Health — Issue No. 4 — Wednesday, February 29, 2012 (HTML)

Present: Norm Letnick, MLA (Chair); Mike Farnworth, MLA (Deputy Chair); Ron Cantelon, MLA; Colin Hansen, MLA; Dave S. Hayer, MLA; Richard T. Lee, MLA; Dr. Moira Stilwell, MLA; Guy Gentner, MLA

2. The Committee received an update from KPMG regarding the stakeholder interviews and how the workshop would inform KPMG’s work.

• Giles Newman, Partner, Advisory Services, KPMG Canada
• Paul A. Tambeau, Senior Consultant, Management Consulting, KPMG Canada

4. Resolved, that the Committee extend the scope of the workshop and KPMG’s work to include non-financial areas of sustainability. (Mike Farnworth, MLA)

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

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH


CONTENTS
Page
Update on KPMG Phase 1 Work	17
G. Newman

N. Letnick (Chair): Because there are 11 members on the committee, we don't have quorum, but if the members are okay, we'll get started. We won't make any motions for now.

I'd like to welcome and acknowledge the MLA for Delta South. Thank you for joining us.

N. Letnick (Chair): Part 1 is: "Update on phase 1 work, including stakeholder interviews, submission summaries and workshop planning." In attendance we have Giles Newman, associate partner, advisory services, for KPMG LLP, Canada, and Paul Tambeau, senior consultant, management consulting. I'd ask Giles and Paul to walk us through their report, please.

Ladies and gentlemen, we agreed that we would provide the committee with an update in February. We'll run through the rest of the project. We do have, as I know you're all aware and hopefully can attend, the workshops in March. Then we will be looking to present a report to the committee — or at least to have presented it to the committee — by the end of April.

What we've prepared is a very brief presentation that just takes everyone through what we see to be the salient issues to date. The first slide in the pack is "Project progress." You'll recall that, essentially, there were four parts to our work, the first being the call for submissions, which was successfully completed.

Within the pack you have with you there is the report from the Clerk's office, with all of the submissions received. In total, 173 submissions were received from 50 stakeholders, of which ourselves, the Clerk's office and Michael Smith Foundation, when we went through them in detail, decided that 114 were judged to be relevant for the conversation in part 1. The rest are, obviously, relevant to part 2 of the process, as we start getting into the further work of the committee. Those will inform our report. They've informed our interviews to date and, essentially, will be informing the process.

We have also interviewed a number of stakeholders, as we agreed with you, and we've listed out here the stakeholders who we have interviewed. We also list for your information those who have declined to participate in the process and also those who haven't responded to our requests for interviews. This is purely for information only. We have no idea…. We have tried to correspond with those who haven't responded but have not had responses. We assume that they do not wish to participate in the process.

We have the workshops on the 22nd and 23rd of March. We'll get to those in a second. We're already starting to collect our thoughts for our report, and we can talk to you about some of the issues that are coming out of the interviews, and that is set out on the next slide.

I think the first thing, which is something that we've known all along, is that it is quite difficult with the scope for part 1 to keep the debate to part 1 of the scope without going into part 2, which is: "Well, what are your ideas, and how do you think it could be fixed?"

The themes emerging from the interviews, by and large, are that the financial definition that is going to be the core of our report is not necessarily what all of the stakeholders that we've interviewed believe is the totality of the debate and the definition of sustainability.

A lot of the conversations that we've had have, essentially, revolved around three areas, which I think need to be tackled in some way, shape or form in part 1, or at least acknowledged in part 1, and then taken forward into part 2. Those general headings are "Outcomes," "Access to Care and Services" and what we've described as "Patient Satisfaction," which is whether or not patients believe the service that's being provided to them is good value, is quality, etc.

We do wish later on — I'll come back to it — to slightly extend the scope of our report to include no more than one or two pages that identify that these areas are things that the committee will need to look at in future parts of the committee's work.

We've also listed here the most common cost drivers that we have discussed with the stakeholders that we've interviewed. They are demographics, aging population, pharmaceuticals and drugs, utilization of services, general price inflation, technology and the impacts of new technology, system design — i.e., where the care is received and a conversation about, essentially, the balance of acute and community services — and labour costs. Those are going to be the issues that we're going to be taking into the workshops to talk about and to try and get some more definition on through the workshop process.

