[ Page 4949 ]

CONTENTS

Routine Proceedings

Committee of Supply: Ministry of Municipal Affairs estimates. (Hon. Mrs. Johnston)

On vote 55: Kootenay development region –– 4949

Mr. Blencoe

Ms. Edwards

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

On vote 45: minister's office –– 4951

Hon. Mr. Dueck

Mrs. Boone

Ms. A. Hagen

The House met at 10:07 a.m.

Prayers.

Orders of the Day

HON. MR. STRACHAN: Before calling Committee of Supply I'd like to advise the Legislative Assembly that Bill 46, which was introduced last night, has now been printed and is available to all members. The government regrets any inconvenience that may have been caused.

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

ESTIMATES: MINISTRY OF
MUNICIPAL AFFAIRS

(continued)

On vote 55: Kootenay development region, $792,988.

MR. BLENCOE: I want to spend a few minutes on this particular section of the minister's responsibilities.

I've already stated that I feel that the Minister of Municipal Affairs is in a really precarious situation by having the portfolio as Minister of State for Kootenay. I've already said — but I'm going to say it again — that I think she should really reconsider her position as Minister of State for Kootenay, when she is supposed to be a minister responsible for all municipalities and deal fairly and equally with all governments. I don't think it's in the interests of such an important portfolio — separating it from the personalities and looking at it in terms of the importance of that ministry — to put that position into such a conflict of interest. I would ask the minister to reconsider that in an upcoming cabinet shuffle she may once again go back to being Minister of Municipal Affairs without being put in a precarious situation.

Interjection.

MR. BLENCOE: No, I did not call for your resignation as Minister of Municipal Affairs. What I'm saying is that I don't think you should be in the position of being a minister of state. I have heard from a number of people at local government level. They may not have said it to the minister directly, but there is concern out there that you are spending so much time in the Kootenays. We have an excellent MLA for that area. We have local councils that are quite prepared to do the work. They have the policies and the ideas for economic development. And yet we have the Minister of Municipal Affairs, from the riding of Surrey, going into the Kootenays to do the work that should, under our parliamentary system, be done by the MLA and those who were elected to do the job. The minister is spending far too much time in the Kootenays; she should be representing all local government in a fair and unbiased way. So I put that on the record, and I hope when the time comes for reassessing, the minister will....

I am sure they are reassessing a number of things. In the days ahead, I am sure that the saner heads will prevail, and we may have a number of things changed in the near future. This side of the House has said that we believe the minister of state system is creating nothing but tension and confrontation in British Columbia. The mayor of Kelowna has clearly stated that tension is mounting. No one really knows who is supposed to make the decisions any more.

The mayor of Kamloops said quite categorically that there is a hidden agenda with the minister of state system. Mr. Jim Matkin has said that he doesn't know what it's supposed to do, and others are very concerned about the process that we've introduced in British Columbia.

I want to quickly dwell on the specifics of the Kootenay development region. I have in my hand the handbook of red tape for the Kootenays. It's one of the few areas that has spent money on producing what looks like a very expensive handbook listing I don't know how many committees that are running around doing the work of local.... There are 17 task forces and committees running around the Kootenays doing the work of local government. This is just another piece of red tape to frustrate local government and the business community in British Columbia.

I also want to put on the record that the parliamentary secretary for the Kootenays district, currently the member for Nelson-Creston (Mr. Dirks), said at a recent meeting that with this development-region concept: "They're reinventing the wheel with the minister of state system." Yes, that's what he said. He says we're on a shakedown cruise, and we're overloading the circuits. The development officer for the region said the process is unwieldy and very frustrating and, "we're still trying to determine what our mandate is in working with all these task forces, but someday we're going to be able to find out what we're supposed to do."

I want to ask the minister, as the minister of state why, when this province should be streamlining and bringing in efficiencies for small business to access small loans in the interests of development in the province of British Columbia, she would want to reinvent the wheel. Why does the Minister of Municipal Affairs want to go into the Kootenays in a system that has no mandate in law, reinvent the wheel and frustrate local politicians who are being asked more and more to go to umpteen task forces? Why would she want to overload the circuits and be on a shakedown cruise in the Kootenays when we have a system in place in the province called local government?

[10:15]

As I've said to every minister of state, and I'll say to you: give them a phone call or a 37-cent stamp to the chairman of the regional district and to the local councils in the democratic fashion that we've accepted in this province since Confederation. Save yourself $14 million in administration costs and talk to local and regional government over the phone and ask them what their priorities are — not another gigantic hunk of red tape to frustrate local government. You have $2 million now here to reinvent the wheel. Madam Minister, as the Minister of Municipal Affairs, can you tell me why you'd want to reinvent the wheel?

Mr. Chairman, I think it's important that the minister answer this question. She is probably the most important minister — in terms of the minister of state system — to comment on the minister of state system. We have categorically said that this system is a power grab over local government. It's usurping their traditional roles. Can the minister tell us why she would want to reinvent the wheel? Is she reinventing local councils in an undemocratic fashion? Is that what she's up to? Is this the new system that we're going to have in the province of British Columbia, that local

[ Page 4950 ]

government is going to become redundant? Maybe the minister, as the Minister of Municipal Affairs, could answer those questions.

HON. MRS. JOHNSTON: We have canvassed this issue substantially during the debates, not only of this ministry but of previous ministries. The only response I can give is that we are not reinventing the wheel. The minister of state initiative is really there to complement what is already in place. I would like to state very simply that we believe in assisting all of the regions of the province in an equitable way, and it appeared that the system that was previously in place was not working. Because of the unemployment statistics in some of our farther-out regions, it was felt that assistance was required. This is not a new level of government. It is simply an initiative to go out into all of the regions of the province and assist them in accomplishing the goals that they have set for themselves.

MR. BLENCOE: The member for Kootenay (Ms. Edwards) wishes to ask a few questions, but I just want to re-emphasize that as I go through this book, I've got page after page of committees or task forces, regional services group representatives.... And who's on them? The mayors and the aldermen. Then I go into the regional diversification group representatives, and who's on them? Mayors and aldermen. Then we go into a multitude of other committees involved in all sorts of things that local government can be doing. Can you imagine a small business person in the Kootenays taking a look at this and saying: "Gee, who do I go and see? Do I go and see the line minister, the Minister of Economic Development? Do I see the parliamentary secretary, the mayor and the council, or the minister? Who do I see?" Then they have to get through this incredibly cumbersome red tape and bureaucracy now for accessing loans.

This whole thing is becoming a joke, and as the Leader of the Opposition says, it will become like the Partners in Enterprise thing: great fanfare, and it will disappear, again costing the taxpayers millions of dollars.

The minister is the Minister of Municipal Affairs. She should be out of the minister of state category — she's in conflict — but also she should be speaking up for local government and calling this for what it is: reinventing the wheel. Local government has been doing a job in the Kootenays and everywhere else in the province. I would hope that now we may get a reassessment of the priorities of this government and get back to some normalcy; return to real democracy and open government, and let local government do the job it is supposed to do.

We continue to be frustrated, as is local government, by the minister of state system.

MS. EDWARDS: I want to begin by asking a question about vote 55, because I did a bit of a comparison with the other development regions, as a matter of some interest. In the Kootenay region our total budget for salaries and benefits is relatively moderate, but for some reason the amount for operating costs is the highest of any of the regional development areas. Would the minister explain why that is the case? And I wonder if she would explain why, under "Asset acquisitions," we are the second highest in the province at $25,000. There's only one region that's higher, and that's the Northeast. I'm not sure why that's there.

