[ Page 6129 ]

CONTENTS

Routine Proceedings

Oral Questions

Gas pipeline to Vancouver Island. Mr. Harcourt –– 6129

Powder Mountain Resorts Ltd. Mr. Sihota –– 6131

Transit fares for post-secondary students. Mr. Rose 6131

Doman Industries Ltd. Mr. Cashore –– 6132

Rural property assessments and timber values. Mr. Long –– 6132

Ministerial Statement

Local government awareness week. Hon. Mrs. Johnston –– 6132

Mr. Blencoe

Tabling Documents –– 6133

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Dueck) –– 6133

Mr. Rose

Ms. A. Hagen

Mr. B.R. Smith

Mr. Jones

Mr. Perry

Mr. R. Fraser

Mr. Gabelmann

Mrs. Boone

Appendix –– 6159

The House met at 2:07 p.m.

Prayers.

HON. MRS. JOHNSTON: I would like to take a moment, on behalf of my colleagues on this side of the House, to issue a couple of tributes.

The first is to two fine British Columbians who are to be honoured tomorrow during a ceremony on Parliament Hill. Bea Leinback of Vancouver and Yukihisa Tanaka of Kelowna will receive citations for outstanding citizenship, marking National Citizenship Week, which begins across the country on April 18.

Ms. Leinback has been involved in community work for more than 45 years and is considered one of the driving forces behind the Kitsilano Showboat, which promotes the performing arts and a multicultural community. She is the recipient of the 1988 Woman of Distinction award for her community and humanitarian work.

Mr. Tanaka, who was presented with the Order of the Sacred Treasure by the late Emperor of Japan in 1987, will be recognized for his volunteer work in the community, which includes founding the Multicultural Society of Kelowna and arranging student exchanges between Kelowna and her sister city in Japan.

These two outstanding people and many others like them are what make this province such an exceptional place, and we take great pride in saluting them and their unselfish dedication to the well-being of our communities.

May I also at this time pay tribute to those Vancouver Canucks, who managed to make it to the seventh and deciding game of the play-off series against the Calgary Flames. Although the scoreboard read 4 to 3 for the Flames after almost a full period of overtime, in the eyes of all British Columbians the Canucks were certainly our winners, and on behalf of all our members, I know congratulations are in order.

HON. MR. WEISGERBER: It is a pleasure for me today to introduce a former Dawson Creek resident, a gentleman now living in Victoria. Would the House please join with me in giving a warm welcome to Mr. Mike Labrecque.

MR. GABELMANN: Annually, for some years, with the exception of one or two years, Fletcher Challenge has organized students from various communities, including Campbell River, to attend the Legislature here in Victoria. Today in the gallery there are 30 grade 11 students from Robron, Southgate and Carihi Secondary Schools in Campbell River. They are accompanied by teachers John Elson and Frances Hudock. Also in the gallery are Bob Porter and Bob Jakubec from Fletcher Challenge. I ask the House to please make all of them welcome.

HON. MR. STRACHAN: Visiting in the galleries today are two very good friends of mine, both politically and socially, from Prince George. Would you please welcome Bob and Lee Acott.

MR. PELTON: I have a number of introductions to make today, if you'll bear with me: Miss Anne Louise Ihasz from Halifax, Nova Scotia; Erwin and Betty Huckele, new residents of Victoria from Germany; and Elizabeth Burnett and Hildegart Hayward from Victoria.

Last, but by no means least, on behalf of the second member for Dewdney (Mr. Jacobsen) and me, I would like to tell the Legislature that in the galleries today we have 30 grade 10 honours students from Maple Ridge Senior Secondary School. These young people are here visiting the Legislature with one of their teachers, Mr. Bugler, a gentleman I know very well. He's one of the outstanding teachers in the system in the Maple Ridge area. These people are here to see what goes on in the Legislature. I would like everyone to welcome them, please.

MR. CASHORE: We have in the gallery today a distinguished citizen of Coquitlam, an individual who has given many years of outstanding leadership in the field of crime prevention: Mr. Les Keen. Would you please join in welcoming him today.

MR. BARNES: I would like the House to join with me in welcoming an old friend of mine, Paul Murphy, and his wife, Judy Wilson, from the Sunshine Coast. Over the years Paul has been a great political friend. Many years ago I had a great deal of fear and trepidation about having to leave my constituency to take a trip to far-off places. When Dave Barrett was Premier he asked me to go to China with him, and I thought: "I can't afford to leave my constituents." Paul said: "You're going to have to make some tough decisions, and this is one I think you should suffer with. Go with the Premier."

MR. B.R. SMITH: I want to introduce four parents who are here today from the Queen Alexandra committee. All are parents of multi-handicapped children, part of a group that has been working hard for the last several years to get home support care for these children — that is, expenses and not salaries. They have gone about their business quietly and in a responsible way, working with very good success within the Health ministry. I have pleasure today in introducing Denise Schmidt, Pat Francis, Joyce Skrivanos and Stan Blythe. Will the House make them welcome.

Oral Questions

GAS PIPELINE TO VANCOUVER ISLAND

MR. HARCOURT: Mr. Speaker, I have a question to the Minister of Environment. On Friday it was announced that the Vancouver Island natural gas pipeline would proceed on a fast-track basis. While I'm certain that everyone would welcome cleaner air and the prevention of bunker fuel spills in the Georgia strait, is the minister satisfied that the route chosen

[ Page 6130 ]

through the Coquitlam watershed will not threaten the quality of the drinking water for 1.3 million residents in greater Vancouver?

[2:15]

HON. MR. STRACHAN: I notice that the Leader of the Opposition first looked to see if the Minister of Energy, Mines and Petroleum Resources (Hon. Mr. Davis) was here before asking the question.

Interjections.

HON. MR. STRACHAN: Actually, it leads me into how I'm going to provide you with the answer, because I'm going to read a statement that is now being faxed to the mayors of all the lower mainland areas from my colleague the Minister of Energy, Mines and Petroleum Resources. The total statement will become public in just a few moments following question period, but I'd like to read the first paragraph to you on behalf of my colleague:

"I am writing to let you know that there is no way that the provincial government will authorize the construction of a natural gas pipeline through the Coquitlam River watershed without first being convinced in advance that the pipeline company will observe all the guidelines and standards established by Canada and the province to protect the health, safety and convenience of all of the people in the lower mainland who are dependent on water drawn from the Coquitlam reservoir."

I think, Mr. Speaker, that should satisfy the member's concern.

MR. HARCOURT: The government's own environmental assessments, which have been described in some detail, point to a number of deficiencies in the pipeline company's application. These include inadequate or inaccurate information on stream crossings and a construction timetable that is too tight to do a proper study of all the environmental impacts in the light of these concerns, why does the minister insist on fast-tracking the natural gas pipeline to Vancouver Island and putting it through the lower mainland's water supply?

HON. MR. STRACHAN: Just let me repeat. Obviously the Leader of the Opposition hasn't heard the answer or wasn't prepared for an answer, which led him to ask the second question, which had been answered in the first place. We say that there is no way — watch my lips, okay? — that the provincial government will authorize the construction of a natural gas pipeline through the Coquitlani watershed, without being convinced that the pipeline company will observe all the guidelines and standards established by Canada and the province to protect the health, safety and convenience of all of the people in the lower mainland who are dependent on water drawn from the Coquitlam reservoir. I'll send you a copy of this after question period.

MR. HARCOURT: In March the Minister of Environment said he had no evidence that there would be any problems. The Minister of Energy has said that this pipeline has to be fast-tracked to be economically viable. So you can throw out these letters in panic, because you've got 18 mayors who are up in arms about it. We have Vancouver's senior medical adviser saying it will cost taxpayers $200 million to $300 million to put in a proper filtration plant. In the light of this hastily-put-together letter, put out to deal with the mayors, who are unanimous, I want to know if the minister has advised his colleagues that there is an alternative route along Indian Arm that is a better way to protect the safety and quality of water supply in the lower mainland?

HON. MR. STRACHAN: That has been discussed. That information, of course, has been looked at by the B.C. Utilities Commission, which the Leader of the Opposition should be aware of. The best advice we have at this point is to proceed the way we are proceeding, with those concerns I have just spoken about in mind. But don't lose sight of the fact, Mr. Member, that there has been continued activity in that area for some time. For example, there are logging roads in that watershed. Industrial activity happens there now. I know you see this as some sort of a problem, and I guess the mayors have spoken to you, but I can assure you that considerable investigation has gone on with respect to this pipeline, its routing and methods of construction, and that all safety and health concerns will be addressed.

MR. HARCOURT: Can you explain, Mr. Minister of the Environment, why your ministry is not even represented on the project monitoring committee, as recommended by the Utilities Commission?

HON. MR. STRACHAN: That's a surprising question coming from someone who was supposedly the mayor of Vancouver at one time. In the GVRD, Mr. Member, air quality emissions and environmental standards are managed by GVRD staff. That's an arrangement we have with them. As a matter of fact, it is mentioned in section 19 of the Waste Management Act. I am surprised you weren't aware of that.

MR. HARCOURT: Mr. Minister, are the economics of this project so precarious and so frail that you can't reroute it around the water supply for the vast majority of people in greater Vancouver?

HON. MR. STRACHAN: I have been asked by my colleagues to read this again. But I think three times would clearly be tedious and repetitious, and obviously it's not sinking in. Perhaps if I send a copy over afterwards, someone will read it to the Leader of the Opposition so he can understand it.

In answer to his question, I am the Minister of Environment, and I am really not responsible for economic questions.

MR. HARCOURT: The last time this government fast-tracked a project, it cost us half a billion dollars. What's the price of this Coquihalla environmental disaster: the clean water of the lower mainland?

[ Page 6131 ]

HON. MR. STRACHAN: There wasn't a question there, Mr. Speaker, and if there was, the previous answers apply.

POWDER MOUNTAIN RESORTS LTD.

MR. SIHOTA: On July 2, 1985, Powder Mountain Resorts was the successful bidder with respect to a proposal to develop a ski facility in British Columbia. Suddenly, in February 1987, on the eve of concluding an agreement with the company, the company was advised that the government was going to seek fresh proposals from other bidders and therefore lost out on the bid. Could the Premier explain why the sudden decision was made in 1987 to terminate discussions with Powder Mountain Resorts Ltd.?

HON. MR. VANDER ZALM: I don't have the dates, but I can tell you that any proposal for Powder Mountain — or any other mountain — must be for the good of the province, and unless there is a benefit to all of the people, it will not proceed. Whether the decision is made within a week, within a month or within a year, if the proposal is such that it is not deemed to be in the best interests of all citizens, it will not proceed.

MR. SIHOTA: The issue here is whether it is for the good of the province or the good of the Premier's friends. Could the Premier advise whether he ordered the then Minister of Forests and Lands to cease and desist proceeding with the Powder Mountain Resorts proposal so that an acquaintance of the Premier's could submit a fresh proposal?

HON. MR. VANDER ZALM: I don't know the status of a proposal made by another group nor do I know who is involved in that particular proposal. I've certainly become aware of at least one person involved, but I don't know that person as well as I know the member opposite. I wish I didn't know you as well; perhaps I would like to know the other person a lot more, but that's the situation.

MR. SIHOTA: A question to the Premier. I have a letter here from the then Minister of Forests and Lands, the member for Omineca (Mr. Kempf). The letter ultimately went to the ombudsman. The letter says, and I quote: "In a memo dated in early 1987, Mr. Flitton informed me — I do not remember the exact wording — that I was to cease and desist seeking a resolution to the Powder Mountain proposal, as the Premier wished to give an acquaintance of his an opportunity to submit a proposal." Is the Premier, in his response to my earlier question, accusing the former minister of not telling the truth?

HON. MR. VANDER ZALM: I can't speak for what somebody else may have written, particularly since I haven't seen the memo.

MR. SIHOTA: Is it the Premier's position that the Premier did not intervene and ask the minister at that time to cease and desist from entertaining the proposal that was before the government, in order to give an advantage — or an opportunity, should I say — to an acquaintance of the Premier's?

HON. MR. VANDER ZALM: I would like as many people as possible to have an opportunity, but certainly no advantage, and I never suggested that someone else be denied an opportunity in order than another might be given that opportunity. If there are people wanting to make proposals, by all means they ought to be given that opportunity. We live in a democratic society where we have a free enterprise government and where we want to give as many people as possible the chance to be involved with the challenges and opportunities as they exist in the province. Unlike the socialists, we're not so narrow-minded as not to allow expansion or opportunities to as many people as possible.

TRANSIT FARES FOR
POST-SECONDARY STUDENTS

MR. ROSE: I have a question for the minister in charge of transit. Since 1984, university and college students have had to pay between 180 percent and 320 percent more to get to school. Fares in B.C. are now higher than in any other provincial jurisdiction. Has the minister decided to grant post-secondary students the same level of concessionary fares that seniors and high-school children enjoy?

HON. MRS. JOHNSTON: The setting of the fares is the responsibility of the Vancouver Regional Transit Commission and the local authorities. I would suggest that you refer your question directly to them. The ministry does not become involved in fare structuring.

MR. ROSE: The local transit authority is interested in doing this on behalf of the students, except they need to replace some $3 million or $4 million in order to make this concession. If it is not forthcoming from the government, then they are not going to do it.

I wonder if I could ask a supplementary question of the Minister of Advanced Education. Last year his ministry underspent student aid by some $18 million. Has the minister considered making up the $3 million or $4 million transit subsidy in order to improve access for post-secondary students through cheaper bus fares?

HON. S. HAGEN: First of all, my ministry did not under spend in that particular area of the budget. Every student who applied and who qualified received the financial assistance that he needed. The fact was that it was not drawn down because it was not requested. I have left in place the advisory committee that deals with the student financial assistance program, and I'm sure the member is aware that just two or three weeks ago we announced significant improvements to that program which will be good for all students of the province. If the member wishes, he can address a letter to me, and I will forward it to the committee that deals with that.

[ Page 6132 ]

DOMAN INDUSTRIES LTD.

MR. CASHORE: A question to the Minister of Environment. Devastating evidence came out during a December 1988 hearing that for at least six years Doman Industries was burning anti-sapstain sludge containing PCPs rather than properly storing it. Your ministry has been aware of these practices since 1982 and on several occasions asked Doman to stop, but these requests were ignored. Why was Doman never charged with any pollution violations over this incident?

HON. MR. STRACHAN: Good question. I will take it as notice and provide the member with an answer.

RURAL PROPERTY ASSESSMENTS
AND TIMBER VALUES

MR. LONG: To the Minister of Finance. Changes in the method of assessing rural property values have apparently resulted in a situation where the merchantable value of living trees is included in a property's assessed value; that is, the assessed value takes into account what these trees would be worth if they were cut and sold as timber.

As you're no doubt aware, concerns have been expressed, particularly by residents of Lasqueti Island, that this method of assessment of land value actually encourages people to cut down trees to lower their property taxes. Can the minister advise the House if he feels that the current assessment technique poses a problem in this regard and, if so, what might be done to correct it for the sake of both property owners and the trees they cut?

[2:30]

HON. MR. COUVELIER: We are, of course, very interested in this issue, and I'm indebted to the hon. member for raising it. It's certainly timely, urgent and appropriate during this question period. The issue really comes down to whether the assessment practices are an incentive to clearcut timber. I suspect all members of this House would agree that this would not be a desirable outcome, and therefore it is something that the ministry and the Assessment Authority must look at very critically.

I would just point out that taxation is a function not only of assessed value but also of tax rate. As the hon. member knows, the rate has not been set for Lasqueti. It is therefore uncertain whether there would be any financial incentive to clearcut, although I have no trouble agreeing with the hon. member that on the basis of assessed values it would appear to have that effect. But clearly it does depend on the tax rate, and that's something that will unfold.

Furthermore, It is my understanding that the Assessment Authority will be holding a public meeting in Lasqueti to deal with citizens' concerns on that subject. I am looking forward to that meeting so that we can get a better level of guidance from the citizens affected. This government, above all things, wants to remain sensitive and responsive to the needs of our people.

Ministerial Statement

LOCAL GOVERNMENT AWARENESS WEEK

HON. MRS. JOHNSTON: I would like to make a statement on the essential importance of local government in British Columbia. I am sure that the members of this Legislature, particularly those who, like myself, have served at the local level, will join me in saluting this week, April 17 to 21, as Local Government Awareness Week. In doing so, we focus public attention on the role of local governments and the importance of participation. In this way, the province joins the Union of B.C. Municipalities in its efforts to improve public awareness of local government and increase participation in local democracy.

