority level, which will ultimately be shared with the ministry. [DRAFT TRANSCRIPT ONLY]
A. Dix: Just to be precise, then. Presumably, this work has been done, even if there isn't a final report. We're living in an age of draft reports. You know, "draft" remains on reports for a long time. I think it has something to do with freedom of information and privacy. [DRAFT TRANSCRIPT ONLY]
I guess my question to the minister is: is it the case that at meetings involving his staff and the health authorities, there's an estimate for 2010-11 — generated, again, by the vote in this fiscal year — of between $35 million and $40 million net impact of the HST on health authorities? Is it the case that that annualized would be between $50 million and $60 million? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Staff advise me that it's very, very difficult to make that quantification, because the Ministry of Finance ultimately has to make policy decisions about how the HST will be applied. There's a theoretical exercise you can go through, and I think that's what the health authorities are likely working on. But again, we could not even responsibly say what we think the impacts may or may not be without knowing from the lead ministry and the minister, the Minister of Finance, what policy decisions they're going to make in terms of the application of HST. [DRAFT TRANSCRIPT ONLY]
That work, I'm led to understand, is still ongoing. The Ministry of Finance is working their way through that. Obviously, once the Ministry of Finance is fully informed and has listened to all the different stakeholders, it will make some final decisions on the policy application of HST. Then we will be far better able to share that with the member opposite. [DRAFT TRANSCRIPT ONLY]
[1045]
A. Dix: Presumably, estimates have been made, because we're talking about this process now. As the minister will know, this process now, because of changes made in the health authority budget submission process…. I mean, the Health Ministry and the health authorities are already presenting their budget to the government for next fiscal year. That's what they're working on. They're using this year's dollars to prepare the budget for next year. That's the planning process that the minister is all too familiar with. [DRAFT TRANSCRIPT ONLY]
I'm asking what the estimate is now. What has been produced in this fiscal year — what estimates to guide the health authorities as they prepare budgets and present them to Treasury Board, which they now have to do for next year? This isn't about care providers or all that stuff. We'll talk about that and the impact on long-term care later. What estimates have been made this year? [DRAFT TRANSCRIPT ONLY]
Is it accurate to say it's between $35 million and $40 million next year and $53 million annualized? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: The member knows me well enough to know that I'm certainly not one to skirt answers. I always give the answers if I have the information, but I'm responsible about it. I just don't have the answer for the member. Not that I don't want to give an answer, but as I said, what I do know is that there's no impact on this year's budget, on which we're here debating the estimates. [DRAFT TRANSCRIPT ONLY]
I also know that the member is right to point out that there's a planning process underway in the Ministry of Finance. I honestly believe that's probably a question for the member to direct to the Minister of Finance in the Ministry of Finance estimates, because that is a policy process and a planning process that they're currently going through. [DRAFT TRANSCRIPT ONLY]
I can't speculate on what the impact will be next year until we have some clear direction from the Ministry of Finance in terms of how they're going to resolve the different policy issues they're no doubt studying right now. [DRAFT TRANSCRIPT ONLY]
A. Dix: Would the minister endeavour — I know he desperately wants to answer this question — to ask the health authorities what their best estimate right now is — we've got several days — on the impact of the HST on them from the work they're doing now and report to the House during these estimates? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: The health authorities, of course.... The decisions they make and the planning processes they would make for future budget would be predicated on the policy decisions made by the Minister of Finance and the Ministry of Finance. Prior to having that information, Member, it is a theoretical exercise really and truly. [DRAFT TRANSCRIPT ONLY]
Even given that we would all like answers to everything right away, I do think in fairness that is a question that is best directed to the Minister of Finance. In the Ministry of Finance they will, as they work through that planning process, no doubt come up with some direction that will help inform the health authorities to then better understand what the impacts may or may not be. [DRAFT TRANSCRIPT ONLY]
Without having that information, I'm not sure what exercise we could ask them to do, because it would be merely theoretical and speculative. [DRAFT TRANSCRIPT ONLY]
The Chair: I would like to remind the member that in most other estimates debates, questions about the HST have been deferred to the Ministry of Finance. [DRAFT TRANSCRIPT ONLY]
A. Dix: That's right, so I'm specifically asking about the money spent by the health authorities to estimate the impact of the HST on them this year. I'm just asking if the minister could bring that information back to the House. [DRAFT TRANSCRIPT ONLY]
I wanted to ask the minister, because he mentioned in his opening statement the issue of shared services, what he believes….This is obviously in more than a planning process, any new future Shared Services organization.... What impact would the HST have on that planning process? [DRAFT TRANSCRIPT ONLY]
Is it in fact the case that the HST might well change the organizational expression of the Shared Services organization? Effectively, is the ministry not constrained by the HST to bring that, in a fashion, in-house to the health authorities and exclude options that might make it external to the health authorities — if he understands that question? [DRAFT TRANSCRIPT ONLY]
Has the HST decision by the government affected the Shared Services organization decision? [DRAFT TRANSCRIPT ONLY]
[1050]
Hon. K. Falcon: Again, I think that's an interesting theoretical question and actually an important one. I don't want to minimize that. Again, it is something that the Ministry of Finance, in determining how they are going to apply policy direction on the HST — what is going to be included and not included in the HST determinations — would allow me to answer that question…. But I don't have that information. I do think it would be a good question for the Minister of Finance. [DRAFT TRANSCRIPT ONLY]