The other thing emerging from the interviews is that if we take…. There are three ways of measuring financial sustainability. The first is as a percentage of GDP, the second is health care as a percentage of government spending, and the third is the per-capita spending for each individual British Columbian. The emerging consensus from the interview process, which we will be looking to confirm during the workshop process, is that the percentage of GDP is the most appropriate measure.

I'll come back to that. It may be something that we can ask the committee today to think about. There are some risks associated with using GDP as the primary indica-
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tor in terms of financial sustainability. So if we move on to the workshops….

Firstly, I do need to formally thank the efforts of Michael Smith Foundation in terms of pulling the workshops together. We have been working very closely with them, with Marty Schechter and his team, and I think that the workshops are going to be significant events in terms of the debate. Also, I'm very comfortable with the fact that Michael Smith is the right organization to be facilitating those conversations.

N. Letnick (Chair): Giles, before you go on to the workshops, I just want to ask the members if they had any questions or comments from the report so far on the interviews.

I do have one. The stakeholder interviews that are marked here. It doesn't show the health authorities or any ministries. Are you doing those as well?

G. Newman: Yes, we are having conversations with the Ministry of Health and, through them, the health authorities. Those will inform the debate, but we haven't included them, if you like, in the formal interview process.

G. Newman: The Ministry of Finance we have requested attend the workshop. They've been fairly busy doing budgeting, etc. We're hoping that someone from the ministry will be able to attend the workshop.

N. Letnick (Chair): So you've received revenue projections for government for the next 25 years from some ministry.

G. Newman: We have received all of that data, and that data has been shared. The Ministry of Health has provided that data to the health economists across British Columbia and to ourselves and to Michael Smith.

G. Gentner: I do have some problems relative to some of the participants who have declined to be part of this, the non-responsive. I'm trying to get beyond the politics here, when I look at the First Nations health council. I don't know what it takes, but we've got to bring them in here somehow if this is going to be worthy of sustainability.

I'll give you an example. We all know about the whooping cough epidemic that started. It really started, in my understanding, up in Stó:lô area by Hope. They are forming their own…. They have their own First Nation health authority up there. Maybe we're creating silos, but when you have a disease or an illness that's airborne, it doesn't know, it doesn't care what health authority it transfers itself in.

There's got to be some cohesiveness. It doesn't matter whether you are a First Nations health authority or Fraser Health Authority or whatever health authority. We've got to work together in this province.

Perhaps, Mr. Newman, you have an explanation of how we have to go and try and further the invitation to First Nations to participate in this matter.

G. Newman: The answer is that I think it would be helpful if we can use the committee to help with our process. As with all of the stakeholders, what we have done is we've provided them with an invitation and an opportunity to participate. Those who have declined have declined for reasons that will be specific to them, and perhaps a further invitation from the committee would be helpful in getting the engagement in the process.

I'm afraid, from our perspective, that we didn't feel it was appropriate for us to be trying to get organizations to commit to a process where they had indicated they didn't want to.

N. Letnick (Chair): Guy, do you have any suggestions on how we can get them to participate?

G. Gentner: At this time, Chair, I don't. I'll leave it to Mike, who's got the….

M. Farnworth (Deputy Chair): I was going to say, perhaps…. Scott is our aboriginal affairs critic. He probably would be able to approach them and just sort of say: "You know you've received this invitation. It would be really good if you were able to participate." Try an informal route that way and see what the reaction and what their reason is. Then, depending on what he says, we can approach with a more formal invitation.

My question is on the last bullet on page 2: "Percentage of GDP is the most appropriate measure in tracking spending, as opposed to health care as a percentage of government spending or per-capita spending."

I think this is the one that somehow there has to be some attention paid to. Maybe we can track all three. I have some people who want the first one, and other ones who want the second one and the third one. You don't want to have people left aside. That's something we have to pay attention to. We don't sort of ignore maybe two-thirds of them by getting one-third. Then all of a sudden the confidence in the report goes down. We have to sort
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of look at it in more detail and probably use expertise as to how we can satisfy all the parties rather than just one-third of them.

M. Stilwell: I don't want to take up a lot of time, but I do want to reiterate what Dave said. I think all of those measures are important, and each number tells a different part of the story that has contributed to the difficulties we have — for example, per-capita spending in a country with few people and big distance. You can't ignore that number, because it creates all sorts of unintended consequences, expectations and difficulties.

