[ Page 4963 ]

CONTENTS

Routine Proceedings

Freedom of Information Act (Bill M206). Mr. Jones

Introduction and first reading –– 4963

Oral Questions

Privatization proposal for ICBC. Mr. Harcourt –– 4964

Layoffs at Rim sawmill. Mr. Miller –– 4964

Privatization of highways maintenance. Mr. Lovick –– 4965

User fees in elderly-care facilities. Ms. A. Hagen –– 4965

Moratorium on uranium-mining. Ms. Smallwood –– 4965

Coquihalla Highway access. Mr. Williams –– 4965

Salmon fishery. Mr. Miller –– 4965

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

On vote 45: minister's office –– 4966

Ms. A. Hagen

Mr. Rose

Mr. Michael

Ms. Marzari

Mrs. Boone

Mr. R. Fraser

The House met at 2:07 p.m.

HON. MR. STRACHAN: On behalf of the government, I'd like to recognize a good and hard-fought election campaign by Mr. Barlee, Mr. Fox and Mrs. Tyabji, and offer our congratulations to the opposition and Mr. Barlee on their electoral success yesterday. I know there's been some question, but we will not be asking for a recount.

HON. MR. REID: I'd like the House to welcome four people from Surrey School Board who are here with us today: board chairman Laurae McNally, board member Pam Lewin, Doug Jennings, superintendent of School District 36 in Surrey, and Mr. Leigh Anderson, secretary- treasurer. On behalf of my colleagues from Surrey, the member for Surrey Guildford-Whalley (Ms. Smallwood) and the member for Surrey-Newton (Hon. Mrs. Johnston), we welcome these people to Victoria. I hope they spend $148 million effectively.

HON. MR. PARKER: In the gallery today is a distinguished visitor, Mr. Brian Watkins, consul-general for Britain. His offices are located in Vancouver. Would the House make him welcome, please.

MR. CASHORE: In the precincts today are 50 students and their teachers from Our Lady of Lourdes School in Coquitlam. Would the House join me in making them welcome.

MR. DIRKS: I'd like to make an introduction this afternoon for my colleague the MLA for Columbia River (Mr. Crandall). There are 38 grade 7 students from the J.A. Laird School in Invermere visiting us this afternoon, accompanied by their teachers David Sharp and Larry Ballard. Would the House please make them welcome.

MR. DAVIDSON: Visiting today are students from the Seaquam alternate program school: Willard L'Hirondelle, Josh Bowman, Elizabeth Megalos, Leesah Haley, Ryan Hewgill; and with them their teachers Joyce Williams, Yashoda Reddy and Steve Ferguson. I would ask the House to make them welcome.

MR. R. FRASER: Mr. Speaker and colleagues, on behalf of the member for Burnaby-Edmonds (Mr. Mercier), I would like to welcome 70 students from St. Thomas More Collegiate, who are visiting the chamber today. There are so many students that a second group is coming at 2:30. Interestingly enough, the member is over at the school right now awarding a large provincial grant for the construction of an all-weather playing-field; otherwise he'd be doing this introduction himself. On behalf of the member and all of us, would we make the students welcome.

MR. HARCOURT: I would like to respond to the very generous words of the government House Leader in regard to the by-election last night. On behalf of the members of the Legislature, I would like to congratulate all of the candidates who participated, and their workers. That is what makes our democracy great: that we have differences of opinion. We work hard for those opinions, and the voters decide. On behalf of all of us, I would like to express congratulations to those who participated in the by-election last night.

I was thinking about starting off question period today by saying: Mr. Speaker, we have no questions; we got the answer we wanted last night. But I think we should proceed with business as usual.

MR. PELTON: With the indulgence of hon. members, I have two or three introductions to make. On your behalf, Mr. Speaker, I would ask the House to welcome Mr. Harold Gregory of Vancouver; Mr. and Mrs. Robert Hounsorn of Brighton, Sussex, England; Mr. Gary Powers of West Vancouver; and Mr. Adel Mosley of Vancouver.

As well, one of our outstanding young legislative interns, Sarah — I'm sure everybody knows Sarah Bonner — has her great-aunt Gretchen Miles, from Kellogg, Idaho, here today; Sarah says that she's not only a great-aunt but she's a great lady. I would ask the House to make her really welcome here this afternoon.

MR. LOVICK: I would also like to introduce my colleagues in the House to some visitors, the family of my legislative assistant Margaret Mortimore: her husband, Jim and her son Michael Mortimore are in the precincts, as well as Michael's wife Rhonda and Rhonda's parents, visiting from Sylvan Lake, Alberta, Alvin and Margaret Lundgren.

MR. BRUCE: I would like to congratulate the NDP on its victory last night. I know the feeling well, having won my riding for the first time for the Social Credit Party in 1986. They must be enjoying that feeling. I appreciate that; it's something that makes you feel very good when you are able to accomplish it for a first time.

With that, I would also like to introduce to you another two members of the constituency of Cowichan-Malahat: Calvin and Sharon Fee. Would you please make them feel welcome.

HON. MR. DUECK: I would like to add to the list of introductions I made this morning. We have another nurse joining us this afternoon. She is the vice-president of the Victoria chapter of the RNABC, Wendy Underhill. Would the House please make her welcome.

[2:15]

Introduction of Bills

FREEDOM OF INFORMATION ACT

Mr. Jones presented a bill intituled Freedom of Information Act.

MR. JONES: Mr. Speaker, we need a statute in this province that will systematically ensure that the public interests will be preserved by providing information. This bill would do that. It would allow for access by individuals to information that the government holds as well as protect the privacy of information that the government holds on individuals. We saw the importance of that recently in Nova Scotia where a cabinet minister was charged under such legislation.

Not a week has gone by in this province where we have not seen the public interest denied because of the lack of this kind of legislation. We saw yesterday, in terms of access to information regarding the sale of public assets, as well as

[ Page 4964 ]

information on the Provincial Capital Commission hearings and on the sectoral analysis of the impact of the free trade agreement and access to pollution reports on pulp mills, that the need for this legislation is overwhelming.

It is overwhelming because of the situation we have now. The discretion is left entirely to the government in the vast majority of areas. So what we have, by default....

MR. REE: On a point of order, I believe the presentation by the member is argument at this point and not related to the bill as such. Possibly the member could be instructed by the Speaker as to what sort of presentation is to be made on first reading.

MR. SPEAKER: The member is supposed to make a brief introduction of the bill and has two minutes to do so.

MR. JONES: By default, we have legislated secrecy in this province, and what we need is legislated openness. This is not radical legislation. It was introduced in the United States some 22 years ago. It exists in this country under federal legislation, and every other province in Canada, except Alberta, Saskatchewan and Prince Edward Island has such legislation. We in this province don't want to be the last province in Canada to enjoy this freedom of information.

I hope that this bill will lead in some way to freedom of information legislation in this province. To do so would be a profound expression of the health of our democracy; to not do so would confirm suspicions that the government is not serving the interests of the people.

Bill M206 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

PRIVATIZATION PROPOSAL FOR ICBC

MR. HARCOURT: I have a question for the Minister of Labour. This morning a small group of private insurers, led in finance by the Toronto-based Insurance Bureau of Canada, have launched an $800,000 public relations campaign to have ICBC privatized.

Last night the minister said that he wasn't really interested, but that he would look at their proposal. Given that the corporate operating costs of private insurers are 11 percent higher than ICBC, Mr. Minister, why are you considering the sale of ICBC?

HON. L. HANSON: First of all, the Leader of the Opposition is making an assumption that we are considering privatizing ICBC, and that is a subject for future policy. As I said in my statements, we have a number of privatization initiatives. ICBC is not on that agenda.

I am pleased to hear that the insurance companies have chosen to spend almost $1 million in British Columbia to add to our economy through a public relations program. That certainly is not difficult for us in British Columbia to agree to. On the other hand, I would have to say that we — unlike the members opposite — are prepared to listen to any presentation by anyone at any time. But that does not necessarily make us agree that the presentation would be accepted or put into effect.

MR. HARCOURT: A supplementary, Mr. Speaker. In British Columbia the Insurance Agents' Association have said: "In our opinion, ICBC is at the present time providing the best motor vehicle insurance in Canada." Since the minister knows that pricing for profit would add at least $115 to every policy, will he now state that ICBC is not for sale and advise the insurance companies involved that they're wasting their clients' money on their campaign?

HON. L. HANSON: Again, that is a subject of future policy. I have already said in my remarks that I think privatization of ICBC is not on our agenda. But unlike the members opposite, we do listen to everyone in British Columbia and their ideas and give them fair and reasonable consideration. We don't have a closed mind about anything.

LAYOFFS AT RIM SAWMILL

MR. MILLER: A question to the Minister of Forests. At a meeting this week in Hazelton with municipal leaders concerned about the closure of Westar's South Hazelton sawmill and the loss of 110 jobs in that community, the minister said, and I quote: "You know as well as I do that in any other culture they would move to look for work. " Would the minister explain to this House just who he was referring to when he said "any other culture?"

HON. MR. PARKER: The member opposite is discussing third hand a conversation in the district manager's office in Hazelton last Saturday, at which time it was pointed out to the folks gathered there from the various councils that a layoff was pending at Westar's Rim sawmill and that some people would be unemployed in the area. I stated that the opportunities may not be in that community for further employment and that people may have to move elsewhere. I remarked to one of the mayors there who had moved into the area that he had seen fit to go where the opportunities were. That was the gist of the conversation.

MR. MILLER: I don't think that's quite good enough, Mr. Speaker. I talked this morning with Alice Maitland, the mayor of Hazelton, who, upon your uttering those words, got up and left the meeting and said: "I've had enough of this." Mr. Minister, it's not good enough. "In any other culture, they would move." Which culture? There's the native community there, and there's the non-native community. Which culture were you specifically referring to when you said they should leave the riding because there are no jobs?

HON. MR. PARKER: I'm sorry, Mr. Speaker, I can't recall using that term at all.

MR. MILLER: Well, it was quite clear in the minds of the people at the meeting, and it was quite clear in the region that you're supposed to represent.

A supplementary, Mr. Speaker. The minister is also a minister of state for economic development, presumably a cornerstone of this government's policy. The minister of state for economic development advises people in a community where 10 percent of the workforce is going to be thrown out of work tomorrow that in his opinion they should leave the area. Is that part of the decentralization policy of the ministers of state of this province?

HON. MR. PARKER: There are substantial opportunities now in the northwest with the initiative for regional

[ Page 4965 ]

economic development. There's a powerline going to Stewart — employment opportunity. There are expanded silviculture jobs in the northwest. There's a new addition to the Kitimat pulp mill underway, and there's substantial employment there. There's substantial employment in the renovations at the pulp mill in Port Edward, and there are opportunities all up and down the north coast. People don't even have to leave the constituency for job opportunities, but they really have to be heads-up and seize the opportunities where they lie. Some people may wish to move further afield. But they can stay right in the region, and they're most welcome, because we have taken great strides toward making those opportunities available to them.

MR. MILLER: A supplementary, Mr. Speaker. I think the people of those constituencies are going to give the minister an opportunity to embark on another career after the next election. One hundred and ten people are losing their jobs this week, Mr. Minister. You promised them an answer today. What are you going to do for the 110 people, the 10 percent of the workforce of the Hazeltons, who are losing their jobs, in terms of giving them some kind of security that there will be further job opportunities in that community?

HON. MR. PARKER: The sawmill being closed in Hazelton tomorrow is one that was destined for closure upon the completion of the new mill at Carnaby siding, about five miles south of the Rim sawmill, so all the employees in the old mill were offered the opportunity to work in the new mill. Some took that opportunity; many didn't, and those are the ones facing layoff now. Of course, being in a bargaining unit, they have the opportunity to bump in to positions in the new mill.

The whole purpose of the exercise in creating the new mill was to replace the old inefficient mill, which has about 25-year-old technology, and that has taken place and the community knew it. It was working on a single-shift basis, where it employed fewer than the 110 mentioned by the member. However, there are a number of people on recall because the bargaining unit — the contract — calls for recall, so the people actually being displaced from a job are considerably fewer than 110, but a lot lose their recall opportunity.

As to what we are doing, I said that I would be communicating with them, and my ministry is communicating with the community now. The Kispiox timber supply area is due for a reanalysis, and that reanalysis was to be completed by the middle of next year. We'll complete that this year and determine what options there are for the Hazelton area and the timber supplies out of the Kispiox. Preliminary information should be available in August, so we should be able to indicate to the village councils and the Gitksan and the chamber of commerce by about the middle of August or so what the options are in the Kispiox.

PRIVATIZATION OF HIGHWAYS MAINTENANCE

MR. LOVICK: A question to the Minister of Transportation and Highways. During the by-election campaign in Boundary-Similkameen, very strong concerns were expressed about Highways privatization, including concerns about public safety and local employment. My question to the minister is just this: given last night's by-election results, has the minister decided to finally listen to the public and abandon the plans to privatize Highways maintenance operations?

HON. MR. ROGERS: No.

USER FEES IN ELDERLY-CARE FACILITIES

MS. A. HAGEN: My question is to the Minister of Health. The riding of Boundary-Similkameen has the highest number of senior residents of any constituency in the province of B.C. They have made their opposition to the longterm user fee imposition very clear during the course of the by-election. Has the minister finally decided to reconsider and to plan to withdraw unfair long-term user fees on the seniors of this province?

HON. MR. DUECK: No, I'm not.

MORATORIUM ON URANIUM-MINING

MS. SMALLWOOD: My question is to the Minister of Energy, Mines and Petroleum Resources. The voters of Boundary-Similkameen have expressed their opposition to uranium mining. They did so in the municipal referendum, and they have again registered their opposition in the by-election. Has the minister reconsidered the moratorium, and will he now reinstate it?

HON. MR. DAVIS: As long as there's no possibility whatsoever of uranium-mining occurring in that area, I see no reason to consider or reconsider a moratorium.

[2:30]

COQUIHALLA HIGHWAY ACCESS

MR. WILLIAMS: To the Minister of Highways. Again, one of the issues in the Boundary-Similkameen area is the question of access to the extension of the Coquihalla Highway, and the question of direct access to Penticton and Summerland. Has the minister reconsidered, and is he considering a proper access to Summerland that will be on a par with the accesses being provided to the city of Kelowna?

HON. MR. ROGERS: We will continue with the construction as has been designed and announced in the communities.

MR. WILLIAMS: Is the minister then not prepared to have a separate, proper cutoff that will give quicker, direct, shorter access to Summerland and Penticton so they will not be hurt in their tourist industry as they will with your present plans?

HON. MR. ROGERS: I thought he would save that very well-researched question for the new member who will come in and obviously want to ask it.

No, there isn't a change. I have not made any changes in the plans. I have not had a request to make a change in the plans.

MR. WILLIAMS: I'm making the request.

HON. MR. ROGERS: From you I wouldn't consider it, but from others I might.

SALMON FISHERY

MR. MILLER: A question to the Minister of Agriculture and Fisheries. We are shortly going to start the major salmon fishing season.

[ Page 4966 ]

Interjection.

MR. MILLER: It's no joking matter, Mr. Minister of Education (Hon. Mr. Brummet).

We are shortly embarking on the major salmon season, and I wonder if the minister has made any representations to his federal counterpart in regard to the mandatory carrying of emergency locators on fish boats on the west coast.

HON. MR. SAVAGE: As I understand it, that has not been brought to my attention to deal with with the federal Minister of Fisheries and Oceans. It has not come across my desk at this stage.