A. Dix: But the question for the Minister of Health is in terms of the development of the Shared Services organization, which is something he mentioned in his opening statement and is a key priority of the Ministry of Health in their service plan and the service plans of the health authorities. Is the Minister of Health waiting for those policy directions in developing the Shared Services organization? I'll put the question the other way. [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: I was just checking to make sure I heard the member's question right. I'll rephrase it to make sure I'm getting this right, because I don't want to put words in the member's mouth. He's saying: "Is the HST going to impact what the structure of the Shared Services organization may ultimately look like?" The answer to that is that in some ways, it will depend on what information we are informed of by the Minister of Finance in terms of the rules they are going to apply and the policy decisions they make around application of the HST. [DRAFT TRANSCRIPT ONLY]
Until we get through the planning process…. My staff advised me that we would not be able to make that determination now, because we're working in the planning process with the Ministry of Finance. [DRAFT TRANSCRIPT ONLY]
A. Dix: But the minister is also working on the Shared Services organization, I presume. Is the minister saying — because I think his answer to the question was yes — that they're going to have to wait for that information from the Ministry of Finance before they make their decisions in the Ministry of Health about the Shared Services organization? It's those latter questions that I want to ask. [DRAFT TRANSCRIPT ONLY]
It seems to me that the answer he's saying is yes — that until there's clarification on that…. You know, there are all kinds of versions of a shared services organization that in effect might…. Presumably, these are services right now, because they tend to be in-house services of a health authority in which no such tax is paid — they're in-house services — or at least not the services tax on them. Presumably, he's saying there's a delay in that development until those decisions come forward. [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Thank you to the member for clarifying a little bit what he's looking for. I think the short answer is yes, we're still moving forward with the Shared Services organization. To be honest, it wasn't a great surprise to me. But there was a lot of pleasant surprise amongst the health authorities on the handful of products that they've already gone out for in terms of joint procurement — realized savings to the tune of just over $89 million over a five-year period. [DRAFT TRANSCRIPT ONLY]
Of course, the Shared Services organization was predicated on a business plan that suggested there could potentially be savings in the $150 million range over a five-year period. The very fact that they are already well past the halfway mark on the first bundle of services that they jointly procured suggests the enormous benefits that can be derived from the organization. So it will continue to move forward. [DRAFT TRANSCRIPT ONLY]
[1055]
What will the implications of HST be? The member is correct to point out that there will presumably be some, but until the Finance Ministry concludes the planning process and policy development around that, I wouldn't be able to itemize that. But I will be able to say with great confidence to the member that regardless of how all of that policy development unfolds, we absolutely remain committed to the shared services model and moving forward with the shared services model. [DRAFT TRANSCRIPT ONLY]
A. Dix: We won't belabour it, because I don't think the minister is going to answer it. Which shared services model? I think that was the question. You can call any model a shared services model, I guess, but it really depends on how you want to structure it. [DRAFT TRANSCRIPT ONLY]
I think that's a reasonable question, but we'll move on because I don't want to get stuck with the minister. It's our first time together in estimates, you know. We want to move the debate forward. [DRAFT TRANSCRIPT ONLY]
I just want to ask the minister in terms of this year because, of course, we're talking about this year's budget. What is the percentage lift of the Fraser Health Authority this year as compared to last year's income from provincial government sources? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: This year the percentage budget lift for Fraser Health is 4.9 percent. Last year the percentage increase for Fraser Health was 8.9 percent. The difference is primarily being driven by the fact that last year the Abbotsford Regional Hospital and Cancer Centre came on line. That was the first new regional hospital and cancer care centre in 35 years in the province of British Columbia, something of which we're very proud. [DRAFT TRANSCRIPT ONLY]
A. Dix: So the chair of the Fraser Health Authority was wrong when he said that the lift was in fact 2.9 percent this year. In fact, if you look at the health service plan, the lift is 2.9 percent. Just to share this with the minister…. The actuals in 2008-2009 in the service plan are $2.270 billion. The budget this year is $2.338 billion, so that's a 2.9 percent lift. [DRAFT TRANSCRIPT ONLY]
It's not my mathematics. It's the chair of the board of the Fraser Health Authority who disagrees with what the minister just said. In fact, there's no real disagreement. It's 2.9 percent. [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: We are calculating, of course, based on base budget one year to base budget the next year. It's in the blue book. The numbers are very clear. [DRAFT TRANSCRIPT ONLY]
I suspect what the chair was probably referring to is that there were one-time dollars that the health authorities received last year. He's probably calculating those one-time dollars and making that part of the base budget calculation. It would be easy to make that calculation, I suppose. But base budget to base budget is 4.9 percent. [DRAFT TRANSCRIPT ONLY]
[1100]
A. Dix: The minister is…. The service plans that presumably he approved, which came forward to him…. Presumably, the minister approves the service plan. The service plan gives last year's actuals and this year's budget, and they say it's a 2.9 percent lift. It says so not somewhere else in the service plan, but on the front page of the service plan, in the letter from the chair of the board of the Fraser Health Authority. It says it's 2.9 percent. So, you know, it's the way it goes. [DRAFT TRANSCRIPT ONLY]
With all of that allocation in 2008-2009, the health authority and, cumulatively, the health authorities ran deficits. If you add the two that ran deficits, which are higher than the four that just barely balanced, it's a cumulative deficit amongst the health authorities — right? [DRAFT TRANSCRIPT ONLY]
With all of that money, all of the actual allocations from the Ministry of Health last year, the Fraser Health Authority, essentially, was right on the number. So when you remove some of that money, obviously you're starting from behind. That number — you add 2.9 percent, and that's what it is. [DRAFT TRANSCRIPT ONLY]
I guess I'll just ask the minister, then, the same question for the Vancouver Coastal Health Authority, and I'll give him a little hint. The number that I think he'll come up with, because it's the one that's in their service plan which the minister approves, is 2.4 percent. [DRAFT TRANSCRIPT ONLY]
What does he suggest? These are the dollars that they actually have to work with and the increases they actually have to work with. Does he not agree with me that the actual increase, as found in the service plan documents for the Vancouver Coastal Health Authority, is 2.4 percent? [DRAFT TRANSCRIPT ONLY]
[L. Reid in the chair.]