Generally speaking, in British Columbia, fresh water keeps pouring from the taps, municipal roads are maintained, trash is removed and recreation centres are built and operated effectively by local governments which are often taken for granted. This lack of awareness could be seen as an indication of how well local governments function, because if they didn't, people would probably become more involved. Local governments, whether municipal, regional district, school board or other, are the way that British Columbia's communities maintain or improve their standard of living.

Not only do local governments provide a critical array of services, but they guide and direct the social, cultural and economic development of B.C.'s communities. This includes the citizens' influence, which is first manifested at the polls and then in participation on committees, boards and councils. Participation is essential if local government is to meet their needs.

The sound functioning of democracy at the local level is a measure of the extent to which the democratic ideal is operative in the lives of the province's citizens. We must do all we can at the provincial level to generate greater popular awareness and involvement. This will lead to local governments which are in close harmony with the desires of the people we all serve. We must affirm that if citizens are really concerned, they can take part and make a difference.

Many of us have spent several years in municipal politics and know that involvement is the only way to get things done, no matter what the issue. I therefore ask the House to lend me their support in recognizing the role of local government as we salute April 17 to April 21 as Local Government Awareness Week.

MR. BLENCOE: Unfortunately, I wasn't aware the minister was going to make a statement today. However, it's not a problem. We on this side of the House join with the minister in applauding local government and recognizing Local Government Awareness Week.

[ Page 6133 ]

Interjection.

MR. BLENCOE: The Premier seems to be very sensitive today. Did we get to you in question period, Mr. Premier?

MR. SPEAKER: Order, please.

MR BLENCOE: I just got up to talk about Local Government Awareness Week....

Interjections.

MR. BLENCOE: Obviously this government doesn't want to hear the opposition talk about how important we feel local government is in the province of British Columbia. For many years we on this side of the House have tabled and suggested all sorts of viable alternatives for local government. We've talked about infrastructure programs and rebuilding municipalities in the province. This government mouthed its acceptance of them, but there were no dollars behind those programs. We're waiting for a decent, fair tax system in the province, and we still don't see it. We now have before us a capping program on assessments, and we have begun to realize it's going to create all sorts of problems in the province.

We believe local government has a far greater role to play in decision-making in the province than it has today. Despite what this government says about the minister-of-state system....

MR. SPEAKER: Order, please. I might remind the member that in answering a ministerial statement, there is no debate or argument. He is to answer the topics raised by the minister.

MR. BLENCOE: We're answering the topics by suggesting that local government, despite what this government says, have a greater role to play in decision-making in the province. In the next six to nine months we intend to work with local government to bring a government to British Columbia that will recognize local government's importance in the decision-making of the province.

Hon. Mrs. Johnston tabled the 1987-88 annual report of the British Columbia Heritage Trust.

MR. SIHOTA: Mr. Speaker, may I have leave to make an introduction?

Leave granted.

MR. SIHOTA: I have often said in this House that Esquimalt Senior Secondary is the greatest school in the universe. I am pleased to bring to the attention of members of this House that shortly after question period, 21 grade 12 students from Esquimalt Senior Secondary came to visit us in the gallery, along with their teacher, David McCarthy. I would ask members to pay tribute to them, along with their special guests from Macdonald-Cartier High School of Montreal. There are 22 grade 11 students, accompanied by their teachers, Ms. Christina Esson and Ben Simo. Would the members make them welcome.

Orders of the Day

HON. MR. RICHMOND: Committee of Supply, Mr. Speaker.

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. ROSE: I enter this debate because I want to talk about poverty. Poverty applies mainly to seniors — although it exists elsewhere; among our native population — and women. I make this intervention because one of the problems with poor seniors — I'll give you the stats in a minute, although they don't describe the suffering or the indignity — is the fact that we have a rotten pension system in this country. The public pension system had gone through all kinds of false starts before we got anything resembling the CPP or the OAS or the supplement. We know that unless you own your own home, the $850 you get out of CPP plus your OAS is not really enough to get by on. That's why we have a provincial program called GAIN.

AN HON. MEMBER: And SAFER.

MR. ROSE: And SAFER. That is one of the major problems. Many women, especially elderly women, never collect CPP, which amounts to about $530 at the top level, because they didn't work in the workforce. And we have no homemaker's pensions, so therefore it's almost a catch-22.

The fewer private and publicly funded pension plans that we have available — and I'll give you the stats on those in a moment as well — then the more the public is asked to submit, through social welfare measures such as GAIN and SAFER and others, to make up for this difference. What I'm asserting is that what we need is a publicly funded public pension plan for every British Columbian, whether they work or not, or whether they work full time or only part time. If we had that contributory compulsory plan, it is my view and the view of many others that we could quite easily cut the costs to health and welfare immeasurably.

Let me give you some of the stats. Of the 2,700,000 people in Canada who get the old age security at roughly $320 a month, 1,300,000, or roughly 50 percent of those, get the supplement. Do you know how you acquire the eligibility for the supplement? In order to receive the supplement, if you're over 65 in most cases, you've got to be broke. You have to have no other income. So we have the universal OAS and a means-tested or needs-tested or income-tested supplement. But because they're broke, 50 percent of those over 65 receive the supplement; and I don't know how many receive SAFER in this country.

[ Page 6134 ]

That's a pretty damning piece of evidence. Precisely because that's the situation is why we have to take millions of dollars out of provincial welfare money and health budgets in order that these people can live in some measure of dignity — even if it isn't a great measure of dignity, especially if they're alone, unmarried, do not own a home and are in urban settings. It's not an insignificant problem. One elderly Canadian in five lived below the poverty line in 1986. The risk of poverty in old age is significantly higher for women: 23.5 percent of women were poor; 12.5 percent of men. Over 70 percent of aged poor are women. And get this: B.C. has 50 percent more people living in poverty, based per capita, than does Ontario. So if this is a rich, bountiful province and one that has been well managed, then this is a shameful statistic and an intolerable statistic. I look to the government, which attempts to provide some sort of leadership in this field, to do something about it.

[2:45]

At the same time, in our public pensions, we must realize that the birth rate is falling, and if present trends continue, fewer and fewer people working will be left to pay to support more and more retired people. We know also that the Canada Pension Plan has markedly increased its premiums over the years. We know that fewer and fewer people in the future, according to demographics, are going to be contributing to it. We also know that when interest rates are at 23 percent, the provinces are continually scalping off that fund of the Canada Pension Plan to borrow at cheap rates, and most of it will never be paid back. So that's why that public pension plan is in trouble.

Poverty, then, is likely to increase unless we do something about it. The point I would like to underline is that poverty is preventable. One weapon against poverty in old age is having a self-funding pension scheme for all British Columbians not participating in a private scheme. In case anybody is lulled into the belief that if you're participating in a private scheme somehow you're safe, think about it again, because most of those private schemes are not even indexed. Companies such as Canada Dry and Conrad Black's companies and Dominion Stores have been caught, and the courts have prevented them from skimming off huge surpluses from those funds, up to $60 million, mainly because of an ancient attitude in which somehow contributing or shared pension plans are some gift of the great corporate elite rather than deferred earnings. They should be deferred earnings, and therefore the employees should have a right to see how these investment policies are operating.

Never in this country or any other country should companies be allowed to skim off the surface or, worse, stop contributing for a while because the fund is in surplus. Have you ever heard of an employee allowed the opportunity to stop contributing for a while? But companies are, and they are a lot of the time. Do you know why? This is one of two provinces in Canada, B.C. and P.E.I., with no pension benefits standards act. As far as we know, companies can do pretty well anything they want with the contributory scheme, and I would love to be corrected if I'm wrong on that score.

We have an ethical obligation, I think, to do all we can from a government's point of view, from an economic point of view, and from the point of view of seniors and younger working people who are going to face increasing premiums as fewer and fewer contribute and the benefits, tied to inflation in the case of the public plans and not tied to inflation in the case of most private plans, increase.

We have OAS here, we've got the CPP and we've got private arrangements. If you work at a job long enough — in most cases ten years, although in Manitoba, I think, vesting now starts after one year — you might have sufficient income to put a little by to participate in. That's what the RRSPs were designed for, but most people who really need these pension plans do not have money enough to set aside to put in the RRSP, so that's no help to them.

Private plans — making regular RRSP contributions is likely to drop, because the incomes of working people have dropped from 72 percent in 1970 to 67 percent in 1987. Over 20 years the share of national income has dropped by about 5 to 6 percent. Labour's real income has not increased since 1982, according to Doug Peters, chief economist of the Toronto-Dominion Bank. Across our country less than half of Canadian workers, 46 percent, were covered by employer-sponsored pension plans at the beginning of '86, with sharply higher participation by men than women: only 30 percent of women, 52 percent for men.

Unless the overall participation rate is increased, unless the proportion of women covered by a pension plan is increased, poverty will remain unacceptably high, especially for women. First of all, they probably are more employed in service jobs; because they are having families they interrupt their work cycle and come back later; and they just generally work at lower wages. Therefore their income, as derived from CPP, is bound to be lower. Women are under-enrolled because they work in the home, they work in service industries — they have the McDonald's hamburger type of job.

Yet there is a strong trend in the private sector to provide non-contributory pensions for significant shareholders and senior executives. We've heard about one recently in the case of Mr. David Poole: a non-contributory pension contributed entirely by the public. If you are an average working person, when do you get a break like that? You don't. But the chief executive officers of many large corporations are able to cream off huge non-contributory pension plans while they skim the surpluses out of the employee contribution plans. It's just not acceptable. It's a crime, and it costs all of us money to protect the insurance industry and other big industries from raids on the employees' pension plans.

Strong trend. The number of non-contributory plans grew 46 percent, but mainly at the higher level, between 1980 and '86. For working British Columbians, the picture is less rosy: 64 percent of British Columbians weren't covered by any plan at all, and

[ Page 6135 ]

certainly not as a freebie, as a significant shareholder or a well-paid executive receives.

I would like to turn to eligibility for membership in a pension plan. For middle-income working British Columbians, eligibility to participate in a pension plan has traditionally been restricted to full-time and long-time employees, mainly male employees. But increasingly this is an era of part-time work. People aren't sticking to one job for their whole lifetimes. They get the golden handshake quite early sometimes; they move from job to job. I moved from job to job, from federal to provincial. My plan wasn't portable; the federal pension plan wasn't portable to this plan in British Columbia. I know the Speaker is in the same position, with nearly six years in Ottawa. I shouldn't raise his name here, but he's been here six years. He has built up no vesting here. And we've got a much greater and richer pension plan than is available to many people.

Increasingly, this is an era of part-time work and frequent job changes. A family with both partners working faces an increasing probability of reaching retirement age without adequate savings. Necessities such as housing are taking a larger chunk of workers' wage packets, and as the Bank of Canada reports, workers' share of national income is shrinking.

Other provinces are moving to make participation in an employer's pension plan compulsory for all full-time employees. Why aren't we? If other provinces can work towards a scheme in which an employer and an employee pension plan is compulsory, then why isn't British Columbia? Are we content always just to let the insurance industry or some other corporation skim off all the surplus while we are left to pick up the debts? We as a province are left to pick up, through our health and welfare schemes, those people who are not covered, while somebody else laughs all the way to the bank with the surpluses.

Part-time employees, full-time employees who work for two years and earn at least 25 percent of the CPP maximum earnings...should be the floor. What are the types of retirement benefits? Canada provides benefits based on one or two considerations if it's private. Defined contribution where the employers and employees are committed to a specified contribution rate.... That usually is compulsory; it is part of the job.

A worker who works for a company with a pension plan cannot decide he is not going to participate; he has to participate. So he has to participate, but the company, if there is a surplus, doesn't have to participate, because you've got a defined contribution plan but you don't even know what the rates and the payouts are going to be. Then there is the defined benefit, where the contributions are fixed, the benefits are fixed but inflation is not even considered.

If you retire on what might be an adequate pension at your retirement age, what happens ten years down the line when you lose half of it— and you can by simply 5 percent inflation? Instead of getting $1,000 a month, you only get $500 a month. Thousands of people are caught in the bind where they thought they had a decent pension setup and then find, to their astonishment, that it is nibbled away, as someone said, "like a rock disappearing in still water." Sinking. That's not a sinking fund, too.

Here are some levels of employee contributions. In 1986, nearly half the members of contributory plans contributed between 7 percent and 9 percent of their salaries. In other words, they are paying their own way here. That represents a major shift. In 1970, two-thirds of the people participating in pension schemes contributed 5 percent to 6 percent of their salaries. When the CPP came in, it was 3.6 percent — 1.88 each. That's got to go up. It can't because provinces are taking the funds out at an alarming rate for their own purposes, without any assurance that a certain, at least minimum, measure of interest would be paid. As a matter of fact, they probably will never even pay these loans back at all.

Sixty-five used to be the normal retirement age. Eighty-eight percent of the plans covering 63 percent of the members provide for a normal retirement age at 65.

MR. CHAIRMAN: Sorry, hon. member. The time under standing orders has expired.

MS. A. HAGEN: The subject that the member has raised regarding pensions is one that needs to be thoroughly discussed, and I am looking forward to the member continuing his comments.

Interjection.

MR. ROSE: Does he want to get away? I want to put this in one package if I can. It's not a pension plan.

HON. MR. VANDER ZALM: It's good, it's good. I am enjoying this.

MR. ROSE: Well, you might need it. I mean, we wouldn't want you to go on welfare or anything.

Let me get back to where I was, and I do apologize to the former Attorney-General. I'd love to let him on, but I want to put this in a package — without having to use a cut-and-paste job on this in Hansard — if I could. If you have to go somewhere in a hurry, then send me a note. I will get on with it; I will try and finish this up. It might seem long, but I won't take long.

Eighty-eight percent of the plans covering 60 percent of the members provided for a normal retirement age of 65, but listen to this: 90 percent of members had 60 as the normal retirement age. Twenty-five percent of members were in plans that had some other condition of retirement, such as years of service, or age plus years of service. That's not an uncommon thing.

Some plans have special events where you can retire before 65. We had an early-retirement arrangement in the last two or three years for our own people in government service. When employees leave, they usually have the opportunity to take out their pension contributions. Get that: they can take

[ Page 6136 ]

out their pension contributions, not the government's or their employer's contributions.

That has a name, and this pension stuff is just full of jargon. If you can wade your way through the jargon, you might have some opportunity of understanding a little bit about pensions, but vesting means that they have no right to that other than what they put in, plus interest. Guess who determines the interest in most cases? The company. The company takes these plans and sometimes they don't put in any money; all they are responsible for is the ultimate benefits, and they forfeit the employer's share at an interest rate set by the employer.

All provinces except P.E.I. and B.C. require plans for the vesting of employers' contributions. Why can't we as a province require certain vesting provisions? The B.C. superannuation fund is a good fund; it's been there for a long time, since about 1965, that I know about. It might have been in there before that. But anyway, we provide that. We have ten-year vesting. I think it's too long; I think it should be five-year vesting. But we've got that.

Why don't private employers have the same obligations? The reason they don't have the same obligations is because we're one of the two provinces that has no pension benefits standards act. There is a federal one, and most provinces have copied it to a better or lesser extent, but we didn't and neither did P.E.I., that backwater on the Atlantic coast where all the Roses came from.

The most common standard for vesting is ten years, age 45 — Ontario, Quebec, Alberta, Nova Scotia, Newfoundland and the federal. Manitoba's legislation, even under a Tory government, has always been stronger and required vesting after ten years of service or participation with no age requirement. Effective 1985, vesting was compulsory in Manitoba after five years of service, and in 1990 after two.

In Saskatchewan since 1981, vesting has been compulsory after one year continuous service and the attainment of age 45. There is a great deal of difference across this country, and I don't think there should be indexing. Traditionally, relatively few plans have provided for indexing: less than 5 percent covering 30 percent of the total employees. Five percent of private plans call for indexing. Guess who benefits from that? You pay in with expensive dollars, and they pay you out at the end — when your work's all done — in cheap dollars. That's what's wrong with most of these plans.

As I said, 93 percent of the private sector plans contain no indexing, although some made some ad hoc adjustments because they're embarrassed about the size of inflation in the last ten years, which has created huge increases in the plans. If you could take that money in the plan, invest it at anywhere from 15 percent to 25 percent interest and then pay it out at some other minor figure, you're making lots of money. That's how we create surpluses. In 1975-86, inflation was 110 percent. Some companies paid out an extra 29 percent only, so they gained about 75 percent.

