[ Page 6079 ]

CONTENTS

Routine Proceedings

An Act to Regulate Smoking in the Parliament Buildings (Bill 207). Mr. R. Fraser

Introduction and first reading –– 6080

Oral Questions

SAFER program advertising. Ms. A. Hagen –– 6080

Demolition of rental housing. Mr. Perry –– 6080

Native education. Mr. G. Hanson –– 6081

Staffing of cardiac surgery wards. Mr. Serwa –– 6081

Provincial emergency program. Mr. Sihota –– 6082

Motions on Notice

Motion 35. Hon. S.D. Smith ––6083

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

On vote 35: minister's office –– 6083

Hon. Mr. Dueck

Mr. Perry

Mr. Serwa

Ms. A. Hagen

Mr. R. Fraser

Mr. Miller

Ms. Smallwood

Mrs. Gran

Hon. Mr. Richmond

The House met at 2:04 p.m.

HON. MR. VEITCH: Mr. Speaker, the other evening I was reading one of the many books that have been written on the history of British Columbia. I was reading Conversations With W.A.C. Bennett, and one of the individuals mentioned in that book is here today. W.A.C., that late, great, famous British Columbian, said that this man gave a tremendous amount to British Columbia and asked nothing in return. He was always there working; he's still doing it today. Bill Clancey is in the gallery, and I ask you to bid him welcome.

HON. MR. REID: It's with a great deal of pleasure that I introduce to the House today His Excellency the Ambassador of Thailand and Mrs. Arthayukti, and the consul-general of the Royal Thai consulate in Vancouver, Horst Koehler, and Mrs. Koehler. Would the House make these people especially welcome.

MR. SIHOTA: I just noticed walking into the gallery a good friend of mine and an active New Democrat in Sooke, one who is responsible for assisting both me and my Member of Parliament, Mr. Barrett, in our political successes. I'm glad to see him here today. Would all members please join me in giving a warm welcome to Stan Smith.

HON. MR. PARKER: In October 1956 the Hungarian uprising focused the world's attention on the circumstances in Hungary, and that uprising was crushed in early December by Russian tanks. The Hungarian Sopron university of mining and forestry escaped to Austria and arrived in Canada in January 1957, at the invitation of the Hon. Jack Pickersgill. The mining, geophysics and surveying group relocated in Toronto. The forestry group, some 20 faculty and 200 students under Dean Kalman Roller were invited by Dean George Allen to join the faculty of forestry at the University of British Columbia.

In the members' gallery today is a member of that Sopron faculty of forestry, who has been a member of the UBC faculty of forestry for more than 30 years and is one of my favourite professors, Dr. Oscar Sziklai. Would the House make him welcome.

MR. ROSE: Could I add my words, Mr. Speaker, to those of the Minister of Forests to welcome Professor Sziklai to the House. He is a former colleague of mine at UBC, and also we were at the same time concurrent members of the alumni association. I certainly enjoyed seeing him again after four or five years having not seen him. I would like to welcome him as well.

HON. MR. REID: I would like the House today to recognize seven very honoured British Columbians who were installed yesterday as new members of the Order of Canada. They are: Ivy Granstrom, Jack Webster, Erwin Swangard, James McFarlane, Samuel Belzberg, David Boyes and John MacDonald. These people received the Order of Canada yesterday in Ottawa. Would the House pay special recognition to those people.

MR. PERRY: I would just like to join the welcome to Professor Sziklai. It's always nice to see fellow members of the university here.

HON. L. HANSON: In the House today, joining my ministerial assistant, Ian MacLean, is his sister Ann Scott. Visiting Ann, from Halifax, Nova Scotia, is Dawn Brown. Please welcome them to the House.

MR. SERWA: This afternoon I have a good-news item for the House. Last Sunday Pat Ryan and his Alberta rink won the men's world curling championship. Three weeks earlier he had won the right to represent Canada by winning the Canadian men's championship. His opponent in the finals was Rick Folk and his British Columbia team. On behalf of the second member for Okanagan South (Mr. Chalmers) and myself, I am pleased to advise members that both Pat Ryan and Rick Folk reside in Kelowna, the city of champions. Pat recently moved to Kelowna from Edmonton and is the director of financial services at the Kelowna General Hospital. Would the members please join me in congratulating Pat and welcoming the world champion curler to British Columbia.

HON. MR. MICHAEL: We have with us in the gallery 31 students from Chase Secondary School, two chaperones and their teacher, a very good friend and constituent, Mr. Tom Atkinson. I would ask that the House make them welcome.

Chase, a community of 1,800 in the great constituency of Shuswap-Revelstoke, is located at the head of the South Thompson River where it leaves Little Shuswap Lake. It is a beautiful community nestled between Mount Boysse and Chase Lake and adjoining the very fertile farmlands known locally as VLA Flats. This being cancer month, I want to advise the House that on a per capita basis the residents of this small community are the most generous contributors to the cancer society of any community in the province.

MR. BRUCE: In your gallery today, Mr. Speaker, is a friend of mine and a director of the Social Credit Party in the North Island constituency, Mr. Neil Kruk. Would you please make him welcome.

MR. CHALMERS: Mr. Speaker, I have some very special guests in the Legislature today — in your gallery, as a matter of fact — from Corner Brook, Newfoundland: Mr. Richard McBurney and his wife Lyn McBurney. Accompanying them is my mother from Enderby, B.C., Jean Chalmers. Would you please make them welcome.

[ Page 6080 ]

Introduction of Bills

AN ACT TO REGULATE SMOKING
IN THE PARLIAMENT BUILDINGS

Mr. R. Fraser presented a bill intituled An Act to Regulate Smoking in the Parliament Buildings.

MR. R. FRASER: I don't think we have to say a lot about smoking and the advantages of non-smoking. I know the government could issue an edict to everybody in the building that smoking would not be allowed, but I wanted to give every member of the House a chance to participate in the passing of this bill. I would like it to be unanimous, and I'm sure that it will be. I would request that we all get the jelly out of our jeans and pass this bill this year.

Bill M207 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

SAFER PROGRAM ADVERTISING

MS. A. HAGEN: In recent days, older adults may have read ads in their local newspapers about "significantly enhanced" SAFER programs. The expensive ad campaign of government and the Ministry of Social Services and Housing gave the minister a significant opportunity as well. Why didn't the minister take this opportunity to use these ads and give seniors some very concrete information about the new ceilings on rents that would be eligible for SAFER?

HON. MR. RICHMOND: The ads are there to inform seniors of the programs that are available and the fact that we are very cognizant of the needs of seniors. Time does not permit the ads going into the detail that the member asks.

MS. A. HAGEN: In 1986 the government had an inquiry which reported that over 50 percent of eligible seniors for the SAFER program did not, in fact, receive it. What steps does the minister now plan to take to ensure that every person in this province who is eligible for SAFER will be informed of its benefits? Further, what assistance will he have to offer to help them in filling out the necessary applications?

[2:15]

HON. MR. RICHMOND: That's precisely why we have launched an extensive advertising program to make sure that all people who are eligible know that they are eligible. All they have to do is phone our nearest office and they will be given every assistance.

MS. A. HAGEN: Perhaps the minister can explain why, when I called that phone number the other day, I had to prompt the person who responded to give me the information about the new ceilings.

HON. MR. RICHMOND: First of all, Mr. Speaker, all the information has gone out to every one of our offices, and I find it hard to believe that one of our staff wouldn't know all about that program. If the member would like to give me the specific office that she called and, if possible, who she spoke to, I will make sure that that person is fully aware of the program.

MS. A. HAGEN: It was the generic number in the ad that I called.

Final question: would the Minister of Social Services and Housing now make a commitment to negotiate with the federal government to include an insert in every old age security GIS cheque in this province informing seniors of the benefits that are available under SAFER?

HON. MR. RICHMOND: Whenever possible, in consultation with the federal government, and I will take that suggestion under advisement.

DEMOLITION OF RENTAL HOUSING

MR. PERRY: Mr. Speaker, another question for the Minister of Housing. Last week I described the plight of many elderly and young apartment dwellers in my riding who are being evicted forcibly from buildings which are in very good condition. I wonder whether the minister has discussed with the city of Vancouver the necessity of amendments to the Vancouver Charter to allow the city the effective power to control unnecessary demolitions of good housing?

HON. MR. RICHMOND: I have had several meetings with the mayor of Vancouver in regard to housing, and they have been very good meetings, by the way. The city of Vancouver is very willing to identify land that will be zoned for housing. However, there are certain matters that fall under the jurisdiction of the city and are not the purview of this government. There are certain matters that they would like to deal with that are not the purview of this ministry, so the exact item the member mentions falls under another minister's jurisdiction.

MR. PERRY: A new question for the Minister of Housing. Has he considered Bill M201, An Act to Prevent the Unnecessary Eviction of Renters — proposed by the second member for Victoria (Mr. Blencoe)? Or has he considered the suggestion I made last week that the province review the Ontario Rental Housing Protection Act, now in second reading in the Ontario Legislature under a Liberal majority government? Have you given consideration to measures like this that will provide genuine protection for rental tenants?

MR. SPEAKER: The first part of the question is out of order, but the minister can answer the second.

HON. MR. RICHMOND: I can tell the member that we have reviewed the current practices that are in effect in Ontario, and as near as we can ascertain

[ Page 6081 ]

with all the figures, they are not working; in fact, they are having an adverse effect on the housing market in Toronto.

MR. PERRY: A supplementary for the Minister of Social Services and Housing. Can the minister explain why the Ontario government is supporting the bill in second reading in the Ontario House, and all task forces in Ontario have recommended passage of a stronger bill which will eliminate the loophole for buildings rendered vacant by the owners?

HON. MR. RICHMOND: Maybe I can elucidate a little more clearly to the member. I haven't studied the bill currently before the Ontario House, and perhaps the need for that bill is to correct mistakes of the past. As usual, we find that when you make one mistake and try to correct it, you usually only compound that mistake.

NATIVE EDUCATION

MR. G. HANSON: I have a question to the Minister Responsible for Native Affairs (Hon. Mr. Weisgerber). For some 23 days now, native students have been fasting, and other native students have been demonstrating across the country to draw attention to their concerns regarding native education. Has the minister protested in the strongest possible terms the federal government's decision to cap native education arbitrarily and to limit financial aid to native students?

HON. MR. WEISGERBER: No, I have not. It seems to me that the decision taken by the federal government is to cap spending that has not as yet been reached. At this point, I don't see any need to protest that decision.

MR. G. HANSON: Mr. Speaker, I think all members of this House realize that Mr. Cadieux, the minister, is locked on to a collision course with the native people of this country, because nothing seems to mobilize the native people more than matters which affect their children's education — as in any other group.

The government's access report embraced the principle that native Indian people should participate fully in decisions affecting their education. Given that the policy changes to financial aid for native Indians were made arbitrarily and will reduce access to post-secondary education, will the minister now demonstrate his commitment by intervening on their behalf in Ottawa?

HON. MR. WEISGERBER: Indeed, it seems to me that the province, through the Ministry of Education and the Ministry of Advanced Education, has just demonstrated repeatedly its commitment to native education. As I said before, I don't see any indication at this time that the cap the federal government is proposing has hindered or prevented anyone from obtaining the kind of education they're looking for.

MR. G. HANSON: Mr. Speaker, the Minister Responsible for Native Affairs is the primary advocate for native people in this province, and he would do the people of this province and the native people of Canada a service if he would act on their behalf.

My question is: does the minister not understand that the need for native education is growing because of the demographics within the native community? In 1960 there were only 60 students in university; now there are 15,000. The demand is there. Would you please ask Mr. Cadieux to change course and to talk to the students that are fasting and give them a say in their own education?

HON. MR. WEISGERBER: Indeed, it seems to me there are several native organizations in British Columbia who are particularly concerned with education and advanced education for native people. None of those groups has contacted my office to date to request any help with lobbying Ottawa. Should they do so, I'll certainly take it under consideration.

STAFFING OF CARDIAC SURGERY WARDS

MR. SERWA: My question is directed to the Minister of Health. I, along with most British Columbians, was exceedingly pleased with the minister's recent announcement of the cardiac surgery wards, both at the Royal Columbian and in Kelowna.

A number of my constituents have expressed concern about the ability to adequately staff these two additional facilities, recognizing that the Royal Columbian is coming on stream very quickly, and the Kelowna facility in the next three to four years. Would the minister comment on measures being taken to meet immediate and long-term staffing challenges associated with this increased capacity?

HON. MR. DUECK: The nursing shortage is not just in British Columbia, and it's not just in Canada; it's in the United States and even further than that. We recognize it is a problem, especially when it pertains to high-risk or critical-care nursing.

We have taken some measures in the past and we will take more measures that will perhaps alleviate the situation in the future. One of them, of course, is that we allocated $560,000 in the summer of 1988 for the upgrading of nurses from general duty to critical care. This was to help nurses who would otherwise have to do it on their own time and at their own expense. We have a number of them enrolled in a program to get this extra training. We are also asking Advanced Education to provide more spaces for nurses, and they have done so. I believe they will have even more spaces in the future.

When we talk about a nursing shortage, we also have to remember that by and large nurses are female, and very often they are also raising a family. While we may have enough nurses in the province to adequately staff all the hospitals, not all of them are working at all times. It presents a problem to the Ministry of Health; there's no question about it.

[ Page 6082 ]

We are also considering bringing in nurses from Europe who would like to work in this province.

Interjection.

HON. MR. DUECK: Well, the question was asked, and it was legitimate. I am explaining it.

Interjections.

MR. SPEAKER: Order, please. If the minister would finish his answer....

HON. MR. DUECK: We are also asking for nurses from Europe who want to take positions in Canada. Some of them have come over, and we are very delighted about that.

I believe in the future. There are now negotiations, and I'm not going to get into that area. It's often said that they work too hard, that the burnout rate is too great. I believe the 12-hour shift is too long. Perhaps some of those changes should be made. We are doing everything we can to alleviate that problem.

PROVINCIAL EMERGENCY PROGRAM

MR. SIHOTA: A question to the Solicitor-General. Does the Solicitor-General agree that the provincial emergency program is inadequately funded and in an unfocused state of preparedness should an earthquake strike this area?

HON. MR. REE: No.

MR. SIHOTA: A supplementary to the Solicitor General. I have a letter here dated February 8, 1989, to the director of the emergency preparedness program. The letter says:

"The situation warrants the strongest representation possible to the provincial government for direction in what is perceived as an unfocused state of emergency preparedness in the province for a catastrophic earthquake. If clear direction is not provided, then there seems little purpose to seek involvement of many persons who are deeply concerned at what is perceived as a very real threat."

Will the minister explain why this government has failed to provide the political leadership requested by his own advisers?

HON. MR. REE: I should appreciate that we are in estimates. The budget has been presented, and I am confident that the member has looked at the blue book and noticed the additional funds. An additional $600,000 has been allocated to the provincial emergency program. In addition, the provincial emergency program is seeking an additional FIE to do emergency preparedness programs and set up programs for us in this province.

The provincial emergency program is one of the best-run and best-staffed branches of the government. We have 6,700 volunteers in this program. These are British Columbians from all parts of the province. The sky is not falling.

MR. SIHOTA: I have the minutes of the interministry emergency preparedness committee and their submissions to cabinet. They asked for $1 per person for this problem — in other words, $2.4 million, not the measly $600,000.

I have here a memorandum dated February 15. The chairman of that committee wrote to the provincial emergency program on February 15 and said: "As you are well aware, the August 1987 evaluation study of PEP stated that the 'provincial emergency program is currently incapable of responding effectively to a major disaster.'" Is the minister aware of that? The memo went on to say: "While progress has been made...."