MR. MILLER: It's across your desk now, Mr. Minister. You're responsible for fisheries, and you and everybody in this House should be aware of the lives that have been lost at sea. Some of those deaths could have been prevented with these devices. Would the minister assure the House that he will take the matter under advisement, including the possibility of some kind of financing scheme to assist some of the smaller boat owners in the capital cost of acquiring these types of locators?

HON. MR. SAVAGE: All I will commit to is to look at what is being suggested. I cannot make any promises at this stage until I see all the information that has to be presented.

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

ESTIMATES: MINISTRY OF HEALTH
(continued)

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

MS. A. HAGEN: When we adjourned at noon, we were discussing aspects related to user fees for seniors in long-term-care facilities. I want to pursue just a couple of other questions with the minister at this time, and then I want to move on to discuss some aspects of home support. Mr. Minister, you did indicate in your reply just at adjournment time that there would be some directives to long-term-care facilities regarding what services, what supplies and what costs would be covered by the user fee presently imposed. I want to ask you one or two questions now.

First of all, will you provide a list of those particular exemptions from charges to residents, and will those go to long-term-care facilities, and can you give me a time-frame in which they will be advised and given direction regarding that particular coverage?

The second question is regarding statements he has made in the press that residents in long-term-care facilities will not have to pay medical service premiums. At the present time, residents in facilities will pay either full premiums or have assistance either at the 55 percent or the 5 percent level. The minister has made announcements that suggest that some residents will be exempt. At the present time, to my knowledge, the only people who are exempt are people who come under Social Services coverage. Would the minister please clarify who will be exempt from medical services premiums among the residents in care?

HON. MR. DUECK: I don't think I ever reported in the press that anyone in a facility, extended or intermediate care, was exempt from premiums. I've never made that statement. But I have said that anyone under OAS-GIS was exempt from premiums, and that is so. Furthermore, of course, the others who are not exempt can get subsidized 95 percent if they're under $2,500 taxable income and 55 percent if they're under $6,500 taxable income. If you want to verify that, if you can find anywhere I've made that statement.... To my knowledge, I never have, because it has never been in the plan.

As far as supplies are concerned, incontinent supplies and other supplies that senior citizens may need in their day to-day living in a facility have never been allowed by the ministry, although we have known of some that have charged for those supplies. We are going — and I directed my deputy a couple of days ago — to get in touch with all the administrators with a list of the items that cannot be charged for. When we have that list complete, I can certainly give you a copy of it.

MR. CHAIRMAN: The first member for Vancouver South requests leave to make an introduction.

Leave granted.

MR. R. FRASER: Thank you. I didn't really intend to break into your line of questioning, but I appreciate the opportunity you gave me. On behalf of the member for Burnaby-Edmonds (Mr. Mercier), I would like to ask you to join with me in welcoming the second half of the group from St. Thomas More Collegiate, who are here with their teacher, Mr. Spanjers. Would the House join with me in welcoming them.

MS. A. HAGEN: One of the advantages I have over the minister — it's not an advantage that he would have had an opportunity to enjoy — is that I really know the system that works for older people, and the benefit package. I think the minister doesn't know that system. At times I think he confuses things — not intentionally — and the result is that the messages that he gives to seniors are confused. I want to try this once more so we have it clear.

You just said, Mr. Minister, that no one is exempt but that people who receive OAS and GIS are exempt. You can't have it both ways. I am asking you: is there anyone in a long-term care facility who will not be paying some medical service premium, whether it be the full premium or one of the two assisted levels of premium for the Medical Services Plan?

HON. MR. DUECK: Mr. Chairman, either I said something I didn't want to say, or you didn't understand. But I said: anyone under OAS-GIS is exempt. Did I say that before?

Interjection.

HON. MR. DUECK: Okay.

MS. A. HAGEN: I don't want to spend a lot of time on this, and maybe we can discuss it in the hall, but I want it on the record. Can you explain to me why a person on OIS-GIS is exempt from the 5 percent premium? They have never been before, to my knowledge. That would apply to 160,000 people who live in the province who get GIS, and they are not exempt. They pay some premium, whatever it may be; it may be only 5 percent. But I want to have clear whether they are exempt or not.

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We've got to be able to communicate to the people in this province what the programs are. The minister needs to not speak unless he clearly understands. If he doesn't, he needs to get some help to clearly understand. I say that with great earnestness, because the minister keeps making statements about policies that are confusing to the people in this province, and he needs to get his facts and his communication clear and straight.

HON. MR. DUECK: I appreciate the member lecturing me; that is very comforting.

I said that we were speaking about facilities; we were not speaking about senior citizens. You asked a simple question about people in facilities. I'm telling you that for people in facilities who receive OAS-GIS, those premiums will be paid for them. They will not be responsible for those payments. I don't know how this confusion came in, because you were very directly asking about people in facilities. I did not say senior citizens in the province, so I answered the question like I've always answered that question. There is no confusion in my mind, but the confusion is perhaps that you didn't quite understand, or maybe you thought of senior citizens in the province rather than senior citizens in facilities.

MS. A. HAGEN: I want to thank the minister for his clarification. One other question on this: is this a new policy?

HON. MR. DUECK: It is a new policy as of May 1; that is correct. The reason for doing that, of course, is that we want to ensure that the individual who is least able to pay or has the least amount of money for their personal needs will not be left with less than $150 a month.

MS. A. HAGEN: The evolution of policy is interesting, and I think the confusion we have is that it is evolving. We had the budget speech, then the application of GAIN, then the Medical Services Plan. We had the issue of single versus couple seniors and the way they would be covered under the new plan. We now have some indication of some policies regarding what will be covered under the 85 percent fee. I simply want to make the point that it is very difficult for people in facilities — families and residents — to understand, when they are not here seeing the press releases and hearing this discussion but are getting it piecemeal. It's not a very satisfactory process.

Let me raise the question of the second matter of fee policy, that of the sliding scale. The minister said this morning when I raised this issue that it was not his intent to discuss this matter further at this time. He has said quite clearly — and I think language has again been used more carefully and cogently — that when the sliding scale of fees comes in, it will apply only to income and not to assets of the resident. He has also indicated that it was his intent, and I presume that it is still his intent, to have that sliding scale of fees introduced by October 1 of this year. I want to ask the minister a few questions about that.

People who went into facilities went in with the expectation that the fees they would be paying were, if not by formal contract, implicitly.... That was the basis for the fees, the basis for their entering the facility. They planned their lives and their finances accordingly.

I want to ask the minister whether he is giving any consideration to grandfathering this sliding scale of fees so that it will not be imposed retroactively on residents presently in facilities. I want to ask him when he plans to announce this sliding scale. I want to know how the information that he will have to gather — presumably through the staff of long-term care facilities — on the incomes of residents will be gathered and whether he has given any consideration to the cost of that endeavour, because there are 20,000-plus residents in care, each of whom, presumably, if this is to go ahead, would have to have an income test administered to them.

[2:45]

1 think that that will give me some indication of the minister's plans at this time, and I'll wait for his response before further questions.

HON. MR. DUECK: I just want to back up a little. The government policy right from the beginning was to do with premiums and GAIN for those who had OAS-GIS. So trying to mislead the House or to mislead Hansard that perhaps we're making a policy as we go, that's not true. I wish to make that very clear.

The other thing, talking about assets versus income, I have been on record again and again....

MR. ROSE: On a point of order, I'm sure that the minister didn't really charge that the member was deliberately misleading the House and Hansard on the matters she raised. If he were, I would think that should be regarded as unparliamentary, and perhaps he would care to withdraw that.

HON. MR. DUECK: Sure, that was a wrong choice of words and I will withdraw that. But it was leading to misunderstand what the government is doing when the policy from the beginning was that. I want to make that clear.

Also, it's been bandied about in the paper and said again and again that I have not yet made up my mind whether it's assets or income. No one on this side has ever talked about assets. I have gone out of my way to tell the news, whenever they've had a scrum, to please get this correct: we're not talking about assets; we're talking about income. If in fact we will is now under review, and I'm not going to discuss the income testing at all. It's under review and it would be inappropriate for me to discuss that.

MS. A. HAGEN: I have to take it that if it's under review, the subject of the review could be reconsideration or implementation. It seems to me that's the only interpretation that I can make with that remark. If the minister wants to provide me with another interpretation, I'd be happy to hear it.

Given that we are now two and a half months into a policy that was announced as a major initiative in the budget of the Minister of Finance and Corporate Relations on March 24 in this House and we are now at June 9; given the fact that the minister has himself said inside and outside this House that it is his intent to impose these fees October 1; given that the Minister of Finance and Corporate Relations has provided me with information about the intended revenue to the province from these fees, I would take it that the minister's comment that this is under review means that it is under review for either reconsideration or implementation. I would ask the minister to advise me if I should interpret those words in any other way.

HON. MR. DUECK: I'm not going to interpret for you or for myself. I'm just saying it's under review. That's the only statement I'll make.

[ Page 4968 ]

MS. A. HAGEN: Since this is a matter for this year's budget then, I would like to leave a couple of thoughts for the minister's consideration. One is that there is a double whammy in the 85 percent user fee and the sliding scale. The sliding scale that he has suggested could mean increases at present rates of over $5,500 to some residents in the system. Those residents are paying taxes. He has quite frequently quoted the person with a $1.6 million estate who either has private nurses in his or her home or is paying in spades through taxes for the kind of care that we should accord him or her as an older person.

The second thing I would like to leave with the minister for his review is the issue of retroactivity. A number of older people — and in many instances their families, because those older people are not always able to speak for themselves because of the state of their health — have expressed concerns about retroactivity. There is a social contract, if you like, that has been in place, and that the policy that the minister is proposing to introduce is a policy that has been imposed without consultation, and, I would submit again, very strongly, without consensus.

Since you're not prepared to discuss the issue of those sliding scales in this House at this time, I would as an advocate for seniors and their families leave those two thoughts with you for your review.

I would like to move on now to another area of home care. I plan to come back to facilities a little bit later on to speak about them as a functioning institution and talk about some concerns I have. But I want to stay with the fee theme and the service theme for a short period of time.

I noted this morning when the minister was providing us with an overview for his ministry that he made no reference to home-support services and fees, although the budget does speak about new user fees in that area as well. Has the matter of fees in the home-support area been dropped? Is it on course for implementation or under review? The matter of a new scale or a new system of home-support fees, which was announced in the budget and which we have had some discussions of in the House, was not, in my recollection — I haven't seen the Blues — included in your comments this morning. Has that matter been dropped? Is it slated for implementation? Is it under review? I would remind the minister that when I asked in this House — I can't give you the date, but it is in Hansard — for the implementation date of those new home-support fees, I was advised that it was August 1.

HON. MR. DUECK: Sometimes statements come forward and not in the form of a question, and then it goes on to another question or statement. So that we don't leave that part out, again and again "no consensus" is mentioned. I mentioned this morning.... I'll just read this into the record again; this is from that review that you said we were not heeding or not looking at. "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." So there was consensus.

Having said that, the next question was in regard to income testing for homemakers. As you well know, there is some user fee now. It is also under review. I thought I meant both of them when I answered the question before; they are both under review. However, if we did put income testing for homemakers, it would be at a higher level. In other words, many of those who are paying today would not be paying.

MS. A. HAGEN: It is very difficult for the minister to comment that a matter is under review and to give us half the picture. In fact, that's what has happened with the mandate review. Now that I have raised some questions in the House about the mandate review, he has given us a glimpse of the picture. But I said this morning that the sum is greater than the parts, and we need to see it all before we can have some judgment. The minister needs to be reminded of the process that he followed with the mental health review, which had the points of view of the wide number of people in the community who had accorded the ministry their thoughts, ideas, concerns and suggestions. We need to have that in its total, and we need to have an opportunity to respond to it before the minister continues to implement in this incredibly piecemeal, half a loaf, little bit of information kind of way.

[Mr. Pelton in the chair.]

For the population that you are dealing with, Mr. Minister, it's almost a form — and I quote not myself here; I quote words that have been said to me — of abuse, because to be uncertain about one's financial needs and the future is very worrisome for many older people. Let me just pursue this issue a little more, because if it's under review, I have some hope that in our discussion in the House today the minister may pay some attention to some of the concerns that have been raised by those who assess the system and those who deliver it.

One of the concerns that people have raised is that if the cost goes higher for people who are receiving homemaker support and paying fees, and if they are paying the full cost for the initial service up to their ability to pay, many of them will choose to move out of the case-managed system. They will choose — or perhaps feel they have been forced — to go into the business of hiring their own homemakers. I could perhaps best reflect that perspective by reading from a brief from the B.C. Nurses' Union, and particularly the nurses of the Capital Regional District, to Mr. Paul Pallan, director of the Victoria seniors' project.

On page 9 of that brief to the Victoria Health Project they say: "We understand that those who require limited service will be advised to contract privately for that service if the new monthly charge would exceed the cost of the service required if paid for on an hourly basis." Remember, an hourly basis to a worker is different from the hourly basis to an agency which also administers that service. This may be fine for those who are competent and capable of managing, hiring, firing, accounting and complaining when the quality of service is substandard. We believe this will be too complicated for some, and there is no mechanism to monitor the quality of the care provided in the absence of supervision by the long-term care program.

Mr. Minister, can you assure us that there is no part of your policy in imposing fees on people receiving homemaker support that would encourage them — or perhaps force them — to consider dropping out of care under the long-term program and instead hire their own people for the services they require?

HON. MR. DUECK: Hopefully not; that is certain. The things that you mentioned certainly must be considered. We are well aware of them. When the review takes place, that is a consideration. There is no question about that.

I would like to go back a little bit on the review. You keep talking about the review. I didn't want to get into that,

[ Page 4969 ]

because it's a very recent review, and it has not even been totally examined by our own senior staff. You know yourself how long it takes to compile, then digest and see what direction we're going to go. The mental health consultation report, which you are well aware of, was started in 1985 — two and a half years ago. The mandate review you're speaking of today was in September or October 1987, I believe, so you can't expect us to be....

Interjection.

HON. MR. DUECK: Was it'86? It's 1987 — that's what I understand. I could be corrected on that date, but I've got the information as '87.

Be that as it may, these things don't come quickly. They will be considered by senior staff, and when that is done, it will be made public like all our reports are made public — or most of them, at least.

[3:00]

MS. A. HAGEN: It was 1986, Mr. Minister, because I happened to be present when a senior member of your staff announced it at a convention in Vancouver. I am sure it took some time, but the report was to have been completed with the mandate review, more or less ready from that continuing care division, for action by your ministry not later than the end of last year. I know that there have been consultations with some groups, and my only request is for you to treat us all the same and make sure that the work of your ministry is in the public domain - not partially in the public domain — so that we can all review the basis on which you are developing policy. That's fair, and I think that's a reasonable request.

I'm going to move on at this point. I want to make sure that I have an opportunity to discuss the whole home support area. It's one that the minister and I discussed at considerable length last year, and I don't plan to revisit it in quite the same way as 1 did last year. There is no question that it is the backbone of the kind of policy that all of us are working on that would limit the number of people moving into care in our province.

The report that I quoted from this morning from Fraser interestingly notes that the trend is for more facility placement in Canada, rather than less. I think last year we talked about the optimum figures that we'd like to see. In European countries it's around 5 percent, and that's because they have a very highly integrated community support system that uses paid services, families, volunteers and communities. It is, as the minister has noted, quite highly centralized.

Prof. Malcolm Brown notes that the trend is up in Canada to 10 percent, and that's worrisome. Therefore what's happening in the home care area worries me a lot. The minister noted that the Capital Regional District has been a very solid and innovative district in terms of the care of the elderly. I just want to quote from a May 10 article in the Times-Colonist where Mr. Watt, who is the director of long-term-care beds in the district, says: "We have approximately the same number of people in long-term care as we did three years ago, but an additional 800 or so who are at home with the help of our community support services."