Hon. K. Falcon: The lift for Vancouver Coastal was 4.3 percent year over year. Again, that's base budget from one year to base budget the next year. Same thing, just to the member's previous answer. [DRAFT TRANSCRIPT ONLY]
I want to emphasize to the member that you do not include, nor do we include, one-time funding that was provided partway through the year to the health authorities as part of their base budget. It is not part of their base budget. [DRAFT TRANSCRIPT ONLY]
They or he may try and consider that it is, but I can tell you that is one-time funding, as I say, added partway through the year to provide for the health authorities, to allow them the opportunity to do one-off initiatives that can provide some improvements to the health system. It's up to them to figure out what to do with that. [DRAFT TRANSCRIPT ONLY]
But the base budget lifts for both the Fraser Health and Vancouver Coastal are base budget lifts from last year's base budget to this year's base budget. [DRAFT TRANSCRIPT ONLY]
A. Dix: The minister simply needs to talk to the health authorities about that. They're the ones, in the service plans that he approved, that put the numbers — last year's actuals and this year's budget. They're the ones that tell us what the actual budget increase is. [DRAFT TRANSCRIPT ONLY]
Remember, with that money last year, in the case of Vancouver Coastal Health, and the minister will agree with me, for the third consecutive time they ran a deficit. [DRAFT TRANSCRIPT ONLY]
I won't have this discussion, because it was a little bit like a Beckett play we used to have with the previous Minister of Health, where we'd say: "Are they allowed to run the budget deficits?" "No." "They are running budget deficits." "Yes." "Are they allowed to run budget deficits?" "No." [DRAFT TRANSCRIPT ONLY]
We won't go through that, but it's the case that with the one-time funding, they still ran an $11 million deficit. If you look at last year's spending as compared to this year's allocation, it's probably even less than 2.4 percent. [DRAFT TRANSCRIPT ONLY]
But does the minister agree that if you take those numbers — and they're right here in his document — between last year's actuals and this year's budget, the increase for Vancouver Coastal Health is 2.4 percent? [DRAFT TRANSCRIPT ONLY]
[1105]
Hon. K. Falcon: Look, I know the member's going to want to try and convince himself that regardless of what it says in the blue book in terms of what the budget increases are for the health authorities, it's somewhat different. It's not. The fact of the matter is that the budget lifts are exactly what they say in the blue book. [DRAFT TRANSCRIPT ONLY]
For Vancouver Coastal, as I mentioned, year over year, base budget over base budget was a 4.3 percent lift. I will also say with respect to the health authorities that it is the position of this minister that health authorities will live within their budgets and they will balance their budgets. [DRAFT TRANSCRIPT ONLY]
It is a position of the Finance Minister, no doubt, and also government that even in an era where almost a 20 percent budget increase, in operating dollars only, over the next three years is still having a system say to us, "We would like more, please," we are saying, "No, we actually expect you to live within that almost 20 percent budget increase over the next three years," particularly given that we find ourselves in an economic environment where we have seen the most difficult economic drop-off in 30 years, not just in British Columbia but in Canada and indeed around the world. [DRAFT TRANSCRIPT ONLY]
I recognize that that requires the health authorities to really look hard at what services they are providing. Are the services direct services that are providing patient care? Do they have to think about doing things differently? [DRAFT TRANSCRIPT ONLY]
The shared services model we touched on just a moment ago was a very good example of that, where we say: "No, actually, instead of you all sort of doing your own joint procurement with your own departments doing procurement, we're going to have you work together as one organization, do those procurements jointly." The savings that have been realized, almost $90 million, will be utilized back into the system to provide direct care. [DRAFT TRANSCRIPT ONLY]
That is the obligation that we are putting onto the health authorities and ourselves. I think it's the right thing to do. I do think that in an era where a 20 percent budget increase is still a challenge for us as a society, it really requires us to say how we are going to do more with the current dollars that we have in the system, billions and billions of dollars by 2011, as I mentioned to the member in my opening remarks — an 87 percent increase in health dollars from 2001, when I was first elected as a member of this government. [DRAFT TRANSCRIPT ONLY]
I know the member would agree. We both routinely look at the system south of the border and shake our heads in the sense that it is the most expensive system. They spend the most dollars, there's no question, but I would not agree that they get the same outcomes that we see here in British Columbia and in Canada. [DRAFT TRANSCRIPT ONLY]
A. Dix: Of course, the reason is that they actually get.... It's right here in the budget presented by the Ministry of Health and released by the Ministry of Health. The Vancouver Coastal Health Authority had a 2.4 percent lift. Now, the minister will know that in 2008-2009, in those service plans, which were, oddly, more fulsome than the service plans presented by this minister — I guess it's innovative to provide less information — in all of those service plans, all of those health authorities stated that there would be a shortfall this year. [DRAFT TRANSCRIPT ONLY]
All of them stated that except the IHA, I think, which didn't state that. They implied it, but they didn't add the number in. In the case of the Fraser Health Authority, for example, I think they said the shortfall would be $98 million this year. So one is perplexed a little bit about the way the government manages these things, because the government was informed in March 2008 that the health authorities would have significant shortfalls, and they made seemingly no effort to address that until this summer, when major cuts started to take place. [DRAFT TRANSCRIPT ONLY]
Can the minister take me through that process? Fraser Health, for example, was $98 million short. I think Vancouver Coastal Health was $78 million short — in that range. Vancouver Island in 2008-2009 told the Ministry of Health it would be $52 million short this year. So that would imply some action. [DRAFT TRANSCRIPT ONLY]
Instead, what happened was, including cuts to services, which, of course, have happened since then…. But they started happening only this fall. They didn't start happening when you would expect them to happen after one year of warning at the beginning of the fiscal year. [DRAFT TRANSCRIPT ONLY]
[1110]
So they were made more extreme or more intense, if you will, by the fact that the government seemed to take no action and was denying that those cuts were going to come in March, prior to the election. I won't bore the minister with the dozens of quotes from his predecessor saying there would be no cuts in services. [DRAFT TRANSCRIPT ONLY]
But the government was aware in 2008-2009 of these shortfalls. What action was taken in order to deal with those shortfalls in advance of the fiscal year? They were clearly aware of…. I mean, it's on paper. [DRAFT TRANSCRIPT ONLY]
