[ Page 7691 ]

CONTENTS

Oral Questions

Protection for food industry in free trade negotiations. Ms. Sanford –– 7691

Annacis Island bridge cables. Mr. Reid –– 7692

Mr. Lockstead

Government passenger vehicles. Mr. Stupich –– 7692

Easter Seal buses. Ms. Brown –– 7692

Motive fuel costs. Mr. D'Arcy –– 7693

B.C. Rail shares. Hon. Mr. Curtis replies –– 7693

Private Members' Statements

Chiropractors' fees. Mr. Stupich –– 7694

Hon. Mr. Nielsen

Mr. Cocke

Licensing of taxis. Mr. Davis –– 7695

Hon. A. Fraser

Job creation. Mr. Michael –– 7697

Mr. Macdonald

Hon. Mr. Segarty

"Queen's Counsel," Mr. Macdonald –– 7699

Hon. Mr. Smith

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen)

On vote 37: minister's office –– 7700

Mr. Cocke

Mr. Michael

Ms. Brown

Mr. Parks

Mrs. Dailly

Mr. Blencoe

Hon. Mr. Gardom

FRIDAY, APRIL 11, 1986

The House met at 10:05 a.m.

[Mr. Strachan in the chair.]

Prayers.

HON. MR. CURTIS: Mr. Speaker, in the gallery today is a constituent of my colleague the Attorney-General, the MLA for Oak Bay–Gordon Head (Hon. Mr. Smith), and it's a pleasure to introduce Elizabeth Friesen, who is a nursing instructor. Would the House make her welcome today on behalf of the member for Oak Bay.

MS. BROWN: Mr. Speaker, a number of visitors from California are with us today, accompanied by one British Columbian: Mr. and Mrs. Bruce Parker from Etna, California, their daughter, Marianne Brown from Los Angeles, and their other daughter, Candace Parker from British Columbia. Will the House bid them welcome.

MR. MOWAT: In the precinct today, and hopefully in the House later, is Miss Betty McGill, the administrator of St. Jude's Anglican Home. I ask the House to make her welcome.

Oral Questions

MS. SANFORD: My first question is: where are all the cabinet ministers so we can ask questions?

HON. MR. McGEER: The cabinet ministers are here; where is the opposition?

PROTECTION FOR FOOD INDUSTRY
IN FREE TRADE NEGOTIATIONS

MS. SANFORD: My question is to the Minister of Agriculture and Food. Has the Minister of Agriculture and Food authorized any studies of those sectors that would be at risk should the Premier decide to sacrifice agriculture as a bargaining chip in the free trade negotiations?

HON. MR. WATERLAND: I take offence at the member's suggestion that the Premier would sacrifice any sector of our economy. My ministry is doing a thorough analysis of what the effects would be on the agriculture industry as we approach free trade discussions with the United States.

MS. SANFORD: I'm not sure whether that entails specific studies that are undertaken to look at the various sectors of the agricultural industry that would be affected. I'm wondering what steps would be taken to prevent the loss of over 5,310 jobs in the immediately threatened agriculture and food processing industries in B.C. Have your studies indicated what steps you could take in order to avoid the loss of those jobs that are immediately threatened?

HON. MR. WATERLAND: The member is asking purely hypothetical questions, the basis of which are probably in the fantasy of the research people in their caucus. I am afraid I can't answer a hypothetical question like that.

MS. SANFORD: The minister's answer flies in the face of the statements made by his own Premier, because his own Premier, when he was in Montreal last November, said:

"There are those who shy from the prospect of increased trade with the United States. I do not have much patience with these people. To my mind they're saying that deep down inside they doubt that our people — the workers of British Columbia and Canada — can cut the mustard in competition with their counterparts in the United States. My position is that all of the trade issues must be placed on the table, and each country should have an opportunity to question the other's trading practices. I believe we, as Canadians, should not exclude items from discussion."

We should not exclude items for discussion, which means that all of these sectors in agriculture are going to be on the table. If that's the case, agriculture's in deep trouble in this province.

DEPUTY SPEAKER: Is there a question?

HON. MR. WATERLAND: Mr. Speaker, I didn't detect a question, but I certainly endorse the statements made by our Premier.

MS. SANFORD: Mr. Speaker, this government is intent on pursuing free trade agreements. What measures will be taken to protect B.C.'s manufacturing and producing sectors, which will be placed at risk or used as bargaining chips by the federal government's negotiator? It's clear, according to the Premier himself, that it's on the table; therefore they must be negotiated.

DEPUTY SPEAKER: The question does beg future action, and the minister may wish to respond.

HON. MR. WATERLAND: Mr. Speaker, I don't know where you saw it, but I didn't see a question at all. It was a rather ridiculous statement made by the member. I think she feels that the people in Canada and in B.C. are incapable of competing with others on this continent. I have much more faith in our people than that, and I'm sure we can compete.

MR. REID: I have a question for the Minister of Highways, since there are no other questions.

MR. BLENCOE: Are you going to ask about automobiles?

MR. REID: Mr. Speaker, can you just shut this pink flamingo up over here, please?

DEPUTY SPEAKER: Order, please.

MR. REID: Mr. Speaker, I'd like to ask the Minister of Highways relative to the cable....

Interjections.

MR. REID: Well, they've got a white swan and a pink goose and a pink swan.

DEPUTY SPEAKER: Perhaps we could get to the question. This is question period.

[ Page 7692 ]

ANNACIS ISLAND BRIDGE CABLES

MR. REID: Okay. The question I'd like to ask, and I think it's the concern of those people out there in Surrey and Delta relative to the cable problem on the Annacis crossing: could the Minister of Highways tell the House the safety that we can expect on the cables being installed and the effective date of the opening of the Annacis crossing?

HON. A. FRASER: Mr. Speaker, I will try to give a little rundown on the problem.

First of all, there are 192 cables involved. Two cables have been rejected for unsatisfactory socket performance when installed on the bridge. One has been replaced, and the second has been removed, and the replacement will be installed within a few days. The reason for the rejection of the cables is excessive movement of the cable strands within the sockets before the cable takes up the full load. Three more cables are being closely monitored, and about six others are being watched. A complete survey of all the cables has been underway for the last three months. Based on current performance, we expect to open the bridge in June, and it will not be opened until we are satisfied with the performance of all the cables.

[10:15]

This beautiful bridge built in our province by our contractors, engineers and consultants has a safety factor of approximately 250 percent engineered into the structure. Replacement and testing work is being performed by the contractor under his warranty requirements. This work is being supervised by the ministry and their consulting engineers. I might say that we feel the consulting engineers that have been on the project from the planning stage right through deserve considerable accolades from all of us. I refer to the firms of Buckland and Taylor — I believe their address is North Vancouver — and CBA Engineering of Vancouver.

We have a beautiful structure there, and certainly we aren't going to open the structure unless it is absolutely safe, and I am sure it will be. We had planned on opening the bridge in June, and I hope we will be able to make that opening when we originally planned.

MR. REID: Mr. Minister, a supplementary. Is your staff involved in helping to correct the situation on the Cambie Street bridge?

HON. A. FRASER: Mr. Speaker, the answer is no.

MR. LOCKSTEAD: Further supplementary to the minister. Could the minister tell us who is bearing the cost of these repairs to the Annacis Island bridge?

HON. A. FRASER: I just said who that was. The cost is being borne by the suppliers of the cable on a warranty basis. I might say that the supplier of the cable is the British government.

MR. LOCKSTEAD: A further supplementary. Can the minister personally guarantee that this bridge will be safe for the next...?

Interjections.

MR. LOCKSTEAD: Personally. And will you resign your seat, Mr. Minister, if the bridge fails?

DEPUTY SPEAKER: Order, please.

GOVERNMENT PASSENGER VEHICLES

MR. STUPICH: I have a question to the Minister of Finance. The auditor-general's report, released yesterday, tells us that the government does not have sufficient information to demonstrate that it receives value for money with respect to its fleet of more than 6,000 passenger vehicles. Has the minister decided to place a moratorium on the acquisition of new vehicles until this report can be considered.

HON. MR. CURTIS: Mr. Speaker, the member for Nanaimo will appreciate, I'm sure, that the auditor-general's report reached me at approximately 12 noon yesterday. It is required, and indeed it is appropriate, that it be presented to this House at the earliest possible opportunity. Therefore I've had little more time to read the entire report, or that section dealing with the subject of his section, than any other member of this House in the interval.

I have not decided to place a moratorium. I welcome the recommendations and comments of the auditor-general. It was this government which committed to create the post of auditor-general in the province of British Columbia, and again we have an instance where the auditor-general, independent from influence of government and ministers, has identified an area which she considers to be a problem. I can tell the member that the Ministry of Finance and those involved with fleet management within government, which is not specifically within the Ministry of Finance, will be examining that section of her report. We will take, I trust, appropriate action, at an early date. I cannot commit as to when that might be.

EASTER SEAL BUSES

MS. BROWN: My question is to the Minister of Health, and it has to do with Easter Seal buses. As a result of a shortfall in revenue, partially due to a new bingo hall that is skimming off such revenue, the Lions Club have been forced to discontinue the Easter Seal bus service in Prince Rupert. Several groups apparently have been sending letters and telegrams to the government stating that this is an urgent matter and a severe loss to that community. So far, they have not received a reply. Can the minister tell me whether the government has decided to make up the difference for the Lions Club by extending the custom transit to Prince Rupert, to meet this very important need?

HON. MR. NEILSEN: No, we have not done that.

MS. BROWN: A supplemental to the minister. Is it possible, then, that the government has decided to at least meet with the Lions Club people and with some of the other groups in that area to discuss how this shortfall is going to be covered? The Easter Seal bus is not a luxury item; it meets a real need. At least the government could sit down and discuss with these people how that shortfall could be covered. Has a decision been made to do that?

[ Page 7693 ]

HON. MR. NIELSEN: Mr. Speaker, I'm unaware of a request from the Lions Club in Prince Rupert. Were they to make a request, or if they have and it hasn't been brought to my attention, certainly I'd sit down and talk to them, to see if there's some way of resolving that problem.

MOTIVE FUEL COSTS

MR. D'ARCY: To the member for North Peace River, our Energy minister. I would like to ask him if he has taken action, or if he has decided to take action, regarding the continuing high costs of petroleum and natural gas motive fuels, as set by the industry. I'm not referring to taxes, federal or provincial, but to the continuing high costs as set by the industry. My information from the industry is that if they were to maintain the same profit margin, both at the retail level and the producer level, that they had when gasoline in this province was 58 cents a litre, the price should be somewhere around 38 cents right now — based on an average price of petroleum of $14(U.S.) and $20(Can.) per barrel, which it has been so far this year.

Also, has the minister taken action regarding the price of natural gas for home heat and industrial purposes, which is supposed to be, by the government's own word, tied to the price of petroleum? In fact, there has been little or no decrease in the price of natural gas to the customers of Hydro, Inland, Columbia or any of the other natural gas utilities, in terms of the price they set for their customers in the province of B.C.

HON. MR. BRUMMET: Mr. Speaker, as, I guess, the member knows as well as anyone, the gas price at the pumps is affected only partly by the raw stock, and there is still some inventory. Those prices are moving down, and our estimates show that in that period of time it should probably be at 38 cents a litre. I think there is some concern about what's going to happen to the price tomorrow or next week. As I think the member knows, there is a 60-90 days' supply of petroleum that was bought at previous prices. We had restrictions on it moving up. So I guess, in effect, we in Canada are hoist on our own petard in that some of those restrictions are affecting prices moving down. They are moving down, and we'd certainly like to see them go down. As far as profit margins in the industry are concerned, I haven't found anyone in the industry talking about profits right now. Rather, there's concern.