I simply use that to epitomize the whole emphasis on people staying in their communities. That means that people who are staying in the community often have a heavier level of care. The minister is wont to quote his father. I will quote my mother, who is totally blind and in her own home with care. She is there partially through a very good long-term care program, so it is possible for people not to be institutionalized, and we should seek that.

Can the minister please give me some breakdown of the new home support system, which last year had several lines that covered it. Last year we looked at home support, which was the homemaker program. and we looked at home nursing, physiotherapy and adult day care. This year in the budget those are all wrapped up into one, and the dollars available for all those programs are one hundredth of 1 percent higher than they were last year. The dollars available in those programs are $62,000 more in an $81 million budget than last year.

When the members of the Home Support Association, who are here to listen to this debate, look at that figure and the budgets of the various member organizations that serve something in the order of 43,000 people in the province, they must be stunned by that figure. According to the Minister of Finance, these user fees are going to bring an additional $10.9 million into that system, from only a quarter of those people, if I'm to believe the minister. It's possible, Mr. Minister, that these user fees are going to provide some of the additional dollars. But the minister needs to give us some very good, solid information about what he and his ministry are providing to achieve his goal of health promotion, preventative service in terms of keeping people in their homes with no increase in budget for home support, home nursing, adult day care and physiotherapy.

I have only the raw figures, Mr. Minister. I hope that with the help of your officials and their enlightenment, you can give us some indication what is in that budget that doesn't appear to be there that's going to make it possible for the Capital Regional District to continue funding and serving 800 more people — for all of the homemakers in the province to serve 50 percent more people with 5 percent less budget that they had last year, and no increase this year. I hope you're a magician, because it's been impossible for me to figure out how you're going to do that. I hope you can enlighten us.

HON. MR. DUECK: Mr. Chairman, I believe the budget figures did reflect some revenue items that would probably come to the ministry due to some income testing and some user fees. If we do not go in that area, then, of course, it will have to be adjusted and reallocated from within the budget. We do show roughly an 8.3 percent increase, but it's reflected with the revenue items, and that is not clear at this time. So that will have to wait until we have a clear picture of what we're going to do.

MS. A. HAGEN: Could I ask the minister if budgets have been requested from the home care agencies for this year. What is the process of those budgets? Let me put this in some context. One of the characteristics of budgeting in this ministry of recent time has been that it is retroactive. I'm going to cite some instances in a few minutes of the effect that has on hard-working agencies that are trying to figure out how they work within a global budget where workloads may not be funded and where they don't have any idea what is coming from the ministry.

Could you give me some indication what is happening with that budget process and when long-term-care agencies will be advised about what it is they're going to have to operate with in this year?

HON. MR. DUECK: Mr. Chairman, the budget letters, I understand, are going out before the end of this month. The

[ Page 4970 ]

homemakers' association is in agreement, and on October I the new budgeting process will be put in place - in consultation with them. I think it's on stream, and earlier than last year. We're working with the association on this.

MS. A. HAGEN: Is that the budget year April 1, 1988, to March 31, 1989, that will be in place on October 1, 1988?

HON. MR. DUECK: If you're referring to the budget letter, that is for the fiscal year, yes — April 1 to March 31.

MS. A. HAGEN: I won't comment specifically about what arrangements you have been working on with the organization, but I know I have talked to any number of home support agencies who have expressed great concern about the delays in the whole budget process. It's giving them a great deal of difficulty. In fact last year in some agencies they did not get retroactive payments that had been agreed to in August until they begged for them at the end of the fiscal year. Many of them had a great deal of difficulty balancing out their year-end.

There are other aspects related to the costs that homemakers are having to meet with the budgets available to them. I think, Mr. Minister, one of the things that would be very helpful for your ministry to do would be to go back to having budgets submitted prior to the end of budget year, not halfway through the next budget year. I think most organizations find it very difficult to set a budget when they don't know until halfway through the year what that budget is going to be.

I want to ask some questions around the dollars that are going to be available to pay people fairly in the home support area. The minister, I think, has advised us that there were some payments made to improve the wages that were available to home support workers last year. We had some discussion during the estimates last year, and the minister expressed concern about the very low level of wages that existed.

There has been some very modest improvement, but this is still a major concern of home support agencies. We are still looking at discrepancies of up to $3 an hour with long-term care aides who work in long-term-care facilities, and in many instances, benefits for those workers are not included in the budgets.

It's not fair for us to treat unfairly workers engaged in the care of the elderly, and yet the very underfunding of the programs we're talking about is achieving that result.

What commitment is the minister prepared to make this year to redressing the very grave imbalance in those wages and the unfairness to the many hundreds of dedicated people who work with seniors in their own homes?

HON. MR. DUECK: Just to back up a bit, I think I should agree with the member that we did have some problems with computers last year. It was a bad scene — I admit that — and some of these facilities got their letters far too late in the season. However, that has been rectified, and I think we are on target again.

Wages for homemakers have been a problem for some time. I agree that there is a disparity, and in some cases the level, in my opinion, is not adequate. We're endeavouring to allocate the funds we have available in the most appropriate way. That's the best I can tell you at this time.

MS. A. HAGEN: Would the minister be prepared to discuss cutbacks in service hours? There is a very great concern in the home support industry that hours are to be cut further. There is no question that the levels of care required for people living in the community have risen as a result of more and more people being accommodated in their own homes, and we have seen this happening without increases in budget. Would the minister give us some indication of whether there are going to be more stringent guidelines about the level of care available?

There has been a steady decline over the past five years in the average hours of service per month. It's gone from 19 hours in 1982 to 12.8 hours in 1987 — a 32 percent reduction — and that in the context of many people who require higher levels of service in order to stay in their homes. I have heard concerns expressed that cuts as high as 10 percent are being considered in the service hours available to homemakers. If that's going to happen — especially with budgets not being known until October — it's disastrous. That happened last year, where some agencies had service hours cut, with their budgets arriving late in the year, and it's not something that home support agencies can tolerate.

I have had people say to me that the home support system is in jeopardy. I know that's strong language, but you can't continue to cut when the service is the backbone of a policy intended to make the very thing you're desiring — a more rational and efficient system.

HON. MR. DUECK: To begin with, we're doing a complete review of long-term care, which was needed very badly, and my new, old deputy has taken it upon himself to make sure this is now done.

As far as cutbacks are concerned, we will provide the service needed for anyone on home care. At times in the past we have had some inappropriate services delivered, and we've perhaps cut back in that area. But as far as the need to keep people at home rather than in a facility is concerned, we will make the promise that we will look after those people in need.

MS. A. HAGEN: I presume that that means the minister is prepared to fund the workload that is out there in the community this year. If there's 15 percent more workload than the budget allows for, you're prepared to go to Treasury Board and ensure that the dollars are available for that workload to be funded.

[3:15]

HON. MR. DUECK: If it is a legitimate, assessed need, we will endeavour to get those funds and look after it, because we feel very strongly that to keep people in their own homes is ultimately better, and it is less expensive. That's the direction this government is going. That's the thrust, and I'm certainly in favour of that.

MS. A. HAGEN: There are times when I get really nervous about words. Endeavour is a worthy word; I would prefer and would like to hear the minister provide a commitment. The people who are getting long-term care under long-term-care services are getting assessed care. You can't have it both ways, Mr. Minister. You're either going to fund it or you're not going to fund it. The long-term-care nurse assessors and the homemaking agencies that are trying to provide that service have got to know whether you are going to fund that workload. Am I sticking on the word "endeavour," or does that really mean that there's a commitment that those services will be funded?

[ Page 4971 ]

HON. MR. DUECK: I don't know how much more accurate I can be. I'm not, of course, at liberty to speak for Treasury Board or government when it comes to dollars except what I have in the budget. In the past, where the legitimate assessment was greater than what was in the budget, we have funded that. I intend to continue to do so, because it's not often clear at the beginning of the year exactly how many hours you need. If it is a legitimate need and the assessment shows that it's legitimate, we will do everything on our part to fund it. We've done it in the past and we will continue to do so. I will make the commitment that I will do everything 1 can so that this commitment is met. I believe that I did it in the other fiscal year, and I certainly think I can do it again this year.

MS. A. HAGEN: Can the minister advise me what portion of the $81 million in home support services is available for homemaker services? I recognize that there may be fees — up to $12.9 million, according to the Minister of Finance (Hon. Mr. Couvelier) — that form a part of that budget, but can he advise us what portion of that $81 million is allocated for home support?

HON. MR. DUECK: It is $57.1 million.

MS. A. HAGEN: Can the minister advise me how much that is up from the adjusted figure that takes in the wage package that was decided on after the amount from last year, which I think was around $53 million or $54 million? How much is that up from the amount from last year?

HON. MR. DUECK: From $53.7 to $57.1.

MS. A. HAGEN: Plus the adjustment.

HON. MR. DUECK: No, that's including the.... Oh, the wage adjustment.

MS. A. HAGEN: How much was the wage adjustment?

HON. MR. DUECK: I haven't got the wage adjustment here on this figure, but I suppose we could get that for you. I think 3 percent was wage adjustment.

MS. A. HAGEN: I know at times in the House the information is not clearly available. I'd like to ask the minister to provide me with the adjusted figure for '87-88 — that would be the original amount plus the dollars that were the adjustment — so I can make the comparison with this year's figures.

I want to move on, Mr. Chairman, with your indulgence, into the area of adult day care.

It would be wonderful to have somebody shuffle my papers the way the minister has someone to shuffle his papers when it comes to doing some of this.

SOME HON. MEMBERS: Later.

MS. A. HAGEN: Yes, we'll wait our turn.

Now that we have this home support area that includes not only the home support program but also adult day care, physio and home nursing, Mr. Minister, could you please let us know whether you're considering changes in fees to each of these services specifically? It's not my understanding that there's any intent for fees to be charged for these services over and above what is presently in place, but I want to ask whether in the whole area of the sliding scale of fees for home support services there is an intention to consider fees for home nursing or physio, or any change in the fees for adult day care where people pay a per them now.

HON. MR. DUECK: There has been no consideration or any consultation in that regard.

MS. A. HAGEN: Let's take a look for a few moments at the adult day care program. The adult day care program is one that I'm sure, when we take a look at what's happening with the Victoria seniors' project, will get a fair amount of attention. Like the homemaker program, it's a very important part of the mix of services that are available.

1 want to start with a very specific request to the minister. I would have made this privately, but I've just confirmed that the problem still exists. There was an adjustment in the wages to adult day care workers last year, as well as to the workers in the home support area. In Second Spring Adult Day Care Centre in my riding, as of last week they were still waiting for that adjustment retroactive to August. In talking to many of the adult day centres. I know that retroactive wage came very late.

That's not the only centre that hasn't received it. I wrote to the minister in April. I was assured that the matter would be addressed. I will leave that to your attention, and I would hope that that day centre and any others waiting for retroactive wages from last year will get them soon. Those workers, in many instances, haven't been paid because people don't have the cash flow to pay for those wages, when they don't have the dollars coming from your ministry. It's shocking because these people are on very modest wages for the work that they do. I think it's not defensible for organizations to have to wait or to pay wages out of their very tight cash flow.

The adult day care centres of the province are moving ahead very slowly. Again, I'm going to use the centre in my own city as an example because it distresses me that we are not seeing some progress in having that centre work to its maximum capacity. It distresses me even more when I see that in some areas dollars are available, and in others where a few dollars would make such a big difference, we can't seem to move the ministry to take some action.

Second Spring Adult Day Care Centre was established in 1981 on a three-day-a-week basis. I think it was in 1986 when they finally got approval for four days. They have been seeking approval for five days. It is the only funded adult day centre for seniors in the ridings of New Westminster, Maillardville-Coquitlam and Coquitlam-Moody, and there are 15,000 seniors in those communities. There is a standard waiting-list of 70 older people, many of whom end up in facilities or whose spouses are caregivers and end up in illness and stress, because that approval for an extra day a week is not granted.

It has the support of the medical health officer, the long-term care association, the B.C. Medical Association and the care facilities, and still we don't have that centre funded. I'm looking at some very major initiatives that are taking place in Victoria, and I don't want to discourage those initiatives. There's a day care being built in Saanich which is going to cost $700,000 to build. There's $2 million or $4 million available for a project in Victoria. I want to try to get at those dollars a little later. We can't manage to get something like an

[ Page 4972 ]

additional $20,000 or $30,000 to look after a backlog of 70 people who need care.

These people are long-term care assessed. At various times, they have simply stopped putting people on the waiting-list. At the same time in New Westminster, Queens Park Hospital has established an excellent day care out of funds it has been able to make available from its operating budget, but this is the last year that they will be able to stretch that. They are serving another number of clients.

Mr. Minister, if you are going to achieve your objectives, you've got to give some priority to these — and I'm sure other — agencies that are bringing these issues to you. They are not huge dollars, but somewhere along the line those dollars are going to save dollars. As Prof. Malcolm Brown tells us, it costs 10 percent of the cost of facility care to keep a person in their own home. Adding adult day care to that is a modest increase that doesn't come anywhere close to the cost of facility care.

Can I get an assurance from this minister that there will be consideration of a five-day-a-week program in that community this year, so that those people end up at home with their family caregivers as they wish to, at less cost to the taxpayer — a cost this province can't afford not to pay?

MRS. GRAN: Seated in the gallery today are several grade 7 students from Alice Brown Elementary School in Langley, along with their teacher Peter Luongo, who is a very good friend of mine. On behalf of the second member for Langley (Mr. Peterson) and myself, would the House please welcome them.

HON. MR. DUECK: Talking about adult day care programs, I cannot argue with you at all about the wonderful things these programs do. I suppose the only answer I can give to that is that, number one, I can't give you a commitment on one specific society.

In general terms, I agree with what you're saying. I think the government agrees; we wouldn't be going into this Victoria Health Project if we didn't. But it requires dollars — as you say, just a few dollars in that area. But all the services we offer are "just a few dollars" in each area, and it comes to $3.9 billion, which is a fair amount of money. The allocation has to be made, and I'm faced with the unenviable situation that when I get my budget and the amount.... Where do I put the money? Everyone is short. Everyone wants more. Everyone can make a good case.

I believe that what you were saying is certainly true. Also, having said that, I must commend all the volunteers that work in these facilities and programs. If it weren't for the volunteers, we would be in much worse shape. They provide so much care, and do so much for people in our society, especially seniors. Having said that, we do everything we can. We're going in that direction. It's not fast enough, as far as I'm concerned, but I'm certainly not going to make a commitment to your specific society in New Westminster at this time. I'm doing my best again this year, as I did last year, to provide as much money and as much help for adult day care as I can. I think it's valuable, and I agree with you.

[3:30]

MS. A. HAGEN: Mr. Chairman, of the $81 million for home support, can the minister tell us what's available for adult day care this year, and what was available last year? I'd like those figures to encompass the wage increase that will alter those figures. If you don't have those figures available, Mr. Minister, I'd like to request, as I requested for homemaker services, that they be made available. I'll wait and see if you can give us some indication. If you could give us an indication of whether it's up at all - just the straight comparative figures — we could deal with the wage matter in a more detailed way afterwards.

HON. MR. DUECK: It's quite difficult to pick out small amounts and percentages, what have you, but we'll make a note of it, and make sure you receive those figures in short order.