I know that the minister doesn't count the numbers that exist in the health service plan when he's calculating the budgets and so on, but they are official documents of the health authorities. They do have a purpose in the process, and they are on his ministry website. Maybe he might comment on what steps were taken. [DRAFT TRANSCRIPT ONLY]
My understanding of the process is that they told the ministry 18 months ago that there was a big shortfall. Then they went to Treasury Board because there was a new process set up by the former Minister of Finance, the former member for Vancouver-Langara for the health authorities to come there and then to deal with some of these matters because of her frustration with it. So I wanted to ask the minister what steps were taken, because this shortfall was coming from a long way off. [DRAFT TRANSCRIPT ONLY]
I guess the final thing I'd point out to him on deficits…. He may say that the health authorities aren't going to run a deficit. The health authorities haven't run cumulative surpluses since 2005-2006. It's something to say it; it's another to do it. [DRAFT TRANSCRIPT ONLY]
I would ask the minister specifically: what happened when the health service plans came in '08-09 for this year saying that there was a big shortfall, and why was it the case that nothing happened? No action was taken on that until July 2009. [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: I've listened to this line of reasoning from the member for some time now. The member has gone around trying to say that before the election there was no talk about this. No one knew that there were going to be any pressures on the system, and oh, big surprise after the election, suddenly there were. [DRAFT TRANSCRIPT ONLY]
That's actually not the case at all. Page 45 of the budget in February of 2008 very clearly pointed out that there was a 3½ percent pressure that the health authorities were going to have to manage. A 3½ percent pressure is about $360 million. That is about as upfront as you can make it, Member. It's right there in the budget for everyone to read. [DRAFT TRANSCRIPT ONLY]
What we have said to the health authorities is: given the fact that over the next three years we will be increasing your budgets by almost 20 percent…. [DRAFT TRANSCRIPT ONLY]
We made a conscious decision in government. In spite of the fact that we faced one of the most serious economic declines that we've seen in a generation in the province of British Columbia, we made a decision — a pointed, very clear decision as a government — that we were going to focus our dollars on health care and education. In health care we said to the authorities that although over the next three years…. [DRAFT TRANSCRIPT ONLY]
The member knows that the CEOs from all the authorities have acknowledged that they are receiving dramatic increases, but in spite of that, there are still pressures. There's never been any mystery about the fact that there have been pressures. As I say, on page 45 of that February budget, it pointed out: "We have pressures. They are 3½ percent of our budgets." [DRAFT TRANSCRIPT ONLY]
It would appear to be…. No, I don't want to put words in the member's mouth. I don't think the member is saying that government should just provide that additional 3½ percent without asking any question or without asking them to do anything differently. [DRAFT TRANSCRIPT ONLY]
What we have said to them is: "We want you to manage that." If a 20 percent budget increase just in operating funds…. I want to emphasize that, because capital is a whole different thing. That's another almost $2.9 billion over the next three years, a record level of capital that will also be going into the health system. [DRAFT TRANSCRIPT ONLY]
There's almost $3 billion in capital, a $2.4 billion increase in operating over the next three years — almost $5½ billion new dollars, additional dollars, into the health system — and there are still pressures. So we have said to the health authorities: "Given that we are in the midst of the worst economic downturn in a generation, we are asking you to manage 3½ percent of your budget." [DRAFT TRANSCRIPT ONLY]
Now, I can tell you that there are a lot of businesses and small businesses and families that…. To manage 3½ percent of their budgets would be a treat, to be honest with you. That doesn't mean it is easy. It is not easy. It is difficult. [DRAFT TRANSCRIPT ONLY]
In fact, I commend the health authorities. I think they are doing an exceptional job, and I want to say that on the record here today. They are doing an exceptional job of managing that pressure within their budgets, even with the almost 20 percent budget lifts. [DRAFT TRANSCRIPT ONLY]
You know, Member, we were as upfront about it as you could…. I don't know how more upfront you can be than having it right in a budget that is presented in the Legislature and is there for the world to see. We couldn't have been more upfront about it. [DRAFT TRANSCRIPT ONLY]
[1115]
We've said to the health authorities that they will have to manage that 3½ percent pressure and stay within the budget increases we've provided them. That's what they're doing. [DRAFT TRANSCRIPT ONLY]
A. Dix: On the day the budget came out, I did a press release about page 45 of the budget. I'm well aware of page 45 of the budget. What we're talking about are the consequences of that. [DRAFT TRANSCRIPT ONLY]
The consequences have been…. The predecessor Minister of Health and the B.C. Liberal Premier and the government explicitly denied before the election…. Not just them but Mr. Waldner, Mr. Ramsden, Dr. Murray and others explicitly denied that there would be cuts in surgeries, cuts in MRIs, cuts in seniors programs and so on. What have there been? There have been cuts in surgeries, in MRIs and in seniors programs. [DRAFT TRANSCRIPT ONLY]
The day that budget came out, I raised this issue of the shortfall. I said that there would be cuts in services, and the government explicitly denied it. What I'm asking is that if they knew it was coming…. They had the budget, and they prepared the three years. The government knew it was coming. The Treasury Board knew it was coming. [DRAFT TRANSCRIPT ONLY]
There wasn't going to be any relief in this fiscal year, as there had presumably been in the last fiscal year. The government and the minister were talking about the increase — that Vancouver Coastal Health was going to have to live within a 2.4 percent increase, given collective agreements, some of which are in the 4 to 5 percent range. [DRAFT TRANSCRIPT ONLY]
If they were going to live with that, why wasn't it the case that the government presented a plan and the health authorities presented a plan so that they dealt with those shortfalls in February, March and April? Why were they instructed — because they were instructed — not to provide their plans to the government until on or around or just after May 12, 2009? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Again, in the February budget it stated very clearly that there was a 3½ percent pressure on their budgets that would have to be managed. I don't know how much more clear that can possibly be. The member is wrong to mention Vancouver Coastal's 2.4 percent increase. It's 4.3 percent; I pointed that out. The member can go to the blue book, and he can look at it. [DRAFT TRANSCRIPT ONLY]
He can try and pretend the blue book doesn't exist and try and pretend that it doesn't actually say 4.3 percent, base budget over base budget, but it does. That is an increase. So the member now is exercised, apparently, by the fact that we have said to the health authorities: "We expect you to manage that 3½ percent pressure." [DRAFT TRANSCRIPT ONLY]