As far as natural gas pricing is concerned, that is being looked at. As you know from the Western Accord, there was a concept to deregulate it. But those steps are not being taken day by day or month by month. When the adjustments were going up and they were tied to oil prices, they were made once a year. We may have to move more quickly than that. Again, the price of the gas from the producer is only one factor in the price at the burner tip. A large portion of the cost is pipelining, which is based on capitalization, and that doesn't change. It's also based on the distribution system, and the cost of that doesn't change. So the actual price of the gas itself is only one factor. I can only say that we are looking at it, and that we are considering moving to deregulation by November '86, as per the Western Accord. When that happens, the utilities may well be negotiating with producers, and then gas prices themselves will be a bigger factor.

B.C. RAIL SHARES

HON. MR. CURTIS: Mr. Speaker, I wish to respond to questions put to me in an earlier question period. On March 13 the first member for Vancouver East (Mr. Macdonald), who is not in his place.... He's now in his place.

Interjection.

HON. MR. CURTIS: The member for New Westminster is grumpy again.

[Deputy Speaker rose.]

DEPUTY SPEAKER: Just a moment. The Minister of Finance will take his seat and the member for New Westminster will withdraw that remark.

Interjection.

DEPUTY SPEAKER: The one that the Chair found offensive, making reference to another member.

[Deputy Speaker resumed his seat.]

Interjection.

DEPUTY SPEAKER: The member will simply state that he withdraws the remark. The member for New Westminster, please.

MR. COCKE: I withdraw the remark.

DEPUTY SPEAKER: Thank you. The Minister of Finance continues in response to a question.

HON. MR. CURTIS: Mr. Speaker....

Interjection.

HON. MR. CURTIS: The member for New Westminster is very testy this morning.

DEPUTY SPEAKER: To the answer, please.

HON. MR. CURTIS: Mr. Speaker, as I said, the first member for Vancouver East (Mr. Macdonald) asked a question on March 13, and then just a few days ago, relative to British Columbia Railway preferred shares. I took parts of his question on notice.

Mr. Speaker, it is a matter of record that B.C. Rail Ltd. undertook a $200 million issue comprised of eight million shares in the first half of 1984. The issue can be identified as $2.1325 cumulative, redeemable, retractable first preferred shares, series A. They were priced at $25 per share, yielding 9.25 percent per annum, and it is also a matter of record that they were then and are now non-voting shares.

The offering memorandum carries a date of May 30, 1984, although I understand that interested Canadian investment dealers received details of the issue in the week of May 22, 1984, somewhere through that period. A news story is available in the Globe and Mail dated May 24, 1984, carrying a general outline of the forthcoming issue. Advertising of

[ Page 7694 ]

the issue also appeared in some Canadian newspapers in the last several days of May of that year.

Mr. Speaker, that's the background in order to answer the member's question. I purchased 100 shares of that issue on the open market, and I have computed that to be 0.0000125 percent of the total issue. The member did not ask how many shares, but I thought I might assist him in telling the House that it was in fact 100 shares which I bought with pride as a British Columbian.

These shares were purchased on the open market through an investment dealer on June 1, 1984, with a settlement date June 19, and these were at the issue price of $25 each. Mr. Speaker, as has been noted by disclosure form, I held the shares for approximately 13 months, selling them again on the open market through an investment dealer on June 27, 1985. The selling price was $27 ⅛.

Mr. Speaker, available to the member would be the trading range over the entire life of the issue from the beginning of June or the end of May, and indeed over the last 52 weeks. I see that in one 52-week period ending just a short while ago, the trading price was from $25 ¾ to $28 ⅜. I trust that answers the member's questions with respect to the B.C. Rail preferred share issue.

[10:30]

Orders of the Day

Private Members' Statements

CHIROPRACTORS' FEES

MR. STUPICH: My topic this morning is ancillary health services. In saying that, I think first of the wide range of ancillary health services that are available, and I think also of the nature of the service and the way in which that particular service deals with disease. When I use the word "disease," I'm not thinking about the narrow sense in which it is usually thought of — that is, a communicable disease — but rather the derivation of the word, which is lack of ease. So it could be entirely physical, it could be physiological, or it could be something that is transmitted.

I think of the way in which these various health services deal with that kind of disease. I think also about the cost to the community and whether or not the community can actually afford to give total health service to everyone. There are some very exotic operations that in some cases prolong life for a relatively short time that couldn't possibly be available to everyone. The community couldn't afford it, so there are questions about that.

[Mr. Ree in the chair.]

On the other hand, there are ancillary services which are much less expensive than the regular health services that are so often resorted to. I think in particular of those ancillary health services which depend upon non-surgical procedures, and certainly if we can have disease control — and I mean there if we can have ease as opposed to lack of ease — with non-surgical procedures, that's cheaper from the point of view of the cost to the health program, and it's also cheaper for the patient, if it can be dealt with reasonably well through non-surgical methods.

The same thing applies to non-drug methods. There are always questions about side effects of drugs. If we can have ease through non-drug methods, it would seem to me that individuals are better off. Certainly in the cost of the program in general, if not in every particular, we are also better off.

If the person providing the service concentrates on prevention, as opposed to dealing with something after the fact, then too the patient is better off, as is the community.

Mr. Speaker, recently we've all had a lot of correspondence from one particular group which is practising health services: the chiropractors. But I had resolved to raise this subject much earlier. I had occasion to use a chiropractor in an emergency over two years ago. I've used chiropractors off and on for the last 35 years, so it's obvious that I do trust what they're doing and I do get a measure of relief. If I use them regularly, once every four to six weeks, then I'm not so likely to have a recurrence of the problem. But I didn't in this case, and I did have to go in a hurry.

For the first time I saw what a chiropractor was getting for a first visit. I saw the receipt: $15. That particular chiropractor spent 50 minutes with me on that first visit. I asked him how he could afford to keep his office open if he was getting a gross fee of $15 out of which he had to pay rent and staff, provide equipment and live. His answer was that his wife works. She does; she's a chiropractor as well. They share an office so they're able to keep it open.

I've had occasion to go to a number of chiropractors on a first visit, and I had no idea that's all they were getting for that first visit. But in every instance the first visit is generally quite a long one. Then there are the subsequent visits. They're not as long, but I found out on the next visit that for subsequent visits that particular chiropractor got $11. In that case he spent only 15 minutes with me. But even at that rate I had to ask the question again: "How can you keep the office open?"

Then I learned more recently something about the training requirements for chiropractors, the fact that they do take nutrition for the whole of their four-year course in college. I understand that doctors are not required to learn any nutrition at all. Many do, and I give them credit for it. But chiropractic college requires four years of training in nutrition. I think that's very important. That was my course of study at UBC. Of course I found out that we know far more about the nutrition of all animals and even many insects than we do about people. It's hard to study people; they live as long as the researchers.

Mr. Speaker, my plea is for meaningful negotiations between the Ministry of Health and the Chiropractic Association. I understand there have not been any results from such negotiations in the past four years. I believe they have not been fairly dealt with in view of the service they render, the relative economy of that service and the way in which they do give ease to the patients who use those services. So my plea is for real negotiations with the Chiropractic Association on behalf of those people.

HON. MR. NIELSEN: I'm in a conflict-of-interest problem with this because I've used chiropractors for many years as well and have long felt myself a champion of the chiropractors.

We have been negotiating with the chiropractors; in fact, we are in negotiations now. The chiropractors, as I mentioned yesterday, have been very responsible in their demands and in the negotiations we've achieved over the years. There have been some improvements in non-financial areas, which I

[ Page 7695 ]

know they are appreciative of and which have assisted them considerably.

This is somewhat of a different occasion. I don't think there's any argument between the two sides on this issue. The chiropractors do render a very important service to the people of British Columbia, and they are well trained and very responsible. The number of incidents of malpractice or improper conduct with chiropractors is very, very low — almost non-existent. I think that's a tribute to their professional standards.

But we are meeting with the chiropractors. I hope to reach a settlement with them very soon with our negotiating team. I was speaking with the president of their organization earlier this week, and we had some informal discussions about that. I agree with the member for Nanaimo that the chiropractors have acted in a very responsible way over the last number of years, and we hope to achieve a settlement with them that will be agreeable to both sides. I'd like to thank the member for Nanaimo for his very strong support of a group of practitioners I also have great admiration for.

MR. COCKE: Mr. Speaker, the whole question of chiropractic and associated health professionals, semi-professionals and others is one that has long been under discussion in this province. It strikes me that we should be moving a lot faster than we have; since 1981-82 they've had no access to an improved situation, as the member for Nanaimo (Mr. Stupich) points out.

This harks back to a situation that I recall very vividly in terms of treatment of chiropractors and the way the medical profession has involved themselves in this particular area. In 1972, '73, '74 — that area — they wanted access to x-ray information, and the medical profession felt that because of their "inadequate training" they shouldn't have this access. We had many arguments with them about the whole question but it never did resolve itself properly. It strikes me that that's partly the reason the chiropractors now have such difficulty dealing with the ministry, dealing with the whole service of medical care. They've proven themselves beyond a doubt, in my opinion, and it's time they were given a real opportunity to negotiate just like everybody else and get themselves into a position where they can provide the service that they so well render.

MR. STUPICH: Just to get into the specifics, I appreciate the minister's comment and I hope he will do everything he can to enter into what the Chiropractic Association believes will be meaningful negotiations.

I have a bar graph that compares the cost-price index increases over the last 15 years with medical doctors' first and subsequent visits, doctors of chiropractic's first and subsequent visits, as well as manufacturing wages. The doctors of chiropractic are lowest on this bar graph, substantially lower than the increase in the cost-price index, whereas the medical doctors are highest for subsequent visits.

The minister spoke about some improvements having been made, and yes indeed they have. For example, they do have access to some x-rays taken by some doctors and, I believe, in some hospital situations. They are having a great deal of difficulty getting into hospitals to visit patients who want to see them, and I think that is something which should be cleared up.

The previous Minister of Health said, on one occasion, that he felt it should be dealt with between the Chiropractic Association and the College of Physicians and Surgeons. That's like the old story about the elephant dancing among the fleas and saving: "Every man for himself." It's not an equal contest to have the college dealing with the Chiropractic Association. They won't get very far if they depend on support from the College of Physicians and Surgeons.

Since 1979-80 the fee for a medical doctor's first visit has gone up substantially — from $25 to $40. It would seem to me relatively easy for a medical doctor to say that it's a first visit; it can be a slightly different condition and it's a first visit, so they qualify for a very high fee. With a chiropractor, if the visit is within six months of the first visit, then it's a subsequent visit and the fee is only $11, even though it was five months and 29 days. That's my understanding of the situation. So even the figures don't tell the whole story. I believe it's easier for doctors generally to say it's the first visit, and very difficult for chiropractors unless there's a lapse of over six months.