Portability. Workers change jobs, and pension benefits don't go with them in too many cases. Multiemployer pension plans covering more than one employer — about 25 percent of all members in the private sector — provide some solution to this, if employees stay in the same sector. That doesn't always happen either.

[3:00]

In 1985, $12.5 billion was invested in Canadian pension plans. B.C. shares amounted to approximately $1 billion. I'd like the Premier to listen to this. If that money was invested soundly here instead of somewhere else, it could be a generator of jobs in our community and a source of capital. I guess my last words were all lost. This money is not invested in British Columbia, by and large, but there's a big ticket there. Across Canada it's $12 billion. If just our $1 billion were managed for investments in this province, it would be a major creator of jobs besides — as I mentioned earlier — saving the public purse millions of dollars every year.

These funds are deferred wages for working people, and it seems only rational that workers — since the funds are theirs principally — should control the plan. They don't. There are very few pension plans in which the working people sit on the boards and make the investment decisions.

HON. MR. VANDER ZALM: Who should?

MR. ROSE: I think the people whose money is used to contribute to the plan should be on the board. The public plan is quite different. You have that in the B.C. superannuation to a limited extent, but I don't know of any plan — except maybe some union plans — where this occurs in B.C. If this money is the contributors' money, then why shouldn't they have a say in how it is invested? I think they should have a share in it. If half the money is employers' money and half is employees' money, wouldn't it seem reasonable to have an outside chairman and board members comprising equal representation of the employer and employees? I think it's right and proper, but it doesn't happen that way, and that's wrong.

The law is very clear. To find out the truth, though, you have to jump around. Consider the Pension (Public Service) Act, for example. "The Minister of Finance may, at his discretion, invest the funds allowed under section 36 (2) of the Financial Administration Act." In other words, the Minister of Finance can invest the funds of the public service here. That section of the Financial Administration Act lists a lot of things like government securities and then allows, subject to regulations — and there aren't many — the minister to put funds into anything that is allowed by section 15 of the Trustee Act. The Trustee Act allows, among other things, the Minister of Finance to invest in common shares of any company incorporated in Canada that has paid a dividend of 4 percent over the last seven years. What company couldn't qualify for that? I'd be interested to know how many companies there are in the Toronto Stock Exchange who could not meet this test.

[ Page 6137 ]

So there are number of issues here. 1. The public sector.... The Minister of Finance has too much power and not enough accountability for his actions. He has, by law, unfettered discretion to place the deferred earnings — not a gift of ordinary British Columbians — wherever he wishes. And while there's informal consultation process through the superannuation commissioner, there's nothing to require radical extreme government from honouring the result.

2. In the private sector a similar situation applies where the employer has enormous disproportionate power to divert allegedly surplus cash for company operations. The attempt by Conrad Black, as I mentioned earlier, on behalf of Dominion Stores to steal the surpluses without notifying former employees is well known. A growing trend to withdraw surplus cash to provide for company operations is found by the auditor-general federally. The department of insurance does not require the submission of complete financial statements. The department relies almost entirely on management representation with few field examinations and no independent review of the underlying value of investments by pension plans in such areas as real estate and mortgages.

3. Fairness requires that working people should have control over how their funds are invested. This will ensure that the broader interests of working people will be protected and there will be an optimum return on the funds invested.

4. At present, many workers through the unions have adopted positions in opposition to such things as increased militarism and investing in South Africa But it is quite possible under the existing framework for their pension to be generated from investments in companies that are directly in opposition to the ethical positions expressed by the contributors to the fund. I may not like what is going on in South Africa. I am a worker and I'm in a contributory plan, but I have no say in whether my money goes to investment in South Africa. This is unfair, and it should be stopped.

Interjection.

MR. ROSE: Or corporations either, because over half the corporations in the United States are owned by unions. There is more union fund investment in the corporations of the United States than there is in Cuba.

Interjection.

MR. ROSE: Well, you squawk about them. That's your job.

5. In the period between 1984 and 1986, the department of insurance allowed the withdrawal of $110 million by the employer from pension funds. Three hundred million dollars went to companies that were allowed to keep their identity a secret. What on earth is the point of having a pension board to protect it if these things are kept in secret?

We need a clear policy. We want all British Columbians to be covered by a pension plan to prevent poverty in their old age. It must be self-funding so younger workers entering the workforce are not left to carry the cost. For British Columbians already in a plan, there should be a policy that gives workers effective control over the way the funds are used. Portability of pensions — jobs are no longer for life; a worker is just as likely to have several careers in unrelated fields before retirement. There must be an end to the diversion of funds, which present federal practice allows. Finally, we need inflation protection.

Mr. Chairman, thank you for being so patient here, and thanks to the former Attorney-General. May I end by a cyclic reference to where I began. We wouldn't need the budget for these supplementary things through the ministry responsible for seniors if we had a decent contributory pension plan for all British Columbians.

HON. MR. DUECK: I believe I should respond to the member's statement. He made some good points. As you well realize, it crosses many ministries; it is not just in my ministry. We find, though, that more and more senior citizens coming into retirement age, where perhaps they are seeking residential care, come from the workforce and have private pensions. So the scene is changing somewhat. There are more with pensions now, so a lot of them no longer rely strictly on the Canada Pension Plan and the old age pension. There are quite a number now coming into retirement age with private pensions.

I think you made a good point. If we could have everyone on a pension rather than coming onto welfare at a later date, it might even save some money in the overall picture. It could be self-financing.

I should also mention that in the very near future we are going to have a seniors' task force called "Towards a Better Age." It will be meeting in 21 communities. One of the concerns raised may well be pensions for all. It will be interesting to see what comes back from the seniors when this item is discussed.

You make good points, and they're well taken.

MR. B.R. SMITH: I want to speak on something that is directly relevant to these estimates, which will be a change. I want to ask for justice for a group of parents who put up with their daily lot in a silent way. They don't wave placards, they don't demonstrate, and they don't come to Victoria. They work within the system. These are the parents — there are about 200 of them in this province — who have severely and multi-disabled children. They are the parents of children who would qualify for pediatric extended care. Each of these parents could take their children and put them into an extended-care institution. Their children could go into Sunny Hill, Queen Alexandra Hospital or other institutions that qualify.

These children have disabilities that we can't imagine. We can't imagine the kind of effort, care, work and anguish that these parents go through. They don't beat a drum, they don't go around and tell sob stories, and they don't rent space in newspapers. The

[ Page 6138 ]

kind of disabilities they have to cope with.... Just let me describe a few of these children.

Laura is five. She is totally dependent. She has cerebral palsy. She is mentally retarded. She has epilepsy. She has lost 90% of her sight, and she has a feeding disorder. Until very recently, her parents have kept her at home and looked after her. They could put the child into care, or they could take advantage of the associate family program, an excellent Health ministry program, whereby we have something like 22 children — maybe it's a little more, but 22 was the last count I had — who are multi-disabled and are looked after by special foster parents known as associate family parents. They receive about $60 a day for this, and the costs are all paid. But nobody pays the natural parents for looking after their children. As a matter of fact, I am not an advocate of that, and neither are they. None of these parents' groups that I know of have come forward to the government and said: "Please pay us so that we can keep our children at home." What they have said is: "Please give us some resources so we can help keep our children at home and not institutionalize them."

[3:15]

[Mr. Rogers in the chair.]

I'm talking about this kind of expense. These children need many expensive medications: anticonvulsants to control seizures; antibiotics because many of them are prone to lung infections. They need costly equipment: wheelchairs, special beds, bathtub aids, physiotherapy devices, standing frames, rolls, special chairs. They need orthotic seating without which a child could not sit or would have progressive problems if it did. They need communication aids and so on. They need special forms of transportation. Much money is spent as well on diapers, on special diets, on vitamins.

Then of course there are homemakers and respite, because it is not possible to look after a severely disabled child 24 hours a day, 30 days a month, without some respite from that. Associate family parents receive respite.

The associate family parents receive those expenses, which are paid for, and in addition they get about $60 a day. But natural parents who keep these children at home with the family are out of pocket somewhere between $19,000 and $36,000 per year. That's a lot of money if there is one breadwinner, and there usually is only one in a family like this, because the other parent is a full-time giver of care. The parents that I have met and interviewed all have one or two other young children. So the mother is a fulltime nurse and attender to the severely disabled child.

These parents are not saying: "Pay us for doing this." They are saying: "Please, will you pick up these extra expenses that we have, provided that we meet the requirements of a new program; provided also they are needed and that they are assessed to be needed."

I know from my discussions with the Health minister and people in his ministry that the ministry has been moving light-years in the direction of providing services for severely disabled persons. I also know that that ministry and the Ministry of Social Services have moved very boldly into the field of deinstitutionalization. But you see, Mr. Chairman, the irony of it is that at the very moment we are doing that, we are creating institutionalization. What's going to happen is that more and more of these parents.... We are talking about 200 or 250 severely multiply disabled children who would qualify for such a program in the whole province. More and more parents, with one breadwinner only, are going to have to put their children into care, which is not deinstitutionalization but institutionalization. Then those children will go into care, and instead of paying out maybe around $24,000 on an average for the cost of keeping them at home, if they are in a hospital the cost could easily be in excess of $90,000 a year; or if they go out of the hospital and go back into the community in an associate family program, that's going to cost at least $60 a day plus the expenses I mentioned. What I'm saying is, a little bit of preventive money now given to that Health budget — I know the minister fought for it too — would save a lot of money down the line and would ensure that we don't have to institutionalize these children.

The parents I introduced in the gallery today have been fighting this cause in a responsible way for some two years. Of those four families that I introduced, three of them now have had to put their children into care because they simply can't pay the staggering burden. I'm saying that that is not wise budgeting. I wish the Finance minister was listening, because he's the culprit here; he is the one we have to persuade to have a special warrant on this. I really believe that this budget cannot go by with this matter unaddressed.

Of these families, three of the four have had to put their children into care. Two of those families are now considering having the children go out from the institutions they are in, to the associate family plan. They are doing that not because they want to do it but because they are forced by financial circumstances. They want to look after their own children. There are others in every part of this province who are in the same pickle.

Mr. Chairman, if we believe in the human dignity of children with multiple disabilities.... These children have very definite personalities, consciousness, psyche and so on. They understand what's going on. They relate. They communicate. They are entitled to be with their parents. They should not have to go into institutional care, and they should not have to be looked after in very dedicated associate family foster parent situations when their natural parents want to look after them.

I'm not in any way being critical of the associate parent program. When you think of the kind of work that's required to look after one of these severely disabled children, anyone who volunteers to do that, I can tell you, doesn't do it because they're in the busi-

[ Page 6139 ]

ness or because they want to make money; they do it because they care for these children themselves and have a tremendous commitment. But it's not the same as the natural parent, and if we as a government believe in support for the family — as we do — and if our programs are geared to support the family — as they are — then it's high time we found some money in a warrant to get this program launched.

If we are a compassionate government, if we believe in helping people like these severely disabled children who can't help themselves, if we believe in keeping families together, we have got to make that commitment. We have to launch this program, and it has to be done in this budget year and not next budget year. We've got to get behind the Health minister and get that money out of treasury.

HON. MR. DUECK: I want to thank the member for that very good delivery. I think I'll take you along to treasury next time.

I agree with most of what you've said. We are pressing in the direction that you're mentioning, although I believe not fast enough. We have been able to help some of these children. I know these children would rather be looked after in their own homes as long as some of the expenses are defrayed for the parents or the people who are looking after them.

If I can just go back to the associate family program, I know you weren't critical of that, Mr. Member. It has been working very well. I believe we have 25 or 27 — whatever it is — children in associate family situations. There are also children in associate family situations who could not be looked after by the natural parent. So the associate family is working out well. However, I do agree that when we have children who could be looked after by the natural parent, and they could be assisted at least in the area of expenses when it comes to equipment and respite.... I should mention that this year my budget is $1,068,000 for nursing respite, and it will alleviate at least some of what you've just mentioned. From time to time the Minister of Social Services and Housing (Hon. Mr. Richmond) supplies equipment from his budget. We should not neglect to mention the service clubs that have always come on board in partnership with the ministers, whether it's my ministry or Social Services, to help in that area.

All I can say is that I agree with what the member has mentioned, and I will continue to press for that type of relief for these people who need that assistance.

MS. A. HAGEN: Last week when we were discussing the services for seniors under the Minister of Health's estimates I made reference to a document prepared for cabinet submission by the continuing care division of the ministry which stated that the government needed $117 million to bring long-term care facilities and home support care up to health and safety standards and to a stable staffing situation with skilled workers.

I want to take a few moments this afternoon to ask the minister some further questions in regard to these needs. First I'd like to refer to the situation of extended-care clients who are in intermediate-care facilities. The continuing care division noted that $11 million would be required to ensure that the staffing levels for extended-care patients in intermediate-care facilities are at government staffing guidelines. Under this budget for continuing care, will extendedcare clients in intermediate-care facilities receive the government staffing guideline care that is his ministry standard?

HON. MR. DUECK: I believe I did say last week when we discussed this that I have money in the budget to look into exactly the area of your concern, that we will be staffing to the ministry's guidelines. I hope there is enough money to look after that deficiency.

MS. A. HAGEN: Do I understand the minister to say that a year later this matter is still under review; that there is no committed money at this stage of the game, but a goal to staff to those guidelines?

HON. MR. DUECK: No, I said there was money in the budget. At this moment I haven't got the figures before me of exactly how many dollars and whether it will be for all facilities. I believe it will be, and we've got, I believe, $11 million to be phased in over a period of two years to bring it right up to standard.

MS. A. HAGEN: I think I hear the minister saying that this particular matter around staffing for intermediate-care facilities for extended-care patients will be addressed over a two-year period.

HON. MR. DUECK: Phased in over two years.

MS. A. HAGEN: Phased in over two years.

I want to then move to a larger issue in respect to staffing needs in intermediate-care facilities. The document that I referred to has noted that the provision of care is tied directly to financial resourcing. If a facility is underfunded, it is highly probable that the care is substandard. I think it goes without saying, as we've noted, that care is provided by people, and the level of staffing has a great deal to do with health and safety and the quality of care.

At the present time, for a variety of reasons, many intermediate-care facilities are not able to staff to ministry guidelines. Will this budget enable facilities to staff to current facility guidelines?

HON. MR. DUECK: I have money in the budget to look after the inequities, and I believe that we will be able to come up to the current staffing guidelines.

MS. A. HAGEN: The document prepared by the ministry's staff says that a total of $28 million will be required for long-term-care facilities to be staffed at 100 percent of guidelines. Is the minister saying that he has $28 million in his budget for that amount? If not, could he tell us, as he did with the previous question, what number of dollars will be available to

[ Page 6140 ]

those facilities so that they may be staffed at 100 percent of guidelines?

HON. MR. DUECK: The document that the member refers to from time to time is not a document that we use as our guidelines. It was a document prepared by an individual and then, of course— at least, I suppose — for some reason or another.... We receive many documents; many things cross my desk. We don't accept the document as the figures that we need to bring those standards up to the guidelines.

MS. A. HAGEN: If the minister doesn't accept that particular document and that particular costing, could he advise this House what number of dollars he anticipates having available in his budget in order to bring that staffing up to guidelines?

HON. MR. DUECK: I think I mentioned just a few minutes ago that I have $74 million, and that is being allocated. We try to put it where it is essentially needed at this time. We haven't yet got to the point of allocation. I believe it will bring those inequities up to standard, phased in over a two-year period.

MS. A. HAGEN: The minister noted in the dollars available to deal with inequities, shortfalls in longterm care and the improvement of wages for home support workers, a broader agenda, a total of $28 million for all of that task. I would appreciate it if the minister could give us some idea of the dollars he anticipates being available for the figure for 100 percent of guidelines.

HON. MR. DUECK: I have not yet got that figure in detail, so I cannot give you that. In a few weeks' time we'll be able to supply that.

MS. A. HAGEN: A number of groups — the ministry people, the Continuing Care Employee Relations Association, the B.C. Health Association — have made reference to goals for non-union staff in longterm care facilities, stating that the goals should be that these staff people receive 85 percent of the salaries and benefits of unionized workers. The cost for improving that particular situation and dealing with the inequity in wages in long-term-care facilities is stated by the continuing care staff to be $24 million.