[2:30]

MR. SPEAKER: Order, please. Could the member put his question.

MR. SIHOTA: The question is this — and I will table this memorandum to the minister, who obviously hasn't seen it. The memorandum talks about....

MR. SPEAKER: Order, please. Will the member put his question.

MR. SIHOTA: Could the minister explain why the government has chosen not to provide the funding that was requested of cabinet — namely, $1 per person — in order to show its commitment to adequate funding of the provincial emergency program?

HON. MR. REE: The member has put forward an excellent question. I certainly would have anticipated it in normal debate in estimates of my ministry. I realize the Leader of the Opposition is not present; therefore there is no direction coming from that side. As I indicated earlier, we have received additional funds of $600,000 in our estimates for the 1989-90 fiscal year. A great deal of these funds will be directed towards additional training of the volunteers throughout the province, the regional directors of the provincial emergency program, and towards earthquake awareness.

One of the aspects of what they will be doing will be making inventories across Canada of equipment, machinery and resources that may be needed at such time as there is a disaster within the province. We certainly hope there will not be one, but we are well cognizant of the recommendations of the various engineering groups that have done a study and advised us of the possibility of an earthquake in this area. We are in a dangerous earthquake zone in our location, the southern part of the province and Vancouver Island. We are well aware of it, and I would ask that member to ask further questions when it comes time for my estimates.

HON. MR. ROSE: My point of order, I must admit, is not quite as valid as it was when I first stood up about five minutes ago.

I do recognize that you did give us extra time to make up for what I regarded as the misuse of ques-

[ Page 6083 ]

tion period by the Minister of Health, whose estimates are before us. The type of question that was asked by the second member for the Okanagan could have been asked during that time.

I'm now objecting to the fact that.... Government members have an opportunity to ask questions; however, I really do feel that when estimates are before the House, perhaps there's not the same urgency for the question or the length of the answer. I congratulate both the new Solicitor-General and the Minister of Health for taking lessons on eloquent, lengthy and loquacious replies from the Minister of Finance (Hon. Mr. Couvelier).

HON. MR. RICHMOND: It might be an apropos time, and I know you have done it on many occasions, to point out to the members, especially some of the new members, article 47A(b) pertaining to question period in Standing Orders. I will quote it for the members: "Questions and answers shall be brief and precise, and stated without argument or opinion."

MR. SPEAKER: I thank both the hon. members for their input, and I appreciate it. I've read that standing order many times myself. I would hope that not only the new members would read it, but some of the members who've been around for a while.

Orders of the Day

Motions on Notice

On Motion 35.

[That this House authorize the Select Standing Committee on Labour, Justice and Intergovernmental Relations to examine, inquire into and make recommendations on the matter of the Builders Lien Act with particular reference to the following:

1. the purposes of and the continuing relevance of the legislation in today's society;

2. the policy consideration behind the act;

3. the desirability of repeal or reform to any or all of the provisions within the act; and

4. the policy directions which would guide any reform; and to report to the House as soon as possible, or following any adjournment, or at the next following session, as the case may be; to deposit the original of its reports with the Clerk of the Legislative Assembly during a period of adjournment and upon the resumption of the sittings of the House, the chairman shall present all reports to the Legislative Assembly.

In addition to the powers previously conferred upon the said committee by the House, the committee shall have the following additional powers, namely:

(a) to appoint of their number one or more subcommittees and to refer to such subcommittees any of the matters referred to the committee;

(b) to sit during any period in which the House is adjourned, during the recess after prorogation until the next following session and during any sitting of the House;

(c) to adjourn from place to place as may be convenient; and

(d) to retain personnel as required to assist the committee.]

HON. S.D. SMITH: I move Motion 35 standing in my name on the order paper.

Motion approved.

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

ESTIMATES: MINISTRY OF HEALTH

On vote 35: minister's office, $333,960 (continued).

MR. CHAIRMAN: If hon. members would take their places, the Chair would have a little less difficulty in finding who wants to speak.

HON. MR. DUECK: I appreciate the courtesy of the House in letting me continue with my opening remarks. I know they were lengthy, but the Ministry of Health has many departments, and in order to even touch lightly on most of them, it makes for a long opening speech. I appreciate the patience the members have, and I will continue. I have only a little left.

Let me reiterate that the intent of this legislation is to provide government with a means to ensure access to quality care well into the future through an efficient, effective and affordable system. It should be emphasized that this is not an attempt to replace the current fee-for-service system, nor do I expect legislative provisions to replace the traditional rounds of talks and negotiations with professional groups which, as it happens, are underway at the present time.

With respect to this last point, I would like to point out that this year's estimates provide more than $76 million in additional funding for MSP. This funding will provide for population and utilization increases as well as changes to fees and the administration of the plan.

In an effort to balance fiscal responsibility and sensitivity towards those with limited incomes, the government will extend Medical Services Plan premium assistance coverage to an additional 15,000 families or 22,000 individuals. In addition, the premium assistance program will be further improved in July 1989, when three new premium assistance levels of 75 percent, 35 percent and 15 percent will be introduced. As a result of these enhancements, the number of persons receiving some form of provincial assistance with their premiums will rise to 700,000 from the current 572,000 now benefiting.

The Pharmacare program provides prescription drugs and other benefits to all British Columbians through its various plans. This year the program will receive $17.5 million in additional funding to address population and utilization growth, increased drug costs and the costs of new drugs to be added to the list of eligible benefits.

While government has provided substantial additional funding to meet rapidly rising drug costs, particularly for new drugs, the concern about these increases has prompted the government to raise the Pharmacare universal plan annual deductible from

[ Page 6084 ]

$300 to $325. This increase will avert an estimated $1.4 million in Pharmacare costs and is consistent with the government's stated belief that those who can afford to should share directly in the costs of their care.

I also wish to point out that British Columbia is one of the only three provinces in Canada with a universal drug program. It should also be noted that universal drug programs and programs offered for seniors are not cost-shareable with the federal government, and therefore their cost must be borne entirely by the provinces.

The Pharmacare program is currently assisting the College of Physicians and Surgeons and the College of Pharmacists in implementing a triplicate prescription program in British Columbia. This program would be similar to ones already in existence in the provinces of Alberta and Saskatchewan. The new triplicate prescription program will assist the colleges in promptly identifying persons who abuse the system and who multiple-doctor for the purpose of obtaining drugs.

In addition, the Pharmacare program is working with the medical and pharmacy professions in investigating the possibility of introducing a computerized linkage of all pharmacies in the province, with a further possibility of this network being expanded to include medical doctors and hospitals. A feasibility study is currently underway by a project team made up of representatives of the two professions and the ministry.

The ministry's vital statistics division has recently taken steps in conjunction with the government agents' branch and certain hospitals to greatly improve services throughout the province by increasing the number of outlets where the public may obtain vital statistics services such as birth, marriage and death certificates.

In addition, to further enhance local responsiveness, the division has recently been reorganized to provide managers responsible for each of the province's economic development regions. As Minister of Health, I am very pleased with this year's budget. I believe that once again my ministry has struck the proper balance of progress, program enhancement and prudence in the management of the health care system.

Further, I see tangible evidence everywhere in the budget of this government's commitment to working together to achieve healthy public policy for the betterment of all British Columbians. The ministry's '89-90 budget will provide significant funding not only to maintain but also to continue the process of steadily improving our already excellent health care system.

Our capital stock of facilities and equipment will continue to be updated and expanded. Existing programs will receive substantial funding increases to allow them to better address the health care needs of British Columbians. Expanded or new surgical programs will shorten the wait for open-heart surgery and will allow a full range of transplants to be carried out in this province. New preventive programming such as breast-screening will be implemented in order to improve and perhaps save the lives of hundreds of women.

Of special note is the commitment being made to the senior citizens of this province. A major report will be released shortly in conjunction with the establishment of a task force whose job will be to gather the opinions and concerns of British Columbian senior citizens on a wide variety of topics of importance to them. As well, a senior citizens' advisory council will be established to provide ongoing grassroot input to government on current issues and future programming needs.

As Minister Responsible for Seniors, I am mindful that the elderly have special needs and am aware of their rapidly growing numbers in our society. It is vitally important for the government to begin to take the appropriate steps now to ensure that future needs can be properly met. It is for this reason that I am very pleased that the government has made a significant financial commitment to the strengthening of the existing continuing care system in order to provide a solid foundation for future program development.

The coming year will also see the introduction of new legislation to increase the government's ability to effectively manage the delivery of medical services in the province. Emphasis will be placed on quality assurance, improving the distribution of services and introducing necessary internal incentives and controls to ensure that our medical services system remains both high quality and affordable.

I believe we have struck the appropriate balance in this budget. We have achieved a balance of high quality and affordability, a balance of community and institutional care, a balance of meeting current needs and providing for a sound future, and a balance of government and personal responsibility for disease prevention and health promotion.

In my ministry's budget, we see tangible proof of our government's assertion that the '89-90 budget is truly balanced with care. Thank you very much.

[2:45]

MR. PERRY: I'd like to say I've enjoyed listening to the Minister of Health, both this morning and this afternoon. I think there were encouraging words in what he said. As a physician involved in the delivery of health services in British Columbia since 1979, and having been involved in health care in several other provinces in Canada and the Territories, I've looked forward for a long time to some of the things I've heard today.

I hope that they will be followed up by action. I think there has been encouraging evidence of action in some fields, such as a mammography screening project carefully developed in conjunction with the Cancer Control Agency. I think that's a very promising beginning, although I regret to say that I think many of the initiatives are long overdue in the province.

I'd like to begin the debate on the estimates by stating some broad, general principles for the health system and some of the problems I see in the current

[ Page 6085 ]

health system in British Columbia, where actions fall short of the words. I reiterate that I recognize the complexity of the minister's assignment, which must be one of the most difficult jobs in the province — the enormity of the budget that he supervises, the complexity of the individual issues with which he is asked to deal on a day-to-day basis — and I recognize the efforts he has made to deal with them. I think at times he has received very good advice, and at other times he has received, shall we say, advice with which I would find more to disagree. I look forward to working from this side of the House, in some senses in a cooperative way, to help him fulfill his mandate, because I think that's what the people of British Columbia expect of us.

In listening to the minister's speech today and thinking about the estimates and some of the issues that confront us, I think our biggest single failing in British Columbia is the lack of an overall sense of where we're going and what we're trying to achieve in health. I found it encouraging to see the beginning of a definition of health in the minister's remarks. I made brief notes to which I would like to refer.

He stated that the government intends to focus on wellness rather than illness. What intrigued me was the recognition in his speech that many social factors contribute to health status. The minister spoke of the many facets of our lives that affect health and referred to education, income assistance, traffic safety, the environment, better housing and nourishment. I think it's particularly salient that he mentioned all of these, because these are factors that have been seriously neglected in the past in British Columbia and that it will take monumental efforts to overcome.

Let me look at some of the broad perspectives we should consider in designing a health strategy for British Columbia which can meet the real needs now and in the future. I think one useful way to do this is to look at some concrete examples and some contradictions between reality and the very fine words of his speech and the best of intentions. The example which strikes me immediately because of my helicopter flight here this morning and a trip to Vancouver yesterday is the problem of environmental pollution, something which must be considered in the long term as a fundamentally important determinant of health. I'm going to argue the point that environmental pollution is very much the concern of a ministry of health and something in which there may be room for specific programs, certainly for intervention at the cabinet table and the Legislature and in every possible forum in society.

I thought the minister was more nostalgic than realistic in remarks he made last week about the purity of the air in the Fraser Valley. I pointed this out once before, but I can't resist reflecting that my community is a major contributor to the pollution of the minister's community in the drift of pollution up the Fraser Valley. I take only a small measure of personal responsibility for this. This is a major problem which I think has long been ignored. It strikes one, from the helicopter or the airplane on a day like today, or yesterday afternoon, that the pall of smog extending up the entire Fraser Valley as far as I could see, from Vancouver Island all the way, I presume, to Hope, certainly must have impacts on health.

These impacts were forecast as early as the 1950s by the Medical Research Council air pollution unit in London, England, largely because of the crisis of the London smogs in the early 1950s in which literally thousands of people with respiratory illnesses required hospitalizations and died prematurely. That led to the first great impetus in air pollution research and the effects of air pollution on health. I was lucky enough to work in the Medical Research Council lab in London and learned then a fundamental observation made by the physiologists and chest physicians at the time: patients could distinguish reliably whether they were better or worse on polluted days, even though physiological measurements could not. Unfortunately, the knowledge gleaned by those very famous professors of physiology at St. Bartholomew's Hospital in London in the early 1950s was lost for a long time because it was impossible to demonstrate statistically through mechanical measurements of the lung the same effects on human health.

The proof of the pudding is that Dr. David Bates, the former dean of medicine at the University of British Columbia, who was a student in those days in London, has demonstrated the health effects of air pollution some 30 years later. In Ontario he demonstrated that hospital admissions due to asthma and other respiratory disease peaked in August during the height of the air pollution season, possibly related to sulphur dioxide; it's very difficult to know exactly to what. Recently he has demonstrated similar effects in the lower mainland.

I understand a paper will be published later this year by Dr. Bates demonstrating a seasonal increase in asthma admissions in the lower mainland in September, quite probably related to atmospheric pollution rather than purely to natural seasonal factors. I don't think this should surprise anyone.

As a physician I have run into this in other parts of British Columbia. In the Slocan Valley, residents who live near the town of Slocan would inform me that when they rounded the great bend of the highway along Slocan Lake and came down over the town of Slocan with its lumber mill, their asthma or chronic bronchitis exacerbated. This was something not well recognized in the medical literature at the time, but obviously a real observation on the part of the patients, and something to which, I submit, we have not paid sufficient attention in British Columbia.

I raise the example of the pollution observed from the helicopter today as an example of the problem foreseen, as I said last week, by the weather bureau in a poster at the old Vancouver airport in the early 1960s, but it was never really acted on. In fact, the whole trend of government policy — or lack of policy — has been to encourage rapid urbanization of the Vancouver district and to encourage single vehicle traffic. There is a lack of attention to car pooling, bus transit and other types of affordable rapid transit to the point where transit fares are now the highest in

[ Page 6086 ]

Canada for a major city. For the average automobile owner, it may be literally cheaper to drive a car than it is to take public transit. Therefore in a sense we have subsidized air pollution, which has been taking a real toll on our health and will continue to do so.

[Mr. Rogers in the chair.]

I think that this is a good example of a global approach to health maintenance and preventive services which no government has taken in British Columbia — and perhaps not in Canada — and which we need to begin to take if we are going to seriously achieve the goals that the minister spoke of this morning.

Let me raise some other examples of what I mean. While we are on the subject of air pollution and have fresh in our minds the introduction of the private member's bill a few minutes ago by the first member for Vancouver South (Mr. R. Fraser), let's consider the issue of smoking in British Columbia. I was very pleased to hear the minister refer to this as one of his principal targets for action. I have regarded this as one of my principal targets for action, both as a physician and as a private citizen, for many years — probably decades now. I think that most of the physicians in British Columbia made this recognition about two or three decades ago.

Historically, physicians in Britain were the first to take their own advice and quit smoking. The health statistics derived from the 1950s demonstrated the major reduction in their mortality. The same was demonstrated in the recent study of American doctors and aspirin, where the death rate was so small because so few doctors were smokers that it was extremely difficult to show statistically an effect of aspirin; so few doctors were dying. Evidently they live quite well in the U.S., maybe better than some of us in Canada.