[10:45]

All the schedules, all the figures.... . the fact that the minister has had personal experience is perhaps worth more than anything else. One can only learn about this, and be comfortable with it, from such experiences. I had my first, as I say, some 35 years ago. I was almost paralyzed. I had never been to a chiropractor: I had never felt the need and was afraid to go, but I was persuaded. After two visits I was walking; uncomfortably, but I was walking. So I do believe in them. I believe in their service. They do give ease without drugs, without operations. I believe that the minister should aggressively pursue the negotiations with the Chiropractic Association so that they feel something positive is happening.

LICENSING OF TAXIS

MR. DAVIS: I'm addressing my remarks today to the Minister of Transportation and Highways (Hon. A. Fraser) because taxi licensing is governed by our provincial Motor Carrier Act. To a degree, it's also administered by this ministry, although the local municipalities have authorities as well.

My comments this morning are in the direction of deregulation. I'd like to see a measure of deregulation take place in the industry in B.C., and I'm also in favour of licensing not by municipalities, particularly small municipalities — small geographically — but by regional districts. I'd go further. Besides expanding the geographical area served by individual taxi companies, I'd limit regulation to conditions of entry and specifically to setting standards as to quality: the safety of vehicles, the condition of the vehicles, their excellence in terms of safety for their passengers, cleanliness and so on.

Following these recommendations, the fares and the routes would be deregulated and a higher-quality service would develop. In the lower mainland we have numerous municipalities, a dozen in the GVRD. Each currently has the power to license taxi companies. These municipal authorities give their companies permission to pick up passengers in their own territory. They cannot reach beyond their own boundaries, thus they lack the power to authorize passenger pickups in adjoining municipalities. As a result, taxis involved in intermunicipal traffic — those moving from one municipality to another and back again — return empty. They deadhead back to their home municipality. There's a waste of energy, a waste of fuel, a waste of space on the streets,

[ Page 7696 ]

obviously at a cost which is eventually borne by the passengers.

Thus there is a strong economic case for broader area regulation — regional district administration of taxi licences rather than administration by individual municipalities. The Economic Council of Canada looked at the taxi industry Canada-wide a few years ago and pointed the finger particularly at the greater Vancouver area. They suggested that costs could be reduced at least 20 percent and perhaps 25 or 30 percent as a result of licensing in a broader area context, and more than implied — said — that rates, taxi fares, would come down correspondingly if this more efficient service were possible.

Most municipalities in the lower mainland now appear to agree with this opinion. Even the city of Vancouver now seems to be, in principle at least, in favour of licensing on a broad regional basis. I know that the Motor Carrier Commission itself has looked at this problem, has advocated several measured steps in that direction: that is, toward broad regional licensing and toward the freedom of individual taxi companies to be full, to have passengers both ways.

I'm particularly concerned about the situation which now is likely to develop at Expo, where taxis originating outside of Vancouver city must return to their home area empty. That doesn't seem to make much sense. I can imagine visitors from outside of Canada, outside of B.C., hailing a taxi originating in Burnaby or Richmond or Surrey or on the North Shore, and in fact being picked up illegally, as it now stands, being carried a few yards, a few blocks, and then being apprehended by the police of the city of Vancouver, as has happened frequently. You can imagine the embarrassment all around. It doesn't make sense, but that, at the moment, given the city administration, is what happens legally.

The other aspect that concerns me is the quality of the service. We've read headlines recently about the Vancouver city police stopping taxis and examining the condition of their brakes, their cleanliness, the knowledge of the drivers as to the points of destination around the lower mainland, and the story is appalling, really. Two out of three taxis fail the tests. A number are taken to the side of the road and have to be carted away other than under their own power, because they're in such bad shape.

I believe that the emphasis of the province, through the Motor Carrier Act, should be on vehicle safety, inspection of those taxis, and should require that the licensing be on a broad regional basis, rather than by individual municipalities.

HON. A. FRASER: I appreciate the observations of the member for North Vancouver–Seymour on regional licensing of taxis. Certainly it is the subject of large public interest — rightly so — and, as you know, the Motor Carrier Commission has jurisdiction over all taxis throughout the province, not just the lower mainland. Then a further licensing exists of taxis by individual municipalities. I agree with some of the remarks made by the member, and the Motor Carrier Commission have certainly tried to do something to resolve all the problems, but I agree they've probably been rather slow and kept their head down because they have to deal with all the jurisdictions.

I'll now get down to the lower mainland. They have to deal with all the municipalities and hear their views. I note in the member's remarks that he feels that all the municipalities in the lower mainland are in favour of regional licensing of cabs. I'm not so sure, from my information from the Motor Carrier Commission, that this is so, particularly with the city of Vancouver. The situation in the lower mainland, and I mention the city of Vancouver because there is an inventory in the lower mainland of about 1,000 taxi cabs.... . . Of those 1,000 cabs, a little better than 50 percent are licensed within the city of Vancouver. The rest are in the North Shore and Burnaby, Delta, Richmond and so on.

One thing that I'm abundantly clear on is that regardless of the politicians on the councils, the operators and owners of the taxi cabs in the city of Vancouver are absolutely opposed to regional licensing. You didn't mention the operators and owners, but it is my opinion, for what it's worth, that they'll go to any degree to stop regional licensing. What I'm really saying is that even if we have the cooperation of all the municipalities — let's say we have — we don't have the cooperation of the owners and operators. Maybe that isn't a big issue, but it's a fact of life as I see it today.

I would just like to make comments regarding Expo and looking after Expo. The Motor Carrier Commission has had a lot of dealings with trying to upgrade and make sure that our visitors are looked after during Expo.

SOME HON. MEMBERS: Clean up those cabs.

HON. A. FRASER: Yes, and that's going on and will continue to go on, but I think it is also very important that the Motor Carrier Commission has dealt with the operators as well as the municipalities, and it's my information from the Motor Carrier Commission that the changes that are being put into effect will supply adequate taxi service to our visitors and will not impair the service to our own citizens as well. Customers will be encouraged to use cabs from the municipality they are travelling to. I think this is very important. Information kiosks are being installed to let visitors know which areas are served by each cab company. Customers will not have to use the first cab in the lineup.

The Motor Carrier Commission is working to ensure the public is supplied with safe, reliable transportation during Expo. It also wants to make sure that all the taxis in the lower mainland aren't serving Expo visitors with no service for the residents and business people. As I said, there are about 1,000 cabs in the inventory in the lower mainland now, and this is being increased by 10 percent, with room for more if there is a real need. In other words, cabs are going to be allowed to return from, say, the airport and pick up a passenger....

DEPUTY SPEAKER: Hon. minister, time is up.

HON. A. FRASER: Thank you.

MR. DAVIS: I can understand why the Vancouver Taxi Owners Association prefers to keep things as they are. I would think that up to half of all the taxi rides in the lower mainland originate or terminate in Vancouver city, largely because that's a working area, the business centre of the lower mainland and so on. Therefore, those who operate cabs based in Vancouver and with the city of Vancouver licenses have an advantage over taxi companies in the outlying areas. They have a kind of monopoly. They're reluctant to engage in some more open competitive situations. They like what they've

[ Page 7697 ]

got. They like the monopoly that they have. That's understandable. The minister is saying they're a substantial political force — a force to be reckoned with, and maybe things should be left as they are because the Taxi Owners' Association is that kind of political entity.

As for the city of Vancouver itself, Alderman Don Bellamy for some years has chaired the taxi etc. committee of city council, and he tells me — indeed, I've seen press reports to that effect — that they have changed their view. They don't like the job of licensing taxis, partly because of the rise in price of taxi licences and so on, and in theory they agree with regionalization. They have their problems with the political force in their area — the Vancouver Taxi Owners' Association. But I think that the province should show leadership, bite the bullet, break that monopoly and see that we have a better service.

[11:00]

JOB CREATION

MR. MICHAEL: Mr. Speaker, I take pleasure in rising today to speak about job creation. I intend to read into the record some facts pertaining to new jobs that have been created in the province of British Columbia in the last while. I will also be quoting some excerpts from Hansard — statements made by the opposition. It's sad, perhaps, in looking at the opposition today to see only two members in the House, and all of the members whom I will be quoting are not present in the chamber today. Nonetheless, Mr. Speaker, I will read it into the record for all to know what's happening in job creation in the province,

On the first Friday of every month Statistics Canada releases figures on new jobs created in every province in the Dominion of Canada during the last 12 months. I've taken the time to examine every newspaper that I've been able to get my hands on in British Columbia since the first Friday of April, and it's sad to say there's not a single newspaper in British Columbia that has quoted the true story of the exciting things that are happening in job creation. I had to go to the Globe and Mail edition dated Saturday, April 5, in order to find one single article in the province quoting the facts. As a matter of fact, if anybody would care to get a copy of the Province dated Monday, April 7, 1986, you will see a headline reading: "Real B.C. Is Seen in Jobless Figures." They go on to say in the first paragraph: "We said the other day that if the 2.5 million people living elsewhere in Canada who want to come to live in B.C. knew about our unemployment, they might think twice. Now that Statistics Canada has come out with new figures, they might be wise to drop their dreams altogether." They go on to say that experience shows that Expo 86 was supposed to have created a lot of work. Not one word, Mr. Speaker, out of the Vancouver Province that day about the truth of what's happening in job creation in British Columbia.

Here are the facts, Mr. Speaker. Fact number one: B.C. created 23,000 new jobs in the month of March 1986. As a matter of interest, that compares with 1,000 in the province of Manitoba. Further to that, fact number two: B.C. created 53,000 new jobs in the past 12 months. Further to that, fact number three: B.C. led all Canadian provinces including Quebec and Ontario — Ontario being over three times the size of British Columbia, and Quebec being over twice the size — in actual new job creations in the month of March 1986. New job creations totalled 23,000 new jobs in one month, and not one whisper in one newspaper in British Columbia. They're too busy up there drinking their coffee and playing with their knitting needles to pay attention to the things that are happening in this exciting province.

Further to that, Mr. Speaker, if one wants to go back just 14 short months and look at the employment figures in January '85 compared to the most recent, March 1986, you will find 89,000 new jobs created in the province of British Columbia. Now, Mr. Speaker, those are the facts and the facts are now on the record. Those are Dominion Bureau of Statistics facts.

You pick up the Hansard dated March 24, 1986, page 7479 and you listen to the member for Okanagan North (Mr. MacWilliam), debating. He goes on to say:

But every one of those jobs was in the greater Vancouver area. There wasn't a single job created in the interior regions of this province. Statistics Canada has indicated that job growth in the interior of this province was nil, zero, zilch. It all went to the greater Vancouver area.

Now what are the facts? I went to Statistics Canada, and I asked for a regional breakdown of job creation. Very, very interesting. What do we find? In the central Kootenay area, which encompasses my constituency, Mr. Speaker, in February 1985 there were 30,000 people working. In March 1986, 13 months later, 36,000 people were working, an increase of 6,000, a full 20 percent increase in those working in that region during that 13-month period.

Mr. Speaker, I could go on. I can look at all kinds of figures here to show employment growth in Okanagan-Boundary: 89,000 people working in February 1985; 93,000 working in February 1986, a gain of 4,000. And yet that member says nothing is happening in the interior of British Columbia. The statistics show the exact opposite.

[Mr. Strachan in the chair.]

Let's go and look at the Hansard of the morning sitting of Friday, March 14, 1986. The member for Cowichan-Malahat (Mrs. Wallace) was speaking. Here is what she has to say:

This indicates that people have been forced to leave the Island because there is no work. They're leaving. Our population is going down.