Is it the minister's goal to, indeed, raise salaries of non-unionized workers in long-term-care facilities, and can he give us some indication of the percentage level he would like to see those salaries rise to, as a goal of his ministry?

HON. MR. DUECK: Mr. Chairman, I can't give you the exact figure, but that is our goal, yes.

MS. A. HAGEN: Could the minister give us, then, some indication of whether he intends to work on that goal on a one-year phase-in or over a longer period of time?

HON. MR. DUECK: I haven't got the figures in front of me right now. There will be a substantial amount immediately and, hopefully, phased in over a two-year period.

MS. A. HAGEN: Just to confirm, I understand the minister to say that it is the goal of the ministry to raise non-union wages to 80 percent of the union level and that it's his intent to phase that in over a two-year period.

HON. MR. DUECK: Mr. Chairman, I did not use the percentage. It may well be; it may well be even a little more.

[3:30]

MS. A. HAGEN: I'm trying to establish a goal, Mr. Chairman. I recognize that the minister may be working within a ballpark. Would it be fair to say that the percentage range for non-unionized employees would not be less than 80 percent?

HON. MR. DUECK: Of course that's speculation at this time, but I certainly hope so.

MS. A. HAGEN: A further question to the minister regarding the full funding of wages and benefits. In a very significant number of facilities, this document and others that I have reviewed state that the ministry doesn't fully fund the facilities for wages and benefits paid by that facility, and that the disparity may be from 10 to 20 percent. Fully half of the facilities are underfunded to some extent, and 36 percent of the cases are funded at between 10 percent and over 20 percent less than the actual cost of their salaries. Is it the minister's intent to deal with this issue and fully fund the wages and benefits negotiated either through union negotiation or in a fair, working relationship between the employers and employees in non-union facilities?

HON. MR. DUECK: From time to time the facilities enter into negotiations and, without regard of resources available, we then have demands that we cannot always meet with the resources allocated to the ministry. In most cases and whenever possible, we do try and meet the negotiated settlements, and this year, I believe, we will come closer to doing that than we've done in the past. But you must realize that just because one facility settles for a number that is perhaps much greater than another facility, I do not necessarily have the moneys in my budget to accommodate it. Yes, there have been at times facilities that have settled with their people on a greater amount than resources were available in my budget.

MS. A. HAGEN: Would the minister agree that it was reasonable for facilities to provide such things as sick pay, some coverage for medicare and a basic benefit package to all employees, whether they are in unionized or non-unionized facilities, and that this would be a reasonable employment standard that we would want all employers in long-term care and home support areas to provide their workers in this day and age?

[ Page 6141 ]

HON. MR. DUECK: We are moving more and more to a global budget, and we expect facilities to operate within that budget, similar to hospitals. We try to be reasonable. There is much contracting, negotiations and consultation with facilities and, by and large, we came out not too badly last year. Hopefully we can improve this year from the last few years.

MS. A. HAGEN: I didn't hear an answer to my question in that response, I don't think, Mr. Chairman, about standards that would guide the minister in setting a global budget. I would appreciate his response to the question: does he believe that employers in long-term-care facilities and home support agencies should be able to negotiate, either through collective agreement or whatever staff association arrangements are made, basic benefits for all employees who work in the continuing-care industry?

HON. MR. DUECK: True, but not beyond the ability to pay. We couldn't just give carte blanche to whatever any facility agrees upon, and say the money's there; that's impossible. I also have a global budget; I must live within it. So there is restraint in that area.

I believe we have worked well with the facilities, whether union or non-union, private or for-profit. As a matter of fact, when they heard about the amount in my budget.... I have been in touch with a number of them. From the feedback I get, they are quite enthused about it, and I think we will have a good year.

MS. A. HAGEN: I won't pursue the issue. I am disappointed that the minister has not been prepared to make a clear and direct answer around the kind of standards that would guide his ministry in funding facilities and home support workers. It may be implicit — I hope not — in some of the minister's comments that the operators of long-term-care facilities and home support agencies are not careful, responsible stewards of their budgets, and that they are, as they say, giving away the store.

I think what I am talking about are the basic benefits that most of us in our workplaces anticipate would be a part of a government's standard. I would certainly like to have that assurance from the minister about contracts and funding available for this very important industry.

Let me now move very specifically to the home support area, in which people receive the lowest level of pay. We still have people in that industry who are earning, for a starting wage, between $6.20 and $6.50 an hour, in spite of some improvements that have come over the last couple of years. I want to acknowledge those improvements, which came after a very long period with no increases. If we look at the period from 1984 to 1987, we find that had these employees been covered under the government's own compensation stabilization program, their wages would have increased 19.8 percent over that time, just with the very modest increases that came under that stabilization program.

In order to bring these people — the home support workers, the homemakers of our province — up to a reasonable standard, the industry has indicated from a number of sources that an amount of $16 million to $17 million, or up to even $21 million, will be required. That is within the same kind of goal-setting: bringing those workers up to between 80 and 87 percent of the unionized workers and closer to the wages offered in long-term-care facilities.

Could the minister please advise us of the goal of his ministry in respect of home support workers and improving their level of salary over the next year? If that is to be phased in, over what period will it take place?

HON. MR. DUECK: We certainly want to bring the homemakers' wages up to a reasonable standard. That is my intention, and I have money in the budget for home support. I have a figure of $20.5 million, making a total for home support for this coming year — and this is correct, I hope — of $102.8 million. I should mention that that is up from $82.3 million last year.

MS. A. HAGEN: What the minister has just mentioned, as I understand it, is the total amount available for home support agencies in the coming year. It has gone from $82 million up to $102 million, which would appear to be about a 20 percent increase. We note in that regard that about $7 million or $7.5 million of that amount was actually paid last year; you will recall that from when we discussed the warrants. So the amount available is in the order of $14 million.

Let me just raise one other issue from the submission I have been dealing with today; I want to be sure that I speak on behalf of all people working in this industry. Management salaries and benefits have, as is often the case, fallen behind. I understand that in some instances people who are either executive directors of organizations or directors of nursing may be earning less than regular staff workers. Could the minister let us know whether there are any dollars in his budget to deal with maintaining a reasonable range of salaries and remunerating senior positions in line with other increases that are taking place in the industry?

HON. MR. DUECK: I believe the member knows well that we don't pay those wages. Out of that global budget they must allocate how many staff, what kind of staff, whether it's supervisory, whether it is a facility where perhaps the owner-operator does a lot of that work himself. There will be money, as I've quoted, and they will have to allocate those funds out of the global budget they will be getting. We don't go around and say: "You have a supervisor; we'll give that supervisor a raise, " It's part of the negotiations they do with the facility. Hopefully with the global budget they receive they will be able to adequately meet that demand.

MS. A. HAGEN: I'd like to ask the minister if, as one might expect, in his budget for this year for continuing care facilities and home support there are in-

[ Page 6142 ]

creases for inflation, for increased salaries for workers and for increased service. To save him an answer to a question, I believe when we addressed this issue the other day the minister did state that built into the overall budget was a 5 percent lift for wages for '89 and '90. If the minister could confirm that, it would be helpful. Then, are there other inflationary amounts that are built in and are there increased levels of service that are going to be offered in the money the government is making available to continuing care?

HON. MR. DUECK: For the utilization and population growth, I've got $1,795,000 and some-odd.

MS. A. HAGEN: So there's a very small amount in your budget for increased service. The total amount for continuing care, long-term-care facilities and home support is something in the order of $400 million, and we're looking at less than $2 million for increased utilization.

I noted when we began these estimates that I didn't want to get into a very detailed look at dollars and cents, but I want to draw some conclusions from the debate and discussion we've had, and I thank the minister for the answers he's been able to provide.

I have gone over the minister's statement at the start of the Health estimates, and I have also carefully gone over the discussion we had last week when I first raised some concerns about the necessary level of increased funding to deal with services for older people. I am still not satisfied that we have, in the minister's answers, the dollars that will address the real health and safety and staffing concerns expressed in the cabinet document that triggered our discussion and provided us with some benchmarks for discussion.

[3:45]

Let me just go back over some of the minister's statements in his own comments and in his answers to my questions.

He noted that there was $28 million for inequities and shortfalls in long-term care and to improve the wages of home support workers. He indicated that there was an unspecified amount for improving the hours available for extended-care patients living in intermediate-care facilities, and I heard him say today that that amount is very consistent with the suggested amount: around $11 million. He also said there was some money to help private facilities with capital funding, and didn't give an amount. Let's assume that the amounts here are similar to the document, and we're looking at something in the order of $45 million out of $170 million.

He then noted that there was about $26.5 million for new wage settlements. That's not catch-up; that's not dealing with some of the inequities we've been talking about. It was also for the inflation that organizations would have on non-salary items and for population utilization increases. He said that altogether there was about $55 million for upgrading. But about half of that is really to look at this year's costs, not catch-up costs. He also stated that within the $97 million he has said is available altogether there is a lot of new stuff.

I would maintain that although he may not have accepted the document that came to him from his own continuing care division and may not have accepted some of the presentations not only from within the ministry but from the technicians — the researchers who are able to put these figures together — it appears that the ministry has not addressed the basic issues of health and safety and staffing that we need to know is in place to secure the industry. I know the minister has been working to make improvements, but in this particular industry I think the neglect of years, which has been well documented, is now such that we can't wait for the additional dollars. I really am very concerned that although the minister is putting a good face on what he has available to him in his budget, when we look at the figures and at the well-researched need, the disparity between what is proposed as necessary and what the minister has is at least $40 million, and it could be as much as $60 million to $65 million.

Those are serious disparities in terms of dealing with an industry that is very much affected by the dollars available for its staffing. When we look at the turnover of up to 50 percent with home support workers, when we look at people trained to go into that work who leave it because the wages are inadequate, then standards of safety, health, quality of care — issues that were also raised by the auditor-general in his review of continuing care — are not being met. It is regrettable that the people who are bearing that burden are the poorest workers in the province — home support workers particularly — and the elderly, who may be deprived of the standards of care that we should offer without question as a priority.

I want to thank the minister for his comments. I look forward to further figures, but they just aren't there to do the job that needs to be done.

HON. MR. DUECK: I believe the document that the member refers to again and again is out of date. We don't use that document; it's not our reference point. We have some $74 million in the budget. We believe that is adequate. The safety and health of seniors will be addressed, will be looked after. I was fortunate enough to get some of that money last year, as you well know. It's never enough. I can assure you that I am pressing on continually to look after some of the disparities, but this year I am more confident than last year. I feel better about the funding situation in the whole area of home support and seniors' facilities.

Having said that, I don't accept the figures you quote from that document. We have our own reference point. Senior citizens will be adequately looked after, as they were last year. There were some concerns, but by and large our system is a model for the rest of Canada. When they come here from other provinces.... Our central registry and various things that we have in our system today for senior citizens are to be commended, not criticized. Although we are always looking for more resources, and could use

[ Page 6143 ]

more resources, I must tell you that I am quite happy. The safety and health of senior citizens will be adequately looked after.

MS. A. HAGEN: Are the quick response teams that the minister has referred to funded out of the home support budget, the facilities budget or some other section of his budget?

HON. MR. SAVAGE: Mr. Chairman, could I have leave for an introduction, please?

Leave granted.

HON. MR. SAVAGE: I am pleased today to introduce a group of 20 grade 9 students from Polyvalente Bernard Gariépy in Tracy, Quebec, who are visiting our constituency and have taken the opportunity to come over and watch the Legislature in session and the debate going on in Health. Would this assembly please make them welcome.

MR. CHAIRMAN: Would the minister please send the spelling of the school's name to Hansard.

MR. PERRY: Mr. Chairman, I'd like to welcome the students from this side of the House as well. J'aimerais leur dire quelques mots en français pour la bienvenue dans notre belle province.

MR. CHAIRMAN: Just for the point of protocol, you are supposed to ask leave.

HON. MR. DUECK: Mr. Chairman, I don't know whether he said something bad about me or whether this was welcoming the students.

MR. CHAIRMAN: No, he did not, Mr. Minister.

HON. MR. DUECK: Thank you.

To the last question from the member, I believe it was where the funding came from for the response teams. It comes out of the continuing care budget, but we find that because we are sponsoring these quick response teams, in fact, we are saving money and FTEs. It is working very well. I believe it was in my estimates speech that we are endeavouring to get a couple more off the ground in a lower mainland community and, I believe, in Kelowna and perhaps one in another part of the lower mainland.

MS. A. HAGEN: Could the minister advise us whence the funding for the Victoria Health Project comes? Does it come under his ministry budget, or is it in a special vote?

HON. MR. DUECK: Last year it was from a special vote; this year it's out of the budget.

MS. A. HAGEN: One final question for this particular time. Could I ask the minister if it is his intent to reduce the caseloads of nurse-assessors in long-term care? I know that those nurse-assessor workloads are 400 clients and up. The auditor-general notes that between 400 and 800 clients may be the responsibility of a long-term-care assessor-nurse within the ministry's health units. Is it his intent to reduce that workload?

HON. MR. DUECK: It is certainly not our intention to reduce, but it's continually reviewed. We may have to increase. It's certainly not being reduced.

MR. JONES: I had intended to rise on Friday and make a few remarks on behalf of my constituents with respect to health care, but time did not permit on that day. I sat through a session on Friday, as part of the minister's estimates, and was a little discouraged because part of that exchange occurred between the minister and the member for Surrey-Guildford-Whalley (Ms. Smallwood).

While the minister recognizes what an important portfolio he has, it seems to me that at that point in time in the House we slipped into a period of debate that is not usual for the Minister of Health, and one that I was moved to want to comment on on that day. I'm still in that frame of mind today.

I think the second member for Vancouver–Point Grey (Mr. Perry) began this debate in a very gracious way. I think he complimented the minister, recognizing the difficulty, the enormity and the complexity of the task of that minister. I think he complimented the minister on many of the fine decisions that he'd made and, of course, pointed out that there were some he would take issue with. I think the tone set at that time was a very gracious one, one that I think did this House justice and did the opposition justice. Unfortunately, I don't think that carried on.

It seems to me that ministers of the Crown have to recognize the very precious gift given them by the people of this province. That precious gift is a gift of power. It's a gift to use creative opportunities as ministers to govern in the best interests of the people; to raise taxes and to spend those taxes wisely and well; and, particularly for the Minister of Health in such an important area of jurisdiction in this province in terms of real issues that are important to people, this minister has the portfolio that is of highest importance to British Columbians.

I think we all want the kind of quality health care that we're proud of in this province. We want it to continue. We want it to improve. While I recognize that the minister has gone about his job with real dedication and care, there are probably many areas where I would also wish to disagree with the minister. I don't know if time will permit to get into any of these. I think in terms of increases, user fees, privatization of our health care system or erosion of universality of our health care system, the minister and I would find strong disagreement in those areas.

I would like the minister to understand that while the people have given that minister the creative opportunity and the power, that power can only be exercised under the scrutiny of people on this side of the House. We have in our British parliamentary system the necessity of a vigorous and determined opposition. It is not our job to make the life of the minister comfortable. By raising concerns and questions and pointing out the shortcomings of government opera-

[ Page 6144 ]

tions we fulfill the responsibilities of our democratic, parliamentary system of government. We do make the life of the minister uncomfortable and unpleasant. That minister has to face the music every day when this House is in session; he has to be accountable every day, and it comes into focus most when this House is in session. It's only through this system of checks and balances that the minister has the right to exercise that power. It's only through the exercise of our obligations on this side of the House that we have limitations to the power of government so that the minister has an opportunity.... We on this side of the House are providing the minister with an opportunity to take a second, third or fourth look, to examine and re-examine the kinds of activities that he is engaged in.

[4:00]

So I was most disappointed in the exchange between the Health minister and the member for Surrey-Guildford-Whalley, particularly when he accused the member of being an instant expert. Certainly that was a pejorative point the minister was making, and I think an unfair one. We on this side of the House are doing our best to raise the concerns of the people of British Columbia, and I think the minister on his side is doing his best to ensure.... But I don't think that when we stoop to name-calling, the minister does any service to his government or himself.

Certainly the minister himself is no expert in health, although he has gained expertise in the last couple of years. I understand that he may have expertise in car sales or insurance or real estate, but the minister came new to this job two and a half years ago and, quite rightly so, he has experts with him today who I hope and assume are experts in the health care field.