MS. A. HAGEN: I hope that with the auditor-general's new estimates process we will perhaps have some information available about fees that are a part of these systems. I'm not quite sure how that happens in terms of accounting, but if we are going to understand the minister's commitment to services for the people he says use 47 percent of our health care dollars — to services that would perhaps enable them to use fewer of those dollars — we need to be able to track them very carefully.

Just for a moment, going back into that area.... Let me just say to the minister that there's very great concern about arbitrary changes and cuts in budgets. It's very difficult for organizations operating on a shoestring. They're not million-dollar budgets, or hundreds of millions of dollars, like Vancouver General or the Royal Columbian. I think the minister would serve those organizations, their volunteers and their board members, who spend countless hours trying to figure out how to balance the books and be fair to their employees.... The minister would do well to do everything he possibly can in management systems to assist that. I appreciate that he said there are some improvements he's attempting to put in place.

I want to now take a look at long-term-care facilities. Originally it was my intention to spend a fair amount of time on long-term-care facilities, but I think the answers are going to be very similar to the answers I've been getting. Let me just, out of some discussion we've had today, throw a kind of conundrum into the minister's pot, if you like. That's not a very good metaphor. Let me just draw on something that the minister mentioned earlier on, to indicate in a very folksy kind of way the problems that long-term-care facilities are having.

I've spent some time this year talking to managers and board people of long-term-care facilities. I have found, to a facility, the same situation: those facilities are running deficits, and those deficits are in the range of $3,000 to $5,000 per staff person. They are running very tight operations because the ministry is not funding their full staff costs. They are not funding benefits and they are not funding increments that are a part of collective agreements. Those are fixed costs that facilities cannot forgo. As a result, facilities are faced with an absolutely catch-22 situation. They haven't got enough dollars to run their facilities with the staffs they have; they have clients who come in at IC-1 and get to be IC-3; that simply means that they come in at a lower level of care and progress to a higher level. These facilities are advised by the ministry, which is now grant-funding them, that they must maintain standards, and those standards require so many people for so many clients.

Those facilities are in an impossible situation, and whether we're talking to the association or to individual long-

[ Page 4973 ]

term-care facilities — and I've talked to them right across the province to be sure that this is not just an isolated situation — the word I'm getting even more strongly than in some of the other sectors is that after three years of this cumulative deficit kind of funding, they are in deep trouble.

How is the minister going to deal with the fact that there are long-term-care facilities that are basically saying: "We can't manage"? Is it his intent to have them moved from the public to the private sector, where somebody might pick this up and go into that facility? Is it his intent to see the non-profit sector, very much supported by volunteers and boards, so bombarded by the problems of deficit financing as a result of government grants that they cannot continue to offer a service? Is it his intent to see those long-term-care facilities offering substandard service, like one of the facilities in my community or a neighbouring community where, for a clientele of 50 on two floors, with one floor of psychogeriatric patients, there is one nurse on duty at night? That is a shocking situation, Mr. Chairman; you and I know that in any difficult situation it could be not only dangerous for the patients but for the nurse as well.

HON. MR. DUECK: Perhaps the last question first — whether we have any design of treating for-profit differently than non-profit societies. I want to emphatically say no. There is no such design; nor do we treat them any differently. We try and treat them equally, and the funding is distributed by formula, the same to all, if we deduct or do not consider the facility or the capital cost.

However, there are some facilities that operate very efficiently and quite well under the funding formula. We've got some that are legitimately in very tight situations. I hear from them; I certainly meet with them; our people meet with them. If they are run inefficiently, we will send someone in so they may perhaps change their way of operation to bring it back to a break-even point. We do the best we can with the funding we have available. The need is always greater than the moneys we have; I have to admit that.

We're doing a complete review of all the long-term-care facilities, homemaker, the whole thing, to see where the shortfall is, how much it is and whether we can embark on some plan to at least come a little closer to the point where these facilities can operate in such a way that, as you mentioned, a certain level of care is not paid for at another level.

We realize that, and it is not an easy question. It's certainly much easier to criticize than it is to solve the problems. I know it is my job, and I'm not trying in any way to duck it; not at all. It is not like running your own business. You are told the job that there is to do and you're also given the amount of money, and then it's up to you to reallocate and try and find a solution to bring those two parts together. It is very difficult.

MS. A. HAGEN: Let me just ask this one question on budgeting. Is it the minister's intent to fund the actual cost of salaries and benefits for these organizations? Is that a part of the budgeting process?

HON. MR. DUECK: No, I didn't say that. I said that we try under all circumstances. If the facility is not operating efficiently, we give all the assistance possible to perhaps.... We have people who are quite familiar with the operations of various facilities, and very often they can give some aid and assistance. We have some that operate quite well with the funding that's there, and others are having a difficulty, perhaps because of, as you mentioned, union contracts.

We look at every one of them; we try to come to some conclusion where they can operate at least for the year — until we can get into another budget and perhaps get more money. It's not easy. I'm not saying it's all good. We are doing a review. We know there is a shortfall, and when we get that total figure, perhaps for the next coming year, we can try and adjust or get more money for that.

MS. A. HAGEN: Please remind us how much money went into hospitals last year because they had a shortfall.

HON. MR. DUECK: If you are referring to the $20 million. it is quite a known amount of money. I don't have to repeat that. We allocated $20 million to the hospitals, not because they had a shortfall.... That's where you make a mistake. We only funded those hospitals that had an increase in patient-days and were operating very efficiently. We paid some money to hospitals that didn't even request money; we did not pay some that were running a deficit by quite a number of dollars. So it was not on the basis of shortfall or inefficiency; it was on the basis of efficiency and workload. Yes, I did get $20 million. and it was distributed in that fashion.

MS. A. HAGEN: I'd like to suggest to the minister that he may face the same situation with long-term-care facilities this year, because there is a shortfall in the budgets that they have been accorded, because they do not provide for dollars for collective agreements that are in place and that they have to honour. They have been advised that they are not permitted to make cuts in their staffing that would alter the standards that the ministry, quite rightly, wants to see in place.

Mr. Minister, it's a hollow comment — and I don't say this personally — to say that we will try, if we are going to look after the older people in our province. We have the resources, and perhaps it is simply a matter of us doing a little less high tech this year and a little more low tech that makes sure that people are safe and well cared for and that there is someone to feed them and get them into activities. Those things are not very glamorous and a lot of people don't know anything about them, because they haven't been there yet or don't happen to have a family member involved. For those who have, these are the realities of health care, day in and day out, with people who don't have any glamour in the work they do but just have to continue trying to make it work.

[Mr. Rabbitt in the chair.]

It's not enough to say to those people: we'll try. It has got to be a part of the priorities of this government. If it's not, then this government is abandoning people who deserve better — not only the older person but the family member who has to deal with that. We all have stories that really do indicate to us why you have no choice. The ministry and this government have no choice but to deal adequately with those needs.

HON. MR. DUECK: When we talk about high tech, it's not brought in on an ad hoc basis. It was the opposition last year that criticized me very severely for being behind in open-heart surgery. It was you people who put the pressure

[ Page 4974 ]

on to a degree unheard of before, and now you are saying: "Drop the high tech." I could get all kinds of money by doing that.

How would you tell someone who has a brain tumour that they cannot use a scan? By not putting this equipment in hospitals .... It's easy to sit there and say: "Don't provide the equipment. Do the homemaker rather than the high tech. " It's not a matter of making comparisons; it's a matter of doing both in the best possible way with the dollars available - and that's what we have done.

I should mention while I'm on my feet that if you look at t the health care system in general and don't pick on just the warts and little things here and there, or the big things, for that matter — if you look at the total — it is a very excellent health care service. That's what we are trying to provide, and at the same time, we're trying to correct any faults and any areas that need correcting. That's what I am trying to do. But to pick on one particular area and say, "Don't buy high tech, because we need more money for homemakers," is a simplistic and silly way of saying it.

I'm telling you that I am trying to get every dollar possible. I know there is a shortfall; I also know that we want to keep people at home. No question about it. I agree with you. However, it still has to be received from another department, and it's not that simple. I have a budget; I have to allocate those dollars and make priorities. I'm trying to do that in the best way I can, and I think that, by and large, we I are doing a good job on that.

[3:45]

MR. ROSE: I don't know why the minister seems to take all these things personally. Maybe he's been a tycoon and a manager so long that he's thinks we're cheeky over here. I hope he doesn't feel that way.

HON. MR. DUECK: No.

MR. ROSE: But he does get aroused occasionally.

HON. MR. DUECK: It helps me.

MR. ROSE: Does it? Well, you watch it, at your age.

You're not getting any younger. Instead of bawling out the critic, maybe you should have some warm milk and cookies, or something like that. Sort of calm down a little bit. It would be good for you. I'm going to take a little time to throw a bouquet of roses to the people who are staffing at Valleyview. I got a letter from a very prominent Canadian by the name of Juliette; her full name is Juliette Cavazzi. She happens to be an old friend of mine going back many, many years. Her husband was hospitalized in Valleyview for Alzheimer's. She wrote me a letter following the funeral, and I would just like to read part of it; it shows an attitude that's out there whether the ministry is aware of it or not. I'll repeat the attitudinal line. Some of it's personal so I don't care to read it, but part of it says: "Thank you for the Alzheimer's contribution. It's been a long struggle" — her husband was in there for a long time; that's not part of the quote, Hansard — "and thank God for Valleyview."

Listen to this next line: "They just can't toy with that place." Who's that "they?" Something out there is leaving the impression that they're toying with that place, and it has something to do with the morale of the staff and other things. She goes on to say:

"Who'll take care of those people? Most of them have no one. Their spouses are just too old to even get there. There were just a few of us who came regularly. I was grateful I was young enough to take it, and I loved it, every minute. It was a sad job, but the best one I had. He needed two people to do everything for him. I've never seen such dedicated nurses and assistants."

That's pretty good, isn't it?

Here's a plea, right at the end: "Please, Mark, fight for that care facility." Now isn't that interesting? Why would those two lines be in a letter written following a funeral, especially when this person has supported the Social Credit government for I don't know how many years. "They just can't toy with that place," she says. Her husband was in there for some months, if not years. "Please, Mark, fight for that care facility." If that's her view, it may be others' as well.

There are fine, dedicated people working there under extremely difficult conditions with extremely difficult patients, with a lot of love and dedication. But there's a fear that this might not persist for others, or else why would Juliette say those words? By the way, I phoned her and asked permission to quote from this letter, and she said yes.

So that's one thing. There are lots of things I could say about Riverview and Valleyview beyond this, but I don't intend to do it at this time. My friend yielded the floor so that could put in that plea and that compliment to the people who work there. The other one is the confusion around the assets test — not that somebody out there is deliberately trying to confuse people. I have my mother in one of those care homes in Mission — Pleasant View. I also have a brother who lives in Chilliwack, and he asked me if it's going to be an income test or an assets test. It seems to me that if it's going to be an assets test, you'll see lots of transferring of assets in a big rush. Neither I nor my brother have any objection to paying for the care of our mother. We don't pay, as a matter of fact; he does. We have no objection to legitimate increases from time to time, because staff need increases and all the rest of it. But if it's going to be a method of confiscation where someone who looked after themselves is able, because of certain assets, to pay more, then that's quite a different thing. So I would just like to warn the ministry not to go for that assets test stuff. Charges for those who can afford to pay for hem are legitimate. But I don't think any attempt to confiscate assets is legitimate, and I don't think it will work.

HON. MR. DUECK: I was just informed as to the letter.... I certainly don't condone it. I think I mentioned earlier that I have, of course, visited Riverview and many, many hospitals, and I can't speak highly enough of the people who work in these places, whether they be RNs or practical nurses or psychiatric nurses or physicians, especially when you go to some of these acute-care children's hospitals, and also the mentally ill. They do more than I could do. I could not do that. I can't say enough good things about them. They are doing a superb job. There's no question about it.

You mentioned the confusion about assets and means versus income testing. It is not I who is confused. It's not this fellow who's confused.

MR. ROSE: No, we're confused.

HON. MR. DUECK: You are confused because of the statements by the news media. When the Province was with

[ Page 4975 ]

me — and here my blood pressure's going up again — and did a scrum, and I said: "Would you please get this straight when you report it? We are not talking about assets; we're talking about income and not means testing. Would you please make sure that that is correct? Because that story is out there and I want it corrected." Next day in the Province it appeared that I had not yet made up my mind whether it would be assets or means testing versus income testing. I'm sorry. If that's what happens, there's nothing I can do on this side to correct it. If they keep printing that and this story goes out, I think it's up to us and it's up to you, when you go to these homes and talk to the people, to tell them.

I've gone on record again and again, because we know that if you attack assets, which I wouldn't want to do anyway because I appreciate that the people who have saved some money and have these dollars for their old age, for the last days of their life, should use them.... Heavens, I don't want anybody to touch my assets. Furthermore, you are absolutely correct that if we did go in that direction or even hinted that we would, those assets would disappear so quickly there wouldn't be any left anyway. Even if that wasn't the case, I have no intention, because I feel that people deserve what they've earned and deserve to keep that. It's not a means test. We're reviewing an income test. I explain again that we're reviewing an income test, not means, and assets are not in the plan at all. I want that for the record.

MS. A. HAGEN: 1 want to thank the minister for that comment. It's a concept that people don't always understand, in terms of the language. I think it is really important. I heard in those comments, I think, a philosophical commitment as well. I think that that's an important one. We disagree, as has been obvious, about the imposition of the user fees, but I'm pleased that he has made very clear and unequivocal his position about the fact that government is looking at income testing.

I would assume in that comment, too, that as long as this minister is minister, this ministry is not going to be moving to consider any change in that policy. I'm gathering that that's a very strong position that you hold. I think it's well that it was stated and stated as strongly as it was.

I want to note, Mr. Minister, that in some ways we have encompassed the discussion around the seniors' issues, because they do deal with some of the less glamorous and more everyday aspects of health care. They're not as big, in terms of your budget. They're about 10 percent of your budget. Nonetheless, they do reflect something to the community of what we stand for as a government and as a people. I should have perhaps said that at the beginning.

I haven't too much more to deal with in those regards, but there are two other items that I want to just touch on briefly. One of them is what is known as the Victoria Health Project. I've just received, in fact, a copy of the first newsletter from that health project dated June 1988. It answers one of my questions. When the minister announced, coming out of vote 74, the special initiatives, that there would be $4 million into Victoria, I think he announced there would be $2 million for the health project and $2 million for a one-stop shop.

There has been a change, and the one-stop shop has gone. I don't know why or where, but it appears that it has gone. Now the whole of the $4 million, I would gather from this newsletter, is in fact being allocated to the health project. It notes that the Victoria Health Project has been allocated $4 million in seed funding for this fiscal year. It notes that it is committed to seeking ways to ensure maximum benefit from existing expenditures on health care in the Victoria area currently in excess of, I think, $36 million annually — and I will check that for Hansard, because there's a little fuzziness here, in case that's not correct. This newsletter also notes that the scope of the project includes all health care services in the Capital Regional District, although the initial focus is on the needs of the frail, elderly and chronically ill.

In the context of some of the discussion that we've just been having about the needs that you have to sort out in allocating dollars within your ministry, whether it is to provide some very specific and very complex services or the nuts and bolts services to people living in their homes and getting home support, $4 million is quite a lot of money.

When that project was announced it was pretty clear that it, like a number of the other initiatives of this budget, seemed to be coming out of the cabinet or the Health ministry without very much in the way of prior consultation, if any. I have some clippings around that indicate that some of the people involved, including the medical health officer in the Capital Regional District, were quite surprised to find that they were going to be accorded this gift of dollars and project.

