First diamond rings and then $170,000 in cash were found in a charity store. Following on that string of luck, the Minister of Health Services "found" $20 million to put into reducing health waiting lists. If that really happens, it will be good fortune, but the timing of the announcement may have caught the government in contempt of the legislature.

The legislature has not yet passed the budget for the Ministry of Health Services. At the end of debate on his "estimates" (legislative jargon for his budget), the motion that was passed was "that the committee rise, report progress and ask leave to sit again." When the budget for a ministry passes, the motion is "the committee rise and report resolution and ask leave to sit again." That means that the Minister of Health announced a $20 million change to his budget while the legislature was debating his budget, but he made the announcement on Saturday in a news release before first informing the legislature.

The government's news release was issued jointly by the Premier and the Minister of Health Services. It quotes the Premier as saying "By properly managing our finances, we're able to inject an additional $20 million for patients, to provide thousands more surgeries, medical procedures and services. Health authorities are directing these funds to improve access to health care for patients and communities where it is most needed." The news release goes on to cite the specific number of each type of procedure that will be funded by the $20 million and a backgrounder gives the precise dollar amount, to the nearest thousand, that each health authority will receive. According to the backgrounder, the Vancouver Island Health Authority will receive $3.419 million. In August 2003 the Vancouver Island Health Authority announced an across the board cut of 2% to each of its departments as part of its plan to reduce spending by $42.5 million by March 31, 2004 (see pdf). Saturday's "found money" will restore a little less than 10% of those cuts. Taking with the right hand while giving a little back with the left hand is but one of several reasons an objective observer might not be able to determine whether the $20 million is actually spent to reduce waiting lists.

This year's budget for the Ministry of Health Services totals $10.6 billion, but rounded to the nearest tenth of a billion, Saturday's announcement would not be visible. The precise budget for the Ministry of Health Services is $10,558,445,000; Saturday's announcement may have increased that to $10,578,445,000 or it might have left it unchanged if the $20 million was found and is a reallocation within the health budget. A single line item is given for all spending done by the health authorities. The line item of $6,495,945,000 should increase to $6,515,945,000 if the news release is more than a shell game over the shift of funds within the regional authorities. Of course, that would also require amending the budget documents that are currently being debated in the legislature.

Throughout the debate over his budget, Health Minister Collin Hansen has accepted that he is fully responsible for his budget, but at the same time he has argued that the regional health authorities make the decisions; he claims he doesn't micromanage. On Thursday, March 4th, in response to questions raised by Jenny Kwan with respect to cuts at Mount St. Joseph's Hospital in Vancouver, Hansen said:

"I don't have any specific detail around any changes to the diabetic service that may have been provided at Mount St. Joseph Hospital, but it may well be that the health authority is making decisions as to where those can be most appropriately provided. That is their mandate. They're empowered to do that."

"If you go to the performance agreements we have with the health authorities…. We hold them accountable, but I don't micromanage them. I don't tell them how to do their job. I just hold them accountable at the end of the day that we get better quality health care for the available dollars that we have for health care delivery in that particular health authority."

On Saturday the news release issued by Campbell and Hansen said:

"The one-time funding for more surgeries and procedures includes funding for:

• An additional 80 open heart surgeries.
• More than 400 hip and knee surgeries.
• More than 3,600 diagnostic procedures.
• More than 500 cataract procedures.
• 20 deep-brain stimulation procedures."

If that is not micromanaging, what is? Pay very careful attention to the subtle language in the government's news release. It says that there will be 80 additional open heart surgeries, but it does not identify the other procedures as additional. It could be that they are only examples of how the money could be spent, but that brings us back to cutting with the right hand while giving a little back with the left. How can the public know whether additional procedures are performed or not?

Contrary to its election rhetoric, the government runs daily television advertisements. Some of its ads show a chart that claims the number of various surgeries has increased. Try finding any information that provides the number of open heart surgeries, hip and knee surgeries or any other data on the number of surgeries on the government's website - it is not there. The fee guide used to pay surgeons (see pdf) includes specific codes that allows MSP (soon to be a US company contracted to the government), to know precisely what surgery was performed on whom, although over 2,000 physicians are not paid on a fee for service basis so collecting detailed information on what procedures they perform requires other methods. In contrast to waitlist information, a tabulation of the statistics on the number of surgeries that were performed does not appear on the website. Data are published on the payments to individual physicians, and it is possible to see the amount paid for the top fifty fee items, but information that would support or refute the government's advertising claims regarding the number of surgeries is not published. It is no surprise that people are reluctant to accept the word of the government when it cannot be verified.