Well, you know, Member, you're right. We just went through an election campaign. Member, I recall that in your budget in the election campaign, you added $100 million to our budget. I'm sitting here doing the math, saying: "Okay, so the NDP also knew there was a 3½ percent pressure." The critic goes around bragging about how he secretly knew that, even though it was in the budget on page 45, but put that aside for the moment. [DRAFT TRANSCRIPT ONLY]
Knowing that there was a $360 million pressure, I am interested in the fact that the NDP only added $100 million to the budget for this year in their election platform. Member, maybe you can tell me where you were going to find the $260 million worth of savings. What were you going to do differently in the health care system should you have — and thankfully you didn't — formed a government? [DRAFT TRANSCRIPT ONLY]
I can tell you what this government said. We said: "With a 20 percent budget increase over the next three years, just in operating dollars, we are asking the health authorities, in the midst of one of the worst economic declines we've seen in a generation, to manage that pressure." [DRAFT TRANSCRIPT ONLY]
Is that an easy thing to do? No, it isn't an easy thing to do — just like it is not easy for families to manage in challenging times or for small businesses to manage in challenging times or even, in some cases, for big businesses to manage in challenging times. But that's what we've asked them to do. Does that mean they have to do things differently? It does. [DRAFT TRANSCRIPT ONLY]
The NDP and the critic have opposed every single one of those initiatives that we have asked the health authorities to try and do, to better manage the existing dollars they get. I just gave an example, on the shared services side, where savings of almost $90 million have been realized by them joint purchasing on their shared services organization. [DRAFT TRANSCRIPT ONLY]
That is actually a change. That is something that was driven by government saying: "We expect you to do different, because the taxpayers do not have an unlimited capacity to fund every increase that is desired in the health authorities." [DRAFT TRANSCRIPT ONLY]
That is not easy, but I think we owe it to the public. I can tell you that when I speak to the public or front-line workers or go tour hospitals, I always hear about how there are ways that things can be done better. Many of those very good ideas can actually come from workers in the front lines of the system. [DRAFT TRANSCRIPT ONLY]
[1120]
We have to listen to that. We have to say: "We will support you when you try to manage the dollars that we're providing you — even the increased dollars we're providing you — to ensure that they go further, to ensure we try to maximize the services and the dollars that are being put into the system." Dollars which, by the way…. There's no such thing as government money, I like to remind people. There's only the money that we take from taxpayers and that we then spend on behalf of taxpayers. [DRAFT TRANSCRIPT ONLY]
When taxpayers have provided us dollars that allow us to increase the health budget by almost 20 percent over the next three years — just in operating dollars, not including capital increases — then I think we owe it to the public, to those taxpayers that work hard to generate those dollars, to make sure we do everything we can to maximize the benefit of those dollars in the system, to make sure we do everything we can to ensure the system is sustainable. That's what we're trying to do, and that's what the health authorities, I believe, are doing very successfully under difficult and trying circumstances. They're doing a very good job. [DRAFT TRANSCRIPT ONLY]
A. Dix: So the minister has decided that the audited statements of the health authorities don't matter, that the service plans of the health authorities don't matter, that the actual increases they get don't matter. He's just going to ignore the fact that Vancouver Coastal Health got 2.4 percent, and Fraser Health — not according to me, according to Fraser Health — got 2.9 percent this year. He's just going to ignore that. [DRAFT TRANSCRIPT ONLY]
I have a strange thing, but I don't think even if I asked the question one more time that he would acknowledge the facts that he himself has presented to this Legislature. So I don't think we'll do that. [DRAFT TRANSCRIPT ONLY]
I think I'll ask the minister another question. That question is: why is it the case that those health service plans — the same health service plans that say he's giving Vancouver Coastal Health 2.4 percent, Fraser Health 2.9 percent — have dramatically fewer performance targets this year than they did two years ago? Why is it that the minister thinks it's innovative in health care to tell the public less in service plans? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: With regards to the performance indicators in the service plans, one of the things that we are trying very hard to do is standardize the performance indicators across the different health authorities so that whether one is looking at a service plan of Coastal or Fraser or Interior or Northern, there's a standardized approach that is being utilized that, frankly, doesn't make it a very, very complex and confusing exercise for people that are trying to look at data and make comparative analysis of data between health authorities. [DRAFT TRANSCRIPT ONLY]
This is actually part of a trend that is a governmentwide effort to ensure that we try to standardize our service plan performance indicators so that even within ministries you start to see some similarities so that it is easier for people to read and understand what the performance indicators are and how those measurements are shaping up year over year. [DRAFT TRANSCRIPT ONLY]
[1125]
It is something that has changed, but in an effort to try and standardize and bring, frankly, less complexity and more understandability for those that are trying to look at the service plan indicators. [DRAFT TRANSCRIPT ONLY]
A. Dix: I generally think that the public likes more information, not less information. You know, you can standardize in all kinds of ways. For example, the minister could have said to the health authorities that provided less information before, "Standardize up to the level of the health authorities that provide the most," but he didn't do that. In fact, every health authority saw a dramatic decline. It went from, roughly speaking, 240 performance indicators to a grand total cumulatively of about 72, or 12 per — right? [DRAFT TRANSCRIPT ONLY]
So the question is…. It's a reasonable question, I think, to ask of the Minister of Health. Why did he choose to, in fact, gut the performance indicators and level down? Why is the lowest-common-denominator standard the right standard? Why didn't he maintain what our…? He will have to agree with me that…. [DRAFT TRANSCRIPT ONLY]