I have another question. In some of these votes there's an item called Other Expenditures. There must have been a directive that said, "If you need that, if you don't know what to do, just put in $40,000, " because four of the regions have budgeted $40,000 for that –– I think one minister got mixed up; he budgeted only $14,000. Three regions have no budget there at all; the Kootenay has none. Would the minister like to give us some background on this budget for the regional development area?

HON. MRS. JOHNSTON: That's a valid question. Because this is a new process, the budget is really an attempt to customize what we felt the needs would be to properly service the region that we refer to as the Kootenay region. With no background or prior experience, it was rather difficult to be more precise. With few exceptions, the items are very general in nature. After a year in operation, I'm sure we'll be better qualified to be far more specific.

We have made provision for all of the items that we felt were important so that there wouldn't be any overruns. The item that you refer to, the $25,000, is for the software equipment and services required for data and word processing systems and some of the minor furnishings and equipment. They've all been placed into the $25,000 bracket.

We've attempted, as I say, to customize each budget to reflect what each of the ministers of state and their staff felt would be required in the region. A year from now, after we've had some experience, we will be better able to say whether those allocations were in line or out of line.

MS. EDWARDS: First of all, I made a mistake in saying we were fairly middle of the road as far as salaries are concerned. A review indicates that we're the lowest region in the province for salaries, which may reflect.... I'm not sure what it reflects, but it could reflect that there weren't the people operating in the Kootenays that had originally been planned.

Of course, the operating expenses, which you said were a guess, I have to assume is an amount for traveling. My colleagues suggest that if a citizen — a small business person or whatever — says, "Who do I see in the Kootenays?" very often there isn't anybody to see, because they're all off at committee meetings. There are 17 committees operating. Almost every one of the municipal politicians who know that they'd better go to those meetings or they might miss out are off at five or six committee meetings. They have to serve on all these meetings. They're carrying on their own municipal government besides all of this, because that's what they have to do. They are scrambling here, there and everywhere. You want to talk to somebody in municipal government, and they might be over in Nelson, or maybe Creston or Trail; or maybe the people from Nelson might be in Fernie or whatever. It's a great scrambling act. It's as though you went in as a mother hen, scratched the dust, scattered the chickens, and away they go. They scramble.

You suggest that this system is not a new level of government, and I think the answer to that pretty generally is: ha, ha, ha. Of course it's a new level of government. In fact, any decisions on economic development projects evidently have to go through the Minister of Economic Development (Hon. Mrs. McCarthy) anyway. So what have you done? You've taken all the old proposals — we're recycling them at the moment. They still have to go back to a line ministry — to a different line ministry — and this is another level of government if we're going to get anything done at all.

You said that what's here is to complement what's in place, and then you said that what's in place wasn't working. That, Madam Minister, doesn't make any sense at all.

[ Page 4951 ]

I don't quite understand what you're doing, except to go back.... I'm going to make an assumption and suggest that under the operating principles of the regional groups, this may be the key to the whole thing. It says: "Task forces will be required to identify and prioritize those projects which can be implemented within" — get this — "a three-year time-frame and a seven-year time-frame." Madam Minister, everybody knows what three- and seven-year time-frames mean from the time this particular program was initiated. They mean elections. This is a great deal: we'll hand out the money in three years and we'll hand out the money in seven years. I think it's a con.

Vote 55 approved on division.

ESTIMATES: MINISTRY OF HEALTH

On vote 45: minister's office, $305,183.

HON. MR. DUECK: I'm pleased to rise today to present the Ministry of Health's budget estimates for '88-89. At $3.9 billion, the Ministry of Health's budget represents by far the largest piece of the spending pie, almost one-third of the government's total projected expenditures. In the coming year we expect to spend more than $1,300 per capita on health care, an increase of 8.3 percent over last year. These figures show clearly that health care continues to be the number one priority of this government.

I would like to outline the principles which have guided the government in its resource allocation decisions with respect to health care. I would then like to demonstrate how those principles are actually embodied in the estimates we are discussing today. As representative of the people and manager of our publicly funded health care system, the government has two overriding responsibilities. First, we must allocate enough funding to preserve and enhance the first-class system of health care we are fortunate to enjoy in this province. The people of British Columbia treasure our top-quality health care services. They know that no other provincial program is more important, and they want us to provide sufficient resources to ensure that access and quality remain second to none.

At the same time, however, the government has a responsibility to exercise prudent stewardship of public funds. The province cannot afford to provide full coverage for every conceivable service without regard to efficacy or efficiency. On the contrary, the provincial health care system must be rational and affordable. We must ensure that we are getting the best possible value for every dollar spent. Moreover, we must pay our way and pay as we go, so that our children can look forward to inheriting an affordable, strong and viable system of health services.

I'm very pleased with the responsible way we are approaching health care in this budget. Well over one-third of a billion dollars are being added to the Ministry of Health's budget to maintain and enhance essential programs. At the same time, we are pursuing important initiatives designed to make the system as a whole more efficient. Let me elaborate.

During the next year, the Ministry of Health will be undertaking construction projects throughout the province. These projects will involve upgrading existing facilities to reflect modem standards and adding new facilities to meet the needs of an expanding and ageing population. The hospital programs and continuing care divisions, for example, will begin construction on 14 major projects in '88-89. These projects will have a value of $140 million and will create approximately 338 man-years of construction-related employment this fiscal year, and about 565 man-years of construction-related employment in '89-90.

[10:30]

In addition, 26 projects valued at $265 million are already under construction. Several projects are scheduled to open during the next 12 months. While I do not have enough time to describe them all to you now, I can give you an idea of the range of new facilities which will be brought on stream. Facilities opening this fiscal year include a diagnostic and treatment centre at Chase, additional extended-care beds in Vancouver, Kamloop, Sechelt, Terrace and Fort St. John, new acute-care beds in Langley, Kamloops, White Rock, Chilliwack and Cranbrook, expanded emergency room facilities in New Westminster and Port Moody and a new rehabilitation unit in Kelowna to serve as a referral centre for the Okanagan and Kootenays, and replacement intermediate-care beds in greater Vancouver.

As well as this ongoing program of capital renewal and expansion, the government has approved substantial increases in institutional operating expenditures. For our 135 hospitals the increases amount to $170 million, bringing the total expenditure for hospital programs alone to $1,890 million. Over $70 million of the increased operating funding will go towards employee wage and benefit increases. The remainder of the hospital program increases will be consumed mainly by non-wage inflation, the operating of additional hospital capacity and new program initiatives.

A common theme of many of the new programs is technological advance. Technological breakthroughs are continually under review and are adopted speedily if they demonstrate the capacity to increase quality of care or effect long-term efficiencies. Again, I have time to discuss only a couple of examples.

One of our most prominent and successful new technologies is organ transplantation. Since the establishment in 1985 of the Pacific organ retrieval program, which is called PORF, British Columbia has achieved the second-highest rate of organ transplantation in Canada. The number of kidney transplants in particular has been rising steadily. In 1987-88, a record 137 kidney transplants were performed at Vancouver General Hospital, St. Paul's Hospital and Children's Hospital. This year we are targeting to achieve 180. In addition, specialized medical teams are currently being developed for heart, liver, lung and pancreas transplants. The Health ministry is firmly committed to establishing a multi-organ transplant centre for the province in the near future. For 1988-89, the government has allocated an additional $3.2 million to cover the costs of developing and expanding transplant services in British Columbia. Moreover, we have approved an additional $3 million to cover the costs of the rising number of transplants which are being performed outside the province pending establishment of our own multi-organ transplant programs.