AN HON. MEMBER: Not true.

That was me, Mr. Speaker. She goes on to say:

That is true. I am talking about Vancouver Island, where it is going down because there are no jobs here. There is a net loss in the province as well.

AN HON. MEMBER: That's not true.

Again, that was the member for Shuswap-Revelstoke. She goes on to say:

There's no sense trying to prove things to that member, because he doesn't listen. He's not prepared to accept facts that point in any direction other than what he thinks.

DEPUTY SPEAKER: Time has expired, hon. member, and you will have an appropriate opportunity to....

Interjections.

DEPUTY SPEAKER: No, leave will not be asked for or given.

MR. MACDONALD: Does the minister have priority?

DEPUTY SPEAKER: No, as a matter of fact, the government member has spoken....

[ Page 7698 ]

MR. MACDONALD: Well, can we share the time? I'll be very brief.

DEPUTY SPEAKER: We'll share the time. That would be great, yes.

MR. MACDONALD: Mr. Speaker, very briefly. It's sad that this kind of a speech is made. The figures lie because they don't explain that we still have about 14 something percent unemployment in this province.

Now maybe it....

Interjections.

MR. MACDONALD: Yes, I know you're talking about how you pulled this away....

Interjection.

MR. MACDONALD: Oh, that fellow makes so much noise. Why doesn't he go sell a wreck?

DEPUTY SPEAKER: Order, please. The second member for Surrey (Mr. Reid) will come to order.

Interjection.

MR. MACDONALD: Go sell a wreck.

Interjections.

[Deputy Speaker rose.]

DEPUTY SPEAKER: Order, please. One moment. The second member for Vancouver East will take his place. The clock will stop. Thank you.

Interjection.

DEPUTY SPEAKER: The second member for Surrey will take his place and remain in order or do so outside of the chamber.

Time during private members' statements is limited. Therefore it is imperative that we give every member who wishes to speak as much opportunity as possible to do so without interjections or interruptions. Understood? Thank you. Please proceed.

[Deputy Speaker resumed his seat.]

MR. MACDONALD: I just want to make a simple point. Things have improved slightly in the province of British Columbia, and the member is right. They've improved slightly from the morass of unemployment we were in, and have been in, really, under Social Credit since 1976 and deepening enormously in 1982-83.

But I get from that member's address that he is accepting as great something like 14 percent unemployment in this province. It's a tragedy, but we're beginning to accept it. We're beginning to accept youth unemployment of 20 percent to 25 percent. We're beginning to accept unemployment among young native people...

Interjection.

MR. MACDONALD: There he goes again.

...of 50 percent, 60 percent, 70 percent. We must not accept these things as normal and say how great things are when we have these ghastly unemployment figures, particularly for young people.

HON. MR. SEGARTY: Mr. Speaker, it is a pleasure for me to get up and participate in this debate somewhat. I want to congratulate the member for Shuswap-Revelstoke (Mr. Michael) for taking the approach that he did in debate, pointing out that there is economic recovery taking place in British Columbia. Certainly no member in this assembly does more for employment creation and job opportunities in his region of British Columbia than the member for Shuswap-Revelstoke. So I give him credit for getting up and participating in debate, and as well for getting up in debate in the spending estimates of each minister of the Crown and putting forward ideas that will provide further employment opportunities in his constituency.

Mr. Speaker, the member for Vancouver East talked about 14 percent as though that was the accepted position of the government of British Columbia. I have to concur with the member for Vancouver East that there are too many people unemployed in British Columbia today. There are too many people unemployed in our country today, particularly among the young. When the Ministry of Labour was establishing its budget for 1986-87, we looked at opportunities that we could provide for young British Columbians in the development of that budgetary process, recognizing that we have an awful lot of very enthusiastic and ambitious young British Columbians. All they need in many cases is a helping hand from government to help them help themselves through the process. That will be in place and is currently being addressed by the Ministry of Labour.

Over the course of debate in the Legislature since 1983.... You will remember the difficult time that we had as members of government bringing in a program of economic recovery and renewal in British Columbia in 1983, recognizing the difficult times that our industry was going to be in, meeting stiff competition throughout the world for the products that we manufacture in and supply from British Columbia to world markets, and recognizing the need to reduce our costs to industries and businesses across British Columbia. The opposition party in this province did everything they could to stop that process from taking place. They voted against every single measure that this government brought in to reduce the tax and regulation burden on British Columbia business. Last year the Minister of Finance (Hon. Mr. Curtis) brought in a budget that would see tax reductions on business and industry in British Columbia in the amount of $1 billion over a three-year period. What the member for Shuswap-Revelstoke points out today is that that program and those policies are working on behalf of the people of B.C.

MR. MICHAEL: Well, Mr. Speaker, I'll just read into the record the Vancouver Island net migration statistics. The last available year's clearly shows an increase — 2,020 people moved to Vancouver Island, not away. Further than that, I'd like to read into the record the population figures for British Columbia for the last few years — the growth figures. In 1982 net growth, total population increase, was 32,025; 1983, 34,559; 1984, 32,653; 1985, 22,612. Yet the members opposite, I read continually in Hansard — and I listen in

[ Page 7699 ]

this assembly — are talking about population decrease, people moving out of the province. Let me tell you something about interprovincial migration. It is true that we've had a loss in the last 12 months, but that trend changed in the last quarter of 1985. I predict that with what's happening in Alberta today, we're going to see a net influx in the year 1986.

In conclusion, I'm not happy with the unemployment figures in British Columbia — none of the members in this House are happy. But we have to understand that we've gone through a very serious international depression, hurting the very basic industries of this province. If you look at the things on the horizon — not just Expo and not just the Coquihalla Highway, but things that are happening positively in the lumber and pulp industry, the prime rate going down, mortgage rates going down, oil and gas prices decreasing, and corporations throughout this province on the upswing.... A lot of things are happening in high tech and in the motion picture industry. Cruise ships are coming into our province. Exciting things are happening in the aquaculture industry. A lot of positive things are happening in this province. But what do we hear from the members opposite? Negative, negative; gloom and doom. It's sad that we can't get some positive news out of the opposition. Why is it that their members in Ottawa aren't standing up and fighting for a better deal for British Columbia? Read the Hansard from Ottawa, Mr. Speaker, and you will see the questions asked by the party of members opposite in Ottawa. There's nothing said about improving the balance of payments for this province. Those kinds of things are ignored by their party. They don't care about B.C.

[11:15]

"QUEEN'S COUNSEL"

MR. MACDONALD: Mr. Speaker, the subject of my discourse this morning is Queen's Counsel, otherwise known as the letters "QC" after the name of a lawyer. When I got my own QC, somebody on the street asked me: "What queens do you act for?" But the term is generally well understood, even by the Attorney-General of British Columbia (Hon. Mr. Smith), who has just entered the chamber.

It's my position that QCs are something lawyers can and should do without, and those that are out there should be called back in. It is something that is being done in the province of Ontario at the present time. The new Liberal government under Premier Peterson is cancelling the QCs — which are outstanding in British Columbia — because it was becoming a joke in that province. So many were granted that if you didn't have one, it looked as if you'd been convicted of some felony, or had been in the provincial cabinet or something — had committed some kind of serious dereliction. The QCs are really misleading advertising. People naturally assume that the lawyer who has the QC has received a Good Housekeeping seal of approval, and that's not the case at all. A lawyer who does not have the QC can talk as well and as long and win as many cases as a lawyer who does have a QC. It's not merit, but the public seems to think it is based upon merit. Basically, the only change when you are anointed with silk, as I was, is that you can more plausibly charge a larger bill. That's about the only change.

We see these QCs being born out of politics. I'm not saying it's bad politics, but I'm saying.... In the case of the bar association it's for meritorious service, in many cases — a committee of the Canadian Bar Association, or something of that kind. For that, the QC is awarded. Or it's awarded for meritorious service in the vineyards of the politics of the government in power in British Columbia. Well, that kind of accolade we can do without. I have an example. I think John Laxton has been through more courts, in one capacity or another, than almost anyone I can think of, and has performed extremely well in those courts, high and low. He hasn't got a QC because he supports the NDP There are exceptions; John Turner appointed Tom Berger to the bench and therefore judicial appointments were no longer political. If you believe that, you believe anything.

Basically it's political, either through the bar or through the politics of the province of B.C. The list passes through the two chief justices, but they don't make the list and they don't make the final appointments. Quite frankly, I think it's a little unfair to the chief justices to be taking part in this particular process. In my own case, which the Minister of Highways keeps bringing up, for many years I was on the list to be given a QC, according to the late J.O. Wilson, when he was chief justice; but I never got past either Leslie Peterson, or whoever the Attorney-General of the day was, until we formed a government in 1972 and I was able to give the invidious accolade to myself, which I promptly did. I ceased all further appointments, except to reward the said J.O. Wilson for having put my name forward all those many years, and then one very meritorious one to the late Ned DeBeck, Clerk of our House, who was then 92 years of age and had had a very distinguished career. The Attorney-General's statute says that Attorneys-General have to give it to themselves, so don't make too big a thing of it that I gave one to myself.

I think my time is up, Mr. Speaker, in more ways than one. We should follow the path of Ontario and do away with QCs I with the possible exception — I'm looking at my friend opposite — of QCs for those who have served in the office of Attorney-General.

HON. MR. SMITH: I enjoyed the remarks of the member for Vancouver East. As always, his views on this are well known and well expressed, and he did so with a good deal of levity. We certainly are going to miss him in this place for his turn of phrase.

The QC subject is, as always, a vexing one. For ten years very few were appointed, I think only the two mentioned by the member. In 1982 the government decided to resume the appointment of QCs. Our act and our situation is very different from that in Ontario. Prior to the abolition of QCs in Ontario, there were 3,057 out of a profession of 17,741; 17 percent of the practising bar had these honours. If you went down to the Ontario Court of Appeal as a silkless British Columbian barrister, you found yourself about 40 feet away from the ear trumpet of the bench, and a callow youth with five years' experience in Ontario was pleading his case right under the ear of the bench.

The situation was very bad in Ontario, and it had to be addressed, but in British Columbia the situation is exactly the opposite. Out of a practising bar of 5,818, we have 248 QCs — only 4 percent of the bar. The problem here is that we have not been able to honour enough of the good practising members with this award. I wish that we could appoint considerably more; there are many deserving people in practice, both barristers and solicitors, who should have this award.

[ Page 7700 ]

It's interesting that the Law Society of Ontario is very distressed at this Cuban decree of taking them away retroactively. I guess that they're going to go and expunge from the gravestone of Arthur Meighen his QC. They're removing these retroactively. The Law Society of Ontario is trying to intervene and to have some better method of appointing them in the future.

I have here a communique from the Law Society of Ontario, February 28, in which they have recommended to their members that the basis for granting QCs in the future be the adoption of the criteria used in British Columbia. That's what they're recommending, and the criteria in British Columbia for the appointment of QCs is being generally acknowledged as: firstly, a leading counsel, or, secondly, recognition by the profession as exceptionally gifted, or demonstration of exceptional qualities of leadership in the profession, including participating in the affairs of the profession through its various bodies, outstanding work in the field of legal education or scholarship, and public service.