The real question is: what would be a realistic and serious approach by a government to the problem of smoking. I would like to develop this theme in some depth and perhaps come back to it in the future, because I don't believe that we have ever seriously addressed this problem in British Columbia. I know this from personal experience.

I spoke last week in the house and alluded to a recent experience with students at Lord Byng high school who told me how little education they currently receive. I have repeated that experience over the years all over the province in visits to schools and communities where I worked briefly as a physician, and I found that in general the students told me they effectively had received no anti-smoking or for that matter no health education whatsoever.

I've made it a practice in my own career to ask all patients who smoke whether they have been advised by their physician or by anyone else to stop smoking and whether they have had anti-smoking education. It has been chronically shocking — if there is such a thing — to find that many patients insist that they are not advised by anyone, including their physicians, to stop smoking. Most of those who have stopped smoking, when one asks them why, say it's because their physician told them to stop smoking immediately.

These observations conflict with what we are told by teachers, by high school principals, by bureaucrats in the Ministry of Health or in the Ministry of Education, by the media or by virtually anyone we ask, which is that we have effective health education programs, and effective anti-smoking programs in particular. The reality is quite different. The best way to find this out, Mr. Chairman, is for any member to visit a school in British Columbia and ask the kids what they are actually learning.

The other arm of the argument which is so important is what we say as governments about smoking. Do we in fact encourage smoking, or have we taken sufficient measures to discourage it? At provincial, federal and municipal levels we have been remarkably slow, in my view, to respond to public demands for anti-smoking measures. I found it a delight earlier today to applaud the introduction of the private member's bill on this subject for the Legislature, but I think these measures are long overdue.

[3:00]

Perhaps the most important measure in controlling cigarette smoking is the price of cigarettes. We have major opportunities to affect consumption through provincial pricing and taxation policies. Studies have shown clearly that the demand for cigarettes is remarkably elastic; that is, the more the price goes up, the more the demand falls. Yet we find a situation where British Columbia's cigarette taxes, even after the recent increases of April 1, 1989, are still modest compared to some other provinces. For example, the tax on cigarettes in British Columbia as of today stands at $1.25 per package, whereas in New Brunswick the tax stands at $1.70; in Saskatchewan, a very conservative government, $1.67; in Newfoundland, $1.59. Our tax is higher than some other provinces; the Yukon seems to be the loser on this scale at 80 cents, and I hope very sincerely that that will change.

We know that if we raise the price substantially we will cut consumption, and we know that if we cut consumption we will do more for the maintenance of British Columbian's health than any other single measure we can do. Therefore I think it would be interesting to hear from the minister. Perhaps he might like to respond at this point. It would be interesting to hear what consideration the minister has given to a serious increase in the tax on tobacco — for example, a doubling or perhaps a tripling of the real price of cigarettes — so that there would be a serious disincentive for consumption. If the minister might like to respond, I would be happy to yield.

HON. MR. DUECK: To begin with, I think I should introduce the people here to the new member. This is Stan Dubas, my deputy minister. We have Andrew Hume, executive director of information services, and Rod Munro; I call him the comptroller, but he is also executive director.

I appreciate much of what the member is saying. Really, you are speaking in terms of philosophy, and I

[ Page 6087 ]

really can't argue with any of it. You could be in this chair and I could be over there and we could have a good conversation. Everything you say as far as smoking is concerned and as far as lifestyle is concerned....

One thing you didn't mention and that I have to point out to everyone in this House and that has to be on the record is that there are so many things we can do individually that cost nothing and that will save us money, and we don't do them. That's in the family; that's as parents; as children. How many people have you talked to? I shouldn't say you. You probably have. But in general terms, in your profession, when people come into the office.... We have 35,000 people die a year directly from the use of tobacco products, but no one is really that concerned.

Government can't do that. It's got to be individuals; it's got to be spoken about in the homes; it's got to be brought across to the kids in the homes first, and then in schools, of course.

There's the matter of diet, of exercise, of alcohol abuse, of getting enough rest, of social contacts. All these things cost nothing. You don't need a government. Let's at least start with the things we can do. I think some of us do; I'm sure you do. This is good, but we always want to say: "What's the government doing?" As if that is the father image — government must do this. Sure, government has to come into play, and we do. We have a plan, and we do consider all these things.

Also, you mentioned that health care in this province has been seriously neglected. I differ with you, of course. Is it seriously neglected? No. Much improvement can be made, but we have the best system in the world, and let nobody argue that.

We have a sense of where we're going. I think the speaker opposite mentioned also that we probably haven't got a sense of where we're going. I've only been in this job two and a half years, and of course it takes a while to get going, and a lot of my ideas are just beginning to take hold. But we have an advisory committee on wellness. We have health promotion and disease prevention committees going. We had a national symposium just a little while ago. The thrust and the trend and everyone's emphasis is on wellness. No question about it; you're right on. You people opposite can help us in this area. We will take advice wherever you can give it on any of these thrusts or initiatives.

As far as the price of tobacco is concerned, you won't get any argument from me. You can up it 100 percent; I won't argue. I think it's a good idea. But that's something you'll have to ask the Minister of Finance (Hon. Mr. Couvelier), because that's in his ministry. We do banter, and again and again when I need funds I suggest very politely where he can get some of that money.

Initiatives to reduce smoking. We have a non-smoking promotion planned. We have the Decisions program in the schools, and have had for some time. As I mentioned earlier, some 55 municipalities in the province, perhaps more by this time, have a bylaw in place.

Nothing like this has ever happened before. I remember just a few years ago, if you were in company — and a lot of my friends smoked — no one would ask: "Do you mind if I smoke?" They would come into your house and fill it up with smoke, and you would be the one that would be intimidated if you suggested perhaps this should not be allowed. It's gone the other way, where people are very sensitive and say: "Do you mind if I smoke?"

The trend is perhaps to cut out smoking, sir, and I think it's a good idea. I think we are all on the same track. But I'm not out to preach to people who smoke. I don't think that's where the emphasis should be. The emphasis should be on the young people who come into our world, that they can make an intelligent and an informed decision. I think governments by and large — the federal government, provincial governments — realize that, and they are taking steps and doing whatever they can to go in that direction.

I just got a note here. The commitment is demonstrated by the fact that 71 percent of the population is covered by a municipal bylaw restricting smoking. That's the latest figure we have, which I think is very encouraging.

Thus far, you and I have started off very well. We don't argue on the points you brought up so far. Just keep it up; I love it.

MR. PERRY: Mr. Chairman, one of the members on our side suggested that we should all take the minister's advice seriously and get more rest. After the first week or two here, I would be prepared to second the motion, if it's in order to make it formally later on today.

I was glad to hear the minister respond as he did in some respects, but I think there's a bit more disagreement than meets the eye. First of all, I don't think that I stated that our health services are in sad neglect. I forget the phrase the minister used. I have not said that.

HON. MR. DUECK: Seriously neglected.

MR. PERRY: I may have said that about certain aspects of the health services. I made a point of saying during my election campaign that in British Columbia we probably do have one of the best health systems, if not the best. I don't think that reflects particularly either on the present government or on former governments; it reflects primarily on the people of British Columbia and those who work within the system. But there are some serious problems, and I will be developing those in the days that come.

I would just like to return to some of the minister's responses, which gave the implication that somehow members on this side of the House feel that the government has the exclusive responsibility to deal with public health issues such as the control and prevention of smoking. Nothing would be further from my viewpoint, or that of my colleagues, I'm sure. I think it's interesting that the examples the

[ Page 6088 ]

minister gave of progress in smoking control were essentially all municipal, local or personal initiatives, which I also feel very good about.

My brother was involved in one of the first in Vancouver in the early 1970s, through Dr. Gerald Bonham, the medical officer of health at the time, a study of the effects of the concentrations of benzopyrene, a polycyclic aromatic hydrocarbon considered the principal carcinogen causative of lung cancer. In those days they did a very simple, unsophisticated study, which was to go into the taverns in Vancouver with a filter, draw air through the filter with a fan and then measure — in my father's lab in the department of pharmacology at UBC — the amount of benzopyrene. A paper was published in the British Columbia Medical Journal — not one of the world's great medical journals, but an important vehicle for local communication — which showed something quite startling, which as far as I know was the first demonstration of its kind of the effects of passive smoking: in two hours in a downtown Vancouver pub one could inhale the equivalent in benzopyrene, a carcinogen, of smoking ten cigarettes. Presumably the people who were smoking there were consuming ten cigarettes plus what they were smoking themselves. Interestingly, no attention was paid to that study. I suppose it was filed in the files of the Vancouver health department. It was published in the British Columbia Medical Journal, which unfortunately is not indexed in the computer indices globally, and it was ignored. About five years later people began to rediscover that issue, and we now know officially that passive smoking is dangerous, something that was proven in that study then.

But looking back on what has been done, I think we should be fair to individuals. I'm speaking not only of myself; many physicians, nurses and other health professionals and individuals not involved in the health professions, including many teachers, have been working vigorously to persuade people to stop smoking.

Although I'm not impressed with the global results in the British Columbia school system, there have been individual examples I've seen where children, for example, in Topley Landing in northern British Columbia, because of a science teacher in grade 4, knew as much or more about the health effects of smoking as most physicians know — certainly most of my medical students. The individual influence of a particular science teacher had been extremely constructive, and none of those kids smoked.

The problem is that we haven't made that universal, and the statistics are very alarming. In fact, more British Columbia children, particularly girls, are smoking now than ever before. I don't pretend to understand completely why this is happening. I'm sure the government doesn't either. But this should be something which alarms all of us, not only because of the human cost, which will be women and men 20, 30 or 40 years from now dying of incurable diseases like lung cancer or suffering severely from the ravages of chronic lung disease or cardiovascular disease, but also the cost, which will be borne by all of us.

Despite the comments of the Attorney-General (Hon. S.D. Smith) the other day, I still think the minister is likely to have more clout with the Minister of Finance than I have. I would urge him to argue in cabinet the point for real increases in tobacco prices. I will continue to do that from this side of the House, but I recognize the obvious, which is that at the moment the minister has more power to do this than we on this side of the House.

I therefore see a very important role for government action added to the individual actions of health professionals and private citizens.

[3:15]

Let me just pursue a few other examples of what I mean by a global approach to health planning, which I think has been deficient, not through lack of good intentions but through lack of sufficient planning and, perhaps through lack of that, manpower. There is another important reason, which is an unwillingness to consult with the people most involved, including the patients and the health care workers from the bottom up, be they members of the health employees' union, the RNABC, the B.C. Nurses' Union or the physicians in this province.

One of the obvious things to a new health critic like me, as well as to someone who's worked in the system, is that government consultation with those who work in the system as opposed to consultation with employers has been quite inadequate. An example of this was given two weeks ago by the health employees' union, in which they complained that the government refuses to meet them to discuss the problem of the licensing of practical nurses. I found it difficult to understand why the government would not want to meet with them. Perhaps the minister can clarify this situation. I've run into similar situations frequently in medical issues to which I've been exposed, and I find that troublesome.

One of the best examples of the outcome of that failure to consult or to listen to what is being said by the professionals in the field is the situation we face in nursing in British Columbia. I think it's painfully obvious that the government has been aware for a long time — there are official reports, and the minister alluded to them in his remarks both in this session and last year in the House — that a nursing shortage was looming in British Columbia. Some efforts have been made to address this situation.

The minister referred earlier to efforts to address the shortage of specialty nurses. I know that ten years ago, when I was working in intensive-care units, the nurses were asking for training programs paid out of public funds so that they could take specialized training in intensive care, instead of having to not only sacrifice their wage but also pay the price of the course. In various paroxysms the government has responded and briefly funded courses, then left them unfunded again. We have faced a chronic shortage of specialized nurses.

I find it disturbing that the budget, in my preliminary glance at the estimates and what was said in the House, does not appear to face up to the seriousness of the nursing shortage. We see this in the problem of

[ Page 6089 ]

announcements for open-heart surgery in Kelowna, where, as the member for Okanagan South mentioned, there are serious concerns that it may be impossible to staff these units. We know now that the reason for waiting-lists for cardiac surgery is not primarily underfunding but lack of trained nursing personnel to perform the nursing duties required.

Similarly, we have seen this problem in the Children's Hospital. It's a perennial problem there now. It's a problem right at this minute, as we speak: children who are psychologically prepared for an operation by their family, families who make plans to travel from wherever they live in the province to the Children's Hospital, who schedule their vacations and make all the arrangements necessary, arrive to find that the surgery is cancelled simply because there are not the nurses to look after the kids in the hospital. This is a problem that I think will only be exacerbated unless, as I said in my speech in the budget debate last week, we face up to the problem that the minister acknowledged last year, which is that nurses are undervalued and underpaid.

This issue obviously is under negotiation now. It's not appropriate for either me or the minister to comment in detail, but it would be refreshing to see a commitment from the government that sufficient funds will be provided to the hospitals, as the employers, so that they can make a meaningful settlement with the nurses. I think it's painfully obvious, as a matter of fact, that without it we can't resolve this situation. I don't think it's a matter of opinion. The proof of that is really in the remarks of the Minister of Health last year in the estimates debate.

Maybe the minister would like to respond now. I would be happy to yield, or I could continue — at his pleasure.

HON. MR. DUECK: There was a sort of question, and later on the member said: "Of course, it's not appropriate." I wish it would be one or the other, that I did not want to meet with HEU.... Then he said: "Of course, it would be inappropriate to do so." It is inappropriate, and I certainly don't want to get into the discussion about settlements or negotiations at this time. It would be completely inappropriate.

But I will say this: I have never refused to see anyone in my office. My record is very straightforward on that. I may not be able to see them whenever they wish to see me, because I'm quite busy, but I have never turned people who wished to see me away from my office. I want to make that very clear, and I want to have that on the record. I think you'll find that's accurate.

As for the waiting-period for people in hospitals, I think it would be very naive.... You were in that profession — and you still are to a degree — so you know that we will never come to a place where we will be able to provide surgery the day people wish to have it. That is absolutely not possible in our system. We haven't got enough money in the world to do that. But I will tell you that the latest figure we have is that 80 percent of in-patients and 85 percent of out-patients wait less than eight weeks. That is for elective. If there is an emergency, of course.... I don't have to tell you; you are more aware of it than I am. I get it from my travels and you've been in it. So it is not bad at all. There are times when I am quite disappointed, as I should be, when people have a surgery cancelled, especially when they are from upcountry. Although it is elective, they may have to wait or come back. We're trying to correct that.

Consultation. I think the remark was made that perhaps there was not enough consultation with outside people. I will have you know I don't think that the Ministry of Health has ever consulted as much as it has in the last two and a half years. We got something like 5,000 replies on the mental consultation review of Riverview Hospital. We did a mandate review of facilities, and there were 700 replies from institutions and facilities. That's just an overview of some of the consultation. You can fault us for many things, but I don't think you can fault us for not consulting or not being willing to consult with people: nurses, physicians, facility operators, boards, societies. I've met with all who have requested it — and some who haven't, and I've asked to see them. I think that's good, and I think that's also my responsibility and my mandate. I am not trying to take some credit for it and say what a great guy I am — not at all. That's my job, and I want to do that, and if I've failed I will correct it and do even better.

Shortage of nurses. It's been brought up again and again in the House. Perhaps if we paid them more.... That's under review. As you well know, it's by contract, by negotiations. But if the United States has such a better plan, why are they looking for nurses? If the rest of the provinces are so much better off, why are they looking for nurses?