Advanced diagnostic imaging offers other examples of beneficial new technologies. Magnetic resonance imaging, for example, is used to diagnose diseases of the central nervous system and other conditions. It provides a rapid diagnosis and very detailed images without risk or discomfort. Magnetic resonance imaging units are scheduled to open in Vancouver this summer and in Victoria this fall. In addition, we now have 17 computerized tomography scan-

[ Page 4952 ]

ners in British Columbia, including two new scanners that were opened in 1987 in Trail and Nanaimo.

There was considerable public discussion earlier this year about the waiting-times for open-heart surgery in British Columbia. The gradual increase in the waiting-lists for open heart surgery during 1986 and 1987 was due primarily to a short supply of the perfusionists and critical-care nurses needed to assist with these operations. To alleviate these staffing shortages, the Ministry of Health provided special budget allocations to enable hospitals to strengthen their training programs and recruitment efforts. As a result, the staffing situation has improved, the number of open-heart operations has risen significantly and the waiting-lists have begun to decline.

To further improve the situation, we are taking two additional steps. First, the open-heart program at Vancouver General Hospital now has new facilities and has agreed to perform another 250 operations each year. Vancouver General Hospital will receive an additional $3.14 million in operating funds in '88-89 to cover the costs of these operations. In another move to help reduce waiting-lists, the Ministry of Health is assisting in the development of alternatives to open-heart surgery such as angioplasty. Vancouver General Hospital, for example, is being granted sufficient funding to perform up to 780 of these procedures each year, more than double the previous total. We are optimistic that the combined effect of these initiatives will be a substantial reduction in the waiting-times for procedures to treat severe coronary artery disease.

Earlier this year my ministry completed a review of rehabilitation services for victims of traumatic head injuries. Head injuries can produce a variety of problems, from paralysis and blindness to slowness of thinking, impaired judgment and severe behaviour disorders. The number of persons with severe head injuries is increasing steadily. Advances have been made in emergency care for saving many individuals who in previous years would have died, and many of these survivors have more severe impairment than we have seen in the past. Most victims of head injuries are young, and many require long periods of rehabilitation to obtain their maximum potential for normal living.

As an initial step in improving services for this group the ministry will be funding a special 15-bed unit at Pearson Hospital in Vancouver. This unit will provide longer-term rehabilitation than that available in existing hospitals. We will also be initiating discussions with community groups about the establishment — on a pilot project basis — of one or two specialized group homes for the head-injured in regions of greatest need.

One of the programs I'm proudest of is the Emergency Health Services Commission, which provides ambulance service and pre-hospital care to the people of this province.

The program is staffed by 762 full-time and 2,000 part-time attendants working out of 185 ambulance stations in 162 communities. During the next 12 months our air and ground ambulances expect to respond to some 267,000 calls. To support this activity the government is providing a 12.5 percent increase in funding, bringing the commission's total budget to $61.7 million. The new funding includes $2.9 million for maintaining the existing fleet and ensuring that we have the most appropriate equipment for air evacuation. In 1988-89 the commission will replace 75 of its ambulances.

I'm very pleased to point out that the paramedics who operate our ambulance services are among the best trained and most competent in the world. In 1987 one of British Columbia's advanced life-support teams placed first in a competition in Alberta, second in the Canadian national competition and third in the international competition in Florida.

One of the main strategies for improving the quality of health care is to bring it closer to the people. Wherever it is feasible and cost-effective to do so, we would prefer to deliver care to people in local community settings rather than in large centralized institutions.

This year the community care services subvote, which includes most of our community-based programs for the mentally ill and multiply handicapped, totals $193.6 million. The mental health services division will be receiving $6 million more this year than it did last year. The majority of his new funding will go towards wage increases. One of the major developments in mental health services during the past ear was the release in October of the "Mental Health Consultation Report," a draft plan to replace Riverview Hospital.

This document was based on consultation over the past two and a half years with thousands of people, including all the key professional, hospital, industry, labour and volunteer groups involved in providing services to the mentally ill in British Columbia. I am pleased to report that, in general, the responses to this report were very positive. Most groups supported the decentralization of institutional care for the mentally ill, provided that replacement resources are developed in the community prior to any corresponding changes at Riverview Hospital.

There was considerable concern expressed, however, about the ability of the current service system to handle the serious mental-health needs that now exist in various communities around the province. I am committed to ensuring that the mental health care system is one of the finest anywhere. I will be taking a plan to cabinet this year that provides for the improvement of current community-based services as well as the proposed replacement of Riverview Hospital over the next several years.

I can assure British Columbians that there will be no reductions in Riverview programs until the community system is strengthened and replacement resources are in place. We will maintain and enhance acute psychiatric beds, longer-term in-patient beds, out-patient treatment and community residential and support services for the mentally ill. We will introduce improvements responsibly, with careful attention to patient care requirements and any community concerns there may be, and we will take as long as is needed to make sure that the process occurs smoothly.

A number of initiatives are underway at Riverview Hospital to improve the effectiveness of clinical programs as much as possible while the old facilities are still in use. The British Columbia Mental Health Society now operates the hospital along the lines of other public hospitals in the province, and this has helped to improve the hospitals' response to changing operational requirements. By the end of this year the present interim board of the senior ministry officials will be replaced by a permanent board composed of community presentatives.

As part of my ministry's commitment to health promotion, we will be working closely with the Canadian Mental Health Association and other interest groups to improve the public’s understanding of the mentally ill and to recognize a wide range of educational and supportive programs in communities around the province.

[ Page 4953 ]

I am very pleased that the Canadian Mental Health Association and other key groups are supportive of our future plans for mental health services in British Columbia. And I am delighted that we are able to cooperate in this important educational campaign at this time.

[10:45]

Mr. Chairman, the services to the handicap division of my ministry was established in 1986 to develop alternatives to institutional care for multiply-handicapped children and adults. During the past year the division has developed group homes and associate families for these severely disabled persons, many of whom have until now lived in institutions. To date, commitments have been made to move 65 adults and 20 children into these homes and families.

The associate-family initiative is one component of the government's strengthening of the family program. The purpose of an associate family is to enable a multiply-handicapped child to live in a family setting, even if the child's natural family is unable to care for him. Associate families are selected for their parenting abilities and are offered special training to help to raise a special-needs child in consultation with the child's natural family.

The Ministry of Health's estimates include $580,000 for the associate-family program. However, in 1988-89 this program's budget will be doubled, to $1,160,000, making use of funding set aside in the new program vote of the Ministry of Finance and Corporate Relations. These additional resources, which are part of the funding earmarked especially for initiatives to strengthen the family, will permit us to place an additional 20 children into associate families.

Mr. Chairman, I think my review of the estimates so far makes it clear that this government is strongly committed to preserving and improving essential health care services. Substantial budgetary increases have been provided throughout the ministry.

As I said earlier, however, a government must do more than simply approve additional resources. We have to look at the system from a structural point of view to make sure that it is as efficient as possible. We have to be able to assure the public that we are obtaining the best possible value for each and every health care dollar.

During the next few minutes I would like to discuss some of the ways in which we are trying to make the health care system more rational and more efficient.

I would like to begin with the Medical Services Plan, which covers payment to physicians and supplemental practitioners. This is one of the largest budgetary components of my ministry, second only to hospital programs. Expenditures are expected to approach $1.1 billion this year, $75 million more than in 1987-88.

In reviewing the experience of the Medical Services Plan over the last several years, the government has recognized the need for rational manpower policies. As stewards of the public's limited health care dollars, the government has the responsibility to ensure optimum supply, distribution and mix of all resources, not only of hospitals, health units or other facilities but also health manpower as well.