I'd like the minister to make a few comments about the goal of this project. Since it is a pilot project I would like him not to spend too much time outlining all the things that might be included. I have them in this newsletter: things like integration, coordination, effectiveness, efficiency, appropriateness of care, responsiveness, acceptability, promotion of wellness, health maintenance, prevention — all the things we are all looking to have in a more health-promoting health care system. I'd ask the minister instead to say: all right, we have a pilot project; it’s going to take $4 million this year. It is being managed by people whom the minister has chosen with considerable care, and it solicited a lot of interest, because nobody has paid attention, I think, to a lot of the ideas that people have had in the past. Nobody has responded, perhaps, to some of the continuum of care proposals that have come from a variety of districts across the province. What's going to happen when the pilot project has run its course and some initiatives have been tried and some conclusions made? Are the good works and the good programs that might come out of this project going to be spread across the province?

[4:00]

Going back to some of the comments I made earlier about underfunding in many of the services that would be needed to complement a project like this, are the dollars going to be there? Or is this going to be a project that will do good work, develop new ideas and involve people in creative and constructive work around a health focus for the frail and the chronically ill and then die because there won't be or there is not a plan for how to work with it once the pilot work has been done? Piloting is great. What's going to happen afterwards? Your comments, Mr. Minister.

HON. MR. DUECK: The $2 million and $2 million were spelt out separately in the budget speech; however, in our evaluation we're taking it as $4 million for the total concept. I can't tell you at this point in time exactly how it will look or what it will be like once it's completed. It is a pilot project.

What we're in fact saying is.... You've read the newsletter and have all the same information I received. A committee has been struck, and you mentioned Paul Pallan, the executive director, who has been seconded from the Ministry of Health for this project.

[ Page 4976 ]

The project involves the Greater Victoria Hospital Society, the Capital Regional District and the Ministry of Health. They will try to develop and improve the management of the health care system. In other words, we're going to try to deliver equal or better health care in another way which is better, especially for the seniors but not necessarily only for the seniors. It is an integrated health care system for the total region. The reason we're calling it a pilot project is that we want to try it in a confined area, and we feel the Capital Regional District is ideally suited for that. When we have that experience, if it is successful — and we have no doubt in our mind that it will be — we then want to try it in other areas of a similar kind where there is a larger population.

The community-based integrated health care system will feature, of course — I think you mentioned some of it — patient access to a responsive and comprehensive continuum of care; careful management of our limited acute-care resources through institution of a new system of managed care and through criteria-based admissions and daily assessment of patients and the need to stay in hospital coupled with an increased commitment to home support services; improved information systems drawing upon the health informatics centre at the University of Victoria — they are also involved in helping us; I think they got a grant of $100,000. New mechanisms to reimburse providers will be considered to promote the most effective use of existing resources and to promote efficient management. Victoria hospital has already done some of these things, and I'm sure you're familiar with that.

You seem to be quite up to date in the Health ministry. As a matter of fact, you and I should get together more often; I could probably learn from you — and I say that quite seriously, not in jest at all. We could talk about some of these things and how we can effect a better health care system.

It may even cost us a little more money to begin with, because we're operating sort of in tandem with another system. So it's not necessarily going to be a savings of dollars — eventually, we hope it will — but I'm absolutely positive that it will be a better health care system. Victoria now has the VICARE program that has been operating for some time, and they evaluate people as they're admitted and perhaps get a second opinion: should this individual be in the hospital in acute care, or could this individual be looked after in the community, or in their own home.

These are some of the things we're looking at. It goes on and on. I can't really explain it much more than that, because it is a pilot project, and some of these things will come to light. We've also told the committee not to be constrained to any particular way that I or the government wish to go but to come up with innovative ideas and give us some direction. Perhaps we can come up with ideas that have been practised in other areas.

The United States has some programs that are not quite like this, but they've gone in that area too, where they have these home maintenance programs. Maybe a facility where senior citizens can come and get attention; perhaps they need someone to talk to; perhaps they're not ill at all in the sense that we're thinking of illnesses where they have to be admitted to acute-care facilities.

I heard of one case of an elderly woman who was ill. She was finally admitted to hospital for some tests, only to find out that her daughter was dying of cancer in Saskatchewan. She had two little children, and the mother was worried to death. So this is what we're talking about. It's probably a very graphic and extreme example. Maybe these people need someone to talk to; maybe they need a physiotherapist; maybe they need an occupational therapist; perhaps they need counselling; maybe they want to attend some smoking cessation programs; maybe they are troubled with the abuse of alcohol — we find quite a few adults have this problem; maybe they could go to a joint exercise class, or maybe some field trips. There are many areas.

You mentioned earlier that it really reflects on the day care programs so much. It's very much the same, only even more integrated, and perhaps more services than we've had in the past. Maybe we need nurse practitioners. Maybe we don't need a full-time physician. There are many areas. You can just let your mind wander. And I think it's going to be a program that we'll all appreciate. From the reports I've had to this point in time, everything looks good; they say that it's about time. So I'm hoping that I'll have the liberty, eventually, to go further and do this across the province in other areas also, if it is successful, and I'm sure it will be.

MS. A. HAGEN: I'd like to thank the minister for his enthusiastic response. I too have a sense that the project is well launched. I have to say, Mr. Minister, that although that initiative is one that will be good for us in the work that it will do, the kinds of things that you are describing as innovative are not innovative in most communities. They have been in place in many communities. Many of the ideas that you're talking about are simply waiting to have some support from the ministry. So I will leave that issue, which we will follow with interest. I will leave that issue, re-echoing your words that it may cost more for a while. That was part of what we were talking about earlier: that it may cost more for a while to get some of these things into place.

Let me just tell you about a centre that needs a lot fewer than $4 million but makes a good story. It's a centre in the interior, in Osoyoos. It's a 50-bed facility. They have plans to develop an integrated program for housing for people who need some support, and for what they call low-level extended care, which, I guess, is something moving into extended care but not requiring a hospital setting. Some decisions have to come very soon if they are going to be able to go ahead with that project. Some of that has to do with the acquisition of the necessary land accumulation, and so on. They can't wait for a pilot project to perhaps show the way. A pilot project in Victoria is likely to be very different from a pilot project in Osoyoos or in Dawson Creek or some other community. I would hope that the minister will, in addition to looking at the kind of innovation that may come with this project, be open to recognizing that sometimes that seed money, along with the core support for community services, is essential.

Let me just ask a couple of questions about community development. This ministry or the Social Services ministry has not funded community groups for some time, but there is an initiative in preventive services in your ministry around core programs with a very strong emphasis on community development and new roles for the union boards of healths. I want to know if this is a policy initiative of this government, and what status it has at this time. I know it has to do with the revision of the Health Act and with initiatives that may give new roles to the amalgamated boards of health that exist in various formats across the province.

I've seen some materials from the ministry that suggest there is a program fairly well in hand with a considerable amount of work gone forward. The member for Prince

[ Page 4977 ]

George North (Mrs. Boone) mentioned that the new roles for the union boards of health might include the possibility of establishing their own programs and having taxing authority. I'd like to ask the minister to comment briefly about the work that is underway in his ministry at this time.

MR. MICHAEL: I have a few points to cover. Before I get to those points, I would certainly like to put on the record my constituents' sincere thanks for the tremendous facility to be opened this Saturday at Chase — the diagnostic and treatment centre. I had a preliminary opportunity to tour the facility a couple of weeks ago, and I am sure the minister is going to be very pleased with what he sees this Saturday in the community of Chase. It is truly a very wonderful addition to that community.

Also being opened this coming Saturday is the health unit located in Salmon Arm. I haven't had an opportunity to tour it yet, but we'll be with the minister this Saturday. I wish to take this opportunity, Mr. Minister, to sincerely thank you for those two great facilities for my constituency. I know my constituents will want me to pass on their thanks to you, as I am sure many will this coming Saturday when they see you personally.

We will also be discussing with you in the coming two or three weeks some innovative ideas that the hospital board has in the Armstrong area. Hopefully we will be able to put some plans together that will satisfy that community for many years in the future.

There are a couple of items I wish to cover. One has been canvassed fairly thoroughly up to now, and I don't want to get into a deep discussion with you on this. But I wish to agree with many things that have been said in the last while about this question of "means test." I know it's not a means test; you're saying it's income testing. If it's income testing, that income must come from assets that have been worked for and earned by people over the years. I can't look at this thing other than that in some way or another, it's taxing the thrifty. It's taxing those people who went to the trouble to save. They perhaps worked a little harder than their neighbour, set money aside in their early years and built up some type of portfolio on which they receive an income. If it's the intention of the ministry to in some way get a bit extra from those people, I have to put on record my objection to that. I just do not believe in the concept of taxing the thrifty, if they have earned and saved that money. It is indeed theirs, and they should pay parity for what other people are required to pay. Conversely, if people can't afford to pay the new rate, it's my view that something should be done through the system to make sure that those people have an adequate amount of money for their monthly spending requirements.

The other thing I know we've talked about before, but I want you to think very hard about it in the coming months. Hopefully we will be able to see some improvements on this subject in this current year. If not, it certainly should be very high on your priority list for the next budget. It is the question of provincial parity for wages paid to employees within your ministry throughout all the regions and communities of British Columbia. You are well aware, as I have reminded you on several occasions, that there are instances where the same work does not receive the same pay. I for one stand against the current policy which allows that situation to exist. Mr. Minister, I will once again urge you, for the record, to please do all you can to see that people doing work of similar nature and requirements are paid equally throughout the regions in the province of British Columbia.

[4:15]

HON. MR. DUECK: Before I answer my own colleague's questions, I'd like to just say a little bit first.... It was indicated that we should look at other areas that might be innovative, at new initiatives other than in the capital region. We certainly don't close our eyes to any area. And if we can see a different way of delivering health care that doesn't impact on the budget in any major way, we would certainly be willing to look at it.

To my colleague on this side of the House. I wish that people would not keep talking about the means test and the income test. I've said again and again that we are reviewing. And there is a big difference between means testing and income testing. When we talk about income testing, we are not talking about assets. An automobile certainly doesn't give revenue. Real estate doesn't provide revenue — unless it's revenue-producing real estate. Dollars in the bank may be at 10 percent or 5 percent. You never touch the asset; the $100,000 is an asset, and the 5 percent would produce $5,000 a year in income. When I say income testing, I mean exactly that. We are not in any way.... I want to make it very clear, because this keeps coming up, and I think it's mostly because a lot of people don't understand the difference between income testing and means testing. They sort of mix them up. We're certainly not interested in someone's home. Quite frankly, I don't care whether someone has a $50,000 home, or $100,000 or $500,000 in real estate. The review is only interested in income. And I want to make it very clear that it's a review at this time. Perhaps we should not touch on that anymore.

As for the same work for the same pay, that is a very broad-brush thing. When it comes to homemakers, we purchase ours, and we have some union people working for some organizations, and we have non-profit organizations. When we have this out on bids, they say they will provide X number of hours for so many dollars. In principle, I agree that we have some whose income is way below what I consider adequate. Some have a fairly decent income. There is some inequity — there's no question about that. That is, of course, a concern of the Ministry of Health and has been for some time. The member and I have discussed this on many occasions. I appreciate his comments and thank him for them.

MS. A. HAGEN: I didn't go out for cookies, but I did miss the comment of the minister on the local boards of health and community development. Without asking him to repeat it all, I would appreciate it if he would just make some brief reference to that in his next comment. I apologize for being out and not having had someone make a note for me about what he had to say.

In that same area of community development, I want to ask the minister if there is, within the mandate review and the discussions going on in his ministry, some consideration of working with volunteer agencies in the community, including possibly some shared funding with those agencies. These groups are part of the continuum of care; they function at a volunteer level, and very often provide a wide range of services that complement health services. I think the best example of that is probably Meals on Wheels. The ministry provides some funding that allows for coordination, although all the rest of the cost is undertaken by volunteers and, actually, by the clients who pay for their meals. Can the

[ Page 4978 ]

minister give us some indication of whether that is under active review, with the mandate discussions he talked about? s

HON. MR. DUECK: I think I mentioned earlier that c volunteers are very high on my priority list, and always have been. I've worked with many volunteers in my life — in my former life — and I appreciate those people very much.

Going to back to your question about whether we would look at innovative ways or initiatives that a community other t than those in the Victoria Health Project might have, one example of community involvement is the Choosing Wellness program, where we are actually asking for input. It's a program designed to promote healthy lifestyles among seniors in particular. This program is being developed by seniors for seniors, and we think it will be a great success. It's something very new, and we hope that it will also fit into the total new initiative of the Victoria Health Project, but it doesn't necessarily have to be in Victoria. That is certainly on our agenda, and we talk about it quite often and have people looking at it. Also, many letters come in for suggestions and advice and wanting to get involved. It's quite gratifying.

I'm not sure whether I understood you correctly about whether we look at different societies or fund different r societies. Was that the question? As you must know, we are involved with umpteen dozens of societies of various kinds that we fund. I can go through pages and pages of them. I'm not quite sure whether that's what you were referring to.

MS. A. HAGEN: Well, if the minister has pages and pages of societies that they fund other than long-term-care facilities or home support organizations which are non-profit profit, I'd certainly like to know about them. I'm not aware of what I call the community-based services, which are the very things you talked about with the Victoria project. They might be friendly visiting or they might be taking somebody on a trip. My question was whether the ministry is considering providing some funds for organizations that do make available in communities many of those services, primarily with volunteers.

I'd like to just comment about the minister's reference to Choosing Wellness and remind him that last year we had c quite a discussion about the fact that there was a pilot project in my riding with $250,000 of Health ministry funding, plus a research project that is just coming to its conclusion under t the health research funding. I would hope that what the minister is talking about is taking the very excellent work that t was done by Dr. Nancy Hall and the people she worked with, and having that pilot project move throughout the province. That was its intent. It still is a program that is alive and well in New Westminster, although I know that there may be some concerns about volunteer support in order for that program to continue.

These things fit well together. They are programs that take the peer groups and the community centres of the province and, working along with materials that may be prepared by the ministry, allow good things to happen. Without belaboring that particular issue, it's good news to hear that the ministry may be moving in that direction, and I would certainly encourage the minister to recognize that those low-cost, very solidly community-based programs are often the fundamental glue that helps to hold some of the other more professionally supported programs in good stead within the communities of the province.

Do you want to comment on that, Mr. Minister? Then I want to move on to one other theme that I want to discuss in my time in your estimates.

HON. MR. DUECK: I was surprised you mentioned Nancy Hall. I had forgotten that that was the same person we poke about last year. We have just established an advisory committee on wellness and health promotion and it just so happens that Dr. Nancy Hall is one of the members, so I'm sure that you will be pleased to hear that. She's a wonderful person and I'm sure she will give us much help in that area.

Societies. I'm still not quite clear on.... I'm not going to read all these societies to you. We've got pages and pages of them: for example, James Bay Community Centre, Houston Health Care Services Society, Granisle Community Health Centre. There are all kinds of societies, and I can go on and on. Of course, there are all the cancers and fibrosis and all those societies, but I don't think those are the ones that you were thinking of. You were thinking more in terms of volunteer groups. Mind you, a lot of these are volunteer groups too — not all of them. St. John's, and then we have, oh, pages and pages of them. Some are not what you are referring to, but they are societies that we are funding.

As a matter of fact, we believe that that's the direction to go with health care: to let someone else take the initiative, rather than our bureaucrats here in Victoria being in charge of all these operations. We find that this is certainly a much better way, because they attract a lot of volunteers and they also do the job much better and are very conscientious and work so hard at it. So when I talk about societies and different groups and volunteers, I just can't say enough about and for hem. They are what we need and we appreciate them. We don't ever want to discourage them. Very often we — including me — don't give them enough accolades for what hey do. We need them, and I appreciate that we are on the same track on that point.