The 23 QCs that were appointed at the end of December were thought to meet those criteria. They not only have to pass through a committee of the two chief justices, but also two members of the Law Society who are chosen for that purpose have to pass over them. I can assure the member opposite that my list wasn't all a one-sided thing, where I said: "These are the ones we are going to have." Some of the people on that list came from the chief justices and the benchers. Their suggestions were incorporated and it was finally a list that everybody agreed with.

There was no disagreement with anybody on the list. I think that if you look at the list, you would see that there were people on there of differing political stripes. They were on there because they met the criteria. Let us, instead of knocking the institution of QCs, try to make more and better honourable appointments which allow the institution to mean something, as it always has in this province, I think.

I think that the great disappointment was that the tradition lapsed for ten years because of the policies of the previous government in not liking to give titles, not liking the idea of awards, not liking the notion that somebody was going to be singled out for some kind of award. They didn't like that philosophically. I think most people in the bar and the public accept these awards if they're done properly and fairly, and they have been done in British Columbia with a good deal of temperance.

MR. MACDONALD: Just briefly, you know I don't think that we should have a class system among the lawyers, and that's what the Attorney-General is basically proposing. He says "those who are exceptionally gifted," and so forth, with some very general phrases, should get the QC. I see the Minister of Health sitting over there. You could do the same with the doctors. You could say: "QD." Why should the lawyers only have it? Or bricklayers — QB, Queen's Bricklayer. Then you would be creating two classes of bricklayer, an invidious distinction.

Interjection.

MR. MACDONALD: PDQ, yes. Anyway, we'd be swallowing the alphabet before we had finished equalizing things.

We would appoint a great many. Instead of 23 this year, I can think of.... . . I see one right across there at the present time in my line of vision. I now see two. I see other lawyers that could equally, meritoriously, have been given the QC, but only a few get it. A class system, and the Attorney-General says: "Don't recall those that are already out there." Some of those out there are the worst appointments that have been made since the Emperor Caligula appointed his horse a proconsul. They are awful.

HON. MR. SMITH: Name names.

MR. MACDONALD: Oh, I could, but I won't, and so could the Attorney-General. He could tell about nephews and nieces and everything else if he wanted to. So could I.

So I say that it should go. We don't need these two classes of lawyers. It's always going to be, in somebody's opinion, that: "This one is better." Let the clients judge that; let the public judge that; let the fellow establish it on his own.

The House in Committee of Supply; Mr. Ree in the chair.

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 37: minister's office, $207, 950.

MR. COCKE: Mr. Chairman, I think I would like to lead off with a couple of cases today. This is under medicare and the recognition of refugees, the recognition of people who are here under ministerial permits. I know that the provincial government does not make the distinction as to who should have a ministerial permit and who shouldn't, but if a person is here under a ministerial permit, then by virtue of the fact that this government decided some time ago that foreign students should not have access to medicare and that they should pay their own way and one thing and another, a lot of other people have fallen into that same situation.

Let me give you an example. You've all seen an example recently where the minister made some changes for a particular family; it was well publicized. I've got another one, in New Westminster. Here's a young woman who has been here for two years, is married to a Canadian citizen and has given birth to a Canadian child, but because of the fact that she is still here under a ministerial permit — incidentally, asking right along that she be given landed immigrant status so that she can apply for Canadian citizenship and all the rest of it.... To this date she has not received that status. Here's a women with a Canadian child and expecting another Canadian child, who thanks to the good offices of our government does not have access to that medical coverage that the rest of her family would naturally have. Her child could have it, her husband has it, but she doesn't. The inconsistency of this, as far as I'm concerned, is absolutely maddening.

[11:30]

I was very angry in the first place when I saw that our government decided to opt against giving foreign students access to our health care. I thought that it was most inhospitable of us. Despite the remonstration that I've heard from the member for North Vancouver–Seymour (Mr. Davis) from time to time, I think that foreign students happen to enrich our country. I think that their influence, when they get back home, enriches the cooperation of our country with other countries. Having said that, I'm really not dealing with that question now; I've dealt with it before. I'm dealing now with people who, by virtue of the fact that these orders were

[ Page 7701 ]

brought in, have fallen between the cracks and are ineligible for coverage.

I'm not going to use this person's name in the House — I don't think that I should — but I can certainly give the minister this person's name. But it goes beyond that. This person got in touch with an MLA. What about the myriad other people out there who have no access to our medicare scheme just by virtue of the fact that they are here under those conditions? Let me just go over it once more. She's here on a ministerial permit, married to a Canadian citizen, has given birth already to a Canadian child and is expecting another little Canadian. But that woman has no access to our medicare scheme by virtue of the orders that have been received at the medicare commission.

Will the minister give me some kind of understanding or some thoughtful answer to the question that I have raised before I do any other raising of questions vis-a-vis the medicare system?

HON. MR. NIELSEN: Mr. Chairman, as I mentioned the other day, the question basically revolves around definitions of residents and visitors. The definition as such now does not include visitors to Canada and various other categories of people as being eligible for the Medical Services Plan.

The question with respect to refugees and others who are in the country on ministerial permits brings in, of course, the federal government. That's not passing the buck, but it is our opinion that the federal government is responsible for the people they admit to the country. We play a minor role with respect to ministerial permits when it is a question of health. The federal government normally, through their ministry of immigration, request an opinion from the province as to whether we support the admission to Canada of certain people who have medical problems. We have the opportunity of responding as to whether we support it or not. But a refugee or a person here on a federal ministerial permit, in my opinion, is the responsibility of the federal government. We do not disagree. We believe the federal government must assume the responsibility for the needs of that individual if they are unable to do it themselves.

We have asked the federal government to please move on this. The member for New Westminster mentioned a woman who has been in Canada for two years, married to a Canadian citizen, has given birth to a child and is due to do so again. I am not evading the point the member made, but my question is: why is the federal government sitting on the case? Why have they not granted landed immigrant status to this woman? I don't understand why they would not do so, and if they were to do that, that person would be eligible for the coverage.

I have a similar situation in Richmond, where we have an almost identical situation. The woman has been here for three or four years, I believe, still waiting for the federal government to make a decision as to her landed immigrant status, and I don't understand why they are holding it up. If the person is unsuitable to be in the country, then why don't they give them that advice?

But I think we have to recognize what the regulations of the Medical Services Plan call for and who is eligible for coverage. There are alternatives — perhaps at a somewhat higher cost. There are private insurance policies available, and many people make use of them. But I think the decision is correct, and to some degree, by way of advice, it is consistent with the Charter of Rights in Canada in that we are not to discriminate against categories of people, be they visitors or residents.

So I can sympathize with an individual case, and perhaps it costs a certain amount of money for them. But I think to a very large degree it is up to the federal government to move far more quickly on citizens or individuals who come to the country and are married to a Canadian citizen and are residing in the country and are producing young Canadians, by way of birth. I don't understand why they drag their feet on these things.

But we have adopted the position of definitions of residence and visitors, and it is applied across the board to all, consistent with the spirit of the Charter, according to our legal advisers. These people are caught between the stools, as the member said. I share the responsibility with the federal government. I am not suggesting it is theirs alone. It is a shared responsibility. It is the law of the land at the moment. Yes, these people sometimes find themselves in somewhat of a difficult situation, not because we've created it but because of circumstances which are real and here at this time.

I think the correct thing has been done. I think there are certain procedures which could alleviate the problem for many individuals. I will be speaking to the federal minister with respect to trying to move these applications for landed immigrant status through whatever system they have back there. But a visitor to Canada is a visitor, whether from Seattle or from Jordan, or some other country. They are to be treated the same, and they are not eligible for a medical services plan.

MR. COCKE: The minister says it's the law of the land. It's a regulation of the land. There was no statute passed in this House providing that kind of situation. It's a regulation. It's a ministerial responsibility, a cabinet responsibility. I think the cabinet was dead wrong in what they did. I think they were most inhospitable.

But getting back to this point, here we're talking about a person who's relatively defenceless. The minister says the federal government are dragging their feet, or maybe they are, or why don't they come to grips with this situation; either the person should be admitted on a landed immigrant status or not, but they shouldn't keep on with a ministerial permit. All very well and good. But that woman had a child in this province, and that pregnancy was paid for prior to this goofy new order-in-council that came out making it inaccessible for her. So she goes from one situation to another.

It strikes me that people in a relationship like this, with a Canadian husband, with a Canadian child, should automatically become eligible, and there should be some way a cabinet can make that kind of distinction. They made a distinction enough when they said anybody here other than landed immigrants or Canadian citizens was ineligible. It strikes me you can make people eligible, providing they have this kind of relationship. I've given up on trying to make us see the light on students, but certainly people here in this situation, I believe, should have access to our medicare scheme.

The minister says: "Oh, private insurance schemes are available for these people." I ask the minister, even in his wealthy state, where he.... No, I can't do that, because he couldn't get pregnant, very likely. But the fact of the matter is, where a person is pregnant, do you mean to tell me that an insurance company is going to offer insurance over a certainty in terms of a claim? I was in the insurance business too

[ Page 7702 ]

long to think that any underwriter would accept that. They would say that's a pre-existing condition — short as it might be, it's a certainty, and you don't insure against certainties.

So they have no access under these circumstances, unbeknownst to them. They get a message in the mail. Everything was fine. The first baby was born. Medicare paid for it. Everything was hunky-dory. They pay their premiums. But then all of a sudden, out of the blue, they're told: "Sorry. Your premiums aren't worth the powder to blow them to heck."

What are you going to do about it? They're going to somehow or another have to pay for it. And at today's prices, for these situations, that is a very great hardship. I happen to know where these people live. They don't live on Snob Hill by any stretch of the imagination. They're just trying to get along, and trying their best to get that ministerial permit out of the way and get landed immigrant status. But if those slowpokes and bureaucrats in Ottawa can't get around to it, I don't think that we should hold these people hostage. It's just too rough. We should be a lot more benevolent in this situation than we appear to be. The minister should take a close look, not only at this one in particular, but at this type of circumstance that leads me to say something must be done if we are to come out looking like really civilized people.

[11:45]

On another subject, Mr. Chairman, on Tuesday last, when the minister was wearing a different hat, but one that was to some extent affected by a group that I talked about at that time, the Cedar Lodge Society, I asked the minister if he would somehow or another intervene on behalf of the people of British Columbia so that the facility the Cedar Lodge Society has been running can be run by a health group in our province until such time as a program can be put together. Since I asked that question I've been informed that the Health Sciences Centre Hospital at UBC are asking for an interim arrangement until such time as they can put together a program for mentally affected young adults. Everybody knows that in our province we have an awful lot of walking wounded in this particular area. Because of their long history in psychiatric care out there, nobody could do a better job, in my opinion, of putting together a program in this marvellous facility at Cobble Hill than the university's Health Sciences Centre Hospital. Has the minister a few dollars for the time being to assist them to at least hold this facility for a better use? I understand that there is an American outfit bidding for it, a Bible society bidding for it and so on. I believe that the greatest use of this facility would be on behalf of the people in B.C. who most need that help. I'm just asking the minister: has he any news for us at this particular time?

HON. MR. NIELSEN: No, I have no news. The mental health division is reviewing the suggestion by the UBC hospital to possibly use that facility for the specific program the member referred to, but I have no news. I suppose it really isn't that important, but the society really, I believe, at one point overextended itself.

MR. COCKE: No question, and then of course they lost out.