I hope in my remarks today the minister doesn't accuse me of being some sort of instant expert. I bring no expertise. I bring some concerns; I bring some questions; I bring some difficulties that I see people in my riding having with the health care system. I hope the minister will respond to those in good kind. I don't think that name-calling happens often in this House, but when it happens in a serious and accusatory way, it does this House a disservice.

There is a second area of concern I had from Friday that I would like to point out to the minister, and I think it is really an important one. We welcomed a new member to this House a couple of weeks ago and welcomed him graciously. Yet what we see now from some members of the government side, in dealing with the second member for Vancouver–Point Grey, is that sort of name-calling again There is a very thinly veiled attempt — to quote the Attorney-General (Hon. S.D. Smith) — to accuse that member of being a "shill for the BCMA." I think that is shocking, first of all in the sense that it is not true. That member sits as an independent member of the Legislature, as independent as any MLA. Secondly, it is very clear that those kinds of accusations will not stick. I am sure by now you have noticed the straightforward nature of that member and his principled and ethical positions on matters that come before this

Legislature. I am sure that members on the government side hastened to look up the blue book of doctors' salaries in this province and were very disappointed to see that the second member for Vancouver–Point Grey did not receive any great amount of money from the Medical Services Plan.

Although I haven't seen in today's discussions the matter I was concerned with on Friday, I am hopeful that the Minister of Health, whom I have respect for as doing a good job, does not stoop to that level of name-calling again.

I am sure there is one thing the minister and I agree on: there are good people in this House and good people in the health care system. One of the points I want to raise — and I think the minister will agree — is that there are just not enough of those good people. I raised this issue with the minister in my first remarks in the House. I pointed out two areas: serious staff shortages in Burnaby Hospital; and a lack of some of the basic necessities of operation in that hospital.

I pointed out to that minister some two and a half years ago that although we received a new CT scanner in the Burnaby Hospital, at the point of purchase there was no new staff hired to operate that piece of equipment. I pointed out to the minister the serious nursing shortage at that hospital and the fact that five head nurses had quit their work at the Burnaby general hospital. I'm sure we've discussed in this House the serious demands on nurses in our hospitals in this province. It doesn't surprise anybody, I'm sure, to see nurses quit. I think it was a little shocking, at one point two and a half years ago, to see five head nurses quit.

I also pointed out in those remarks a serious consequence of the nursing shortage. I pointed out to the minister at that time that there had been documented cases of dispensing errors that were attributed to a nursing shortage. I think that's a serious charge from a member of the opposition, on behalf of my constituents who reported that to me.

In addition to the staff shortages, I pointed out a shortage of equipment and even of some basic necessities in the hospital. I pointed out at that time that a couple of those necessities were even in the areas of pillows and pajama bottoms — which may seem humorous from this vantage point, but I can assure the minister that the shortage was no joke in the Burnaby Hospital.

Those remarks were made a couple of years ago, and yet the kinds of problems we saw in Burnaby Hospital are still extant today. I am wondering if the minister is aware how long the waiting-list is for the use of the CT scanner in that hospital, because of staff shortages, how many people are on that waiting-list or how long the bookings for the use of that scanner go into the future. To my knowledge there are over 300 on that waiting-list. Bookings are being made well into July and August for the use of that piece of equipment. The staff, I think, are trying their best, but they feel they are on a treadmill there; that they will never get caught up with these long waiting lists.

[ Page 6145 ]

[Mr. Pelton in the chair.]

They question the concept of using this expensive piece of equipment for only 11 hours a day. I know the minister is extremely concerned with the effective, efficient and economical operation of our health care system. Yet we have these long waiting-lists, and we have this expensive piece of equipment sitting idle for several hours during the day and on weekends. It would seem reasonable to take advantage of some of the staff there or bring in some new staff to at least catch up by working evenings and weekends to solve the problem of the long waiting list for the CT scanner at Burnaby Hospital. It seems to me, and I hope to the minister, to make economic sense— I know the minister is very concerned about that — to staff that operation so that the waiting-list could be caught up.

I think my comments about the CT scanner were indicative of staff shortages. The other area that I mentioned in my maiden speech two and a half years ago and that is still apparent today is the shortage of equipment and replacement of equipment. While we have high-profile and high-tech equipment like the CT scanner, some of the fundamental equipment for the effective and efficient operation of our hospitals, at least in Burnaby, is not in place.

I'm sure the minister, if he has appliances like a dishwasher in his own home, figures the dishwasher has a ten-year life, so after ten years he is going to have to replace it. If he had in his house thousands of dishwashers — which I know doesn't make any sense, but in an operation like a hospital it does — he would find out the useful life of those things and figure out how many he would have to replace each year, and he would budget accordingly.

From my information, however, at Burnaby Hospital that fundamental equipment seems to be lacking. I spoke recently to a member of staff at the hospital who commented that the chair she was sitting on while she was talking to me on the telephone was virtually falling apart. They had put in some 70 requisitions of minor capital requests and had received approval for only four. Some of the basic equipment, right down to basic....

MR. CHAIRMAN: Sorry, hon. member, your time has expired under standing orders.

MR. PERRY: I'm finding the hon. member's comments sufficiently interesting. I'd feel privileged to hear him continue, Mr. Chairman.

MR. JONES: I was commenting earlier that there are two major areas that were a problem two and a half years ago in Burnaby Hospital, and those problems continue today. I was listing some examples not just in terms of staff shortages but also in terms of replacement of equipment. I think there are some false economies being practised. We're all interested in getting the most out of the people's investment, through our hospitals, in our medical service.

For example, does it make any sense to have an old piece of x-ray equipment that cannot guarantee true radiation levels because of its age? I'm not suggesting that there's any health hazard as a result of that, but in terms of the effective and efficient operation of that x-ray machine, which, as a result of its age, cannot be calibrated as effectively as when it was new and produces poor x-ray photographs.... As a result of not being able to guarantee radiation levels, does it make sense to have the staff take extra photographs, and use extra film, extra chemicals and extra staff time, to produce a good x-ray photograph — to get a decent result, which should have been available in the first place?

To me it only makes sense to replace it, to use it at its optimum level, and not to allow these old pieces of equipment that need replacing to continue to be used or to continue to eat away at staff time and to cause unnecessary and excess equipment and materials because of their operation.

The minister not only has Burnaby Hospital to consider, but all the hospitals in the province. The points that I raise here about staff shortages and about the lack of replacement of basic equipment don't just exist in that hospital, but in hospitals around the province. Although I said that the points I wanted to raise with the minister were small ones, I think they are important, because the people of this province consider health care to be such an important issue, and because they want their hospitals to provide the highest-quality service possible. They can only do that if the minister will seriously address the problems I raised two and a half years ago; namely, staff shortages and replacement of basic equipment. I anxiously await the minister's response.

[4:15]

HON. MR. DUECK: I think I should make some remark for the record as to the member's statement about name-calling and there not being proper decorum in the House. I agree with him wholeheartedly. It was not proper for either of us to get into that kind of dialogue. I have to tell the member that at one of the first meetings I had with my senior staff, I told them that if any decisions were made in the Ministry of Health that tended to be political, I would be the first to tell them so. I did not want any political decisions made in Health that affected people in a certain area. I meant that very sincerely.

When we look at hospitals, be they extended-care or intermediate-care, or home support services.... I think I've lived up to that as best I could. I've been accused by both sides of not doing it properly. I've been accused by people who say they are onside.... They say that I'm favouring them. I've been accused by the other side of favouring the opposition because I want to gain some popularity.

I have to tell you that that's not true. I've truly tried to do it on the basis of health, never mind who the people are or how they voted. I didn't even want to know. I truly think I did that. I do not use my power as minister in a frivolous way. I don't think I do; at least I try not to. I know a lot of pressure is put on me from time to time from both sides. I try to be upfront and to exercise my power in such a way that

[ Page 6146 ]

it is the position, rather than me trying to do something for somebody to make them happy. I truly try to do it from the point of view of exercising my responsibility in the areas where it's needed.

I was going to say more about that. I think that's sufficient.

When we talk about a scanner — I think that was one of the questions you asked — I have to tell you that whenever we put in equipment that impacts on operations, we do not give authority for its purchase unless we also have funding for its operation. The CT scanner that went into Burnaby got full operational money. When you suggest that perhaps there wasn't enough funding, I would have to tell you that the allocation of time and how often they use it is for the management of the hospital. We do not go in there and manage that hospital. They get a global dollar. They get X number of dollars for the CT scanner, and it is up to them how they choose to use that or anything else in the hospital.

At the present time we are doing a complete review of Burnaby, and when the results are in we will, of course, let the hospital know first, and it will be known to the people most affected.

At this time I can tell you that as of April 1 there will be a base funding increase, which we've recognized. If there is any other area we have to recognize as to the deficits, whether it's overpopulation or an increase in population, it will be looked at when that review is completed.

You mentioned something about insignificant things, and I can't help but respond to it. You talk about pillows, sheets and things like that. You know, a hospital couldn't get accreditation unless that was all in place; it has to be. It may be that they were short of something at one time or another; I'm not sure. They must have those things in place and have proper staffing to get accreditation, and they have had accreditation for a number of years. Perhaps they're telling you something that is not quite the way it is.

Hospitals are under pressure, no question about it. I'm not going to stand here and say that everything is rosy and if they want extra money, here it is. They are under pressure, and it takes an administrator with real initiative to be able to balance the need with the dollars, with the resources that he's got. It's not easy, and I really have to commend administrators who do a fine job. And Burnaby is doing a good job; they're a good hospital. But there are times when they haven't looked after management perhaps in the way they should, and in retrospect the review will probably indicate some areas where they can improve. It's not a matter of us telling them what to do; it's a matter of assisting. We try and assist hospitals to meet that pressure they're under.

Equipment costs are, of course, shared mostly on a 50-50 basis, some on a 75-25 basis, and that is done from time to time. They cannot purchase anything they desire or everything they desire, but by and large they get the equipment they need.

I think you also mentioned some equipment completely broken down, perhaps not even safe to operate. If the equipment is not safe, we would then find the dollars to replace it. I don't think we'd want a hospital to operate equipment that isn't safe, and I hope I'm correct and you're wrong. But these are areas I will have to look at.

Waiting-lists. It is not the number of people that are waiting; it is really the length of the wait. You may have a figure of how many people are on the wait-list for elective, but it's really how long they've waited. It's perhaps a little bit longer than I would like to see. We're addressing that from time to time. Hopefully we can bring that down.

MR. JONES: I want to thank the minister for the concern he shares with me as far as decorum in the House goes. I'd like to let him know that I very much respect what he described as a non-political approach to the administration of his office. But I do get a little frustrated in this process, and it's not necessarily the minister's fault. In this method of communication we have there seems to be a lot of misunderstanding and need for clarification, so I'm going to go back and try and clarify some of the points I made earlier.

First of all, I was contrasting concerns that I had — and the pajama bottoms were in that category that I raised in this House two and a half years ago. They were of a general nature of shortages, and I'm sure the accreditation process solves some of those kinds of things. What I'm saying to the minister is that those equipment shortages may be different than they were two years ago; they were pillows and pajama bottoms two and a half years ago, but there are still basic equipment shortages in our hospitals and in Burnaby Hospital in particular. It may be typewriters, office equipment and some of those things now. Two and a half years ago it was one category of basic equipment; now, although the needs have changed, they're still there. I think it's symptomatic of a number of years of serious underfunding that probably preceded this minister. It may take a change in government or much more time to resolve some of these shortages.

I did not, at any point in time, say equipment was unsafe, and I'm sure the minister would respond more promptly if I had indicated that, although he seemed to be suggesting that was what I said. No, I was suggesting to the minister the inefficiencies in having outdated equipment, and I used the example of an x-ray machine. If an x-ray machine cannot be calibrated properly as to the amount of radiation it gives off, then rather than being unsafe, it's going to produce ineffective x-ray photographs. So extra staff time, extra chemicals and extra materials are going to be used in the process of compensating for an outdated piece of equipment that perhaps, if replaced, would in the long term result in a cost saving to the ministry and the people of this province.

I suggested to the minister that the waiting-lists were long, and I suggested a number of something like 300 for the CT scanner. The minister seemed to indicate that it's not the number on the waiting-list but actually how long they were waiting. I indicated to the minister that there are people asking to be

[ Page 6147 ]

booked for that CT scanner who are being booked well into the summer. I'm sure they use a triage system, where the most serious cases are dealt with first, but I think that virtually any case that requires the use of a CT scanner must be a fairly serious case, for the physician to request that kind of technical aid for the diagnosis. So if the waiting-list goes into the summer and there is a waiting-list of 300, I think that is serious.

Perhaps nothing can be done about Burnaby's waiting-list, but if those waiting-lists exist all around the province, perhaps some sort of emergency measures could be taken. Perhaps the minister could view that as an emergency that may cause him to make a visit to Treasury Board and to seek to resolve some of those problems that are really a result of tremendous shortages in staff. Nurses, of course, are another area, and we've mentioned that before.

I would like to ask the minister how he feels about a waiting-list of 300 that goes into the summer. I'd like to know what the minister has done, since I raised those concerns two and a half years ago, to address the serious staffing shortages. Has the minister decided to do anything in a major way to resolve those staff shortages between now and the time that his mandate expires?

HON. MR. DUECK: Mr. Chairman, I'm just looking at some graphs here about Burnaby Hospital's surgical waiting-list, and it's very stable. It hasn't changed much from 1984. I also should mention that we're talking about elective. If it's emergency, then of course there isn't a waiting-period — in some cases none and in some cases a very short period of time. I don't see the problem in the same light. I think it's somewhat exaggerated by the member. We'll always have some waiting-time for elective surgery, because there's never enough money to do it all the day after you require it.

As far as the scanner is concerned, adequate funding was allowed for the scanner, and within that funding they should be able to manage the people who the doctor refers to that particular equipment. The scanners, too.... I'm not sure. This is something I should perhaps looks at, though.

You were talking about x-ray equipment. That equipment generally lasts 10 to 15 years. You're raising a point specifically about Burnaby Hospital, and maybe I should, before I say it's still in good use or it isn't.... I really don't know. This is something we would have to check out.

You mentioned, too, that people are asking to be booked for the scanner. You're not suggesting that people go to a doctor and request to have a scan; you're suggesting that the physician in fact refers them. Okay. I just thought perhaps you thought people were lining up saying: "Well, maybe I should have a scan to see what my insides look like."

By and large, Burnaby Hospital is adequately funded. We're doing a review. I'll have my people look at the x-ray equipment. Maybe there's something we're not aware of; maybe they haven't told us about it.

Concerns about shortages. I think you can go to any hospital and speak to individual physicians, and they'll cry that they haven't got the latest toy, the latest equipment. They all want the latest. Even if it's three years old and another hospital has something better, they want that equipment. There's not enough money in the world to do that. We do the best we can with the resources available. I think most hospitals operate efficiently and look after the needs of the people in their community, in their catchment area, quite well.

MR. R. FRASER: I was in the debate earlier in the week. By the way, I'm glad to see that the opposition critic is here, because I'm going to address some remarks in his direction — through the minister, naturally.

It's interesting to listen to the members of the opposition, who talk about their own little hospital, their own town, in their own area. I have yet to hear one of them talk about health care.... The former critic is here. You were very good. I'm sorry that you're not there. In fact, maybe you will be after today.

They almost never talk about the provincial health care system. They only talk about hospital by hospital, and why can't "my" hospital — in quotation marks, with a little possession there — have whatever it is that my friendly doctor would like to have.

[4:30]

MR. GABELMANN: It's because you don't have a hospital.

MR. R. FRASER: We have many hospitals in the city of Vancouver. There are many hospitals around the province I would be very happy to go to, because I know the kind of effort our doctors put into health care. Not that I haven't said a word about them from time to time.

We have a health care system here that is so incredibly good that it really is nearly impossible to be critical. We talk about whether we are using an old-fashioned x-ray machine. How is the minister supposed to know? He doesn't pick that equipment; it's the doctors that pick it. I don't think most doctors, unlike the opposition, would take all of last year's x-ray equipment and throw it out because it might be doing something that they don't think is right.