I checked with the president of RNABC just the other day, and they tell me that there is no net outflow. It is about equal; we get them and they go. We haven't got a great big army of people leaving this province. I hope that once the negotiations are completely over we get back to having a good working relationship, because nothing is worse than having negotiations that drag on and there are hard feelings. I hope this doesn't happen and that it does not continue. I hope that we come to some settlement.

We've done a nurse manpower study, as you know, and there were certain things identified as to the shortage, which we are aware of. I have already alluded to some of the corrective measures we have taken, such as the extra money for critical-care nurses. It wasn't just critical-care nurses; it was also perfusionists. There were all kinds of other problems. There was also the waiting-list which grew larger and larger because one particular physician had a longer waiting-list than others. You should be very well aware of that. People were not willing to change. We have even suggested another hospital like the Jubilee here in Victoria, which sometimes had a very short waiting-list, and we were able to bring them in here and have the operation done sooner.

The other answer I should give you as to the question of shortage of nurses or waiting-lists is that it's the time-period, not necessarily the numbers. You

[ Page 6090 ]

must agree. It's how long they wait. When we look at the total aspect of waiting and people wanting to get into hospital, you must also remember that the increase in open-heart surgery has soared tremendously. You know that better than I do. Where just a few years ago we did a couple of hundred, we're now doing 2,000, plus angioplasty. How many of those? It's a tremendous, growing industry. We're helping many people live a very good life.

It's been suggested from the other side, from our side and from people from the medical profession.... As a matter of fact, if you have followed the politics closely you will know that I was completely hammered in the House when one day I took up an article written by a physician that said perhaps some heart surgery was trendy. The blame was laid on me, as if I had made the statement that heart surgery was trendy. My health critic from my previous life, from whom you've taken over now, asked in the throne speech debate, I believe it was, if all these heart surgeries were really necessary. Suddenly it's in vogue to say: "Well, maybe that procedure wasn't necessary." Now the medical profession are writing letters. You know, when I made that statement in the House, when I held up that article, I got more letters from the medical profession, saying: "Right on! It's about time somebody said it."

Why do we have differences from jurisdiction from jurisdiction? In one jurisdiction we have hysterectomies done by the hundreds and thousands. Another jurisdiction that's just a few miles away does very few. Why?

We get criticisms about whether these medical procedures are necessary. Who's making the decision? The medical profession. We trust them; they are the experts. Surely you don't expect me to go into a hospital and say: "Aha! Maybe you shouldn't have done that." Maybe we should have some doctors on salary. Maybe we should have a second opinion. These are all options, but thus far I think our medical profession has been very good, very honourable, very sophisticated in their approach. They have looked at operations and said: "Yes, if we don't do this within a certain period, there may be some problems."

By and large, I think the system is working well. We can make some corrections. The United States, I understand, has gatekeepers because they work on private insurance. They have gatekeepers who say: "I'm sorry. You're not going to get an operation," and out the door you go. Or: "Have you got money? If you have, you may come in. If you haven't, we don't want you." They'll even go out and say: "Have you got money? You have a little bit of pain, haven't you? Let's do an operation." It's pretty wild out there.

I think we can look at our system and say it is good. We have a good, solid system. We're moving ahead very pragmatically; we think things out before we do them. The health care system in the last few years, as far as I'm concerned, although there are many warts and blemishes, is not bad. We can correct many things, and with your help I'm sure we will be able to.

The number of open-heart surgical procedures for 1988-89 was 2,095, an increase of 228 cases from the previous year. That's just in one year. The number of pediatric open-heart surgeries declined slightly, but the demand was fully met. So we were not bad in the children's surgery, but we were somewhat behind in the other. The increase is dramatic. I'm glad we were able to do this, and to do it in British Columbia.

[3:30]

The same with the transplants: we are now doing them in British Columbia. We were sending people to Edmonton. We had a contract with them; it cost us more. People had the anxiety of being out of town, being somewhere else. We'll be able to do those at home, and hopefully we'll be able to catch up and have a shorter waiting-period for people and have fewer people waiting, especially if it's semi-emergent. Emergent cases, of course, have always been looked after immediately. By and large, there are corrections to be made, but I'm quite happy that we are improving and going in the right direction.

MR. SERWA: Mr. Chairman, I would just like to interject for a few minutes here and say how much I am enjoying being in attendance in the House listening to well-reasoned presentations that are well researched and, as a result of common and shared interests here on both sides of the House, devoted to the health and welfare of the people of the province. If we can continue on this level of presentation, this is going to be a most enjoyable set of ministry estimates to listen to.

I enjoyed the minister's dialogue, with the emphasis on prevention and wellness for the people of British Columbia. For a number of years dental surgeons have carried on a very extensive presentation. As a matter of fact, for the past 30 years or more, we knew that with proper dental hygiene we could really reduce cavities. They appear to be determined to work themselves right out of business.

I recognize, as the hon. member for Vancouver-Point Grey has said, that government cannot do everything. I would like to know what percentage of the Ministry of Health's budget is being spent at present on the preventive and wellness aspects of health. It appears to me that many other agencies are participants to a degree, such as the public school system. Some organizations.... The Lions have the Quest program. But it seems to me that if we're going to be successful in reducing the demands on the hospital system, especially being aware of the baby-boomers approaching their odd-forties, we have to start emphasizing and recognizing that not only does that emphasis have to be made but there has to be a firm commitment to provide funding for a long time — certainly a generation at least, the 20 or 30 years required to educate the young people coming up through the system. That appears to be the only control on the future. Over a third of the provincial budget is spent at present by the Ministry of Health, and there is concern expressed that we are not going to be able to sustain the needs if people continue to abuse the bodies that the Good Lord provided.

[ Page 6091 ]

HON. MR. DUECK: Mr. Chairman, it's very difficult to really give you a percentage of the total budget, because preventive health is being practised in doctors' offices, in hospitals, by physios, in occupational therapy and in union boards of health. I suppose we can come up with a figure, but I haven't got that in a percentage at this time.

MR. PERRY: I am quite eager to hear what my colleague has to say in a few minutes, so I'll try to be brief. I just want to thank the member for Okanagan South for his comments and I would like to say how much I am looking forward to continuing the debate when I can look at him from the other side of the House. In the meantime, I'll enjoy it from where I am.

I think the minister misunderstood one of the points I was making. I would just like to correct any misapprehension. I wasn't suggesting that he meet with the health employees' union now to discuss their contract demands in the midst of negotiations. The point they had brought up, if I understood it correctly, was that they are concerned that new licensing procedures required by statute might lead to the elimination of some of their jobs and to a situation in which an employee, for example, who had worked 15 years as a practical nurse, might not be granted a licence.

I found, frankly, that the concern struck me as somewhat excessive, and I don't think the province can afford to do without their services. I could not imagine the situation in which employers can dismiss such employees, because we can't run our hospitals without them. I told them so at the time. Nonetheless, it's a real concern. They feel they had taken the trouble to come to Victoria to bring this to the attention of members on this side of the House, and I can only relay their complaint, which was that they had not been able to achieve a meeting with the government on this.

I have no reason to doubt the minister's statement that he meets all people who request to see him, but I can simply say this is what we were told. I think it's an example where consultation is failing and where a rather simple consultation could avoid problems before they occur.

I'll give another example, since I'm not sure the minister took my point accurately. He was kind enough to arrange a briefing for me on the new Continuing Care Act. When I asked the officials, who briefed me very thoroughly, whether they had consulted with the employees that work in continuing care, the answer was: "No, that would not normally be something we would do." All I can say is I expressed surprise at the time; I express it again. I would think that it is obviously in the public interest to consult with employees affected by legislation, if only — I see the deputy minister shaking his head — to learn their concerns and attempt to respond to them. I don't see why one party or another would not be interested in knowing the views of people who are also directly affected by legislation, at least potentially.

I am concerned somewhat at the information reaching the minister. I think — through no fault of his own; he is faced with a tremendously difficult job — that he is perhaps not fully aware of real circumstances in British Columbia. I'm referring to his reply to my comments on the cancellation of elective surgery.

I would like to make the point again, with one very important example. The Children's Hospital of British Columbia is a hospital which by virtually any expert account was underbuilt and supplies far fewer beds than any other jurisdiction in Canada. If we compare it to the Hospital for Sick Children in Toronto and the population it serves, or the Montreal Children's Hospital, or the children's hospitals in Edmonton or Calgary, our children's hospital is expected to serve a much larger population.

I have this from the chief pediatrician there. Children frequently arrive at the hospital for scheduled elective surgery — I am not referring to the waiting time which may be very long indeed, or it may be shorter, and the parents have telephoned the hospital to confirm whether they should come from Prince George or Dawson Creek or Atlin or wherever they reside, and they arrive at the hospital only to find there are no beds. I have, unfortunately, had personal experience in my family of this situation so I know that this is not an exaggeration. I have no reason to think that the chief pediatrician of the Children's Hospital would exaggerate his concerns. I can only wonder whether the minister is fully aware of the situation which has been tremendously troublesome, and for which the immediate remedy is the hiring of new nurses.

The truth is that conditions are, in some jurisdictions, better in the United States. In some places nurses are paid up to $80,000 (U.S.) per year through private agencies. Also, nurses are simply finding it's not worth their while, and they drift into other professions right here in British Columbia; for example, real estate, in the booming Vancouver market.

The last point, since it was raised, is the issue of transplants. I think we have seen major improvements in this field; there's a very progressive program now. To be historically fair, the impetus for this program has come not from the government but from the physicians. I had some exposure to the process during my specialist training, so I know that for a long time there was a totally inadequate number of kidney transplants being done in British Columbia; an enormous dialysis list built up. The cost saving to the government was pointed out extremely clearly. Eventually the argument evidently convinced the government that an annual cost in the range of $40,000 for dialysis for one patient could clearly be improved on by renal transplantation.

I think the government's current actions are commendable. Let's not forget that the impetus came from the public, not from the government, in this case. We have seen some fiascos, such as the charge to renal transplant patients for their cyclosporin, clearly an integral part of their treatment without which the

[ Page 6092 ]

transplant would fail, where it took a public campaign to reverse the charge.

I would like to leave it at that and come back to the themes a little bit later after we hear from my colleague from New Westminster.

MS. A. HAGEN: It's a pleasure to participate in the debate on health estimates for the third year and to acknowledge the new title of the minister: the Minister Responsible for Seniors. I'm really pleased that that particular title is one to which he gave so much attention in his comments about his estimates this morning. As he well knows, it's the area I will want to discuss in the debate this afternoon.

I would also like to welcome the deputy minister and the other two officials who are here to help brief the minister during our discussions.

Without question — and I haven't got the total speech of the minister, which was quite a lengthy and very useful one, I think, that led off this debate — the minister has spent a very large amount of time talking about initiatives in respect to the older people of the province. I know from discussions I have had with him since the throne speech and the budget speech in late March that he is very pleased with the work that has been done in that area. I think there are, within the plans of the government this year, some very good initiatives indeed.

What I want to do with the time available is to try to be as focused as I can be around some questions and issues that I would like to take this opportunity to discuss with the minister in this much more open forum than we are usually able to have in this House. I thought that the point at which I might like to begin is just a bit of an overview of the issue of seniors.

The occasion this year is much happier than those of the previous two years in which we have had discussions around the needs of older people in this province. I think the minister would agree with me that they have been unhappy times; they have been hard times for older people. On behalf of his government, the minister has been the bearer of news of initiatives that have taken place without consultation with older people and that have affected their economic well-being and their sense of security.

[3:45]

Just to quickly recap those times and the ongoing effects, user fees for Pharmacare and for alternative therapies were introduced in the first year of this minister's responsibility for health. In the second year there was a really major battle over user fees in the long-term-care area. There were very significant increases for people who live in long-term-care facilities, to the tune of.... Something like $23 million in additional income came into the long-term-care funding formula from the increase from 75 percent to 85 percent. Those increases continue each quarter as people who are in long-term-care facilities have an increase in the fees that they pay.

The initiative last year that caused the greatest concern was the plan to income-test the fees that people pay, not only when they live in facilities but if they are in receipt of homemaker services. I think the reason that seniors felt so betrayed by that particular initiative was that it had come without consultation with them.

I remember that in that debate, when we were discussing it during the minister's estimates — and that was only a part of the discussion we had in last year's estimates — the minister noted that there had been some discussion of this in a major mandate review that the minister had commissioned shortly after he took on this responsibility in the fall of 1986, a review that has still never seen the light of day. It still has not had any publicity or exposure to the cumulative results of the input of many people who were concerned about the mandate and the delivery of services under continuing care.

I think people felt betrayed because there had been no consultation. Whether they were consumers of services, families striving to look after older spouses or family members, or the hard-pressed caregivers, they felt betrayed by that initiative. The government backed off that initiative and did not implement the income-testing user fees. I believe they changed their minds last year, first of all because it was a politically undesirable move on their part to go ahead with those user fees. I haven't had an opportunity, though, to find out whether they backed off for a more fundamental reason, that they had in fact reviewed policy on user fees to guide any future initiative that they might take in the imposition of user fees.

I know this minister has on many occasions expressed his own philosophy about user fees. He has said he would like to have user fees on medical service premiums. He has gone to the federal government urging them to change their procedures in that regard. He has said many times in this House that he believes user fees are appropriate.

As my first question to the Minister of Health, I would like to ask whether it is still the policy or the philosophy of this government to use income-tested user fees for homemaker and long-term-care services.

HON. MR. DUECK: I have no plans of introducing.... I'm glad you are saying income testing rather than.... Last year we had an awful time trying to convince or educate some people who were using the wrong phraseology by talking about assets. We were never considering assets, but we had before us a recommendation that income testing would be appropriate in certain areas.

I have to explain even for last year, so that we don't.... I want to make it clear that there are no plans in place to have income testing, but at the same time, I had a plan last year, and had I introduced it, it would not have been objectionable to anyone. But no one would listen, including your side. We were talking in terms of anyone earning $20,000 after taxes paying 50 cents on every dollar over and above that — it was more than $20,000; it was $24,000 or something. We were only going to get those people with large incomes. This was strictly income after taxes.

I still agree that "Why should I use the system and get everything free when I don't need it?" On that

[ Page 6093 ]

principle, I felt that someone with all kinds of money should pay for the services. The BCMA, which your member on that side is a member of, lobbied me as minister to go to the federal government. They sent a letter to the federal government recommending a user fee for medical services in doctors' offices.

It wasn't just one-sided. It was really put forward by a lot of people, including the BCMA. Be that as it may, the Canada Health Act does not allow even an introduction, even looking at that area, and we have not followed suit other than telling the federal government that unless they are willing to make the transfer payments equal and go up with inflation, it's pretty tough for provincial governments to supply all these services. Now this year it's $3.4 billion, not including environment and all the other areas that refer to health, which makes it a very huge bill.

It's easy to sit on that side and criticize that we should do this or do something else. It's another thing to get the money and do all those things that you'd like to do. Even myself, I have to admit that there are certain areas I would like to expand if I had the resources. Maybe we're not that far apart, but we always have to balance where the dollar is available and how far you can go.

But the long answer to your question: we're not planning on introducing income testing.

MS. A. HAGEN: The minister has very clearly given me a twofold answer. One part is that it is not the government's plan to introduce income testing on homemaker and long-term-care fees at this time. The second part is that it is still the philosophy of this government that user fees are appropriate for health care.