I would say that the more measures that we actually understand what they mean on the dashboard, the more likely that we can get to a solution that's not just a retread of the things we've been saying for a lot of years.

G. Newman: I think that's helpful. If I can just bring committee members to the attention of slide 4, where we set out why the stakeholders have said this.

GDP does seem in the views of the people we've interviewed to be the best — although what it does do, of course, is it provides quite a skewed view of the system if compared with other provinces where, for example, income may be higher. Then you would see that proportionately the spending patterns are different. If you were to use GDP to compare British Columbia with other provinces in Canada, you wouldn't necessarily get a true view as to the proportion of government spending that is spent on health care within the province.

As a percentage of government spending in British Columbia, it's got the disadvantage of being too dependent on future policy — tax policy, income generation policy, whatever it may be. We see that that may be an issue.

The spending per capita doesn't really provide a relevant comparison to today in 25 years' time, given the demographic differences that you've got. So there are risks to using all of those as indicators.

I am, actually, very comfortable with the decision, if it is the decision of the committee, to run with all three and to point out in the report why any of them may not be a panacea in their own right in terms of providing an answer.

N. Letnick (Chair): I think that would be a fair way to approach it. But also, remember that it's your report, at the end of the day, and you're putting your name on it. If you want to put all three, that's great. But if you believe, at the end of the day, that GDP is the correct way, from KPMG's perspective, feel free to say so as well.

G. Newman: Indeed, and I wouldn't do anything that we didn't feel comfortable with doing. It is more of a calculation exercise and just spinning the calculator and, therefore, is not a massive increase in scope. I don't see any reason why we shouldn't provide all three in terms of the report.

N. Letnick (Chair): If I remember correctly, through the submissions that we received — the hundred-and-several that were appropriate…. When we start comparing our system against other systems, it's mostly based on a percentage-to-GDP comparison and sometimes on a per-capita expense comparison. It's very infrequent that I've seen a percentage of provincial government expenditure as the comparison between jurisdictions.

G. Newman: That's the one I'm the most worried about in terms of how we manage to map that, because I don't think the projections are there for that. We would just have to make some assumptions and then assume that the projections for GDP equate to what the province is going to raise in terms of income, etc. We'll have to think about what the additional assumptions are as we're collating the report.

D. Hayer: I agree with Norm on this, because many times I get my constituents talking to me and saying: "Look at all these provinces where people spend their lives when they are actually younger, but when they move to a province like British Columbia, maybe we should ask them to transfer some funds with them because they got the best of the money, and then we are left with most of the expenses."

By looking at all three, I think you will satisfy all of them. We know it's your report, and you have to feel comfortable if you think it's the right thing to do or not. But on the other hand, if it's broad enough, people from all parts of society can say: "Yes, I can agree with this, but maybe not the other part."

G. Newman: Indeed. Subject to us actually running the numbers and seeing what assumptions we need to make, you'll have to leave it with me as to what ends up in the final report. But if we can, we'll have a go at all three. But the assumptions that we make might have to be….

M. Farnworth (Deputy Chair): I was just going to say that given what we're hearing from in terms of the expert submissions, to me it makes sense that if that's where they're focused on…. If they're focused on all three, great. If they're focused on one, great. If they're focused on two out of the three, that's fine too. I think that's what we're asking for — their input. But we certainly don't want to
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be prejudging that.

The workshops. I hope that the members of the committee are able to attend the workshops. We would very much encourage your participation. This is more of a reminder than anything else, really, in terms of the way that we have set them up with Michael Smith in terms of the structure.

The first day will be a stakeholder day where we will be asking a number of stakeholders — those interviewed, some that have submitted — to attend and to discuss, essentially, four areas, four things. The first is to share with them the Ministry of Health's 25-year projections and to look at what they show and to get comments back and engage in a debate around the projections that we have from the ministry.

The second will be to provide input on what the stakeholders see to be the key cost drivers in the debate — to essentially confirm the list that we've run through earlier on but also to see if there's anything else that people believe is relevant that needs to be taken forward into the academic conversation and into the report.

We'd like to discuss the broader definitions of sustainability and see if we can agree with the stakeholders what they might be, lumped into a number of what I would describe as key headings. We have, in our thinking, come up with the three additional ones of outcomes, access and patient satisfaction. It may well be that there are more that the stakeholders consider that need to be included as headings within that debate.