HON. MR. NIELSEN: Yes. But the Health Sciences Centre is looking at the possibility of developing a program which, I believe, would be useful no matter where located; and they have spoken with the people about the possibility of using that facility. So I don't believe the facility is lost to that purpose. We are discussing it presently, and we'll know pretty quickly what the feasibility is. I'll try to find the money — maybe the hospital has it.

MR. MICHAEL: Mr. Chairman, I'd like to pass on to the minister some problems in my constituency. There are a number of communities looking for additional health facilities. Armstrong has been looking for a new hospital facility for many years. I understand that a property has been identified and that plans are in the works. The Enderby community is looking for an extension to their facilities. And, of course, Salmon Ann is looking for a new 100-bed extended-care/intermediate-care hospital.

I'd like to make a special pitch for the community of Chase. Chase is located approximately 38 to 40 miles from Kamloops and probably about 42 miles from the nearest hospital — in Kamloops, which is the hospital that serves the Chase community. Chase has a population somewhere in the neighbourhood of 2,000 residents, and serves quite a perimeter around that community: communities such as Pritchard, Chase Creek, China Valley and the north shore communities such as Celista and Anglemont — all look to Chase as their town. To my knowledge — certainly from any communities that I travel to or am familiar with — the community of Chase is the largest community without any kind of health facility. I believe there are three doctors practising in the community, but they do not even have a diagnostic and treatment centre. Mr. Minister, I would ask that your ministry give special attention to reviewing at the earliest possible date.... I know we have had a lot of correspondence on this, but I have yet to receive a positive indication that Chase is going to be getting a facility. What they want is a diagnostic and treatment centre as well as a care facility. There are a lot of seniors not only in the community of Chase but also in the surrounding area. Its population is largely retired, and I would say that if there's any community that I can think of in the areas that I travel that is deserving of early attention by the Minister of Health to consider a new health facility, I would have to say that Chase should be very high on any priority list.

[Mr. Strachan in the chair.]

The other thing is the question of a speech pathologist situation we have in the community of Salmon Arm. It's been an ongoing problem. There are speech pathologists in Salmon Arm, but they all work for the school board. I believe there are four of them, but someone who is not going to a school and who has a speech problem has to drive all the way down to Vernon, and the Vernon people are booked very heavily. They have quite a caseload, and it means a long waiting list and a lot of travelling by the people in Salmon Arm who need this type of service. We had a speech pathologist in Salmon Arm who, I believe, was servicing Salmon Arm on a half-time basis, the other half being in Armstrong. Fortunately, or unfortunately, her husband got a job in Victoria and she had to leave the community, and that position was given to another community.

I would ask the minister to please have his staff review the speech pathologist situation in Salmon Arm. I know there have been some discussions going on between your ministry and the Ministry of Education as to how the overall speech pathologist situation is going to be handled in the community of Salmon Ann. Perhaps it should come under just one

[ Page 7703 ]

umbrella and in such a way that the speech pathologist could look after the entire community.

That is one of the situations I would appreciate the minister looking at, and I would ask him to please have a very close look at the situation in Chase, British Columbia. The community there is very anxious for an announcement about their centre, their health facility. They have a society formed and there are hundreds and hundreds of people — I don't know what the total score is; I believe it's over a thousand now who have joined that society — backing the committee that was formed to bring a health care facility to the community of Chase.

Interjection.

MS. BROWN: Well, no, I will not, I'm sorry. My own debate leader is harassing me. She thinks I should....

I'm not going to go into full flight on this one; I just have one small issue that I want to deal with, and that's the homemakers. I have been receiving a number of letters from homemakers in my riding — the aides — saying that they have not received an increase in their income in five years. Five years ago the dollar was worth close to a dollar, while today it's worth 76 cents or something of that nature. But in any event, on behalf of the homemakers I would like to ask the minister if he can give me any indication as to whether there is an increase in the budget for them anyway.

At the same time as the homemakers are not getting an increase, we are finding a decrease in the number of hours that they are able to give to any one person. I want to draw specific attention to a woman living in the Hall Towers who is quite severely disabled. She gets around very slowly and with the use of two canes. She has real problems in terms of doing her shopping, getting out to the bank and dealing with those kinds of errands. Until about a month ago she had a homemaker who would come in and not just help around her apartment, in terms of the things that homemakers do, but in addition would do her banking and her grocery shopping for her. She has now been informed that this is no longer possible, that the homemaker's hours are being curtailed and that there is no time for the homemaker to do her banking or her grocery shopping for her. This is a person who cannot walk and carry a bag of groceries at the same time. It's not possible, because she has to use two canes. So here is her dilemma. How are we going to deal with this particular dilemma? Of course, getting from Hall Towers to the bank takes her a very long time because she has to move so very slowly.

I am wondering whether the minister is considering some of these requests from people whose homemaker services have been cut, in terms of reinstating their services and, in addition, is looking at the whole business of the fees being paid homemakers to see whether there is any possibility for an increase in their wages.

MR. PARKS: Through you, Mr. Chairman, I would like to extend a rose or two to the hon. minister, and then an urging or two.

MR. BLENCOE: A thistle or two.

MR. PARKS: No, not a thistle. I don't think there is any need to throw any thistles at the hon. minister.

First I'd like to discuss an institution that I'm sure the hon. member for New Westminster shares a concern with, and that's Royal Columbian. As we well know, Royal Columbian Hospital is the largest tertiary trauma care centre in this province, even larger than Vancouver General Hospital. I'm very pleased — and this is one of the roses that I'd like to extend to the ministry and the minister — that they have approved a much-needed and perhaps long overdue expansion to that emergency facility. They have undoubtedly a first-class group of professionals in the emergency ward at Royal Columbian, and I think the delivery of health care services to the northeast sector — our area — will definitely be enhanced with the much-needed expansion of that emergency ward.

Speaking of emergencies, Mr. Minister, we have another very fine institution in my area called Eagle Ridge Hospital. It has been open a couple of years and we are looking at approximately 110 beds now being licensed and in use. A few weeks ago we were fortunate to have your ministry open a discharge and planning unit. However, one of those frequent inquiries that I receive in my constituency office is: when are we going to have an emergency ward at Eagle Ridge Hospital? I would certainly urge the minister to give that some further consideration and hopefully we'll see that emergency facility initiated in the very near future.

Interjection.

MR. PARKS: I know that the Fraser-Burrard Hospital Association, which encompasses both the Royal Columbian Hospital and the Eagle Ridge Hospital, has embarked on a discussion paper and is inviting community input. I know the hon. member for New Westminster has given some input and I'm sure the other community input is very much appreciated by the administration. But I believe that falls within the administration's purview as much as the ministry's.

[12:00]

Before I conclude my remarks in these estimates, I would be remiss if I didn't acknowledge how much I enjoyed, as the former parliamentary secretary to the Minister of Health, the cooperation I received from the senior administration. In particular the deputy minister and the associate deputy ministers were of immense assistance to me in first of all learning a little bit about an extremely expansive ministry. I came to an appreciation that British Columbians are indeed very fortunate to have such dedicated civil servants working on their behalf. So would the minister please pass on that rose to his senior staff. I'm sure that all British Columbians, notwithstanding what they read or hear in the media from time to time, do appreciate that B.C. has the finest health care delivery system. We are very fortunate to live in British Columbia

HON. MR. NIELSEN: Just a few quick comments on the last three members. The member for Shuswap-Revelstoke is one of the most aggressive MLA lobbyists for his own constituency — Armstrong, Enderby, Salmon Arm, Chase. He mentioned all of these today, and has mentioned them many times in the past. All I can say, I guess, now that he's not in his seat is that all of those are under consideration. The people of Chase particularly — here's the member now — have been aggressive in their petition. I have talked with some representatives from there, and we are giving consideration to their application for a D and T centre at Chase.

[ Page 7704 ]

Speech pathology is a very real problem in two areas: a general shortage of speech pathologists available to us and the role so many play with other agencies, which restricts their access by other citizens. I believe the ministries of Health and Education have been working to see if different utilization could be made of the pathologists, but I gather there are strong arguments about it. We moved in a similar area in audiology and made some changes which permitted greater access for more people; unfortunately, the thing went to court and was overturned, for some unknown strange reason. We hope to be able to resolve those. Speech pathology is a problem, and I appreciate what the member was saying. We're trying to resolve it through the ministries of Health and Education.

The member for Burnaby-Edmonds (Ms. Brown) was speaking of homemakers. The individual homemaker works for an agency or a contractor. It is the contractor or agency who negotiates what these people are paid. There is no consistent amount paid throughout the province; it varies from agency to agency. These people are hired by the agency, and it is for them to determine what the payment is. We don't negotiate with them at all. There is $48 million allocated for homemakers in the budget. It serves approximately 30,000 clients in the province.

The situation with respect to homemakers is that it is a very fluid circumstance, A homemaker may provide a certain service to an individual today that will not be required next week. The individual who may be suffering from a temporary difficulty may in a week or a month be cured of that problem and no longer require the service; others' conditions, of course, deteriorate, and they require greater service. So it's a very variable thing — not consistent at all. The condition of the individual can change, and the long-term care assessment people have to determine what the priorities are. People's conditions do change.

The member mentioned an individual case. I would like to get the name of the individual, so we could look at it very specifically to see what the circumstances are. Each person is to be assessed as to their need, and the hours are developed for that purpose.

The member for Maillardville-Coquitlam (Mr. Parks) asked some questions with respect to Eagle Ridge. When Eagle Ridge was opened, their needs were reviewed by a committee of their peers — I guess, for want of a better term — as to what should occur at the hospital, and when. One of their strongest recommendations was that Eagle Ridge should open without an emergency department. In effect, they said: "Allow the hospital to mature and develop programs. Attract the necessary professional staff before you open an emergency." They said: "Please do not have an emergency ward that cannot respond to the emergencies that may present themselves at the hospital."

So they said: "Allow the various sections of the hospital to mature first, so they can be there when emergencies are required." I can't give you a date. There is a general timetable for the further development of Eagle Ridge. I know the requests are there, but we will move at the appropriate time.

MS. BROWN: I have a couple of questions to the minister. Has there been an increase in the budget for homemaker services?

Interjection.

MS. BROWN: Yes. So that's the dilemma that the homemaker organizations run into. There hasn't been a dollar increase in the amount of money that they have to spend in terms of homemaker salaries. In addition, the Vancouver homemaker organization received a memo stating that because of a budget overrun there would have to be a 17.2 percent reduction in the number of authorized hours for the Vancouver long-term care program for the months January to March. Not only is there not an increase.... . .

Interjection.

MS. BROWN: The problem is that the homemaker service keeps people out of acute-care beds in hospitals. The more people who can be assisted and helped to stay at home, the better for everybody: the better for the people involved, the better for the taxpayer. The homemakers are really involved in preventive health; that's what's so vital about the service that they deliver, They're trying, on very low.... The homemakers are not paid a wonderful salary, by any means. When there is not an increase in the budget, and they're told that there's been an overrun, obviously that means that there's been an increase in the service and in the demand for their service, and that they have to start cutting back; that's the problem that we run into. Maybe the minister will take into account that they've been told that something in the neighbourhood of 20,000 hours are going to have to be cut out of their delivery system. That's the problem that people like this woman in Burnaby, and other people, are running into. The organization is trying to balance its books, and is having real problems doing that.

HON. MR. NIELSEN: I appreciate the difficulties of managing an organization such as homemaker services, and the difficulties of cost efficiency and the discipline that's necessary to stay within a budget. The Vancouver folks were provided with a budget. For the first nine months of their fiscal year they were not within budget and had to make an adjustment in the last three months of their fiscal year.