We can list off the performance indicators that he decided to cut. It's information that's readily available to the health authorities, because presumably they were keeping it before. Why did he decide that it was a good thing — that it was innovative, that it was smart — when he talks of standardization, to provide the public with dramatically less information? If you want to take them cumulatively and you don't want to quantify these things too much, why did he decide that 75 percent fewer performance indicators was a good thing? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: In some ways I think the member answered his own question in the question itself. I mean, 240 indicators is borderline ridiculous. You can't just overwhelm people with a whole bunch of indicators that are very difficult to allow someone, any reasonable person, to try and ascertain or make comparatives between health authorities. We actually think the quality of the information is far more important. [DRAFT TRANSCRIPT ONLY]
One of the things we have tried to do is to make sure that the indicators that are there are evidence-based, and also to take what used to previously be in the government letter of expectations to each of the health authorities — take that information — and make that part of the service plan performance indicators. Then you have a situation where you can look and do comparative analysis in a manner that is much easier, particularly for the public. [DRAFT TRANSCRIPT ONLY]
Not everybody is going to be fascinated trying to look at 240 indicators and try and figure out what that means in relation to their health authority compared with another health authority. That's a very, very difficult exercise to expect the public to go to. [DRAFT TRANSCRIPT ONLY]
One of the things we are trying to do in government is make the service plans actually mean something to people that may take the time to read them. Part of that is trying to reduce the utter complexity — which was always a challenge in Health; I acknowledge that — and trying to give something that are meaningful indicators, that are evidence-based indicators, that the public can readily and more easily understand. [DRAFT TRANSCRIPT ONLY]
A. Dix: I don't know if I should be surprised that the minister doesn't think that providing information to the public is a good thing. Even in health authorities that, say, had 20 indicators, which seems like a reasonable number for a health authority, even they had the number of indicators reduced dramatically from 20 to 12. Those are the least ones. [DRAFT TRANSCRIPT ONLY]
[1130]
So what you have are service plans that used to tell quite a bit about what goes on to the health authorities, and we've moved to service plans that tell almost nothing but government spin. [DRAFT TRANSCRIPT ONLY]
Even then, they provide government spin, like the chair of the Fraser Health Authority saying: "We've got a 2.9 percent increase this year." Even the minister doesn't believe that. He denies what the head of the Fraser Health Authority says is actually true. [DRAFT TRANSCRIPT ONLY]
The documents have become kind of, surprisingly, meaningless. Presumably this sanitizing, this stripping of anything of interest in the documents, is an innovation by this minister and a disappointing one at that. [DRAFT TRANSCRIPT ONLY]
I guess I wanted to ask the minister a little bit about those Fraser Health Authority questions. We'll start there, and we'll try and work our way through. We'll start with Fraser Health because it's the minister's home authority, so he will have particular interest, I'm sure, in these questions. [DRAFT TRANSCRIPT ONLY]
The Fraser Health service plan — which, yes, I acknowledge that the minister doesn't think matters, because they only represent the budgets of the health authority for which he is responsible in the House — says that in acute care this year there will be a 2.19 percent increase in Fraser Health acute care. This inevitably, of course, has meant that in services, because of lifts and so on, there are cuts. I want to ask the minister, particularly now, about elective surgery cuts. [DRAFT TRANSCRIPT ONLY]
Is it the case that each hospital within Fraser Health...? There was a debate about how they were going to manage the cuts in elective surgery, I understand. There were a number of proposals put forward to focus them on certain hospitals and to not focus them on certain hospitals. [DRAFT TRANSCRIPT ONLY]
Was it the case that the final decision in terms of cutting elective surgeries in Fraser Health was that it would be 14 percent at all hospitals in all periods? Was that the decision that was made on or around the middle of August? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Just to the member's first comment about the service plans. The member was talking about how the service plans are made up of spin. Actually, I thought the member's comments kind of sounded like spin to me. [DRAFT TRANSCRIPT ONLY]
[1135]
But I do think there are two comments I would have to make about that. For the benefit of the members that are in the gallery here or in the Legislature, there were never any service plans under the NDP government in the entire ten years they were in power. You could have searched day and night, and you would not find a service plan anywhere. Why is that? That is because we actually introduced service plans. [DRAFT TRANSCRIPT ONLY]
I'm quite okay with the member taking exception or us having a debate about what should or shouldn't be in a service plan. But I'll tell you, I can go only so far before I have to remind the member that they had absolutely no information available to the public or to the opposition at that time. So I am very proud of the fact that we do have that information. [DRAFT TRANSCRIPT ONLY]
With respect to elective surgical volume reductions in Fraser Health. As the member knows and as I've indicated, Fraser Health will be receiving a 20 percent funding increase over the next three years. Contrary to what the NDP has repeatedly tried to say, the acute care budget is increasing this year. It's not decreasing. However, even with those record levels of funding, there are still pressures. We talked about the 3½ percent pressures. [DRAFT TRANSCRIPT ONLY]
Fraser Health is taking every possible action to try and mitigate that, and 91 percent of what they're doing in terms of reduction in costs to try and make sure that they can manage that 3½ percent budget pressure is being done by administrative reductions and clinical efficiencies, which I think is appropriate. [DRAFT TRANSCRIPT ONLY]
In fact, I am advised that only 6/10 of 1 percent of their almost $2½ billion budget will actually have any kind of impact on a core service delivered directly to a patient. Elective surgery is one of those areas where there will be about a 4.6 percent reduction in elective surgical volumes in Fraser Health Authority to help them manage their 3½ percent pressure. [DRAFT TRANSCRIPT ONLY]
To put that into perspective — and this is a very important perspective — the levels of surgical procedures that have been undertaken, not just at Fraser Health but indeed across the province, are at record…. We are coming off of record levels of surgical procedures. In '08-09 there were 83,600 surgical procedures performed in Fraser Health. Of those, 65,716 were elective. I say that because it allows a perspective. [DRAFT TRANSCRIPT ONLY]
What we're talking about with a 4.6 percent reduction in elective is about 3,000 fewer elective surgeries. For the benefit of those paying attention today, anyone with urgent or emergent surgical requirements gets them right away. They always have, in our health system. [DRAFT TRANSCRIPT ONLY]
Elective surgeries are generally dependent upon the direction of the physician and the specialist in consultation in terms of the time frame in which individuals will receive those. But at the end of the day, a 4.6 percent reduction in elective surgical procedures is about 3,000 out of the 65,716 performed annually. [DRAFT TRANSCRIPT ONLY]