MS. A. HAGEN: I'm delighted to hear that Dr. Hall is going to be working with you. I think she's Dr. King now, just so we know that we're talking about the same person. I'm really pleased to know that the work of that project will, I hope, be continued throughout the province. Nancy will make an excellent addition, and you are well advised in choosing her to sit on that committee.

There are a number of other areas that I would like to explore in the continuing care area, but in this huge a ministry here is never enough time, so I am going to reserve the option to have some discussions with either you, Mr. Minister, or your deputy about some other aspects of these services.

There is just one question that I want to leave with about straight budget items. There's a huge increase in the program management section of continuing care. Can you explain why that budget has gone up from $3 million to $5 million a year?

[4:30]

HON. MR. DUECK: Some of these items, of course, as you can well appreciate.... We have a number-cruncher here who does nothing but numbers, and I have to keep asking: "What is it?" He tells me it is a reserve for increased wages.

MS. A. HAGEN: I'm not sure how to quantify that, but I will certainly cogitate on that comment.

If I may, I want to move to local issues for just a moment. As the minister well knows — because he has been there on numerous occasions — my constituency is a health town. A very large part of our economy in New Westminster is related

[ Page 4979 ]

to the health industry, and I certainly need to spend a few moments raising some issues of concern to that community.

The minister will be familiar with the northeast sector report which, I understand, was tabled with the ministry early this year. I can't recall exactly when the report was tabled with the various parties — the Fraser-Burrard Hospital Society, St. Mary's Hospital and Queens Park Hospital — but over 1987, 1 know that extensive discussions occurred among the administrators and senior staff of those institutions. When the report went to the ministry, it is my understanding that the parties had arrived at a substantial consensus around some changes in the original recommendations, positions on which they had all reached an accord. I want to question the minister on the status of that report.

Since it was tabled with the minister by Mr. Emmott, the chairman of the committee, it is my understanding that there has been no formal action, nothing to indicate what is going to happen with that report as to implementing the reallocations of various programs with the modifications that may have to occur before those programs can go into place.

Let me take one example which a year ago was a very important issue in my community — that of the closing of the palliative care unit in the Royal Columbian Hospital, an issue that aroused the community as few have. It's my understanding that St. Mary's Hospital has agreed that it will be the home of that program and that it is prepared to be a geriatric acute-care hospital, but that funds need to be available before those new programs can go into place.

I think that some good, solid action on these programs would benefit effectiveness of health care in the community. I am very pleased that the various parties of my health community have worked so hard and so effectively to arrive at a position that they can all support and that will improve the delivery of health care service. That's something we all want to see, because of the huge area covered by the various services that they provide.

We would welcome some indication of how that whole northeast sector report is moving through your ministry, when we might expect to hear, and whether, in your view, there is going to be some good action that will see some of those changes beginning to flow into active service in the community in the very near future.

HON. MR. DUECK: Yes, you are quite right about that report. It was not initiated by us; it was initiated by those players involved. We have the report now. It's under active consideration. We are going to move forward on some of the recommendations. It took quite a while to get the consensus of all the players, but I am very pleased that they were able to work out most of their differences. It involved Eagle Ridge, St. Mary's, Royal Columbian, palliative care and which hospital should do what, and that is coming together quite well.

There will be some announcements in the not too distant future, I hope. I can't really give you more than that. I can't release the report at this time. As a matter of fact, I think we would have to get the permission of the parties involved. It was not our report; it was their report for us. So they are really the owners of it. Although I don't believe there's anything in it, once all the parties have agreed that they would wish to release it.... So I will find out. It's coming together well as far as I know. I know some of the initiatives are being undertaken at the present time, and some announcements should be made soon.

MS. A. HAGEN: Mr. Chairman, the people in my constituency do believe it's in your court, whoever owns it, and I recognize the sensitivities there. They'll look forward to some announcements.

A second matter that has gone forward with the support of the New Westminster hospitals — St. Mary's, Royal Columbian and Queens Park — is a proposal for a geriatrician in that community. I'm not sure whether the minister will have received it at this time, but I want to speak very strongly in favour of that particular initiative. I noted earlier the large number of older people who live in that community. There is not one practising geriatrician in the northeast sector. I think the fact that the three hospitals worked together around seeing this particular person as being a useful adjunct to their professional staff is part of the cooperation that has developed out of these discussions, and it would be a good immediate byproduct of their initiatives. I want to encourage the minister when and if he gets it - as I say, Fm not sure it's in his hands yet; it's my understanding that if it isn’t. it’s on the way - to give it immediate and prompt consideration. I'd be happy to discuss that with him.

In his comments earlier the minister spoke about expansions to the open-heart and angioplasty programs at the Vancouver General. I want to ask him what consideration he is giving to the fact that the Royal Columbian Hospital has made a number of proposals to the ministry about the availability of facilities for development, with the necessary expertise in heart surgeons and so on, at that hospital. I think they are available to provide up to 300 surgeries a year. I understand that angioplasty in now almost a de rigueur part of that service, that the two complement one another. Of course, there are discussions about replacing the old hospital and finally getting the new tower underway. Again, given the placement of the hospital industry in New Westminster and the centrality of expertise and specialists in the area, I would hope that we are going to see that facility as part of the Royal Columbian Hospital services.

Finally, my last pitch for regional needs. I'm sure the minister has had before him the report of the greater Vancouver hospital district society on care needs of the elderly. I know I have it here among all my papers, but I won't necessarily seek it out right now. They have really done an excellent continuum-of-care study that looks at the home support needs we'll have in the future and the need for facilities.

We haven't talked today about facilities that are in the planning stage. 1 know the minister has provided us in this session with some information about intermediate-care and extended-care beds that are either on the drawing-board or planned. But can you give me any indication, Mr. Minister, about whether there are any plans other than for a Burnaby facility, which I understand is on the drawing-board? Are there any plans for further intermediate- or extended-care beds in our area?

The need is quite extreme. The member for Coquitlam-Moody (Mr. Rose) spoke about Valleyview, which houses 300 to 500, which I hope is going to be a facility that continues to operate. But the current need is somewhere in the order of 200 to 250, and there is no sign of building plans that I know of that are committed. It would be good to know what your thoughts are about getting moving with that before the waiting-list gets to be just unmanageable.

HON. MR. DUECK: You are going to steal my thunder when you start announcing a tower for Royal Columbian.

[ Page 4980 ]

Gee, I was quite shocked. I just whispered to my deputy: "Where did that leak out?" You know more than I do.

Anyway, as far as angioplasty and perhaps open-heart surgery are concerned, they of course are under consideration at Royal Columbian and have been for some time. I can't at this point tell you exactly whether or when it will be, because we've expanded the capacity at the VGH, which has considerable space available. We don't have any need to expand at present, because they are going to do an extra 250-odd open-heart surgeries, plus more than 700 angioplasties. It appears that the waiting-list is declining and we're catching up.

As for intermediate-care facilities in the Burnaby area, of course we make those announcements as they come up, and it would be pre-empting that particular announcement.

I find it somewhat — not amusing.... The problem you're in is the problem I'm in every day. Earlier it was mentioned: "Yes, but you have more beds now than most jurisdictions have. Why are you not giving more home care so you don't need the beds?" But now you've ended your questions: "But why haven't we got more beds?" This is exactly the point I was trying to make: there is a need everywhere, and I recognize that need. I have pressure from every group, and they're all good causes; every one will save money; every one is needed. But you can only do so much. I find it interesting that you yourself came on both sides of that argument. I'm not blaming you at all, because that's exactly the problem I have every day. I have people come to me and say: "Why can't you give us some money for extended or intermediate care? Because there are bed-blockers in the acute care." Then I have another group coming in an hour later and saying: "If you would just give us more money, we could keep all those people out of the facility, and we would keep them in their homes. " We try and do that balancing act between the two or three, and it's difficult; I admit that. I find that I spend a lot of time juggling that financial crystal ball and.... I shouldn't say crystal ball; I don't want to be accused of having someone like Nancy Reagan; I do this thing more pragmatically, I hope. We try and balance the need as best we can, to keep them out of the facility, but there comes a time when they must be in a facility. If we clear all the bed-blockers that should be in extended or intermediate care, we find, within weeks, those beds are taken by more people.

There is an endless number of people that need care. I mentioned earlier that 12 percent are over 65, and we find that in the last few years the acuity is much higher and much greater — and I think you alluded to that a little earlier — because people are living longer. I understand that the number of those 85 years and over will double in the next 20 years, and those 75 and older will increase by 73 percent, while our population will increase by something like 23 percent.

The need is there; there's no question about that. I recognize that, but I still have to somehow balance the need with the dollars that I've got. It's not a simple chore. Maybe in the future we will have enough funds to do all the things, although I doubt it very much. I don't think you'll ever have a government that will be able to meet that demand; not when people are ageing and staying alive longer — and they should be, because we're providing the medical care, and people are looking after themselves more than they did before. However, there still comes a time in every person's life where the acuity.... That last two, three or six months is where the costs are. That will continue, I suppose, and we must provide for it.

That's why we're taking some of these unpopular stands, saying we want to protect the system; we want to protect it not just for our society. I'll get through okay — no problem. But how about our children? How about their children? Unless some government says: "Look, we've got to do something with the system so it will survive...." We find now that other jurisdictions, other provinces, are phoning and coming here as a delegation, saying: "How are you doing with continuing care?" We have the best integrated continuing care — extended care, intermediate care — of any province in Canada; maybe not in every area, but by and large they come to us for an example. I'm not saying this to have accolades or a pat on my back, because I didn't do it; it was my predecessors and people in the ministry; they've guided it that way, and we want to continue that. We want, if at all possible, to preserve this good system we have, and I'll do everything I can on my part. As long as I have that mandate and as long as I'm responsible for that, in this position, I will continue to do it.

[4:45]

MS. A. HAGEN: I want to have just the last word, and thank the minister for our discussions this afternoon. At the risk of lecturing him, perhaps I will make a couple of comments.

I have concurred with the minister that we....

MR. CHAIRMAN: Please continue, hon. member.

MS. A. HAGEN: I saw the government House Leader over there looking speculatively in this direction.

HON. MR. STRACHAN: Are you ready for the next vote?

MS. A. HAGEN: No, I don't think so. You're a little optimistic, Mr. Government House Leader. Try a day or so from now.

[Mr. Pelton in the chair.]

I want to thank the minister for the opportunity to discuss a number of issues. I will be back to him on some where we haven't had answers.

I think it is very important to add a caveat to your comments. You and I have agreed that we have a fine system in B.C. That was part of my initial comments, as well. My intent today has been to raise some very real signals of problems that are magnifying to the point where they need attention now.

The home support system and the long-term care system are having difficulty in terms of the funding there, and there's a great deal of uncertainty.

The issue of user fees is one that I don't think is going away. I appreciated the comments of the member for Shuswap-Revelstoke (Mr. Michael), and I might like to close on a note in which an older person expresses views that are not always acknowledged in the House.

Chuck Bayley is a very strong and active senior advocate in the community and has for many years written columns in the Vancouver Sun on issues of concern to seniors. He's done many of the things you've spoken about. He's been the source of information and clarification. I thought the article he wrote in this week's Vancouver Sun — I think it was June 7 — is one

[ Page 4981 ]

of the best summations of the user fee issue that I have read. It presents the issue from a whole range of perspectives: from the perspective of the consumer, the seniors and their reaction.... He compares it — and I think it's a very valid comparison — to the response of seniors to the de-indexing of pensions which the Conservative government brought in early in its mandate. He refers to a long-term-care administrator and his concerns. He refers to people who work actively with the very thing you're trying to promote in this year's budget: wellness and health promotion. He refers to the concerns of active workers in that field like Kay Stovold in the West End, who runs a wellness network and has been one of the outstanding seniors in the lower mainland and has spoken out in ways that have captured the attention of seniors across the province. He speaks of organized work on the part of seniors to address this issue and a group in the Premier's riding who will be speaking to him about that. He speaks about the escalation of costs for older people. Finally, he tells the story of an older person who has an older parent. In that very simple story about how those user fees are already affecting him, we have an issue that is the nuts and bolts of this debate today.

I want to conclude my remarks by urging you, in that review of the user fees, to listen, to remember the comments we made earlier about mandate, consensus and consultation and to think about the things that are part of the Victoria Health Project, which in some ways are at odds with the initiative on user fees — which is too much too fast. It's my hope that we will see that particular initiative of this government in the budget year rescinded, as other hasty decisions have been rescinded to the benefit of the older people in the province. That would be very good news indeed.

HON. MR. DUECK: I appreciate those remarks, and if we weren't on either side of the House, we could probably get along quite well — and I suppose we do. We've been at functions for the same purpose: trying to help people who need health care. We have an appointment in the near future to go to a facility, and I'm looking forward to that.

However, there was one remark you made just at the end: "too much too fast." We are increasing it by just a little over $20 a month. But at the same time we're also giving those people who have the least the opportunity of having their premiums paid for, and they also don't have to pay the $5 chiropractor fee. When you take the total package, we're not really affecting the person who hasn't got money. It's designed more for the individual who perhaps has a little extra.

I would rather not do it all. It's certainly much more popular to be in this position, if I could stand up in the House and say that we have just reduced the user fee in long-term care. I would be a hero. But unfortunately, that luxury isn't for me; it just isn't in the cards.

Perhaps in the coming year, we can work a little closer together on some of the concerns you and others have about seniors and genuinely look after the health care people, rather than debate to see who can make the extra points. I agree with what you said in your closing remarks. It's right on, and I'm not at odds at all with you.

MS.MARZARI: As my colleague the member for New Westminster (Ms. A. Hagen) has dealt with community facilities and extended-care facilities for the aged, I would like to turn the attention of the committee at this point to community care facilities for the very young child and early childhood education.

It is a fact in this province that early childhood education, child care and its protection comes under three agencies: Education, Health and Social Services. In previous interventions in the House, when we have discussed child care, I have generally directed questions to the Minister of Social Services and Housing. However, the community care facilities licensing process has changed substantially, and is undergoing changes even now in this province. I think it's time for the minister and me to have an exchange around the nature of what is happening in community care facilities licensing.

I think we have to talk about what the ultimate goals are. We would all agree that we want accessible and safe child care. We want to see that throughout the province, and we want to see it in every community. It is particularly the health department's responsibility to assure that programs that are offered for young children are properly monitored for their safety and properly accredited and that the teachers who teach and the people who take care of children have properly graduated with the appropriate training.

We would like to commend the government from this side for a number of things that they have done in the last number of years. We would like to commend you for separating adult care from child care. so now we have the child care facilities licensing committee. We'd like to commend you for putting community representatives on that committee so that it is no longer simply an in-house committee of civil servants with one lay person but a number of community reps.

We would also commend you for your attempts to decentralize the licensing, which I gather is now going on. It has been a long-time concern of mine that licensing for child care and adult care and appeals occurred behind closed doors and that there was very little consultation with the community. I have for 15 years been recommending a decentralization of licensing, and now I gather that process is about to unfold.

However, the questions I wish to put to the minister have to do with the nature of that decentralization. 1 would like to assure myself, and I would like the minister to assure me, that when the licensing goes to the local communities the appropriate staff is there, ready and waiting, appropriately trained, sensitive to the needs of child care centres and facilities. I would like to know that decentralization is occurring at the correct level. Would the minister tell the House whether this is going to be done through municipalities, the new regional structures, metropolitan health boards, or whether it will simply be done through medical health officers?