It is difficult to anticipate precisely what the demand on the service is going to be because the demand changes almost on a daily basis. New people make application; others come off, no longer require the homemaker services. The agencies have to determine what services they will be offering, what are the most important services, and they really have to tailor the needs of all their clients to that which is available in services provided and hours provided. There is no question that there are some services provided which by rational analysis could be avoided in order to provide a much more needed service to a new client.

There is no question about that, and that's not a criticism. It is simply a matter they have to take into consideration. The member mentioned the 20,000 hours, and that 20,000 is a large number. But across the province, if we were to reduce the homemaker service by 30,000 hours, that would be one hour per client per year. So while we're dealing in large numbers, the distribution is quite different.

But the homemaker program is quite successful. It has assisted many thousands of people by permitting them to carry on a much more normal life, by eliminating some of the minor problems such as you mentioned that simply incapacitate the individual in many instances — shopping and whatever. But I think it is functioning reasonably well: $48 million

[ Page 7705 ]

is a substantial budget for the program, and it has grown significantly over the past four or five years.

It is $48,503,000 for the fiscal year we are speaking of. I believe it is adequate to provide the level of service we have established in the province. It will require more detail from the management point of view. In December 1984 it was 361 000 hours of service; in December 1985 it was 394,000 hours of service. So the program has expanded in hours of service to the recipients. But the budget is $48.5 million. We are trying to keep that branch within budget, and we will be asking them to stay within budget as much as possible.

But there are so many variables in the homemaker service that I believe they can accommodate those who are truly in need. There are some services which I don't support at all that are provided on occasion, but the general services that are common to most people are much needed and provided. I believe they can tailor their own program to accommodate those in real need. The individual you spoke of, incapacitated to that degree, obviously needs assistance, and I am rather surprised that there would even be discussion that assistance would not be available, because we do provide services to some people in far less sensitive areas.

It's a trade-off that I think they can make, but if the member would let me have the name later, I would....

Interjection.

HON. MR. NIELSEN: Okay, I will get in touch, and we will look at that one very specifically.

[12:15]

MRS. DAILLY: I have one quick question just at this time as a follow-up question before the member for Victoria takes his place. It is a follow-up to the member for New Westminster (Mr. Cocke), just on a point of clarification for me. It is to do with the coverage of medicare for Canadian citizens, and I am referring to babies born here in British Columbia whose parents are here on a student visa.

Now when you said "ministerial permits," I wasn't quite clear if that means somebody here on a student visa. That isn't the same thing.

Interjection.

MRS. DAILLY: No, I didn't think so. So my question is.... I have had a couple of cases brought to my attention where these babies were born here, and yet because the parents were on a student visa, I don't believe they were granted coverage by medicare.

HON. MR. NIELSEN: After three months.

MRS. DAILLY: After three months they can get coverage — the child? Thanks very much.

MR. BLENCOE: There are a number of things that I would like to cover in these estimates. First, some of the things have been touched upon this morning very briefly, but I would like the opportunity to go into a little more depth and maybe get some discussion about future direction of this government.

The first issue I wish to cover is how we treat the elderly. As the minister knows, in this particular area we have a high proportion of those senior citizens, the elderly, who do require a lot of health care and sometimes a high degree of institutionalization. But the issue that I want to cover this morning is how we approach health care and how we deal with the elderly in terms of health matters. I want to refer to an excellent task force on the allocation of health care resources. The minister may not be aware of the task force, but I'm sure his deputy is aware of it. It was commissioned by the Canadian Medical Association in 1984, and its report is called "Health: A Need for Redirection." It was an excellent task force. One particular chapter, chapter 2, was on the elderly, and it talked about how the health care enterprise should be looking at the elderly. It had some projections on needs, and on institutions and long-term care facilities. I will just very quickly read a section of the introduction on the elderly, which I think gives an indication of where I would like to go this morning — and maybe get some response from the minister.

"An area of major concern to those who appeared before the task force was the increasing need for more attention to the elderly population. This concern in itself indicates an encouraging trend toward a greater awareness that our seniors are likely to play an increasingly important role in society in the future. For too long the elderly have been regarded more as a liability than as an asset, and have been ignored by society, especially in the provision of services, including health services."

That was the introduction, Mr. Minister. It goes on in this first part of the chapter to outline the problem in a global sense.

"Time and again the submissions suggested a new program of care for the elderly which would emphasize independent and productive living at home. The majority of elderly people would prefer to be out in the community living in their own homes rather than in institutions, and there is strong evidence to suggest that this is not only possible but economically attractive, if the right support systems could be put in place. The problem is that at present in many places these support systems are grossly inadequate."

I won't quote again from that for a minute or two. To go back to some of the discussion this morning about, for instance, the homemaker service, the minister has indicated that there is $48 million. But this report and, I think, others are indicating that there has to be a strong determination to really pursue this particular kind of philosophical approach. Not only is it socially responsible, but it's obviously economically responsible. I think the minister really has to consider that while $48 million may be a respectable figure, if we're ever to get a handle on the increasing costs of health care, not only in this province but in this country, we must start to seriously tackle this prevention side and this deinstitutionalization side of health care.

The report goes on to state that there is the deinstitutionalization solution.

"If we continue to put old people into institutions at the rate we do now, the costs will not only be prohibitive, but we will perpetuate the callous practice of warehousing the elderly. Old people do not want to live in institutions, even in the best of them. Governments are worried about the additional stress on budgets...."

[ Page 7706 ]

And I know we're all concerned about that. This is a very important point:

"The thrust in the redirection of health care resources undeniably needs to be in the development of community services to keep the elderly out of institutions for as long as possible, not only to reduce costs but to enhance the quality of life."

That is a very important statement, Mr. Chairman. Again, maybe we're going to get the minister to respond to that kind of philosophical statement. The task force report goes on to talk about community services, and specifically refers to the expansion of the homemaker service. I have to indicate that this is, of course, on a national basis. But the report does say that British Columbia is going to be one of the provinces that's going to feel most the financial implications of this growing problem of serving the elderly — we're one of the provinces that's going to feel the pinch the most.

"Free homemakers are often provided only to those with a very low income, and commercial rates can impose a severe strain on those whose income is restricted. These services must be more readily available, not only to replace institutional care but to promote independent living among the elderly community at large."

Mr. Chairman, I think this report and others — and this is one of the more recognized task forces in the country; it was commissioned by the Canadian Medical Association — are indicating that we have to have a fundamental shift in how we approach health care, not only in the country but also obviously on a provincial basis. I would like to hear the minister discuss this morning how the government of British Columbia is preparing itself for .... I will go on later to give some statistics for the numbers of beds and facilities that are going to be required and the astronomical increases if we continue with the same kind of priority in terms of institutionalizing. Do we have long-range programs for the things that I am talking about this morning — for putting our elderly as a first priority, retaining them in the community? Such things as homemaker budgets would have to expand dramatically. I'd like to start on that topic this morning.

[Mr. Ree in the chair.]

HON. MR. NIELSEN: The homemaker budget has expanded dramatically. In 1978, only recipients of Human Resources were eligible for homemaker service. Since that time it has expanded to over 30,000 people. So it has expanded dramatically. I'm not quite sure what the budget was in 1978, but I seem to believe the number was about $15 million. It is now $48 million.

The report that the member referred to in his general statements.... I find no disagreement from a philosophical point of view. But it's interesting to note, Mr. Chairman, that less than 7 percent of our seniors are institutionalized. They are very visible, and when you go to institutions you see great numbers of elderly people, but about 7 percent or less than 7 percent are in extended-care or long-term-care facilities: about 21,000 or 22,000 of the almost 350,000 seniors in B.C. So the vast majority do live in private accommodation or on their own.

Mr. Chairman, somewhat quickly on the elderly problem, please recognize that I'm not criticizing the elderly. It's a fact of life: people do age. But over 50 percent of our health care budget deals with people very late in life. Forty percent of our institutional costs are paid on behalf of people in excess of the age of 80. It's a very real part of the cost of health care. Statistically it is suggested that a person over the age of 65 requires about three and a half times the health care of a person under 65. So the seniors certainly are a very major part of our health care system. The member mentioned some references from a report, and I think the report has stated the obvious — not that that report isn't worth considering, but they have stated the correct picture.

We must look to the future with respect to our health care and how seniors are to be taken care of in our society. It extends far beyond health; it extends to almost every aspect of our society as to how the senior citizen as part of our society is to be accommodated — not taken care of as though they were incapable of taking care of themselves, but assisted and accommodated. Part of it is housing; part of it is health care; part of it is other forms of assistance; part of it is education.

Recognizing that senior citizens are a valuable resource and have a role to play in our society, the federal government recently made a decision that they would no longer enforce mandatory retirement. It is also statistically known that the increase in the deterioration of health frequently occurs upon forced retirement. Statistics are quite alarming with respect to the maintenance of the health care after forced retirement. Not that it is just health....

Some programs have been advanced in other countries with considerable success with respect to utilizing senior citizens. In Canada there seems to have been a trend over the last number of years to warehouse senior citizens — it is not a very kind term — basically to just find a space for them and have them occupy the space. From the point of view of health, their health begins to deteriorate badly. A report issued, I believe, last week by medical scientists said that the most dangerous situation from a health point of view for senior citizens is the lack of exercise. They deteriorate very rapidly if they are not receiving adequate exercise. Sometimes it is somewhat difficult to exercise in a facility that was never designed for that purpose. That's not unlike what the member said in that report.

We are very concerned about the plight of seniors. They represent a major factor in our health care system, as everyone would know. The seniors in our province are well provided for. Many programs assist them both in health and other branches of government. It's a problem that sometimes is more acute in areas that have enthusiastically sought retired people to come to their community. The member for Shuswap-Revelstoke (Mr. Michael) was speaking of Chase. Some time back Chase made a concerted effort to attract retired people to the area. Of course, the services then follow. I believe that Nanaimo has made quite an effort to have retired people move to that community. Thus the need for increased facilities, including the 150-bed extended-care unit that's been approved for Nanaimo. I agree that it's a problem that we have to live with and plan for.

[12:30]

One quick comment, Mr. Chairman. The member asked about planning. I don't know which area is most difficult to consider in the future. When you consider that economists have an almost impossible task to project the economy of the future, when you get into the field of health care, there's a National Association of Hospitals who wanted to have a review of the hospital of the year 2000 or whatever — I'm not sure. What should we be planning for? Part of the discussion was, can we really say today? Would we even consider

[ Page 7707 ]

designing a hospital for the year 2000 today? It's only 15 years away, but would we be correct? Mr. Chairman, the changes in technology are such and are happening so rapidly today that the facilities we have could become redundant in some instances. I mentioned the kidney lithotripter, our new toy. The success is so phenomenal that since it has been in operation, the lithotripter at Vancouver General Hospital has maybe treated almost 200 patients. That represents almost 1,600 bed-days freed up. If we have success with the excimer laser for arterial blockages, our heart bypass program could be virtually eliminated, and all of the facilities that go with it.

In treatment for elderly people, many ailments which in the past required an elderly person to remain confined are being conquered. Examples I could use are the hip replacement, the knee replacement and various other things that previously were not treatable and the person was confined to a wheelchair or a bed, or whatever. These are becoming far more common. The implantation for cataracts — removal of the cataracts and the implantation of lenses — has freed up literally hundreds, if not thousands, of elderly people. They are now mobile; they no longer require being cared for in that traditional way, and their health improves because of that. Many other features are coming along.