We talk about health care; we talk about money. It's always money, because we have to keep buying new equipment. I suppose, now that we have a new master agreement with the doctors — worked out with great attention and great care by the minister — we're going to be talking about fees. Indeed, I have had letters from doctors saying: "I haven't had a raise, hon. MLA, for three whole years." I know it's hard getting by on $300,000 a year. The man that wrote me said, "I haven't had a raise in three years, " and he only makes $320,000 — or whatever thousand it is. I know how tough it is for him to get by. I am really sympathetic to him, but before I gave that man a raise I think I would give a little money to the

[ Page 6148 ]

nurses. I hope the doctors will be onside and will say: "We don't need any money this year, Mr. Minister; we want it to go to the nurses in the hospital." I think there are lots of things we can do about that, and I want the doctors to be in on that. There's a doctor over there; you know, the official critic. We were talking about that.

The interesting thing about doctors.... There was a case in Quebec recently. Some doctors came to Canada and they hadn't gone through the immigration system yet. They hadn't managed to get past the Quebec medical college yet, and they protested; they demanded that they be permitted to practise in Canada. I thought that was really an amazing thing for them to do: to come here and demand the right to practise. Ask, maybe; beg, possibly; demand — unbelievable! I hope that's not a characteristic of all doctors in Canada. In fact, it couldn't be. It's obviously an unusual case.

We hear across the floor about long waiting-lists. I heard about waiting-lists in 1983, 1984, 1985 and 1986. Every time I got a phone call from someone whose friend or spouse was in the hospital, complaining about the waiting-list, it seemed the doctor said it was the fault of the government. The amazing part about that is, the government doesn't decide when some procedure is going to take place; the doctors decide. I phoned the hospital and talked to the chief there and said: "I had a call from Mr. or Mrs. X about their spouse and they said it is our fault. I thought you were in the medical business; I'm in public life. Who decides when the procedure is going to take place?" He said: "The doctor decides. If it's an emergency, the doctor decides."

We are also told from time to time that people on waiting-lists die. Tragic as that might be — and it is — none of us knows when the moment is going to come. We all know people who have died for reasons that are unimaginable, at an age that is unrealistic You know, the fighter pilot, 29 or 30 years of age, a picture of health, dies of a heart attack. For that reason, I don't think it is reasonable to blame the government when somebody on a waiting-list dies. It is tragic, but it's not the government's fault and it's not the doctor's fault. Maybe nature is telling us something.

MR. PERRY: We should rejoice when somebody dies?

MR. R. FRASER: No, we shouldn't rejoice when someone dies — not necessarily. There are times....

One of the things I note about the opposition party.... I'm really glad you're here, honestly. I really wanted the second member for Vancouver–Point Grey (Mr. Perry) to be here today. I look at my friend Jack Davis and I think, there is an engineer; he's in Energy, Mines and Petroleum Resources. That doesn't sound too bad. Then I look at the hon. Minister of Forests (Hon. Mr. Parker), who happens to be a forester. Well, that's funny; he's a Forests minister and he's a forester, and he's in Energy and he's an engineer. And I think: the critic is a doctor and he's a critic at the same time. But they're not quite the same, because the forester and the engineer don't bargain for fees or have a master agreement with the provincial government, but the BCMA does. For that reason I am amazed that you are the critic. That member over there is put in very tenuous circumstances, according to me. For example, how is he, as a member of a group that bargains with the government, going to make it completely conspicuous that his defences of the public health care system are on behalf of the public, when his friends and colleagues in the BCMA are negotiating for money? That is a most unfair situation to put that member in; he's new.

MR. PERRY: Just watch me. Read my lips.

MR. R. FRASER: I know he can talk; we all know that. He's certainly articulate. That's a very difficult position for him to be in, and I would like to hear him ask the minister how he can get out of that situation.

MR. MESSMER: Immunity of the House.

MR. R. FRASER: Immunity of the House, I suppose. Mr. Minister, I ask you.... Whether or not you want to answer that question, of course, is up to you. I would like to hear about that possible potential conflict, because I think some people think it will exist, and it will compromise your production in the House. I don't want to have that. I want every member who comes to this House to say what's on his or her mind, to do his or her job, to defend the nurses, to defend the doctors and to make sure that we have a provincial health care system — not every little thing in every little hospital. Think big. Think positive. That's what's being done, and that's why we have such a great health care system.

HON. MR. DUECK: I'm not going to respond to that, other than to say that the new member, my critic, has been a gentleman. I hope that through the year we will be able to function in such a way that our aims are the same; that is, to look after the people of the province, rather than trying to criticize or find fault with each other. Hopefully, the physicians that my hon. friend mentioned.... Like any people in the workforce, you have the good and the bad. I must say that when I've met the doctors around the province, there are far more good than bad. Hopefully they themselves will weed out the bad, and we'll have only good ones. That's all I'm going to say in that regard.

I would like to respond to the equipment question. I didn't have it in front of me at the time. If I may now, Mr. Chairman, I'd like to read this into the record. Burnaby Hospital: received and approved 22 grant applications for a total of $285,000 in 1988-89. In addition, they received their secondary equipment allocation of $121,000 in 1988-89. In addition, there was funding of $9,500 for equipment for 35 discharge-planning units. Funding of $742,000 is approved for two phases of nuclear medicine expansion this fiscal year, 1989-90. Our staff met with Burnaby

[ Page 6149 ]

Hospital to acquire an additional 16 pieces of equipment, approximately another $370,000.

I'm not trying to impress you with all these figures. What I'm trying to say is that it's an ongoing thing. As they apply, it's looked at, and hopefully we come to an agreement; then we fund it. Whenever necessary, we do try to meet the demand — or the need rather than the demand — or perhaps the request. There isn't an unlimited amount of money. So when the request comes in, we meet with them, look at the equipment, see whether it can be funded and whether they have the funds for their share. When you see this for last year, there were a number of dollars spent on equipment for Burnaby Hospital.

MR. PERRY: I don't want to impinge on my colleague's time. I just wanted to comment briefly on the remarks from the first member for Vancouver South (Mr. R. Fraser). I'm really delighted to see that my anticipation that there would be some humour in the House was not completely in vain. I've enjoyed his remarks a lot.

I would urge him, if he finds time, to read some of my comments from last Thursday's debate on the global issues of health care, since he began his remarks by suggesting that we on this side think only in terms of specific hospitals and not the global problems. I think one of the best ways of understanding some failures in global planning is to look at specific detailed examples. Therefore it's very interesting to hear the situation of Burnaby or Surrey or wherever the case may be.

I really wanted to make an offer based on my unique capabilities as a physician, because I noticed that the response of my colleague from Prince George North (Mrs. Boone) was so favourable. I'd like to extend the same offer to the members on the government side, which is a small prescription for a brief holiday. I'd be happy to offer that prescription to any colleagues on the other side as well.

MR. JONES: I'd like to give the Minister of Health an opportunity to get his position on the record in this House on a very important issue that this government seems to be pursuing. I understand that the Minister of Health and the Minister of Finance (Hon Mr. Couvelier) recently met with their counterparts across Canada in order to convince those people that we should reintroduce user fees in the Canada Health Act for visits to hospitals and to doctors. Perhaps the minister would like to report on those meetings and on the future of this issue. Does the minister plan to continue lobbying on behalf of that issue across Canada, and does he anticipate any success with that issue in British Columbia?

HON. MR. DUECK: Yes, it was a joint meeting with ministers of finance and ministers of health. We suggested that to keep the costs of health care in Canada under control, perhaps a user fee would be an appropriate way to go. The Canada Health Act, of course, does not allow this. Unless that has changed, this will not happen.

I must tell you that it was not unanimous in every province. Some provinces felt that politically it was not wise; others said they would like to go in that direction. The BCMA has lobbied very hard on this issue and has said that they want some user fees for visits to doctors' offices. It has not been an isolated case from the ministries of health across the country. As a matter of fact, the president of the BCMA wrote to Hon. Jake Epp and requested that it should be reviewed, provided there was a good safety net so that people with an income problem — or who weren't in the fortunate position that some were — would not be penalized, and no one would be deprived of health care.

Even when we had user fees In this province, I didn't agree with user fees in hospitals — perhaps in day surgery, but not hospital use. I think people don't generally go to an acute-care hospital or into a bed because they want to be there. Maybe an exception can be made in that area.

While we had a user fee in emergency, for hospital visits and for day surgery, no one was deprived of health care. The hospitals just wrote off the debt incurred. No one was ever turned away. I can speak only for British Columbia. I don't believe anyone in British Columbia has ever been turned away from a hospital or a doctor's office; it just wasn't done. Everyone was looked after. It did provide for some responsibility by the individual; health care is not free, and it reminded people that there was a cost to pay. It was a nominal amount.

I get many letters today asking why we don't have a user fee. I got no letters when we discontinued it. The only letters I got asked why we don't have a user fee. There is no sense in talking about it. The Canada Health Act does not allow it; therefore it is a non-issue.

[4:45]

MR. JONES: The Minister of Health says it is a non-issue. Given that he got some sympathetic reaction when he met with his colleagues across Canada, I wonder if he really believes it is a dead issue, and if he is interested in pursuing this issue any further. Has the Minister of Health decided at this point that this is really a dead issue, or is he going to continue the lobbying effort on behalf of his government to reintroduce user fees in the Canada Health Act in the future?

HON. MR. DUECK: What I am doing, and what I will continue to do, is to tell the federal government they must pay their share of health costs in this province and across Canada. They are not doing this. They are reducing their share, and I am lobbying. If they can't do that, then we find some other method to fund health care. The provinces can only do so much. They have, over the years, very efficiently cut a little back by changing the formula and giving a little less to the provinces in the area of health care.

That was basically why we asked for some change — whether that's a user fee or a greater amount of transfer payment. I am very fearful of what they

[ Page 6150 ]

might do in the coming weeks when the budget is being considered from the federal point of view. Health care in this province is very high, as you know — $4.3 billion. That's just the operating cost. The amount that we receive in transfer payments is less and less each year. We are saying that unless they are willing to do their share, it's going to be very difficult for us to continue with the good health care delivery system that we have in British Columbia. I have to tell you it is one of the best — if not the best — in Canada. We are operating a very efficient system and will continue to do so to the best of our ability.

My colleague in front of me just walked into the House. He assures me that we will not let up on good health care in this province. We may shift somewhat, and already are shifting, to talking about wellness. I think we have the physicians on side, and the nurses have lobbied in this area for many years. We have until this time talked much about looking after sick people but very little about looking after people so that they don't get ill. A lot of that can be done on our own.

As a matter of fact, we can save money. We must educate people; we must get this information to them. It's not always government handing out dollars; it's also what we do for ourselves. I mentioned the other day about racing around the track as fast as we can go. We come to a pit stop and say there's something wrong and hope to get a pill or shot, and then continue to race around that track. That will not do. We must look after our own selves. We can do that and do it responsibly.

MR. JONES: The Minister of Health says the question of user fees is a dead issue. His lack of success in persuading counterparts across the country perhaps makes that a dead issue. I just wonder about the credibility of that statement, because I've heard it from the Minister of Health before. At the time the $5 user fees were imposed on patients who visit chiropractors, physiotherapists and massage therapists, that minister made the exact same statement. In July 1987 he said: "That is a dead issue. We can do nothing more about it. We are not contemplating or searching for ways to circumvent that piece of legislation." Yet we see these lobbying efforts continue two years after that, in 1989.

It seems to me that this government has a bent to introduce user fees across the health care system. He may have the Solicitor-General (Hon. Mr. Ree) and members of the government onside, and he may even have the BCMA onside. But let me assure you, Mr. Chairman, that he does not have this side of the House onside, and he does not have the people of British Columbia onside.

HON. MR. DUECK: I cannot help but tell you that the BCMA lobbied very hard. Does the critic still belong to the BCMA? The BCMA is continuing to lobby the federal government very hard for user fees. You say that your side of the House is definitely not in favour, but your own member belongs to the organization that is lobbying for this chance. I did not say it was a dead issue. I am asking the federal government to do its share so that we can continue with the wonderful health care system we have in British Columbia.

MR. GABELMANN: In the interests of the minister's health, I will attempt to reduce the stress levels that are becoming apparent. In a budget of $4 billion, or whatever it is, this issue will not be one to capture the front pages of the Vancouver Sun. It is a minor issue that I have been unsuccessful in dealing with by correspondence, and so I want to try to deal with it using the venue of these estimates.

It relates to people who have lost their parathyroids. I don't know what they are, but they're an important element of our bodies. People who lose their parathyroids due to cancer are then required to take calcium for the rest of their lives. I've written to the minister about the fact that when people are eligible for Pharmacare support for calcium dosages, the current Pharmacare policy requires the attending physician to request, every three months, the next three months' worth of calcium and, in some cases, some other prescriptive items as well.

In an instance like this, it doesn't make any sense to me that the ministry.... I recognize that the minister doesn't draft his own letters, but he signs them, and therefore they are his responsibility.

HON. MR. DUECK: I can change them.

MR. GABELMANN: I wish you had changed the ones on this subject, but you didn't. The quarterly request will be reviewed and acknowledged directly to the physician. What you're basically saying to physicians is that every three months, on behalf of any number of patients who may require this permanent prescription for the rest of their lives, they make a request to Pharmacare. That sets up a bureaucratic process in the doctor's office, first of all, where they have to go through the paperwork and make sure they get the letter down to Pharmacare, who have to go through a similar bureaucratic process in order to meet and to fulfill the request to simply pay for this medicine. In cases of this kind, where a particular operation results in a situation where a certain medication will be required for life, it doesn't make any sense for the doctor to go through this process every three months for the rest of that patient's life and for Pharmacare to also have to go through that process in I don't know how many cases there are in British Columbia — no doubt, hundreds; I have three or four in Campbell River that I know of.

It's a minor issue in the scheme of things, I acknowledge, but it's an aggravation that I think could be readily solved. I would urge the minister, if he can't agree to this request here now during this debate, to at least give it some thought and come back to us shortly with a change in policy here.

HON. MR. DUECK: I'm asking for some information to be brought down from my office. Calcium has been eliminated from the Pharmacare program. In

[ Page 6151 ]

cases where it's a certain ingredient, of course, it can still go through the Pharmacare program, and that's probably what you are speaking of now. I'll have to get some information. I know I said we were reviewing it, and we are, but what the latest is now, I'm not quite sure, so we'll wait for some information to come from my office.

MR. PERRY: I'd like to continue where I left off last week, in a broad examination of where we should be going in health care in British Columbia, but I just want to begin by referring to the exchange which happened late on Thursday afternoon and adding a very brief comment.

I also want to reiterate my appreciation of the minister's efforts. I've said it before and I'll say it again now: I think he's doing a very serious, concerned job as minister. I think there's no question, Mr. Chairman, that his intentions are the best for the people of British Columbia. I sometimes wonder — listening to one of the other members a few minutes ago — whether some members sometimes wonder if it wouldn't be lovely if we had no people in B.C. so we had to spend no government money on them. But I don't think this minister is one of those people at all.

The issue which disturbed me, listening to the debate on Thursday, was the implication somehow that one of the members of this House had brought children to the House. Essentially I know nothing about the details of this particular case. I listened to the comments both from the member on this side and the minister, and what struck me was that these children were brought here by their parents, and that there's no way, in my experience dealing with families and patients, that the children would not be here if their parents had not wished them to be here. I think that they were here out of frustration with the pace with which events often move in bureaucracies, not out of ill intentions. I don't think there is any reason of any kind, in anything I've ever seen of this minister, to think that he has anything less than the best of intentions regarding these children. But the fact remains, having experience in dealing with people with serious illnesses, that when one puts oneself in their shoes, there's no experience like it.

I know a little bit about this, both from professional experience and personal experience in life. There is nothing like being in the actual position of the patient faced with a situation like these children or their parents are in. And one naturally and quite properly loses patience with any bureaucratic or administrative delays, because for these children this is the only life that they have to live on this earth. Their life may not be very long — we hope it will be, but no one knows — and therefore months and weeks and even days are precious to them. Probably the greatest Canadian doctor and one of the greatest doctors in history, Sir William Osler, always advised his students to live for the day, to treat every single day as if it were the beginning of their life or the most important day in their life. If one puts oneself in the position of these patients, it's not hard to imagine why they would be impatient. I think I've made the point, but I sympathized with them and with their parents, and I thought the House should consider that perspective.

Let me just return to where I had left off last week, which was in a discussion of the problem of global planning for the health system in B.C. We've heard a lot of very interesting discourse recently on the user fees. I might return to that to make some comments on it in a moment.