I would like to make sure there is no misapprehension on the part of the minister that policies of an independent organization such as the BCMA are policies of this side of the House. We have, I think, made our position clear on the universality of health care and the using of the income tax system to deal with some of the areas you might want to tap as a source of additional income, as a means for a fairer system. If both of us were talking about a fairer system and a tax system that worked towards that fairness, we might indeed have agreement.

I want now to look, in a broad way, at the initiatives the minister announced this morning around what I guess I would call a consultative approach with older people and the caregiving community and families that work with and are concerned about older people. The minister mentioned a number of initiatives that he plans to take. One of them is that he will soon be publishing a report toward better aging, with strategies that might deal with that title. He spoke about a task force that will be traveling around the province. He says there will be legislation to establish a seniors' advisory committee, and he talks about setting up a seniors' office or a seniors' secretariat in his own ministry. Very much a focus on seniors.

As the person who, through the time that both the minister and I have been members, has been the spokesperson for seniors for our side of the House, I want to put those initiatives in something of a historical perspective. Over that period of time there has been, I think, a tremendous amount of consultation, and I give the minister full marks for the kind of consultation he has engaged in, particularly with the providers of service. I think he has a good record in that regard. But the minister seems to be reinventing some wheels at this time in some of the work he is doing.

The mandate review done in 1986 was a major review in terms of the responses that it received. He'll be able to tell us the number of people who responded, but I recall the minister himself saying there was something like 700 or 800 submissions to that review. That was, admittedly, more targeted to the providers than the users, the consumers of service. It was input from the various people who work all across the province to provide service for seniors. In that regard it certainly was not an all-encompassing approach. I have been very disappointed, as have people who contributed to that mandate, that it has simply been lost in the ministry.

I know the minister will say it has not been lost. He will say it has provided the kind of information he needed over these two years to get on with his planning and the initiatives he is announcing this year in this House. When you ask people to contribute to your policy planning and to the directions you may want to take, the most fundamental courtesy you accord those people is to share not only your own responses to that mandate review, but to empower them with information about what has been said by others who have similar kinds of interests to the contributors. This minister has a record of not following through on that kind of disclosure, if you like: sharing publication of the work that has been done on behalf of people by, in this case, caregivers in the province.

Now we are talking about embarking on consultation with older people. Up until now, older people have consulted with the minister mostly in a reactive way, because they have been so disturbed about initiatives of the first couple of years of this government's mandate. There will be some skepticism and some cynicism, perhaps, as the minister goes about it. On the other hand, I think there will be pleasure that there is now a process for open consultation. However, if the minister goes about that consultation without giving to all of us — consumers, caregivers, people who are interested in policy — some perspective on where he is coming from, we won't get nearly as much out of it as we should.

Before the minister begins what I anticipate will be his travels to various parts of the province as soon as we finish with the estimates, I would like to have some idea about what the mandate is for the task force; what the terms of reference are for the appointment of people to that task force; whether there is a plan that some of the people on that task force will in fact be representative of seniors' groups, not just chosen by the minister but actually selected by some of the major seniors' organizations in the province,

[ Page 6094 ]

and recommended to the minister for membership on that task force: organizations such as COSCO, the Old Age Pensioners' Organization, or the seniors' research and referral centre, just to name three organizations that are broadly representative and with membership open to any seniors interested in the affairs of their peers. Those same principles, I think, should apply to the seniors' advisory council. I understand from the minister's comment this morning that he intends to enshrine that particular group, through legislation, which I think is a very good move, if in fact the seniors' advisory council is to be a mandated group whose status is protected by legislation.

[4:00]

[Mr. Rabbitt in the chair.]

I'd like to ask, again in a kind of principled way, if the minister is looking to clarify now, before all of the actual meetings begin to take place, the mandate that these groups have and the ways in which he would, in general principles, look to select or have appointed to these two bodies, the task force and the seniors' advisory council, representatives from consumer groups. I might say that I think that the same principle should apply for representatives from workers' groups and representatives from agency or operator groups. The idea of representation would be a very important principle for the minister to consider and incorporate into these bodies, so there is the sense that these people are free both to speak on behalf of and to carry back and forth perspectives between the ministry and the various parties who I know will be participating in the consultations that the task force and the advisory committee will facilitate.

Perhaps the minister can give us some perspective on how he intends to go about this mandate, appointment — representativeness with consumers, caregivers and other groups which will be a party to those advisory bodies he is establishing.

HON. MR. DUECK: Mr. Chairman, I should add a little bit to the previous questions that the member opposite asked about some testing of a homemaker. That is in place and has been for years and years, and you are aware of that. I just didn't want you to misunderstand. It is still there. But what we had planned last year, had it gone through, would have relieved.... In other words, more would be receiving homemakers and not paying for it. So it was an improvement in that area, but we have left it as it is.

Another thing I might mention. I visited Europe and looked at health systems in five different countries. Since we are talking about user fees, I found it absolutely astounding that Sweden, the capital of socialism, which had everything from the cradle to the grave.... We all looked at that country as being the country that had the best health care, free and universal. To my horror — I didn't know until I checked with government health officials — they are charging 55 kronor, which is roughly $11, for every prescription up front. When I said to them that this is really astounding, that I had never heard of this before, they just told me in a very point-blank way: "Do you think health care is free? You'll learn, when you get full circle. You'll learn that there is not enough money in the world to cover it."

They also have a good safety net that catches all the ones who can't pay, so I must say that they look after the poor. They were very straightforward in saying: "What's wrong with that?" Many other countries, of course, are the same; they are doing that. But I want to put you at ease: we are not planning on putting in income testing, just so you know.

Within "Toward a Better Age," we have two initiatives. One is a task force, which we will be making a public announcement about on April 25. You will then hear all about it. I will not go into that any further, except to say that it will be a discussion paper called "Toward a Better Age" and that there will be strategies for improving the lives of senior British Columbians. We will be releasing that information on April 25, and we will be going around with this task force to ask for information and concerns of seniors in various communities. As a matter of fact, we are identifying 21 communities in the province.

The task force is going to be made up of four individuals, who will be doing that work; I will not necessarily travel with them. It is strictly a forum where people can come — whether it be a society or individuals — and bring their concerns and priorities forward. It's not just in the Ministry of Health; we are going cross-ministry. It applies to Transportation, Housing, Environment — you name it. It will go across government ministries. What are the concerns and what should government look at? We want to have an open forum without a politician there, where they can come and talk freely about their concerns. Those will then be brought back to us.

An advisory committee will be made up of people from various areas, hopefully from every region and various backgrounds, and will advise the ministry on the concerns of seniors.

I think I've covered most or all of the concerns you had; I'm not sure whether I missed something. If I did, you will bring it up, I'm sure.

MS. A. HAGEN: Just a comment about the reference to Sweden and the fees there. Those fees, I understand, are capped at a very low level, and we will come back to talk about the capping of our fees a little later, Mr. Minister.

Interjection.

MS. A. HAGEN: Yes. We have a system like that with Pharmacare, and there is a cap on it. I understand that there is a cap on the payment in Sweden as well. So they don't pay for every doctor's visit; they pay for every doctor's visit up to a certain amount, a little over a hundred dollars.

I gather, then, that the minister is not prepared at this stage of the game to discuss this issue of mandate. I'm not going to belabour it, because there are a lot of things that we want to get on with today. But you know, if we're going to talk about a care system

[ Page 6095 ]

for older people, we certainly need to do it within a framework. With all due respect to the minister, it seems to me that a framework clearly needs to be there. I will look forward to the discussion paper, and I anticipate that it will indeed have some of that framework. He'll know what I will be looking for in it.

It's always good to go out and talk to the people who are affected by the decisions we make and who need the services that are a part of government and community work. I think, however, that sometimes we may be in danger of also using that as a tactic that delays us from getting on with things. I hope that's not the case, because there are some very major things that need to take place.

For example, if we want to look at what we already know, a document that I am sure the minister knows and that I use often is one called "Toward a Community Support Policy for Canadians." It's a discussion paper released by the National Advisory Council on Aging in 1986. There is a single page in that document that provides almost a bible for any government in terms of the policy action it needs to take around community support services.

This is a product of hundreds of people participating, not just in talking-heads sorts of discussions but in very extensive discussions — what they call "listen to me" discussions. People really round-tabled and worked on the themes and issues that were important to them.

The fundamental concern of the hundreds and indeed thousands of older people who participated in this consultation process was that the primary interest of seniors is to continue to live autonomously in the community and preferably in their own homes. That word "autonomously" is one that I want us to keep in mind this afternoon, because we need to talk to older people about their autonomy, and how they control their lives, not simply about how we provide care for them.

The mandate and the perspective we take into these discussions is extremely important. Throughout all the discussions we'll be having this year, I want to say to the minister that I'll be looking for those tones and perspectives that reflect the autonomy and empowerment of older people.

I want now to turn to some of the nuts and bolts of this debate. We've been talking about some of the philosophy and procedures. The minister repeated comments he's made about additional dollars available for the continuing care system. That system is the safety net available to older people either for chronic health disability or frailty reasons. It's a very important part of his ministry, and one that's incredibly important to a lot of people.

One of the characteristics of this whole discussion we have about seniors is that we're not just talking about the 360,000 people over 65 in the province — or the 370,000 or the 380,000; the numbers are increasing. The minister notes that he is one; I'm getting closer to one milestone — one of several. We're not only talking about those people, but we're also talking about their families right through to their grandchildren; we're talking about the caregivers. We're talking about something that literally affects thousands of people. The minister probably knows better than I the number of people who actually work in a professional way in this particular field.

The minister noted that there are some increases in dollars coming into the system at this time. I want to use some material as a benchmark for measuring what those dollars are going to do, and indeed whether this government is moving fast enough in this area.

First of all, I want to state that it's an area that has been neglected. I'm grateful to an article in the RNABC News of January-February 1989 for producing some very useful statistics about the continuing care program. It notes first of all — I think this is something we don't pay enough attention to — the number of families in British Columbia who live below the poverty line. It notes that the percentage of families living below the poverty line has increased significantly since the beginning of this decade. In 1980 those living below the poverty line were fewer than 10 percent of our population: 9.5 percent. That's too many, but that was the figure at that time. The figure rose to over 15 percent in 1984, at the end of a very serious economic downturn — almost a depression — in this province.

Even in a period when we saw some recovery, we were still looking in 1986 at a figure of 13.3 percent. If I were able to extrapolate that to more current studies such as the "ReGAINing Dignity" work that's been done by SPARC in Vancouver.... We know that people who live in poverty are a very major component of our population. It's too large, and it's bad news for us all. It's certainly bad news in terms of the initiative of the minister around prevention, because if you live in poverty, you're not going to be able to deal with prevention. You may not get enough rest, in fact, because you've got to work and look after your family. You may not have an adequate diet, and you may smoke because of stress, even though we wish people would not.

[4:15]

This same article notes that a full 33 percent of unattached individuals — individuals living alone — are living below the poverty line. That has implications for older people, because in my community, for instance, the number of people who live alone is two to one. There are twice as many people living alone as people living with spouses or partners.

The same article notes the level of dollars available to continuing care over a period of four years from 1983-84 to 1987-88 — in actual dollars $320 million in '83-84 and only $10 million more in '87-88, $330 million. If we're looking in constant dollars — what those dollars will purchase — we'll find that continuing care dollars have gone down from $320 million to $285 million in that period. That doesn't address at all the demographics, the increasing number of people who are older and in receipt of care. I think one figure in the auditor-general's report notes a 45 percent increase in requests for home care in that same period.

[ Page 6096 ]

As we look at the figures the minister has tabled with us — the dollars that are available for these important services — we have in those numbers some indication of an underfunded system. It's what one senior executive director who works in the care system has called a siege situation within the industry.

I'd like to also read into the record some material I've had for some time. It's material that came to me in a brown envelope. Quite honestly I made the decision I would not use this document until the government had time to respond to what it had to say. It speaks about the historical shortfalls "for continuing care facilities and home support agencies." In the background statement it says:

"The underfunding for staff, and in the private sector for capital and maintenance costs, has encouraged the reduction of staff, provision of compromising diets, application of user charges for incontinence supplies as well as the imposition of room differentials. Home support agencies have trained employees who subsequently left for higher levels in unionized facilities, which has generally meant a compromise in standards of service to our home support clients."

We're really talking about the situation I discussed in the last couple of years in estimates where the long-term care industry and the home support industry were advising the minister that the situation had reached crisis proportions.

The document goes on, and I think this is perhaps the most significant statement in the perspective that's presented:

"Although most clients and owner-operators believe in ensuring proper control of government spending, the community and industry does not subscribe to the current resourcing of care, which compromises the health and safety of residents in both the community and facilities. The large number of complaints received monthly by the continuing care division, MLAs and the Premier is a testament of an industry in trouble."

I want to emphasize again the statement, "...the community and the industry does not subscribe to the current resourcing of care, which compromises the health and safety of residents in both the community and facilities."

The material then goes on to talk about what is needed simply to bring the industry up to what it acknowledges are already outdated and inadequate guidelines around staffing and to deal with the very fundamental needs of care facilities and home support agencies to provide for the people for which they are responsible.

The minister has indicated a total of some considerable dollars that will be available to address the very critical issue that has come to his attention and has been in the hands of this government since last year's session.

I think that organizations such as the Home Support Association of B.C., the Long Term Care Association, Pricare, workers who are in the field trying to do their job in long-term care facilities, workers who are working for pitiful wages in the home support industry, are really eager to know what is going to be available to them this year. Let me just say that the total dollars that were called for in that document to arrive not at any improvements in service or any improvements in guidelines for staffing that were already outdated, but simply to bring the funding up to a level that would allow for that health and safety, were in the order of $117 million.

The final recommendation states that to approve this cost shortfall to meet our political mandate — and I note that the briefers to the minister and the government were aware of political implications — is "...to provide a measurable level of safe and health-driven care for residents of British Columbia through the ordained intervention of the home support and facility care. This financial initiative will correct as much as four to eight years of increasing inequity in the system."

MR. CHAIRMAN: I regret to inform the member her time has expired.

MR. PERRY: Mr. Chairman, I am finding these remarks so fascinating I would like to hear more from the member for New Westminster. I would like her to reiterate the title of the document for my interest when she begins again please.

MS. A. HAGEN: This is a Ministry of Health continuing care document to the cabinet. I don't want, Mr. Minister, to get into a detailed discussion about all the aspects of the continuing care budget. There is no question that there are increases this year. I haven't had an opportunity since this morning to study more carefully some of the figures that you read into the record with your address in preparation for this debate this morning. But I would like you to perhaps take this opportunity to provide some information to those people in the field about the government's response to the needs which they have presented to you on many occasions and that I know have been documented well for you by your ministry staff.

I think at this point, as the minister responsible for seniors and as a person that I know really is concerned about that aspect of the ministry, that you provide as clear and honest information as you can and are prepared to do about how you plan in this year's budget to address those fundamental issues that really are just designed to get the industry, the services and the support for staffs up to some basic level.

I know there are more dollars there. I don't think that there are enough, and I know that, as the minister says, there are never enough. But I know the industry too has welcomed the dollar initiatives that are there. This is an opportunity for you to give us some information about how you plan to deal with those inequities, how you plan to deal with some of those health and safety issues. I will listen carefully and look forward to some opportunity to discuss your response with you.

HON. MR. DUECK: I am sure that we will have ongoing discussions in the future, which we have had in the past. I know you take a great interest in that subject, which is admirable. You quote a document

[ Page 6097 ]

that was given to you. We receive many documents from many people. That particular document we found inaccurate, and certainly we have not followed through on those particular figures.