To be effective, health manpower policies must address several major concerns. First, British Columbia has a significant oversupply of physicians. As of December 1987, there was one physician for every 501 British Columbians, compared to a ratio of one to 529 in Ontario, or one to 623 in Alberta, or one to 542 in Canada as a whole. Second, the British Columbia physicians' fee is the highest in Canada — more than 20 percent above the national average. Third, over the last several years, utilization increases have significantly outpaced increases in the size of the population.

The Ministry of Health has adopted short- and long-term strategies for dealing with these issues. As a short-term strategy, we have pursued sensible and fair agreements with the medical profession. We are now in the final year of a three-year agreement with the B.C. Medical Association. This agreement has provided reasonable fee increases to doctors and has given government some degree of control over excess utilization. When utilization exceeded specified limits in 1986-87, we were able to negotiate a revised agreement under which doctors received prorated fees. The same provision may be necessary in 1988-89 and is in place. This provides the government greater certainty about our total expenditures in the upcoming year.

In the longer term we are continuing our policy of restricting practitioners' numbers. This policy is essential not just to manage the oversupply of physicians but to improve their distribution. Many remote and rural areas of the province still have inadequate physician coverage despite a variety of financial incentives designed to attract them to such regions.

Another key aspect of our approach to medical manpower is support for the proper use of health professionals other than physicians. We believe that supplemental practitioners such as chiropractors, podiatrists, physiotherapists, optometrists, massage practitioners and naturopaths can offer cost-effective therapies in many cases. Consequently the Medical Services Plan will continue to provide coverage for these services in spite of the fact that the province receives no financial contributions from the federal government for this purpose.

As managers of the health care system, we must extend our leadership beyond service-providers to include consumers as well. In the absence of user charges, the use of hospital and physician services has no immediate financial impact on consumers. But it is extremely important for all of us to be reminded that the services are not free and that we must use them responsibly. Accordingly, we have taken steps to make the costs of health care more visible. As the Minister of Finance announced, we are setting Medical Services Plan premiums at a rate which will fund 50 percent of physician fees and 100 percent of the insured portion of supplemental practitioner services. This move will be beneficial both from a revenue standpoint and a public awareness standpoint.

I must point out that we have taken great care to ensure that lower-income persons will not be affected adversely by the premium increases. Fifty-five percent premium assistance will be extended to an additional 56,000 persons with taxable income under $6,500 per annum, and 95 percent premium assistance will continue to be available to subscribers with taxable income of less than $2,500.

We are also taking one further step to make consumers more conscious of their utilization of physicians' services. Doctors have been asked to print a statement of their patients at the time of each visit. This statement will not be a bill, but it will show the patient how much the Medical Services Plan is being charged for the services he has just received. Ultimately we would like to encourage individuals to make responsible choices not only about their use of the health care system but also about their lifestyles, for it is certainly preferable where at all possible to avoid health problems rather than to try and cure them.

[ Page 4954 ]

During 1988-89 the Ministry of Health will continue to take the lead role in promoting responsible, healthy lifestyles. One of the top priorities is smoking prevention. The reasons for focusing on this practice are obvious when one considers that smoking accounts for 17 percent of adult deaths, 5 percent of employee disability days and 3 percent of physician visits. The ministry's anti-smoking efforts cover a wide spectrum. For example, we are assisting the Ministry of Education to develop a comprehensive health curriculum in kindergarten to grade 12. This curriculum will include smoking prevention. The ministry supports the development of municipal bylaws restricting smoking in public places and also encourages workplace policies on smoking as a way of improving employee health and productivity.

During the past year the ministry has placed considerable emphasis on the prevention of acquired immune deficiency syndrome, or AIDS. The ministry has distributed written information about this fatal and, to date, incurable disease to every household in the province and has supplemented this material with prime-time television bulletins. Our objective is to make the public aware of the risk factors associated with AIDS and to assure them that responsible personal conduct can prevent the spread of this virus.

The Ministry of Health also has a key role in the government's new strengthening the family program. During the upcoming year, the ministry will undertake a review of the organization and delivery of health-care services to the family, in order to ensure that we are as responsive as possible to the health care needs of families.

The ministry is also taking a number of steps to encourage responsible decisions. For example, we are supporting a public awareness program on the prevention of unwanted pregnancies, in cooperation with medical and helping professionals such as the British Columbia Public Health Association. Informational materials have been made available at doctors' offices, pharmacies, local health units and other public information outlets.

To help women with unplanned pregnancies make informed decisions about their future, the ministry has produced a special video on the decision-making process. The video has been distributed to health units, video outlets and libraries throughout British Columbia. The decision-making model was developed by a leading psychologist.

We have also distributed a pregnancy support services resource guide to health care professionals and social workers who counsel pregnant women. This guide provides a listing of community based counselling and resource services.

The management of a publicly funded health care system requires regular and careful review of the services for which we are paying. The government cannot afford to pay for every conceivable health-related service. Our limited public resources must be allocated judiciously. If we are to maintain our comprehensive, universal coverage of essential health care services, we have to limit our coverage of non-essential and non-health items.

Accordingly, we are eliminating hospital insurance coverage for non-medically necessary cosmetic surgery, as well as medical insurance coverage for sex change surgery. These measures will save the ministry approximately $1 million in the health care system.

MR. CHAIRMAN: I'm sorry, Mr. Minister, but your time has expired under standing order 45. I'm sure that one of our members would intercede so that you can complete your statement.

MR. REE: I find the minister's comments most enlightening and informative, and I would like him to continue.

HON. MR. DUECK: I appreciate that from my colleague; I needed a drink of water anyway.

Similarly, we are increasing the user fees for extended care hospitals, personal and intermediate care facilities and mental health boarding homes. These user fees are not a charge for essential health care. Instead, they are intended to help cover such personal living costs as accommodation and meals — expenses residents would have to cover if they were living on their own in the community.

I should point out that even with the higher user charges, the lowest-income facility residents will still be receiving a substantial personal living cost subsidy. Moreover, they will continue to be left with a higher disposable income than facility residents in most other provinces.

The question on how we deliver health services to our elderly citizens is going to become increasingly important over the next several years as our population ages. While the population as a whole will increase by about 30 percent in the next two decades, the number of persons aged 85 and over will increase by more than 125 percent. We have to begin planning now if we are to deal effectively with these changes.

In the past year, the continuing care division, which has primary responsibility for long-term care for the elderly, has completed a comprehensive community consultation and mandate review process. The division surveyed clients, their families and care providers, and they received almost 800 submissions. These submissions indicated that there is a high level of satisfaction with the services now being delivered. More important, however, the submissions contained many good proposals which will help us to plan future services.

[11:00]

The government believes we need to explore new models of delivering health care, particularly care for the elderly. Seniors have special health care needs and special social needs. For many seniors, isolation and loneliness are serious problems. Others have difficulty finding their way through the complex system of services.

To explore ways of addressing these issues, the Ministry of Health, the Greater Victoria Hospital Society and the Capital Regional District are undertaking a special pilot project called the Victoria Health Project. This project will aim to establish a more integrated system of service delivery at the community level. The government is not going to place any particular constraints on what this pilot project may involve. We want the ministry and local managers to be innovative. We have said, however, that we would like to see the project experiment in new mechanisms for organizing and delivering health care, the use of alternative health care professionals, improved information systems, special preventive and socialization programs for seniors and reallocation of resources to permit shorter acute-care hospital stays.