Thirdly, would the minister tell the House what standards will be expected of those who will be doing the monitoring? Have they been established? Has the minister canvassed the community at large to discover exactly who he is handing the responsibility over to? Will that responsibility be properly funded by the province? Everyone in the House appreciates the need for decentralization and deinstitutionalization. We have talked about it for many years. But just as you have assured us that Riverview will not be decentralized too soon without appropriate community structures being evolved to support the deinstitutionalization of patients, I would like to be assured that this decentralization won't occur until there are appropriate, sensitive staff in those communities.

Perhaps the minister would like to answer those three questions first, on the decentralization.

HON. MR. DUECK: Yes, we're going in that direction. We're not moving too quickly, I believe, because we want to

[ Page 4982 ]

have some of this staff in place and we want them trained. I believe we will be working through the health units, and we'll be establishing a standards branch to monitor it once it's in place. It is currently taking place, but it is not yet established. When you ask if it will be appropriately staffed with trained personnel, that is certainly the intent; I do not believe we would go ahead in that area unless they were. At this point I can certainly tell you that's the direction we're going. Needless to say, I certainly wouldn't want to have a new set of people working out there and not knowing what they were doing.

MS. MARZARI: It's a very important question, Mr. Minister, and I would ask you to follow it up very closely.

Over many years, the rationale given me for not decentralizing licensing has been that, although the Vancouver area and its medical health officers have been perfectly capable of finding the staff and delivering the service to local day care centres, the regions — the northern and eastern parts of the province, and Prince George — have not been able to deliver the service in any substantive way. In fact, time and time again the word has been that with all the problems day care has — the lack of spaces, the line-ups of parents waiting to get their children in, the cutbacks in education for teachers from two years to ten months, the inability of the subsidy to meet the real costs of day care and the inability of parents to meet the real costs of day care — standards have always remained firm and solid. We've always had good standards in B.C. There was always a concern that we could not deliver the necessary level of monitoring to the regions. That seems to have been the case. I've had case after case of communities telling me by letter, or as I've traveled the province, that there is simply nobody there to do the job.

[5:00]

The social workers from Human Resources, as it then was, have basically said they're swamped. There is no conceivable way they can monitor child care facilities, child care centres, group homes or family care homes. They pulled out of it some time ago — if not within the last year, certainly within the last three or four years. The public health nurses have basically, very often, been unable to do the monitoring required. Neither the public health nurses nor the social workers really had the training, the almost inborn sense of the standards, as they went out to the facilities. Nobody ever truly felt that a uniform set of standards was applied uniformly and fairly throughout the province.

As a result, many child care centres have been operating in a basically unsafe manner. Other child care centres have been monitored very well. There just has not been a uniform application of the very good standards we've had. It's extremely important that the people hired by the medical health officers through the local health offices are specifically trained to do that and have the time to do that, because very often the monitoring of child care facilities falls to the last on the list — from experiences, as I've told you, that have come across my desk.

I would also ask you about the accreditation standards. I have received a number of calls regarding the Early Childhood Education Articulation Committee, which I gather is a creature of the Ministry of Education. That committee has apparently been working for some time to ensure that standards of education for the teachers of young children are up to scratch, that these teachers are properly trained to carry into the workplace appropriate techniques for dealing with young children, that they are in fact professionals. It is my understanding that some consultation has gone on in the last little while about the accreditation of a provincial exam by the Ministry of Health to ensure the quality of graduates. I gather that the Ministry of Health, through CCFL, has something to do with accrediting the actual exam that the aspiring teachers write. Am I correct in that assumption?

HON. MR. DUECK: I can't answer that at....

MS. MARZARI: Okay. I have some letters, correspondence between Mr. Glen Timbers and teachers, with some concern being expressed that the accreditation procedure for teachers be something more than a multiple-choice exam. I would very much appreciate getting more information if your department of the CCFL has something to do with the accreditation of this particular examination process.

HON. MR. DUECK: I'm a little bit at a loss. I think we're getting into the area of education. I don't think that's my department. I can check for you, but I'm not aware of the accreditation for teachers being under my jurisdiction.

The other thing about monitoring. Yes, we license facilities and we monitor safety and health. Whether it's our program, Education's or Social Services is another area. Yes, anything coming under Health, we would be responsible for the programs. If they are under Social Services, even if we license the facility for health and for safety, we would not necessarily be responsible for the program. I think we were getting one program mixed up with the other. Be as it may, I know what you were saying. Where it affects health we certainly have an interest in it.

MS. MARZARI: We've just stumbled onto one of the basic problems dealing with child care, the fact that the three ministries are involved. Very often it's difficult to understand when one steps in and another steps out. As you know, there's a new federal program, or at least a promise of a program, that will bring child care spaces into provinces with federal subsidies to a level that have never been offered before.

It seems to be the intent of this province not to take advantage of new spaces in any serious way. In fact, it seems to be the intent of this province to continue to underwrite the low-income parent into existing spaces rather than to massively expand spaces. It would seem to me that we are being faced with such a demand for new child care spaces that I am even now beginning to see the Ministry of Social Services and Housing softening a little on that position and talking about perhaps creating a few new spaces every year.

I am hoping that your department is therefore ready to take on the job of monitoring and supervising the physical standards of those spaces because it could be, in the last analysis, a very ambitious project, particularly when our government is in power.

Is the process that's going on now that Mr. Timbers seems to be engaged in with Miss Gayle Davies from your department a complete rewrite of the standards that we have now, or is it an organizational change that they are working on? Are they working on the decentralization or are they actually working on a change in the actual physical standards for licensing in the child care area?

HON. MR. DUECK: I'm just given to understand it's organization and standards both in that particular facility.

[ Page 4983 ]

MS. MARZARI: That is where I'd like to get involved: the substance of the child care standards. Over the last year and a half, since I've been sitting in this House, I have seen many instances of standards that have evolved being eroded. Under the grand guise of privatization, or whatever we want to call it, I have watched, in some instances, group homes being removed from community care facilities licensing in the Attorney-General's department, for example. It was very much my suspicion and feeling that that was being done to ready those facilities for privatization — in other words, to sell them off and not have to have them conform to a community care facilities standard.

It is my concern that any dilution and deterioration of those standards should be viewed very seriously by the ministry and by the community at large. I think the best way we have to keep those standards high but perhaps make them more community sensitive is to go to a public hearing process. I would like the minister to talk to me and to the House about consultative processes he has established as these standards are being reviewed.

Is there an outreach program that in fact will talk to the communities about the standards they have now and the standards they might like to have, which might be slightly more flexible without losing their quality?

HON. MR. DUECK: We will be establishing a standards committee and the guidelines for it. We have not come to that place yet but we intend to have a consultative process in place for that purpose.

MS. MARZARI: Could I please ask that you let my office know when that consultative process will take place and what it will look like? I would be more than pleased to assist in getting out to my mailing list where these meetings will take place, and I will make the assumption in good faith that the terms of reference for these hearings will be flexible and open and that the new standards will not be written in stone before you go to public consultation. This side of the House has had some experience with that from your side of the House, where legislation has been written before consultation has taken place. I will assume that this will occur in good faith and that we will continue to have high standards.

Asking these questions is my way of trying to preempt some rather wholesale changes that could occur in child care in this province once the free trade deal is signed. If we begin to think about commercialized day care, your department is the last line of defence. Your standards are our line of defence to ensure that our kids' health and environment in their child care settings are properly protected.

HON. MR. DUECK: I have just asked my deputy to make sure you are contacted. You will be involved if you so wish.

MRS. BOONE: The minister said earlier that he could learn a lot from talking with my colleague, and now he has indicated that there is going to be a committee. I would like to suggest that perhaps some things could be referred to our select standing committee, to which nothing has been referred; we have not sat since our initial day. You know, we can't meet unless you, as the minister, refer things to us, so by all means refer something to us. We'd be glad to confer and give you all the knowledge we can. I can assure you that the knowledge of the member for New Westminster (Ms. A. Hagen) is extensive, and all of us could learn a lot from her.

I'd like to touch on something that I mentioned last year with regard to the nurses in this province. It's a situation that still exists. I could reiterate everything that I talked about last year: the fact that our nurses are overworked; that they're literally run off their feet; that we have shortages; that they put in extremely arduous days; and that we don't seem to be doing too much about this. I'd like to add some information that I didn't have last year: as of March 1988, our vacancies for registered nurses is still at 516, which is up 34 percent from February. We've had, in the past two years, increasingly high vacancy rates for our nurses. I'm not really surprised, because when you look at the statistics with regards to the staffing levels of our nurses, we did have severely underpaid nurses for many years. They're still not up to par, but they're getting a little bit better.

But we have done absolutely nothing to deal with the staffing levels of our nurses in our hospitals. In fact, B.C. is ninth in Canada out of the ten provinces in the number of nursing hours provided per patient per day. A patient in a B.C. hospital in 1986-87 received an average of 6.19 hours of nursing care a day. A patient in an Alberta hospital received 8.32 hours per day.

[5:15]

Interjections.

MRS. BOONE: The people across don't seem to understand that when nurses are working so hard.... We have a level of staffing in our hospitals where nurses are caring for so many patients that it is just not possible to cope. We have nurses dropping out of the nursing profession at a level that is extremely high. They are not staying in the profession at all. I would like to know what you intend to do about this situation, Mr. Minister, because you, along with everybody else, acknowledge that our nurses are extremely well-serving people doing the best they can in the situation. You and I have probably both received letters from people who have been in hospital and have had some problems in there, but the bottom line always come down to the fact that the nurses are working and run off their feet trying to provide the type of care necessary.

A problem that we have is that the number of nurses required in the U.S. is jumping extensively and that there is a good chance that we are going to be losing even more of our nurses to the U.S. within the next 15 years, as we have lost many of our teachers in the past year. The implication is that B.C. is going to have even fewer nurses than ever before.

The minister knows and I know that nursing shortages throughout Canada are a severe problem, but when you are given the fact that the staffing levels — the nursing hours given per patient — are the second-lowest in Canada, you can understand why we are having problems attracting and keeping our nurses here. B.C. right now is the most heavily dependent on migration from other countries of qualified nurses. They are coming to B.C....

MR. S.D. SMITH: It's a good place to work.

MRS. BOONE: Oh, but they're not staying here. They are moving onward, and it's a problem that the minister understands. We have talked about this before. I would like him to respond that there is a nursing manpower study that was done, commissioned by the Ministry of Health and chaired by Dr. Annette Stark. This was scheduled for release

[ Page 4984 ]

at the end of March, and I would like to know if this report is available now and if he will make it available to me and to the public at this time.

HON. MR. DUECK: I certainly cannot argue the point that our nurses are doing a fantastic job. There is no question about that. They are overworked, underpaid and not appreciated enough. I have to say all those things myself. They are doing one heck of a good job under the circumstances. However, by saying that we haven't got enough nurses in the hospitals, I must also remind you that we could not qualify for the accreditation standards if we did not meet their criteria. Although we have a shortage, to get the accreditation for a hospital they must have that manpower in place, and that's how they get the accreditation.

There are many reasons why there is a shortage. It's not as simple as just saying: why don't you do something about it? We are not the only ones that have the problem. First of all, nurses are mostly women. They often take time off to raise a family, which is natural. They take time off, perhaps, to be with their children in the summer months. It is a problem that is facing not just us. I've got an article here, for example, from the province of Ontario. It says that we can go through hospital after hospital and show where there are patients who are having their care delayed simply because there are not enough nurses on staff. This is a problem not just in Canada, where every province is experiencing this; this is a problem across the United States and the western world in general. There is a shortage of nurse manpower and every province and health ministry is trying to come to grips with it and do various things to attract more nurses.

We are also told by some studies that the pay is not necessarily the only criterion. Many nurses are now choosing other professions because they can get more money, perhaps with a more exciting career. Nursing is a tough business, and you know that as well as I do, if not better. Especially when you work in critical care areas, there's a lot of burnout. I sympathize with these people.

But you also mention that people will report and talk about the experiences they have in hospitals. My experience has been the other way around. The letters I've received and the contacts I've made with people are exactly the opposite. They say that the nurses work under extremely difficult situations, but they have never complained that they didn't get cared for 100 percent in British Columbia hospitals. The complaints I get about care in hospitals are so few and so minor that I must say that even under the circumstances you describe, hospitals are giving tremendous care to the people of our province. I'm extremely proud of that, and I hope that they will continue to do so, because we never know when one of us will need that care and have to go to one of those facilities.

Some of the initiatives that we have going for us and that we are looking at are.... I will just go over them quickly. The nursing population in British Columbia has increased by 60 percent. We say: "Why have we got a shortage of nurses?" It's not that they're leaving, but that we have so many more in facilities — a 60 percent increase in nurses since 1974.

Nurses' refresher programs for registered nurses who have been out of the workforce, and the registered nurses' access programs for licensed practical nurses, have helped to increase the nurse manpower. Remote access nursing programs, which are offered at several community colleges, have made it easier for students in rural areas to receive nurses' training.

The grant program for allied health care personnel provides grants of up to $5,000 a year for students of specified health occupations in return for a commitment of work in those areas. In 1986-87, five nursing students were given these awards. Through hospital programs, the ministry has made funds available to St. Paul's Hospital, Royal Columbian Hospital and Vancouver General Hospital to train nurses for critical care areas.

The ministry continues to support increasing seats for training nurses through community colleges and institutions. The Ministry of Health conducted a nurse manpower study and a workplace considerations study in cooperation with the Ministry of Advanced Education and Job Training, the University of British Columbia and health organizations such as the RNABC and the British Columbia Health Association. The Ministry of Health, through the Federal-Provincial Advisory Committee on Health and Human Resources, continues to lobby the CEIC to increase recruitment of for emigrated nurses.

I think we're doing just about everything we can, for the time being, to attract more nurses. There is a shortage; I know that. There's a shortage across Canada. I was talking to one of the hospital administrators, and he says that for every nurse that leaves there's another one coming from somewhere. So it's not that they're leaving our province the way you indicated and all going to Ontario and the United States. It's just about static. We lose as many as we get back, but there still is a shortage.

As far as wages are concerned, I suppose this is something that is generally done by contract negotiations. Hopefully, when they arrive at that stage we will be able to get together in an amiable way and won't have disruption in our hospitals, because we really need that service that they provide so well.

[Mr. Rabbitt in the chair.]

MRS. BOONE: I never indicated that the wages were something that I was talking about. I indicated that wages had improved considerably but were still a little bit lower. You may be doing a lot to attract nurses here and to train them, but you still aren't doing enough to give them decent working conditions by providing them with a level of staffing so that they are not run off their feet, so that they are able to provide the services that are required.

You have talked about the nursing staff. The nurses that I know and the nurses that you know as well — and I think the nurses that most British Columbians have come in contact with — are people who go over and beyond; who go through their coffee breaks, through their lunch breaks, in order to provide the services that they know are required of them because there aren't enough staff there. That is the issue I'm talking about.

Mr. Minister, it is appalling when you look at the hours of nursing care per patient-day. The highest ones are given by Manitoba, Nova Scotia and Newfoundland; those rich provinces, Newfoundland and Nova Scotia, are some of the highest in hours of care per patient. British Columbia has only one province lower, and that is Quebec. If we truly are interested in keeping our nurses here.... Again, I didn't say that our nurses were rushing away; I said our nurses were leaving the practice, retiring, going into other things. You

[ Page 4985 ]

indicated that salary wasn't everything. You're right, salary isn't everything to these nurses. Most of them are very dedicated people, but they can't cope in a situation where they are rushed off their feet, where they are unable to give the type of care that they think they should be giving and have been trained to give in the past.