We are in the process of allocating the funds available at this time. So I haven't got them before me; I have the total amount, but we have not yet allocated it. Except that we have identified the inequality of the homemakers, one versus the other, and we are trying to bring them up to a standard equal to the ones at the upper level. So that will be done.

You also mentioned that in constant dollars perhaps we haven't kept up with the funding. I think we are also much more efficient than we were some years ago. I think we are providing far more care with perhaps equal dollars or less dollars than we did in the past.

For example, our numbers of monthly hours per patient perhaps have gone down. But we have not covered all the items we covered some years ago like canning, sidewalk snow clearing. All those things were eliminated from this particular homemaker service, but we have far more clients. We have increased the number of clients by a tremendous amount. For example, we have increased to approximately 35,100 a month the number of clients who are receiving homemaker service. That's perhaps not as many hours; at one time when we were fairly young in this whole area of providing homemaker services, we did all kinds of services we are not providing today.

Additional funding has been approved to upgrade the compensation level of homemakers, which I just mentioned. In '87-88, funding was provided to begin to reduce the wage disparity which you referred to and which we all knew existed between homemakers and those workers providing similar services in long-term-care facilities. A further 3 percent wage increase was also provided for both that fiscal year, which was last year, and for '88-89. In the fiscal year '89-90, additional funding will be provided to further decrease the wage disparity for homemakers, in addition to a 5 percent general wage increase provided to the homemaker support industry. So we are recognizing that there were a number of these people not receiving proper compensation, and we would like to correct that.

You also mentioned incontinent supplies. Although there were some facilities charging for these, it was never really approved. We have now served notice to all the facilities that they do not charge for incontinent supplies at all.

[4:30]

You also mentioned that there have been more complaints received than ever before. Not in my office. When I travel the province and speak to senior citizens in homes, in their private homes, or in different societies.... You must be meeting different people than I am, because by and large, although they were perhaps a little bit startled and even a bit unsure what direction we were going, mainly because of how the opposition brought the story across last year.... You really frightened them. But once we explained what we did with the 75 percent to 85 percent, when I travel throughout the province and ask them personally, without anyone there, "Are you happy? Can you make out? Can you get by?" I don't find them to be unhappy. I find them to be extremely happy. Again and again they come to me and say: "We've never had it so good."

Seniors in this province are being looked after quite well. That doesn't say we can't improve. I would like to have more money and do even more things for them. But by and large I have to tell you that seniors in this province are cared for, and I take pride in that. I hope in the future we can do even more.

Of course, many of the issues raised in that document are reflected in our budget, which has a 20.4 percent increase overall. So I believe that we can in fact correct some of the issues that you mentioned. I have to agree with that. I did not approve that level of funding for some of the workers who had a pretty tough job and, when you compared them with others in similar occupations, were underpaid. We are trying to correct that.

MS. A. HAGEN: I am a little disappointed in the minister's answer. He should know by now from my questioning in previous years that I really appreciate it when he comes to this House prepared with answers to some specific questions about important initiatives.

I would just like to quote a friend of mine who commented about a person who was a former health minister and a very good mentor for me, the former member for New Westminster, Mr. Dennis Cocke. One of the things that she said was a part of his remarkable achievement as minister was that he anticipated and was able to respond concretely to every question that came to him in the House. It seems to me that when we are dealing with budget estimates, and with budget estimates that affect the lives of people....

I have presented information to this House from a document that I have no reason to question as being at least very close to accurate. We quibbled about whether the figures should have been $95 million or $110 million or $117 million. The document comes from reputable sources within the ministry. The answer I get is one that talks about reducing wage disparities and trying to deal with the issue, when people are really wanting to know if there are dollars there to accommodate the fundamental problems in health and safety. I think the minister should be able to give us in this House and the people in the province a more comprehensive answer. It's he who has in fact said that is happening to improve the lives of seniors, to improve the quality of care for those — as someone said in one of the quotes I read — "ordained services."

When he made statements that suggest that this government's record this year is one to be proud of, I think he should provide us with concrete information that wage disparities are going to be addressed, that staffing to the guidelines — the antiquated, but none-

[ Page 6098 ]

theless the only guidelines that exist — will be available and that negotiated and paid settlements will not be underfunded, as is noted in this document, by 10 percent to 20 percent. This means that agencies and organizations have to decide whether they are going to lay off staff in order to balance their budget or meet negotiated and agreed-upon increases.

Those are very fundamental day-to-day problems about how organizations that already have a tough job try to do their job. This minister knows that the people working in that field and the organizations working with them are among the most competent, concerned and professional people that any province could want. They have repeated the story, which came from the ministry's own continuing care division, over and over again to the minister.

Last year, the executive director of the Long Term Care Association said that if things didn't improve soon, there was going to be a collapse within the industry. The minister knows that home support agencies are seeing turnovers of 30 percent to 60 percent, so that quality of care, no matter how concerned the agency is about preserving it, is compromised.

I'm asking the minister to give us some hard and fast indications of what those dollars are going to address besides wage inequities. How much of that $94 million or $97 million is going directly toward salaries, care guidelines and making sure that agencies are funded to the full cost of their salary budgets? I imagine, like any other human service budget, it is something like 70 percent of the total cost of their operation. That's where the cost of service industries like this lies: in the people who provide service and do the work that we ask them to do for the most frail and needy people in the province and under working circumstances that are darned difficult.

All of them deserve better than starting wages of $6 or $6.50 an hour and contracts or working conditions that don't give them any sick pay. In some instances, they may not even be covered by the WCB. I'm asking the minister to give us some concrete information about what those dollars are allocated to do, so we can know if we're seeing some real improvements in a service area that has really suffered under this government for the last number of years.

HON. MR. DUECK: I do not accept the statement that it has really suffered under this government. I think a lot of words are being said to get them into the record. I just don't accept it; I don't agree with that. I think there have been shortfalls; I will agree with that. But for that side to say again and again that this government does nothing and to make these wild statements.... I don't accept them at all.

When I told you earlier that we are addressing the shortfalls, that is a fact. For funding shortfalls, wages and benefits — I have a rough figure because we have not yet allocated — $55 million. Then there will be new bed facility operating costs, extended-care nursing — income has been cancelled, of course — capital costs, new construction, non-wage inflation and population increase. All these things will be addressed.

I'm trying to point out that I have not yet allocated specific funds. This is the global fund that we requested. We seriously looked at the document you are speaking of, and we brought the figure down to $74 million. We feel that is adequate to operate these facilities in a manner which will be improved over last year.

I will not accept the idea that we are not adequately funded. I will say that you never have enough money, and it's easy to sit on that side of the House and say: "More money, more money." Sure, but you can't cure everything with money. We have more homemaker services and more clients now than we've ever had before. I also reject the statement that people are.... If I listen to you, then I understand all these people are suffering and in dire straits. This is not true; the people in facilities are doing well. They are happy; they are thankful. We had a problem with shortfall, with some caregivers not getting enough income. We are addressing that, and we believe that once it has been established exactly how many dollars there are to bring up certain levels, they also will be happy.

We are providing good care, and when I meet with the facility operators, other than the shortfall of wage disparity, and in some facility renovations and what have you, where there was also a shortfall.... We're addressing that, and I think this year will be much better in that area than last year was.

MS. A. HAGEN: I just want to say before I proceed that I am concerned when the minister takes umbrage at statements I make about health and safety, and at where I am getting my information. I get my information from the same people he gets information from: I talk to the people who work in the field. I don't go looking for trouble. I call and say, "How are things?" and they provide me with information about their concerns. I am sure they provide you with the same information.

I think it's really important that we look at this as a discussion that's dealing with some very fundamental principles that should be in place. The auditor-general has, in his inestimable way, addressed a number of the same concerns that we are talking about.

Let me just pursue for another moment or two.... I don't want to spend a lot of time on dollars, but there are some issues that I think would be helpful to get a little more information about. The minister has said that $74 million is going towards the issues of wages and wage inequities. I gather he's talking about providing some funding for a higher level of staffing for the extended-care people in intermediate care facilities. That's a very great need, and it will be welcomed by people who are dealing with that circumstance.

Let me then ask the minister if, within the global $97 million that he has spoken about, there is any money for new services. I'm hearing you say that most of the money is going to deal with problems that you know about, and a lot of it is going into the

[ Page 6099 ]

wage area. Is there any money going into new services?

Let me just take one very down-home example. You just noted in your comments that we are doing more because we have cut back on certain services. One of the services that you cut back on was the handyman service, which is still a part of the services offered. I'm not sure whether it's still a part of the services offered or whether you've removed it already. I've talked to a couple of agencies that deal with inquiries that come to them for information and services and, you know, the most often received request is for some assistance in the field of handyman services. It is spring, and that's one of the reasons, but that area, for people in their own homes, is a very practical need.

There are also increased numbers of people in the system. I suppose we can reduce hours from 22 to 13 as an average for a client and say we are being more efficient, but there comes a point when there is a law of diminishing returns with that, where you simply have to add services in order to achieve that goal — which we would both agree is an important one — of supporting people in their homes with help, if they are able to stay.

Can you give us, Mr. Minister, some indication of what improvements in the continuing care system you see occurring as a result of the additional dollars that you have been able to acquire for your ministry?

[4:45]

MR. R. FRASER: It is a pleasure to take part in this debate today on the Ministry of Health. I would like to carry on from where the member for New Westminster left off and ask the minister something about utilization.

As the minister knows, I get some quite interesting letters from doctors, and I send many of them on to the minister with my remarks and comments. I always write and answer the doctors; it's always nice to hear from them. One of the more interesting ones I had recently concerned utilization of doctors in the health care system.

A doctor, whom I know very well and believe has a very good reputation, wrote me recently and said that his particular discipline was having to compete for funds with other disciplines. His great worry was that some of the money that should have gone to serious medical care was being diverted by what he alluded to as overutilization of doctors, too many people going to the doctor when they don't have to go. I really had to write back and say I frankly didn't know how I could be expected to judge whether you should or shouldn't go to the doctor. I presume the doctor could tell you that. And I presume if a citizen went to a doctor repeatedly with the same problem, it wouldn't be too long before the doctor could say: "You don't need to come to see me. You are really okay."

If indeed we can't convince people to limit the times they go to the doctor, to go to the doctor when they have a legitimate problem and not just go endlessly, maybe we should be getting other trained people in the health care profession to become more involved in work that doesn't seem to be, from this doctor's point of view, a serious concern. Perhaps we should be diverting constant visitors to the doctor's office to the nurse, who is well trained and able to recognize the symptoms of most common diseases, I presume. Obviously he or she can't give any medical care, but he or she certainly could get involved in a conversation with the patient and perhaps thereby relieve the doctor to see people who really needed the care of a physician.

I wonder if the minister has had a chance to consider any of those things.

HON. MR. DUECK: This has been recommended and talked about by the nursing profession for many years. We are considering and going in that direction. We believe that many of these functions can in fact be done by nurses adequately, if not better. This is why the Victoria Health Project is so successful, because we are opening up these wellness centres where people can go and get multidisciplinary help, whether that be from physios or occupational therapists or a chiropractor. Nurses will be there. All these various functions can be provided, and also a physician if it is required.

Yes, that is certainly part of the wellness aspect and the thrust and the initiative that we are going on. That doesn't mean to say that we don't need physicians. It is very difficult for doctors, when people come in to see them, to say: "I'm sorry, but you've been here three times in this last month, and perhaps I should no longer see you." If that's the case, they'll go to another physician, and of course our system is based on a fee for service, so it is very difficult to turn people away.

I talk on this subject to physicians all the time. Some are very conscientious and actually tell patients, "I'm sorry, but there is nothing I can do; your problem is that you haven't got a social life, " or whatever. And the doctor is smiling. I'm sure he is well aware of that, because many people go to a doctor for company. I have friends who do this, and I chastise them and say: "Now look, why did you go to a doctor?" "Well, I thought I should go because I wanted to go away and I wanted to know what he thought about it, " or, "My daughter is living on the Prairies and I just want to see what he thinks about the children." There are all kinds of reasons why they go to the doctor. It is very difficult for a physician to say: "I'm sorry, you should not come." It is difficult, and I sympathize with him. But I believe there are certain things we can do in the total area of health care that would be more efficient and better for the individual.

I'd like to just mention one incident of a woman who went to a doctor. I'm not saying "a woman" in any disparaging way; this happened to be a woman. She went to a doctor quite often. Finally the doctor said: "Well, what really is the problem?" There was nothing physical. Her problem was that her daughter, living in Saskatchewan, was dying of cancer and had two little children. I'm saying there is good reason to

[ Page 6100 ]

believe there are things you can do for people, other than going to a physician. That woman needed help in the worst way, but she did not need to see a physician to get another prescription of drugs. She didn't need that at all.

Another instance I read of in the paper the other day was of a doctor in Edmonton. This is written by a physician, and I can give you the paper and the quote. This doctor said he does raids on patients, and he found, within a very short period of time, enough Valium in these homes he raided to put Edmonton to sleep for ten days. It's not necessarily an indictment on that physician; it's just saying we've come into a system where prescription drugs are supposed to do all, and they don't. Drugs are wonderful, and they help many people. But we've come to a place in life where we think we can do everything with a pill — just another prescription — and somehow that will make us well. That's not so. There are many other things we can do to keep us well.

MR. MILLER: I have a couple of comments on the idea that the first member for Vancouver South (Mr. R. Fraser) was talking about. Of course, that works in some areas. It also gives rise to some disputes. I'm sure that being an engineer that member is familiar with the current dispute the engineers have with the technologists in terms of jurisdiction. Perhaps that would be a problem area.

I recall that when we were government we did bring in the Sheriffs Service and expanded the sheriffs' service, and although there were some rather wild charges about building up secret police and caches of guns all over the province — I seem to recall some remarks in that regard — from an administrative point of view, of course, it made much more sense to have trained RCMP officers doing their job as opposed to the routine stuff like transporting prisoners and serving summons. So there are some pitfalls when one attempts to improve the situation.

That's not really why I got up to speak in these estimates. I have a number of important issues to canvass.

I listened with interest to the discussion on the evils of tobacco. I take the view, as one who has not yet been able to successfully combat that, that it is in fact an addiction and there needs to be constant pressure and assistance in order for people to kick that habit.

I think we have seen some progress. I'm pleased to see that among some young people — and I understand the statistics tell us that there are more male young people not smoking than female....

MR. CHAIRMAN: Hon. member, I have to interrupt you. I've just been informed that you're not speaking from your desk; you're speaking from that of the second member for Nanaimo (Ms. Pullinger).

MS. PULLINGER: Because I spread out.

MR. MILLER: Thank you, Mr. Chairman. My desk was occupied. My colleague had spread her papers all over my desk, and it was my error.

Nonetheless, back to my topic at hand.

I do take the view that smoking is an addiction and that people do require assistance. I'm not convinced that we yet offer enough, and I actually support the motion and the types of activities that were talked about by the first member for Vancouver South restricting smoking. I think that is one device to use to encourage people to give it up, and I can certainly support that kind of initiative.

When I started working, it was accepted. I worked in industry, and quite often that was the break you really enjoyed: when you could get out of the hot spot, the sweat and the dirt and sit down somewhere and have a cigarette. That was a real break and you really appreciated it, and it's easy to see why some of us did get hooked.

[Mr. Pelton in the chair.]

First of all, Mr. Minister, I wanted to thank you in the House — I have thanked you privately — for your activities in terms of the Medivac helicopter stationed in Prince Rupert. I know you made some difficult decisions, and I want to say that I believe you made the right decision. I did question you quite strongly in previous years in this House about that situation, and I'm pleased to say that the situation seems to be well in hand, with a twin-engine helicopter available when it's needed to provide that service. As I said, on behalf of the people in that area who worked so hard to develop that system, I extend my thanks.