The Victoria Health Project reflects our determination to take a fresh look at the existing service delivery structure in health care. It is not the only initiative of this type that we will be taking. Although the Health ministry is already very decentralized, we will be expanding the possibility of further regionalization, in step with the government's commitment to make government services as responsive as possible to local needs.

[ Page 4955 ]

We will also be exploring ways of rationalizing and streamlining the ministry's management structure; for example, through a better integration of preventive and community health services.

As Minister of Health, I am very pleased with this budget. It provides significant funding increases for essential health care services. Our facility inventory is being updated and expanded. The latest technologies are being adopted. New programs are being introduced, and community-based care is receiving increasing emphasis. At the same time, however, the budget makes it clear that we intend to oversee our health care funding very carefully and do everything possible to get maximum value for it.

We accept the responsibility of bringing a managed approach to medical manpower. We intend to make consumers more conscious of the costs of health care services, and we will encourage them to make responsible decisions about their lifestyles. We will also endeavour to pilot projects to find new, more efficient ways of delivering health care, innovations which might eventually be introduced into the system as a whole.

Mr. Chairman, I look forward to comments from any of the members here in the House today.

MRS. BOONE: Last year I focused my opening remarks on the need for the government to reassess its approach to health care and to stress prevention and keeping people well rather than treating illness all the time. I was surprised to hear some of my message repeated in the budget speech by the Minister of Finance (Hon. Mr. Couvelier), but the problem is that we've heard the words and yet we do not see any action by the government to match those words, as we've heard words this morning. The major problem is that the government has embraced the idea of prevention without fully understanding how this can be achieved and what the needs of our society are.

Health groups throughout the province have called for a full review of our health care system. The BCMA and the HEU — those are just a few of them — have called for a royal commission. I'm not so sure that that's necessary, but I do know that we need a full review of our entire system to see how it can be made better. It is not good enough to have an ethics committee working outside on its own, outside all other health issues. It's not acceptable that the Deputy Minister of Health announces major changes in restructuring of the ministry and then announces the formation of a provincial advisory board made up of representatives from the health care professionals — and the general public, I might add. It is not acceptable that major changes are being proposed in the areas of community health, yet no one from the public is aware of it.

I might add that some of the changes that we have seen indicate that there could be a radical shift to allow taxation at the local level, which, as you've seen in the way of school taxation, is just a way of shifting the burden onto the local taxpayers and out of the hands of the ministry. If these are the types of things that are taking place and the ideas that are being promoted, then the public and everybody ought to have some say in this.

We cannot have a trial setup starting in Victoria, an area that has absolutely no relationship to the rest of the province.

It's time that the province realized that we can't fly by the seat of our pants. Nor can we continue to develop plans in secrecy. The Ontario government acknowledged this and have stated in their report called "Health for All Ontario," which I have here: "Enormous amounts of money are spent on health services and much smaller amounts on health promotion, but these efforts lack coordination and an overall sense of direction. Development of health goals can help to focus these efforts and thus lead to improvements in health."

[Mr. Rabbitt in the chair.]

In response to the World Health Organization, which is what Ontario was responding to, European countries, the U.S.A. and Quebec have instituted a study to develop their goals. That is what we need: goals that we can work towards. The establishment of goals is a crucial step in strategic planning, as service guidelines by which the needs of the community can be coupled with the available resources to generate priorities for program development. At the same time, the goals encourage coordination between the ministries within the government and between organizations, services and community groups.

I might add that it would certainly be advantageous in this area if, for example, the goal of the government was to promote dealing with alcohol abuse. If that were a goal of the entire government rather than just the Ministry of Health, then perhaps we wouldn't get into one ministry saying, "We're going to sell off the liquor stores," and others saying, "No, that's not in the best interests of the people of B.C."; or some people saying, "We're going to mine uranium," yet we all know that mining uranium is not in the best interests of the people of B.C. People are allowing pollutants to be put in the water, and we know that's not in the best interests of the people of B.C. We need to have a coordinated effort, but that coordinated effort exists neither here nor throughout the province.

Canadian health policy has been based on improving access to health care services — a worthwhile goal and one which I heard the minister mention here again, but one that has not set priorities nor challenged the status quo. We need to have a thorough evaluation of all our health programs. To do that, we need to review all the information we have from other areas, and we must look around, throughout our own country and into the U.S., to find out some of the innovative ideas that are going on. We must solicit input from health and social organizations. We must assemble data on the current health status of British Columbians. We can do that. We have the information that tells us where people are best coping, where people are suffering more from certain diseases. We must consult with experts, produce a working paper and then get public input. I urge you to start this review immediately. Only then will you be aware of how to achieve the government’s goals without causing major disruption to existing programs.

Over the past few months, the government has consistently stressed the rising cost of our health care and the fact that we won't be able to afford it in the future. I believe that this is being done to make us accept the increased use of user fees and the present notion that we can't afford universality. Nothing could be further from the truth. The fact is that universality may be an essential factor in maintaining control over total program costs.

Comparison of the U.S. and Canadian systems will show you that the bargaining situation that exists between the province, who is the payer, and the providers of the service has kept Canadian health care costs contained; while the

[ Page 4956 ]

U.S. system, which embraces payments of many sorts — total payment, user fees — has not been contained at all. In fact, our costs were in line with the U.S.A.'s until we introduced our own universal plans, at which time the U.S.A.'s shot to 11 percent of their gross national product, while Canadian health care costs remained around 8.5 percent.

As Bob Evans, a UBC economist, points out, health costs must be taken as a whole. Whether we pay through taxation or through user fees, the cost of health care to the citizens of B.C. is not just the amount shown in your budget. The cost to the citizens of B.C. is everything they pay, and that includes user fees. To say that you are reducing health care costs by introducing user fees does not mean that you are keeping total health care costs down; it just means that you are shifting the burden from one pocket of the payer to the other. It doesn't make any sense to talk about reducing costs in that way. The final result to the consumer is that health care costs more.

We have some major concerns about the direction this government is taking us. We have a commitment to prevention and community health, yet we still have deterrent fees. As the minister stated last year, deterrent fees on many of the prevention items he promoted today in his speech, such as physiotherapy, chiropractic and massage, areas that are very cost-effective . . . . Yet we as a government are still deterring people from utilizing them.

We see a major problem here: no increase at all in home care programs. It's a very worthwhile program and one that the minister has himself acknowledged as very worthwhile, very cost-effective. Yet we see no increase.

We see announcements for new programs without any consultation, and a steady drop in morale in the ministry because no one knows what lies in the future. I would urge the minister to go out and talk to his people in the field and find out just how low their morale is.

At this point I think I must bring to your attention that over the last six months there's been an increasing reluctance in your ministry to provide service at the lower end of the totem-pole. The people at the lower end of the totem-pole are very nervous and very scared to give any information to us when we talk to them, and we find ourselves frequently having to go to the minister's or the deputy minister's office in order to get information that I think should be provided very easily; however, it is not. As I stated, I believe it's because people are very nervous about the state their jobs are in.

They're very nervous that they may be giving information that is not acceptable, so they are putting the decision as to whether information is available to us onto the higher-level bureaucrats, and I find that really disturbing.

One of the major problems in this budget, as we see it in our terms, is the increase in long-term-care fees and user fees for mental health. I am going to let my colleague from New Westminster take over and lead the discussion on this.

MR. CHAIRMAN: The second member for Central Fraser Valley requests leave to make an introduction.

Leave granted.