For example, you could say that the condition of the estate and the modernization of buildings and the actual structure of the health care system could be decided to be a separate issue. We've put that into the "Patient Satisfaction" heading at the moment, but I think there is a debate to be had about that which will be important, particularly as the committee moves into phase 2.

Then finally, what I would also like to do is to take what the committee believes are the key questions that the committee should be asking around either the projections or the process going forward, and to discuss those with the stakeholders.

We do have the opportunity, with them all in the same room, for the committee to actually engage on a sort of semi-formal basis with them, without necessarily having anything that's attributable. I think that would be a really important session for the committee.

At the moment we have ten questions that have been received through the Chair. What I would encourage members to do over the course of the next fortnight — so two weeks — is to think about whether there's anything else that members would like the stakeholders to consider. Then what we would do is agree with the Michael Smith Foundation on the top, probably, ten questions that we will weave into the facilitation of the debate on the day.

The more we receive, the more we can have the conversation, the more we can get to a view on the top issues for the committee.

I do think it is an important opportunity for you to be able to work with the stakeholders in a forum that allows you to start getting a good perception of what the issues are, from the key people involved in this debate across the province.

D. Hayer: It starts at eight o'clock in the morning. Nine. Nine till 4:30? All right, thank you.

N. Letnick (Chair): But the conversation in the hallway after 4:30 will be dynamic, so don't go away too fast.

G. Newman: The second day is with the academic community. We have, so far, five of the experts, the health economists, from across the province that will be attending that day.

It will be a day that is far more driven by attempting to ascertain from the academic community what they believe to be the ranges of the cost drivers that we've identified. We will take a view, in our report, about some of them. But what I would like is for the academic community to get as close as they can to agreement on the range of the impact of all of the identified cost drivers.

We've spoken with Michael Smith, and I'm comfortable that we can get, by the end of that day, to the point where the projections are on the table and the ranges for each of the areas are agreed.

That will be an important aspect of our report, because we will be taking the output of that and then saying, "Right, okay," and then in terms of the economic model that we've created for the report, we'll feed that in.

That will inform three things. It will inform, if you like, a best- and the worst-case scenario, because there will be ranges, and we'll be taking the most appropriate values, the bottom of the range and top of the range. Then there will be a likely scenario that will be essentially what KPMG considers is the most likely scenario given the range of the data that we have available to us.

A couple of decisions that we wanted to bring to the committee today. The first is….

N. Letnick (Chair): May I interrupt just for a second? Could we take a two-minute break? Let's take a two-minute break — okay? And we'll come back.

N. Letnick (Chair): I'd like to take a moment to thank Tim Scolnick and Susan Sourial for their great work in support of the committee, especially going through all of the submissions and the research that you folks have done over the last few months. I really appreciate it, especially from my seat on the beach. It provided me with some great reading material. I appreciate that — wonderful.

Okay. Mr. Newman, if you'd like to discuss the last item on your agenda, which I believe is the extended scope.

G. Newman: There are two things that we wanted to get out of the meeting today in terms of guidance as to how we take some of the issues forward. The first I think we have broadly agreed, which is that we will try our best to include all three measures of financial sustainability. We will make assumptions, see what it looks like and include as many as we can in our final report.

The other is to formally extend the scope of our work to include, as I said earlier on, acknowledgment in our report of the other areas of sustainability and what is coming out of the workshops.

I think it's important for our report to be balanced. What I do not desire, and I don't think it would helpful for the committee, is a report that concentrates on finance at the exclusion of everything else. I do see, from the interviews with stakeholders, that most of the stakeholders we've interviewed would have a view on that.

I think it means that the report is not as rounded as it might be if we included some additional aspects to it and attempted to help the committee in terms of defining what those additional areas are. I don't think that needs to be an extensive part of the report, but I do think it is an important part of the report, and it needs to be acknowledged within the report. What I would request from the committee is that I get agreement that we should proceed on that basis, to make sure that those areas are defined.

I think for phase 2, when you start getting into that piece of work about how the key drivers need to…. You know, what you need to do to fix the system. It's going to be important for you to have the view as to what all of the aspects of sustainability are and therefore attempt to start defining them. I think it would be helpful for the committee if our report was extended to include that scope.

N. Letnick (Chair): Continuing on our conversation from before, we'll put it here on the record, and we'll get members to provide their input.