A. Dix: The question to the minister was…. We're presumably talking about the period from roughly September 18 to March 31, 2009-2010. If they're keeping track in the back rooms, that's period 7 to period 13 of the fiscal year. The decision by Fraser Health — and this is what I'm asking — was to reduce OR hours by 14 percent at all hospitals during that period. [DRAFT TRANSCRIPT ONLY]
I'll just give the minister an example of what that means. At Surrey Memorial Hospital that would mean going from the base for that period of 10,109 hours to a new base of 8,694 hours. That is a reduction of 1,415 hours or 14 percent. That was the instruction from Fraser Health, and what Fraser Health instructed the hospitals to do is make these reductions hospital by hospital. [DRAFT TRANSCRIPT ONLY]
I don't think we need to discuss the nature of it. It's happened. The decision was that the cut would be felt equitably across hospitals. That was the decision. I'm asking the minister to confirm that, in fact, that was the decision and that the decision was taken to essentially do the cut equitably across hospitals. [DRAFT TRANSCRIPT ONLY]
[1140]
I'm delighted to hear that the government isn't considering cutting emergency surgeries. I would think not. I mean, who would consider doing that? But elective surgeries, the minister will agree, are all serious, all medically necessary. If you're having the surgery, including elective neurosurgeries, which are among the things being cut here…. They have real impact on people. Because the government decided not to announce these or deal with them prior to the election, they're being focused in the period of September 18, 2009, to March 31, 2010. [DRAFT TRANSCRIPT ONLY]
So that's my question. Were the hospitals ordered to reduce their OR time by 14 percent at that time, and was it equitably spread amongst the hospitals in the Fraser Health Authority? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: What happened, as I understand, is that the surgical chiefs, the medical directors, the OR managers and the hospital directors worked together to implement a reduction at each of their sites in a way that works best for their hospital, for their patients, for the surgeons and the staff. Decisions had to be carefully weighed in the context of the Fraser Health, in the context of an evidence-based process that protects patient quality and care as much as possible. [DRAFT TRANSCRIPT ONLY]
Obviously, as you can see by the individuals that were involved — right from the hospital directors all the way up to the medical directors, surgical chiefs — they all worked together to make sure they did this in a manner that was consistent with the evidence-based process that will protect patients and ensure that those requiring the surgeries first — of course, they prioritize, as the member correctly pointed out — will receive surgeries based on their acuity level and move down the line. [DRAFT TRANSCRIPT ONLY]
The member is right to point out that elective surgeries are very much on a continuum. It can be anywhere from elective surgeries that are medically urgent to those that are less serious and in some cases even optional. What the surgical chiefs, the OR managers, the medical directors and the hospital directors do is work together in each OR facility to manage those patients in a manner that is in the best interests of the patients and also, of course, in the evidence-based process that Fraser Health is working their way through. [DRAFT TRANSCRIPT ONLY]
A. Dix: Well, let's be specific then, because I think it's pretty clear that they were all instructed…. All the hospitals said: "Your budget has got to be reduced by this amount — your elective surgery budget." That amount for the remainder of the fiscal year was approximately 14 percent. Fraser Health has said elsewhere 10 to 15 percent, but I think the number is actually 14 percent, which is between 10 and 15 percent. That works out rather well. [DRAFT TRANSCRIPT ONLY]
So let's start and ask –– the plans for each of the hospitals, because I think the people in those communities want to know what the impact of these cuts in surgery, which I think are pretty significant, have on each of the hospitals. [DRAFT TRANSCRIPT ONLY]
Let's start in Chilliwack. In Chilliwack, apparently, there's a decision to close an operating room. They're closing one of three operating rooms in Chilliwack. I'll just quote Dr. Richard Schwarz. He calls it an 18 percent cut and says: "Patients who would have had their surgery done on a scheduled basis could become emergency cases because of the long wait, which will then increase health care costs." [DRAFT TRANSCRIPT ONLY]
In terms of Chilliwack, let's be focused. How many operating rooms is the Fraser Health Authority closing in Chilliwack, and what impact will that have on elective OR hours in Chilliwack? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Staff will gather the information for me on Chilliwack General. One thing I do want to emphasize to the member…. I think he's confusing figures. It's important that he not do that. [DRAFT TRANSCRIPT ONLY]
As I pointed out, Fraser Health will see a 4.6 percent reduction in annual elective surgeries this year compared to last year. Remember, last year, coming off a record year in terms of the volume of surgeries that were performed — in fact, at a level that has never been performed before. [DRAFT TRANSCRIPT ONLY]
Clearly, excellent work has been done. Although that is somewhat less, I think it is important to know, Member, that through efficiencies and other savings that Fraser Health has very competently worked on, they actually reduced that from an approximate 7.7 percent reduction that they had initially been contemplating. [DRAFT TRANSCRIPT ONLY]
[1145]
The member has to be careful when talking about 14 percent. A 14 percent reduction in OR budgets does not translate into a 14 percent reduction in the number of patients that will be dealt with through the number of procedures they actually perform. [DRAFT TRANSCRIPT ONLY]
One of the things that they have been doing, again, is working with the surgeons and the OR directors and managers to say: "How can we try, with the infrastructure that we have, and do things better with the dollars that we have?" [DRAFT TRANSCRIPT ONLY]
I know the member doesn't apparently believe that it is possible to actually do more even with existing dollars, but that has been demonstrated. The public health system is capable of innovating and doing more. [DRAFT TRANSCRIPT ONLY]
I just want to correct that for the member. It is not a 14 percent reduction in the number of elective surgeries. It is a 4.6 percent reduction in elective surgeries. Though that is a reduction, and I acknowledge that, it is a reduction coming off record levels of surgical procedures that have been performed in Fraser Health. [DRAFT TRANSCRIPT ONLY]
A. Dix: The reason it's 14 percent, the minister will of course know, is that the health authorities weren't allowed to submit budgets before the election. They weren't allowed to spread this 4.6 percent cut in elective surgery that he's talking about across the fiscal year. That's why Fraser Health itself calls it a 10 to 15 percent cut from September 18 to the end of the fiscal year. [DRAFT TRANSCRIPT ONLY]
The reason for that is we're a good way through to the end of the fiscal year. Presumably, that doesn't include the period of spring break and Olympic closures. [DRAFT TRANSCRIPT ONLY]