Secondly, I want to ask the minister about a program he initiated, I believe, a couple of years ago. Basically it was that financial assistance would be made available for training in certain areas of health care on the condition that the recipient of that assistance agreed to spend some time in a remote location in the province. When the program was initially introduced, I think it was rather modest. Perhaps the minister could advise us just how that program has proceeded, if it is still proceeding, and whether it has been expanded in any way. I believe that would be useful.

I know from talking to some of the health care professionals in my area.... We do have a particular problem in my area, as in many remote locations in this province, of attracting health care professionals and keeping them. We've seen lots of instances in Prince Rupert where medical specialists have come and gone in a matter of weeks, months or, at the very most, years. You don't get consistency in terms of the same people dealing with the citizenry. Many positions are simply vacant and appear to be almost unfillable. I think that program is one way to address that. Certainly the physiotherapists in my constituency have endorsed it. I understand there are similar programs in Ontario.

That's my first question. I have two other areas to canvass. If the minister wants to respond to that one, I'll get on with the other ones.

HON. MR. DUECK: To begin with, I appreciate getting a thank-you in the House from the other side. It's not that common. I didn't do it because you asked

[ Page 6101 ]

me; I did it because I thought it was the right thing to do. I got a lot of flak over it, as you know. It's not that I bend to flak, even if it comes from either side. I try and do what I think is correct under the circumstances. In this case, I believe we made the correct decision.

[5:00]

As far as the bursary program you alluded to is concerned, it has been extremely successful. I was just asking how many we put through that program who serve, for every $5,000 we give them for attending school, one year in an area that we designate. It has been successful. I haven't got the numbers on how many we put through, mostly in the area of physiotherapy, but I can get them for you. That was, I think, one of the main shortages of personnel in the north. It has been a successful program, and we're reviewing it again from time to time this year to see whether we should continue it. I believe we will, because there's still a shortage in your area and in some others as well.

Perhaps I could take the time, although you were up last, to answer some questions from the member just prior to you. In regard to homemakers, the increase in homemaker clients last year averaged 2,100 per month. When we make statements that we're not serving the public.... I want you to know that maybe the hours per patient have decreased, but we are looking after the people who require these services.

I would like to give more services. I can't argue against someone needing help: a handyman to plant a garden, to do some canning, to clean the sidewalk. It's all very well, but under health we're looking at health issues. If we define that narrowly, it would perhaps come under Social Services rather than under my ministry. I believe they have some services in that area, but we in the Ministry of Health do not supply that kind of service.

I want to go back, because I haven't got some of this information at my fingertips. Again, I want to respond to the member for Vancouver-Point Grey in reference to Children's Hospital. The hospital is making arrangements with the British Columbia Institute of Technology to develop a pediatric intensive care nurses' program, which is scheduled to begin in the summer. Practical experience will be obtained at Children's Hospital starting in September. The hospital is also developing a student nurse preceptorship program, providing extended orientation in pediatric nursing to newly graduated nurses. Both of these programs are expected to increase the number of trained pediatric nurses available to the hospital and to the province in general.

He raised the question that there weren't enough staff, and perhaps not enough trained staff. That is an ongoing thing. There are shortages from time to time, especially in the nursing area; there's no sense denying it. That is the case, and I have brought it up with the Minister of Advanced Education and Job Training (Hon. S. Hagen) from time to time. He has increased the number of spaces. I believe more should be added.

The universities, of course, are quite reluctant to make quick changes. We have too many engineers — we just heard an engineer speak a little while ago — but they keep churning them out by the hundreds. We have too many doctors, but they keep churning them out year after year. We haven't got enough nurses, and we're begging for places to put more through. It's the same with some other health care professionals. We need more of them. We need more in the area of hearing and speech pathology. We need more in a number of these areas. We cannot get them. I would hope universities would open up more spaces to get more of this profession into the marketplace.

I think I've answered some of your questions, if not all. I will continue to do so.

MR. MILLER: I wasn't going to raise it, but certainly it's my view that we are a bit backward in terms of coordinating the training of specialists or skilled people in this province in a number of areas. I've long felt that when it comes to training tradesmen, for example, we've not taken a coordinated approach in terms of our future requirements and gearing up our institutions to make those spaces available. Certainly the minister has confirmed that there needs to be a much more coordinated strategy in the whole question of training.

Interjection.

MR. MILLER: I will resist the temptation to respond to the second member for Vancouver South. I have some feelings on that, but I didn't rise to deal with it.

I want to deal with the question of the burden of costs....

MR. R. FRASER: Mr. Chairman, I didn't want to interrupt my illustrious friend, but I don't want my colleague from Vancouver South being upset, having remarks attributed to him when it's me. I am the first member for Vancouver South.

MR. MILLER: Mr. Chairman, I suppose I could be forgiven for sometimes being confused about who is the first member and who is the second member for Vancouver South.

I wanted to talk about the burden of transportation costs faced by people in remote regions of this province. It's been my experience over the years that there is a tremendous burden on people who have to be referred to medical specialists not available in their own community. Any member representing a remote region of the province can attest to the difficulty faced by people.

We can cover some of that by trying to increase the number of specialists in remote locations, by trying to create regional centres that shorten the distance of travel. There are also programs where specialists visit remote locations regularly, and programs are set up with the Vancouver hospitals to do that.

But there is a bottom line, and that is that in many cases the only way you're going to seek the medical

[ Page 6102 ]

advice you need is to travel. In my case, that is from the Queen Charlotte Islands or Prince Rupert down to Vancouver, primarily. The cost of a return airfare now is in excess of $400. I don't know what it is for the member for North Peace River (Hon. Mr. Brummet), but it must be higher than that, and Prince George somewhat lower. Nonetheless, you are looking at a significant cost burden in transportation alone, as well as the cost of accommodation and all the other things that go with it.

It's my view that it would be possible to cover this through the Medical Plan. Perhaps one of the objections is the possibility that it would be open to abuse. But I would point out that many of the unions have now negotiated plans with their employers. The members of the pulp union in Prince Rupert, I think the city workers in Prince Rupert and possibly others have negotiated insurance plans to cover these costs. They are run fairly strictly. They require the doctor involved to signify by letter that it is necessary for a person to be referred to a specialist. They require the specialist to indicate, by letter, that he has seen and examined the person for a particular purpose.

It works well. It doesn't cover all the costs, and perhaps that's as it should be, because some restrictions do tend to minimize the possibility of abuse. Nonetheless, I think it's feasible to implement this kind of system through B.C. Medical, and I don't see that it would be all that costly. I don't think it would require an enormous increase in premiums to include such an insurance scheme that would see the people in the remote sections of this province really given equal access to medical care, because that is a fundamental principle of our medical care system. As much as it is possible to devise a system that provides equal access, it is nonetheless a tenet — if you like — of our medical care system. I have pursued this for years.

I recently wrote to the hospitals in my region, and by and large, I received letters from them endorsing the principles of such a scheme. I would ask the minister whether or not he, or perhaps his predecessor, has ever undertaken any studies to determine the feasibility or the practicality of implementing such a scheme.

I really can't stress enough that I have seen a lot of financial and emotional hardship when people have to do that kind of traveling. Some of those people are helped by agencies. I know that the Lions Club, the Moose and other agencies help people. I know that friends of mine stayed in McDonald House in Vancouver, so there are some assistance programs available to alleviate some of the pressure — but not fundamentally. Has the minister or the ministry ever undertaken a serious examination of the proposal to see whether or not it would be feasible?

HON. MR. DUECK: Yes, you could say there is an inequity when it comes to health care. There is an inequity even in Chilliwack or Abbotsford versus Vancouver. I don't think we will ever have a situation where it is completely equitable. The accessibility is really what we are stressing more than equity.

I would like to tell this House that if someone needs to see a doctor at a tertiary hospital or a referral hospital in Vancouver, and that service is not offered in the particular city where the individual is from, that transportation, lodging and everything will be paid for for the family. That's ideal. We haven't done a study. We have talked about this from time to time.

I am very pleased, as you mentioned, that McDonald House, Heart House and a lot of these places develop programs from service clubs and people who are interested in helping, and we don't want to take that away from them either. They do a very excellent job. If it is an emergency, of course transportation will be provided in those instances, as you well know.

For some years now, we have been trying to bring specialists to the community where they can see a number of people that may need that service and cannot get it unless they go to the big city to that particular hospital or the doctor's office. Last year, the northern and isolation allowance program paid a premium fee to physicians; in other words, $3,051,000 to go to those areas. Subsidized income physician program guaranteed a minimum income of $237. Continuous locum coverage.... That wouldn't really answer the question you had; it was more for specialists. Northern isolation travel assistance program is for people going to the area rather than someone coming to the city. But there are still many times when people must go to a larger centre. It is unfortunate; it costs more. The equity isn't there. But I don't think that at present we can cover that under MSP because the cost would be quite horrendous. Even someone coming from Hope.... It's not equity to someone living three blocks from Vancouver General Hospital. I accept the point you are making, but I haven't got an answer for you.

[3:15]

MR. MILLER: The minister has responded somewhat to my question. Certainly a range of programs is required. I would not suggest, for example, that we cancel visiting specialists or programs to locate specialists in remote communities. I think all of those need to be done. I think the minister understands that it would be virtually impossible to duplicate in a small community the full range of health services that might be available in a large urban centre. The practicality of that is simply out of the question.

Despite all of the support programs, whether through service clubs or whatever, a very serious problem still remains. I don't think that you can eliminate every inequity that exists, and I think the argument about someone who lives in Hope versus someone who lives in Prince Rupert or Prince George or Dawson Creek is carrying the example to an illogical extreme.

When I presented my argument, I talked about a need for a system that had checks and balances to prevent abuse. I'm not suggesting the full cost of transportation or that you could take all of your family with you. In other words, I am talking about a

[ Page 6103 ]

bare-bones or beginning program that would offer some support, some assistance, to people caught in that really terrible cycle of having to go from a remote location to an urban centre to receive medical care. Most often we are taking about medical care that is not routine — clearly, if it's not available. It's something beyond the norm. That of course adds to the emotional trauma suffered by those people.

The minister seems to be saying that it wasn't a question of philosophy; it was a question of cost. I do believe you indicated that cost was the factor. I am simply asking, and I will leave it at that, whether the minister would consider the advisability — I hate to use the word "pre-pre-feasibility," because we had some laughs about that yesterday — of conducting a study, even if it's a cursory study at this point, about the possibility of implementing a system with controls. What would it really add to all of our medical premiums if such a system were to be implemented? What is the real cost? I think that's an important question, because it does give us an idea. If we don't have a difference of philosophy, what is the cost? Is it possible to approach this?

I will leave my suggestions at that and canvass the last issue on my list. There is a proposal to locate nuclear medicine in the northwest. My understanding of nuclear medicine is somewhat limited. I did talk to the administrator in Prince Rupert. I have talked to two people on the hospital board, and I have talked to a person here at Royal Jubilee who I believe runs the nuclear medicine program or at least is involved with nuclear medicine. The reason I talked to the person here in Victoria is that they run a mobile facility out of Royal Jubilee, I believe, serving various communities on Vancouver Island. As I understand it, the proposal is to locate this service in one hospital in the northwest. We certainly welcome — and hope we will get — this kind of diagnostic equipment. Perhaps it can prevent some of the travel issues that I've just talked about. Certainly, through better diagnosis it might be possible, for example, to tell someone that no, you don't have to go south to be diagnosed and then come back home, and then go back for treatment. You can do the diagnosis in Prince Rupert; the images can be electronically transmitted to Vancouver. Perhaps that would head off a lot of the travel issues.

The issue of locating nuclear medicine in one community is, it seems to me, rather shortsighted. I think it makes much more sense to have a mobile facility in the northwest that could travel to the Queen Charlotte Islands, Prince Rupert, Terrace, Kitimat, Stewart, Smithers, Hazelton. It would be able to cover all of these communities and, instead of the transportation cost being borne by the patient, the facility would come to the patient. My initial research tells me it would be cost-effective. There is more of a capital cost in terms of having a mobile versus a stationary facility, but that is basically confined to the cost of a vehicle to transport the equipment. I don't think there is an additional cost in having an examination room available when the facility arrives at a particular hospital.

It seems to make a lot of sense to take that approach to the location of nuclear medicine — this diagnostic facility — in the northwest as opposed to locating it in one spot. I would simply ask, Mr. Minister, if you would give me a commitment to have your ministry undertake an investigation of my suggestion. It does tie in with the issue of travel costs that I have previously spoken about. I think it would be cost-effective. I think it would provide for many more patients to be treated and diagnosed than if the facility was located in one centre. I would ask the minister to respond to that. As I said, I think it's important that your ministry at least conduct an investigation as to the suitability of a mobile facility versus a stationary facility.

HON. MR. DUECK: To the first question you asked in regard to a study or perhaps even quantifying what it would cost to transport people, and with certain very tight controls so it wouldn't be abused, I think I would be quite willing to see exactly where we are on that. Why not? It shouldn't be a tremendously high-cost study or a commission. I would be interested in knowing myself how many do come to the city who would perhaps need some assistance: overnight stay, maybe travel; not for the whole family, but perhaps if it is a child, the mother could go with the child. Yes, I'd be willing to see if we can quantify that.

The nuclear medicine issue has been ongoing for some time. To begin with, I believe we asked both hospitals — Prince Rupert and Mills Memorial — to between themselves come up with a solution. We're thinking more and more in terms of hospitals trying to do something in a region, rather than each competing.

I speak from firsthand experience, because my own community and Chilliwack and Langley all wanted scanners. We had indicated that perhaps we could afford one scanner in one area. We asked the three to get together — and Mission was included — and please come up with a plan and a recommendation where all had agreed, because we could only provide one. It had a disastrous effect on me personally, because here I was, the Minister of Health — my constituency is Abbotsford or Central Fraser Valley — and the other communities were vying for the same service and none was willing to give in to the other. This went on for quite some time, and I was really distressed by it, because whatever I did, I was in a box. If I didn't give it to MSA, then of course I was mistreating them, and it's my own riding. If I gave it to them, I would be looked upon as favouring my own community. So I was in a terrible situation. To top it off, each one went out and bought their own scanner. I'm not saying this to ridicule my community, but it caused me much consternation. We got an outside committee to look at it independently and make a recommendation. At the outset I said I would put the scanner where the committee recommended. Only one community really liked me after that, because there was only one that got it. The others still don't like me.

[ Page 6104 ]

Nuclear medicine is a similar situation. We asked Mills Memorial and Prince Rupert, and they just can't get together. We had hoped they would, but they don't seem able to come together at all. In the process, Prince Rupert sort of backed off and Memorial did make a proposal. I don't think it has gone any further, but at this point it appears Mills Memorial is probably the hospital that will get that particular piece of equipment.

We also looked at mobile, and your point is well taken. We felt that the road conditions....

Interjection.

HON. MR. DUECK: I know, but it was a consideration. We felt that for the time being it would perhaps be better in one hospital. Their proposal was acceptable, and as much as I hate making decisions between one community and another, because it always causes hard feelings — and I know, because I speak from experience — at this time it appears Mills Memorial will be getting that nuclear medicine facility.