We in the ministry are, I think, very conscious of the question: how do you service the elderly in this manner? It obviously is the largest factor in health care, I guess internationally; certainly in North America. We are very fortunate in B.C. to have at our disposal adequate funding — others may argue it is not adequate — to service the elderly patients. In some countries there are quotas with respect to service, including quotas such as accessibility to dialysis. One country has a committee which sits to decide who gets the treatment and who doesn't. In Canada, any person who requires it gets it. So we are very fortunate.

I very much appreciate the topic of the elderly. Were I to have the solutions, I would perhaps be the most sought-after person internationally, because there are symposiums, conferences, research and studies looking at that question all the time, including our own people. It is one of the key topics. I appreciate it having been brought up, and I look forward to hearing more.

MR. BLENCOE: I appreciate the remarks of the minister. I think this is a useful discussion this morning.

The minister stated that he wished he had all the answers. Obviously no minister has all the answers, and no one in this chamber has all the answers. But I think what we should be doing is starting with a basic premise. I note with interest that Saskatchewan has adopted three basic premises for its work on behalf of and with the elderly. I think we can apply them to all areas in terms of how we deal with the elderly. Specifically this morning, however, I must deal with health. Those three basic premises are: independence, integration and involvement. Those aren't new premises, Mr. Chairman. I think we've all talked about them for a number of years. I guess what we haven't done is really taken the time and the planning and the studying and analysis to put those basic premises into practice, in a terms of how we deal with the elderly.

I know we're struggling with something that's really difficult. We're growing and learning in this particular area. I know I, living in a riding that probably has one of the highest number of senior citizens in the country per capita, continue to learn and experience from people in my riding about how we approach the topic of elderly and those who retire, how we respect them. You know, they're not put out to pasture. They have some meaning, and they can contribute. I think we have to look at that, and how we approach health. I think it's just a matter of us all deciding that those are the principles, those are the premises. How do we apply those premises in our daily development of our policies and our budgets and our long-range planning, for instance, in health?

The minister talked about looking at ideas and changes. I want to share with the minister.... and he may or may not be aware of these particular demographic projections in this task force. It is alarming and distressing, in terms of the financial implications, if we don't start to do the things that I'm talking about this morning: accepting these basic premises, and building upon them.

There are some incredible projections here. If we continue to carry on health policies in the same vein we are continuing today, we're going to face some incredible financial implications. To put this in perspective, total public health expenditures — that is, by governments and municipalities, excluding private spending — in 1981, excluding capital expenditures, was $18.5 billion. Of course, I'm talking on a Canada-wide basis; and you have to prorate that for British Columbia. I haven't done those formulas, Mr. Chairman. But let me talk on a national basis. If we continue with the same approach, primarily as we have today, by the year 2021 demographic changes alone will increase current expenditures on health care by about 75 percent, to over $32 billion, if current patterns of providing care remain unchanged. That's why we continue to say: "Look, we really have to take a look at things like the homemakers' service and home nursing care and adult day care and those sort of things."

It indicates again in this task force that if we don't take a look at deinstitutionalization, the greatest growth area will be in long-term-care facilities. I won't give all the numbers, but again it indicates by the years I have suggested that the greatest area of increase will have to be in long-term care. Now that's not to suggest that we shouldn't continue in the meantime, while we try to build toward a full policy of deinstitutionalization.... that we don't need further facilities in long-term care today.

I know in greater Victoria we are in great need, and the minister is well aware of the pressure that it puts on acute-care beds in our hospitals. If we don't have the will or the resolve to deal with these facts and these projections — which are, I think, fairly conservative in terms of the model and the projections they have used — we are going to have to have a massive expansion of these long-term-care facilities at great expense to the taxpayer, when it has been pointed out and proven that deinstitutionalizing, retaining people in the community, is beneficial not only socially but economically.

These figures really must concern us all, and I hope in the next few years we can start to deal with these implications and take a look at some of the further recommendations in this particular task force. There are others, and I'm not going to go into the details, but they talk about the Meals on Wheels expansion, respite care expansion, companion program expansion, drop-in centre expansion, the whole area of community health maintenance expansion, that really allow us not only in a social way but in a financial way to maybe once and for all start to come to grips with the financial implications of this growing area of health care for the elderly.

[ Page 7708 ]

Now I don't know if the minister wants to respond to that; if he doesn't, I want to move on to some other particular topics.

HON. MR. NIELSEN: I just want to give a couple of figures that I think everyone will find of interest — not in defence or in argument, but just of interest.

Of the people in B.C. who are over 90 years of age...

HON. MR. GARDOM: Ninety?

HON. MR. NIELSEN: Ninety.

HON. MR. GARDOM: That's me.

HON. MR. NIELSEN: Including the House Leader.

...50 percent plus live in their own accommodations, which I think is quite an amazing figure. At the 85 year level about 27 percent are in institutions; at the 80 year level, about 14 percent. So it's interesting that the vast majority remain at home, although it is certainly a growing situation — a growing problem. But I just wanted to mention those statistics and then go on to your next question.

MR. BLENCOE: Mr. Chairman, there are two or three other small items — small in terms of time, but not small in terms of impact on this particular region — that I want to touch upon. The first is, again, related to the problems of the elderly in this community, but it's not just related to this community per se. It's the problem of the long waiting-list that the hospice here in Victoria is struggling with. I'm sure the minister is aware that the hospice here in Victoria is not meeting the community needs and that there are usually more people on the waiting-list than the program can deal with. Again, without going into detail, I refer back to the task force where they talk about this area as being a very important one that has to expand. I know that in Victoria the hospice here has been met with open arms and that the community really respects the work that is carried out there, but unfortunately there is usually a waiting-list of 40 to 60 people wanting to get into that kind of environment and community — and we all know what it means to people who are terminally ill to be able to be placed in such a caring facility at the end of their days. I'm wondering if the minister can tell us this morning what plans he has for not only the Victoria hospice but for other kinds of community facilities like this, and can we look for an expansion of this particular kind of facility?

HON. MR. NIELSEN: Just very quickly, because the member next to me wishes to speak on the subject, the answer would be yes. The hospice is growing and is becoming far more accepted, and they are learning more about it.

There are some strange trends with respect to it. In the United States they have had a reversal in the hospice program. But I think that here, yes, you will see expansion. I can't be specific as to where or when, but I think the hospice concept will continue to grow.

[12:45]

HON. MR. GARDOM: Mr. Chairman, I did wish to briefly enter into this debate. There is just one topic I would like to discuss with my colleague the Minister of Health. I know that he and all members are mightily aware of the fact that I am a great advocate for the medical profession and all connected with it. I have supported them in the past, I support them at the present time, and I suppose I will be even more supportive in the future as this old frame starts to rust and needs some repair. But I would ask my colleague the Minister of Health if any thought or study or consultation has taken place concerning changing the concept of what is essentially pay for piecework — so much to fix the headlights, so much to fix the burnpers, the wheels, the radiators or the tailpipes — knowing at the same time that the public purse essentially pays for about 80 to 90 percent of the educational costs of these fine professionals. It pays for their garage completely. It pretty well pays for every tool they use in their garage. When you take everything into account — and I am not begrudging them this — they happen to be probably the highest-paid people, out of the public purse, in the history of the world. I just wonder whether the system of pay for piecework is one that is going to be continued or one that is not necessarily implanted in stone.

Interjections.

HON. MR. GARDOM: I've got my fingers and everything else crossed.

HON. MR. NIELSEN: I'm concerned that there may be a rush at the emergency wards by doctors if they hear you say such things. We don't call it piecework, Mr. Chairman; we refer to it as fee for services.

HON. MR. GARDOM: For parts of the body.

HON. MR. NIELSEN: For parts of the body.

I suppose that's the cornerstone of the medical profession's attitude with respect to their trade: that is, the individual fee for service rather than a salary basis. Doctors have expressed to me their fear that if they were paid salaries they would become public servants and lose their independence. That's the rhetoric. There could be room for both; there are now doctors who are on salary and doctors who are under contractual arrangements other than fee for service. It is suggested that the concept of fee for service provides an opportunity for the system to be abused. The fee for service adds up. I see you have the blue book — the financial statements — which indicates that the fee for service does amount to a considerable expenditure. I have no great complaint about the fee-for-service concept, provided we can agree with those who are providing the services that there is a limit to the expenditure overall.

I'm not quite sure we would get the same productivity from our medical profession if we were to establish a salary, presumably with hours of service and so on. I think it's probably much more flexible as it is today. Some countries have tried the salaries, with varying results. I am concerned primarily with the growth in cost. If we can arrange programs whereby the budget is protected, then I think the fee for service could go along with that. I know that members of the bar like the idea of being salaried rather than fee for service.

HON. MR. GARDOM: They're not paid out of the public purse. There's a big difference.

HON. MR. NIELSEN: I agree; they're not paid out of the public purse. I appreciate that. But a practice that is accepted in our society is the fee-for-service concept of payments. The

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Minister of Intergovernmental Relations indicated that he is a strong supporter of the medical profession — I think as most people are. The fee for service has been with us for a long time. I think it is a cornerstone of their attitude, and I wouldn't hastily suggest that it be completely thrown out.

HON. MR. GARDOM: I agree indeed, Mr. Chairman, with the sage comments of my colleague. Not for one moment was I suggesting that it be thrown out. The point that I was making was: has any thought or study or consultation been given to perhaps a better method and not necessarily a salary, First of all, how does one arrive at the rate to fix a carburetor in a human body or the shocks, or, as I said, the radiator or even indeed the tailpipe? Where indeed are those rates determined? Is there any public input into the determination of that specific fee?

HON. MR. NIELSEN: The fee schedule 1s established primarily by the profession themselves. They publish their fee schedule, their rate schedule. The Ministry of Health, through the Medical Services Plan, reviews that schedule, and the increases over the years have come as a percentage increase to the schedule.

The medical practitioners then determine what particular services are to be modified. It's very much like a master agreement with the forest industry, where the IWA would work for a percentage increase, but various components would receive different increases, if any increases at all. At the moment the general practitioners feel they are being badly outdistanced by the specialists. It is really the BCMA who have to make the adjustments within that fee schedule to satisfy their own constituents.

We have not done that. We do reserve the right to call to their attention what we believe to be an exorbitant fee for a service and can make some modifications. Without an agreement with the BCMA or other medical associations, we presumably have the right to set the rates ourselves, but it would require a tremendous amount of research which is done now by the profession.

HON. MR. GARDOM: I just wonder whether or not the schedule 1s consistent throughout the country. Is there a different rate, for example, in Edmonton and in Toronto and in Quebec City and Montreal and, indeed, in Vancouver — and Moose Jaw, as my colleague says? If so, is there really a fundamental requirement for that difference in rates?

However, we are approaching the witching hour on Friday afternoon, and I do pray I do not get sick over the weekend.

MRS. DAILLY: Well, I hate to break up this interesting discussion. I hope we can continue it on Monday.

The House resumed; Mr. Strachan in the chair.

The committee, having reported progress, was granted leave to sit again.

Hon. Mr. Gardom moved adjournment of the House.

Motion approved.

The House adjourned at 12:54 p.m.