MR. DE JONG: It's my pleasure, on behalf of the member for Nelson-Creston (Mr. Dirks), to introduce to the House this morning a class of schoolchildren from W.E. Graham School in Slocan. There are approximately 30children, accompanied by 13 parents and their teacher, Mrs. Larsen. I ask the House to give them a cordial welcome.

HON. MR. DUECK: Mr. Chairman, I'd also like leave to make an introduction.

Leave granted.

HON. MR. DUECK: In the gallery today we have a number of nurses: Marilyn Baines, Molly Butler, Anna Marie Wells and Pat Banks, newly elected president of the Victoria chapter of RNABC. We also have Gloria Lifton, executive director; John Bennett, president; and Bea Holland, past president of the Home Support Association of British Columbia. Would the House please make them welcome.

MS. A. HAGEN: I'd like to join the minister in welcoming visitors to the gallery today for the discussion of the Ministry of Health estimates. Before I begin my comments I would also like to ask the minister if he would introduce to the House the officials he has with him this morning. I think we would all like to welcome them.

HON. MR. DUECK: To my left is my deputy, Stan Dubas; and we have Andrew Hume, information services, and Rod Munro, the number-cruncher.

MS. A. HAGEN: As my colleague the member for Prince George has noted, we are going to begin the examination of the Ministry of Health estimates by looking at a very significant portion of the budget and the people it serves and the kind of service that is available. In examining that area, I think we have an opportunity too to examine a number of the points the minister made in his opening remarks around principles, initiatives and a rational and efficient system.

I don't think it will be any surprise to the House that this morning I will be speaking not only in terms of the programs the ministry is encompassing in its budget but as an advocate for the 360,000 older people in this province and their families and for the 14 percent of the workers in this province who are involved with services for older people — a very significant constituency.

The first thrust of my questions to the minister will centre on the mandate that he has for the decisions that he and his ministry have taken in respect to services to seniors in this province. I have a thesis, Mr. Chairman: that the minister is acting without a mandate, without consensus, without consultation. It is not because he does not have the materials at hand to develop the mandate, the consensus and the consultation. Indeed, much of the work of the past couple of years led people to believe that the minister was about the development of programs in that kind of a construct; but I think the people who work with seniors and who are consumers of seniors' services have been very much disappointed in the manner in which the minister, both last year and this year, introduced programs that affect seniors. Even in his comments this morning I noted that whereas he gave us great detail about high tech issues and transplants, very important and new and exciting things in the field of the Ministry of Health, he skimmed over — with rather unseemly haste, I felt — some of the initiatives that the ministry is taking in respect to older people.

The minister has a good deal of material to provide him with a sense of direction and a perspective on the history and

[ Page 4957 ]

the development of continuing care in this province. Although not the work of his own ministry, certainly an inheritance from the previous minister is a very extensive consultation and study and symposium which was conducted in the fall of 1986, called "Health Care for the Elderly in the Year 2000," sponsored by the Ministry of Health and the faculty of human and social development at the University of Victoria. It's a document that I hope the minister knows very well, a document that I've read a couple of times now, because it provides some very solid bases for the kinds of initiatives that the ministry might be taking.

Certainly that symposium is a very comprehensive one in the documentation that we have, but I want to mention just a couple of issues that come out of that symposium.

The first is that this province has a continuing care system which is the envy of most jurisdictions not only in this country but on this continent. The minister can take some pride in that, as his government has had a significant role to play in the development of that program, as I am sure he would note back to me. The long-term-care program, as we know it, was really institutionalized about ten years ago under a previous administration. It is a case-managed system that is accessible, affordable and universal and has in fact developed out of principles consistent with the federal Health Act which we work with.

The other point coming out of that symposium was noted by my colleague from Prince George North, and it is the issue of the cost of health care. Dr. Bob Evans is a health economist at the University of British Columbia, whose research and expertise in this area is acknowledged not only in this province but in other jurisdictions. He makes the point very clearly in his paper to that symposium that the costs, as they pertain to the elderly, are not escalating out of balance with other costs. As one analyzes those, one finds — in Dr. Evans's perspective — that they are rising at the very modest rate of about 1 percent a year. Even with the rapid growth of the elderly population, which the minister has noted and which all of us are aware of, those costs are still being very well maintained.

Just to dwell on that particular issue for another moment, there was a very interesting study published at the end of last year by Malcolm Brown from the University of Calgary, who paints an even more optimistic picture of the projections around the cost of ageing to the health system in this province. To quote one comment from that very extensive study: "While it is true that as the population ages there will therefore be some tendency for overall medical costs to increase, my projections suggest that the ageing population between now and the end of the century will raise health costs by 0.23 of one percent annually" — a quarter of 1 percent annually.

There is no question that there are costs related to the care of the elderly, but they are costs that are well within our ability to manage with the system we have in place at the present time.

I want to go back to my theme of mandate, consensus and consultation and speak for a moment about the mandate review of continuing care that the minister mentioned in his remarks. That mandate review was initiated by his ministry at the same time that this symposium was taking place in November 1986. It is a mandate review that has followed quite a different process — I would submit — from the process that the minister described around the mental health review.

Certainly it was a process that initiated a great number of responses. I think the minister noted 800 in his comments today. I know the process was welcomed by people in the field, the service-providers, the old age pension organizations and various people concerned about the care of the elderly. That's reflected in the number of submissions.

But to this point, that particular mandate review reposes somewhere in the ministry. I don't know where it is, nor do the people who submitted their ideas to the ministry. What came of that? What are the results of that mandate review? Are they influencing the policies that the minister has been promulgating around user fees for older people?

Let's just look at the mental health review. The mental health review was carried out in a very public way. This was more focused. I don't consider that to be an issue, but it was less public. The mental health review, once it was completed, was published. All of us had an opportunity to receive it, to read it, to respond to its recommendations and to provide further input, because we know that the input singly then creates something that's greater than the parts. Everyone understands that. That's what the consultation process generates and requires. In the name of fairness, it requires integrity, the development of a consensus and opportunity for people to review not only their submissions but the submissions of others, and how those might be formulated into recommendations or policy directions.

At this point, a year and a half later, that mandate review is off somewhere in the offices of the ministry, and no one has heard about it in a formal way. I understand that some groups who have raised questions with the ministry have been accorded some kind of a private briefing. It appears that if someone has squeaked a little bit or requested some information, there has been some response. But I know of a number of very concerned groups whose members have been so upset about the lack of feedback that they have taken initiatives to write the ministry requesting a full presentation.

In the midst of all these initiatives — a major study, a mandate review that talks to the people of the province who are concerned with seniors' services — the minister doesn't do as he has done with the mental health review, which is to say: "I have heard your input. I know there are concerns about the closure of Riverview and what's available in community services, and I am telling you that I am integrating that into our planning and into the policies that we will be developing." Mr. Minister, the community interested in seniors' services has seen no such endeavour and no such integrity in the process in which they have engaged.

There is not, I would submit, a consensus about the initiatives that you have been taking recently in seniors' services. This is a partial list to just note some of the organizations and individuals who have fed back to you their concern about the initiatives of this budget. I want to put at the very top of the list the consumers of the services, COSCO and the old age pensioners' organizations — umbrella organizations for hundreds of small groups of active seniors in their communities, people who have become so concerned that they have mounted a major campaign to express that concern through a petition, which I hope will be presented to this House before it adjourns at the end of this session, sometime this month or next month.

[11:30]

Some of the major service-providers are represented here today: the Home Support Association of B.C., the Long Term Care Association, the B.C. Nurses' Union, the Hospital

[ Page 4958 ]

Employees' Union, the Alzheimer's association, municipal councils — five; I don't know the number at this stage, many of them unanimously reflecting their concern to you — and interestingly, business people, because business people do not share the view of this government, a view that we haven't heard since 1931 when they did stop people at the borders from coming in . . . . They do not agree with the perspective of this government that we do not want to have any more older people moving to this province.