MR. MILLER: A couple of quick points before my colleague for Surrey-Guildford-Whalley (Ms. Smallwood) gets up. Just a suggestion in terms of perhaps gathering some data on the feasibility of a travel plan. I would suggest you go to those companies.... I know that both the city of Prince Rupert and the pulp company in Prince Rupert have negotiated plans, and perhaps statistics might be readily available from those existing negotiated plans that would give you some kind of quick snapshot of costs, etc.

Interjection.

MR. MILLER: Mr. Minister, I said I was going to go after your colleague the Minister of Highways (Hon. Mr. Vant) for comments about the road conditions in my region. I don't want to get caught out here, because I do have issues that I want to explore with him.

I can appreciate the dilemma you find yourself in, whereby because of parochial interests you are unable to come to a decision. I have some background on that. It varies somewhat from what you said, but in substance I agree that there was some kind of rivalry involved.

I don't know whether, in looking at a mobile unit, you have seriously quantified the cost of transportation and looked at the number of patients that might be served. I think there is a possibility here of removing it from being a parochial Terrace versus Prince Rupert issue and giving serious consideration to Stewart, Queen Charlotte City, Kitimat, Smithers and Hazelton. Certainly if it is possible — and I will do what I can to advance the suggestion in the region — for those people to come to some kind of consensus regionally on the issue, I would simply ask that perhaps the door be kept ajar somewhat. I truly believe that despite the history of how this came to be and the decision to locate it in one community, we really would be serving the interests of a far greater number of people if we had the kind of facility that I am suggesting.

[5:30]

I don't know if your medical advisory committee has considered this, but I would ask that the matter be referred to them as well. As soon as I can, I will contact all of those hospitals to see if I can't get some kind of consensus on the idea I am proposing. I will get back to you as quickly as possible. Perhaps I will leave it at that. If it's possible to leave that door open for a little while so that a better decision can be made, then I think we should do that.

HON. MR. DUECK: Well, I appreciate you offering your services. Very often one can get things done when someone in that community is also attempting to have the community arrive at a consensus.

I didn't mention before and should have that this was not done in isolation by senior people of my ministry saying: "Well, should it be here or another place?" We did refer it to the professional advisory committee of the B.C. Medical Association. So it wasn't done in my office just because someone made an application. It did go through the professional route, and that's the suggestion that was made.

I am not sure at this point how far we have gone in this area. I have no problem with looking at that whole issue again. I have no problem with talking to our senior people and also the advisory committee from the BCMA, just in case there is something we have missed, and looking at it again, saying: "Should we? Is there any merit in this?" Maybe looking at it the second time may give us some more insight. I have no problem with that at all.

MS. SMALLWOOD: I have two issues I would like to talk to the minister about. I'd like to start off by thanking him for providing time for both the Bonsons and the Van Egdoms the other day, and I'd like to talk a bit about ventilator-dependent kids and handicapped kids, as they fall under the minister's responsibility. I know that that whole day was wrought with some distress, as far as the minister is concerned, and I would like to talk to him about that.

First of all, when I first became involved with Ryan Bonson's case, I met with the parents in my office. When we were discussing Ryan, Ryan's mother said to me: "Before we go any further, I want you to come to Children's Hospital and meet Ryan, because I don't want anybody talking about Ryan and Ryan's care without understanding who he is and what his situation is." So I went down to Children's Hospital and met Ryan. I have to admit that that's the first time I've ever been in Children's, in the intensive-care unit. The whole process of being involved with that family has been a learning experience for me. The more time I spent with Ryan, the more I understood what the parents' first request was all about. Because even upon meeting Ryan, I still had some predetermined ideas about this little boy who was so dependent on technology and so severely handicapped. Yet after seeing him in his little corner in the acute-care ward.... His corner is absolutely plastered with

[ Page 6105 ]

posters of Hulk Hogan and hockey stars and all the rest of it. The more I learned some of Ryan's little tricks — I think he shared that with you when he was in your office, pretending that he couldn't talk very loud and trying to get people to come close so that he could threaten them with his fist — the more I understood that this little guy had quite a character and was your typical 11-year-old boy in spite of all the hurdles he had to overcome just to maintain daily life.

I also wanted to tell you about a conversation I had with Ryan's dad when they returned to Surrey after the visit to Victoria. He said first of all that they had had a really good time over here, and secondly that he was delighted because for the first time in a long time Ryan was acting like any other kid. Ryan was really energized by that whole process. I think part of that was the fact that he felt he had the opportunity, along with his parents, to put his case. I wanted to tell you that the family appreciated that opportunity, and Ryan appreciated it as well.

Part of what I learned when I was in Children's Hospital is that there are many kids like Ryan. I was a little bit disturbed, and I'll have to admit that the image is still with me of those children in the back of the IC unit. The unit those children are in is something like a room of broken dolls. There are all these children in that ward who don't have to be there. They don't have any good medical reason to be in the hospital. They are there because we haven't managed to find a place for them yet. They are in the back of the ward because there's nowhere to move them to, because there's no need.... You can't move them into another ward, and there are no care homes that will receive them. Because of the rapid advancement of technology, those kids are doing the best they can, given their circumstances.

For instance, the care home that Ryan was in, before he was ventilator-dependent, will no longer take him, because they are unskilled at dealing with the technology and that particular medical need. There is a crying need for training of staff in those care homes, whether it is Sunny Hill or any other home in B.C., as well as for support of programs for those kids. We went through this process, and I think the family, as well as myself and the Van Egdoms, are very happy with the commitments both you and the Minister of Social Services (Hon. Mr. Richmond) made to work through the individual problems that those families face.

I wanted, though, to take you up on one of the comments made in the press, that you didn't feel there was a need for an overall coordinated program to deal with these children, because each child and each family had such different needs that they each had to be dealt with on an individual basis. I agree with you wholeheartedly that each and every family and child is different and has different needs. However, having tried to work through the process with both of those families, it became very obvious that, given the pressures those families are under, the system is far too cumbersome. What is needed is someone to act on their behalf to help put the package together, identify the needs and expedite the process. Without that kind of contact and a single person or single office responsible for that, there is a constant shuffling back and forth between the Ministry of Health, the Ministry of Social Services and any other ministry that may be involved, depending on the circumstances. It is an impossible situation without a coordinated program. I did talk to you about that, but I wanted it on the official record.

I'd like to sit down before I go onto my other issue and hear if the minister has any specific ideas about the situation and whether or not he has any new news concerning Ryan's case. Mrs. Bonson has been in touch with our office again. She has asked us to help her get the process underway. We're working with the social worker at Children's. Other than the contact that the minister offered, we're stymied as to ideas the ministry may have to expedite this process.

HON. MR. DUECK: If I may, I would like to first of all go back to the other question asked by the member for Prince Rupert (Mr. Miller). I was asked about the grants or bursaries that we were offering for health professionals. I have some figures here now.

Last year, 19 people went through the program: six occupational therapists, six physiotherapists, one nursing master's degree and six pharmacists. In 1988-89 there were 24 recipients: two occupational therapists, two physios, eight speech pathologists, four public health inspectors, two social workers, one nurse, three dental hygienists, one audiologist and one pharmacist. The program has really been quite successful. I just wanted that on the record because I didn't have those figures before.

I'm not going to say much about the Bonson and Van Egdom cases. I said before that I thought it was very poorly handled. I think we put those children through a lot of stress, and they need not have gone that route, because the member was aware that we had already solved this problem but insisted that those people had to come to the building. I think that is disgusting. I'll say that again and again. I don't believe we should use kids to make political points. It is not correct. I have to put it on the record. It's a shameful demonstration from a member on that side of the House.

MS. SMALLWOOD: The minister's actions, when dealing with these children, were appalling. This was an opportunity for you to see firsthand what families and children in the province have to deal with on a daily basis. This was an opportunity for you to deal with a problem in a humane and sensitive manner. Your suggestion that it was inappropriate says to this family that they should keep their child locked up so no one else can see.

Why is it inappropriate for an 11-year-old boy to come to Victoria on a lovely, sunny day to see how the political process works and to talk to the very people who are making decisions about his life? What that says to me, sir, is that you could not stand the glare of the questions that were being asked.

[ Page 6106 ]

Those children and those families were dealing with their lives quietly, through the system, for six to eight months. That boy, young Ryan Bonson, was in the hospital for eight months, when there was absolutely no reason for him to be there. Every piece of medical advice that the family got said that.

[5:45]

That family was trying to work through the process. I, on behalf of them, tried to work through the process. The Van Egdoms provided written documentation to your ministry showing the number of times that your ministry refused to meet with them and talk to them. Now if it takes a field trip to come over and get you to deal with these situations, then, quite frankly, I will tell you that there will be many more. We have not satisfactorily had this reality dealt with.

When you suggest to this House and to the media that their problems were dealt with prior to the visit, that is absolute and total nonsense. That family's situation was not addressed satisfactorily until we had that meeting and had the commitment of the Social Services minister, who said he would do whatever was necessary to get Ryan home. Until that meeting you did not understand what the needs of that family were. When you suggested that there were two programs to be offered to that family — respite and a W card, which provided medical care — that said to the family that you did not understand. They had other needs in addition to the ones you have outlined, and they wanted the opportunity to be able to tell you what those needs were, so they could securely look after their children.

It was a very small request that had been needed in bureaucracy for eight months, until such time as we brought it to the light of day. I make absolutely no apologies for bringing reality to this House. I think we should bring reality to this House more often.

HON. MR. DUECK: I am not going to carry this debate any further. The member knows very well what the situation was when she held her press conference and asked the press to come to Langley. She knew at that time that we had already solved the problem, and she still insisted on going to the press. I stand by my word and leave it at that.

When the lawyer for this family wanted to speak to my office or to my deputy.... When lawyers get involved, it's lawyer to lawyer. He said our lawyer was not competent, so he didn't wish to speak to him. When you get lawyers involved, you may have this type of situation. I still maintain that when you get a lawyer involved, he speaks to our lawyer. We're not going to mix them up with lay people, because if they want to go the legal route that's the route you go.

The other thing that's far more important.... You bring this case forward as though these children weren't looked after. They had the absolutely best medical care this world can offer. You are now an instant expert in health care, and it was the first time you had ever gone to Children's Hospital, the first time you'd ever been in intensive care. Suddenly you're the expert on how everything should operate in the Ministry of Health. I want you to know that I have just as much care and sympathy for those children as you do, if not more. I deal with them daily. I will not have you stand up and make this House think that you care and that the rest of us don't. That is absolute garbage, and I won't buy it.

MS. SMALLWOOD: The minister confuses facts once more. The minister suggests that holding a press conference to bring the Langley papers up to date on what is happening with Heather Van Egdom....

Interjections.

MR. CHAIRMAN: Order, please, hon. members.

MS. SMALLWOOD: The minister, when he talks about the press conference that was organized for Friday, again doesn't have the facts before him. The Van Egdom case, the people who actually live in Langley.... We're talking about Heather here, not Ryan, Mr. Minister. Heather is at home. Heather is having a wheelchair-accessible home built for her by the community. Heather has been at home for almost a year since her accident, and she is in school and being supported by her family. It has been with her family and community support that she has managed to get back to school. There has been no support for this family, no support for Heather, up until the time when the minister was prepared to look at her case because of our intervention. That particular press conference had nothing to do with Ryan, and the government had nothing to do with Heather. So for the minister to say that we held a press conference when we understood that the situation was taken care of points out that the minister is unaware of the facts and is making comments that don't even relate to what is going on.

I asked the minister, and the minister has not provided information, as to whether he is prepared to lessen the stress and confusion to these families by providing a coordinated program that will deal with their needs and give the support necessary for their children. The minister is prepared to make outrageous statements and throw blame around, but he is not prepared to answer the needs of these families.

Mr. Minister, will you provide a coordinated program, working with other ministries, to identify and serve the needs of these families?

MRS. GRAN: I find it very difficult not to say a few words on this subject. I am offended, quite frankly, by some of the things the member for Surrey-Guildford-Whalley has said. I was deeply offended when she brought Heather over here for a political show. I really feel badly about that, because I think all members in this house, regardless of political persuasion, should not be involved in that kind of thing. Heather has had a tremendous amount of support, an outpouring of love from a community that is always there when people are in need. Quite frankly, our community is also offended. The community has done a lot of fund-raising; but more than that, they have been a support base for the entire family.

[ Page 6107 ]

I know what the member is saying, Mr. Chairman. She is concerned about the people in this province who have children or relatives who find themselves in the kind of situation that Heather and others have. I have met with many head injury people. I have gone to their meetings. I have been in their homes. We have several people living in their homes in Langley. Even living in their homes is difficult. There is no perfect answer for some of these problems. You can talk about sending people back to their homes until you're blue in the face, and what happens when they get home is that there are just not enough people to cope with the problems that are there.

So to that member: to say categorically that the government is at fault, that the minister is at fault, that we're not doing enough, is wrong. The government is trying, in every way possible, to accommodate these people.

One of the things that the member knows — and she knows it well — is that we are keeping people alive today who never used to live: people who have come through car accidents, accidents in swimming pools, and a lot of different things. As a society we have to learn to cope with that. I think it's grossly unfair for any member in this House to say that the Minister of Health is responsible because those people are not being treated the way she thinks they should be treated, and to allege.... Bringing two of those delicate children to the parliament buildings to embarrass the government, I think, is wrong. I think it's immoral for any member to do that. All I want is to be on record as being offended, as a member of this Legislature, because I have worked hard to help Heather. I compliment the minister for the many meetings that he has had with other groups who have similar problems.

HON. MR. RICHMOND: Before we get out of here for the evening, I just want to put on record that this government probably has the most enviable record of any government in this country for putting people with disabilities and handicaps back into the community and back with their families. We have led the way in this. We have people coming from around the world to see how we are deinstitutionalizing people.

I would remind the member that both of the cases of which she speaks.... The Bonson boy is an especially fragile person. I think she knows that. To put him back into his home, which we will do, requires a tremendous amount of preparation. You have to have training and get the home ready. It will be several months yet before it is accomplished. We will achieve it, and we will work toward that end.

The member for Langley makes a good point when she says that some of these children are a recent phenomenon of technology and of our society, and we are coming to grips with it. There are some 30 such cases in the province. They are so different that we must treat each one as an individual case. The worst thing we could do, I think, is to put together some program where they had to fit into a pigeonhole. I think we do better with the Ministry of Health, my ministry and others treating them as individuals for the time being rather than just saying this is the program and you have to fit into it or else.

Recognizing the time, 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.

MR. ROSE: On a point of order, the government House Leader on these occasions usually describes the business when this House sits again. Does that mean we return to Health tomorrow, or do we go back to Government Management Services? He also knows that I've been discussing with him the propriety of using Friday, private members' day, for things other than government business.

You know that according to rule 3, while the business of supply takes precedence, urgent government business really occurs on Friday only with the consent of the Speaker. I'd like to know if the minister is prepared to tell the House right now if he's considering a request to call the dozens of resolutions from both sides of the House and bills that are on the order paper, and whether he's considering doing that if not on this Friday, subsequent Fridays.

HON. MR. RICHMOND: The member is fully aware that I am considering that, and I have made him aware of that. But for tomorrow we will stick to standing orders, and it will be orders of the day, which is Committee of Supply. But I am considering his request.

MR. ROSE: Statements?

HON. MR. RICHMOND: It will be the usual private members' statements and then orders of the day. Pursuant to rule 3, we'll proceed to Committee of Supply.

MR. ROSE: Environment? Health?

HON. MR. RICHMOND: We're going to stay in Health, yes.

Hon. Mr. Richmond moved adjournment of the House.

Motion approved.

The House adjourned at 5:59 p.m.