[5:00]

Perhaps while I think of it, I should clarify the situation in Sweden, since I have lived there, been a patient there and worked in medical research there, and I am familiar with the system firsthand. In Sweden there is a user fee of, I guess, 50 or 55 crowns, which is approximately $10 or $11 (Canadian) at the current exchange rate. However, the maximum user fee per year is 750 crowns, or about $150, so the frequent user rapidly stops paying user fees. There is a small fixed limit, and in Swedish terms those charges are remarkably small. For example, the cost to get by train from central Stockholm to a hospital where one might be treated could easily exceed the user fee.

It is similar for prescription drugs. There are small user fees, but they are also capped at a low level. In Swedish terms, the fees are very modest.

I agree entirely with the Minister of Health that effectively the discussion right now is irrelevant because the Canada Health Act makes the imposition of user fees illegal. This was a decision arrived at by the Parliament of Canada after considerable public debate at the national level. There are some very good reasons for it; there are some disadvantages to it, in my view, but it happens to be the law. I think, relatively speaking, that it's somewhat idle to discuss it at length, given that fact.

Some of the experience with user fees is a little bit ominous. For example, the experience in Saskatchewan, where shortly after the defeat of the NDP government — the original instituter of medicare in Canada and of hospital services in Saskatchewan — the Liberal government of Premier Thatcher imposed a small service charge.... In those days — if I remember, this would be about 1968 — it was $2, which presumably is equivalent in today's terms to somewhere between $5 and $10. That ended up having to be withdrawn because the public reaction to it was so strong.

There was clear evidence, if I understand it, that it was hurting people it did not intend to hurt. It was almost certainly not worth the administrative cost of collection. I think the member for Kootenay (Ms. Edwards) referred to some of these problems on Friday in discussing the case of physiotherapists. It really didn't accomplish the purpose the government saw for it.

Another piece of evidence is the studies conducted in Quebec in particular — I think elsewhere in Canada too, but Quebec had the best statistics — just prior to the institution of medicare.

My professors would probably be amazed to know that I remember some of this discussion from my first

[ Page 6152 ]

year of medical school in 1974, but at that time the studies were quite fresh, and they clearly showed the effect of medicare on improving the utilization of health services by the disadvantaged and the poor people in Quebec. There was no question that more health services were also used by wealthy people, but the great improvement in utilization of health services was by poor people who before had nominal access to the system, because doctors have historically always taken the position that they will not deny services to people who can't pay. This was a well-established tradition in Canadian medicine, as elsewhere, which was honoured quite scrupulously. Still, patients were deterred by the necessity of paying a fee.

The fees were quite modest in those days for many medical services, so I think that regardless of what one might think from an ideological or even a philosophical point of view, it's very important to consider the facts and the evidence as to how user fees work. My understanding is that this has been the very strong reason for a strong argument against user fees by groups which represent patients and other consumers of health care. Although they might seem like a good idea to discourage inappropriate or unnecessary use of the system, in fact they tend to hurt the people whom one would most want to use the system.

Enough of that, because I agree with the minister that it's a philosophical rather than a practical issue right now in British Columbia.

Let me go back to some of the broad themes in health promotion, where I see contradictions between what sounds like a very encouraging government philosophy in the minister's opening remarks, in the throne speech, and even in the budget speech of the Minister of Finance (Hon. Mr. Couvelier).... There are contradictions between those high-sounding goals and reality.

Let's take alcohol abuse as a good example. The TRY program, which I am sure we'll debate in more depth under different estimates, is an interesting initiative. I've read the material that was sent to all physicians around British Columbia. There are some positive elements to it, but to me it doesn't seem coordinated into a general strategy to seriously address the problem of alcohol abuse in the province. Consider three examples of where I see the government actually acting in contradiction to its expressed goals.

The most serious — or perhaps the most blatant symbolically — would be the issue of the Knight Street Pub, where a device for the purveying of alcoholic beverages — a device which can only thrive by pushing the sale of alcoholic beverages — was located directly on the most dangerous intersection in Vancouver. It's well known to the police that that is a street where they can set new records for speeding tickets any time they have the time; it's well known that it has perhaps the highest accident rate in the city. These statistics were being sent around by the insurance corporation as an advisory to subscribers to avoid the street in order to avoid accidents. Yet the government facilitated the location of a pub right on that street. This strikes me as the height of contradiction between expressed goals and....

MR. CHAIRMAN: I was just going to mention to the hon. member that I appreciate the fact that he's dealing with this issue from the point of view of health. But I think we can get on shaky ground here. Perhaps when the member is discussing the alcohol problem, he would be so kind as to discuss it completely within the parameters provided under the Health minister's budget.

MR. PERRY: I'll try to, Mr. Chairman. It's a tricky assignment because the point I'm trying to make is that the ministry which controls a third of the provincial budget — and is arguably the most important ministry in the government — must, as one of its mandates, concern itself with alcohol. Alcohol, after or perhaps even before cigarette smoking, is the single biggest remediable threat to health in B.C.

The point I was trying to make, without belabouring that example, is that there are contradictions in government policy in the stimulation of drinking — the consumption of alcohol particularly close to a major provincial highway or traffic route — and in a government which states that one of its prime goals is to reduce the consumption of alcohol.

[Mr. Rogers in the chair.]

Another example — although the technical responsibility might fall under another ministry, the moral responsibility clearly falls under the Ministry of Health — is the pricing policy for alcohol. In Sweden — since members on the other side have admitted that there are useful things we can learn from Sweden — and in other Scandinavian countries, alcohol pricing policy differs radically from our own country. For example, the price of a regular beer equivalent to a Canadian bottled beer of 12 ounces or 330 milliliters is approximately $3 or $3.50 in a liquor store in Sweden. At the same time, that beer has an alcohol content of 4 percent or 5 percent by volume.

MR. CHAIRMAN: Order, please. The member is relatively new, and I just want to review what the purpose of committee is, and what we're allowed to discuss in committee.

Standing Orders and Sir Erskine May's nineteenth and twentieth editions are very explicit in that they require us to deal with the administrative responsibility of the minister in question. In this particular case, the pricing of alcohol is not the responsibility of the Minister of Health; it is the responsibility of the Minister of Labour and Consumer Services (Hon. L. Hanson). Therefore your remarks on this matter should be more correctly addressed to the appropriate minister when that time....

Could I ask you to confine your comments to those areas that come under the administrative responsibility of the Minister of Health. That's a very broad scope, but alcohol pricing isn't one of those items. If you wish to discuss that as a general health

[ Page 6153 ]

issue, that would have to be done during something like a throne speech or budget speech debate.

You've got about a minute to go on your time, unless you wish to yield to the minister.

HON. MR. DUECK: Thus far, everything that has been said is pretty well what I've been saying when I travel around the province.

I agree that alcohol is a problem. A lot of the things we can do ourselves — how many times have I said it in the House? — require no government funding. As a matter of fact, the individual could save money. But is it always government that has to hold everybody by the hand and lead them? Surely the public realizes the dangers of some of these products. I'm hoping that by going around the province, perhaps holding some symposiums, giving that information, educating in schools — which we're doing — and bringing some curriculum into the school system, some of these issues will be addressed.

I believe that what you're saying is correct, and a lot of those things can be done without any government intervention or any government dollars whatsoever. So I agree with what you've said. I don't know if you've asked me any questions, but I agree with you.

MRS. BOONE: How soon we forget. I'd like to carry this on a little bit. I disagree with your interpretation that what the second member for Vancouver–Point Grey (Mr. Perry) is saying is not pertinent to health. I think it is, because the minister himself stood in this House today — and on numerous occasions — and talked about how the ministry has to promote health and keep people well.

If that is in fact one of the mandates of the Ministry of Health right now and what they're working towards as their goal, then one of the jobs of the Ministry of Health is to work with other ministries to encourage them to develop policies that will keep people well. It should be within the Ministry of Health's mandate and budget to encourage the Ministry of Education to implement alcohol and drug programs and stop-smoking programs within the schools; to deal with the Ministry of Labour and Consumer Affairs to institute programs and policies that will encourage people to lead healthy lifestyles; to deal with the Ministry of Social Services and Housing to encourage him to develop policies that will enable people to get out of poverty, to live life properly, to eat well. Given the mandate that the Minister of Health has been given and the broad description he has taken on with regard to keeping people well, then I think the second member for Point Grey is very much within the scope of this debate and has the wellness of the people of B.C. at stake.

Those are the things I would like to bring to the minister's attention, and I think the minister has that role. I would like to ask him then if within his role....

[5:15]

MR. CHAIRMAN: Just before you ask the minister a question, I'm sure you're not challenging the Chair, but the Chair is in the awkward position of always having to determine what is in order and what is out of order. All of your remarks have been in order. The remarks of the second member for Vancouver–Point Grey were not in order, in that they discussed and dealt with specific matters. This is whether we're dealing with a general area or whether we're dealing with a specific area.... Would the member please have a seat. He'll be recognized in a moment.

I am not going to read the whole of the citation from page 107 of Parliamentary Practice in British Columbia, but it very clearly lays out what we can and cannot discuss in committee. It's left to the Chairman. If you'd like to come and be the Chairman, you can test your own skills at this particular chair. I can assure you we would be most pleased to have a volunteer from your side of the House come and do that, but it's left up to the Chairman to make that determination.

When the subject is something I know a little bit about — specifically, the price of beer — I determine that is to be dealt with by the Minister of Labour and Consumer Services (Hon. L. Hanson) and not by the Minister of Health when it comes to liquor pricing. All of your remarks were in order. Please proceed.

Interjection.

MRS. BOONE: By no means. I would never challenge the Chair.

I think there was a three-ministry group dealing with a lot of different things last year. Social Services, Advanced Education and Health, I believe, were the ministries that were working together. Are these ministries currently working together? Is the minister looking to work with other ministries to encourage some of the policies that you've been talking about?

HON. MR. DUECK: The answer to that question is a resounding yes. It's an ongoing thing. Just to give the House and the questioner a bit of a background of what we have done in the past year, it might be enlightening to go over this and give you an idea of what we've done in the area of prevention.

Prenatal care. "Baby's Best Chance" is a publication I'm sure you're familiar with. We've now done it for a number of years. It's one of the best sellers in British Columbia. We give it away free to pregnant women, and anyone else can buy it for $6.95. I've had a lot of feedback on it. It's well accepted. It's a good book.

For back injury prevention we have "Back Check," another publication. In senior's health we have "Choosing Wellness" — and we'll hear more of that in the next few weeks. School-age children: "Health Guidance Curriculum" was one we worked on with the Ministry of Education. "Health and Multiculturalism" was worked on with community organizations. "Heart Health Survey" is another one, along with "Healthy Connections" in educational programs for communities and union boards of health. Incidentally, we're going to make far more use of union boards of health than we have in the past. I think you

[ Page 6154 ]

have mentioned a number of times that we didn't use them often enough or extensively enough. They have a tremendous role to play in the community. They are much better prepared or equipped to do that than we in Victoria. There will be a much greater emphasis on the union boards of health.

"Dial-a-Dietician" — we've now got a phone number. "Food Safe" — food production guidance for restaurants. Some areas have gone quite extensively into this area. School food guidelines. These are just a few examples. We had a national symposium in Victoria on health promotion and disease prevention, very well attended from across Canada. I could go on and on. I've got a number of things that I could talk about in this regard, but I'm sure you are familiar with most of it.

We are going to have an advisory committee on wellness and health promotion. We have an office of wellness. Further initiatives will be announced later in the year. I said there is a different direction in which the Ministry of Health is going. I've talked about this ever since I got into the ministry: we must look after people before they get to this area.

Dr. Rachlis had a very good example. A man was walking along the river bank and saw a person drowning. He jumped into the river and rescued this individual. Then he looked up and there was another person. This went on and on until he was completely exhausted. He said: "This is crazy. We had better go upstream and see who's pushing in all these people." So it wasn't a matter of rescuing the people but what was happening upstream.

I think that's a good example. We have to look after people before they reach that stage. A lot of it is the individual's responsibility rather than government saying: "Here's money; do something about it." It must come from the individual — a lot of it at least. And we must assist.

Before I sit down I would like to read into the record the question that was asked a little earlier about calcium. Calcium is provided only by exception in essential cases. I think the member mentioned that exceptional case. Pharmacare still requires confirmation from a doctor every three months. This issue has been referred for the new advisory committee to consider. We will probably have a few lifetime conditions that can be done without going to see a physician every three months. We're looking at that whole area. Generally, the physician is very reluctant to do this because he doesn't know the condition of the individual and would like to see the individual every three months; but perhaps some exceptions can be made.

MR. PERRY: I am still in the position — and expect to remain that way for a while — where I welcome all advice from the Chair. Even if I don't appear to agree with it, I welcome it. I still wonder, though, whether it isn't appropriate to discuss the issues I'm raising in a very broad sense. I meant them not as specific questions of government policy; really, I was developing an example of policy in another country which I think is relevant to health promotion. I will return to it in other estimates if you deem it inappropriate.

I just want to remind the House of the minister's remarks from last week at page 6075 of Hansard, in which he cited a policy that I think is the one I'm trying to explore:

"Health affects everything we do as individuals and as government. We therefore cannot view it in isolation as something that can be realized by independent action. The state of our personal health is intrinsic to every facet of our own lives....

"Many facets of our lives affect our state of health and quality of life. Governments must learn to better appreciate the relationship between individuals and their environment. We as government recognize that issues such as education, income assistance, traffic safety and the environment all directly affect the health status of British Columbians. We know that a better educated, better housed and better nourished population is also destined to be a healthier one."

I think these are very progressive words. This is not the first time they've been said in the world, but I think it may be one of the first times in recent memory that they've been said in the House — at least from that side of the House — and they're very welcome.

With the Chair's indulgence, I might attempt to complete the example I was giving from another country which I think relates to health policy, which is simply that the price of low-alcohol beer in Sweden is much lower in comparison with regular beer at $3.00 or $3.50. A 2-percent-alcohol beer is priced in the supermarket at 25 cents, so there is a very strong incentive to drink low-alcohol beer. As I'm sure the Chairman would appreciate — speaking as a connoisseur — it is an exceptionally fine beer and comes in about 30 varieties in Sweden, yet the alcohol content is so low that it may be that the liver extracts virtually all of it before it ever hits the systemic blood. That is really a major improvement over what we call a low-alcohol beer in this province. I will return to that under other estimates.

Let me pursue, though, another example under the same heading, where health ought to be viewed in a very global perspective: this is the issue of sponsorship of sporting events by breweries. I would leave it at this for the moment, Mr. Chairman, that I question whether it is a sane policy, in a province intending to reduce consumption of alcohol as part of a comprehensive global health strategy, to undertake any measures which encourage the association of alcohol with sporting events, such as the proposed Indy 500 race in Vancouver.

Let me pursue another example of the global approach where I think we're failing. Since the minister in one of his recent answers referred to obstetrical services, I think it's apposite now to raise a particular example where I think our planning has fallen short. This is the example of the crowded situation that has arisen in Grace Hospital in Vancouver. I received from a Vancouver physician a letter dated April 12, 1989. This one was sent to me in confidence, but I presume similar letters have been sent to the minister, expressing concern at the situation in Grace Hospital and St. Paul's Hospital, where women who

[ Page 6155 ]

live within the city of Vancouver or its neighbouring municipalities find they cannot register or gain entrance to the hospital to deliver their babies.

The case which prompted this doctor to write to me is a maternity patient, due in May, now at 34 weeks of gestation, who found herself rejected this week by both Grace Hospital and St. Paul's Hospital — this was last week she was writing. The practical implication of this is that a woman who lives in Vancouver and has been a patient of the same physician for many years, including throughout this pregnancy, must transfer to another physician in order to deliver her baby. She must not only deliver outside her own city, but must transfer to another physician who has privileges in a hospital in Richmond, Burnaby or North Vancouver. I think the minister will likely concede this to be a totally inappropriate situation. Women are suddenly being asked near the end of their pregnancy to transfer to another physician and to drive to another hospital, at the same time as other women from other parts of the lower mainland are heading into Vancouver to Grace Hospital, seeking to deliver there.

The situation is getting rapidly worse due to errors in planning. I am not suggesting that these errors were deliberately made, but the fact is that the planning did not adequately predict the situation which ensued.

One of the problems is that Grace Hospital was underbuilt, as was the pediatric hospital in British Columbia. This is a well-recognized fact. For example, at Grace Hospital there are only 22 ante-partum beds for high-risk pregnancies. In 1988 the average occupancy at Grace Hospital for high-risk pregnant women awaiting delivery was 34 beds, with an excess of 12 beds blocking the post-partum beds for women with normal pregnancies who would leave the hospital two or three days after delivery.