Would it be possible during part of the workshop, then, to ask the participants to define what they would like to see measured in phase 2? For example, phase 2 is about us looking at ways of changing the system or improving the system based on the bottlenecks you discover in phase 1 — right?

Assuming you come back in phase 1 and say that the system is "sustainable" for the next ten years, but as the boomers get into their elderly years we hit the wall — year 15, year 20, year 25 — you'll come back and say: "Here are some areas, some pinch points that we need to look at." That's fine. We knew that going in.

The other part of that is even if the system showed in the numbers that it is sustainable — in other words, we continue doing roughly what we're doing now — the question is: do we want to? Do we want to live with whatever way the system is working today? We've heard reports from across the country saying ours is one of the best. Not the best in many areas, but that's fine. There are always ways to improve.

Do we want to set ourselves some benchmarks over the next 25 years, some targets that we can use in phase 2, so that when we go to the public and ask them what their ideas are for phase 2 — assuming that's what we do in part of phase 2 — they actually have something to react to? In other words, not just another Conversation on Health — here's a whole bunch of ideas; now go for it — but here are some ideas on this particular issue and that particular issue.

The question is: do you believe that we can engage some of our workshop participants in defining that, even though it wasn't part of the phase 1 work? And would you want to do that during that workshop versus having some other process?

G. Newman: Okay, so the answer for the first question — is it is possible for us to ask participants of the workshop, particularly in day 1, what they think? — I think it's up to the committee to come to agreement on how this would be taken forward, not only for part 1 but
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also for part 2.

I think what you're asking is for us to consider how we can set what British Columbians believe are fair values for the health system, what British Columbians consider important for the health system and how we define that. I use the example from the U.K., where the government, as part of the reform agenda for the National Health Service in the U.K., set targets for the health system based on what they considered to be the most important indicators of quality and access.

For example, the top five were access to a primary care physician, the amount of time you waited in the ER, the amount of time you waited from a GP referral to see a surgeon, the time you waited for a cancer appointment and so on and so forth. That essentially drove the redesign of the system, the whole of the health care system in the U.K., from '99, or whenever it was put in place, onwards.

What I don't see in British Columbia at the moment is agreement on what those key issues are. What I see to be one of the challenges of the committee is how we get to the point where we are agreed on what those key aspects of care should be.

My personal view is that this isn't necessarily a political debate. It's a debate about values and what British Columbians see to be important and, perhaps, something that the committee needs to be thinking about for phase 2.

From my personal perspective, if you can get to a point where you are agreed as a committee what those drivers are, then you can start putting in place a system with accountability and everything else that goes with that. I think that will assist you in terms of looking at the importance of the various aspects of the health care system when you are looking to drive change through the health care system.

Without that I think it's difficult, because you are then into a debate that is difficult to structure, around the importance of one service against another, without having the conversation about what is more important in the first place. That is where I think you're going to struggle, as a group, to make the impact that I know that you all hope that you're going to be able to make.

I would see that you could use the workshop to start to get into that debate and start thinking about that. My own personal view is that you would probably need to have sessions as part of the early part of phase 2 of your work to really get to grips with that as a group and to then go out and, if needs be, consult or at least share the message with your constituents in terms of what was and what wasn't considered to be important in the health care system — to have that and then to use that to start thinking about the redesign.

N. Letnick (Chair): The only thing I'll add before I open up the floor is that from what you said, I don't know why we'd have to wait for the workshop for us to start that discussion.

N. Letnick (Chair): We could have a meeting next week and start that discussion and get the Ministry of Health to come in here and give us a presentation on what they're trying to achieve, what values, and talk amongst ourselves and see — before the workshop ever happens, I would suspect.

N. Letnick (Chair): The outcomes of the workshop and even the outcomes of your report won't determine what we need to get to.

G. Newman: No, no. Indeed. It is a leadership discussion for the province. In terms of health care, I would find it difficult to argue that the debate shouldn't start in this room.

N. Letnick (Chair): Actually, it might have already been done, and I personally don't know about it. Maybe that's the challenge.

I see no comment. On the scope, if anybody has any issue? Otherwise, we'll move forward with that.

C. Hansen: In terms of the terms of reference from the House…. I haven't got that here, but is this expanded scope totally consistent with that wording, or do we have to go back to the House for an amendment, which might be difficult?