I've traveled this year across the south of this province from Cranbrook through to Osoyoos and Penticton, where anywhere from 25 to 65 percent of the population of the small towns is older people. You talk to the business people in those communities. The older people are the secure anchor of those business communities, and a very small proportion of them require the special services that are a part of continuing care.

My first question to you is: where is your mandate? Where is the consensus for your action? I would submit, Mr. Minister, that perhaps what happened in a riding in the interior last night helps to provide you with some of the answer that I think would be the honest one: that there is not a consensus and that you do not have a mandate for the actions you have proposed in the budget which will affect the most needy — the special needs of our elderly population. Let's remember, that is a small proportion of the elderly who contribute to our economy. It is a proportion of 15 or 16 percent at the maximum. Where is your mandate to take the issue forward as you have with fees and user fees?

HON. MR. DUECK: First of all, I think I should at least state that I hope we do not get into these discussions on a political level when we are thinking about health care of the elderly or health care in British Columbia as a whole. I do not wish to get involved politically at all. I've said before that when we're talking about health care it should be absolutely devoid of any connotation of votes, and I mean it sincerely. We've talked about this before.

Secondly, I would like to say that you practically indicated that perhaps the government of British Columbia or some people in this government were taking the attitude that seniors are a burden and that we somehow wished that they weren't there. This is very wrong. I for one think very highly of seniors. As a matter of fact, the life that we enjoy today.... The life that I have today is due to my parents. It's due to the senior people that have gone on before us and created the wealth and the system that we have today, and we are ultimately thankful to them for having done that. It is our responsibility — no question about it — to do everything we can for these people, and that is also my responsibility. I don't take it lightly at all, and I wish to make that very clear at the beginning of this debate.

However, having said that, I think you mentioned too that the costs somehow don't matter. We have to address costs; there is no question about it. Money doesn't keep rolling in from somewhere that is secret, that is somehow from the sky or from a money tree. It does not come in; it must be generated. When I look at my budget of just a few dollars under $4 billion, the allocation has to be made and the priorities have to be struck.

When we are talking about senior citizens, it is a known fact that in the province today the number over 65 is 12 percent, and they consume 47 percent of the total budget. This not saying we don't want seniors. We owe it to them, and we owe them perhaps more than we're giving them. I'm trying very hard to make their lives easier and better. That's why we have initiated this Victoria Health Project, to do exactly what you were mentioning. Perhaps some of these services that we have not offered to them in real terms and have stayed away from.... We're saying we're going to have a more integrated and sophisticated health care system for the seniors exactly. This health care project that we've initiated, a pilot project now underway in Victoria, will do that.

You also mentioned the review that was initiated. I believe my deputy was very much involved in this review. That mandate review is currently being reviewed internally, and we'll certainly take that into consideration. We're looking at it, and it will be made public once we have looked at all the recommendations and at what is entailed in that particular review.

As far as my mandate is concerned, and consensus, that of course can be argued. I travel the province, I suppose, more than anyone.

When it comes to hospitals and senior citizen homes, I never hesitate to go into a senior citizen home. No matter where it is, I make every effort to visit them and talk to them and see what their concerns are. Yes, I would like more money in that area, no question about it. I would like more money in many areas. However, I also have limitations. But to say that maybe somehow we're not concerned about senior citizens.... I would like to tell you that you are very wrong. My father's 89, and he's still living with my stepmother, and I visit a lot of senior citizen homes, and I know the problems, concerns and needs they have. It's up to this ministry, especially when it comes to health, to look after them. I certainly will do everything I can to do that.

MS. A. HAGEN: I have never questioned the minister's personal commitment to his ministry and to this population in his ministry. But, Mr. Chairman, a minister has a very major responsibility in the development of public policy and public initiatives. With respect, I don't think he did justice to my question about the issue of consensus on the policy of new user fees. I put it in the context of studies that were part of his own ministry's examination of the mandate, which suggested that user fees should not be a route to follow. I was asking the minister to provide us with some basis for the mandate to do what he is doing in user fees. He has not provided me with an answer. He has not provided this House with an answer.

I would like to ask him some more specific questions on the issue of user fees. I think I should clarify which user fees I'm talking about. Since the budget was tabled in this House, we have had no further direction from this minister about how and when and to what degree user fees will be introduced.

We have three user fees that are proposed. One is to increase the base rate in all long-term-care facilities, including extended-care hospitals, by 25 percent, from $16.70 to $19.20 a day, a rate, I assume, that will continue to have be COLAed every three months as they have been now for the last two or three years. That means that the $19.20 a day will increase in July and October of this year and in January of next year and so on. That's the one rate that is in place. It is a basic rate that will continue to increase.

There's a second rate which the minister has announced will be imposed. It's a sliding scale rate, somewhere up to $30 or $32 a day, based on income-testing for every resident in long-term-care facilities. The third fee change is a change in the fees for home-care recipients living in their own

[ Page 4959 ]

homes, a fee increase that the Minister of Finance and Corporate Relations (Hon. Mr. Couvelier) has indicated would increase by four times what is collected from the 40,000 people who live and receive help in their own homes. These are the fees that I'm talking about.

I want this to be an orderly debate where we can try to get some information from the minister about this part of his budget. I want the minister to give us some information about the studies that made him decide that these fees would go into place. I know those fee increases went into place without consultation, except at very senior levels of government. They went into place without recognition of the minister's own symposium on health care in the future and without any publication of the mandate review so that people could examine it and respond to it. It's gone into place in an isolated way and obviously without a great deal of planning. That's the only interpretation I can place on the fact that two and a half months after those increases were announced we still have no concrete information, except for the across-the-board fee increase that everyone in a facility has had to pay. Will the minister please give us some of that background, and then I want to ask him further questions about the specifics of the various fee increases.

HON. MR. DUECK: I've got some more information. I think you mentioned the mandate review that the ministry had undertaken. True, there were many briefs, and there was much involvement from the community. I would just like to go over some of them. I'm going back a bit, if you don't mind, to give you that information. I think you asked the question, and you should have some of that information.

There were many submissions: I understand 711 provincial organization discussions with 13 government programs or services; 39 briefs from several verbal submissions; 200 recipients of services; 200 of their relatives; 200 direct-care staff and service-providers, and on and on it goes. We have implemented some of the things that came forward. It said home support services was the most frequently addressed issue in the submissions, the need to strengthen homemaker services. The home nursing care programs, adult day care, respite care and community physiotherapy were consistently noted, and that was good. We've done a lot in that particular area. When we take home care, which I know has been criticized — and we never have enough in that particular budget — just a few years ago we only had a few dollars in it, and we're now at $50 million to $60 million a year. So you cannot say that it has not been improved.

Education was the second most frequently addressed issue. Strongly supported recommendations included education of public and health care professionals with respect to program availability; the ageing process; education of clients of the importance of independence; self care; healthy lifestyle; again, education of direct-care staff; service-provider agencies of volunteers and family caregivers; and, finally, development of wellness clinics for the education of clients and their families.

[11:45]

So the Victoria Health Project actually has followed on these requests from the submissions. There was another one: greater access to preventive services by the elderly was recommended. Again, the Victoria Health Project is taking that into consideration. Identified services needs include physiotherapy, occupational therapy, nutrition, speech therapy, podiatry and specialized professional health care services. Again, we're definitely going in that direction with this health care project. It's a new initiative, but that's the area we're addressing,

The expansion of the handyDART bus service: we've done that.