We asked about Chilliwack. Perhaps we can ask the minister…. We'll go through it, because Fraser Health, when they sent the instruction, said to the Chilliwack main hospital that they should reduce by 424 their elective OR hours in the period. [DRAFT TRANSCRIPT ONLY]
Let's go to Abbotsford where they go from a base of 4,424, which includes what would be expected in this period, to a new base of 3,805 surgical hours. What changes are being made specifically at Abbotsford? [DRAFT TRANSCRIPT ONLY]
What changes are specifically being made at Burnaby, where they're losing 811 elective OR hours? What specific changes are being made in Delta, where they're losing 296 OR hours? What changes are being made at Eagle Ridge and so on? [DRAFT TRANSCRIPT ONLY]
I don't want to belabour this. The minister has said that he'll get the specific information about what specific surgeries are being cut; what number of OR times are being cut — according to Fraser Health, that's in the range of 6.5 average ORs per day — how many FTEs that means they've lost and all of this information per hospital. Each hospital — and this seems to me to make sense under the circumstances — has a different kind of patient load and is making a different level of cuts. [DRAFT TRANSCRIPT ONLY]
Will the minister provide — I'm happy to do it today — the information about all of these hospitals, and how these 14 percent cuts are being implemented in all the hospitals across Fraser Health? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: That's why I say that what Fraser Health has actually done is gone through, I think, a very thoughtful and responsible process of ensuring that these surgical chiefs, the medical directors, the OR managers and the hospital directors all work together to determine and apportion how they are going to manage a very modest but indeed a reduction of 4.6 percent of elective surgeries, given their effort to manage a 3½ percent cost pressure. [DRAFT TRANSCRIPT ONLY]
They are doing that, working with the people in each of the facilities who understand exactly what their patient requirements are and what their needs are, and they work with the surgeons. [DRAFT TRANSCRIPT ONLY]
As I said to the member, you may be and apparently are surprised to find that in some cases, they get some pretty good ideas that come forward in terms of how they think they can do more surgeries, based on the dollars they have, by trying different approaches. We certainly encourage them to continue to do so. [DRAFT TRANSCRIPT ONLY]
I'll tell you, those are decisions that are appropriately being made by the surgical chiefs, the OR managers, the medical directors and the hospital directors working together to make those decisions. They're certainly not going to be decisions being made by the Minister of Health. [DRAFT TRANSCRIPT ONLY]
[1150]
I certainly would rely on the expertise and professionalism of the medical professionals at the health authorities to make sure they manage those decisions, as they do every year, by the way — always manage their surgical slates in a manner that will ensure they are ensuring that the patients who are receiving surgical procedures are done in an evidence-based process that recognizes acuity levels and organizes the procedures from the highest level of acuity to the lowest. That's what they're doing here. [DRAFT TRANSCRIPT ONLY]
A. Dix: Of course the Minister of Health is responsible in this House for reporting on what those decisions are. That's why we're asking what the decisions are. [DRAFT TRANSCRIPT ONLY]
I guess my question to the Minister of Health is — or we could go through them all, and he can answer them all individually: will he provide to us today the decisions that were made in terms of reductions in elective surgery by hospital so that we can see those decisions and see their impact on those hospitals? [DRAFT TRANSCRIPT ONLY]
We know that an operating room was closed in Chilliwack, because that's been a public issue. We know operating rooms were closed at Surrey Memorial. We know operating rooms were closed at Eagle Ridge. [DRAFT TRANSCRIPT ONLY]
Will the minister commit? I didn't ask him how the decisions were made. I understand how the decisions were made. What I'm asking him is what the decision to implement this cut in elective surgery was, by hospital. [DRAFT TRANSCRIPT ONLY]
Specifically, because he keeps referring to 4.6 percent…. I think he'll agree with me that that means a larger than 4.6 percent cut — a cut between 10 percent and 15 percent for the remaining period of the fiscal year in order to make an annualized figure of 4.6 percent, because those cuts started on September 18. [DRAFT TRANSCRIPT ONLY]
I'm asking the minister if he'll provide the information for Abbotsford, Chilliwack, Burnaby and all the other hospitals of the health authority to this House. Specifically, what's the plan in each hospital, what surgeries are being cut, and what types of surgeries are being cut, etc.? [DRAFT TRANSCRIPT ONLY]
Hon. K. Falcon: Again, I have to put some perspective on this for the member opposite, because I know the members opposite love to talk about cuts. They're fascinated with that word even in an era where the budget is going up 20 percent. Some perspective might help the member. [DRAFT TRANSCRIPT ONLY]
First of all, it is important to know that Fraser Health has actually done an exceptional job in reducing wait times, particularly in the areas of hip and knee surgeries. The member will be, I'm sure, interested to know that the wait time for hip surgery has been reduced from 19 weeks to ten weeks. Knee surgeries have been reduced from a 21-week wait to 13 weeks, a significant and dramatic improvement. [DRAFT TRANSCRIPT ONLY]
Yes, they are having to see a 4.6 percent reduction in elective surgeries in an effort to manage some of the challenges they face. The member is asking me for a breakdown on every single hospital and which patients. I'm advised by staff — not surprisingly, perhaps — that of course we don't have that information. That information would be information that I imagine the authority themselves could gather after spending some time. [DRAFT TRANSCRIPT ONLY]
But it doesn't take away from the fundamental premise that in an era where we've seen dramatic improvements in wait times as a result of an average reduction of 50 percent in hips, knees and cardiac surgeries, they are still on the elective basis going to be reducing by about 4.6 percent. [DRAFT TRANSCRIPT ONLY]
Noting the hour, hon. Chair, I move that the committee rise, report progress and seek leave to sit again. [DRAFT TRANSCRIPT ONLY]
Motion approved.
The committee rose at 11:54 a.m.
The House resumed; Mr. Speaker in the chair.
Committee of Supply (Section B), having reported progress, was granted leave to sit again.
Committee of Supply (Section A), having reported progress, was granted leave to sit again.
[1155]
Statements
Correction to comments
made in the House
J. Kwan: Mr. Speaker, I wish to correct for the record a comment I made in the November 3 Committee of Supply where I stated that Mr. Francis Chen, who is representing the Chinese Consumers Association, is against the HST. [DRAFT TRANSCRIPT ONLY]
I should have said instead that Mr. Chen, who is a director of the Canadian Chinese Consumers Association, is against the HST. [DRAFT TRANSCRIPT ONLY]
Hon. B. Penner moved adjournment of the House.
Motion approved.
Mr. Speaker: This House stands adjourned until 1:30 this afternoon. [DRAFT TRANSCRIPT ONLY]
The House adjourned at 11:56 a.m.
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