They are not leaving right now, but I am saying, Mr. Minister, that in the future, when the needs for staff in the U.S. become higher, they will be leaving our province. I sincerely hope it doesn't reach that period, but it will happen not because of the salaries but because the people in that profession will not be able to cope any longer. The burnout period will be the same as that which is affecting our social workers now. In our area, I know the social workers have a burnout period of eight months. Can you believe that? I sincerely hope that we never reach that stage with our nurses, but because of the dedication of these people, they are giving over and beyond the care that is expected of them and, as I stated, on a level that is only lower in Quebec — one other province.

If we are serious about keeping our nurses, about providing them with good-quality working conditions, Mr. Minister, we're going to have to address that level of staffing so that they can be proud of the work they're doing, assist in the whole operation of the hospital and not come home absolutely washed out to the extent where they are leaving the profession.

I asked you if you would make that manpower committee report available to me. I understood it was supposed to be out at the end of March. Do you have it available, and would you make it available to me?

HON. MR. DUECK: We received that not too long ago, and we haven't totally reviewed it. We will release it to you soon.

MRS. BOONE: Thank you.

Last year when we were talking about specialized nurses, the minister said: "We are looking at the whole issue of critical-care nurses and other nursing shortages, and what we can do for the future." I understood that the minister was sitting on a joint committee with the nurses' union to come to grips with the idea of specialized payments to any specialized nursing, whether it be critical care, pediatrics or any of the necessary specialized services and to give them some kind of pay differential. Can the minister please give me some indication of what has happened to that whole issue, and whether there's going to be any pay differential coming through with regards to the various types of nursing in the province?

[5:30]

HON. MR. DUECK: We're getting into an area that is not really my purview. These are negotiations, and HLRA is our agent. Furthermore, we fund hospitals at global budget, and they are the ones that hire the nurses, although we are involved in the funding. We get involved in an indirect way, but really they are not employed by us. So I cannot really comment except to say that I made that statement last year —  and I've made it in the past — that I believe perhaps a differential should be there for certain people working in those critical care areas.

MRS. BOONE: I certainly don't want to intrude on any of the negotiations, and I certainly don't expect you to unfold your hand in that area. I understood — and perhaps I understood wrongly — that the ministry was working with the nurses' union on a joint committee to establish some kind of differential in there. At that time last year, I know the minister indicated: "We want to pay the nurses more, but they won't accept it." I think those were his words at that time.

The minister mentioned that you have increased the number of people being trained in critical care areas. 1 don't want to pick out the critical care. although that gets the most notice all the time, because those are the high-profile surgery type areas. There are a lot other specialized areas as well.

There is a serious problem with regard to postgraduate studies and education for these people. I mentioned to the minister last year that a nurse who wants to gain extra training in anything takes a leave of absence without pay, pays for her own course and then gets no extra pay at the end of that period. Can the ministry please advise me if there have been an), moves to assist nurses with regard to the post-secondary training they have to take, so that they can get a leave of absence and have their courses paid for? Or is there some area where there is some assistance for these nurses so that we can be encouraging them into specialized areas?

HON. MR. DUECK: I'm just looking around for some notes. I gave you the list of initiatives we've taken, and there are some others that are in the reviewing stage or in the area of being finalized. I was looking for my notes. I haven't got it here — perhaps it's not even for public consumption at this time — but we're looking at areas to further encourage people to enter into that particular profession, and to stay when they do. We know it's an area that has caused us much problem and caused problems for the people working in the hospitals, especially where the bum-out is so great. You're right, it's not just in the high-profile areas; it's in other areas too. So if I find that information in the next while I will certainly give it to you if it's already at the stage of being public.

Many other initiatives have been put in place since we spoke last year on these estimates. I think you have to admit that we've come a long way. I've worked very hard at this area because it has been troubling — not just for me as minister, but it's a real problem for health care in the province when we're looking after people who need to come into an acute care hospital or another hospital, even the extended.

So it's not as though we're not aware of it, the same as other provinces. I haven't got a magic wand. Neither has Minister Caplan in Ontario; neither has the Health minister in Saskatchewan or Manitoba. They all seem to struggle with the same set of problems when it comes to a shortage of nurse manpower. As a matter of fact, we've had conferences with Health ministers from right across the country, and that was one of the very areas we discussed at length. That is a problem in Canada. When you want to go further, it's a problem in the United States and the whole western world. I don't know whether they have that problem in the eastern world; maybe there they just shut the door when the hospital is full. We have a different system — we try to look after everyone.

We're expanding. If you look at health care today versus 10 or 20 years ago, there's just no comparison. The health care in this province or in Canada is absolutely excellent. It is really good. I know you have to come up with areas of concern; that's your job, and I appreciate it. But let's not ever

[ Page 4986 ]

forget that the health care system is doing well and that we are looking after the people who get ill in our province.

I've just gotten a note here now, and I suppose we can tell you this much. We're looking at the possibility of a forgivable loan program for critical care nurses in return for a commitment of service. We've had meetings on it for some time. The program isn't quite in place, but that's what we thought we would perhaps do shortly. We would then perhaps allow them to take this program to advance themselves in the area of their profession, as long as we could have in turn the commitment that they would then serve this province for a length of time.

MRS. BOONE: Also last year, I mentioned and we had a discussion around the registered nurses' status. Protection of the title "nurse, " I think, is what is currently being negotiated with the minister, and I would like to ask the minister what stage that is at. I know that the registered nurses have been in contact with you on a continuing basis over the past year. The latest, as I said, was the protection of the title "nurse." I'd like to know what effect this registration will have on licensed practical nurses or psychiatric nurses. I've been given the understanding that this will not deny them the ability to use the title "nurse, " and I would like you to tell me whether that is in fact what you are talking about and if you see that as what would be taking place.

HON. MR. DUECK: This has been an issue in my office ever since I became Health minister, and we have worked hard and long, not just from our side but from the registered nurses' and all: nurses' point of view. We have come to an agreement and are now proceeding, and hopefully it will come before the House in this session. Cabinet has accepted it and has approved the legislation, and I believe it is ready to come into the House for discussion and final resolution.

As far as protection of the title is concerned, each group will be protected under its own legislation. In other words, nurses will not be able to practise as nurses - whether registered, practical or psychiatric - unless they are registered under the legislation as nurses. That will give them protective title, and that's what they were after. We have agreed that we will proceed in that area.

MRS. BOONE: I thank the minister for bringing this forward, and I look forward to the legislation, as do many of the nurses.

I'd also like at this time to discuss something . . . . I find it really difficult to understand what's happening, because both you and I acknowledge that we have a tremendous shortage of nurses. Yet we are seeing, for example, at the Vancouver General Hospital a reduction in the licensed practical nurses and orderlies, and a move to replace them with registered nurses.

I find it difficult to understand: (1) registered nurses cost more than licensed practical nurses or orderlies; and (2) we don't have enough licensed practical nurses to begin with. It's taking away from the whole team approach that has worked so well in our hospitals - the idea that we have licensed practical nurses that have particular jobs that are theirs and orderlies that have particular jobs that are theirs, and then we can leave the registered nurses to do the actual nursing. Surely it makes far more economic sense to use a team approach to health care than to put everything onto the registered nurses, particularly when we don't have enough of them anyway.

Can the minister please respond to this move that is taking place in some of our hospitals?

HON. MR. DUECK: Mr. Chairman, to begin with - I must say this - the hospitals are autonomous bodies. We give them global funding. We do not hire registered nurses or practical nurses, nor do we tell them what the mix should be.

Having said that, I agree that practical nurses can give bedside nursing as well as, if not better than, anyone. They are just as capable as the registered nurses. However, when we're talking about Vancouver General we have to take into consideration that it is a teaching hospital. It is a major acute care hospital and a provincial referral centre. Early in '88 the hospital determined that with a reorganization of the nursing department, there could be better utilization of nursing staff.

The hospital stated that the reason for making these changes was "to ensure that the appropriate care would be given to patients. " In order to meet the increasing demands of modem and medical technology, the hospital chose to reduce the use of licensed practical nurses and orderlies and almost totally replace them with registered nurses, other specialists and non-professional staff such as unit clerks and operating-room attendants. With a reduction of non-professional staff, there has been an increase in the recruitment program for registered nurses, and neither the recruitment nor the replacement of non-registered nursing staff is complete.

All 1 can say is that the reason given to us - and I looked at this extensively - was that they were replacing them for reasons of operating that type of facility, a teaching hospital, very high tech, with specialized equipment, and they needed that mix to operate that particular hospital. The administration, surely, with the funds they have available, would not choose one person over another for no reason. They did that for specific reasons, and I'm told that their function is such that they required that mix of nurses.

MRS. BOONE: I find it a little hard. The minister is the Minister of Health, and yet everything I talk to him about with regard to hospitals seems not to be in his area and he has no say in it.

I can understand that in some circumstances, where there's a smaller hospital and only one nurse or two nurses on, it makes sense to replace the LPNs with a registered nurse because there are times when, the other nurse may be ill or on a break or something like that, and you need the nurse there.

I certainly can't understand the move at VGH, which is an extremely large hospital, to replace that number of LPNs and orderlies with registered nurses. In fact, many of the nurses don't understand it and have again spoken out in favour of the team approach to nursing, to health care, as compared to the single issue. Once again, they are being asked to perform functions that can be done by somebody less qualified, and their whole workload increases because they can afford fewer nurses. It's an economic fact, when you have a budget, that if you are hiring more expensive people, they are going to be able to hire fewer nurses than they can LPNs and orderlies. Therefore the whole area makes it even more difficult.

[5:45]

I'd like to talk to you a little bit about something that was brought up in the budget speech, and something that we haven't heard very much about lately, and that is the legalization of midwifery. As Canada is the only industrialized nation

[ Page 4987 ]

without legal provision for midwifery services, and the World Health Organization recognizes midwives as the international specialists in normal childbirth, and numerous studies have been repeatedly done to demonstrate that midwives provide a safe standard for maternity care . . . . In that area they have fewer interventions, Caesareans and deliveries by forceps. Is the ministry committed to recognizing midwifery, and what is the ministry doing to work towards that goal?

HON. MR. DUECK: Yes, I mentioned it in the estimates speech. We have a committee doing a study of this. Their report is not yet in.

I should perhaps tell you that anyone who delivers a baby is a midwife, so we have a lot of midwives around now. I know what you're referring to; I'm just trying to be a little funny. They're all midwives.

Another thing, too, with our hospitals, with the care and the equipment and the facilities we have .... There are certainly many facilities, and no one has to worry about not finding a hospital. Even if we did go to the midwife, as you're referring to, let's say a qualified nurse or anyone else that's qualified . . . . I don't want to preempt the report, but I still believe that a hospital setting would be the place to have a child rather than in a home and taking a chance. It happened not too long ago, as you probably read in the paper.

We will look at the report, and we certainly want to look at it with an open mind and see if we can accommodate some of these women who prefer that type of delivery rather than having a physician. It's quite complicated, because in the time before they deliver, they do see a physician to make sure everything is okay, and then a midwife just for the delivery part, or shortly before and after. That has to be coordinated so we don't end up with two professionals looking after the same procedure.

It is not as simple as saying: "Okay, let's license a whole bunch of people to be midwives and away we go. " It's got to be done with care and with thought for the best health care for the child and for the mother, and also the wishes, of the individual. We recognize that. That's why I mentioned it and that's why we've got this committee out there working. They will bring their report forward I understand, not too far in the future. When we get that report~, we'll certainly look at it and go from there.

MRS. BOONE: I think the minister has a different feeling of what midwifery is than I do. I see the midwife working with the expectant mother right from the beginning on planning, nutrition, use of drugs and any number of things. I see this person working in conjunction with the family doctor or the obstetrician. I see that person being involved right from the beginning and all the way through. I don't necessarily see the use of midwifery being exclusively at home; I see midwifery being possibly performed in hospitals - or at home as well.

It's important. But if we are looking at midwifery . . . . I understand from your remarks that you have this report coming. I'm glad that's happening. We have to be assured that we have our regulations in place, and that we know what type of licensing procedures will be established. I would like to ask the minister whether he is looking at this program as a self-regulating program or as attached to some other medical profession.

HON. MR. DUECK: Mr. Chairman, I would gladly let my colleague ask a question, but I'll answer this one first.

Before we look at any regulations, of course, we'll look at the report and see whether we are in fact going in that direction.

I'm glad you mentioned that you are not necessarily referring to home births, because a lot of the letters I receive are from people who really believe that someone has the gift of being a midwife and want to go into practice. This is something I certainly would not be in favour of.

The other thing is the cost of having two practitioners, because they will still see their physician. We have to make sure that whatever we do. it's not a duplication. If we duplicate too many of these functions or procedures, then there won't be anything left for seniors. Again, I'm referring to the ever-demand.

There are all these new areas, like acupuncture. We've just received a report on that, and we're looking at it at this time. Thousands of people are very pleased with acupuncture procedures. As a matter of fact, I read an article over the weekend saying that 30 percent of the population in Canada and the United States get well from using placebos. Not only do they think they are getting well - that it's up here - but the doctor states that they in fact do get well, because our bodies are wonderful mechanisms and they can, with enough willpower, heal themselves. They are saying that all these methods of healing that you hear about - and there are more and more coming on the market . . . . People will say: "You know, I took this particular whatever it is" - juice or pill or whatever - "and I got well." And they go to the doctor and they did get well.

We have to be very careful in all these areas that we don't compound the cost of health care, but I am always willing to look at all areas, because if we shut our minds to these new areas and innovative ideas that people have had from years back . . . . Maybe we're missing something by producing new technology and new drugs. I think our society is over drugged, anyway. I think the doctors are prescribing too many drugs to too many people. So there is an area that we have to look at very carefully. It probably would save us a lot of money and people would be less ill than they are now.

I will let my colleague ask a question.

MR. R. FRASER: Probably to the surprise of some of our friends, I have some interest in the subject of midwifery, because at the moment I don't happen to support the concept of midwifery. It seems to me that now that we have doctors in abundance in the province - certainly in most locations, anyway - it would be a step backward to use a sub professional when you can use a professional. When you get into the midwifery aspect, it would seem to me that you're adding costs, adding professionals and adding a debt load for the rest of the people to pay, and it would be a very serious step to take. I want the minister to assure me that before anything is done on this issue, we'll all have a hard look at the subject.

MRS. BOONE: I am glad to see that the member for Vancouver South is staying in the nineteenth century.

Midwifery is controversial right now because of the problems that exist right at this moment, but some of those problems exist because there have not been established procedures, established regulations or any of those things. I don't think there's one legal midwife out there who would indicate that there are not occasions when a doctor is required and they can't perform those things. Certainly women have been giving birth for many years, and they don't always need to have a professional obstetrician around. Men seem to think that this is a difficult procedure.

[ Page 4988 ]

I'm concerned that there are increasing costs with regard to the number of Caesareans that are being performed. I had an interesting discussion last week with a gentleman who was a former executive director with the Ministry of Health during the Conservative era in Ontario. He indicated that he asked his staff - and it would be interesting for this minister to do the same thing - to do a printout of the days of the week when Caesareans were performed and the number that were performed. Surprisingly enough, they found out that the majority of Caesareans were performed on Friday. It's interesting. They want to get home for their weekend. They don't want their golf day interrupted or what have you, or for convenience.

Interjection.

MRS. BOONE: It is a terrible thing to say, but it is a more terrible thing to do to a woman; I'll tell you that much.

I have finished my section, and I move that the committee rise, report progress and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Strachan moved adjournment of the House.

Motion approved.

The House adjourned at 5:56 p.m.