N. Letnick (Chair): Just for the record, the first part is: "Examine the projected impact on the provincial health care system of demographic trends to the year 2036 on a sustainable health care system for British Columbians." The second part is: "Outline potential alternative strategies to mitigate the impact of the baby boomers on the provincial health system." The third part is: "Identify current public levels of acceptance toward the alternative strategies."

I would think it falls within the scope. That's my interpretation of it. I guess I'll leave it up to the committee members to see whether or not they believe it's outside.

C. Hansen: One of the concerns I would have…. I think, the way it's been described, this expanded scope would help us flesh out some of the dimensions to the other work that's being done. I think we would just have to be guarded against allowing that expanded scope to become sort of the centrepiece of the work we have to do,
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or we will be here till the year 2025, not being able to accomplish very much.

M. Farnworth (Deputy Chair): I think it does, but I think Colin's also right. And I think, Giles, you've said that you see this not as the major but just as a brief area, one that will provide some balance in the report. I think if we stick to that, then we will avoid being here in 2025 still doing this.

D. Hayer: I just want to say that sometimes we have written reports in the last 11 years, and the report is hundreds of pages and there's a small, little section of a few pages. All of a sudden everybody only talks about those. Maybe not even two pages; maybe it's a couple of paragraphs — right? I guess you have to keep that in mind when you're writing it to make sure that….

Also, in your report write down what you think is the main part so we don't end up having certain sections or certain parts taken out and then we're saying: "Look, everything else was flushed down the drain." The only thing left was that one little section, which you maybe thought was not the main purpose of the report or main part of the report.

I just want to keep saying from my own experience from the last 11 years. On the other hand, these two colleagues have a lot more experience, because they have both served on the Ministry of Health, and they understand the issues and the concerns from the last 22 years or so, approximately.

N. Letnick (Chair): As the Chair, I do have to ask the question. Will there be a higher fee for the expanded scope, or are you assuming that this will fall within your fee-for-service?

N. Letnick (Chair): You are a good man, Giles. That was the right answer. The same answer as Michael Smith yesterday. Thank you very much for that.

Susan, since we had a motion to accept their scope of work in their contract, I guess we should have a motion then.

N. Letnick (Chair): You've got your expanded…. And by the way, if you want any more expansions for free, you just let us know.

N. Letnick (Chair): All right. Thank you very much for an excellent presentation and all the work that you're doing. I really appreciate this. I'm sure the people of British Columbia will appreciate it as well, once they have the final report.

The date of the next meeting. Since we had this discussion, how about we meet again to discuss what we just talked about just prior to the workshop? Could we meet in a couple of weeks, in March sometime?

D. Hayer: Didn't I hear that you were going to maybe ask the Ministry of Health to provide some other discussion about something? Maybe you need a little extra lead time than a few days.

N. Letnick (Chair): Well, if we project for maybe two or three weeks from now, prior to the workshop, that should give them enough time to get something ready for us — okay? So we'll coordinate that with the Ministry of Health and with our CAs.

If nothing else, a motion to adjourn, please. Dave, thank you. Moira, second. Those opposed can stay.

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Chair:	* Norm Letnick (Kelowna–Lake Country BC Liberal)
Deputy Chair:	* Mike Farnworth (Port Coquitlam NDP)
Members:	Bill Bennett (Kootenay East BC Liberal)
	* Ron Cantelon (Parksville-Qualicum BC Liberal)
	* Colin Hansen (Vancouver-Quilchena BC Liberal)
	* Dave S. Hayer (Surrey-Tynehead BC Liberal)
	* Richard T. Lee (Burnaby North BC Liberal)
	* Dr. Moira Stilwell (Vancouver-Langara BC Liberal)
	Katrine Conroy (Kootenay West NDP)
	* Guy Gentner (Delta North NDP)
	Sue Hammell (Surrey–Green Timbers NDP)
	* denotes member present
Clerk:	Susan Sourial
Committee Staff:	Timothy Scolnick (Committee Researcher)
Other MLAs:	Vicki Huntington (Delta South Ind.)

Witnesses:	Giles Newman (KPMG LLP, Canada)
	Paul Tambeau (KPMG LLP, Canada)

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON HEALTH

REPORT OF PROCEEDINGS
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SELECT STANDING COMMITTEE ON
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