There was very strong support for user fees and their consistent application across the various continuing care services. The most frequently recommended option was user fees based on the income of clients. That was part of the review you are speaking of — and there were other things too. But when we're talking about user fees, it has been mentioned that health care should be universal, and we agree with that, and we could not have a user fee for continuing care if that were so. We're talking about the facility, and surely when these people move from their homes or apartments that particular part of their life is looked after, and we're saying that it should continue. However, as far as the income-testing is concerned, it's under review, and I'm not going to remark any further on that until it becomes policy.

Supplementary services. I'm sure you are well aware that the federal government doesn't share in any cost of those services. We feel that the $5 charge is certainly acceptable, and it does not affect anyone on low income; neither does it affect anyone in a situation of subsidized income from the government.

MS. A. HAGEN: I detect in a rather lengthy answer that gives us some glimpses into the mandate review, which again I note has not seen the light of day, that there was input from the community on the issue of user fees, and I presume that it's on that basis that the minister is perhaps answering my question as to where he has got the mandate and where he has got the consensus.

I would go back to my earlier comment that a mandate review which sits in the ministry's hands and has not worked its way through the system — including back to those people who had input to that system — doth not a policy make. It appears to me that the minister is continuing his role of being less than candid about a policy that I would suggest was put into place hastily and without consideration of its implications. It's a policy that already, even in terms of the across-the-board 85 percent, has met with a great lack of consensus and support in the province. Even among those people who are prepared to look at some income-testing, the 85 percent rate has been very strongly condemned.

Let's look at it for just a moment. I want to draw to the minister's attention some examples of the circumstances that older people face and to speak first for couples. It's interesting, Mr. Minister. I hadn't realized this; perhaps your ministry hadn't realized it either. Until the new policy was introduced, for a long time couples had been abused by the system, because they were paying close to 87 percent of the cost of their room and board and other care. They paid the same rate as a single person, even though they were each getting $100 a month less in the way of income. You are aware that the unfairness existed, and the unfairness has in fact continued and is in place at this time.

I want to quote to you the case of a couple who live in a care facility on the lower mainland. They live together; they are not involuntarily separated, that terrible bureaucratic phrase that we use. I hope we can all persuade the old age pension people to alter that in the interests of being more sensitive to people's feelings. Their present income is $553 and some cents a month. They have not received GAIN for

[ Page 4960 ]

Seniors, and I haven't been able to find out, through the services for seniors' offices of Social Services and Housing, when they will receive it. The only thing I have been able to find out is that they hope they will be on the tape and have a cheque by the end of June.

That couple is presently in an $80- or $90-a-month deficit for their bill, which is $1,200 a month. These are people on basic old age pension income. In fact, $2 a month comes off their cheques from the maximum they might receive. The gentleman in that household had to go to Social Services and Housing in the last couple of weeks to get a special grant in order to buy new eyeglasses. They're expensive, because he happens to have the kind of glasses that older people often need, which are expensive. I want to use that just as an example to point out to the minister that the 85 percent rate he has set is not a reasonable rate for the independence and good health of older people.

Let's look at some of the things they have to pay for at this time. Obviously they have personal needs: a phone; many of them pay for cablevision; there are activity fees charged by care homes; transportation for older people is more expensive. One of the most telling letters was the story told by a man of 70, who every week went to visit his mother of 95 and had to travel from South Vancouver to North Vancouver — to the tune of $5; $20 a month for him to visit with his mother.

There are medical supplies that are not covered. I have talked to seniors who pay anywhere from $50 to $80 a month for continence supplies. Bandages are not always covered. Non-prescription drugs are not covered. Seniors who are not well have extra expenses. I have an 83-year-old mother. She's blind, she's living on her own, and she has extra expenses because of her disability.

There are other health care expenses that older people have to manage with the money that they have — dental, eye, hearing, mobility aids, you name it — plus all the personal needs. Many of those seniors will have difficulty. If it is a couple, then that difficulty will be enhanced because that income is shared between two people, and the spouse at home has the stress of an older person in care and will feel even more the problems of trying to remain independent.

I have been told that old age security has rejected the unilateral initiative of this government that everybody in a care home will be treated as single. No other province has that dispensation. So couples will have the lower income and everyone will face those additional costs.

The minister has been less than honest when he's talked about other provinces. We are in fact the only province that charges MSP premiums. The minister has said that people will not have to pay those premiums if they're getting maximum old age pension....

HON. MR. STRACHAN: On a point of order, Mr. Chairman. I know the member really didn't mean this, but I think it should be withdrawn. The term "less than honest," when applied to another member, is not parliamentary.

MR. CHAIRMAN: Thank you. Would the member withdraw.

MS. A. HAGEN: Let me substitute: less than clear in his presentation of the facts in comparison with other provinces.

MR. CHAIRMAN: The substitution can be made later, but the....

MS. A. HAGEN: I would certainly withdraw and clarify the remark I was making, Mr. Chairman.

The minister has suggested that people will all get GAIN, that they will not pay MSP. In fact, we are looking here at very few people being protected. I wanted him to clarify who is going to be excluded from MSP premiums.

We're the only province in Canada that charges older people for their medical service premiums. Even the provinces that have premiums for younger members of society do not charge them to older people. Alberta doesn't; Ontario doesn't.

Mr. Minister, you have set in place a fee level that is unacceptable and is working hardship. It was poorly considered, when one looks at the other costs that seniors must undertake. Could you please justify why that fee increase can stand, when you have had so much evidence of the problems it has given rise to for many people in the province? It's an extra $900 for 20,000 seniors living in care at this time. That is the base figure; that's going to rise as the months progress.

HON. MR. DUECK: I've made it quite clear in the House and also when I spoke to the member privately: we are not penalizing couples. They will be treated exactly at the same rate as singles.

The other area of concern I believe you raised was the....

MS. A. HAGEN: When, Mr. Minister?

HON. MR. DUECK: We're asking them to come forward now. If some have not been identified, we'll make it retroactive from May 1.

Also, you mentioned incontinence supplies and some of these other supplies. They were never sanctioned or allowed by us, but some facilities did charge for them. We're now getting word out that they are not to charge those extra services to these people.

The basic minimum income that any individual in a facility will have, whether single or a couple, will be $150 per month. It is approximately $20 less than before. And we are saying that anyone on OAS-GIS does qualify for GAIN — which prior to the budget speech was not possible. Therefore the difference is 20-odd dollars, and we feel that with everything else being paid for, other than personal items, this is indeed a very good program and these people are being looked after well.

As a matter of fact, when I travel through the province and stop in at senior citizen homes — and the horror stories that you are telling me — I don't get that same feeling when I talk to them. I have people writing to me and they tell me in person that they are adequately looked after. Some of them say they have never been looked after as well as they are now. So don't use this as a tactic to scare people. We know that there will be poor people with us. Not everyone is going to drive a Cadillac or live in a $4,000-a-month home. We accept that. I wish everyone could, but that's not so.

At the same time, when we are allocating $4 billion, we are saying that everyone in a facility.... Before they came into a facility, they paid for their room and board 100 percent. It's still very heavily subsidized, even at these rates. What I'm saying is that, since May 1, they are paying the $19.20

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and, yes, it will be indexed like it was before. However, the $150 a month for the poor, for the least unfortunate, is not a bad program.

HON. MR. STRACHAN: I move the committee rise, report resolutions and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Strachan moved adjournment of the House.

Motion approved.

The House adjourned at 12 noon.