This letter comes from a member of the department of family practice, which does a large part of the normal or low-risk obstetrics. It points out that because of this, approximately 120 deliveries per month are excluded from Grace Hospital because of the shortage of beds for high-risk patients. The letter also points out that solutions have been suggested: for example, renovating Grace Hospital itself, which apparently is logistically very difficult; or opening one of the closed wards, which are now empty, in Shaughnessy Hospital next door and using them for high-risk patients who are essentially sitting in bed waiting for something to happen. Shaughnessy is close enough to Grace Hospital that this would be a practical solution, at least potentially.

The doctor who writes to me notes: "This one simple move would virtually eliminate the pressure on utilization." This is not an individual doctor who writes; she clearly represents a consensus within the department of family medicine.

[5:30]

The situation has now got to the point where the numbers are becoming extremely serious; I know the minister is aware of this from media reports as well in the months of April to June 1989, 311 Vancouver residents will be excluded from delivering their babies within the city of Vancouver. This means approximately 300 patients must transfer to another doctor late in their pregnancy. When their labour begins, they must drive further outside of the city.

Doctors are concerned that inevitably there will be a disaster. In particular, patients who arrive at St. Paul's Hospital thinking they will find refuge there have sometimes been transferred to Grace Hospital, and eventually a delivery will occur when one of these women is transferred in labour. The delivery may occur in an awkward site, like the Granville Street bridge or the Burrard bridge, and some catastrophe may happen.

I'd like to ask the minister what plans are afoot to resolve this situation. I guess I should preface the question with one other remark, which is that my understanding of why so many women seek to be hospitalized in Grace is that not only does it have a very high and justly earned reputation for high-quality obstetrical care but the physical facilities are somewhat better than some outlying hospitals.

A conventional response to this is to say: why should a woman in delivery be entitled to a private room, be entitled to deliver in the same room in which she labours, be entitled to have a private room or at least the chance of a private room after delivery? Why should the mother be entitled to have the baby room in with her in the same room that she sleeps in after delivery?

This is modern obstetrics. It may be difficult for older members of this House to understand how much obstetrics has been revolutionized in the last ten years in Canada. I see one member laughing. If children of yours have delivered recently, then you'll know that the situation is completely incomparable to that which prevailed only 10 or 15 years ago. The modern standard of medical care is to provide a comfortable, relaxing environment for the women in labour and after delivery, This is accepted as an important part of high-quality maternal care.

MR. R. FRASER: It can't be new.

MR. PERRY: It's very new in this province. It's very new in Canada.

Another point that is brought out by this physician is that women seek Grace Hospital because of the 24-hour assurance of appropriate, modern anesthetic services, such as an epidural service. Clearly this cannot be provided in all small hospitals in B.C., but there are not good reasons why it cannot be provided in larger hospitals such as Richmond, Lions Gate Hospital, Burnaby Hospital or hospitals further out in the Fraser Valley.

I would like to ask the minister what plans are afoot to resolve the situation and what, if any, immediate measures he has in mind to deal with the problem of literally hundreds of women being forced out of their own city to deliver and having to change physicians.

[ Page 6156 ]

HON. MR. DUECK: Mr. Chairman, before I answer that question I would like to go back to the CT issue.

There are 280 patients waiting for a CT scan at Burnaby Hospital. Of these 280 cases, 205 are elective and 75 are semi-urgent. They attempt to do the semi-urgent patients within three weeks. Elective cases are booked to mid-June. Burnaby Hospital is currently doing 17 to 20 scans a day, which includes in-patients from Burnaby and Richmond as well as elective cases to be done on an out-patient basis.

Bookings are now being made for Saturdays; the member asked why we didn't expand on the weekend. This is done to relieve the pressures, but the units are still booked to about June, about ten weeks, even with the extra day.

Just to give you a comparison to Burnaby Hospital's ten-week wait, Royal Columbian has a 16-week wait for electives; Matsqui-Abbotsford has a two- or three-week wait; Lions Gate Hospital has an average of two or three weeks.

Now back to maternity, obstetrics. I would like it on the record that Grace Hospital is a tertiary hospital, and since there is such an increase in births.... Perhaps we should find out why, but there seems to be a tremendous increase in births, which was predicted by us. We have informed the hospitals in the city, and there are other hospitals in the city that have this function — for example, St. Paul's, Royal Columbian, Lions Gate, Richmond, Burnaby, Surrey Memorial; so it's all in that same catchment area. If we didn't have some control on Grace Hospital, I think every woman in the province would want to deliver there, because that is the hospital to deliver your baby. It is a very popular place. They have the best equipment, the best care, especially for the ones who may have some risk. We've notified women who were expecting that perhaps they would not be able to use Grace Hospital and would have to make arrangements in other hospitals, and have done so quite successfully. We have made arrangements with the other hospitals. All those hospitals had a meeting, and they decided they would give the physicians from other hospitals privileges in all the other outlying hospitals so that the woman did not have to change doctors. You should be aware of that, because you are a medical person. You should be up to date on this.

MR. CHAIRMAN: Please address the Chair. Those remarks were out of order in terms of addressing the Chair.

HON. MR. DUECK: I'm sorry, Mr. Chairman. I didn't think you were interested in obstetrics.

MR. CHAIRMAN: I'm not, but I'm interested in order.

HON. MR. DUECK: The Ministry of Health has approved additional funding for St. Paul's of $484,406 to handle the increased workload in obstetrics. It's easily said that Grace Hospital is overloaded and where do these women go? It's not quite like that.

You make up a story that sounds like, my gosh, they're going to deliver the baby on the street. That's not so at all. They have a place to go. The other hospitals know about it. The doctors have privileges in the other hospitals. The women do not have to change doctors. It's being addressed. It's being looked after.

When you have an increase in births the way we have this spring, it is sometimes not predictable.... Well, it's predictable nine months in advance, I suppose, or shortly after. Other than that, why these things happen all of a sudden, I don't know. I guess there's a great love and attention being paid in the last while between couples, so this is what happens.

HON. MR. STRACHAN: A good clean environment.

HON. MR. DUECK: Yes, a good clean environment. We did predict the increase, and we expected a 15 percent increase over May of last year, along with a rise in the high-risk patients, and Grace Hospital is reserved for those high-risk patients. I think you as a physician, Mr. Member, must understand that we certainly don't want to jeopardize a safe delivery for those women. That's what Grace Hospital is all about. It is a tertiary hospital, and that's where we're directing women who are at risk. I can assure anyone who is going to have a baby that they will have the best of circumstances with the best physicians, like we do with all health care in British Columbia: the best health care anywhere in Canada, and it will continue to be.

MR. R. FRASER: I was glad to hear the minister say a minute ago that it's safe to get a baby delivered in every hospital in British Columbia. For a minute there I had the funny feeling that Grace had everything and no one else had anything. I'm pleased to hear that's true, minister.

I've written to a number of women and told them: "If you're not at risk, you should be thrilled. There are lots of good hospitals. Don't take a bed away from some lady who needs extra care." Most people have accepted that rather graciously, which is sensible. But why shouldn't they? They're bright people.

One of the things that has begun to worry me just a little bit — without respect to the health care issue itself — is that from time to time we hear rumblings about a new sales tax from the federal government on things like fees and services.

MR. CHAIRMAN: Matters involving legislation or requiring legislation are out of order. The Chair is enforcing order this afternoon. Please remain in order.

MR. R. FRASER: In the event....

MR. CHAIRMAN: No, no. I must refer you to the same page that I referred the second member for Vancouver–Point Grey. It's Mr. MacMinn's very fine tome, which has been circulated to all members.

[ Page 6157 ]

MR. R. FRASER: Then I will not ask the minister what would happen in the event. We will get to that some other day.

In the meantime, I was very glad to hear about the delivery, because the second member for Vancouver–Point Grey said that women weren't treated well in hospitals. From all the reports I have had, long before I got to this place, the B.C. health care system has done a great job with the delivery of babies in hospitals.

MR. PERRY: Let's be clear, please, about what we're talking about. I was looking for the message from an angry father of a woman eight months pregnant. Perhaps the member for Vancouver South had the same message, judging by the telephone number on the message.

What we're talking about in this case is whether people have the right, under a progressive health care system which many of us consider to be one of the best in the world, to attend the doctor of their choice and to deliver their baby with the assistance of that physician in their local community or reasonably close to their own local community. The issue here is not the primary purpose of the Grace Hospital, which clearly is a tertiary referral hospital designed to provide hopefully the best obstetrical care in the country for women at high risk and women with particular problems in pregnancy.

The real issue is: is it reasonable and progressive to oblige women to go further and further afield? Most of the members in this House have had the experience of having children. A few — regrettably too few — have had the experience of actually delivering babies, either as the prime participant or as one of the assistants. But most have at least some passing acquaintance with the phenomenon of labour and delivery.

One of the cardinal features of it is that the course can never be predicted; untoward events during the course of labour usually cannot be predicted. Most obstetrical problems and disasters happen very rapidly without a great deal of warning. Therefore it is in the public interest for women to be able to enter a hospital in labour and deliver relatively close to where they live. It is not inherently reasonable for a woman living in the southwestern or southeastern portion of Vancouver to be obliged to cross the Lions Gate Bridge or the Seconds Narrows Bridge to Lions Gate Hospital for a routine labour and delivery. In an emergency or war-time situation, it might be reasonable, but it's not an acceptable standard for the late 20th century. This is what these physicians are concerned about.

[5:45]

I'm intrigued by what the minister stated about the agreement to allow physicians temporary privileges, because although I no longer practise obstetrics — I'm a specialist physician — the normal practice is, when a decision of this type has been made, to circularize all physicians in the region, through the Medical Services Plan newsletters, the College of Physicians, or sometimes through an announcement from that dreaded organization, the B.C. Medical Association.

Interjection.

MR. PERRY: I'm not aware of any such circular. Interestingly, the letter that came to me dated April 12 states, as of April 12, that this physician whose patient is denied access to the local hospitals, is not entitled to privileges at Richmond, Burnaby or Lions Gate Hospitals even on a temporary basis. So I'd like to ask the minister simply a factual question: can he clarify for me and for the other people in the Vancouver region when this decision was arrived at to allow all physicians involved in obstetrics temporary privileges at other local hospitals or regional hospitals? Has this been published? Has the medical profession been notified, and if so, when? And why doesn't this doctor in Vancouver know about it?

HON. MR. DUECK: Mr. Chairman, it doesn't come from our office; it's from the hospital itself. Grace Hospital issued a press release on that on April 14. But I think the specific case that you're referring to, if they had gone to Grace.... We don't direct that from Victoria; it is done between the hospitals, the privileges granted. It wouldn't come directly from the Ministry of Health. But if a woman wanted to keep a certain physician, I am certain that arrangements would have been made for her also, to whatever hospital she was referred to or wished to go to.

Surely you're not suggesting, if everyone in the province wanted to have their baby in Grace, that we should make some arrangement for this to be done — as you suggested, in our enlightened age. That's what's happening, because most people want to go to Grace Hospital. It's just not possible. We're not talking about going far afield to some other country; that's not what we're talking about. We're talking about that catchment area; it's really part of that total city, Mr. Chairman. We're talking about Grace Hospital, St. Paul's, Lions Gate, Royal Columbian, Richmond — if they're closer to that end of the city — Burnaby. There are hospitals everywhere. Surely you're not suggesting — if you are, it would be absolutely ludicrous — that these poor women who are going to the hospital to have their babies are going to have to go to Alberta. They are right there within the catchment area, and they are looked after.

I can certainly understand a pregnant women deciding to go to Grace. It is recognized as the hospital to deliver babies. I can understand that she would be disappointed. But if it is not considered a risk delivery, and because of the tremendous increase in deliveries in the last while, she is being asked to choose another hospital.

The press release states: "In many cases these hospitals have agreed to provide necessary privileges to the members of the Grace Hospital medical staff. As in the past these hospitals have agreed to accommodate patients whose physician would have delivered at Grace Hospital."

[ Page 6158 ]

As Minister of Health, I'm concerned that when a delivery is about to take place they have a place to go. I am assured by the administration and board chairmen of these various hospitals that everything is under control. They met and they managed it well, without my intervention. There is quite an increase in deliveries in the month of May and there will be in the month of June, but I understand it's well looked after and under control. You, as a physician, should be very calm and very cool about it and say that everything is going according to schedule and will be looked after.

Hospitals in the lower mainland offer a very high level of obstetrical care, and I am confident they will continue to do so. It's not just one hospital; many of the other hospitals can perform high-risk deliveries; there are many, not just Grace. I gave all these hospitals in that catchment area. I don't think any woman should be at risk or should be fearful that she perhaps cannot deliver a baby in a good setting, which she is entitled to.

MR. PERRY: I'm always calm and collected. I just wanted to point out that I hop up and down sometimes to prevent stasis in my legs and the development of blood clots there.

I have to assume that some of the minister's questions were rhetorical; I don't think he misunderstood me quite as badly as he implied. I'm not suggesting that all women in greater Vancouver or the Fraser Valley should deliver at Grace Hospital; quite the contrary. Those who live in surrounding communities who are not high-risk should stay in their own communities. But those who do live in Vancouver, within, for example, a five- or ten-mile radius of Grace or St. Paul's Hospital, ought to have access to the local hospital.

There seems to be a relatively simple solution to part of the problem. I'm genuinely interested in the minister's response to this. Given that there is at least one empty ward in Shaughnessy Hospital, why would it not be sensible to refurbish that ward for the use of high-risk patients who are waiting for their delivery, in order to free up more of the post-partum beds for normal deliveries; or, for that matter, to refurbish the ward in Shaughnessy Hospital for postpartum patients who have had normal deliveries? We're only talking about something in the order of 12 hospital beds, which would largely relieve the congestion in Grace Hospital for Vancouver-area residents.

I'm delighted to hear that the hospitals have been flexible. This is not routine; I suspect the minister is aware that this represents a somewhat extraordinary response to a problem. I had not been aware that that had been taken on Friday, so I'm delighted to hear it.

The question still remains: what about making better use of the underutilized facilities in Shaughnessy Hospital?

HON. MR. DUECK: As far as hospital operations are concerned, the management of the hospital, not the Minister of Health, directs which beds should be used for which purpose. If there is a case — and I think the member mentioned one — where the father was quite angry, I wish these people would come to the proper ministry and say: "This is my problem. Can you help?" We'd certainly investigate.

Since it is very close to the time when my stomach says we should go and eat, Mr. Chairman, I move that the committee rise, report progress and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Richmond moved adjournment of the House.

Motion approved.

The House adjourned at 5:54 p.m.

[ Page 6159 ]

Appendix

WRITTEN ANSWERS TO QUESTIONS

28 Mr. Barnes asked the Hon. the Minister of Social Services and Housing the following questions:

With reference to the provision of emergency shelters in the Vancouver area:

l. How many facilities exist for men, and how many beds do they contain?

2. How many facilities exist for women, and how many beds do they contain?

3. What is the ratio of men to women in the Vancouver area?

4. If the provision identified in the answers to Nos. 1 and 2 is not in the same ratio as that in No. 3, has the Minister decided to increase the number of beds available to reflect the population in the area?

The Hon. C. H. Richmond, replied as follows:

"The area defined as the Vancouver area by my Ministry includes four of our regions, namely, Vancouver/Richmond, Vancouver/Howe Sound, Fraser North and Fraser South. The population figures I am using are from the Central Statistics Bureau for the Greater Vancouver Regional District as of June 1, 1988.

"My Ministry defines facilities for single/transient men as hostels. In the figures below, emergency shelters/transition houses for women have been compared with single persons' hostels for men.

"Taking the above into consideration, the answers to the questions are as follows:

"1. The number of facilities for men is 11, with a total capacity of 275 beds.

"2. The number of facilities for women is 21, with a total capacity of 230 beds.

"The ratio of men's beds to women's beds is 120 beds for men to 100 beds for women.

"3. The ratio of men to women in the Vancouver area is as follows: Males 19 years+ = 493,699 Females 19 years+ = 527,745.

"The sex ratio in the Vancouver area is 94 men for every 100 women.

"4. My Ministry is concerned about meeting the needs of all people who require emergency facilities. This is a complex social issue requiring much more detailed analysis than simply using the sex ratio of men to women in the Vancouver area. My Ministry assesses need on an on-going basis; need may not be in direct proportion to gender ratios."